Amesh Adalja
@AmeshAA
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Infectious disease MD (also CCM & EM) focused on pandemics, emerging infections, biosecurity, biotech
Pittsburgh, NYC
Joined December 2010
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Just saw a patient with fever and body aches with 2 negative SARS-CoV2 tests but is positive for influenza B. One of the B lineages has been thought to have almost went extinct, this person was vaccinated so curious as to what the vaccine strain match is
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“G4’s inclusion of genes from the 2009 H1N1 pandemic “may promote the virus adaptation” that leads to human-to-human transmission. Therefore, ‘It’s necessary to strengthen the surveillance’ of Chinese pigs for influenza viruses”
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Breakthru
#COVID19
“infections” are expected. Vaccines aren’t bug zappers. Some low level infection is likely to occur alerting immune system of intruder. These “infections” are mostly non-productive, aborted, & medically insignificant. Stop testing the asymptomatic vaccinated!
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"With 140,000 people tested, the country’s mortality rate is just over 0.6%" -- this is more accurate than the severity-biased samples from other countries; increased testing will illustrate this everywhere
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I anticipate being exposed at the hospital very soon and I don’t know how the system can function if healthcare workers are quarantined for 2 weeks. This needs to be more rationally focused
The reports of first responders and healthcare workers being quarantined after exposure to COVID19 patients are concerning. This will not be sustainable as case # grows. We will have to monitor for symptoms daily and isolate the sick.
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“Testing people who have been vaccinated and have no symptoms could extend this pandemic forever” —
@MonicaGandhi9
and
@MartyMakary
make an excellent point that needs amplifying
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Excellent instagram post by
@JohnsHopkinsSPH
illustrating how our memory T-cells see the
#COVID19
omicron spike — they can handle it and that’s why immune individuals are protected against severe disease
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“It’s often normal to experience mild fatigue or weakness for weeks after being sick & inactive and not eating well. Calling these cases long Covid is the medicalization of ordinary life”—good piece by
@MartyMakary
. Need to get specific w/ this dx
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“the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly graver than the direct toll of the virus itself”
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“The research revealed a previously hidden spread of the virus that might have been detected if aggressive testing programs had been put in place.” — this is why having testing restricted to those who traveled to China was wrong
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If the Belgian Omicron case had no contact or link with anyone from or neighboring countries it suggests, which is almost always the case with respiratory viruses, that it escaped from where it originated even before noticed. Travel bans don’t make sense.
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I wrote a piece on
#COVID2019
that I published on
@medium
. It details what I personally think are the right actions to take, how to face this pandemic, how to weigh the benefits and risks of shutdowns, and ensure hospitals are adequately prepared for surge
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“Neck fleeces, also called gaiter masks & often used by runners, were the least effective. In fact, wearing a fleece mask resulted in a higher number of respiratory droplets because the material seemed to break down larger droplets into smaller particles”
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“The main observation that we have made over the last two weeks is that the majority of patients in the COVID wards have not been oxygen dependent. SARS-CoV-2 has been an incidental finding in patients that were admitted..for another..reason”
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“We cannot keep [boosting] and say: ‘We’re going to prevent colds in everybody,’ ”
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“An estimated 10% of people with Covid-19 are responsible for about 80% of transmissions”
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Exactly. When the virus can no longer threaten hospital capacity, it’s much more manageable and recommended mitigation techniques need to change with the lower risk of hospital capacity concerns
More than 40% of those over age 65 are vaccinated with at least one dose. We need to start considering that population is becoming less vulnerable to covid. Against that backdrop, we should judge mitigation and the risk of infection differently as the vulnerable become protected.
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“I’m very doubtful that 3 people in highly protected circumstances in a level 3 laboratory working on coronaviruses would all get sick with influenza that put them in the hospital..all in the same week, & it didn’t have anything to do with the coronavirus”
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I occasionally do emergency dept shifts at my hometown hospital outside of Pittsburgh (I'm also an EM physician in addition to ID & CCM).Today, it was
#COVID19
patient after patient. It's not sustainable for community hospitals. Actions have consequences and this is the result
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As a healthcare worker & an infectious disease doctor vaccinated with the Pfizer vaccine I don’t know if I should follow the ACIP panel booster recommendation or the
@CDCDirector
’s modification. What data did she weigh heavier than the majority of the ACIP?
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I suspect like what has occurred in Washington there are other previous deaths (as well as recovered individuals) from pneumonia across the country caused by
#COVID2019
that went undiagnosed because of no travel link
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Instead of focusing on and emphasizing the 5,800 why not focus on and emphasize the 99.993% of vaccinated individuals that this didn't happen to ??
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How can anyone afford to undertake the tremendous risk of pursuing this type of research or investing in it if we live under a legal regime where, if they are successful, their products can be seized from them by whim ?
BREAKING: U.S. will back proposal to waive patent rights and boost Covid-19 vaccine production
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This is the predictable negative consequence of the ill-advised travel bans (which should be rescinded immediately). South Africa deserves praise for alerting the world, not punishment. If they’re unable to secure reagents for important experiments on Omicron we are all worse off
Today, I spent a big part of my day talking to genomic and biotech companies as soon we will run out of reagents as airplanes are not flying to South Africa! It will be 'evil' if we can not answer the questions that the world needs about
#Omicron
due to the travel ban!
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In the earliest days of the pandemic I remember multiple patients I knew were likely to be
#COVID19
positive but I was not permitted to test them. Undetected chains of transmission likely began this way and were only noticed when they spilled into hospitals
Hopefully in future epidemics, leaders will see the initial testing strategy detailed here as wrong path. In Italy, US, elsewhere, restricting testing to only those who travelled to China, even when disease suspected by doctors, badly set back the response
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The entity known as Navarro shouldn’t even be allowed to be in the same room as Dr. Fauci
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Today at the hospital I came across an HIV patient who has been admitted for 2 weeks for mental status changes..recently worsened and is now
#COVID19
positive. Acquired in hospital. This is why healthcare workers must be vaccinated as a condition of employment
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“Had we had done more testing from the very beginning and caught cases earlier we would be in a far different place.” —
@JenniferNuzzo
. This is exactly why diagnostic testing is a key pillar of pandemic preparedness & explains our situation
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How is this even debatable? Vaccines are going into the trash can everyday. They should unequivocally be offering vaccine to migrants. This is what happens when politicians, with their short-range unprincipled nature, inject themselves into an infectious disease emergency
Biden administration again debating whether to provide COVID vaccines for asylum seekers and undocumented immigrants
@priscialva
discusses
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Working in my hometown emergency department, frustratingly seeing unvaccinated
#COVID19
patients. Had confrontation with unvaccinated healthcare workers sparking a complaint against me for my strong advocacy for healthcare worker vaccine mandates. It was well worth it.
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In this piece I am quoted about masks on planes for
#COVID19
— I think planes have high enough air exchange to be one of the lowest risk places. There’s not a need for continuing the govt mandate.
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This illustrates the complete folly of travel bans. It was predictable. They cause so many negative consequences and have little value. Politicians love them because they can say they’re doing something even when it is 100% the wrong action to take.
JUST IN: Omicron COVID variant was in Europe before South African scientists detected and flagged it to the world
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“The vaccines also saved the U.S. $1 trillion in additional medical costs.”
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“As a result of these efforts, cervical cancer rates among vaccinated girls and young women have decreased by nearly 90 percent since 2006, potentially saving thousands of lives.”
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A very sound policy that other countries should adopt to find mild cases and non-travel related cases
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“We urge public health and school officials to educate communities on one-way masking, emphasizing personal choice regarding self-protection and supporting those who choose to remain masked.”
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“Deadly diseases such as measles, tetanus and whooping cough are on the rise in Ethiopia's Tigray region”
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“White House doctors have not informed the D.C. Department of Health of any of the positive test results — a necessary step before contact tracing and quarantining can begin”
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"You know, this has been a mismanaged situation every step of the way..It’s shocking. It’s unbelievable—the fact that we would be among the worst in the world” [and on the convalescent plasma overstatement]“This is 3rd grade math. I mean, are you kidding?”
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“there is little a vaccinated person should be discouraged from doing”— agree with Dr
@MartyMakary
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That a heroic physician needs increased security is a testament to how the Dark Ages mentality — which thrived during the epidemic-littered medieval period — is still alive and well with this pandemic.
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How is he priority group 1a? Many of my colleagues and I are not vaccinated yet but have to see
#COVID19
patients continually. Stick to the priority groups and don’t let bureaucrats and politicians skip the line
Acting Secretary of Defense Christopher Miller receives vaccination at Walter Reed.
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“‘It’s very, very rare’ to get reinfected”
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“‘The message we received in previous administrations was, you guys are the scientists,’ the employee said. ‘That's not the case this time. If the science that we are offering up contradicts a specific policy goal, then we are the problem.’”
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"In NY state, hit by the largest US cluster of cases, the Health Dept is accelerating regulations to get nursing students certified to work more quickly & is asking retired doctors & nurses to offer their services"-all states should be preparing to do this
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I do think
@tedcruz
’s idea regarding FDA reciprocity with other countries could be a crucial tool in pandemic preparedness, especially with the diagnostic devices we need
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“So I said to my people, ‘slow the testing down’”— this is massive scale evasion & what has magnified the impact of this pandemic in the US. That it can be mentioned by him openly in such a manner is testament to how wrong the approach has been and will be
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Dr. Fauci is an icon, a genius-level infectious disease physician, a major force for science and rationality, and a role model. Those that attack him reveal their own character.
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“A cruise line medical officer said Saturday that the man who died brought the virus with him when he boarded the Grand Princess”— this means, as many of us have been saying, that community spread is likely wide in the US and will only get more prevalent
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I don’t think that name is very useful and connotes something about the variant that is not true
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Excellent piece by
@MonicaGandhi9
on how to gauge
#COVID19
impact in the context of cases decoupling from hospitalization
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“Nearly one in four cancer patients reported delays in their care because of the pandemic”— this is an important phenomenon that merits a lot more attention than it’s getting
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"Giving a booster to vaccinated people is not going to control Delta. What’s going to control Delta is vaccinating unvaccinated people. That is the bottom line.” -- I agree completely
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“A pandemic is a lot like a forest fire. If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can spread quickly beyond our ability to control it."
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"The plummeting case numbers in late April and May weren’t the result of vaccination alone, and they came amid a loosening of both restrictions and behavior." -- important point by
@MartyMakary
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“almost every death due to COVID-19 in the U.S. is now preventable and said the administration was ‘laser focused’ on reducing illnesses and deaths in the country”— laser focused would mean targeting boosters to the high risk
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“Concerns have risen about the United States becoming stuck in “a perpetual state of emergency.” “As we transition to endemic Covid, we need to change our understanding of what a success is, what target we’re aiming at.”
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“The
@gatesfoundation
, could mobilize faster than govts to fight the coronavirus outbreak”—
@BillGates
-genius innovative producer who has already changed the lives of billions forever w/ his unrivaled ability-this is another example of it
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“In fact, students in most grades showed slower than average growth in math and reading, when compared with students before the pandemic. That means learning gaps created during the pandemic are not closing — if anything, the gaps may be widening.”
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“This is so frustrating, this booster discussion. I don’t think boosters will have a major impact on the arc of the pandemic.” —
@DrPaulOffit
; Agree 100%
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“Patients with flu-like respiratory systems who test negative will be tested for the new coronavirus”— this is the most important action to take as it will provide information about mild cases and whether the virus has been here circulating
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Since I was a child I have been fascinated with infectious disease heroes, beginning with Pasteur. This mug (I received as a Xmas present) won’t give me his intellect, virtue, or presence of mind but it will be reminder of what is possible & why I love infectious disease
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“China's Central Military Commission approved the use of the vaccine by the military on June 25 for a period of one year, CanSino said in a filing.”
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This is the model for the world
Taiwan has hit 200 days without any domestically transmitted cases of COVID-19, highlighting the island’s continued success at keeping the virus under control even as cases surge in other parts of the world.
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"We've got to expect that businesses must reopen and schools must teach again. Whether it's travel or sports or live entertainment, we're going to have to return to some semblance of normalcy." -- Dr. David Ho (whose TIME Man of the Year cover I framed)
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I think Detroit citizens should decline the mayor, saying others are better
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“Regarding the most dangerous outcomes from disease, recent research from the CDC indicates that—shot for shot—the immunocompromised achieve most of the same benefits as healthy people”
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My usual storage closet/office I sit in at this hospital was occupied and I had to improvise fast
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“Dr.
@eliowa
& his colleagues expect that more research will show shields to be superior to cloth masks, not only because shields provide full face protection but as they are nearly impossible to wear incorrectly” — I think this is a better option
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“The US military's National Center for Medical Intelligence (NCMI) compiled a November intelligence report in which ‘analysts concluded it could be a cataclysmic event’”— November ! Want to know what they saw back then to key them in to what was occurring
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Import to recognize XBB.1.5 is more likely to infect people who are have been vaccinated or already had COVID-19 *versus other variants* not the unvaccinated (seeing this tweet get misread)
Omicron subvariant XBB.1.5 now accounts for 73% of all sequenced COVID-19 cases in NYC. XBB.1.5 is the most transmissible form of COVID-19 that we know of to date and may be more likely to infect people who have been vaccinated or already had COVID-19.
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The new H3N2 influenza clade is poorly neutralized by this year’s
#Influenza
vaccine, it is mismatched
In recent weeks, a unique H3N2 clade, 3C.2a1b.2a2 (herein 2a2), has circulated at elevated levels in the United States and other parts of the world. 3/10
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One important policy measure that will increase our capacity to cope with
#COVID19
is to immediately expand practice authority for nurse practicioners and physician assistants. Some states have resisted, but this is a simple means to augment our healthcare workforce now
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This is the voice of the Dark Ages speaking— the same organization that tried to silence Galileo. No one should listen to them—clerics (just like real estate developers) have no standing when it comes to science and this nihilistic stance will result in death.
#BREAKING
: The Diocese of Pittsburgh tells me it agrees with the U.S. Conference of Catholic Bishops, urging
#Pittsburgh
#catholics
to *avoid* the Johnson & Johnson COVID-19 vaccine.
@KDKA
@ismithKDKA
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“I will name..scientists & experts as Transition Advisors to help take the Biden-Harris COVID plan & convert it into an action blueprint...will be built on a bedrock of science...I will spare no effort—or commitment—to turn this pandemic around”
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"the hospital’s virology team could have created the test much earlier if the federal govt had not insisted that it could handle testing on its own"-more evidence of how bureaucracy created self-inflicted avoidable deficits in pandemic preparedness
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I don't believe that more travel bans are impactful. We have unrecognized chains of transmission in the US. Diagnostic testing scale up, targeted social distancing, hospital preparedness, and self-isolation of cases are the key actions
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“more than 90% fewer cases of symptomatic Covid-19 than those who received a placebo”— very impressive results and much higher than expectations
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“Seven of the detections were in Colorado, where the virus was found in three mountain lions, a bobcat, two red fox, and a black bear. Kansas and Oregon both reported detections in striped skunks, and North Carolina reported a detection in a black bear.”
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This is evidence of vaccines working not evidence of their shortcoming. The goal is to take the virus and make it unable to cause serious illness, death or threaten hospital capacity the way it once could— it’s not to drive cases to zero (which is impossible)
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“Unfortunately, some of the new federal recommendations go well beyond the data” — agree with
@jeremyfaust
and
@meganranney
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I suspect it was here even before the 1st official case was diagnosed in Washington state in mid-January
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Not surprising that people in the US likely were infected with
#covid
in December — a respiratory virus with efficient transmission is likely everywhere (at low levels) before you even notice it
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“When the researchers parsed their data to distinguish between those who had been vaccinated against the coronavirus and those who weren’t, they found that the vaccinated had almost no increased risk of diabetes after Covid-19”
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"'I don't trust the reporting in China,'" as it has included only the most severe cases, in part because of limited testing capacity. This underreporting could lead to a "'skewed view of the case fatality rate'"--
@ScottGottliebMD
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This is another cascading impact that should be highlighted. Closing primary care and other clinics leads to health costs that aren’t accounted for in models that focus solely on
#COVID
ー19 to the exclusion of other health outcomes
Concerning public health data: During
#COVID19
pandemic, prescriptions for vaccines declined significantly (down 85%); a falloff in use that sharply exceeds drop in any other drug category, likely reflecting in part people skipping primary care. Data from Bernstein research team.
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“among individuals who historically never got the influenza vaccine, those receiving COVID19 vaccine were substantially more likely to switch toward getting the influenza vaccine..investing in vaccine acceptance has payoffs beyond the vaccine itself”
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Fraud is a crime so this is unsurprising and justified
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I mostly get hate mail and threats being an infectious disease physician but every once in a while I get something nice like this virus tie clip
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I think an uncontainable virus is going to spread worldwide despite what actions are taken and blanket quarantines like this (and China’s) will be more disruptive than the virus. A more nuanced approach with social distancing is what is needed
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“The new study showed Black Covid-19 patients were 36% less likely than White patients to be treated with Paxlovid, and Hispanic patients were 30% less likely than non-Hispanic patients to receive the antiviral pill.”
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