If you're in the US right now, how worried should you be about the recent uptick in COVID cases?

A plain-language thread below.

Long story short - the 4th wave is here, and it's time to start acting now before things get worse. But without hitting the panic button.
1. Let's start with the bad news.

Cases are doubling about every 9 days right now - nationwide. This is eerily similar to the rate of increase when each of the previous 3 waves hit. And no state is being spared.

In terms of case counts, the 4th wave is happening. Now.
2. COVID deaths are likely to follow.

We generally see a 3-week delay between when cases go up and when deaths increase.

Since cases have only been increasing for 3 weeks now, we haven't seen an increase in deaths - but we will soon.
3. And even though nearly half the population is fully vaccinated, things can still get a lot worse.

In the UK, for example, vaccination levels are very similar to those in the US. And the UK has seen a huge surge - cases are now back where they were in January.
4. Also - like it or not, we're all in this together.

What began as an outbreak in states like AK, MO, NV has now spread across the country.

Even if vaccination levels are high where you live - if rates are going up in other places, the wave will eventually hit your area too.
5. But there's also room for hope.

First, the one population in which COVID cases are staying stable is people 65+ years old (because their vaccination levels are much higher).

COVID can kill (or cause long-term effects) at any age. But vaccines are protecting older age groups.
6. Thanks to vaccines, deaths will rise more slowly than cases this time.

In the UK (below), cases have multiplied ~20x, but deaths so far only ~5x.

In the US, this would be ~1300 deaths/day.

That's 25 COVID deaths for every homicide. But still only 40% of what we saw in Jan.
7. Most importantly, it's not too late to act.

The UK and Portugal were the first 2 countries in Europe hit hard by this wave. Portugal adopted a more proactive approach.

Case rates in Portugal are now 50% those in UK. Plus, deaths are stable, vs doubling every 2 wks in the UK.
To summarize, the 4th wave is here.

Cases are doubling every 9 days, deaths will rise soon, and things can get a lot worse before they get better.

But vaccines will make this wave less severe - and if we take action now, we can prevent ~1000 deaths per day in the coming weeks.

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More from @davidwdowdy

1 Jul
The golden rule of epidemiology:
Association does not equal causation.

New variants are associated with epidemic waves, but what is the evidence they *cause* them?

An application of classical causal thinking to the question:
"Did the alpha variant cause a COVID wave in the US?"
An introduction to the Helix data (tabsoft.co/3h6fTUd):

Blue bars show % of samples that are the alpha variant, from Jan 2021 to present. Numbers in each state are # of specimens.

Caveat: Data are not representative. But have been used to argue that alpha caused a surge.
Alpha reached 50% of specimens ~Mar 20. Four weeks later, the US saw 30% rise in cases.

Current dogma: This surge was caused by alpha variant.

But this is only an association. Let's look at evidence for causality, taking the 5 states w most data (not cherry-picked). Image
Read 12 tweets
29 Jun
I'm really struggling these days with the politicization of pandemic science.

A quick thread on why I worry that we as scientists are only being inclusive of certain perspectives.

And thereby pushing people away who might otherwise have a lot to offer.
Consider papers with one of the following conclusions:

COVID worsened disease X (except flu).
COVID worsened disparities.
Measures should be more stringent.
Things are going to get worse.
Conservative policies made things worse.

Then consider papers with opposite conclusions.
These conclusions all have political undertones.

But papers w certain conclusions are more likely to be published & cited, while others are more likely to be criticized.

So, if you are an intelligent, but conservative-leaning, thinker, is this a game you want to join?
Read 4 tweets
13 Jun
A reflection thread for junior scientists - but also myself.

It's worth thinking, "when other people talk about me, what do they say?"

Those conversations - which can be key to getting a grant, job, etc. - are less about how smart you are, more what it's like to work with you.
Six qualities you can foster to bolster your reputation, in rough order of importance:

- Conscientiousness
- Reliable communication
- Supportiveness (toward peers/teammates)
- Graciousness (especially w authorship)
- Intellectual engagement
- Work ethic

People notice these.
1. Conscientiousness

My dad's mantra: "If something is worth doing, it's worth doing well. If it's not worth doing well, it's not worth doing."

Some people approach their work as a job, others b/c they care about doing good work. The difference is critical - and easy to spot.
Read 9 tweets
13 Jun
COVID rates are:
- declining in India, US, most of Europe
- stable & high in Latin America
- rising in sub-Saharan Africa & UK

Why such "random" waves of disease?

It's easy to blame variants, but this doesn't explain variability.

Segregated networks can explain five phenomena.
First, an orientation to this figure.
- Dot: person
- Dark line: very close contact (e.g., household)
- Light line: occasional contact
- Dotted circle: mini-network (e.g., same employer/school)
- Blue = uninfected, red = infected, orange = secondary infection, green = immune.
1. Small epidemics can occur without triggering a nationwide epidemic.

Say the person in the red square gets infected (via the line to the left). This will cause a micro-epidemic among their 2 close contacts, but might not spread.
Read 8 tweets
26 May
Are you a prospective PhD/fellow/postdoc looking for the right mentor?

A thread on how to approach the process.

Long story short, two steps:
1) Define your "must-have" priorities.
2) Find evidence (reputation & track record) that a potential mentor will help you achieve those.
Step 1. Define your "must-have" priorities.

There are many things you can accomplish in a 2-4 year program. No mentor will be excellent in helping mentees achieve all of these. List out your "must-haves": things that you will be disappointed if you don't have/accomplish.
13 things a mentor can provide (non-exhaustive):
- Role model
- High-impact publications
- Work-life balance
- Technical skills
- Networking/introductions
- Support for future job
- Personality fit
- Freedom to choose projects
- Strong team
- Time
- Name recognition
- Funding
Read 14 tweets
5 May
One term I worry that we (as a public health community) have mis-messaged during the pandemic:

"herd immunity threshold"

A non-technical thread on why this is not "% of the population that needs to be vaccinated for us to return to life as normal while eradicating COVID-19"...
Disclaimer to the experts: This is for a non-expert audience.

Let's start with the virus that's currently circulating, and estimate roughly that - with no vaccine, no immunity, and "life as normal" - this person would infect ~5 other people before recovering (or dying).
Next, let's take a situation similar to the USA. Out of these 5 possible people infected, 2 might be vaccinated; 1 out of the remaining 3 might be someone who's already have had COVID; and 1 of the remaining 2 might be prevented by current behaviors (masks, distancing, etc).
Read 11 tweets

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