Key feature of the Delta variant is everyone needs both shots of the mRNA vaccines to be protected

But national vaccination data suggests about 10% of people have missed their 2nd shot

That's about 18 million people

And those 18M aren't spread evenly across the US

thread
So some math

As of today, there are 29M people with 1 shot

Based on daily vaccination rates, about 11M of those 29M are in window between 1st and 2nd shot

Leaving about 18M people who missed 2nd shot.
That's 10% of folks who started getting vaccinated

But....
People missing 2nd shot varies widely by state

In Hawaii, nearly 1 in 4 people who got their first shot missed their 2nd shot

Utah is at 20% of people missing their 2nd shot

IL (18%), PA (16%), and Arkansas (15%) round out worst 5

So who's good?

3/5
Iowa best with only 5% missing 2nd shot

Next are Ohio (5.3%), Louisiana (5.7%), Maine (5.7%), Nebraska (6%)

Interestingly, no correlation between underlying vax rates and missing 2nd shot

That is, high vaccination states have comparable proportion of people missing 2nd shot
So what does this all mean?

First, a lot of people (18 million) have missed their 2nd dose

That's bad when Delta variant is around

Second, some states have far fewer folks missing 2nd shot

Iowa, Ohio, LA are among the best

We should learn what they are doing

5/6
Third, we must focus more on helping people get their 2nd shot

Explain why its important
Make it easier (give people day off!)

And have a clear message to those who missed their appointment:

Don't worry why you missed it

Better late than never.

Go get the 2nd shot

Fin

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More from @ashishkjha

18 Jun
Important study out of UK

Worth your time

Researchers examined brain MRIs of people before and after they got COVID, matched with controls

What did they find?

Substantial loss of grey matter in those who had gotten but recovered from COVID

Thread

medrxiv.org/content/10.110…
Loss of grey matter (thickness and volume) suggests damage to areas of the brain

Which areas?

Areas involved in smell/taste, cognitive function, and memory formation

And the kicker?

Most of COVID patients examined had had mild to moderate disease in the past

2/3
So what does this mean?

1 Appears to be good evidence that infections lead to neurologic damage in some portion of people

2 severity of neurologic effects not related to severity of initial disease

3 we have to begin to put effort into long-term effects of COVID

And....

3/4
Read 4 tweets
29 May
Tempting to look at vaccinations in US by states

And it makes sense: states have a lot of control over vaccination sites, outreach, etc

But there's ton of variation within states

So let's talk Massachusetts, a super high vaccination state

Its a tale of two cities

Thread
Lets look at two of the larger cities in Massachusetts

Springfield and Newton

Springfield 3rd largest with a population of 150K

Newton 11th largest with a population of 91K

Difference in vaccination rates between them?

Stunning

So let's go to the numbers

2/5
Springfield:

12% of kids aged 12-15 with at least 1 shot
55% of people over 20
64% of people over 30

Newton:

64% of kids aged 12-15
93% of people over 20
99% of people over 30

That's not a typo. 99% of people over 30!!

3/6
Read 7 tweets
16 May
A lot of folks wondering since I'm fully vaccinated, why would I wear a mask at a grocery store?

Every action we take is a weighing of costs and benefits

So lets talk about fully-vaccinated me in a grocery store

Am I a risk to others? No

Am I at risk? Not much

Thread
So whats the risk to me?

Right now, infection numbers still high in MA, although falling

And if grocery store has lots of unvaxed, unmasked folks, I have a tiny risk of picking it up

Tiny

But cost of masking up is also tiny

But that's not the real reason

2/4
There are lots of folks who want to be but are not yet fully vaccinated

My wife for instance

She got her first shot right after she became eligible

She's close but not fully vaccinated. There are lots of folks like her

And by masking up, I help create a norm in society

3/4
Read 5 tweets
15 May
Thoughts on @CDCgov mask update

They got the science right: fully vaccinated folks don't need to wear masks indoors

Of course, there is one major problem: how do you know who is vaccinated?

States/companies are getting policy response to CDC guidance wrong

thread
In response to CDC, states/businesses have 3 choices:

1. Figure out who is vaccinated or not (hard to do but not undoable)

2. Drop mask requirements for everyone, hope for honor system (easy to do, not great)

3. Keep masking a bit longer (not hard to do, much better)

2/n
Option 1: figure out who is vaccinated

I get this is hard. Vax verification systems are coming but not here yet

Option 2: Drop mask mandates and hope

Not a good idea. Why? Lots of folks still not yet vaccinated. Infection levels high

Option 3: wait about 4 more weeks

3/5
Read 5 tweets
9 May
Wrote about why India likely has 25K+ deaths daily

Pushback: we lack hard data on crematoriums so we can't be sure

True

But we get 25K+ deaths no matter how you look

Another approach:

400,000 cases, 22% test positivity

Likely means we're missing 90% of infections

Thread
Here's a way to think about it:

In the US, 60K cases from 3 weeks ago leading to 600 deaths today

A case fatality rate of 1%

But my best guess of infection fatality rate (IFR) in US now is 0.5%

So that means US missing half of infections

With a test positivity of 4%

2/5
So in the US, for every 25 test we perform, there is 1 positive

But we're still missing half the infections

In India, every 4 tests turns up 1 case

Meaning India missing a vast, vast majority of infections

Probably around 90%

So true # of infections in India closer to 4M
Read 5 tweets
9 May
India reports another 400,000+ cases, 4000+ death day

A sustained level of horribleness

And its not correct

True number surely closer to 25,000 deaths, 2-5 million infections today

Lots of ways to estimate but here's a simple one

Look at the crematoriums

Thread
During non-pandemic year 2019

About 27,000 Indians died on typical day

Crematoriums handle that level of deaths every day

Additional 4,000 deaths won't knock them off their feet

Crematoriums across the country reporting 2-4X normal business

2/4
So best estimate 55K to 80K people dying daily in India

If you assume baseline deaths of 25-30K

COVID likely causing additional 25K to 50K deaths daily

Not 4,000

What about infections?

Lets start with Infection Fatality Ratio (IFR)

In India, at least 1% right now

3/5
Read 6 tweets

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