Experment: Surface Best covid19 threads from @ThreadReaderApp
As we head into fall, worth reflecting on the past 3 months, and what it portends for next few
While things are clearly better since summer peak, serious warning signs ahead
The biggest one?
We go into Labor day with much more infection than we did Memorial Day
Thread
While things are clearly better since summer peak, serious warning signs ahead
The biggest one?
We go into Labor day with much more infection than we did Memorial Day
Thread
So a walk down memory lane
We opened up Memorial Day with 20,000 daily cases, 5.4% test positivity rate
We peaked around July 22, we had about 75,000 daily cases, nearly 9% positivity rate
As we enter Labor Day, we are at about 40,000 new cases, 6.3% positivity rate
2/5
We opened up Memorial Day with 20,000 daily cases, 5.4% test positivity rate
We peaked around July 22, we had about 75,000 daily cases, nearly 9% positivity rate
As we enter Labor Day, we are at about 40,000 new cases, 6.3% positivity rate
2/5
Compared to the peak, we are clearly better
But few things should worry us
1. We're going into fall with a lot more disease than we entered summer
2. Our test positivity rate higher now than June 1: means we are missing more cases
3. Our testing is DOWN over past month
But few things should worry us
1. We're going into fall with a lot more disease than we entered summer
2. Our test positivity rate higher now than June 1: means we are missing more cases
3. Our testing is DOWN over past month
So many people have sent this to to me today, and I'm going to go against the grain on this one.
I acknowledge that the impression that the quotes selected create is not a good one.
But I don't think they present a fair picture of the researchers involved.
I acknowledge that the impression that the quotes selected create is not a good one.
But I don't think they present a fair picture of the researchers involved.
I had never met @NigelGoldenfeld prior to the pandemic, but we've interacted a number of times since. He's been the opposite of every arrogant physicist stereotype throughout.
He's worked extremely hard to listen to and learn from epidemiologists, and to take on a thankless job.
He's worked extremely hard to listen to and learn from epidemiologists, and to take on a thankless job.
With respect to what is happening at UIUC, I think it's too early to say the effort will fail—though of course it could fail. We knew that all along, or at least that's what I've been telling reporters for weeks.
COVID Update September 3: Who is this "deep state?"
1/
1/
Are career civil servants a conspiratorial, non-elected force out to topple Donald Trump?
The answer is most decidedly not. They have no need. If they wait long enough, political leaders topple themselves.
2/
The answer is most decidedly not. They have no need. If they wait long enough, political leaders topple themselves.
2/
Civil servants are often insulted by people who don't know better as second-tier, lazy, unqualified 9 to 5ers.
That's the furthest thing from the truth.
They are however, often poorly led. 3/
That's the furthest thing from the truth.
They are however, often poorly led. 3/
Today we learned ~1/3 Big Ten athletes who were #covid19 + had abnormal heart MRIs, consistent w/ myocarditis, even those without symptoms. If anyone still is questioning whether this virus attacks the heart, it's denialism.
There have been multiple reports of heart involvement with #covid19, including young athletes, and replication of @GladstoneInst iPSC-> heart cell findings. Very little is known about heart inflammation among asymptomatics (unlike lung Δs) 
Documented #SARSCoV2 particles in heart cells in a tragic case of an 11-year-old girl
A little primer on independent Data and Safety Monitoring Boards (DSMB), who will be reviewing the #SARSCoV2 vaccine trials to adjudicate safety and efficacy, making recommendations to the clinical trialists 1/
Consists of a multidisciplinary group of several members: clinical trialists, biostatistician, bioethicist, and experts in topic (virologist, immunologist, epidemiologists, vaccinologists)
The timing/schedule of data review usually based on enrollment 2/
The timing/schedule of data review usually based on enrollment 2/
The data are teed up by the biostatisticians. The DSMB is blinded to vaccine or placebo groups. There is ordinarily a time lag/gap from the "cleaned" dataset reviewed by DSMB that is behind ongoing events 3/
COVID Update September 2: Vaccine by November 1 come hell or high water.
Some misunderstand the purpose of vaccines. Commissioner @SteveFDA is one of them. Donald Trump is another.
That lack of understanding has the potential to cause COVID-19 to be hear for a long time.
Some misunderstand the purpose of vaccines. Commissioner @SteveFDA is one of them. Donald Trump is another.
That lack of understanding has the potential to cause COVID-19 to be hear for a long time.
The purpose of a vaccine is not to protect "me." It is to protect "we."
Done right, vaccines end pandemics. Done wrong, pandemics end vaccines.
1/13: New Thread: A dozen reasons why I'm worried about releasing a #covid19 #vaccine through an emergency use authorization (EUA)
2/13:
1. We haven't done this before for a #vaccine, or at least a major vaccine released to a large segment of the population. We've done it for technicalities, but nothing like this.
1. We haven't done this before for a #vaccine, or at least a major vaccine released to a large segment of the population. We've done it for technicalities, but nothing like this.
3/13:
2. And for good reason, EUAs involve substandard or lesser reviews. How can you justify a substandard or lesser review for something that would be injected in tens of millions, maybe hundreds of millions of Americans?
2. And for good reason, EUAs involve substandard or lesser reviews. How can you justify a substandard or lesser review for something that would be injected in tens of millions, maybe hundreds of millions of Americans?
On the #SARSCoV2 immune response and vaccine I just did a podcast with Dennis Burton, a leading immunologist and vaccinologist and co-faculty @scrippsresearch. We covered so much a long🧵summary was needed
soundcloud.com/prescrippsions… 1/x
soundcloud.com/prescrippsions… 1/x
Optimism. "The pandemic is not going to be with us forever"
(This comes from a leader of the HIV vaccine program) 2/x
(This comes from a leader of the HIV vaccine program) 2/x
1st line of defense, interferons: will they likely be helpful given as an early intervention?
Yes, but we have to be very careful 3/x
Yes, but we have to be very careful 3/x
ALERT
Aug 27 letter from @CDCDirector to all Governors says the agency is, "rapidly making preparations to implement large-scale distribution of #covid19 #vaccines in the fall of 2020" using a contractor (McKesson Corp). Redfield asks Governors to grant...
MORE
Aug 27 letter from @CDCDirector to all Governors says the agency is, "rapidly making preparations to implement large-scale distribution of #covid19 #vaccines in the fall of 2020" using a contractor (McKesson Corp). Redfield asks Governors to grant...
MORE
ALERT/2
..McKesson full licensed access to sites statewide for mass #covid19 immunizations, which must be "fully operational" by November 1st -- 2 days before the national elections.
..McKesson full licensed access to sites statewide for mass #covid19 immunizations, which must be "fully operational" by November 1st -- 2 days before the national elections.
1/8 Corticosteroids and covid19
*Three* RCTs and a new @WHO meta-analysis add to #RECOVERY trial data that corticosteroids reduce mortality in critically ill #covid19 patients
jamanetwork.com/journals/jama/…
*Three* RCTs and a new @WHO meta-analysis add to #RECOVERY trial data that corticosteroids reduce mortality in critically ill #covid19 patients
jamanetwork.com/journals/jama/…
2/8 Corticosteroids & covid19
i. Low-dose hydrocortisone didn't reduce death, persistent respiratory support at day 21 vs placebo among critically ill patients w #covid19 and ARF, but the study was stopped early when RECOVERY trial findings were announced
ja.ma/31NqEDf
i. Low-dose hydrocortisone didn't reduce death, persistent respiratory support at day 21 vs placebo among critically ill patients w #covid19 and ARF, but the study was stopped early when RECOVERY trial findings were announced
ja.ma/31NqEDf
3/8 Corticosteroids and #covid19
ii. IV #dexamethasone increased the number of ventilator-free days by day 28 vs standard care alone among patients with covid19 and moderate or severe ARDS
ja.ma/3bjH2yt
@ICURevisited @FlaviaSepsis @israelmaia16
ii. IV #dexamethasone increased the number of ventilator-free days by day 28 vs standard care alone among patients with covid19 and moderate or severe ARDS
ja.ma/3bjH2yt
@ICURevisited @FlaviaSepsis @israelmaia16
1/ We have heard about a number of potential breakthroughs for COVID response- large scale/cheap testing, immune therapy, vaccine progress.
But when it comes to "getting eyes on the outbreak" we are still peering through the same dirty windshields.
Could $100k change that?
But when it comes to "getting eyes on the outbreak" we are still peering through the same dirty windshields.
Could $100k change that?
2/ We *still* don't have a good answer to the most fundamental epidemiologic question - "what's the intensity of COVID activity in my community this week?"
We have lots of websites and lots of citizen scientists (including me) trying to piece it together
nytimes.com/2020/07/21/opi…
We have lots of websites and lots of citizen scientists (including me) trying to piece it together
nytimes.com/2020/07/21/opi…
3/ This *matters*
We don't have a national strategy.
The CDC has been muzzled.
State/local leaders are mostly overwhelmed with trying to figure out what's going on, or have stopped looking at science altogether.
Businesses, schools, families have to decide for ourselves...
We don't have a national strategy.
The CDC has been muzzled.
State/local leaders are mostly overwhelmed with trying to figure out what's going on, or have stopped looking at science altogether.
Businesses, schools, families have to decide for ourselves...
COVID Update September 2: Lets say we were in a war. A war where we are attacked at home and hundreds of thousands of people died.
We would have a few expectations of the president in a war. Protect the citizenry, defend the nation, honor those we lose.
Arming the troops is the first obligation. People on the front lines need protection. Having a battle plan and reviewing data every day. Hiring the best generals.
Minimize casualties. Deploy all our resources. Don’t quit in the middle. Rally the country. Make an alliance.
Minimize casualties. Deploy all our resources. Don’t quit in the middle. Rally the country. Make an alliance.
Announcing our Long-Term Care COVID Tracker—the most comprehensive dataset on COVID-19 in long-term care facilities in the Unisted States. covidtracking.com/data/longtermc…
Dating back to May 21, the Long-Term Care Tracker compiles all available information of COVID-19 cases and related deaths in long-term care facilities—nursing homes, skilled nursing facilities, assisted living facilities, and other care homes—and tracks both residents and staff.
COVID-19 deaths in US long-term care facilities have surpassed 73,000, representing 43% of all deaths and one out of every 28 LTC residents in America. And we’re still learning how states count and report these figures. covidtracking.com/blog/long-term…
New @AIP_Publishing: Demonstration of why air shields alone and N95 masks with valves are not adequate protection
aip.scitation.org/journal/phf
aip.scitation.org/journal/phf
N95 with valve
N95 without a valve
New weekly #covid19 sit rep by @WHO is up:
Another almost 1,8 million new cases added last week.
Another 38,000 deaths.
At this pace the world is on track to cross one million reported deaths at the end of this month.
Another almost 1,8 million new cases added last week.
Another 38,000 deaths.
At this pace the world is on track to cross one million reported deaths at the end of this month.
@WHO Americas:
Still the hardest hit region.
Roughly 13% of world’s population, but more than 50% of global cases and deaths.
"biggest drivers of the case counts in the region have observed a moderate decline or stabalisation”, but increases in Peru, Mexico, Colombia, Argentina...
Still the hardest hit region.
Roughly 13% of world’s population, but more than 50% of global cases and deaths.
"biggest drivers of the case counts in the region have observed a moderate decline or stabalisation”, but increases in Peru, Mexico, Colombia, Argentina...
@WHO South-East Asia:
Biggest increase in cases compared to previous week (+9%), driven by India which reported nearly half a million cases in a week.
"While these trends are concerning, the increase in cases should be seen against a substantive rise in testing in recent weeks"
Biggest increase in cases compared to previous week (+9%), driven by India which reported nearly half a million cases in a week.
"While these trends are concerning, the increase in cases should be seen against a substantive rise in testing in recent weeks"
COVID Update: August 31, 2020: Each month I give a sense of what to expect the following month.
This ought to be entertaining because I'm not sure anyone can tell you what happened this month. 1/
This ought to be entertaining because I'm not sure anyone can tell you what happened this month. 1/
The good news is as I and others suggested would happen the Southern states got their rising curve under control. Things flattened. 2/
Some people will tell you its because we hit some magic herd immunity level in the South. There is no evidence of that. Not even circumstantial.
Here's what we learned about Southern Spread... (fav Neil Young song? Mine too.) 3/
Here's what we learned about Southern Spread... (fav Neil Young song? Mine too.) 3/
1/5 Thread: Many thanks Jim @Acosta for hosting me today @CNNSitRoom where I explained my concerned about EUAs for #covid19 #vaccines.
Here's why:
Here's why:
2/5 Thread:
1) We don't do EUAs for #vaccines reaching large segments of the US population...
2) ) because it's an incomplete and substandard review
1) We don't do EUAs for #vaccines reaching large segments of the US population...
2) ) because it's an incomplete and substandard review
3/5 Thread:
3) Rightfully, American people don't trust EUAs after FDA implemented and then revoked an EUA this year for hydroxychloroquine, and then the EUA for plasma Rx was poorly explained
3) Rightfully, American people don't trust EUAs after FDA implemented and then revoked an EUA this year for hydroxychloroquine, and then the EUA for plasma Rx was poorly explained
My kids started school today, via Zoom. They and millions of other children will spend the fall stuck in learning limbo.
This was not inevitable. It is a result of the President and his advisors putting magical thinking ahead of preparedness.
This was not inevitable. It is a result of the President and his advisors putting magical thinking ahead of preparedness.
With better planning and preparedness, schools could have safely opened - with adaptations - for in-person learning.
They still could.
But it would require investing in three big things.
They still could.
But it would require investing in three big things.
Some countries have been able to reopen schools safely and sustainably. Others have reopened and immediately seen cases start to spike (e.g. Israel, and numerous US colleges).
The places that have reopened safely have have a few common characteristics:
The places that have reopened safely have have a few common characteristics:
This is a brief thread on a critical and underappreciated difference between *approval* and *emergency authorization* by the FDA for drugs and vaccines.
It relates to the difference between “shall” and “may” 1/8
It relates to the difference between “shall” and “may” 1/8
For approval, the law makes clear that once specific standards are met, including evidence of safety and effectiveness, the Secretary “shall issue an order approving the application.”
Another way to say this: Meeting the FDA’s approval standards ---> approval. 2/8
Another way to say this: Meeting the FDA’s approval standards ---> approval. 2/8
But for emergency authorization, the law says that the Secretary “may” authorize the use of a drug or vaccine in the setting of declared emergency. 3/8
“No country can just pretend the pandemic is over”, says @drtedros at @WHO presser on #covid19. "The reality is that this coronavirus spreads easily.
It can be fatal to people of all ages and most people remain susceptible."
It can be fatal to people of all ages and most people remain susceptible."
1/ #covid19 outbreak investigation of the Yokohama Cruise Ship
Over 3 week period, 20% of passengers infected; 14% of staff
Attack rate was highest in cabins of size 4 or more-- 30%
Not convinced by their thoughts on mode of transmission..
wwwnc.cdc.gov/eid/article/26…
Over 3 week period, 20% of passengers infected; 14% of staff
Attack rate was highest in cabins of size 4 or more-- 30%
Not convinced by their thoughts on mode of transmission..
wwwnc.cdc.gov/eid/article/26…
2/ They mention that there didn't seem to be spatial clustering of infected cabins on the same floor/zone, & that this implies it was not primarily spread via droplets/ more evidence it was potentially spread by aerosolized particles?
This doesn't make sense to me.
This doesn't make sense to me.
3/ Most people prob aren't interacting closely w/ other random cabins on their floor but do share same hallways at diff times.
If anything, clustering by floor/zone in which people don't interact face to face as much would suggest lingering aerosols- which we didn't see here.
If anything, clustering by floor/zone in which people don't interact face to face as much would suggest lingering aerosols- which we didn't see here.
A wedding in rural Maine led to the state's largest #covid19 outbreak. The screening for the party was symptom and temperature checks. The presumed index case showed symptoms the day after the ceremony. Remember- spread is also *presymptomatic*
bostonglobe.com/2020/08/29/nat…
bostonglobe.com/2020/08/29/nat…
2/ In all, half of the attendees became ill. An elderly couple were infected by a wedding guest-- the wife unfortunately passed away.
A jail 220 miles away had an outbreak from one of the wedding attendees.
This article tells the story of one outbreak...
A jail 220 miles away had an outbreak from one of the wedding attendees.
This article tells the story of one outbreak...
3/ But it really tells the story of how outbreaks happen.
They happen when you least expect it-- when you think you've taken enough precaution; they spread quickly, and affect people far and near.
The best we can do is follow the basics consistently.
They happen when you least expect it-- when you think you've taken enough precaution; they spread quickly, and affect people far and near.
The best we can do is follow the basics consistently.
COVID Update August 30: The propaganda wars have hit a fever pitch.
Let’s review. 1/
Let’s review. 1/
We have 9000 people dead from COVID according to a QAnon source and Trump.
Praise God. They have risen from the dead!! 2/
Praise God. They have risen from the dead!! 2/
We’re going to have a vaccine by the end of the year. If you don’t believe me just ask my colleague at the FDA— Steven Yessir! 3/