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Monica Gandhi MD, MPH Profile picture
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7 Dec, 4 tweets, 2 min read
Epidemiological update: Omicron continued reporting from EU CDC equivalent as of 6 December. "All [Omicron] cases for which there is available information on severity were either asymptomatic or mild. No deaths". Immune system more than antibodies
ecdc.europa.eu/en/news-events…
Although some references need updating, this explains how the immune system is not just antibodies but cellular memory too
leaps.org/how-long-do-co…
If hybrid immunity strongest type of immunity at all (as shown by the Sigal lab), much better to be vaccinated first & then get benign infection on top than vice versa (not safe). Remains to be seen if boosters stimulate memory/antibodies enough (boosted people have mild Omicron)
Data from laboratory studies on 12 Omicron patients showing reduced neutralizing antibodies against a highly mutated spike protein. Does not tell us vaccine effectiveness (VE). Real world VE data emerging & we also have cellular immunity

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
4 Dec
ENDEMICITY - What does a controlled infectious disease look like? Reduce illness to low impact Image
Only smallpox (and a cattle virus named rinderpest) have been eradicated worldwide Image
Measles has a vaccine for control; pertussis has prevention and treatment Image
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
3 Dec
Yes, it is true that an attenuated virus (led to more mild symptoms) did help end the 1918 influenza pandemic as Dr. Friedland said; we will keep watching Omicron variant but important observation
I would like to add a comment as a long-standing HIV doctor & researcher. Many of us have worked with South African doctors & infectious diseases epidemiologists for decades; this verified by conversations with SA colleagues; amazing doctors, researchers, scientists; we are lucky
And many of us were in touch with Indian researchers, scientists and epidemiologists at the start of the delta wave there and this was not at all true; it was terrible (4% vaccination rate); so let's all keep watching; ambiguity hard; let's wait & see
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
3 Dec
In places of low vaxn (23% in S Africa), hospitalizations rise with increasing cases with new variant; does not mean it is more virulent; means it is a COVID variant. Now 8 cases at least in US but likely much more (5 in NY, verified community spread)
cnb.cx/3lpjnTE
Yesterday, WHO & S. Africa reported 90% of those in hospital were unvaccinated (meaning vaccines work); there is nothing nothing more important than getting vaccines out to the world (S. Africa 23% vax'd; surrounding countries less)
Watch carefully- current disconnect in trends in S. Africa, comparing cases and deaths. We expect lag but the increasing cases with omicron not showing the same patterns as with delta so may be clue of lower virulence. More data needed
ourworldindata.org/explorers/coro…
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
30 Nov
Omicron COVID variant was in Europe before South African detected & flagged for world. Agree with AztraZeneca -no evidence vax doesn't protect from severe disease with variants (AZ less profit oriented); 2) S. Africa scientists that they felt 'punished'
cbsnews.com/news/omicron-v…
This is some of the immunology behind why vaccines likely to still be protective against variants:
And the 2-dose vaccines seem to protect against severe disease per BioNtech; if you want to avoid mild breakthrough, certainly get boosted. With an endemic virus, virus will likely be seen again in future after booster antibodies come down
wsj.com/articles/omicr…
Read 12 tweets
Monica Gandhi MD, MPH Profile picture
28 Nov
3 characteristics to ask about a variant. Is it more transmissible, more virulent, can it evade vaccines? Delta was 1st, not second two. We don’t know enough about omicron but this is a thread on polyclonal antibodies and B/T cell immunity from vax that makes 3rd more unlikely
And agree with Dr. Katz that the most important thing to understand is the degree of symptoms (illness) from a new variant: preliminary reports on more mild need verification, more study just like the risk stratification by age in COVID so important
linkedin.com/pulse/omicron-…
We know from HIV how incredibly amazing S. Africa scientists, doctors/ epidemiologists are; careful work should be commended, not punished. So far "presents mild disease with symptoms being sore muscles and tiredness" (cough, smell, taste not prominent)
wionews.com/world/covid-om…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
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
thenationalnews.com/coronavirus/20…
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,
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)
Read 16 tweets

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