When folks think about highly vaccinated places in America

They think Vermont or CT or MA

Those places are good

But not the most vaccinated place in America

So who's #1?

Puerto Rico!

But PR has gotten way too little attention

Its worth reflecting on how they did it

Thread
So lets talk numbers

Proportion of population fully vaccinated

MA is 68.8%

CT and RI are both at 69.8%

VT is at 70.5%

PR? 72.0%

Among older folks (those >65) fully vaccinated

VT is highest state at 96.3%

Puerto Rico? 99.9%. Basically everyone

And its paying off

2/5
Since July 1, when the Delta wave started

VT has had 50% more cases than PR

And today, PR has one of the lowest infections rates in America

Here's data from @CovidActNow

You can see Puerto Rico has one of the lowest infection rate in the US (way lower than most states)
Ah you say, but its Puerto Rico – and they are tiny

Actually, no

They are about 5 times bigger than VT

And PR has more people than 21 states

So how have they done it?

Its not their immense wealth – PR is actually quite poor compared to much of the US

4/6
So how has PR done it?

Best I can tell, they’ve done this largely by not tying vaccines to politics

They pay less attention to mainland politics

All their political parties actively support vaccinations

And generally, political identify & vaccinations are not intermixed

5/6
So next time someone tells you

Oh, only "wealthy" New England states can achieve high vaccination rates

Remind them that the super star in America is not VT or CT or MA or RI

Its Puerto Rico

Doing a fabulous job vaccinating its people to keep everyone safe

End

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More from @ashishkjha

18 Oct
Given the passing of General Powell who was fully vaccinated

A lot of misinformation spreading about breakthrough infections

So let's talk about breakthroughs

What are they about?

When are they a big deal?

Let's put on our public health and clinician hats on this

Thread
First, what is a “breakthrough” infection?

Its when someone who is fully vaccinated still gets infected

We know these vaccines prevent infection – but not 100%

So vaccinated people can still get infected

But then, your immune system, trained by vaccines, really kicks in

2/6
Within days of infection, a vaccinated person's immune system goes into high gear

Memory B cells make antibodies

T cells arrive to kill infected cells

And for most people, they don’t go on to have severe disease

A few days of symptoms, then they recover

Awesome

3/6
Read 8 tweets
13 Oct
5 weeks ago, our public schools returned to full-time in-person classes

To keep schools safe, we implemented:

Indoor masking
Ventilation upgrades
Weekly testing
Encouraging vaccinations

We didn't push hard for distancing

So how's it going?

Pretty well actually

Short thread
We've seen essentially no spread within schools

Across the nearly 13,000 students who attend

There have been, on average, 10 cases per week

Number of kids getting infected likely has gone down since school began

But are schools driving community transmission?

No

2/3
Daily incidence down 10% since schools re-opened

And test positivity down nearly half in last month

Miracle?

No, just use of simple data-driven policies

And the few kids that are positive?

They aren't triggering quarantines

Because with "test and stay" - kids stay in school
Read 4 tweets
10 Oct
Quick update on state of the pandemic in the US in 4 graphs

First, nationally

We have clearly turned the corner on the delta surge

Now down 40% since peak a month ago

Still at high levels of infections and deaths

But good to be heading down as we head into fall and winter
Next, lets look at the big 4 states

CA, TX, FL, and NY

Geographically diverse

All of them are low and generally declining

Given 1 in 3 Americans live in these 4 states, they matter a lot to the national picture

This is good

So are there troubling areas?

Yes...

2/5
If we look at the national map

We see that deep south is done with its horrible summer surge

But great plains, Alaska are concerning

Here in New England, MA, CT, and RI have low levels of infection and declining!

Driven by high vaccination rates and public health measures
Read 5 tweets
4 Oct
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
Read 8 tweets
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

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