Quick update on the state of the pandemic in the US

The fourth wave has peaked and is turning down

The downturn is broad-based

What happens next is up to us

So lets start with where we are

Infections down about 10% from the peak

Deaths will turn around soon as well

Thread
Beyond the national picture, its always worth looking at the Big 4: CA, TX, FL, and NY

Together, about 1 in 3 Americans live here

And they are geographically and politically dispersed

So what do we see?

FL, CA turning down

NY flat

and TX rising, but slowly

All good
I often next go to @CovidActNow to quantify what we see

Their estimates of Rt -- infection rate

Here again, you see Rt <1 in FL, CA, at 1.0 in NY, and slightly above 1 in TX

Though PA and OH worry me

But overall Rt <1.1 in about 35 states

So that's good

3/6
But there are real threats we must confront

Schools, colleges are back across the US now

And in places without mitigation efforts (testing, vaccines for adults, masking indoors)

Reasons to believe infection numbers will rise

And of course, weather starting to get cooler

4/7
And we're peaking at high level of infections, deaths

If we level off or meander down slowly, we'll lose another 100K Americans before end of year

So -- no time for complacency

But here's the good news

We don't need major restrictions on people's lives in order to save lives
We don't need to have a 5th wave this winter

We don't need to tolerate another 100K deaths

I wrote about it for @BostonGlobe

The COVID cavalry is here

We have all the tools we need

I think over the next month, 3 things will make a big difference

6/7
bostonglobe.com/2021/09/09/opi…
1. Authorization for 5-11 year-olds. About 28M kiddos will become eligible

2. Mandates will drive vaccinations up. Hopefully a lot

3. Ubiquitous testing. President promised this. Execution will be very hard

And keep improving indoor air, masking during high transmission times
But bottom line is this

We have peaked and are coming down

Experience of UK, others says we can't be complacent

We need to drive deaths down, keep low

We are now at a point in the pandemic where we can prevent deaths without disrupting lives

That's a good place to be

End
And as @AstorAaron reminded me, the 3rd shot!

The 3rd shot ("booster") for high risk individuals like elderly, frail, those with chronic diseases

That'll help in saving lives

• • •

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More from @ashishkjha

11 Sep
Late night of September 10, 2001, I landed at Dulles airport. Had flown in from San Francisco

I had a 9 am meeting the next day

A joint VA / DOD meeting about improving preventive care for veterans and members of the military

The meeting was to be held at the Pentagon

Thread
Had booked a hotel next to the Pentagon in Crystal City

Getting off the plane, I realized meeting had been moved

Construction at the Pentagon so meeting was moved to VA headquarters, near the White House

Next morning at 9:10, meeting began and beepers started going off

2/5
All the DOD personnel left

By 9:30, meeting was adjourned and we evacuated the building

I walked out and strolled towards the White House, was stopped by police

Standing around, heard that WTC had been attacked

My mom, brother were in lower Manhattan near WTC that day

3/5
Read 7 tweets
10 Sep
If you are vaccinated, why should you care if there are a lot of unvaccinated folks?

After all vaccines are really protective, right?

Yes, vaccines are really protective

But what happens to unvaccinated folks affects us all

Why we have to get more people vaccinated

Thread
So if you are fully vaccinated, why should you care?

1. Hospitals full of unvaccinated COVID-19 patients

Don't have room for people who have appendicitis, heart attacks, or a car accident

2. Spikes in cases shut down schools, which is terrible for kids and parents

2/4
3. Raging infections shut down restaurants, stores, make it hard for folks to get people back to offices

4. High infection rates put vulnerable people who can't get immunity at risk

Pandemics sicken and kill a lot of people

But they also disrupt the social fabric

3/4
Read 5 tweets
9 Sep
I'm pretty thrilled with @potus announcement today

COVID is killing 1500 Americans. Every. Day.

We have the tools to defeat COVID

1. Driving vaccinations

This is not about mandates

This is about creating safe work, hospitals, schools, houses of worship

Thread
2. Testing: this is a VERY big deal

We have way underestimated the power of rapid, frequent, ubiquitous testing

Ramping up testing is exactly what our nation needs

3. Boosters -- President says we need a plan for 3rd shot for the vulnerable

Science on this increasingly clear
High risk people: immunocompromised, frail, elders, chronically ill folks need 3rd shot for greater protection

4. Schools -- my goodness. Who doesn't want schools to open safely?

So @POTUS uses the playbook: masking, regular testing, vaccines, ventilation

That's right

3/5
Read 6 tweets
8 Sep
Given COVID is now a largely vaccine-preventable disease

We can judge how well states are managing once vaccines became plentiful

So lets look at two big states: California and Florida

And see what we see in the data

In a nutshell, bad news for Floridians

Thread
So why compare FL and CA?

Two large states in southern half of US (less seasonal confounding), both with diverse populations

But with very different approaches

CA continues masking, testing, pushing vax

FL? Not so much

So how have people of CA and FL done?
We could examine cases but might be affected by testing (CA does more!)

So lets focus on deaths per capita

Here are daily deaths in CA, FL

They track closely from April through mid-July

Then, FL took off while CA rose slowly

Now, per capita, FL has 6 times daily deaths of CA Image
Read 6 tweets
5 Sep
Close family member just called to say he tested positive for COVID

He's 21, healthy, college senior, vaxxed

Feels OK. Sore throat, cough, can't smell

Called for advice

He'll be fine

Its his inept university and others like this one that worry me

Thread
He got tested yesterday after he woke up with symptoms

Thought he had allergies but he's a super responsible guy

His university has no regular testing

He couldn't get a rapid test -- which would have come back positive yesterday

So got PCR. Results back this afternoon

2/6
He asked what he should do

He's heard nothing from contact tracers

Why?

University only does contact tracing from 9 am - 5 pm weekdays

He'll get a call Tuesday or Wednesday

Isolation protocol?

None

He lives "off campus" with 4 friends in an apartment.

He's on his own
Read 6 tweets
31 Aug
With US averaging 1200 COVID deaths daily

Things look bad

But there is some good news. May be

Case Fatality Rate is dropping

In fact, CFR down 50% over past 6 weeks

That's good. Mostly

Because its driven largely by who is increasingly getting infected

Kids

Thread
Background

One strange feature of our Delta surge is that our CFR has been VERY high

Other countries like UK have had much lower CFR

They've seen a disconnect between infections & deaths

Largely because they did a fabulous job vaccinating the elderly

The US? not as much

2/6
In UK about 95% of elderly fully vaccinated

In US? About 80%

Impact is clear in our high death rates

But first, lets talk CFR

CFR is cases leading to deaths -- with a lag

How much lag? Many of us use 22 days

So a death on July 23 is from a case on July 1

On average

3/6
Read 10 tweets

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