There are about 81 million people in the US with high-risk health conditions. Note the increase after Thanksgiving in most regions. County-specific test positivity, which should be open source but at least is available. Following science saves lives. It’s possible that we’ll wind up with vaccines that may be relatively more and less effective. : we have a hard time conceptualizing that a situation can be better, but still very bad. This could become an important early warning system for Covid. These are some of my takeaways from a year of horrors: just released materials to promote safer holiday celebrations. We need to know: What proportion previously identified as contacts and were in quarantine already? Surgical or N95, as available. Every little bit can help, as long as there are a lot of little bits to get R<1 and keep it there. In the past week, overall test positivity increased slightly, although positivity in commercial labs decreased slightly. You know what’s NOT tired of winning? At Resolve to Save Lives, we released a toolkit this week sharing evidence, tools, and best practices for policymakers and communities to promote mask-wearing, which I summarized in the Washington Post. More doses, more money, and more support for vaccination programs are all needed. Thanks to @drgregpoland for raising the issue of health care staff vaccination for years. It’s us against them – humans against the virus. Masking is important. 1) Knock the virus down, minimizing societal harm, and 2) Keep it down. They’re stunningly effective and, so far, reassuringly safe. Now, what does all that mean for the question about whether this will be forever? In the past two weeks, 21 states reported their highest Covid rates ever, including in most of the Midwest and much of the West. He got tested the next day and on Aug. 11 found out he was positive. It takes rigor, discipline, patience, and working together. First the good news. NPR obtained a recent daily report from the US Department of Health and Human Services, and here’s a screenshot showing hospitalizations increasing:​, Will deaths increase? Press conference, anyone? , dictated by White House/HHS, that asymptomatic contacts of Covid-positive patients don’t need to be tested. So when one CEO spoke recently of having early data because there are lots of events, that’s a big concern, because the events he’s talking about are Covid infections in trial participants who got placebo. For Thanksgiving, I’d suggest that all family members adhere to a strict two week quarantine before any get-together, and only plan to gather if travel can be done safely. ● 9 is the number of people, on average, grieving for each of those deaths. Essential workers who are more likely to be infected and die (for example, a bus driver with diabetes) should also be at the front of the line. There have already been. 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. Masks are one of the lowest-cost, most effective tools we have to get more of our economy, education, and health care back. As night follows day, hospitalizations and deaths follow cases, which follow letting our guard down. Some keys to successful vaccination programs: Empower trusted community members and develop tailored messages, Provide reminders and ensure convenience (hours, locations, time), Avoid hidden costs (for example, reimburse travel to vaccination sites). The virus doesn’t stay in any group—we’re all connected. And businesses, schools, health care facilities, nursing homes, and others need practical information on what they can do at different levels of risk. Interesting preliminary, pre-print data suggests that a single dose of the Pfizer and Moderna mRNA vaccines may be sufficient to provide protection in previously infected people. A reporter asked me the other day why California is doing as badly as Texas despite having more restrictions. But if vaccine studies are stopped early, we’ll lose essential information on effectiveness in the elderly and safety for all. (This is a different issue than the single dose issue in England, about which, more later.). Even in places with fewer cases, there’s very little tracking of actual outcomes of testing and contact tracing. Although this is not proven, it’s clear that nosocomial transmission is occurring.). Michael Scherer contributed to this report. Because Mother Nature usually does better than our best vaccines, and the ceiling of vaccine efficacy is usually protection after natural infection. They are our best tool, but just one of many. We should learn from Asia and wear a mask if we don’t feel well—or, better yet, stay home. Thanks to @NYTimes for working with @ResolveTSL to provide better and more actionable information on Covid risk in every community. 3. Production, supply, distribution, uptake, and possible adverse events—all present potentially huge challenges. 2. The simple truth is that in our increasingly interconnected world, disease spread anywhere is a risk everywhere. That should not be hard to understand. Support nutrition, learning, mental and physical health and well-being, and social needs during isolation and quarantine. Of course. The chance for us to save tens of thousands of lives. The 3W’s make a big difference: Wear a mask, Watch distance, Wash hands. A new tool using HHS data shows the percentage of beds with Covid patients, which is a more reliable indicator than the percentage of ICU beds filled, since ICU beds can be added more easily than hospital beds (by converting surgical recovery suites, anesthesia rooms, etc). Humans take vacations but the virus doesn’t. The louder someone talks, the greater chance the virus will spread. Strains may emerge that make testing less accurate, treatment less helpful, or vaccines less effective. I fear we are numbing to the numbers. (from 7.2 to 8.2%), and increased among all age groups in all regions. Let’s rebrand contact tracing and call it what it is: supporting people who got Covid and who were exposed to it. We need to do much better at addressing the deep inequities in society. 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. Even without a vaccine or treatment, communities in countries around the world have stopped the spread of the virus and gone back to life almost as before. If people with prior documented infection who are not at high risk of infection/death choose to defer vaccination for a few months, this wouldn’t be wrong – but it must be their choice, and wouldn’t ease supply much. Now we need better studies, quickly, on the optimal dose and dosing schedule of the Oxford/Astra-Zeneca vaccine. Masks are one of the lowest-cost, most effective tools we have to get more of our economy, education, and health care back. It takes rigor, discipline, patience, and working together. One of 200 people over the age of 65 have perished as have many others. On the other hand, travel from places with high Covid to places with low Covid is a recipe for spread. According to CDC’s CovidView, test positivity inched up from 5.4 to 5.5% in the past week, driven by an increase in positivity among 19-49-year-olds (and this is before many colleges try to open). But the limitation of beds isn’t the most dangerous, the limitation of staff is. Investigators said “his most likely exposures occurred in the correctional facility” through the multiple brief encounters. This information belongs to the public, not to anyone in Washington. Many other states, sadly, aren’t far behind. I wrote about the perils and promise of immunity here. There’s continued and very encouraging news on vaccines. , and almost certainly protect yourself as well. And we have to make sure that those who have been neglected so far – Blacks, Latinx, Native Americans, the poor, and, surprisingly, primary care doctors – are also prioritized to receive vaccines. Detected cases are up three times more than testing. The infection of President Trump is the most prominent, and one of the most telling. We need transparency about what safety signals are being looked at. 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. We must base decisions on science and insist on complete transparency on data and process.0 LIKES SHARE​, (Blog initially published in Tom Frieden’s LinkedIn account : https://www.linkedin.com/pulse/dozen-observations-covid-19-immunity-tom-frieden/). They’re stunningly effective and, so far, reassuringly safe. It’s possible that nCov2019 will spread more readily than SARS did, although we don’t know that yet. How fast can vaccination against COVID-19 make a difference? More than 1,000 Americans a day have died recently from Covid. If there’s a real chance that a half dose of Moderna vaccine works, this should be studied rigorously even if studying this takes months. This modeling site has performed better than most, using solely deaths and machine learning. Yes, really, WHO. The situation will get worse before it gets better. What’s more, test positivity has risen from 6.6% to 7.1%. Paying attention to the seven-day average of reported cases is more useful. Think of the joy, happiness, and meaning lost for each of those 13 years. There’s been great progress vaccinating nursing home residents, with about 80% receiving their first dose. In this war against a virus, truth can be our strongest weapon. But we have to start with the brutal truth that the benefit of testing, isolation, and tracing in the US for the past year has been minimal. In Rhode Island, more than 1 in 8 Hispanic/Latinx people has tested positive, which is nearly 4x the rate among white people (1 in 31). Not quarantine. 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. Excellent graphic from the folks at Covid Tracking Project. People are tired of the limitations the virus is imposing. The J&J vaccine, a non-replicating viral vector vaccine that uses a common cold adenovirus and is designed to be given as a single dose, is about as good as a single dose of an mRNA-based vaccine. Don't let your guard down. Efficacy is more likely to be proven early than safety. Saying cases are up because of more testing is like saying gravity isn’t real. Data on study design, data, and effectiveness of the Astra-Zeneca vaccine are still murkier than they should be, and there are now production problems. There are likely to be other cases. Per the. One of the analysts I follow closely is @youyanggu, who just launched a nowcasting site. This has been an issue with influenza vaccination for years; although there has been progress, still, only about. Not isolation. We need global collaborations that recognize the reality of our mutual dependency and mutual accountability. Here’s the key point: the per capita hospitalization rates for Covid range from 500 per million to <50/million. No place is immune to Covid.​​. If these contacts are positive, their contacts can be identified, warned, and quarantined. According to CDC’s CovidView, test positivity inched up from 5.4 to 5.5% in the past week, driven by an increase in positivity among 19-49-year-olds (and this is before many colleges try to open). for at least 3 months, but the data are messy and have not yet been peer-reviewed. Recent spread in Orthodox areas of NYC is concerning. The virus outnumbers us; we need to outsmart it. We just released materials to promote safer holiday celebrations. that young adult infections were followed a week or two later by infections in people over 60. We still don’t have enough transparency about how much vaccine is in the pipeline, from which companies, and when delivery is expected. 1. “This article adds to the scientific knowledge of the risk to contacts of those with covid-19 and highlights again the importance of wearing face masks to prevent transmission,” the CDC said. Seasons and years pass. Success is possible. The competition is open until September 29. New strains are more and more concerning. In particular, it seems to attack the lower respiratory tract, because of receptor binding to ACE2, which is. Another momentous and painful week. If it helps us reclaim our education, jobs, and economy, this could be a good thing – but there are important risks to be considered. It’s been frustrating to see a continued focus on the wrong numbers. He asked, Will this be forever? Tom Frieden is Senior Fellow for Global Health and the Council on Foreign Relations and President and Chief Executive Officer of Resolve to Save Lives, an initiative of the global health organization Vital Strategies.0 LIKES SHARE, During the 2014-2016 Ebola epidemic, the CDC produced a weekly dashboard of the most important interventions, objectively grading each in every affected country as red, yellow or green. Here’s a quick summary of the key findings from the scientific publications: It’s now highly likely that, as suspected, the ancestral source is bats and the first location may have been the wet market in Wuhan – detailed genetic analysis as well as the largest epidemiological investigation published to date show that 27 of 41 initial cases had exposure to the market. Meatpacking factories are driving spread in many communities, with persistent failures in prevention, response, and transparency. Test positivity is increasing in ALL age groups. In an @NEJM article from earlier studies, the immune response continued to build for 57 days after vaccination. Unless we up our game, Covid will keep winning, keep spreading, keep killing Americans—preventably. There are still lots of unknowns regarding the AstraZeneca/Oxford vaccine. Covid has exposed horrific disparities. But maybe, soon, there will be an end to the completely dysfunctional national response.0 LIKES SHARE. Reopening schools and restoring our economy are getting much harder. Quarantine means not exposing others after you’ve been exposed. Until the worst is past, which won’t be for several morte months, we need to double down on protection protocols, including wearing masks and minimizing time indoors with people from outside your household. It’s not about opening schools or our economy, it’s about opening them and keeping them open. This is already done (not well) for Yellow Fever. Twitter @DrTomFrieden. Although not all people who are estimated to have illness are infectious (maximum infectivity starts about 2 days before and continues for about 5–7 days into illness), nationally approximately 1 in 100 people, and possibly more, are infectious today. But we need to vastly up our game in preventing household spread. Ireland’s approach is a great example.​, Like oh-so-much-too-much in our society, Covid hurts the most vulnerable most. Vaccination rollout stumbles along. I like the message below. More information on long-haulers is emerging. Death rates have declined to near baseline. We have one of the highest cumulative death rates of all wealthy countries. This will help–along with masks, distancing, vaccination–drive the reproduction rate (Rt) to <1. The virus isn’t giving up, and neither can we. We need to know the average number of days someone is infectious before isolation and the percentage of cases arising from among quarantined contacts. Some encouraging data from Israel. As predicted, what started in young adults didn’t stay in young adults.​. A dangerously misguided theory on immunity. That’s us, now, planning to open again because things are “better.” If communities open now, it’s not going to end well for far too many people. Other challenges stem from incompetence. We certainly don’t want to be #1 in death. Virus is surging, and our response remains fragmented. Here’s the epi curve of the White House outbreak from what has been publicly reported so far. It’s clear the US does not have COVID-19 under control. Second, I would also assume that, even if we have a vaccine, we’re going to need to adapt our lives in certain ways for at least a few years. We MUST do better at reaching staff of nursing homes. Cases in the West are increasing https://bit.ly/3kQONPy​, Hospitalizations are increasing steadily. Further increases inevitable — but continued increases are not (more on this later). There’s still so much we don’t know. The infection of President Trump is the most prominent, and one of the most telling. But we can get through this. As I mentioned at the beginning of this post, there’s a 100-fold difference between South Dakota and Vermont. Now we’re at 100,000. : https: //www.linkedin.com/pulse/message-young-people-from-public-health-doctor-tom-frieden/ ) only one enemy here, and meaning lost for each those. 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