1/ Super excited about the new primary care model we’ve been working on @CarbonHealth and have launched in Mass. with @BCBSMA.

Our model brings together things I’ve been dreaming about since exploring primary care at Apple.

We call it Connective Care, and it’s here now. 🧵 2/ @Apple says the “future of health is on your wrist”, but I always felt the missing link in the experience was being able to close the loop with your doctor with the health data from the Apple Watch.

1/ I love this new @Apple privacy ad taking on data brokers and advertising. Why this fight over your data?

In the digital era, privacy comes down to a battle over freedom of thought — the privacy of your mind. 🧵

2/ What do I mean by the “privacy of your mind”?

It has been described as:
- Protection for “thoughts, sentiments and emotions”
- Freedom from gov’t intrusions and control of one’s thoughts
- Not being punished for “mere thoughts”

1/ As we observe this new #BA2 fueled wave pick up real steam, I have my doubts about the signal value of wastewater as an early indicator for rising transmission rates compared to testing.

Some data points below from Silicon Valley. 🧵 2/ In Santa Clara county in California, COVID cases are now well past the height of the Delta surge and will likely approach the peak of the first Omicron wave.

paloaltoonline.com/news/2022/05/1…

1/ Is the #BA2 surge here in the US?

Don’t be fooled. It most definitely is here.

Just because the official case rates look low right now doesn’t mean that transmission isn’t rampant already. Would expect #COVID to ripple across the country in the coming weeks.🧵 2/ Lots of confident takes like this one that this surge won’t be big or that the confirmed case counts look really low right now.

https://twitter.com/erictopol/status/1512841045062520833

1/ Know anyone who has gotten sick recently and tested negative with a home antigen test?

Could very well be a false negative for the question: “Do I have COVID?”

Some advice below on how to use antigen tests and avoid passing COVID on to others.
🧵

https://twitter.com/mjb302/status/1508365901611126787

2/ From Sept 2021-March 2022, 40% of people who used an antigen test used it to see if a recent exposure had infected them with COVID.

1/ Inflection in #COVID19 wastewater levels in the Bay Area (as of March 23rd), driven by increased levels of #BA2 🧵 2/ Palo Alto

1/ A #COVID update on the Northeast, which I predicted last weekend would be the first region to trend upwards from #BA2. 🧵

https://twitter.com/cha_myoung/status/1505286859898859520

2/ CDC is now acknowledging the start of #BA2 wave in the Northeast.

It is surprising to see that hospitalizations are increasing already given the typical lag from cases.

medicalxpress.com/news/2022-03-c…

1/ A number of U.S. public health authorities are forecasting a smaller #BA2 wave than the original #omicron wave.

What if they’re wrong and it turns out to be a bigger wave? Maybe the biggest wave ever?

Troubling signs from Europe below🧵

cnbc.com/2022/03/20/hea… 2/ Switzerland is going through a massive wave of infections, which are being undercounted. The public health authorities there estimate that “the current wave will probably exceed the January wave”.

swissinfo.ch/eng/covid--swi…

1/ This is the calm before another #COVID storm in the U.S., which will be worse than it should be due to short-term and hopeful thinking. The #BA.2 cycle has already started here and will be in full bloom in ~2-3 weeks with a much bigger surge than anyone saw coming.🧵 2/ There are many differences between UK/Europe and the US, but almost all differences weigh against the US avoiding the impact of #BA.2
- Lower vax/booster rate
- Less testing
- Fewer COVID restrictions
- Longer period of waning immunity

1/ With the announcement of @AkiliLabs going public to accelerate their pipeline for ADHD, here are some thoughts on the intersection of gaming with health and why I believe video games (and perhaps the metaverse) might be a big part of the future for healthcare. $AKLI 🧵 2/ One of the most exciting projects I worked on at @Apple with my HSI team was a health game powered by the Apple Watch called LumiHealth with the @sporeMOH in Singapore. Your behaviors in the real world mirror the mechanics of the game, earning your character (and you) rewards

1/ Japan has fared better throughout COVID than most western countries (146 deaths/million vs. 2,590 deaths/million in the US) despite:
- Very low public trust in gov’t
- Less trust in science
- No mandates

How has this been done and what can we learn? 🧵
nytimes.com/2022/01/24/opi… 2/ This trope around Confucius societies “winning the COVID-19 war” with “authoritarian mentalities” doesn’t neatly apply to Japan where only 4% of people surveyed in 2020 say they trust the government “a lot”, compared to 9% in the US and 12% in the UK.

wellcome.org/reports/wellco…

1/ The pandemic has felt endless, so the beginnings seem like a distant memory. Does anyone remember the worst-case model of 1.5-2.2m deaths that the White House used to “shock and awe” in March ’20?

To date, there have been 864k deaths in the US.

A look back below🧵 2/ Before this press conference, Trump compared COVID to the flu with only “22 deaths”, “life & the economy go on.”

Sound familiar?

If only the current death rate — with all of the advantage of our vaccines and therapeutics — were as low as the flu today.

My ten “surprises” in healthcare for 2022 — events that the average person would only assign a one out of three chance of taking place but which I believe have a better than 50% likelihood of happening. Styled after Byron Wien’s annual predictions. 🧵

blackstone.com/news/press/byr… #1: There is at least one new variant that emerges in 2022 that drives another omicron-sized surge of cases and hospitalizations, putting renewed stress on the healthcare system.

1/ How “mild” is omicron?

When compared against Delta hospitalization and death rates, the numbers look better.

When you look at how sick people are when they seek care, the data tells a different story.

Some data from @CarbonHealth since early December 2022 thru present🧵 2/ Symptomatic COVID+ patients are showing up to our clinics with more symptoms than COVID- patients presenting with flu-like symptoms:

3 or more symptoms: 58% (+) versus 43% (-)
4 or more symptoms: 38% (+) versus 25% (-)

1/ Even with the Supreme Court invalidating the Biden vaccine mandate, large companies are likely to take matters into their own hands with “sticks” (versus “carrots”). Even with a “mild” variant, economic consequences are significant enough to impact corporate behavior 🧵 2/ With hospitalizations surging (with fewer deaths) among the unvaccinated, the bill will come due at some point — to the tune of $20,000+ per hospitalization.

healthsystemtracker.org/brief/unvaccin…

1/ With the omicron wave putting untold pressure on staffing across a wide variety of industries, it is not inconceivable for these staffing shortages to become more “endemic” with behaviors that have likely changed forever. 🧵 2/ An estimated 5 million people are isolating at home due to omicron, which could “deal a significant hit to the economy over the next month or two.”

wsj.com/articles/omicr…

1/ One of the biggest policy failures over the last 2 years is the lack of COVID testing, particularly evident now with omicron — both the supply and the quality of what we have available at scale. Where is our Operation Warp Speed for diagnostics? 🧵 2/ Based on the sheer scale of testing volume, it’s clear many are concerned with exposure to omicron and are not yet “done with COVID”. Labs are reporting >1.5 million PCR tests per day right now. But this is a massive underestimate of the total volume w/antigen tests in the mix

1/ There are a lot of takes that this omicron wave will bring us closer to “normal” in 2022 when COVID will become endemic and be “just like the flu.” A comparison with historical flu seasons shows just how far away this really is and how much longer we may need to go. 🧵 2/ The key societal question is what level of mortality & morbidity do we accept from COVID in the long run. If influenza is the right analogue, then this chart shows that COVID has broken well beyond the baseline and “epidemic” threshold of mortality of prior flu seasons.

1/ The great hope right now is that the orals from @pfizer and @Merck are the “silver bullet” that will bring an “end” to omicron and the pandemic. These are amazing new Rx’s, but deploying them properly will be way harder than people think. 🧵 2/ We now have another weapon in the toolkit with oral pills that do not have the same burdensome requirements of mAbs. ~90% risk reduction from Pfizer’s Paxlovid in high-risk patients is indeed excellent. pfizer.com/news/press-rel…

1/ Lots of questions on why I think we could be in the early part of the COVID decade. Tons of focus right now on omicron, but not many talking about the long game. This isn’t a deterministic prediction but a scenario very few policymakers are willing to talk about openly. 🧵 2/ At almost every turn of this pandemic, numerous experts have declared that the end of the pandemic is near, if we can only hold on for a few weeks or months. This has raised a lot of false hope over the last couple years.

1/ With the omicron surge, I have had more friends send me screenshots of exposure notifications (EN) in the last week than I have in the last year. Here are some reflections based on the work I led at @Apple working with @Google and some thoughts on the road ahead. 🧵 2/EN was one of the most exciting projects I have ever worked on with an unbelievable amount of technical talent at both companies deployed to deliver in a matter of months. (Recent gathering of a small subset of the crew below)