Things are very concerning with the pandemic

Not just vaccine distribution but outbreak itself

It's bad

Yesterday we had more than 4,000 deaths from COVID19

Highest single day ever

But story is worse when you look at cases, hospitalizations

And thus, urgency to act

Thread
Let's talk data -- via @COVID19Tracking

7-day moving averages from yesterday

Daily deaths 2761: highest ever

Daily new hospitalizations: 4284: highest ever

Daily new cases: 224K: highest ever

% positive: 16.6%: highest since Apr 21

You know what's not highest ever? Testing
So this is a problem for lots of reasons

Obviously, having more Americans dying is horrible

But yesterday's deaths represent infections from mid-December

Before the holiday surge

And back then, cases were lower

And the percentage of tests positive was lower

3/8
Remember, % positive is another way of asking – how many infections are you missing?

And at 16.6% positive – we are missing a vast majority of infections

And of course, there’s the new variant that we aren’t tracking closely

So what do the numbers mean?

4/8
With case fatality rate around 1.7%

Yesterday's 4,000 deaths will soon become new daily norm

And lets talk testing because it remains a problem

We did as much testing yesterday as we did on November 20

So since 11/20, Cases are up 35%, deaths have doubled, but testing is same
With variant starting to take off, easy to see us hit 500,000 deaths before February ends

Catastrophic

But not baked in. Not inevitable.

We can substantially slow deaths in February

How? By getting high risk people vaccinated in January

6/8
Remember that >90% of deaths are in people over 55

Which is why we have to prioritize getting vaccines out quickly, especially to older people

And why Biden Team announcement to not hold back doses is so smart

Bottom line is this:

We are in for a VERY rough few months.

7/8
A horrible January largely baked in because of failures in December

But what we do in upcoming weeks will shape February

We have to remain careful, wear masks, and push on testing

But critical to get as many vaccinated in next few weeks as possible

It will save a lot of lives

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More from @ashishkjha

3 Jan
I've been thinking about the debate of delayed vs. immediate 2nd dose for some time

Over past week, have become convinced that getting all doses out now is better

Its NOT a no-brainer

Reasonable people can (and do!!) disagree

So here's why my thinking evolved

Thread
Obviously, if you want to stick to the trials (reasonable position), then stay with standard interval

But soon, we'll be confronted with question -- do we give 2nd shot to some people or 1st shot to more people

Is there clinical trial evidence that 1 dose is helpful?

Yes

2/n
Yes

There is compelling data from Pfizer and Moderna trials that after about 10 d after 1 dose, you get 80-90% efficacy

fda.gov/media/144245/d…

nejm.org/doi/full/10.10…

So the BIG question is -- is that going to be durable beyond 21 to 28 days?

We don't know for sure

3/n
Read 10 tweets
30 Dec 20
Really important news out of UK

Important for UK and the world

But I have mixed feelings about the science here

So what's the news?

UK MHRA (their FDA) has authorized the Oxford Astra-Zeneca vaccine

Why such a big deal & why am I conflicted?

Thread

gov.uk/government/new…
First, the data

UK regulators suggesting that the data they evaluated suggests vaccine has 70.4% efficacy

gov.uk/government/pub…

With zero hospitalizations & zero severe disease in vaccine arm

So that’s good

But not as good as Moderna or Pfizer vaccines (in efficacy)
So why is it such a big deal?

1st, UK will start vaccinating people next week at large scale

2nd, India, other countries will likely now approve this vaccine

And India likely has tens of millions (if not more) doses ready to go

3/n
Read 9 tweets
29 Dec 20
So a lot of chatter happening on the slow vaccine roll out

Personally, I'm incredibly frustrated.

Did we not know that vaccines were coming? Is vaccine administration a surprise?

Several complex issues so lets break things down a bit

Warning, this is a bit of a rant

Thread
First, we were told in October that we'd have 100 million doses by end of December

100 million

Who said that? @SecAzar

In The Hill. Like 10 weeks ago

Then, by november, Azar was saying 40 million doses ready to ship out by end of December

thehill.com/changing-ameri…
Here's Azar in @thehill saying 40 million by end of the year

In December, Operation Warp Speed says 20 million doses will be out by end of year, they'll keep the other 20M in reserve for 2nd dose. Fine

3/n

thehill.com/changing-ameri…
Read 14 tweets
12 Dec 20
Michigan vs. Ohio State Football today postponed due to COVID

But a comparison of MI vs OH on COVID is useful

Why?

While vaccines are coming, we have 6-8 hard weeks ahead

And the big question is -- can we do anything to save lives?

Lets look at MI, OH for insights

Thread
On 11/15, Michigan announced series of restrictions

Ohio didn’t

We can compare the two to see if Michigan policies helped

Why is Ohio a good comparison?

OH a neighbor of similar size, make-up (urban/rural, etc)

Here's COVID cases through 11/15

(OH in red, MI in blue)
The two states have tracked very closely

Similar states

Similar policies

But then, things changed mid-November

So let’s talk data (@COVID19Tracking 7-day moving avgs)

3/9
Read 8 tweets
7 Dec 20
Something concerning happening tomorrow in Senate Homeland Security Committee

Sound familiar? It is

@RonJohnsonWI holding part II hearings on Hydroxychloroquine

Prominent Anti-vax & pro-hydroxychloroquine doctors (yes, they exist) will be there

We have a response

Thread
The hearings are meant as a questioning of the scientific process

To sew doubt on what we know and how we know it

So a group of us organized a response, which we just posted on our website

It isn't pro or anti hydroxy

Its about the scientific method and why it matters

2/3
Signatories are many of the leading experts medicine, biomedical science

There are other experts we didn't get to ask (sorry)

Not arguing that you should trust me or us over others

You should trust the scientific method

And the scientific community that tries to get it right
Read 5 tweets
5 Dec 20
There were 225,000 new cases identified yesterday

Sat through Monday, cases will dip (usually do)

But we are now seeing Thanksgiving effect

Based on yesterday's cases alone

Expect 5K-6K hospitalizations 12/11 (if hospitals can accommodate)

and 4,000 deaths on 12/26

Thread
225K yesterday is starting to incorporate Thanksgiving infections

After every holiday, we see cases rising Thursday/ Friday after

I expect next week’s case numbers to climb higher

Thanksgiving surge just beginning so things could get worse

But there is hope here

2/5
They could get worse because after every holiday weekend, the surge begins Thursday/Friday after

And keeps going for a while

So we could easily get to 250K cases a day and keep rising

But here's what might help

In some places, people are starting to respond

3/5
Read 5 tweets

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