9/ And now turning to @edyong209's piece

theatlantic.com/health/archive…

We understood, back then, that social injustice caused disease and that this was immoral.

10/ Public health forgot that social injustice is at the root of disease.

theatlantic.com/health/archive…

11/ Taking on moral issues is really hard, uncomfortable, and controversial.

theatlantic.com/health/archive…

12/ Back then, it was about plumbing, "a matter of pipes."

theatlantic.com/health/archive…

13/ Today, it's a matter of ventilation and air filtration:

theatlantic.com/ideas/archive/…

nytimes.com/2021/10/19/opi…

https://twitter.com/celinegounder/status/1452287816780730378?s=20

14/ Public health forgot its philosophical origins.

theatlantic.com/health/archive…

https://twitter.com/celinegounder/status/1452287816780730378?s=20

15/ Public health reframed disease due to social ills into issues of personal responsibility.

theatlantic.com/health/archive…

16/ I came of age and trained when the HIV/AIDS pandemic was at its peak in sub-Saharan Africa.

Those experiences taught many of us that disease is very much social.

theatlantic.com/health/archive…

17/ We live in an era of "libertarian public health."

theatlantic.com/health/archive…

18/ To cure diseases caused by social ills, we need the moral urgency to address those social ills.

But are we willing to make sacrifices on behalf of society when the individual has become the center of our moral universe?

theatlantic.com/health/archive…

19/ Sadly, this is all too true. 👇🏾

And sadly, wanting to protect and save lives is political, not moral.

theatlantic.com/health/archive…

20/ Public health is also inherently political because it:
- deals with collective action by governments on behalf of society.
- involves the allocation of scarce resources.
- balances individual vs public rights and responsibilities.

theatlantic.com/health/archive…

21/ In my opinion, ALL that is not strictly biomedical but impacts on health IS public health.

theatlantic.com/health/archive…

22/ Baltimore & NYC are "reopening the umbrella" with their community heath corps: people from the most vulnerable, hard-hit communities working in their communities and serving their communities.

theatlantic.com/health/archive…

23/ We need to rebuild social capital and civic life in this country.

nytimes.com/2020/10/13/boo…

Public health can help drive that and be strengthened by it.

theatlantic.com/health/archive…

@amandamull

24/ I have hope.

theatlantic.com/technology/arc…
by @amandamull for @TheAtlantic

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA

@celinegounder

25 Oct

@KizzyPhD

1/ Important new research by @KizzyPhD & other @NIAIDNews scientists on the Moderna vaccine in non-human primates.

They gave the primates 2 doses of the Moderna vaccine 4 weeks apart.

And challenged them with Delta variant virus 1 year later.

biorxiv.org/content/10.110…

2/
Gray: unvaccinated
Red: vaccinated

After vaccination, binding antibody levels:
- peaked at 6 weeks
- dropped weeks 6-25
- rate of decline slowed weeks 25-48

3/
Serum neutralizing antibody titers:
- dropped weeks 6-24
- rate of decline slowed weeks 24-48
- were highest vs D614G (early variant)⚫️>Gamma🟢>Beta🔴>Delta🔵

Read 28 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

25 Oct

1/ There's good evidence that to protect against severe disease, hospitalization, & death, the following would benefit from an additional dose of COVID vaccine:
- immunocompromised persons
- people 60-65+ (? 40+)
- residents of long-term care facilities

nytimes.com/2021/10/25/hea…

3/ What should our goal be with the vaccines?
- Prevention of severe disease, hospitalization, & death
- Prevention of symptomatic infection (which means trying to prevent ALL infections since we can't always predict who'll be symptomatic)

Read 6 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

24 Oct

1/ Why can't we just test people to see if they have immunity to SARS-CoV-2 and decide whether they need to be vaccinated based on that test result?

jamanetwork.com/journals/jama/…

2/ Commercially available tests (what you'd get through your doc's office / urgent care clinic) measure binding, not neutralizing antibodies.

While there is a correlation, it's an imperfect one.

We don't know what level of neutralizing antibodies are necessary for protection.

3/ Some tests only pick up antibodies after infection (e.g. antibodies to nucleocapside protein).

Others pick up antibodies after infection or vaccination (e.g. antibodies to spike protein).

Read 7 tweets

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

@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…

Read 9 tweets

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