Health Officer, Public Health - Seattle & King Co, WA; ID doc; Prof. Medicine/Infectious Diseases, U Washington; FACP, FIDSA. Personal = not representing PHSKC.
Straight Talk About the New Variant COVID-19 Strain. As much as I regret saying it just when so many need & deserve a break, the new variant COVID-19 strain is a serious problem. It’s likely a matter of time before it arrives here & we need to beware & prepare. Here’s why. 1/
No team has done a better job of avoiding the dangers of CoV-19 than these Seahawks. The team incredibly went the entire 2020 season without a single COVID-19 case…Now, coach Pete Carroll says the entire team is getting booster shots today.
We hear/read a lot about "breakthrough" infections & the % of people getting or hospitalized or dying with CoV-19 that are vaccinated. But this tells us nothing about what is most important: how the risk changes for vaccinated people compared to unvaccinated people.
1/
“COVID’s potential to damage the brain is…one more reason to…avoid getting this disease. Masks & social distancing still are important in crowded, indoor public spaces…vaccines…reduce the risk of…long-term damage from COVID, incl damage to the brain.”
Excellent summary of where we are w/long CoV from
@EricTopol
“Right now, our best chance to prevent long COVID is to not get COVID or to avoid getting it again. That’s why it’s vital to stay COVID-cautious now, and not capitulate to the notion that we should “live with COVID.”
👉This is important: THE VARIANT STRAIN SPREADS THE SAME WAY as other COVID-19 strains, IT'S JUST BETTER AT IT. For this reason, WE NEED TO GET BETTER at the same effective ways of stopping the spread until enough of us are vaccinated. 10/
“If we started at 2 air changes/hour & we added 8 air changes/hour, we’re roughly getting about an 80% reduction in inhalation dose with that single Corsi-Rosenthal Box…a huge reduction. That’s like everybody wearing pretty decent masks in the classroom.”
@trvrb
Outstanding post by an outstanding scientist revising conclusions of earlier work to reflect ongoing accumulation of new information. Science in action.
“Two families who attended the party & later tested positive for the coronavirus returned to work afterward, infecting at least 9 of their co-workers, the contact tracing map shows. Those co-workers subsequently infected their parents, kids & spouses.”
“Federal Reserve chair Jerome Powell struck a particularly somber note at his press conference earlier this week when he mentioned that one reason the labor market is so tight right now is that many workers died from COVID-19.”
Age-adjusted CoV-19 rates for past 30 days in King County, WA:
Compared to fully-vaccinated people, those not fully vaccinated are:
- 6 X more likely to test + for CoV-19
- 37 X more likely to be hospitalized for CoV-19
- 67 X more likely to die due to CoV-19 related illness
3/
That means decreasing activities & the number & duration of contacts w/others outside the home (keep it brief), always wear face masks when around non-household members indoors, avoiding crowded/poorly ventilated indoor spaces, improving ventilation in homes & workplaces... 11/
“The growing body of research now confirms…CoV-19 should be considered a virus w/ a significant impact on the brain. The implications are far-reaching, from individuals experiencing cognitive struggles to the potential impact on populations &…economy.”
Timing matters when using at-home antigen tests for CoV-19: “Estimated rapid antigen test sensitivity was 30.0% - 60.0% on the 1st day, 59.2% - 74.8% on the 3rd, & 80.0% - 93.3% on the 4th.”
If neg, retest in 48 hrs (if before day 4, test again on day 4).
Remember COVID-19 can spread from people that look & feel well. Don't let your guard down around friends or relatives just because they look healthy - they may not know they are infected but can unintentionally spread COVID-19. 14/
"Masking is 100% mandatory as far as I'm concerned...Esp [bc] you have no idea which patient is going to end up being vulnerable to the disease, who has a compromised immune system or who has high risk past medical history that makes them really at risk."
“One year later, the Seattle area has the lowest death rate of the 20 largest metropolitan regions in the country. If the rest of the United States had kept pace with Seattle, the nation could have avoided more than 300,000 coronavirus deaths.”
“Unfortunately, when states or countries proclaim that we just need to live with the virus and end all restrictions, many people interpret that message as meaning the pandemic is actually over — for good. That would be a fantasy…”
However, faster spread leads to more people becoming infected in a shorter period of time, and that’s dangerous. A rapid increase in people with COVID-19 causes fast-growing outbreaks & more people infected means more requiring hospitalization & more people dying. 8/
"At every turn, Americans have failed to grasp just how much indoor air matters for this pandemic. HEPA filters would be in every restaurant already if that’s what customers truly wanted, or if governments required them..." 1/
Most important to know at the moment is that the new strain spreads more easily (that is, faster) than other strains - it’s more contagious. This means if exposed, your risk of becoming infected is higher with the variant strain than with the previous strains. 5/
...keeping 6 feet distance (or more when possible), & paying attention to environmental cleaning & hand washing. Consider looking onto germ-killing UV technology for buildings in addition to improving ventilation (see CDC site below). 12/
Brief update 🧵on the Omicron surge in King County, WA. We are seeing record-breaking numbers of cases - currently 2.5 times our previous peak incidence & rising.
Hospitalizations began to increase a week after cases, but not at levels of past surges currently.
1/
Some good news: at this time, people infected with the variant strain don’t seem to have more severe illnesses than with previous strains. And it’s likely that vaccines will still be highly effective (although this needs to be monitored). 7/
Ultimately, vaccination is our best defense but at this time it can’t be our only defense. When you are able, get vaccinated to protect yourself & others. Will update as more information about the variant strain is available. Some key resources follow. We can do it. 15/
However, at least one newly recognized strain, often called B.1.1.7., “SARS-CoV-2 VOC 202012/01” or an "N501Y" strain, has been shown to have multiple mutations that are changing the way the virus behaves in important ways. 3/
If you’re exposed to COVID-19, please quarantine & if ill, isolate. Please don’t go out - to work, socialize or elsewhere - if you’ve been exposed or have symptoms. Travel is risky – best to avoid it if you can but if you must, take precautions including quarantine & testing. 13/
And if infected with the variant strain, you are more likely to spread your COVID-19 to others. Each person infected with the variant strain spreads it to more people than they would have if infected with previous strains. 6/
This B.1.1.7. variant has been found in many countries, most notably the UK, & in several US states but not in Washington state yet, although it may very well be present at low levels & undetected. Once it hits a critical threshold, it will spread rapidly unless we slow it. 4/
All viruses mutate resulting in new strains that vary from their ancestors. These are called variant strains. Most coronavirus mutations don’t fundamentally change how the virus behaves or affects us. 2/
Oh, yeah! Out for a bit of exercise (ouch) fully-vaccinated 2 weeks after dose 2 & NO MASK! The snout is out! And such a nice breezy day for it in the beautiful PNW. Vaccinate = Liberate.
We should plan for the worst-case scenario which involves a large second peak of cases in the fall of 2020...this pandemic will not be over soon and people need to be prepared for possible resurgences of disease over the next 2 years.
This can increase suffering in our community & overload our healthcare system, further increasing the danger for bad outcomes from COVID-19 & from other serious medical problems if hospitals can’t provide their usual level of care. 9/
@aetiology
If the post is sincere it’s not deserving of mockery but a question many people who don’t share our professional backgrounds might naturally wonder about.
King County friends, this is getting serious. Cases rising, holiday coming & the risk higher than it's been in months. Critical to avoid crowds, minimize close contacts, use a face mask. COVID-19 is smart as ever (but are we?) Do the right thing and care.
Friends and community members: Please celebrate smart and safe! Remember that we are in the middle of a dangerous spike in COVID-19 cases and be sure to wear a mask, distance from others, & avoid crowds - esp. indoors during your observances of the day's events.
Delta’s rise is fuelled by rampant spread from people who feel fine: “As a result, 74% of infections with Delta took place during the presymptomatic phase — a higher proportion than for previous variants.”
“93% of staff who have contracted the virus did so in the community -- away from the job -- and that the majority of those who contracted the virus at work did so while eating in a break room with a mask off.”
“...conference organizers should take reasonable steps to decrease the risk...by optimizing venue indoor air quality…opting for outdoor venues when possible, minimizing crowding, & providing N95 & KN95 masks for those who want to reduce their risk,”
1/ The airborne transmission route for respiratory infections is potentially the dominant mode of transmission, and there are numerous cost-effective, performance-enhancing solutions to minimize the risk of infection transmission.
Message on behalf of King County hospitals:
Please do not come to emergency departments & urgent care clinics just for CoV-19 testing - they are overloaded caring for ill patients & cannot provide testing for people who do not need emergency care.
1/
Everyone can help protect kids & the healthcare system w/actions effective against RSV, flu & CoV-19: wear well-fitting masks in public indoor spaces; get flu & CoV-19 vaccines; improve indoor ventilation; keep infants away from ill people; get treated for CoV-19 if eligible.
The surge in
#RSV
cases is overwhelming pediatric hospital systems, says Tina Tan, MD FIDSA of
@LuriePedsID
, adding that many community hospitals have closed their pediatric unit, making it difficult for children to get care.
Outstanding post by an outstanding scientist revising conclusions of earlier work to reflect ongoing accumulation of new information. Science in action.
On Feb 29, using the genetic sequence of the first community case of
#COVID19
in Washington State, I made the claim that the Washington State outbreak descended directly from the Jan 15 arrival of the WA1 case with direct travel history to Wuhan. 1/18
1/ Breaking down breakthrough infections: a short 🧵.
As more people are vaccinated w/CoV-19 vaccines, we hear more about so-called breakthrough infections being reported among vaccinated people, which can be confusing.
Congratulations to the Seattle Seahawks for winning the most important competition of the year and being the only team in the NFL without a confirmed COVID-19 infection.
@Seahawks
The N.F.L. Had Over 700 Coronavirus Positives. The Seahawks Had None.
If you’re wondering if you really need to stay home and avoid ALL non-essential contact, this should straighten you out: State preparing to make life-or-death decisions if coronavirus overwhelms health care system
Over the next 6 months in King County, IHME estimates that a vaccine verification requirement at restaurants, bars, & gyms alone could prevent between 17,900 and 75,900 infections, between 421 & 1,760 hospitalizations, and between 63 & 257 deaths.
If low-risk people don’t socially distance, then the entire containment process is not effective. Social distancing is a responsibility. It’s not about panicking and quarantining to protect one’s self, but to protect others around you.
Increasing concern re: fall/winter surge from one or more variants on the horizon that may escape immunity from vaccine & past infections. Which is why we need a vaccines-plus strategy: improve indoor air, masks for indoor public spaces, testing, treatment. Simple. Saves lives.
"The
@IHME_UW
@UW
and other experts, including Dr. Anthony Fauci, the nation’s top infectious disease expert, foresee a wave beginning to swell in late October, and peaking in late December or January."
#COVID19
is not over.
Test or no test, if you've got fever or cough, stay home until you're well and if you're well, stay home and avoid non-essential contact with others. It will save lives. Really.
Slow federal action to get coronavirus tests to Seattle doctors has created a bottleneck of patients who want to be screened, and a public health system that's struggling to catch up with the spread of the disease.
@AshishKJha46
Is 2000 deaths a week low?
That would be over 100,000 deaths per year.
More than double the number of deaths seen in the worst influenza season in the past 10 years…
“Citing high-quality filtration systems aboard planes, Southwest Airlines CEO…stated that "masks don't add much, if anything, in the air cabin environment.” But experts strongly disagree.
After a recent x-country flight I had 2 exposure notifications.
Among not-fully-vaccinated people, age-adjusted HOSPITALIZATIONS increased from 1/100,000 people/day to 7/100,000 people/day vs. an increase from 0.04/100,000/day to 0.2/100,000 people/day for the fully vaccinated.
6/
“... researchers said college towns in general should brace for a sharp increase in cases as students return for the fall semester.” Coronavirus is spreading in fraternity houses, raising concerns for campuses opening this fall.
We must decisively — and apologetically — disabuse the public of the myth that, barring a miracle, the Covid-19 pandemic can possibly be nearing its end in the next few months.
1/ A few thoughts on CDC’s new mask guidance, vaccination & CoV-19 risk.
Vaccinated people have a VERY high level of protection vs CoV-19 compared to unvaccinated with a MUCH LOWER chance of getting sick if exposed or spreading CoV-19 to others.
When considering lifting mandates, it's important to recognize where we actually are as well as where we think we're going. In King Co, WA, we're headed in the right direction (👍), but cases, hospitalizations & deaths currently remain well above past pandemic peaks (👎). 1/
New COVID-19 Outcomes by Vaccination Status dashboard is up! Compare rates of CoV-19 cases, hospitalizations, & deaths for vaccinated & unvaccinated & rates by vaccine status, age group & geography. Thanks to our great analytics & epi team.
Seattleites get it: we’re in this for the long haul & ongoing precautions with distancing, handwashing, mask use and protection of high risk populations will be the new normal for the foreseeable future. Don’t let up.
When asked what changes they anticipate making for the next year or longer after the lockdown is lifted, a majority of Seattle residents say they will continue to avoid social gatherings and physical contact — in other words, people.
From a celestial perspective, the darkest days of the year are behind us & we can look forward to more sunlight each day. Let's do everything we can to put the darkest days of COVID-19 behind us as well. 1/n
"CoV-19 is a public health threat that affects everyone, but it does not affect everyone equally...Unlike the Urgency of Normal, the Urgency of Equity recognizes the desire for normalcy without giving short shrift to society’s shared destiny."
@JenniferNuzzo
Authors’ conclusions: “The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions…”
@jscooben
@KCPubHealth
@SeattlePD
Public Health - Seattle & King Co opposes the use of tear gas & other respiratory irritants based on the potential to increase COVID-19 spread.
In the recent Delta surge, the age-adjusted rate of CASES among people who are not fully vaccinated increased from 7 daily cases/100,000 people at the beginning of July to 77 daily cases/100,000 people as of August 17, an increase of 70 new cases per day per 100,000 people.
4/
CDC no longer recommends universal masking in healthcare facilities unless local CoV-19 transmission is high (>/= 100/100k/7d). This is a problem for several reasons.
But first, most of US has high transmission currently, so no change at the moment. 1/
If you test positive for CoV-19 in WA state, you can get a free telehealth appointment to see if you need treatment & if yes, help you get if it & stay out of the hospital👇🏼
New telehealth option launched to expand COVID-19 treatment access.
“There is no time limit to wearing a respirator, says N95 manufacturer 3M. They are designed for multiple uses and can be worn until they are dirty, damaged or difficult to breathe through.”
“Ending routine masking in hospital settings is a dangerous move. It puts patients and staff at risk for infection, and its potential long-term effects. It also exposes hospitals to the risk of liability.”
Despite the most unwelcome Omicron surge, there is good news: vaxxed/boosted have excellent protection from serious illness.
Omicron will pass & things will improve. We can limit its damage.
I'm looking forward to, & wishing all, a much better, healthier, & more peaceful 2022.
“It is not a violation of...federal privacy law to ask your doctor, dentist or other health-care workers, as well as people who provide close-contact services...hair stylists, aestheticians, massage therapists & physical trainers, if they are vaccinated.”
Although more studies needed to confirm this & the severity & natural history of brain changes after CoV-19 are not clear, we know enough about potentially serious post-CoV-19 conditions to say avoiding even mild CoV-19 is a very good idea.
1/
Well done King County, WA! 92% residents 65 yrs & older w/ 1 or more doses, 82% complete series! 2/3 of 16 & older w/ 1+ doses; 46% fully vaxxed! Now we have to do whatever we can to bring protection to more young adults, decrease community risk & get back to more normal life!
To determine the risk, you need to know how frequently these outcomes occur in vaccinated & unvaccinated groups (the rates of disease in each group). To compare most accurately, we should compare vaccinated & unvaccinated people of similar ages (adjusting for age).
2/
What does this mean? We need a vaccine-plus strategy to prevent CoV-19: updated boosters, improve indoor air, masks in public spaces, widespread access to testing & treatment, good surveillance. This is not the time to relax these simple precautions.
The BA.4.6 variant now accounts for >12% of US cases, steadily rising. Its Arg346 mutation, shared w/ many of the new variants, makes it more immune evasive than BA.5, resistant to Evusheld prophylaxis and potential of reinfections after BA.5
@yunlong_cao
Lots of soothsayers predicting Omicron peaking soon in the US. That would be most welcome, yet begs the question, what comes next? Shangri-La?
S. Africa (graph ⬇️) took a month to peak & now, 3 weeks post peak, incidence is still is 25X above the pre-Omicron baseline. 1/
“Americans don’t need to accept…disease surges & overrun health systems as an inevitable new normal. Instead, the country should…reinvigorate public health strategies in response to these threats to the health of our communities.”
During this same period, the age-adjusted rate of CASES among fully vaccinated people increased from 1 daily case/100,000 people to 10 daily cases/100,000 people, an increase of 9 new cases per day/100,000 people.
5/
I strongly encourage all KC residents (not just unvaccinated people) to continue wearing face masks when in indoor public spaces & strongly encourage KC businesses to continue their policies to ensure all customers & workers wear masks when in indoor public spaces.
Public Health – Seattle & King County is considering whether ending the indoor mask mandate is the best option in King County at this time and if additional guidance or clarification is needed. We will provide an update later this week.
Paul Farmer: "You have to look at what's happening to the patient...& think about ways to address social disparities. If there's food insecurity...you provide food...if patients drop out of treatment, you provide transportation...or...send community health workers to the patient"
“We should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal prepandemic behaviors.”
I LIKE THESE NUMBERS: There are now more King County (KC), WA residents protected against COVID-19 through vaccination than have been infected by SARS-CoV-2 since the outbreak began. 1/
44% of secondary cases were infected during the index cases’ presymptomatic stage...Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.