Quick update on the pandemic in US

We're averaging about 800K identified cases daily

Likely missing 75% - 80% of infections

If you do the math

At least 1 in 100 Americans getting infected every day

Everyone wants to know: when do we peak?

Here's the national picture

Thread
The national picture shows a slowing of the surge

But we're still rising

But if we dig a bit deeper, a few things emerge

First, let's start with the big 4

CA, TX, FL, NY

Why? Lots of people live there, geographically and politically diverse

What do we see?

a few things
There is no doubt NY has peaked, down a lot

FL looks like it has peaked, down some

California may be plateauing, likely

Texas is hard to tell, likely still rising, not sure

And that is the 2nd big point:

There is no single national experience

Local conditions vary, widely
Hospitalizations lag a week behind

We now have more folks in the hospital with COVID than at any point in the pandemic

With fewer staff than at any point in the pandemic

That is a bad combo

And whatever plateau we get in cases

Hospitalizations will be rising for a while

4/7
And deaths?

We're at about 1800 deaths per day

While about half as bad as the worst days of the pandemic last year

It is still shockingly high given that we have vaccines widely available

And nearly everyone dying now is someone unvaccinated or high risk but not boosted

5/7
So what should we expect over next couple of weeks?

The states that have already peaked (states in new england, NY, NJ, FL others)

Will continue down

States still early in the Omicron surge to continue rising

And hospitalizations, deaths to continue climbing nearly everywhere
But remember that when infections peak

There will be as many new infections on way down as there were on way up

We still have lots of folks at risk

So across the nation, I think we have several more weeks of rampant infections

And many more weeks of high hospitalizations

7/8
Bottom line?

National peak means less than what is happening locally

After peak, we want to drive infections down quickly

So we need to continue to focus on vaccinations, testing, ventilation, and wearing mask indoors

To slow spread and reduce the burden on our hospitals

End

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More from @ashishkjha

Jan 10,
Given the immense value of in person schooling for America's kids,

Lets talk about how every school can be in person safely today

Not under ideal conditions

But under real-world conditions

First, let's start with "ideal", which LOTS of school districts have done

Thread
What is ideal?

1. Teachers vaxxed/boosted
2. Kids vaxxed
3. Everyone masked w/good masks
4. Ventilation
5. Testing

Billions of $ available for ventilation and testing
Vaccines free, widely available

I get it, some places chose not to do it

But $ is not the barrier

2/n
So lots of school districts chose not to do these things

What if a school doesn't have testing and systemic upgrades in ventilation?

Can schools still be safe?

Absolutely!

If folks vaxxed/boosted
And we have masking (compliance doesn't have to be 100%)

Still very safe
Read 7 tweets
Jan 8,
Watching national data

And being in the hospital this week

I see two things that appear contradictory

But both are true

1. Link between cases & hospitalizations is much weaker with Omicron than in the past

2. Our healthcare system is in trouble

Thread: the moment we are in
Let's talk about I'm seeing in the hospital first

In the hospital, seeing lots of COVID patients

Some admitted due to COVID

They are all either:

1. Unvaccinated

2. Very high risk folks not boosted

And some admitted "with" COVID as incidental

Almost all not boosted

2/n
Haven't seen a single boosted person admitted for COVID

And in the national data

Risk of hospitalizations is still those two groups

Unvaccinated
High risk not boosted

And that pool of people is still very, very large

And that is driving the surge of hospitalizations

3/
Read 14 tweets
Jan 4,
Day 2 of hospital service

A few observations about the whole "hospitalized for COVID" versus "hospitalized with COVID"

This distinction matters

But may be not in the way people think

First, we have a few patients in the hospital for COVID

But not many, thank goodness

Thread
Not many because RI is highly vaccinated state

More common on our service is folks admitted with COVID

That is, they came to hospital for something else and found to have COVID

Its tempting to say that COVID here incidental and therefore, doesn't matter

Not quite right

2/n
There are two types of "with COVID" patients and they both have an impact on care, utilization, stress to the system

The first type is: had COVID -- was "mild" -- but now have complications

Example (changing details for confidentiality)

The 86 y.o. man with kidney disease

3/n
Read 7 tweets
Jan 3,
We know how to keep people safe in schools during COVID

For an airborne virus

Masking and ventilation/filtration substantially slow spread

As does regular testing

And vaccines protect from bad outcomes

So I've been puzzling over why this isn't happening everywhere

Thread
If key strategies include masking, ventilation, testing, vaccines

Masks became widely available late 2020

By early 2021, there was lots of $ from Feds for improving vent/filtration as well as testing

By fall 2021, every adult & school-aged kid was eligible for vaccines

2/n
So barriers are now primarily not money or availability (though testing is currently a challenge)

So what are the main barriers?

First, misinformation

Like schools are always safe (you have to make them safe)

Or masks don't work (they do, some more than others)

3/n
Read 6 tweets
Dec 29, 2021
.@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
Read 4 tweets
Dec 28, 2021
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

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