Tweet

Ashish K. Jha, MD, MPH

7 Feb, 10 tweets, 4 min read

@k_g_andersen

Am optimistic about late spring and summer

But concerned about next couple of months

So let's chat why

B117 – the UK variant

Its here and spreading quickly

Great new analysis by @k_g_andersen et al out today confirms as much

Its a problem

Thread

medrxiv.org/content/10.110…

@carlzimmer

B117 is much more contagious – so it can quickly overwhelm a nation

Great write-up about Andersen piece and broader issues by @carlzimmer in @nytimes today

If you want to understand what this variant can do to a nation, let’s look at some data

2/8

nytimes.com/2021/02/07/hea…

First, let's look at pandemic in two nations:

Ireland (blue)

Germany (red)

Until mid-December, outbreaks had looked similar

Ireland had a spike in October did a lockdown, and got it under control

Germany rising in November, December with modest restrictions in place

3/8

In Mid-December, Germany (red) looked worse than Ireland (blue)

But B117 was circulating in Ireland and starting to grow

Not so much in Germany

And what happened next in Ireland was really rough

What you see is a exponential growth

4/8

Here are some key dates, case numbers

December 10: 5.8 new cases / 100K

Dec 17: 7.9 new cases / 100K

Dec 24: 16.9 new cases / 100K

Dec 31: 27.3 new cases / 100K

In 3 weeks, number of new cases went up more than 4X

Ireland went into full lockdown end of December

5/8

Cases peaked on 1/9 at 132 new cases / 100K

US has never seen numbers like that

Only the Dakotas had infection rates that high

In comparison, here's US during this time

Our holiday "surge" was small in comparison

6/8

One more thing about Germany

Head of their public health institute announced Friday that 6% of their infections are from B117

Germany is in a pretty tight lockdown

So they may see only a modest spike

But US is pretty open

7/9

May be 2% of our infections are from B117

But we don’t know because we still aren’t doing enough genomic surveillance

So most public health experts expect a spike from B117

But we can avoid a horrible spike that flattens our hospitals and kills tens of thousands

How?

8/9

We have real tools

Most importantly, we have a federal government that is now actually run by competent people

We need to substantially ramp up genomic surveillance

We need to act very quickly if we see infections starting to inch up

And we have vaccines

9/10

Our vaccines will work against B117

And they will blunt the effects on high risk people

If we can get them into arms fast enough

Today's analysis shows that B117 will become widespread in the US

But it need not flatten us

We have the tools to beat it

Fin

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More from @ashishkjha

Ashish K. Jha, MD, MPH

@ashishkjha

9 Feb

About 3,000 Americans are dying every day

They reflect infections from mid-January

Given dropping infections since, we'll see dramatic drops in deaths over next few weeks

This is great

It'll also tempt policymakers to relax restrictions...just at riskiest moment

Thread

Current 7-day moving avg about 3000 deaths/day

In a week, that'll be down to 2500

2000 daily deaths a week later

And 1500 a week after that..3 weeks from now

Best guess based on infection numbers

Nearly 20K fewer deaths over next 3 wks than if infections had stayed flat

2/4

And if infections continue falling, we might even get under a 1000 deaths a day by Mid March!

Which would be amazing!

With one challenge:

Dropping deaths will put pressure on political leaders to substantially lift restrictions

Just as the variants will be taking off

3/4

Read 4 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

5 Feb

Feeling pessimistic about COVID & 2021?

Don't!

I'm not. Here's why

We'll likely have about 400M doses of Moderna/Pfizer by end of June

Enough to vaccinate 80% of adults

And that means a much better summer

Of course, we'll likely also have J&J, AZ, Novavax

Short thread

So by the time summer arrives, we'll have way more vaccines than people

Including for kids -- they'll likely get vaccinated over summer if not prior

That's supply. What about distribution?

Distribution problems were real in Dec/Jan

They are largely getting fixed

2/3

So I see no difficulties with us vaccinating 2-3M / day as we get into March/April. And vaccinated 150-200M by July 1

What could go wrong with scenario?

Pfizer/Moderna both suffer big production problems

AND

J&J, AZ, and Novavax don't deliver

Seems way, way unlikely

3/4

Read 4 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

29 Jan

Heard of SARS-CoV2 variant from Japan?

No?

How about one from South Korea?

No?

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

Thread

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

2/6

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?

3/6

Read 9 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

24 Jan

@FT

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

Thread

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

True

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

2/7

@covid19tracking

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

3/7

Read 10 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

20 Jan

@WHO

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

Thread

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

2/6

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

Ashish K. Jha, MD, MPH

@ashishkjha

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

Thread

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

2/10

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

3/10

Read 14 tweets

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