1/ Jeff Zients was the right person to lead the US response when we faced unimaginable organizational challenges in getting a whole of government response into operations.

He and his team really did an admirable job, but communicating to the public was mostly Walensky and Fauci
2/ communicating to the public, in the midst of intense partisanship, evolving science, and evolving virus has been....difficult.

Fair or not, we have not had a single national credible, trusted spokesperson, managing public communications in a time of uncertainty (and anger)
3/ the Surgeon General picked his spots, focusing on health equity and misinformation in social media

Outside experts like @ASlavitt @ScottGottliebMD @ashishkjha @DrTomFrieden were at times not just commentators but almost substitutes for a missing authoritative national voice
4/ @ashishkjha has been a deft..and consistent communicator.

He has somehow been able to strike that perfect balance between reassurance (we have the tools, we know what to do) and caution (this could get worse, we need individual and collective action)

He. Sounds. Good.
5/ He navigated that "step over" moment when the lines crossed in the lockdown debate with great skill

In his own institution when other elite colleges were announcing a return to virtual education, he advocated for maintaining in-person, and took some lumps for it

He was right
6/ Ashish can bring consistency and poise to the US messaging on covid

We are likely to see less of Dr Fauci (unfairly, perhaps, given partisan attacks against him) and Dr Walensky (unfairly, perhaps, seen as fumbling the timing across that "step over" moment)
7/ the question is, with Zients and key deputies like @NQuillian leaving - and we owe them a huge debt- are we going to put operations and execution at risk?

There is still a lot of blocking and tackling needed on things like "test to treat" and vaccine boosters. We're not done!
8/ maybe it's not needed.

Certainly most departments and agencies usually feel that they would do just fine on execution without the White House's help 😄

And the "cover" on communication could help them get back to a focus on doing their jobs (@RonaldKlain did this for Ebola)
9/ Chances are, we haven't seen the last pendulum swing.

New variants can surprise us

Immunity steadily leaks away

This👏is👏a👏seasonal👏virus👏

We may face new logistical challenges, but also new "step over" moments when the lines cross.

I'm rooting for @ashishkjha

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More from @Farzad_MD

Jan 12
1/ Would you want your employees, your customers, your partners, and government regulators to hear what you tell investors?

It's not done! Different audiences will understand and react to the same thing very differently

I'm going to take that risk today, show you my deck 😱🙏
2/ I'm going to walk through what I presented and said yesterday at the big healthcare investor meeting #JPMHC22

In a normal year, to hear the coveted private company presentations you'd have to be there, investors and executives crammed into small rooms

camera crews outside
3/ What's the problem we're solving?

In the US, we wait until someone has a stroke or heart attack, and will then spare no expense

But we control blood pressure 63% of the time

All the "action" is at the bottom of the waterfall

That's a trillion dollars a year of suffering
Read 27 tweets
Jan 8
1/ Tom captures well this reality.

Where we are now with vaccinations, therapeutic- and with the Omicron variant- is very different from March 2020, or December 2020, or even October 2021.

We were not wrong to urge NPIs when the population was spike naive, and R0 was 2.5
2/ in fact, these actions, painful as they were, bought us time for the vaccine rollout, and saved hundreds of thousands of lives.

But we can't insist on the same prescriptions when the disease has changed, for fear of being called "inconsistent", or "giving up"
3/ Omicron is less deadly than the Wuhan strain for unvaccinated, and 10x less deadly for the vaccinated

We have the vaccines and the boosters and the meds and the tests and the good masks to protect the elderly and the immunocompromised, - if we can just marshal them.
Read 7 tweets
Jan 8
1/ The biggest challenge with the Omicron surge is hospital and ICU capacity, w a lot of infections in a short period, and health care workers out with infection

Anecdotally, many hospitals aren't cancelling elective procedures yet-because of finances (Anyone have data on this?)
2/ Could the remaining relief funds from @CMSGov be conditioned on hospitals deferring elective surgeries? ie framed as compensating for foregone elective procedures?
3/ I'm mindful that deferring these procedures has real-life consequences for patients and their families, in addition to hospital finances

But the risk to everyone (including those getting elective procedures) of overwhelmed and burnt out medical staff is very real.
Read 4 tweets
Dec 24, 2021
1/ We are all seeing the massive wave of Omicron sweep through our communities

Severity will make the difference between a bad winter and a horrific one

We keep saying "hospitalizations are still low, but it's early"

When is it time?

In NYC, it should be showing now.
2/ If you look at the counts of COVID cases and subsequent hospitalizations, they tend to track each other quite closely, but with a lag of 5-6 days

Deaths follow hospitalizations, by about 12 days. (it's too soon for that)

[Big props to my alma mater @nycHealthy for #opendata]
3/ So how many hospital admissions should we be seeing right now?

First, let's look at what's happened to the hospitalization rate in NYC since the awful days of March 2020.

It's gotten a LOT better (in part because we're better at testing and diagnosing COVID)
Read 17 tweets
Dec 21, 2021
1/ A big part of understanding the relationship between COVID cases and mortality is understanding the age structure of the waves

I've been looking at NYC "Respiratory" syndrome for ED visits (I was a member of the group that pioneered its use for public health 20 years ago)
2/ During prior influenza seasons, NYC would have up to 1,000 extra emergency department visits a day, much of the increase driven by babies and children (low prior immunity). Their share of ED visits would increase from ~20% to 40%

COVID19 was a completely different story
3/ Every day the number of ED visits rose higher. I remember seeing the first break in the relentless increase, and barely daring to believe that we had reached a peak. It was March 28. There were an extra 3,000 ED visits that day.

But even worse, they were almost adults.
Read 9 tweets
Dec 21, 2021
1/ The rate of Omicron infections in NYC is unprecedented.

I'd estimate 100,000 infections occurred ... yesterday. Maybe 300,000 over the past 10 days.

1% hospitalization rate would mean 3,000 admits to come over the next few days

I hope it's much less than that (86 so far).
2/ Complicating matters, after driving down influenza (and RSV) to undetectable levels last year, we let up on social distancing, masking, and they have come back

So at least part of the increase in ED visits and hospitalizations will be due to influenza/RSV (especially in kids)
3/ On the other hand, using COVID-specific hospitalizations may be overcounting "incidental" cases among those admitted (or dying) for other reasons, especially if very high attack rate for Omicron

(got to rerun excess mortality analysis, @WeinbergerDan)
jamanetwork.com/journals/jamai…
Read 6 tweets

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