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Monica Gandhi MD, MPH Profile picture
@MonicaGandhi9
Nov 17, 2021 • 11 tweets • 4 min read • Read on X
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SCHOOL CLOSURES: Wow, think we should invest in emotional support for children instead of closing schools again after prolonged schools closures last year (that led to mental/emotional difficulty).
I gave talk in Pediatric Grand Rounds this am at UCSF which made me look more deeply at the history of school closures for infectious diseases in US. School closures were ALWAYS last resort & only happened for raging infections (esp those worse for kids than adults like measles)
In influenza pandemic of 1918 (encourage you to read this article), schools were not closed in NYC (& Chicago/ New Haven) because progressive cities (we really changed!) & out of 1 million children, 750K were not from affluent families; schools place for food, safety, learning
Despite opposition, public health officials in these progressive cities said, no, we are not going to close schools; children are better off in schools. This was in a pandemic that actually affected very young & older unlike COVID which has increasing severe disease with age
Would encourage reading this interesting article- well known that children needed school so ventilation was main strategy employed (open windows, outside) for a respiratory pathogen and schools either kept open whole time or opened soon.
There were some of the strategies employed; school nurses for the first time.
Since children "better off in school", strategies employed to keep them there
These were some of the strategies employed; school nurses in school for the first time
Topsy turvy pandemic response in the US
Oh I see we didn’t learn anything. Ok.
Detroit school district moves to virtual learning 3 Fridays in December freep.com/story/news/edu… via @freep
I and co-authors wrote a piece published last week (@sdbaral, @drklausner) that stressed the importance of keeping schools open, avoiding lockdowns/abandoning ineffective mitigation procedures, & vaccines (including global equity) to fight the pandemic
bmcpublichealth.biomedcentral.com/articles/10.11…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
Aug 30, 2023
HOW LONG DOES IMMUNITY LAST? To COVID vaccines or infection? We do not really know but there have been some really nice papers lately that give us more information. Please remember immunity divided into antibodies (which can come down & not work as well against variants)
IgA is one in the nose & mouth ("mucosa") that is raised by shots (vaccines) to certain extent but rise higher after natural infection; IgG is the one that is "humoral" or in the bloodstream. Many threads on here about cellular-mediated immunity: B & T cells cover all variants
This recent preprint is really important and summarized by @florian_krammer below in depth. Main take-aways: Breakthrough infections induce IgA (we knew) but protection from vaccine long-lasting even against former variants to severe disease/mortality
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
May 3, 2023
RSV VACCINE FOR OLDER ADULTS: Respiratory syncytial virus (RSV) respiratory virus (most common after flu pre-COVID). 2 subtypes, A&B (1 dominates/season). Droplet; Recurrent infections. Most severe in neonates & adults >65; FDA approves 1st RSV vax today
msn.com/en-us/news/us/…
RSV vaccine 3 trials of new RSV vaccine, all published in the @NEJM recently so just to keep them straight- here is the vaccine which just got approved May 3 by the FDA for older adults. Remember our T/B cells so protection against severe disease higher!
nejm.org/doi/full/10.10…
A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related severe respiratory illness by 94% in adults>=60 years (71% against RSV infection, likely to fall with time as antibodies fall but severe disease protection will remain)
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Mar 21, 2023
NASAL VACCINES: To explain nasal vaccines, we have to explain the immune system first.
IgA is an antibody that helps attack the pathogen and exists in mucosal surfaces (like nose/mouth)
IgG is an antibody that is in the bloodstream
bbc.com/news/world-asi…
Cellular immunity is fantastic, redundant (so even if one cell line down in immunocompromised, have other), generated by either vaccine or infection; Comprised of
T cells- so in breadth from vax - works even across spike protein with its mutations
And the 2nd type of cell produced by vaccines or infection -B cell- amazing thing about B cells is that - if see omicron or one of its subvariants in future- they make antibodies adapted to that variant or subvariant (aided by T cells); adaptive immunity
Read 15 tweets
Monica Gandhi MD, MPH Profile picture
Mar 15, 2023
PUBLIC HEALTH POLICY: Seem to be at reckoning phase of COVID response- what worked, what didn't. Which interventions will be used in future pandemic responses? Interventions asked of public need good medical evidence for them (e.g. RCTs preferably, systematic reviews) to impose
In our field, Cochrane reviews represent best way to sum up the medical evidence to date by performing meta-analyses or systemic reviews of currently-available data; here is Cochrane on masks & other interventions for respiratory viruses including COVID
cochranelibrary.com/cdsr/doi/10.10…
Many asked past 3 years how CDC developed policies on masks (& age to mask), distancing (feet), ventilation, schools-> all non-pharmaceutical interventions. Originally theory-based. Now 3 years in, have data (RCTs highest level) to form policies from both US and other countries
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Mar 6, 2023
VACCINE DISCRIMINATION: We need to stop vaccine requirements for US entry like almost every other country. Am finishing COVID chapter for our ID "bible" & vaccines prevented transmission early on with alpha, but not enough now with current variants to justify such discrimination
Moreover, shame, stigma, blame (remember COVIDiots?), coercion, discrimination not good public health tools. When used for HIV, public health & ID physicians decried them but tactics used a lot in COVID. This book tries to explore & correct that for future
barnesandnoble.com/w/endemic-moni…
Concept of #harmreduction in pandemic responses means watching carefully if vulnerable people (like students, older people, low-income populations, migrants, sex workers, prisoners, those with disabilities, refugees, minorities) harmed more by response
nature.com/articles/s4146…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Feb 8, 2023
FEAR: Some media & public health officials concerned Americans aren't fearful of COVID now. But the vaccines & therapeutics DO WORK. If we can't celebrate biomedical advances & imbibe their effectiveness (we have better tools for COVID than flu), what is point of developing?
In HIV medicine, when therapies came out, we didn't say to people- stay fearful; make this the controlling principle of your life. The book #Endemic I wrote (coming out July 11, 2023) hails these biomedical advances & the age we are in to fight pandemics to reassure the world
This is a rather brilliant summary of the issue from @benryanwriter
Read 4 tweets

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