Thread by @DrTomFrieden

Covid Epi Weekly: Don’t Ease Up on the Brakes!

Variants are coming—but so are vaccines. Let’s double down on protection protocols (masks, distance), scale up equitable vaccine delivery, spur innovation in vaccination and control measures. We can avoid another, steeper curve.1/

First, encouraging news. Cases, hospitalizations and percent positivity plummeting in all ages, all parts of the country, and deaths have begun to decline. Now the bad news: infections are still VERY high, as high as the peak of prior surges. Can’t ease up on the brakes now! 2/

Most likely explanation for the rapid rise and rapid fall: travel accelerates viral spread exponentially. We’re recovering from the huge amount of ill-advised travel and indoor contact over the holidays. And, far too many are not recovering. More than 20,000 died last week. 3/

This is a fight against the virus, but also against becoming numb to the horrifying toll. The 7-day average is still 3,000 deaths per day, the number killed on 9/11. Every life is precious. Every death robs us all. 4/

The sooner we vaccinate and the better we tamp down spread, the lower the risk from variants. Steady tho rocky and uneven progress with vaccination. @ResolveTSL & partners released recommendations for indicators every state should post on vaccination. bit.ly/39SOKRl 5/

Two glaring gaps: data on vaccination by race/ethnicity over time and vaccination coverage of staff and residents in nursing homes. Not coincidentally, there are problems not just with data availability but also reality in both areas. These are life and death problems. 6/

First, race/ethnicity. We need to see vaccinations by race/ethnicity over time. Unless this is available weekly, there’s no way to know if we're getting better addressing inequality or not. See age coverage over time from N Dakota. Need same by race/ethnicity. 7/

Data on vax by race/ethnicity is alarming: KFF: bit.ly/3aBT86d. Ohio has a good dashboard; as appears to be case nationally, Black and Latinx people are getting vaccinated at about half the rate of White people, despite having 2-3x the death rate. We MUST do better. 8/

Great progress vaccinating nursing home residents, ~80% first dose. Staff, well under half. There’s lots of turnover of residents, so admission vaccinations are essential, and we MUST do better reaching staff. Positive and negative incentives for staff are important. 9/

Vax on nursing home admission needs to be routine, but that means a different model from the pharmacy program. Unless there’s focused attention to vaccinating new residents, this will be missed. In the context of low staff vaccination rates, that would be a deadly mistake. 10/

Staff vaccination needs focused outreach, education, engagement. But at some point, there’s an ethical question. A staff member who isn’t vaccinated may bring in infection that results in deaths of many residents. This has been an issue with influenza vaccination for years. 11/

Thanks to @drgregpoland for raising the issue of health care staff vaccination for years. First must come making vaccination free, convenient, and sensitive, and addressing staff concerns. But at some point, staff choices may have lethal implications. bit.ly/2MDg796 12/

Tsunami of info on vaccines in the past week. J&J vaccine is promising: single dose, easy to handle, 85% protection against severe illness. Every new way to fight Covid helps. Expect approval in Feb and increasingly widespread availability of this vaccine starting in April. 13/

Interesting pre-print data suggesting that single dose of mRNA vax may be sufficient in previously infected people. Practically, it would be difficult to get serology in the context of a mass vaccination program. But may be relevant for individuals. bit.ly/2ObydQ1 14/

Single dose of AZ vaccine reported to result in stable immunity for at least 3 months, but data is messy and not yet peer-reviewed. UK decision to delay second dose is reasonable in context of explosive spread of variant, but we need much more data. bit.ly/3cMgzfK 15/

An approach from Russia using two different vectors also appears to be effective. Remember that old saw: Just because you’re paranoid doesn’t mean they’re not out to get you? Well, just because the data is dodgy, doesn’t mean the vaccine doesn’t work. bit.ly/39QuuzM 16/

Many different vaccine approaches are still being developed. China has a wide range of vaccines under development, ranging from inactivated, to vector (like Astra-Zeneca and J&J), to subunit (like Novovax). Shouldn’t mRNA be a global public good for all? 17/

Thanks to Tony Fauci for clear summary below of the different approaches being used for vaccine development in the US. It’s amazing scientific progress – and also luck: Immunity is robust (unlike TB, malaria, HIV), mRNA and adenovirus vector technologies are just-in-time. 18/

Encouraging data from Israel. Vaccination of people over age 60 leads to big reductions (dark blue line in middle and right graphs) of severe illness. How about Palestinians in Israel and in the Occupied Territories? Everywhere, disparities and inequalities must be fought. 19/

So if we’re ramping up vaccination, and the proportion of people with immunity from being infected (which, as another and very interesting study shows is likely protective bit.ly/2MZpUWO) is increasing steadily, what could possibly go wrong?

Variants, that’s what. 20/

In Manaus, Brazil, P1 variant caused at least 1 reinfection. Not enough data to know if rapid rise due to reinfection among people previously infected with other strains (due to waning immunity or immune escape), increased transmissibility of new variant, or combination. 21/

One line in Novovax press release on South Africa trial reports reinfections with new variant but no data. Another good summary from Tony Fauci of what we know about variants. We need to pay less attention to individual variants and more to what variants are telling us. 22/

The virus outnumbers us; we need to outsmart it. Uncontrolled spread ANYWHERE is a risk everywhere; deadlier strains may emerge. It’s in our self-interest to make sure the virus is controlled in US and globally. Vaccines protect us. We must reduce spread to protect vaccines. 23/

“Injustice anywhere is a threat to justice everywhere.”
Dr. Martin Luther King, Jr

Uncontrolled viral spread anywhere is a threat to viral control everywhere.

Ill health anywhere is a threat to health everywhere.

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