I've been saying for weeks that as cases recede

We can soon relax public health restrictions

I think of this like the weather

When it is bucketing rain

Umbrella, rain coat, boots, are all essential

When the storm turns into a drizzle, those become less critical

A big spike (like Omicron surge) is like a major storm

If you don't want to get wet, you need to stay home

But if you venture out

Bring a big umbrella (vaccines)
Wear a raincoat (good masks)
And rainboots (avoid crowded indoor spaces)

You get the idea

Right now, the storm is starting to ebb

Infections are falling, hospitalizations down

But with infections still high

Indoor mask mandates make sense. As do indoor capacity limits

Many states still have them (though bars are open in every city in America, as far as I know)

As storm passes

You'll always have your big umbrella (vaccines)

So it may be reasonable to take put away the raincoat (masks) and boots (indoor gatherings)

As bucketing rain becomes a drizzle, people will make different choices

And mandates are far less necessary

Why be judicious with mandates?

Because over time, effectiveness of mandates wane

People tire of them

Key is to communicate:

During periods of low infections, restrictions come off

During potential future surges, public health measures may need to temporarily return

Part of the reason is that during big surges, as hospitals overflow

Individual action isn't enough

Collective action is needed, which often means mandates

That's fine

But during periods of low infections, reasonable for individuals to choose their own risk tolerance

What are the problems with this idea?

Some might wonder, how do we protect the immunocompromised?

Good news is that Evusheld (protective monoclonal) is becoming more available

As is Paxlovid, a great oral antiviral

And IC folks can protect themselves with good masking

Another argument against relaxing?

Once you relax restrictions, you can't go back

I have never understood this

Do we keep mandates in place for years?

I'd rather just be straight with folks:

Public health measures during surges

Not when cases, hospitalizations are low

With infections still high (hard rain)

I wouldn't end public health measures today

But soon, as cases, hospitalizations get low (drizzle)

Lifting restrictions reasonable

To be clear: the pandemic won't be over

But as we prepare for future risks

We can enjoy the present


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More from @ashishkjha

Jan 30
You all know the data demonstrating dramatically higher hospitalization rates for unvaccinated folks

But one key point often not discussed?

Around 60%-70% of unvaccinated adults have already been previously infected

Which tells us a lot about infection-induced immunity

We see large gaps in hospitalizations between vaccinated and unvaccinated

But unvaccinated are not immunologically naïve

At this point, probably 2/3 have been previously infected

And yet, we still see 50X differences in hospitalizations between vaccinated and unvaccinated

One possibility is that hospitalizations are happening in the dwindling group of unvaccinated who haven't been previously infected

Means true benefit of the vaccines is even higher (by a lot)

But much more likely, it means infection-induced immunity is not holding up

Read 10 tweets
Jan 25
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?

Read 14 tweets
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

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