Covid Epi Weekly: An Epidemic of Vaccine Inequity

As predicted, a US 4th surge appears to be beginning, fueled by variants and reopening. Cases up 7%. Positivity inching up, to 4.7%. Because of vaccination, deaths won't increase substantially. We must solve vaccine inequity. 1/
Michigan hospitalizations are increasing rapidly esp. among 40-49 y.o. Middle and high school 30% increase in cases associated with outbreaks in tandem with increased community transmission. Fewer people staying home, similar to prepandemic levels. Harbinger of spring surges? 2/
Important new data on the mental health harms of the pandemic in the US. Large increases in depression and anxiety, especially among young people and those with less education. Treatment hasn’t kept up. At least 12 million more Americans are struggling.3/
Vaccinations continuing at a high rate: 2-2.5 million/day. That’s ~1% of eligible Americans every day, and the challenge isn’t to increase much more but to keep up that pace to meet the new goal of 200M. Expanding eligibility helps. More J&J vaccine helps. Communication helps 4/
3 big gaps in US vaccine program. 1. Equity. Black and Latinx people still about twice as likely to be killed by Covid but half as likely to be vaccinated. We mocked up a data visualization [DATA NOT REAL]; every place should publish to track as they implement programs to fix.5/
2. Doctors. Covid vaccination should be available in just about every doctor’s office, in addition to pharmacies and community vaccination sites. Many people who are reluctant to get vaccinated elsewhere will get vaccinated by their doctor. All hands on deck. 6/
3. Convenience. Polls show that many people who want to be vaccinated haven’t been able to get vaccinated. Variability among states is big. Particularly as J&J becomes more available, 1-shot vaccination at malls and other sites will be important. Convenience trumps reluctance. 7/
Vaccines are saving lives already and will save even more in coming months. As estimated last wk, 40,000+ more people would have died since Jan 1 in US nursing homes & elsewhere without vax. Credit where due: the LTC vaccine program is a big success! 8/
How long-lasting and strong is vaccine-induced immunity? Will variants evade vaccine protection? Time will tell. Reduce uncontrolled spread wherever it occurs for ethical and epidemiologic reasons; risk of dangerous variants is proportional to amount of uncontrolled spread. 9/
AZ and ?AE. People have adverse events after vaccination. 20 million doses of AZ vax, <30 blood clot cases reported. Link? Maybe, but even if so, not strong and benefits of vaccination outweigh risks. Resist drawing causal links where none may exist. 10/
No vaccine is 100% effective or 100% safe. We’ll find out about vaccine failure when there are breakthrough cases, and about very rare adverse effects, if there are any, when many millions of people are vaccinated. So far, the vaccines are astonishingly safe and effective. 11/
Global vaccine inequity is horrific. There is simply no ethical justification for healthy young people in any country getting the vaccine before a senior or health worker in a place where virus is spreading does. Increase vaccine production fast. 12/
Vaccine nationalism is ethically inexcusable but politically inevitable. Must increase production. Tho vectored vaccines less expensive, easier to store& single-dose, mRNA technology has lower risk of missing production targets, more adaptable to variants and faster to scale. 13/
Inevitable unless, of course, you’re Norway. Again showing moral and financial global leadership. Norway played a critical role in development of many global health initiatives, and may well help create a better global system of solidarity and safety. 14/
Cases are increasing again in many countries. Brazil, Kenya, Ethiopia, Poland, the Philippines just some of the countries struggling to control transmission and treat patients. We need control measures and vaccines quickly, for everyone. Until all are safe, none of us are. 15/
It's very unlikely SARS-CoV-2 was created in a lab. The genetic information strongly suggests that the virus evolved naturally. Is unintentional lab release a possibility? Yes, as the review commission has noted. In any case, we need better global lab safety and security. 16/
The last smallpox case in the world was from lab error in the UK. A flu strain accidentally released in the former Soviet Union in the 1970s may have spread around the world. Let's work together globally to make laboratories safer and reduce the risk of future health threats. 17/
Two great unknowns:
1/What will humans do–will we lose motivation as vaccines roll out and fail to maintain patience, discipline, and solidarity?
2/What will the virus do–will variants evade the vaccine?
The future isn’t certain, but it’s certain our actions can make it safer.18/
The Navajo Nation has crushed the curve with an impressive vaccination campaign: 57% received at least 1 dose (compared to 26% of the US population), maintained a mask mandate and continues to provide free masks and hand sanitizer and to discourage travel. Result: No cases. 19/
After 14 months writing weekly epi threads every Friday nite, I’m stopping. I may launch a weekly analysis of Covid & other public health issues. Remember, the right answer to epi questions is often: It depends. Life is complex, wonderful, and evolving. Thank you for reading! 20/
It’s been said the only thing certain in life is death and taxes. To that, we must add the threat of future pandemics. 21/
Covid is far from over, and the next pandemic could start any time. We must be better prepared, healthier, and more coordinated globally. Our public health and primary care systems need long-term investment.

Microbes outnumber us. If we work together, we can outsmart them. 22/
“Encountering apathy, ignorance, and avarice is the lot of all conscientious health officers. As preventive measures in the health area are more successful, the public is less inclined to support the programs which ensure this success.”

John Duffy

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More from @DrTomFrieden

26 Mar
It's very unlikely that SARS-CoV-2 was created in a lab. The genetic information strongly suggests that the virus evolved naturally.
Is unintentional lab release a possibility? Yes, as the review commission has noted.
The last human case of smallpox was the result of a lab error in the UK. It is believed—though not proven—that a flu strain accidentally released in the former Soviet Union in the 1970s spread around the world.
Read 6 tweets
24 Mar
Vaccination is the way out of this pandemic. Five facts about Covid vaccines:
The risks of infection are vastly higher than the risks of vaccination. Even healthy young people can become severely ill, die, or suffer long-term harm from Covid infection.
Covid vaccines prime your immune system to fight the virus, then disappear. They don't stay in your body.
Read 6 tweets
20 Mar
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/
Read 20 tweets
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

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