You know what just hit me when I read about 100% of the patients in LA County public system in hospital with COVID being unvax'd or see this in SF much smaller numbers (unvax'd in hospital) or see data from around country that 99% of those in hospital are unvax'd?
The vaccines are extraordinarily effective (even against the delta variant) since the PHE England data said Pfizer 96% preventative against hospitalizations. And it reminds me of this yellow line from the clinical trials that show such high protection against hospitalization
Efficacy is the term for outcomes in clinical trial; effectiveness is what you see in "real life". And effectiveness mirroring efficacy (even with delta variant) is unusual for a drug or vax. CDC publicly-available data doesn't show increase in hospitalizations in kids
So, the best thing we can do for children right now is to get as many adults vaccinated as possible while young children clinical trials of vax are ongoing, especially anyone who will be teaching children or sending them to school (e.g. teachers/parents). Thanks
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The Reassuring Data on the Delta Variant. By I and @LeslieBienen and @citizen_oregon . There are 3 things concerning about a variant - transmissibility, whether increased virulence & whether evades vaccines. Virus likely more "fit" which we explain wsj.com/articles/delta…
but to public, the delta will become the dominant variant if more fit. So, 2nd question is whether the delta is more virulent. Luckily, there is CDC publicly-available data one can download & look at this. 1st step is to show hospitalizations not increasing in kids with delta
Then one wants to look at regions with prominent delta prevalence in the US and ask whether "hospitalizations per case" is increasing to see if more virulent. Luckily, not the case as shown by the chart in the paper - actually hospitalizations per case less with more delta
I know many would like to put back masks for the vaccinated; every county's jurisdiction. But I encourage you to try to understand why @CDCgov released masks for vax'd which was around effectiveness of vaccines (even with delta)/reduced transmission after washingtonpost.com/outlook/2021/0…
I know vax'd talk to each other; unvax'd talk to each other and we are not conversing but their reasoning was helping unvax'd become convinced to vaccinate. This seems even more important to me today - to use science to convince those still on the fence to please get the vaccine
After CDC said masks not needed for vax'd in May, uptick in vax. So, masking after vax should done based on your personal risk tolerance/immunocompromise/elderly, but consider psychology of messaging in this delicate period cnn.com/2021/05/27/hea…
I know I have a mixed twitter following which earns me ire, but the reason I was so impressed by the @CDCgov guidance on schools last Friday and the follow-up @CAPublicHealth statement was how in-person learning with mitigation was stressed so much because so important for kids
@CAPublicHealth opted for universal masking in schools in order to forgo distancing so that children could get back to school. I saw @sfchronicle editorial board saying this am that they did an "about face" on this but they did not, actually. @CAPublicHealth (@TAragonMD)
said they would clarify their messaging so doesn't fall on districts to interpret and enforce, which they will. With delta, mitigation indicated at first, they chose masks will clarify for districts a likely metric-based approach of when mitigations ease nytimes.com/2021/06/08/opi…
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)
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/
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…