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Dr. Nahid Bhadelia Profile picture
Dr. Nahid Bhadelia
@BhadeliaMD
Infectious diseases doc, Director @BUCEID. Former Sr Advisor, @WhiteHouse. Emerging infections, policy, preparedness, health security. FIDSA. Personal account.
Apr 26, 2024 • 6 tweets • 2 min read
Lot of #H5N1 news this week: 🧵
-phylogenetic analysis suggests virus may have made single jump from bird to cows in Dec, & circulating in cows since
-virus is jumping back from cows in birds (no good, implies further opportunity for adaptation) 1/n -H5N1 + reported in asymptomatic cows
-studies in milk show 1 in 5 (FDA data) to 40% of samples had H5N1 remnants on PCR, suggesting a much more widespread outbreak
-NIAID supported study showed no live virus in pasteurized milk, FDA results on larger national sample pending 2/n
Apr 19, 2022 • 6 tweets • 5 min read
Dr @matthewjhepburn, Senior Advisor on Pandemic Preparedness, @WHOSTP, opens the Summit highlighting the importance of early detection both domestically and globally. Dr @AlondraNelson46 reflects how @CDCgov Center for Forecasting and Outbreak Analytics should be a national asset with equity at its core, providing data from and to all our communities. And how important it is to link action to early warning.
Jan 26, 2022 • 4 tweets • 1 min read
Still opportunities to use infrastructure set up to give Regeneron/Lilly monoclonals (current versions don't work w omicron because of mutations). Administer:
1) Sotrovimab (this monoclonal still works w omicron)
2) Remdesivir (given w/in 7 days, ⬇️ hosp 87%)

Give what works. Remdesivir is given as 3 day course, which means patients have to come back but dedicated infusion centers can provide good infrastructure. The data is very striking for early administration. nejm.org/doi/full/10.10…
Jan 5, 2022 • 4 tweets • 1 min read
To figure out if we have reached endemicity with a disease, we have to answer the question: Can our society function if current moment became status quo?

The surge of cases leading to worker shortages & still overwhelmed hospitals tells us for COVID, the answer currently is NO. I think we need to think of the next few weeks of surge as phase onto itself that we have to manage and minimize damage from.

After the surge, we can ask that same question again and figure out the best metrics to follow in that new reality.
Oct 18, 2021 • 5 tweets • 1 min read
I have news for people who are looking at the unfortunate loss of Colin Powell as a sign that covid-19 vaccines are not working: Almost no vaccines prevent ALL infections & deaths. Older & immunocompromised pts always depend on the rest of us to create population level immunity. If you think it’s awful that lack of higher level population level to immunity to this virus is causing the vulnerable among us to suffer, wait till you see when the high anti-vax sentiment in some parts of this country makes us lose the same protection from other … contd
Apr 18, 2021 • 22 tweets • 4 min read
What infectious diseases/epidemiology/global health topics in general or COVID-19 issues would you like more information on or are confused about?

What can scientists and public health folks do a better job of explaining? A) honored you are sharing your questions & concerns here
B) because of the sheer number will try to group together in themes & respond to common ones
C) we are hoping to work on some web/social media resources down the road which maybe helpful
Jan 25, 2021 • 4 tweets • 1 min read
Here's the bottom line on general terms: A small group of COVID-19 survivors who were initially outpatient seemed to develop antibodies against targets in their own bodies after their initial infection which seemed to last in some cases up to 7 months out. We don't know what these findings mean but they support what people have found in those with acute illness which implies that part of how this virus works is turn tour own immune system against itself
Jan 25, 2021 • 12 tweets • 3 min read
Excited to present early data from our #COVID19 survivor work. Small sample size, preprint, caveats outlined.

We detected autoimmune antibodies in patients who survived SARS-CoV-2 infection (up to 7M out) at statistically higher rates than in unexposed 🧵medrxiv.org/content/10.110… So far, pathophysiology of acute COVID-19 appears to be combo direct viral invasion, coagulopathy & an overactive hyperinflammatory immune response. New data is hinting autoimmunity may be a critical component of the maladaptive immune reaction. nature.com/articles/d4158…
Dec 15, 2020 • 8 tweets • 2 min read
Ok so quick thoughts: overall safety profile & efficacy is pretty similar to Pfizer. Some data on the 13 pregnancies within the trial shared leading to FDA assessment that the mRNA vaccine did not seem to have an effect on mother or baby. Image As others have said, Moderna shared their assessment of asymptomatic infections. They tested people who were coming in for second dose of vaccine/placebo and found that those who got vaccine had 2/3rds fewer positive tests compared to placebo. Image
Dec 10, 2020 • 5 tweets • 2 min read
In historic vote, Vaccine & Related Bio Products Advisory Committee recommends @FDA grant EUA to @pfizer's mRNA vaccine.
It was a vote for emergency use authorization due to public health emergency where benefits were demonstrated to be higher than risks. Not full approval yet. Hence, the CDC, FDA (& others) will continue extensive long-term monitoring for safety once the vaccine released in a larger population and have studies planned to look at real-life effectiveness of the vaccine
Dec 10, 2020 • 4 tweets • 1 min read
An important conversation on the committee right now-FDA is not requiring immediate unblinding on placebo participants but those who got placebo can decide to leave trial and get an EUA issued vaccines. This may make it harder to collect long term efficacy data. contd... Second, once you have an EUA approved vaccine, will people want to take part in other trials for other vaccine candidates? FDA rep just said the supply of EUA vaccines are low enough other trials may continue. But I am not sure...
Dec 10, 2020 • 21 tweets • 6 min read
Take a listen live to the FDA's independent committee (VRBPAC) meeting re Pfizer vaccine. In case you haven't seen it- here is the FDA brief with the details on all the Pfizer vaccine studies to date along with study methodology and results. fda.gov/media/144245/d…
Dec 8, 2020 • 5 tweets • 2 min read
Couple of interesting things about this Astra Zeneca vaccine data just released. First, they did a substudy in UK where they asked participants to do at home NP swabs to detect incidence of asymptomatic (or unreported) infections.
thelancet.com/journals/lance… This is important to know about all vaccines coz we are entering a phase of pandemic where some people will be vaccinated and majority will not and we need to ensure that vaccinated people don't let their guard done, end up getting asymptomatic infection & passing it on contd..
Nov 3, 2020 • 8 tweets • 2 min read
This is for the 5 remaining undecided people in the country who have not voted yet.

After Woodward tapes, a ton of people said, “The President knew and lied to the American people.” That’s not the whole truth. Many people including government scientists knew how bad this was. What the President has done over the last 8 months is not just mislead the American people but also silence government scientists, while trying to discredit those public health experts outside his purview if what they said didn’t fit his narrative of denial.
Oct 26, 2020 • 5 tweets • 2 min read
Utah gets ready to invoke crisis standard of care, triaging limited medical resources among growing number of patients.

As someone who has had to do this at patient bedsides in resource limited settings during an epidemic, it’s heartbreaking and horrendous. And like this article says with what’s going on in Utah- as health workers, it is the most heart breaking & traumatic thing in the world when the resource that’s been triaged is us: our attention, our time, because we keep pushing, keep spreading ourselves thinner.
Oct 25, 2020 • 8 tweets • 2 min read
This is not a normal person. These claims are an insult to the almost quarter of a million people who have died of this disease. This should not be the person leading us through a worldwide tragedy. In people with comorbidities, covid like any major insult to the system serves to worsen the outcome. The virus is still absolutely the reason that person died. The comorbidities were their vulnerabilities that the virus took advantage of.
Oct 24, 2020 • 4 tweets • 2 min read
“This President wants to take full credit for an economy he inherited and zero blame for a pandemic he ignored.” @POTUS44 @BarackObama in Florida. “8 months into this pandemic, cases are hitting record highs. Donald Trump isn’t suddenly going to protect all of us. He can’t even take the basic steps to protect himself...he doesn’t even acknowledge there is a problem.”
Oct 7, 2020 • 6 tweets • 1 min read
So many issues with this new video from the President. I don't know where to start. Let me start by saying, I think monoclonal antibodies hold promise & I am waiting to see the clinical trial data to back that up. But to declare a drug used under compassionate use as a miracle cure harms the development of data around its efficacy and politicizes yet another medical therapeutic/vaccine in this pandemic.
Sep 21, 2020 • 6 tweets • 1 min read
No we dont get an A grade on this. US failures so far w COVID19 response. Please feel free to add:
1) Delayed roll out of testing capacity
2) Held on to overly stringent case definition that delayed recognition of community transmission
3) Didn't federalize supply distribution e 4) Left too much of response architecture & reopening to states, who took widely different approaches
5) Didn't invoke DPA earlier or enough times to cover all needed supplies
6) Relied too much on tracking sympt cases even after role of asx was clear(not enough contact tracing)
Aug 17, 2020 • 5 tweets • 2 min read
I see a lot of question re flu shot timing in my timeline. Since I'm on clinical service, doing one single main tweet on it here: Generally CDC recommend Sept-Oct for flu shot because you need time to build the immunity after vaccine (~2 weeks). 1/3

cdc.gov/flu/prevent/ke… Here is what CDC recommends:
cdc.gov/flu/season/faq…
Jun 16, 2020 • 16 tweets • 4 min read
My thoughts on RECOVERY trial results (not data). First, here is the methodology & results.
-Large (11k) trial testing multiple treatment arms
-2104 randomised to dexamethasone 6mg/d for ten days and compared with 4321 patients randomised to usual care alone. Dexamethasone reduced deaths by 1/3 in ventilated patients (p=0.0003), 1/5 in other patients receiving oxygen only (p=0.0021), no benefit in patients who did not require oxygen (p=0.14).
It reduced the 28d mortality by 17% (P=0.0007) w greatest benefit in pts requiring vents.