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Céline Gounder, MD, ScM, FIDSA Profile picture
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18 Aug, 13 tweets, 4 min read
1/ Here's my summary of the papers on COVID vaccines out from @CDCgov @CDCMMWR today:
2/ This is data from New York state.

There was a reduction in vaccine effectiveness against SARS-CoV-2 infection, but NOT against hospitalization.

The vaccines remain highly protective against hospitalization in ALL age groups.
3/ This is data from a national research network.

The vaccines were 90% effective in preventing hospitalization among adults without immunocompromising conditions, which is excellent.
4/ There was no reduction in vaccine effectiveness over time, which demonstrates that protection against hospitalization after the emergence of the Delta variant or due to waning immunity.
5/ However, the vaccines were less protective against hospitalization among immunocompromised persons, which supports plans to give these patients additional doses of vaccine to optimize their neutralizing antibody responses.
6/ This makes sense for their individual protection as well as to prevent the emergence of immune-evading variants.
7/ Other studies have shown that variants are more likely to emerge in immunocompromised patients who experience longer SARS-CoV-2 infections.

nejm.org/doi/full/10.10…
8/ But not all immunocompromised persons will respond to an additional dose of vaccine, so it's important that everyone around them be vaccinated to reduce their risk of exposure, that they & those around them continue to mask, & that they optimize ventilation & air filtration.
9/ This paper is on long-term care facilities (including nursing homes):
10/ We see decreased vaccine effectiveness against SARS-CoV-2 infection over time among nursing home residents.

It is unclear if this reduced vaccine effectiveness is because Delta is more immune-evading than prior variants or because there is waning immunity in this population.
11/ It makes sense to give an extra dose of vaccine to vaccinated nursing home residents,

but what will have an even bigger impact on protecting those nursing home residents is to vaccinate their caregivers.
12/ Here are links to the three papers:
cdc.gov/mmwr/volumes/7…
cdc.gov/mmwr/volumes/7…
cdc.gov/mmwr/volumes/7…
13/ And see also:

- On the elderly starting at tweet #88
- On HIGHLY immunocompromised persons starting at tweet #94

And on additional doses for nursing home residents:

• • •

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA Profile picture
16 Sep
1/ The decision to not get vaccinated, from the perspective of the unvaccinated
by @davidlazer & colleagues
osf.io/fazup/

Life constraints
Perception of benefit
Perception of risk
Uncertainty regarding the risks of vaxx
Lack of trust in institutions
Fear of needles
2/ About 2/3 of respondents had already gotten at least 1 dose of vaccine.

15% willing to get vaccinated.

But 18% won't get vaccinated. Image
3/ Among those not yet vaccinated, here are their reasons for not getting vaccinated:

#1, #2 They are worried about the risks of vaccination.
#3 Lack of trust in institutions (eg gov't, healthcare)
#4 Don't see much of an upside (ie don't think they're at risk for COVID) Image
Read 8 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
16 Sep
1/ Great analysis of the famous Israeli data by my friend @jeremyfaust.
2/ If all you get is a transient boost in neutralizing antibody levels, you'll find yourself right back where you were in 3-6 months.

If booster leads to a more robust/durable memory response, that would be valuable.


3/ I think there is data here supporting a booster dose for the elderly:
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
15 Sep
1/ Not everyone would benefit from an additional dose of COVID vaccine right now:

nytimes.com/2021/09/15/hea…
by @apoorva_nyc with @PepperMarion @PCH_SF @NussenzweigL
2/ There is good evidence to back additional doses of COVID vaccine for:
- HIGHLY immunocompromised
- Elderly
AND
- Nursing home residents
- Single-dose J&J recipients
BUT NOT for the general public at this time.

nytimes.com/2021/08/09/opi…
3/ We need to be thinking about the endgame, otherwise, we could find ourselves in a situation like Israel, chasing our tail with booster after booster:
Read 7 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
15 Sep
1/ @WSJ podcast is doing a really important series on Facebook: wsj.com/podcasts/the-j…

Powerful people, famous people, people with lots of followers get "white listed, which means they're above the rules.
2/ If powerful people, famous people, and people with lots of followers aren't policed like the rest of us,

they can become important vectors of mis-/disinformation.
3/
16.4 BILLION
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
15 Sep
1/ @FDA’s are skeptical about the need for additional doses of COVID vaccine for the general public.

"data indicate that currently US-licensed or authorized COVID vaccines still afford protection against severe COVID disease & death in the United States"

statnews.com/2021/09/15/fda…
2/ Agree!

There is good evidence to back additional doses of COVID vaccine for:
- HIGHLY immunocompromised
- Elderly
AND
- Nursing home residents
- Single-dose J&J recipients
BUT NOT for the general public at this time.
3/ We need to be thinking about the endgame, otherwise, we could find ourselves in a situation like Israel, chasing our tail with booster after booster:
Read 7 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
14 Sep
1/ Agree with @EricTopol. There is good evidence to back additional doses of COVID vaccine for:
- HIGHLY immunocompromised
- Elderly
AND
- Nursing home residents
- Single-dose J&J recipients

BUT NOT for the general public at this time.
2/ We need to be thinking about the endgame, otherwise, we could find ourselves in a situation like Israel, chasing our tail with booster after booster:
3/ Yes, the Pfizer and Moderna vaccine regimens will likely end up being 3-dose vaccines, but there's no urgency to give 3rd doses to the general public now:
nytimes.com/2021/08/09/opi…
with Drs. @CarlosdelRio7 & John Moore
Read 6 tweets

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