#TheGreatBarringtonDeclaration calls for allowing #covid19 to spread openly while “protecting” the elderly/vulnerable.

While I actually believe the authors mean well, there are multiple reasons why I believe this is a seriously problematic proposition.

-With asymptomatic & presymptomatic spread, the virus will inevitably find its way beyond the first layer of “healthy” people, esp in crowded households & intergenerational households— & especially in our most vulnerable communities who are more likely to run this risk.
-Allowing millions of cases to spread unabashedly will absolutely mean at least several thousands of cases requiring hospitalizations. And those of us who are still working on the frontlines will be the ones — once again— fighting to care for patients w/o adequate supplies.
-Millions of sick young Americans may have mild disease that doesn’t kill them— but the *morbidity* costs are real. We still have so much to understand about longer term effects. Subjecting people to a novel virus that we are still understanding and studying is inhumane.
5/ Why is #HerdImmunity being proposed as a “strategy”? When so many countries have controlled this epidemic by employing fundamental public health response tactics, why are we making excuses? Why are we unwilling to put in the work that so many others have done?
6/ Ultimately, we are letting this “strategy” get adopted by politicians who have no idea what they are doing, whose main goal is to try and change the narrative around #covid19 so that their failed response gets re-framed as a successful one. That’s not going to happen.
7/ I agree whole heartedly that the focus of the epidemic response must be on equity; it must be on providing the most vulnerable with the most resources and protections; & ultimately lockdowns are *not* a strategy but an emergency backdrop when the response itself has failed.
8/ But the options here are not #herdimmunity vs hardcore lockdowns— that’s a false dichotomy. Neither of those (IMO) are sustainable or true “strategies”— one is a disaster waiting to happen, & the other is what must be done to quickly stop transmission when it’s uncontrolled.

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More from @AbraarKaran

14 Oct
"One of American culture’s most cherished traditions is for a mix of young & old people from different households to sit close together & share food in a poorly ventilated space without masks on for an extended period of time. It’s called Thanksgiving."

2/ I agree w/ the concern in this piece. The holiday season is approaching. We have all had an exhausting year.

The inclination will be for folks to want to travel & spend time with loved ones in close settings indoors.

But the virus doesn't care about how we feel.
3/ We need to maintain precautions through the rest of this year.

W/ a number of vaccines in phase 3, we could be heading into a new chapter of the epidemic soon.

But until then, we have to double down on what we know works- avoiding close indoor contact is essential.
Read 4 tweets
14 Oct
1/ Interesting piece by @alexismadrigal and @yayitsrob on the current debate re rapid antigen testing for #covid19 epidemic control. As w/ anything, need to ask what the alternative is-- which largely is people not getting tested at all.

2/ They cite one critic who believes the answer is not to increase the supply of tests but to decrease the demand for those tests by improving other prevention measures, such as masking etc

Personally, I think it takes both of those things. Rapid testing is not simple...
3/ To actually implement. The more asymptomatic screening you do, the more false positives you will get (poor positive predictive value when population prevalence is low), & you need a confirmatory follow-up for those, or else risk the system collapsing.
Read 4 tweets
14 Oct
1/ This was an excellent piece on the use of genomic sequencing to better understand #covid19 spread. One of the biggest challenges is understanding how and why spread is happening.


cc @chriscmooney @brady_dennis @sarahkaplan48 @Harry_Stevens
2/ @RanuDhillon and I wrote about this in @washingtonpost earlier this year-- genomic sequencing could provide a lot of this information. This helps to understand if x infected y, or if x and y both were infected separately. washingtonpost.com/outlook/2020/0…
3/ This has big implications.

For instance, if we found that cases in schools were largely happening from adults to children in the home, but not from children to other children in schools, it may change our calculus on school reopening.
Read 4 tweets
10 Oct
1/ This is one of the best pieces you will read to put Trump's #covid19 infection into context.

As a physician, so much of what @edyong209 writes here resonates deeply, particularly that the language we use to describe disease is very problematic.

2/ "This connection between physicality and righteousness created, as its dark corollary, a link between disability and moral failing."

This is one of my favorite quotes from the piece; and it gets right at the heart of a false dichotomy that frames illness as weakness.
I could go on and on-- I won't.

Read the piece.

And get your subscription to @TheAtlantic -- just $25 for the entire year for students and academics/educators.

Really strong work @edyong209
Read 5 tweets
7 Oct
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:

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."
Read 8 tweets
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*

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.

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

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