Thread by @DrTomFrieden

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

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. bit.ly/3pCEKQT 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.

https://twitter.com/youyanggu/status/1362476060907077636?s=20

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. wapo.st/2Nqc2pd 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. bit.ly/3bpMPD5 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. bit.ly/3sbYZq5 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. mdpi.com/2076-393X/9/1/3 13/14

“We are only as blind as we want to be.”

Maya Angelou

14/end