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Monica Gandhi MD, MPH Profile picture
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21 Dec, 4 tweets, 1 min read
OMICRON: 2 fascinating articles today from S Africa in pre-print (researchers/doctors there are excellent)- question of day: Is Omicron less virulent intrinsically or is the lower hospitalization rate due to increased immunity? This one argues for latter
medrxiv.org/content/10.110…
Looked at seroprevalence rates in Guateng Province, S. Africa, 7010 people (18.8% had received vax'd). Overall seroprevalence ranged from 56.2% in children <13 to 79.7% aged >50 years. Cases went up, rates of hospitalizations & excess deaths did not increase proportionately, low
However, this one argues for less virulence intrinsically beyond just higher rates of immunity in Dec 2021. Proportion of omicron increased from 3% in early October (week 39) to 98% in early December (week 48). On multivariable analysis, after
medrxiv.org/content/10.110…
controlling for factors associated with severe disease (getting hospitalized), individuals with Omicron had lower odds of being admitted to hospital compared to non-Omicron infections (adjusted odds ratio 0.2) - 80% less severe; And compared to delta, 70% less severe (aOR 0.3).

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
20 Dec
Speech tomorrow night by President Biden: Some ideas/notes/references from our team for consideration by @POTUS @WHCOVIDResponse. Thank you for considering!
Goes along with this editorial by @j_g_allen in @NYT today to not close schools again
nytimes.com/2021/12/20/opi…
Here is a downloadable link to those suggestion for @POTUS, @WHCOVIDResponse so you can click on links. Of course we have dreams of ventilation and universal health care but we are focusing on what to do now for tomorrow's night speech. Thanks!
ucsf.box.com/s/r0gu16r1p8nl…
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
17 Dec
These virulence studies showing Omicron may be more mild not only due to increased immunity in population but something to do with its viral pathogenesis are fascinating
And yes @sailorrooscout, I saw your tweet from earlier but not believing our South African colleagues when they tell us something is different about Omicron feels disrespectful to me too. HIV MD/researchers know our S. Africa colleagues working in the field of HIV well
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
15 Dec
My 8 suggested changes for COVID policy 2022:
1) Boosters: risk stratify, do young males need? Space doses
2) Mask mandates based on hospitalization rates like Marin
3) CDC endorse test-to-stay. schools
4) Masks optional schools 8-12 weeks after availability of child vax (11/4)
5)Paxlovid asap
6)Acknowledge natural immunity more like Europe
7)CDC reporting: Better data on severe breakthroughs so can advise boosters, masks, etc.
8) Stop travel bans, harm reduction approach, global equity, acknowledge endemic, prevent illness
nytimes.com/2021/12/11/opi…
Guess not clear. Suggesting off ramps for masks for both adults and kids for top points. I said after AVAILABILITY of child vax; some adults deciding. And yes I recommend for immunocompromised like my dad -fit and filtered masks inside. Everytime I mention masks, both sides yell
Read 8 tweets
Monica Gandhi MD, MPH Profile picture
14 Dec
There seems to be a lament on twitter today that COVID zero could have been possible (although many countries tried so hard & couldn't); it is actually the properties of the virus itself that make that impossible; lucky these amazing vaccines so effective against severe disease
This is a longer discussion on what makes a virus "eradicable" or not
When a virus is recognized to have properties that will make it endemic but have strategies to protect against severe disease (vaccines & therapeutics-Paxlovid- for those who decline), we track cases in health departments, policy formed on hospitalizations
nytimes.com/2021/12/11/opi…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
11 Dec
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
Read 11 tweets
Monica Gandhi MD, MPH Profile picture
11 Dec
Covid Malaise - great article on what it feels like to be in a blue state at this point in the pandemic (@DLeonhardt has written plenty of red states having less vaccine uptake & more COVID hospitalizations since vax available). I call it "twilight zone"
nytimes.com/2021/12/10/bri…
It is important to assess the collateral damage of any interventions we put into place in public health to combat one disease on other conditions and @DLeonhardt does so here, also commenting "And school operations are still not back to normal. Students are sometimes.. Image
"forbidden to sit or talk with one another during lunch — or to eat indoors. Masks make communication harder, especially for students with learning disabilities. Positive Covid tests/worker shortages can cause schools to close temporarily". In blue states, other problems ignored Image
Read 4 tweets

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