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Monica Gandhi MD, MPH Profile picture
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7 Oct, 5 tweets, 2 min read
San Francisco to lift some mask rules Oct. 15, other counties lay out criteria (metrics good for public health dictums; increases trust) sfchronicle.com/health/article… via @sfchronicle
Good article from @j_g_allen on why the CDC metrics probably not best criteria though...
washingtonpost.com/opinions/2021/…
Here are criteria for Bay Area
•Moderate (yellow) COVID-19 transmission tier >=3 wks
•COVID-19 hospitalizations low/ stable (health officer judgement)
•80% fully vax'd (boosters not needed)
OR 8 weeks since EUA for 5-11 year old vaccine.
Probably strictest criteria in US
But San Francisco adds clause for some places using vaccine passports (offices, gyms, etc.)- if <100 people, no mask needed on October 15. So, may be strictest in nation but at least metrics, off-ramps which is all good for Bay Area signaling emergency near-ending with high vax
This is why I think California in good shape with high rates of natural immunity + high rates of vaccination together (same as European countries fully re-opening; doing well so far)
sfgate.com/politics-op-ed…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
8 Oct
California's COVID cases are lower than in other states that are more vaccinated. Why? - Agree mix of natural immunity plus high vaccination sfchronicle.com/bayarea/articl… via @sfchronicle
Some of the statistics on our natural immunity (38% by end of winter surge) + vaccination rates are in this article I wrote yesterday:
sfgate.com/politics-op-ed…
Where are we with our rates of immunity overall? Dr. Rutherford at UCSF estimates 84% needed for delta & every state is different with rates of natural+vax before delta but delta led to more vax + many more cases
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
7 Oct
As FDA weighs decisions on boosters for Moderna and J&J this month, remember this comparison effectiveness study from CDC last month: Moderna 93%; Pfizer 88%; J&J 71% effective against hospitalization in delta era. Moderna is 100 micrograms (3 times dose
cdc.gov/mmwr/volumes/7…
of Pfizer which is 30 micrograms) & also given at 4 weeks instead of 3 weeks apart. Vaccines usually given at least 1 month apart (& more) so 3 weeks very short for duration. Moderna dose of 100 micrograms may be too high for 12-17 years for toxicity
reuters.com/business/healt…
Dose for 5-11 year olds that Pfizer submitted to FDA for EUA today is 10 microgram dose so adjusted downwards for younger people (but still given 3 weeks apart- latter may be too short for maximal immunogenicity/safety). Would love vaccinologists' thoughts
nytimes.com/2021/10/07/us/…
Read 6 tweets
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 7 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
4 Oct
"“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…
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

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