1/ I received a note the other day from an 18-year-old high school senior who's concerned and feels he may be getting depressed about the future. He asked, Will this be forever? Are we doomed? THREAD:
2/ He asked when he'll be able to attend a sports game or concert again, when he'll be able to visit his grandparents, and if we'll ever get back to normal life.
3/ Young people are facing a lot of stress and uncertainty right now. Schools in many places are closing almost as soon as they reopen. Sports, concerts, and large gatherings are either cancelled or risky. Recent college grads are entering a flagging economy.
1/9 Covid Epi Weekly: One Step Forward, One Step Back
Decreasing cases in much of country. But decreasing testing, less information, and impending explosions with schools, universities, and more.
Primary concern : “A single death is a tragedy, a million deaths is a statistic.”
2/9 Positivity rate decreased from 5.5 to 5.1% nationally. That’s good - it’s progress. But we’re losing the ability to track the virus - antigen tests, less testing, and still no reliable information on who is being tested. We should have better information each week, but don’t.
3/9 Most of U.S. still failing. Too many cases to test, trace, isolate. Even in places with fewer cases, very little tracking of actual outcomes:
*Days infectious before isolation
*% cases from quarantined contacts.
Tens of thousands of lives and millions of jobs depend on this.
Dr. Atlas' confidence in his own judgment is exceeded only by his ignorance and sophistry. Here -thanks @EricTopol for Senate testimony (under oath) - direct quotations. Yes, he never says "I advocate for herd immunity" but that is EXACTLY what he proposes. See exact words (next)
Atlas: "infected people are the immediately available vehicle for establishing widespread immunity. By transmitting the virus to others in lower‐risk groups who then generate antibodies, pathways toward the most vulnerable people are blocked, ultimately eradicating the threat."
Atlas: "If infection is still prevalent, socializing among these low‐risk groups represents the opportunity for developing widespread immunity and eradicating the threat." COVID isn't a candidate for eradication, basic error, but not nearly as deadly as concept of herd immunity.
Continued spread of Covid in the US will continue to undermine health, jobs, economy, and education. A concerted, strategic approach would help, a lot. Fundamental error: Failure to recognize we’re all connected, all in this together.
2/9 CovidView positivity inched up from 5.4 to 5.5%, driven by increase among 18-49-year-olds. Low levels in northeast, some others, but still not finding most sources, not quarantining most contacts, so risk remains. High or increasing rates in most of US, too high for recovery.
3/9 Two data sources of note. County-specific test positivity, which should be open source but at least is available here (image below, wish they had zip code lookup). bit.ly/2F3wBmX And we’re delighted to work on the Covid Symptom Data Challenge. bit.ly/3201H83
1/9 COVID This Week: Decreasing Cases, Increasing Danger
Covid is decreasing from very high to high levels in much of US. Schools resuming; outbreaks inevitable.
Human immunity against the virus appears possible; FDA and CDC immunity from political interference, much less so.
2/9 First, the trends. Northeast remains relatively low, now joined by MI, WV, NM, MT, WY, AK. Number of tests decreased in some states, including Florida. Good national positivity decrease: 6.2 to 5.7%. Antigen testing will make this number harder to track; need 100% reporting.
3/9 More than 500,000 hospitalizations, 6 million diagnosed cases, 180,000 reported deaths, plus at least another 50,000 excess deaths above baseline from undiagnosed Covid and Covid-disrupted care. The US Covid death rate last week was more than 3x rate in S Korea since January.
OK, I've gotten feedback that these tweets are confusing. To clarify: Recently CDC quietly changed its website. First, they no longer recommend quarantine for travelers from high-prevalence areas. Second, they no longer recommend testing for asymptomatic people, even contacts.
Both changes are highly problematic. If explained openly in a press conference, perhaps defensible, tho hard to see how.
Re quarantine, it's not enough to mask, distance, and wash hands. And you can go outside if not near others, but not to crowded spaces. Masks aren't perfect.
Re testing. It's very important to test contacts of cases - in outbreaks and families and elsewhere, so we can find other infected people and trace their contacts and stop webs of transmission. The plain truth is, we don't have enough tests, so we must admit that and prioritize.
1/16 COVID Epi This Week: The Peril and Promise of Immunity
Covid continues to spread in most of the US at rates too high for effective contact tracing, safe in-person schooling, or economic recovery. Important hints published this week about immunity. cnn.it/2QglARk
2/16 Getting harder to track the virus. Test volumes all over the map are … all over the map. Big increases (Alabama, Arkansas, NY, SC, TX), big decreases (Alaska, FL, LA, MS, WI), some stable (e.g. CA). Haven’t seen any good data on reasons for testing decreases.
3/16 Test positivity, the most important single indicator, falling in many states. But it is measured differently in different places. Patients vs. tests. Exclude outbreaks? Exclude screening? Exclude repeats on the same person? In any case, overall percent: from 6.9% to 6.3%.
The looming question: Internal travel restrictions
1/22 This week: continued spread of Covid at a high rate in most of the US, continued shortages and delays in testing, and continued confusion about what the data show and what we need to do to control Covid.
2/22 First, how much Covid is there? I track percent positivity as the least bad indicator. Reported cases are the tip of the iceberg: these cases reflect both how much spread there is and how much testing and reporting there is.
3/22 Although test positivity decreased slightly, from 7.7 to 7.0, it remains high in much of the country and very high in the South. But there’s a problem. Antigen tests becoming widespread and if not reported, we will lose ability to know of all positive and negative tests.
1/14 COVID Epidemiology thread for the week, bottom line up front:
The tide is turning but is still very high.
Decreasing positivity rates in many areas, but still very high. Will we relax control measures too soon again, before we have the virus on the run and can corner it?
2/14 Positivity down (8.7 to 7.8%, decreases all lab types, 9 of 10 regions) but still high in many places. Surprisingly high in 5-17-year-olds: >10%, highest of any age group. Any place above 5% has LOTS of Covid, probably too much to be able to open schools and keep them open.
3/14 It's not just about having enough tests, it's about having fewer cases. Unless we decrease spread, we'll never have enough tests. And when we decrease spread, we need to use tests to quickly isolate infectious people and warn contacts before they infect others.
1/10 Epi review of the week. Bottom line: some decreases in case rates in some states, deaths increasing, but even with case decreases, rates in much of the US are very high. We’re a long way from safety. Close bars or open schools safely? Lots of states chose to keep bars open.
2/10 Test positivity stable overall, decreasing in the South but still very high, increasing in the Midwest. Different trends from different labs but from public health labs, increases in kids especially 0-4, also 5-17 (gray, orange lines). Not promising for opening schools.
3/10 Testing charade continues. We shouldn’t pay a dime for any test that takes more than 72 hours to come back. Every state and county should report the proportion of tests with results within 24 and 48 hours. What gets measured can get managed.
Deploying a Covid vaccine is the most important thing we can do to restore some order and normalcy to our world. But the push for a vaccine faces three key hurdles.
First, will it work? We don’t know yet whether any vaccine candidate is protective, how extensive protection will be, how long protection will last, or whether all people will be protected. Most vaccines never make it to approval; many of today’s promising candidates may fail.
Second, will it be safe? A lot can go wrong with new vaccines. We have limited experience with the new technologies being used. Although most vaccines are strikingly safe, adverse events from vaccination may not be readily apparent, and there can be no shortcuts on safety.
1/17 What a week. Broader recognition of how serious the US failure is. Not enough action on what needs to get done. The virus has the upper hand and won’t stop until we stop it. We won’t stop it until we focus better on the most important data. bit.ly/3fXHhkh
2/17 Misleading to focus on case counts. Probably more than 25 million Americans infected already, tho we don’t know for sure. Test positivity rates are instructive, and deeply concerning. Other than the NE, the country is awash in virus, but the increase is ebbing in some areas.
3/17 We are THESE not THE United States. Overall positivity rates declined, but increased in many states. Clinical (mostly hospital) and commercial positivity rates decreased; public health lab positivity rates increased.
1/11 Weekly epi review. Just when you thought it couldn’t get worse….But stay tuned for news Tuesday about a better way to get a nation-wide approach despite lack of national leadership. The folks at exit strategy added “bruised red” to their map. The bruise is spreading.
2/11 Overall test positivity increased slightly, tho positivity in commercial labs decreased slightly. Something odd is going on with the commercial lab data -- the number of tests reported is way down and we’ll have to wait until next week to know if their trends are reliable.
3/11 Look carefully at public health lab results. Lines are positivity rates, on the Y axis. Note yellow - young adults- increasing for more than a month. Older adults, blue and green lines, increased sharply last week. Not good. First cases increase then 2-3 weeks later, deaths.
1/5 The way to make Americans safer is to build on, not bypass, our public health system. CDC’s National Healthcare Safety Network has been a comprehensive resource to support hospitals and increase public accountability for decades.
2/5 Rather than strengthening the public health data system to improve hospital reporting, the administration has chosen to hand data to an unproven, commercial entity, reporting to political appointees, not scientific experts.
3/5 As with mask recommendations and schools reopening guidance, the administration has sidelined & undermined CDC in the middle of the worst pandemic in 100 years. People in Arizona, Texas, South Carolina, Florida and elsewhere are already paying the price for this.
1/9 Weekly epi roundup: US lagging in control, surging in cases. Only the Northeast is at all reassuring, and those gains are at risk. Reopening schools is getting much harder. Drawing from @CDCgov Covid-View and covidexitstrategy.org
2/9 Test positivity reported up: 9.2%; South-Central at 17%! Look carefully at trends from commercial labs. The first decrease in positivity among young adults in 2 months...and now increasing in older adults. What started in young adults, didn’t stay in young adults.
3/10 Every state should report testing rates by race/ethnicity, and tests that take more than 48 hours to come back are of little value. We should see by state and race/ethnicity, the rates of tests that return results within 48 hours.
1/10 Another week, more spread of #Covid19. Bottom line: it’s worse, will continue to get worse, and will take months to improve substantially.We are going in the wrong direction, fast. @CDCgov’s Covid-View here: bit.ly/30Fj11C
2/10 No single indicator sufficient, but if I had to pick one, it would be the proportion of tests positive. This increased from 8.1% to 8.7%. We should measure and report turnaround time: symptoms to test and isolation. Lab turnaround times of more than a day limit test utility.
3/10 Look carefully at the yellow line and bar. The bar shows that public health labs have been testing about 125,000 people age 18-49 each week, and the positivity rate has been rising for a month, from about 5% to about 7%, driving the overall increase.
1/25 Weekly Covid epi. Lean into a punch, get hit hard. States that opened while cases increasing predictably having big increases. Increases will continue weeks more, longer without more distancing. The virus does not just go away - we have to stop it! bit.ly/30Fj11C
2/25 Big picture: overall, national test positivity is increasing, as are case counts. Bad news. Dangerous. Avoidable. Predicable. Predicted. A massive viral reservoir that will continue for a long time.
3/25 Cases don’t always reflect spread, but this graph tells the story. American exceptionalism means many things to many people, but shouldn’t mean this. The US has become a global laggard. Travel restrictions. Economic harm. Deaths.
1/25 This week’s Covid-View tells the story of many epidemics. Trends are diverging within the US and globally. What will places do about travel from areas with lots of spread? Details matter, and this week’s data is particularly complicated. bit.ly/30Fj11C
2/25 @CDCgov publicly available data doesn’t provide the kind of granularity needed to look at states, but they did provide the code to the great folks at exitstrategy.org so I use their data to look at states.
3/25 The proportion of tests positive continued to increase slightly for the second week in a
row. Increases were driven by northeast, southeast, south central, central, and pacific northwest.
1/ THREAD: Can differences in the genetic makeup of the #COVID19 virus affect its severity? This is a hugely important question that has major implications for how we approach public health measures and vaccine development. nyti.ms/2Biis3n
2/ A few weeks ago I asked what factors might explain why some people have severe Covid illness and others have mild symptoms or none. I continue to think strain differences may be contributing to the differences seen in severity around the world.
3/ Mutations are common in most viruses as they spread, including in enveloped RNA viruses such as SARS-CoV-2. Even if only a small proportion of the genome has changed, we’re not always sure what that small part does, especially in a new coronavirus.
1/ THREAD: Important study just out from @CDCgov shows certain characteristics may increase risk of hospitalization: age, black race, diabetes, lack of insurance, male sex, smoking, and obesity. Although there are limitations, these are important findings. bit.ly/MMWR61720
2/ Interesting figure. Note the differences between adjusted and unadjusted odds ratios, especially for hypertension, age 45-64, and insurance status. Adjusting (i.e. correcting for likely bias or confounding) makes the elevated risk for hypertension disappear.
3/ Increased risk among black people is consistent with multiple studies, and may be due to more exposure to Covid, more underlying illness, less access to health care, and possibly other issues as well. We must do better to protect and care for those most at risk.
1/11 I wish CDC would review this on regular media briefings but since they aren’t being allowed to, for 3rd week in a row I will summarize what I see as the most important findings of #Covid-View - the single best source of information on the pandemic. bit.ly/30Fj11C
2/11 Good news first. Deaths continue to decline, athough not to baseline yet. But remember, even at baseline there could be hundreds of people killed each day by #COVID19 Covid. These are trends on the basis of large denominators.
3/11 Flu and flu-like activity are just about gone, as expected by now. Flu continues to circulate at low levels over the summer, too low to be picked up by most surveillance systems. We need to track Covid-like illness as an early warning.