This reflects entirely how a rational population would act: disease acquisition inversely proportional to risk.

Challenge: can we convince those at low personal risk to reduce risk-taking behaviour? Options below:
My bread-and-butter framework comes from @SusanMichie and colleagues: The behaviour change wheel: a new method for characterising and designing behaviour change interventions. doi: 10.1186/1748-5908-6-42
ncbi.nlm.nih.gov/pubmed/21513547
1. Education: this has a weak track record. But maybe universities/colleges—regardless of virtual or not—can make knowledge a criterion of ongoing assessment/performance.
2. Persuasion: tough sell so far. But if it were tied to their ability to maintain a reasonably free lifestyle, it might work. But just saying “do it!” hasn’t and won’t work. This has the greatest potential for success on campus (if campuses intend to stay open).
3. Incentivisation: unsure how this could/would work above/beyond persuasion. But perhaps sponsor “safe parties” in lieu of these unsafe ones. There are creative ways to do this responsibly using a harm-reduction framework.
4. Coercion: I’m rarely a fan of this method. Unless you are a parent of young children, in which case coercion is a legacy tactic for behaviour change.
5. Training: This COULD go the wrong way with young adults. But what if there were training videos of how to look cool being responsible? Training how to respond to situations that aren’t safe, how to have conversations with roommates, friends,family, etc.
6. Enablement: similar for incentives, but this is 🔑—pose the challenge to young adults to come up with solutions. Young Adults are smart (as evidenced by their rational approach to personal risk), so we should harness their brains and creativity.
We really need them to help us address the concept of “bubbles”—because they don’t function like nuclear families: they HAVE nuclear families, but have their YOUNG ADULT “families”, too. It ain’t easy for them to navigate this without home testing.
7. Modeling: when I asked my young adult kids to help me survey their peers, it was immediately clear that non-masking at parties is normalized. We need party “hosts” to start off wearing masks and for DMs/texts to say “bring a mask”
8. Environmental restructuring: Young adults need safe places to convene. Allow drinking and marijuana use outside (preferably in places separate from young children!), and create more outdoor spaces that are comfortable. Invest in pop-up nighttime park use for young adults.
9. Restrictions: wouldn’t go there. In fact, almost never go with restrictions. Not in my antimicrobial stewardship work, not as a parent, not as a basketball coach.
Addressing COVID-19 in young adults should be our highest priority based on our and international experience. Nobody seems to have got this right, yet.
One last nota bene: sex is important for young adults and promoting safe sex is always the right thing. But this pandemic is being driven by gatherings not 1-on-1 interactions. Targeting non-group sex as a risk for spread is low impact with a low likelihood of success.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Andrew Morris

Andrew Morris 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!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @ASPphysician

26 Aug
New Ontario Govt guidance on School Outbreak management ontario.ca/page/operation….
...recognizing that it is largely up to local Public Health Units: even though Gov defines what is an outbreak, it is the PHUs that call the outbreak and determines what measures to follow. Summary👇
Outbreak = 2 or more confirmed cases in students and/or staff WITH AN EPIDEMIOLOGICAL LINK within a 14-day period. PHU determines epi links and determines which cohorts are high risk contacts.

Outbreak over = at least 14d from last outbreak case and 0 further symptomatic indiv
Schools responsible for reporting probably/confirmed cases to PHU and MoEd

PHUs responsible for determining if outbreak in a school exists, managing outbreak, declaring outbreak over

Schools responsible for preventing cases, cooperating with PHUs, maintaining accurate records
Read 10 tweets
8 Aug
This thread addresses my main job: youth basketball coach. I’m going to address youth sports in general, though, with an eye to school-based education:

@CanBball @OBABBall @USPORTSca
1/ Youth sports—whether houseleague or competitive—is of value to most kids. Effort should be made to be inclusive as possible to account for physical, developmental, or psychological barriers. I’ve coached kids with all of these, and they are possible.
2/ Sports and competition will be a likely victim of COVID—just think to what extent pro sports has gone to minimize transmission, and its challenges. We will see the same unless prevalence rates remain low.
Read 13 tweets
24 May
Spent the last several hours trying to make sense of ACCT-1 (remdesivir). Several people DMed me, asking why I haven't commented. Answer: I took yesterday off.
Design: Multicentre double-blind RCT remdesivir (up to 10 days) vs placebo.
Effort: Herculean--an amazing collaboration.
Population: hospitalized adults. 50% age 40-64. About 50% with pretty mild disease (see image 2 from Supplement).
It's an adaptive trial. Many clinicians are unfamiliar with adaptive trials. Others just don't like them. Because they feel treif (i.e. not kosher): the definitive review IMHO is from @DLBHATTMD and Cyrus Mehta (ncbi.nlm.nih.gov/pubmed/27406349)
Read 12 tweets
17 May
Tweet on #OneHealth: There is no public health, seniors health, animal health, women's health, minority health, environmental health, etc.--it is all One Health. We need to see it that way.
I live in Toronto. @epdevilla as Medical Office officer of @TOPublicHealth looks out for me. @PublicHealthON is an arm's length agency that provides provincial scientific guidance and data, but doesn't issue policy. Dr. David Williams is Provincial Chief Medical Officer of Health
They all have different accountabilities, data systems, etc I haven't even touched Ministry of Long-Term Care, who oversee LTC facilities, but outbreaks managed by municipal public health units. Oh, and hospitals ... they have their own Infection Prevention and Control Programs
Read 10 tweets
18 Mar
First major RCT in severe #COVID19 Rx. First: wow! This disease is a few months old, and we have an RCT with ~200 patients. Almost certainly record-setting. @GWR nejm.org/doi/full/10.10… Image
What did they do? They gave lopinavir-ritonavir (a drug used in HIV infection) to half the patients, and the other half got "usual care". This was "open label", meaning that investigators knew who was getting the lop-rit. Totally understandable in a trial during an outbreak.
Their primary outcome was "time to clinical improvement". They initially planned a trial with 160 patients, decided they needed more, but then halted it because they wanted to try remdesivir (presumably because this drug's performance was disappointing).

60% male; avg. age 58
Read 7 tweets
7 Oct 19
After 12 yrs of waiting, and 5 years of development, the @atscommunity @IDSAInfo community-acquired pneumonia guidelines have come out atsjournals.org/doi/suppl/10.1…. I have been asked repeatedly for my take and it has taken a while to fully dig my teeth into everything w/ a #tweetorial
Summary:
Minimize microbiology (no sputum/BC unless severe of MDRO Rx)
Don't base initial Rx on PCT
Don't use steroids
Macrolides for outpts ONLY if low resistance
Stop using "HCAP"
Severe CAP: BL+macrolide OR FQ
No routine F/U CXR
Process:
prepared by an ad hoc committee (15)
COI wasn't an exclusion; 2 members recused themselves because of ++ COI
M:F 10:5 (@geetamehta0)
Cauc 13, Hisp 2, Other 0 (@DrJRMarcelin)
ER 0, GIM 4, ID 3, Resp 7, Pharm 0 (@EMCases @Kerry_LaPlante)
0 patients (@SolidFooting)
Read 22 tweets

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/month or $30/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!

Follow Us on Twitter!