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Abraar Karan Profile picture
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7 Oct, 8 tweets, 6 min read
Just read Dr. Foege's full letter to @cdcdir Redfield; this will go down as a pivotal moment in the field of public health.

Read it.

@washingtonpost has the full transcript here:

context-cdn.washingtonpost.com/notes/prod/def…
2/ "I don't for one-minute relish your position but FDA or NIH cannot make a statement that changes the course of this epidemic. You and CDC could."
3/ "You don't want to be seen, in the future, as forsaking your role as servant to the public in order to become a servant to a corrupt president."
4/ "The failure of the White House to put CDC in charge, has resulted in the violation of every lesson learned in the last 75 years that made CDC the gold standard for public health in the world."

Again-- you need to read this letter. Dr. Foege is speaking the truth here.
Cc @JohnJHarwood @MollyJongFast @carlzimmer @NickKristof
Cc @gregggonsalves @nataliexdean @EpiEllie @DrTomFrieden @ASlavitt
cc @DrJoelKatz @CarlosdelRio7 @PaulSaxMD @jeremyfaust @zeynep @ReganHMarsh @thehowie
cc @ddiamond @bylenasun @lauriemcginley2 @yabutaleb7 @Laurie_Garrett @pw_cunningham @apoorva_nyc @kakape

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More from @AbraarKaran

Abraar Karan Profile picture
5 Oct
1/ Throwback to 2 key articles that @RanuDhillon @sri_srikrishna and I wrote in @HarvardBiz, the one below in May & a subsequent follow up in June.

Both were premised on needing better masks bc we had enough evidence to suggest aerosols played *a role*

hbr.org/2020/05/a-plan…
2/ While this is important in many ways, high filtrate masks are *most critical* for frontline workers who are regularly confronted with conditions in which aerosol spread can happen more easily.

hbr.org/2020/06/we-nee…
3/ You know-- the frontline workers who literally kept this economy and this country afloat on their backs while those who were more privileged could safely "stay home".

These are some of our society's most vulnerable people; and they deserve to be *protected*
Read 4 tweets
Abraar Karan Profile picture
5 Oct
1/ The CDC guidelines that are finally acknowledging aerosols-- particles that hang around in the air/travel more than 6 feet--playing a role in #covid19 transmission is *not new*

Within the public health community, it was clear that they did play *some* role, unclear how big
2/ But even now, what % of transmission is happening via respiratory route that is *not* from droplets is unclear.

What we suspect is that in situations w/ poor ventilation, crowds, & sustained contact, aerosols (in addition to droplets) can lead to transmission of the #covid19.
3/ This has a number of implications for public health--especially as it relates to what level of minimal protection (type of mask) is needed in different situations.

As healthcare workers, we are using N95 masks if #covid19 is suspected or confirmed.
Read 5 tweets
Abraar Karan Profile picture
5 Oct
NEW: CDC has now *officially* updated their #covid19 transmission guidelines acknowledging that the virus can hang around in the air for several mins or more— & it can transmit beyond 6 feet in scenarios with poor ventilation that are enclosed.

washingtonpost.com/health/2020/10…
2/ Several outbreak studies have suggested this for months—& yet it is only now that this is being officially acknowledged

This is one of my personal biggest issues w/ our epidemic response— despite having some data, we don’t move to act when benefits of doing so outweigh costs
3/ Our communications to the public have focused almost exclusively on droplet-based spread— “6 feet apart” and “wear a mask”.

6 feet apart is NOT always sufficient!

And cloth masks are NOT designed to stop aerosols that hang around in the air.
Read 4 tweets
Abraar Karan Profile picture
4 Oct
1/ Reports that Trump received #dexamethasone— a steroid that should only be used on patients who require oxygen or are critically ill with #covid19. This was proven to reduce mortality in the RECOVERY trial published in @NEJM earlier this year.

nejm.org/doi/full/10.10…
2/ But, they found no mortality benefit in patients that were not on supplemental oxygen or ventilators.

In fact, those patients actually had a slightly higher mortality rate, although not statistically significant.
3/ The basic premise is that once you are sick enough, your immune response is what needs to be tempered/ what may end up killing you rather than the virus itself. So steroids can help control this.

Speculating what this could mean...
Read 4 tweets
Abraar Karan Profile picture
1 Oct
Thread
1/ Covid alert NY--> an app that uses bluetooth technology to help notify people if they were exposed within 6 feet to someone who tests positive for #covid19 w/o storing any personal information & without tracking location.

Important effort here
coronavirus.health.ny.gov/covid-alert-ny
2/ Closing the exposure to quarantine/isolation window is critical to stop spread

Recent report from NC--> specimen collection to contact notification median of *6 days*

A number of cases did not report *any* contacts, & many could not be reached at all
cdc.gov/mmwr/volumes/6…
3/ If enough people opt-in to a bluetooth based exposure notification system, we can re-direct resources appropriately, particularly around who to test; also increase *speed*

Exposure notification needs to take time spent/location of exposure into account as well.
Read 8 tweets
Abraar Karan Profile picture
25 Sep
Many close colleagues & friends were impacted by this; & many of our incredible hospital epidemiologists are hard at work.

But, I do think that it is critically important that all hospitals provide regular #covid19 testing for employees, especially given asymptomatic spread.
2/ By the nature of hospital work-- crowded together in small rooms for much of the day-- it becomes virtually impossible to prevent this type of spread without regular testing.

And, given aerosol contribution is most relevant in closed, poorly ventilated rooms...
3/ ...surgical masks alone are not always sufficient, for individual protection, or for source control.

We need to protect our healthcare workers. This is one of the applications in which rapid antigen testing could have big implications- ensuring no infectious worker comes in.
Read 5 tweets

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