Covid Epi Weekly: It Ain't Over 'Til It's Over

100 million Covid infections in the US
100 million vaccine doses administered

In the race of vaccination vs. variants, we're gaining on the virus. But nobody should declare victory in the third quarter. Safer doesn't mean safe.
@CDCgov weekly summary and website:
-11% case decrease this week
-Positivity down 11%, to an encouragingly low 4.1%
-Vaccination up to 2.2M/day, 8% increase
-100 million people vaccinated
-Deaths down 19% - faster decrease from vaccination saving lives
But better doesn’t mean good. Rates still very high:
>50,000 cases/day
Nearly 5,000 hospitalizations last week
>1,400 deaths/day
Variants spreading, possibly more than half of NYC cases

It’s a race: vaccination vs. variants. Who wins will determine whether there’s a 4th surge.3/
Variant B1 bombers:
-EEK! Possibly overcoming immunity from infection
Good news from Brazil: The vaccine appears to overcome that variant.
But no guarantee new variants won’t escape vaccine-induced immunity.
The more the virus spreads, the greater that risk.
Will there be a 4th surge in the US?

Those who answered the poll are optimistic there won’t be.

How well variants do depends partly on the virus but mostly on us. Mask. Distance. Vaccinate.

Variants may well be more deadly.
Don’t let up too soon. Don’t assume protection until 2 weeks after full vaccination.

Don’t lift mask mandates while the virus is still spreading.

The pandemic isn’t over. Not in the US, and certainly not globally.

Clear discussion of CDC guidance post vaccination. As more data become available & more people get vaccinated, recommendations will evolve. That's science.

No vaccine is 100% effective. Rare vaccine reactions happen–much less than risk from infection.
Scale up vaccination using multiple platforms
-Mass sites
-Pop-up locations
-Doctors’ offices
Soon we'll go from too few vaccines to too few arms to put vaccines into.
Find and address barriers: to access, to understanding, to acceptance.
It’s not wrong to open schools, businesses. Restaurants, bars, and large indoor events are much riskier, especially without mask mandates. No worker should be avoidably exposed to Covid, or have to plead with a customer to mask up. OSHA should act.
~1 in 200 infections in the US result in death: more than 100 million people infected already. Globally, with a younger population, maybe one death per 300 or more infections, and Covid deaths under-reported. There may have already been a billion Covid infections globally. 10/
Five points to end the week.

First, Covid is far from over. Have a look at the map from @NYTimes below.

It’s still raining Covid pretty hard out there. Not much green on the map yet.

Stay safe. Mask up. Patience, discipline, solidarity.

Second, think about the next generation. It was to have been Gen Alpha, now maybe Gen C, skipping A and B after X, Y and Z.

The sooner we get to the new normal the better we will all do. Masks, distance, vaccination. Patience, discipline, solidarity.
Third, recognize failures at local, state, national and global levels. No institution got it right. US public health systems had pre-existing conditions that increased our vulnerability. We need long-term solutions.

Good report: Ready or Not?

We need to improve emergency response, public health, primary care. I outline what’s needed broadly and on cardiovascular health. Even BEFORE Covid, US life expectancy was lagging behind other countries’ –more disability, more illness, earlier death.
We must build health resilience. The Biden-Harris Administration can build on success stopping Covid. Start with preventing heart attacks and strokes, which kill nearly a million Americans a year. Most of those deaths can be prevented. Here’s how 15/
“It ain’t over ‘till it’s over.”

Yogi Berra
Great American Philosopher (and Catcher)

16/(this week’s thread IS over)

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More from @DrTomFrieden

6 Mar
Covid Epi Weekly: Keep your mask and guard up!

Are we near the new normal? By May we'll be much safer—but we're not there yet. Vaccine rollout gaining momentum, saving lives. Cases trending down. But transmission still high and variants could derail progress. Hang in there! 1/16
HUGE thank you to Covid Tracking Project, winding down this week. Last weekly metrics below – still not completely replicable @CDCGov but getting there. Blip last week seems to have been mostly weather-related, with cases trending down, but we’re not out of the woods. 2/
For bookmarking (I did): Where to find and how to use Covid data. Thanks to all who worked on the Covid Tracking Project. Hope we never need something like this again – that the Federal government never again abdicates its fundamental responsibility. 3/
Read 17 tweets
27 Feb
Covid Epi Weekly: The End is Near! But Not for the World.

Steady good news in the US: Decreasing cases, hospitalizations, and deaths, and increasing vaccination pace.

Serious risks: Variants, vaccine inequity, and failure to learn the lessons of Covid.

The good news first. US cases decreased 75% from the peak, with hospitalizations and deaths following. Vaccination (after a weather-related disruption) is increasing, and much more supply is on the way. In June, anyone in US over 16 who wants a vaccine will be able to get one. 2/
Vaccinations are already saving lives! Progress in nursing homes; expect larger reductions of nursing home deaths in the coming weeks as vaccine-induced immunity kicks in. As predicted, the risk of death from Covid among all those infected will fall by at least two thirds. 3/
Read 21 tweets
20 Feb
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
Read 14 tweets
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

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