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Charles Holmes Profile picture
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6 Oct, 7 tweets, 3 min read
As an infectious diseases physician & someone who has practiced public health for the last 25 years, I'm appalled by @VP Pence's lack of respect for basic protective measures. This disregard for science- and more importantly, the health of those in the room with him- is stunning.
With President Trump & many other senior staff ill, the @VP has cast aside CDC guidance by breaking quarantine. Putting aside concerns about continuity of government, ask yourself - would I want to be maskless in a room with someone who had his exposures?

cdc.gov/coronavirus/20…
Especially in light of CDC's new guidance on the potential for airborne spread of the virus (meaning it can linger in the air for minutes or hours), the Trump administration should be taking *more* precautions with meetings and tomorrow's VP debate.
washingtonpost.com/health/2020/10…
Instead, after forcing an in-person debate, Pence has taken this one step further by objecting to plexiglass barriers, which could provide some protection for his opponent and the moderators, and argued that the debaters should stand closer (!!) together.
nytimes.com/live/2020/10/0…
This disrespect for public health is inexcusable, but is par for the course with Pence. As a governor of Indiana, he presided over one of the worst documented HIV outbreaks in the past 2 decades after refusing to take recommended public health measures. usatoday.com/story/news/nat…
Just this April, Pence even met with Mayo clinic patients - some possibly immunocompromised - without wearing a mask. His argument (that he's tested regularly so isn't a risk) didn’t hold up then, and it definitely doesn’t now that Trump is positive. washingtonpost.com/politics/pence…
This much is clear- Pence needs to leave infection control to the experts. Trump’s #superspreading administration needs to wake up to the crisis they are worsening, and take actions to save lives, not threaten them.

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More from @CharlesBHolmes

Charles Holmes Profile picture
8 Oct
Pence said many things last night that bothered me, but one line in particular stuck in my head this morning. He said, President Trump and I have the same plan as Joe Biden - we’re talking about testing, creating new PPE, and developing a vaccine.

But, here’s the truth. 1/
Public health is about doing the right things at the right time. You don’t get credit for a testing strategy if millions couldn’t get tested when they needed it. You don’t get credit for creating PPE in Oct if health workers were dying because they lacked N95s in April. 2/
You certainly don’t get credit for a vaccine if you rush an untested candidate to market in order to score political points, and in so doing undermine public trust in vaccines. 3/

cnn.com/2020/10/05/hea…
Read 8 tweets
Charles Holmes Profile picture
4 Oct
The President’s medical team started him on the steroid dexamethasone yesterday. Of the COVID therapeutics I’ve discussed this weekend, dex is the only one shown to reduce mortality in patients w/ severe COVID-19. But it can also be risky for patients with mild illness. 1/7
Data published earlier this year showed that dex reduced deaths by one-third in COVID patients who had been sick >7 days and were on mechanical ventilators. Among patients receiving oxygen by less invasive means it reduced deaths by one-fifth. 2/7

nejm.org/doi/full/10.10…
However, here’s a key point: patients given dex who weren't on respiratory support died at a *higher* rate than similar pts who didn’t get dex. This wasn’t statistically significant, but if there’s no benefit & may be harmful, this is not a drug you start w/out good reason. 3/7
Read 7 tweets
Charles Holmes Profile picture
3 Oct
Americans are getting a crash course in novel therapies for #COVID19. This is a hotly debated topic, even among physicians. As we saw with hydroxychloroquine, the decisions Trump/his docs make affect what patients expect in their own care, so it’s worth talking about remdesivir.
Remdesivir is an antiviral originally developed to treat hepatitis C and later tried as a treatment for Ebola & Marburg. It didn’t work against those viruses, but it appears to have an effect on coronavirus (a good reminder that research on rare viruses can benefit us all)
2/n
Initial data from clinical trials were promising enough that the FDA granted emergency use authorization on May 1 for use in severely ill COVID-19 patients. In August FDA expanded this to apply to any hospitalized patient (the category Trump apparently falls under).
3/n
Read 12 tweets
Charles Holmes Profile picture
3 Oct
Earlier today President Trump received a polyclonal antibody cocktail made by the company Regeneron. Here’s what we know about this drug, and the additional drugs a patient in his situation might receive in the coming days.

Thread.
The cocktail is a combo of 2 lab-generated antibodies. The goal here is to boost an individual’s immune system rather than waiting for the body’s response to kick in on its own. When given early in the course of infection, this can theoretically shorten the length of illness 2/n
No peer-reviewed studies have examined whether Regeneron’s cocktail is safe or effective. Just 3 days ago the company announced (but did not publish) preliminary data from its ongoing trial. 3/n

investor.regeneron.com/news-releases/…
Read 11 tweets
Charles Holmes Profile picture
30 Sep
COVID-19 will be one of the most important debate topics tonight. As he has since Jan, Trump will try to distort the facts about his response.

We can't allow this.

A brief timeline thread–using Trump’s own words–to remind you how tragically wrong he has been at every step.
January: “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.” (2/x)

#Debates2020
washingtonpost.com/health/2020/01…
February: “Looks like by April, you know in theory when it gets a little warmer, it miraculously goes away.” (3/x)
abcnews.go.com/International/…
Read 15 tweets
Charles Holmes Profile picture
16 Sep
.@gatesfoundation's Goalkeepers report is the blueprint for an effective global health response that the US & allies should have set in motion months ago. It's a clear-eyed assessment of where we stand & what we need to do. Quick highlight thread (1/x):
gatesfoundation.org/goalkeepers/re…
First, where we stand: “We’ve been set back about 25 years in about 25 weeks.” This sobering assessment sums up the tragic fact that because of COVID, we risk losing gains made in reducing poverty, hunger, maternal mortality, HIV infections, & virtually every SDG indicator (2/x)
The report's modeling shows how much of a hit development has taken in just 6 months. But it also shows we can get back on track – if the US and other donors recommit to the trailblazing programs that have already saved millions of lives & led countless more out of poverty. (3/x) Image
Read 8 tweets

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