Thread by @UCSFDOM

1/ Starting NOW on Zoom - welcome back to #UCSFMGR where we'll discuss vax, Paxlovid & all things COVID w/ Drs. @DrPaulOffit @SDoernberg & @annieluet moderated by @Bob_Wachter

2/ First up @DrPaulOffit: The goal of the vax is to protect against serious illness...To be protected against mild dz, you need high levels of neutralizing Abs at the time of exposure, which you would need fairly frequent boosters for. "I think one of the communication...

3/ ..mistakes was to use the term 'breakthrough:'mild illness means vax is working well..Similarly, rotavirus vax keeps babies out of the ICU & the vax is working well...This is a drifted virus, it's more like flu & the good news is that you're protected against serious illness."

4/ His take-home: "We are going to have to get used to mild illness since this virus is going to be circulating for decades, which is true for every other mucosal vaccine...the early vax efficacy against mild disease drops over time, which is exactly what you would expect."

5/ Vax development effort is currently remarkably quick:rotavirus vaccine efforts took ~26 yrs for context, he notes. Phase 1 studies to get right dose & # of doses takes time. Data review for peds is going to be much more extensive than just the press release that we've seen.

6/ What abt misinfo? He notes that anti-vax sentiment often related to mistrust in govt, medical community, pharma, etc. He points to advocates like Dr. @alastanford re: working closely w/ communities to promote vax update.
Next up:Dr. @annieluet: Mild illness still v disruptive

7/ ...Disruptive to work life, family life, risk of long COVID, & more. Dr. @SDoernberg: Meds are great at 🔽 risk of infxn, but unknown reductions in vaxed population as trials were in unvaxed.
She asks, what are the true goals of therapeutics? She offers a 4-part framework:

8/ 1. Protection against hospitalization?
2. Prevention of long COVID?
3. Sx relief?
4. Public health benefit?
For Paxlovid, risk of hospitalization/death 🔽 significantly. So for #1: clear benefit. For long COVID, sx relief, pub health benefit, VL does 🔽 but no clear data yet.

9/ Dr. @annieluet: "It's hard to argue against wanting to treat long COVID early, but also raises the question of if we treat too early, does this affect our immune response, related to Paxlovid rebound? A lot more to learn here...We need to find out true prevalence of this too."

@annieluet 10/ Dr. @SDoernberg: "We need more information. How often is this happening in placebo group as well? From an infxn control perspective, if retesting +, I would consider them infectious." Re: Drug interactions: "It's a challenge but not insurmountable:can be inducer & inhibitor."

@annieluet @SDoernberg 11/ Make sure to check: covid19-druginteractions.org/checker including for not-prescribed meds like St. John's Wort.
Dr. @annieluet: If you can't get Paxlovid, outpt IV remdesivir is best next choice, but can be hard to get logistically. After that, consider bebtelovimab vs. molnupiravir.

@annieluet @SDoernberg 12/ So far, paxlovid for post-exposure ppx doesn't seem to be answer: definitely isolate as getting COVID is NOT inevitable: "Isolation does work, it's NOT inevitable for everyone in the house!"

For high-risk individuals, pre-exposure ppx w/ Evusheld: nejm.org/doi/full/10.10…

@annieluet @SDoernberg 13/ A fascinating hour w/ Q&A frm Dr. @Bob_Wachter. Thank you to Drs. @DrPaulOffit @SDoernberg @annieluet Find us on YouTube if you missed it youtube.com/channel/UCxZIc…
See you back next week for #UCSFMGR back to hybrid audience for the Occupational & Environmental Hamilton lecture