Eric Topol Profile picture
25 Oct, 11 tweets, 3 min read
Diagnosis: Uncontrolled spread
covidexitstrategy.org
1/
A ladder. Off the chart again with 83,000 new confirmed infections the past 2 days. Years from now people will look back and think how is this possible in the USA. Bleak? 2/
It doesn't have to be. We know we could achieve marked suppression by a universal mask mandate and aggressive non-pharmacologic mitigation measures. That doesn't have to equate to the "L" word. But timing is critical now 3/
Not just because the virus spread is rampant and needs to be contained. But keeping people safe now, for a matter of weeks, when we're getting close to turnaround strategies. 4/
Already the fatality rate for #COVID19 is declining. Many people who died in March-April-May wouldn't today. 5/
We are just weeks away from EUA approval of multiple monoclonal antibody programs. These will be the 1st drugs to intervene early, block progression of illness, and likely further improve the outlook for high-risk individuals 6/
By year end the stunning, unparalleled progress in vaccines from sequence in January to completed megatrials in October will be capped with EUA of vaccines and the Phase 1 rollout 7/
And the right and only way to work towards herd immunity, via vaccines 8/
We will also have rapid home tests. They should have been widely available months ago and they have remarkable potential to promote our mobility and safety by diagnosing infectiousness. Only pending FDA developing the path and validation studies 9/
We can't surrender when we're this close to exceptional promise. Pandemic fatigue is pervasive, but letting up is worse. Patience, aggressive efforts, building on our successes in the pipeline. Optimism. 10/
Tired

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More from @EricTopol

23 Oct
A new American pandemic record
83,010 cases reported today
@COVID19Tracking
Hospitalizations on a relentless rise
One week ago, there were concerns that the 3rd surge was manifest with highest cases since August.
Now highest cases in 2020.
Read 6 tweets
23 Oct
😷😷😷
In the next 4 months, 130,000 American lives could be saved by universal mask use, according to the new @IHME_UW forecast which gets us to >510,000 deaths by end February
@NatureMedicine nature.com/articles/s4159…
As compared with the status now:
"Mask use has emerged as a contentious issue in the United States with only 49% of US residents reporting that they ‘always’ wear a mask in public as of 21 September 2020"
Where people wear masks in the United States
covidcast.cmu.edu/?sensor=fb-sur…
Read 4 tweets
18 Oct
Almost the whole country is in the "Uncontrolled Spread" category covidexitstrategy.org 1/
The Upper Midwest and Sturgis, likely America's largest superspreader event
870 infections per million people in ND is an unprecedented peak in the US pandemic and around the world (2nd is SD/Czech Republic, currently 740) 2/
Like the #RoseGarden event, there was no contact tracing so the full extent of both these clusters will never be known
washingtonpost.com/health/2020/10… by @britsham @bylenasun
Deaths have risen sharply in ND, SD, MT 3/
Read 5 tweets
15 Oct
One monstrous wave, 3 phases, onto new heights, with no plan
Hospitalizations tracking with infections
@COVID19Tracking
Read 5 tweets
14 Oct
What if Lilly's monoclonal antibody trial was stopped due to futility?
1. A pause at 300 patients after 5 days of treatment was pre-specified in the protocol
nytimes.com/2020/10/13/hea… by @KatherineJWu @katie_thomas Image
2. Trials have stopping rules for 3 main reasons:
—futility (further enrollment would not show benefit)
—safety (the intervention appears to have a hazard that precludes further enrollment)
—efficacy (the efficacy evidence is overwhelming and it would not be ethical to proceed)
3. Since the pause was pre-specified and Lilly announced a "potential safety concern," we don't know yet if it was for futility or safety. So far there have not been safety issues disclosed for the monoclonal antibody programs w/ now thousands of patients enrolled (Ab or placebo)
Read 6 tweets
12 Oct
Covid reinfection in a 25 year-old man in Nevada, as confirmed by virus genomic sequencing; 2nd infection more severe @TheLancetInfDis
thelancet.com/journals/lanin…
This is the 1st USA documented reinfection
Conclusion: "All individuals, whether previously diagnosed with COVID-19 or not, should take identical precautions to avoid infection w/ #SARSCoV2."
Several more global cases are in process of peer review now. Appears rare, but possible
This★ insightful commentary by @VirusesImmunity on the new reinfection case and the other 3 previously published pulls it all together, along with the known unknowns (a lot of those)
thelancet.com/journals/lanin… @TheLancetInfDis
Read 5 tweets

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