Covid Epi Weekly: First Sighting of Vaccine-Induced Immunity
Imagine: You’ve been on a dangerous sea voyage. One of 200 people >65 have died. Safe land is sighted in the distance. Everyone on board must do everything possible to reduce deaths until safe harbor is reached. 1/17
Imagine: You’ve been on a dangerous sea voyage. One of 200 people >65 have died. Safe land is sighted in the distance. Everyone on board must do everything possible to reduce deaths until safe harbor is reached. 1/17
A tale of two realities. Worst spread in US since pandemic started. Highest case, hospitalization, and death rates. Continuing high levels of spread. And at the same time, the most hope we’ve had for a beginning of the end, with highly effective, safe vaccines rolling out. 2/17 
First, the epi. GREAT that CDC and HHS have finally been allowed to release — TODAY!!! — some of the information they have. This belongs to the public, not, dammit, to anyone in Washington. The headline says it all ... but 10 months too late. beta.healthdata.gov/download/gqxm-… 3/17
NOT GREAT: What the data show. Every US region, along with most counties for which there are data, is at the highest (red) level in terms of case incidence — more than 200/100K/week. That’s about 6x the rate at which we figured contact tracing would be hard or impossible. 4/17
Counties across the US are sustained hotspots, meaning there is a high case burden and a risk of overwhelming health care. Here’s the point: the longer you delay closures, the longer you have to keep things shut, the higher risk the of overwhelmed ICUs, and more people die. 5/17
Hospital beds are being filled by COVID-19 patients. There were 156,000 admissions in the past week and there are more than 110,00 people hospitalized. Cases are still increasing; hospitalizations will increases even more. Note the Thanksgiving increase in most regions. 6/17
The post-Thanksgiving bump is evident in cases and positivity. With December holidays coming, it’s best to celebrate at home. When people travel, the virus travels. When people share air, the virus spreads. Not every state had a bump — protection protocols save lives. 7/17
Finally public! Makes clear what’s happening. Very high rates in most of country; decreases from high rates over past week in much of country, particularly upper midwest. Thanksgiving surge is ebbing, in time for next holiday surge. Tennessee: Deeply red, deeply concerning. 8/17
Worth focusing on this graphic. Gives a sense of both test positivity and trend. States all over the map are … all over the map. Some are high and increasing, some high and decreasing, some staying high, some low. HI, VT, ME are the Covid-safest places to be today. 9/17
Farewell and thanks covidexitstrategy.org. Welcome covidactnow.org. If CDC/HHS continues to improve, these sites — and this weekly thread! — will be unnecessary. (I’d like that a lot.) Communication, based on facts, is an essential weapon to fight the pandemic. 10/17
Now for the view of the safe harbor — vaccine-induced immunity. It’s coming, but there will be barriers: Production, distribution, adverse events, uptake, and more. It won’t be fast or easy but it will happen. 2 vaccines good. 4 vaccines better. More are coming —next year.11/17
Production is a big unknown. J&J is the only of the 4 first companies likely to have a vaccine that has extensive production experience. And we expect adverse events. Some related to vaccines, some not. Complete transparency and immediate communication are both essential. 12/17
We MUST do better protecting the most vulnerable. There’s not enough vaccine now. Horrific outbreaks and deaths in nursing homes. Monoclonal antibody treatment must be scaled up fast - NOW! The grim harvest of misguided advice to let infections spread among young people. 13/17
Misguided debate: vaccine for elderly vs. essential workers. Essential workers who are likely to be infected and die (e.g. bus driver with diabetes) should also be at front of line. An 85-year-old is at massively higher risk than 65-year-old. Granularity can help deconflict.13/17
Outbreaks and deaths among incarcerated people continue. Sensible decarceration is a public health and ethical imperative. A prison sentence shouldn’t be a death sentence bit.ly/34suwdR 14/17
Some progress on global vaccine access; potentially 2 billion doses. More doses, more money, more support for vaccination programs needed. Ironically, many countries last on line for vaccine have vaccination systems best able to deliver it. @gavi bit.ly/37xmcM1 15/17
It’s literally now or never to fix public health at local, city, state, national, global levels. If this isn’t a teachable moment, there will never be one. Vaccination may end this pandemic but not the risk of pandemics. Money, technical & operational capacity all needed. 16/17
So we come to the end of the last epi thread of an awful year. We’re in this world together. Those who die diminish us all. Those who build community strengthen us all. Seasons and years pass. What could possibly be more important than preventing disability and death? 17/end
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