The number of Covid cases, hospitalizations, and deaths is going to continue to grow sharply as we enter the winter; until all of us on our own start taking enough collective action to slow the spread. There is no seasonal backstop, and won’t be any new national policy action.
When people wear masks, it reduces likelihood of spreading Covid if they're an asymptomatic or pre-symptomatic carrier. A new @Nature study finds if 85% of Americans wore masks, we would save 95,000 people. Greater adherence to masking will reduce spread. nature.com/articles/s4159…
Masks can also protect you from contracting Covid if you are exposed to someone who is contagious; and the quality of the mask you wear can matter. The higher the quality of the mask, the greater the protection that it can afford you.
Epidemics in the South during the Summer started to peak and decline when people took collective action to adopt more precautions - masks, distancing, reducing activity where possible (evidenced by declines in mobility data). Coupled with targeted mitigation, it slowed the spread

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More from @ScottGottliebMD

11 Oct
A good reference from CDC on SARS-CoV-2 Virus Culture and Subgenomic RNA for Respiratory Specimens. Authors investigated 68 respiratory specimens from 35 coronavirus disease patients in Hong Kong, assessing them for subgenomic RNA and virus RNA by rtPCR. wwwnc.cdc.gov/eid/article/26…
Subgenomic mRNA is a newer test being used to assess for active infection and live virus and it's generally considered a good - but not foolproof - proxy for culturable, live virus.
As always, @ashishkjha with a timely and insightful explainer and assessment here:
Read 4 tweets
14 Sep
Thread: My longstanding public health perspective is a critical shortcoming of our early response was the lack of diagnostic testing to detect community spread and target early mitigation. We were situationally blind. So we over-relied on flu surveillance because it’s all we had
I first raised these concerns in writing on Jan 27, when I said "global spread appears inevitable. So too are...outbreaks in the U.S." and called for the rapid development of accessible diagnostics as a "key to enabling successful public health measures" cnbc.com/2020/01/26/op-…
There were regulatory hurdles that had to be cleared to enable academic and commercial labs to offer their own, lab developed tests that could help meet the testing demand. I outlined the "Catch-22" that was blocking these tests in a series of tweets.
Read 5 tweets
22 Aug
THREAD: For the last 6 months, FDA’s device center worked effectively with labs to advance hundreds of tests for Covid. A new HHS policy that extricates FDA from this work - and goes further, by removing any FDA role over any lab developed test - could put this work at risk. 1/x
At issue are lab developed tests. For a time, there was debate what FDA’s role was over these LDTs. It was long settled that LDTs were medical devices, subject to FDA oversight. For the vast majority of LDTs, FDA exercised enforcement discretion, and didn’t actively regulate 2/x
This FDA authority was articulated in countless guidances, enforcement actions, testimony. It was the subject of 2006 guidance that was cleared by HHS under Bush. Bipartisan legislation now moving through Congress would further codify the contours of this general framework. 3/x
Read 13 tweets
16 Aug
Lessons for success from abroad: "Physical distancing in and out of the classroom is common practice... Schools in Switzerland use tape on floors to mark adequate space between desks. To further limit contact, many Swiss schools reduced class sizes by 50%" commonwealthfund.org/blog/2020/reop…
"Primary school children have returned first in Denmark, and a system is in place to keep children in small groups...The other lynchpin of the Danish approach is a huge amount of hand washing and sterilizing." bbc.com/news/education…
In Iceland, where epidemic is controlled, "the 100-person limit at public gatherings remains unchanged. At secondary schools and universities, a one-meter social distancing rule will apply, without the use of face masks" Children born after 2005 are exempt icelandmonitor.mbl.is/news/news/2020…
Read 4 tweets
8 Aug
THREAD: Covid caused 338,000 diagnosed infections in kids. 86 tragically died, thousands more hospitalized. To compare burden to flu, an estimated 11.3 million kids got symptomatic flu in 2018-19, 477 died. If Covid became as widespread in kids as flu, outcomes could be grim. 1/3
Our focus must be on preventing Covid from becoming epidemic in kids and safely reopening schools in communities that controlled spread. There are steps we can take to accomplish these goals; reducing risks of outbreaks in schools and keeping kids safe 2/3 wsj.com/articles/want-…
There’s lot we don’t understand about Covid in kids. We shouldn't trivialize observed or possible risks. Schools have been closed; many kids deliberately sheltered from infection. In coaxing schools to open it’s imprudent to argue Covid is harmless, or milder in kids than flu 3/3
Read 6 tweets
29 Jul
From @AmerAcadPeds data on Covid in kids. Documents 288K total child cases, and 76 tragic deaths. CDC in its school opening guidance compares pediatric Covid deaths to pediatric flu deaths. Flu caused 11.3M documented cases of symptomatic disease in kids in 2018-19 vs Covid 288K. ImageImage
More information on CDC's data regarding influenza in children for 2018-19 can be found here: cdc.gov/flu/about/burd… Image
The upshot here is Covid has not infected nearly as many children as flu does; in part because we have deliberately sheltered kids from Covid. So the comparisons in total morbidity between Covid and flu that CDC makes in their back-to-school guidance need to be viewed cautiously.
Read 4 tweets

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