570,000 Americans have died due to COVID.

Even if we assume every single American has already had COVID, the lowest possible infection fatality rate (IFR) is 0.17%.

The true IFR is likely ~0.5%.
This is similar to what I had estimated a year ago.

In symptomatic people with confirmed COVID, the mortality rate is ~2%.
IFR can vary: by population characteristics, time period, availability of treatments, health system capabilities, etc.

But the death rate in the US, 1700 deaths per million, shows how devastating COVID can be in a rich country with supposedly the best healthcare resources of any
COVID is not the flu. It's not the common cold. It's far worse.

Our best hope with the multiple multiple variants is that the approved vaccines can prevent infection and even if infection occurs, reduce its severity to that of the flu or common cold.
Thankfully the vaccines seem to do just that. The purpose of this thread is two-fold:

1) Do not minimize the severity, loss of life, and devastation of COVID
2) Our best hope of getting out of this is to get vaccinated with these amazingly effective vaccines.

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More from @VincentRK

8 Apr
Mortality rate of symptomatic COVID when healthcare system was overwhelmed early on (as in Italy, Spain, Belgium, & parts of the US) was incredibly high. As we flattened the curve & learnt to treat, the rate reduced to 2-3%.

cf. Australia didn't get overwhelmed. @OurWorldInData Image
It is indeed remarkable how across the world the mortality rate of confirmed, presumably symptomatic, COVID has coalesced to around 2-3%. Image
Although with improvements in treatment, mortality rates of symptomatic COVID may be lower that what we saw early last year in places that got overwhelmed, no country should be in a situation where the healthcare system is overwhelmed. That leads to much higher loss of life.
Read 4 tweets
4 Apr
Few places in the world have suffered more losses from COVID than New York.

4 factors for disconnect below in cases and deaths:

-Health system not overwhelmed
-Better treatments
-More testing = milder cases detected
-Some are mild reinfections in people who already had COVID
One reason why I think immunity is playing a role is that the reduction in deaths with second wave seems to depend on how high the first wave was.
It's a complicated argument, but my summary after looking at this is that undiagnosed reinfections probably exist quite a bit more than we initially thought but they do not have the natural history of COVID for the first time: Much milder due to better prepared immune system.
Read 4 tweets
3 Apr
From Feb 1, the date COVID vaccine effect probably started: Israel provides a preview into what can happen in the US as we race to get 80% of eligible public vaccinated.

Deaths and hospitalizations eventually will be driven by cases in unvaccinated adults.
Deaths in the US have resumed their downward trend after a brief plateau. I hope this continues. Metrics of vaccine success to track will be hospitalizations, ICU admissions, and deaths.
I'm saying 80% of the eligible public as target for herd immunity as opposed to 80% of the whole country because while we are not vaccinating kids, we also do have at least 10% of the population who have had confirmed COVID and at least another 10% who have had undiagnosed COVID.
Read 4 tweets
1 Apr
How long will protection from COVID vaccines last?

If you are going by lab studies & antibody levels: Few months

If you are going based what we know about the immune system, and in terms of ability to prevent serious disease & deaths: Years or decades.

That's my opinion FWIW.
The big unknown is the ability of the virus to mutate to a variant that is both more infectious and more lethal while being different enough to evade vaccine generated immune response.

The reason I'm not alarmed by this prospect is the natural redundancy of the immune response.
Of course no one can know for sure, only time will tell. Whatever you hear is one persons opinion versus the other. No more, no less.

Again I'm using metrics of ability to prevent serious disease and deaths. Not any infection.
Read 5 tweets
31 Mar
Europe is struggling with the vaccine roll out. Any decision on vaccines needs to take into account that every single day 2500 lives are being lost due to COVID. That's the risk/benefit trade off to consider.

The UK in comparison is doing extremely well with vaccinations. ImageImage
Deaths are driven by people getting COVID. People get COVID from other people.

The elderly get COVID not just from other elderly people but also from young people. High COVID rates in young people places the lives of elderly at greater risk.
Vaccination rates. Image
Read 4 tweets
30 Mar
Why do you often get confusing and contradictory messages from experts?

Why does medical expert opinion sometimes seem incorrect, outdated, or even contrary to the evidence?

1/ Medicine is really complicated. No one is truly an expert except in a tiny segment of it, at best.
2/ When a car doesn't work a good mechanic knows what each part does. To know what's wrong. Doesn't need a randomized trial to know how to fix it.

Our body is not like a car. We don't know a fraction of how it works and what each part does. Human biology is still in its infancy
3/ Medicine moves at speed of light. Keeping up to date is no small task. Even if you read all the latest information as they come in, you may have time to scan the headlines or abstract—
Not critically review it.
Read 12 tweets

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