3/ Now, we aren't living in an R0 world. Even though it may feel like it sometimes
People are vaccinated (despite breakthrough infections)
People are infected (despite reinfection risk)
People have changed behaviors
But "Delta variant is as transmissible as Chicken Pox"(R0~9)??
4/ Let me blunt.
I think that's nonsense.
Delta is more infectious. Maybe it's 3.5 as initially estimated. Maybe it also has a shorter incubation period. Maybe it's as high as 5. That's bad enough.
it's not 9.
5/ The reason we are in another surge has as much to do with our shift in behaviors as it does in some "contagious as chickenpox" boogie man.
We snapped back too fast, when there were still not enough people vaccinated.
You know what tells me that?
RSV
6/ Last year, we saw a near complete suppression of respiratory viruses, including influenza and Respiratory Syncitial Virus (RSV).
But RSV is now back, off season, with a vengeance.
Took off, starting in April.
This isn't because there was a different covid variant
7/ So what's my takeaway from all this?
*Let's not be &^*ing fatalistic. Exponential growth at Rt 1.2 is a small nudge away from exponential decline with Rt <1.
That can be vaccinations, or behavior change, or by default, waiting for infections to get us there.
8/ If part of the upsurge is due to Delta having shorter incubation period and faster generation times, then that could mean an even smaller R0, and correspondingly quicker reversal of the surge, as we saw in the UK.
2/ In 2021 delta it was only 3.7 days (vs 5.6 days for 2020 outbreak).
This would have an impact on a key transmission dynamic factor we often look for: "serial interval periods" (time between symptom onset for index case vs subsequent case in a contact tracing investigation)
3/ What you are trying to estimate from observable symptom intervals is underlying mean generation time.
tangent: If you find negative serial intervals as in COVID, it's a sign of asymptomatic and presymptomatic spread.
TY @bijans for spotting the "full pdf" download button.
3/ what do we learn?
The mysterious "other data" for high viral load in breakthrough cases came from a 4th of July outbreak in Provincetown (Barnstable, Mass) where the “vast majority” of the new cases were among fully vaccinated individuals
2/ MACRA was a true milestone, and a concept that I still support- instead of artificially capping medical inflation (and then not having the guts to actually see doc pay cuts) lets create 2 paths- a "pay for performance" base and an incentivized alternative payment model track.
3/ But 3 seemingly technical details fundamentally sapped the potential impact of this huge bill.
classic behavioral economics- the impact of an incentive is not just proportional to its size, but also its cost, uncertainty, and delay
2/ in this article, Joseph Kannarkat and I break down all the tools that the Biden administration and @SecBecerra have to address competition beyond antitrust reviews
2/ Why do I think it's "The Question" of this moment for field epi to try to answer?
I'm going to be joining @Bob_Wachter@cmyeaton@inthebubblepod tomorrow in our continuing "Safe or Not Safe" series, and Variant vs Vaccine will make all the difference