Thread by @MonicaGandhi9

"Dr. Gottlieb sees Covid’s ‘pandemic phase’ ending when antiviral pills, kids' vaccines available": wanted to explain from infectious diseases principles what @ScottGottliebMD means by this which makes sense to me
cnb.cx/3DjvoR0

There was a time between alpha and delta when there was talk of herd immunity - where the vaccinated or immune would protect the non-immune. But delta is so transmissible, that it changed the equation & the dialogue
washingtonpost.com/outlook/2021/0…

Now "control" and "endemicity" being discussed (as in article I wrote for @washingtonpost above) where control is a place where the virus is brought down to low circulating levels but outbreaks still seen among unvaccinated & ongoing vaccination of susceptible (kids) needed

COVID doesn't have features that make it "eradicable" - looks so much like other respiratory viruses. But we are so lucky we have vaccines to bring it to control and treatments coming that will help us treat it in the outpatient setting when needed

And when virus is down to a low circulating level, those vaccinated or with prior immunity will not be susceptible to re-infection to same degree because they won't be seeing virus at all- this is how amazing the immune system is in responding if it sees virus again

Which is why booster discussion is not from immunologic research since immunocompetent create strong immunity with vaccines (boosters for >65 and immunocompromised makes sense) but about epidemiology- with lots of virus around, re-infection more common

https://twitter.com/MonicaGandhi9/status/1438873395144249347

So, what will endemic COVID look like- it is a very manageable place to be (we have not reached this here in the US as delta caused a lot of severe disease in regions with low rates of vaccination but reaching in other countries who have low rates of severe disease and opened)

And delta (this is not a happy thing; it has caused suffering) is causing a lot of immunity right now in the world because those who decline to vaccinate in the US are very susceptible to it & those without vaccine access due to lack of #globalvaccineequity are exposed

And I know COVID always surprises us but usually the most transmissible variant of a virus "wins" because it makes more copies of itself which is evolutionary advantageous for a virus but a virus takes "fitness" costs to become more pathogenic so hopefully delta is the worst one

So, what does a controlled infectious pathogen look like? One example is pertussis (whooping cough) and this is because it has both prevention (vaccines) and treatment (macrolides in this case). Don't see much pertussis here but increasing in past decade
cdc.gov/pertussis/abou…

in regions of country where childhood vaccines have been declined by parents. And what is an easier to give medication for COVID if unvaccinated person has mild-moderate disease or if a vaccinated person gets a mild-moderate breakthrough? Molnupiravir

https://twitter.com/MonicaGandhi9/status/1415093950000422912

is an outpatient medication given for 5 days (antiviral, hopefully short duration will not lead to resistance or toxicities). So, someone comes in with mild-mod respiratory infection, swabbed - if flu, give Tamiflu; if COVID, give molnupiravir. But ongoing control of COVID

needs higher levels of immunity than alpha. Dr. Rutherford estimates 84% immunity needed; others say 90%; which means control best achieved with childhood vax (5-11 vax being reviewed Nov 2-3 by FDA) & an antiviral treatment; agree with @ScottGottliebMD

https://mobile.twitter.com/monicagandhi9/status/1437537143908274176?lang=ar

And without #globalvacineequity, we cannot control a virus. With rich countries having on average 5 vaccines for every person & 4.4% of doses worldwide given out to low-income countries, the moral/ethical failing right now is mind-blowing