Today CDC/ACIP recommended everyone 6 months & older get an updated CoV-19 vaccine to protect against potentially serious outcomes of CoV-19 this fall/winter.

Good to have vaccine available to everyone 6 months & older who chooses to be vaccinated. 1/

cdc.gov/media/releases… Why do we need an updated vaccine now?

The (new) 2023-2024 XBB-containing vaccine is formulated to be effective against currently circulating strains of CoV-19, which have changed since the previous bivalent-booster vaccines were released...
2/

What’s happening w/ CoV-19 in Seattle & King County, WA? No CoV-19 tidal waves visible on the horizon, but the tide is relatively high & rogue waves are possible in the future. Don't turn your back on the water.

Vaccination & other steps to reduce risk remain important. 🧵1/ CoV-19 hospitalizations & deaths are much lower recently than during last winter’s peaks & have been holding steady over the past few months, although at higher levels compared to past troughs. 2/

kingcounty.gov/depts/health/c…

This is a thoughtful & important report on Long-CoV w/many good observations & recommendations. Check it out.

A few key observations + recommendations that the report highlights, below. 1/

@HHS_ASH: What is the national plan for implementation?

https://twitter.com/HHS_Innovates/status/1597324029215805441

Long CoV symptoms may last for weeks-months & dissipate w/time or last for months to years. Although people with more severe initial infection are more likely to develop Long CoV, it can arise in anyone who had CoV-19, regardless of the severity of the initial infection. 2/

CDC no longer recommends universal masking in healthcare facilities unless local CoV-19 transmission is high (>/= 100/100k/7d). This is a problem for several reasons.

But first, most of US has high transmission currently, so no change at the moment. 1/
thehill.com/homenews/state… This guidance refers to masking for "source control" to prevent spread of CoV-19 in healthcare facilities, it is separate from guidance for PPE use by healthcare providers to protect themselves from infection when caring for patients with known or suspected CoV-19. 2/

Update 🧵on CoV-19 in King County, WA.

Our “Omicron BA.2/BA.5 wave” plateaued in late May, was sustained throughout most of the summer & has been decreasing since mid-July. Over the last month, CoV-19 activity has decreased among all age groups. 1/ We’re currently classified in CDC’s low CoV community level while our CoV transmission rate based on reported cases remains just above the 100/100K/7d cutoff separating high transmission from substantial. 2/

Update 🧵on CoV-19 in King County, WA.

Over the past week, CoV-19 cases, ED visits, hospitalizations, & deaths have slowed or decreased slightly. That's good.

However, rates of CoV-19 + risk of infection remain high in all age groups. That's a problem.
1/ Reported cases remain higher than during all past surges but Omicron, & many more are not reported.

LOTS of CoV-19 out there, everywhere.

Layered strategies to decrease risk continue to be important. 2/

⚠️ CoV-19 Activity Update - King Co, WA ⚠️
Seems everyone knows someone w/CoV-19 right now as cases continue to rise above last summer's Delta surge peak despite significant undercount - actual cases are manyfold higher than reported.
Young adult case rates > youth > elders.
1/ Hospitalizations & deaths also rising & although well below recent peak levels, hospitals are feeling it as they struggle to catch up with huge burden of deferred care while taking on more CoV-19 hospitalizations. Elders at highest risk, but younger adults also hospitalized.
2/

Lot' of good in 👇 from @DrJayVarma

Describes a fundamental lack of awareness of how public health works (and does not work) in the US, and why.

1/
theatlantic.com/ideas/archive/… "Into that void...stepped university-based physicians, epidemiologists, & virologists opining about what the govt should do without fully understanding or communicating what is feasible, affordable, legal, & politically acceptable for public-health agencies."

2/

Over the past month cases in King County, WA, have increased to just under CDC's "medium" COVID-19 Community Level.

Hospitalizations & deaths remain stable & relatively low at this time.

What does this mean?
1/ That hospitalizations, deaths are stable & relatively low = very important & good sign that vaxxed people have great protection from serious infections.

This can change if cases continue to ⬆️, but so far, it's reassuring.

Unvaxxed at ⬆️⬆️ risk for hospitalization, death.
2/

Update 🧵on CoV-19 in King County:

The Omicron surge rose rapidly in DEC & peaked in early JAN. A steep decline followed, w/nadir in mid-March. Since then, cases are rising again, but more slowly & are much lower than the peak we saw in January. 1/
kingcounty.gov/depts/health/c… At the peak of the Omicron surge, an average of 6,500 new cases were reported daily. Currently, we’re seeing an average of 484 new cases/day.

That’s about 3X the # reported at the post-surge nadir a month ago, but 7% of the number at the Omicron peak.
2/

Detecting increase in CoV-19 cases over past week in King County for 1st time since Omicron peak in early JAN. No increase in hospitalizations at this time, & a decrease in deaths.

What does this mean?

A brief 🧵...
1/ There are multiple drivers of CoV-19 transmission that interact in complex ways. Influences on case, hospitalization, & death trends likely include the increasing more contagious (!) BA.2 Omicron variant...
2/

A 🧵on new booster guidance from CDC. The guidance:

1) People ages 12 years & older who are moderately or severely immunocompromised may choose to receive a 2nd booster dose using an mRNA CoV-19 vaccine at least 4 months after the first booster dose. 1/
cdc.gov/vaccines/covid… 2) Adults ages 50 years and older who are not moderately or severely immunocompromised may choose to receive a second booster dose using an mRNA COVID-19 vaccine at least 4 months after the first booster dose. 2/

Although more studies needed to confirm this & the severity & natural history of brain changes after CoV-19 are not clear, we know enough about potentially serious post-CoV-19 conditions to say avoiding even mild CoV-19 is a very good idea.
1/
jamanetwork.com/journals/jama/… There are additional reasons to avoid CoV-19 even if you're not concerned about being hospitalized, dying, or brain changes: other potential complications of even "non-severe" CoV-19 include a new diagnosis of type 2 diabetes...
2/
thelancet.com/journals/landi…

Updated (March 23) guidance from AAP on face masks for children.

aap.org/en/pages/2019-…

Excerpts below:
"High-quality, well-fitting face masks should be worn by all individuals who are 2 years of age and older when the community level risk is considered 'high.'”
1/ "Well-fitting face masks should be worn in accordance with CDC quarantine and isolation guidelines for those who have a SARS-CoV-2 positive test or were exposed to COVID-19."
2/

A few questions for @CDCgov colleagues about the new community transmission levels rationale. I may have missed the explanations during today's briefing.
@CDCDirector
cdc.gov/coronavirus/20…
1/ Slide 7, indicators, "New hospital admissions w/confirmed CoV-19/100,000 people & % of inpatient beds occupied w/ CoV-19 patients."
What proportion of admissions are considered to be for vs with CoV-19?...
2/

"The most compelling misinformation and disinformation has a small kernel of truth that is twisted and twisted and twisted in a way that then makes it misleading, and makes it support some alternative narrative...”
1/
grid.news/story/science/… "And professional sports leagues have reported no increased incidents in adverse medical events in the last year."
2/

“...the term endemic doesn’t really help us know what we can expect with respect to severity of illness, frequency of surges, seasonal patterns, or overall impact on the population.”
1/
mynorthwest.com/3337381/health… “What it does do is imply a more predictable range of illness, occurrence, and impacts. We just don’t know with much certainty yet what that state will look like.”
2/

COVID-19 May be Heading Down, But Don’t Count it Out (aka be cautious about proclamations that the pandemic is ending or has transitioned to endemic).
A bit of a mash-up 🧵
1/ From DEC 9 2021 to our local Omicron peak on JAN 10th, the number of reported CoV-19 cases in King County increased 23-fold, peaking at about 6400 reported new cases daily.
kingcounty.gov/depts/health/c…
2/

ED visits for CoV-like illness & CoV-19 cases trending down - great to see. Graphs below show the record-breaking peaks in ED visits & hospitalizations & relatively smaller increase in deaths becoming apparent. Still LOTS of CoV-19 out there: not time to let up on precautions. 1/ Can't predict how long the descent to low levels of transmission will be, but our hurting hospitals will take significantly longer to get relief from patient load, staffing shortages, patient discharge barriers. But moving in the right direction, for now. 2/

Very good to see we've had several days of decreasing cases since Jan 10th w/possible plateau in hospitalizations, while deaths have increased but at a relatively low level c/w past surges. 1/ I'm pretty confident that just as we had record-breaking # of cases & hospitalizations going up, we'll have large numbers going down. Hospitalizations & deaths lag cases by weeks. We're not out of the woods yet.

Continue all current precautions. 2/2

https://twitter.com/DocJeffD/status/1483131254660907012?s=20

Lots of soothsayers predicting Omicron peaking soon in the US. That would be most welcome, yet begs the question, what comes next? Shangri-La?
S. Africa (graph ⬇️) took a month to peak & now, 3 weeks post peak, incidence is still is 25X above the pre-Omicron baseline. 1/ Of course, S. Africa (SA) is a very different place than US for reasons previously discussed, & our trajectory may well differ. But UK also declining, and there are reasons to think we will soon too, given the vast number recently infected. But, then what? 2/