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. 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?) 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. 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: 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%. 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. 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. 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. 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. 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! 19/
“We ignore public understanding of science at our peril”

— Eugenie Clark

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More from @DrTomFrieden

13 Mar
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/
Read 16 tweets
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

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