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Monica Gandhi MD, MPH Profile picture
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13 Jul, 4 tweets, 2 min read
Yes, well, we call "dead virus in the nose" as you know, fellow ID MD, "colonization" instead of infection. How do we know that immunity from vax (or natural infection) limits viral load replication in the nose? Have large 5 studies showing low viral load after vax with exposure
What immune response gets into the nose? Well, we know the COVID vaccines produce IgA (the "mucosal" or nose immunoglobulin) from multiple studies & IgG from the vaccines very happily get into the nose too- see this paper that shows high IgG, nasal cavity
pubmed.ncbi.nlm.nih.gov/23882268/
And of course even our trusty T cells will fight virus in the nose if you are exposed to the virus or vaccine, limiting viral replication (and limiting the utility of a test of an asymptomatic person after vax unless you measure viral load on PCR machine)
pubmed.ncbi.nlm.nih.gov/9490657/
And if you get one dose of an mRNA vaccine after natural infection (like France recommends), the T cells you generate are persistent and "nasopharynx-homing" (going to nose) than if not had infection before. So, 1 dose after natural infection may help
biorxiv.org/content/10.110…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
13 Jul
Thread on MOLNUPIRAVIR. First, what is this medication? First we should remember, there is not a highly effective outpatient oral treatment for COVID yet. There are tantalizing glimpses into other meds but they are still in clinical trials. So, let's explore this one.
Molnupiravir was not developed for SARS-CoV-2- originally thought of as a broad-spectrum antiviral because it is a "nucleoside analogs". We use those a lot in HIV but they basically inhibit the virus from replicating because this compound interrupts the process of copying
Remdesivir is a nucleoside analog that we use for inpatient treatment because it is intravenous. But what if there was an outpatient oral treatment that you could give to someone like Tamiflu (or in the case of HIV treaters, we give this type of med in combo with others)
Read 14 tweets
Monica Gandhi MD, MPH Profile picture
12 Jul
In terms of CDC guidance Fri, what I admired was strong push to get children back into in-person learning. Asymptomatic testing not necessary & Bayes' theorem says will increase not-needed quarantining (see WaPo article). CDPH put masks & waived distancing
washingtonpost.com/outlook/2021/0…
I know masks didn't follow a metric-based approach to remove, what we wrote @nytimes - but all dynamic with COVID now & will be re-evaluated soon into school year with CDPH. I am grateful for no 3 feet & please read WaPo article above re: Bayes' Theorem
nytimes.com/2021/06/08/opi…
Plot thickens with masking in schools in CA. Yesterday's announcement that children would be banned from school if not wearing mask not consistent with position to get children back in school so now seems up to individual counties, back to metric approach?
abcnews.go.com/Health/califor…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
10 Jul
Was asked if could get long COVID from a mild breakthrough infection with delta? No, likely not from pathophysiology. Persistent symptoms usually occur after a severe viral infection; lot of poor methodology of long COVID studies. Best review here
nature.com/articles/s4159…
And here is one of the best done analyses in terms of methodology which showed that more symptomatic * severe acute illness associated with more prolonged symptoms after (breakthroughs in vax'd generally mild)
ons.gov.uk/peoplepopulati…
This paper shows something similar- again, it is very important to look at the methodology of how analyses are done before taking statistics like 20%, 50%, etc. from insurance ICD-10 codes or other poorly done studies
nature.com/articles/s4159…
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
9 Jul
CDC school guidance released. What I appreciated was that the guidance acknowledged what the US did (more than Europe/UK) was so difficult for children in terms of mental health effects & other disorders and that in-person learning essential.
cnb.cx/3r0Pb2E
Didn't acknowledge data from yesterday, all year, low risk of young children; Europe, UK, WHO decide which mitigation strategies needed differentially by age. Each state will tailor. CA Gov recall partially based on CA being 50/50 for in-person learning
nytimes.com/2021/06/08/opi…
When looking at COVID hospitalizations/100K to confirm your county has reached metric proposed of <5/100K, use this HHS dataset: lists confirmed COVID hospitalizations (since universal screening, must confirm admission reason). Most US counties at metric
protect-public.hhs.gov/datasets/HHSGO…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
9 Jul
The risk of children under 18 developing serious illness or dying from Covid-19 is very slim, said researchers, who found a death rate of 0.005% in England—lower than initially thought wsj.com/articles/in-ch… via @WSJ
Very comprehensive study- can help ease some of the parents' fears about school opening
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
8 Jul
Wanted to explain one more thing before I go for my break which is the difference between what T cells and antibodies do for you in terms of protecting you against COVID. T cells protect you against severe disease. We have already gone over how variants
rupress.org/jem/article/21…
unlikely to evade T cell immunity since 80-100 T cells line up across the spike protein so 10-13 mutations of variants can't evade that many T cells. You have the data in the T cell thread but here are the 2 best papers on this- 1st here
biorxiv.org/content/10.110…
Here is the 2nd paper on this. Variants can't evade our T cell response so we are protected against severe disease. That is why vaccines 92-100% protective against severe disease in the real-world or the trials variants or not
cell.com/cell-reports-m…
Read 12 tweets

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