Thread by @jonlevyBU

1. Something interesting is happening with #COVID19 in MA, where case incidence appears much higher right now in wealthier suburbs. My guess is one of two things is happening, neither of which bodes well. 🧵

2. First, the data. We are seeing average daily rates > 20 per 100K in towns like Manchester, Sherborn, Wayland, Concord, and Wellesley. In contrast, it’s <= 5 in Chelsea, Lawrence, and Brockton. This isn’t a formal analysis and there are counterexamples, but you get the idea.

3. Hypotheses 1: This is the #UrgencyOfNormal crowd. Wealthy suburbs with high vaccination and booster rates are dropping pandemic precautions at a faster rate. This is certainly happening anecdotally ⬇️

4. Now in many respects this is logical from an individual perspective. Vaccines and boosters work well, and wealthier populations generally fare better with, well, everything. Except what happens In Wellesley doesn’t stay in Wellesley. Infectious diseases spread.

5. And if the people in places with high case incidence are less likely to be hospitalized because of vaccines and wealth, that means hospitalizations won’t move up as quickly. That’s a good thing, except if you use hospitalizations as your metric for statewide action.

6. Under this #UrgencyOfNormal hypothesis, we will see cases and hospitalizations “decouple” until cases ramp up in more vulnerable communities, at which point it will be much harder to bring things under control. And vulnerable communities will bear the burden.

7. Hypothesis 2: With the “individual responsibility” model now prevalent and reduced testing access, wealthier households who have stocked up on rapid tests are more likely to get diagnosed, and if positive, more likely to get PCR confirmed and reported.

8. There is certainly evidence of disparities in at-home test access during the Omicron wave ⬇️

cdc.gov/mmwr/volumes/7…

9. I’m not sure that this would be the leading explanation, but it’s likely a contributor. And the fact that PCR testing is now no longer covered for the uninsured won’t help.

10. Under this hypothesis, there would be a large amount of undetected spread in vulnerable communities with lower vaccination and booster rates. It’s pretty obvious why that’s not a good thing.

11. Some might say “Wait, Jon, you were concerned that there were COVID disparities. Now you are concerned that there are disproportionate burdens on the wealthy?”

12. But pandemics are dynamic, and given our hospitalization-based decision metrics and our individualized response, we are setting ourselves up for problems (and disparities) down the road. I would love to be wrong, and maybe we will dodge a bullet with BA.2. But maybe we won’t.