Charles Holmes MD, MPH, FIDSA Profile picture
Sep 16, 2020 8 tweets 3 min read Read on X
.@gatesfoundation's Goalkeepers report is the blueprint for an effective global health response that the US & allies should have set in motion months ago. It's a clear-eyed assessment of where we stand & what we need to do. Quick highlight thread (1/x):
gatesfoundation.org/goalkeepers/re…
First, where we stand: “We’ve been set back about 25 years in about 25 weeks.” This sobering assessment sums up the tragic fact that because of COVID, we risk losing gains made in reducing poverty, hunger, maternal mortality, HIV infections, & virtually every SDG indicator (2/x)
The report's modeling shows how much of a hit development has taken in just 6 months. But it also shows we can get back on track – if the US and other donors recommit to the trailblazing programs that have already saved millions of lives & led countless more out of poverty. (3/x) Image
That’s why Bill Gates has been pressing Congress to contribute $4 billion to @gavi and $4 billion to the @GlobalFund. These funds will fight COVID while also shoring up some of the best bulwarks we have to avoid backsliding on HIV, TB, and malaria (4/x)
statnews.com/2020/09/14/bil…
His push for funding reinforces the report's key takeaway: massive global damage can be mitigated if wealthy countries recommit to global equity. This includes equity for a COVID vaccine: modeling shows that equitable vaccination will result in half as many COVID deaths. (5/x) Image
COVID is a clarion call for countries to ‘innovate with equity in mind.’ Globally and domestically, the pandemic has amplified pre-existing societal inequalities. Only by acknowledging inequity head-on in our COVID response plans can we get global development back on track. (6/x)
Let's put this into action by getting tests, treatments, & vaccines to the people who need them most, no matter where they are. Like the report’s conclusion says, what the world does in the next few months matters a great deal. Now is the time to think & act globally. (7/x) Image
If you’ve made it this far, I highly recommend taking a few mins to browse the full report. The analysis, stories, and modeling drive home how much could be lost if we don’t redouble our global efforts. We've come far in recent decades - we can't afford to backtrack now. (8/8)

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More from @CharlesBHolmes

Mar 16, 2021
Last month South Africa halted rollout of the AstraZeneca #COVID19Vaccine because it provided "minimal protection" against the B.1.351 variant first identified there.

We now know more details about what drove this decision, and it's concerning. (1/6)

statnews.com/2021/02/07/sou…
Study data published in @NEJM today found the A-Z vaccine "had no efficacy against the B.1.351 variant in preventing mild-to-moderate Covid-19." There were no severe cases in vaccine or placebo group, so we don't know if it prevents severe COVID. (2/6)
nejm.org/doi/full/10.10…
There's currently no evidence this vaccine is unsafe (despite concerns in Europe). But lack of efficacy against the B.1.351 strain has major implications for vaccination campaigns in low/middle income countries, especially in southern Africa. (3/6)

bmj.com/content/372/bm…
Read 6 tweets
Jan 27, 2021
One week ago today President Biden took the oath of office. For those of you keeping track, here are the concrete steps @POTUS has taken in his first 7 days to implement a national strategy to beat #COVID19:
✅ ↑ weekly vaccine distribution to states/tribes/territories by 16% (an extra 1.4 m doses per week)

✅ ↑ USG’s total vaccine order by 50% to 600 million doses – enough to fully vaccinate all adults by the end of the summer or early fall. 2/
✅ Announced a federally-led vaccination strategy that will build the infrastructure to deliver these 600 million doses, and directed @FEMA to stand up the first federally supported community vaccination centers. 3/
Read 8 tweets
Oct 8, 2020
Pence said many things last night that bothered me, but one line in particular stuck in my head this morning. He said, President Trump and I have the same plan as Joe Biden - we’re talking about testing, creating new PPE, and developing a vaccine.

But, here’s the truth. 1/
Public health is about doing the right things at the right time. You don’t get credit for a testing strategy if millions couldn’t get tested when they needed it. You don’t get credit for creating PPE in Oct if health workers were dying because they lacked N95s in April. 2/
You certainly don’t get credit for a vaccine if you rush an untested candidate to market in order to score political points, and in so doing undermine public trust in vaccines. 3/

cnn.com/2020/10/05/hea…
Read 8 tweets
Oct 6, 2020
As an infectious diseases physician & someone who has practiced public health for the last 25 years, I'm appalled by @VP Pence's lack of respect for basic protective measures. This disregard for science- and more importantly, the health of those in the room with him- is stunning.
With President Trump & many other senior staff ill, the @VP has cast aside CDC guidance by breaking quarantine. Putting aside concerns about continuity of government, ask yourself - would I want to be maskless in a room with someone who had his exposures?

cdc.gov/coronavirus/20…
Especially in light of CDC's new guidance on the potential for airborne spread of the virus (meaning it can linger in the air for minutes or hours), the Trump administration should be taking *more* precautions with meetings and tomorrow's VP debate.
washingtonpost.com/health/2020/10…
Read 7 tweets
Oct 4, 2020
The President’s medical team started him on the steroid dexamethasone yesterday. Of the COVID therapeutics I’ve discussed this weekend, dex is the only one shown to reduce mortality in patients w/ severe COVID-19. But it can also be risky for patients with mild illness. 1/7
Data published earlier this year showed that dex reduced deaths by one-third in COVID patients who had been sick >7 days and were on mechanical ventilators. Among patients receiving oxygen by less invasive means it reduced deaths by one-fifth. 2/7

nejm.org/doi/full/10.10…
However, here’s a key point: patients given dex who weren't on respiratory support died at a *higher* rate than similar pts who didn’t get dex. This wasn’t statistically significant, but if there’s no benefit & may be harmful, this is not a drug you start w/out good reason. 3/7
Read 7 tweets
Oct 3, 2020
Americans are getting a crash course in novel therapies for #COVID19. This is a hotly debated topic, even among physicians. As we saw with hydroxychloroquine, the decisions Trump/his docs make affect what patients expect in their own care, so it’s worth talking about remdesivir.
Remdesivir is an antiviral originally developed to treat hepatitis C and later tried as a treatment for Ebola & Marburg. It didn’t work against those viruses, but it appears to have an effect on coronavirus (a good reminder that research on rare viruses can benefit us all)
2/n
Initial data from clinical trials were promising enough that the FDA granted emergency use authorization on May 1 for use in severely ill COVID-19 patients. In August FDA expanded this to apply to any hospitalized patient (the category Trump apparently falls under).
3/n
Read 12 tweets

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