Thread by @RanuDhillon

1/ #TestTraceIsolate is undoubtedly essential to rein in COVID from a 'top-down' public health perspective

Stopping epidemics though requires responses from 'bottom up' too

From HIV, Ebola & Zika, 'behavior changes' that help people protect themselves can be just as important

2/ Behavior change was THE turning point in West African Ebola epidemic. I remember when this @sherifink article came out. In Guinea, we wondered if transmission was exploding underground...it wasn't; communities retrofitted their lives to prevent spread

nytimes.com/2014/10/29/wor…

3/ We faced asymptomatic transmission w/Zika:

"About 80% of infected people are asymptomatic &.. unaware they (propagate)..'invisible' spread"

With vaccines years away, the solutions we proposed then:

Widespread #TestTraceIsolate AND...behavior change

bmj.com/content/356/bm…

4/ How can we apply these lessons to COVID?

COVID primarily spreads among people who are close confines with one another for prolonged periods of times

How can we stop this transmission especially when some are pre/asymptomatic?

washingtonpost.com/opinions/the-c…

5/ In workplaces, public transit etc:
strict spacing, ubiquitous hand sanitizing & EFFECTIVE face protection

In shelters, nursing homes, jails:
PPE & hospital-level infection control protocols w/periodic screening once testing capacity is sufficient to do that

6/ In the home:
anyone who is symptomatic or a known contact should be truly isolated at home (like @ChrisCuomo did) or given the option to isolate in a repurposed hotel or dorm at no charge

washingtonpost.com/outlook/2020/0…

7/ Biggest challenge is preventing in-house pre/asymptomatic transmission especially as people start going out more & back to work

Frequent disinfecting (especially of bathrooms) & handwashing in the home is important - similar to what we do vs Ebola

thelancet.com/journals/langl…

8/ It may be too much to expect people to mask & distance in their own home when no one is symptomatic/a contact

If other transmission is sufficiently blocked, risk of this spread may be small enough that stopping it is not needed for R<1 though some individual risk would remain

9/ Maximizing behavior changes/'social protections' require

- community leaders to spread awareness why these steps are important

- equipping people w/resources they need (eg, masks, hand sanitizers)

- empowering people to know that they have agency in stopping this virus