Stefan Baral Profile picture
Sep 12, 2020 7 tweets 2 min read Read on X
My dream response:
TAGOPIE
Team, Analysis, Goal, Objectives, Planning, Implementation, Evaluate

Team -- what competencies should be in the emergency operations center (EOC) making decisions (methodologists, practitioners, clinicians, gov't, lawyers, clinicians, economists)
TAGOPIE
Analysis

Stakeholder Analysis (who will be affected/needs representation)
Epidemiological Analysis (CFR, IFR, RR, etc)
Situational Analysis (decision tree with different response models of expected benefits and costs. Costs include human, financial, and institutional.
Goals
Based on the three types of analyses, set a goal for your response.

Set specific, measurable, attainable, relevant, and time-bound (SMART) Objectives that flow from the goal used to inform key performance indicators.

Can be done in 2-3 hours with with analyses complete.
Plan implementation

Consider how you are going to pull off each of these elements--you know who stakeholders are, relevant agencies, etc. Consider strategies to sustain key health and social services to prevent COVID-mortality but also support acute and chronic health needs.
Implementation : use the E's
Economical (supports to mitigate infection)
Environmental (housing, occupational IPAC, etc)
Engineering (ventilation, innovative strategies)
Empathy (meet people where they are, not where we want them to be)
Education
Empowerment
Equity
Enforcement
Evaluate

Key performance indicators looking at overall COVID-morbidity and mortality, disparities, non-COVID morbidity and mortality, social welfare, well being, etc.

Adapt plan accordingly--spend more for those who need more.

Communicate consistently, compassionately, etc
Yes, this was a new bug. But we could have used public health principles that have been around for centuries and scaled them to this PHEIC.

But we did none of this.

We threw playbook out the window, ran a model, shutdown, and now hoping testing and masks can bring us back.

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More from @sdbaral

Jul 20, 2022
For everyone coming to #AIDS2022, the Canadian gov't has reintroduced mandatory random arrivals testing.

The process will likely be convoluted for people staying in hotels as kits will need to be shipped to you or maybe can get one at airport and then returned somehow.

(sorry)
Most people attending #AIDS2022 will be flying into YUL/Montreal Airport.

I contacted Biron (the federal testing contractor in Quebec) and there are 3 options for testing.

1) At airport
2) Locations in Montreal where nurse will take swab
3) Shipping self-collection swab.

2/x
The Biron representative said that testing at YUL should continue for the next two weeks which would include folks arriving for the conference.

So if chosen, could just do test there and will get results in 24h.

If no longer there or wait too long (or tired), options 2/3.

3/x
Read 9 tweets
May 11, 2022
A public health program implemented without a detailed plan is no more likely to succeed than a house built without a detailed blueprint.
Epidemiological data is one of many inputs into public health recommendations.

Others include:
1) knowledge, attitudes, and practices of affected communities
2) human rights
3) legal contexts
4) human behavior and desires

A pragmatic PH recommendation integrates more than data.
Never get ahead of the community or population you aim to serve with your program or message.

It is natural to assume that you are "helping" but critical to have a feedback mechanism in place to continually confirm and adapt as needed.

If no one comes, it's on you and not them.
Read 4 tweets
Feb 15, 2022
Paper 19:

Led @Mat__MG, @mishrash, we studied structural risks for #COVID19 in 16 cities across Canada.

Critical for resource-driven interventions to address unmet needs as hypothesized "trickledown benefits" from protecting some folks was insufficient.

cmaj.ca/content/194/6/…
Paper 20:

Led by Barlo MS Center, we studied the prevalence & severity of #COVID19 in 7000 people with multiple sclerosis (PwMS).

No clear increase in burden of #COVID19 in PwMS, but trend of increased severity with certain disease modifying therapies.

msard-journal.com/article/S2211-…
Paper 21:

Led @mugecevik, we built on ideas by @mishrash about importance of networks when considering #COVID19 transmission dynamics and intervention impact.

tldr: we need to do more for people who need more--and need to ask them what it is they need.

science.org/doi/10.1126/sc…
Read 7 tweets
Nov 11, 2021
I'm going to start a living thread summarizing all of the #COVID19 papers that I have been part of--both data-driven and commentaries/editorials.

Ultimately, anything I say here is based on what I've seen play out in studies around the world.

20 months in...we know a lot.

1/x
Paper 1:

In working with our colleagues at @amfar, we described the disproportionate effects of #COVID19 on disproportionately Black counties across the US.

Drivers of disparities were related to living & working conditions at the ecological level.

2/x

pubmed.ncbi.nlm.nih.gov/32419766/
Paper 2:

We published a commentary in @CMAJ suggesting that early data showed #COVID19 in Canada was marked by heterogeneity in risks of infection, spread and severity across people, places and time.

And responding necessitated adaptive responses.

3/x

cmaj.ca/content/192/25…
Read 12 tweets
Oct 4, 2021
Just a FYI that one can be very pro-vaccination and appreciate that immunity from infection is real.

Thoughts:
1) No sane folks seek to be infected
2) Immune system is more than a few antibodies
3) Downplaying infection-derived immunity is an unnecessary battle that burns trust.
Read 7 tweets
Apr 5, 2021
Let's pretend every business implements a #vaccinepassport.

Stay with me and let's think through some logistics.

1/x

(I'm not gonna edit as need to do kiddo bedtime stuff...but just to say, anyone who thinks this is easy has not really thought about that much at all)
Entering business

Does business scan your passport at the front door? If so, do they place an employee by the front door? If not, is the door locked and then unlocked via QR code? If so, does it only allow one person in at a time? If not, do they have a person watching?

2/x
If it is a restaurant, maybe the host does it before seating you? And if self-seating, then maybe waiter does it at the table? So they just eye ball it or do they need to scan something? Do they scan each person or just one person? Do they also check matching photo ID?

3/x
Read 5 tweets

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