Covid Epi Weekly: Best of Times, Worst of Times

The third US surge is fading fast but variants, some ominous, are spreading fast. Vaccination is picking up steam but we're failing to address equity and pandemic fatigue is high. We must hang on until most of us are vaccinated. 1/

The fundamental question is whether we’ll have a 4th surge. If we do it will cost lives and also increase the risk of more dangerous variants spreading widely. But first good news: dramatically fast decline in cases and positivity. Steeper decline than in either prior surge. 2/

The thing about masks, not traveling, and minimizing time sharing indoor air with people not in our household? It works. It’s war against the virus. Any time we let down our defenses, it attacks. When we let down our guard (and masks), we are complicit with our viral enemy. 3/

But is this the calm before the variant storm? Spikes in cases in other countries with variants are scary. Variants doubling in a bit over a week in the US. First case found in a prison. No time for complacency – masks and distancing stop even the more transmissible strains. 4/

As CDC put it in their weekly summary which debuted today: “Better, but not good enough”. Sign up for their weekly newsletter at: http://bit.ly/30Fj11C . Hope they add test positivity next week. See @NYTimes graphic below: Way better than December, way worse than September. 5/

And there are warning signs, including in NYC, where test positivity is not decreasing (below from @NYChealthy). In the battle against Covid, a stalemate favors the virus. The next few weeks crucial: If we don’t maintain discipline, viral variants can cause explosive spread. 6/

But what is even more ominous is preliminary data from Novovax trial in South Africa. Previous infection did not protect against reinfection with variant strain: rates of COVID-19 among placebo group 7 days post-dose 1:
Seronegative: 3.9% (58/1494)
Seropositive: 3.9% (26/674)
7/

People born with severe immune deficiencies can harbor (and spread) the polio virus for years, and there has been work to identify and work on treating and curing these people. Evolution/recombination in immunosuppressed people is one theory for the rapid variant changes. 8/

Picking up vax pace, now 1.6 million doses/day. Pfizer & Moderna are promising to basically double deliveries in next few weeks. Hope they keep that promise. We must do MUCH better on equity. Black/Latinx have 2-3x risk of death and ½ likelihood of vaccination. Not acceptable. 9/

The math is harsh. 70M doses sent to states. 364M doses needed for groups 1A,B + those w/ underlying conditions in 1C. And that would leave out people age 50-64 who are high risk, including those not aware of their underlying conditions. Two more months of scarcity, at least. 10/

Nursing home vax likely to drive deaths there down by mid-March, and this will also reduce overall case fatality ratio significantly. Israel’s data is encouraging. Comparison between population age 0-59 years old (orange line) and 60+ (blue line). https://bit.ly/3qd2VpY  11/

Good new CDC guidance on schools. Mask. Distance. Test if possible. Vaccinate as soon as possible. Teachers are and should be priority for vax; we wish we had enough for everyone now, but we don’t. Schools, esp, K-8, should open with safety measures. http://bit.ly/3qiKfoL  12/

Today I published an article in the @WSJ (open access) on how to prevent the next pandemic. @ResolveTSL has worked with partners on this for the past 4 years. It’s now or never; a teachable moment like no other in our lifetimes. https://twitter.com/DrTomFrieden/status/1360392956071534597?s=2013/

I suggest a global target: 7-1-7. Every country, every community should be able to find an outbreak in 7 days, investigate and report in 1, and respond effectively in 7. Success will take money, technical skill, collaboration, persistence. Our children’s safety depends on it. 14/

Six steps to meet 7-1-7 target
-Agree on target
-Build country capacity with collaboration among lower-income countries
-Improve global institutions with WHO as anchor and key role for Global Fund
-Get money–at least $5-10B/yr additional for countries
-Collaborate
-Act now
15/

Hang in there. The pandemic won’t go on forever. By the fall, we'll be in a much better situation. Mask up and limit time indoors with people not in your household. Vaccines are coming and we're learning more every day about Covid and how to prevent and treat it. 16/

No winter lasts forever; no spring skips its turn.
Hal Borland

17/

When day comes we step out of the shade,
aflame and unafraid,
the new dawn blooms as we free it.
For there is always light,
if only we're brave enough to see it.
If only we're brave enough to be it.

Amanda Gorman, US National Youth Poet Laureate

18/End of thread