Thread by @DrTomFrieden

Covid Epi Weekly January 29: To Arms, to Arms!

Let’s focus:
Get doses out of freezers and into arms ASAP
Denominators: What % of nursing home residents and staff have been vaccinated?
Improve equity. Reach Black, Latinx, Native American, and all underserved groups now.

1/thread

First, let’s get clear about the epidemiology. Better does NOT mean good!! In this case, it means less terrible. The peak of hospitalizations in the prior two surges was 60,000 and we’re at 100,000. So our decreased number is higher than any prior peak. 2/

Thanks @NYTimes for working with @ResolveTSL to provide information on risk in every community. I’m horrified to see communities opening because things are “better” when risk is still very very high, as is the risk of new, more infectious variants. 3/ nyti.ms/2MglGKu

That sickening feeling. Imagine a punch-drunk boxer who has been knocked down twice, staggering up again to face the opponent. That’s us, now, planning to open again because things are “better”. If communities open now, it’s not going to end well for far, far too many people. 4/

Lots of vax developments
J&J single dose about as good as mRNA single dose; 2-dose data pending. Billion doses in 2021. Easier to make, store, ship, give. Half the price
Novovax nearly as good as mRNA
Some strains evade some vaccine-induced immunity
Astra-Zeneca data too murky
5/

J&J vaccine encouraging. In @NEJM article from earlier studies, immune response continued to build at least 57 days after vaccination, and today’s results only to 28 days. Jury still out. But it’s possible we’ll have more and less effective vaccines. bit.ly/3pJSquh 6/

SARS-Cov-2 evolving to adapt to human context. Possible we eventually may need multivalent vaccines – vaccines to cover multiple strains. This wouldn’t be new. Polio: 3 strains. HPV: up to 9. Pneumococcal: up to 23. In future, could be where we’re heading with Covid vaccines. 7/

Vaccines work against strains circulating now. Get them out of freezers into arms. Complicated program, bumpy start. Neglected: Black, Latinx, Native American, poor…and primary care doctors. First-come, first-serve is a recipe to exacerbate inequality. n.pr/36p9wG0 8/

Four platforms:
1-Health care systems
2-Mass vaccination clinics (great article describing one nyti.ms/3j77mzV but do NOT reduce observation time to <15 minutes)
3-Pharmacies (chains AND independent pharmacies)
4-Pop-up, community-outreach sites run by any of first 3.
9/

Biden-Harris goal of 100M in 100 days is ambitious, achievable, but a minimum. Supply will improve in coming months, then need to parse “underlying conditions” w medical judgment not just data re Covid. Higher risk conditions may be rare so no data on people with these&Covid. 10/

There are about 81 million people with high-risk conditions in US. Complexity will make implementation so difficult, but CDC might consider dividing this group into very high risk vs. high risk, not based on Covid-specific data but on review of all available information. 11/

If successful, proportion of deaths in nursing homes will decline then plummet during March. Wow! bit.ly/3psRSsm 1.4M residents 1 dose vax. WHAT’S THE DENOMINATOR? How can we do MUCH better vaccinating staff. Lots of turnover in nursing homes, admission vax needed. 12/

Kudos to NYS for nursing home vax data: bit.ly/3psRSsm. Need positive and negative incentives to encourage staff vaccination. Minnesota also has a good website: bit.ly/3oxleEw. Up next: @Resolve and partners release recommended vaccine indicators this week. 13/

#ProtectHealthWorkers as @AmandaMcClella2 and I wrote for @CNN cnn.it/2LZRhjq. We have failed our caregivers for far too long. In 2021, we should provide safe water for hundreds of thousands of health care facilities, among many areas to make rapid progress. 14/

Vaccine nationalism is self-defeating. Uncontrolled spread anywhere is a risk everywhere. The only way through this is to scale up production, and this will require not only intellectual property as a global good but also vaccine production capacity. bit.ly/3amDZpw 15/

5 points to wrap. First, lower doesn’t mean low. If floodwaters were over the roof of your house and now are up to the top-floor window, it’s still a flood. Especially if a hurricane (read: more infectious variants) may hit you soon. Double down on protection protocols. 16/

Second, don’t focus on individual variants. What variants are telling us is the virus is wily: it can evade our defenses. We need better tracking of not just genomes but how they relate to epidemiology. More infectious variants will spread –that’s how natural selection works. 17/

Third, masking is important. A mask not worn doesn’t protect anyone; any mask is a lot better than none. Better masks MIGHT reduce spread. Double masking, surgical, N95/K95/KN94 have theoretical benefits, but key is to increase the percent of at-risk time people wear ANY mask.18/

Fourth, improve test/isolate/trace/quarantine, even if we can’t do much at current sky-high levels of spread. When cases decrease we can reduce spread through rapid isolation & effective tracing. This will help prevent emergence of escape-mutant strains. Protect our vaccines. 19/

Fifth, Congress must act. Funds needed to reimburse people for isolating. For US Public Health Job Corps. For schools to stay open more safely. For restaurants and bars to stay afloat while they are closed. To protect the US by improving global health security. And much more. 20/

People are what matter to government and a government should aim to give all people under its jurisdiction the best possible life
Most problems have been solved either partially or as a whole by experiment based on common sense and carried out with courage
– Francis Perkins
/end

Correct link for NYS: covid19vaccine.health.ny.gov/covid-19-vacci…