We proposed metrics when restrictions could be safely lifted in states- which are1) high rates of vaccination & 2) getting down to 5 hospitalizations per 100,000. Wanted to list where each state is in hospitalization metric (surge vaccine to those highest) washingtonpost.com/outlook/2021/0…
4/3/21 HHS COVID-19 Patient Impact and Hospital Capacity by State Report and COVID Tracking Project (for pandemic peaks):
Total U.S. Total: 15 hospitalizations per 100k; peak of pandemic was 64 per 100k, as of 4/3/21 we are at 23% of the pandemic peak
MI: 34 per 100k; peak of pandemic was 54 per 100k so at 63% of pandemic peak
DC: 33 per 100k; peak was 84 per 100k so at 39% of pandemic peak
NY: 32 per 100k; peak was 123 per 100k so at 26% of pandemic peak
NJ: 31 per 100K; peak was 116 per 100k so at 27% of peak
MD: 27 per 100k
;peak was 40 per 100k, so at 66% of peak
PA: 23 per 100k; peak was 59 per 100k so at 39% of pandemic peak
WV: 21 per 100k; peak was 59 per 100k so at 36% of peak
DE: 19 per 100k; peak 55 per 100K so at 34% of peak
CT: 19 per 100k; peak was 63 per 100k so at 30% of peak
FL: 19 per 100K; peak of pandemic 71 per 100K so 26% of peak
RI: 19 per 100k; peak was 46 per 100k so 40% of peak
TN: 15 per 100k; peak was 64 per 100k so 24% of peak
MO: 15 per 100k; peak was 58 per 100k so 26% of peak
GA: 15 per 100K; peak was 71 per 100k so 21% of peak
VA: 15 per 100k; peak was 44 per 100k; so at 33% of peak
TX: 15 per 100k; peak was 61 per 100K so 25% of peak
IL: 14 per 100k; peak was 58 per 100k so at 25% of peak
OH: 14 per 100k from peak of 56 per 100K (25% of peak)
SD: 14 per 100k; peak 81 per 100k, at 17% of peak --
ND: 14 per 100k; peak 63 per 100k, at 22% of peak
IN: 13 per 100K: peak 66 per 100k so 19% of peak
SC: 12 per 100k; peak 59 per 100k so 21% of peak
AL: 12 per 100k; peak 97 per 100k so 12% of peak
NC: 12 per 100k; peak 46 per 100k, so 26% of peak
MN: 12 per 100k; peak 40 per 100k so 30% of peak
MA: 12 per 100k; peak 74 per 100k so 16% of peak -
NV: 11 per 100k; peak 81 per 100k (14%)
MS: 11 per 100k; peak 63 per 100k (18%)
ID: 11 per 100k; peak 33 per 100k (33%)
KY: 11 per 100k; peak 52 per 100k (21%)
OK: 10 per 100k (peak 63 so 16% of peak)
NE: 10 per 100k (peak 68 so 15% of peak)
CO: 9 per 100k (peak 44 so 22% of peak)
AZ: 9 per 100k (peak 86 so 11% of peak)
ME: 9 per 100k (peak 21 so 45% of peak)
LA: 9 per 100k (peak 56 so 17% of peak)
NH: 8 per 100k (peak 33 so 25% of peak)
IA: 8 per 100k (peak 58 so 14% of peak)
AR: 8 per 100k (peak 61 so 14% of peak)
AK: 8 per 100k (peak 24 so 33% of peak)
WA: 8 per 100k (peak 21 so 37% of peak)
CA: 8 per 100k (peak 70 so 11% of peak)
KS: 7 per 100k (peak 53 so 14% of peak)
NM: 7 per 100k (peak 57 so 12% of peak)
OR: 7 per 100k (peak 19 so 36% of peak)
WI: 7 per 100k (peak 47 so 14% of peak)
VT: 6 per 100k (peak 13 so 48% of peak)
MT: 6 per 100k (peak 56 so 10% of peak)
UT: 5 per 100k (peak 27 so 20% of peak)
WY: 5 per 100k (peak 63 so 9% of peak)
HI: 4 per 100k (peak 19 so 22% of peak)

Remember influenza results in 20-40 hospitalizations per 100,000 on a typical year
cdc.gov/flu/about/burd…
So, already achieved that metric (if we use 20 hospitalizations per 100K for influenza) in 43 out of 50 states or in 50 out of 50 states (if we use 40 hospitalizations per 100K for flu). Getting to 5 is low but achievable with such effective vaccines; give 1 dose & wait on 2nd

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More from @MonicaGandhi9

7 Apr
Let's talk B117 and why I don't think this variant is going to deter our progress. What are 3 things you worry about with a variant? 1) Increased transmissibility; 2) Increased virulence; 3) Can escape immunity from your vaccine (or natural infection). Let's take them 1 at a time
1) Increased transmissibility: There is lab data showing higher viral loads with this variant in nose so could be more infectious. However please look at epidemiology on world stage and in U.S. to make your decisions. UK tamped down virus with vaccines with 90% of their strains
being B117 and never saw their dreaded surge once vaccine roll-out started; 2) Israel started rolling out vaccine with 80% of strains being B117, saw surge as we are seeing in some states here (will get to that in min.) but then tamped down with vaccine
pfizer.com/news/press-rel…
Read 18 tweets
6 Apr
Why should we not worry about VARIANTS "escaping" immunity from vaccines or natural infection; why are we not likely to need vaccine BOOSTERS? Remember immunity is both antibody and cell-mediated (CD4 and CD8 cells). Long-term immunity mediated by memory B & T cells (both get
stimulated if they see the virus again). We now feel secure that T-cell immunity will be preserved against variants after these 2 papers reassured us. Sette's great paper showing T-cell immunity after natural infection or mRNA vaccination preserved against biorxiv.org/content/10.110…
B.1.1.7 (UK), B.1.351 (South Africa), P.1 (Brazil), and CAL.20C (California). Means T cells generated by vaccines can readily fight these variants. 2nd paper is by Dr. Redd one showing that CD8 responses preserved despite spike protein mutations
academic.oup.com/ofid/advance-a…
Read 14 tweets
5 Apr
Let's look at CDC data on "inflection point". Is there a pattern emerging whereby those who are getting close to 40% 1st dose vax rate are seeing turn-around in cases (read below on inflection point). We've already seen hospitalizations per case decrease
threadreaderapp.com/thread/1378411…
due to vaccinations, which is why we know B117 is not creating more virulence (not more hospitalizations per case) although certainly seems more transmissible which is why you want to vax FAST with your restrictions. Data sources: beta.healthdata.gov/browse & covidtracking.com/data/state/tex…
&, Let's look at
*7 day average of cases, comparing to an earlier 7 day average, to get test/positivity rate comparison from different times during the pandemic.
*Number of days in a downward trajectory.
*Positivity rate by week for the last 6 weeks
nytimes.com/interactive/20…
Read 12 tweets
4 Apr
Wanted to address question of "should I get vaccinated if I have had #covid19"?. Fair question given that immunity likely long-lived from natural infection per this study from Drs. Weiskopf, Sette, & Shane Crotty from the La Jolla Institute for Immunology
nih.gov/news-events/ni…
And other evidence laid out in this thread. However, I would take the vaccine (1 dose) if I had COVID-19 in the past personally. Why? Because I hate COVID and vax can serve as major immune response booster when a virus is still circulating at high rates
threadreaderapp.com/thread/1368679…
See difference between now & any other time in history is that we are giving out vaccine AS CASES are still circulating high rates. So unprecedented! In fact those who had chickenpox as child (like me, I am old enough!) were not offered VZV vax because I have natural immunity
Read 6 tweets
4 Apr
4 reasons Giants stadium should not ask for random testing of fans in SF to come to games (fans have to pay for their tickets and tests too!):
1) Masks, distancing, ventilation (being outside!) work
bloomberg.com/news/articles/…
2) Being outside is safe
sfgate.com/giants/article…
Remember, outside transmission is rare (20x less than inside transmission and likely much less). In fact, the WHO does not even recommend masking outside unless you can't distance and the Giants stadium is planning on masks, small pods
academic.oup.com/jid/advance-ar…
3) We are all getting vax or at least whoever wants vax >16 can get one as of April 15. We have learned by now that your viral load in your nose if you have exposure after vaccination is very low and non-infectious. Fans + noninfectious test = anxiety
nature.com/articles/s4159…
Read 4 tweets
3 Apr
Still trying figure out that "inflection" point where vaccines given out enough to population that cases decrease (again, irrespective of lockdown in a way, right, because nursing homes very locked down in US & cases plummeted after vaccine roll-out reached certain threshold) Image
This article in Nature from very early on in the Israel roll-out (they were far & away ahead of us by then though), says "You need to vaccinate much more than a third of the population to really see a reduction in transmission"
nature.com/articles/d4158…
US is right now at 31.4% first dose, 18% fully vaccinated per CDC vaccine tracker but that of course wildly fluctuates per county & state since our public health system is so local-based (federal responses work better in pandemics but not how US built)
covid.cdc.gov/covid-data-tra…
Read 19 tweets

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