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Céline Gounder, MD, ScM, FIDSA

21 Oct, 9 tweets, 4 min read

@CDCgov

1/ Some interesting slides from today's @CDCgov ACIP meeting:
cdc.gov/vaccines/acip/…

Waning immunity?
Or the Delta factor (more infectious, somewhat more immune-evading)?

Some of both.
But in 65+, it's the Delta factor.

2/ Also, those 65+ have a weaker immune response up front.

I'd expect to see the same among immunocompromised persons.

Immunosenescence is a form of immunocompromise.

3/ Why is there ⬇️VE vs hospitalization over time among those among 18-44 yo with 1+ non-immunocompromising chronic conditions?

Confounding by behavior?

If real, this would justify different eligibility criteria by race based on "weathering" argument:
washingtonpost.com/opinions/black…

https://twitter.com/celinegounder/status/1446253034644905985?s=20

4/ This (and Israeli data) might justify lowering age of booster eligibility:

https://twitter.com/celinegounder/status/1446253034644905985?s=20

5/ Important point:

6/ Almost 11M (~3%) of Americans have already gotten additional doses of COVID vaccine.

7/ I don't think this will surprise anyone:

https://twitter.com/celinegounder/status/1451277830889910273?s=20

8/ Exposure & healthcare access certainly do vary by SES, race/ethnicity, and other demographics.

We do not know if "weathering" leads to more severe breakthrough infections by race/ethnicity.

On that, see earlier in this thread:

https://twitter.com/celinegounder/status/1451277830889910273?s=20

9/ Many of us have thought that J&J was a two-dose vaccine for some time now:
nytimes.com/2021/08/09/opi…

That more vulnerable populations have gotten more J&J makes giving a 2nd dose to J&J recipients more pressing from an equity perspective.

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA

@celinegounder

22 Oct

@snolen

1/ Important reporting by @snolen for @nytimes today:
nytimes.com/interactive/20…

We keep being told: "Yes, we know. It's not right. It's a really hard problem. We're doing everything we can."

No, that's not Facebook on disinformation (well, that too).

That's the USG & Moderna.

2/ It makes no sense when you want to maintain control over the technology.

You could TRAIN people how to make mRNA vaccines.

@DrTomFrieden

3/ Thanks to @DrTomFrieden, @Public_Citizen, @PrEP4AllNow, & @MSF_USA for beating the drum on this:

Read 25 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

22 Oct

@KatherineJWu

1/ On mixing & matching COVID shots, by @KatherineJWu in @TheAtlantic:
theatlantic.com/health/archive…

If you're eligible for an additional dose of COVID vaccine, you can get whichever you want (Pfizer, Moderna, or J&J).

https://twitter.com/celinegounder/status/1448356527702675458?s=20

2/ There were only ~50 people in each 9-arm of the NIH mix & match study for a total of less than 500.

Moderna was given full-dose (100 mcg) in the NIH mix & match study, not half-dose (50 mcg) as approved for boosters.
Higher dose➡️more side-effects

https://twitter.com/celinegounder/status/1448356527702675458?s=20

https://twitter.com/celinegounder/status/1448356527702675458?s=20

3/ Many other caveats outlined here:

https://twitter.com/celinegounder/status/1448356527702675458?s=20

Read 5 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

21 Oct

@TheAtlantic

1/ @TheAtlantic's @KatherineJWu expands on B-cell immunology & antibodies:
theatlantic.com/science/archiv…

I've been trying, but I'm not sure it's getting through:
theatlantic.com/ideas/archive/…
newyorker.com/news/q-and-a/w…

Read 7 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

21 Oct

1/ Colin Powell warned that HIV/AIDS posed “a clear and present danger to the world," that it was a global security issue.

Today the White House, Pentagon & intelligence agencies warn that climate change is a global security threat.

washingtonpost.com/national-secur…

2/
- China & others could take advantage of rising seas & melting glaciers
- drought & other extreme weather can spark conflicts and forced displacement—countries like China & Russia are poised to take advantage

3/ 11 countries in that category of acute risk: Afghanistan, Colombia*, Guatemala*, Haiti*, Honduras*, India, Iraq, Myanmar, North Korea, Nicaragua* & Pakistan.

* half in our backyard

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

20 Oct

1/ This is what it's like to be a public health official in 2021.

Not only do you have to cope with the stress that the pandemic has created for everyone, you have to deal with this 👇🏾👇🏾👇🏾

naccho.org/uploads/downlo…

Read 9 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

19 Oct

1/ High-profile and fully vaccinated but immunocompromised:

Colin Powell’s death wrongly seized upon to undermine utility of coronavirus vaccines

washingtonpost.com/politics/powel…

Powell was 84 and had multiple myeloma, prostate cancer, and Parkinson's disease.

2/ 45% of people with active multiple myeloma developed an adequate response to the Pfizer or Moderna COVID vaccines in this study:
nature.com/articles/s4137…

That means that more than half of people with multiple myeloma who were vaccinated did not respond to vaccination.

@MSNBC

3/ To protect people who are too young to be vaccinated, elderly & immunocompromised, it is essential that everyone around them ALSO be vaccinated & take reasonable precautions (masking, testing, etc).

People in civilized societies look out for one another.

w/@MSNBC's @nbcaaron