Sobering—“It is already clear that the virus is changing too quickly, new variants are spreading too easily & vaccination is proceeding too slowly for herd immunity to be within reach anytime soon.”

➡️ Vaccine hesitancy hurts public health.🧵 #COVID19
nytimes.com/2021/05/03/hea…
2) I don’t like this— “daily vaccination rates are slipping, and there is widespread consensus among scientists and public health experts that the herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever.”
3) “rather than making a long-promised exit, the virus will most likely become a manageable threat that will continue to circulate in US for years to come, still causing hospitalizations and deaths but in much smaller numbers.”

➡️I don’t like waving this surrender flag.
4) “Continued immunizations, especially for people at highest risk because of age, exposure or health status, will be crucial to limiting the severity of outbreaks, if not their frequency, experts believe.
5) “The virus is unlikely to go away,” said Rustom Antia, an evolutionary biologist at Emory University in Atlanta. “But we want to do all we can to check that it’s likely to become a mild infection.”

➡️No, I think we can do better with #ZeroCovid approach.
6) “The shift in outlook presents a new challenge for public health authorities. The drive for herd immunity — by the summer, some experts once thought possible — captured the imagination of large segments of the public.”

➡️putting all eggs into vaccine basket inadequate.
7) “To say the goal will not be attained adds another “why bother” to the list of reasons that vaccine skeptics use to avoid being inoculated.”

➡️ INDEED—this is why this “vaccine savior” singular push is tricky to communicate. We need both vaccines & #ZeroCovid approach.
8) “People were getting confused and thinking you’re never going to get the infections down until you reach this mystical level of herd immunity, whatever that number is,” Fauci said.
“That’s why we stopped using herd immunity in the classic sense,” he added.
9) Fauci: “I’m saying: Forget that for a second. You vaccinate enough people, the infections are going to go down.”

➡️ My take: This is true, but “down” for some (India and Brazil) is not adequately down for others. “Down” is too subjective. And allows authoritarians to dismiss.
10) HERD IS A MOVING TARGET: “Early on, the target herd immunity threshold was estimated to be about 60 to 70 percent of the population. Most experts, including Dr. Fauci, expected that the United States would be able to reach it once vaccines were available.
11) “But as vaccines were developed and distribution ramped up through the winter and into the spring, estimates of the threshold began to rise. That is because the initial calculations were based on the contagiousness of the original version of the virus…
12) “The predominant variant now circulating in the United States, called B.1.1.7 and first identified in Britain, is about 60 percent more transmissible.
As a result, experts now calculate the herd immunity threshold to be at least 80 percent…”

MY TAKE: likely 80-90% for #P1.
13) “If even more contagious variants develop, or if scientists find that immunized people can still transmit the virus, the calculation will have to be revised upward again.”

My take➡️ we need to get serious that we need both vaccines and a #ZeroCovid mitigation approach.
14) At this point, all creative approaches to get people to vaccinate are on the table… even comedy…
15) “How insulated a particular region is from the coronavirus depends on a dizzying array of factors.
Herd immunity can fluctuate with “population crowding, human behavior, sanitation and all sorts of other things,” said Dr. David M. Morens, a senior adviser to Dr. Fauci.
16) “The herd immunity for a wealthy neighborhood might be X, then you go into a crowded neighborhood one block away and it’s 10X.”
Given the degree of movement, a small wave in a region with a low vaccination level can easily spill over into where a majority of is protected.
17) “At the same time, the connectivity between countries, particularly as travel restrictions ease, emphasizes the urgency of protecting not just Americans but everyone in the world, said Natalie E. Dean. Any variants that arise in the world will eventually reach the US.” ⚠️
18) Let me repeat: •Any variants that arise in the world will eventually reach the United States”!

➡️So damnit, those living in cushy bubbles in Manhattan who think we don’t have to worry about 🇧🇷#P1 or 🇮🇳 #B1617 variants coming to the US (you know who you are!)—wake up!
19) The only one thing that annoys me as much as anti-mask/anti-vax people are those who are “don’t worry about variants / vaccines will solve it soon” folks who dismiss the seriousness of variants & and foolishly think #COVID19 is over in US. It’s not!

nytimes.com/2021/05/03/hea…
20) Also, #P1 is rising across many parts of the US, hence we need to vaccinate more than ever.
21) Unvaccinated people need to stop thinking they are invulnerable.

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More from @DrEricDing

15 May
Doctors treating patients in India 🇮🇳 have marked a distinct trend during the 2nd wave—#COVID19 now appears to be impacting children more severely. Children and adolescents are now showing more obvious symptoms such as prolonged fever and gastroenteritis.🧵hindustantimes.com/india-news/in-… Image
2) During the first wave, most children remained asymptomatic, and a large number of them went untested because of that,” said paediatrician Dr. Bakul Parekh. “We tested children only when someone in the family had a history of Covid-19.”
3) Over the last fortnight, Parekh, who runs a children’s hospital in Ghatkopar, has admitted six children between 1 and 7 years old to the hospital -- three with severe gastrointestinal infections and fever, and others with breathlessness and fever.
Read 11 tweets
15 May
HEALTHIER THAN EVEREST CLIMBER? Mount Everest 🏔 base camp outbreak—expedition cancelled after climbers sickened by #COVID19—An American climber & 3 Sherpa guides from a 51-person expedition were evacuated from base camp & hospitalized in Kathmandu Nepal🇳🇵
nytimes.com/2021/05/15/wor… Image
2) “A second wave of the coronavirus is ravaging Nepal, overwhelming its feeble health care system. On Saturday, the authorities reported 8,167 new cases and 187 deaths.
On the peaks, the spread of the virus is unclear, but signs of trouble are growing…”
3) “Starting this month, hundreds of foreign climbers, Sherpas and other support staff have lived at Everest’s high-altitude base camp, preparing for an ascent to the world’s tallest peak.
Read 4 tweets
15 May
BREAKING—Taipei, Taiwan 🇹🇼 has raised its local #COVID19 crisis rating to Level 3 alert for the first time, after 180 domestic transmission cases. Masks will now be required indoors & outdoors. 🇹🇼 has 23 mil people—first time exceeding single digit average daily cases in a year. Image
2) Under the CECC's four-tier alert system, a Level 3 alert means people are now required to wear masks at all times when they leave their homes, indoor gatherings of more than five people are not allowed, and outdoor gatherings are limited to 10 people.

focustaiwan.tw/society/202105…
3) A Level 3 alert, which has been in imposed in Taiwan for the first time, stops short of a lockdown and goes into effect when more than three community clusters are confirmed in a week or over 10 domestic cases of unknown origin are reported in a single day.
Read 7 tweets
14 May
KEEP WEARING THE MASK—We card-carrying epidemiologists (with formal doctorate in epidemiology) know what we are talking about. Vast majority of 700+ epidemiologists surveyed says we would keep wearing masks for 1 year or longer. #COVID19 #MaskUp

nytimes.com/2021/05/13/ups… ImageImage
2) “When federal health officials said on Thursday that fully vaccinated Americans no longer needed to wear masks in most places, it came as a surprise to many people in public health. It also was a stark contrast with the views of a large majority of epidemiologists surveyed.
3) “In the informal survey (of professional epidemiologists), 80 percent said they thought Americans would need to wear masks in public indoor places for at least another year. Just 5 percent said people would no longer need to wear masks indoors by this summer.
Read 8 tweets
14 May
96% of critical care beds in Osaka Japan 🇯🇵 are full. Hospitals “overwhelmed”.

Olympics in 70 days? 🤷🏻‍♂️ #COVID19

theguardian.com/world/2021/may…
2) Osaka, along with Tokyo and two other prefectures, will remain under a state of emergency called in late April until at least the end of this month, and another three regions are due to join them from Sunday, Japanese media reported on Friday.
3) the vaccine rollout for older people and other at-risk groups is only just picking up speed. About 3% of the population of 126 million have been inoculated so far, amid reports of problems with the vaccination booking system, queue-jumping by local politicians & businesspeople
Read 4 tweets
14 May
ONLY VACCINES?—What if we dropped all masks/mitigation, and only rely on vaccines? Well, with 70% fully vaccinated, even if vaccines have 97% efficacy against all transmission (they don’t)—we can only stop Wuhan 1.0 slower strain. Forget #B117/#P1/#B1617.🧵

(HT @GosiaGasperoPhD)
2) However, the math to stop #COVID19 completely changes if we add masks and other public health motivations. Even with lower transmission efficacy vaccines, even with more faster contagious variants—when combined together, vaccines + masks + mitigation can hold back surge!
3) the main leakage with the vaccine only approach is that asymptomatics keep spreading even if vaccines work for severe #COVID19 disease. And it will leak to the vulnerable.
Read 4 tweets

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