Covid Epi Weekly: Safer Doesn’t Mean Safe (yet)

Cases continue to plummet. Vaccination roll-out is going more smoothly, tho must address equity much more effectively. Deaths are decreasing. Global collaboration is increasing. Spring, not Covid, is increasingly in the air. 1/14
Decreases are steep, sustained, and national. Cases decrease first, then hospitalizations, then deaths. Why? Less travel and less indoor mixing. More masks. And growing immunity from infections (~30% of US) and vaccination (12% started). The virus has less room to maneuver. 2/14
Mobility and mixing were the major drivers of both the increase and decrease. Herd immunity isn’t an on-off switch; increased immunity accelerates decreases in cases. Herd immunity also isn’t uniform across society. There are still plenty of susceptible people – most of us. 3/14 Facebook/CMU data based on anonymized, opt-in survey respons
Variants are THE wild card. If they evade natural or vaccine defenses, risk of explosive spread is high. CDC in their excellent weekly summary: “Stop variants by stopping the spread”. Test positivity⬇️5.9% but 7000 hospitalizations, 2700 deaths/week. 4/14
Another great thread by @youyanggu: B117 doubling as a proportion every 10 days doesn’t mean B117 doubling. Graph above from preprint that may explain at least some of the increased infectivity of this variant. 5/14
Tho not decreasing cases much yet, vaccination IS driving down nursing home deaths: from >30% to <20% of deaths. With most residents and many over 65 vaccinated, the infection fatality ratio likely to decrease from 1 in 200 infections resulting in death to <1/600 in March. 6/14
Let’s talk about death. We need to do that more. 344,854 reported Covid deaths in 2020, of which 37% were Jan 1-June 30. CDC just published data on projected life expectancy decreases driven by these deaths: -1 year overall, 2.7 years for Black people, 1.9 for Hispanics. 7/14
These decreases erase years of progress. Before we do a deep dive into the numbers, let’s try to never forget that each is a life, a tragedy. Deeply moving effort to give some sense of the enormity of the losses. Please read it. 8/14
Because more than 60% of Covid deaths were in the second half of 2020, likely the actual decrease in life expectancy will be well over 2 years. The Black/White disparity may decrease, but not for good reason: As Covid spread, the proportion of cases among Whites doubled. 9/14
There’s far too much missing data but the data is still stark, with higher deaths rates among Black and Latinx. Vaccination programs have to prioritize the hardest hit groups. Vaccine hesitancy is real, but lack of access is the driving reason for lower vaccination rates. 10/14
Good article in @NEJM about effective communication strategies to encourage “moveable middle” people to accept vaccination. But convenience overcomes reluctance, and difficulty getting vaccination perpetuates unjust, racist power dynamics in the US. 11/14
New and troubling data from Zambia. Only 6/70 Covid deaths diagnosed before death; how many have we missed globally? Sometimes the dog not barking in the night is really no one listening. Improved death reporting is crucial to improve global health. 12/14
Vaccine inequity in US is small microcosm of vaccine inequity globally. Can we have a healthy arms race: Which country can help other countries get the most vaccines into arms? Increased manufacturing will be essential; expanding mRNA is promising. 13/14
“We are only as blind as we want to be.”

Maya Angelou


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More from @DrTomFrieden

13 Feb
Covid Epi Weekly: Best of Times, Worst of Times

The third US surge is fading fast but variants, some ominous, are spreading fast. Vaccination is picking up steam but we're failing to address equity and pandemic fatigue is high. We must hang on until most of us are vaccinated. 1/
The fundamental question is whether we’ll have a 4th surge. If we do it will cost lives and also increase the risk of more dangerous variants spreading widely. But first good news: dramatically fast decline in cases and positivity. Steeper decline than in either prior surge. 2/
The thing about masks, not traveling, and minimizing time sharing indoor air with people not in our household? It works. It’s war against the virus. Any time we let down our defenses, it attacks. When we let down our guard (and masks), we are complicit with our viral enemy. 3/
Read 18 tweets
6 Feb
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/ Graph courtesy Tony Fauci
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/
Read 24 tweets
30 Jan
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.

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/
Read 22 tweets
27 Jan
LAUNCHED TODAY: Our team at @ResolveTSL worked with @NYTimes on an interactive risk alert tracker so you can see detailed information on risk in your community—and guidance on how to stay safe. 1/
We check the weather before we leave our homes. Now there's a new way to check how much Covid is "raining" in all 3,000+ U.S. counties. 2/
Although state and county health departments share Covid data, there are often big differences in what gets reported and how. 3/
Read 9 tweets
23 Jan
Covid Epi Weekly Jan 22: Racing Against Mutants!

The post-holiday flood cresting but cases, hospitalizations and deaths remain astronomically high. Viral mutants increasingly concerning. Vaccination is our best tool but only one of several we must use more and better. 1/17
Although the wave is cresting, last week cases (3x), hospitalizations (2x), and deaths were still far higher than at any point before the current surge. National positivity decreased from 15% to 12%. A flood with receding waters is still a flood. 2/
Reported cases don’t necessarily reflect community risk. E.g., NYS has higher rate than Tennessee, but Tennessee tests at 3x lower rate, with much higher percent positivity. Tennessee likely diagnosing smaller proportion of its COVID-19 cases than New York. Risk is higher. 3/
Read 17 tweets
16 Jan
Covid Epi Weekly: Could Covid Kill 1 Million Americans?

New strains are a shot across the bow. A message from the virus: We outnumber you. We’re more persistent. We change and adapt.

It’s up to us: Fight smarter. Collaborate. Protect ourselves and each other better. 1/thread
First, the numbers. Cases, hospitalizations, deaths continue to increase; expect continuing increases. The scale of cases is mind-boggling. More than 1.6 MILLION diagnosed last week - maybe a million total infections a day. 2/
May be the beginning of a plateau of hospitalizations; too soon to be sure. If we could scale up infusion of monoclonal antibodies for people at risk for hospitalization but not yet very ill, we could reduce this number and the stress on health workers and health systems. 3/
Read 24 tweets

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