THREAD
1/ Our new piece in the @HarvardBiz outlines what we may need to do if testing remains inadequate and contact tracing cannot be rapidly/efficiently scaled up-- both which seem like long-shots in the near future (although we truly hope not)
hbr.org/2020/05/a-plan…
1/ Our new piece in the @HarvardBiz outlines what we may need to do if testing remains inadequate and contact tracing cannot be rapidly/efficiently scaled up-- both which seem like long-shots in the near future (although we truly hope not)
hbr.org/2020/05/a-plan…
2/ A number of states will meet their own gating thresholds to reopen well before we are at an ideal place in terms of testing or tracing to the level that we need
A number already have done this, as we are witnessing. We need to act quickly to reduce R0 by every means possible
A number already have done this, as we are witnessing. We need to act quickly to reduce R0 by every means possible
3/ A lot of people are saying "test more" but very few are saying how we actually do this; it isn't that easy unfortunately.
4/ Also, manual contact tracing is critical- but will become tougher as R0 increases when society begins re-opening, largely bc of presymptomatic spread.
Digital tracing could help, but unclear how this gets implemented in light of privacy issues here.
Digital tracing could help, but unclear how this gets implemented in light of privacy issues here.
5/ We argue for the optimization of a third lever- what we term here as "social protections"; essentially the individual level factors that impact transmission which we have not come close to getting right at all.
We focus on blunting respiratory and fomites based transmission.
We focus on blunting respiratory and fomites based transmission.
6/ Based on epidemiological models led by experts
@g_chowell @diegochowell, we believe the right combination of testing/tracing/isolation AND social protections can keep R0 below 1 consistently if done right.
medrxiv.org/content/10.110…
@g_chowell @diegochowell, we believe the right combination of testing/tracing/isolation AND social protections can keep R0 below 1 consistently if done right.
medrxiv.org/content/10.110…
7/ Social distancing has gotten us this far. We now need to mimic its effects as best as we can through all phases of re-opening.
In our piece, we argue for the massive scale-up and utilization of high-filtrate masks- much room for innovation here.
In our piece, we argue for the massive scale-up and utilization of high-filtrate masks- much room for innovation here.
8/ Not everyone will be able to do this all the time; the key is enough people doing it enough of the time to keep R0 below 1.
This will be important at the community level, the neighborhood level, and in the home.
All epidemics must be dealt with locally first.
This will be important at the community level, the neighborhood level, and in the home.
All epidemics must be dealt with locally first.
9/ Physical distancing in workplaces and public spaces needs to be carefully choreographed- staggering shifts; keeping tele-health going where it is working now; rigorously cleaning/disinfecting of personal spaces etc-anything to minimize physical interaction/ chance of spread.
10/ We also need a stronger focus on stopping in-home transmission.
I fear we are falling behind on presymptomatic transmission in the home, where face/face contact is highest + mask usage is probably minimal at best if at all.
I fear we are falling behind on presymptomatic transmission in the home, where face/face contact is highest + mask usage is probably minimal at best if at all.
11/ The final point is that we will need immense public buy-in for this to all work well.
And while certain policies are now being mandated, like masking w/ punitive measures, those measures can worsen health inequities. Thus, these need to be considered very carefully.
And while certain policies are now being mandated, like masking w/ punitive measures, those measures can worsen health inequities. Thus, these need to be considered very carefully.
Cc sharing our new piece on optimizing a third lever if we don’t have enough testing/tracing @FutureDocs @DhruvKhullar @KrutikaKuppalli @alikhan28 @FranciscoMarty_ @aetiology @cbpolis @DrLeanaWen @JenniferNuzzo @alexandraphelan @UNMC_DrKhan @KellyCawcuttMD @AndrewMIbrahim @V2019N
Sharing our new piece on what we may need to do w/out adequate scale up of testing/tracing to move forward Cc @VBKerry @JournalofEthics @FASPEnews @marciacastrorj @muhammadpate @neel_shah @RifatAtun @Nonstopdoc @SCBriand @angie_rasmussen @MarionKoopmans @VivekJainMD @PeterHotez
