There's a group of pesky unvaccinated ruffians I want to discuss

You know -- no lottery tickets will get them vaccinated

They are recalcitrant

I have one of them in my house

Yes, the under 12

How best to protect them?

Empirical data can show us the way

Short thread
Despite stark differences in vaccinations by state,

In Louisiana, 0% of kids under 12 vaccinated
In Florida, 0% of kids under 12 vaccinated

Even in high vax Massachusetts

0% of kids under 12 vaccinated

So if we're in a pandemic of the unvaccinated, are these kids in trouble?
Actually, while vaccination rates for kids under 12 are identical (0%) across states,

Infection numbers are not

In Massachusetts, about 250 kids under 10 years of age infected last week

In Florida, it was about 9,000

In Louisiana, it was about 1600

3/5
Adjusted for population

Florida had 12X as many kids infected as Massachusetts last week

And Louisiana? About 10X

So what's going on?

None of these kids are vaccinated!

So why are infection rates so much lower in MA?

Right, because kids are protected by adults

4/5
Kid infection numbers driven largely by infection numbers in adults

In Israel, we saw that as adults got vaccinated

Infection numbers in kids plummeted

So how do I best protect my 9 year-old unvaccinated kid?

By making sure all adults around him are vaxxed

5/6
So when you hear we have a pandemic of the unvaccinated

Yes that includes kids

But largely only in unvaccinated communities

Very few kids in highly vaccinated places are getting sick

So if you want to protect unvaccinated kids

Make sure everyone around them has the shot

Fin

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More from @ashishkjha

1 Aug
Nursing home COVID infections are rising

While absolute numbers still low, they are up 3X over past month and highest since March

And we need a national strategy to prevent more suffering in this very vulnerable population

Why are they rising and what can we do?

Thread (1/4)
First, you may be surprised

Didn't we vaccinate NH residents?

We did -- but about 19% still unvaccinated

But the big issue?

42% of NH workers not vaccinated

So when community transmission rises, more COVID shows up in nursing homes

But there are two more issues

2/4
First, NH residents were among the first to get vaccinated

Based on Israeli data, their immunity may be waning

And second, they are vulnerable, often frail

So a breakthrough infection, which might be a nuisance for a healthy person, can be very serious for a frail person

3/4
Read 4 tweets
31 Jul
Lots of confusion about what Provincetown outbreak & CDC guidance mean

Mainly: how to think about spread among the vaccinated

And as importantly, what we know and what we don't

So a short thread
First, the P-town outbreak unusual

Many thousands of people (some unvaccinated) showed up to celebrate July 4

Leading to packed bars, clubs, and lots of mixing of vaccinated and unvaccinated folks in tight quarters

Ideal conditions for COVID spread

And COVID did spread

2/n
And there were a lot of infections, including among vaccinated folks

We've seen this before -- Singapore airport, Yankees clubhouse

Key issue is: did vaccines fail to

1. Prevent infection?
2. Prevent spread?
3. Prevent severe illness?
Read 8 tweets
30 Jul
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
Read 9 tweets
28 Jul
CDC revised its mask recommendations for vaccinated people

Its causing relief among in some circles, confusion in others and anger in others yet

My take?

A modest change with likely modest effects

A change that is responding to the realities on the ground

Thread
So here's the thing

Changing guidance in response to new evidence isn't flip-flopping

Its what we should always do

CDC said in May that vaccinated people are largely safe (they rarely get infected, they don't spread)

That was correct

At the time

Before Delta showed up

2/5
With delta:

unvaccinated people have 1000X the viral load of the previous variant

And now, new data (we haven't seen it yet) suggests:

While breakthrough infections are uncommon

But when they happen, some vaccinated folks have a high viral load too

Not ideal

3/6
Read 7 tweets
25 Jul
For much of winter, spring, I was VERY optimistic we'd have a great summer with few infections, deaths

Through June, things looked good

But situation has clearly turned worse

There are 3 things that have turned out worse than I anticipated

So lets talk about them

Thread
1. Delta -- turns out to be way more contagious than anything we've seen before

2. Vaccinations. We hit a wall with under 50% of population fully immunized

3. Waning immunity -- still prelim -- but more breakthrough infections as folks get further out from their shots

2/4
Combo:

Super contagious variant
Lots of unvaccinated folks
And more breakthrough infections

Sets up a vicious cycle

And a tough few months ahead

We need to break the cycle

How?

Public health measures (masks, reduced indoor gatherings, ventilation, testing) will help

3/4
Read 4 tweets
21 Jul
Vaccinations have fallen off a cliff

We are now administering about 500K shots a day -- half of them 2nd shots

At this rate, it'll take about another year to get to 80% fully vaccinated

But we can do better than that if we do a few things

Short thread
If we continue vaccinating 250K new folks/day, yes, it'll take another year to get to 80%

But of course, as we vaccinate,

remaining population gets harder to reach...so things will slow further

So what to do?

First, it'll help to get kids 5-11 eligible -- probably fall

2/4
But that won't be near enough

So what will help?

1. Continue reaching out to unvaccinated, answering questions, improving access

2. FDA full approval. Yes, this will help a lot

3. Schools & businesses creating virus-free spaces through vaccination requirements

3/4
Read 5 tweets

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