Important results: Remember the 2 MO hairstylists who saw 140 clients over 8 days while infected with COVID but everyone had worn masks? Contact tracers found ZERO secondary infections. More evidence that masks work. cnn.com/2020/06/11/us/…
By contrast, in Israel, two weeks after reopening schools, at least one infected student at a Jerusalem high school led to 130 cases among students and teachers. Dozens of schools had to be closed again as the outbreak spread. npr.org/sections/coron…
The likely difference: There was wide evidence students were not taking the virus seriously and were ignoring mask guidelines. jpost.com/israel-news/an…
New data further bolster the evidence for mask use. This study of outbreaks in China, Italy, and NYC found that social distancing slowed spread but did not stop it until masks were introduced, because of distant airborne viral transmission. pnas.org/content/early/…
And this analysis of studies with >10K total patients found that surgical masks and extra thick (12-16 layer) cotton masks not only prevent transmission, they also protect the wearer more than recognized before, reducing likelihood of infection >80%. thelancet.com/journals/lance…
States across the south and west (eg CA, AZ, TX, FL, SC, NC) hit record high new cases and rising hospitalizations. Deaths will soon follow. If more wear masks and get tested for symptoms or concern of exposure, we can stop this and avoid re-lockdown. usnews.com/news/health-ne…
We really do know how to stop this. So let’s do it. #MoreMasks #MoreTesting #MoreTracing newyorker.com/science/medica…

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More from @Atul_Gawande

Dec 8, 2021
As we continue on our grim march to 800K COVID deaths by Xmas, we seem to be deciding to live with 1000+ extra avoidable deaths a day. That puts us on path to exceed 1M deaths in early 2022. Image
The prevailing view seems to be that we must accept that our chances of living past 80 have gone down—even indefinitely, and despite the economic damage—so younger, healthy people can live without having to vaccinate or to test regularly.
This mindset predates COVID. As this @NIHDirector interview notes, we’ve had many breakthroughs for health, but failure to implement has left a decade of sinking life expectancy. Yet as we lose years to opioids & COVID, anger targets efforts to fix this. npr.org/sections/healt…
Read 5 tweets
Apr 23, 2021
This outbreak is vital to understand. It shows what we still face if younger folks go unvaccinated.

47% of health care workers refused vax, while only 10% of residents did.

Result: 1 unvax'd HCW with COVID led to 20 HCWs & 26 residents infected, of whom 3 died (1 vaccinated).
Let's unpack the details.

Q: Did the vax (2 doses of Pfizer) work? Absolutely. It was remarkable - but not perfect.

-Of 8 unvax residents, 6 got COVID (75% attack rate), 2 died (33% death rate).
-Of 71 vax residents, 18 got COVID (25%), 1 died (6%).
cdc.gov/mmwr/volumes/7…
Vaccine effectiveness against symptomatic infection was 87%. Protection against death was 94%.

Clearly, in nursing homes, protection against death is not 100%. Why? Residents are more frail. The virus was also a new variant (R1) which might have had slightly reduced vax effect.
Read 4 tweets
Apr 20, 2021
US COVID-19 deaths remain upwards of 700 deaths a day. Who are these people who are dying?

🧵
COVID deaths in nursing homes are down massively.

- In Dec 2020, these accounted for 32% of all COVID deaths.
- In Mar 2021, thanks to vaccination, they accounted for just 4%.

So who are the remaining 96%?

data.cms.gov/stories/s/COVI…
Here's the change in distribution of COVID deaths by age.

- In Dec, 63% of all deaths were in ages 75+.
- In Mar, most deaths were UNDER age 75,

The flattening of COVID deaths according to age is extraordinary.
cdc.gov/nchs/nvss/vsrr…
Read 6 tweets
Apr 14, 2021
Update from listening to the CDC ACIP meeting on the J&J vaccine:

They postponed making any decision, effectively continuing the pause on use of the vaccine.

They will reconvene in 7-10 days to review case reports from the ~4M who received the vax in last two weeks.
Why wait for more info? A new case of cerebral sinus venus thrombosis was reported in a 25 year old man who became critically ill from a cerebral hemorrhage.

And for women age 20-50, CSVT occurred in 1 in 13,000, or 4-15X higher than background.
My guess is that additional data and a full risk analysis will support a recommendation that women <50 get mRNA vaccines unless no other choice, but for people >50, J&J is fine.

What the story in young males will be remains to be seen.
Read 4 tweets
Mar 31, 2021
As cases and hospitalizations rise again, we can't count on behavior alone reversing this course.

Therefore, it's time for the Biden admin to delay 2nd vax doses to 12 weeks. Getting as many people as possible a vax dose is now urgent.
I was on the fence on this. I'm not anymore. Here's why.

1. More contagious strains are now >1/3 of all US cases. And new evidence confirms B117 causes more severe disease, with MUCH higher rates of severe illness and death at younger ages. directorsblog.nih.gov/author/collins…
2. Rising cases require more commitment to masks, testing, indoor limits. But the recurring pattern here and abroad is many people and local leaders won't tighten these until too late.

And 11% of us attended large events in last 24h, almost 2x early Jan. delphi.cmu.edu/covidcast/surv…
Read 7 tweets
Mar 30, 2021
This is our warning call, America.

Cases are now climbing again in a majority of states--esp across the northeast and midwest.

@CDCDirector Walensky is right to be sounding the alarm. This is how surges start.
We are a few weeks behind the pattern of the surges now happening in Europe, Asia, and South America.
In the last week, US hospitalizations have started to climb, as well. And cases are up despite a marked drop in testing. washingtonpost.com/graphics/2020/…
Read 6 tweets

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