I disagree (in a way) with the idea that the details of the Cambodia cases matter a great deal. Just like it's very unlikely that the mink outbreak itself is *the* genesis for efficient mammal spread, this cluster is not independently meaningful. These events are allegorical. 1/ They are allegorical in that they prove that spillover events can and do happen all the time, especially given the footprint of this epidemic in birds. The overwhelming majority of those spillovers are unobserved. Each is a coin flip. 2/

I took a look at CDC's 2nd monkeypox technical report. Some interesting finds. The fraction of cases in people with no recent MSM contact has been growing over time. Either the virus is moving into new pops or case finding has improved.
caitlinrivers.substack.com/p/changing-tre… At the national level, epidemic growth is beginning to slow (and so are vaccinations). At the state level, the picture changes. States hit early and hard (e.g., NY) are improving markedly, but other states are just picking up.

It's especially concerning that cases include healthcare workers and multiple pathogens have already been ruled out. One to watch.

https://twitter.com/BNOFeed/status/1565436517648138240

"The Ministry of Health reports that a new patient linked to the cluster of pneumonia of unknown origin has been detected. Case #10 is an 81-year-old male patient with comorbidities hospitalized in serious condition, with ARM, in the public sector." msptucuman.gov.ar/comunicado-ofi…

A roundup of new outbreak data that has caught my eye. First, disparities around monkeypox cases and vaccinations have come into focus. Multiple states report that Black men are disproportionately affected have received relatively few vaccines. caitlinrivers.substack.com/p/outbreak-dat… One good piece of news is that monkeypox testing is up and test positivity is down. This may be the first sign that the US is rounding the bend, following on signs of improvement in UK and Europe.

I have some concerns about the rollout of the new monkeypox vaccine strategy. State and local public health authorities are receiving *less* supply following the move to intradermal administration. caitlinrivers.substack.com/p/concerns-abo… One challenge is that getting 5 doses out of a vial is proving difficult. Multiple health officials told me that 3-4 doses per vial is more like it. (Low dead space syringes may help.) 2/

New blog post from me on data needed to manage the monkeypox response ⬇️ caitlinrivers.substack.com/p/data-needed-… What gets measured, gets managed. We need metrics and targets to evaluate our progress toward containment and uncover areas in need of improvement I propose 3. 2/

I’ve been vocal about my frustration that some schools are giving up covid control measures. But if you’re a parent with kids in school, you’ve probably got to work with what you’ve got. Here is news you can use. 1/7 If your kid is 12+, get them vaccinated. Coverage is only 30% in ages 12-15 and 41% for 16-17. Low. It’s understandable if you have questions, but get them answered. By a medical professional. ASAP. It takes several weeks to be fully vaxxed so start now 2/ covid.cdc.gov/covid-data-tra…

There may be confusion today about what CDC's new mask guidance means about the protection of vaccination. There are multiple levels of protection, and it’s important to know which level is up for discussion. Quick review. 1/6 1. Any infection. If you are vaccinated, would your body fight off the virus so that you would never even test positive or become infectious? This scenario is what original CDC guidance allowing vaxxed people to unmask was banking on being most common. 2/ cdc.gov/coronavirus/20…

Time to return to indoor mask policies in states that are surging. It happened sooner than I expected, but when hospitalization trends look like this, something has to change. Yes, it's perhaps unfair to vaccinated people, but with no way to differentiate a policy for all is the only practical way.

One in a million will not be the final estimate for the unconfirmed J&J events and I think we should be cautious in citing it. The incidence will surely be rare, but @C_R_Watson and I wrote about biases in estimating mortality last Feb, and similar issues are in play here 1/ @C_R_Watson First, the numerator. Now that awareness has been raised, more cases may be reported. 2/
vox.com/2020/2/12/2113…

Cases are on the rise in many states. How worried am I? I am concerned, but not as much as I would have been 6 months ago with these trends. Short thread. 1/ Many states are doing quite well. I would like to see cases fall below 20 cases per 100,000 per day as a first goal and 10 as a second goal (and then the lower the better). By that measure, we are doing ok: 35 states are at or below 20 and 12 are below 10. 2/

So, how are we doing with covid? Nationally, reported incidence has fallen from around 76 cases per 100,000 population per day to about 43. Better! But not yet good. Thresholds are contentious, but I think 20 as a first goal and 10 as a second goal are reasonable to start. 1/ Nationally, those thresholds correspond to approx. 66,000 and 33,000 daily cases, respectively. Right now, we’re at ~140,000 cases reported each day on average, so we need to more than halve incidence to get to Goal 1. 2/

Fantastic development. This test is already authorized for home use without a prescription, including in children and people without symptoms. Increasing supply critical to allow people to easily access tests.

https://twitter.com/kaitlancollins/status/1356279434110775307

The test was authorized in Dec but supplies are limited. The Biden Admin is investing in expanding manufacturing capacity. It will take a while (months, probably) for that to result in more supply available to consumers, but we'll need tests for a long time so still useful.

I could not be more thrilled that the Biden-Harris Administration has announced an intention to create a National Center for Epidemic Forecasting and Outbreak Analytics @dylanbgeorge 1/ whitehouse.gov/briefing-room/… @dylanbgeorge This idea has a long history, with dozens of brilliant scientists, policymakers and innovators behind the wheel, including many who roll up their sleeves every day to make sure our leaders have what they need to fight outbreaks effectively @dylanbgeorge 2/
foreignaffairs.com/articles/unite…

There are around 30 big counties, with a combined population of over 12 million, where upwards of 40% of the population has been infected. It's stunning how hard the pandemic has hit part of the US.

Estimates from covid19-projections.com/infections/sum… % total infected is a modeled number that tries to estimate missed cases. You can read more here: covid19-projections.com/about/#infecti… @youyanggu

I’m volunteering w/ the Covid-19 Symptom Data Challenge. Colleagues at CMU and UMD have been surveying people (e.g. on Facebook) whether they or people they know have covid-like symptoms. The goal is to explore how this data can be useful for tracking the virus. 1/ The CMU team has some analyses exploring uses for the data. They found, for example, an association between covid-like illness and covid incidence at the state level in July. 2/

Today I had the honor of testifying on reopening K12 schools for the House Select Committee on the Coronavirus Crisis. Here is what I said. 1/ It was exactly 3 mos ago that I last testified - we had 25-30k cases and >2k deaths daily. I said then that I feared complacency, that we would become numb to the crisis and would again create the conditions that led to us being the worst affected country in the world. 2/

If I told you in March or April that we would still have a 60-70k daily cases in July, what would you think? Now carry that forward. Where do we want to be in Sep, Oct, Nov & how do we get there? Answering that question has to be priority #1. It's time to reset the US response 1/ Colleagues and I are out with a new report today with 10 recommendations for how the US should chart a new course. Here’s a thread with a quick rundown of the 10 -
centerforhealthsecurity.org/our-work/publi…

Second thread. The way I see it, two different things are happening related to CDC and schools. First, there was a lot useful material released today. There are decision tools and checklists for parents, guidance on mitigation measures, and more epi. cdc.gov/coronavirus/20… This is the work of the brilliant CDC scientists who have devoted their lives to improving public health, and it is the CDC we need front and center in this time of crisis. 2/

CDC just published a doc purporting to weigh the public health risks and education benefits of reopening schools. Having recently participated in a National Academies of Science committee on just that, I am not impressed at the paucity of this document 1/ cdc.gov/coronavirus/20… Covid is the reason schools were closed. It should be central to decisions about reopening in-person. To do otherwise is unfair to our families, teachers & communities. That doesn’t mean schools can’t open in person. But this is a weighty decision that deserves careful thought 2/

I want to gently point out that voices on twitter, even experts, usually do not have any affiliation to one another. If you follow a lot of different experts, you might get a lot of different opinions, particularly on issues where evidence is mixed or absent. 1/ It is institutions e.g. CDC that coordinate the messages of the people who speak on their behalf so that everything is clear, consistent and trusted. We haven’t been able to hear from them as much as we would all like, and that has left a gap. 2/