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Ashish K. Jha, MD, MPH

@ashishkjha

26 Sep

The southern surge is slowing

And cases in some Northern states rising

So it is all seasonal? Are vaccines working?

Let's look at data

Today the 10 LEAST vaccinated states had

2X the cases
3X the hospitalizations
5X the deaths

compared to 10 most vaccinated states

Thread

A lot of folks have been arguing the summer surge was "seasonal"

And now, the northern half of US poised to get hit

And if you look at states with biggest outbreaks today

Alaska, ID, WY, WV, MT, KY, ND

Largely not in the deep south

So should all northern states worry?

2/4

While we see cases rising in northern states

There are two distinct patterns here:

1. States with low vax rates getting slammed, having to ration hospital beds

2. States with high vax rates rising slowly with lots of hospital capacity

And the most interesting part?

Read 4 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

17 Sep

People concerned if we give 3rd shots (booster) to Americans

it'll mean fewer shots for the many unvaccinated folks in the world

Sounds right

But reality is more complicated

In the short run, I think we can boost the elderly largely with vaccines we can't send abroad

Thread

As of today, we have 80 million doses distributed to states

They are sitting in pharmacies, doctors' offices, hospitals

It is not possible to go collect those doses, pack them up, and ship them to another nation

No country would accept them

So we have to use them here

2/4

They all have limited shelf life

We are using about 0.77M doses/day

And at current pace, it'd take 104 days to use up doses already distributed

Many of these doses will expire before then

Does that mean we should start boosting to avoid wasting doses?

Of course not

3/5

Read 6 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

15 Sep

@DLeonhardt

President Biden quoted @DLeonhardt

Suggesting daily risk of breakthrough infection among vaccinated folks about 1 in 5,000

Is that a lot?

Well, that would be 36,000 breakthrough infections daily

Seems bad!

So if you're vaccinated, should you worry?

Not really

Short thread

What does 36K infections mean in terms of hospitalizations, deaths?

Among UNvaccinated, about 1 in 20 infections lead to hospitalization and 1 in 200 lead to death

Vaccines cut risk of each by 90%

Which means daily, 180 vaccinated folks getting hospitalized and about 18 dying

Instead of IFR, what if we applied CFR?

That's 1.2% for unvaxxed, about 0.12% for vaxxed

Would mean 40 deaths a day

So how bad is 18 (or even 40) deaths a day?

After accounting for proportion of population vaccinated

Its lower than daily deaths in an avg flu season

4/5

Read 6 tweets

Ashish K. Jha, MD, MPH

@ashishkjha

12 Sep

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

@CovidActNow

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

Read 9 tweets

Ashish K. Jha, MD, MPH

@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

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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

Ashish K. Jha, MD, MPH

@ashishkjha

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

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