The US vaccination campaign is facing a fundamental challenge: getting the vaccine where it’s needed most. Millions of Americans are still unprotected, many of them at high risk of severe illness. Our 4th surge is beginning. Lives are at stake. 1 of thread/
1 in 3 people in the US have gotten at least one dose of vaccine—but that means 2 in 3 haven’t. Millions of people age 50-64 and 65+ who haven’t yet been vaccinated can still get Covid and are at much higher risk of severe illness or death, especially with the new variants. 2/
Some states are doing much better than others reaching older people: NH, VT, ME, RI, CT, MA, SD have given >1 dose to more than 85% of residents 65+ years old. In TN, WV, MS, Alabama, HI, and PR that proportion is less than 70%. 3/
There are still 12 million people 65+ unvaccinated. Nearly half of 50-64 are vaccinated, but that leaves 34 million in that group unvaccinated. Those not yet vaccinated are disproportionately Black and Latinx. We must do better. 4/
The most prevalent strain of Covid in the US now is B117. This variant is more contagious and likely more deadly. How bad it gets depends more on us than on the virus. New variant, same response needed: vaccinate, mask, distance. Patience, discipline, solidarity. 5/
In the coming weeks, we need to shift our strategy. It’s not enough for everyone to be eligible for vaccination, we have to make sure people actually get vaccinated. That means reaching people at highest risk of severe illness and death, in the places with most spread. 6/
I explained last week how a single well-targeted vaccination could save 10 times more lives, and prevent 100 times more cases, than vaccinating a low-risk person in a low-risk community. 7/
If we optimize vaccine distribution we can save the most lives. The number needed to vaccinate to save one life shows impact of vaccines in high- vs low-risk groups. Vaccinating anyone helps, but for the next 1-2 months, focus can save many lives. Aim our shots better. 8/
There have been ~560K Covid deaths in the US: 1 of 586 Americans. To prevent one death we need to vaccinate ~586 people/year. Vaccinating 100 million people will save >170K lives from Covid this year (more when secondary cases prevented are included in the calculation). 9/
This is even more dramatic when we look at nursing homes. ~220K nursing home residents have died from Covid. To prevent one death, we need to vaccinate ~7 nursing home residents, so vaccinating 1 million in this population alone will save 140K lives (!). 10/
But focusing on age alone isn’t enough—we have to improve vaccine equity by race/ethnicity also. @KFF data shows a consistent pattern: Black & Latinx people are less likely to be vaccinated even though they’re more likely to get Covid and die from it. 11/
A preprint study showed we can save more lives if we prioritize high-risk areas.… 12/
Right now, Michigan is being hit hard. Other states may follow. As hotspots emerge, we should flood the zone with vaccines. We also need to mask up and take other measures, such as closing bars and limiting restaurants until vaccine coverage increases or cases decrease. 13/
There’s a lot more we can do to improve equity and overcome vaccine hesitancy. Make it easy to get vaccinated. Convenience overcomes reluctance. 14/
Instead of requiring appointments, let people walk in—esp those at high risk of severe illness & in places with extensive spread. Offer extended hours, allow time off from work & provide transportation to vaccination sites. Make vaccines widely available at doctors’ offices. 15/
Reach people where they are. That means getting creative with mobile and non-traditional vaccination sites such as churches, schools, corner stores, bars & pop-ups at community events. Use the right messages and the right messengers. Partner with community orgs and leaders. 16/
Ask our friends, family and neighbors if they've been vaccinated. If not, ask if you can help them sign up or support them to get vaccinated. Listen and acknowledge concerns, address with facts, and tell real stories of real people harmed by Covid and protected by vaccine. 17/
We must do better with focused, rapid vaccination in the US. And we must recognize that global vaccine equity is an urgent crisis. Increasing manufacturing is the only way forward. Uncontrolled spread anywhere is a threat everywhere. 18/end

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More from @DrTomFrieden

2 Apr
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/
Read 22 tweets
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

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