Thread by @BillHanage

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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