Thread by @DrTomFrieden

Covid Epi Weekly. Progress and Peril.

Vaccinations have already saved 40,000+ lives in the US and the pace keeps increasing. But explosive spread of variants in Brazil and lower interest in vaccination are ominous portents.

A 4th surge is likely, but a less deadly one. 1/thread

First, the epi. Cases have stopped decreasing in many places and are increasing in some. Vaccinations are preventing deaths. Cases (~50,000/d) and test positivity plateauing nationally, with a concerning trend of PCR test positivity increasing slightly to 4.3% last week. 2/

The faster decline in deaths is striking and undoubtedly from vaccination. Look how steep the red line is below. Because vaccination rates in people over 65, especially those in nursing homes, are so high, the lethality of the virus is, as a result of vaccination, decreasing. 3/

Vaccines have likely saved 40,000+ lives in the US. Previously, ~40% of reported Covid deaths were among nursing home residents vs ~19% of ~200,000 deaths in 2021. If nursing home residents still accounted for 40% of Covid deaths, 40,000 more would have died since January. 4/

Will we have a 4th surge? I think so, but not huge & not nearly as deadly because so many of the most vulnerable people have been vaccinated. The more we mask up & distance, the less we travel, the faster we vaccinate, the fewer cases, hospitalizations & deaths there will be. 5/

Cases are increasing in parts of Europe, often despite masks and distancing – following vacation travel. Travel is an accelerator of viral transmission. Spring break travels while the virus isn’t taking a break – not a good idea. bit.ly/3s3O8Pv 6/

Surprisingly high second-dose vaccine completion largely among long-term care population & healthcare workers, so expect this proportion to decrease. The single-dose J&J vaccine will be a big help in many settings (shopping center vaccination, anyone?) bit.ly/3tBfCw6 7/

You shouldn’t have to live in the right place or know the right people to get vaccinated. Highlights of inequities in distribution; 43 countries are on track to vaccinate in 2021, but 148 are not. Ramping up mRNA production is a promising approach. nyti.ms/30Zmo2p 8/

Will be increasingly difficult to keep up pace of vaccination. Many of the most eager got vaccinated. Next will be the willing, then the reluctant, finally the late converts. For each area and demographic, key is to listen, address concerns with right messages and messengers. 9/

Brazil – a cautionary tale. Uncontrolled spread and slow vaccination led to huge wave even though there was a devastating earlier wave. Seems likely that the P1 variant can reinfect people, although evidence for this still emerging. Read our summary: bit.ly/3eTYiOH 10/

The B117 variant is spreading throughout the US and may be associated with higher risk of death. Growing evidence suggests that available vaccines protect against this variant, but the bigger problem is the possibility of newer variants. Immunity after infection isn’t perfect.11/

Those who have had COVID-19 should still be vaccinated! A study from Denmark suggests that previous infection provided 80% protection against reinfection, but protection among those age 65 and older was only 47%. bit.ly/3cO9PN4 12/

More people vaccinated means that selective pressure on the virus increases, and if strains emerge that can evade this immunity, they can spread. We don’t know if this will happen, but it’s a risk, and we can reduce the risk by reducing uncontrolled spread wherever it occurs.13/

The virus is a wily enemy, and this investigation demonstrates just how contagious it can be. If we let our guard down too early, Covid will take advantage.

https://twitter.com/HelenBranswell/status/1372568216342556675?s=20

14/

With proper measures in place, especially masks, we can begin to do more as vaccination makes the virus less lethal–adjusting if there are rising cases. The virus has had a major impact on many facets of our lives, from schools to jobs, and recovery will take awhile. 15/

Multiple studies demonstrate that schools can open without excess Covid risk, and CDC has appropriately updated its guidance. However, the more Covid spreads in a community, the higher the risk for everyone, including school staff and students. bit.ly/3qiKfoL 16/

In some places, the pandemic's impact has been as harmful as Covid itself. Data from 19 @_AfricanUnion Member States shows the pandemic has driven food insecurity and disruptions to health services. We must ensure equitable access to vaccines. bit.ly/2ZjPrNA 17/

A new report shows that Covid set us back years in tuberculosis control. A million patients may have been missed as a result of the lack of access to health facilities. Each one can potentially infect others. A devastating setback. bit.ly/3vI9Z0S 18/

This timeline of progress from the past year: remarkable. Scientists across the globe made rapid progress against the most disruptive health threat of the past century, but there is so much more to learn! go.nature.com/3qXlQ7S 19/

“We ignore public understanding of science at our peril”

— Eugenie Clark

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