Thread by @DrTomFrieden

Covid Epi Weekly: Humanity vs Virus – the Virus is Winning

Perfect storm: 1. Uncontrolled spread in most of US, 2. Slow vaccine rollout, 3. Worrisome mutations increase transmissibility and could undermine diagnostic testing, antibody treatment and vaccine efficacy.

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A misleading narrative suggests that uncontrolled spread of Covid shows that public health measures don’t work. The plain truth: most places didn’t stick with the program long enough to get cases to a manageable level and now masking and distancing aren’t being done reliably. 2/

So yes, if you don’t use masks correctly and consistently, they don’t work. And vaccines don't work if people don’t take them. CDC data getting ever more available and useful; Covid Tracking Project remains invaluable. bit.ly/3q2jAMm 3/

Record high cases, hospitalizations, deaths–with continued increases. There’s a 1-2 week lag between cases and hospitalizations and hospitalizations and deaths. Expect continued increases in deaths. Scaling up antibody treatment might help, but, like vaccines, rollout botched. 4/

How stressed are hospitals? New tool with HHS data shows % of beds with Covid patients, which is more reliable than % of ICU beds filled; ICU beds can be added more easily than hospital beds (convert surgical recovery suites, anesthesia rooms, etc). Anything >15-20% is bad. 5/

But it’s not limitation of beds that’s most dangerous, it’s limitation of staff. Health care workers are exhausted, at risk, relief months away, no reinforcements likely to arrive from other parts of the country. Great that vaccines getting rolled out. bit.ly/2LyOKw9 6/

Why do some parts of country have much more Covid than others? Rates of hospitalization range 4-10-fold among states. Fundamentally:
Opening too soon, leading to rapid resurgence
Failure to distance and mask
Failure to find and stop outbreaks
Bad luck - superspreading events. 7/

In most places, public health measures didn’t fail, they weren’t applied. To a striking degree, this breaks down along partisan lines. Look at Staten Island. The northern part, which is poorer and more Black and Latinx, has worse health outcomes and shorter life expectancy. 8/

But southern Staten Island, which is richer, whiter, & regularly votes Republican, has higher rates of Covid, including higher test positivity (~15% vs.~10%). on.nyc.gov/2X0R6Ya Similar differences, generally, between southern/northern California and US South and North. 9/

We take vacations but the virus doesn’t. Good thread from YYG; we are nowhere near herd immunity. bit.ly/3nsw7aq As Josh Lederberg used to say, microbes outnumber us: it’s our brains against their numbers. Places like VT, Oregon doing much better than others. 10/

Reporter asked why Ca doing as badly as Texas despite more restrictions. Faulty premises. If Texas had California's death rate, 8,120 dead Texans would be alive today. And places in California haven’t masked, distanced. Societal failure to implement public health measures. 11/

PCR test positivity rates are increasing steadily in 12-17-year olds and in 5-11-year-olds, these ages now highest of any age groups. Although imperfect, positivity rates are important to track. Not a good trend. Seeding of the virus throughout communities and the country. 12/

SECOND concerning trend: slow vaccine rollout. Some understandable–new vaccine, difficult storage. Some incompetence–run like grocery delivery not vaccination campaign, failure to support state/local microplans. Even for a competent government this would have been hard, and….13/

Grocery delivery: temperature, restocking cadence. Vaccination program: community engagement, detailed microplanning of who will vaccinate, where, when, how, and two-way communication, identification of trusted messengers and messaging in every community. 14/

Most important, least known documents re vaccination, buried.
1. Checklist bit.ly/39fCwR5Vaccine
2. Action: bit.ly/2L5Teul
3. HCW bit.ly/35qeYrB
We put together materials on how to plan for and communicate about Covid vaccination. bit.ly/38tmEeC 15/

Some plain talk on vaccines. They’re stunningly effective and, so far, reassuringly safe. Allergic reactions to Pfizer vax: 11 per million, 70% among people with a history of anaphylaxis or allergy. Among people without such a history, about 1/500,000 bit.ly/3hXOv9L 16/

Operation Warp Speed: Stop hoarding vaccines!!! No need to hold back half. Get them out fast. Although it’s possible manufacturers will miss their production targets, that’s a lesser risk than not flooding the zone ASAP with vaccines. Jeez. 17/

We should move to Phase 1C1 ASAP (like, today)–all 65+, all health workers, all nursing home residents/staff, frontline essential workers. Good information on how to promote vaccination. Bottom line: focus on making it convenient and the movable middle bit.ly/3nmjbCU 18/

Hint: same folks not likely to wear masks not likely to get vaccines. Need to segment market and target messages to different groups. Focus on getting back to normal. Protecting jobs. Protecting our families. Despite rocky start, we’re making real progress – 7M vax given. 19/

Lots of unknowns re AZ/Oxford vaccine. Maybe less likely to give “sterilizing immunity”. Studies urgently needed on prime/boost approach to see if higher protective efficacy confirmed. Reassuring fewer serious infections and no serious adverse events. bit.ly/3s55wUh 20/

But...if it turns out that we have vaccines that are 70% effective vs 95% effective, it’s going to raise terrible questions. Scientific knowledge should be public domain, and walk-in rights for making the best vaccines for the most people are a moral imperative. 21/

Now, THIRD, if uncontrolled spread and slow rollout didn’t alarm you...new strains of virus. At first I thought maybe the UK was blaming mutations for sloppy public health work – but no. Strain is more transmissible. Not inevitable that it will spread in the US, but likely. 22/

I've never seen an epidemic curve like this. If strain becomes common in US, close to worst-case scenario, w/ baseline of full hospitals. (Not worst case: Covid CFR ~1/200. Worst case 1/10.) Potential for perfect storm especially with political turmoil and leadership vacuum. 23/

UK and Ireland deeply concerning. In just a few weeks, from less than 1 in 10 new strain to nearly 1 in 4 (Ireland) and half (London). Need more data, and relaxation of indoor restrictions undoubtedly helped the virus spread, but the trend is ominous. bit.ly/3oFSQRT 24/

Let’s be clear: new strains emerge. B.1.1.7 more transmissible so will cause more infections, hospitalizations, deaths. Strains may emerge that make testing less accurate, treatment less helpful and vaccines less effective. B117 is a shot across the bow. Covid here for years. 25/

We’ve failed at controlling Covid in US. If more infectious strain takes hold we’ll have to do much better. No avoidable indoor exposures. Maybe, better masks. We should definitely not change vaccine schedule now, but if we get a UK-like situation, this has to be considered. 26/

We have another 11+ days of absent leadership and active undermining of public health measures to save lives. These days are so very dangerous, for so many reasons, including the potential for exponential growth of the B.1.1.7 strain. 27/

Many years ago, Senator Moynihan said, "Everyone is entitled to his own opinion, but not his own facts." That should not be too much to ask. We need to get back to that perspective, urgently, to protect ourselves and our families. 28/

Long but must-read article. As I think about 2020, I mourn the 400K+ (right number considering excess mortality) deaths in US, many/most preventable. But I can never forget–and do not want to forget–the horrific, lynching-like killing of George Floyd. bit.ly/3sfvS6j 29/

“Concern for man and his fate must always form the chief interest of all technical endeavors. Never forget this in the midst of your diagrams and equations.”
– Albert Einstein
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