Tom Inglesby Profile picture
Director of @JHSPH_CHS, working to protect people from epidemics & disasters. Inf diseases, pub health, research, policy
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19 Oct
A state official working on COVID asked this week: given the number of deaths per 100 cases seem be lower than March, is the needed government response now similar to that which we need for a particularly strong strain of flu? Answer: definitely not, and here's why... 1/x
Yes COVID clinical case fatality rate has been moving lower as compared to early on in the pandemic. @WHO has noted that this past week and attributed it largely to improving medical response. 2/x…
The improved care seems a combination of dexamethasone (perhaps to small extent remdesivir, though new trial results suggest effect is small if at all) and better medical care in general as clinical world figured out how to deal w/ disease better (e.g. prone positioning) 3/x
Read 19 tweets
16 Oct
Dangerous rise in COVID cases around US. We need to strengthen containment efforts and change directions. But it’s not inevitable that COVID cases will inexorably grow thru winter, sweep all parts of the country, or that our fate is sealed. We can change directions. 1/x
First – need to take serious look at the really concerning trends: > 65,000 cases nationally yesterday, the most since mid August, with average of 700 deaths a day. 2/x
Hopkins site shows 37 states rising in the last week.… Many states, particularly in the Midwest and plains are seeing highest numbers of cases and highest numbers of deaths per day since the start of the pandemic 3/x
Read 21 tweets
4 Oct
Ramifications of the COVID events in the White House of the last week for the public: 1/x
Its not right to say that the pandemic is turning the corner. We continue to be in the dangerous middle of it. 2/x
There are average of 43,000 new COVID cases happening every day, That’s 20% higher than 3 weeks ago. Cases are rising in >2/3rds of states.… Hospitalizations on the rise for first time in long time. An average of about 700 deaths a day. 3/x
Read 6 tweets
4 Oct
Anyone in close contact w president in time in which he was deemed to be contagious should be quarantined and tested. 1x
If president’s symptoms started Thursday, anyone he was in close contact with on Tuesday onward should quarantine for 2 wks. From this account that includes VIce President Pence… 2/x
Given Vice President Pence’s close proximity to the president - as per the NYT - the VP debate should be virtual. This debate could be done easily by a videolink and it would reduce risks to all concerned. 3/x
Read 7 tweets
4 Oct
President’s doctors’ briefing today presented some encouraging news. They reported he was breathing w/out oxygen and feeling well. They reported normal cardiac, liver and kidney fxn. But some news raised concerns. And other key information hasn’t yet been presented: 1/x
They reported president needed oxygen twice since symptoms started, which would likely mean he has underlying pulmonary involvement. The results of Chest X ray(s) and Chest CT(s) would provide specific information about the level and kind of pulmonary disease 2/x
In addition, Chest X ray and Chest CT at time of presentation with COVID has been shown to be predictive of a patient’s future course. Such as in this study… 3/x
Read 12 tweets
2 Oct
Its terrible to see the President, First lady and other(s) in the White House staff sickened with COVID and I hope they recover quickly. It is important to consider and respond to the implications of their illnesses: 1/x
As with all people who get sick with COVID, it will take days or possibly weeks to know how it will affect any one individual in the White House who has become infected. 2/x
The fact that the President is going to Walter Reed may mean his symptoms are now concerning enough to his physician team for him to be hospitalized or that he is going to get a specific treatment, or that they just want him there to be closely monitored as a precaution.3/x
Read 12 tweets
29 Sep
We're now passing very sad milestone of 1 Million deaths from COVID in the world. Its worth thinking about what is working effectively internationally, and what isn’t, esp in terms of global cooperation and systems. Here are some thoughts on that: 1/x
.@WHO and most countries in world have joined together to jointly plan and buy vaccine via the COVID-19 Vaccines Global Access [COVAX] Facility. There has never been an effort like this before. This has potential to do enormous good.… 2/x
If it succeeds as planned, it'll accelerate vaccine development + allow access to vaccine to high income + low income countries. But it'll require substantial fundraising. Unfortunately neither China nor US are partners in it, which is leadership failure on both their parts. 3/x
Read 14 tweets
29 Sep
White House press conference today on 150M Abbott rapid antigen tests.… Some reactions to what was said at the event: 1/x
As background: coming arrival of the Abbott rapid antigen testing was previously announced by White House on Aug 27th.… 2/x
150M is substantial number of Ag tests. Their arrival will be very welcome. Important to plan for how these and other Ag tests coming on line should best be used. It’s a very big supply of testing, but not enough to meet range of potential public and institutional needs. 3/x
Read 15 tweets
27 Sep
Many important things happened related to COVID in the US this past week. Here are some of the good and some of the not-good developments, and their implications. First, here are some of the good: 1/x
J&J started large (60,000 person) phase 3 trial of its vaccine. Its 1 dose only, which distinguishes it. Safety + efficacy results by early 2021. Storage requirements (-20 C) are compatible w/ standard vaccine distribution approaches. Very good. 2/x…
This is more forward progress from Op Ward speed collaboration btwn gov & vaccine makers. Potentially invaluable for fight against COVID. Important to let trials and regulatory process proceed safely, so people don’t lose confidence in what could be most helpful tools. 3/x
Read 20 tweets
19 Sep
We're about to pass the deeply tragic milestone of 200,000 deaths from COVID in the US. What have we learned about COVID and our response to it over the last 7 months? So much. Here is a start: 1/x
When a new epidemic shows signs it'll become a terrible pandemic as COVID did in China in Jan – healthy people dying, HCW infections and deaths, hospitals filling w/ critically ill, et al – countries should recognize a pandemic is coming + emergently prepare themselves 2/x
Government needs diagnostic manufacturers to be ready to prepare to develop & mass manufacture diagnostic tests (PCR and rapid Ag) – to Dx the sick and their contacts, to screen asymp in higher risk environments, and for surveillance. We need a national testing strategy. 3/x
Read 30 tweets
18 Sep
“But Dr. Alexander, a part-time assistant professor of health research methods, appeared sure he understood the coronavirus better [than Dep Director Anne Schuchat].” Completely absurd. Schuchat is one of most experienced pub health officials in US…
How did HHS leadership and White House permit this badgering and undermining of CDC for 5 months?
Manipulation of the science is what you do when you fear the true data and the real evidence will make you look bad, it’s what happens in autocracies.
Read 5 tweets
21 Aug
If health Dept says you’re a close contact of a Covid case, you are quarantined because you are a risk to others. If a teacher catches covid from a close contact, he/she can inadvertently spread it before symptoms start or even if there aren’t symptoms 1/x…
Calling teachers essential workers doesn’t change how this disease is transmitted. They can still get covid from exposures to Covid cases. And they can still infect others after exposure to a close contact.2/x
The way to have teachers be ready to teach across the country is to protect them from getting sick in the first place. Schools needs the funds to put all mitigation measures in place. Require universal masking. 3/x
Read 7 tweets
17 Aug
How can we learn about school risk w/ this approach?: "There is no official national tally of school-linked COVID-19 cases, and some states are not reporting how many outbreaks have occurred or how many students and staff members have been infected"1/x…
It's as if leaders don't want to know: "Some [states] claimed that coronavirus data on schools was not critical to protecting the broader public...And only a handful of states said they would report the actual numbers of infected students and staff." 2/x
Not even @cdcgov. Really discouraging. "A spokeswoman for the Centers for Disease Control and Prevention said that the agency was not tracking school-based COVID-19 cases, and the Education Department did not respond to a request for comment." 3/x
Read 5 tweets
15 Aug
.@CDCgov published report on more than 800 COVID hotspots happening between March and Mid July. A few key report findings in thread below, but first question is why isn’t all data related to hotspots publicly available in real time?… 1/x
Hotspot cities or counties have right+need to know that WH or @CDCgov considers them hotspots. Not only political, pub health, medical professionals, but also the public. If public understands their community is a hotspot, could create better decisions, stronger resposne 2/x
This federal data on COVID trends should all be public + transparent in real time. Why isn't it? Data in new CDC report ends July 15. What are designated hotspots around country in last month? Why isn’t that conveyed to people living in these places? 3/x
Read 10 tweets
9 Aug
To have officials say they can’t cancel or limit attendance or legally enforce social distancing measures for this SD rally of tens or hundreds of thousands of people is example of why we can’t get control of COVID. That’s what leader’s job should be. 1/x…
To say that it’s up to individuals to decide it they want to go into crowded bar and take on risk of getting infected or possibly infecting a whole lot of others is not right. We don’t say it’s up to individuals to decide if they want to drive under the influence of alcohol 2/x
SD had increase of 25% in Covid cases in last 2 weeks and has 8.7% test positivity rate - substantially above the 5% target it’s possible to do so much better - some states in the 2% or less range, being above 5% means risks are high of cases surging 3/x
Read 5 tweets
30 Jul
Recent days have brought new highs in COVID case numbers nationally, 30 states w/ cases rising and many states with high test positivity, near peak hospitalizations, >1,000 deaths a day. We need to reset response, and we have a new report proposing how to do that. 1/x
Our @JHSPH_CHS report: Resetting Our Response: Changes Needed in the US Approach to COVID-19. @cmyeaton @Elena_Martin33 @C_R_Watson @MSchochSpana @anita_cicero
and I recommend what needs to happen now.2/x…
1) Encourage, and where needed, require the fundamental interventions that lower risk of spread. Face coverings, physical distancing, limiting the size of gatherings (<10 in places where transmission high, 25 in places where disease under control).3/x
Read 35 tweets
24 Jul
This @CDCgov guidance on schools should have included more detail on what is known and unknown about transmission risk (e.g nothing about large Korean study this week that showed kids 10-19 transmitted as well as adults, nothing on Israel experience...1/x…
And did not include reference to this Kentucky school outbreak where 18 students, 3 coaches, and 17 family members and close contacts were infected 2/x…
This new CDC document did dedicate most of its space to describing the importance of school, which is widely agreed to and understood already.3/x
Read 6 tweets
21 Jul
The president spoke this afternoon about the US response to the coronavirus pandemic. There were a number of welcome public health-grounded messages. But there are places where he needed to go further, or to clarify or ask more from governors.1/x
He asked people to use masks and social distance and said he had a mask in his pocket and said he would wear one whenever he was around others. This was all good. The next important step is for him to tell all governors to require masks in all states.2/x
He conveyed how poorly things are going in FL, which was important to say. But the next needed step is for him to call on FL governor to take decisive steps to control spread.3/x
Read 14 tweets
8 Jul
At White House Coronavirus task force meeting today, they described how each governor is given detailed data on regular basis about it's COVID numbers, statistics etc. That data should be made available to public so they can understand their own risks.1/x
At the meeting it was reported that diagnostic test positivity is showing signs of improving in FL, AZ, TX, CA. But those numbers have all been rising, with the first three in double digits, and AZ up to 26.8%.… 2/x
Very good to hear Dr. Birx at that meeting recommend that in places w serious transmission going on people should wear face coverings, avoid indoor restaurants and bars, avoid gathering in homes or indoors anywhere of more than 10 people.3/x
Read 6 tweets
7 Jul
The White House hosted an event called National Dialogue on Safely Reopening Schools. Many there talking about importance of schools in US but no one talking details about how to deal w risks or reopen safely, or what it will cost.1/x
Schools are extraordinarily important and we should work to open them safely in the fall. But mtg today had no one expressing concerns of so many parents+teachers. And no one talking about what is known /not known about the science related to schools and COVID spread.2/x
Children are at far lower risk of serious illness than adults in terms of COVID19. But we still don’t have enough evidence about how frequently children spread COVID to other children. Or how frequently children spread the disease to adults in school or adults in their homes.3/x
Read 22 tweets
3 Jul
Some constructive reactions to the continued highly alarming rise in COVID cases and hospitalizations in many US states, and some comments and decisions that threaten to make national COVID epidemic worse. Evidence of both in this article:… 1/x
On the constructive side, TX Gov required masks in public. And earlier in week AZ Gov ordered 30 day suspension of bars and some businesses which have large indoor gatherings (though unfortunately seems to not have included casinos, large indoor restaurants, entertainment?). 2/x
Also valuable: this clear assessment: "Earlier this week, Federal Reserve Chair Jerome H. Powell warned Congress that unless the virus is brought under control, the nation’s economic outlook is “extraordinarily uncertain.” 3/x
Read 9 tweets