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1/ For those who want a critical view on the *ethical* issues that come up w/ epidemics like #COVID19 #Ebola below is the medical journal I led over the past year for the @JournalofEthics on this topic. All free content. Many experts that contributed. ⬇️

journalofethics.ama-assn.org/issue/culture-…
2/ We must ensure there are #mentalhealth resources available, something often forgotten in epidemics. #COVID19 is causing mass panic. We need to make sure people have professional support for this. It may sound secondary but I think it’s critical.

journalofethics.ama-assn.org/article/how-sh…
3/ the topic of “biocontainment” comes up again w/ #COVID19

“Being close enough to patients to care is as critical as remaining distant enough from a pathogen to be safe. This strategy simultaneously frustrates and supports public trust.”

journalofethics.ama-assn.org/article/five-t…
4/ the topic of using experimental drugs/vaccines comes up again as well.

Can we mandate vaccination when we produce one? Lots to think about here. Remember- many people don’t even take a vaccine for the flu, which has killed more people than #COVID19 ⬇️
journalofethics.ama-assn.org/article/making…
5/ and perhaps one of the most important articles in this issue: how should the media respond to epidemics? How do we ensure that the public gets honest, accurate information? ⬇️

journalofethics.ama-assn.org/article/what-s…
6/ and as #COVID19 spreads to low-income countries w/ much weaker health systems, how will we respond? What is our duty and role to stay connected globally and help where we can? ⬇️

journalofethics.ama-assn.org/article/how-sh…
7/ More on thinking about vaccine mandates & when they are appropriate, if ever. #COVID19 ⬇️

journalofethics.ama-assn.org/article/when-a…
8/ and lastly- a very important topic: the sharing of data during a global outbreak. There has been much discussion about whether data from China was shared in time or transparently. I don’t know the answer. But here is a way to think about this topic ⬇️
journalofethics.ama-assn.org/article/how-sh…
9/ & thanks to everyone that contributed to the issue over the course of last year (@BhadeliaMD @neva9257 @rocza @doritmi @klgthomas & more)- this is the time we really need it. Special shout out to @IngridKatzMD who has been my mentor & supporter for so much of the work inc this
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More from @AbraarKaran see all

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Abraar Karan MD, MPH, DTM&H
@AbraarKaran
1/ NEW @JAMA_current research letter out today.

-Important findings w/ regard to extensive level of room contamination w/ #COVID19 in patients who were in airborne infection isolation rooms in Singapore

The patient to notice in the paper is "Patient C"
jamanetwork.com/journals/jama/… Image
2/
 -Patient C had rtPCR positive stool samples despite not having diarrhea or infectious GI symptoms

-Before cleaning Pt C's room, 13 (87%) of 15 room sites (including air outlet fans) & 3 (60%) of 5 toilet sites (toilet bowl, sink, and door handle) tested positive (see tables) ImageImage
3/
-These samples were all negative after cleaning, suggesting our decontamination procedures likely sufficient

-Big question/issue w/ just doing rtPCR w/o viral load = is the sample actually viable to cause infection? We don't know. Study here w/ same limitation.
Read 5 tweets
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Abraar Karan MD, MPH, DTM&H
@AbraarKaran
THREAD

What constitutes an "expert" in a novel epidemic?
Serious question.

Many laypeople and even doctors are looking to "experts" on #COVID19. Who do we turn to? For what?

Some thoughts:
1/ First thing to remember: anyone claiming to be an "expert" on #COVID19, a completely new disease for which the medical/scientific data is changing almost daily, probably isn't.

Most doctors, including myself, will not say they are "experts" on #COVID19.
2/ What medical doctors are trained to do is:
-take care of patients (some specifically for infectious disease)

-read the medical literature/ interpret it, albeit with caution

-for some, run clinical trials, produce the data/medical literature that the rest of us read
Read 13 tweets
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Abraar Karan MD, MPH, DTM&H
@AbraarKaran
*THREAD*

1/ I think that information transparency is one of the most important things we can provide during the #COVID19 outbreak.

To help, I am going to share where "experts" are getting some of the big numbers/data so that people can go read it for themselves.
2/ The first big numbers are the 81/14/5.
81% of cases are MILD
14% are SEVERE
5% are CRITICAL

The other big number: 2.3% case fatality rate

These numbers are from the Chinese CDC. They were published in @JAMA_current Feb 24th. They are available here: jamanetwork.com/journals/jama/…
3/ Some of these %ages are likely OVERESTIMATES. This is because we are less likely to catch MILD or asymptomatic cases early in an epidemic. So, rather than 5/100 (5%) being critical, it may actually be 5/200 or 5/2000-- we just don't fully know yet.
Read 17 tweets

Related threads

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Ali
@aliostad
I will start today's thread on #COVID in Iran, following up from yesterday's #irancorona
DISCLAIMER:

The GOOD
- Government in a complete reversal taken #COVID seriously
- As per contacts, many stay indoors if they can

The BAD:
- Explosion of cases in new cities
- Tehran seems to be next
- Extreme shortage of basic hygiene supplies
- Street collapses continue
#irancorona
Read 37 tweets
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Gary Holland 🇺🇸 ⭐️⭐️⭐️ 🇺🇸
@gholland04
!!Quick-DECODE (08/29/19 4:10 PM EST)

Decode of POTUS Tweet T-7870

Here we find ...

TimeStamp 7:03
TimeDelta 5m

Keywords:
Prepared
Follow State & Federal Officials
Big Hurricane
Biggest Ever

#Qanon
@realDonaldTrump

...
@realDonaldTrump 1.

The TimeStamp 7:03 Clue
Leads us to Q-Drop 703

Here we find ...

Title:
JFK Prayer

“Rest in peace Mr. President (JFK), through your wisdom and strength, since your tragic death, Patriots have planned, installed, and by the grace of God, activated, the

...
@realDonaldTrump 2.

beam of LIGHT. We will forever remember your sacrifice. May you look down from above and continue to guide us as we ring the bell of FREEDOM and destroy those who wish to sacrifice our children, our way of life, and our world. We, the PEOPLE.”

...
Read 37 tweets
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Gary Holland 🇺🇸 ⭐️⭐️⭐️ 🇺🇸
@gholland04
!!DECODE (07/17/19 12:29 AM EST)

DECODE 07/16/2019 — POTUS Tweet T-6957 & US Air Force Tweet

“For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. Love is patient, love is kind.”

...
1.
God bless my fellow Americans.
4,10,2

#Qanon
@realDonaldTrump

...
@realDonaldTrump 2.

POTUS Tweet T-6957

Here we find …

TimeStamp 11:11
Time Delta 1h 12m
Time Delta to US Air Force 1m
Caps Gematria Value 1118
Keywords:
‘ALL POLITICS’
President
Tweet

...
Read 185 tweets
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FRONTLINE
@frontlinepbs
A new textbook refuting global warming is set for release – just as a series of guides on teaching the human causes of climate change are poised to be published. Inside the political fight over climate change in classrooms, via @frontlinePBS & @groundtruth pbs.org/wgbh/frontline…
These dueling education campaigns are the latest sign that children’s understanding of climate change is seen as up for grabs – a fight @frontlinePBS and @GroundTruth Project have been reporting on over the past year.
.@katieworth first broke the story in March of 2017 that the Heartland Institute was mailing science teachers across the country a book titled "Why Scientists Disagree About Global Warming.” pbs.org/wgbh/frontline…
Read 10 tweets
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Jeewan C
@jeewanc
(THREAD) When my son was in Gr 10 he brough home, To Kill a Mockingbird. I was angry -my child, was reading a text of a past romanticized by some, even tho it was riddled with #racism. I wondered how many texts he would read that looked like him. But he had to read that- why?
I had asked many times for a reading list of books theyd have in their English class. I asked if the texts looked like them, reflected their experiences bc #IdentityMatters. I never could get an answer. Replies included, it was a #Classic but y'all know #Classics aint #Neutral
Of course, the response when we have these convos - "Y'all want to Censor...". Funny how "#freeSpeech" and "#censorship" always come up when issues of #equity are being discussed. That our children shouldn't be exposed to #racism and #trauma they live EVERY. SINGLE. DAY
Read 17 tweets
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Portlus Glam
@PortlusGlam
HEADS UP: there's prob kompromat on Rudy Giuliani from his activities in Ukraine over the past year. You don't met w/ President Poroshenko, Pavel Fuchs, Victor Pinchuk, and Alexander Rovt w/out them attempting to gain kompromat @MichaelAvenatti - see thread for dates/locations.
Fun fact from googling Руди Джулиани (Rudy Giuliani). His son, Andrew Giuliani, works in the Office of Public Liaison and Intergovernmental Affairs. Is this who is getting Vampire Rudy all these crazy bookings and interviews? politico.com/story/2017/03/…
Wow, Andrew Giuliani seems nice and not at all a mini-tyrant. He got expelled from Duke for being a dickhead. Lost his dream of becoming a professional golfer....#sad. dukechronicle.com/article/2017/0…
Read 8 tweets

Trending hashtags

#anotheronebitesthedust #impeach #USsanctions #IRGC #COVIDー19 #WeThePeople #FactsMatter #academia #Tehran #Benghazi #COVID #DoubleStandards #boywhocriedwolf #JCPOA #BreatheLife #equity #Grace1 #Africa #DirectTaxes #Iraqi #IPU141 #FalseFlag #Mideast #UNGA #Iran

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