Marc Lipsitch
@mlipsitch
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@[email protected] This place is getting more sinister, maybe on my way out. Director @CCDD_HSPH Tweets in personal capacity. Didn’t pay for blue check
Boston, MA
Joined September 2009
Repeating my plea to media: PLEASE stop saying "there are now X number of cases in the US" and start saying "as of today X cases have been reported in the US. Because of limited testing, experts agree the real number is far higher." We don't know how much higher but many times.
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Tonight #DeborahBirx stated that models anticipating large-scale transmission of COVID-19 do not match reality on the ground. Our modeling (done by @StephenKissler based on work with @ctedijanto and @yhgrad and me) is one of the models she is talking about.
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It is a fundamental scientific error to take the current success of containment in some places as a sign that permanent containment is possible. We should work to make it possible, but 1918 flu and, frankly, the germ theory of disease show that containment is a temporary victory.
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2) we remain woefully behind on testing capacity, especially in many parts of the country. Like a forest fire, intense control in one place fails if there are sparks from other places. We must strengthen the weak links. But test reagents, swabs, PPE remain in short supply.
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If at the same time we ramp up testing capacity and the ability to trace contacts, in a very best-case scenario, we might conceivably be able to turn to a Korea- or Singapore-style mix of less intense distancing combined with super-intense contact tracing, isolation, quarantine.
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Modeling the scenario of intense social distancing for a temporary period, followed by a letup, produces predictions of resurgent transmission and large epidemics, with the exact consequences depending on the degree and duration of reduced transmission during social distancing.
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For the 12-18 months (best case under current models) till a vaccine. I desperately hope she is right, because much suffering will be avoided. But reassurance that this is likely, or even plausible, with the disorganized track record of the US response, is false reassurance.
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So the scenario Dr. Birx is "assuring" us about is one in which we somehow escape Italy's problem of overloaded healthcare system despite the fact that social distancing is not really happening in large parts of the US
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If our social distancing works it is possible we will not just flatten the curve, but get a decline in cases. Under a best-case scenario, we will keep that policy in place long enough to get down to very, very few cases domestically.
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Solving the testing problems will not be easy, despite heroic local and state efforts to make up for the feckless federal efforts on this front. Supply chains are delicate and it may not be possible to come from behind and establish Korea-level testing capacity.
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Hey @nytimes @washingtonpost @WSJ @latimes this is a good time to unpaywall #COVIDー19 coverage. All responsible med journals are doing it. Public needs good info & the paywalls turn income inequality into health disparities. I fully support paid model for journo but not for this.
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But here's why it is a best-case, likely unattainable scenario. 1) We have not proven that US-style social distancing can produce R_effective<1 (declining case numbers). On this I'm hopeful, but it's a hope not a fact.
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We received a request to model dozens of scenarios from the US government at 5pm on Tuesday. We responded to many of these on Wednesday evening, thanks to fast and careful work by @StephenKissler. This was done in good faith in order to help support the USG response.
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True. We are near the beginning of the epidemic, with most people still susceptible. China and Korea have suppressed transmission by massive testing, combined in China with far more intense distancing than here and in Korea with significant distancing
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3) We have never accomplished contact tracing on the scale that will be necessary -- and again, to keep cases low, we will have to accomplish that everywhere, not just some places.
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I have always thought that analogies were helpful in #scicomm and wondered if I went overboard with them when talking to reporters. But I feel the presence of an (anonymous) superstar in analogy-based scicomm when I see this example.
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Just heard Boston's St. Patrick's parade is on for Sunday. A million expected people at a big gathering is not what we need as a pandemic is starting. Philadelphia tried this in 1918
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That will not be easy with this virus as our @CCDD_HSPH analysis has shown but as some (mainly island) countries have shown, it may be just possible. We should do everything we can to reach for this goal, even if it is unattainable.
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On a simpler level, saying that "facts on the ground" are not consistent with 20% of the population getting infected is really quite deceptive. Likely, no population has 20% yet infected (though we can't be completely sure until serologic testing is widespread).
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I must agree. I am generally a hawk about maintaining rules with a clear benefit. Outdoor masking has notable costs and really no evidence of benefits
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I'm getting >100 press queries per day and have to triage many good ones. I'm prioritizing orgs that are free @NPR @propublica or have dropped paywalls for COVID coverage @WSJ @nytimes @TheAtlantic for example (some days can't even do those). In a pandemic good info saves lives.
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That is unlikely. Then the rosy scenario assumes we get to minimal numbers of cases everywhere, develop and maintain testing and tracing capacity, execute well on it, don't miss imported cases that spark new chains of transmission, and somehow maintain this delicate balance. .
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4) If we manage all of that, there will still be a world of COVID-19 transmission throwing sparks back at us. Like China today we will be in a long-term effort to prevent these sparks from starting new chains of transmission.
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But it would be extremely naive to imagine that they are likely, and what do I know, but it seems like bad politics to "assure" the American people that they will come to pass when so many things could go wrong, any one of which leads to much worse outcomes.
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Show me a seasonal flu that leads to triage of whom to let die in icus despite intense social distancing & I’ll stop worrying. Or an exponentially growing uncontrolled pathogen that infects 1% then “dissipates”. This is wishful fantasy not contrarianism. True we need more data.
This (currently) contrarian view of COVID-19 response deserves close attention and debate by all experts, as it is the view of John Ioannidis, whose attention to data and fact-based analysis is well known. @statnews @ashishkjha @mlipsitch @NAChristakis @ScottGottliebMD.
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But this virus has shown in countries around the world that it can spread rapidly, and a small problem can become a big problem -- that is how exponential growth works.
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In places with many known & suspected COVID cases it is getting really intense. Efforts to do contact tracing are overwhelming even the top health departments At this stage it is wrongheaded to pour exponentially growing resources into this strategy.
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We should work our hardest to create the conditions to make the scenarios being described here (one bad wave, contained by social distancing, and we're down to a point of controllable spread) a reality. Doing so will make us better prepared, even if they don't come to pass.
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A little good news. Survivors of SARS1 from 2003 retain neutralizing antibody 9-17 years later. So it is possible for functional antibody to a coronavirus to persist for longer than previously shown.
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The sparks from abroad won't be stopped by detection at the border; we don't do that too well as we showed empirically and others @cmmid_lshtm showed theoretically
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Dr. Birx's statements today indicated that "when people start talking about 20% of a population getting infected, it's very scary, but we don't have data that matches that based on our experience.".
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I'm taking a break from talking to the press for a few days. I'm planning to spend the next several days, at least through the weekend, resting, exercising, and focusing on scientific work.
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The numbers of "new" cases reported daily in the US are not new. They are newly discovered as we start to test more. Testing is still completely inadequate, and actual case numbers are much larger than the numbers we're hearing because most cases never get tested.
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Sad to see my 20-year colleague and friend @neil_ferguson slammed in the press. Say what you will about foibles (a darn sight smaller than those of many with greater power). People of UK will suffer from losing direct access to expertise of world-class epidemiologist.
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In light of the retractions it's worth remembering: Peer review is one imperfect part of the at-least 4-part safety net that keeps science functioning. Layer 1 is basic ethics among investigators: don't make up or misrepresent data.
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This article describes a radical approach to (not) managing the COVID epidemic in India. It misrepresents my views worse than almost any article I have ever been quoted in. We talked for 1/2 an hour and my quote is wildly unrepresentative of what I said
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US national flu-like illness (symptoms fever+[cough &or sore throat] trended up for first time while flu test + going down. Only one week so far but best evidence I know for widespread COVID-19 in absence of viral testing. Something to watch carefully in each region @CDCFlu
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Seeing Dr. Anne Schuchat speaking out and getting quoted in the press is the most encouraging COVID development in a long time, notwithstanding that she is bringing bad news = truth, a scarce commodity from USG recently.
CDC official: "As much as we've studied [the 1918 flu pandemic], I think what we're experiencing as a global community is really bad and it's similar to that 1918 transformational experience."
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This is simply wrong. Herd immunity is not a strategy or a solution. It is surrender to a preventable virus.
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The idea that covid is less severe than seasonal flu is inconsistent with data and with the fact that an epidemic just gathering steam can overwhelm ICU capacity in a rich country like Italy or China.
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And more good news from studies by Korea CDC : the “repositives” are shedding only dead virus.
Covid Patients Testing Positive After Recovery Aren’t Infectious, Study Shows
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First we in the infectious disease community watched as the president denied the science of our colleagues in climate research. Now we've experienced @realDonaldTrump denying our science and stating COVID-19 would go away like a miracle. How did that go? Almost like a pattern.
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Hard to escape the conclusion that being a vegetarian is the pro public health thing to do right now. Perhaps that’s always true, but now enough so to compel me.
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Excited to start a secondment to @CDCgov to co-lead the establishment of the Center for Epidemic Forecasting and Outbreak Analytics. Fantastic team of @dylanbgeorge @rebeccajk13 @cmyeaton + CDC colleagues.
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It is unsustainable (effort grows with epidemic size). We need measures that while painful for all will slow social contact - cancelling public gatherings, paid sick leave, working from home, and the like. Social distancing is the general name for these interventions.
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Keep parks open. The benefits of fresh air outweigh the risks of infection. With @j_g_allen & Ned Friedman @ArnArbDirector
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This is a disgrace. Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response via @khnews.
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And we need to stop feeling sheepish about it and just realize that some places (Italy, Iran) are in crisis, and some are very likely in the days before crisis, a crisis that will be less bad if we slow down the virus. #flattenthecurve to reduce peak demand on health care.
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.@alisonannyoung has been one among the most active, persistent, and fair-minded reporters covering lab accidents in the US @USATODAY. This long piece makes the serious case for investigating poss lab origin for #SARSCoV2.
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This is an even bigger story than the President’s reckless personal behavior and refusal to practice public health in the Whirr House. Exactly what many predicted and feared. Watch this space.
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Two preprints recently make an important point: for any infection, including COVID-19, it is possible that herd immunity can be accomplished with more than 1/R0 of the population still susceptible. The first was by Gabriela Gomes et al. @LSTMnews
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This article is better than its headline (can we just stop the antiquated tradition of letting late-night copyeditors write the titles that may be all anyone reads of our long articles that we labor over?), "Models vs. Evidence".
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My takeaways: 1) early intervention spares the health system from intense stress -- like Philly vs. St. Louis. 2) Early intervention means before it feels bad. Guangzho intervened when they had 7 confirmed cases & 0 deaths. Wuhan's came when they had 495 confirmed cases, 23 dead.
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Amazing to watch roll call in House and see a good 2/3 of @GOP vote for the nonsense that brought today’s sedition and riots.
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No decent epidemiologist thinks all cases (or all deaths) have been identified. No one with sense divides observed deaths by observed cases.
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Navarro should be ashamed of himself. Not a shred of truth. This is people’s lives. President has declared surrender and he’s making excuses.
Navarro: Everybody thought and this was a reasonable presumption, that come summer, the heat and humidity would get rid of the virus. It doesn’t look that way. This looks like a weaponized virus.
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Media: you need to stop reporting on new cases in the US. They are newly discovered. I know you don't mean to but by saying the literal case numbers you are playing into the false narrative that things are under control in the US.
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Why are the media not reporting on how many arrests have (not) been made? Sedition is a crime, destruction of property is a crime, etc., even when committed by Trump supporters.
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Disgusting. This administration finds ever more ways to destroy what is best about our country and promote its basest instincts.
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Lots of places are closing outdoor spaces, which seems terrible for mental health and fitness, and not obviously helpful for COVID blocking. I was all for cancelling large parades (St P's) where people stay in close proximity for hours outdoors, then have house parties etc.
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'Flattening the curve’ may be the world’s best bet to slow the coronavirus. Right on the mark by @HelenBranswell
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I can't wait until there are far fewer people interested in what epidemiologists think on a daily basis. That will be a sign of a return to normalcy. But hope people keep listening to us enough to help prevent another similar catastrophe.
I can’t wait to drop some of these pandemic related folks I follow. Follow for more cartoons!. #pandemic #pandemicfatigue #COVID19 @Bob_Wachter @mlipsitch @ASlavitt @DrEricDing #epidemiologist #SocialMedia #comics #webcomic #webcomics #cartoon #CovidVaccine
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I did actually say the quote that is going around, but the article contained vital context -- we don't know what proportion are symptomatic. Also we have only a rough estimate of what proportion of symptomatic people will have severe outcomes.
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Important consensus statement in favor of controlling COVID-19 and countering irresponsible calls for herd immunity by natural infection.
NEW Correspondence—80+ researchers warn that a so-called #herdimmunity approach to managing #COVID19 is “a dangerous fallacy unsupported by the scientific evidence” #WCPH2020
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There is a big if to this. Works if the vaccines strongly block infection/infectiousness/transmission like measles and mumps vaccines. Won't work if vax effects mainly on illness, with more modest effects on transmission, like pneumococcal and acellular pertussis vaccines.
Dr. Anthony Fauci predicts the U.S. could begin to achieve early stages of herd immunity against the coronavirus by late spring or summer. And if that happens, he anticipates, "we could really turn this thing around" toward the end of 2021.
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Always relevant. Why Most Published Research Findings Are False
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Important data. First indication with Delta that despite comparable Ct values, vaxed breakthru cases likely less infectious than unvaxed cases.
Virological characteristics of SARS-CoV-2 vaccine breakthrough infections in health care workers. What would you expect from a symptomatic breakthrough causing cold/flu symptoms? That your immune response (antibodies/T cells in nose/respiratory tract)
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Prepare Now for Long War Against Covid-19. With Richard Danzig. We propose scale up of serology, war-level production of medical countermeasures, national effort on education, preparing for safe democratic November elections, infrastructure strengthening
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Apologies to the hundreds who have emailed (journalists et al) and I have ignored. I fear those numbers will grow. I am prioritizing trying to do science, keep some time aside to think out of the box about ways out of our distancing vs ICU dilemma, sleep, & see family.
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Coronavirus Task Force Officially Split as Fauci Announces Solo Album
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It is hard to know where to start with how naive this article is.
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Important points from two top epidemiologists. I have been very cautious due to limited evidence on transmission effects but agree with the authors that a large transmission effect is the best explanation of the limited evidence to date. Zero would indeed be beyond shocking.
"It may be that protection against transmission is appreciably less than protection against severe [#COVID19] disease, but at this point it would be beyond shocking if no impact was there," write @KateGrabowski and @JustinLessler. 🔗
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It's getting increasingly hard to take John Ioannidis's "let's keep to the science" line seriously. My postdoc advisor Bruce Levin said "What distinguishes science from the rest of academia is that in science, you can't predict the conclusion from the name of the author.".
Today, this new preprint from John Ioannidis (of "Most Published Research Findings Are False" fame) went online. Already up to Altmetric of 541. Let's do a rapid peer-review on twitter 1/n
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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!.
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White House events like this are one way, but not a good way, to reduce racial disparities in COVID-19 incidence
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I have deleted all tweets I could find about Eric Ding. The impact of these was more hurtful than I realized, and while I strongly disagree with many of his actions and statements, I do not wish to cause unhappiness by expressing those disagreements.
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I do not think that word means what you think that it means
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ht @KeyaJoshi3: "I just got kicked out of a flat-earth Facebook group because I asked if the 6' social distancing rule had pushed anyone over the edge yet".
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The 1918 analogies have been discussed a lot and are correect. Flattening the curve reduces health care load, delays risk for everyone, and reduces total epidemic size. Here are some data from a paper we submitted to @medrxivpreprint and is awaiting clearance. Led by @ruoranepi.
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So here's my take on the BU experiments. I know you can't say this on Twitter, but it is my current state of understanding, possibly imperfect, subject to revision with better understanding, and trying to make sense rather than condemn opponents.
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Reupping this. Existing vaccines may well have been unable to get us to the herd immunity threshold before the variants made things harder. Now more unlikely. But if we can identify (hard) and vaccinate (harder) the most vulnerable it will make continued spread less destructive.
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Estimating an absolute risk at the start of a pandemic is like estimating the absolute risk of dying within three days after a cancer diagnosis. Not false but not either serious or sensible.
New pre-print by John PA Ioannidis. Certain to be provocative, Ioannidis and colleagues estimate the risk of dying <65 vs >80 from COVID-19. If you disagree with the result, try to articulate what you think is wrong, AND what your estimate is.
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Great interview with @CT_Bergstrom. ‘There is no absolute truth': an infectious disease expert on Covid-19, misinformation and 'bullshit'
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Same applies for some other countries, but US is among rich countries perhaps the champion of undertesting. Kudos to many colleagues for racing to fix that, but for now the numbers are wildly underestimated.
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It has been cancelled. Thanks to these political figures for your leadership.
St. Patrick's parade needs to be cancelled. @marty_walsh.@CharlieBakerMA @wutrain @BOSCityCouncil @Kim_Janey @mfflaherty @juliaforboston @LydiaMEdwards @edforboston @CampbellforD4 @RicardoNArroyo @MattOMalley @KenzieBok @Liz4AB.
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Just like people now discuss how cloning a gene used to be a PhD and is now an afternoon, I look forward to the day when people recall that formatting an article f/ journal submission used to take most of a day when A COMPUTER COULD DO IT IF JOURNALS JUST INVESTED & STANDARDIZED.
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Hard to think of a more fitting time for this award.
Congratulations again to Anthony Fauci of @NIAIDNews, 2020 recipient of the Gustav O. Lienhard Award for Advancement of Health Care! #NAMmtg
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Another myth to bust: Wuhan stopped short of 20% of the population being infected -- how can you say it will be 20-60% who will get it? FACT: yes Wuhan is short of that. The epidemic is not over. China is restricting travel from outside (irony!) but COVID certainly still there. .
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This is just crazy. Mainstream experts have been trying to get through with almost no success. But take an out-there position and you get access. Of course take extra precautions for the most vulnerable. But don't relax everything else before evidence these precautions work.
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Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period new paper with @StephenKissler @ctedijanto Ed Goldstein and @yhgrad
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