Over 100 governments in low- and middle-income countries have introduced anti-poverty cash transfer programs over the last 3 decades

In new research, we examined the effects of these initiatives on the ultimate health outcome — mortality

Published today in @Nature /1 We used >80 national surveys in 37 low- and middle-income countries to create longitudinal survival datasets for 4 million adults & 3 million children 2000-2019

About 1/2 the countries started cash transfer programs, & 1/2 the programs were unconditional (no strings attached) /2

New pre-print from @EricMeyerowitz and me reviewing loads of new Delta transmission data.

One area we cover — updates on vaccines' effects on transmission in the Delta era 🧵 1/24

papers.ssrn.com/sol3/papers.cf… First, to review, vaccines can provide:
-direct protection (reduction in infx/disease among vaccinated ppl)
-indirect protection (reduction in infection among all community members through ⬇️ transmission)
/2
nature.com/articles/s4157…

As @mugecevik points out, despite the recent proliferation of vaccine studies using routinely collected testing data, the majority of these cannot be reliably be used to estimate VE vs all infections because they do not use systematic testing and/or control for confounding.

https://twitter.com/mugecevik/status/1430218419094306826

Vaccine protection against all infections is one important way (of several) that vaccines reduce transmission (discussed👇). Here is an updated table of high-quality studies assessing VE against infection, including just 3 from the delta era at the bottom
academic.oup.com/ofid/advance-a…

This 👇claim arises principally from Israeli data (which is unpublished in any form so will withhold judgment) and from the UK REACT 1 study, rounds 12 & 13. But... is the REACT 1 data likely to be solely explained by delta? 🧵
(study link spiral.imperial.ac.uk/handle/10044/1…)

https://twitter.com/EricTopol/status/1425492860619481098

This is the table in question. You can see VE of a combination of AZ/MRNA vs symptomatic infection was 83% (19-97%) in round 12, but only 59% (23-78%) in round 13. The concern of course is that this drop in VE is due to delta, which had completely taken over by round 13 /2

The question at hand: what is the relative transmission potential of a vaccinated person who becomes infected with delta? This 👇new report from Singapore is much more informative on this question than the CT data released so far from Ptown and Wisconsin.
medrxiv.org/content/10.110… First, importantly, reducing transmission potential of a person who becomes infected is only one component on the transmission reduction effect of the vaccines. The other: reducing the likelihood of becoming infected in the first place. We discuss here👇
academic.oup.com/ofid/advance-a…

Interesting poll. Selection/response bias aside, majority picked a low probability, but 40% still thought there was 10+% prob that vaccines will not substantially prevent transmission. This is why I have become convinced this concern is highly unlikely (borderline implausible) 🧵

https://twitter.com/AaronRichterman/status/1348492463229562880

1. Data from screening PCR at the time of the 2nd moderna mrna vaccine, showing reductions in asymptomatic PCR positivity. This is before the 2nd dose and if anything will underestimate effect. Will have additional confirmation from unblinding pcr and ab

https://twitter.com/JakeJohnsonMD/status/1348665305799811072?s=20

Thankful to Singapore for surveillance systems that allow for the detailed studies required to truly assess the relative transmission risk of asymptomatic vs symptomatic cov-2 👇, which they find to be much higher in those who develop symptoms /1

thelancet.com/journals/lance… couple points:

1. Use of serology to stratify recency infection was a nice addition

2. A better description of asymptomatic definition would be helpful. We go through this thorny issue here👇 @mugecevik @EricMeyerowitz @BogochIsaac @nicolamlow

/2
thelancet.com/journals/lanin…

Yesterday @EricMeyerowitz and I presented insights from new COVID19 papers published over the last month at the HOPE conference. Posting slides and video if interested

Video: hopeconference.net/conferences/fi…
Slide deck at end of thread

https://twitter.com/HarvardCFAR/status/1306958585075826688?s=20

@HarvardCFAR @RMKGandhi Agenda

Political appointees move to silence @CDCMMWR reports, the weekly lifeline from a barely functioning institution and the cornerstone of public health reporting in the US

Selection of reports that have been essential to understanding the US epidemic 👇🏻

politico.com/news/2020/09/1… March 20 — cruise ship investigation with early hint about crucial importance of indoor dining for transmission

cdc.gov/mmwr/volumes/6…

This is the key observation that somehow has not really made it outside of hospital circles. Still waiting for the first detailed report from a large health system of in-hospital transmissions in the universal masking era. Per hospital epis I’ve spoken with close to 0

https://twitter.com/MichaelGIsonMD/status/1303651458211086336

This Lancet report gets highly referenced suggesting healthcare workers higher risk but 1) much of it pre-universal masking 2) don’t report whether community acquired (much of it is per other publications from healthcare) 3) no contact tracing

thelancet.com/journals/lanpu…

Really nice to see this WHO analysis in JAMA (along w 3 RCTs) put to bed the importance of corticosteroids in ventilated patients w COVID-19. A lot of good stuff here.

So what to do w steroids in those requiring supp O2 only? /1

jamanetwork.com/journals/jama/… RECOVERY results suggest a mortality benefit in this population (supp O2 only), and I have seen basically every patient in this category receive dex, appropriately... but there are enough odd features of this single open-label trial that make me wonder. /2

To add to this - today we have a very nice study of patient contacts of infected healthcare workers, with universal masking implemented during the study period /1

academic.oup.com/cid/advance-ar…

https://twitter.com/AaronRichterman/status/1298813568998141952

Out of 226 patient exposures there was only one likely transmission, in a case where both clinician and patient were unmasked. /2

Antiretroviral therapy is not enough —
background and findings from our new paper in OFID:

with @LeandreFernet @drdrtsai @drlouiseivers
academic.oup.com/ofid/article/7… 2/ Annual deaths from HIV have decreased by 50% since peaking in 2006, mostly because of expansion in access to antiretroviral therapy

But huge disparities remain – HIV is the leading cause of death in Sub-Saharan Africa, & the 9th leading cause of death in low-income countries

Preterm birth and being born small for gestational age have major short & long term consequences for newborns & are responsible for 1000s deaths/day worldwide

Now in @GlobalHealthBMJ, our study of these conditions among 1089 pregnant women in rural Haiti

gh.bmj.com/content/5/7/e0… There are a # of interesting findings, most compelling to me the link we found between household food insecurity and preterm birth. Another of the many many connections between hunger and poor health outcomes. Again and again, hunger = fundamentally important intervention target

With growing evidence of prolonged & frequent shedding of (non-infectious) Cov2 RNA in the stool, @EricMeyerowitz and I discussed ?utility of wastewater surveillance on April 8

Today this super interesting new preprint from Mass adds a lot of detail /1

medrxiv.org/content/10.110… The study was conducted at one wastewater plant in Massachusetts with two major influent streams - "northern" and "southern." They collected 116 samples from January to May. Cov2 RNA was first detected March 3, at a time when there were only 2 known cases in the state.

A pleasure to read this new well-done modeling paper on mask effectiveness. Two points:

royalsocietypublishing.org/doi/10.1098/rs… 1. Addressing this issue of whether mask wearers may actually be higher risk of infection (unlikely imo) was particularly interesting

New study finds ~90% of people on Diamond Princess who were asymptomatic at time of +CoV2 PCR never went on to develop symptoms while monitored in a hospital for wks

But @EricMeyerowitz & I are having trouble squaring this with 2 other detailed reports:

nejm.org/doi/full/10.10… The first is this study of an outbreak in a SNF, where 89% asymptomatically CoV2 PCR+ went on to develop symptoms.

nejm.org/doi/full/10.10…

After 5 years, I will be moving on from @BrighamWomens at the end of the month. In this brilliant perspective, @michellemorse provides an account of the movement that has erupted since my arrival, led by her, @eberly_lauren, @Lachelle_Dawn, @EldrinL, + /1

nejm.org/doi/full/10.10… Especially within the dept of medicine (and internal medicine residency), there has been a cultural shift towards centering equity and naming/countering systems of oppression, including racism. This work is in its infancy, as it is in most American institutions. /2

In the last wk we have seen a staggering amt of new important CoV2 data

Update #7 w @EricMeyerowitz :



01:05 –ACTT-1
14:15 – Transmission
40:45 – Spectrum of clinical severity
1:04:21 – Immunity/vax
1:11:00 – Pandemic side effects

Key pts/slide deck👇 We'll start with a detailed review of the Adaptive COVID-19 Treatment Trial - 1 (or ACTT-1) which was published on Friday May 22 in the NEJM

nejm.org/doi/full/10.10…

Here is The 5th installment of COVID-19 Literature updates with @EricMeyerowitz and me, covering 5/6-5/18.

Watch here:

Key points and slides below (full slide deck at the end) Agenda

COVID-19 literature updates covering two weeks 4/23-5/5 by @EricMeyerowitz and me

Recording:

Slides: docs.google.com/presentation/d…

Key points and links to papers below We’ll start with some updates in therapeutics