DC has dropped its mask mandate. Why I and others think that - with an endemic virus - very justified to do this. Would recommend older people & immunocompromised get boosters & to mask indoors in mixed venues this winter if live in place with cases up
Moreover, we are in unique situation in US where 1) highly vax'd places (like Bay Area) still have remaining mask mandates (except Marin, which is going by hospitalization data); 2) we are now finally acknowledging as public health community vax >>masks so let's motivate vax!
Finally, our group seeing 3 patterns worldwide where severe illness low: 1) high natural immunity (tragically gained, India); 2) high vax rate >75%; 3) lots of hybrid immunity (UK opened 7/19 in midst delta surge but with lots of vax). Maybe 3rd shot Covaxin? whole virus?
Vaccines work & I am grateful for them as safer way to gain control than natural immunity (India/Bangladesh tragically gained) & I am grateful for the upcoming antivirals (Paxlovid, molnupiravir) here before Jan 2022 to prevent severe disease; targeted oral therapy

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More from @MonicaGandhi9

26 Nov
NU VARIANT (B.1.1.529) in South Africa & why unlikely to evade vaccine-induced immunity. So, what is this variant? Number 1, we don't know yet if it is more transmissible. Still being studied & described. 59 cases uploaded to database
Okay, so what is a "variant" mean for COVID? Means mutations in spike protein that attaches the virus to the host cell: mutations that differ from the "ancestral strain". This is the bit of the virus that tends to mutate most (like H and N surface proteins of influenza). Also, Image
of the 8 vaccines approved by the WHO (Novavax will be added soon & will make the 9th), 6 of those 9 involve the spike protein in some way (either code for it with mRNA, DNA; Novavax is protein itself); 3 of the 9 are whole inactivated virions (Covaxin, Sinopharm, Sinovac) Image
Read 13 tweets
23 Nov
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!)
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
Read 7 tweets
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
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
#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:
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)
Read 5 tweets
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.).
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
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
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:
Read 8 tweets

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