Good morning

Here's a quick update on the state of COVID in the US

5 points:

1. Infections are down 50% from September 1

Last year, infections rose 100% from September 1 to October 31

So we are, at least right now, on a pretty different trajectory

Thread
2. Deaths are down about 30% from the peak

This is good but not great

Why not more?

Deaths lag

But also, we are still seeing a lot of infections among vulnerable, high risk people

This is no time to be older, chronically ill and unvaccinated

2/6
3. Most new infections are in the northern half the US

And largely in Midwest, Great Plains states

7 states with the highest infection rates (AK, MT, WY, ID, ND, WV, UT)

They also have very low vaccination rates

In New England, cases flat despite weather getting colder

🤞
4. 57% of the entire population is fully vaccinated

4 states have crossed the 70% threshold:

VT, CT, RI, and ME

15 states are below 50%

ID, WY, and WV are the least vaccinated states

I'm worried about the winter ahead for these states

4/6
5. About 1 in 6 fully vaccinated older Americans have gotten a booster

We want to see this number rise quickly

Boosters are essential for older and other vulnerable folks to be protected as we head into the rest of fall and winter

5/6
Bottom line

We are in a better place

But places with low vaccination rates remain at risk as it gets colder

And older, vulnerable people not fully protected will remain at risk for poor outcomes

We can absolutely avoid a bad winter

We need to get everyone protected

• • •

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Keep Current with Ashish K. Jha, MD, MPH

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More from @ashishkjha

26 Oct
FDA expert advisors meeting on kids (5-11) and vaccines

I expect they'll follow the data and authorize vaccines for kids

And soon, I'm getting my 9 year-old vaccinated

Why am I so confident this is the right thing for my kid?

Because of the data

So lets review

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First, the vaccine is very effective

In the trial, they reduced infections by 91%

That's during time when Delta variant was widespread

Safety data also compelling

You see standard stuff of course: sore arm, headache, low grade fever after the vaccine

But nothing serious

2/4
But lets look at the bigger picture

These vaccines have been given to half of all humanity (3.8 Billion folks)

They are among the most closely studied vaccine in history

15 million kids in the US have already been given the Pfizer vaccine

Side effects happen but are rare

3/4
Read 5 tweets
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
17 Oct
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

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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)
Read 6 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

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