Thread by @paulgknox

@YoniFreedhoff @carlyweeks Thread:

Suggesting that “a large number of people are selfish assholes” displays a breathtaking lack of humility, unworthy of those MD initials.

Lots more could have been done to convey risks, starting with acknowledging large deficiencies in knowledge about SARS-CoV-2. 1/x

@YoniFreedhoff @carlyweeks 1. The existence of asymptomatic transmission (AT) was initially denied. When it was acknowledged, its significance was played down. The difference between this virus and SARS (2002-2003) wasn’t sufficiently clear. 2/x

@YoniFreedhoff @carlyweeks 2. Failing to appreciate AT’s importance underpinned early surveillance missteps. Thousands of clinically observed COVID19 patients were denied testing and sent home. Whatever the medical merits of this, the message was that the disease was not serious. Communication failure. 3/x

@YoniFreedhoff @carlyweeks 3. Authorities then denied widespread testing was necessary, either for population incidence or contact tracing. Epidemiologists were pleading for this, but no. Result: lack of knowledge on which to base communication strategy. 4/x

@YoniFreedhoff @carlyweeks 4. Authorities also refused to release information on locations of cases, outbreaks and deaths. This further reduced the scope of information on which to base communication strategies. News reports eventually forced them to acknowledge the unfolding long-term care disaster. 5/x

@YoniFreedhoff @carlyweeks 5. Of course, the effect of keeping the lid on the LTC disaster was to ensure that when it broke it would dominate news coverage for some time, reinforcing the notion that the main COVID19 threat was to sick old people & care workers. Still no widespread testing in ON and QC. 6/x

@YoniFreedhoff @carlyweeks 6. Beyond health-care workers, testing was limited to a portion of whoever showed up & asked for it. Without detailed knowledge from widespread testing, authorities fell back on daily repetitions of the “stay home, wash your hands” mantra. Guess what, it wore thin. 7/x

@YoniFreedhoff @carlyweeks 7. Outbreaks and deaths at packing plants highlighted an underappreciated feature of lockdown - “essential” workers tended to be people who had to go to work to survive. Not all were in health care. Evidence of inequities began to undermine consensus on mitigation measures. 8/x

@YoniFreedhoff @carlyweeks 8. ON announced a re-opening that favoured rich-people pastimes - golf, stored boats, second homes, further undermining social consensus. Contact tracing is under way, but under capacity & still based in part on who shows up. Epidemiologists are asking for population surveys. 9/x

@YoniFreedhoff @carlyweeks 9. Authorities finally have come around to publicly acknowledging the need for widespread testing. They’ve also begun touting the virtues of non-surgical masks. Earlier they’d said masks offered little personal protection and were outweighed by isolation & social distancing. 10/x

@YoniFreedhoff @carlyweeks 10. Because of basic policy development errors:

- the knowledge base on which communication strategy is built has significant gaps;

- risks inherent in re-mingling haven’t been convincingly conveyed;

- there’s a sense of inequity in sharing the burden of mitigation. 11/x

@YoniFreedhoff @carlyweeks 11. I don’t condone the swarming of parks right now, either for individual relief or as a political or social statement. While my medical condition has forced me to stay on top of COVID19 and the science around it, I don’t pretend to be an expert in epidemiology or medicine. 12/x

@YoniFreedhoff @carlyweeks 12. What I do know something about are politics, policy, communication and public opinion. What I know tells me that three months into a life-defining pandemic, whose contours and consequences are far from clear, emergency fatigue ought to surprise no one. 13/x

@YoniFreedhoff @carlyweeks 13./ I also know that despite the temptation it is never, repeat never, a good idea to call people assholes if you want them on your side. From the looks of things this is now specialized expert knowledge. If so, I’m happy to claim it. 14/x

@YoniFreedhoff @carlyweeks 14. COVID19 demands humility from all of us. It forces everyone to re-assess what’s important, accept the limits of our knowledge, ask tough questions and be satisfied only with answers we understand. It tests our sense of boundaries between our lives and those of others. 15/x

@YoniFreedhoff @carlyweeks 15. @YoniFreedhoff muted me one tweet into this. Maybe he’ll discover it some day. I know other MDs & PhDs will be willing to reflect on the course of the #COVID19 pandemic & ask what lessons can be drawn from it. I hope for the same from everyone. I’ll do the best I can. 16/16

@YoniFreedhoff @carlyweeks @threadreaderapp pls unroll tks