Thread by @WhitneyEpi

@rwidome Popping in real quick with my gut opinion: what goes up must come down”. The pattern is US is, when things spin out of control to a certain threshold, governments, workplaces and individuals alter behavior...

@rwidome It can be hard too see nationally because many of the outbreaks are local...

@rwidome But, over and over again, the big spikes in cases, hospitalizations, and deaths are followed by steep drops in Rt (transmission rates) as people and institutions get the message that, Oh, this is bad!

@rwidome You saw it even in very anti-restriction places like SD after their awful outbreak a few months ago. I really like @_stah’s daily plots of state Rt vs infection rates to visualize this. You definitely see the regional changes after outbreaks.

@rwidome @_stah The issue is that it’s not durable. So, over the past year, you’ve seen a place like AZ climb in Rt, get to a tragic level, decline in transmission then months later, another climb. Has happened in other states too.

@rwidome @_stah There is a widespread national decline in transmission rates happening now (<Rt), which is good news... (except TX going in wrong direction fast! 🤦🏾‍♀️)

https://twitter.com/_stah/status/1357638227306426373

@rwidome @_stah I think what made January different is that every part of the country saw a rapid rise in transmission: the Thanksgiving increase, followed quickly by the Christmas increase caused a crush of hospitalizations and deaths... it was widespread and un-ignorable...

@rwidome @_stah So I makes sense that rates coming down fast all of the country now, but there are caveats...

@rwidome @_stah First some of this is “regression to the mean” (not using that term accurately). Rates got so dizzingly high in January that they almost had to fall...

https://twitter.com/covid19tracking/status/1357855157338443780

@rwidome @_stah Even with case rates dropping fast, they are still double what they were at the peak of the summer surge. That’s remarkable! Im going to show the pics again bc they are stunning. We’ve just been through a terrifying surge in cases

https://twitter.com/covid19tracking/status/1357855157338443780

@rwidome @_stah * typo above: Rt<1

@rwidome @_stah I fear that this drop is not durable either. Our pattern in much of US is rolling surges (case surge, tighten up, loosen up, stabilize, case surge...repeat). Now throw new variants into mix potentially. depressing but not surprising that transmission rates rising in most states

https://twitter.com/_stah/status/1357638227306426373

@rwidome @_stah So in the picture above every state has 2 nodes connected by a line. Node in darker color is more recent, lighter colored node is past. If dark node higher on y-axis than light-colored node, then transmission rising. We see that in TX but many other states too

@rwidome @_stah Fortunately Rt still looks to be under 1 for most states so case numbers should keep dropping. But the direction shows rising Rt. Once Rt>1, case counts start rising again. It’s not looking great to me without serious National intervention...

@rwidome @_stah I think vaccination will help, but supplies limited & most states poorly targetting by (1) highest risk of death (besides nursing homes, #LTC - that’s good targetting! 🎯) & (2) esp transmission. #2 relevant for case counts. I’m not expecting big drops in cases soon from vaccine

@rwidome @_stah So it’s still about policy (federal, state, local, workplace), public health infrastructure and practice, and behaviors.