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Monica Gandhi MD, MPH Profile picture
@MonicaGandhi9
Dec 11, 2021 • 11 tweets • 5 min read • Read on X
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1. WHY HOSPITALIZATIONS ARE NOW A BETTER INDICTOR OF COVID'S IMPACT: This is my 50th op-ed on @COVID this year, round number. Suggest with @LeslieBienen and @citizen_oregon how to shift US strategy on restrictions & policies at this stage in pandemic
nytimes.com/2021/12/11/opi…
2. New strategy likely even more important to institute (with our current tools) with the new #Omicron variant which - since likely more transmissible but more mild by accounts to date- can be in people's noses without disease. Public health sworn to protect us against illness
3. The US (and any other country) accepting that a highly transmissible virus with animal reservoirs will be endemic is not "giving up" & cases will still be tracked by health departments, but by focusing on disease, we can work harder to prevent iy
4. We know immune system will protect us against severe disease via knowledge of B/T immunity (please see cellular immunity thread) so case counts becoming even more complicated now
5. Singapore is doing this and increases trust in public health not to have see-saw pattern of restrictions based on short-term bumps or declines in case numbers now
6. Health departments must and will keep tracking cases as they do for influenza but two counties side by side (Marin & SF) using different parameters for restrictions and decreases trust in public health which badly needs our trust
7. Case counts will still be tracked but restrictions based on hospitalizations with vaccination now. Moreover, we need to focus on getting Americans who are older (retired so not part of vax mandate) & disabled vaccinated - 10 to 20 million in US
8. Finally, important shift in strategy as it is good public health to turn our attention to the effect of restrictions & school closures on young people given Surgeon General @vivek_murthy's recent report on mental health crisis in our youth
9. Not in article but this strategy will depend on determining who is in the hospital for COVID or with COVID as we swab everyone's noses for COVID in hospitals for infection control. If we switch, need proper adjudication on reason for hospitalizing
10. Also there is concern about long COVID not in article: Very reassuring podcast from infectious diseases experts (2000 surveyed) on how they are not seeing long COVID with breakthroughs after vax. Please listen.
microbe.tv/twiv/twiv-828/
NYT op-ed discussed here on podcast with @jarod_ormsby - thanks
podcasts.apple.com/us/podcast/cli…

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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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