Thread by @JasonSalemi

In the US, the best #COVID19 #vaccine data comes from states, reporting @CDCgov

But the current reporting as "at least 1 dose" & "fully vaccinated" neglects the impact of waning immunity, esp among vulnerable populations.

An important🧵 from me, @BethPathak & @COVKIDProject

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When #COVID19 vaccines first became available, nobody knew how long the benefits would last. Many hoped the shots would offer full protection for a year or longer.

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Unfortunately, well-conducted research studies in the summer of 2021 have demonstrated that the effectiveness of the vaccines starts to decline (wane) after 4-6 months. For the Janssen (J&J) vaccine, waning begins after only 2 months!

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Waning means that vaccinated people become vulnerable again to infection, illness, and hospitalization.

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Because of waning vaccine effectiveness, the FDA and CDC approved booster shots. The booster shots ramp up the body’s immune response to #SARS-CoV-2 even higher than the initial shots.

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BUT – the CDC still labels everyone who has ever received a complete initial #COVID19 vaccine series as “fully vaccinated”, no matter how long ago they got their shots – even if the shots were 8-10 months ago!

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In our new preprint on medRxiv, we propose a new designation to replace the phrase “fully vaccinated,” and we analyzed the CDC vaccination data to reveal what proportion of the US population are “optimally immunized”

MEDRXIV/2021/267295 (pending)

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The current approach treats as "fully vaccinated" a senior who may have received 2 doses of an mRNA vax in Feb 2021, but nothing since.

At 4-6 months, we expect vax-acquired immunity to wane. Hence the booster recommendations.

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@BethPathak and I propose an alternative way of utilizing the current data from @CDCgov.

With this approach, we take into account the waning immunity ~6 mo after the 2nd mRNA dose, or ~2 mo after the J&J dose.

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Does it make a difference?

If we just look at the % of people fully vaccinated (the 'old' classification) & the % of people optimally immunized (the 'new' classification) over time, the difference is clear.

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Below is a state-level image of vax status, across age grps that can be gleaned from CDC tracker.

This is based on the existing classification:
-not vax
-partially vax
-fully vax

For those 65+, we appear to be sitting pretty, with every state w/ >75% of seniors fully vax.

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But when you account for waning immunity, it is clear, the US population is not well-protected against #COVID19 and we have a lot of work to do.

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Even among seniors, only about half of states even have 50% of seniors who are optimally immunized (vax 'recently' or boostered to address waning immunity).

The viz below now appears on the vaccine page of my dashboard at covid19florida.mystrikingly.com

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It's much worse for non-elderly adults (18-64).

Less than a handful of states have even 1 in 3 optimally immunized, due both to only recent rec of boosters for all 18+ & to a likely low uptake.

Wish we could parse out more granular (eg 50-64), but not possible w/ data.

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Our estimates for children 12-17 do not account for any waning immunity since boosters have not yet been approved by the FDA.

And of course, a very small % of 5-11 years olds have received 2 doses thus far.

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So on the TOP LEFT is a map w the reported % of seniors who were optimally immunized as of Dec 3.

On the TOP RIGHT is a map w the reported % of seniors who were immunized but with 'waning' immunity as of Dec 3.

The figs at the BOTTOM are the same info for those 18-64.

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From 11/1 to 11/30, the % of the US pop who were immunized with waning immunity & needed their booster shot increased. There were 19 states which experienced improvement (i.e. declining % who needed a booster shot), while the majority of states experienced a worsening trend.

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Now, these data are imperfect. Not at the individual level, but aggregated counts.

And the data are messy, as pointed out by @trvrb and so many others. A few states have obvious data problems, which can likely be resolved by better QC.

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https://twitter.com/trvrb/status/1462152380376485903?s=20

Nonetheless, we must consider things like waning immunity & uptake of booster doses (esp in high-risk groups) to forecast how vulnerable our communities may be to whatever the virus throws our way.

Happy to see this also mentioned by @EricTopol.

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https://twitter.com/EricTopol/status/1466885255915184128?s=20

KEEP IN MIND: Vaccines are most powerful when they are combined with all the mitigation strategies which are proven to work against the highly infectious, airborne #SARS-CoV-2 virus.

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We need vaccines PLUS indoor masking PLUS reduced size gatherings PLUS HEPA filtration to remove virus from the air PLUS improved ventilation to refresh indoor air.

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The vaccines are like a great pair of brand new snow boots that keep your feet toasty warm. After six months, when your boots wear out and you have a hole in the bottom, you get a new sole and they’re as good as new!

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That patch on the hole in the bottom of your snow boots is your vaccine booster. But guess what? Patching up your boots doesn’t mean that you start going outside in the freezing cold with no coat, no gloves, and no hat!

We need layers of mitigation to keep SARS-CoV-2 out!

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Our medRxiv paper is pending: MEDRXIV/2021/267295.

Feel free to visit my dashboard for these new visualizations & much more info to help track #COVID19.

It compiles a ton of data from @HealthyFla, @CDCgov, & @HHSGov to track key metrics nationally.

covid19florida.mystrikingly.com

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Also, for a wealth of epidemiologic surveillance data on #COVID19 in #children and #teens in the United States, visit the dashboards created by @COVKIDProject.

covkidproject.org

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We could REALLY use your help in disseminating this information!

@bethlinas @nataliexdean @angie_rasmussen @berthahidalgo @EpiEllie
@BillHanage @bhrenton @EricTopol @JenniferNuzzo @dr_kkjetelina @meganranney @aetiology @ashtroid22 @ashishkjha @Cleavon_MD @DrLeanaWen

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We could REALLY use your help in disseminating this information!

@Theresa_Chapple @uche_blackstock @WesElyMD @WhitneyEpi @yoreekoh @EllieMargolis @mugecevik @kaikape @jtrebach @profshanecrotty @choo_ek @paimadhu @Surgeon_General

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