1/9 Covid Epi Weekly: One Step Forward, One Step Back

Decreasing cases in much of country. But decreasing testing, less information, and impending explosions with schools, universities, and more.

Primary concern : “A single death is a tragedy, a million deaths is a statistic.”
2/9 Positivity rate decreased from 5.5 to 5.1% nationally. That’s good - it’s progress. But we’re losing the ability to track the virus - antigen tests, less testing, and still no reliable information on who is being tested. We should have better information each week, but don’t.
3/9 Most of U.S. still failing. Too many cases to test, trace, isolate. Even in places with fewer cases, very little tracking of actual outcomes:
*Days infectious before isolation
*% cases from quarantined contacts.
Tens of thousands of lives and millions of jobs depend on this.
4/9 STILL don’t have reliable information on cases, hospitalizations, deaths by race/ethnicity. Outrageous. Proportion among Latinx & Black people unacceptably high, indefensibly invisible. Every place should report these numbers weekly for prior week and work to end disparities.
5/9 Avoidable cases and deaths are heartbreaking. Avoidable economic decline is grinding. Carville said, “It’s the economy, stupid!” To get the economy back, “It’s the pandemic, stupid”. Unless we control the virus, we can’t get our jobs back. Striking data confirms this:
6/9 Deaths matter most. US will hit 200,000 deaths and world 1 million reported deaths in next few weeks. Germany has had less than one fifth US death rate, Canada less than half. Tens of thousands didn’t need to die from Covid. We don’t want to be #1 in death, but see below.
7/9 On 9/11, I reflect on deaths. My group is called Resolve to Save Lives with reason. We risk getting hardened to tragedy. Superb article on this and more at bit.ly/2ZvJc9C. More than 1,000 deaths/day recently. Even at “only” 500 deaths/day, this would mean:
8/9 Communication matters. 1. Be first. 2. Be right. 3. Be credible. 4. Be empathetic. 5. Give people practical things to do to protect themselves & their family. Is it possible for US national response to have violated these proven principles more than it did?? We can do better.
9/9 We must chip away. Close riskiest places. Mask up. 3W's. Box it in (test, trace, isolate). Ventilation. Every little bit helps, as long as there are enough little bits to get R<1 and keep it there. Vaccination can help if it's safe, effective, accessible, and trusted. IF.

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More from @DrTomFrieden

5 Sep
Dr. Atlas' confidence in his own judgment is exceeded only by his ignorance and sophistry. Here -thanks @EricTopol for Senate testimony (under oath) - direct quotations. Yes, he never says "I advocate for herd immunity" but that is EXACTLY what he proposes. See exact words (next)
Atlas: "infected people are the immediately available vehicle for establishing widespread immunity. By transmitting the virus to others in lower‐risk groups who then generate antibodies, pathways toward the most vulnerable people are blocked, ultimately eradicating the threat."
Atlas: "If infection is still prevalent, socializing among these low‐risk groups represents the opportunity for developing widespread immunity and eradicating the threat." COVID isn't a candidate for eradication, basic error, but not nearly as deadly as concept of herd immunity.
Read 4 tweets
5 Sep
1/9 Covid Epi Weekly: Stalling and Failing

Continued spread of Covid in the US will continue to undermine health, jobs, economy, and education. A concerted, strategic approach would help, a lot. Fundamental error: Failure to recognize we’re all connected, all in this together.
2/9 CovidView positivity inched up from 5.4 to 5.5%, driven by increase among 18-49-year-olds. Low levels in northeast, some others, but still not finding most sources, not quarantining most contacts, so risk remains. High or increasing rates in most of US, too high for recovery.
3/9 Two data sources of note. County-specific test positivity, which should be open source but at least is available here (image below, wish they had zip code lookup). bit.ly/2F3wBmX And we’re delighted to work on the Covid Symptom Data Challenge. bit.ly/3201H83
Read 9 tweets
29 Aug
1/9 COVID This Week: Decreasing Cases, Increasing Danger

Covid is decreasing from very high to high levels in much of US. Schools resuming; outbreaks inevitable.

Human immunity against the virus appears possible; FDA and CDC immunity from political interference, much less so.
2/9 First, the trends. Northeast remains relatively low, now joined by MI, WV, NM, MT, WY, AK. Number of tests decreased in some states, including Florida. Good national positivity decrease: 6.2 to 5.7%. Antigen testing will make this number harder to track; need 100% reporting.
3/9 More than 500,000 hospitalizations, 6 million diagnosed cases, 180,000 reported deaths, plus at least another 50,000 excess deaths above baseline from undiagnosed Covid and Covid-disrupted care. The US Covid death rate last week was more than 3x rate in S Korea since January.
Read 9 tweets
26 Aug
OK, I've gotten feedback that these tweets are confusing. To clarify: Recently CDC quietly changed its website. First, they no longer recommend quarantine for travelers from high-prevalence areas. Second, they no longer recommend testing for asymptomatic people, even contacts.
Both changes are highly problematic. If explained openly in a press conference, perhaps defensible, tho hard to see how.

Re quarantine, it's not enough to mask, distance, and wash hands. And you can go outside if not near others, but not to crowded spaces. Masks aren't perfect.
Re testing. It's very important to test contacts of cases - in outbreaks and families and elsewhere, so we can find other infected people and trace their contacts and stop webs of transmission. The plain truth is, we don't have enough tests, so we must admit that and prioritize.
Read 6 tweets
21 Aug
1/16 COVID Epi This Week: The Peril and Promise of Immunity

Covid continues to spread in most of the US at rates too high for effective contact tracing, safe in-person schooling, or economic recovery. Important hints published this week about immunity. cnn.it/2QglARk
2/16 Getting harder to track the virus. Test volumes all over the map are … all over the map. Big increases (Alabama, Arkansas, NY, SC, TX), big decreases (Alaska, FL, LA, MS, WI), some stable (e.g. CA). Haven’t seen any good data on reasons for testing decreases.
3/16 Test positivity, the most important single indicator, falling in many states. But it is measured differently in different places. Patients vs. tests. Exclude outbreaks? Exclude screening? Exclude repeats on the same person? In any case, overall percent: from 6.9% to 6.3%.
Read 16 tweets
14 Aug
COVID This Week

The looming question: Internal travel restrictions

1/22 This week: continued spread of Covid at a high rate in most of the US, continued shortages and delays in testing, and continued confusion about what the data show and what we need to do to control Covid.
2/22 First, how much Covid is there? I track percent positivity as the least bad indicator. Reported cases are the tip of the iceberg: these cases reflect both how much spread there is and how much testing and reporting there is.
3/22 Although test positivity decreased slightly, from 7.7 to 7.0, it remains high in much of the country and very high in the South. But there’s a problem. Antigen tests becoming widespread and if not reported, we will lose ability to know of all positive and negative tests. Image
Read 22 tweets

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