Ashish K. Jha, MD, MPH Profile picture
Physician, researcher, advocate for notion that an ounce of data is worth a thousand pounds of opinion. Personal account Currently tweeting from @ashishkjha46
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Mar 17 9 tweets 3 min read
So, as they say…

Some news

For all the progress we’ve made in this pandemic (and there is a lot)

We still have important work to do to protect Americans’ lives and well being

So when @POTUS asked me to serve, I was honored to have the opportunity

nytimes.com/2022/03/17/us/… This President has spoken the truth about this virus

Has prioritized policies based on science and evidence

Americans are going back to work and school

And it is an honor to work under his leadership

One focused on the health and well-being of the American people
Mar 3 10 tweets 2 min read
With infections down more than 90% since highs just 6 weeks ago

It is tempting to decide the pandemic is over

It is not

During this upcoming lull of infections (and falling deaths),

It's time to prepare for whatever is next

So what to prepare for -- and how?

Thread The two questions I get asked most often these days are:

1. Will we see future variant

Answer: I don't know. No one does. Reasonable to assume we will. Let's hope we don't

2. Will we see future surges

Answer: most likely yes. Hope not

But remember: hope isn't a strategy

2/n
Feb 26 9 tweets 2 min read
For two months, I've said we're entering a new phase of the pandemic

A phase marked by a lot of population immunity, a more immune-evasive but less virulent virus

This new phase requires new metrics

My @nytopinion piece on the latest CDC metrics

nytimes.com/2022/02/25/opi… Fundamentally, new CDC metrics get it right

Why?

Because cases no longer are the most important measure

For nearly 2 years, for every 1000 cases, you could reliably predict 50-80 would end up in the hospital and about 15 to 20 people would die

That was true in 2020. And 2021
Feb 18 6 tweets 2 min read
Nationally as infections return to pre-Omicron surge levels,

Two states I've tracked closely are California & Florida

They're both large with diverse populations, similar seasonality, different COVID approaches

So what can we learn from comparing them?

A few things

Thread First, let's compare how they did on infections during Omicron surge

Strikingly similar (see graph)

Florida peaked earlier, California a bit later

Cumulatively, they had nearly identical infection rates

About 9.50% of Floridians got infected while 9.54% of Californians did
Feb 16 10 tweets 2 min read
As the Omicron surge of infections abates,

Its worth reflecting on few lessons we learned

Today, lets' discuss whether Omicron was indeed "milder"

Short answer? Yes it was

But it still caused a devastating loss of life

And that's a lesson for managing future waves

Thread First, let's talk about how we might assess whether Omicron was "milder" than Delta

One way is to look at case fatality rate

Remember CFR is proportion of identified cases that end up dying

Throughout the pandemic, the CFR of of COVID in the US has been between 1.5% to 2.0%
Feb 10 10 tweets 2 min read
Let's discuss a path forward for masks in schools

I've been a strong proponent of masking in schools

So as we enter a new phase

Do we need to keep masking for the foreseeable future

I don't think so

Should we ban masks in schools today?

No

Let's find a middle path

Thread First, let's talk evidence

Do masks work to reduce transmission?

Absolutely

What about in kids?

The evidence is less strong but clearly, the weight of evidence says that masking also works in kids

Are there harms?

Not much evidence either way but there could be

2/n
Feb 6 8 tweets 3 min read
Quick update on the state of the pandemic in the US

Nationally,

Infections are down 60%

Hospitalizations down about 30%

Deaths have largely plateaued at a very high 2500+ per day

Beneath the headlines, we see dropping infections in every part of the country Here are the four largest states

Geographically, politically diverse with very different strategies and mitigation policies

Infections are down 50-80% across these states

And hospitalizations have turned the corner in each of these states

Deaths are starting to follow
Feb 1 9 tweets 2 min read
I've been saying for weeks that as cases recede

We can soon relax public health restrictions

I think of this like the weather

When it is bucketing rain

Umbrella, rain coat, boots, are all essential

When the storm turns into a drizzle, those become less critical

Thread A big spike (like Omicron surge) is like a major storm

If you don't want to get wet, you need to stay home

But if you venture out

Bring a big umbrella (vaccines)
Wear a raincoat (good masks)
And rainboots (avoid crowded indoor spaces)

You get the idea

2/n
Jan 30 10 tweets 3 min read
You all know the data demonstrating dramatically higher hospitalization rates for unvaccinated folks

But one key point often not discussed?

Around 60%-70% of unvaccinated adults have already been previously infected

Which tells us a lot about infection-induced immunity

Thread We see large gaps in hospitalizations between vaccinated and unvaccinated

But unvaccinated are not immunologically naïve

At this point, probably 2/3 have been previously infected

And yet, we still see 50X differences in hospitalizations between vaccinated and unvaccinated

2/7
Jan 25 14 tweets 3 min read
We're in a transition moment in this pandemic

We're coming off highs of the worst surge of infections we've ever had

Cases are high but starting to fall in much of the nation

This moment raises lots of questions

With one big one: What happens next?

Thread As Yogi Berra once said,

It's tough to make predictions, especially about the future

So we should be circumspect about how much we can predict with certainty

But some things seem pretty reasonable to assume

First, infections are likely to decline in upcoming weeks

2/n
Jan 20 7 tweets 2 min read
Getting asked when will Omicron peak in the US?

My best guess?

I think we are there

We are seeing a little bumpiness in the data because of MLK day holiday

But evidence says as a nation, we have likely peaked

Big states: CA, FL, and NY have peaked. May be even Texas

Thread Beyond peak, there are two surprises worth discussing

First, I said few days ago that I expected hospitalizations to rise a while longer

Turns out, not so much

Hospitalizations have flattened nationally and are declining in places like NY

Why? What did I get wrong?

2/4
Jan 16 8 tweets 3 min read
Quick update on the pandemic in US

We're averaging about 800K identified cases daily

Likely missing 75% - 80% of infections

If you do the math

At least 1 in 100 Americans getting infected every day

Everyone wants to know: when do we peak?

Here's the national picture

Thread The national picture shows a slowing of the surge

But we're still rising

But if we dig a bit deeper, a few things emerge

First, let's start with the big 4

CA, TX, FL, NY

Why? Lots of people live there, geographically and politically diverse

What do we see?

a few things
Jan 10 7 tweets 2 min read
Given the immense value of in person schooling for America's kids,

Lets talk about how every school can be in person safely today

Not under ideal conditions

But under real-world conditions

First, let's start with "ideal", which LOTS of school districts have done

Thread What is ideal?

1. Teachers vaxxed/boosted
2. Kids vaxxed
3. Everyone masked w/good masks
4. Ventilation
5. Testing

Billions of $ available for ventilation and testing
Vaccines free, widely available

I get it, some places chose not to do it

But $ is not the barrier

2/n
Jan 8 14 tweets 3 min read
Watching national data

And being in the hospital this week

I see two things that appear contradictory

But both are true

1. Link between cases & hospitalizations is much weaker with Omicron than in the past

2. Our healthcare system is in trouble

Thread: the moment we are in Let's talk about I'm seeing in the hospital first

In the hospital, seeing lots of COVID patients

Some admitted due to COVID

They are all either:

1. Unvaccinated

2. Very high risk folks not boosted

And some admitted "with" COVID as incidental

Almost all not boosted

2/n
Jan 4 7 tweets 2 min read
Day 2 of hospital service

A few observations about the whole "hospitalized for COVID" versus "hospitalized with COVID"

This distinction matters

But may be not in the way people think

First, we have a few patients in the hospital for COVID

But not many, thank goodness

Thread Not many because RI is highly vaccinated state

More common on our service is folks admitted with COVID

That is, they came to hospital for something else and found to have COVID

Its tempting to say that COVID here incidental and therefore, doesn't matter

Not quite right

2/n
Jan 3 6 tweets 1 min read
We know how to keep people safe in schools during COVID

For an airborne virus

Masking and ventilation/filtration substantially slow spread

As does regular testing

And vaccines protect from bad outcomes

So I've been puzzling over why this isn't happening everywhere

Thread If key strategies include masking, ventilation, testing, vaccines

Masks became widely available late 2020

By early 2021, there was lots of $ from Feds for improving vent/filtration as well as testing

By fall 2021, every adult & school-aged kid was eligible for vaccines

2/n
Dec 29, 2021 4 tweets 2 min read
.@ezraklein asks a great question

What is the goal at this point?

I think it needs another element

What costs we are willing to pay to achieve that goal?

My goals?

Save lives, prevent hospitals getting overwhelmed, keep essential things (schools) open

In that order

And

🧵 Let's talk about other goals and costs we're willing to bear

Reduce infections? Yes!

Low cost things like encouraging indoor masks will help

But to really suppress infections? We likely need hard lockdowns

Which makes no sense at this point in pandemic

So the other goals...
Dec 28, 2021 5 tweets 1 min read
While new CDC isolation guidelines are reasonable, here's what I would have done differently

1. Required a neg antigen test after 5 days

2. Had different guidelines for vaccinated (contagious for shorter time) versus unvaccinated

3. Specified higher quality masks

Short thread So why are CDC guidelines still reasonable?

Because if you actually follow what CDC says,

They require people be asymptomatic

And wear a mask for 5 more days

And if people actually followed the guidelines

I can't come up with how they aren't quite reasonable

2/4
Dec 26, 2021 15 tweets 5 min read
As Omicron cases explode

We need a strategy for isolating folks who test positive

We need to think about the purpose of isolation clearly

Because if we don't get it right,

It'll both be hugely disruptive and won't keep us safe

So let's discuss what we need to do

Thread First principles:

Why ask people to isolate at all?

Well, that’s obvious

We don’t want them spreading

So what we care about is CONTAGIOUSNESS

We want folks to isolate when they're contagious

So when are people contagious?

Well, it varies. A lot

OK, so what to do?

2/n
Dec 18, 2021 5 tweets 2 min read
Lets talk about why we'll soon see an uncoupling of infections and hospitalizations

No, its not because Omicron is "mild"

I'm not sure it is

Its because Omicron has so much immune evasion

That we'll see a change in who gets infected

Thread How to think about it

We know among unvaccinated

About 5% of infected folks get hospitalized

Among vaccinated

About 0.5%

Throughout the pandemic (including delta wave), most infections were among unvaccinated

So hospitalization rates have been about 5% of cases
Dec 17, 2021 10 tweets 2 min read
The conversation about the coming Omicron wave vacillates between

OMG -- Omicron will be cataclysmic

to

I'm done with this pandemic and have moved on

Neither is helpful

A middle course can help navigate this complex time without massive disruptions or a lot of deaths

Thread First, lets get on the same page

We should expect a large wave of infections

Likely gathering steam in late December peaking sometime in mid January

And likely falling quickly to low numbers by end of February

This is about the next 2 months

What should our goal be?

2/6