Covid Epi Weekly: Turning the Corner on Covid in the US ... Into an Oncoming Tsunami of Cases, Hospitalizations, and Death

You know who’s NOT tired of winning? Covid, that's who. Unless we up our game, it will keep winning, keep spreading, keep killing Americans preventably.

1/
Test positivity increasing in ALL age groups. Positivity in >65s increased 44%, from 3.6% 5 weeks ago to 5.2%; 5 weeks ago rate in young adults was 50% higher than in over 65s; last week 20% higher. What started in the young didn’t stay in the young. 2/
bit.ly/3jq6k0n
Cumulative hospitalizations people >65 in US
1 in 300 Caucasians
1 in 120 American Indian/AN
1 in 110 Latinx
1 in 87 (!) Black people

Covid+ failure to protect essential workers, many Black/Latinx+ baseline less access to healthcare = exacerbated racial injustice in health. 3/
Years of life lost measures burden, although imperfectly. 2.5 million life years lost already. More than 13 years for each of the 225,000 people killed. Think of the joy, happiness and meaning lost for each of those 13 years. Each of the 2.5 million. bit.ly/2TmZoqc 4/
Working paper by @DrMaryTBassett: years of life lost before age 65

White 33,446
Black 45,777
Hispanic 48,204

Black and Latinx people in US: 33% of adults, 74% of early death. Valid responses to this information include rage, action. bit.ly/3kqGL0E 5/
Other than Northeast, bleak. Positivity less informative than before. Case rates are an even worse indicator - 77,000 infections reported today only ~20% of all infections. Failure of federal leadership means we’re not tracking the right indicators: wapo.st/2B1GaAt 6/
Look at the Dakotas. No mask mandates. Losing to Covid. Reported rates are slightly higher in North Dakota (1,000 vs. 800/million/day), but, correct for test intensity and South Dakota has about 4x the rate of North Dakota and 20x rate of the Northeast. bit.ly/3eVJdsl 7/
Rural areas are getting slammed. n.pr/3kr0D3L and nyti.ms/34oT0VX. Graphs from @NYTimes show this clearly. Meat packing and agricultural outbreaks are part of, but only part of, the factors driving the increase. No place is immune to Covid. 8/
Increasing cases in Alaska suggest that colder weather may favor the virus. Sun Tzu’s 5 factors that determine success or failure in war: moral influence, weather, terrain, leadership, and strategy. The US is not organized for success in any of the 5. 9/ nyti.ms/3onOcrG
Parts of Europe are also getting hit hard. Places that didn’t drive cases down enough to find and stop clusters face ever-present risk of explosive spread. Some didn’t flatten the curve sufficiently (Spain, France, Italy, UK, Belgium) and some did (Germany, Norway, Finland). 10/
Economic pain is real, and deadly. Paraphrasing Carville, to fix the economy, it’s the pandemic, stupid. More evidence that it's the virus rather than control efforts suppressing economic recovery most. “It has almost nothing to do with regulations”
nyti.ms/3mcrxN2
11/
Balance is key. More granularity to circuit breakers to stop Covid. Schools, healthcare, workplaces, stores CAN open more safely. Outdoors is great. Travel from high to low Covid prevalence is a recipe for spread. Restaurants, bars, and indoor get-togethers amplify the virus. 12/
The higher the peak, the longer it lasts. The lower Covid goes, the longer it takes to come back. As you sow, so shall you reap. Hyperbolic discounting is not in our favor. As night follows day, hospitalizations and deaths follow cases, which follow letting our guard down. 13/
Civic responsibilities include not harming (e.g., infecting with coronavirus) others, staying informed, paying taxes, participating in your community. And VOTING. We released materials on voting safely. I like message below. Please spread the word. bit.ly/3kruHfv 14/End

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More from @DrTomFrieden

16 Oct
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. bit.ly/30Fj11C 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
Read 14 tweets
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 bit.ly/36UK4tb
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. fxn.ws/3ioVuaG
2/16
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.
3/16
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.
1/9
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. bit.ly/369yrOu
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

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