Wow. On board JetBlue. Attendant just announced that the courts struck down CDC’s 2 week extension of the mask mandate today and JetBlue now dropped its mask requirement. The attendant added he is taking his off.

(Meanwhile: double digit increases in cases in the northeast.) With cases rising, and superspreader events like the Gridiron dinner, I thought CDC’s 2 wk wait to see if hospitalizations climb was sensible. Moreover, it seemed far from an abuse of public health authority. Different courts 2nd guessing seems mainly likely to confuse matters.

As we continue on our grim march to 800K COVID deaths by Xmas, we seem to be deciding to live with 1000+ extra avoidable deaths a day. That puts us on path to exceed 1M deaths in early 2022. The prevailing view seems to be that we must accept that our chances of living past 80 have gone down—even indefinitely, and despite the economic damage—so younger, healthy people can live without having to vaccinate or to test regularly.

This outbreak is vital to understand. It shows what we still face if younger folks go unvaccinated.

47% of health care workers refused vax, while only 10% of residents did.

Result: 1 unvax'd HCW with COVID led to 20 HCWs & 26 residents infected, of whom 3 died (1 vaccinated).

https://twitter.com/nytimes/status/1384980269984370692

Let's unpack the details.

Q: Did the vax (2 doses of Pfizer) work? Absolutely. It was remarkable - but not perfect.

-Of 8 unvax residents, 6 got COVID (75% attack rate), 2 died (33% death rate).
-Of 71 vax residents, 18 got COVID (25%), 1 died (6%).
cdc.gov/mmwr/volumes/7…

US COVID-19 deaths remain upwards of 700 deaths a day. Who are these people who are dying?

🧵 COVID deaths in nursing homes are down massively.

- In Dec 2020, these accounted for 32% of all COVID deaths.
- In Mar 2021, thanks to vaccination, they accounted for just 4%.

So who are the remaining 96%?

data.cms.gov/stories/s/COVI…

Update from listening to the CDC ACIP meeting on the J&J vaccine:

They postponed making any decision, effectively continuing the pause on use of the vaccine.

They will reconvene in 7-10 days to review case reports from the ~4M who received the vax in last two weeks. Why wait for more info? A new case of cerebral sinus venus thrombosis was reported in a 25 year old man who became critically ill from a cerebral hemorrhage.

And for women age 20-50, CSVT occurred in 1 in 13,000, or 4-15X higher than background.

As cases and hospitalizations rise again, we can't count on behavior alone reversing this course.

Therefore, it's time for the Biden admin to delay 2nd vax doses to 12 weeks. Getting as many people as possible a vax dose is now urgent.

https://twitter.com/Atul_Gawande/status/1376888536129998850?s=20

I was on the fence on this. I'm not anymore. Here's why.

1. More contagious strains are now >1/3 of all US cases. And new evidence confirms B117 causes more severe disease, with MUCH higher rates of severe illness and death at younger ages. directorsblog.nih.gov/author/collins…

This is our warning call, America.

Cases are now climbing again in a majority of states--esp across the northeast and midwest.

@CDCDirector Walensky is right to be sounding the alarm. This is how surges start. We are a few weeks behind the pattern of the surges now happening in Europe, Asia, and South America.

I know COVID seems like it is subsiding. But the B117 variant is spreading. What we do now to stop it determines whether it takes over and fills hospitals again in 2 months.

It's going to take more than vaccinations--the supply won't come fast enough. nytimes.com/2021/02/17/opi… 1. We need all Americans to wear a high quality mask. Upgrading to one with a metal nose clip and a snug fit so it doesn't fall when you talk or leak so much out the sides--ideally a medical grade mask--is important. This variant is 30-50% more contagious than what we've faced.

Pfizer's move is indefensible. Yes, squeeze every dose we can. But cutting deliveries from 40M to 33M vials for the same price cannot be justified. Especially when many places lack the special "low dead space" syringes needed to get the "extra" dose. nytimes.com/2021/01/22/hea… "The world’s largest syringe maker does not have the capacity to substantially increase U.S. supplies of specialty syringes needed to squeeze more doses from Pfizer's vaccine vials in the coming weeks, an executive said." reuters.com/article/us-hea…

Key findings from the latest Axios-Ipsos Coronavirus poll.

1. Americans are more worried about COVID's impact on their health, job, and finances than since June. And for most, out of home activity is declining accordingly. axios.com/axios-ipsos-po… 2. Vaccine interest is up, with most now saying they are likely to take a COVID-19 vaccine if it public health officials say it is safe and effective (69%), has a 90%+ effectiveness rate (67%), or has been on the market a few months (65%). ipsos.com/en-us/news-pol…

Spoke to @MarketWatch and here are a few of the points I made:

- Today's election determines who's in charge Jan 20, but what happens with addressing the major surge of COVID19 cases and hospitalizations and with vaccines is being determined now. marketwatch.com/story/dr-gawan… - If we get an effective vaccine, the big problem won't be hesitancy, but lack of supply and distribution resources forcing hard choices among priority groups.

- We will need a mass movement to back mask-wearing, far more testing, and open hospital data.

This week, we at @AriadneLabs and @SurgoFoundation released a Vaccine Allocation Planner for states and cities to plan #COVID19vaccine distribution. As you start working with it, you realize just how wrenching the choices are going to be. covid19vaccineallocation.org .@moderna_tx says it will have 20M doses of its vaccine by Jan; @pfizer 30-40M. It’s unknown if either will work. But if one does, we may have enough for 10-20M people. (Remember, it’s 2 doses per person). qz.com/1924433/the-us…

.@casssunstein lays out the prisoner's dilemma that Democrats find themselves in with the GOP, but doesn't quite lay out what game theory has taught us about the best way to proceed: Generous Tit-for-Tat (or Tit-for-Tat with Forgiveness). 1/9 bloomberg.com/opinion/articl… This @Radiolab episode describes the 1960s tournament with computer programs vying with one another in a version of a Cuban Missile crisis to see if they could avoid escalating to Armageddon. Here were the algorithms. 2/9 wnycstudios.org/podcasts/radio…

Masks work? YES. This is appalling. Atlas offers no explanation for the increasing mountain of evidence in support, and instead offers only a bizarre and incoherent paper. I don't know why the administration wants to die on this hill.

https://twitter.com/SWAtlasHoover/status/1317465173347700740

So, once again, what is the evidence?

In my May article on the regimen hospitals have used to stop spread of COVID19 (hygiene, distancing, masks, and testing at least symptomatic people), I review the copious evidence to then on why masks work. newyorker.com/science/medica…

Warning for COVID scientists: An impostor is asking scientists for an interview using the email atulgawande65@gmail.com (not mine) and signature “Atul Gawande, Staff Writer, The New Yorker.”

These are fake. Do not respond. I use a bwh.harvard.edu address for work. 1/4 One scientist did respond. It led to back-and-forth emails and a brief phone call to settle on an interview time. The impersonator sent a Microsoft Teams-like link. The result was a hack that accessed the victim’s computer, phone, apple ID, business and home gmail accounts. 2/4

Here we go again politico.com/news/2020/10/1… And with the CDC under a political thumb, it’s crazy but fortunate we can rely on independent sources like Johns Hopkins’ @JHUSystems and @TheAtlantic’s @COVID19Tracking for basic facts on COVID19

https://twitter.com/erictopol/status/1316923282264891395

Recently, @BrighamWomens had a COVID-19 outbreak among 20+ patients & staff. We rapidly traced and tested all contacts and advised quarantine. We deployed PCR testing in <24 hours for ~9,000 staff. We ID’d 52 total cases associated w the cluster and are containing the outbreak. The White House now has an outbreak involving 20+ guests and staff. They have done no tracing, no broad testing. And the outbreak is spreading outward. nytimes.com/interactive/20…

This boggles the mind. With sky high COVID infections and deaths rising back to 1000/day, this: In talks w Senate GOP over the weekend, “administration officials instead pushed to zero out the funding for testing and for the nation’s top health agencies” nytimes.com/2020/07/18/wor… More details in this @washingtonpost story. “Several Senate Republicans including @SenBillCassidy (R-La.) are exploring pushing a testing and tracing provision in the next stimulus package but are expected to meet resistance from the White House.” washingtonpost.com/us-policy/2020…

Important results: Remember the 2 MO hairstylists who saw 140 clients over 8 days while infected with COVID but everyone had worn masks? Contact tracers found ZERO secondary infections. More evidence that masks work. cnn.com/2020/06/11/us/… By contrast, in Israel, two weeks after reopening schools, at least one infected student at a Jerusalem high school led to 130 cases among students and teachers. Dozens of schools had to be closed again as the outbreak spread. npr.org/sections/coron…

I'm very worried about what this means for the South. But results will be different depending on how many cases they had when they finally took action. nytimes.com/interactive/20… Ohio set the example for the US. The Governor shut down early (3/23) under intense criticism, and that is slowing spread and likely averting overwhelming ICU admissions and deaths. They'll get through the worst of it this month. covid19.healthdata.org/projections

This, from @HarvardHBS, is the best analysis I've seen on what happened in Italy. hbr.org/2020/03/lesson… Many lessons here. Most notable to me: 1. PARTIAL SOLUTIONS DON'T WORK. Italy locked down only high risk areas ("red zones"), but it only facilitated spread as people fled lockdown areas. "Italy followed the spread rather than prevented it." Exactly what the US is doing.