Thread by @MonicaGandhi9

Reason viral load (VL) becomes so important now is due to delta. So much more transmissible with those studies showing higher VLs. Those vax'd may get some in nose, will strengthen your immune response to fight it off so need to know if VL stays low
washingtonpost.com/outlook/2021/0…

Then for a mild breakthrough infection after vax, is that when an antiviral like molnupiravir comes into play - best to stop viral replication early for mild disease (severe disease mediated by innate immunity which is why we use steroids)

https://twitter.com/MonicaGandhi9/status/1415093950000422912

And then severe disease of course prevented by vaccination which everyone very convinced of at this point with what we have seen from delta. So, working on getting vaccination rates up is of utmost importance as outlined well here @apoorva_nyc
nytimes.com/2021/07/25/hea…

3 types of "breakthroughs"
1) asymptomatic: assess viral load - did you fight it in your nose & kept VL low & boosted immunity or VL high implications for transmission
2) symptomatic mild- oral antivirals coming
3) severe breakthrough, consider groups: boost immunocompromised

Oh and the ring to rule them all? Global vaccine equity and now, before end of 2021, get vaccines out worldwide. You think this pandemic never ends? It doesn't until we get life-saving vaccines to rest of world as soon as possible.
kff.org/coronavirus-co…