Heard of SARS-CoV2 variant from Japan?


How about one from South Korea?


Surely variants from New Zealand & Vietnam?

Of course not

Because these places haven't given rise to scary variants

But what places have.....has big implications for ending the pandemic

So let’s talk about where variants ARE coming from and under what circumstances

Variants arise when infections run wild

And selection pressures lead to dangerous mutations that can then thrive

Remember, every infection creates opportunities for “errors” – or mutations

Most mutations are meaningless

They will have no real clinical implications

But every once in a while, a set of mutations will lead the virus to become more contagious, more lethal, or improve its ability to escape our vaccines

So where are the variants coming from?

UK, South Africa, Brazil –and possibly US (LA variant still being sorted out)

Each of these countries had large outbreaks even before their variants took off

So what are implications if we ever want to end this pandemic?

We have to bring pandemic under control everywhere

Letting virus run wild, like US, Brazil did, endangers everyone

Imagine this

Some nations are largely vaccinated

But outbreaks are surging elsewhere

What might happen? We might see rise of variants that eventually escape the vaccines

And make everyone vulnerable again

In a future where US is vaccinated but others are not

We could see rise of variants that can infect, cause outbreaks here and other vaccinated places

Requiring us to update our vaccines and vaccinate everyone again

It’s the nightmare scenario of a never-ending pandemic

There is only one solution to put this nightmare pandemic behind us

Get outbreaks under control everywhere


Put in place virus control policies, get people to wear high quality masks, have more testing


Vaccinate the world


As quickly as possible

This is what makes herd immunity advocates (remember Great Barrington Declaration?) so naive

They literally advocated for virus to have more chances to mutate

And what makes U.S. isolationist policies so naive

Because we live on one planet

And variants travel

Want to end the pandemic?

Lets marshal global manufacturing effort to make lots of vaccine quickly

And vaccinate everyone

Because large outbreaks anywhere can give rise to variants that can escape vaccines everywhere

At the end of the day, we really are in this together


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More from @ashishkjha

24 Jan
Wondering whether the national COVID data is just a blip or something more substantive?

I think there is something good going on

Cases across the U.S. really are falling...and while its only been 2 weeks, it looks real

Here’s @FT graph that shows drop in new infections

You could look at this and say – hey, we’ve been in downturns before.


But last 2 downturns were smaller and both were largely data artifacts (under-reporting during Thanksgiving and Christmas)

This one is different

Is it a big deal? I think so

Let’s look at data: 7-day moving average from @covid19tracking

US case counts peaked 1/11/21 at new 244K cases daily

We are now down nearly 30% to 173K

Hospitalizations peaked at 131K, now down about 8% to 120K

We know deaths lag so no surprise, deaths are flat

Read 10 tweets
20 Jan
Among the Executive Orders that President Biden will sign today, I want to highlight one

It is critically important if we want to end this global pandemic

The EO that rescinds Trump's efforts to withdraw the US from @WHO

America is better off engaged with WHO

We live in a deeply interconnected -- indeed, interdependent world

That may be the single most important lesson of the pandemic

Support for U.S. leadership in global health has always been deeply bipartisan

Engaging WHO and global health more broadly has many benefits

Engaging in global health is consistent with our moral values

We are, at our best, a nation deeply committed to partnership and well-being of others

But U.S. engagement also benefits us

Bringing the pandemic to an end saves lives across the world, including those of Americans
Read 6 tweets
13 Jan
Looking at hospital data, there's something concerning happening in America's ICUs

There are 27,000 COVID patients in ICUs right now

On October 2, there were 7,000

And in order to accommodate the increase, hospitals are reducing access of non-COVID patients to ICU care

So let’s talk data, hospitalizations, & rationing

Think like a hospital leader facing a surge of COVID patients

What do you do?

First, as # of COVID patients starts to spike, you expand capacity

You convert ORs and anesthesia units to ICUs

You open up field hospitals

But what if surge continues?

At some point you can’t expand further – you're running out of staff

So you tell your doctors & nurses: Hey, ICU is full

Implicit message: slow down ICU admissions

As ICUs fill w COVID pts, ability of non-COVID pts to get ICU care diminishes

Read 14 tweets
12 Jan
We are in the worst days of the pandemic

How do we get through this?

So I’m teaming up w/ my friend, colleague, @MeganRanney to teach a new rapid-response course in Pandemic Problem Solving at @BrownUniversity


Quick thread on why & what to expect
Things are bad with this pandemic

Our institutions continue to confront major disruptions

The healthcare system is reeling

The vaccine rollout is slow

Businesses keep having to adjust their operations

Policymakers are struggling with how to devise good policy

But we have learned a lot already from how we navigated earlier waves of this pandemic

From sourcing PPE to our struggles to implement robust testing and tracing

Each week in this course, we will hear from leaders who will share their lessons learned

Read 6 tweets
11 Jan
Just spoke with a close colleague, thought I'd share his story

Have changed minor details to protect him

He's an ER Doc, working in a hot spot

Few days ago, early evening, vaccine team showed up with a bunch of extra doses of Moderna vaccine

They were looking for unvaccinated employees

Most employees there had been vaccinated. Rest were unwilling

Found several EMTs & patients who were excited to be vaccinated

But hospital policy was clear: non-employees aren't eligible

My friend, ER Doc, incensed, intervened

He tried to persuade vaccine team but they wouldn't over-ride hospital policy.

He called ER leadership. They wouldn't over-ride

Next, hospital leadership. They initially said no, claiming state mandate

He is persuasive and persistent....so they eventually relented

Read 5 tweets
10 Jan
Important @apoorva_nyc piece. Highlights bigger issue

Hospitals rightly prioritized for vaccines because of front-line workers: nurses, doctors, staff

But many vaccinating non-front-line staff, administrators, even wealthy donors on their Board


I have mixed feelings here

We need to get shots out

Reasonable to vaccinate folks working in hospital lab

But administrators? donors on boards? Their families?

There is a better way

Hospitals should use left-over doses for elderly, at-risk folks in their community

Hospitals are getting mixed messages

Told to use their vaccines quickly (good)

Told to not let any cut in line (appropriate)

Told not to give it to non-hospital folks (ugh)

Hospitals have doses left over (due to staff hesitancy)

They are worried about not using it right

Read 4 tweets

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