Monica Gandhi is an infectious diseases specialist and professor of medicine at the University of California San Francisco. I heard her on a podcast about a month ago speaking about the COVID pandemic with more nuance and less hysteria than what you hear from most non-experts and political commentators. Many commentators flail around spouting numbers and terms that most people do not understand (including the speakers themselves) and irresponsibly interpret their misunderstandings to further one skewed political belief or another. I imagine some of Gandhi's thinking is controversial among fellow infectious disease experts, but that is as it should be. Discussion about uncertainties among experts about a contagious disease is what leads to better understanding and better evidence-based public policy decisions.
Her article is well-sourced for anyone wanting to learn more and to follow her reasoning.
My own interest in this is in keeping my sons, who have multiple disabilities, and other residents of their group home from contracting COVID. None of them need or deserve the consequences of sloppy thinking and excessive risk-taking that could lead to the preventable transmission of the virus. The so-called "Dignity of Risk" where many disability advocates see risk as a virtue, does not apply in this situation.
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Excerpts from "We need to start thinking differently about COVID outbreaks, says UCSF's Monica Gandhi" by Monica Gandhi, 11/11/21
Gandhi takes issue with the recent cancellation of the University of California/USC football game after 44 students and staff tested positive for COVID despite a 99% vaccination rate:
"...the cancellation of a highly anticipated game like this one due to COVID-19 has led to online speculation — fueled by scary headlines — about the dwindling efficacy of vaccination and a return to the conditions that led to last year’s deadly winter surge..."
High vaccination rates means that some restrictions can be lifted:
"But, in truth, clusters of mostly asymptomatic cases among the vaccinated, like what we’re seeing at Cal, are neither cause for concern, nor unexpected with a virus that will become endemic. They are an emerging part of our new normal. And we need to start recognizing — and more importantly — speaking about them as such."
..."Prior to the availability of the vaccines, we employed a variety of techniques to control the virus...But things have changed. In areas of high vaccination, mass asymptomatic testing no longer needs to done for those who are vaccinated, according to Centers for Disease Control and Prevention guidelines. Even testing for coronavirus exposure should be confined to individuals who were in close contact of a symptomatic person."
Vaccines reduce transmission:
"...A study of symptomatic delta variant breakthroughs from Singapore showed that the viral load by a value on the PCR test (cycle threshold, a test that should not be used to make clinical decisions) may start as high, but quickly comes down in the vaccinated (compared to the unvaccinated). This makes sense, since the immune response in the vaccinated can take a moment to kick in and fight the virus..."
"It’s essential to remember that we only need to take emergency medical or public health measures if there are clinical implications in play...if vaccines reduce the chance of being infected (vaccinated people are 13 times less likely to be infected than unvaccinated) an asymptomatic vaccinated person should not be tested without a direct exposure from someone who is ill."
Different metrics should be used in determining restrictions:
"[Using asymptomatic case counts] public health officials in the Bay Area (except for Marin County) appear to be using this metric to determine the necessity of restrictions such as masks, instead of a more appropriate index like COVID hospitalizations...Young people have been restricted during the pandemic in the United States...to protect others. We owe it to them to return their lives to normal, especially when that was the promise of public health officials in the context of vaccine mandates at many colleges and universities. Football (an outside activity) was shown to be safe and lead to no transmissions in a study from last year, prior to vaccinations and in areas of high community transmission. It is too late for this Cal-USC football game, but we need to think of outbreaks differently from now on in the context of the vaccines and live our lives accordingly."
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See the original article for complete references.
