Jeremy Faust MD MS (ER physician) Profile picture
Oct 2, 2020 17 tweets 5 min read Read on X
⚠️ Let's start over.

(This thread will review the timeline of early events of this crisis, and then towards the end, I will add my analysis of what went wrong)

🦠COVID-19 is a life-threatening disease.

It is caused by SARS-CoV-2, a coronavirus.

1/
Cases first emerged, likely jumping to humans from fruit bats, in late December. The first cases were reported then.

At first, the WHO and CDC did not know whether this was contagious between humans.

But by January 9th, we knew that it was a coronavirus.
On January 11, China furnished the genetic sequence of the virus initially called nCoV-2, and now referred to as SARS-CoV-2.

By January 14, human-to-human transmission was a real concern.
The early availability of the genetic sequence meant that testing could soon be done.

Here in the United States, we failed to act upon this soon enough.

The CDC is underfunded.

It shows.

It's tests didn't work.

The "control" assay kept failing.

Lost time.

Lost lives.
On January 30th, WHO Director-General @DrTedros declared a public health emergency.

By then, there had already been a few cases in France and the US.
On February 2nd, parcels with RT-PCR kits to detect SARS-CoV-2 were sent to WHO offices all over the world.

(The United States has since announced its intention to drop out of the WHO. Unclear why.)
Meanwhile, tests were being rolled out in dozens of countries.

But by late February, the United States still had almost no tests.

You still had to beg the CDC for a test.

People like @llborio and @michaelmina_lab were out there saying this was a huge problem.
Once I realized that we could not test people with clear cut cases I was seeing in my ER (early March), I joined them in my concern.

That was the day I first became very, very, very worried that we were not going to be able to control this--as I KNOW we could have, if we tried.
I called for enough tests for every American.

washingtonpost.com/opinions/2020/…

For months, people like @ashishkjha and @meganranney stayed on this message.

We needed TESTS AND PPE.

We failed on both accounts.
Meanwhile, our understanding of how this virus spreads has developed.

We now agree that droplets (I won't get into semantics--the point is, not primarily surfaces) likely accounts for a far greater fraction of spread than initially thought.
The second day I knew we were in big, big trouble was when I realized that MASKS--simple masks--were being help up as something to resist (!)

There is something deeply wrong with our society if people see wearing a piece of cloth for a few months when indoors as "tyranny."
That leads us back to the current situation.

The President of the United States has SARS-CoV-2.

This man refused to wear a mask.

That choice has caused many deaths in others.

He hoped that marketing ploys like hydroxychloroquine would make it all go away.
He marginalized true experts like Dr. Anthony Fauci, and brought in people way out of their league and element like Scott Atlas.

(There's no better microcosm for our failures than that; Fauci does not speak at press briefings, but Adams does? This is, on its face, insane).
The President was deadly wrong on these choices.

But most prominently, masks.

I'll never understand why he didn't decide to "make masks great," or whatever marketing ploy he could use.

I sincerely hope he does not pay for this choice with his own life.

No one wants that.
Today is day 0.

Let's start over.

Masks.

Hygiene.

No indoor restaurant dining (Outdoor dining likely is okay. Invest in heat lamps!)

Prioritize school for kids 5-17 over every other thing in society. The lower the cases, the more in-person school, the better for all!
Finally, no more false idols.

No unproven drugs which never had a chance , like hydroxychloroquine.

No convalescent plasma until there's a proven benefit that absolutely shows it saves more than the 1 in 1250 it kills.

Vaccines when they are proven SAFE AND EFFECTIVE.
For more on why we failed to contain COVID-19, read what @nowroozpoor @choo_ek and I wrote this summer.

onlinelibrary.wiley.com/doi/full/10.10…

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More from @jeremyfaust

Jun 8, 2023
I’m pleased to share my Commentary on the newly published *positive trial* finding metformin decreased Long Covid (Dr. Carolyn Bramante + ⁦@boulware_dr⁩)!

The therapeutic validation of long COVID. Lancet Infectious Diseases ⁦@TheLancetInfDisthelancet.com/journals/lanin…
“First, to our knowledge, this is the first high-quality evidence from a randomised controlled trial to show that the incidence of long COVID can be reduced by a medical intervention, metformin—an inexpensive treatment with which clinicians have ample experience…
“Second, the authors have, perhaps inadvertently, made an important contribution to medical epistemology…
Read 6 tweets
Jun 7, 2023
Quick poll.

Stop what you’re doing.

Put your hands in your lap.

Don’t move for 5 seconds.

Can you feel your hands or fingers tingling?

Even a tiny bit?
If you answered yes, were you aware of this before?
Thank you!
Read 5 tweets
Dec 22, 2022
Breaking: Covid-19 antiviral Molnupiravir not effective in preventing hospitalization and death among vaccinated patients with high risks.

It did shorten recovery time...

But that's not even the most interesting part...

open.substack.com/pub/insidemedi…
This is the first randomized controlled human trial that has studied Covid-19 outcomes among *only vaccinated* people that we’ve ever seen.

That’s an absolutely astonishing fact, if you think about it.

(Assuming I am correct here. Am I wrong?)
This gives us an unusual chance to look at all-cause mortality and all-cause hospitalization among infected vaccinated people during the Omicron era...

And to compare that the pre-Omicron and pre-vaccine era...
Read 14 tweets
Sep 12, 2022
The asymmetry of anecdote.

If you aren’t seeing a disease whose true prevalence is ~1% of the population and has a 10 day course, consider the fact that if you see 20 patients in a day, your odds that none will have it is about 82%.

And yet 3m Americans would have it.

1/
This means that your small sample size is fooling your “I can’t think beyond what I can see” big brain energy.

Proceed with caution before making any declarations.

It’s to notice and even share it. It is not okay to tell people “it’s over.”

However… 2/
However, if, say, 2 or 3 of your patients (out of 20) are positive 10%-15% of your patients!) and that happens to you more than once this week, the asymmetry of anecdote becomes important.

Your anecdotal experience could have at least 3 possible meanings.

3/
Read 5 tweets
Apr 28, 2022
Moderna files for emergency use for its Covid vaccine for children 6 months to 6 years.

They are saying 51% effective against symptomatic Covid for ages 6 months to 2 years and 37% for ages 2 to 6.

Sounds mediocre but here's why it may be MUCH better than that....
🧵
The data reflect a lot of cases during Omicron.

We know these vaccines provide very good short-term protection against infection, but that's a honeymoon phase.

That's important. But the way these vaccines were designed, and how they work best, is not really about infection...
What these vaccines have been shown to really do, over and over, is protect against severe disease and hospitalization, longterm consequences.

A pediatric trial can't be large enough to detect that. But the "immune bridge" strategy used both by Moderna and Pfizer has worked...
Read 11 tweets
Nov 22, 2021
Our new paper on deaths among adults ages 25-44 in Texas is out.

I want to highlight some key findings...
🧵

Causes of Death Among Young Adults by Race and Ethnicity in Texas During the COVID-19 Pandemic, 2020 ja.ma/3CChpFb via @JAMAInternalMed part of @JAMANetwork
Among Texas adults ages 25-44:
1. Covid-19 was the leading cause of death in July and December of 2020.

2. Covid-19 was the 2nd leading cause from the start of the outbreak thru December 2020.

3. Covid-19 was *by far* the leading cause of death among Hispanic residents.
4. Covid-19 was the leading causer of deaths among Black residents for July, and 2nd in December.

That level of data is more clearly shown (link): insidemedicine.bulletin.com/15084746495095…

5. Covid-19 broke into the top 5 leading causes of death among White residents just once (#5 in December).
Read 12 tweets

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