1/ I've been feeling more and more disengaged from COVID work, disillusioned with the growing realization that all the smart research and policy doesn't make a damn bit of difference
Not for the 1st time, I've seen that what I thought was an information problem is something else
2/ I so admire those public health Cassandras who've been unrelenting, continuing to beat the drum of science and policy for the past 9 months
repeating over and over again what must be done, as the cases and deaths mount, with no strategy in sight
tweets, interviews, articles
3/ It's perhaps no accident that they (and I) are "formers"
People who ran the agencies, who know the pain of the experts and scientists working inside, and are free to speak
***We need a laboratory testing and public health surveillance system that actually gives us eyes on the outbreak, as @ScottGottliebMD@ZekeEmanuel and I laid out
@ASlavitt first priority was healthcare workers, who have been put in harm's way (and the supply chain is again at risk of snapping)
He called for us to protect the elderly in nursing homes
And by now ALL OF US should have and wear masks
6/ We need to enforce reduced crowding
We know that the outbreak is driven by super-spreader events that are most likely to happen when lots of people are in crowded, noisy indoor spaces without masks
When the outbreak is rising, we have to limit indoor gatherings, close bars
7/ And when the outbreak fires are put out, we need to stamp out the embers through timely testing, isolation of those infected, finding their contacts, and enabling quarantine- the #BoxItIn strategy laid out by @DrTomFrieden@ResolveTSL
2/ To test hypothesis that health systems provide better care to patients w high needs, diff in quality b/w system‐affiliated & nonaffiliated physicians
ED visits were significantly *different* in system‐affiliated (117.5 per 100) & nonaffiliated POs (106.8 per 100, P < .0001).
3/ I love how delicately the RAND researchers approach this in their conclusion: “Health systems may not confer hypothesized quality advantages to patients with high needs.”
2/ When CMS first released their public use files, I ran some analyses looking for aberrations-
One thing that jumped right out was...Repetitive non-emergency ambulance runs- often for the same person going back and forth to dialysis 3 times a week.
"Medicare and law enforcement officials will need to create new processes for dealing with a potential flood of outlier reports from amateur sleuths like me."
2/ @AledadeACO is proud to be the largest, most successful nationwide enabler of physician-led ACOs, delivering better care at lower cost for >340,000 Medicare beneficiaries, saving Medicare and American taxpayers nearly $180 million in unnecessary health care spending last year!
3/ Here's the list of the physician-led ACOs we are supporting, and our performance data.
* It doesn't matter if you're urban, rural, suburban, or in which state
* It gets better. The longer you work, the more the chances of success
2/ We *still* don't have a good answer to the most fundamental epidemiologic question - "what's the intensity of COVID activity in my community this week?"
We have lots of websites and lots of citizen scientists (including me) trying to piece it together
We don't have a national strategy.
The CDC has been muzzled.
State/local leaders are mostly overwhelmed with trying to figure out what's going on, or have stopped looking at science altogether.
Businesses, schools, families have to decide for ourselves...