RED vs BLUE STATES in US: When @DLeonhardt wrote this important article about the vaccine divide in red vs blue states, I think something got missed, which is the part that blue states had more cases than red prior to the vaccine (& yes, blue states mask)
nytimes.com/2021/09/27/bri…
As an ID doctor who thinks about #harmreduction and the differences between poor/rich in the bluest city in the bluest state in the country, I see this as related to over-restrictions that didn't make sense like closing outdoors, didn't protect working class, favored wealthy
California was 50 out of 50 in opening schools in US & San Francisco (of all the Bay Area counties) kept public schools closed the longest (but private schools open here so wealthy allowed schooling). Think will be important to acknowledge in our after-conversations of COVID
And now -since immunity is the only way to get through a pandemic- during the delta surge, hospitalizations were so much higher in places with low vaccine (and low natural immunity- CA had both), which is a very sad aspect of our politicization
salon.com/2021/10/14/the…
And it is the blue states without clear off ramps for children (college students) to go back to normal school even with vaccines coming (here in colleges). Metrics to lift mandates are not cavalier; they provide populations with hope as immunity getting us through a pandemic
In my opinion, the lack of off-ramps in blue places is reflecting a lack of confidence among health officers/administrators/CDC etc. in the vaccines but I tweet pretty much continuously about how important immunity is in getting through a pandemic!

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More from @MonicaGandhi9

16 Oct
HYBRID IMMUNITY: Amazing article that explains "hybrid immunity" (infection then vaccination) and why it essentially provides superhuman protection (no one is advocating for natural infection but it happened; vaccination then exposure will likely do same)
nature.com/articles/d4158…
Article explains it is all about developing those memory B cells which explode with antibodies (they are the recipe) if see virus again (aided by T cells). 2 other important lines:
1) Extending the interval between vaccine doses could also mimic aspects of hybrid immunity
2) Places with high rates of natural immunity & therefore hybrid immunity (as vaccination is on top of natural immunity) have lowest rate of transmission. Makes sense as some of those "superhuman" antibodies are IgA & IgG in nose - note CA vs Israel
twitter.com/i/web/status/1…
Read 6 tweets
15 Oct
BOOSTER confusion: My thoughts
Immunocompromised: Get 3rd shot
>65 & got Pfizer 3 weeks apart: Recommend booster
>65 & got Moderna: Can decide with your MD, holding up well!
J&J: Get 2nd shot (J&J or mRNA) >=2 months after 1st
(All others- ask MD, evaluate risk & decide)
This is why if you got your Pfizer 2nd shot at a longer interval (7-8 weeks or more), the data from Canada shows you are better protected (and also a basic principle of vaccinology)
Essentially, extending interval between Pfizer from 3-4 to 6-14 weeks increased both antibodies & - most importantly for durable immunity - CD4 cells (T cells). Basis for my recommendation above (probably why Israel, using Pfizer 3 weeks, boosted)
cell.com/cell/fulltext/…
Read 4 tweets
13 Oct
HETEROLOGOUS VACCINATION (means one dose of one type of vaccine & 2nd dose of another type of vaccine): Paper came out today (mix & match) that finally looked at J&J + mRNA vaccine together; 1st let me tell you about studies in past which examined this with AztraZeneca + mRNA
Study from the UK (Com-CoV) looked at an adenovirus DNA vaccine (examples are AztreZeneca (AZ) J&J, Sputnik V - in this case it was AZ) and the mRNA vaccine (only two examples are Moderna + Pfizer, in this case studied Pfizer) 28, 84 days (4,7 wks) apart
papers.ssrn.com/sol3/papers.cf…
Did combination in the 4 ways (Pfizer/Pfizer, AZ/AZ, AZ/Pfizer, Pfizer/AZ) and found that the best combination in terms of both neutralizing antibody titers AND T cells was AZ then Pfizer (so adenovirus/DNA then mRNA). 2nd study from Spain, summary here
nature.com/articles/d4158…
Read 8 tweets
10 Oct
"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
Read 14 tweets
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
7 Oct
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
Read 5 tweets

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