Ashish K. Jha, MD, MPH Profile picture
Physician, researcher, and advocate for the notion that an ounce of data is worth a thousand pounds of opinion Views here definitely my own Dean @Brown_SPH
Antone Johnson 😷 Profile picture Chris 😷#WearAMask #NotIntentional #FBPE 3.5% Profile picture Mangorangutan Is History & a Future Federal Inmate Profile picture mark Profile picture Buck Borasky, Frontier Programmer Profile picture 31 added to My Authors
23 Nov
If its Monday -- it must be more vaccine news

@UniofOxford / @AstraZeneca vaccine results posted

This is largely more good news

Overall efficacy of 70% but one dosing regimen was 62%, other 90%

A key result reported was safety: no severe adverse events reported

Short thread
What do these results mean and is this actually good news?

Why yes it is

First, I don't fully understand why two dosing regimens were so different in efficacy

One possibility is vector immunity

This vaccine uses adenovirus vector (virus to deliver the genetic material)

2/4
Less efficacious arm used full dose of vaccine in both shots

More efficacious arm was half dose followed by full dose

It MAY be that the full first dose generated immunity against vector, causing second dose to be less effective

We don't know but will need to sort out

3/4
Read 5 tweets
23 Nov
Daily reports tell us what happened last week, 2 weeks ago, 4 weeks ago

This is why folks are worried about what's next

Today's 7 day moving avgs

167K cases, 3600 new hospitalizations, 1460 deaths

What does this tell us about upcoming weeks?

It says we have a problem

Thread
Today's 167K cases? infection happened last week

Today's 3600 new hospitalizations?

Infections happened about 12-15 days ago

Today's 1460 deaths?

Infections happened about 3+ weeks ago

And that's why we have a problem

2/4
About 3.5% of identified cases get hospitalized

CFR right now about 1.7%

So today's new cases will cause:

5000 new hospitalizations in 10 days

2900 new deaths in 3 weeks

Corollary

Today's hospitalizations were cases 10 days ago

Today's deaths were cases 3 weeks ago

3/4
Read 7 tweets
22 Nov
Slaoui, speaking to @jaketapper, lays out an aggressive vaccination timeline

If he's right, we'll see virus spread starting to slow from growing population immunity by end of January into February

And much better by March

How?

Short thread
By end of January, based on timeline laid out:

50M vaccinated

And I suspect 60M infected, recovered by then

Obviously overlap between groups

So likely at 30%+ population immunity by 1/31/2021

That'll slow spread

By end of Feb, probably 40%+

Not "herd immunity"

But

2/4
Herd immunity not like a light switch

As population immunity builds, spread slows

By 30-40% immunity, spread becomes meaningfully slower

When we get to HI threshold, infections won't "disappear" overnight

But they will stop being self-sustaining

3/4
Read 4 tweets
20 Nov
Today was a very, very odd day

I testified before @SenateHomeland

They held a hearing on hydroxychloroquine.

Yup, HCQ

In the middle of the worst surge of pandemic

HCQ

It was clear how our information architecture shapes questions of science and medicine of COVID

A thread
There were 4 witnesses.

3 who strongly supported HCQ

They believed thousands of Americans were dying from lack of HCQ

And then, there was me

This split was not a reflection of evidence or the consensus in medicine

It reflected ability of the majority to seat more witnesses
The hearing was a testament to how politicized science has become

I shared evidence of studies that have failed to find benefit of HCQ

3 other witnesses shared personal experiences

And suggested my testimony was reckless because it would deny people access to lifesaving HCQ
Read 9 tweets
18 Nov
Number of COVID infections is high, rising.

What should we expect between now and December 1?

How many more infections?

Looking at the last 6 weeks gives us some clues

But bottom line?

We will likely have 250K to 300K new daily infections by December 1

Thread
All data from @COVID19Tracking and 7-day moving avgs

Oct 1 to Oct 15

42K new cases --> 53K new cases

This was an increase of 24% off base of 42K cases

Oct 16 to Oct 31

53K --> 78K; Increased 46% off base of 53K

Nov 1 to Nov 16

78K-->150K; Increased 88% off base of 78K

2/4
So infections accelerating off of a higher and higher baseline

If things continue without intervention, expect around 300K or more new cases on December 1

And the implications for hospitalizations and deaths is awful

But a few things can alter this:

3/4
Read 6 tweets
15 Nov
With cases spiking across the U.S. and national leadership nowhere to be found, states are taking the lead

Watching @GovWhitmer announcement. Feels like kind of science-based, nuanced policy intervention we need right now

What is Michigan doing?

A good amount

Thread
Michigan is doing a 3-week pause on:

indoor dining

bowling alleys and other indoor recreation

high schools

group fitness

And limiting informal indoor gatherings substantially

What are they NOT pausing?
Michigan is NOT pausing:

outdoor gatherings

essential work places

And most critically:

They are not pausing K-8 in-person schools

And they've ramped up testing to one of the higher levels in the country
Read 4 tweets
13 Nov
Things are obviously horrible re COVID

Our 7-day moving avg # of infections now 130K, 11.2% positivity, 60k hospitalizations 1050 deaths

But two of our largest states are still keeping things under control

NY and CA

And if they lose control, things will get much worse

Thread
NY and California combined represent 58 Million People

18% of US population

But they are doing 26% of all tests and rising

Have only 8% of all cases

8% of all hospitalizations

and 6% of all deaths

How are they doing it?
They have similar approaches

On per capita basis, they are, combined, doing about 60% more testing than rest of nation

Both states use data to drive local actions:

When cases rise, they curtail activities locally

Not perfect (hello NYC indoor dining??) but largely works

3/4
Read 4 tweets
10 Nov
Biden team won't have formal power to manage COVID until January 20

71 days

Between now and then, we may see additional 100,00 deaths from COVID

Its a horribly high number

Why do I say that? Heres the math

Right now, 1000 people dying every day

That number will rise

Thread
The 1,000 deaths represents infections that happened 4-5 weeks ago

So how many infections happened 4-5 weeks ago?

On October 7, we had about 45,000 cases with 5% positivity rate

Yesterday, we had 110,000 cases with 10% positive rate

These are 7-d moving averages

2/6
So number of identified infections 2.5X

And % positive doubled.....meaning we are missing MANY more cases today than on Oct 7

We're missing so many cases today b/c of our wholly inadequate testing

So I suspect true number of infections at least 3-5X what it was on Oct 7

3/4
Read 6 tweets
8 Nov
Through their votes, the American people have decided they want a new approach to the pandemic

But we have 73 days until new President takes office

73 hard days

Without action, additional 100,000 Americans will die by inauguration day. At least

So we can't wait to act

Thread
The key is that we are not likely to get much action from the Trump Administration

So we need to look for leadership elsewhere

But first, a little data on how we got here

Let’s talk about this moment.

All data from @covid19tracking using 7-d moving avgs

2/n
First, the current surge started soon after labor day.

We went into labor day with about 35K new cases/day

And now, we are at about 100,000 per day New infections in the US from September 11 through November
Read 12 tweets
27 Oct
President keeps saying we have more cases because we are testing more

This is not true

But wait, how do we know?

Doesn't more testing lead to identifying more cases?

Actually, it does

So we look at other data to know if its just about testing or underlying infections

Thread
Easiest is to wait 2-4 weeks

If underlying infections stable but you test more, hospitalizations and deaths will remain stable

But what if you don't want to wait?

Look at test positivity

As testing increases, becomes harder to find the next case

So test positivity drops
Best example is NY, which tests more than 100K people daily, test + of about 1.3%

So now, let's look at where we are as a nation vs 2 weeks ago

All data from @COVID19Tracking using 7d moving avg

Yesterday, did 960K tests
2 weeks ago, 898K tests

So testing is going up

3/n
Read 6 tweets
25 Oct
President Trump, advisor @SWAtlasHoover arguing there's lot of false coding of COVID

This is junk news

Like junk food, junk news tastes good but has no nutritional value

So what are the facts?

Don't hospitals get more $ for COVID?

Thread on hospital billing, COVID, and fraud
Our payment system is insanely complex

So this is a simplification

Hospitals get paid based on what condition patient has

A patient with pneumonia?

Typical hospital might get between $8K to $11K from Medicare, depending on whether pt has major comorbid conditions or not

2/n
So what happened in COVID era?

Cares Act gives hospitals a 20% bump (to about $9600 – 13K) if pneumonia is from COVID

Additional $1600 - $2200 for a typical COVID pneumonia patient

To get this bump, hospitals must document that patient is COVID positive

3/n
Read 11 tweets
25 Oct
I tweeted data from @MWRA_update on amount of virus in wastewater in Massachusetts starting to spike

What about more traditional metrics like infections, hospitalizations and deaths in Massachusetts?

Let's compared today's number with where we were after labor day

Short thread
All data from @COVID19Tracking. 7-day moving avgs

6 weeks ago, Massachusetts had:

323 daily new infections
331 people in hospital
12 people dying every day

Today?

937 daily new infections (up nearly 3 fold)
532 folks in hospital (up 58%)
17 people dying daily (up 37%)

2/3
What's driving this?

Indoor dining recently expanded

House gatherings/parties big driver

Disinformation makes it harder for people to stay focused

And complacency settling in that we did well over summer so we're all good.

We aren't

3/4
Read 4 tweets
21 Oct
On 9/23, Indiana's @GovHolcomb lifted nearly all COVID19 restrictions

wfyi.org/news/articles/…

This struck me and other public health folks as dangerous

A month later, how's it gone?

Pretty badly. Like really badly.

Don't take my word for it.

Let's look at data!

Thread
First, let’s look at Infections over past 2 months

All numbers 7-day moving avg from @COVID19Tracking

Between August 1 and September 23, cases fluctuating between 700-900 per day

Restrictions lifted 9/23

Infections start to take off by Oct 1

By 10/19, over 1800 cases per day
Test positivity was around 9% on 9/23

Today? Around 18%

Meaning Indiana missing way more cases now than they were a month ago

So identified infections AND missed infections way up

Ah you say, but what about hospitalizations?

Isn't that what matters?

3/n
Read 7 tweets
19 Oct
You know about dramatic increases in cases, hospitalizations across US

Surge began after labor day

But one state has done well during this time

Big state that would move national numbers

And what they've done holds a lesson for all of us

Yes -- let's talk California

Thread
Walk down memory lane:

California early to act in March, preventing surge of cases that affected many others

Over April/May, CA cases were low

But California had an awful summer surge, especially in SoCal

Cases peaked in late July: over 12,000 cases, 150 deaths / day

2/6
But in August, strong leadership from @CHHSAgency Health Secretary Mark Ghaly and @GavinNewsom

What did they do? Huge increases in testing including bringing new capacity online

Created highly customized approach on a county by county level -- micro targeting policies

3/6
Read 7 tweets
12 Oct
So this tweet is getting me lots of flak

Few points

I've become more optimistic that with proper masking, some distancing, more schools can open safely

Why? Because evidence base changing

Schools open in many places and aren't generally seeing large outbreaks

Short thread
I've been particularly swayed by work of the brilliant @ProfEmilyOster.

She brings evidence, not bluster, to this topic. Its inspiring

She's actually tracking data (!!). Yup, its not perfect. But its the best we have

Read her in @TheAtlantic

theatlantic.com/ideas/archive/…
Will we see some spread in schools?

Sure

Will it be worse than spread happening outside of school?

Not that we see in the (limited) data

But isn't it just "safe" to keep kids online until some unspecified future time?

No

So let's talk costs of keeping kids remote only

3/5
Read 5 tweets
12 Oct
Cases and hospitalizations are rising across the US

And I’m getting asked repeatedly whether we're heading toward lockdowns

Short answer – no – not if we are smart

Long answer? Its complicated

So let’s talk about lockdowns – and how we get through next few months

Thread
Lockdowns – shelter in place orders – are extreme

And awful. Super costly and usually not necessary

We locked down in March/April because virus spread across US in Jan/Feb

And we were blind. We had no testing. We had little choice

Situation now different. We know more

2/n
First, let’s talk about why everyone is concerned:

Cases rising in most states

Hospitalizations rising in most states

Test + going up too

As weather gets colder, expect things to get worse in much of nation

Why?

People will spend more time indoors. But not just that

3/n
Read 11 tweets
8 Oct
Have been getting asked a lot about whether its safe for President Trump and VP Biden to debate in person on October 15.

So here are some thoughts.

Bottom line: depends on how luck we feel

But here's a bit more detail

Thread
CDC recommendations for isolation for people with mild to moderate disease is 10 days after symptom onset.

If we assume symptom onset was October 1, then debate Oct 15 should be fine

But for "more severe" disease, infected people remain infectious out to 20 days

2/n
But there's a twist

President got steroids early in disease course (day 3) which likely affects duration of viral shedding

Steroids likely extend shedding of SARS-CoV2

We saw this with MERS (another coronavirus) and have some evidence with COVID

frontiersin.org/articles/10.33…

3/n
Read 5 tweets
7 Oct
While nation is distracted with Presidential tweets, FDA rules and CDC guidance...

COVID cases are continuing to rise

Today's numbers are out and they are heading in wrong direction.

Averaging close to 45K cases a day

But underlying data more concerning

Thread
All data from @COVID19Tracking using 7-day moving averages

White House Task Force designates states as red, yellow, or green based on cases over the past week

Based on their cut-points

25 states are now in red zone

25 states + DC in yellow zone

No greens

2/n
In red zone, out of 25 states

18 have rising cases over past 2 weeks

15 have rising test positivity

13 have test + > 10%

20 have increasing hospitalizations

So in red zone, states have lots of cases and are getting worse

Not good. Need action to stem tide

3/5
Read 5 tweets
2 Oct
President was diagnosed with SARS-CoV2 infection evening of Oct 1.

First and foremost, we wish him and FLOTUS a speedy recovery

We also need to sort out who else has been infected

Incubation period of the infection is 2-14 days but reality is that its usually 3-5 days

Thread
So, depending on when he was previously tested, reasonable to assume following:

He was likely infected between Saturday and Monday.

Could have been earlier or possibly Tuesday (though unlikely)

If he was infected over w/e, he was infectious to others Tuesday on

2/4
It is not clear who infected the President

It might be Ms. Hicks but also possible they had common source

So what does that mean?

This will be a big contact tracing effort.

Everyone who has been near the President at least from Saturday, on needs to be identified

3/4
Read 6 tweets
1 Oct
Was on @CNN talking Wisconsin, campaign rallies coming up this weekend

So how are things going with COVID in Wisconsin?

Pretty bad

New daily COVID cases per capita is 3X the White House threshold for a “red zone”

So let's talk data

Thread

So some data:

Wisconsin currently generating 42 cases/100K/day.

That’s # 3 in the nation after the Dakotas.

And things have been getting worse all month.

2/6
Sept 1:

750 cases
8.8% test positive
305 hospitalized
5 people dying daily

Sept 30:

2400 cases
21% of tests positive
595 hospitalized
10 daily deaths

Staggering changes in a month

More than tripling of cases, doubling of test positivity, hospitalizations and deaths.

3/6
Read 6 tweets
30 Sep
About to testify to to House @EnergyCommerce committee about a pathway to safe effective vaccines

3 key points:

1. Science has gotten us here so fast.

People are losing faith in vaccines because of politicization. We must not let that happen.

Thread

We must let science, not politics drive the timeline to EUA

2. We need to ensure equitable distribution -- not repeat our mistakes from testing where pro teams, WH get testing but teachers and nurses don't

2/4
3. We need to eliminate financial barriers to the vaccine. A third of Americans say they won't get the vaccine for financial reasons. We can't allow that to be a barrier.

If we do our job, we can have safe, effective vaccines that are widely available sometime in 2021

3/4
Read 4 tweets