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There is a 3rd dial in the #covid19 response that urgently needs to be cranked up: social protections

•widespread use of high-filtrate masks

•rigorous orchestration of hygiene + distancing in public & private spaces (workplaces, transit, stores, home)

hbr.org/2020/05/a-plan…
The first two dials- testing and contact tracing- are already underway, but need to be scaled significantly and quickly.

It remains unclear how that will happen, if it can at all, in the short term.

As places are reopening prematurely (which is very ill advised)...
We must *optimize* every single move in our arsenal to bring transmission down.

We need to focus on cutting respiratory spread in any way we can- and if we are leveraging universal masking, we should be bolstering it with high-filtrate products rather than cotton cutouts.
There are likely some quicker/easier fixes to the issue. Teams are now exploring the potential of multi-layered material masks that may have much better filtration efficacy. Prototyping, mass producing, distributing, and using these will be critical.

“redesign our lives to reduce risk”— this last part of @DrTomFrieden excellent tweet/light switch analogy below is what our piece/strategy ⬆️ focuses on.

Cc @RanuDhillon @sri_srikrishna @diegochowell @HarvardBiz

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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
A short thread

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."
Read 9 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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