INDIA: True that cases rising in US during the winter (at least colder states) which happens with any respiratory virus (as people gather inside during colder months). But not rising in India (and COVID hospitalizations remaining low). This being taken to mean that natural
immunity more powerful than vaccination because India had such a terrible 2nd wave but would point to 2 things: 1) Natural immunity came at terrible price of suffering & death; most of our COVID deaths in US since delta among unvaccinated; 2) This study
jamanetwork.com/journals/jama/…
showed that vaccinated individuals with prior infection 6 months or more before (HYBRID IMMUNITY) had statistically significantly lower risk for breakthrough infection than those vaccinated less than 6 months before dose 1 (adjusted hazard ratio, 0.62). Hybrid immunity powerful
True that vaccine gives you exposure to just a part of the spike protein to which you raise immune responses & infection shows you whole virus but again, illness causes suffering & vaccination after natural infection leads to less re-infection
nature.com/articles/d4158…
When cases rose in the US with delta, places with low rates of vaccinations had hospitalizations rise with those cases but the "uncoupling" phenomenon (cases rise, hospitalizations stayed lower) occurred in places of high vaccination
sfchronicle.com/health/article…
And protection from natural immunity vs vaccine probably depends on type of infection and type of vaccine threadreaderapp.com/thread/1453408…
We are 68.4 percent vaccinated (full) over 12 in US with pediatric vaccines available as of last week covid.cdc.gov/covid-data-tra…
Getting the unvaccinated vax'd in our country would have more effect, boosters should definitely be given per FDA/CDC guidelines to >65 years old, if you got Pfizer & high risk, J&J needs 2nd dose, immunocompromised; 3rd dose with hybrid prob not needed
threadreaderapp.com/thread/1454085…
As antibodies wane those most at risk of a severe breakthrough are older & immunocompromised so protect those individuals at all costs (including booster/masks) with higher cases; antibodies wane immunocompetent too; B cells (with T) make more
leaps.org/how-long-do-co…
And I am very excited - as are we all- about ways to treat moderate infection in those at high risk for going on to severe infection (eventually prophylaxis and those at low risk- being studied) of new antivirals
Important to know that the use of antivirals as prophylaxis is under study and results should be available soon. Right now, Marin 0 COVID patients in hospital as cases up because vaccinations high, cellular immunity, boosters for older/immunocompromised
We need constant vigilance with vaccinations and now getting antiviral treatments for an endemic virus. There won't be a "day" that this is declared "over", but we will always be treating, vaccinating for an endemic virus:

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More from @MonicaGandhi9

9 Nov
Democrats Desperately Need Schools to Get Back to Normal- important article "Because America’s response to Covid was so politically polarized, school shutdowns longest in blue states..only 6 states had fewer in-person days last year" than VA (CA was 50/50)
nytimes.com/2021/11/08/opi…
May be difficult from parents in other states to understand but this is what it feels like to be a parent in a blue state right now- November 2021. @JVergales and I and so many others have written about how quarantine in 2021 is the new "school closure" from 2020
important thing about quarantine as a historical concept in infectious diseases is that the benefits of that practice were ALWAYS weighed against its risks of isolation, exclusion, lost opportunities, and educational loss if enacted @JVergales & I write
washingtonpost.com/outlook/2021/1…
Read 7 tweets
7 Nov
NYC Mayor (Democrat) said today "off ramp" for masking in schools (Jan now that 5-11 vaccine here). Whatever metric you choose (MA doing 80% vax in community + hospitalization rate), looks like @NYT piece below (local NYC paper) opened door to discussion forbes.com/sites/marisade…
Reason to discuss is that children have had more restrictions in our country (more in blue states) than adults though less at risk. Our group's research on masks show masks protect wearer; anyone can still mask after mandate lifted to protect themselves
cell.com/med/pdf/S2666-…
Finally although @sfchronicle @erinallday wrote piece on off-ramps for masking children in schools today, @NYT ("liberal" paper, opposite coast) wrote powerful piece supporting school openings in 8/21; they were right, heralded last week's election
nytimes.com/2021/08/21/opi…
Read 5 tweets
6 Nov
ORAL ANTIVIRALS (e.g. molnupiravir and now "Paxlovid"): Why is everyone so excited about designated antivirals that target enzymes involved in the viral lifecycle of SARS-CoV-2? Because they will directly treat COVID & hopefully prevent severe disease
smithsonianmag.com/science-nature…
So, what is the lifecycle of the virus & where do these antivirals work? Good article on lifecycle, showing various steps how SARS-CoV-2 enters the cell & replicates. There is a polymerase called the viral RNA-dependent RNA polymerase and a viral protease
nature.com/articles/s4157…
Molnupiravir is a nucleoside analog that we have discussed before but it essentially is incorporated into the growing RNA strand of a new virus by the RNA-dependent RNA polymerase which messes up the RNA & can't continue to make new virus
Read 10 tweets
5 Nov
Totally agree @DrLeanaWen, we somehow muddled the messaging to say masks more effective than vaccines instead of vice versa and didn't motivate vaccination uptake starting from July. We can reverse this now.
I see many people discussing that "messaging" doesn't matter- all misinformation. I don't agree. We learned from all things infectious diseases that messaging does matter- if you tell someone vaccines don't reduce transmission & they have to mask forever after, not good message
If you tell a parent that "hey get your child the vaccine to protect others but their lives will always be restricted & they will mask in schools", not a good way to win over parents
Read 4 tweets
5 Nov
TWILIGHT ZONE: I call it the twilight zone that highly vaccinated states in the US are the most likely to be following CDC guidance to both 1) test if COVID exposed; 2) have mask mandates in response to red/orange zones which are only red/orange because of #1 (artifactual)
Problem with the "twilight zone" is that the CDC put us here on July 30 when they revised their masking guidelines to forget about vaccination status in a region & go back to former definition of community spread, which as explained, does not make sense in places of high vax
I had student with me in clinic today from UC school & at 100% vax rate, students all masking, temperature screening, testing like in 2020 but they are ...100% vaccinated so 2020 not 2021 style. CDC problem here: didn't say "unmask when 80% vax" just mask
cdc.gov/mmwr/volumes/7…
Read 10 tweets
2 Nov
Entire Bay Area is back in CDC's orange and red tiers for COVID spread - right, but this is because a highly vaccinated place will always be at risk of being in these "tiers" due to the outdated definition of the CDC's metrics of community spread.
sfchronicle.com/health/article…
To put it most simply, he current CDC guidance states that masks should be used in areas of high to substantial transmission (based on test positivity and cases/100,000 rates) but those metrics only made sense when mass asymptomatic testing was occurring prior to vaccination.
After vaccination, per the CDC guidance, only those with exposures or symptoms should test so tests are likely to reveal positive cases, which is not a good measure of community transmission or spread (but just means the people who should test are testing). Marin mask mandate
Read 6 tweets

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