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Atul Gawande Profile picture
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20 Apr, 6 tweets, 3 min read
US COVID-19 deaths remain upwards of 700 deaths a day. Who are these people who are dying?

🧵
COVID deaths in nursing homes are down massively.

- In Dec 2020, these accounted for 32% of all COVID deaths.
- In Mar 2021, thanks to vaccination, they accounted for just 4%.

So who are the remaining 96%?

data.cms.gov/stories/s/COVI…
Here's the change in distribution of COVID deaths by age.

- In Dec, 63% of all deaths were in ages 75+.
- In Mar, most deaths were UNDER age 75,

The flattening of COVID deaths according to age is extraordinary.
cdc.gov/nchs/nvss/vsrr…
@Bob_Wachter has an excellent piece outlining why vaccination is key, given local officials unwillingness to give up relaxing mitigation measures.

But who should be the focus of vaccination efforts?

washingtonpost.com/opinions/2021/…
Below are the current vaccination rates by age group.

covid.cdc.gov/covid-data-tra…
With vaccination >80% for people 65+, the group to focus on to reduce the most deaths are those aged 50-64.

Is reaching them more important than vaccinating the young transmitters? I'd say yes. We can do both, but the middle aged are crucial

They're how we get deaths down.

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More from @Atul_Gawande

Atul Gawande Profile picture
14 Apr
Update from listening to the CDC ACIP meeting on the J&J vaccine:

They postponed making any decision, effectively continuing the pause on use of the vaccine.

They will reconvene in 7-10 days to review case reports from the ~4M who received the vax in last two weeks.
Why wait for more info? A new case of cerebral sinus venus thrombosis was reported in a 25 year old man who became critically ill from a cerebral hemorrhage.

And for women age 20-50, CSVT occurred in 1 in 13,000, or 4-15X higher than background.
My guess is that additional data and a full risk analysis will support a recommendation that women <50 get mRNA vaccines unless no other choice, but for people >50, J&J is fine.

What the story in young males will be remains to be seen.
Read 4 tweets
Atul Gawande Profile picture
31 Mar
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…
Read 7 tweets
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

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