We're in a transition moment in this pandemic

We're coming off highs of the worst surge of infections we've ever had

Cases are high but starting to fall in much of the nation

This moment raises lots of questions

With one big one: What happens next?

As Yogi Berra once said,

It's tough to make predictions, especially about the future

So we should be circumspect about how much we can predict with certainty

But some things seem pretty reasonable to assume

First, infections are likely to decline in upcoming weeks

Here's wastewater data from Massachusetts

Infections are falling fast. Expect to get to pre-Omicron surge levels within a week or two

The rest of the nation will soon follow

And by Mid-February, infections should be relatively low across much of the nation

Why low?

Because of high levels of population immunity

Probably 100M to 120M people will have gotten infected in the omicron surge

And with about 90M folks also boosted

We have a lot of people with relatively high degree of immunity for the next few months

Given the likely upcoming reprieve, what should we do?

As case numbers fall AND hospital capacity improves meaningfully

We should relax public health restrictions

Including relaxing mask mandates and indoor gathering limits


Why not leave them on?

Because mandates are costly and should be used sparingly

And because during future surges, we may need to ask people to pull back or mask up again

Preserving people's willingness to do things is critical


We should use the reprieve to prepare


The big questions are:

Will there be another summer surge in the South as weather gets hot, people head indoors?

I suspect yes

Will there be another surge next winter in the North as weather gets cold?

I suspect yes

Will there be another variant?

I suspect yes
So as we pull back on public health restrictions

We must begin to prepare for future surges - whether its omicron, delta, or another variant

Obviously, I hope there won't be future surges

Or surges won't matter (because of our high pop immunity)

But hope is not a strategy
So prepare we must


1. Vaccines

Current ones are terrific

But lets continue to develop new ones

Like ones that cover multiple variants or are pancoronaviruses or generate better mucosal immunity

And commit to building lots of doses early

Operation Warp Speed 2.0

2. Testing

There is still a testing shortage...though getting better

Within a month, there will be a glut of tests

And if no one buys them, manufacturers will stop making them

So time for US government to commit to buying, storing billions of tests

To use in the next surge
3. Therapeutics

We don't have enough therapeutic doses

Time to build up a large supply of orals (Pfizer, Merck), iv antivirals (remdesivir) and monoclonals


4. Lets replenish strategic reserve of masks

5. Put more emphasis on indoor ventilation/filtration

And last but not least

Focus on global vaccinations

Soon, the roadblock won't be vaccine doses

It'll be syringes, needles, cold storage, personnel

And lack of demand due to misinformation

We must combat all of these

And help get the world vaccinated

If we prepare

No matter what surge happens

We can be ready

With tests and mask and therapeutics and a well-vaccinated population

We'll manage future surges without large disruptions to our lives or livelihoods

We can't predict what SARS-CoV2 will do

But we can prepare

I wrote this out in greater detail in this @PostOpinions piece

Things are getting better

The next few months should be a reprieve

Lets use that time to recuperate

And prepare


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Keep Current with Ashish K. Jha, MD, MPH

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More from @ashishkjha

Jan 20
Getting asked when will Omicron peak in the US?

My best guess?

I think we are there

We are seeing a little bumpiness in the data because of MLK day holiday

But evidence says as a nation, we have likely peaked

Big states: CA, FL, and NY have peaked. May be even Texas

Beyond peak, there are two surprises worth discussing

First, I said few days ago that I expected hospitalizations to rise a while longer

Turns out, not so much

Hospitalizations have flattened nationally and are declining in places like NY

Why? What did I get wrong?

The reason my guess on hospitalizations may have been too pessimistic?

In previous surges, cases caused hospitalizations and folks stayed in hospital for a while

With Omicron, fewer hospitalizations

And Omicron hospitalizations are, on average, much shorter

That's good!

Read 7 tweets
Jan 16
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

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


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
Read 8 tweets
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

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

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?


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

Haven't seen a single boosted person admitted for COVID

And in the national data

Risk of hospitalizations is still those two groups

High risk not boosted

And that pool of people is still very, very large

And that is driving the surge of hospitalizations

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

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

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

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

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

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)

Read 6 tweets

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