Josh Michaud Profile picture
Associate Director Global Health @KFF. @SAISHopkins Prof. U.S. & International Health Policy, Health Security, Infectious Disease Epidemiology
Percy22 Profile picture Carol Corrie Cynova Profile picture 2 added to My Authors
19 Jan
30% of Israel's population has received at least 1 dose of Covid-19 vaccine, but no indications yet that case numbers are coming down there (chart).

A few reasons why this might be:

1) Cases reported now were infected 7+ days ago, when vaccinations were lower Image
2) Less than 500,000 (out of ~2.7 M vaccinated) have so far received a 2nd dose. A single dose is "less effective than we hoped" in providing protection, according to Israeli health leaders.
theguardian.com/world/2021/jan…
3) Israel has vaccinated by age, starting with older persons, vaccinating to date:
80% of 70+
68% of 60-69
50% of 50-59
28% 40-49

Older ages are protected from severe disease, but younger ages typically contribute most to transmission
timesofisrael.com/israelis-aged-…
Read 6 tweets
9 Jan
Beyond the scientific and epidemiological reasons to doubt the lab escape theory of pandemic origin, let’s not forget that no US or allied intelligence has emerged with even a whiff of evidence that a lab was the origin by accident or intention.
To believe the lab escape theory you also have to believe the Chinese have mounted a successful, extended campaign to eliminate incriminating evidence and muzzle officials and scientists who knew or might have suspected it came from a lab.
It’s a pretty big secret to hold on to, especially for a sizeable group of people that includes an international network of scientists, other workers, and families -- many of whom are not exactly in the secrecy business.
Read 17 tweets
1 Jan
That the US might adopt a 1 dose regimen or significantly delayed 2nd dose for vaccines already authorized seems more fanciful thought experiment than tractable policy. Pretty much all institutions and incentives are lined up against such a change and not without reason.
Current vaccines are authorized via EUAs from FDA, which both clearly state terms of use including a two-dose regimen. Moderna’s EUA says the vaccine is “administered as a series of two doses 1 month apart…”
“…Individuals who have received one dose of Moderna COVID-19 Vaccine should receive a second dose of Moderna COVID-19 Vaccine to complete the vaccination series.”
modernatx.com/covid19vaccine…
Read 20 tweets
31 Dec 20
CDC now provides more data on vaccine distribution and administration by state, agency, etc. Worth a look and a bookmark.

A few things that jumped out to me, in a short thread.

covid.cdc.gov/covid-data-tra…
2.17 million doses distributed through the federal pharmacy partnership prgm for long-term care, but only 167,149, or 7.8%, administered. This is the phase 1a component that needs to make up the most ground.

If this program were a state, it would easily be the worst performer.
States/jurisdictions' overall progress in administering the vaccines they have received continues to vary widely.

DC has administered over 50% of its vaccines on hand, while Kansas has administered just over 10%.
Read 6 tweets
30 Dec 20
Worth noting that Kathleen Hicks, President-elect Biden's pick for the number 2 spot at the Pentagon, would be that unusual senior defense official with some background in global health, as it relates to national security.
She's co-authored reports on the Department of Defense and global health, such as this one from 2009
csis-website-prod.s3.amazonaws.com/s3fs-public/le…
From that report: If "virulent diseases can destabilize economies and entire political systems, then it is in the national security interest of the US to address the causes of diseases and develop effective systems to detect and contain them."
Read 6 tweets
22 Dec 20
You may have seen CDC reporting 4.6 million doses of #COVID19 vaccine have been distributed & 614,117 administered. Why the huge gap between doses distributed vs administered numbers? (short thread)
Some of the gap is from reporting lag: it can take up to 3 days for providers distributing the vaccine to report to state/local health officials, and additional time for officials to report to CDC
covid.cdc.gov/covid-data-tra…
Also, doses distributed to states have been held for use in long-term care facilities via the federal pharmacy partnership, which is only now starting to ramp up. Its goal is to reach 4.5 million residents and staff at 55,000 nursing homes nationwide
foxnews.com/health/nursing…
Read 8 tweets
4 Oct 20
I realize that without further details made public we're left picking up scraps of info about the White House cluster, but putting together a list of people and their test results and speculating about their exposures is not "contact tracing".
Contact tracing is supposed to be a methodical effort by investigators to speak with known cases, ensuring they have support and are taking proper precautions, and also ask them about their close contacts so those people can be told they have been exposed and take proper action.
Contact tracers:
-Let people know they may have been exposed and should monitor their health for signs and symptoms of the disease.
-Help people who may have been exposed get tested.
-Ask people to self-isolate if they have the disease or self-quarantine if a close contact.
Read 5 tweets
12 Sep 20
ICYMI: @KFF released the results of a new poll a few days ago, covering a number of #COVID19 topics.

I'll highlight a few of the findings in a thread.

kff.org/coronavirus-co…
Among all registered voters the economy ranks as the most important voting issue, the coronavirus pandemic next. However, there is a stark difference by party, with 36% of Dems saying coronavirus is most important and just 4% of Republicans saying that. Image
If a Covid-19 vaccine became available before the election, just 4 in 10 said they would choose to get vaccinated (with Republicans slightly more likely to say no than Democrats). Image
Read 6 tweets
12 Sep 20
Contact tracing apps have evolved to become "exposure notification apps"; Apple and Google are streamlining the process of participation, allowing push notifications for users to opt-in automatically (Apple) or direct users to state-supported notification apps (Google).
The hope is that there will be much greater adoption of these apps because now opt-in will be embedded directly in device operating systems.

Adoption is state-by-state, and about 20 states have, or will soon be, deploying this approach.
Up until now, uptake of state contact tracing apps has been quite low. For example, "less than 5% of the population in North Dakota downloaded the state’s app as of June, while only about 1.8% of Utahns had done so by July."
slate.com/technology/202…
Read 7 tweets
7 Sep 20
I’ve been thinking about the only other time a pandemic vaccine was rolled out during a US Presidential election year: the 1976 “swine flu” campaign. What warnings and lessons might that experience hold?
In brief, a new influenza virus was detected in January 1976 in NJ. Public health officials at the time thought the US (and the world) faced an imminent pandemic from this virus, to which no one under 50 had pre-existing immunity.
In March President Ford, following strong recommendations from CDC experts and other health officials, announced the US would develop and distribute enough vaccines to immunize every man, woman, and child in the country to prevent a pandemic.
Read 23 tweets
20 Aug 20
It is increasingly clear that Chinese government officials- locally in Wuhan and nationally in Beijing- sought to hide information and downplay the seriousness of the coronavirus outbreak in the critical first weeks of the pandemic.
nytimes.com/2020/08/19/wor…
Wuhan officials hid information from national authorities. A recent U.S. intelligence community assessment concluded "Officials in Beijing were kept in the dark for weeks about the potential devastation of the virus by local officials in central China."
At the same time "senior officials in Beijing, even as they were scrambling to pry data from officials in central China, played a role in obscuring the outbreak by withholding information from the World Health Organization."
Read 5 tweets
13 Aug 20
A few weeks ago @ForeignAffairs asked a group of experts if they agreed or disagreed with the following statement (and level of confidence):

"The daily tally of COVID-19 cases around the world will be higher at the beginning of 2021 than it is today."

foreignaffairs.com/ask-the-expert…
Prediction is a fool's game, especially when it comes to pandemics, but even so a number of us responded. Most agreed with the statement, some with fairly high levels of confidence.
I disagreed with the statement (though with little confidence).

When we were asked to weigh in, the global average number of new cases was surpassing 200,000 daily. So I thought, how might that level compare to the tally we will see in the first weeks of 2021?
Read 7 tweets
12 Aug 20
There continues to be a divide among health experts about kids, schools, and coronavirus. Here are a few articles published just in the last few days looking at the evidence and coming to different conclusions.

1) "Kids Aren't Viral Vectors. Really."
nytimes.com/2020/08/12/opi…
2) "COVID-19, children, and schools: overlooked and at risk"

"Seroprevalence and contact tracing studies show children are similarly vulnerable [to adults] and transmit the virus to a meaningful degree"
mja.com.au/journal/2020/c…
3) "Latest research points to children carrying, transmitting coronavirus"
"Are they susceptible to catching the virus? Absolutely. Are they able to transmit the virus? Absolutely"
wsj.com/articles/lates…
Read 6 tweets
8 Aug 20
Appreciate this thoughtful analysis around the influence of herd immunity on infection rates. I think one underappreciated aspect of this is just how much race/ethnicity has been a facet of this so far, especially in the states identified in this tweet.
Take Arizona, for example. Whites comprise 54% of the population in AZ, but only 17% of the Covid-19 cases reported.

In FL Whites are 53% of the pop, but just 21% of the cases. kff.org/other/state-in…
To the extent that herd immunity is influencing transmission patterns in US states, it needs to be well understood that these effects are likely quite different in different populations.
Read 5 tweets
2 Aug 20
Hard to deny that travel bans are now a key tool in the pandemic prevention toolbox. Fascinating to see how #COVID19 upended prior global health conventional wisdom about travel bans for epidemics and pandemics
Policies have evolved alongside the pandemic. In Jan @WHO recommended against travel restrictions when it declared coronavirus a public health emergency of international concern who.int/news-room/deta…
In Feb/Mar, WHO advise against the "application of travel or trade restrictions to countries experiencing COVID-19 outbreaks” and recommended “health measures be implemented in ways that minimize unnecessary interference w international traffic and trade”
who.int/news-room/arti…
Read 23 tweets
29 Jul 20
Many in the US are facing difficult questions about whether and how to reopen schools with students back in their classrooms. In this context @jenkatesdc and I look at what we know (and what remains to be understood) about children and COVID-19 kff.org/coronavirus-co…
Something that’s been clear all along is children have milder disease compared to adults. In the US children comprise 22% of the population but only 1% of hospitalizations and <1% of deaths from COVID-19 to date. Still, a small subset of children affected can become severely ill
Evidence is also clear that children are at risk of being infected and can transmit the virus to others – though the magnitude of the transmission risks in children is still not completely understood and more information needed.
Read 9 tweets
19 Jul 20
In regard to reopening US schools, one country presents a cautionary tale: Israel. After opening schools to smaller “capsules” of students in early May, Israel removed class size restrictions May 17 and most kids were back in person in full size classes.
wsj.com/articles/israe…
Two weeks after that, cases began to increase in Israel, with notable outbreaks in schools (particularly middle- and high-schools). By last week there were 1,335 cases among students and 691 among staff.
Schools have been identified by the health department as being common sources of infection. These outbreaks have been disruptive, with 125 schools and 258 kindergartens being closed again since classes were restarted in May.
Read 10 tweets
16 Jul 20
If children contract #covid19 at school, they could bring the virus home to higher risk adults. Our new piece estimates the number of kids & adults 65+ living together in multigenerational households.
kff.org/coronavirus-co… @jenkatesdc
3.3 million people age 65 or older live with school-age children and could be at heightened risk of COVID-19 if kids bring the virus home and 4.1 million school age children live with adults 65+.
#ReopeningSchools Image
Older people of color are significantly more likely to live with a school-age child compared to their White counterparts: 17% of Hispanic older adults, 13% of AIAN older adults, 11% Black older adults (compared with 4% of older White adults) lives with a school-age child.
Read 6 tweets
10 Jul 20
Without centralized tracking we're mostly left with anecdotes about coronavirus test delays. Still, the anecdotes we do have are extremely worrying, as this article illustrates.
khn.org/news/as-covid-…
-"CEO of Bond Community Health Center in Tallahassee, Florida, said test results have gone from a three-day turnaround to 10 days in the past several weeks."

-"The Health Care District of Palm Beach County...said findings are taking seven to nine days"
-"CityMD, a large urgent care chain in the New York City area, said it now tells patients they will likely wait at least seven days for results."

-"Quest Diagnostics...said average turnaround time has increased from three to five days to four to six days in the past two weeks"
Read 4 tweets
6 Jul 20
The debate over "airborne transmission" of coronavirus has picked up steam. An upcoming journal article from >200 scientists urges WHO to consider incorporating risk of "airborne" spread in its recommendations. washingtonpost.com/world/europe/c…
A number of scientists have been saying this for a while now. Since early March (at least) scientists have been saying WHO (and CDC) should highlight the potential role of airborne transmission more.
wired.com/story/they-say…
Some of this boils down to a difference in definitions, as many epidemiologists think about "airborne" as a specific type of transmission where tiny droplets with virus particles can float in the air for a long time and still infect people.
Read 5 tweets
30 Jun 20
Some red flags in recent polls on #covid19 in the US.

@pewresearch reports more of the public now believes the outbreak has been made “a bigger deal than it really is.” 63% of Republicans (38% of all US adults) felt this way, up significantly from April journalism.org/2020/06/29/thr…
More Americans say it is now *harder* to identify facts about coronavirus than in the first weeks of the pandemic. Also, more believe media/news on the virus is *more partisan* than it was at the start: 41% saying it is more partisan now vs 22% saying partisanship has lessened.
.@KFF polling has found a much larger share of the US public reported leaving the house in June compared to April. For example, over half (54%) of Americans reported visiting friends and family in June compared to 30% back in April. kff.org/report-section… Image
Read 9 tweets