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Monica Gandhi MD, MPH Profile picture
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23 Nov, 7 tweets, 3 min read
Poll: 74% of Americans Say Lives Have Returned to 'Normal' - very happy to see the confidence many in the US have in the vaccines, despite both 1) misinformation; 2) fearful messaging from some public health officials that they don't work well (they do!)
medscape.com/viewarticle/96…
Mistaken messages on if vaccines reduce transmission (they do) and if vaccines are working during booster conversation (they do) eroded confidence in the vaccines
Cases used to track with hospitalizations but not now after vaccines- so we should now track hospitalizations to track the pandemic, not cases. Places with very high vax (80%), lots of natural immunity (sadly like India), hybrid immunity (UK) doing best
Hospitalizations for COVID in US since vaccines available mostly in unvaccinated & even hospitalizations among vaccinated may be 1) COVID in nose, not in lung since we swab; 2) more among older who NEED boosters
covid.cdc.gov/covid-data-tra…
covid.cdc.gov/covid-data-tra…
And for those who decline vaccination, Paxlovid (here soon) literally prevents severe disease at the same rate as vaccines & molnupiravir being reviewed next Tuesday:
Here is data that shows unvaccinated 44 times more likely to be hospitalized than vaccinated for COVID-19 in LA - data from a week ago (before widespread boosters); vaccines are working & for adults who decline, therapeutics around the corner
publichealth.lacounty.gov/phcommon/publi…
And finally, 96% of doctors vax'd but 30% of doctors not yet sure about vaccinating their 5-11 year old children since so much less at risk. Fair enough to wait for more safety data; US should be patient - exaggerating risks to kids did not earn trust here
medscape.com/viewarticle/96…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
17 Nov
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
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
16 Nov
Protective immunity after recovery from SARS-CoV-2 infection - an important review in Lancet ID about protection from repeat infection after prior infection vs vaccination. Immunologic review AND review of re-infection studies
thelancet.com/journals/lanin…
#1. Developing illness is what all doctors are sworn to prevent so there is rarely advocacy for natural infection but this is what happens if natural infection occurs. Strongest immunologic evidence for enduring immunity, T cells from Science study here:
science.org/doi/10.1126/sc…
And 2nd amazing paper showing that your B cells will adapt antibodies if they see a variant in the future to the variant in front of them is here (we have discussed this and the above paper in T & B cell threads if you search them)
science.org/doi/epdf/10.11…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
14 Nov
SHIFT in CDC: Feel like was likely the biggest news of the week & the message may have been missed. With such a transmissible virus, shift away from herd immunity goal is prudent. Can no longer count cases as goal of US epidemic (e.g. get <10K etc.).
ktla.com/news/nationwor…
If we track cases as our main metric after vaccination, you will see this yo-yo effect. In late September, CA had lowest cases (yes people gather inside as it gets colder), now FL has lowest cases but tracking hospitalizations is the key after vax
abc7.com/california-cov…
And - during delta- a lot of natural immunity occurred in Florida, tragically in many cases but also a lot of natural immunity in younger healthier individuals too which brings up the IgA in the nose & brings down cases; this is chasing one's tail
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
12 Nov
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:
sfchronicle.com/opinion/openfo…
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
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
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
Read 12 tweets
Monica Gandhi MD, MPH Profile picture
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

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