Brandon Smith

[Brandon Smith @DrBrandonMSmith]

Today I cared for a 17 y.o. girl coming from PICU w/COVID pneumonia

Very high risk, also congenial ❤️ dz

Parents worried myocarditis would worsen ❤️ -> not vax

Parents unaware of
-gender differences
-spacing doses
-how bad COVID could be for her

We have to do better than this

[Brandon Smith @DrBrandonMSmith]

@dpreview https://t.co/fAVy6QqlfM

[Brandon Smith @DrBrandonMSmith]

Ask Amazon not to close DPReview​, or at least to maintain access to all the old databases, reviews, etc.

https://t.co/beO3YgbNJQ via @Change

[Brandon Smith @DrBrandonMSmith]

Ask Amazon not to close DPReview​, or at least to maintain access to all the old databases, reviews, etc.

https://t.co/beO3YgbNJQ via @Change

[Brandon Smith @DrBrandonMSmith]

@petapixel Hopefully someone is also figuring out how to save the data and search tools for the “Camera feature search” and “Lens feature search”

[Brandon Smith @DrBrandonMSmith]

@Saikmedi Those graphs were before we could know the answer, but this graph👇 supports your point since we’re far enough out to have complete post-BA.1 data

Key thing to recognize is that early 2022 MIS-C peak’s height/location is c/w being due to the Delta upturn just prior to Omicron

[Brandon Smith @DrBrandonMSmith]

@ebennett74 @sdbaral As a residency director, this was my focus each year during the 1st hour of new resident orientation

Most complaints I heard from nurses about residents involved them being “cocky” or “overconfident,” but in most cases, it was fake overconfidence trying to cover up insecurity

[Brandon Smith @DrBrandonMSmith]

@daniela127 Unless this was recently fixed, in December, Pennsylvania started requiring a physician or nurse practitioner to certify that a kid with COVID is no longer contagious before returning to an early childhood program.

https://t.co/R7rAnkSocS

[Brandon Smith @DrBrandonMSmith]

@Infecti13786677 @JuliaRaifman What’s the Scandinavia approach to prior infection with regard to passports? Does that count in some way?

[Brandon Smith @DrBrandonMSmith]

@freyas_house @Data_logical0 @MarcusBeam1 For whatever it’s worth, there is solid Delta data on teenager vaccination reducing MIS-C

For Omicron, CDC data recently updated👇but still very incomplete (gray area)

UK and Norway pre-prints do show lower MIS-C from Omicron:

https://t.co/D97VfAhYcH

https://t.co/5GFNwoYwjC

[Brandon Smith @DrBrandonMSmith]

@BenK78457034 @FSBuchholzer That’s certainly plausible, but I’m curious why you feel confident about it.

More importantly, if that’s true, do you expect it to continue with future variants, or are we at decent risk that a future variant will emerge for which somewhat frequent MIS-C triggering is restored?

[Brandon Smith @DrBrandonMSmith]

How frequent is MIS-C post-Omicron?

Anecdotally, rates are low relative to COVID rates, but data is sparse because of 2 types of lag: COVID->MIS-C & clinical diagnosis reporting

3 CDC 📉’s👇(🔵line) illustrate challenge during Delta, w/MIS-C peak & trough both ⬆️ w/updated data

[Brandon Smith @DrBrandonMSmith]

@WendyHassonMD Norway reporting something similar:
https://t.co/5GFNwoYwjC

[Brandon Smith @DrBrandonMSmith]

@FSBuchholzer Here’s Norway data in unvax kids showing half as many MIS-C (7 Omicron vs 14 Delta) despite 2x as many infections -> ~75% decreased risk per infection. Doesn’t address if could be due to immunity from prior infection vs inherent differences by variant.
https://t.co/5GFNwoYwjC

[Brandon Smith @DrBrandonMSmith]

@IanRicksecker New study👇 suggests that Omicron generation time was not shorter than with prior variants, which would be consistent with the higher Ro as you had stated in your thread.

https://t.co/Ycw4fX113E

[Eric Topol @EricTopol]

A comprehensive contact tracing study of >23,000 people with Covid and their ~9,000 households demonstrates that Omicron has a similar generation time and period of viral shedding as the Delta and Alpha variants https://t.co/RnSspP1FfN

[Brandon Smith @DrBrandonMSmith]

@JesseRapp15 Yes, but with a smaller absolute difference than in the older age groups, and only really visible at the peak of the Omicron wave.

https://t.co/W9IhNIeAGY

[Brandon Smith @DrBrandonMSmith]

@jenkinshelen I’ve had that same experience

Having advised small organizations serving very different purposes and people — K-8 school, preschool/daycare, community center, camp, house of worship, religious school — I’d add that different organizations will have different goals, values, etc.

[Brandon Smith @DrBrandonMSmith]

@EricTopol Relevant data from southern Connecticut 👇

[Brandon Smith @DrBrandonMSmith]

@NathanGrubaugh @CovidCT @CTDPH @CDC_AMD @YaleSPH @YaleMed Is there a way to partially crowd-fund this? Maybe a more detailed explanation each week on a subscription Substack?

Your updates are the best thing I’ve found so far for understanding variants in the US, and I bet that I’m not alone in thinking that.

[Brandon Smith @DrBrandonMSmith]

@ebennett74 That asthma has not been prominent in terms of pediatric COVID admits has been really interesting. When planning in March 2020, we anticipated having many contagious kids on continuous albuterol nebs w/a limited supply of negative pressure rooms, but that never really happened.

[Brandon Smith @DrBrandonMSmith]

@JuliaRaifman The problem is only having two options. I’ve seen kids hospitalized for COVID and ones w/truly incidental positive PCRs, including some who likely had asymptomatic infection weeks earlier.

You’re describing a 3rd group, where COVID contributes to/complicates the hospitalization.

[Brandon Smith @DrBrandonMSmith]

@greg_travis Can you explain that number? Maybe I’m mistaken, but I thought WONDER & NCHS had been in the 800s. I know that the data tracker figure was revised downwards, but was the figure from WONDER also revised downwards? Or is this a matter of underlying cause vs contributing condition?

[Brandon Smith @DrBrandonMSmith]

@Michigan_Noah @DrJBhattacharya This is a complex paper that I don’t fully understand, but they did adjust for prior infection👇

My take home points:
- O causes fewer severe outcomes in adults than D
- Vaccines protect against severe outcomes from either variant, but make a bigger difference for D than for O

[Meaghan Kall has moved to Bluesky @kallmemeg]

Clear evidence that Omicron is intrinsically less severe than Delta, as the analysis accounted for immunity from vaccines & prior infection.