Thread by @DrTomFrieden

As masks come down and cases go up, it’s worth revisiting how deadly Covid is at this moment in the pandemic. 1/thread

We’re in a much different place now than two years ago. Now, the virus is more contagious but less virulent, we have a wall of immunity from vaccination and previous infection, and better tests, treatments and disease surveillance. 2/

Two years ago, Covid hospitalized & killed a higher proportion of people it infected. Nearly all people who tested positive in hospitals were there because the virus was making them sick—after all, there was NO immunity to it, and, also, the virus was more lethal than Omicron. 3/

Now, more than 90% of Americans likely have some level of immunity to Covid—from vaccinations, prior infection, or both. Although far too many aren't up-to-date with their vaccination, we still have substantial protection. 4/

The virus itself has evolved, becoming more contagious (Alpha), more contagious AND more virulent (Delta) and MUCH more contagious but less virulent (Omicron). It could—and almost certainly will—change again, unpredictably. 5/

Even though many at-home Covid test results aren’t being reported, actual case rates now are without doubt a lot lower than they were a few months ago, and many people feel more comfortable traveling, gathering indoors and shedding their masks. 6/

If you’re healthy and up-to-date with your vaccination, that’s a reasonable approach. Covid poses a relatively low risk of severe illness to you, especially compared with other daily risks we willingly accept. 7/

Let’s spend a moment on the charged issue of flu vs. Covid. It’s worth using comparisons with flu as a guide to understand how much Covid has changed. 8/

First, let’s be clear: We vastly UNDER-react to flu. Flu kills tens of thousands of people a year, sends hundreds of thousands to the hospital and results in a big hit to our economy, schools & productivity. So comparing Covid to flu isn’t like comparing Covid to, say, a cold. 9/

For most of the pandemic, it was clear that Covid was significantly deadlier than flu.

https://twitter.com/DrTomFrieden/status/1474491758054625287

10/

Today, there are probably fewer people hospitalized in US from Covid than hospitalized for flu during an average flu year. BUT hospitalizations have started to rise and have nearly doubled in some places in past 6 weeks, though are still a small fraction of recent peaks. 11/

It’s challenging to explain, but the fact is that a higher proportion of the people hospitalized today who test positive for Covid are in the hospital for other reasons than was the case two years ago, when we didn’t have any immunity, and the strain was deadlier. 12/

New data from CDC show Covid was the third leading cause of death in 2021. About half of US Covid deaths in 2020 were preventable through better public health action, and more than half of 2021 deaths were preventable through improved vaccination. bit.ly/MMWR7117 13/

With vaccines, our wall of immunity and new highly effective treatment, especially Paxlovid, we can now likely keep severe disease caused by Omicron variants at or under that caused by flu. A measured approach to both can prevent deaths while limiting disruption to our lives. 14/

But Omicron can still be dangerous, especially in people who are older, immunosuppressed or not up-to-date with their vaccination, as we tragically saw in Hong Kong. bit.ly/3Ow50tK 15/

And long Covid is a serious risk that we can’t dismiss or take lightly. A new meta-analysis reported that HALF of people infected with Covid have symptoms at least four months later. bit.ly/36DzY23 16/

We need to speed up therapeutic trials for long Covid patients—a lot of people are suffering. ACT UP showed us that we can and must move science fast. n.pr/3OwUhz3 17/

Weighing all of the above is no easy task, and each of us may come to different conclusions about what activities we’re comfortable doing given factors such as our vaccination status, risk tolerance, age, underlying health and who we could potentially spread the virus to. 18/

If you're immunosuppressed, older or medically vulnerable—or live with someone who is—you’ll likely want to continue to mask up, and, in fact, up your mask game to an N95 and make sure you're up-to-date with vaccination and seek prompt treatment if you do get sick. 19/

Even if we personally don’t feel at risk from Covid, people around us might be. We have a responsibility to protect those among us who are most vulnerable by taking reasonable precautions, including masking up in higher-risk environments or when community spread is high. 20/

When a judge overturned the federal mask mandate on public transportation this week, it raised a big issue, which is whether we may lose the tools we need to protect ourselves not just now but against a future variant or a future health threat. n.pr/36ArLvl 21/

We have a reasonable expectation that society will take action so our child doesn’t get killed by a drunk driver, the local restaurant doesn’t serve us food that sends us to the hospital, and medicines in the neighborhood pharmacy aren’t contaminated. 22/

We must bolster public health, not undermine its budgetary stability and legal authority. Covid didn’t have to kill most of the people in the US and globally who died from it. If we heed the lessons of this pandemic, we can have safer, healthier, more stable societies. 23/end