Covid Epi Weekly: The Centrality of Equity

Lots of good news on vaccines, but the virus and variants are gaining ground. Variants are spreading rapidly in the US, driving (along with premature opening) the fourth surge that’s now underway. 1/
I had planned to stop Friday night threads, but couldn’t help sharing thoughts on this week’s developments—there have been so many.

Fourth surge is building. Cases up 8%, test positivity up to 5.1%. Michigan situation worse, other states could follow. 2/
News on vaccines just keeps getting better. CDC study of mRNA vaccines found that Pfizer and Moderna vaccines blocked 90% of infections. Vaccinated people won’t spread much disease. HUGE implications for guidance for fully vaccinated people and the trajectory of the pandemic. 3/
Pfizer released new clinical trial data showing their vaccine protects for at least 6 months. Will likely be longer—only time will tell how long. Also found that vaccines work well against at least some variants. Highly effective against B.1.351, first identified in S. Africa. 4/
Now we have to get vaccine there and around the world. Transfer of mRNA technology is key, because it can be tweaked for variants and is less susceptible to production problems. A biological vaccine process made into a chemical, more predictable one. 5/
There’s no question the vaccines are working. Look at the striking impact protecting the elderly in Michigan. Vaccines rock...but, we’re failing to get them to where they are most needed. 6/
Israel is crushing the curve with vaccine. More places need the vaccine, especially Brazil and other places being hit hard. 7/
Despite glitches (see: J&J/Emergent’s 15 million botched doses), supply keeps increasing. US is vaccinating more than 2.5 million people a day now. BUT: quality, i.e. targeting of vaccines is important, probably more important than quantity. See below. 8/
Reluctance keeps decreasing. And more availability and more convenience will overcome much of the remaining reluctance. New survey from @KFF: 9/
News on variants is mixed, but mostly bad. On a positive note, Israel’s success shows that these vaccines beat these variants. But variants are spreading rapidly in the US. 10/
Deaths aren’t falling nationally as rapidly as I had anticipated they would—likely because the variants are not only more transmissible but also more lethal. @EricTopol summarized the data on variant lethality well. 11/
Some think SARS-CoV-2 may be running out of genetic tricks, and I hope they’re right, but hope is not a plan. We have to anticipate the possibility of vaccine escape mutants and reduce uncontrolled spread wherever it occurs. 12/
Now the most important point of this non-thread thread, and the main reason I am writing it. Equity, equity, equity. This is not just about what’s right ethically, but what’s essential for pandemic control in both the near- and long-term. 13/
If we just chase the number vaccinated, we miss the point. We want maximum impact from vaccine—for fairness, to reduce deaths, to reduce cases, and to reduce risk of emergence of even more dangerous variants. 14/
100 million people in US have received 1 dose of vaccine. But about 50 million people over 50 (~37M age 50-64 and ~13M 60+) haven't been vaccinated. Vaccinating these folks, who are disproportionately Black & Latinx, will prevent many more deaths than vaccinating young folks. 15/
Think of it this way. Targeting vaccinations to people at highest medical risk—who are 10 to 100 times more likely to die if they get infected—is 10 to 100 times more likely to save a life. 16/
So we'd have to vaccinate 10 million people at low medical risk to save as many lives as vaccinating 100,000 to 1 million people at high medical risk. 17/
And targeting vaccinations to the communities at highest risk for spread is MUCH more likely to prevent cases than targeting vaccinations at low risk of spread. 18/
In some low-risk communities, for example, 0.6% of the population may be infected each month, while in high-risk communities, it may be 6%. With a vaccine that offers 90% protection, if we vaccinate 1M people in low-risk communities, 5,400 cases would be prevented. 19/
In contrast, If we vaccinate 1M in high-risk communities, this would prevent 54,000 cases—10 times as many. This difference will compound in future generations of spread, so the actual impact could be 40 times or 100 times larger. 20/
In other words, a single well-targeted vaccination could save 10x more lives and prevent 100x more cases than vaccinating a low-risk person in a low-risk community.

This is the essential fact we must act on. Equity isn’t only good ethics. It’s essential for epidemic control. 21/
“The availability of good medical care tends to vary inversely with the need for it in the population served.”

Julian Tudor Hart, The Lancet

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Dr. Tom Frieden

Dr. Tom Frieden Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @DrTomFrieden

27 Mar
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/
Read 23 tweets
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

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!