Tweet

Monica Gandhi MD, MPH

17 Jul, 9 tweets, 4 min read

@PCH_SF

Wanted to address one thing before I come back since I live in SF & saw despair that masks recommended again as feeling like we took a "step back" as my friend @PCH_SF acknowledged in this piece. Know it feels disappointing: delta so fit, not expected
sfgate.com/coronavirus/ar…

But thought you'd be interested in this from Israel on what they are calling "soft suppression" with the delta variant: not closing society as only high amounts of severe disease can do that (45 in hospital across whole country of 9 million) but doing 2
reuters.com/world/middle-e…

things: 1) keeping masks indoors for all, also normalize mask wearing for unvax'd (have pockets of communities not yet interested in vax); 2) tracking severe disease as main metric: tests are flawed (PCR without CT & cases not main metric with vax)
jpost.com/israel-news/fo…

@PCH_SF

Israel also tracking mild breakthroughs (@PCH_SF calls "bummer"!) many don't want, but won't shut down society, only severe disease can do that with implications on overdoses, schools, other aspects of public health. Mild breakthroughs less transmissible
nejm.org/doi/full/10.10…

Mild infections also likely prime immune system (pubmed.ncbi.nlm.nih.gov/34067349/). And the vaccine reduces transmission to others even those in households as shown in multiple papers including this one from yesterday for parents concerned about bringing home
medrxiv.org/content/10.110…

Then some very concerned that - even though vast majority of those with severe disease in US are unvaccinated (Dr. Walensky said 99.4% in White House briefing yesterday), what about severe breakthroughs in vax'd? Israel has identified risk factors
jpost.com/health-science…

for these & please see that these 152 in Israel with multiple other health conditions so Israel likely to give boost vax to these individuals; CDC meeting next week to decide on this strategy too. Delta disappointing I know, @globalvaxequity paramount
washingtonpost.com/health/2021/07…

SF and Israel using "soft suppression" strategy; encourage you to read Israel's approach in this interim period with delta, article above. SF focused on continuing vax as is entire US; we are divided; Surgeon General came out against addressing internet misinformation yesterday

So sorry on politicization of the vaccine, know as ID MD what vaccines did historically for the world for all infectious diseases; hope gets FDA approved soon, convince with compassion, education & incentives to take. See you on 7/26 where I will come back to immunity & Novavax

• • •

Missing some Tweet in this thread? You can try to force a refresh

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @MonicaGandhi9

Monica Gandhi MD, MPH

@MonicaGandhi9

16 Jul

@LeslieBienen

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

Read 8 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

15 Jul

@CDCgov

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…

Read 4 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

15 Jul

@CDCgov

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

@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…

Read 7 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

15 Jul

@KatherineJWu

Nice explanation of why symptoms define real vax "breakthrough" @KatherineJWu: "Bungling messaging around shots’ astounding success has made it hard to convey the truly minimal risk that the vaccinated face & the enormous gamble taken by those" not vax'd
theatlantic.com/science/archiv…

Good to check in with CDC breakthrough data in light of delta to see if same; hasn't budged:
Of >157 million people fully vax'd,
0.002% hospitalized with COVID-19
0.0004% deaths from COVID-19 (4 in 1 million)
cdc.gov/vaccines/covid…

This Israeli study gives risk factors for a severe breakthrough infection among vaccinated- small number (152) because vax so effective but high rate of immunocompromise or severe other medical conditions. Good demographic for 3rd dose
jpost.com/health-science…

Read 4 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

14 Jul

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

Read 4 tweets

Monica Gandhi MD, MPH

@MonicaGandhi9

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 16 tweets

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!