Coronavirus Insights: Interview with Dr. Monica Gandhi – February 24, 2021

Regulation | February 24, 2021 | by Jill Schumann

Dr. Monica Gandhi, Professor of Medicine and Associate Chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco (UCSF), joined LeadingAge for the Coronavirus Update Call on February 24, 2021.

Dr. Monica Gandhi, Professor of Medicine and Associate Chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco (UCSF), joined LeadingAge for the Coronavirus Update Call on February 24, 2021. She responded to questions from Ruth Katz and from callers.

Q: Now that more nursing home residents and staff are getting vaccinated, what will we need to do to make sure visits are safe when visitation guidance is changed?

A: I hope they do change the guidance soon as a vaccinated person is extremely protected (nearly 100%) from developing severe illness if they should contract COVID-19. The difference in efficacy of the vaccines is related to symptoms of mild illness. I think with high vaccination rates we should open nursing homes full-on, hugs and all.

Q: Just to play devil’s advocate – what about unvaccinated visitors coming in and out?

A: Just to be clear, I am talking about two fully vaccinated people. If everyone in the facility is vaccinated and they have an unvaccinated visitor, the visitor should likely wear a mask. This is because the clinical trials were not designed to tell us if a vaccinated person could harbor virus in their noses and transmit the virus to others. A real-world study in the U.K. of vaccinated healthcare workers indicates that a fully vaccinated person does not pass the virus on. I believe the guidance will change soon.

Q: Since in most nursing homes, staff are not 100% vaccinated -perhaps 50-60% vaccinated -what does that mean for precautions inside the nursing home?

A: Unvaccinated staff will need to mask and distance in this interim period. Any unvaccinated person must still “live as if it is 2020” and maintain all precautions. However, as more people are vaccinated and we reach herd immunity, precautions can be lifted.

Q: Please elaborate, as a significant number of staff members are vaccine hesitant.

A: When we say “herd immunity”, 100% of the “herd” does not need to be vaccinated. When enough people in the herd are vaccinated it is less of a problem for those who are not vaccinated as the community incidence will drop. Looking at Israel and the U.K. who are leading the world in percentage of people vaccinated, rates are dropping in part because the virus can’t find enough unvaccinated hosts and thus does not circulate. We are heading to hugging and we will be there soon. The U.K. will be there by this summer, but it will take longer in our country because our vaccination process is slower and there is less uptake.

Q: Are they vaccinating children in the U.K.?

A: No, but it really doesn’t matter because once herd immunity is in force, we don’t need to worry so much about unvaccinated children.

Q: What about variants, what will be the effect of those?

A: Variants are getting overblown attention in the media. The Johnson and Johnson vaccine efficacy varied across mild disease but not serious illness for both the South Africa and Brazil variants. T- cell immunity works against multiple parts of the spike protein so it will protect against severe disease with the variants.

Q: What can you tell us about how long the vaccinations will provide protection?

A: Extrapolating from natural immunity, it looks like immunity will last at least ten years in the T-cell response and maybe longer. People who contracted and recovered from the 1918 flu still had antibodies 90 years later. I do not believe we will need annual vaccines. A coronavirus is different from an influenza virus.

Q: If someone has gotten a vaccine and comes into contact with someone who is positive, what is the chance that the vaccinated person will contract the virus and test positive?

A: That chance is quite small – the immune response will mitigate contracting the virus.

Q: People who, early in the pandemic thought they may have had COVID, but weren’t tested, are coming back with negative antibody tests. Does this mean they didn’t have COVID?

A: If you had a mild infection you may not have developed antibodies. Antibody tests are not a particularly accurate measure. It would be better to look at T-cell responses, but that testing is very expensive, so it isn’t practical.