Ashish K. Jha, MD, MPH Profile picture
Sep 27, 2020 10 tweets 3 min read Read on X
Its been nearly 3 weeks since Labor Day

We were all worried about surge after holiday

Has it happened?

Actually, yes

Data here pretty clear

First, here’s a graph of the number of new daily cases (y-axis) over past month

7-day moving averages

What does this mean?

Thread
Cases slowly declining as we entered September

Labor Day weekend 9/5-7

If holiday set off new infections...you’d expect to see cases rising 5 to 7 days later (around 9/12)

That’s exactly what we see in graph

So 2 weeks ago, we were at 34K/day

Today, at 44K/day

Up 30%

2/7
39 states have more cases today than just 2 weeks ago

31 states have higher % of tests returning positive

And 16 states have % test positive > 10%

That’s not great. Those 16 states are missing a lot of infections

But patterns vary across states. So let’s dive in

3/7
Lets start with 15 states with highest per capita new cases

ND #1 at 52 new cases /100K/d)

Others include SD, WI, UT, OK, IA, AR, MO, etc

But its not just small states

In fact, about 25% of America lives in these 15 states

How are things going here?

Not great

4/8
Across these 15 states:

1. New infections are up 67% in last two weeks. That a lot.

2. Their collective % of test positives is 11.6%

3. Their hospitalizations are starting to creep up

But there’s another problem – rest of the country is not doing so hot either

5/7
Across other 35 states:

Cases up about 11%

% of tests positive, hospitalizations flat

So, almost no one getting better but many getting worse

And, of course

Some states further easing restrictions (FL, IN, even NY)

Colleges, many businesses back, some seeing outbreaks

6/8
And with colder weather, outdoor activity, which is so much safer, will get harder

This is why @IHME_UW and others predicting a bad fall/winter

But I'm a bit more optimistic

We can avoid the @IHME_UW scenario of 400K dead by January

What makes me more optimistic?

7/9
A bunch of things.

More testing finally coming (pretty sure)

Some policymakers are being data driven, limiting indoor gatherings

And of course, as infections rise, folks will pull back on their own

Plus -- therapies keep getting better. This allows us lower deaths

8/9
Bottom line

We have a long way to go in this pandemic

Must focus on keeping infections, hospitalizations, and deaths low

Not in a good spot but we can control this

We can get through next 7-9 months until we hopefully have safe, effective vaccines widely available

9/10
Here's our charge

Avoid indoors when possible (push leaders to limit dining, bars)

When indoors are super important (schools), improve ventilation: open windows, air exchange. And wear a mask!

And democratize testing for everyone, not just well-connected.

We can do this

Fin

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More from @ashishkjha

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
Mar 3, 2022
With infections down more than 90% since highs just 6 weeks ago

It is tempting to decide the pandemic is over

It is not

During this upcoming lull of infections (and falling deaths),

It's time to prepare for whatever is next

So what to prepare for -- and how?

Thread
The two questions I get asked most often these days are:

1. Will we see future variant

Answer: I don't know. No one does. Reasonable to assume we will. Let's hope we don't

2. Will we see future surges

Answer: most likely yes. Hope not

But remember: hope isn't a strategy

2/n
So with possible future variants and surges

We should focus on the playbook:

1. Surveillance
2. Vaccinations
3. Testing
4. Ventilation/filtration
5. Masking
6. Therapeutics

Much of this is in today's White House plan

(disclosure: I, others have shared our ideas with them)
Read 10 tweets
Feb 26, 2022
For two months, I've said we're entering a new phase of the pandemic

A phase marked by a lot of population immunity, a more immune-evasive but less virulent virus

This new phase requires new metrics

My @nytopinion piece on the latest CDC metrics

nytimes.com/2022/02/25/opi…
Fundamentally, new CDC metrics get it right

Why?

Because cases no longer are the most important measure

For nearly 2 years, for every 1000 cases, you could reliably predict 50-80 would end up in the hospital and about 15 to 20 people would die

That was true in 2020. And 2021
That tight link between cases --> hospitalizations --> deaths was true for original strain

And for Alpha
And for Delta

But Omicron severed that link (mostly)

Now, if you told me there were a 1000 new cases

I can no longer tell how many will end up hospitalized or dead

3/n
Read 9 tweets

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