"Medicine is a social science & politics nothing but medicine on a large scale. The physicians are the natural attorneys of the poor & the social problems should largely be solved by them"
- Rudolf Virchow, who discovered cell theory, leukemia, VTE & autopsy #GoldfarbChallenge
The principles Dr. Goldfarb is attacking are not new or ‘tangential’ as he claims; rather, they are fundamental & foundational.
Working in West Philly, Dr. Goldfarb should know that biomedical science & social justice are not only not mutually exclusive, but intertwined & essential to great health care.
The most systemic & sustainable 'solution' to the pandemic is to implement clean indoor air -- eliminate virus from the air enough that risk is always low
A big barrier to this in real life is that there was no guidance on just how clean is clean enough?
For years, CDC and ASHRAE, the bodies responsible for putting forward standards, were unwilling to do so
As a result, schools, businesses & other didn't know what to do. Some put one HEPA filter in a room & hoped it was enough (it wasn't)
In this letter, we (@sri_srikrishna@AbraarKaran) push for clear clean air targets &, based on available evidence & guidance, propose 6 air changes per hour (ACH) as a minimum & 12 ACH (which is what hospital isolation rooms have) as the ideal
Thanks @Bob_Wachter for sharing such a personal situation that allows us all to learn
What strikes me is that so many factors in how you’re navigating this situation are beyond the means & agency of our most vulnerable yet are being thrust on them to manage on their own
The judgements you expertly made are ones that are currently being put on all individuals irrespective of their knowledge & comfort with Covid
Just like we wouldn’t leave it up to individuals to determine what traffic rules to follow, guidance should be clearer
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In addition, you & your friends are appropriately doing serial testing to offset onward spread & access Paxloid promptly, something that many families can't afford
I’m @harvardmed & mainly work abroad but, due to family reasons, work clinically in low income areas in CA..
I've been working in a hospital in a low-income area for the past several nights
From talking with our many unvaccinated Covid patients, there are 2 general responses I've heard as to why they weren't vaccinated...
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1) Several people said they knew vaccination was *important* but never perceived it as their *most immediate* need until they got sick
Had we been going door-to-door, eliminating the burden on them to search out & get vaccinated, most felt like they would have gotten it
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2) Distrust -- not of vaccines -- but of the formal authority structures from whom they see them pushed
This rational distrust is from decades of injustices & continued negative interactions with these structures that is hard to undo or overcome quickly & amid a crisis
We're deploying vaccines like we do annual flu shots rather than the mass vaccinations done in Africa & Asia where millions are vaccinated in weeks
Years ago, Joe Rhatigan & I studied these campaigns. They offer several lessons that can inform what we need in the US now
THREAD
1/ Be proactive
Instead of passively waiting for people to come get vaccinated, we need to search them out & go to where they are & keep following up until they opt out or are vaccinated
We should be rolling out the vaccine like we do the Census, even going door-to-door
2/ Remove barriers & be redundant
In each community, have multiple ways to get vaccinated including CVS/Walgreens, pop-up sites & near high-throughput places people have to to go like grocery stores
Make some venues 24/7 so people can get vaccinated anytime that works for them