US has done well on vaccinations

Will it be enough to ward off spike from Delta variant?

Let's look to UK for to peek into our future

A month ago, UK had half the cases (per capita) as the US

Delta was starting to take hold in UK

See graph (US in blue, UK in red)

Thread
Then, over past month, Delta became dominant in UK

So what happened?

See graph

UK's infections increased nearly 6X in the past month or so

And UK cases now 5X that of the US!!

Ah you say -- that's infections. But surely no impact on hospitalizations!

3/6
Actually, hospitalization in the UK are also up

Up nearly 80% from a month ago

With no signs of slowing down

So that's not great

But surely given that UK has vaccinated all of its high risk folks, deaths are falling?

4/7
Here, there is good news

Deaths are low (largely because almost all older folks are vaccinated)

But even here, there are preliminary signs that deaths are rising

5/7
So not great.

But may be its because UK hasn't been doing a great job fully vaccinating people?

Actually, that's not right

UK has fully vaccinated (2 shots) a higher portion of its population than the US has

6/7
So what does this mean?

In UK, Delta became dominant and

Cases spiked 5X

Hospitalizations up 90%

Deaths rising albeit slowly so far

Despite having vaccinated more folks than US

7/8
The UK experience suggests US vaccination level will not be enough to ward of Delta spike

Infection rises likely to become apparent over next few weeks as Delta becomes dominant

The spike won't be uniform across nation

Indeed, low vax communities are particularly at risk

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
17 Jun
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
Read 6 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

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