Profile picture
, 4 tweets, 6 min read
My Authors
Read all threads
1/ Let's cut thru the noise: the central issue in addressing Covid in US is figuring out how to engage communities who currently don't follow PH guidance especially around masks

Amid the overarching crisis this pandemic has created, we actually know how & have ways to stop Covid
2/ What we lack is a coherent national response & enough public buy-in for it to happen

We faced an analogous scenario with Ebola in West Africa. We overcame it by painstakingly engaging skeptical communities 1 by 1

We need to do the same now in the US

nejm.org/doi/full/10.10…
3/ Once you recognize that #TestTraceIsolate can scale only as far as testing can, the hurdles are not as much technical (though technical issues eg how to create better masks, persist) but are mainly those of trust & buy-in

How we solve these dictates what happens next
@AnokoJulienne @DrMikeRyan @JeanMombouli @MTamfum @agnesbinagwaho @NyenswahG @mfallah1969 @gregggonsalves @devisridhar @SuerieMoon @MartenRobert @DrTomFrieden @JeremyKonyndyk @JoiaMukherjee @MackayIM @RonaldKlain @Craig_A_Spencer @AbraarKaran @ashishkjha @Atul_Gawande
Missing some Tweet in this thread? You can try to force a refresh.

Keep Current with Ranu Dhillon

Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Related hashtags

#TestTraceIsolate

More from @RanuDhillon see all

Profile picture
Ranu Dhillon
@RanuDhillon
(1/3) Preprint: >7K cases, only 2 happened outdoors

Caveats
-cases not sampled but chosen if recorded w/description

-includes ~3 wks before lockdowns but people may have already gone indoors & changed behaviors

-excludes Hubei which had most spread

medrxiv.org/content/10.110…
(2/3) Takeaways (1 of 2)
-despite caveats, broadly consistent w/other findings that indicate less risk outside

-how can more activities be revised to be done outdoors?

-even if outside, distancing + masks are still important if around others
(3/3) Takeaways (2 of 2)
-are there ways to mimic benefit of the outdoors with ventilation & air flow management indoors?

-we should start recording cases w/similar detail so we can understand where & why transmission is happening & use that information to guide intervention
Read 3 tweets
Profile picture
Ranu Dhillon
@RanuDhillon
1/ With R~1 in many places despite social distancing & (possibly)⬆️testing, we need to precisely understand why, where &, if possible, how transmission is still happening so we can refine our response to get it down further

This is what we did against Ebola in West Africa
2/ Once main broad strategies - #TestTraceIsolate, behavior change – were put into play, transmission came down but still lingered

We serially found gaps, tightened/tailored response, got transmission down & then repeated this process over and over again to drill down to zero
3/ Based on ‘verbal autopsies’ used in health systems strengthening to discern medical causes of each death & more importantly systems gaps that failed to prevent it, we should do ‘epidemiological autopsies’ to understand the story – the why & how – behind every new infection
Read 11 tweets
Profile picture
Ranu Dhillon
@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…
Read 9 tweets

Embed code for your website

×
Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!