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Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Jan 27, 2020 • 11 tweets • 9 min read • Read on X

Big developments re: #Wuhan #nCoV2019 #coronavirus outbreak in China since Friday. It looks like the virus has been spreading since November, maybe even October, and may not have started at the Wuhan market. thelancet.com/journals/lance…

This means that the virus may have already spread more widely in the region than we'd realized... just under the radar. Now that our radar is up, and we're looking and testing for #coronavirus cases, we may be picking them up.

So the dramatic increase in cases over the last couple days not actually be as sudden as it seems... but something that's been building up over months.

It's hard to find a needle in a haystack when the haystack is big. It's cough/cold/flu season. The symptoms of the #coronavirus are the same. So it's tough to pick up a #NovelCoronavirus outbreak in the middle of that.

Lesson 3 from the #Ebola epidemic for the #Wuhan #nCoV2019 #coronavirus outbreak: Signal-to-noise. It was hard to differentiate #Ebola patients from those with fever from run-of-the-mill malaria, typhoid, and other fever-causing diseases in the region.

When you're looking for a needle (in this case, the #Wuhan #nCoV2019 #coronavirus) in a haystack, anything you can do to reduce the size of the haystack helps! Please get your #influenza #flu #flushot. Wash your hands. Cover your mouth with your elbow when you cough/sneeze.

The other big news: the Chinese health minister says the #Wuhan #nCoV2019 #coronavirus might be spread by infected persons without symptoms. This would be a gamechanger. businessinsider.com/coronavirus-ca…

@CDCgov

Note that whether #Wuhan #nCoV2019 #coronavirus might be transmitted by asymptomatic persons has yet to be confirmed by @CDCgov scientists. But *if* true, this is scary.

@CDCgov

@CDCgov When we don't have drugs/vaccines for a disease, we rely on the basics: identify cases by screening for symptoms & testing for disease and conduct contact-tracing. But case-finding and contact-tracing rely on looking for symptoms.

@CDCgov

@CDCgov I really hope the #wuhan #nCoV19 #coronavirus isn't transmitted by asymptomatic persons.

@CDCgov

@CDCgov More on the #Wuhan #nCoV19 #coronavirus: bloomberg.com/news/videos/20…

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Sep 1

1/ Why the confusion over COVID vaccines now?

What’s changed isn’t the science. It’s the process.

Policy is increasingly announced by officials online & outside the usual evidence review, creating mixed messages for families.

on @CBSMornings with @edokeefe @TheKellyOGrady

2/ Normally, FDA reviews products, then CDC’s vaccine advisers (ACIP) publicly weigh evidence & vote.

CDC adopts guidance, which insurers & programs like Medicaid, the Children's Vaccine Program (CHIP), & Vaccines for Children follow.

That process has been corrupted.

3/ This season, the FDA narrowed COVID vaccine approvals:
🔹People 65+
🔹People 6m to 64y if they have at least one risk factor for severe COVID (including pregnancy)

Off-label use:
🔹Healthy people 6m to 64y in consultation with your doctor

Read 10 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Sep 1

1/ It’s been a chaotic week at the CDC.

The director was fired less than a month into her tenure, four senior leaders resigned in protest, & the agency is still reeling from a shooting at its Atlanta HQ.

on @CBSNews @FaceTheNation with @EdOKeefe

2/ These aren’t just headlines about “palace intrigue.”

What’s unraveling is the basic machinery that keeps Americans safe: vaccines, outbreak detection, lab guidance, and expert support for state health departments.

3/ Within hours of the firing of CDC Director Dr. Susan Monarez’s, 3 leaders—responsible for vaccine safety, respiratory diseases, & the chief medical officer role—resigned.

Earlier that week, CDC’s head of data systems also stepped down.

More departures are expected.

Read 14 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Aug 22

1/ After the shooting at CDC earlier this month, employees sent a blunt letter to HHS Secretary Robert F. Kennedy Jr.

They said that instead of standing with them, RFK Jr. is spreading conspiracy theories about the CDC & their work.

on @CBSEveningNews with @jdickerson

2/ They called this dangerous & made 3 requests:
🔹Stop spreading inaccurate health info
🔹Affirm CDC’s scientific integrity
🔹Guarantee safety of the HHS workforce

savehhs.org/letter/hhs-sta…

3/ Since the shooting, CDC staff say they’ve been harassed with phone calls.

Callers mockingly ask, “Are you resilient?” before playing gunfire sounds, echoing CDC’s own post-shooting messaging.

Read 12 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Aug 20

1/ For the first time in decades, US pediatricians have released their own vaccine schedule, separate from the CDC.

Why? Because they no longer trust the government’s process.

Here’s what parents need to know. 🧵
on @CBSEveningNews with @jdickerson

2/ Earlier this year, the CDC’s vaccine advisory committee was overhauled.

All 17 experts were dismissed & replaced with just 7 appointees—several with a history of spreading vaccine misinformation or skepticism.

3/ The Vaccine Integrity Project was established to fill the void & brings together many of top vaccine experts.

Today, the Vaccine Integrity Project reviewed the most up-to-date science on the safety & effectiveness of flu, RSV & COVID vaccines.

Read 15 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Aug 8

1/ New CDC data show just how much ultra-processed foods dominate U.S. diets.

Americans get ~55% of daily calories from UPFs.

Almost 2/3 of what kids & teens eat is ultra-processed.

on @CBSEveningNews with @TheKellyOGrady

2/ The biggest sources?

Sandwiches, sweet bakery goods, packaged snacks, & sugary drinks. 🥪🍩🥤

3/ So why does this matter?

Because a major new U.K. clinical trial—the largest & longest yet—found that even “improved” UPFs can’t match the benefits of minimally processed meals. 🍎🥗

Read 14 tweets

Céline Gounder, MD, ScM, FIDSA 🇺🇦

@celinegounder

Jul 29

1/@DeionSanders’ bladder cancer diagnosis was caught by chance, during a CT scan for an unrelated issue.

with @nateburleson @vladduthiersCBS @AdrianaDiaz on @CBSMornings

2/ Most bladder cancers are found when people notice blood🩸 in their urine, the hallmark symptom.

But early cancers can be silent, as in Sanders’ case.

3/ His scans, done for blood clots, ended up saving his life.

Even though his cancer was high-grade, it hadn’t invaded the bladder muscle.

That allowed surgeons to remove his bladder & cure him.

Read 18 tweets

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