A few thoughts on this...

(Other folks who know much more than me should definitely chime in! Looking at you @Theresa_Chapple @JasonSalemi @COVKIDProject @EpiEllie!)

Mini thread. 1/n
I’m all for a data-driven approach & I definitely applaud the work needed to pull this data together!

But.

Epidemics & outbreaks are local.

To me, pooling data across all states-or even within a state-is asking the wrong question.

Especially since testing in kids is low. 2/ Image
One thing to keep in mind is that schools within states have different policies.

The data we see are not that of opening all schools - some are fully virtual, some partly, some not at all.

Not all kids in these analyses are in school.

This will underestimate any effect. 3/ Image
Studies based on contact tracing in a local area would be much more informative than high level stats.

These could help us understand the effects on the broader community & staff.

Staff are an important target, and there have been deaths of teachers. 4/
cdc.gov/mmwr/volumes/6…
Elementary and secondary schools don’t have the resources & testing anywhere near the level of colleges or some summer camps.

It’s not that schools CAN’T be safely opened. It’s that the resources aren’t there for many schools so caution is warranted.

5/
cdc.gov/mmwr/volumes/6…
And as overconfident as the article comes off to me, this statement👇🏻is maybe the most problematic.

Reminder: Crowding ⬆️ transmission.

Limiting school to kids in need ⬇️ crowding.

Limited students IS safer vs full school attendance.

Add everyone & the risk changes.

6/ Image
To me this seems like basic aresol transmission control so I find it really odd that someone claiming expertise is making such an obvious mistake. Stones and glass houses and all...

But claiming business are not mass spreaders is way off base. See: bars & eat-in restaurants. 7/ Image
My restaurant-worker Covid+ Uncle would like a word on that...
To sum up: this is a very bold article that I’m not convinced can really back up its claims.

Does’t mean it’s wrong.

But I don’t think the evidence is nearly as strong as it is made out to be.

STILL.

Govs can still choose to put kids over bars and help schools open.

/Fin
Addendum: I am coming from a somewhat risk-adverse position given that my cousin’s daughter was very ill with MIS-C earlier this summer.

20 days of fever & 15lbs of weight loss was traumatic for her & her family.

Thankfully she recovered & is doing well now but it was awful.
Addendum II:

The underlying data require scrutiny as well. Great thread in the subject.

Suffice it to say this is inadequate data, especially for such bold conclusions.
Jinx?

Thread has some additional perspectives though seems to be in agreement on a number of points.
And a very important thread as somewhat of a counterpoint.

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More from @Epi_D_Nique

21 Jul
This is based on two pre-print studies (links in thread) one in Ireland and one in Denmark.

A few cautions are warranted in interpreting these studies. I won't cover the papers completely, just a few points 👇🏻
First, these are pretty small studies for the subject matter.

Ex: The Irish study covers only 1381 births in the window they studied (Jan - April). A similar number of births in the prior year led to 8 extremely low birth weight infants and 12 very lbw infants vs 0 & 3 this yr.
While prior yrs consistently showed more births in those categories than this yr, it's a handful off from normal variation.

medrxiv.org/content/10.110…
Read 7 tweets
27 May
Since selection/collider bias is currently a hot topic, it seems like a good time for a #tweetorial!

Gather round #EpiTwitter (but not too close!) for a tour of my paper investigating the when's and why's of selection bias in birth defect epi. 👇🏻

1/🤷🏼‍♀️

onlinelibrary.wiley.com/doi/10.1111/pp…
One of the reasons reproductive epidemiology is trick is that you are *always* dealing with selection.

Who becomes pregnant? Who stays pregnant? Who delivers too soon? Who has an induction?

Is the population in your study a biased sample?

2/
link.springer.com/article/10.100…
Let's add in a rare outcome with a strong effect on survival: birth defects.

Because specific birth defects are rare, we need huge samples to do meaningful studies. But many times data sources with these properties only have live births.

Can we still do valid studies?

3/
Read 29 tweets
15 Mar
Hey everyone:

This is a very uncertain and honestly scary time.

There are genuine risks to the health & safety of ourselves & those we care about.

Our lives are being significantly disrupted.

Here’s how I, someone w anxiety, is getting through. 🧵
Step one:

Radical acceptance.

My grandmother is 96. She lives in a rural area and relies on caretakers.

There’s a good chance she won’t make it through this.

I can’t change this.

So I accept this.

Life is different now & will be for a while.

I accept this.

2/
Step two:

Figure out what you CAN do.

Examples:

Sign up for volunteer lists to help those who need assistance with housing, food, funds.

Check in on vulnerable neighbors.

Call/write your local & state reps to ask them to care for vulnerable folx during shutdowns.

3/
Read 9 tweets
21 Jan
#Epitwitter Fun with Numbers:

It’s possible to put bounds on the case-fatality rate (CFR) for this outbreak with the available data.

A quick #tweetorial on the partial identification of absolute risk bounds!

1/n
According to the quoted tweet we have this data:

31 cases with known outcome
6 of whom died

227 with an unknown outcome

First, the CFR among known data: 6/31 = 19%

2/n
Next, we include unknown outcomes, taking them to their logical extremes (all live or all die).

The lower risk bounds is calculated under the “all live” extreme:

6/(31+227) = 2.3%

Given the available data, this is the lowest possible CFR (i.e., if no new cases arise).

3/n
Read 7 tweets
15 Jul 19
If the amazing, cutting edge, in-depth discussions on #EpiTwitter make you feel both *inspired and incompetent*

(out-of-your-depth, totally lost, etc)

Here is your reminder that this is TOTALLY OK!

👇🏻 #SendingToMyself 🧵
Not all methods/issues are relevant to everyone’s work so there’s no reason you should be fluent in all of Epi.

In fact, you can’t be.

What you can be is the expert that I know I can go to when I come across something new that overlaps with your area!
#EpiTwitter is not here to make you an expert on everything.

These discussions & #Tweetorials are here to give you an idea of when things you work on might go wrong and to let you know who can be your phone-a-friend when it does.
Read 6 tweets
8 Jul 19
I remember this feeling 👇🏻 so distinctly when I started at @NorthwesternU.

Tho not #FirstGen, growing up in an impoverished rural area (WV) with not great schools, attending a highly selective school was a huge culture shock. 🧵

politi.co/2FAIKOk
Although I did very well in the end, I had a very rough start. I was convinced my admission was a mistake.

The culture was completely foreign to me & I didn’t begin to know how to navigate it. My parents had attended a very small, not selective LA school - not much help there./
I remember being overwhelmed by the level & speed of my classes and marveled at the other freshman who seemed to learn so much faster than I could - I later learned many had already taken the classes in private HS & but retook then to boost their GPA. 3/
Read 11 tweets

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