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Monica Gandhi MD, MPH Profile picture
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3 Sep, 4 tweets, 2 min read
Important to understand biases and interpret studies correctly when making statements (like @davidwdowdy did for NEJM health care worker study yesterday). So, this seroprevalence study among blood donors in US showed 83% COVID antibodies in May 2021
jamanetwork.com/journals/jama/…
Why are blood donors not representative of the general population (more positives)? Because
1) Earlier, people with COVID were giving blood so that their convalescent plasma could be used as potential treatment for COVID patients
2) People give blood to know their antibody status
3) Maybe more likely to be vax'd
Same thing happened with Manaus Brazil study in Lancet: blood donors showed high level of antibodies & people mistakenly at 1st thought this was representative of general population (blood donors enriched for having COVID)
thelancet.com/article/S0140-…
So, do I think the US population was at 83% seroprevalence in May 2021? No
Do I think the blood donor population in the US was at 83% seroprevalence in May 2021? Yes
Wish I knew what the seroprevalence in the general population is...

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
15 Sep
This is likely study (just got released) pushing booster conversation in US for >60 (of note, booster discussion most relevant to places with high circulating virus due to low vax rates, not urgent in EU now). Data from Israel -not an RCT-
nejm.org/doi/full/10.10…
but decision made in Israel to boost those >60 whose 2nd shot >5 months ago on June 30. This is data from July 30-August 31, 2021, from Israeli Ministry of Health database comparing those who had 3rd shot >=12 days before to those who had not. No matching on co-morbidities etc. Image
>= 12 days after booster, rate of confirmed infection lower (factor 11.3) in booster group than in nonbooster group as was rate of severe illness (factor of 19.5) . Better protection later on. Likely to push US to boost >60 while cases will circulating with our low vax rate
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
15 Sep
Don't have time to analyze this now but publicly-available documents that the FDA will review for their decision on boosters on Friday are now available here if you want to take a look
fda.gov/media/152176/d…
FDA seems unconvinced so far but we need to go through it bit-by-bit and make a clean decision by Friday so will analyze the studies for you later today
endpts.com/as-booster-sho…
However, this India study showing declining antibodies after vaccination is not really showing anything but how the immune system works. Antibodies wane to avoid your blood becoming the consistency of a milkshake but memory cells make more
reuters.com/world/india/in…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
14 Sep
Discussing balance, nuance, risk factors for COVID (before vax or even after vax, including heart disease, obesity, etc.) is important. Episode with @DrTomRifai & @DrDavidKatz about balance, collateral damage of pandemic (ok to say that word) and 1918 pandemic
For instance, even fetal stress in 1918 due to health, lower attainment of adulthood income, and occupational fulfillment led to shorter lifespans. Similar to discussions of long-acting impacts of our prolonged school closures in US last year (balance)
read.dukeupress.edu/demography/art…
Cohorts born during 1918 pandemic and in its aftermath exposed to stress, which leads to inflammation which has long-term health effects (on cancer, cardiovascular disease, etc.)
ajph.aphapublications.org/doi/10.2105/AJ…
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
13 Sep
A lot on boosters & immunity (the higher the better; obviously in a surge, immunity goes higher but vaccination rates up too) this week with a summary on @MdMashup
mashupmd.com/weekly-expert-…
Nice paper this morning from Lancet on "Considerations on boosting COVID-19 vaccine immune responses". "The vaccines that are currently available are safe, effective, and save lives. The limited supply of these vaccines will save the most lives if made ..
thelancet.com/pb-assets/Lanc…
available to those who are at appreciable risk of serious disease and have not yet received any vaccine. Even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated" [ and tamping down variants]
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
11 Sep
NOVAVAX vaccine: Want to do a thread on this more traditional vaccine as it involves a protein (spike protein) + an adjuvant instead of genetic material for you to code for spike protein. Remember, we have >9 vaccine candidates worldwide
6 of the vaccines involve the spike protein (5 have you produce the spike protein from genetic code; 1 - Novavax- is the spike protein + adjuvant) and 3 are inactivated whole virions. Spike protein attaches virus to cell
Here are the 6 that involve the spike protein including Novavax so let's explain the latter next and data to date
Read 10 tweets
Monica Gandhi MD, MPH Profile picture
7 Sep
Realistic article by @DLeonhardt walking us through risks to the vaccinated of the delta variant. "In Britain, many people have become comfortable with current Covid risks. Vaccines make serious illness rare in adults, and risks to young children are low"
nytimes.com/2021/09/07/bri…
"There's a feeling we can finally breathe, get back to what we have lost" in UK "Many Americans feel differently. Our level of Covid anxiety is higher, especially in communities that lean to the left politically. ..But at least one part of the American anxiety does seem to have
"become disconnected from the facts in recent weeks: the effectiveness of the vaccines...". Despite recent poll showing many vax'd Americans still think they can get very sick, "In reality, the risks of getting any version of the virus remain small for the vaccinated"
Read 9 tweets

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