Another momentous and painful week. PPE remains insufficient. It’s preventable. Now we need better studies, quickly, on the optimal dose and dosing schedule of the Oxford/Astra-Zeneca vaccine. The more safe we all are, the more safe we all will be. . But there are still many unknowns. Vaccination may end this pandemic, but not the risk of pandemics. And there has never been a better time to quit smoking, get your blood pressure under control, make sure that if you have diabetes it’s well-controlled, and get regular physical activity. Covid’s not tired of winning. . We can only reopen more by staying safer, masking up, and finding and stopping spread with the box-it-in strategy.​, Masks matter. is not in our favor here. Meat packing and agricultural outbreaks are part of, but only part of, the factors driving the increase. They had an indoor concert with everyone wearing masks, but repeated it 3 times—with distancing, with some distancing, and without distancing. First, let’s get clear about the epidemiology and continued trajectory of the pandemic. Give people practical things to do to protect themselves, their family, and their community. Impressive graphics — the line graph is worth careful study. These proportions can be misleading because when people do not go to healthcare facilities or seek treatment to avoid exposure to COVID-19, the proportions can increase even if infections are decreasing. Let’s prioritize getting services to people and communities most in need. As we sow, so shall we reap. The United States is Both Stalling and Failing in Our Effort to Combat Covid. Please spread the word. Masks work. (see Figure) was from December 1, and there was no uptick in cases until around December 20, with the first alert reported on December 31 – a relatively rapid reporting interval. An investigation should be able to determine the likely source and identify those most at risk. We should be seeing testing rates by race and ethnicity—and all tests results must come back quickly. Credit to the UK for doing quick analyses showing that dexamethasone works, identifying the variant, and publishing important findings (such as on, protection of health care workers by prior infection with SARS-nCoV-2. ) This can happen, but only if we let it happen. The vaccines are highly effective, including for older people (though few frail elderly were included in the studies), and against severe infection. “It has almost nothing to do with regulations.” Paraphrasing James Carville, to fix the economy, it’s the pandemic, stupid. We can get to a new normal if we improve control today, stay apart, work together, and prepare for vaccination if and when it becomes available. 9 of 10 people understand the importance of masking up. Although imperfect, positivity rates are important to track – and this is not a good trend. Each country should review its ability to find, stop, and prevent coronavirus cases. These represent millions of tragedies, most of the preventable. National test positivity decreased from 6.2 to 5.7%, which confirms that there has been a steady decrease in cases over the past few weeks. The ONLY way to stop spread in this community is to engage the community, support and collaborate on education from within, and encourage religious leaders to establish and manage acceptable isolation facilities. Hospitalizations are, of course, increasing following case increases. calling for global action to protect them. Covid has exposed horrific disparities. Nursing home data is now on the CDC website, but there’s no denominator data. But the vaccines we have now work against strains that are circulating today. Governments and private companies must join forces to make massive, continued investments in testing and distributing a vaccine as soon as possible, ensuring rapid and equitable access in this country and around the world. “Concern for man and his fate must always form the chief interest of all technical endeavors. What proportion of residents and staff have been vaccinated nationally, in each state, and in each facility. Although the more people who are immune, the slower virus spreads, every infection is a setback, not a step forward. In the Dakotas, 1 in 8 Black people has tested positive. It’s worth reading. We don’t know. Vaccination prioritization should be straightforward: All healthcare workers with potential exposures. With uncontrolled spread, more variants will emerge. It’s not enough to bet your life on, but it’s enough to be optimistic about the potential for immunity. It's a continuum, not a dichotomy. And by reducing indoor maskless contact in poorly ventilated spaces. is helpful, although the trends are discouraging. We don’t know if some people who get vaccinated will develop harmful immune over-reaction. We don’t know how long immunity, if it occurs, will last or how complete the protection is. This is horrifying. Black and Latinx communities already had less access to health care. Unless this is made available and updated weekly, there’s no way for us to know if we're getting better at addressing inequality or not. – one individual or event resulting in many infections – are likely to occur or to have occurred, as they did with both SARS and MERS. If the world is safer, we will be safer here at home. Hong Kong and Singapore created a travel bubble. New data from the UK suggest that the B.1.1.7 variant may be not only more infectious but also more lethal. Improve implementation of our “Box It In” strategy to test/isolate/trace/quarantine, even if we can’t do much at the current sky-high levels of spread. We. , which will be taking its place. Careful reopening. One thing is clear: we need to pay less attention to individual variants and more to what the variants as a group are telling us. All of those can help, but until and unless we have a safe and effective vaccine, there’s no single weapon that will deliver a knock-out punch. (For staff in China – work from home to the greatest extent possible, avoid crowds and, if possible, avoid health care facilities unless you’re sick.). in the South, Southwest, and West, offsetting the decline in New England, Mid-Atlantic, and Midwest. Because turnover of residents is high, including people moving between facilities, vaccination of people when they are admitted to nursing homes is essential and needs to be routine. These actions raise the question: is this action, which will increase cases in a month, intentional or just neglect of science? In this war against a virus, truth can be our strongest weapon. Get more epidemiologic information. This long article on the impact of Covid on young Black men is a must-read. He asked, Will this be forever? Communication, based on facts, is an essential weapon to fight the pandemic. To remedy this, we should offer housing for the infectious period for all with COVID-19. We must work to find cases before they become clusters, clusters before they become outbreaks, and outbreaks before they become explosive epidemics that risk the lives of health care workers and others. The MMWR reports that young adult infections were followed a week or two later by infections in people over 60. I shared, he possible hurdles and limitations of a vaccine. Detected cases are up three times more than testing. The authors note that Ro can decrease as control measures are implemented, but note: “Whether the reduction in transmission is sufficient to reduce, to below 1 – and thus end the outbreak – remains to be seen.”. Only Maine and Vermont are reassuring. We must apply more granularity to our “circuit breakers” to stop Covid. , the greater chance the virus will spread. Death rates have declined to near baseline. Focus on personal, family, and collective benefits of vaccination. , which the president received, are promising (especially early in illness) but unproven. But it’s important to remember, as Ghana President Nana Akufo-Addo said, “We know how to bring the economy back to life. “Injustice anywhere is a threat to justice everywhere.”. With a new approach based on science, organized response, and honest communication, together we can make steady progress. The claim in this White House letter is Orwellian. Also, in 2021, clean water, sanitation and hygiene (WASH) are not consistently available in about a third of health facilities worldwide. (to 5.4%), but positivity is now more difficult to interpret due to new antigen tests and a lack of consistent definitions and reporting. At Resolve to Save Lives, we’ve been saying since March that we must keep in-person learning as available as possible, which means reducing spread in the community and adapting the school environment and policies. As many as half of all people who have the virus don’t show symptoms, “so it’s critical to wear a mask because you could be carrying the virus and not know it,” the CDC said. Currently, we have. Operation Warp Speed, the effort to deliver a Covid vaccine, has gotten some things right. The outgoing administration’s plan seems to be pointing fingers at states. And we have to do much better at vaccinating staff. Yes, really, WHO. There’s a lot of turnover at nursing homes, so we need to vaccinate every resident when they are admitted, as well as every new staff member as part of their onboarding. However, at this point it appears likely that the mortality rate is lower than it was for SARS (11% for SARS vs. 3-4% so far for nCov2019 –, 25 deaths out of 835 diagnosed patients initially. Note, the below chart shows the percent of death from pneumonia, influenza, and COVID-19. is concerning. Every US region and most counties for which there are data are at the highest level in terms of case incidence — more than 200 cases per 100,000 a week. Humans take vacations but the virus doesn’t. Remember the wisdom of William Farr: The death rate is a fact, all else is an inference. The only states with reassuringly low rates of Covid are Maine, Vermont, New Hampshire, and perhaps Connecticut. The state has seen a huge increase in Covid deaths. B.1.1.7 is more transmissible, so it will cause more infections, hospitalizations, and deaths. Although the wave is cresting, last week cases (3x), hospitalizations (2x), and deaths were still far higher than at any point before the current surge. There are two glaring gaps in the information the federal and state governments publish: data on vaccination by race/ethnicity over time, and vaccination coverage of staff and residents in nursing homes. Unfortunately, there will be continued increases in cases, and eventually deaths. The increases in hospitalizations required the Covid Exit Strategy team to add a new color. Vaccine supplies are short now, but will improve in the coming months. He estimates that there are 3.3 infections for each diagnosed infection. This is a high number that is consistent with rapid spread observed. The sooner we recognize that, the sooner we can move forward more safely. In the classic Art of War, Sun Tzu defined five factors that determine success or failure in war: moral influence, weather, terrain, leadership, and strategy. 5) Have new safety measures in place – open in phases, waiting at least 3 weeks to see if there’s spread between steps, use hand sanitizer, door-front shop pickups, open spaces, physical distancing, and more. Box the virus in: test, isolate, contact trace, and quarantine. Although cases in the Midwest are coming down, they’re still very high, and cases are increasing almost everywhere else. Many measures we’re seeing now – floor markings to denote safe distancing, requirements to use hand sanitizer before entering a building, capacity restrictions in restaurants and stores – may be with us for some time. There may be light at the end of the tunnel, but immunity is definitely not just around the corner! The update comes as the United States is “unfortunately seeing a distressing trend, with cases increasing in nearly 75 percent of the country,” Jay Butler, the CDC’s deputy director for infectious diseases, said Wednesday at CDC headquarters in Atlanta, in the first news conference administration officials permitted in more than eight weeks. Bottom line: focus on making it convenient and on communicating with the movable middle. Will we be able to go to indoor concerts and indoor sporting events safely in the next few years? We may eventually need multivalent vaccines to fight these multiple strains. The more uncontrolled spread of Covid there is, the higher the risk that mutants that can evade our natural defenses (immunity from either infection or vaccination) will arise and spread. ​Outbreaks and deaths among incarcerated people continue. Here’s the key point: the per capita hospitalization rates for Covid range from 500 per million to <50/million. , at its best, is about the organized efforts of society to do what individuals cannot do or cannot do as effectively. Here’s the key point: the per capita hospitalization rates for Covid range from 500 per million to <50/million. behind the allergic reactions to Pfizer vaccine: there were 11 cases per million, 70%+ among people with a history of anaphylaxis or allergy. We’ve made some progress on global vaccine access -- potentially. The J&J vaccine can be kept at regular refrigerator temperatures (no need for deep freeze) and is easier to make, store, ship, and give – at half the price. Following science saves lives. I anticipate that we’ll get, for the first time, transparent information about the pace of future dose delivery. We’ve had steady – though rocky and uneven – progress with vaccination. Ireland’s approach is a great example.​, Like oh-so-much-too-much in our society, Covid hurts the most vulnerable most. The. But...if it turns out that we have vaccines that are 70% effective (e.g., AstraZeneca, unless the prime/boost data is confirmed) vs. 90%+ effective, it’s going to raise terrible questions. We hope this is true, but it is not yet proven. And VOTING. We would like to show you a description here but the site won’t allow us. New financial modeling by @iccwbo warns of the cost of vaccine nationalism: $9.2 trillion, with nearly half, $4.5 trillion, incurred by wealthy economies including the United States. These give us more information than we’ve ever had, but leave many key questions unanswered. We need continuous improvement in testing, isolation, tracing, and quarantine. This is likely much less common with Covid than with measles. Horrifying. Transmission depends on the index case, ventilation, whether people are wearing masks, what activities they’re doing (singing, shouting, etc. As per CDC’s CovidView weekly, test positivity, which remains one of the most important indicators of disease spread, increased from 10.8% to 11.9%. Some states are providing more comprehensive data on vaccine coverage, including. Fundamentally, there are four factors: Opening too soon, leading to rapid resurgence. And we’re delighted to work on the Covid Symptom Data Challenge. It may be less likely to give “sterilizing immunity.” Studies are urgently needed on the prime/boost approach to see if higher protective efficacy is confirmed. This is 100% certain. There’s not yet enough data to know if the rapid increase in cases in that city is due to reinfection among people previously infected with other strains (due to waning immunity or immune escape), increased transmissibility of this new variant, or some combination. We understand the virus and how to protect ourselves better. That’s a faulty premise. That recommendation is not backed by science. Although there have been 7.4 million reported infections in the United States with the virus that causes Covid, estimates suggest that the number of. is a must-read. Money, technical capacity, and operational capacity are all needed. One possible way forward would be to scale up mRNA manufacturing capacity in countries that have large populations and strong pharmaceutical sectors, such as Brazil, South Africa, India, and Vietnam. Johnson & Johnson is the only company that has extensive vaccine production experience of the first four companies likely to have a vaccine. about where we are and what we can do for the holidays. I think about his call to empathy and to recognize that our enemy is hatred. Hyperbolic discounting is not in our favor here. You know what’s NOT tired of winning? Have there been superspreader events? States all over the map are … all over the map. Even if only 1 in a million people, or 1 in 100,000 people have a bad reaction, that’s a lot of people for a vaccine which billions of people may take. Let’s learn, connect, and empower. Case rates in the Northeast remain relatively low, and these states are now joined by MI, WV, NM, MT, WY, AK which have relatively low rates. “The pandemic we’re currently living through is both a manifestation of and a mere interruption in the relentless march toward an interconnected world.”. More information on long-haulers is emerging. Disproportionate impact of Covid means the need for disproportionate resources and support. By ensuring residents and staff get vaccinated, we can reduce death rates before we reduce case rates. The officer reported no other known close contact exposures to individuals with the coronavirus outside work, and did not travel outside Vermont during the 14 days before he got sick, the report said. It’s possible that nCov2019 will spread more readily than SARS did, although we don’t know that yet. But southern Staten Island, which is richer, whiter, and regularly votes Republican, has higher rates of Covid, including higher test positivity (~15% vs. ~10%). As night follows day, hospitalizations and deaths follow cases, which follow letting our guard down. Today’s results from the latest trial only show the effects 28 days after vaccination. The Washington Post is providing this important information about the coronavirus for free. Hope we’ll get the hint and strengthen primary care and make it central to our response. Primary care is the most important part of our health care system, but it’s also the most underfunded and neglected. Deaths are increasing. The first case in the epi-curve that was just published (see Figure) was from December 1, and there was no uptick in cases until around December 20, with the first alert reported on December 31 – a relatively rapid reporting interval. This week. However, if CDC and HHS continue to improve their data sharing, these sites — and this weekly thread! At the Vermont prison, the correctional worker had multiple brief encounters on July 28 with six prisoners while their coronavirus test results were pending. Imagine a punch-drunk boxer who has been knocked down twice, staggering up again to face an opponent winding up to deliver a knockout blow. We may learn from that. But we need to look at all the data. And although human immunity against the virus now appears possible, FDA and CDC immunity from political interference is much less so. This won’t change the current outbreak, but allowing the current arrangement to continue, which leads to outbreaks, is not a responsible option. reported: case numbers, which are largely irrelevant. But only time will tell. Going back to nursing homes, if we’re successful, deaths that occur in these facilities will decline as a proportion of all deaths, then plummet dramatically during March. There will be. A 74-year-old has approximately a 3% chance of death. If we reduce cases by wearing masks, watching our distance, washing our hands, and avoiding risky indoor spaces, we can create a virtuous cycle: fewer cases, better contact tracing, and enhanced ability to stop spread. Countries all over the world have failed our caregivers for far too long. I felt safe. and at risk. More infectious strains require better defenses. Covid-disrupted care is an even greater risk in Africa and elsewhere, where measles, malaria, and other causes of death can rapidly and drastically increase death rates. This could become an important early warning system for Covid. Data scientist Youyang Gu. The updated guidance, which health departments rely on to conduct contact tracing, ... Tom Frieden, who was CDC director during the Obama administration, called the guidance “a sensible change We need to know: What proportion previously identified as contacts and were in quarantine already? Influenza-like and Covid-like illnesses are continuing to increase in much of the country. Those who build community strengthen us all. First, let’s take a look at the numbers. Tens of thousands didn’t need to die from Covid. Improving ventilation and spending more time outdoors also help. The data on convalescent plasma is contradictory. There’s continued and very encouraging news on vaccines. Covid Epi Weekly: Turning the Corner on Covid in the US—Into an Oncoming Tsunami of Cases, Hospitalizations, and Death. Nosocomial transmission (spread within health care facilities), which was a major source of spread for MERS and SARS, and remains a major risk for nCov2019 – and is also a major intervention point for control. Ebola, also known as Ebola virus disease (EVD) or Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever of humans and other primates caused by ebolaviruses. The basic 1-2 punch concept still applies. Continued spread of Covid in the US will continue to undermine health, jobs, economy, and education. Next week, I’ll delve into differences in Covid incidence among the states and explain why most comparisons you read are wrong. Not contact tracing. New York Times: Chaotic policies about who can get vaccinated in the U.S. has gotten better, and it’s encouraging to see that some states are doing well and making steady progress in long-term care facilities. One of the analysts I follow closely is @youyanggu, who just launched a nowcasting site. It’s 10 months late, but the headline says it all. ​Revealing description of the smoother roll-out in the UK, where they relied on their National Health Service and primary care doctors. As predicted, we’ve surpassed 50,000 reported cases per day. . We’re recovering from the huge amount of ill-advised travel and indoor contact over the holidays. First, the trends from last week. For example: What antibodies should be used? Many tests take more than 2-3 days to come back, which means they are of little value. That’s why the unspoken advocacy for herd immunity by this White House is so revealing. This is likely, but not certain, and depends in part on what kind of mask you wear and whether you put it on, wear it, and take it off correctly. Testing available for every patient with pneumonia within four hours, every symptomatic person within 12 hours, and capacity for drive-through testing. That doesn’t mean we won’t be able to get much of our former lives back, but it does mean there are likely to be some differences. Covid is NOT the zombie apocalypse. Community engagement, empowerment, and leadership is crucial for progress. This is complex, important, high-skill, high-empathy work. Be empathetic. Masks and mask mandates work! We can expect approval in February and increasingly widespread availability of this vaccine starting in April. Imagine you’ve been on a dangerous sea voyage. An investigation should be able to determine the likely source and identify those most at risk. This is already done (not well) for Yellow Fever. When more people wear masks, more people are protected.”. There’s actually an article about how to hug grandparents and other elderly loved ones more safely. It’s 10 months late, but the headline says it all. It’s reassuring that. 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