Jennifer Nuzzo, DrPH
@JenniferNuzzo
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Epidemiology and global health security policy. @jennifernuzzo.bsky.social Speaking requests: https://t.co/mflNldsXnL
Providence, RI
Joined April 2009
I've been using twitter since the 2009 pandemic. Sadly, it seems to be dying. In anticipation of Twitter's demise, I'll be posting on threads and Blue Sky, as well. Please join me there: jennifernuzzo on Blue Sky; jenniferbnuzzo on threads.
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These data don’t belong to the White House. They belong to American taxpayers. There are no grounds for federal agencies to withhold from the public lifesaving information.
More cases of H5N1 are occurring in the United States than in any other country. Pausing our health communications at a time when states are scrambling to contain this virus is dangerously misguided. This will make America less healthy and will worsen the virus’s economic tolls.
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Accountability time. I was really worried about Texas’s decision in March to lift its mask requirements. I’m happy to report that cases don’t appear to have increased as I feared they could. I like having being wrong on this.
Now is not the time for this.
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Once a respiratory therapist told me she never gets the flu vax b/c she had the flu once and it was mild. When I pointed out that she could infect her patients, she said “I never thought of that.” Don’t assume people who aren’t vaccinated are selfish. Not everyone understands.
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Interesting data. Immunocompromised children and young people are at no increased risk of severe COVID-19 - ScienceDirect h/t @apsmunro
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I don’t care how many tests we do if the results come back a week later. Number of tests is the wrong metric.
Well, the news wasn't *all* bad. We did set a record for the number of new tests conducted in a day (930,000!) although it's not clear if that reflects an actual increase in testing capacity or if states just happened to do a lot of reporting today.
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Starting to see tweets from people who got bivalent booster and then got infected >2 weeks later. We'll likely see more of these. It doesn't mean vaccines failed. The primary goal of vaccination--to reduce severity of illness-- has not changed.
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Do not downplay this death based on the fact that this patient had underlying health conditions. This virus also recently put a teenager in critical condition. We do not have a clear idea of why some infections are mild and others deadly.
A tragic reminder that H5N1 is a deadly virus.
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I have an epidemiology joke, but odds are you won’t get it.
I have a security dilemma joke but you might find it offensive.
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Vaccine passports are the wrong answer to the question: “How do we get back to normal and restore our economy?” The correct answer is: “We end fears about this virus.” The way to do that is to work to ensure that all countries have vaccines, not to reinforce disparities.
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Do not downplay this death based on the fact that this patient had underlying health conditions. This virus also recently put a teenager in critical condition. We do not have a clear idea of why some infections are mild and others deadly.
A tragic reminder that H5N1 is a deadly virus.
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There are huge disparities in how much sequencing countries are doing. This tells us: 1) the country that 1st reports may not be origin; 2) penalizing countries that report variants may have a chilling effect on surveillance for variants.
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We have to talk about this Cochrane review of masking and handwashing that found “little to no evidence” masks (surgical & N95) reduce viral infections at the population level and some evidence that handwashing may help. Let’s dive in to understand why 1/
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ATTN close contacts of #COVID19 cases, you are supposed to quarantine for 14 days REGARDLESS of whether you’ve tested negative.
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Here's another side-by-side: US and Italy. Which one flattened its curve?
To illustrate Dr. Facui's observation, I offer two epidemic curves: the United States and Spain. Both countries were hard hit in the Spring, but only one (Spain) brought case numbers down and seen numbers stay low.
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Harvard has decided to end asymptomatic COVID testing.
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Apparently lots of people don't think that covid19 vaccines will restore normalcy to kids' lives. This is a worrisome sign that we've lost the message on vaccines. And yet another sign that we need a covid-19 control strategy that defines goals and off-ramps for restrictions.
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In my experience, people who are on the fence about covid vaccines have a long list of questions that require nuanced answers. Most of these reasonable questions stem from disinformation spread widely on-line. But they must be answered.
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You don’t send farm workers in to cull H5N1 infected birds without goggles and masks. Period. If it’s too hot to wear those protections, it’s too hot to cull. We need vaccines to be made available to farmworkers. We have to stop gambling with peoples’ lives.
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The US urgently needs an educational recovery plan to address pandemic learning loss. We can't simply ignore and pass the problem onto future years. Our children are too important to the future of this country.
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How is it possible that nearly 1 year after the first outbreak of H5N1 on a dairy this man couldn’t be tested due to lack of tests?!?.
“After the cats got sick. he fell ill himself & sought care at a Kaiser Permanente hospital in Fontana, CA. He said he wasn’t checked for bird flu, despite his known exposure to the virus, b/c medical staff didn’t have tests available to detect it”
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I happened to be at CVS after they restocked rapid COVID tests. Thought I’d pick up two boxes for “just in case”. It cost me $50. At this price, these tools are just not a practical option for many people. They need to be close to free to work as many are calling.
“To end the coronavirus’s grip on American society, the United States must embrace rapid testing in a more substantial way by making it easier and cheaper for people to frequently use them,” write @michaelmina_lab and Dr. Steven Phillips.
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Testing positivity is going UP in nearly half of US states, which is a sign that increasing case numbers is not just due to more testing.
Pence tells governors to stress that rising case numbers are due to more testing & that the economy is safely opening. . If that were true, we would on the other side of the mountain with Italy, France, Spain. But instead we're on a range with false peaks.
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We have been warning that it could just be a matter of time until we see serious illness from H5N1. Under reacting to this virus in the hope that it would cause only mild infections is nothing short of gambling with people’s lives.
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This is a really good explainer about we need to be careful w/ using unadjusted summary statistics to make assertions about vaccine efficacy.
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The idea that we can use travel restrictions to stop or slow the spread of a variant assumes we know where in the world a variant is or isn’t. But that’s fantasy. We only know where a few cases are. No idea if these are most of them.
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"Free rapid tests for all were scrapped nearly a month ago in an effort to incentivise more people to get vaccinated. There are now widespread calls for them to be reintroduced.". Germany made same mistake as the US--thinking it's testing OR vaccines .
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With the increasing potential of another rise in infections in the US, we should be laser focused on vaccinating and/or boosting 65+ and immunocompromised adults and getting 1st and second doses into all other eligible arms. These are top priorities.
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This is the scenario that most worries me about school closures. There are a lot of single moms in healthcare industry.
Health care workers who are single parents will face a terrible dilemma is schools close.
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Positivity is not a measure of prevalence. It’s a measure of if the state is testing enough. SD’s high prevalence means it’s likely only testing sickest of sick, but it’s is prevalence of infection is likely no where near 57%.
So have 10 pals over for dinner, 6 are likely to be viral carriers,.statistically. #COVID19 in No Dakota. .
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“The Centers for Disease Control and Prevention had a contact tracing team ready to go, according to multiple sources, but had not been asked to mobilize”.
New: Trump may have exposed hundreds of supporters and staff in the days before he was hospitalized with covid-19, but there was no systematic effort to inform those people or to avoid further spread.
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It doesn’t matter what the case numbers or test positivities are or what private venues are open, communities that are unable to send their children to school in-person are in crisis. Working to get children back into school must be the top priority.
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This graph does not show "waning". There are more infections now, so more people likely to encounter virus and get infected. The vaccine is not a forcefield that keeps the virus out. It trains your immune system to respond to infection to prevent disease.
HAPPENING NOW: @CDCDirector Walensky releases data showing that vaccine effectiveness against Covid Delta variant is "waning" -- a reason for boosters. But the vaccines are "holding up pretty well" in protecting against severe disease & hospitalization, she said.
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I am deeply worried about political interference at FDA and CDC. But I do not believe these agencies have “lost all credibility” as so many are alleging.
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The utilization of rapid tests in this pandemic have been undermined by two factors: 1) limited supplies; and, 2) cost. Making more tests available will help. But these tests should be free. And we need them now, not months from now.
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It's not great to cherry pick statistics to fit into your fear-based messaging aimed at convincing people to get vaccinated. It's even less great when those stats turn out to be wrong. We can make a compelling case for vaccines that doesn't have to invoke fear.
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More cases of H5N1 are occurring in the United States than in any other country. Pausing our health communications at a time when states are scrambling to contain this virus is dangerously misguided. This will make America less healthy and will worsen the virus’s economic tolls.
NEW: The Trump administration has instructed federal health agencies to pause all external communications, such as health advisories, weekly scientific reports, updates to websites and social media posts, according to officials/others familiar. Our story.
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In my community, restaurants and bars, which have been shown to be particularly high risk for spread, are fully open. But schools are only open to kids 2 days a week and you need an appointment to go to the public library. Our priorities are all wrong. @AACoExec.
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Virologist Nancy Cox knows the harms that will come to the US for leaving @who. We give up access to intelligence from others that helps protect the US from flu and other viruses.
“To do this in the middle of a pandemic is breathtakingly dangerous,” said Nancy Cox, a former CDC virologist, who for 22 years led the agency’s WHO center on influenza surveillance and control.
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From @WHO_Europe: "even with the wider spread of more infectious variants, there is no evidence that schools contribute in a major way to community transmission"
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There are now multiple, concurrent public health crises: an international mpox emergency, unprecedented outbreaks of H5N1, the highest levels of Covid in a long time. Infectious diseases are the recurring hazards of our times. They require sustained commitment to preparedness.
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Yes, we must increase COVID19 testing capacity. But that doesn't mean everyone needs to be tested. Even if there were enough tests, there aren't enough clinicians to test everyone. If you are sick and don't need to be hospitalized, stay home.
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India's case curve looks like a skyscraper. No country can handle this level of accelerated spread on its own. India needs assistance from the US and others.
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Think of vaccines in terms of how well they protect against disease. They aren't a force field against virus. They train your immune system to recognize and go after a virus that is infecting your cells before serious disease sets in--often so quickly, you don't notice symptoms.
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Vaccinating adults protects kids too young to be vaccinated. My daughter’s (vaccinated) daycare teacher tested positive and had mild symptoms. Happy to report no additional cases in the daycare!.
A teacher who was unvaccinated ignored Covid symptoms, took off the mask, and infected 12 kids
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This is not a normal situation. Yes, there have been occasional spillovers of animal, influenza viruses to humans. But H5N1 is not the same. It is now a persistent, occupational hazard to agricultural workers.
.@CAPublicHealth reports another 4 probable #H5N1 #birdflu human cases today. Their release says 5 presumptive positives, but one was reported on Friday. If @CDCgov confirms all of these, it would take the state's total to 11 cases & the national total to 25 this year. Wowza.
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The United States only loses by leaving @who. We can't work for improved preparedness or protect Americans from global health threats if we don't have a seat at the table. This decision is like deciding you don't like the curtains in your house, so you burn the whole thing down.
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Governor, due to regs set by your administration, my 8yo son's county-run camp requires he wear masks and not get closer than 3' to his friends--even outside! Also, they won't allow kids to play Pokemon and other games that can't be sterilized. How is that "open for summer"?.
What a beautiful day on the Ocean City Boardwalk—Maryland is truly open for business and open for summer.
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We shouldn’t be surprised by public interest in Covaxin. Many unvaccinated people I’ve spoken to are holding out for what they perceive to be a more traditional vaccine. Don’t assume everyone who is not yet vaccinated doesn’t want to be.
This report clarifies that Covaxin EUA submitted to FDA and would give us vaccine option down to age of two years old .
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Discussing what epidemiological and operational conditions could allow for a lifting of mask mandates shouldn’t be controversial. Good policy is data-driven and transparent. Establishing off-ramps helps ensure both data and transparency are central to decision-making.
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Please be careful who you follow on here for your COVID information. I’m seeing many accounts run by self-proclaimed health experts that are likely fraudulent. If someone is truly an expert, you should be able to Google them and find out where they work. If you can’t, be wary.
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Masks in schools were meant to be a temporary measure. It is good policy and practice to establish off-ramps for interventions that aren’t meant to be permanent. So many parents I talk to ask “When does it end?”. We should be able to answer what conditions would enable an end.
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A THREAD ON TESTING: I am deeply worried about the serious testing delays and bottlenecks being reported throughout the US. It will only get worse when flu season starts.
“The supply chain issues have led officials in New Orleans to reduce the tests they carry out: At one site on Monday, officials handed out just 150 tickets for testing, which were gone in minutes.”
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That was lovely. Many returns of the day, Dr. Fauci!.
SURPRISE! Dr. Anthony Fauci is serenaded as he leaves work on his 80th birthday.
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If states/cities are going to reinstate mandates, they need to tie the lifting of these restrictions to vaccination coverage goals. NPIs are pause buttons. If we don’t improve vaccination uptake, we’re just going to keep playing Whac-a-Mole with rising case numbers.
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Yes, the US has greatly expanded testing for #COVID19. Unfortunately, rising positivity in many states shows that spread of the virus is increasing even faster. My op/ed for @washingtonpost
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I have some news! This spring, I will be joining the @Brown_SPH to help build and lead a new center on pandemic preparedness. I feel very strongly that this pandemic has demonstrated the need for new thinking and new collaborations in public health.
The School of Public Health is excited to announce that Jennifer Nuzzo, Dr. Scott Rivkees, and Claire Wardle will be bringing their expertise to @BrownUniversity to advance SPH work on pandemic preparedness and mis/disinformation. @JenniferNuzzo @card1e
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The US has greatly expanded the number of tests it can conduct. We went from ~25,000 tests per day in March to well over 500K tests per day. But it is still not enough because spread of the virus outpaced these efforts.
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Bad precedent to set. Make no mistake, the discussion will happen. But without credible scientists leading the discussion.
.@US_FDA has authorized Pfizer booster shots for 16- & 17-years olds, without asking its vax expert panel for advice. @CDCDirector isn't expected to ask #ACIP either. This approach sidesteps what would likely have been lengthy discussion about myocarditis.
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As many have readily pointed out, today’s much deserved Nobel a prize is an indictment of traditional academic metrics for promotion/advancement. I hope it forces the academy to rethink how it supports and promotes researchers.
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Healthcare workers who go into communities to offer covid vaccines are not Nazis. Comparing them to such is reprehensible. Any politician who asserts or implies that healthcare workers who vaccinate are doing anything but trying to save lives deserves our strong rebuke.
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Really interesting to read how Japan is bringing its resurgence under control. without lockdowns and the high levels of testing that other countries have used.
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In NYC, where XBB 1.5 has dominated cases, COVID hospitalizations now appear to be declining. Seeing similar trends in hospitalizations other places in the northeast. Early data, but encouraging.
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Covid vaccines for kids are a “nice to have” not a “need to have”. Vaccinating adults brings down all cases, which greatly protects kids. But the US continuing to use more than its fair share of global vaccines, while the virus spreads unchecked elsewhere for lack of vax is bad.
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For #H5N1 , we must remember that we will only find infections where we look for them. If we test only symptomatic herds or farms with dead animals, we miss important opportunities to prevent spread among animals and to farmworkers.
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And then he made a public show of hugging his recovered patient to combat stigma that #Ebola survivors often experience:
Throwback to 5 years ago when Tony Fauci, at 74 yo, was suiting up to treat an Ebola patient himself because he "wanted to show his staff that he wouldn't ask them to do anything he wouldn't do himself". This is what leadership looks like.
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I've tried to engage with Facebook groups to counter vaccine mis/disinformation, but have ultimately concluded it's like trying to use bubble gum to plug a bursting dam. The information ecosystem has too much poison for public health to combat on its own.
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A note to those who are wondering if it’s healthier to drink raw water: the disinfection of drinking water was one of the greatest public health achievements in terms of preventing loss of lives.
The outbreak follows a trend that sprang up in the US several years ago of drinking so-called "raw water," which claims (without evidence) that untreated, unfiltered water collected directly from freshwater sources has health benefits.
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Test positivity should not be the sole metric for making high consequence decisions about opening or closing businesses or schools.
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New COVID wastewater data posted yesterday. Declines in all regions. Good sign.
Two weeks later, things are looking better. Data as of 9/13. No sign of acceleration. All regions either plateauing or declining.
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A tragic reminder that H5N1 is a deadly virus.
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I was trying to be diplomatic yesterday but others tore in, so I will say what I think. You don’t convince people to vaccinate their kids by cherry picking from among old data. That only erodes trust. As @Surgeon_General said vaccination efforts will move “at the speed of trust”.
Thoughts on new @CDCMMWR study showing rise in hospitalizations in teens. 1) Study only looked at hospitalizations during March-April 2021. During that time, cases rose in kids and adults. An increase in hospitalizations would be expected.
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Variants don’t help, but they aren’t the main cause of case acceleration. A failed public health response that permits uncontrolled case growth is. Countries have paused the spread of variants with public health measures. Vaccines are needed for long term protection.
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"The U.S. death rate in 2020 was the highest above normal ever recorded in the country — even surpassing the calamity of the 1918 flu pandemic."
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Since US started vaccinating oldest first, the % of all cases due to younger groups (eg. kids) will increase over time because fewer infections in older ages. But # of cases in adults AND kids are decreasing. Vaccinating adults protects kids.
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We should always evaluate the risks and benefits of efforts to control the virus. In this moment the public health risks of not protesting to demand an end to systemic racism greatly exceed the harms of the virus.
For folks wondering why public health experts aren’t calling out the protests as violations of social distancing, take it from the former head of the CDC:.
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Apparently some are still trying to dismiss growth in cases as artifact of increased testing. It’s not true. When positivity is surging it signals that increase in infection is outpacing increase in tests.
No, more testing doesn’t explain the rise of covid-19 cases in the U.S. a new op/ed by @JenniferNuzzo in @washingtonpost. "Ignoring the data is not a serious strategy: It is a threat to health and the economy.".
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The US needs an educational recovery plan to address learning loss from this pandemic. This plan should also include provisions to help kids reintegrate into classroom settings. We can't just assume that they can go back one day like nothing happened.
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Debunking antivaxxers' assertions that cases in Iceland mean vaccines don't work: health officials in Iceland report vaccines preventing 60% of vaccinated from any infection and 90% against serious illness. 97% of vaccinated cases have mild or no symptoms.
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We need to rethink the US's approach to testing. Performing >600,000 tests per day is pointless if it takes more than a week to get test results. We've technically expanded testing to include mild or asymptomatic infections, but functionally haven't.
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The assault on physicians and science must end | American Medical Association
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Great, nuanced thread on masks. I’ve been seeing lots of people wearing N95s under their noses or pulling them down every few minutes to catch a breath. The best mask is one you can wear reliably.
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“First, schools should be open. They should never have closed and should never close again. That was a mistake we will pay for over decades.”.
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In which a (likely exasperated) govt official has to explain basic physics: "This isn't like 'Top Gun' where it just explodes and doesn't go anywhere. It's large and it's metal, it would put hundreds of Americans at risk."
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My 8yo and 5yo got their first #covid19 shots last week. The only side effect either reported was my son's observation that he was having a harder time opening his mandarin orange container with his teeth. 😬 I've not asked if that symptom has since resolved.
My 9 year-old got his first COVID vaccine shot yesterday. Joining the 2.6 million other kids 5-11 who've already gotten. That's 1 out of 10 kids in that age range!. Despite a bit of a sore arm this morning, he's already looking forward to a more normal holiday season.
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I am so deeply proud to be able to contribute to these efforts.
The Johns Hopkins University Coronavirus Resource Center has been named one of TIME’s Best Inventions of 2020! #TIMEBestInventions.
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While everyone was likely refreshing election counts, #covid19 case numbers in US jumped by more than 18% yesterday. For the first time, we exceeded 120,000 cases reported in a single day.
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I got the updated COVID booster last week. I had been planning to get it closer to the holidays, but there started to be enough infections in my extended network such that benefit of waiting was getting lower. The best time to get a booster is before you get infected. 1/.
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Embarrassment is the least of it. It makes public health look like sanctimonious, biased bullies and not the non-judgmental, empathetic supporters we’re supposed to be.
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Testing positivity is ticking up across the US. Today 18 states have 14 day positivity average over 5%.
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Lots of questions about what to make of X, Y, Z variants. I'd like to stress the bigger problem that is not being discussed: our scale-back in testing has greatly eroded our abilities to detect, characterize, and track variants. You can't sequence what you don't test.
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This is a moral stain on the handful of high-income countries that are sitting on more doses than they are using and are casually contemplating use in low-priority groups before most of the world has had a chance to vaccinate even their most vulnerable.
Only 1% of people in low-income countries have been given at least one dose of a COVID vaccine, and most will have to wait another two years to be vaccinated.
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There has been an uptick in news stories about the origins of the covid pandemic. But no new data or evidence. I happen to believe that extraordinary claims require evidence. We’ve already seen harms come from making claims without data.
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Yet again we are hearing of White House opposition to expand #COVID19 testing for fear it will identify more cases. The thing is, you can't hide from the pandemic by not testing. Rising test positivity will provide clear evidence that we are undertesting.
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For example, if healthcare workers don’t wear masks socially outside work or in the breakroom it can undermine the estimate of overall effectiveness of their masking at work. It doesn't necessarily mean masks don't help protect individuals when they're seeing patients. 16/.
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Poor communication by political leaders is degrading the response to this pandemic. Public health experts should lead communications about #COVID19 not just b/c they know epidemiology or virology but b/c they also know basics of field of health risk communication.
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I don’t understand @PressSec’s answer. By dismissing the idea of sending every American a rapid test due to cost, she seems to imply that the insurance reimbursement plan won’t come close to doing that. Not a good sign. As many feared.
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The Bad: the risk of more pandemics is high & increasing. The Good: there are steps we can take to reduce the frequency and severity of pandemic threats. How we combat urban fires serves as a guide. My @TEDWomen talk:
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