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Monica Gandhi MD, MPH Profile picture
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31 Oct, 6 tweets, 3 min read
How other countries can teach the Bay Area about the COVID-19 endgame - Think important for California to keep looking at Denmark (opened up completely on Sept 10 at same vax rate) for their trends
sfchronicle.com/opinion/openfo…
If you look at Denmark's graphics, you will see cases going up but deaths staying low - in fact, please go to this website & put your cursor on y-axis (0-4 per day since opened)
graphics.reuters.com/world-coronavi…
So, keep on looking at hospitalizations as cases rising in highly vaccinated regions are not the best indictor of the high protection of the vaccines (can be simplified into T cells/B cells - high protection- vs antibodies - which fade; see pinned tweet)
This uncoupling between cases and deaths seen in Denmark with high vaccination rate seen here in San Francisco too
sf.gov/data/covid-19-…
Good for public health officials to message confidence in the vaccines and immunity if they want people to vaccinate - looking at above data is helpful
I wrote the CDC, NIH and the Biden Administration task force about this (got reply back from 1 person at CDC who said makes sense); their metrics for assessing community transmission made sense before vaccination but need different ones after vaccination:

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
31 Oct
ENDEMICITY: Singapore also makes announcement it will abandon COVID-zero strategy leaving only China currently pursuing this strategy worldwide. Vaccines have massively decoupled cases from hospitalizations & older patients should be boosted & protected
npr.org/transcripts/10…
Somehow cases in light of vaccinations have led some to think vaccines don't work. It is the amazing ability of the vaccines to defang the virus that show they work.
We can see different states in the US also pursuing COVID zero too but it is the duty of public health to attend to all ills of society, people didn't come in because of COVID fear " we're seeing more acute cases than we were pre-pandemic"
medscape.com/viewarticle/96…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
30 Oct
COMMUNITY TRANSMISSION: CDC definitions of test positivity + case rates made sense before vax but not after:
1) Test positivity: Depends how much testing a place does. CDC doesn't rec asymptomatic test after vax if no exposure (does before vax); places who test more asymptomatic
will have lower test positivity (places who test less asymptomatic look high test positivity but may not mean high community transmission as that is what CDC recs)
2) Case rates: After vax, people test if feel sick (before vax if not sick per CDC guidance) so case rates per 100K
will look high because reflecting those who actually feel ill & test for COVID, but may not reflect general community transmission. Suggest using hospitalization metric to determine degree of COVID after vax in community. Well explained by @j_g_allen here:
washingtonpost.com/opinions/2021/…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
30 Oct
OFF-RAMPS FOR MASKS IN SCHOOLS: @nytimes @JessGrose (I & others interviewed) on off-ramps for masks in schools. I suggest mask optional (people can still wear of course!) 8 weeks after 5-11 can get vax. "Intellectually honest" to discuss downsides to kids wearing masks
My co-author on mask article @linseymarr: "The vaccine should change things for us, and we don’t want kids to wear masks in school indefinitely
Kid masking has been one of the most controversial issues in our country. I think inside masking very important until we got to metric or child vax availability. Don't think governments can impose mask mandates for other pathogens like colds but will be everyone's choice
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
29 Oct
DO YOU NEED 3RD SHOT IF INFECTED AFTER VAX?: We definitely know exposure after vaccination (like in the Provincetown outbreak) stimulates both antibodies/T cells to the variant you see. Exposure after vax will happen (not deliberately); would not boost with 3rd dose if happens
Your B cells will actually adapt antibodies if they see virus again to that variant so those in the P-town outbreak study above had delta variant-specific antibodies (including those in nose, IgA, and blood/respiratory tract, IgG)
P-town study above shows BOTH antibodies and CD4 cells (these are T cells) increase with the exposure and the antibodies are directed against not just the spike protein but other parts of the virus Image
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
29 Oct
This article is interesting at @sfchronicle because it discusses concept of risk analysis and our broken relationship with it after vaccination.
sfchronicle.com/opinion/openfo… v Image
Image
"Rather, it is whether officials are using sound scientific reasoning and quantitative methods in their policy decisions" Image
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
28 Oct
MISTAKEN MESSAGES: Think these 2 messages continue to decrease confidence in the vaccines: 1) Vaccines don't reduce transmission: Untrue. CDC data shows 6x less likely to get infected if vax'd to begin with; 2) Boosters needed so didn't work but 2-dose vax holding up really well
Mistaken message #1: Here is thread on why you are less likely to transmit if vaccinated (which is compelling reason that vaccines protect you and others)
Mistaken message #2: Nice article today about how well the original vax holding up to protect against severe disease. Yes, after President Biden made announcement re: boosters, FDA/CDC had to address so said boost J&J & >65 but look how well working
abcnews.go.com/Health/booster…
Read 4 tweets

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