Thread by @DrTomFrieden

Covid Epi (and Research) Weekly: New Highs, New Lows

More cases in more places than ever. More hospitalizations. Sadly, as much division as ever. Encouraging news on vaccines, immunity but many hard months ahead. Together we can reduce spread, save lives, protect jobs. 1/thread

Stunning increase in cases, dangerous increase in hospitalizations, tragic increase in deaths. On March 10 @cyrushapar and I estimated deaths with .5% fatality rate. Sadly, our projections are on track. Act now or half million people could die. bit.ly/35s0nwm 2/

Simple, depressing math. Test positivity increased from 8.4% to 10.5% in a week. Cases are increasing exponentially. Hospitalizations lag cases by 1-2 weeks. Hospitalizations will pass 100,000 within a month. Deaths will reach 2,000 a day by the end of the year. 3/

PCR test positivity is still the best single indicator of risk in communities. Good national map -this information and more should be publicly available in real time. Gives a good sense of the enormous variability of Covid rates and risk across the US. bit.ly/2UrdTdq 4/

The Northeast and Hawaii continue to do better, with California and Louisiana also better than most. But as we travel and mix over Thanksgiving, risk is that we all increase to the HIGHEST common denominator - that’s how infectious diseases work. Travel accelerates spread. 5/

In NYC, northern part of Staten Island generally has the worst health status, but the southern part is having a large Covid outbreak. Support for Trump and lack of safety precautions against the virus are highly correlated. Article describing dynamics. nyti.ms/3eWnJx2 6/

Cases and deaths increasing in nursing homes, homeless, prisons. Outbreaks can be prevented and stopped as demonstrated by quick, hard work described here: bit.ly/3nmL9Pd Good article on unacceptable risks in correctional facilities. wapo.st/3kDlVKV 7/

We are hitting new highs of Covid and new lows in our response. A good article on the various worsts of the pandemic. Highest rates, highest numbers, highest numbers of deaths. Unfortunately, the worst is yet to come. nyti.ms/3lwRIOy 8/

Now, research developments. Most encouraging thing I learned this week? MMWR about large outbreak in a summer camp. Testing doesn’t replace safety strategies. Camper tested negative day before event, more than 100 people infected. bit.ly/36ssPgE What was encouraging? 9/

Of 24 people who had antibodies before camp, none became infected. Of the other 128 people tested, 116 were infected. Odds that this happened by chance? More than a million to one. Reinfection happens, but most people with antibodies are protected, at least for some time. 10/

Two big mysteries: Why do kids get less severely ill than adults, and why is there such variation in severity of illness even in people of the same age with the same risk factors? Back in May, I reviewed theories and evidence on the second question. bit.ly/2JZC8gA 11/

We still don’t know the answer, but there’s some new evidence -- a theory, not proof! -- that cross-reacting antibodies to other coronaviruses may protect from Covid. One study from London bit.ly/2IBJExH and another study from Africa bit.ly/38IG9k6 12/

On the other hand, this study suggested prior infection with other coronaviruses didn’t help bit.ly/3pAl6Gr Confused? So is the world. Want to learn more? Excellent, clear (and open-source) summary of knowledge of immunology of Covid. bit.ly/35umFxx 13/

Which brings me back to why the Wisconsin outbreak is so encouraging. Sherlock Holmes’ clue of the dog not barking in the night -the equivalent is 24 antibody-positive people not getting Covid. If Mother Nature can protect us, vaccines can also. Immunity passports are coming. 14/

Well-founded excitement about mRNA vaccines. Very encouraging report from Pfizer - hope for long-term efficacy including in elderly, with safety confirmed as it’s rolled out. To a great extent we owe these vaccines to one woman who for 30 years didn’t give up: Katalin Karikó 15/

Here’s a good explainer on the history and details of the vaccine and Dr. Karikó’s role. The vaccines turn your body into a factory for the antibodies you need, and could be important for vaccination and treatment for many diseases. bit.ly/36CU5Jo 16/

The article outlines role of finance and venture capital in drug/vaccine development. In 1900, the NYC Health Department produced antitoxins for diphtheria and other life-saving products; Lederle Labs was formed by an Assistant Commissioner who learned from the Department. 17/

This started a long tradition of taxpayer money funding inventions that the private sector then makes and charges the taxpayers for. Innovation of the private sector is a great engine of productivity, but we have to make sure that public funds are used to protect the public. 18/

What are we learning about fighting Covid from all this? I summarized that today in an article for @TheAtlantic. The virus will force us to close many things, but we can do this more safely, and with less collateral damage. bit.ly/2UqdKGX 19/

How much do we have to close? This modeling article shows that smaller group size, less spread. But there’s no threshold, and where people come from, ventilation, how long they stay, whether they wear masks matters. Thanksgiving plans need to change. bit.ly/3psPDpq 20/

As cases rise, restaurants and bars will need to close for indoor service. Let’s work together so we can keep our kids in school, our parents alive, and, if we’re really careful, still be able to shop for the holidays and get a haircut. wapo.st/35uhY6R 21/

Outdoors remains healthy and safer from Covid. Unless gyms are very, very careful, they will need to close. Unfortunate. Physical activity is the closest thing we have to a wonder drug. Good example of careful measures preventing spread in a gym. 22/ bit.ly/3pt2Nms

Encouraging new science brief from @CDC. Masks not only protect others but also likely protect the wearer. No one thing will make the pandemic go away, but masks are one of our most important tools. It’s great that nearly everyone understands this now. bit.ly/38BrG9w 23/

New low: blocking transition work. This is a relay race, and anything that prevents a smooth handover can cost more lives to Covid. January 20 … of 2020 … the first case of Covid in the US. January 20, 2021 ... the beginning of a much more effective response. 24/

I’m horrified to see case increases and delays dialing back indoor contact. In March, I felt like Cassandra: able to foresee impending disaster and unable to stop it. Now, the impending disaster is plain for all to see. There will be 1 million diagnoses in the coming week. 25/

Have we become hardened to deaths? Can we personalize what this means? Would it help to point out that Betty White is at risk? Won’t we forego an indoor get-together to save her life and the lives of 100,000 of our neighbors? Must we wait for mass death to change our behavior? 26

Flu activity is still low, but could increase. Get your flu shot if you haven’t already.

Happy Diwali! From my 5 years living in India, Diwali is my favorite holiday. The moment when all is right with the world, whatever the future will bring. 27/

Dr. Bill Foege quotes Lincoln Steffens, and it couldn’t be more true about our Covid knowledge and what we need to keep in mind. All the best to all for the holidays. The more we work together, the better we will pull through. 28. See next for end of this thread.

The best picture has not yet been painted; the greatest poem is still unsung; the mightiest novel remains to be written; the divinest music has not been conceived, even by Bach. In science probably ninety-nine percent of the knowable has not yet been discovered. -Lincoln Steffens