Very important distinction: giving flexibility for states to delay 2nd dose a few weeks (while production ramps is) is NOT about denying a 2nd dose. It’s about acknowledging the benefit NOW of ⬆️ the number of people who can get 92% protection vs giving some 94% protection. 👇🏽 Image
This is not about 1 dose vs 2 (at least from my POV). I still feel the 2nd dose is important for variants, and likely for durability of protection. But in the real world (ie NOW) the way we best stop spread and variants is to give more people some (92%) protection.
With us approaching 20% vax rates in some places/ groups, here’s a real world possibility:

A) 10 strangers in a room, 2 fully vaxed (94% protection)

B) 10 strangers in a room, 4 with 1 vax dose (92% protection).

Which room do you feel has greater risk of spread right now?🤔
Science /projections are often done in a lab or based on best case/ condition scenario (eg a world of unlimited vaccines) - but the challenge is real world application. In the real world we are racing against the virus, and giving flexibility to delay 2nd dose could help us win.

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More from @JeromeAdamsMD

2 Mar
Good protection for many (w/ 1 shot) is better than great protection for a few. 2000 people a day are dying because they can’t get a 1st #covid19 shot- not because they can’t get a 2nd...

One dose or two? Fauci says U.S. must stick with two-shot plan. washingtonpost.com/health/2021/03…
Pivots on mask wearing and on school closures show advice can be well intended, and scientifically grounded, yet still need to be changed based on the reality on the ground. The risk for most of no protection at all >> than the risk of breakthrough variants at this point.
And as @Atul_Gawande has pointed out, simply affording states the okay to be somewhat flexible could unleash millions of doses sitting on shelves (out of fear of not having the golden 2nd dose for people, and getting in trouble). Push out all doses NOW, and lean into production!
Read 6 tweets
1 Mar
Here’s a #COVID19 FAQ I often get:

Why should I get a vaccine for disease with a 99% “recovery rate” (ie according to many studies only 1% of those infected will die)? 🤷🏽‍♂️

It’s a fair question, and here’s a short 🧵 explaining why. 1/?
In science and medicine we look at both morbidity (the consequences of having a illness or condition) & mortality (the number/ chance of death due to said illness/ condition). The mortality of #covid19 is 1%, but the consequences of getting/ having it can be far greater.
2/?
Around 97-99% of people who get #covid19 will live. But even if you live, that doesn’t mean you won’t get sick as hell/ end up in the hospital/ have long term health issues.

It also doesn’t mean that a 1% death rate is acceptable (1% of US population = 3 million people).
3/?
Read 5 tweets
1 Mar
Some great info from my buddy @NIAIDNews Director Fauci on the newly approved Johnson and Johnson #covid19 vaccine, including some FAQs. 👇🏽

FAQ: can you get #COVID19 from the vaccine?

Answer: Absolutely NOT! The vaccines help your body make one of the numerous proteins the virus has, so your body can produce virus fighting antibodies. But there’s no virus in the vaccine, so you can’t get Covid from it!
FAQ: Isn’t the J&J vaccine much less effective than the others?

Answer: the different vaccines were tested at different times, in different countries. But the J&J vaccine (as well as the other two) are almost 100% effective at preventing severe disease/ hospitalization/ death!
Read 4 tweets
22 Feb
I believe in following the science, but I also believe we must always discuss, and when data and circumstances dictate, have the fortitude to change recommendations. And based on what I’ve seen, I think we need to delay the second dose of #COVID19 vax.

globalnews.ca/news/7647751/p…
The bird in hand we have offers the possibility of 1.5-2x number of available vaccine doses right now. The “two in the bush” is a hedge against the possibility that people won’t come back for a delayed second dose, or won’t achieve/ maintain high enough levels of immunity. 2/?
Studies are increasingly showing one dose of mRNA vax is highly effective, and provides protection for much longer than 1st thought. I just don’t think the fear that people won’t come back, or that immunity will wane in 3 months, outweighs people infected/ dying right now... 3/?
Read 8 tweets
19 Feb
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn @CVSHealth @Morehouse Thanks for that- minorities were disproportionately dying long before #COVID19 & will continue to afterwards- but we have an opportunity to change trajectories for the better. We must first understand not everyone has the same opportunities for health- equality isn't equity. 1/ Image
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn @CVSHealth @Morehouse We talk about "social determinants of health." Thinks like transportation, and housing, and a good paying job. All of these things are just as important (studies actually show them to be more important in many cases) as access to doctors or medicines. 2/?
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn @CVSHealth @Morehouse What does it mean to tell someone exposed to #covid19 to quarantine for instance, if we don't take the time to ask them about or address that they take the bus, or live in crowded multigenerational housing? 3/?
Read 6 tweets
19 Feb
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn Public health experts always knew this was going to be the hardest vaccine distribution in history. And we need to understand that while federal planning and funding/ support are critical, most of the work happens at the state and local level. 1/?
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn I used to run a State Health Department. You absolutely cannot bypass the state or you will have chaos. But you also have to recognize that not all states have the local partnerships in place to reach the most vulnerable communities. 2/?
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn One of the things we need to do is learn from places like West Virginia. They are blowing away much larger, better funded, & healthier states. So sometimes it IS about leadership, and we need to share best practices and put some friendly pressure on poor performers w the data. 3/
Read 4 tweets

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