Its time for vaccine mandate for air travel

Lack of one is becoming an issue

So here's my story from last night that confirmed why we need it

Basically, we can't expect mitigation measures to be enforced well enough to prevent transmission on airplanes forever

Short thread
Last night I took an overnight from LAX to Boston

I got to the gate, found myself next to a person whose mask barely covered her mouth

Mask was nowhere near her nose let alone covering it

I walked away

My flight boarded and I sat down in a window seat

She soon sat next to me
Sitting next to someone who is essentially maskless wasn't great

Truth is, if your nose isn't covered, you really aren't wearing a mask

She then started singing to a video on her phone

Really

Her flimsy cloth mask wasn't doing much at that point

3/5
Flight attendant asked her to pull up her mask

She did

She chatted with me about having seen me on TV

She then volunteered she wasn't going to get the vaccine

I tried to engage her on why

Her mask fell below her nose again

We kept chatting for a bit
I asked her nicely to pull up her mask

She got annoyed but did

10 minutes later, it was down again

After waiting, I asked again. She glared and pulled it up

Cabin lights dimmed. And now I couldn't see

We sat inches apart for a 5 1/2 hour flight with her variably masked
I don't love sitting next to an unvaccinated, unmasked person for hours

Why do I care?

I'd rather not get a breakthrough infection

So I sat in my KF94, likely safe

She was in the middle seat

Her neighbor in the aisle seat was an older man with a cloth mask. Not great
We have very little ability to control what happens on planes

Its a place where we share the air with strangers for long periods of time

We could do stricter enforcement of masks

Flight attendants are trying but are also exhausted

Asking them to do more is not tenable
But vaccine mandates for air travel are

Canada has done it

We should too. Mandate vaccine or negative test for air travel

I understand the person next to me had the freedom not to be vaccinated

The old man next to her has the right to fly without getting infected

End

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More from @ashishkjha

1 Oct
Great piece by @matthewherper

molnupiravir cut hospitalizations by 50% in among high-risk folks (older, obese, those with cardiovascular disease)

Despite the fact that we only have a press release

I am optimistic this will pan out

Why?

Short thread

statnews.com/2021/10/01/mer…
This result feels a lot more believable than many others we have seen

Why?

First, molnupiravir is a nucleoside-analog, a type of anti-viral that has been effective against other viruses

So the mechanism here makes sense

Second, this is not just a Merck press release

2/4
A group of independent experts saw the data and said "we've seen enough"

And stopped the trial because the drug was clearly working

That's important verification

It also makes me far more optimistic about other similar therapies being studies for COVID will pan out

3/4
Read 4 tweets
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
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
15 Sep
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
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
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
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

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