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Ashish K. Jha, MD, MPH Profile picture
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29 Dec, 4 tweets, 2 min read
.@ezraklein asks a great question

What is the goal at this point?

I think it needs another element

What costs we are willing to pay to achieve that goal?

My goals?

Save lives, prevent hospitals getting overwhelmed, keep essential things (schools) open

In that order

And

🧵
Let's talk about other goals and costs we're willing to bear

Reduce infections? Yes!

Low cost things like encouraging indoor masks will help

But to really suppress infections? We likely need hard lockdowns

Which makes no sense at this point in pandemic

So the other goals...
Saving lives, keeping hospitals functional, schools open?

We know how to do that

1. Vaccines & boosters for all but especially high risk folks

2. Lots of rapid tests in key settings (nursing homes, schools, etc)

3. More ventilation/filtration

This all feels doable

3/4
So if it were cost free (socially)

We'd all agree on goals: no infections, deaths, etc.

But there is a cost to reaching each goal

And that's where we all differ

For me now, sure, do simple things to prevent infections

But focus on big stuff (lives, hospitals, schools)

• • •

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More from @ashishkjha

Ashish K. Jha, MD, MPH Profile picture
28 Dec
While new CDC isolation guidelines are reasonable, here's what I would have done differently

1. Required a neg antigen test after 5 days

2. Had different guidelines for vaccinated (contagious for shorter time) versus unvaccinated

3. Specified higher quality masks

Short thread
So why are CDC guidelines still reasonable?

Because if you actually follow what CDC says,

They require people be asymptomatic

And wear a mask for 5 more days

And if people actually followed the guidelines

I can't come up with how they aren't quite reasonable

2/4
The critique appears to be that people won't follow CDC guidelines

That they'll stop isolating after 5 days even with symptoms and/or not wear a mask

Yes. That'll happen for some

But shorter isolation means lower barrier to test/isolate

Which will motivate others to test

3/4
Read 5 tweets
Ashish K. Jha, MD, MPH Profile picture
26 Dec
As Omicron cases explode

We need a strategy for isolating folks who test positive

We need to think about the purpose of isolation clearly

Because if we don't get it right,

It'll both be hugely disruptive and won't keep us safe

So let's discuss what we need to do

Thread
First principles:

Why ask people to isolate at all?

Well, that’s obvious

We don’t want them spreading

So what we care about is CONTAGIOUSNESS

We want folks to isolate when they're contagious

So when are people contagious?

Well, it varies. A lot

OK, so what to do?

2/n
How long folks are contagious depends on two things

1. When they test positive (i.e. early in the phase of infection vs. late)

2. Their immune system's ability to clear the virus

Take the average person who tests PCR+ today

How long will they be contagious?

3/n
Read 15 tweets
Ashish K. Jha, MD, MPH Profile picture
18 Dec
Lets talk about why we'll soon see an uncoupling of infections and hospitalizations

No, its not because Omicron is "mild"

I'm not sure it is

Its because Omicron has so much immune evasion

That we'll see a change in who gets infected

Thread
How to think about it

We know among unvaccinated

About 5% of infected folks get hospitalized

Among vaccinated

About 0.5%

Throughout the pandemic (including delta wave), most infections were among unvaccinated

So hospitalization rates have been about 5% of cases
Omicron is different

It'll cause many more infections among 2-shot vaxxed folks

So we'll see large increases in infections in that crowd

So as cases spike

Rate of hospitalization will not spike to the same degree

Because many of the cases will be of vaccinated folks

3/5
Read 5 tweets
Ashish K. Jha, MD, MPH Profile picture
17 Dec
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
Read 10 tweets
Ashish K. Jha, MD, MPH Profile picture
8 Dec
With early data rolling in, here’s where we currently stand with Omicron

First, we have plenty of evidence that Omicron will spread easily, quickly, and far

We should expect, globally, relatively large waves of infections

How will people fare?

Depends on who you are

Thread
I think of 3 groups of people

Immunologically naïve

Somewhat protected

Highly protected

Depending on which group you are in

Your risk of infection varies

As does your risk of bad outcomes

So let's talk about each of them

2/6
Group 1 Immunologically naïve:

Who are they?

Unvaccinated and not recently infected

How will they fare?

They are likely to get infected with Omicron at very, very high rates

Many of them will get sick. I hope...but doubt... that the virus will be mild for them

3/6
Read 6 tweets
Ashish K. Jha, MD, MPH Profile picture
30 Nov
While everyone is focused on #Omicron

Let's not forget Delta, our current scourge

And over past 5 days, we've seen a 25% drop in cases (see graph)

Good news, right?

No

Its what we see during every holiday: drops in cases due to drops in testing

And its a problem

Thread
Some of the drop off is lack of reporting

But a lot of it is sick people not getting tested

That's a problem because...with less testing

more infected people are spreading to others

And what we've seen?

Bigger the drop during the holiday

Bigger the bounce that follows

2/4
Which gets us to this Thanksgiving

We've seen a 25% drop in cases over Thanksgiving holiday

That's big -- much bigger than last Thanksgiving

Which means we should expect a sharp jump in reported infections later this week

Some of those will be reporting catchup

But....

3/4
Read 4 tweets

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