Ashish K. Jha, MD, MPH Profile picture
Dec 17, 2021 10 tweets 2 min read Read on X
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

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Ashish K. Jha, MD, MPH

Ashish K. Jha, MD, MPH Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @ashishkjha

Jan 30
There is an Ebola outbreak in Uganda

There are two red flags here

The index case is a healthcare worker

Its happening in Kampala, a city of nearly 2 million people

Here's what the USG should be doing right now to ensure Ebola is contained in Uganda and doesn't spread

🧵
The red flags means to me that we are likely to see a lot more cases in the days and weeks ahead

So what normally happens when there is an Ebola outbreak to keep America safe?

1. USG works with WHO to offer help (with tests, vaccines, treatments, expertise)

2/n
2. CDC usually sends a team right away to help bolster staff that might already be there and support the ministry of health

3. USG would do a risk assessment of the threat to the US and look at additional protective measures such as travel advisories

3/n
Read 7 tweets
Aug 23, 2024
The FDA authorized the new version of the covid vaccine

Which prompted my parents to ask me whether they should get their annual covid vaccine now

My response? I'd wait until late October

So here's my thinking

First, I think the summer COVID wave has largely peaked (some regions may still rise for another week or two)

So getting a vaccine in the upcoming weeks (when vaccines will become available in your pharmacy) is probably not optimal

Instead, I told them that they should get their covid and flu vaccine together in late October, ideally by Halloween

That sets them up to be optimally protected for the winter -- where we get both flu and usually a bigger winter covid wave (along with RSV and other respiratory infections)

If you got a vaccine now, you would get some benefit in the upcoming couple of months

But would be more vulnerable if the winter wave arrives in December or January

At the end of the day, the most important thing is that -higher risk folks (older people, chronically ill and immunocompromised folks) get vaccinated

So if you want to get it now, its fine

But to me, late October is probably a better time -- and I would get both covid and flu shots then
By the way, if you're wondering why I think the summer wave has largely peaked, here's the key data

first -- waste water

It looks like the waste water levels have peaked nationally, as well midwest and south with a plateau in the West and Northeast Image
The second is the data on ER visits and deaths

while the death data is still filling in, ER visits have peaked Image
Read 4 tweets
Jun 27, 2024
I'm hearing a lot of people say we are in the middle of a new covid wave

So a little data might be useful

Almost no one is testing anymore so case numbers are useless

wastewater is the only reliable source of data for community infection levels

And what does wastewater tell us?

Well sure enough, community infection levels are up about 50% over the past 2 months

BUT

A little perspective is helpful

🧵Image
Overall, infection levels in the community are still quite low

Certainly compared to historical average

Here's the wastewater data over the past 2 year

The recent blip up is still low

But two more points worth knowing

2/n Image
First, we pretty typically have two waves every year

A modest summer wave

And a bigger winter wave

The waves come because the virus continues to evolve and immunity against infection wanes

And during the summer, it gets hot in lots of places and people are spending more time indoors, driving infections

And second, this year's summer wave seems to be starting a little earlier than last year

So expect to see a modest wave probably peaking in early to mid August

3/4
Read 5 tweets
Mar 1, 2024
OK -- so CDC has come out with new guidance saying if you have COVID

Isolate while you have a fever but...

you can stop isolating once your fever is better and symptoms are resolving

Seems right to me

What you ask? Has the science changed? Why do this now?

Good questions

🧵
So first question: has the science changed?

No -- data on infection and spread remains the same

Most of the spread happens when people are pre-symptomatic (before symptoms) or when they have symptoms. Less after symptoms resolve

So what's changed? Population immunity

2/n
The question is not whether guidance will have benefits

If we only focused on benefit

Public health would recommend

You never drive over 30 MPH
Ever drink alcohol (no amount is safe!)
Ever eat bacon (class 1 carcinogen!!)

And so on

But those would be bad recommendations
Read 7 tweets
Dec 27, 2023
What happens to patient care when private equity firms take over hospitals?

Well, there's new data out and its not great news for all you fans of private equity in healthcare

Here's the write-up in the @nytimes by @sangerkatz and @ReedAbelson

Short 🧵

nytimes.com/2023/12/26/ups…
Researchers looked at 51 private-equity (PE) acquired hospitals

And compared them to matched hospitals not acquired by PE

They found patients at PE hospitals experienced 25% higher rates of complications compared to controls

Here's the original paper

jamanetwork.com/journals/jama/…
Does this make sense?

Could quality (or in this case, patient safety) get worse after PE take over?

Yup possible

patient harms like hospital-acquired infections & falls occur when:

you have inadequate staffing

or you don't have strong processes to prevents them

3/n
Read 6 tweets
Aug 7, 2023
How should we be thinking about COVID at this moment?

Last week, I had an op-ed in @BostonGlobe to lay out what I think is a pretty reasonable way to think about it

But first, here's the state of COVID

Thread

bostonglobe.com/2023/07/31/opi…
Infections are rising in every part of the US based on wastewater data

This is exactly what many of us expected this summer

How bad is it?

Well, its up about 3X from lows of mid-June

But still only a third of last summer's peak

So its up. But not a lot.

So what to do?
The most important thing you can do is ensure your immunity is up to date

Getting an annual vaccine (for most folks) and 2X/year for vulnerable folks makes a lot of sense

But also: SUPER important to consider getting treated if you get infected

Treatments are still free!
Read 6 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(