Want to talk about INFLECTION POINT and how it looks like we have reached this in our country with hospitalizations at this vaccination rate & also turning the corner in Michigan. We discussed this first with Israel & I think "inflection point" with both hospitalizations & cases
will be different by country/state/region depending on degree of natural immunity there. This article in Nature from early on in the Israel roll-out: "You need to vaccinate much >1/3 of the population to really see a reduction in transmission", how much
nature.com/articles/d4158…
more probably depends on 1) natural immunity (surges before (CA has 38% of its population exposed); 2) degree of lockdown as you are vaccinating (UK more; Israel less; places in US variable); 3) maybe even what vaccine (?India). Paper from Israel (Fig)
nature.com/articles/s4157…
looks like lockdown restrictions eased 2/7/21. Paper specifically said "In conclusion, patience was needed before the real-life effect of the mass vaccination campaign in Israel became apparent" (I used word "patience" with reporter about US today). Graph
ourworldindata.org/coronavirus/co…
from Israel (Figure above) shows us cases started plummeting about 40% 1st dose vax rate (other inflection point - where hospitalizations started becoming decoupled from cases & those in hospitals were unvaccinated had occurred before). Economy open 3/8/21
euronews.com/2021/03/07/isr…
In US (source) entire U.S. total (w/o territories) for confirmed COVID hospitalizations over past 7d coming down day-by-day: now at 36.8K confirmed COVID admissions over last 7d: 29K by end next week or lower (Once Israel started descent, went down fast)
healthdata.gov/Health/COVID-1…
If you look at this tweet and world data Israel: & ourworldindata.org/coronavirus/co…
3/8/21: Critically ill hospitalizations were at ~47%, cases were 3,594
3/15/21: ICU ~39%, cases 2,257 or -37% from prior week
3/22/21: ICU ~23%, cases 1,122 or -50% from prior week
3/29/21: ICU ~18%, cases were 480 or -57% from prior week
4/5/21: ICU ~10%, cases were 354 or -26% from prior week
4/12/21: ICU ~7%, cases were 222 or -38% from prior week
So, what about Michigan? See current data here - hook at end look like turning corner & admissions peaked
Michigan is at 45.6% 1st dose (below source), lower than average of US which is at 51.1% 1st dose today (covid.cdc.gov/covid-data-tra…). So, go faster, looks like inflection point being reached
michigan.gov/coronavirus/0,…
Think we are getting closer and closer to that inflection point when things turn around in these regions of the US. So, this is important- we are not in a 4th surge overall. 5 states in our country are reporting 75% of our new cases
salon.com/2021/04/21/a-q…
Those states are Michigan, Florida, New York, Pennsylvania, New Jersey. We compared ER visits against hospital admissions now vs. peak of pandemic, to see if ratio declined and it has - 22% ER to admission Jan 5, 2021; 11% ER to admission now
wsj.com/articles/old-u…
Past 2 days on cases took steep decline per CDC site; NYT website has 7 day average on cases of 64.5K so down -5% day over day (67.2k cases) vs. a week ago -9% (71.1k cases). My data analyst therefore makes following projections based on inflection points: nytimes.com/interactive/20…
1,200 Total U.S. Hospitalizations for COVID inpatient, & 300 for COVID ICU by 6/5/21 (total 1,500 U.S. Hospitalizations for COVID by 6/5/21) and that we will reach what Dr. Fauci messaged as 10K a day by 5/29/21. Helpful to have publicly available data, watch UK (senior) &
UK (junior) while we are sophomores in high school fast catching up vaccinations with one part of our student body (the 5 states) above with 75% of new cases. Let's all watch carefully, get vaccine out as fast as possible in these regions, & see if these projections come true.
Perhaps on cue regarding the inflection point of 40% 1st dose?

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More from @MonicaGandhi9

20 Apr
This is true but I am VERY worried about India right now. My understanding is that vaccine capacity is not maximal because more raw materials are needed. India has called on the Biden Administration (ASlavitt) for help. Masks/distancing as much as possible in crowded conditions.
India has Covishield (AZ vaccine) + Covaxin (Bharat Pharm). I see from phase I/II trial of the Covaxin vaccine that cell-mediated responses were generated (although used IFN-gamma assay that Sputnik V used in their paper instead of direct measurement).
medrxiv.org/content/10.110…
However, reason worried about Covaxin is that we have not seen phase 3 clinical trial results yet except in press release; would love to see peer reviewed publication (does anyone know status?). Covaxin is a whole inactivated viral vaccine like Sinovac
economist.com/graphic-detail…
Read 7 tweets
20 Apr
Will we be able to achieve herd immunity and at what level vaccination? I believe we will but I don't know at what % vaccination though I suspect it could be 65-70%. Why?
1) Achieving herd immunity with a vaccine is dependent on its effectiveness; the mRNA vaccines are more
effective than we dared hope with 100% efficacy at 6 months per Pfizer data and amazing CDC breakthrough data showing (with ongoing cases), of 77 million fully vaccinated against COVID-19, ~5,800 infections (0.008%) – 0.005% symptomatic (29% asymptomatic)
pfizer.com/news/press-rel…
2) Study from Israel shows children do not need to be vaccinated to massively reduce transmission in this group. Just vaccinating adults >16 years brings down infections among children substantially (every 20 point increase adults; halves in children)
medrxiv.org/content/10.110…
Read 6 tweets
19 Apr
@DLeonhardt article today NYT illustrates what @drlucymcbride, I & so many others discussing: a fear of normal or even following simple March 8 CDC guidelines that vaccinated people can get together without masks/distancing due to irrational fear.
nytimes.com/2021/04/19/bri…
"Fortunately, [fear] also curable. The vaccines have nearly eliminated death, hospitalization and other serious Covid illness among people who [got] shots. .vaccines have also radically reduced chances that people contract even a mild version of Covid or can pass it on to others"
Even acclaimed experts like @ashishjha realized how "awesome" it was to meet friend for drink unmasked 2 months (!) after his last shot. My advice for society on this as MD who talks to patients about irrational fear all time?
1) Leaders like President Biden? Model behavior like
Read 7 tweets
19 Apr
Breakthrough infections by CDC. If we take out 29% of the 5814 who were asymptomatic, the rate of breakthrough infection is actually 0.00005 (or 0.005%). That is amazing! I took out asymptomatic infection because those actually show vax works: IgA in nose
cdc.gov/vaccines/covid…
limits replication & keeps viral load low so can't transmit (multiple articles below). For instance careful contact tracing of 39 breakthrough infections in Sonoma County last week showed no transmission!
nature.com/articles/s4159…
medrxiv.org/content/10.110…
academic.oup.com/cid/advance-ar…
And please remember that is vaccine effectiveness (how do they work in real world?) under "stress conditions": we still have high cases in some areas, variable mask wearing, people have to work, etc. So should see very little breakthrough (with symptoms) in places with low cases
Read 4 tweets
18 Apr
How is US doing? 44 states doing well. In HHS/CDC/ASPR Report, 6 States have almost 50% of Confirmed COVID-19 Admissions in the last 7 days; these states represent 26% of the U.S. Population (MI, NY, FL, PA, NJ, IL). Reason such a mix of caution/optimism on the news.
Most of this still in Michigan although they have now reached peak hospitalizations and are coming down. Less natural immunity, B117 (but not all explained by that, see thread yesterday), seasonality?, vax rate slow in some counties esp at first
clickondetroit.com/news/local/202…
NY, NJ, PA: didn't vaccinate seniors (in SNFs) as fast as other states. So remaining 44 states + DC + the territories (74% of pop), have hospitalization rate of 8.5 per 100K overall (much less than 20-40K of flu) and approaching 5/100K in article washingtonpost.com/outlook/2021/0…
Read 5 tweets
18 Apr
I really admire especially my local paper's dogged determination to help open schools given the impacts of school closures on child mental & physical health. However, would argue with @drlucymcbride that we need a @factsnotfear approach to our reporting
sfchronicle.com/opinion/editor…
if we really want parents/teachers/students to feel safe about school openings. Examples of #factsnotfear reports are 1) explain to public what the vax effectiveness data is showing us in real-world: vax incredibly effective under stress of surges, differential mask wearing etc.
Very difficult to get or give #covid19 after vaccine. So, also explain to public all the accumulating data that vaccines massively reduce transmission. Cover the multiple papers which show this & discuss how IgA (mucosal antibody) generated by vax protect from nasal infection
Read 12 tweets

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