Thread/ Colleges, testing, & why we need caution.

I am FAR LESS worried about the students. I worry about this -

"One major risk is that infections could spread to at-risk faculty and staff and those in the surrounding community."

The national figures that we have come to rely on are more reliable but subject to MUCH more challenging interpretation than at any time.

A LARGE percent (20% of Illinois in this article) of current tests are from colleges doing MASSIVE testing, in some cases. 2/8
This is reducing the positive rate, giving us a less reliable indicator. We know from hospitalization and death data a lot about infections that happened in early to mid August, and that news is good. But what is happening NOW? I don't think we know enough. 3/8
Case counts continue to drift lower. But we have recent experience where average age of cases drifted lower when bars reopened & severe cases showed up much later. Florida, for instance, hit a low for positive rate in late May - 2 weeks later cases started to take off. 4/8
We KNOW we have more college testing. We also know testing, overall, is trending lower = non-college-related testing is dropping sharply.

Over the last 2 weeks many hot-spots have either already re-opened bars or have announced plans to do so. 5/8

College testing skews data.

In NYS, Tompkins county(Ithaca/Cornell) is responsible for 0.5% of the population but 4% of the total testing. 0.2% positive rate.

OTOH - Oswego (SUNY) -0.5% of pop is responsible for 0.5% of total testing with 5% positive rate. 6/8
For those who think we are reopening too slow, look to Sweden: they are not relaxing measures until October. Their Universities remain in hybrid format. Or look to Israel, where they are on the cusp of a full lockdown after throwing caution to the wind. 7/8
We can't predict the future. But we know only fools repeat errors of the past over & over without giving consideration to the best evidence available. The next 2 weeks will fill in a lot of details. Be patient. Be vigilant. Be careful. #MaskUp #SocialDistance #TestTestTest

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More from @thehowie

10 Sep
Thread : #Sweden & #HerdImmunity

When folks talk about the US attempting #HerdImmunity "strategy," they look to Sweden. They (sometimes) acknowledge vast death, early on, but then point to the mitigation of cases and dramatic reduction in recent deaths. 1/13
And many in Sweden encourage this myth. But even they have admitted that herd immunity is unlikely nor the goal. 2/13….
Is it possible that Sweden has achieved herd immunity & that is why their outbreak has abated? ABSOLUTELY not. Their overall activities are comparable to many US states that have controlled their outbreaks: Per capita daily cases are similar to NY, CT, NJ. 3/13
Read 14 tweets
28 Aug
THREAD on College reopening dashboards

I am both heartened as well as DEEPLY disappointed to see spectrum of Covid19 reporting by colleges & universities. Some have made enormous efforts at transparency (even if formats could be better); others seem afraid of reporting. 1/8
My employer, @Yale, is currently in the category of being transparent, but presenting data that is NOT user friendly, or even useful.… 2/8
Huge kudos to @USD for reliably posting every day, even as numbers are not flattering. (They started classes 9 days ago)… 3/8
Read 9 tweets
19 Aug
Thread about how one teacher (me) has pivoted to online teaching. (follow along, if interested).

As more & more schools move to online-only, and others to hybrid (online and in-person), formats, I thought I would tell you how I spent my summer! 1/
I've been teaching the same basic course (Health care policy, finance, and economics), in different formats, @Yale, for 22 yrs. I have taught at least 80 classes of students at the undergraduate, graduate, & graduate medical levels. Until March 23rd, this was always in-person. 2/
I update my slides EVERY year. Most slides require minimal or no changes, but many are updated to the most recent available data or changes in legislation, regulation, or evidence. This is no small effort, but 20 hours can be spread over 3-4 classes each year. 3/
Read 16 tweets
26 Jun
Short thread on the near future.

Roughly speaking, we hit nadir in case growth on June 10, positive rate on June 14, and hospitalizations on June 21. With seemingly no major measures to slow this down we will achieve a new peak in hospitalization on or around July 22. 1/5
Deaths are in the process of plateau & will likely begin ascent next week. 4-5K deaths per week will follow and then increase. 2/4
That ship has sailed: The infections that will lead to those hospitalizations & deaths have already happened or are imminent. Since there have been no major policy shifts over the last few weeks, we will only see things worsen through much of July. 3/5
Read 5 tweets
11 Jun
#California & MORE thread.
CA will NOT be a repeat of NYS or Italy. That doesn't mean it couldn't creep up to levels that overwhelm hospitals, cripple local economies, or cause spread to other regions through travel. Hospitalizations are GROWING in SoCal, by ANY metric. 1/9
There are no perfect metrics to track the outbreak. Deaths are lagging (& often under-counted); hospitalizations are less lagging, but still only bump with a ~ 2 week delay; case finding is least lagged, but biased by efforts at testing (limited by supply AND demand). 2/9
Tracking testing & positive rate (daily positive cases divided by daily testing) is one of best measures, but also relies on timely reporting & this is often LAGGED. For instance, I do not know whether tests that are returning today are from yesterday, or from last Friday. 3/9
Read 9 tweets
8 Jun
Brief thread:

This is BIG news, but many questions.
Even if true, literally (as below), it is HUGE. It also would change how we manage this: from contact tracing to social distancing measures.

@mvankerkhove of @WHO says that there are only the rarest instances of asymptomatic spread. She also clarifies that "many" so-called asymptomatic patients are actually mildly symptomatic (and therefore not included in the prior statement about no spread).

She implies, but without follow-up, that even pre-symptomatic (subcategory of asymptomatic) patients are not likely to infect. This is one of the main targets of efficient testing and contact tracing and SEEMS to fly in the face of Korean CDC efforts and findings. 3/4
Read 4 tweets

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