Sorry for those who really want the COVID-19 graphs, I am checking them. We have a disease burden about 50% higher than a normal flu season (most active 3 months), and we are likely close to our seasonal high in the next week or two. Hospitals are not like last year.

1/ What can an individual do?

1) Get vaccinations up to date. These are REALLY high cost/benefit shots. I got my fourth about six week ago.
2) Wear an N95 in crowded indoor settings. Especially homes (which are by design poorly ventilated).
2/

Atlanta Medical Center is closing. This choice, by their owners, occurred because it is not profitable, and it is not profitable because it provides free health care to too large a portion of uninsured Georgians.
1/ This profit/uninsured problem exists because hospitals must serve people in need regardless of their ability to pay, and in some cases 40% of a hospital's patients will be uninsured. So hospitals play games to try to minimize their uninsured patient fraction.
2/

US COVID-19 cases, census, and deaths. In this plot, these three lines were aligned in amplitude for their peaks in January. The idea is that shifts between cases, census, and deaths, would show by relative line height today. We are near the national peak for this wave.
1/ Census is up a little for this wave, the ratio between deaths and cases are about the same as late January. Case Fatality Ratio is also about the same.
2/

@JasonSalemi I think the CDC move is actually in the right direction. Omicron featured huge problems, but among the positives were a five-fold decline in CFR. Which implies a five-fold reduction in disease burden per case.
1/ @JasonSalemi Which doesn't matter much when cases are several times higher than prior peaks.

But what happens when cases drop precipitously to levels below prior peaks? That five-fold reduction in disease burden per case really starts to matter.
2/

Interesting thoughts on Sars-COV-2. As the pandemic progressed, people generated ever increasing proportions of the population that needed resistance to generate an Rt under 1 (a temporary herd immunity), because it was assumed R0 was rising.

What if they were mostly wrong?
1/ The evidence is now emerging that MOST of the increased transmissibility of Sars-COV-2 came from shorter intervals from a person infected to a secondary attack (the next person in the transmission chain).
2/

US COVID-19 cases, census, and deaths. Again. Rt for hospitalizations is nearly one, about to decline. Some states with delta outbreaks and early omicron outbreaks are shown in thread.
🧵 1/ New York state. Census was climbing over a month before omicron onset, and is now preparing to turn. It is important to distinguish census from hospitalizations (of which there are many). The hospital average length of stay for omicron is MUCH shorter.
2/

So, how can air quality be boosted without using huge amounts of energy? The answer is simple - energy exchange.
1/ There are ventilation boosters under the category energy recovery ventilators, and have been for years. The air intake and outflow run past each other, with narrow membranes separating them. This creates a smooth temperature gradient in the exchange region.
2/

There are multiple people claiming endemicity is inevitable. Vaccine effects wane, and people start catching COVID-19, with a reduced range of severity. I don't think it is inevitable.
1/ At this point, we KNOW a wide range of non-pharmaceutical interventions (NPIs), and the relative effects of each. The real question is, are we willing to combine NPIs with vaccines?
2/

We are getting far enough into the delta wave that re-infection data is accumulating, and it can inform how protected someone recovered from infection is.
1/ Austria: "Protection against SARS-CoV-2 after natural infection is comparable to the highest available estimates on vaccine efficacies."
medrxiv.org/content/10.110…

2/

New day, let's keep the ball rolling. The claims are
1) Both medical and public health considerations support someone recovered from COVID-19 getting one vaccination shot. Not two. Weigh the risks and benefits, it is worth it.

1/ 2) When faced with a mandate, when the issue is ensuring each person has an "expected" level of protection against symptomatic disease equivalent to the vaccinated, the "documented" recovered should be exempted from the mandate and still encouraged to get one shot.
2/

So many people are confused about the levels of protection in those recovered from Sars-COV-2 infection. It is not that complicated.
1/ There are four major adaptive components of the immune response. Two of them are B cell mediated, two are T cell mediated.
2/

Your CDC media release does not cite a study that actually compares immunity from recover to immunity from vaccination. It compares "recovered+vaccinated" to "recovered" and finds that adding a shot boosts protection...

Which is well established. 1/

https://twitter.com/HarmitMalik/status/1443077951587700739

What is not well established is that the recovered have a greater likelihood of becoming re-infected than the Sars-COV-2 naive vaccinated have of becoming a breakthrough infection. There are many studies on this.

https://twitter.com/_stah/status/1424719345062658048?s=20

2/

In a sense, the current COVID-19 political divisions reflect different approaches to a difficult situation. Lots of Americans won't take the vaccine. They consist of people who
1) Can't be convinced no matter what
2) Need more convenience or more education or more caring.
🧵
1/ The Republican approach, by and large, is to simply give up. We tried. We offered. They would not accept. Screw them and our healthcare system and let the rest of us go on with life.
2/

A new thread comparing immune protection levels in four categories of people. 1) The immune naive 2) those vaccinated but never infected 3) those infected AND recovered but never vaccinated and 4) Those with both.

I think the ratio protections are X, 2-3X, 2-3X, 6X

🧵 First, compare the immune naive with those vaccinated. With the new variants, protection against symptomatic infection is estimated at 85-90%. This cite says 88% in NEJM from the UK.
nejm.org/doi/full/10.10…

2/

The ozone plot, a primer 🧵. First, the plot uses an X axis that is percent currently infected. It assumes 3.67 infections per confirmed case, which was ballpark accurate last winter. I've simply left it the same. 1/ The y axis is Rt, the ratio change in each 5.2 days. It is actually the ratio change in the past 14 days, rescaled to a 5.2 day ratio. This measure is time centered 12 days in the past, a reflect of change in our recent past.
2/

The X axis is cases per capita in the past week. The Y axis is cases per fatality, recently. What was the ratio between deaths in the past two weeks, and cases 20 days earlier in a two week sampling period?
2/

Dr Blake, I am responsible for an enterprise. I read your thread on the recovered, and
1) want to be convinced the recovered are as protected as the vaccinated, AND
2) want to set up a reasonable policy that will require immune protection
1/ The two best bits of evidence that the recovered are protected are the Israeli study, and the Cleveland Clinic study. Each too prior PCR positives and followed them and their likelihood of infection, and compared to the fully vaccinated with Pfizer or Pfizer/Moderna.
2/

People misunderstand when I post about the science of natural immunity showing its protection is substantial. I am not anti-vax - I am very positive about the vaccines.
1/ The vaccines are among the best ever produced, and 100-1,000,000 times safer than COVID-19 in the immune naive (age and condition dependent).

But there is another issue.
2/

Interesting new study on Alzheimer's out. But I don't think it implies what the news headlines state. "Researchers question prevailing Alzheimer's theory " eurekalert.org/pub_releases/2…
1/ The authors performed beta-amyloid imaging, and measured soluble beta-amyloid-42 (the form associated with Alzheimer's). Soluble Ab42 was not associated with plaque formation, but was associated with increased hippocampal size and cognitive grouping (Normal vs MCI vs AD).2/

It has been variously sourced that natural immunity, or protection from re-infection after COVID-19 disease, is strong. Here is some of the evidence used to suggest it is roughly equal to the protection from the PfizerBioNTech🧵 or Moderna vaccines. 1/

https://twitter.com/_stah/status/1406983733304082433?s=20

2/

Why COVID-19 vaccine boosters appear likely this fall. A thread. 🧵 1/ Delta variant is estimated by various sources to be 50% more transmissible than alpha which is 75-100% more transmissible than the original strain. If you add it all up, delta is estimated to have an R0 in the range of 5-8. 2/