Trevor Bedford Profile picture
23 Dec, 12 tweets, 5 min read
Given the large discrepancy in specimens collected in Dec that were sequenced and shared between the US and the UK, I wanted to follow up on the relative quality of genomic surveillance in the US and the UK. 1/12
First thing to clarify, in the @nytopinion opinion piece yesterday (nytimes.com/2020/12/22/opi…), it's mentioned that "since Dec. 1, Britain has sequenced more than 3,700 coronavirus cases, compared with fewer than 40 cases in the United States, according to Trevor Bedford". 2/12
As of today, the UK has shared to @GISAID 23,377 genomes during Dec and the US has shared 8033 genomes. However, the UK turnaround time has been much faster with 5010 specimens that were collected in Dec shared vs 65 collected in Dec and shared by the US. 3/12
So, although the UK has sequenced and shared a total of 134k genomes during the pandemic and the US has sequenced and shared a total of 52k genomes, the UK has been much more timely in its sequencing. 4/12
Here, I've adapted a plotting style from @hamesjadfield to show specimen collection date in blue and sequence sharing date in yellow for US genomes. There are a great many specimens collected in the spring that are just now being sequenced and shared. 5/12
The average lag between specimen collection and sequence sharing in the US has been 98 days, although 15% of samples are sequenced and shared within 30 days of specimen collection. 6/12
I wanted to look backwards and see if the US's current data level matches historical patterns. Here, I'm showing the number of genomes available from specimens collected in the previous 30 days through time. Recently, there are 100-300 sequences available. 7/12
Comparing to the UK we see a clear difference. Here is the same plot of specimen collection date in blue and sequence sharing date in yellow for the UK. You can see that in the fall the UK made remarkable improvements to their timeliness of sequencing. 8/12
The average lag between specimen collection and sequence sharing in the UK has been 39 days with 59% of samples sequenced and shared within 30 days of specimen collection. 9/12
If we again look backwards at data availability, we see that starting in Oct the UK has thousands of genomes available that were collected, sequenced and shared within the previous 30 days. This is incredibly impressive. 10/12
We can put these two lines on the same plot to see how stark the difference between timeliness of data availability in the US and the UK has been this fall. 11/12
So, the core issue with US genomic surveillance is not volume but cadence. We absolutely need faster turnarounds between specimen collection and sequence sharing. @CovidGenomicsUK has shown what's possible. 12/12

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More from @trvrb

22 Dec
Following up on general thoughts on antigenic drift of #COVID19 from this weekend, I wanted to discuss what we know about the new variant of SARS-CoV-2 thats emerged in the UK. 1/17
This variant is referred to as the B.1.1.7 lineage in cov-lineages.org nomenclature and clade 20B/501Y.V1 in @nextstrain nomenclature and can be seen here within circulating viral diversity, where the variant lineage is highlighted in orange (nextstrain.org/ncov/europe?c=…). 2/17
Broadly, I'd characterize the source of concern as arising from the combination of:
1. Multiple mutations that from sequence composition alone are suggestive of biological importance
2. Observed rapid epidemic spread
3/17
Read 17 tweets
19 Dec
With #COVID19 vaccine efficacy of ~95%, I'm looking forward to vaccine distribution in 2021 bringing the pandemic under control. However, I'm concerned that we'll see antigenic drift of SARS-CoV-2 and may need to update the strain used in the vaccine with some regularity. 1/18
First, some background. RNA viruses all evolve extremely rapidly, but some like influenza are able to accept mutations to their surface proteins in such a way that they can partially escape human immunity. This process is known as "antigenic drift". 2/18
For influenza, this necessitates regular vaccine updates to keep up with an evolving virus population. Other RNA viruses like measles mutate quickly but are unable to change protein structure to escape from immunity and so these vaccines don't need updating. 3/18
Read 18 tweets
17 Dec
There has been a significant question about the degree to which Thanksgiving holiday and associated travel and social gatherings may have contributed to transmission of #COVID19. Here I try to briefly address this question. 1/8
Based on known incubation periods (nejm.org/doi/full/10.10…), we expect, on one end, some infections arising on Nov 26 to become symptomatic on Nov 30 and on the other end, for some infections arising on Nov 30 to become symptomatic on Dec 6. 2/8
This brackets the window where we expect most of the increased case load to be. However, most states only list cases based on date of report rather than date the case became symptomatic. This causes jitter that's hard to deal with when looking for a Thanksgiving effect. 3/8
Read 8 tweets
12 Dec
Although the US is continuing to hit records for daily #COVID19 cases reported, the rate of exponential growth has slowed. Mortality is still catching up to increased case loads and I expect daily deaths reported to further increase. 1/8
This plot summarizes the overall picture. Bubble size is proportional to daily cases per capita from @COVID19Tracking and bubble color shows Rt from rt.live. Timepoints are shown up to two weeks ago due to delay in reliable estimates of Rt. 2/8
The Midwest and Mountain West had rapid growth during October resulting in large epidemics in November, but they're now starting to plateau or decline in incidence. Although current incidence is lower, the epidemic is still growing in much of the East Coast. 3/8
Read 8 tweets
10 Dec
The US reported over 3000 deaths from #COVID19 today and the 7-day average of deaths has hit a record with today's average of 2276. Here, I dig into these grim mortality numbers and look at deaths across ages and across weeks in the epidemic. 1/14
I'm using data from @CDCgov (cdc.gov/nchs/nvss/vsrr…) that records weekly deaths involving COVID-19 as well as deaths from all causes. These data use actual date of death but there is a reporting lag. 2/14
CDC reports 261k deaths involving COVID-19 in this dataset. Over half of these deaths are in individuals 75 or older and over three quarters are in individuals 65 or older. 3/14
Read 14 tweets
4 Dec
The US is reporting over 2000 deaths per day from Dec 1 and I believe will do so consistently throughout December based on daily case loads above 120k starting early November. 1/4
A drop in reporting over Thanksgiving weekend has made for some difficulty in directly comparing 7-day averaged deaths, but the trend is clear. Red bars are daily reported deaths from @COVID19Tracking and black line is 7-day sliding average. 2/4
The simple projection of 1.7% of reported cases into deaths 22 days later has remained largely accurate, although drop of reporting during Thanksgiving weekend is quite clear. We'll know soon whether 7-day average returns back to projection. 3/4
Read 4 tweets

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