Ashish K. Jha, MD, MPH Profile picture
Jul 30, 2021 9 tweets 3 min read Read on X
Leaked CDC slides on delta variant got you concerned?

I find the slides insightful & largely reassuring

Bottom line

Delta variant is a problem

Vaccines prevent vast majority of infections, transmission

And nearly all hospitalizations, deaths

Thread

washingtonpost.com/context/cdc-br…
So let's talk about what's in the slides about the delta variant

First, it is really, really contagious

Like more contagious than Ebola, Spanish Flu and probably chicken pox

Really contagious

2/n
Second, it appears to cause more serious disease if you get infected

I've been worried this is the case but certainly not sure

The data here is suggestive but not definitive

So reasonable to say delta probably more severe

3/n
But the vaccines are working.

Let me repeat, the vaccines are working

80-90% effectiveness against symptomatic infection

90-95% effectiveness against severe disease

That's what the data from other countries say

But what about data from our country??

Glad you asked

4/n
Right now, about 35K vaccinated Americans having breakthrough infections weekly

Sound high?

Actually, probably 300K unvaccinated Americans having infections weekly

And given 50% of Americans are vaccinated

That's a rough vaccine effectiveness of around 88%

Very rough

5/n
Oh -- and protection against severe infection well above 90%

So yeah, vaccines are working fine

But what about this whole breakthrough infections and spreadability?

Can vaccinated folks with breakthrough spread?

Yes. And this is the bad news

6/9
CDC cites several studies (and I'm aware of even more data) showing

vaccinated folks with breakthrough infections have similar viral loads to unvaccinated folks with infections

These are viral loads, not actual evidence of similar transmission

But a reasonable assumption

7/9
Then CDC has modeling that says universal masking is critically important

But they assume no other behavior change like some folks avoiding large gatherings, etc.

But you know what their model also says would work great?

Near universal vaccinations

8/9
So bottom line?

Yeah, delta variant is bad. Like really bad

Our vaccines are good. Like really good

Breakthrough infections happen

Sometimes they may spread to others

But if enough people get the shot

The pandemic does come to an end

Fin

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More from @ashishkjha

Aug 23
The FDA authorized the new version of the covid vaccine

Which prompted my parents to ask me whether they should get their annual covid vaccine now

My response? I'd wait until late October

So here's my thinking

First, I think the summer COVID wave has largely peaked (some regions may still rise for another week or two)

So getting a vaccine in the upcoming weeks (when vaccines will become available in your pharmacy) is probably not optimal

Instead, I told them that they should get their covid and flu vaccine together in late October, ideally by Halloween

That sets them up to be optimally protected for the winter -- where we get both flu and usually a bigger winter covid wave (along with RSV and other respiratory infections)

If you got a vaccine now, you would get some benefit in the upcoming couple of months

But would be more vulnerable if the winter wave arrives in December or January

At the end of the day, the most important thing is that -higher risk folks (older people, chronically ill and immunocompromised folks) get vaccinated

So if you want to get it now, its fine

But to me, late October is probably a better time -- and I would get both covid and flu shots then
By the way, if you're wondering why I think the summer wave has largely peaked, here's the key data

first -- waste water

It looks like the waste water levels have peaked nationally, as well midwest and south with a plateau in the West and Northeast Image
The second is the data on ER visits and deaths

while the death data is still filling in, ER visits have peaked Image
Read 4 tweets
Jun 27
I'm hearing a lot of people say we are in the middle of a new covid wave

So a little data might be useful

Almost no one is testing anymore so case numbers are useless

wastewater is the only reliable source of data for community infection levels

And what does wastewater tell us?

Well sure enough, community infection levels are up about 50% over the past 2 months

BUT

A little perspective is helpful

🧵Image
Overall, infection levels in the community are still quite low

Certainly compared to historical average

Here's the wastewater data over the past 2 year

The recent blip up is still low

But two more points worth knowing

2/n Image
First, we pretty typically have two waves every year

A modest summer wave

And a bigger winter wave

The waves come because the virus continues to evolve and immunity against infection wanes

And during the summer, it gets hot in lots of places and people are spending more time indoors, driving infections

And second, this year's summer wave seems to be starting a little earlier than last year

So expect to see a modest wave probably peaking in early to mid August

3/4
Read 5 tweets
Mar 1
OK -- so CDC has come out with new guidance saying if you have COVID

Isolate while you have a fever but...

you can stop isolating once your fever is better and symptoms are resolving

Seems right to me

What you ask? Has the science changed? Why do this now?

Good questions

🧵
So first question: has the science changed?

No -- data on infection and spread remains the same

Most of the spread happens when people are pre-symptomatic (before symptoms) or when they have symptoms. Less after symptoms resolve

So what's changed? Population immunity

2/n
The question is not whether guidance will have benefits

If we only focused on benefit

Public health would recommend

You never drive over 30 MPH
Ever drink alcohol (no amount is safe!)
Ever eat bacon (class 1 carcinogen!!)

And so on

But those would be bad recommendations
Read 7 tweets
Dec 27, 2023
What happens to patient care when private equity firms take over hospitals?

Well, there's new data out and its not great news for all you fans of private equity in healthcare

Here's the write-up in the @nytimes by @sangerkatz and @ReedAbelson

Short 🧵

nytimes.com/2023/12/26/ups…
Researchers looked at 51 private-equity (PE) acquired hospitals

And compared them to matched hospitals not acquired by PE

They found patients at PE hospitals experienced 25% higher rates of complications compared to controls

Here's the original paper

jamanetwork.com/journals/jama/…
Does this make sense?

Could quality (or in this case, patient safety) get worse after PE take over?

Yup possible

patient harms like hospital-acquired infections & falls occur when:

you have inadequate staffing

or you don't have strong processes to prevents them

3/n
Read 6 tweets
Aug 7, 2023
How should we be thinking about COVID at this moment?

Last week, I had an op-ed in @BostonGlobe to lay out what I think is a pretty reasonable way to think about it

But first, here's the state of COVID

Thread

bostonglobe.com/2023/07/31/opi…
Infections are rising in every part of the US based on wastewater data

This is exactly what many of us expected this summer

How bad is it?

Well, its up about 3X from lows of mid-June

But still only a third of last summer's peak

So its up. But not a lot.

So what to do?
The most important thing you can do is ensure your immunity is up to date

Getting an annual vaccine (for most folks) and 2X/year for vulnerable folks makes a lot of sense

But also: SUPER important to consider getting treated if you get infected

Treatments are still free!
Read 6 tweets
Mar 17, 2022
So, as they say…

Some news

For all the progress we’ve made in this pandemic (and there is a lot)

We still have important work to do to protect Americans’ lives and well being

So when @POTUS asked me to serve, I was honored to have the opportunity

nytimes.com/2022/03/17/us/…
This President has spoken the truth about this virus

Has prioritized policies based on science and evidence

Americans are going back to work and school

And it is an honor to work under his leadership

One focused on the health and well-being of the American people
We are in so much of a better place with vaccines, diagnostics, increasingly, therapeutics, and much more

Much of this because of the superb leadership of Jeff Zients

Who has used the levers of the US government to make available these miracles of science to the American people
Read 9 tweets

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