1/ THREAD on Sweden & "natural herd immunity":
COVID cases RISING in Sweden since August/September, as is the case across Europe. DEATHS are a LAGGING indicator (~6-8+ weeks after infections). It is likely Sweden will experience another SURGE in DEATHS in the coming weeks.

@celinegounder

@celinegounder 2/ Like the U.S., Sweden FAILED to suppress virus transmission over the summer, in contrast to Sweden’s neighbors, like Norway and Germany. That was DESPITE many Swedes leaving urban and suburban areas for remote cabins in the summer.

@celinegounder

@celinegounder 3/ Italy was hit hard and early. England initially took a herd immunity approach to the pandemic (the tallest peak). The U.S. and Sweden have almost identical curves. Sweden’s neighbors Norway and Germany sustained much smaller losses from COVID.

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Céline Gounder, MD, ScM, FIDSA

@celinegounder

16 Oct 20

1/ LOVELY in THEORY, but herd immunity WILL NOT work:
POTUS "vowed to shield America’s senior citizens from the coronavirus & directed them to stay home amid the pandemic" politico.com/news/2020/10/1…

2/ Measles has infected humans since at least the 9th century. Smallpox? Since the 3rd century BC. Both are respiratory viruses, like coronavirus.

3/ We have yet to eradicate measles via natural infection & immunity. We only reached herd immunity to smallpox with a vaccine & a MASSIVE eradication effort. When you let respiratory viruses like measles, smallpox, and coronavirus spread naturally, you get big epidemic spikes:

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

7 Oct 20

@CDCgov

1/ Late last month, Dr. Bill Foege—@CDCgov Director '77-83, central figure in smallpox eradication, former Task Force for Global Health & Carter Center leader, Senior Fellow at the @gatesfoundation, and a devout Christian—sent this plea to @CDCDirector Bob Redfield.

@CDCgov

2/ We are witnessing a "colossal failure of the public health response in this country." The result of "incompetence and illogic." The @CDCgov is the preeminent public health institution in the world. They should have been leading the response from the beginning.

3/ Basic tenets of public health:
- "Know the Truth." This White House is about obfuscation & confabulation.
- "a coherent FEDERAL plan," not a patchwork response: podcasts.apple.com/us/podcast/epi…
- We need cooperation & coalition, not division. The virus is winning by divide & conquer.

Read 8 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

5 Oct 20

@Elemental

1/ Great speaking with @Elemental's @smithdag today.
elemental.medium.com/everything-we-…
Some highlights:
- “If the fever came down on its own, that’s a very good sign prognostically. If the fever required medication to come down […] it wouldn’t necessarily mean he’s getting better..."

2/ Steroids like dexamethasone and medications like aspirin, Tylenol, and ibuprofen will reduce a fever.

3/ On Fri/Sat, Trump had an oxygen saturation below 94%. Dr. Conley said it didn't got down to the low 80s. So that would imply it dropped to the upper 80s.

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA

@celinegounder

5 Oct 20

1/ POTUS says he's leaving Walter Reed and going back to the White House: washingtonpost.com/elections/2020…
Assuming he got sick Wed/Thurs, he's on day 5 or 6 of COVID. It's too early.

2/ On day 2 or 3 of COVID POTUS already had evidence of severe COVID with oxygen saturation under 94% on room air (& likely into upper 80s) & supplemental oxygen requirement.

3/ COVID patients often get worse at 7-10 days into illness (i.e. this Fri or Sat). I hope that doesn't happen. But he should be closely monitoring in a hospital NEAR AN INTENSIVE CARE UNIT until then.

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