The conversation about the coming Omicron wave vacillates between

OMG -- Omicron will be cataclysmic

to

I'm done with this pandemic and have moved on

Neither is helpful

A middle course can help navigate this complex time without massive disruptions or a lot of deaths

Thread
First, lets get on the same page

We should expect a large wave of infections

Likely gathering steam in late December peaking sometime in mid January

And likely falling quickly to low numbers by end of February

This is about the next 2 months

What should our goal be?

2/6
Given how transmissibility of Omicron

It'll be hard to suppress infections without very large restrictions

There is neither appetite for big restrictions

Nor do I think needed

So what should our goal be?

Saving lives, keeping hospitals functional, schools open

as starters
So how do we do that?

First boosters are important for everyone

They are lifesaving for older and high-risk folks

Best guess?

40%-50% of high-risk folks (nursing home residents, elderly, etc) not boosted

Huge problem

Boosting them will save lives, keep hospitals functional
Next

Folks will travel, see family/friends this holiday season

Use of rapid tests can make things safer

Tests are becoming cheaper, more available. Slowly

Problem is both supply & demand

Yes, need more, cheaper tests

We also need to encourage more use of tests we have

5/7
Avoiding large unmasked crowds

Not ideal to have a large indoor holiday party with eating, drinking

I enjoy them but its a luxury we can avoid this year

You know what's not a luxury?

Seeing family & friends

That we can enjoy

Especially if folks vaxxed & we use testing

5/8
Masking in places with large surges

Encouraging mask wearing is weirdly political

Masks work

Tying them to hospital capacity makes sense

Act early when hospitals start filling. Fine to pull back when pressure on hospitals eases

They are one more tool in our toolbox

6/8
And begin deploying test to stay

If wave is big

We’ll need a strategy to avoid disruptive quarantines in school and work

test and stay helps

Will require lots of tests, which are coming

We will want to use test and stay in schools, work places, etc

7/8
So here's the bottom line:

Omicron is here

We'll see lots of infections

Boosted folks will largely do fine

Others will get infected at high rates

Unvaccinated and high risk folks with breakthroughs will be at risk for hospitalizations

So our strategy should be.....

8/9
Boost every adult, especially high risk

Use lots of rapid tests

Encourage masks in high-risk public indoor spaces

Use test and stay to keep kids, workers safe in school/work

And be prepared for a complicated and disruptive January

End

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More from @ashishkjha

Mar 17
So, as they say…

Some news

For all the progress we’ve made in this pandemic (and there is a lot)

We still have important work to do to protect Americans’ lives and well being

So when @POTUS asked me to serve, I was honored to have the opportunity

nytimes.com/2022/03/17/us/…
This President has spoken the truth about this virus

Has prioritized policies based on science and evidence

Americans are going back to work and school

And it is an honor to work under his leadership

One focused on the health and well-being of the American people
We are in so much of a better place with vaccines, diagnostics, increasingly, therapeutics, and much more

Much of this because of the superb leadership of Jeff Zients

Who has used the levers of the US government to make available these miracles of science to the American people
Read 9 tweets
Mar 3
With infections down more than 90% since highs just 6 weeks ago

It is tempting to decide the pandemic is over

It is not

During this upcoming lull of infections (and falling deaths),

It's time to prepare for whatever is next

So what to prepare for -- and how?

Thread
The two questions I get asked most often these days are:

1. Will we see future variant

Answer: I don't know. No one does. Reasonable to assume we will. Let's hope we don't

2. Will we see future surges

Answer: most likely yes. Hope not

But remember: hope isn't a strategy

2/n
So with possible future variants and surges

We should focus on the playbook:

1. Surveillance
2. Vaccinations
3. Testing
4. Ventilation/filtration
5. Masking
6. Therapeutics

Much of this is in today's White House plan

(disclosure: I, others have shared our ideas with them)
Read 10 tweets
Feb 26
For two months, I've said we're entering a new phase of the pandemic

A phase marked by a lot of population immunity, a more immune-evasive but less virulent virus

This new phase requires new metrics

My @nytopinion piece on the latest CDC metrics

nytimes.com/2022/02/25/opi…
Fundamentally, new CDC metrics get it right

Why?

Because cases no longer are the most important measure

For nearly 2 years, for every 1000 cases, you could reliably predict 50-80 would end up in the hospital and about 15 to 20 people would die

That was true in 2020. And 2021
That tight link between cases --> hospitalizations --> deaths was true for original strain

And for Alpha
And for Delta

But Omicron severed that link (mostly)

Now, if you told me there were a 1000 new cases

I can no longer tell how many will end up hospitalized or dead

3/n
Read 9 tweets
Feb 18
Nationally as infections return to pre-Omicron surge levels,

Two states I've tracked closely are California & Florida

They're both large with diverse populations, similar seasonality, different COVID approaches

So what can we learn from comparing them?

A few things

Thread
First, let's compare how they did on infections during Omicron surge

Strikingly similar (see graph)

Florida peaked earlier, California a bit later

Cumulatively, they had nearly identical infection rates

About 9.50% of Floridians got infected while 9.54% of Californians did
So at first blush, looks like their different COVID strategies did not end up mattering much

But, when we look at deaths,

A different, surprising pattern emerges

Cumulatively, Florida had 33% more deaths per capita than California during Omi surge

That's a lot

Why?

3/5
Read 6 tweets
Feb 16
As the Omicron surge of infections abates,

Its worth reflecting on few lessons we learned

Today, lets' discuss whether Omicron was indeed "milder"

Short answer? Yes it was

But it still caused a devastating loss of life

And that's a lesson for managing future waves

Thread
First, let's talk about how we might assess whether Omicron was "milder" than Delta

One way is to look at case fatality rate

Remember CFR is proportion of identified cases that end up dying

Throughout the pandemic, the CFR of of COVID in the US has been between 1.5% to 2.0%
CFR is usually 1.5% but rises to 2.0% during surges as hospitals fill

Meaning that as hospitals fill up, admission thresholds rises...and ability to care for sick people diminishes

Its bad to be sick during a COVID surge

So what happened to CFR over the past 2 months?
Read 10 tweets
Feb 10
Let's discuss a path forward for masks in schools

I've been a strong proponent of masking in schools

So as we enter a new phase

Do we need to keep masking for the foreseeable future

I don't think so

Should we ban masks in schools today?

No

Let's find a middle path

Thread
First, let's talk evidence

Do masks work to reduce transmission?

Absolutely

What about in kids?

The evidence is less strong but clearly, the weight of evidence says that masking also works in kids

Are there harms?

Not much evidence either way but there could be

2/n
So given the (imperfect) evidence

Masking in schools was important while two things were true:

There were no vaccines for kids

Large surge of infections in the community

Now, as we enter a new phase

Every school-age kid can be vaccinated

And infections are getting low

3/n
Read 10 tweets

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