We need to start thinking differently about COVID outbreaks- this is not really about this particular outbreak (we don't know all the details)- this is about thinking differently after vaccines:
This is a tipping point in the pandemic with highly effective vaccines, the 5-11 year old vaccine, two oral antivirals on their way for treatment & we have to use dialogue from 2021, not 2020, to explain it
Today, the CDC reports that measles vaccination programs worldwide derailed (especially 2nd dose among US children). We cannot lose sight of other pathogens we managed to get under control while we work on COVID control

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More from @MonicaGandhi9

10 Nov
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
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
Read 12 tweets
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)
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
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
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
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
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
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
Read 10 tweets

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