Ashish K. Jha, MD, MPH Profile picture
Physician, researcher, advocate for the notion that an ounce of data is worth a thousand pounds of opinion Views here surely my own Professor, Dean @Brown_SPH
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8 Dec
With early data rolling in, here’s where we currently stand with Omicron

First, we have plenty of evidence that Omicron will spread easily, quickly, and far

We should expect, globally, relatively large waves of infections

How will people fare?

Depends on who you are

Thread
I think of 3 groups of people

Immunologically naïve

Somewhat protected

Highly protected

Depending on which group you are in

Your risk of infection varies

As does your risk of bad outcomes

So let's talk about each of them

2/6
Group 1 Immunologically naïve:

Who are they?

Unvaccinated and not recently infected

How will they fare?

They are likely to get infected with Omicron at very, very high rates

Many of them will get sick. I hope...but doubt... that the virus will be mild for them

3/6
Read 6 tweets
30 Nov
While everyone is focused on #Omicron

Let's not forget Delta, our current scourge

And over past 5 days, we've seen a 25% drop in cases (see graph)

Good news, right?

No

Its what we see during every holiday: drops in cases due to drops in testing

And its a problem

Thread
Some of the drop off is lack of reporting

But a lot of it is sick people not getting tested

That's a problem because...with less testing

more infected people are spreading to others

And what we've seen?

Bigger the drop during the holiday

Bigger the bounce that follows

2/4
Which gets us to this Thanksgiving

We've seen a 25% drop in cases over Thanksgiving holiday

That's big -- much bigger than last Thanksgiving

Which means we should expect a sharp jump in reported infections later this week

Some of those will be reporting catchup

But....

3/4
Read 4 tweets
26 Nov
A key question US policymakers are asking

Should they follow the EU and put in a travel ban to South Africa?

Is there any benefit of travel bans? Yes here is

Is there any cost of travel bans? Yes there is

So lets talk about what we know

Thread (1 of 4)
First, most of the evidence suggests that travel bans

If put in early, can slow spread of the new variant into a country by a week or two

Not keep it out -- but slow it

Why not keep it out? Because the variant is already in Asia (HK), Europe (Belgium) and other parts of Africa
And it is entirely possible its already here in the US

So travel bans help a little....and buys us a week or two

So what's the cost?

South Africa has done an extraordinary job identifying, sequencing and transparently sharing data on the variant

If we impose a travel ban...
Read 4 tweets
26 Nov
Every few months, we hear about anew variant

Most turn out to not be much

Well, unfortunately, there's a new variant B.1.1.529 that is concerning

What do we know so far? A few things but not a lot

Reminder: when it comes to variants, we focus on three things

Short thread
What are those three to pay attention to?

Is it more transmissible than current strain (Delta)?

Does it cause more severe disease?

And does have it more immune escape (will it render prior infections or vaccines less effective)?

So lets talk quickly about what we know

2/5
On transmissibility, data look worrisome

It has taken off quickly in South Africa

This graphs look concerning

But with case numbers in SA low right now, rapid takeover could be driven in part by other factors

So yes, am worried about transmissibility. But not sure

3/5
Read 7 tweets
7 Nov
Quick update on state of pandemic in the US

National picture has turned mixed

Bad news: rapid declines in cases has plateaued

Over past 2 weeks, new infections flat at about 75K per day

The good news?

Early in November, we're flat

Could be much worse. Could be 2020

Thread
If we compare same two months to last year, we see a very different picture

Last year at this time, infection numbers were taking off!

Doubling every 3 weeks

We were on a steep acceleration

This year, we have the FAR more contagious Delta

Schools are open

And we're flat!
You all know why

Nearly 60% of Americans now fully vaccinated

So as the air gets cold and dry

The virus, spreading more efficiently, keeps running into walls of vaccinated people

And can't accelerate

If you look at the state picture, this becomes clearer
Read 7 tweets
31 Oct
As a dad, I've thought a lot about the vaccines that will get authorized this week

And tried to think through the risk and benefits for my 9-year-old son

Based on data

I wrote out my thinking in a piece in @TIME

Here are some key points

Thread

time.com/6111965/vaccin…
A common misinformation refrain is kids are at lower risk than adults

True

Not the point

I don't think about my kids risk for COVID compared to my parents risk for COVID

I think about my kids risk for COVID compared to other risks my kids face

And what how to reduce them
The second issue is one of myocarditis or inflammation of the heart muscle

This is a real thing

But vaccine-induced myocarditis is rare and appears based on all the data to be relatively mild

COVID induced myocarditis is more common, and likely worse
Read 5 tweets
26 Oct
FDA expert advisors meeting on kids (5-11) and vaccines

I expect they'll follow the data and authorize vaccines for kids

And soon, I'm getting my 9 year-old vaccinated

Why am I so confident this is the right thing for my kid?

Because of the data

So lets review

Thread
First, the vaccine is very effective

In the trial, they reduced infections by 91%

That's during time when Delta variant was widespread

Safety data also compelling

You see standard stuff of course: sore arm, headache, low grade fever after the vaccine

But nothing serious

2/4
But lets look at the bigger picture

These vaccines have been given to half of all humanity (3.8 Billion folks)

They are among the most closely studied vaccine in history

15 million kids in the US have already been given the Pfizer vaccine

Side effects happen but are rare

3/4
Read 5 tweets
24 Oct
Good morning

Here's a quick update on the state of COVID in the US

5 points:

1. Infections are down 50% from September 1

Last year, infections rose 100% from September 1 to October 31

So we are, at least right now, on a pretty different trajectory

Thread
2. Deaths are down about 30% from the peak

This is good but not great

Why not more?

Deaths lag

But also, we are still seeing a lot of infections among vulnerable, high risk people

This is no time to be older, chronically ill and unvaccinated

2/6
3. Most new infections are in the northern half the US

And largely in Midwest, Great Plains states

7 states with the highest infection rates (AK, MT, WY, ID, ND, WV, UT)

They also have very low vaccination rates

In New England, cases flat despite weather getting colder

🤞
Read 6 tweets
18 Oct
Given the passing of General Powell who was fully vaccinated

A lot of misinformation spreading about breakthrough infections

So let's talk about breakthroughs

What are they about?

When are they a big deal?

Let's put on our public health and clinician hats on this

Thread
First, what is a “breakthrough” infection?

Its when someone who is fully vaccinated still gets infected

We know these vaccines prevent infection – but not 100%

So vaccinated people can still get infected

But then, your immune system, trained by vaccines, really kicks in

2/6
Within days of infection, a vaccinated person's immune system goes into high gear

Memory B cells make antibodies

T cells arrive to kill infected cells

And for most people, they don’t go on to have severe disease

A few days of symptoms, then they recover

Awesome

3/6
Read 8 tweets
17 Oct
When folks think about highly vaccinated places in America

They think Vermont or CT or MA

Those places are good

But not the most vaccinated place in America

So who's #1?

Puerto Rico!

But PR has gotten way too little attention

Its worth reflecting on how they did it

Thread
So lets talk numbers

Proportion of population fully vaccinated

MA is 68.8%

CT and RI are both at 69.8%

VT is at 70.5%

PR? 72.0%

Among older folks (those >65) fully vaccinated

VT is highest state at 96.3%

Puerto Rico? 99.9%. Basically everyone

And its paying off

2/5
Since July 1, when the Delta wave started

VT has had 50% more cases than PR

And today, PR has one of the lowest infections rates in America

Here's data from @CovidActNow

You can see Puerto Rico has one of the lowest infection rate in the US (way lower than most states)
Read 6 tweets
13 Oct
5 weeks ago, our public schools returned to full-time in-person classes

To keep schools safe, we implemented:

Indoor masking
Ventilation upgrades
Weekly testing
Encouraging vaccinations

We didn't push hard for distancing

So how's it going?

Pretty well actually

Short thread
We've seen essentially no spread within schools

Across the nearly 13,000 students who attend

There have been, on average, 10 cases per week

Number of kids getting infected likely has gone down since school began

But are schools driving community transmission?

No

2/3
Daily incidence down 10% since schools re-opened

And test positivity down nearly half in last month

Miracle?

No, just use of simple data-driven policies

And the few kids that are positive?

They aren't triggering quarantines

Because with "test and stay" - kids stay in school
Read 4 tweets
10 Oct
Quick update on state of the pandemic in the US in 4 graphs

First, nationally

We have clearly turned the corner on the delta surge

Now down 40% since peak a month ago

Still at high levels of infections and deaths

But good to be heading down as we head into fall and winter
Next, lets look at the big 4 states

CA, TX, FL, and NY

Geographically diverse

All of them are low and generally declining

Given 1 in 3 Americans live in these 4 states, they matter a lot to the national picture

This is good

So are there troubling areas?

Yes...

2/5
If we look at the national map

We see that deep south is done with its horrible summer surge

But great plains, Alaska are concerning

Here in New England, MA, CT, and RI have low levels of infection and declining!

Driven by high vaccination rates and public health measures
Read 5 tweets
4 Oct
Its time for vaccine mandate for air travel

Lack of one is becoming an issue

So here's my story from last night that confirmed why we need it

Basically, we can't expect mitigation measures to be enforced well enough to prevent transmission on airplanes forever

Short thread
Last night I took an overnight from LAX to Boston

I got to the gate, found myself next to a person whose mask barely covered her mouth

Mask was nowhere near her nose let alone covering it

I walked away

My flight boarded and I sat down in a window seat

She soon sat next to me
Sitting next to someone who is essentially maskless wasn't great

Truth is, if your nose isn't covered, you really aren't wearing a mask

She then started singing to a video on her phone

Really

Her flimsy cloth mask wasn't doing much at that point

3/5
Read 8 tweets
1 Oct
Great piece by @matthewherper

molnupiravir cut hospitalizations by 50% in among high-risk folks (older, obese, those with cardiovascular disease)

Despite the fact that we only have a press release

I am optimistic this will pan out

Why?

Short thread

statnews.com/2021/10/01/mer…
This result feels a lot more believable than many others we have seen

Why?

First, molnupiravir is a nucleoside-analog, a type of anti-viral that has been effective against other viruses

So the mechanism here makes sense

Second, this is not just a Merck press release

2/4
A group of independent experts saw the data and said "we've seen enough"

And stopped the trial because the drug was clearly working

That's important verification

It also makes me far more optimistic about other similar therapies being studies for COVID will pan out

3/4
Read 4 tweets
26 Sep
The southern surge is slowing

And cases in some Northern states rising

So it is all seasonal? Are vaccines working?

Let's look at data

Today the 10 LEAST vaccinated states had

2X the cases
3X the hospitalizations
5X the deaths

compared to 10 most vaccinated states

Thread
A lot of folks have been arguing the summer surge was "seasonal"

And now, the northern half of US poised to get hit

And if you look at states with biggest outbreaks today

Alaska, ID, WY, WV, MT, KY, ND

Largely not in the deep south

So should all northern states worry?

2/4
While we see cases rising in northern states

There are two distinct patterns here:

1. States with low vax rates getting slammed, having to ration hospital beds

2. States with high vax rates rising slowly with lots of hospital capacity

And the most interesting part?
Read 4 tweets
17 Sep
People concerned if we give 3rd shots (booster) to Americans

it'll mean fewer shots for the many unvaccinated folks in the world

Sounds right

But reality is more complicated

In the short run, I think we can boost the elderly largely with vaccines we can't send abroad

Thread
As of today, we have 80 million doses distributed to states

They are sitting in pharmacies, doctors' offices, hospitals

It is not possible to go collect those doses, pack them up, and ship them to another nation

No country would accept them

So we have to use them here

2/4
They all have limited shelf life

We are using about 0.77M doses/day

And at current pace, it'd take 104 days to use up doses already distributed

Many of these doses will expire before then

Does that mean we should start boosting to avoid wasting doses?

Of course not

3/5
Read 6 tweets
15 Sep
President Biden quoted @DLeonhardt

Suggesting daily risk of breakthrough infection among vaccinated folks about 1 in 5,000

Is that a lot?

Well, that would be 36,000 breakthrough infections daily

Seems bad!

So if you're vaccinated, should you worry?

Not really

Short thread
What does 36K infections mean in terms of hospitalizations, deaths?

Among UNvaccinated, about 1 in 20 infections lead to hospitalization and 1 in 200 lead to death

Vaccines cut risk of each by 90%

Which means daily, 180 vaccinated folks getting hospitalized and about 18 dying
Instead of IFR, what if we applied CFR?

That's 1.2% for unvaxxed, about 0.12% for vaxxed

Would mean 40 deaths a day

So how bad is 18 (or even 40) deaths a day?

After accounting for proportion of population vaccinated

Its lower than daily deaths in an avg flu season

4/5
Read 6 tweets
12 Sep
Quick update on the state of the pandemic in the US

The fourth wave has peaked and is turning down

The downturn is broad-based

What happens next is up to us

So lets start with where we are

Infections down about 10% from the peak

Deaths will turn around soon as well

Thread
Beyond the national picture, its always worth looking at the Big 4: CA, TX, FL, and NY

Together, about 1 in 3 Americans live here

And they are geographically and politically dispersed

So what do we see?

FL, CA turning down

NY flat

and TX rising, but slowly

All good
I often next go to @CovidActNow to quantify what we see

Their estimates of Rt -- infection rate

Here again, you see Rt <1 in FL, CA, at 1.0 in NY, and slightly above 1 in TX

Though PA and OH worry me

But overall Rt <1.1 in about 35 states

So that's good

3/6
Read 9 tweets
11 Sep
Late night of September 10, 2001, I landed at Dulles airport. Had flown in from San Francisco

I had a 9 am meeting the next day

A joint VA / DOD meeting about improving preventive care for veterans and members of the military

The meeting was to be held at the Pentagon

Thread
Had booked a hotel next to the Pentagon in Crystal City

Getting off the plane, I realized meeting had been moved

Construction at the Pentagon so meeting was moved to VA headquarters, near the White House

Next morning at 9:10, meeting began and beepers started going off

2/5
All the DOD personnel left

By 9:30, meeting was adjourned and we evacuated the building

I walked out and strolled towards the White House, was stopped by police

Standing around, heard that WTC had been attacked

My mom, brother were in lower Manhattan near WTC that day

3/5
Read 7 tweets
10 Sep
If you are vaccinated, why should you care if there are a lot of unvaccinated folks?

After all vaccines are really protective, right?

Yes, vaccines are really protective

But what happens to unvaccinated folks affects us all

Why we have to get more people vaccinated

Thread
So if you are fully vaccinated, why should you care?

1. Hospitals full of unvaccinated COVID-19 patients

Don't have room for people who have appendicitis, heart attacks, or a car accident

2. Spikes in cases shut down schools, which is terrible for kids and parents

2/4
3. Raging infections shut down restaurants, stores, make it hard for folks to get people back to offices

4. High infection rates put vulnerable people who can't get immunity at risk

Pandemics sicken and kill a lot of people

But they also disrupt the social fabric

3/4
Read 5 tweets
9 Sep
I'm pretty thrilled with @potus announcement today

COVID is killing 1500 Americans. Every. Day.

We have the tools to defeat COVID

1. Driving vaccinations

This is not about mandates

This is about creating safe work, hospitals, schools, houses of worship

Thread
2. Testing: this is a VERY big deal

We have way underestimated the power of rapid, frequent, ubiquitous testing

Ramping up testing is exactly what our nation needs

3. Boosters -- President says we need a plan for 3rd shot for the vulnerable

Science on this increasingly clear
High risk people: immunocompromised, frail, elders, chronically ill folks need 3rd shot for greater protection

4. Schools -- my goodness. Who doesn't want schools to open safely?

So @POTUS uses the playbook: masking, regular testing, vaccines, ventilation

That's right

3/5
Read 6 tweets