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Atul Gawande Profile picture
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31 Mar, 7 tweets, 3 min read
As cases and hospitalizations rise again, we can't count on behavior alone reversing this course.

Therefore, it's time for the Biden admin to delay 2nd vax doses to 12 weeks. Getting as many people as possible a vax dose is now urgent.
I was on the fence on this. I'm not anymore. Here's why.

1. More contagious strains are now >1/3 of all US cases. And new evidence confirms B117 causes more severe disease, with MUCH higher rates of severe illness and death at younger ages. directorsblog.nih.gov/author/collins…
2. Rising cases require more commitment to masks, testing, indoor limits. But the recurring pattern here and abroad is many people and local leaders won't tighten these until too late.

And 11% of us attended large events in last 24h, almost 2x early Jan. delphi.cmu.edu/covidcast/surv…
3. The vaccines work against B117.

While Europe is in another surge of cases and deaths due to it, UK and Israel are not, because of high levels of at least first-dose vaccination.
4. We have evidence of strong effectiveness after a single dose. A new CDC MMWR study found mRNA vaccines reduced risk of COVID19 infection among health care & other essential workers by 80% after the 1st dose and 90% following the 2nd dose. cdc.gov/mmwr/volumes/7…
5. I had concerns that dose sparing protocols could result in development of variants that evade vaccine protection. Preliminary evidence, however, suggests it's very unlikely -- indeed "such strategies should slow the rate of vaccine or immune escape." dash.harvard.edu/handle/1/37366…
We must still follow basic steps for 6-10 weeks more: masks, testing, no big indoor events. They work, as seen in hospitals & schools abroad.

But we must speed vaccination now.

Pushing 2nd doses to 12 weeks like the UK will do that. And I believe the country is ready for it.

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More from @Atul_Gawande

Atul Gawande Profile picture
30 Mar
This is our warning call, America.

Cases are now climbing again in a majority of states--esp across the northeast and midwest.

@CDCDirector Walensky is right to be sounding the alarm. This is how surges start.
We are a few weeks behind the pattern of the surges now happening in Europe, Asia, and South America.
In the last week, US hospitalizations have started to climb, as well. And cases are up despite a marked drop in testing. washingtonpost.com/graphics/2020/…
Read 6 tweets
Atul Gawande Profile picture
18 Feb
I know COVID seems like it is subsiding. But the B117 variant is spreading. What we do now to stop it determines whether it takes over and fills hospitals again in 2 months.

It's going to take more than vaccinations--the supply won't come fast enough. nytimes.com/2021/02/17/opi…
1. We need all Americans to wear a high quality mask. Upgrading to one with a metal nose clip and a snug fit so it doesn't fall when you talk or leak so much out the sides--ideally a medical grade mask--is important. This variant is 30-50% more contagious than what we've faced.
2. We must keep avoiding socializing indoors in groups (eg >10 people). While overall COVID rates are falling, B117 variant is doubling every 10 days. It was 4.5% of all cases in Florida last week--and expected to be the majority in early March. sciencealert.com/uk-coronavirus…
Read 6 tweets
Atul Gawande Profile picture
25 Jan
Pfizer's move is indefensible. Yes, squeeze every dose we can. But cutting deliveries from 40M to 33M vials for the same price cannot be justified. Especially when many places lack the special "low dead space" syringes needed to get the "extra" dose. nytimes.com/2021/01/22/hea…
"The world’s largest syringe maker does not have the capacity to substantially increase U.S. supplies of specialty syringes needed to squeeze more doses from Pfizer's vaccine vials in the coming weeks, an executive said." reuters.com/article/us-hea…
This image was very helpful for me to understand the difference between low dead space syringes and needles from the standard ones. (Thanks Harm Reduction Journal and whomever thought to come up with such a publication.) harmreductionjournal.biomedcentral.com/articles/10.11…
Read 4 tweets
Atul Gawande Profile picture
10 Dec 20
Key findings from the latest Axios-Ipsos Coronavirus poll.

1. Americans are more worried about COVID's impact on their health, job, and finances than since June. And for most, out of home activity is declining accordingly. axios.com/axios-ipsos-po…
2. Vaccine interest is up, with most now saying they are likely to take a COVID-19 vaccine if it public health officials say it is safe and effective (69%), has a 90%+ effectiveness rate (67%), or has been on the market a few months (65%). ipsos.com/en-us/news-pol…
3. A small minority of people (18%) are driving most of the indoor activity outside the home that drives spread. Only 44% of this group wear a mask when outside home and only 36% are very concerned about the virus. These are the folks (more male, <55, GOP) whose help we need.
Read 4 tweets
Atul Gawande Profile picture
3 Nov 20
Spoke to @MarketWatch and here are a few of the points I made:

- Today's election determines who's in charge Jan 20, but what happens with addressing the major surge of COVID19 cases and hospitalizations and with vaccines is being determined now. marketwatch.com/story/dr-gawan…
- If we get an effective vaccine, the big problem won't be hesitancy, but lack of supply and distribution resources forcing hard choices among priority groups.

- We will need a mass movement to back mask-wearing, far more testing, and open hospital data.
- And, finally, if Trump holds onto power, we cannot give up hope. We still have ways for states, Congress, and the public to fight the virus even if this administration won't. We still have ways to not let doctors and science become demonized.
Read 4 tweets
Atul Gawande Profile picture
29 Oct 20
This week, we at @AriadneLabs and @SurgoFoundation released a Vaccine Allocation Planner for states and cities to plan #COVID19vaccine distribution. As you start working with it, you realize just how wrenching the choices are going to be. covid19vaccineallocation.org
.@moderna_tx says it will have 20M doses of its vaccine by Jan; @pfizer 30-40M. It’s unknown if either will work. But if one does, we may have enough for 10-20M people. (Remember, it’s 2 doses per person). qz.com/1924433/the-us…
We have 19M first responders and high-risk health care workers. For this group alone, we may already have shortages. And that’s without even getting to nursing home residents, the chronically ill, or essential workers.
Read 5 tweets

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