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1/ Throughout my time working on #covid19 response here in Massachusetts, I have come back time & time again to this single video by the head of the WHO epidemics response, @DrMikeRyan

If there's only one thing you watch, let it be this:
2/ @HelenBranswell wrote a great piece on him during his management of the last #Ebola outbreak.

A lot of people will talk a lot about epidemic response, but many have not worked in communities, on the ground.

Mike Ryan has truly walked the walk.

statnews.com/2019/10/30/the…
3/ "The lessons I've learned after so many Ebola outbreaks in my career:

Be fast.

Have no regrets.

You must be the first mover.

The virus will always get you if you don't move quickly."
4/ My favorite line from his whole speech is this:

"If you need to be right before you move, you will never win."

Read that one more time. And then consider how many times we have done the opposite in our response here in the US.
5/ "Perfection is the enemy of the good when it comes to emergency management.

Speed trumps perfection...

The problem in society at the moment...everyone is afraid of the consequence of error.

The greatest error is not to move...to be paralyzed by the fear of failure."
cc tagging colleagues in emergency medicine who know this all too well

@DrMikeRyan on epidemic response: "If you have to be right before you move, you'll never win"

cc @jeremyfaust @choo_ek @ReganHMarsh @hstoklosa @meganranney @Craig_A_Spencer @darakass @AliRaja_MD
Some more thoughts on this thread below...in another thread

Cc @WHO @gabbystern @DrTedros @doctorsoumya @MoetiTshidi important words from Dr. Ryan as we continue fighting #covid19
To put some actionable moves to @DrMikeRyan advice from above- we argue here @HarvardBiz that the next step is to scale up high-filtrate masks to a level that can blunt respiratory transmission at a population level better than we are currently doing

hbr.org/2020/05/a-plan…
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Abraar Karan, MD MPH DTM&H
@AbraarKaran
In medicine, we as a profession are very conservative. We live by the principle, "First, do no harm."

As internal medicine doctors, we are more likely to say "Don't just do something; stand there!"

Now working on epidemic response, I am realizing we don't have that luxury.
2/ We shouldn't be cavalier or reckless. All actions have consequences, some of which can be more harmful than the action itself.

But, we may not have every single data point that we need before we are forced to act.

And that is immensely difficult.
3/ As doctors, we often act under uncertainty, juggling probabilities & risk/benefit calculations in our heads.

The same is true w/ #covid19. Universal masking. Closing schools. Closing borders.

Every decision has predictable and less predictable consequences.
Read 6 tweets
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Abraar Karan, MD MPH DTM&H
@AbraarKaran
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…
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
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.

Read 15 tweets
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Abraar Karan, MD MPH DTM&H
@AbraarKaran
This is important
1/ New @JAMA_current looking at exposed contacts of 100 infected #covid19 cases.

Secondary attack rate in family contacts (5.3%)/ in-home (4.6%) was much higher than other contacts (0.7%).

Presymptomatic-symptomatic rate was similar.
jamanetwork.com/journals/jamai…
2/ This points back to two big and recurrent issues:

-home-based transmission
-transmission before symptom onset

If these are two big drivers of the epidemic, strategies that focus on detecting symptoms or that fail to stop home-based transmission will be inadequate.
3/ This means that contact tracing has to be very quick from case detection to strict quarantining of exposures well before they develop any symptoms.

Combine this with the reality that home-based quarantine/isolation isn't feasible for many & you can see the glaring issues here
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