Thread by @VPrasadMDMPH

Great article, but I fear the CDC director is doomed. Here's why.

In the next few months, we will have to accept the inevitable, that all people will be infected with the virus at some point in the future. Better to be vaccinated/ or have nat immunity when you meet it...🧵

.. But avoiding it is not an option

Draconian mitigation efforts to delay the time to meet the virus make no sense.

Makes no sense for a vaccinated person to wear an n95 or equivalent. Certainly makes no sense, and is borderline insane, to make a child wear such a mask.

It is also borderline insane to make college students who have already had multiple vaccines keep getting more, or sit all day in their dorm room to avoid meeting it.

It is coming for them.

They're sacrifice won't change broader dynamics.

Mandating booster after booster is a fool's errand. It will target low risk populations, younger people who are working, and won't be the people you need to boost: nursing, home residents, and very old people.

You have no power over 80-year-olds to mandate.

By not having coordinated boosting in nursing homes, however, you are making a huge error.

What a screw up.

Boost nursing homes NOW!!!

If you feel fine, you will be asked to go to work. It doesn't matter if you would test positive by some test.

Some amount of infection is inevitable and cannot be avoided.

Collapse of social services & hospitals cannot happen.

So the CDC director will increasingly have to communicate policies that engage in trade-offs.

Balancing continuing society with trying to prevent local health care system collapse.

In many cases the right answer will be to ease up on your mandates, ease up on draconian policies, not double down on them.

This is when the CDC director will be in a jam

You see the CDC directors base is a group of online zealots who think the virus can be eliminated.

I'm worried they're going to take up hunting deer when they learn how many have SARS-CoV-2

The CDC director, who signed the John Snow memo, will have to communicate to them that the dream is dead. They won't like that. Just like they don't like 5 vs 10 days..

Thankfully, outcomes among young people are terrific. And yet, they are incredibly concerned with spread in young populations. So much so that they're willing to close schools. The only tattered ladder of opportunity left in this country.

Closing schools is catastrophic error

The CDC director is going to increasingly have to tell these people the truth.
That the virus will never be eliminated.
That it will eventually reach all people.
As such making a child wearing n95 or equivalent is a delusion.

It, at best, delays an inevitability, with loss of speaking and social cohesion, with no great gain. Should not be pursued.

Mandatory booster policies will also be unable to contain the virus. And thus the CDC director will have to eat crow.

Someone may someday ask if it made sense to boost 12-year-old boys with essentially no efficacy data...

Did it make sense to make the moderna booster 5 months with no day at all?

So the CDC director is in an impossible position. Having an embraced an ideology of zero COVID (John Snow), the CDC director will have to abandon it, and communicate policies that make compromises.

And thus, it is likely that the White House will sacrifice her. And they will be more infighting among the zero covid crowd

How can the CDC director save herself? The answer is clear: just tell the truth. That was always the secret.

If we told the truth about the efficacy of cloth masking, we would have had a lot more public trust.

If we told the truth that vaccines are tremendously effective for older people, but the risk benefit profile of multiple doses of younger people is dubious, we'd have had trust

More randomized trials and not fewer were the answer. We needed more randomized trials of masking in school. It's likely would have failed. But doubling down on rhetoric without doing studies is no good.

Even though Omicron is super contagious, it is possible that rich people are still making behavioral changes that will delay the time until they meet the virus. This will just lead to another peak in a few more months when they fatigue. Eventually all people will be exposed.

Optimize your medical problems, lose weight, get vaccinated, and get on with life. That was always the right answer. Everything else is a fools errand.

Good luck CDC director, you will need it.

Here is a long form explanation of why the n95 is pointless for a vaccinated person

vinayprasadmdmph.substack.com/p/should-you-w…

Oh. And, For all the people who think masks will keep flu away forever. Flu will find us all soon and it will punish us twice as bad for avoiding it.

There is no avoiding respiratory viruses. They only exist because we must be close to each other to truly live.

Yup, the policy shift has begun....

Here are the implications of this thread on schools
city-journal.org/school-closure…

Here are the implications fro vaccine mandates
vinayprasadmdmph.substack.com/p/vaccine-effe…