Nationally, Youyang Gu estimates there are 4.8 million people with Covid today—1 of every 78 people. 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.”. Avoidable economic decline is grinding. We’ve seen a dramatic increase in the use of Remdesivir and a steady increase in plasma treatment in hospitalized patients with Covid. There’s still so much we don’t know. Virus is surging, and our response remains fragmented. 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. If we do all of these four things well, even if we don’t have a vaccine, we can begin to return our society and economy to a more normal footing. Places that didn’t drive cases down enough to find and stop clusters face the ever-present risk of explosive spread. Nursing homes and other vulnerable congregate settings house approximately 4 million people in the United States. We’re definitely not doomed. Well, just because the data are dodgy, doesn’t mean that the vaccine doesn’t work. The vaccines are highly effective, including for older people (though few frail elderly were included in the studies), and against severe infection. Now, for the most encouraging trend. We’re conditioned to think in dichotomies of A vs. B – but open vs. closed isn’t a true dichotomy. The company plans to manufacture a billion doses this year. We’ll need to make preparations for vaccination, hoping that safe and effective vaccines become available. Yes, we’ll have to adapt our lives for the foreseeable future. Don’t let your mask down. The basic 1-2 punch concept still applies. There’s a big difference if the virus has been spreading from high-risk, aerosol-generating procedures such as sputum induction and bronchoscopy, as opposed to spread in waiting rooms and through other casual contact. , which provided excellent data and visualizations of the state of the pandemic in the US. Now, the disheartening numbers. Good report by the Kaiser Family Foundation, with some key findings below. 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. If we could scale up infusion of monoclonal antibodies for people who are at risk for hospitalization but not yet very ill, we could reduce this number and decrease the stress on our health workers and health systems. 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. Disparities and inequalities must be fought everywhere they exist. That’s not a plan, that’s a catastrophe. And we have to do much better at vaccinating staff. Science is back, and there’s appropriate attention to organization, equity, communication, data transparency, and using all levers of government to fight the pandemic. One of 200 people over the age of 65 have perished as have many others. Sustained, baseline funding is the only way we will ensure we are prepared for the next pandemic. Test positivity across the US is up to 9.2%. But maybe, soon, there will be an end to the completely dysfunctional national response.1 LIKES SHARE. On balance, what we’ve learned is good news, but there are important caveats and implications. Did earlier clades spread then die out? An investigation should be able to determine the likely source and identify those most at risk. New strains are more and more concerning. As parts of Europe and the US show, if you turn your back on Covid, it will come back to bite you. Unless we up our game, Covid will keep winning, keep spreading, keep killing Americans—preventably. We need continuous improvement in testing, isolation, tracing, and quarantine. It won’t be fast or easy, but it will happen. Below is a quick summary of the key findings. Covidview deaths are below the epidemic threshold, but how long will that last? States should also report the proportion of unduplicated people who tested positive, cross-referencing the two types of test.​. some of the information they have. — will become unnecessary. 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. Yes, really, 35%. This syndromic surveillance is an important early warning system that first sounded the alarm in Arizona in late May…​, Death rates have declined to near baseline. I shared some ideas on how Halloween can happen without increasing the spread of Covid. Test positivity is increasing in ALL age groups. 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. Being in a bubble or pod is an important concept, but each bubble is only as strong as its weakest part. Only the Northeast is at all reassuring, and those gains are at risk. Coordinate with states and localities so guidance and policies are implemented within 24 hours of publication. The record 85,000 infections reported for Friday represent only about 20% of all infections. In New York City, it’s on the order of the influenza pandemic of 1918-1919. These findings can be revised or reversed - early in an outbreak, there's a "fog of war" reality. About this, we are 100% certain. We need better tracking of not just genomes but how they relate to epidemiology. in ALL age groups. A horrifying new projection shows that COVID-19 will reduce US life expectancy by 1.1 years, with reductions for Black and Latinx populations 3 to 4 times that, reversing more than 10 years of progress closing the Black-White gap in life expectancy. In the Dakotas, 1 in 8 Black people has tested positive. Positive and negative incentives for staff can increase vaccine coverage. on the company’s South Africa trial reports reinfections with new variant, but provides no data. Dexamethasone, which the president also received, may reduce the risk of death by about a third, but is generally thought to be most helpful late in the course of illness, when a patient’s own immune system, rather than the virus, is causing much of the harm. Deaths follow case increases by about three weeks.​, Wisconsin is a bellwether … including for Covid deaths. It’s been said that in war, truth is the first casualty. Schools are reopening and outbreaks are inevitable. For example: What antibodies should be used? Here’s a sad tale of 2 states. We need to get back to that perspective, urgently, to protect ourselves and our families. Influenza-like and Covid-like illnesses are continuing to increase in much of the country. We have one of the highest cumulative death rates of all wealthy countries. Contact the AJC Editorial Board ... in indoor settings, testing, contact tracing, quarantine and isolation, WHO, via guidance. 2. States have made some progress but much more is needed, and states need money to prepare and implement. Hospitalizations are trending down. It takes rigor, discipline, patience, and working together. Not travel restrictions. At the same time, the rollout of highly effective, safe vaccines has given us the most hope we’ve had for a beginning of the end. This is a high number that is consistent with rapid spread observed. There are still lots of unknowns regarding the AstraZeneca/Oxford vaccine. It’s going to take a lot of hard work over the coming months to get control of the virus. It’s tragic. The NBA's COVID-19 protocol is necessarily rigorous, but it's thus far had a disproportionate effect on teams' training staffs. My mother is 91 years old and used to love to sing in chorus, but there’s no way she can go back to doing that any time soon. ... six times better — than shopping for 30 minutes,” Tom Frieden We should know testing rates for each race/ethnic group and ensure all results come back within 48 hours. Federal health officials issued new guidance on Wednesday that greatly expands the pool of people considered at risk of contracting the novel coronavirus by changing the definition of who is a “close contact” of an infected individual. Like oh-so-much-too-much in our society, Covid hurts the most vulnerable most. Nosocomial transmission (spread within health care facilities), which was a major source of spread for MERS and SARS, has occurred and remains a major risk for nCov2019 – and is also a major intervention point for control. Money, technical capacity, and operational capacity are all needed. I outlined how we can, make progress using a one-two punch strategy. This post-Thanksgiving bump is evident in cases and test positivity. We public health specialists must never underestimate the health and social impact of economic harm. However, they were not masked during several that took place in a cell doorway and a prison recreation room, the report said. Thanks to Dr. Tony Fauci for the clear summary below of the different approaches being used for vaccine development in the United States. With a vaccine and treatment, even more progress will be possible. The failure of federal leadership means we’re not tracking the right indicators. Here’s. Strategic closures. Many of us (myself included) think it is the case, but how well these antibodies protect, and for how long—or even if they protect at all—isn’t known. Positivity in people over the age of 65 increased from 3.6% five weeks ago to 5.2%—a 44% increase. Contract tracing is a core public health function that public health agencies have done for years. Even countries which have done relatively well are now struggling. A weighted ranking of test-intensity and incidence helps. That doesn’t mean masks are 100% protective, it just means that wearing a mask reduces the risk to others. We will need to reduce travel and risky indoor gatherings. Economic pain is real, and deadly. Even with a vaccine, the virus is here to stay. . There is no magic bullet. 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. Antibodies, particularly neutralizing antibodies, may protect at least some people who have recovered for at least some time against getting infected with Covid again. Kudos to Philadelphia for measuring and improving use. Continued spread of Covid in the US will continue to undermine health, jobs, economy, and education. The record 85,000 infections reported for Friday represent only about 20% of all infections. Those who don’t are a small, misguided minority. And vaccines don't work if people don’t take them. Also, in 2021, clean water, sanitation and hygiene (WASH) are not consistently available in about a third of health facilities worldwide. Tom Frieden, former CDC director, calls the new definition a “sensible change.” “Makes a big difference for contact tracing efforts,” tweeted Syra Madad, PhD, an epidemiologist and director of the special pathogens program at NYC Health + Hospitals, a public health system. Each of those 2.5 million years. 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. 9 of 10 people understand the importance of masking up. Tens of thousands of lives and millions of jobs depend on this. Yes, really, WHO. We need to be particularly careful about vaccine safety. It's a continuum, not a dichotomy. More than 1,000 Americans a day have died recently from Covid. It is inevitable that there will be future outbreaks. And in the context of low staff vaccination rates, that would be a deadly mistake. So far, we’ve failed at controlling Covid in the US. “Ending the COVID-19 pandemic”? Once it became clear that he had symptoms, the estimated risk increased to about 10%. First, let’s take a look at the numbers. It's past time to begin conversations with communities, sharing what we know and don’t know and listening to concerns and perceptions. Better a Zoom Thanksgiving than an ICU Christmas. There’s a one- to two-week lag between cases and hospitalizations, as well as between hospitalizations and deaths. describes how the virus can become much more dangerous. We may learn from that. Among people without such a history, the rate is about 1/500,000. And although human immunity against the virus now appears possible, FDA and CDC immunity from political interference is much less so. As I mentioned above, new variants are a shot across the bow. From overconfidence in testing, to lack of basic safety precautions in crowded indoor places, to delayed isolation, incomplete contact tracing, and failure to quarantine, there have been so many preventable missteps. . It’s shameful and inexcusable that the federal government is not publishing data it has on the pandemic. Two authorized vaccines are good, four authorized vaccines will be better. We must double down on protection protocols. We need to test asymptomatic contacts. 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. Establish additional sentinel sites in China to determine what proportion of people both with and without symptoms who attend health care facilities are infected. Because there’s a lag in deaths we’ll first see an increase in cases. Not every state had a bump — protection protocols save lives. White House divisiveness is the best ally the novel coronavirus could possibly have. The more safe we all are, the more safe we all will be. The Johnson & Johnson vaccine looks promising and likely to be submitted for approval to the FDA and approved soon. By being careful now, we’ll have more to celebrate and less to regret in the new year. 2021 can usher in a more connected, empathetic world. Hope for the best, plan for the worst.1 LIKES SHARE, Blog initially published on my LinkedIn profile ( ). Sheltering in place is a blunt but effective weapon: it suppresses spread of the virus but inflicts severe hardship on individuals and the economy. Although this is not proven, it’s clear that nosocomial transmission is occurring.). Spending time outdoors is great. In the medium term, decide whether live markets should be regulated far more strictly, or closed completely. that could be implemented by city, state, and national governments — with wide consultation within society. Dexamethasone and other steroids—cheap, available meds—reduce the likelihood of death by as much as a third. Vaccine protects against 3 different strains of polio, up to 9 of HPV, and up to 23 different pneumococcal strains. They had an indoor concert with everyone wearing masks, but repeated it 3 times—with distancing, with some distancing, and without distancing. The plain truth is that most places didn’t stick with the program long enough to get cases to a manageable level, and now masking and distancing aren’t being done reliably. Reported cases don’t necessarily reflect community risk. But doing that while allowing the virus to spread among the young is an impossibility. Scaling up antibody treatment might help, but, like vaccines, rollout has been botched. Imagine how many fewer deaths the US could have had if the Federal government had focused right. Arizona has stabilized at a high rate. Vaccines are coming. Down With the Covid-19 Virus, Up With the Economy, Blog initially published on my LinkedIn profile (,, Resolve to Save Lives released a four-level, color-coded alert system for COVID-19. Rapid isolation reduces secondary cases. More than 15,000 dead. On Saturday there were at least 200,000, possibly many more than that. 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. Top performing states include West Virginia (8% coverage) and Alabama (4%). Inside—same as the concert, we don’t know. Doing real-time research in an emergency is hard but important. Community engagement, empowerment, and leadership is crucial for progress. In an @NEJM article from earlier studies, the immune response continued to build for 57 days after vaccination. We ardently hope that deaths won’t increase as much as in the past, due to better care, fewer overwhelmed hospitals, and the use of dexamethasone and possibly other treatments. Inequity causes crushing burdens on those people who are unfairly treated, but it also harms everyone. 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. We can control Covid, but to do so we must chip away at it. 6) Track the virus closely to implement physical distancing again if virus spread could overwhelm our health or public health services. Civic responsibilities include not harming (e.g., infecting with coronavirus) others, staying informed, paying taxes, participating in your community. 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. 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. See the interesting trends from commercial labs in this graph below. Now we’re at 100,000. By investing in public health protection, we will honor those lost to this pandemic and protect those at risk from the next. 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. Handshakes are probably out for a while. 6) It’s crucially important to protect the health care workers and other essential staff who are the front-line heroes of this war. Let’s learn, connect, and empower. Let’s not get ahead of ourselves on vaccines. Covid Epi Weekly: Turning the Corner on Covid in the US—Into an Oncoming Tsunami of Cases, Hospitalizations, and Death. But only time will tell. This is 100% certain. So yes, if you don’t use masks correctly and consistently, they don’t work. Two weeks after 40% of those over 60 who had been vaccinated, the number of critically ill in the age 60+ group grew by 7% compared with the previous week’s growth of over 30%. Here are the positivity rates in hotspots, according to Governor Cuomo (Media statements from the city government have shockingly lacked basic information on the number of people tested and positive cases, as well as on trends). For Ebola, interventions were in five domains: command and control, surveillance and epidemiology, case management (including laboratory testing), essential health services, and effective communication.​. That’s a 10-fold difference. These are important but not well known documents about vaccination. By signing up you agree to our Terms of Use and Privacy Policy, CDC expands definition of who is a ‘close contact’ of an individual with covid-19. Thanks to @NYTimes for working with @ResolveTSL to provide better and more actionable information on Covid risk in every community. They quit rather than risk covid at work. We can do this sensibly, keeping schools, childcare, universities, shopping, barber shops, and other places open—but ONLY with rigorous safety measures and modifications. SHOW US THE DATA! Because of that, virtually everywhere, the risk of explosive outbreaks remains. Links to articles cited and linked above: ​A Novel Coronavirus from Patients with Pneumonia in China, 2019, New England Journal of Medicine, ​Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, The Lancet, ​Another decade, another coronavirus, New England Journal of Medicine, ​Coronavirus infections, more than just the common cold, JAMA, ​A Novel Coronavirus Emerging in China – Key Questions for Impact Assessment, New England Journal of Medicine, ​A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster, The Lancet. 10) We can never again be caught so underprepared. Meat packing and agricultural outbreaks are part of, but only part of, the factors driving the increase. We've never used this type of vaccine in people before. Is it possible for the US national response to have violated these principles more than it did? They had an indoor concert with everyone wearing masks, but repeated it 3 times—with distancing, with some distancing, and without distancing. Strains that increase the duration of shedding would have an evolutionary advantage and might be more deadly. 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. Both presidential campaigns have relied on the CDC’s previous definitions of “close contact” to determine when candidates and staff members need to be quarantined. It’s spent less than a year living with humans and we’re learning more every day. Especially if a hurricane (read: more infectious variants) may hit you soon. Health care workers are exhausted and at risk. For each recognized outbreak with transmission links, what are the most likely modes of spread and what control measures have been tried, with what effect? These numbers will continue to rise.​, Many thanks to Covid Exit Strategy for their great work tracking the situation in each state. Wide swaths of the country remain at extremely high risk, with only isolated pockets of low or even medium risk. The First Cluster - Epi Weekly Update October 12, Masks are particularly important. If vaccination is run like a grocery delivery rather than a comprehensive campaign, it won’t succeed. How is this being evaluated for? Be empathetic. There have already been. We need more science and less politics. It’s crucial that there be a smooth handoff to the incoming Biden administration — this is going to be the most complicated vaccination program in the history of the United States. It’s misguided to debate whether the elderly or essential workers should get vaccinated first. Cases are surging in much of the US. Get them out fast. We will look back and ask why we didn’t do more. treatment of heart disease) caused by Covid (such as South Korea). For example, the federal government has failed to support state and local microplans. There are times when older adults and people with serious health conditions should be extra careful to avoid infection. by the Kaiser Family Foundation, with some key findings below. 4/10. There were 215,000 more US deaths March-July than baseline. We don’t know if they will be effective, safe, accessible, trusted. “Only that day dawns to which we are awake. ​Look at Staten Island. There are too many cases to test, trace, isolate. Furthermore, Dr. Tom Frieden, who was the Director of the US Center for Disease Control (US CDC) and worked closely with Dr. Fallah, during the 2014/2015 Ebola outbreak in West Africa, stated in the recent Wall Street Journal that Liberia, hard hit by the Ebola epidemic in 2014, was one of the first countries to … Saying cases are up because of more testing is like saying gravity isn’t real. I shared in Fox News the five things we must do to prevent a surge in Covid deaths. Given crowding and alienation from government, spread within the community is a near-inevitability, but wider spread in NYC can be prevented if the city does much better at rapid isolation and effective contact tracing. The simple truth is that in our increasingly interconnected world, disease spread anywhere is a risk everywhere. suggests that neutralizing antibodies in people may be protective against re-infection, at least for some time for some people. Animal studies suggest that infection protects against re-infection, at least in these animals, at least in a laboratory model, at least for a few weeks. What could possibly be more important than preventing disability and death? It was surreal to walk through empty halls of Congress and speak in front of masked representatives, but this reflects our new reality. This is not a complicated idea: The way to protect the vulnerable is to have fewer infections, not more infections. We need to test asymptomatic contacts. What dose? Some of the challenges are understandable – the vaccines are new and difficult to store. 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. So our lower number is nearly double what it was at any prior peak. Oh, and for the mRNA vaccines, what adverse events do we even look for? 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