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Ashish K. Jha, MD, MPH

@ashishkjha

Feb 18

Nationally as infections return to pre-Omicron surge levels,

Two states I've tracked closely are California & Florida

They're both large with diverse populations, similar seasonality, different COVID approaches

So what can we learn from comparing them?

A few things

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First, let's compare how they did on infections during Omicron surge

Strikingly similar (see graph)

Florida peaked earlier, California a bit later

Cumulatively, they had nearly identical infection rates

About 9.50% of Floridians got infected while 9.54% of Californians did

So at first blush, looks like their different COVID strategies did not end up mattering much

But, when we look at deaths,

A different, surprising pattern emerges

Cumulatively, Florida had 33% more deaths per capita than California during Omi surge

That's a lot

Why?

3/5

Read 6 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

Feb 16

As the Omicron surge of infections abates,

Its worth reflecting on few lessons we learned

Today, lets' discuss whether Omicron was indeed "milder"

Short answer? Yes it was

But it still caused a devastating loss of life

And that's a lesson for managing future waves

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First, let's talk about how we might assess whether Omicron was "milder" than Delta

One way is to look at case fatality rate

Remember CFR is proportion of identified cases that end up dying

Throughout the pandemic, the CFR of of COVID in the US has been between 1.5% to 2.0%

CFR is usually 1.5% but rises to 2.0% during surges as hospitals fill

Meaning that as hospitals fill up, admission thresholds rises...and ability to care for sick people diminishes

Its bad to be sick during a COVID surge

So what happened to CFR over the past 2 months?

Read 10 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

Feb 10

Let's discuss a path forward for masks in schools

I've been a strong proponent of masking in schools

So as we enter a new phase

Do we need to keep masking for the foreseeable future

I don't think so

Should we ban masks in schools today?

No

Let's find a middle path

Thread

First, let's talk evidence

Do masks work to reduce transmission?

Absolutely

What about in kids?

The evidence is less strong but clearly, the weight of evidence says that masking also works in kids

Are there harms?

Not much evidence either way but there could be

2/n

So given the (imperfect) evidence

Masking in schools was important while two things were true:

There were no vaccines for kids

Large surge of infections in the community

Now, as we enter a new phase

Every school-age kid can be vaccinated

And infections are getting low

3/n

Read 10 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

Feb 6

Quick update on the state of the pandemic in the US

Nationally,

Infections are down 60%

Hospitalizations down about 30%

Deaths have largely plateaued at a very high 2500+ per day

Beneath the headlines, we see dropping infections in every part of the country

Here are the four largest states

Geographically, politically diverse with very different strategies and mitigation policies

Infections are down 50-80% across these states

And hospitalizations have turned the corner in each of these states

Deaths are starting to follow

@CovidActNow

In fact, based on analysis from @CovidActNow

Infections are falling in 47 states. And quickly

And in 3 states, they have plateaued

That's good

So what happens next?

Several things

Read 8 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

Feb 1

I've been saying for weeks that as cases recede

We can soon relax public health restrictions

I think of this like the weather

When it is bucketing rain

Umbrella, rain coat, boots, are all essential

When the storm turns into a drizzle, those become less critical

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A big spike (like Omicron surge) is like a major storm

If you don't want to get wet, you need to stay home

But if you venture out

Bring a big umbrella (vaccines)
Wear a raincoat (good masks)
And rainboots (avoid crowded indoor spaces)

You get the idea

2/n

Right now, the storm is starting to ebb

Infections are falling, hospitalizations down

But with infections still high

Indoor mask mandates make sense. As do indoor capacity limits

Many states still have them (though bars are open in every city in America, as far as I know)

3/

Read 9 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

Jan 30

You all know the data demonstrating dramatically higher hospitalization rates for unvaccinated folks

But one key point often not discussed?

Around 60%-70% of unvaccinated adults have already been previously infected

Which tells us a lot about infection-induced immunity

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We see large gaps in hospitalizations between vaccinated and unvaccinated

But unvaccinated are not immunologically naïve

At this point, probably 2/3 have been previously infected

And yet, we still see 50X differences in hospitalizations between vaccinated and unvaccinated

2/7

One possibility is that hospitalizations are happening in the dwindling group of unvaccinated who haven't been previously infected

Means true benefit of the vaccines is even higher (by a lot)

But much more likely, it means infection-induced immunity is not holding up

3/8

Read 10 tweets

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