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Monica Gandhi MD, MPH Profile picture
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13 Sep, 4 tweets, 2 min read
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]
I am sure it is lost on no one that FDA's Dr. Krause first-authored this Lancet paper and Dr. Gruber is a co-author and that the wording is unequivocal. Of note, nice review of the studies to date -randomized and observational -in Figure.
thelancet.com/pb-assets/Lanc…

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More from @MonicaGandhi9

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
Monica Gandhi MD, MPH Profile picture
7 Sep
As you know, multiple models showing cases declining in two months with worst of this behind us then but we can get there in 2 ways: 1) delta spreading to unvaccinated eligible adults leading to natural immunity (happening anyway); 2) increasing vaccination which will accomplish
same without same hospitalization/death rate. Delta leaves immunity in its wake…One analysis that assumes that the delta variant is so contagious that it will infect adults in the US (over 17) in the US predicted the current decline in the South and now predicts that the states
most vulnerable to increasing cases and hospitalizations are Michigan, Wisconsin, Minnesota and Iowa due to their relatively lower vaccination rates and the fact that it appears that delta is just taking hold in these states. Places like Northeast with high rates of vaccination
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
5 Sep
HOW MUCH CAN VACCINATED PERSON TRANSMIT WITH DELTA? Answer is - we don't know, but most certainly less than unvaccinated person and good to be humble and say "I don't know'. Why did we universally mask early in the pandemic (April 3 CDC guidelines?)
ncbi.nlm.nih.gov/pmc/articles/P…
To prevent asymptomatic transmission. By November 9, 2020, when CDC changed guidelines to "masks protect you and others, it was clear that it is more fit and filtered masks that protect you; cloth masks not as effective as shown by recent Bangladesh RCT
cell.com/med/pdf/S2666-…
So, CDC put out new guidance on Feb 9, 2021 saying more fit & filtered protect you but not really implemented for worker protection like other places. O but then why did CDC say no masks for vaccinated on May 13 - because, with alpha & early on
cdc.gov/mmwr/volumes/7…
Read 27 tweets
Monica Gandhi MD, MPH Profile picture
3 Sep
Does anyone besides me feel that the messaging over the last month in the US has basically served to terrify the vaccinated and make unvaccinated eligible adults doubt the effectiveness of the vaccines?
If I could message, I would start with history of infectious diseases, how the immune system works, how the vaccines are working well if you understand the immune system, and how (like Europe) we can get back to normal life with vax
leaps.org/how-long-do-co…
Would also explain that asymptomatic transmission from vax'd with delta rare per contact tracing studies (CT values on PCR is a surrogate, contact tracing is how you determine transmission). Get source code here for Singapore data- we found 1 transmission
covid.viz.sg/historic.html
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
3 Sep
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-…
Read 4 tweets

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