Leana Wen, M.D. Profile picture
Visiting Professor @GWPublicHealth. Author of Lifelines. Contributing columnist @WashingtonPost. @CNN medical analyst. Frmr Baltimore Health Commissioner. Mom.
30 Apr
The US is in an "in-between" place. Vaccination substantially reduces #covid19 risk but doesn't eliminate it. There isn't one right answer & people will make different choices from one another.

Here are 3 ways to think about which activities to resume🧵: washingtonpost.com/opinions/2021/…
For vaccinated people, consider three factors when deciding which activities to bring back to your lives:
1) Medical risk of your household
2) Personal risk tolerance (more on this soon)
3) Risk of specific activities
Risk tolerance is a key point. People will have wildly different interpretations of the same statistics. Some want to keep hunkering down. Others will decide that once vaccinated, they can take off their masks and return to pre-pandemic normal. Most are somewhere in between.
Read 4 tweets
29 Apr
Imagine, if at last night's #JointSession, President Biden allowed only vaccinated individuals. They could take off their masks, hug & sit together--just like 2019.

That would be the strongest message that vaccines = return to pre-pandemic normal. /1 washingtonpost.com/opinions/2021/…
Is this scientifically sound?

According to the CDC's own data, there were only 7,157 breakthrough infections among 87 million fully vaccinated people — a rate of 0.008%.

A room of 1,600 is unlikely to have anyone infected. Testing would reduce the likelihood to zero. /2
You wouldn’t know that the vaccines are so effective based on CDC guidelines.

A very damaging narrative is taking hold: If the vaccines are so effective, then why so many precautions for the fully vaccinated? What’s the point of getting inoculated if not much changes? /3
Read 6 tweets
24 Apr
I'm a physician & woman who's in the under 50 age group. I'd chosen to receive the Johnson & Johnson vaccine. If I knew then what I know now about the risk of a rare but serious blood clotting disorder, I would have chosen another vaccine. 🧵@postopinions
The blood clotting disorder associated with J&J, thrombosis with thrombocytopenia syndrome (TTS), is not a run-of-the-mill blood clot. Of the 15 women who had TTS, 3 died. 7 remain hospitalized, 4 in intensive care. Most were previously healthy women, median age of 37. /2
15 cases out of 8 million doses seems like a very low risk. The risk for women in the 18-49 group is higher--1 in 80,000.

This is still low, and benefits of preventing severe illness from #covid19 still far outweigh risks if the J&J is the only vaccine available. /3
Read 6 tweets
13 Apr
As a doctor and volunteer in the J&J clinical trial who received the vaccine <2 weeks ago, here's my take on the recommendation for the FDA & CDC pause for the Johnson & Johnson #covid19 #vaccine: 🧵

(1) This is exactly the right move. All possibly concerning safety signals should be immediately & transparently investigated.

This shows that regulatory entities are doing their job. Even something very rare (6 cases out of 7 million) will be immediately looked into.
(2) The events flagged (blood clots with low platelets) are extremely rare. Causation hasn't been established. The reason this really needs to be alerted now is for doctors who may see patients with this rare condition, to know what to look for and how to treat them.
Read 5 tweets
12 Apr
My latest @PostOpinions column is about the need for urgent attention to an epidemic that is responsible for 300,000 deaths every year: obesity.

As @Dmozaffarian told me, "the slow pandemic of #obesity has intertwined with the fast pandemic of #covid19".🧵washingtonpost.com/opinions/2021/…
Obesity is a major risk factor for diabetes, heart disease, certain cancers & worse outcomes from #covid19. With stress & food insecurity, 42% self-reported gaining weight since the pandemic, with an average addition of 29 pounds. 10% gained 50+ pounds. /2 apa.org/news/press/rel…
The experts I spoke to proposed numerous solutions, including seeing food as medicine so doctors can prescribe healthy produce for patients; changing policies around ultra-processed foods & sugary sodas; and recognizing that systemic racism is built into our food system. /3
Read 6 tweets
7 Apr
There's lots of discussion on the pros/cons of "vaccine passports".

We need to stop using this term. It's inaccurate, inflammatory & divisive.

Instead, let's describe how proof of #covid19 #vaccination can return us to normalcy @postopinions (thread):

Asking for vaccination status is a kind of health screen to identify those at low risk for infecting others, not unlike symptom questionnaires or #covid19 tests.

If these aren’t seen as constraints on individual liberties, showing vaccine status shouldn't be, either. /2
In addition, individuals are increasingly asking one another whether they’ve gotten their shots. Vaccination enables activities that otherwise couldn’t occur safely.

I think it’s time for us to extend the newfound normalcy from social settings to business operations. /3
Read 9 tweets
11 Mar
It's been one year since the World Health Organization officially declared #covid19 to be a #pandemic.

What have we learned? Where do we go from here?

A thread. /1
5 key lessons:
1) Importance of a national, coordinated response. Piecemeal approaches to PPE, testing & vaccination do not work.

2) Without data, we are flying blind. A year ago, every detected case was a canary in a coal mine. Same issue with lack of genomic surveillance. /2
3) Hospitals are the last line of defense, not the first. The community, through preventive measures, are the frontlines.

4) Public health depends on public trust. Mixed messaging erodes trust & leads to politicizing of basic measures like masks./3
Read 9 tweets
9 Mar
Today's CDC guidelines on what fully vaccinated people can do are too timid, too limited & fail to tie reopening guidance with vaccination status.

As a result, we are missing a critical opportunity to incentivize Americans to be vaccinated. @PostOpinions washingtonpost.com/opinions/cdc-r…
I know this is a difficult needle to thread. What I want to see is nuance & risk estimates instead of taking an absolutist approach. Healthcare providers must help people exercise good judgment while considering each person’s individual values, or else we lose their trust.
Also, people need to be given incentives to get vaccinated As reopening occurs & people return back to normal, we are losing the opportunity to tie reopening to vaccination. At some point soon, everything will be fully reopened anyway, and there will be no carrot left to offer.
Read 4 tweets
16 Feb
This is the #1 question I get asked: What can newly vaccinated do? Is it safe to see grandkids?

Though there are still unknowns, we need to give a better answer than "follow all precautions".

My dos/don't in this week's @PostOpinions column: washingtonpost.com/opinions/2021/… (1/5)
The #covid19 vaccine is extremely protective against severe disease. There's growing evidence that it may reduce the likelihood of people being carriers.

People should resume essential activities but were being put off--like cancer screenings & dental screenings. (2/5)
It's probably fine to resume some non-essential activities, like going to the gym & out to eat. People should still abide by masking & distancing in case they can infect others. I'd still avoid crowded bars--& be extra cautious if others in your home are unvaccinated. (3/5)
Read 5 tweets
4 Feb
Here’s my best-case scenario: With existing vaccines, we turn #covid19 into an illness akin to the seasonal flu. By the end of 2021, we can resume much of our pre-pandemic lives.

This @PostOpinions column explains how this could happen: washingtonpost.com/opinions/2021/…

I’m optimistic because of a specific result in the vaccine trials that, so far, has received little attention: very few vaccinated people have become severely ill to the point of requiring hospitalization.

This one measure could change everything. Families could safely spend holidays together again if the worst-case scenario shifted from being put on a ventilator or dying to possible fever and body aches. Schools could reopen and much of the economy could return to normal.

Read 4 tweets
27 Jan
Many Qs about why it is that new #covid19 variants that are more transmissible will cause exponentially more infections (i.e. why something that is 70% more transmissible doesn't just cause 70% more infections & deaths). 

A thread with an illustrative example (1/5):
Let's say that R0 (virus reproduction number) is 1.1

In the first round of infection, number of people infected = 1 (original person) + 1.1 =2.1

Next round = (2.1-1)*1.1 + 2.1 = 3.3
Third round = (3.3-2.1)*1.1 + 3.3 = 4.6

After 9 rounds, we get to 15.9.
Now, let's say a new variant is 70% more transmissible--say the R0 for the new strain is 1.1*1.7.

You still start out with 1. Then:

First round = (1)*1.1* 1.7 + 1 = 2.9
Second round = (2.9-1)*1.1*1.7 + 2.9 = 6.4

After 9 rounds, we get to a whopping 600 infected.
Read 5 tweets
9 Jan
While I applaud pres-elect @JoeBiden's commitment to speeding up vaccinations, I'm concerned about the new policy to release all available doses without guarantee of timely administration of 2nd doses for all 1st doses given.

My @PostOpinions op-ed (1/6): washingtonpost.com/opinions/2021/…
First, the bottleneck now is not supply, but the "last mile" between getting the vaccine to distribution sites & injecting it into people's arms. Speeding up this process should be the focus, or else vaccines will just sit in different freezers.

I'm also deeply troubled by the idea that we could be rushing first doses out without a guarantee of timely 2nd doses. Clinical trials were conducted with 2nd dose 3- or 4-weeks after the 1st. If we deviate from science, this could fuel vaccine hesitancy.

Read 6 tweets
29 Dec 20
At the current rate of #covid19 vaccinations, it will take the U.S. 10 years to inoculate 80% of Americans.

Instead of obfuscating & deflecting responsibility, the federal government needs to take 3 urgent steps.

My @washingtonpost op-ed (1/6): washingtonpost.com/opinions/2020/…
I know ramping up a complex operation is hard. It's possible 2 million is an undercount.

What concerns me most is that officials are backtracking on their promises. It's giving me flashbacks to the testing debacle (remember "everyone who wants a test can get one")? (2/6)
So what can be done? 3 things.

1) Set up a real-time public dashboard to hold the right officials responsible and to target additional resources to where are most needed. (3/6)
Read 6 tweets
10 Jul 20
In my testimony to the House Homeland Security Subcommittee today, I provide 10 actions Congress must take to reduce the unequal impact of #covid19 on Latinos, African-Americans, Native-Americans & other communities of color.

My recommendations: (1/7)
1. Target testing to minority & underserved communities. Congress must instruct FEMA to ramp up testing & set up facilities all across the country.
2. Track demographic information to ensure equitable resource allocation. 
3. Hire contact tracers from minority communities. (2/7)
4. Provide free facilities for isolation & quarantine. 
5. Suspend immigration enforcement for those seeking medical assistance for covid-19. Congress should prohibit ICE from accessing records of those seeking care for covid-19. (3/7)
Read 7 tweets
26 Jun 20
So much wrong with @WhiteHouse presser on #covid19. We have record #s of infections in the U.S.--40,000 yesterday, and if only 1 in 10 being detected, means 400,000 people became infected. Hospitalizations are rising. Deaths will soon follow. Where is the urgency? (1/4)
They're saying testing is important. That's what public health experts have been asking for all along.

But where's the national plan for testing (& tracing + isolation)? We need at least 10X amount of testing we have now. (2/4)
In some areas, testing, tracing, isolation will not be enough: we need aggressive social distancing measures. Yes, it's individual responsibility, but public officials need to emphasize public health messaging + institute policies. Require masks. Limit indoor gatherings. (3/4)
Read 4 tweets
4 Jun 20
Testifying now to U.S. House of Representatives Select Subcommittee on #Coronavirus Crisis, on how #covid19 has unmasked long-standing health disparities among African-Africans & other minorities, who now bear the greatest brunt of this pandemic coronavirus.house.gov/news/press-rel… (1/9)
The problems of structural racism & systemic inequities are huge and cannot be solved overnight. But there are concrete actions that can be taken now.

I outline four in my oral testimony. Full written testimony to be posted on @COVIDOversight coronavirus.house.gov/subcommittee-a…. (2/9)
1. The federal government must target public health resources to minority and underserved communities. This includes targeted testing with a real-time dashboard for testing & contact tracing  + providing free housing for those who need to self-isolate. (3/9)
Read 9 tweets
27 May 20
The U.S. has just reached 100,000 deaths from #covid19. What have we learned? A thread of 10 lessons:
1. This is an extremely contagious respiratory illness that spreads rapidly from person-to-person. Containment is very hard.
2. But it can be done. South Korea, New Zealand, Germany & many others have been able to reduce covid-19 infections to low enough levels that they can identify and rein in new infections. It takes strong, consistent & clear national leadership.
Read 11 tweets
26 Feb 19
As a mother to a one-year old, I am disgusted by @RealDonaldTrump’s lies that aim to stoke fear and division. I know his true intention: to shame women, limit our access to health care, and take away our rights.
The President of the United States is lying to the American people about the Sasse bill. What @RealDonaldTrump is saying has no basis in medicine—or reality.
We should all speak up and fight back when @RealDonaldTrump is spreading lies & deliberate misinformation. The Sasse bill is about criminalizing doctors and taking away the right to safe, legal abortion. #ProtectProviders
Read 4 tweets