1/ "As we have said, this [COVID] is very heterogeneous across the country, and these decisions have to be made at the local level." —@CDCDirector @RWalensky
2/ "If you have areas of low vaccination & high case rates...local policymakers might consider whether masking...would be helpful for their community until they scale up their vaccination rates..." —@CDCDirector @RWalensky
3/ This speaks to our broken federalist approach to public health:
- technical guidance from the @CDCgov that needs to be interpreted locally
BUT
- no real power or $$$ at state/local level

continued...
4/ continued...

- increasing restrictions on public health emergency powers mlive.com/politics/2021/…
- state/local public health officials under attack
tennessean.com/story/news/hea…
justhumanproductions.org/podcasts/s1-e4…
6/ Peter Sandman for @statnews
7/ If state/local health departments are going to be responsible for formulating and implementing policies based on science but tailored for their communities, they need to have the $$, people, and power to do so. BUT THEY DON'T.
8/ Imagine if we were under attack by Russia or China... and each town or county or state had to muster its own defense against that outside threat.

THAT'S the state of public health in this country.

justsecurity.org/77442/new-legi…

• • •

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Keep Current with Céline Gounder, MD, ScM, FIDSA

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More from @celinegounder

13 Jul
1/ Great speaking with @TheAtlantic's @KatherineJWu about "breakthrough infections."
theatlantic.com/science/archiv…
We need to distinguish between breakthrough INFECTIONS and breakthrough DISEASE.
2/
3/ The COVID vaccines are truly amazing: safe and highly effective in preventing severe disease, hospitalization, and death.

We vaccinate to save lives, not to prevent the sniffles.
Read 9 tweets
8 Jul
1/ New data in the last day on how well natural immunity and vaccine-induced immunity protect us against the Delta variant.

Here's the take-home message:
2 doses of Pfizer or Moderna vaccine will protect you,
even against the Delta variant.
2/ Published in the @NEJM
nejm.org/doi/full/10.10…

Delta is 2.4-3.3x less susceptible to neutralizing Abs elicited by prior infection or Pfizer/Moderna vaccination as compared to the early WA1/2020 variant.

The dotted line represents protective immunity.
3/ Published in @Nature:
nature.com/articles/s4158…

Left:
Low neutralizing antibody (nAbs) levels by 12 months after natural infection
4x decrease in nAbs vs Beta & Delta compared to Alpha

Right:
Dramatic bump in nAbs levels if vaccinated after infection, including vs Beta & Delta
Read 8 tweets
7 Jul
1/ I really appreciated @EricTopol's guest essay in the @nytimes: nytimes.com/2021/07/01/opi…

I agree with much of this, but a few thoughts...
2/ There are really two questions here:

- How long will it take the FDA to grant full approval and why does it take that long?

- Will a full approval lead to greater confidence in the COVID vaccines and uptake among those not yet vaccinated?
3/ Regarding the first question:

I agree with @EricTopol:

I don't understand why the FDA approved aducanumab for treatment of Alzheimer's. There's limited data on its efficacy and there are real risks.

3 FDA advisory board members resigned in protest of this approval.
Read 26 tweets
1 Jul
1/ What should you do if you got one shot of J&J COVID vaccine with the Delta variant spreading?
2/ The Delta variant is spreading in the U.S. as it did in the UK, as did the Alpha variant before it. The Delta variant is more infectious than other variants and can evade the immune response to older variants.
3/ The Pfizer, Moderna, and J&J vaccines remain effective in preventing severe disease and death from the Delta variant, but we see a significant drop in overall vaccine effectiveness with the J&J vaccine versus the Delta variant.
Read 6 tweets
9 Jun
1/ Our 4 Americas:
Free America celebrates the energy of the unencumbered individual.
Smart America respects intelligence & welcomes change.
Real America commits itself to a place & has a sense of limits.
Just America demands a confrontation with what the others want to avoid.
2/ "In Free America, the winners are the makers, and the losers are the takers who want to drag the rest down in perpetual dependency on a smothering government."
3/ "In Smart America, the winners are the credentialed meritocrats, and the losers are the poorly educated who want to resist inevitable progress."
Read 7 tweets
9 Jun
1/ This is how infectious diseases
that threatened EVERYONE
quickly become the scourge of the MOST VULNERABLE among us:

theatlantic.com/ideas/archive/…
2/ To forget is the definition of privilege: Image
3/ To close the book on the story is a privilege: Image
Read 5 tweets

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