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Monica Gandhi MD, MPH Profile picture
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28 Sep, 5 tweets, 3 min read
"Indoor masking doesn’t always make sense when everyone is vaccinated" Great piece by @j_g_allen in @washingtonpost about how to define metrics for not requiring indoor masking for vax'd (not CDC way): instead message delivered was "vaccines don't work"
washingtonpost.com/opinions/2021/…
@j_g_allen explains why CDC metric doesn't make sense because those with symptoms more likely to test (skewing rate), why test positivity rate is a function of the degree of testing. So use different metric; also vaccinated much less likely to get infected
washingtonpost.com/opinions/2021/…
Moreover, we know there is no "fixed way" to do things in a pandemic (while still keeping people safe) & the fear-based messaging in this country for the past two months has been not science-based: vaccines working well
So I go back to two pieces I wrote with others on a hospitalization + vax rate metric guiding removal of masks. This is not fixed. Flu leads to 20-40/100K hospitalizations typical season, COVID much more deadly than flu for adults so we suggested 5-10/100K
washingtonpost.com/outlook/2021/0…
And we suggested same metric of overall hospitalization rate in a region for unmasking children because you know threat is then so much less of the virus. I don't make policy but would say reasonable policy will increase public health trust
nytimes.com/2021/06/08/opi…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
29 Sep
B CELLS ADAPT THEIR ANTIBODIES TO THE VARIANTS: This is article that showed antibodies & T cells durable (x 8 months) from 1-shot J&J but note: [We] "observed expansion of neutralizing antibody breadth against variants over time..." specifically delta
nejm.org/doi/full/10.10…
beta, gamma. "which suggests maturation of B-cell responses even without further boosting". This is not 1st paper that shows this. Natural immunity or vax generates B cells that go into memory and then they produce antibodies directed against variant they see (ADAPTIVE immunity)
So, I know people have asked about "variant specific boosters" or wanting to boost antibodies with original vax repeatedly, but original vax has mRNA or DNA in it that codes for the L ancestral SARS-CoV-2 strain, not the variants. Your immune system adapts if see virus again to
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
27 Sep
California is now the only state with 'moderate' COVID transmission - we had bad winter surge so natural immunity there and then very good vax rate with passports/mandates (puts us in category touted by CDC as safe cdc.gov/mmwr/volumes/7…)
sfchronicle.com/health/article…
Links with @DLeonhardt article from this am about blue states like CA having higher rates of COVID prior to vaccinations- our winter surge very difficult
And are you seeing the theme? High rates of natural immunity + high rates of vax (blue states) vs high but lower rates natural immunity + lower rate of vax (red states)? Theme is that immunity only way to get through pandemic if we remember history:
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
27 Sep
"Red Covid" - an absolutely fascinating article by the great @DLeonhardt at @nytimes with a notable point prior to getting to current situation (which is that red states have more COVID now) which is that blue states had more COVID before vax. Although
nytimes.com/2021/09/27/bri…
Although good explanation not given, likely in CA due to over-restrictive policies like closing outside during winter which drove people inside (outside so safe). Now with 86% of Democrat voters having received 1 shot compared to 60% of Republicans, deaths/cases are in red states
"Because the vaccines are so effective at preventing serious illness, Covid deaths are also showing a partisan pattern...Some left-leaning communities — like suburbs of NY, SF, & WA, as well as New England — have such high vax rates that even unvax'd protected by low numbers" (of Image
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
26 Sep
MISTAKEN MESSAGING: On this Sunday 9/26 we can get on top of 2 messages that went awry in US for 2 months (started 7/27): 1) vaccinated spread as readily as unvaccinated; 2) booster discussion means vaccines not working. Let's move past these; sorry they happened; neither true.
Here is an explanation of how (even with delta), vaccinated do not spread as readily as unvaccinated and likely very little if at all if you don't have symptoms by careful contact tracing studies
And here is an explanation by video of how CDC said this statement of "vax spread as readily as unvax" mistakenly on July 26 week but walked it back with new data coming out as evidenced by their online briefs which are great
news.yahoo.com/common-breakth…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
24 Sep
Okay, you can see public health people now trying to justify a 3rd shot & it is getting more and more complicated as we try to name different groups but the reason the initial booster announcement by Biden was so disarming WAS because of cellular immunity
This article explains how antibodies wane but cellular immunity brings them right back up!
leaps.org/how-long-do-co…
@mugecevik, @jakescottMD, and @AaronRichterman state that reports of waning effectiveness greatly exaggerated. At this point, too late. Biden said it; FDA tried to walk back; CDC added more criteria & took away some, we have to bumble through best we can
bmj.com/content/374/bm…
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
23 Sep
When public health officials do not provide "off ramps", clear metrics of taking off and on restrictions, a city will be parodied. Europe did this cleanly (Denmark when 74% vax'd- no restrictions). CDC trying to do here: cdc.gov/mmwr/volumes/7…
sfgate.com/sf-culture/art…
France looked at COVID transmission rates in a region to decide when to remove masks for children. These are clean metrics, earns trust of the people, we are not doing this in US even as we admit the virus will be endemic
thelocal.fr/20210922/franc…
Decide on metrics to remove restrictions, relay cleanly, have public health officials say same thing or US will have deepening distrust. Denmark & so many places had high acceptance of vax because trusted public health. Ideas of school metrics here:
nytimes.com/2021/06/08/opi…
Read 4 tweets

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