Ashish K. Jha, MD, MPH
@AshishKJha46
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White House COVID-19 Response Coordinator, physician, researcher, husband, dad. Official account
Washington, D.C.
Joined April 2022
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Last Seen Profiles
So evidence for bivalent vaccines keeps getting stronger
Latest from Israel
Compared to vaccinated folks who had NOT gotten bivalent
Older folks who got the bivalent had
81% reduction in hospitalizations
86% reduction in deaths
Pretty stunning stuff
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Its a Sunday so a quick update on the state of the pandemic in the US
Infections are up about 50% and hospitalizations are rising too
But there is an important pattern emerging in the Northeast that helps chart the path forward
Thread
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You may have heard that Congress is considering funding for COVID
It's actually a pretty simple question in front of them
Do we continue to fight COVID or do we give up?
Let's talk about what happens if Congress decides to give up
It's not pretty
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Good morning
Over the holidays, you may have heard about Omicron XBB.1.5
It went from 4% of sequences to 40% in just a few weeks
That’s a stunning increase
So what does it mean? Will it cause a wave of serious illness and death?
Here's what we know, don't know
🧵
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In areas of high transmission
When you are in crowded indoor spaces
Wearing a high quality mask reduces your risk of getting infected and your risk of spreading it to others
It’s basic public health
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24 hours ago, a federal judge vacated
@CDCgov
mask mandate on airplanes
This was deeply disappointing
CDC scientists had asked for 15 days to make a more data-driven durable decision
We should have given it to them
But I'll continue to follow CDC guidance & mask up on planes
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Update on the state of the pandemic in the US as BA.5 becomes dominant
Over past month, reported cases have remained steady at about 100K a day
But thankfully, deaths & ICU stays have remained low
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This is absurd and disingenuous
When the Biden Administration came into office, only 46% of schools were open. Today it’s >99%
We are 100% committed to ensuring schools remain fully open and safe in this pandemic
OMG. Lockdown partisan and White House Covid advisor
@AshishKJha46
is asked about schools staying open next Fall. Before he can answer Press Sec. whooshes him off the stage! 😱
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Keep getting people and communities the tools they need
Tests, vaccines, Evusheld, masks, treatments, and more
And ensure we have the resources to continue this work moving forward
And manage the pandemic in a way that protects lives and livelihoods
End
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So, as they say, some news.
It has been the honor of my life to serve the American people and this President in our fight against COVID.
We have some of the lowest rates of hospitalizations and deaths since COVID first appeared.
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It’s the honor of a lifetime to serve as the new White House COVID-19 Response Coordinator
Jeff Zients leaves big shoes to fill
But the pandemic is still with us
And we must all work to continue to protect the health of the American people
Ready to get to work
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And it worries me for the fall/winter
Because if we do see a wave of infections, we'll want to be able to protect people
Like with the next generation of vaccines that are likely coming
And treatments
And tests
None of which will be available unless Congress steps us now
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You’ve all heard that
@potus
has COVID “rebound”
Lets talk about rebound -- what we know and what we don't know
Bottom line (tl;dr): Treatments like Paxlovid are designed to prevent serious illness. And they are doing that. Very well
But back to rebound. What is it?
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Tony Fauci is the most consequential physician scientist of the past half century
Having served 7 Presidents through HIV/AIDS, Anthrax, H1N1, Ebola, Zika, and of course COVID
Thousands consider him their mentor, including me
Grateful for your service to our country Dr. Fauci
After 54 years, Tony Fauci is stepping down from NIH in December. He told me he is “not retiring in the classic sense” but wants to travel, write (he is working on a memoir) and “hopefully inspire the younger generation" to go into public service.
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And of course, during waves, we'll want to have plenty of masks available for Americans
And improvements in ventilation/filtration
And keep vigilant for future variants
And did I mention -- keep vaccinating the world?
Those are the jobs ahead of us
9/10
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So the bottom line is this
We're at a point in the pandemic where we know how to manage the virus
To keep infections low
To prevent serious illness
And to protect the most vulnerable
And that's our focus right now
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Folks are wondering -- should I be wearing a mask when getting on a plane or in a train or mass transit?
Answer? Yup. A high quality mask protects you and those around you. That's why the CDC recommends it
But, there is another issue that's very important
Short thread (1 of 2)
CDC continues to recommend that people wear masks in all indoor public transportation settings. See full CDC statement:
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All of this is preventable
None of this needs to happen
But Congress needs to act
The longer they wait, the further back in line we fall
Its time for Congress to step up and protect the American people
The pandemic is not over
End
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Almost nothing in medicine cuts risk of death by 96%
Almost nothing
Except the COVID vaccines
Double boosted folks had 96% lower risk of death compared to unvaccinated
If you're 50 or older and haven't gotten a vaccine in 2022
Please go get one now
It may save your life
Here's the latest data from the US CDC on Covid vaccine effectiveness, with individuals categorized from unvaccinated (0 dose) to 2 boosters.
During the last week of May, a full primary vaccination + 2 boosters meant a risk of death cut by 96% compared to unvaccinated people.
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So in the northeast, we're seeing a real split between cases and deaths
With CFR down 80%
So what explains it?
High booster rates and treatments
And testing
These states do more tests, have higher booster rates than many other places
So what happens next?
6/9
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BA.5 is not the last variant we'll confront
But over the past 18 months, we've learned a lot about this virus
And have built up our capabilities
So as BA.5 becomes dominant
We're ready to manage it in a way that minimizes disruptions and suffering for the American people
End
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A lot of misinformation spreading about a point I made yesterday on COVID vaccines and deaths
So here's what we know
IF
You are up to date on your vaccines
AND
You get treated if you have a breakthrough infection
Your risk of death from COVID is close to zero
Short 🧵
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Unfortunately, other parts of our nation have lower booster rates and less testing
So the virus can spread more easily without detection
And the population is less well protected
Which worries me for the weeks/months ahead as BA.2.12.1 spreads to other, less boosted places
7/
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How much better are the new bivalent COVID vaccines compared to original?
Meaningfully better
Protection against BA5 about 4 times better than what you'd get with original shot
That's based on the latest data out today
So when I read these studies, what do I look for?
🧵
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With COVID infections rising
A great way to slow the spread is by using rapid tests
So we are launching another round of free tests from the government
Go to
It takes about a minute to fill out
And you'll get 8 tests delivered to your home via USPS
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Months ago, Paxlovid was scarce
With lots of work, this is no longer the case
Over the next week, you'll hear a lot more about what the Biden Administration is doing to make Pax widely available and easily accessible to all Americans
What are we working on?
Thread (1/2)
Biden's team is planning an event next week to announce that Pfizer's Covid pill is, finally, abundant - that doctors should prescribe it more and more people can seek it out.
(How long the supply will last without new funding from Congress is unclear.)
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What's the other issue?
It is critical that our public health agency have the ability to protect Americans during a pandemic
And that's the issue at play in this court decision
If we want to protect the health of the American people, there's only one right answer
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Thrilled to see CDC's clear support for booster for 5-11 year-olds
Independent advisors reviewed the data, voted 11-1 in favor of supporting kids getting the booster
I have a 10-year-old so what do I plan to do?
Follow the evidence and get him boosted
Lets talk why
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Tony and Stephen visit a pharmacy so Tony can get his updated COVID shot.
This is so, so awesome
Dr. Fauci was eligible for his COVID booster shot so Stephen took him next door to the pharmacy to get vaccinated — and they had quite the journey.
#Colbert
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@mattyglesias
Total nonsense
He knew I was late and had to leave
Asked an absurd question
I couldn’t answer
So its clipped to misrepresent my views
I’ve been a huge advocate of keeping schools fully open to in person education since October of 2020
Still am
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Here’s what folks can do to minimize risk:
1. Make sure you are up to date on the bivalent booster (critical)
2. Test before large gatherings or before seeing someone vulnerable (I did over the holidays)
3. Wear a high-quality mask in crowded indoor spaces
8/n
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If you look at the case-fatality rate now in places like NY or MA
Down to 0.3% (that's deaths today divided by cases 3 weeks ago)
And given we're missing lots of cases (because of home testing)
CFR is even lower
Remember, throughout the pandemic, CFR has been closer to 1.6%
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First, what is driving the increase in infection?
Largely Omicron subvariant BA.2 and increasingly, BA.2.12.1
When we look at the northeast, a few things emerge
First, infections started rising around March 20 (give or take a few days)
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Great figure by
@jeremyfaust
says it all
COVID is a far greater threat to kids than flu is
And you know what dramatically lowers risk and keeps kids out of the hospital?
Vaccines
If your kid 5 or older isn't vaccinated, its time
Full article:
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Cases are up 3-4X in the northeast -- from New York to CT, RI, and Massachusetts
As you see, it began rising around March 20
Throughout the pandemic, we've seen about 3 week lag until deaths begin to rise
So we'd expect by April 10 or so, deaths beginning to climb
Do we?
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There's a new generation of treatments coming
Some of them look VERY promising
Countries are lining up to purchase them
But we can't
Because we don't have the money
And if we don't act soon
Americans will watch others around the world have these treatments
And we won't
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Well, not so much
Deaths are up a bit, and about 6 weeks after cases began rising
Not what you would have expected
Now, hospitalizations are up some in these states, but again, not as much as one would have expected
So what is happening?
4/8
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Without more funding
We won't get the next generation of vaccines
Yup -- we may get new vaccines this fall
Vaccines that may be even more effective and durable
Contracts for those vaccines will need to be negotiated soon
If Congress fails to act?
You guessed it
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Paxlovid is making a big difference in preventing hospitalizations, deaths
So who should get it?
There is some confusion out there
So let's clear it up with data
Bottom line?
If you're over 50 or have comorbid conditions
For you, benefits from Pax likely outweighs risks
🧵
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We will run out of treatments for COVID
So if you get COVID later this year, there will be no treatments available for you
And no, your insurer won't be able to step in and buy it instead (for a whole host of reasons)
But there's an even bigger problem for therapies
2/n
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If you are over 50 and haven't gotten a vaccine shot in 2022, you need to get one. Really
Second, if you get infected – especially if you're over 50, you should seriously consider getting treated
Talk to your doctor
or go to to learn about test to treat
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We are in a complicated moment
On one hand, hospitalizations are at historic lows, deaths are falling
On the other?
BA.2 is dominant with cases rising
So how to think about this?
In this op-ed, I lay out the moment we are in and what to do next
🧵
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If Congress fails to act....
We won't get those vaccines. Others will
Beyond treatments, vaccines,
We won't have tests needed for the next surge
We have made big efforts to build up domestic manufacturing
But with demand down, those manufacturing lines are getting shuttered
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Without funding, we won't be able to stockpile enough tests or keep domestic manufacturers afloat
So when the next surge hits -- we may not have the tests we need
And will rely on manufacturers in other countries to send us tests. If they can.
6/n
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So am I concerned about XBB.1.5? Yes
Am I worried this represents some huge set back? No
We can work together to manage the virus
And if we all do our part
We can reduce the impact it will have on our lives
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What you can do (continued)...
4. Work to improve ventilation/filtration in indoor spaces
5. If you have symptoms: test right away and avoid hanging out with high risk folks
6. If you do get Covid – immediately get evaluated for treatments. They are lifesavers.
9/n
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How much protection do vaccines or recent infections offer?
What we currently know:
If you had an infection before July OR
Your last vaccine was before bivalent update in September
Your protection against an XBB.1.5 infection is probably not that great
4/n
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Do COVID vaccines reduce transmission?
Why yes they do
And no surprise
Latest evidence finds that:
Vaccinated folks with breakthrough infections?
Less likely to transmit than unvaccinated folks experiencing their first infection
h/t
@K_G_Andersen
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There’s Paxlovid, which is doing a remarkable job keeping people out of the hospital
And Bebtelovimab, a monoclonal which continues to work well against BA.5
If you’re immunocompromised, there's never been a better time to get Evusheld, which is also free and widely available
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But the bottom line is this
Paxlovid is saving lives
Therapeutics are an essential part of fighting this pandemic
And way too many Americans are still dying of COVID
And when it comes to treatments like Paxlovid and monoclonals,
We need to be using more of it, not less
End
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Great to see the President today
He received world-class care for his COVID infection
Boosters of advanced mRNA vaccines
Cutting-edge oral antivirals
Treatments fit for a President
And also available to every American
For free
Because of my Administration's investment in free booster shots, at-home tests, and effective treatments, today, we can protect ourselves from serious illness and prevent most COVID deaths.
COVID is still with us, but our fight against it is stronger than ever.
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A central goal of the COVID response is to dramatically reduce number of people who get serious ill or die
With vaccinations, boosting, and widespread use of therapeutics
We are doing just that
No, our work isn't done
But we are making serious progress
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We will soon have more data on how well vaccines neutralize XBB.1.5
But right now, for folks without a very recent infection or a bivalent vaccine
You likely have very little protection against infection
And for older folks, diminishing protection against serious illness
5/n
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What can you do to prevent infections beyond vaccines?
If you’re going to a large indoor gathering or visiting someone vulnerable, take a test right before
You don’t want to be the person who gives COVID to your family or friends
Testing before gatherings can help. A lot
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Here is what the federal government has been doing:
1. Tracking XBB.1.5 and other variants closely
2. Providing easy access to updated COVID-19 vaccines.
Remember, they're still free!
3. Providing free, high quality masks through pharmacies, food banks, etc.
10/n
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If you are UP TO DATE on your vaccines
AND if you get treated if infected
Your chances of surviving COVID is close to 100%
Those are the facts
The rest is noise
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The new bivalent shot is your best protection against both infection & serious illness
Another question:
How well do our tests work XBB.1.5?
All the evidence says that they should work just fine
And last but not least, how well do our treatments work?
6/n
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1. More immune evasive? Probably yes. More than other Omicron variants
2. More inherently contagious? May be. It binds more tightly to the human ACE receptor. Might affect contagiousness
3. Is it more dangerous: We don’t know
So of course, the big question is.....
3/n
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The Administration just laid out plans to end the COVID national emergency & public health emergency on May 11
Why now?
Because we're in a better place
We're getting through this winter without a big surge or run on hospitals
Because we have the tools to manage this virus
🧵
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Dr. Topol is right.
The evidence from high quality studies is clear:
The bivalent vaccine is far superior to the original vaccine against circulating variants
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In the least surprising but still helpful study
Ivermectin is great as a dewormer in horses
It does not work for COVID
We all wish it did
It doesn’t
But thankfully we have drugs that do. Like Paxlovid
So if you get COVID — skip the Ivermectin and get a medicine that works
NIH ACTIV-6
#ivermectin
early
#covid19
treatment results with 1591 randomized participants.
No difference in ER visits, hospitalizations, deaths (all numerically higher with IVM, but no statistical difference).
Time to recovery 11 vs 11.5 days.
#idtwitter
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4. Providing free tests () & making free tests available through food banks, community health centers, schools, more
5 Providing support for schools, businesses to improve ventilation and filtration in buildings
6 Ensuring access to free treatments
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How often does rebound happen?
In Twitter world, it seems that 90% of people on Pax get rebound
In real world data we’ve been tracking from large health systems
Rebound after Pax ranges from 0.5% to 10%
I know, big range
My best guess based on today's data? About 5%
3/n
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With any new variant or subvariant,
Remember -- there are always 3 key questions we want to answer:
1. Is it more immune evasive?
2. Is it more inherently contagious?
3. Is it more virulent/dangerous
So what do we know?
2/n
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Together, we can keep the disruption of XBB.1.5 to a minimum
If more people get the updated vaccine
And people who are at elevated risk get treated
We can prevent most cases of serious illness
And save lives
11/12
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It appears that folks previously infected with SARS-CoV2: original strain, alpha, delta or even the BA.1 of Omicron (cause of January wave) have little protection against infection from BA.5
We know less about cross-protection from more recent subvariants like BA.2 or BA.2.12.1
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In crowded indoor spaces, high quality masks work well to prevent infection, spread
And always think about bringing in more fresh air
What are we doing here in the Administration?
Ensuring vaccines remain free, widely available, easily accessible
So folks can stay up to date
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Its worth remembering why we use Paxlovid or other therapies
To prevent serious illness and death
Worth remembering: rebound largely doesn't lead to serious illness
So rebound is not Paxlovid failure
Because the goal is to prevent serious illness – and Pax does that. Well
6/
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As
@POTUS
said
COVID used to dominate our lives
No longer
Our vaccines have saved millions of lives
And while the toll of the virus has been enormous
Lets honor those lost by continuing to fight COVID
And build next generation vaccines & treatments to keep America safe
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Why has serious illness remained low?
Its not random
Its from vaccinations and therapeutics that are widely available and easy to access
But -- we're at a new inflection point
We could see current patterns continue
Or we could see a new rise in infections and serious illness
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Paxlovid and Molnupiravir (the oral pills) should work fine based on what we know
So what does this mean for the weeks ahead?
Whether we’ll have an XBB.1.5 wave (and if yes, how big) will depend on many factors
Including immunity of the population, people’s actions, etc
7/n
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Why an inflection point? What’s new?
BA.5
This new subvariant, along with its close cousin BA.4, makes up nearly 70% of infections in the US
So let’s chat about BA.5
What we know
What we don’t know
And how we've prepared for the upcoming weeks and months
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But the experience of Portugal was unfortunately worse
A sizeable wave of infections followed by a sizeable wave of serious illness and death
And Portugal was highly vaccinated/boosted and had already had a very big Omicron wave in January
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So here’s the bottom line
Should high risk people (over 50, chronic diseases) get Paxlovid?
Absolutely! It prevents serious illness
My parents recently got COVID and both got Pax
Because I care less about rebound than I care about preventing serious illness
And Pax did that
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And working to ensure free high-quality masks remain available to Americans around the country
We've sent high quality masks to thousands of locations to distribute to Americans who need and want them
You can get access to all this at
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So is rebound a big deal?
Well – it is important
Important because when you rebound, you can potentially be contagious
So paying attention to rebound is important
But rebound does not seem to lead to serious illness (i.e. hospitalization, etc.)
And that's key
5/n
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Huge thanks to nurse Thomas from
@_DCHealth
for expertly administering both flu and new, updated COVID vaccine
And to
@SecondGentleman
Emhoff, a great advocate for protecting people's health
We don't agree on baseball (go
@RedSox
)
But we do agree on this:
Vaccines save lives
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And while vaccines continue to be remarkable at preventing serious illness
Over time, more 6 or more months out from the last shot, protection against infection wanes substantially
And that sets up a risk, now that BA.5 is dominant, of creating a new wave of infections
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The President made a commitment to protect the American people from.
That commitment continues.
I am deeply grateful to the President for this opportunity to serve
End
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You're hearing a lot about kids vaccines today
So what do America's Pediatricians (you know, the folks who actually take care of children) think?
Yeah -- they are pretty excited
Dancing band-aids and all
Its a big day for kids under 5
Big day for kids under 5: COVID vaccines are finally here and soon will be heading out to pediatricians’ offices! 🧵
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OK so BA.5 is dominant
How did it become dominant?
Because it has a growth advantage largely because it is very good at escaping, at least partly, prior immunity
4/n
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A lot more places where Pax will be available including more test-to-treat
Education for providers to use it more regularly for eligible patients
And more
Paxlovid is extraordinarily effective at preventing bad outcomes
We're getting it out to the American people
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What a great week for vaccines for kids under 5!
Compelling data the vaccines are safe and effective
External experts vote 21-0 to authorize the vaccines
Now FDA authorization is in
Next step? CDC weighs in
And we start shipping vaccines out today
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Making sure doctors and pharmacists and others know about treatments
And making sure there’s plenty of treatments widely available
We’ve sent out >500 million home tests and working to get more
And making sure tests are cheap, easy to access
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OK, but will BA.5 infections cause a lot more serious illness?
The experience from other countries is mixed
In South Africa, BA.5 became dominant in mid-April but deaths thankfully remained low
That's good
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Right, COVID is a lot more dangerous to kids than many other childhood illnesses for which we rightly vaccinate our kids
And the benefits of vaccinations for COVID?
They dramatically lower than risk of hospitalizations and deaths for children
But that's not all
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So here's how to think about this moment
Do we know exactly how BA.5 will play out in the US in the upcoming weeks to months?
We don't. No one does
But we are prepared
We know how to manage this moment
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So we don’t know which path the US will take – or whether different parts of the US will take different paths
Though in large part, we collectively can shape how much serious illness we see
How?
First, people should be up to date on their vaccines
Here's how I think about it
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So let’s talk about President’s “rebound”
He had no new symptoms
He tested positive on a routine test
His testing cadence, to continue testing after recovery, is unusual. Not what most Americans do
But he is President of the United States
And wanted to be extra careful
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It was a pleasure speaking to
@IAmAmnaNawaz
on
@pbsnewshour
An “exit” interview of sorts as I finish my term at the White House
So where are we with COVID?
We are down to about 100 deaths per day
Among the lowest in the pandemic. That’s good
But
🧵
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So let’s remember why we have worked so hard to get free Paxlovid widely available
It’ll dramatically reduce your risk of getting hospitalized or dying
Yes rebound is a concern
We all wish it didn’t happen with Pax, Molnupiravir, or when people aren’t treated at all
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Seeing a lot of headlines predicting what COVID will be like this winter
My take?
It depends largely on us
COVID is still killing 300 people a day
And this year, even more folks will be gathering with family and friends
So can we really gather safely? Yup. Absolutely
🧵
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We will continue to track BA.5 closely as we do all variants
We will continue to make sure vaccines, tests, and treatments are widely available and easily accessible
We will monitor healthcare capacity to ensure our healthcare system continues to be able to care for everyone
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In a study of Italian healthcare workers,
About 30% of folks had at least 1 residual symptom a month after getting COVID
However odds of Long COVID was 84% lower for those vaccinated
More evidence that vaccines dramatically reduce risk of Long COVID
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All with one goal: better protecting the American people
On a personal note
For a poor immigrant kid from India
The privilege to work for this President on behalf of the American people has been just extraordinary
I am so deeply grateful
Signing off from this account
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Another study showing large benefits of vaccines
Soon after 2nd boosters authorized
Nursing home residents who got them were 90% less likely to die than residents who didn't
Wow
This is why we're so focused on ensuring folks, particularly the high risk, get the latest vaccine
In nursing home residents, a 2nd mRNA COVID-19 booster dose during Omicron was 74% effective at 60 days against severe CoV-19–related outcomes (including hospitalization or death) & 90% against death alone compared with receipt of a single booster dose.
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We have tests, vaccines and treatments now widely available to the American people to help manage the virus
We built up our surveillance systems and our stockpiles and are better prepared for the future
The Public Health Emergency is over but COVID isn’t. The work continues
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That’s why we should all be clear:
If you're over 50
Or have significant health issues
If you get COVID
You should talk to someone about getting treated
It will reduce your chances of getting very sick
End
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