Restriction-Driven Responses Make No Sense (to me)

Wave 1 Ontario Data
170k tested & 16k #COVID19 diagnoses

Rate of positive test
64x in long term care (LTC)
19x in shelter

Age-Adjusted Mortality
40% higher in LTC

Txs @mishrash for including me:
cmajopen.ca/content/8/4/E6…

1/4
As of Oct 11 in Ontario, 58 LTC facilities in outbreak.

What did we need to do?

Paid leave for part-time staff if need to quarantine or isolate
(Seriously, how has this not happened yet? WTF!)

Overcome barriers to testing/symptom disclosure
(see note about PAID-LEAVE???)

2/4
What did we actually do?

Shut restaurants, gyms, and strip clubs.

I'm not an economist, but guess structural interventions would cost pennies on the dollar to whatever is happening now.

So when do we move from a populist to an empiric response? Ie, when is enough enough?

3/4
With wave 2, can we start addressing underlying determinants with:

1) Paid leave if under investigation or infected
2) Housing support particularly for those in multigenerational households
3) Overcoming any barriers to testing and health care

#resourcesbeforerestrictions

4/4

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More from @sdbaral

25 Sep
Quantitative Study Designs and Critical Appraisal

Intended to help to do independent critical appraisal of the data being released in #COVID19 including an overview of study designs.

Also to help you assess whether "experts" did critical appraisal or are just repeating abstract
Quantitative Study Designs

Only covering studies where unit of analysis is an individual person.

There are also ecological studies which use a population as the level of analysis and systematic reviews & meta analyses which quantitatively combine results of several studies.
Observational Studies - Descriptive

Examples: case reports, case-series reports, surveillance studies, surveys

Cross-sectional studies - Describe the prevalence of a disease or other phenomena without looking for associations between variables
Read 13 tweets
22 Sep
Public Health Practice Gems

#COVID19 has increased the general interest in public health.

So I thought it worthwhile to provide some framing for folks new to this field.

The goal is to provide an overview of public health:
1) Principles
2) Intervention Strategies
3) Actors
Public health practice is a service industry.

Similar to other service industries, the customer is always right.

If we don't understand our customer and empathetically address needs, people vote with their feet.

ie, PHP is Public Health Practitioner, not Public Health Police
Public Health Principles

Equity -- Given inequities across society, public health should aim to do more for those who need more

Social Justice -- Achieve balance between intervention burden and benefit

Participation -- public to be engaged in decisions that will affect them
Read 25 tweets
15 Sep
Are we testing #COVID19 vaccines for kids?

I often see an assumption that the COVID vaccines being trialed will be available for kids at the same time as adults assuming efficacy. And that's a big (HUGE) assumption.

Let's take a look at the Oxford, Moderna, and Pfizer trials
Oxford Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

Two things:
1) Efficacy doesn't appear to be primary outcome for kids as they are only getting one dose
2) Where are the 13-17 yo kids

If I am missing something, happy to be corrected ImageImage
The two mRNA candidates:
Moderna Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

Pfizer Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

These trials are easier as are both 18+ so no inclusion of kids. The others including the NA-831 adjuvant for OPV also focused on adults.
Read 6 tweets
12 Sep
My dream response:
TAGOPIE
Team, Analysis, Goal, Objectives, Planning, Implementation, Evaluate

Team -- what competencies should be in the emergency operations center (EOC) making decisions (methodologists, practitioners, clinicians, gov't, lawyers, clinicians, economists)
TAGOPIE
Analysis

Stakeholder Analysis (who will be affected/needs representation)
Epidemiological Analysis (CFR, IFR, RR, etc)
Situational Analysis (decision tree with different response models of expected benefits and costs. Costs include human, financial, and institutional.
Goals
Based on the three types of analyses, set a goal for your response.

Set specific, measurable, attainable, relevant, and time-bound (SMART) Objectives that flow from the goal used to inform key performance indicators.

Can be done in 2-3 hours with with analyses complete.
Read 7 tweets
4 Sep
Warning!!!!

Unpopular #COVID19 opinion:

Testing is not an intervention
Diagnosis is not an intervention

Testing and diagnosis will only have as much public health and clinical impacts as they facilitate decreasing onward transmission risks or access to care, respectively

1/6
For sexually transmitted infections, testing and diagnosis are critical because they are linked to interventions or actions that directly decrease onward transmission risks including:

1) Curative antibiotics
2) Antiretroviral therapy for HIV
3) Condoms
4) Avoid sex

2/6
For respiratory infections, how will a diagnosis help if your:

1) Living situation does not allow for isolation?
2) Work does not provide paid or even unpaid sick leave?
3) Family is dependent on your income to meet basic needs?
4) Access to care is linked to employment

3/6
Read 6 tweets
26 Aug
Lockdown Thread #2

Was invited to provide a brief presentation on concerns with #Lockdowns today and hopefully works to post here

Outline of Talk:
Inequities in #Covid_19 Acquisition and Transmission Risks
Inequities in the Enforcement of Lockdowns
Competing Health Risks
Read 15 tweets

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