Thread by @ASlavitt

COVID Update: There is an amazing array of efforts, some not very visible, to tackle COVID.

If you want to know how COVID plays out, the variables are here. But there’s the fatal flaw: us. 1/

I can try to classify many of the efforts to address COVID as now (high impact progress we are working on now), med term (things underway but not immediate), and long term (potential big game changers). 2/

The now items are critical to saving lives today & reducing the odds of future variants.

Number one on that list is to vaccinate the majority of the globe by the first quarter. 3/

12 billion doses in arms are required to get the majority of adults vaccinated. We stand at about 5.5 billion & have been averaging 1 billion/month.

The challenge begins now, however, as the largest & cosmopolitan areas complete their vaccinations. 4/

As Japan & China get through the bulk of their populations (Japan, which began last is now ahead of the US), the least developed nations (mostly Africa & South Asia) & rural areas are more challenging.

The issue isn’t $. It’s not vaccines. It’s last mile distribution.5/

Vaccinating adults around the globe has always been a challenge. The ingredients to solving it are tens of thousands of UN troops, PEPFAR infrastructure, cold storage, global logistics, & US-China collaboration. We can do this. We must. 6/

Near term item 2: Overcoming vaccine hesitancy in the US.

Right now, the US has the potential to be the global weak spot as everyone who rolls out vaccinations passes the US vaccination levels. 7/

Vaccine requirements in health care settings, employers, venues, and potentially travel are going to be necessary to drive those outcomes. The cost of not getting there is high. 8/

Near term item 3 is abundant, ubiquitous rapid testing. Some steps have been taken but the key, as @michaelmina_lab has articulated, is to change the regulation of rapid tests (like the UK) not a diagnostic, but for public health.

We can’t operate with current shortages. 9/

Near term item 4: Boosters for immunocompromised & at least those over 65. A combination of waning VE & Delta means those at most risk of hospitalization need a boost.

All early data on boosters looks very promising. You can hear Fauci discuss this. 10/

podcasts.apple.com/us/podcast/in-…

FDA meets on Friday & CDC booster guidance will come Monday. Expect an 8 month window, beginning with Pfizer, likely with an age threshold.

They must speak to what the plan is for people w Moderna & J&J. The hope is they defer to doctors to allow anyone to get a Pfizer boost.11/

Over the medium term there are many helpful & critical prioritie.

To pick 3 important ones:

1- NIH research into long-COVID
2- Development of an oral anti-viral
3- Platform for addressing vaccine changes (& monoclonals) for new variants 12/

1- Over $1 billion has been allocated to research long COVID. The goal is to create cohorts & develop an understanding & a platform to develop treatments & therapies.

2- There are 5 oral anti-viral candidates & 1 or 2 are quite promising. Hope to see results By YE. 13/

3- Many investments are being made ensuring that the mRNA platform (the most scalable & easy to amend) can produce variant-specific vaccines win 100 days.

Important if a faster variant than Delta comes along that creates problems for the vaccines. 14/

If the short term initiatives are necessary & the mid-term initiatives are critical to reduce deaths, abate suffering & reduce risks.

The long term work will make all of this easier. 15/

Some of the most exciting long term items include
-development of a “multi-valent” vaccine that can address multiple variants & even the flu in one (or more) jabs.
-vaccines in oral/nasal forms for much easier global distribution/storage/use 16/

-prophylaxis that prevent spreading for people highly exposed
-sophisticated surveillance & sequencing to allow earlier reaction times/prevention
-breakthroughs in ventilation

There are more items but hitting some of the high potential ones here would lead us to a good place.17/

If the key to our future rested on these initiatives— science— the future would be remarkably bright.

But unfortunately almost all of these efforts depend on an additional factor— our own human behavior. 18/

Humans have to play ball. If we don’t reduce spread, we will be chasing not preventing. If we don’t care about communities hard hit & far from view, they will bare the brunt for too long. If only people who feel most at risk vaccinate & mask, spread & variants won’t subside.19/

We don’t care about great new vaccines, we care about vaccinations.
Vaccines can’t be dropped off at African airports.
Boosters can’t sit on shelves.
Long COVID must see continued funding. 20/

If we choose to invest our energy in preventing schools from protecting kids, allowing Facebook to spew mis-information, distrusting experts, radicalizing vaccine hesitancy & shaming people— any new science will be viewed not only skeptically but as a new battle to fight. 21/

Even 80% buy in to these solutions is not enough. Every item on the ST, MT & LT list will fail with a public that denies COVID, hunts for Internet recipes (veterinary or otherwise) & promotes “natural” immunity and doesn’t care about spread. 22/

We won’t recover without an embrace not just of these solutions, but people’s willingness to make modest sacrifices for the good of everyone.

The difference will play out in years of duration, lives lost & how much suffering is endured. 23/

Tough measures are needed & supported to get all the way there. Granted it’s California, but by 2:1, free spread of COVID was rejected in favor of continued common sense measures. Biden’s aggressive plan enjoys similar popularity. This should cause the Abbott-DeSantis to pause.24

So much promise by so many dedicated people that can paint a promising future are in the works. It represents ingenuity & science at its best. It only needs to overcome humanity & politics at its worst. /end