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Monica Gandhi MD, MPH Profile picture
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4 Oct, 5 tweets, 2 min read
"“In any epidemic wave, you have to have susceptibles,” [Dr. Rubin] “Between increasing vaccination and sheer number of people infected,...[reach] level where don’t have susceptibles left, so virus is being blocked ..one of those disappearing moments.”"
washingtonpost.com/health/2021/10…
And of course we want reduction in susceptibility to occur through vaccination but yes, a highly transmissible variant also causes many infections. Increasing immunity leads to a control of a virus that is difficult to eradicate; control manageable place
washingtonpost.com/outlook/2021/0…
Eventually, "immunity will become widespread enough that another wave as large and damaging as the Delta wave will not be possible. “Barring something unexpected,” Dr. S. Gottlieb.. “I’m of the opinion that this is the last major wave of infection.” Agree
nytimes.com/2021/10/04/bri…
Even New Zealand just announced they will be phasing out their elimination strategy
axios.com/new-zealand-co…
Luckily, even without elimination, control is very nondisruptive to life - takes mass vaccination (immunity also occurring naturally) + treatments and vaccination of children
wsj.com/articles/covid…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
5 Oct
Written with @JVergales. Many ways to keep children safe in school, most notably high adult vaccination in 2021 but many mitigation procedures shown beneficial in 2020 (masks, ventilation, testing exposed, etc.). Quarantine without test-to-stay likely least effective
Quarantining is by no means a new tool to curb the spread of illness. Descriptions of periods of isolation for those who may have come into contact with a highly contagious disease date to the 14th century as various plagues ravaged parts of Europe.
Ships sat for 40 days at ports until all contagion was thought to be cleared and the name stems from the Italian words quaranta giorni which mean 40 days. US used quarantine throughout the 19th and 20th centuries when epidemics of polio, tuberculosis
cdc.gov/quarantine/his….
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
4 Oct
Were California county mask mandates effective against delta? Here's what the data says- analysis from @SFGate that tells us what most of already know: "Health experts largely agree that vaccines are a more effective intervention than masks". Agree
sfgate.com/coronavirus/ar…
Most notable comparison is between Orange County (no mask mandate) & LA (yes mask mandate) but same rates of hospitalizations (OC had fewer cases). Masking & behavior are human variables but strong conclusion can be made "regarding vaccine efficacy against hospitalization"
Masks important tool to lower disease prior to vax but countries that messaged optimism in vaccines as way back to normal (Wrote this piece FEB '21) & did not have this much misinformation had much better vax rates; White House should message optimism now
leaps.org/want-to-motiva…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
1 Oct
California first state to mandate student COVID vaccination: I support this (deleted former tweet & apologize) because: 1) delta needs higher immunity in population; 2) more transmission from younger in delta case rates in 12-17 in LA in delta high; calmatters.org/education/k-12…
3) EUA issued May 10 for 12-15 year olds & won't be approved for 6 months until FDA assured of safety - FDA is very careful about safety. My 13 year old vaccinated but delayed duration between doses 1 & 2 to 6-8 weeks for increased effectiveness/safety
lite.cnn.com/en/article/h_e…
4) And vaccinating children also protects adults which is important and vaccine safe/effective with so much more data now. We mandate multiple childhood vaccinations in schools to protect kids & adults (pneumococcal disease plummeted when vax'd children)
thorax.bmj.com/content/74/5/4…
Read 6 tweets
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
28 Sep
"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
Read 5 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

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