I hate to be the party pooper on the “until we get to herd immunity” goal post, but if defined as 85%+ (Fauci and others) and most hospitals/ nursing homes can’t even get that level of compliance, we’re not likely to get there as a society. We need to discuss this differently...
“Herd immunity” isn’t a on/ off switch- it’s a risk spectrum. And it differs based on the setting/ person/ other mitigation measures taken. For example, nursing homes seeing much lower spread and death, despite lower than 90% total vaccination rates in most...
And I’d LOVE to see 90% plus vax rates, but telling people / leading them to believe we can’t reopen or stop wearing masks until then, risks losing many people/ being seen as (for good reason) dishonest, or unrealistic. We need to lay out honest and achievable goals...
Here’s my take- herd immunity thresholds are likely 80-90% IF we do nothing else. But IF we combine with other risk lowering measures (less exposure for some, masks for most when in public, vax for as many as possible- but at least 50-60% in a group), we can likely safely reopen.
Again it’s about ⬇️ risk, and it’s a spectrum with many variables. Vaccinations are the most important variable because they are our strongest/ most effective tool, but it’s going to be very hard / unlikely to ever get to 90% as a Nation- which is why masks remain important.
So let’s reset the conversation on “herd immunity,” and talk about how we can all do our part to reopen by making the most use of all the tools we have. We can slow spread, save lives, and reopen even if we don’t get 90% of the public vaxxed, but it’s going to take herd effort!
Also- this was not an anti- Fauci post- in the purest sense – a virological sense- I absolutely agree with him on 80-90%
threshold. But from a communication standpoint when people then use that to say it’s the goal post for reopening, that’s where we risk losing the public.

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More from @JeromeAdamsMD

20 Mar
I literally almost had to cancel the circus once due to a tuberculosis case- I can’t imagine making the call to cancel a #MarchMadness game. But Dr. Caine with MCHD is a friend, and the sharpest public health officer I know. She made a tough call, but the right one. Safety1st.👍🏽
We should honestly be thanking all of the public health officials & support staff doing the testing and helping maintain a safe environment for the players. And we must remember the tournament can and likely will be further affected moving forward. There are no guarantees here.
Attempting #MarchMadness is certainly a worthwhile endeavor, but we must remember it is a massive experiment. We will learn from it & it will help us as we learn to live with #COVID19. But there’s still a lot of spread, and as such, the best protocols can still fail to protect.
Read 4 tweets
4 Mar
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?🤔
Read 4 tweets
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

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