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Monica Gandhi MD, MPH Profile picture
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Jan 29 • 4 tweets • 2 min read
ADOLESENTS: NIH Study (Stanford study, SF). "School shutdowns, severed social channels, and amplified stress at home and in their communities" during COVID amplified anxiety, depression, and brain aging "reflecting more lasting effects of adversity"
nimh.nih.gov/news/research-…
Important piece from @NEJM this week on #harmreduction in pandemic management. Do everything in your power to minimize severe disease but stop interventions which cause harm without decreasing pathogen impact; new era in COVID 2023 w/ immunity/vaccines
A holistic view of public health during a pandemic (consider societal effects of interventions; are they really helping?), can increase trust in public health. I - like most ID MDs on this platform- am concerned about trust & less uptake of other vaccines
From Dr. Maldonado at Stanford this week in @JIDJournal -"In the wake of the COVID pandemic, critical to reflect on the spectacular successes and failures of epidemiology, vaccinology, and public health in preventing other global infectious diseases"
academic.oup.com/jid/advance-ar…

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
Jan 30
POPULATION IMMUNITY: Nothing stresses a respiratory pathogen like winter months & this 3rd pandemic winter shows what high population immunity has done to decrease mortality rates from COVID:
ourworldindata.org/covid-deaths Image
Place with the lowest amount of population immunity is China as less natural infection from zero COVID policies and vaccination (and boosting rates in elderly) not as high as desired. World & @WHO very rightly worried about China- need vax & therapeutics Image
PANORAMIC trial (ongoing) in UK will define use of Paxlovid with high population immunity- latter not there in China; China vulnerable 65 & up vax'd or unvax'd high risk need wide availability of Paxlovid (Pfizer CEO ruling out generic in China troubling)
reuters.com/business/healt…)
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
Jan 23
ONCE YEARLY? Agree with most on here that 1) yearly vaccination needed but for older & more vulnerable (co-morbidities multiple, immunocompromised); 2) May not able to adapt mRNA vax quickly enough
FDA considers major shift in COVID vaccine strategy npr.org/sections/healt…
to new subvariants (e.g. our last bivalent is against BA4/BA5 but Omicron up to XBB1.5) & not clearly better due to adaptive power of cellular immunity (see thread on B cells) so any boost probably ok. Latter in line with @WHO endemic plan put out on March 30, 2022
Immunity works beautifully. Lancet ID 30 million people UK study shows who is still at risk after 2 doses of vaccine for severe disease (>80, immunocompromised, multiple 5 comorbidities) & needed boost. B cells adapt antibodies they make - B cell thread:
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
Jan 19
Excess deaths during COVID are very complicated & vary by region & duration/degree of lockdown; this was very true at Ward 86 (our HIV clinic at county hospital); sorry to hear this for the city of San Francisco; very much appreciate hard work of addiction teams at SFGH
Good article-excess mortality in COVID likely neglect other med care: "in countries like Belgium/Sweden [highly vax'd], ratio between excess deaths & COVID deaths 1..net change mortality [from] other diseases/injuries during pandemic period minimal" there
thelancet.com/article/S0140-…
In US (like article in SF), excess deaths in young people up from accidents, overdoses, suicides, homicides, and internal causes from neglect of medical care (no, not from the vaccines). Very disruptive time for other services & caused despair
bloomberg.com/opinion/articl…
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Jan 8
Yes immune system works
-Please see cellular immunity pinned tweet; so many papers! Will post more
-This is 7th human coronavirus; we know how coronaviruses work
-Retroviruses (HIV: start RNA & go to DNA) & coronaviruses (RNA virus) different
-Basic principles of immunology hold
Below simple tutorial I hope is how cellular immunity & immune memory work- there will always be variants that may evade antibodies but we are lucky immune system more than antibodies! T and B cells too for variants; Media, good science reporting please!
medscape.com/viewarticle/98…
Cellular immunity (high population immunity from the vaccine, natural infection or hybrid immunity) why hospitalizations not rising MA (& why hospitalizations so linked to vaccine rates with delta & BA1; now high immunity from natural/hybrid too)
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
Jan 7
EXTREMES: Alan Watts (“This is it”): “Furthermore, so far from being the smug rationalization of a Mr. Pangloss, the experience has a tendency to arise in situations of total extremity or despair, when the individual finds himself without any alternative but to surrender himself
entirely. Something of this kind came to me in a dream when I was about eight years old. I was sick at the time and almost delirious with fever, and in the dream I found myself attached face-downward and spread-eagled to an immense ball of steel which was spinning about the earth
I knew in this dream with complete certainty that I was doomed to be spun in this sickening and terrifying whirl forever and ever, and the conviction was so intense that there was nothing for it but to give up—for this was hell itself and nothing lay before me but a literal
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
Jan 6
NEW ANTIVIRAL FOR COVID: This one (related to remdesivir so a nucleoside analog- stops viral replication) is being compared to Paxlovid so will first remind you of Paxlovid data (which is a protease inhibitor- also stops viral replication). Both
should work against variants (as will molnupiravir) since they work upstream from production of the virus, variant or not. I have molnupiravir thread elsewhere which I will update since Lancet published PANORAMIC findings on it- this new one called VV116
nejm.org/doi/full/10.10…
Paxlovid (nirmatrelvir–ritonavir) recommended & under EUA in many countries but access worldwide more limited & does have drug-drug interactions with the ritonavir (although just short period 5 days). VV116 is a deuterated remdesivir hydrobromide with oral bioavailability
Read 6 tweets

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