Myoung Cha Profile picture
Mar 19 23 tweets 7 min read
1/ This is the calm before another #COVID storm in the U.S., which will be worse than it should be due to short-term and hopeful thinking. The #BA.2 cycle has already started here and will be in full bloom in ~2-3 weeks with a much bigger surge than anyone saw coming.🧵
2/ There are many differences between UK/Europe and the US, but almost all differences weigh against the US avoiding the impact of #BA.2
- Lower vax/booster rate
- Less testing
- Fewer COVID restrictions
- Longer period of waning immunity
3/ The trough of COVID cases in Europe occurred when BA.2 penetration reached 50-60% based on genomic surveillance (BA.2 figures from outbreak.info).
4/ The U.S. BA.2 penetration as of last week was ~23% and has roughly doubled every week since early February. At this rate, we would reach the 50-60% threshold in the coming week.
5/ We are most likely to see cases plateau and inflect in the Northeast first.
6/ Our ability to see this inflection in the U.S. is hindered by the overall decrease in testing and the mix shift towards antigen test kits. We do much less testing than Europe does.
7/ As laid out really well here, the new CDC Community Levels metric is a lagging indicator and we’ll never see this surge coming with this metric before it is already upon us.
8/ It's hard to interpret case rates given the belated push to send free antigen tests to US households, but my bet is that there has been a big change in behavior with upwards of 3-5x more antigen tests than PCR right now. Many positive cases are probably not being recorded.
9/ Positivity rates for PCR don’t look like they are increasing yet, but there are some signs that antigen test positivity is increasing in the northeast week-over-week (March 14th)
- DE: +126%
- Maine: +69%
- MA: +27%
- NH: +21%
- NY: +10%
- RI: +60%
delphi.cmu.edu/covidcast/indi…
10/ Google search trends for cold-like symptoms also seem to be on the rise right now.
11/ In venues like schools where serial PCR testing is still being done, it looks like there is an uptick in cases. Here is an example from this past week in MA public schools where cases are up 19%.

masslive.com/coronavirus/20…
12/ My hypothesis is that transmission in the community is higher than we can see based on official data because most people are likely experiencing symptoms, testing at home, and not seeking care. This by itself would be fine, if omicron wasn’t so transmissible.
13/ I have had numerous friends tell me that they got sick with omicron in January and tested repeatedly negative with an antigen test during the early onset of symptoms. This is likely due to the lower sensitivity of these tests compared to PCR.
14/ Once BA.2 really gets going, this false negative phenomenon will likely drive false confidence in not having COVID — with an unintended consequence of driving higher transmission to others.
15/ What is also unfortunate is that this false negative rate may delay treatment with mAbs and oral therapies that so far having been sitting unused despite all of the hype.
16/ Deaths are still stubbornly high despite the availability of mAbs and the orals — still as high as early January during the last omicron wave. We aren’t doing a good job of treating high-risk COVID+ patients.
17/ The hope that we have enough of an “immunity wall” where we don’t experience a rise in hospitalizations and deaths is wishful thinking. Hospitalizations in the UK are up 30% week-over-week right now.

abcnews.go.com/Politics/fauci…
18/ The irony is that eagerness to go back to normal and the lifting of social distancing measures will accelerate the surge beyond what otherwise would have been. Spring break, return to work, and lifting of masking in schools will allow the virus to flourish — a perfect storm.
19/ For many people, going back to pre-COVID behaviors may seem fine and the actual risk from BA.2 may be low. What is at stake is the impact on immunocompromised and older adults who will be disproportionately affected by another surge along with our healthcare system.
20/ Those groups are being hospitalized and dying disproportionately in the current BA.2 surge in the UK.
21/ Wouldn’t be surprising to see a higher re-infection rate among people who got sick during the first omicron surge.

22/ For those who say “this is just like the flu”, the periodicity of waves is much higher frequency than a normal flu season. This volatility is not something our healthcare system is built to handle.
23/ If this BA.2 wave is much worse than people expect, it will put the government in a tough spot to re-introduce restrictions without any of the funding to respond in a timely fashion. We could be in rough shape by May/June without much recourse.

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More from @cha_myoung

Jan 28
1/ With the announcement of @AkiliLabs going public to accelerate their pipeline for ADHD, here are some thoughts on the intersection of gaming with health and why I believe video games (and perhaps the metaverse) might be a big part of the future for healthcare. $AKLI 🧵 Image
2/ One of the most exciting projects I worked on at @Apple with my HSI team was a health game powered by the Apple Watch called LumiHealth with the @sporeMOH in Singapore. Your behaviors in the real world mirror the mechanics of the game, earning your character (and you) rewards Image
3/ Apple recently reported some of the Year 1 results of LumiHealth last fall with some impressive milestones:
- 200k users participating in 7m challenges
- 39% increase in exercise minutes overall
- 88% increase in exercise minutes for sedentary groups

apple.com/sg/newsroom/20…
Read 15 tweets
Jan 25
1/ Japan has fared better throughout COVID than most western countries (146 deaths/million vs. 2,590 deaths/million in the US) despite:
- Very low public trust in gov’t
- Less trust in science
- No mandates

How has this been done and what can we learn? 🧵
nytimes.com/2022/01/24/opi…
2/ This trope around Confucius societies “winning the COVID-19 war” with “authoritarian mentalities” doesn’t neatly apply to Japan where only 4% of people surveyed in 2020 say they trust the government “a lot”, compared to 9% in the US and 12% in the UK.

wellcome.org/reports/wellco…
3/ Japan has led the way with vaccines among the G-7 without a government mandate and way higher vaccine hesitancy pre-COVID than the U.S.
Read 13 tweets
Jan 23
1/ The pandemic has felt endless, so the beginnings seem like a distant memory. Does anyone remember the worst-case model of 1.5-2.2m deaths that the White House used to “shock and awe” in March ’20?

To date, there have been 864k deaths in the US.

A look back below🧵 Image
2/ Before this press conference, Trump compared COVID to the flu with only “22 deaths”, “life & the economy go on.”

Sound familiar?

If only the current death rate — with all of the advantage of our vaccines and therapeutics — were as low as the flu today. Image
3/ The current 7-day average of COVID deaths is 2k+/day with yesterday's number of 3,866 deaths being one of the worst days ever during the pandemic.

At this rate, this is a 20-50x difference from what the average flu season is like!
Read 12 tweets
Jan 18
My ten “surprises” in healthcare for 2022 — events that the average person would only assign a one out of three chance of taking place but which I believe have a better than 50% likelihood of happening. Styled after Byron Wien’s annual predictions. 🧵

blackstone.com/news/press/byr…
#1: There is at least one new variant that emerges in 2022 that drives another omicron-sized surge of cases and hospitalizations, putting renewed stress on the healthcare system.
#2: Employers capitulate in mandating in-person return-to-work (with a few notable exceptions) for 2022. A widely distributed workforce enhances the value proposition of national, scaled healthcare players and virtual solutions.
Read 11 tweets
Jan 16
1/ How “mild” is omicron?

When compared against Delta hospitalization and death rates, the numbers look better.

When you look at how sick people are when they seek care, the data tells a different story.

Some data from @CarbonHealth since early December 2022 thru present🧵
2/ Symptomatic COVID+ patients are showing up to our clinics with more symptoms than COVID- patients presenting with flu-like symptoms:

3 or more symptoms: 58% (+) versus 43% (-)
4 or more symptoms: 38% (+) versus 25% (-)
3/ Most common COVID+ symptoms are cough (65%), sore throat (51%), headache (45%), and runny nose (45%).

COVID+ symptoms are 1.5-2.0x overweight cough and fever compared to COVID- patients
Read 6 tweets
Jan 13
1/ Even with the Supreme Court invalidating the Biden vaccine mandate, large companies are likely to take matters into their own hands with “sticks” (versus “carrots”). Even with a “mild” variant, economic consequences are significant enough to impact corporate behavior 🧵
2/ With hospitalizations surging (with fewer deaths) among the unvaccinated, the bill will come due at some point — to the tune of $20,000+ per hospitalization.

healthsystemtracker.org/brief/unvaccin…
3/ Beyond hospitalization costs, the higher case rates of unvaccinated people have implications for productivity loss due to absence along with short-term disability costs. Chart below shows the trend for NYC.
Read 11 tweets

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