Thread by @ASlavitt

COVID Update: COVID has been defined by its unpredictability. But what happens next is as predictable as it’s ever been.

Our job now is to beat away any potential surprises. 1/

1. Case & death rates should decline in much of the country & most hospitals should get a reprieve.

Danger areas will be in rural areas in the Upper Midwest & Great Plaines. 2/

The hard way or the easy way…

Big states like Texas and Florida have seen their surge & our thankfully recovering.

The Northeast & California have high levels of vaccinations. Those states should have low levels of COVID relative to last winter. 3/

Because population centers will see mostly declines, the overall national picture will blur trouble spots in less vaccinated rural areas.

Until vaccines spread across these regions, expect some trouble spots. 4/

2. Booster shots will magnify the effective reduction in deaths & in some cases even infections.

We are 2 weeks into the booster program, boosting mostly seniors who were vaccinated in March. 5/

While the effects should just be beginning here, we have solid data from Israel that extends only the 2 months their program has been running.

It reveals what we should expect. 6/

Data in Israel show very positive impact in reducing hospitalizations & deaths for seniors.

For those under 60, where severe cases are less likely, there appear to be a strong reduction in cases & the ability to spread the infection. 7/

Boosters only work if people take them however.

It’s hard to predict the take up rates for vaccines for people under 60. There’s the matter of which vaccine they took, when, whether they’re technically allowed to get vaccinated & if they even want to. 8/

Booster approval & availability will likely improve the safest areas even further this Fall but have little impact in trouble spots.

9/

3. Higher vaccination levels at employers, universities & health care settings with new requirements & at schools with 5-11 year olds soon vaccinated will cause case counts to drop & reduce spread. 10/

4. What about variants?

We can’t eliminate the possibility that another variant that spreads more easily than Detla won’t arrive, but the chance of this happening in 2021 is going remote. 11/

COVID mutations, unlike the flu, are subject to a survival of the fittest competition. Variants that don’t spread as fast as Delta have had a difficult time multiplying in the face of Delta & vaccines. 12/

Should a troublesome variant emerge it is most likely to emerge from a part of the world with low vaccination rates &/or areas with lots of immunocompromised people.

The one place this increasingly describes is Africa. Our vaccination mission there couldn’t be more important.13/

But if the worst does happen & a new variant begins to rapidly spread in Africa or another part of the world, unless it was both faster spreading & highly immune evasive, the damage would be muted among vaccinated populations & areas where people take layered precautions. 14/

If all of this sounds like a somewhat rosy picture, there’s some important cautions still. 15/

The first is many of us can’t shake the feeling that as soon as we have started to take our eyes off of the pandemic & let our habits slip, we end up paying the price.

This is true. Until case counts, down 40% over the last few weeks, do this 2x again, masks will be needed.16/

And the holidays of course have triggered massive increases in cases in the past. To be clear, after nearly 2 years of the pandemic, people absolutely gather this year with family & friends & travel. 17/

While this increases certain risks, those risks can be mitigated & in many cases will be worth taking.

Rapid resting before you fly, vaccination requirements at holiday gatherings, ventilation, masks & caution around vulnerable populations should make most of this safe. 18/

The areas with super-spreader events will be in unvaccinated areas, particularly where there has been less COVID. This is not a mystery to those communities but it is a danger to them & others. 19/

Until we get to the summer & the point where 70%+ of the globe is vaccinated, complacency will be our enemy— particularly as conditions brighten.

There will be small steps backwards even under the best of circumstances & particularly in 2022, there is room for surprises.20/

The difference between today & last year is we can act to reduce the likelihood & severity of those surprises.

-Vax requirements
-Better monitoring
-Rapid testing
-Masking as needed
-Global vaccinations

The path back, while far from guaranteed, is at least visible now./end