1/ New CDC report on #covid19 outbreak caused by Delta variant in Oklahoma gym, causing 47 cases.

Notably- over 90% of cases were among *unvaccinated or partially vaccinated* people.

Very high household secondary attack rate (53%)

2/ Risk factors here:
-larger groups
-inconsistent mask use
-poor ventilation
-low vaccination rates

3/ As others are bringing up in the comments-- it is important to understand, among the vaccinated 'cases'-- how their cycle threshold values (proxy for viral loads) compared to unvaccinated-- this tells us about their transmission potential in real world. #covid19
4/ Without this, treating vaccinated 'cases' as equivalent to unvaccinated 'cases' doesn't tell the full story

Also- important to follow out 'cases' in both groups to better understand development of long term symptoms (beyond just deaths & hospitalizations) #covid19
5/ Noticing that people are seeming to focus on the idea that reporting 'cases' is misleading because unvaccinated folks here didn't die so what's the big deal?

At least two reasons:
-secondary/tertiary etc cases (not fully traced out here)
-long term morbidity, limited data
-Unvaccinated cases--> suspect higher viral loads/ possibly longer periods where they can transmit to others, causing more cases among vulnerable people. This matters

-Long term morbidity from #Covid19 is a problem. We see it in the follow up clinic.

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More from @AbraarKaran

28 Jun
As #covid19 variants spread— the basics of how the virus transmits, & how to protect ourselves remains largely the same

Unfortunately, these basics/essentials are largely out of reach in many countries; &, this is exactly what many expected would happen.

2/ Some have commented previously on reasons that mRNA vaccines may be preferable to the J&J vaccine esp during non-surges; but at a population level, vaccines with ease of storage & single dose would be preferable in hard to reach groups

3/ The variable of interest here is vaccine efficacy against variants like Delta; two dose mRNA regimens seem to still hold up against this variant (unless there’s newer data I haven’t seen); I still have to take a closer look at J&J & Novavax results against Delta
Read 5 tweets
9 Jun
This piece is on point— but also not surprising. Individualism has plagued public health for a long time; it is a byproduct of our society & American culture at large. At the center of this is a *disregard* for equity. This is not new. ⁦@edyong209theatlantic.com/health/archive…
2/ That an institution like @CDCgov would make statements that refocus on individual responsibility is not surprising. This is a great way to shift blame and accountability to the public and away from the institution. This is the same as the “stay home” rhetoric
3/ The type of messaging referenced here telling individual to take matters into “their own hands”— that speaks to people who view the world through their lens of privilege & view others who aren’t living to their standard as being worthy of blame rather than in need of resources
Read 9 tweets
24 May
1/ Nice column by @DLeonhardt this morning

Removing barriers for vaxx is our next big task to close inequities

Part of that is information, but I think a bigger part is overcoming pragmatic challenges:
•paid time off to get 💉/recover
•on-site vaxx in workplaces
2/ For the past year, I rarely had any #covid19 patients who worked from home

The inequities of who got sick were baked right into the way our society was already set up

We are seeing vaxx inequity play out the same — being able to get the vaxx is a big privilege (time,$ etc)
3/ While attitudes don’t explain the whole story, there is an interesting reduction in the % of “definitely not” getting 💉 group when you subdivide it into “college grads” v “non-grads” seen across categories

source @KFF /graphics @nytimes
Read 10 tweets
19 May
New from CDC EID-->

Large #SARSCoV2 outbreak at fitness center in Hong Kong, March 2021

~300 tested w/ 102 cases confirmed

All unvaccinated

No mask use

Poor ventilation

2/ no mandated mask use*; and says many did not wear a mask; after this outbreak, the article reports that Hong Kong mandated mask use in exercise facilities.

Again- March 2021; but, with low vaccination rates, the epidemic will continue to spread.
3/ It seems from the report that many of these patients were younger/healthy (average age 38); none were reported to have any severe outcomes and a number were asymptomatic.

Big takeaway: large susceptible unmasked/unvaxxed populations are still vulnerable

Read 4 tweets
19 May
Just walked down the sidewalk in Boston where summer has undoubtedly arrived.

Two folks walked out from my apartment building w/ their masks on; both pulled them off once they were outside.

Times are changing. #covid19
2/ And yet, half-way across the world-- I am in contact with my relatives in India daily. My cousin, uncle, and aunt all were sick with the virus. We tried to manage my uncle at home for days; eventually got him a hospital bed.

We will continue to see this dichotomy globally.
3/ While it may feel like we are out of the woods here, the surges in South Asia are reminders that inequity- primarily but not solely vaccination inequity- will haunt us all.

#Covid19 will be an endemic disease; unvaccinated places will likely suffer epidemic surges.
Read 4 tweets
8 May
1/ Three Cs from Japan- avoid crowds, prolonged close contact, & closed spaces (poor ventilation)

These fundamental principles must be the core of reducing transmission during #covid19 surges in large unvaccinated populations

Adhering to these requires serious social supports
2/ There will still be a number of essential activities that must be done for survival.

The safest way to do these is with the best personal protective equipment available: namely, high filtration masks, whether N95 or reusable eN95 respirators, or equivalents KF94, KN95, FFP2
3/ Beyond these, rapid at-home POC diagnostics (cc @RanuDhillon @sri_srikrishna) at scale could be key; ideally, these should be available universally before surges happen--> these can quickly remove highly-infectious people from the pool daily before they become superspreaders
Read 11 tweets

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