Covid Epi Weekly: Immunizing Against Herd Stupidity

Bad week for fight against Covid. Reopening without sufficient care. Failure to isolate. Failure to communicate. Dangerously misguided theory on immunity. Cases increasing, hospitalizations following, more deaths to come. 1/15
Test positivity increased for first time in a month (to 5.4%), but positivity difficult to interpret. Antigen tests, lack of consistent definitions. Hospitalization data concerning tho in the crazy world of US health economics supply creates demand. 2/15
In the past 2 weeks, 21 states had their highest reported rates ever, including most of the midwest, much of the west. As predicted, we have surpassed 50,000 cases/day. White House cluster up to 40 known cases, hundreds not untested. Maine and Vermont still encouraging. 3/15
More information on long-haulers is emerging. We must better understand and care for people who are suffering. Excellent article by the incomparable Jane Brody. 4/15
Great new data on self-reported mask-wearing. More masks→less illness. Shameful misrepresentation of CDC study which found restaurants, bars, and family members with Covid associated with illness. Masks are a low-cost, effective way to reduce spread. 5/15
Nowhere 90%+ mask wearing >20% know someone sick, and nowhere with <85% mask wearing <20% who know someone who is sick. How did masks become political? Masks are only against a virus, not against any party or person. We're in this together! Us against them. Them=virus! 6/15
Bad news 1. Remdesivir doesn’t appear to reduce death 2. US continues to fail at contact and source case tracing. Complex, important, high-skill, high-empathy work. 3. Dangerously misguided concept of herd immunity through natural infection spreading. 7/15
“We’re all connected” is reality. Infections in healthy people lead to infections in others. “Protect the vulnerable” requires reducing risk of infection in all. Altho the more people who are immune, the slower virus spreads, every infection is a setback, not a step forward. 8/15
Now three pieces of good news. At least 199/200 people with infection recover - Covid is NOT the Zombie Apocalypse. Dexamethasone and other steroids - cheap, available meds - reduce death rate by as much as a third. And lots of safer social and economic activity is possible. 9/15
With Halloween, Thanksgiving coming we CAN have some safer connections. Halloween ideas below. For Thanksgiving, suggest 2 weeks strict quarantine before any family get-together, and only if travel can be done safely. That’s what my family is doing. 10/15
Let’s not get ahead of ourselves on vaccines. Our best tool, but just one of many. We don’t know if they will be effective, safe, accessible, and trusted. Even if all 4, they won’t end the pandemic, and rare, serious adverse reactions may occur. Underpromise, overdeliver. 11/15
Simple measures, such as ensuring paid sick leave, are also very important. Interesting new analysis suggesting “roughly 1 prevented COVID-19 case per day per 1300 workers who newly gained the option to take up to two weeks of paid sick leave.” 13/15
Public health must do better understanding, empathizing with people experiencing social, economic pain of pandemic. It's the pandemic, not the response, that's killing jobs and people. In US, >30 people have lost jobs because of pandemic for every 1 who has lost their life. 14/15
“We know how to bring the economy back to life. What we do not know is how to bring people back to life.”
-Ghana President Nana Akufo-Addo

Covid is here to stay. We must live, fully, now.

“The present moment is the only moment available to us.”
-Thich Nhat Hanh


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More from @DrTomFrieden

9 Oct
Covid Epi Weekly: The First Cluster

Cluster at White House is symptom and symbol of the failure of Federal response. Overconfidence in testing. Lack of basic safety precautions in crowded indoor places. Delayed isolation. Incomplete contact tracing. Failure to quarantine. 1/13
Testing only useful as part of a comprehensive strategy; it doesn’t replace safety measures. There are false negatives, and even if accurately negative in morning someone can be highly infectious hours later. Also need 3W’s: wear a mask, watch your distance, wash your hands. 2/13
Masks are important. Worth reading science review by the wonderful @CyrusShahpar. I learned from it. In addition to protecting others & yourself, masks may reduce inoculum and make it more likely that if you do get infected you won’t get severely ill. 3/13
Read 13 tweets
5 Oct
We still don't know key elements about the Covid outbreak affecting the White House. This is what needs to happen to assess the outbreak's impact and stop continued spread. 6 steps in an epidemiologic investigation:
Step 1: Establish the case definition: person, place, and time. For example, someone who had contact with anyone in the White House after September 18 and has a positive test for Covid (confirmed) or symptoms consistent with Covid (suspected).
Step 2: Find all who meet the case definition through active surveillance.
Read 8 tweets
2 Oct
Epi Weekly. 40 million plus 1. And…NYC is on the brink of a precipice.

A minimal estimate is about 40 million infections in the United States with the virus that causes Covid. The infection of President Trump is the most prominent, and one of the most telling.

First of thread/
My thoughts are with the President, First Lady, family, and all others infected with and affected by Covid. The President’s infection is a reminder that Covid is an ongoing threat. No one is safe – not even heads of state – until everyone is safe.
Risk of severe illness and death increases with age. A 74-year-old has approximately 3% chance of death, higher in males and people who are obese, and much higher if hospitalization is required. 85-90% of those infected in their 70’s will have no, mild, or minor illness.
Read 16 tweets
25 Sep
Covid Epi Weekly: People are tired of fighting the virus, but the virus isn’t tired of infecting people

As parts of Europe and the US show, turn your back on Covid and it will come back to bite you. Cases trending up again in many states, likely to hit 50,000/day in October.
2/9 Trends in positivity are getting harder to track. Per Covid Tracking Project, only 9 states documented to follow best practice of reporting antigen & PCR tests separately. (States should also report unduplicated people positive/tested, crossreferencing the two types of test.)
3/9 What starts in the young doesn’t stay in the young. @MMWR reports young adult infections were followed a week or two later by infections in people over 60. We are all connected. The sooner we recognize that, the sooner we can move forward more safely.
Read 9 tweets
22 Sep
Every one of the 200,000 Americans killed by Covid is a tragedy, and most of these deaths did not have to happen. The future is in our hands.
We can save lives and accelerate economic recovery by putting science and public health at the center of our response. As the global death toll passes one million, this also means collaborating to improve public health systems worldwide.
There is no fairy tale ending to this pandemic—not even a vaccine.
Read 5 tweets
19 Sep
Epi Weekly Review: No Fairy-Tale Ending to The Covid Pandemic

Less testing, less information on tests, apparently less Covid. Positivity decreased 5.2 to 4.8% per CovidView. Testing decreased for multiple reasons, including antigen test results not being reliably tracked.
In the past week, most diagnosed cases in TX, CA, FL, IL, GA, MO, WI; these 6 states account for nearly half of diagnosed cases. But diagnosed cases only roughly a fifth of total infections. Virus spreading on campuses will spread to homes, parents, grandparents, and others.
3/6 @nytimes tracks counties with the highest rates. Here are top 28. They look me. The virus doesn’t see red or blue states, only people it can infect. In too many places, the virus is still winning. If we work together but stay apart, we can stop the spread.
Read 6 tweets

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