Ashish K. Jha, MD, MPH Profile picture
Sep 16, 2020 8 tweets 2 min read Read on X
.@CDCgov out with metrics to guide school reopenings.

I like it. It sets out risk levels based on key metrics using a color scheme

But if you apply their metrics, the news isn't good.

Most of the country is in red or orange

Thread

cdc.gov/coronavirus/20…
Three key criteria:

1. # of cases in community
2. % of test positives
3. # of mitigation strategies you can do

Cases in the community: range from <5 per 100K/14 days as dark green to >200 as red

% pos <3% dark green to >10% red

So how do communities across America fare?

2/n
We applied these two criteria to states+DC

What did we find?

20 states in red "highest risk"
28 states in orange "higher risk"
2 in yellow "moderate risk"
1 light green "low risk"
0 dark green "lowest risk"

Ah you say -- states too big. How about counties?

3/n
So what about counties?

56% counties are highest (red)
31% are higher (orange)

But counties vary in population -- so about where people live?

Well, 40% of people live in counties that are red (highest risk)

48% of people live in counties that are orange (higher risk)

4/n
Only 11% live in the yellow counties (moderate risk)

1% live in light green (lower risk)

Theses are super sobering numbers

5/n
What does this mean?

First, it is awesome to see CDC put out this risk criteria.

Its a bit agressive in its threshold (I might have made orange a bit higher) but its still quite good.

It is not mean to be prescriptive -- saying red counties can't open.

6/8
But it does mean it'll be very hard to re-open schools in many places across the nation.

My take is that counties that are orange -- but close to yellow -- can open if they have the mitigation strategies

But red counties will struggle no matter what they do

7/8
Finally,

Its a reminder that we had all spring and summer to get our schools ready.

And we largely didn't.

And new CDC criteria laying out how much of America has not done the job to ope schools safely

And by that failure, we are letting our kids down.

Fin

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More from @ashishkjha

Aug 23
The FDA authorized the new version of the covid vaccine

Which prompted my parents to ask me whether they should get their annual covid vaccine now

My response? I'd wait until late October

So here's my thinking

First, I think the summer COVID wave has largely peaked (some regions may still rise for another week or two)

So getting a vaccine in the upcoming weeks (when vaccines will become available in your pharmacy) is probably not optimal

Instead, I told them that they should get their covid and flu vaccine together in late October, ideally by Halloween

That sets them up to be optimally protected for the winter -- where we get both flu and usually a bigger winter covid wave (along with RSV and other respiratory infections)

If you got a vaccine now, you would get some benefit in the upcoming couple of months

But would be more vulnerable if the winter wave arrives in December or January

At the end of the day, the most important thing is that -higher risk folks (older people, chronically ill and immunocompromised folks) get vaccinated

So if you want to get it now, its fine

But to me, late October is probably a better time -- and I would get both covid and flu shots then
By the way, if you're wondering why I think the summer wave has largely peaked, here's the key data

first -- waste water

It looks like the waste water levels have peaked nationally, as well midwest and south with a plateau in the West and Northeast Image
The second is the data on ER visits and deaths

while the death data is still filling in, ER visits have peaked Image
Read 4 tweets
Jun 27
I'm hearing a lot of people say we are in the middle of a new covid wave

So a little data might be useful

Almost no one is testing anymore so case numbers are useless

wastewater is the only reliable source of data for community infection levels

And what does wastewater tell us?

Well sure enough, community infection levels are up about 50% over the past 2 months

BUT

A little perspective is helpful

🧵Image
Overall, infection levels in the community are still quite low

Certainly compared to historical average

Here's the wastewater data over the past 2 year

The recent blip up is still low

But two more points worth knowing

2/n Image
First, we pretty typically have two waves every year

A modest summer wave

And a bigger winter wave

The waves come because the virus continues to evolve and immunity against infection wanes

And during the summer, it gets hot in lots of places and people are spending more time indoors, driving infections

And second, this year's summer wave seems to be starting a little earlier than last year

So expect to see a modest wave probably peaking in early to mid August

3/4
Read 5 tweets
Mar 1
OK -- so CDC has come out with new guidance saying if you have COVID

Isolate while you have a fever but...

you can stop isolating once your fever is better and symptoms are resolving

Seems right to me

What you ask? Has the science changed? Why do this now?

Good questions

🧵
So first question: has the science changed?

No -- data on infection and spread remains the same

Most of the spread happens when people are pre-symptomatic (before symptoms) or when they have symptoms. Less after symptoms resolve

So what's changed? Population immunity

2/n
The question is not whether guidance will have benefits

If we only focused on benefit

Public health would recommend

You never drive over 30 MPH
Ever drink alcohol (no amount is safe!)
Ever eat bacon (class 1 carcinogen!!)

And so on

But those would be bad recommendations
Read 7 tweets
Dec 27, 2023
What happens to patient care when private equity firms take over hospitals?

Well, there's new data out and its not great news for all you fans of private equity in healthcare

Here's the write-up in the @nytimes by @sangerkatz and @ReedAbelson

Short 🧵

nytimes.com/2023/12/26/ups…
Researchers looked at 51 private-equity (PE) acquired hospitals

And compared them to matched hospitals not acquired by PE

They found patients at PE hospitals experienced 25% higher rates of complications compared to controls

Here's the original paper

jamanetwork.com/journals/jama/…
Does this make sense?

Could quality (or in this case, patient safety) get worse after PE take over?

Yup possible

patient harms like hospital-acquired infections & falls occur when:

you have inadequate staffing

or you don't have strong processes to prevents them

3/n
Read 6 tweets
Aug 7, 2023
How should we be thinking about COVID at this moment?

Last week, I had an op-ed in @BostonGlobe to lay out what I think is a pretty reasonable way to think about it

But first, here's the state of COVID

Thread

bostonglobe.com/2023/07/31/opi…
Infections are rising in every part of the US based on wastewater data

This is exactly what many of us expected this summer

How bad is it?

Well, its up about 3X from lows of mid-June

But still only a third of last summer's peak

So its up. But not a lot.

So what to do?
The most important thing you can do is ensure your immunity is up to date

Getting an annual vaccine (for most folks) and 2X/year for vulnerable folks makes a lot of sense

But also: SUPER important to consider getting treated if you get infected

Treatments are still free!
Read 6 tweets
Mar 17, 2022
So, as they say…

Some news

For all the progress we’ve made in this pandemic (and there is a lot)

We still have important work to do to protect Americans’ lives and well being

So when @POTUS asked me to serve, I was honored to have the opportunity

nytimes.com/2022/03/17/us/…
This President has spoken the truth about this virus

Has prioritized policies based on science and evidence

Americans are going back to work and school

And it is an honor to work under his leadership

One focused on the health and well-being of the American people
We are in so much of a better place with vaccines, diagnostics, increasingly, therapeutics, and much more

Much of this because of the superb leadership of Jeff Zients

Who has used the levers of the US government to make available these miracles of science to the American people
Read 9 tweets

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