My kids went back to school this week. Half in-person, half distance learning.

There's lots of consternation on all sides about this decision in the midst of #COVID19.

A thread.
Half the parents are horrified that we aren't fully in person. Distance learning is tough, and feels pointless to them: "no one here has #COVID19" and "my family is healthy" and "I need my kid to be in school for [my work/my sanity/my kid's mental health/my kid's safety]"
The other half are horrified that ANYONE is back.

I have, for example, been told that: "the school will have blood on its hands."

I have been told "19 people tested + already" ignoring that those tests cannot physically be due to school reopening (they opened on Monday!)
My plea on this issue - as for all #publichealth - is to do our best to follow the science..... while recognizing that science is evolving.

Yes, this is scary.
Yes, this is unprecedented.
Yes, there are NO universal right answers.
BUT -

1. For the love of all that is good, let's be nice to each other.

Let's recognize that there are reasons that some kids NEED to be in school, and there are some reasons that teachers or parents NEED their kids to stay home.

Both are okay.
2. At the same time, let's be honest: If there's any community #COVID19, there WILL be cases among ppl affiliated with schools. The test is not: do infections happen? Instead, the test is: does it spread?

(article by @AJNierenberg w/me & @DrLeanaWen)

nytimes.com/2020/09/16/us/…
3. We have growing evidence from schools, daycares, healthcare facilities & hair salons across the US & the globe: it is POSSIBLE to stop spread, if a few conditions are met -
1⃣universal masking
2⃣stable pods
3⃣adequate ventilation
4⃣ testing availability
4. We also have growing evidence that it comes down to one thing: do we prioritize our schools?

(Why re-opening, say, offices is... a bad idea. The more people that are mixing, the higher the community rates. The higher the community rates, the higher the rates at school.)
5. Finally, to state the obvious. Yes kids can get sick - really sick - from COVID. There's some risk in letting your kid (or yourself) ever leave the house. But that's true in non-COVID times too. The Q is: how big is the risk? How big is the benefit?
bmj.com/content/370/bm…
5b. (Also obvious: in states or cities with high infection rates and inability to follow public health guidelines, the risk is too big.)

5c. (Also obvious: we have to talk about disparities in education & housing & food & structural racism too. It's all related.)
5d. (Also obvious: sports, chorus, and band are higher risk activities than sitting in a classroom.)

nationalgeographic.com/science/2020/0…
6. Finally, to those who are adamantly against ANY schools reopening, I hope you are aligning your actions and words, & not going out with friends, not sending your kids to the playground, etc. I hope to not see pictures of you on Facebook, maskless, at a party or restaurant.
7. My personal litmus test for school reopening remains the same as it was in August. Evidence has accumulated to back me up.
-> low community spread
-> universal masking
-> testing availability

==> highly likely to be safe, for most of us (recognizing that some will opt out)
==> and the all-important caveat: most schools in the US still do not meet these very basic criteria.

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More from @meganranney

22 Sep
To be clear: These 200,000 people are NOT "nobody". They are people. With families, communities, and lives.

news.yahoo.com/u-hits-200-000…
As an emergency physician, I can attest:

Human suffering is not unique to a political party. It is not unique to a state, or a city. It is not unique to a race, a gender, an ethnic group.

Human suffering is universal.
Human loss is universal.
Death, too, is universal.

It is inevitable, no matter our power, our wealth, or our connections.

At the moment when the breath leaves the body - when I pronounce the death - we are, ultimately, all the same.
Read 4 tweets
21 Sep
Today (or maybe yesterday, or maybe a few days before that), our country hit 200,000 #COVID19 deaths.

It's a sobering number. It's the population of a small city. It's 67 times the number who died in 9/11. It's 200,000 families' lives changed.

>A thread on what comes next:🧵
We know it didn't have to be this way. The US has ~4% of the world's population, but ~23% of the world's #COVID19 deaths.

But here we are.

ourworldindata.org/coronavirus-da…
Reasons for our failures are innumerable:
* lack of early national strategy for detection of the virus
* lack of public trust of the gov't
* lack of smart utilization of strategic stockpiles
* continued underfunding of #publichealth

jamanetwork.com/journals/jama/…
Read 24 tweets
18 Sep
That this could happen, is:

A. Believable
B. Horrific
C. More consistent with Stalinistt Russia than the great U.S.A.

(Cf, Lysenkoism ... we are getting close) en.m.wikipedia.org/wiki/Lysenkoism
"H.H.S. and the White House writing scientifically inaccurate statements such as ‘don’t test all contacts’ on C.D.C.’s website is like someone vandalizing a national monument with graffiti." - @DrTomFrieden
“The idea that someone at H.H.S. would write guidelines and have it posted under the C.D.C. banner is absolutely chilling,” - @DrRichBesser
Read 5 tweets
16 Sep
Telling the story that those of us on the frontlines already knew: “Policy shouldn’t be based on scarcity.”

usatoday.com/in-depth/news/…

#TestTraceIsolate #maskup #GetUsPPE
"Truly, you just want to get the information that you need to do the right thing." .... and the information didn't come.
"This pandemic has spotlighted shortcomings within our nation’s public health system, including the need for long-term and sustained funding for state and local health departments,” the agency said in its statement."
Read 4 tweets
16 Sep
Yet another reason that PPE matters: without it, we endanger not just #healthcare workers, but also our patients.

#GetUsPPE #WearAMask wsj.com/articles/hospi… Image
Two critical elements to highlight:

1) Quoting: "DATA AFTER THAT DATE IS UNAVAILABLE because the government stopped asking for it."

So we have to rely on best guesses and non-official data sources. But based on @getusppe data, shortages of PPE are still common across the US.
2) Hospitals are overall safe, and WITH proper PPE, there are virtually no in-hospital infections.

Here's a study from Boston - only 2 hospital-acquired infexns, 1 of which came from a spouse: jamanetwork.com/journals/jaman…
Read 4 tweets
12 Sep
Why we can't win against #covid19:
N
"Without up-to-date, reliable information on who is infected, why and where, US scientists, policymakers and the public must instead rely on media reports and independent efforts" nature.com/articles/d4158…
Nb: this is the same problem we have faced for 20+ years re #gunviolence. We rely on groups like @teamtrace and @GunViolenceArch for reliable data - and find that much of what we want, is censored.
Step 1 of Public Health is data. Period.
Read 7 tweets

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