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Monica Gandhi MD, MPH Profile picture
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26 Oct, 4 tweets, 2 min read
COVID cases keep falling across US; in states with low vax with delta, hospitalizations at 1st increased (no T cells). But many areas didn't increase vax rate nor put back masks-still falling cases: highly transmissible variant causes lots of immunity
nytimes.com/2021/10/26/bri…
@ZDoggMD, I know there are those who hoped masks, distancing, ventilation, testing, contact tracing could get countries through a pandemic but (like in 1918), immunity seems to be the only real way to get to other side (so much more needed with delta)
and we will post our seroprevalence comparison soon - but simple example here. CA has lots of natural immunity (38% in general population before rolling out vax); Vermont had 1.7% before vax. Both 80% vax rate >=12. Cases staying low in CA but increasing in VT but both have high
protection from hospitalizations (simplified: T cells from vax). Antibodies decline in both states: swabbing noses will find cases in VT but hybrid immunity must indeed lead to more in-breadth & enduring antibodies in CA:
covid19serohub.nih.gov & sfchronicle.com/health/article…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
27 Oct
WHY DID THAT ISRAELI STUDY SHOW BETTER PROTECTION FROM NATURAL IMMUNITY THAN VAX? Because complicated as everything is in COVID. Ignore tweets at top of this thread as re-infection with delta way more common now - summarized some studies of natural vs vax
Okay, so the rate of natural infection in Israel was 3.8% in September & vax rolled out early (we don't have good seroprevalence data in winter, sorry). CA had 38% seroprevalence when vax rolled out to general population here
twitter.com/i/web/status/1…
That Israeli preprint does not tell us breakdown of severe infections versus mild but data compelling that more durable responses in severe infections. Ok, then you give ONLY Pfizer in a country with low natural immunity at strict 3 week intervals
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
26 Oct
Good summary: "FDA scientists concluded that benefits outweigh risks in most scenarios when Covid widespread. Only when Covid cases were very low in the community — as was the case in June — that it did not appear beneficial to vaccinate children."
nbcnews.com/health/health-…
Would advise CDC ACIP to discuss only 1 dose after natural immunity and spacing strategy as below.
Original FDA document, Pfizer presented to advisory committee: 3 reasons listed: 1) rare severe disease in kids; 2) prevent transmission; 3) return children to normal life- will ask my local DPH if kids will unmask in school when adults do in public here (8 weeks post child vax)
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
26 Oct
CAN YOU TRANSMIT IF ASYMPTOMATIC AND VACCINATED? (delta) Will put into context later, contact tracing studies; briefly, difficult to transmit if asymptomatic/vax'd. Health workers swabbed- if no symptoms, test turned negative fast: don't isolate 10-14 days
acpjournals.org/doi/10.7326/M2…
Annals of Internal Medicine study may make CDC rethink quarantine after exposures when vax'd and isolation after testing positive if no symptoms and vax'd (or masking everyone vax'd/asymptomatic) - see below for microbiology: immunity works to kill virus
Please remember CDC does not actually recommend testing asymptomatic individuals who are vaccinated without an exposure but this is being done in many settings. This is important data from the Annals of Internal Medicine (a very high impact journal)
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
25 Oct
DELTA NOT MORE VIRULENT IN US STUDY: In viral evolution, variants like to become more transmissible to create more copies of themselves, but good to see the most transmissible variant of all in the US (still massively dominating) not more virulent; haven't seen this yet
But with increased transmissibility comes increased cases; those cases will turn into hospitalizations (or there will be less "uncoupling" of cases & hospitalizations like in places of high vax) in places of low vax. So delta hard in US in low vax states
sfchronicle.com/health/article…
We had written this in the WSJ early on after delta (with @LeslieBienen and @citizen_oregon) that delta doesn't cause more severe disease per case; it will cause more cases and therefore hospitalizations in areas of low vax (that did happen)
wsj.com/articles/delta…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
24 Oct
CONTROL: I have always loved @Bob_Wachter's multidimensional chess analogy and was a privilege to speak in his 300 attendees in-person conference last week as COVID approaches control here
I think " state of control for communicable diseases (when disease is brought to low circulating levels and impact) takes constant vigilance; vigilance is in vaccinating those who are still without immunity (e.g. children) and using treatment for those who decline vaccination.”
Impending state of control in the US is not just from vaccinations but from a highly transmissible variant causing natural infection; vaccine so much safer and was easier conduit in many other countries. Control manageable place; doesn't cause public fear
washingtonpost.com/outlook/2021/0…
Read 9 tweets
Monica Gandhi MD, MPH Profile picture
19 Oct
Why I think PRIMARY SERIES OF COVID VACCINES SHOULD NOW BE SPACED OUT >6 WEEKS: We now have 3 lines of research that we should extend the duration between 2-shot COVID vax series: 1) immunologic; 2) effectiveness; 3) safety. Vaccinology principles here
academic.oup.com/cid/advance-ar…
Immunologic research here- Extending duration between doses 6-14 weeks compared to 3-4 weeks with Pfizer vaccine both increased neutralizing antibodies AND production of T cells (CD4 expressing IL-2)
cell.com/cell/fulltext/…
Data from Canada over the past week shows us that extending the duration from 3 to 7-8 weeks for the Pfizer vaccine increased vaccine effectiveness from hospitalization 82% to 92% (and increased protected against any infection from 47% to over 90%)
cbc.ca/news/canada/mo…
Read 5 tweets

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