A short thread on this new Working Paper "Counting the missteps of the U.S. Federal Government's handling of COVID-19" . This is me w Nancy Krieger @_christiantesta
Jarvis Chen, L Davis, E Pechter and @MauSantillana hsph.harvard.edu/population-dev… 1/n
First of all - we can all learn from the first part of the pandemic. But to do that we have to be honest about the mistakes. The first misstep is letting the virus in, and not even looking for it 2/n
This was eloquently discussed in this from @tomaspueyo et al. (which actually adopts a far wider angle lens and is worth your time) but also illustrates the point. Stopping introductions matters 3/n nytimes.com/interactive/20…
Here in Boston, a business conference in late February led to a superspreading event sparking transmission chains which scant weeks later were infecting people experiencing homelessness 4/n metrowestdailynews.com/news/20200826/…
You can read the preprint here. Stopping this introduction, through quarantine for example, would like have only delayed the pandemic, but it would have bought time to develop testing resources that were in short supply at that time 5/n medrxiv.org/content/10.110…
Of course there were many more introductions, but there was no serious attempt to stop or detect them. And so by the time the pandemic was detected on these shores it was already establishing itself (note the date) 6/n washingtonpost.com/outlook/corona…
Once here it becomes important to protect people. Here @OSHA_DOL plays a role (alongside agencies with a similar remit in some states). The Occupational Safety and Health Administration tracks complaints and can work to protect workers when they are put at risk 7/n
We wondered whether complaints to OSHA might be a proxy for the perception of risk and how well workers were being protected. We found that the volume of complaints was indeed correlated with deaths/million 17 days later 8/n
Look at the North East. The darker purple bars in the spring are complaints in Healthcare and associated industries. This is consistent with the struggle to obtain adequate PPE during the surge 9/n
Then there is the total excess deaths. This is from data reported by @CDCgov. Even the most generous estimate is north of 230,000, and this is only including deaths *up to August 16th*. They have obviously continued to climb since then. Next let's look at inequities 10/n
First the legends for what follows, this is how to interpret each line 11/n
This shows the huge difference in mortality among older age groups by race/ethnicity, and how it has varied over time. It is not constant, but shifts depending on where pandemic activity is most intense 12/n
And it is not only older age groups. Look at the mortality rate ratios in even younger people of multiple minorities, compared with a reference group of non-hispanic white. 13/n
There is much more in the whole working paper which I urge you to read. But a couple comments; remember that 230,000 excess deaths by 8/16? Read this and remember that 240,000 used to be the worse end of the best case scenario *for the whole pandemic* 14/n washingtonpost.com/politics/trump…
and look at this healthypeople.gov/2020/About-Hea…. It sets out the goals for the next decade. It came out in August. Let's look at some of the goals 15/n
“Attain healthy, thriving lives and well-being free of preventable disease, injury, and premature death” and... 16/n
“Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.”

Once we get past the pandemic, I think it is fair to say there's a ways to go.


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More from @BillHanage

6 Oct
Scientists are not "divided". If you want to know what scientists really think, ask them and interpret the results scientifically 1/n spectator.co.uk/article/with-s…
What do I mean by that? I mean that obviously people have some disagreements about interpretation of the data and the best way forward, but mostly there is more that they agree on than that they do not 2/n
First identify the people who you should take seriously on the subject. That is those with relevant expertise, in this case infectious disease. No matter how much someone knows about say cell cycles, they aren't qualified for this 3/n
Read 7 tweets
6 Oct
I recently discovered the charming term "sealioning". According to wikipedia it is "a type of trolling or harassment which consists of pursuing people with persistent requests for evidence or repeated questions, while maintaining a pretense of civility and sincerity" 1/n
Apparently it originates from this little piece of genius from @wondermarkfeed. Now I have met my fair share of sealions, and I am sure they know who they are! wondermark.com/1k62/ 2/n
What amuses me is the way that when you finally, with your actual job and family wanting your attention, *use* the word sealioning in front of them the interaction always goes something like 3/n
Read 5 tweets
6 Oct
Herd immunity is back. This article quotes its proponents, and then yours truly and @gregggonsalves on why in the absence of a clear way to protect the vulnerable from a raging storm of infection among the less vulnerable, it is a very dangerous idea 1/n thehill.com/policy/healthc…
Want to note that this latest suggestion has a new tweak. While herd immunity is the point at which the infection starts to infect fewer people because there just aren't many left that aren't immune, the proposal here is to get to endemic transmission. What's the difference? 2/n
Endemic transmission means the virus is always there, transmitting at a prevalence determined by the 'resupply of susceptibles' (either generated by waning immunity or new potential hosts being born) 3/n
Read 8 tweets
5 Oct
This happened. There has been a lot of noise about it and much of it doesn’t reflect reality, but can help understand the pandemic better and how to deal with it 1/n
If you want to stop the virus transmitting you want people to avoid crowds, close contact and closed spaces without ventilation. Period. That matters for everyone infected or not. This dude knows he is infected 2/n
This is not a crowd but a small group in the car, in a closed space in close contact. Surely this is bad in terms of risking transmission to others in the car? Surely? 3/n
Read 7 tweets
3 Oct
Some comments on the last few days. I will start by saying I wish the President and First Lady a speedy recovery. This is about what the events as currently understood illustrate about transmission risks and handling the pandemic 🧵1/n
As I write more and more apparently connected infections are being reported. It is hard to interpret them without more information about contacts, but many appear linked to an event in the Rose Garden last weekend washingtonpost.com/politics/trump… 2/n
It should be noted that risks of transmission outdoors are usually considered low. So it would be valuable to know whether and which guests were indoors together, both in term of understanding risk of infection and tracking new chains of infection along contact networks 3/n
Read 11 tweets
29 Sep
I feel it is important to call out misunderstandings about what 'herd immunity' means. It is clear from this little thread that @TheEliKlein has no idea. I'm not trying to be mean, just to correct a decidedly... odd take. I hope he'll end up understanding it a little better 1/n
First, I am going to ditch the phrase 'herd immunity' because bluntly it annoys me and it understandably makes folks indignant about being compared to cattle. We will use population immunity instead 2/n
There are lots of very clever (too clever by half imo) takes on how few people you might actually need to have immunity in order to exclude the virus from a community. That's what the term means by the way, not just *slowing* it 3/n
Read 15 tweets

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