This is valuable reporting but there's a lot in here that's confusing. Would the Post or the CDC consider just publishing the slide deck?

1/
washingtonpost.com/health/2021/07…
"there is a higher risk among older age groups for hospitalization and death relative to younger people, regardless of vaccination status"
- but surely what should matter is whether vaccination reduces absolute risk for one or both groups, not risk relative to one another?
2/
"there are 35,000 symptomatic infections per week among 162 million vaccinated Americans"
- not sure how to think about this. Seems a lot lower when you think of it as 3.5/wk out of every 162,000.
- what should we expect given a very effective vaccine but high exposure?
3/
"Although it’s rare, we believe that at an individual level, vaccinated people may spread the virus, which is why we updated our recommendation"
- but who thought breakthrough infections never transmit?
- the question is how often ("rare") vax'd people are infected & spread
4/
"the vaccines are not as effective in immunocompromised patients and nursing home residents, raising the possibility that some at-risk individuals will need an additional vaccine dose"
-very important, but boosters/KN95s might be more relevant than cloth mask guidance
5/
I think universal masking is wise to reduce spread, especially in areas with hospitals at risk of being overwhelmed. But I'm surprised to see vaccination being described as purely "personal protection." There's a spectrum between 0% transmission reduction & 100% reduction
6/6

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More from @GovindPersad

30 Jul
This is the most compelling slide in the set, and makes a very good case for universal masking right now, which I agree with.

However, I'd have liked to see CDC grapple with this: what's the overall reduction in R if vaccinated people mask, but unvaccinated people don't?

1/5
My other concern about some framing (in reporting/Twitter, not the slides) is that it may fuel the following misinterpretation: "a vaccinated/vaccinated person encounter is as likely to transmit Covid as an unvaccinated/unvaccinated one"

That isn't what the slides/data say!
2/5
Even if we assume breakthroughs are just as likely to produce an infectious dose as an unvaccinated person's infection (stronger than CDC's claim):

- vaccines make people much less likely to *be* infectious
- vaccines reduce susceptibility to an otherwise infectious dose

3/5
Read 5 tweets
29 Jul
The plurality answer in my (unscientific!) poll was the CDC's rec: require masks for everyone everywhere, but allow any type

A less popular answer--don't require masks everywhere (esp. for vaccinated people), but sometimes require KN95+ masks--may better balance benefit/burden.
People often want one-size-fits-all guidance

But current guidance allows high risk (unvaxed hospital visitors w/1-layer cloth masks) & imposes burden w/o large benefit (masking in distanced/ventilated indoor spaces w/everyone vaccinated)

Also hard to square w/open indoor dining
I can see good rationales for universal masking in supermarkets while allowing indoor dining

- everyone needs groceries, dining out's optional
- reducing risk at stores is low-burden vs doing so in dining

But also seems we're placing more restrictions on the lower-risk activity
Read 5 tweets
7 Jul
Very detailed and helpful paper. Upshot:
- found a small (non-significant) *decrease* in full vax rates in Ohio post lottery
- found a small (non-significant) increase over all lottery states
Agree: "unlikely there are hugely positive or hugely negative effects"
As a non-expert, I like the preregistration & use of synthetic control. Some remaining questions
- is theirs the right counterfactual? (see thread)
- is the proper outcome to measure full vax, as they did, or 1 dose (I'd actually think 1 dose is the more lottery-relevant outcome)
Disappointingly, the quote tweets of the paper mostly seem to read "lol, vaccine lotteries didn't work"

People should read the whole thread & embrace the acknowledgement of substantial uncertainty that the authors recognize! (I know this runs contrary to twitter norms.)
Read 6 tweets
22 Apr
"77% of white adults who want a shot have gotten one, compared with 60% of Black adults and 55% of Hispanics who want one."

Not everyone who WANTS a vaccine has been able to get one. "The survey suggests that vaccine access is at least as big of a problem as vaccine hesitancy."
"The racial gap persists across income levels, but is widest among people making less than $50,000 annually: 72 percent of white adults in that group who want a shot have gotten one, compared with 57 percent of Black adults and 47 percent of Hispanic adults in that income range."
"Otis Rolley...of The Rockefeller Fdn's U.S. equity and economic opportunity initiative, said the emphasis on vaccine hesitancy puts the burden on individual people rather than on institutions that should be providing information about the shots and making it easy for people."
Read 4 tweets
19 Apr
You may have heard @washingtonpost published an op-ed by @WF_Parker and I over the weekend

We argued ACIP was wrong to extend the pause on J&J vaccine in the middle of a pandemic

Thread for those who were enjoying a weekend off Twitter, incl. answers to some objections

1/12
COVID-19 remains a pandemic that causes serious, widespread, not fully understood harms

Universally stopping an efficacious COVID-19 vaccine should only be done after seriously weighing the harms of stopped access against side effects of the vaccine

ACIP didn’t do this

2/12
ACIP justified not rigorously weighing harms/benefits b/c other vaccines “are available”

“Availability” doesn’t mean equally easy access & uptake, equally quick protection, identical acceptance

Not every J&J vaccine appt became a Pfizer/Moderna one

3/12
Read 12 tweets
15 Apr
A lot of praise for #ACIP's transparency

But de facto pausing for 7-10 days got the *substance* wrong, as @ashishkjha et al. observe

Understanding the expertise of ACIP members (deep but too narrow) can help understand why these decisions need diverse experts, not just MDs

1/6
For vaccine allocation, CDC/NIH called on @NASEM_Health committee: nationalacademies.org/our-work/a-fra…

Not just MDs but:
- health econ (@healthecon_dan)
- behavioral health (@abuttenheim)
- literally wrote the book on "nonmaleficence" (Jim Childress)
- tribal health (@echohawkd3)
et al

2/6
In contrast, every #ACIP voting member (exc 1 community member) is a MD/DO/RN. Couple w/a MPH. But no health econ. No ethicists. No behavioral sci. No tribal health experts.

Great group for indiv patient care & virology expertise

Not for managing trade-offs in a pandemic

3/6
Read 9 tweets

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