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Ashish K. Jha, MD, MPH Profile picture
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23 Nov, 7 tweets, 2 min read
Daily reports tell us what happened last week, 2 weeks ago, 4 weeks ago

This is why folks are worried about what's next

Today's 7 day moving avgs

167K cases, 3600 new hospitalizations, 1460 deaths

What does this tell us about upcoming weeks?

It says we have a problem

Thread
Today's 167K cases? infection happened last week

Today's 3600 new hospitalizations?

Infections happened about 12-15 days ago

Today's 1460 deaths?

Infections happened about 3+ weeks ago

And that's why we have a problem

2/4
About 3.5% of identified cases get hospitalized

CFR right now about 1.7%

So today's new cases will cause:

5000 new hospitalizations in 10 days

2900 new deaths in 3 weeks

Corollary

Today's hospitalizations were cases 10 days ago

Today's deaths were cases 3 weeks ago

3/4
So, best guess by 12/1/2020?

We'll have 120K hospitalized patients

50% more than today

This will strain capacity for hospital care in majority of states well beyond capacity

And it won't be lack of ICU beds, ventilators

Nope

We'll struggle with enough doctors, nurses

3/4
All based on infections we have already

But we'll add more infections in weeks ahead

Thus I think we'll be beyond capacity in majority of states in next 2-3 weeks

And remember hospitals aren't just for COVID care

Others need it too

Overwhelmed hospitals bad for everyone

4/5
And also built in are deaths from COVID in next 3 weeks

I suspect about 40K or more

We'll easily be near 300K deaths by Christmas

Obviously, things can alter this grim scenario

Michigan-style policies to slow spread

Wont help with infections we have but can prevent more

5/6
But what can help folks already infected?

Ideally widespread availability of Monoclonal Abs

Scarce supply is the challenge. Can be helpful for high risk folks

So that's should be our strategy;

Targeted restrictions
Push for more therapy
Hope for fast vaccine rollout

Fin

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More from @ashishkjha

Ashish K. Jha, MD, MPH Profile picture
23 Nov
If its Monday -- it must be more vaccine news

@UniofOxford / @AstraZeneca vaccine results posted

This is largely more good news

Overall efficacy of 70% but one dosing regimen was 62%, other 90%

A key result reported was safety: no severe adverse events reported

Short thread
What do these results mean and is this actually good news?

Why yes it is

First, I don't fully understand why two dosing regimens were so different in efficacy

One possibility is vector immunity

This vaccine uses adenovirus vector (virus to deliver the genetic material)

2/4
Less efficacious arm used full dose of vaccine in both shots

More efficacious arm was half dose followed by full dose

It MAY be that the full first dose generated immunity against vector, causing second dose to be less effective

We don't know but will need to sort out

3/4
Read 5 tweets
Ashish K. Jha, MD, MPH Profile picture
22 Nov
Slaoui, speaking to @jaketapper, lays out an aggressive vaccination timeline

If he's right, we'll see virus spread starting to slow from growing population immunity by end of January into February

And much better by March

How?

Short thread
By end of January, based on timeline laid out:

50M vaccinated

And I suspect 60M infected, recovered by then

Obviously overlap between groups

So likely at 30%+ population immunity by 1/31/2021

That'll slow spread

By end of Feb, probably 40%+

Not "herd immunity"

But

2/4
Herd immunity not like a light switch

As population immunity builds, spread slows

By 30-40% immunity, spread becomes meaningfully slower

When we get to HI threshold, infections won't "disappear" overnight

But they will stop being self-sustaining

3/4
Read 4 tweets
Ashish K. Jha, MD, MPH Profile picture
20 Nov
Today was a very, very odd day

I testified before @SenateHomeland

They held a hearing on hydroxychloroquine.

Yup, HCQ

In the middle of the worst surge of pandemic

HCQ

It was clear how our information architecture shapes questions of science and medicine of COVID

A thread
There were 4 witnesses.

3 who strongly supported HCQ

They believed thousands of Americans were dying from lack of HCQ

And then, there was me

This split was not a reflection of evidence or the consensus in medicine

It reflected ability of the majority to seat more witnesses
The hearing was a testament to how politicized science has become

I shared evidence of studies that have failed to find benefit of HCQ

3 other witnesses shared personal experiences

And suggested my testimony was reckless because it would deny people access to lifesaving HCQ
Read 9 tweets
Ashish K. Jha, MD, MPH Profile picture
18 Nov
Number of COVID infections is high, rising.

What should we expect between now and December 1?

How many more infections?

Looking at the last 6 weeks gives us some clues

But bottom line?

We will likely have 250K to 300K new daily infections by December 1

Thread
All data from @COVID19Tracking and 7-day moving avgs

Oct 1 to Oct 15

42K new cases --> 53K new cases

This was an increase of 24% off base of 42K cases

Oct 16 to Oct 31

53K --> 78K; Increased 46% off base of 53K

Nov 1 to Nov 16

78K-->150K; Increased 88% off base of 78K

2/4
So infections accelerating off of a higher and higher baseline

If things continue without intervention, expect around 300K or more new cases on December 1

And the implications for hospitalizations and deaths is awful

But a few things can alter this:

3/4
Read 6 tweets
Ashish K. Jha, MD, MPH Profile picture
15 Nov
With cases spiking across the U.S. and national leadership nowhere to be found, states are taking the lead

Watching @GovWhitmer announcement. Feels like kind of science-based, nuanced policy intervention we need right now

What is Michigan doing?

A good amount

Thread
Michigan is doing a 3-week pause on:

indoor dining

bowling alleys and other indoor recreation

high schools

group fitness

And limiting informal indoor gatherings substantially

What are they NOT pausing?
Michigan is NOT pausing:

outdoor gatherings

essential work places

And most critically:

They are not pausing K-8 in-person schools

And they've ramped up testing to one of the higher levels in the country
Read 4 tweets
Ashish K. Jha, MD, MPH Profile picture
13 Nov
Things are obviously horrible re COVID

Our 7-day moving avg # of infections now 130K, 11.2% positivity, 60k hospitalizations 1050 deaths

But two of our largest states are still keeping things under control

NY and CA

And if they lose control, things will get much worse

Thread
NY and California combined represent 58 Million People

18% of US population

But they are doing 26% of all tests and rising

Have only 8% of all cases

8% of all hospitalizations

and 6% of all deaths

How are they doing it?
They have similar approaches

On per capita basis, they are, combined, doing about 60% more testing than rest of nation

Both states use data to drive local actions:

When cases rise, they curtail activities locally

Not perfect (hello NYC indoor dining??) but largely works

3/4
Read 4 tweets

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