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Natalie E. Dean, PhD Jun 23
THINK LIKE AN EPIDEMIOLOGIST: What does it mean that the median age of new cases is dropping in some areas? I see three possible explanations, not all good. A thread on how to distinguish between them. 1/10 (Figure h/t )
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
Explanation 1: More testing. As we do more testing in the community, we are able to capture more mild or even asymptomatic infections. This is especially true for routine workplace testing. As younger people have milder disease, this shifts the age distribution lower. 2/10
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
If median age drops because of more testing only, we expect: - Increase in number of cases detected across all age groups - Test positivity to drop in all age groups (size of drop depends on which groups are targeted for testing) - No change in hospitalizations 3/10
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
Explanation 2: Elderly people are more cautious. Median age could also drop if the elderly were protecting themselves better, even with no change in testing. For example, we are preventing more nursing home outbreaks. 4/10
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
If median age drops only because the elderly are more cautious, we expect: - Drop in number of new cases in the elderly - Drop in test positivity among the elderly (fever/illness is more likely due to other non-COVID causes) - Drop in hospitalizations (after a lag) 5/10
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
Explanation 3 (the not good one): Young people are less cautious. This is distinct from the previous scenario. It means that young people are being infected even more than before. This could occur if there are many bar/nightclub or workplace outbreaks. 6/10
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Natalie E. Dean, PhD
If median age drops only because young people are being infected more, we expect: - Numbers of new cases to rise in young people - Test positivity to increase in young people - More young people being hospitalized (after a lag) 7/10
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
Besides the fact that young people can face unknown long-term outcomes of infection, they can also inadvertently spread the virus to their communities. So the median age could start to creep back up if it moves from bars out to coworkers, family members, etc. 8/10
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Natalie E. Dean, PhD Jun 23
Replying to @trvrb
The reality is almost certainly some mixture of all three explanations. In this figure (h/t ), test positivity drops for everyone (more testing), but most in the elderly (more protection). But it is flatlining in 18-49 y/o and could start increasing (more infection). 9/10
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Natalie E. Dean, PhD Jun 23
Replying to @nataliexdean
Ultimately, we need more high quality age-stratified data on cases, testing, and hospitalizations. These are my preliminary thoughts on how to distinguish between these scenarios. Looking forward to discussing with more! 10/END
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WEAR YOUR MASK Jun 23
Sadly I’m afraid this scenario is already starting to be validated by hospitalization numbers discussed by
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theunretired Jun 23
Replying to @nataliexdean
But they might not need hospitalization
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Antifa HR. 🇨🇦 Jun 23
But at the same time hospitalisations are going up. Low risk of hospitalisations (let say 1%) in 100 people equal 1, in 10 000 equal 100
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BioReport Jun 23
Replying to @nataliexdean
The percentage of young people needing hospitalization will be low but can still put pressure on hospital systems when 30,000 a day being infected.
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Greg Beckman Jun 24
Replying to @nataliexdean
Why- you are Agassi I gotta that the comorbidities in young and old Are equivalent?
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Absurd Airplane Jun 23
Replying to @nataliexdean
Except that nothing of the sort of .#3 exists, we should have experienced this already. The hospitalization lag time is up, yet not only have new hospital admissions decreased, there’s no change in median hospitalization age. Yet mobility has increased.
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Michael Hill Jun 23
Replying to @nataliexdean
Not sure where you get more young people being hospitalized after a lag. 75% of hospitalizations were those >50yo. Less elderly infected means > proportion of youth make up hospitalizations. But that does not mean a greater % of youth infected will be hospitalized.
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