Covid Epi Weekly Jan 22: Racing Against Mutants!

The post-holiday flood cresting but cases, hospitalizations and deaths remain astronomically high. Viral mutants increasingly concerning. Vaccination is our best tool but only one of several we must use more and better. 1/17

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. National positivity decreased from 15% to 12%. A flood with receding waters is still a flood. http://bit.ly/39WQ9VF  2/

Reported cases don’t necessarily reflect community risk. E.g., NYS has higher rate than Tennessee, but Tennessee tests at 3x lower rate, with much higher percent positivity. Tennessee likely diagnosing smaller proportion of its COVID-19 cases than New York. Risk is higher. 3/

Deaths are the key indicator. Trend since Oct below. These numbers are SO high. If we mask and distance better we can drive cases down and hospitalizations and deaths will follow. The road ahead will be long and bumpy, there are no shortcuts, but, at long last, a good start. 4/

New strains are becoming more and more concerning. Flu evolves in years, Covid in weeks or months. Did earlier clades spread then die out?

New data from the UK suggest that the B.1.1.7 variant may be not only more infectious but also more lethal. https://bit.ly/398C73Y  5/

Credit to the UK for doing quick analyses that showed that dexamethasone works, identifying the variant, and publishing findings in real time. Doing real-time research in an emergency is hard but important. Need better studies, quickly, on optimal dose of the Oxford vaccine. 6/

Vaccination rollout stumbles along. Anticipate that we’ll get, for the first time, transparent information about future dose delivery projection. So far 20 million doses given to 16M people. 8% coverage WVA, 4% Alabama. 2M vaccinations in nursing homes. What’s the denominator? 7/

Some states are providing comprehensive data on vaccine coverage including Ohio http://bit.ly/3sJqzw5 , North Dakota http://bit.ly/3653NVG , and Massachusetts. Rapid changes in data presentation and availability – a national standard, pattern, and support would help. 8/

The US will have too little vaccine supply for months. If people with prior documented infection who are not at high risk of infection or death choose to defer vaccination for a few months, this wouldn’t be wrong–but it must be their choice, and this wouldn’t ease supply much. 9/

New syringes to get 6th dose out of Pfizer vial should be available soon. If there’s a real chance half dose of Moderna vax works this should be studied rigorously even if that takes months. New admin has the good focus of partnering to get doses out of freezers and into arms.10/

Here’s a crucially important risk. As immunity from infection and vaccination increases, selective pressure on the virus will favor emergence of strains that can reinfect people and also strains that can escape vaccine-induced immunity. Never under-estimate the enemy. 11/

And don’t assume that more infectious strains will be less lethal. Strains that increase the duration of shedding would have an evolutionary advantage. Instead of declining rapidly, viral load might persist, increasing spread and also increasing risk to health care workers. 12/

The more uncontrolled spread of Covid, the higher the risk that mutants that can evade our natural defenses (immunity from infection or vaccination) will arise and spread. So as we vaccinate, it’s EVEN MORE important we improve testing, isolation, tracing, and quarantine. 13/

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. If we find ⅓ of cases, isolate only ⅓ of those before they spread virus, quarantine ⅓ of contacts, we reduce spread by less than 5%. 14/

There’s hope. Faster testing, rapid isolation with cash support/services, expert forward & backward contact tracing with supportive quarantine can substantially reduce spread, helping–along with masks, distancing, vaccination–drive Rt to <1. Hard work but possible, necessary. 15/

The pandemic is bad in much of world & worsening in many countries. In parts of Africa there’s an impression that risks were exaggerated before; future is uncertain. Disruption of health care systems remains a deadly consequence. Global solidarity is needed for global safety. 16/

Great start from incoming administration. Excellent plan, clear and focused, hits all the right points, including data transparency, organization, and equity. So encouraging!

"Truth is powerful and it prevails."

Sojourner Truth

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