1/n I’ve been thinking about where we stand in the US currently with respect to COVID19 and how things might proceed until the end of the year and into Q1 2023
2/n right now as a nation the number of cases has declined considerably. For example here in Texas we’re at around 6 new cases per 100,000 which is among the lowest we’ve been during the entire pandemic. This gives us the ability to do things we haven’t been able to do previously
3/n even so we’re still just under 400 deaths per day on average so that Covid likely remains one of the top 5 causes of death in America on a daily basis. Moreover I’m worried as we head later into the fall and Thanksgiving and Christmas holiday seasons. Here’s why…
4/n I’m looking at what’s happening in Western and Central Europe, which historically had been a pretty reliable indicator of what we might expect in the US weeks later…
5/n for instance Germany at >100 new cases per 100,000 with stories such as this abcnews.go.com/Health/wireSto…
6/n Germany is not alone, also Austria, Italy, Switzerland, France. The difference, however, this time is that the rise does not seem to be fueled by any one variant. This wasn’t the case previously where one could pin the rise to the emergence of say alpha, delta, etc
7/n for instance BQ.1.1 is present in Germany but only about 1 in 10 cases if this report is accurate, but sounds about right thehealthsite.com/news/covid-19-…
8/n There are some exceptions to this globally. For example in Singapore, their surge seems to be driven by XBB. I was quoted in @thedailybeast about this recently thedailybeast.com/the-nightmare-…
9/n so what then is driving the European surge? Speaking with both @mtosterholm @EricTopol recently they think perhaps their initial hump = behavior change + relaxation of masks etc, but eventually will followed by emergence of a dominant variant, BQ.1.1 the most likely candidate
10/n so if that happens here, then a rise in cases as we head into November, followed possibly by a BQ.1.1 wave is one possible scenario. Another included it first begins in Northeast before spreading across the country.
11/n but this one is not as cut and dry and still squishy to predict because again so far that rise in Europe not yet linked with a predominant variant as in the past.
12/n so what to do? Well my biggest priority and number one talking point is to get your Pfizer or Moderna bivalent booster. This has both the original China lineage + BA.5 mRNAs. BA.5 is now the predominant variant in U.S. and…
13/n …and as you can see in this tweet from @Laurie_Garrett BQ.1.1 derives from BA.5, although some debate exactly how well the BA.5 immunization will hold up vs BQ.1.1. I think yes it will help, we’ll see if a new more specific booster required down the line
https://twitter.com/laurie_garrett/status/1580334138380328961
14/n what else besides getting your bivalent booster? I feel it’s important to vaccinate and boost your kids, we’re not doing that, and the @WHCOVIDResponse reminds us of the importance of getting Paxlovid especially for seniors, in the event of breakthrough infection
15/n I was hoping that the winter of 2023 would not resemble our alpha winter 2021 or omicron BA.1 winter 2022, but I think we could face a rough Covid winter again in 2023, unless we max out our boosters (not to mention those who still remain unvaccinated, we need to fix that)
16/n …and of course all the NPI masks and testing
17/n a couple of other things to consider: other respiratory viruses RSV flu might exacerbate hospital surges this winter. Get your influenza vaccine
18/n seems like everyone is so aggressive and opinionated ahead of the midterms. For full disclosure all this = my personal assessment from decades as a vaccine scientist, including >10 years developing coronavirus vaccines in our labs: SARS MERS Covid-19.
19/n so far our @TexasChildrens @BCM_TropMed low-cost, patent-free, Covid vaccine had gone into 80+ million arms in India and Indonesia, hoping to hit 100 million by year’s end, and several times that in 2023
20/n nothing to add except 20 seems better than 19, that’s it.
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