Thread by @DrTomFrieden

Covid Epi Weekly: Could Covid Kill 1 Million Americans?

New strains are a shot across the bow. A message from the virus: We outnumber you. We’re more persistent. We change and adapt.

It’s up to us: Fight smarter. Collaborate. Protect ourselves and each other better. 1/thread

First, the numbers. Cases, hospitalizations, deaths continue to increase; expect continuing increases. The scale of cases is mind-boggling. More than 1.6 MILLION diagnosed last week - maybe a million total infections a day. bit.ly/2XLsamQ 2/

May be the beginning of a plateau of hospitalizations; too soon to be sure. If we could scale up infusion of monoclonal antibodies for people at risk for hospitalization but not yet very ill, we could reduce this number and the stress on health workers and health systems. 3/

Health care workers continue to be avoidably and unacceptably at risk. @ResolveTSL and partners released a report this week calling for action globally. Banging pots is great, but providing the policies, support, and supplies needed is a lot better. bit.ly/3nPkhaz 4/

Epidemics are guided missiles attacking disenfranchised people. We need to do much better. Disproportionate impact means the need for disproportionate resources and support. Focusing on the hardest-hit communities is not just about fairness, it’s also about effectiveness. 5/

Horrifying new projection: COVID-19 will reduce US life expectancy by 1.1 years, with reductions for Black and Latinx populations of 3 to 4 times that, reversing more than 10 years of progress closing the Black−White gap in life expectancy. 6/ bit.ly/35L9JTB

New strains. Data from UK clear: B.1.1.7 more infectious, maybe 30%+ more. Strains from S Africa and US also likely more dangerous. Evolution of a microbe that evolves quickly. More uncontrolled spread anywhere means more dangerous strains, higher herd immunity threshold. 7/

More infectious strains require better defenses. Not more of same, better of same.
Minimize time indoors with others not in your household
Better masks. Surgical, N95, as available. bit.ly/3ijuV85
Accelerate vaccination
Treat early
Test, isolate, quarantine
8/

I wrote about this earlier today in the link here. Bottom line: It’s not impossible that Covid could kill 1 million Americans. But it’s not inevitable either. This can happen, but only if we let it happen. fxn.ws/3ighOVe 9/

New variants are a shot across the bow: the virus can become much more dangerous. Scary study: “SARS-CoV-2 has the potential to escape an effective immune response and that vaccines and antibodies able to control emerging variants should be developed” bit.ly/35GTvuE 10/

Vaccination: progress but avoidable confusion, continuation of failure of organization and marginalization of public health. Better CDC website on vaccines. Most encouraging: some states doing well and steady progress in long-term care facilities. bit.ly/2Kichkw 11/

It should be straightforward. 4 priority groups for vaccines:
All nursing home residents and staff
All healthcare workers with potential exposures
All people over age 65
All frontline essential workers.
That’s ~100 million people, ~200 million doses, but uptake will be <100%. 12/

We will have too little vaccine until we have too much. Not enough transparency about how much vaccine is in pipeline from which companies, when delivery is expected. Too little accountability or ability to plan. By March/April, hope to have additional vaccines and quantity. 13/

Chaotic rollout, patchwork policies. Current admin plan seems to be pointing fingers at states. Only route to success is a whole-of-government, whole-of-society approach. If we’re divided, the virus will continue to conquer us. Won’t be quick or easy. nyti.ms/39FbwdQ 14/

Vaccination in nursing homes is crucial. We can reduce death rates before we reduce case rates. By mid-February, the proportion of deaths from nursing homes should start to fall as a result of vaccination. Way too little data on LTCF vaccination. bit.ly/2LF0sFR 15/

Kudos WVa, credit @claymarsh&co >6% vaccinated, all LTCF started, good vaccine dashboard tho better if compared vax with % of state population. If US had given the same % of distributed doses as WVa, another 8 MILLION vaccines would have been given!!! bit.ly/2XMFbMJ 16/

Primary care important for vax. Now, many primary care clinicians can’t even get vaccinated themselves! Data from MA shows gap. Deeper issue: We must fix US primary care system, in addition to fixing US public health system. More to come on this. bit.ly/3oPK3wF 17/

Expect to see better information on who’s getting vaccinated. Need more transparency on this and on reasons for delays releasing information. Understandable there’s missing data. Zip code data can help since, sadly, geography is usually a close proxy for socioeconomic status. 18/

Some keys to successful vax programs:
Trusted community members, messages
Reminders, convenience (hours, locations, time)
Avoid hidden costs eg reimburse travel to sites
Make vax social norm
Anticipate and counter misinformation
Focus on personal, family, collective benefits
19/

Next week will delve into differences among states & why most comparisons you read are wrong. Look at differences in testing rates by state. Incidence numbers of little use without knowing testing intensity (range<100 to 10,000/100K) and positivity. bit.ly/3ig5PXX 20/

Remember the wisdom of William Farr: The death rate is a fact; all else is an inference. Very concerning death rate increases in the UK, Ireland (note horrifying shape of curve), S Africa. More infectious virus → more infections → more deaths. 21/

Thanks to @WSJ for analyzing excess deaths. This is important. Many excess, most in some countries, are from Covid directly (likely Russia, Turkey, Mexico), and others from disruptions (e.g. treatment of heart disease) caused by Covid (e.g., S Korea). on.wsj.com/3623MSz 22/

There’s good news. Vaccines are coming. We understand the virus and how to protect ourselves better. The US response is getting more organized, competent, and transparent. More recognition that we’re all connected. The virus can catalyze community and global collaboration. 23/

Don’t let your mask down. Don't let our guard down.

Learn, connect, empower.

2021 can usher in a more connected, empathetic world.

“Only that day dawns to which we are awake. There is more day to dawn. The sun is but a morning star.”
-- Thoreau

24/end of thread