The word "lockdown" is really disturbing. San Francisco has essentially been locked down x 8 months. Testing is helpful but acknowledge limitations of each test. Non-pharmaceutical interventions (distance, masks, hand hygiene, ventilation) work.
and everyone has to decide for themselves their level of fear (I call it "strata of fear", stratosphere) which will determine what they do in terms of being with each other (e.g. is it more ethical to stay away from demented elderly relative or more ethical to see them with NPI?)
No one has seen a movie or performance in 8 months; very few things open (at least in SF) so lockdown hard. What you do to behave "ethically" towards family/friends should be a personal decision, right? The elderly, widows, orphans may be more scared of no contact than contact.
Not sure it is the role of a public health agency to tell me who to see and not see if I know how to exercise precaution. Frankly, I don't think there is a single person in the U.S. who doesn't know about non-pharmaceutical interventions. But if masks work to protect you
and, if you do get an infection but it is mild, the data is very hopeful on T-cell immunity with even mild infection. This is a weird virus and it is a weird time but all I can think of is that I need to see my 86 year old father soon as he is dear to me and I know how to keep
him safe. So, please please stop telling me what is "right" and what is "wrong" as life is a spectrum of moral decisions and me showing him love is not "wrong". Okay really sorry about twitterhea, but I needed to say this as I am so very tired of people saying lockdown.
and I am so tired of public health agencies yelling at people about upcoming holidays and how very dire and horrible it will be if you want to hug your mother. Masks, ventilation, hand hygiene, distancing into households when eating; testing if you can afford; please see mom.
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HI all, we submitted a paper on this today but we want to go from cheapest interventions to most expensive in our response. Cheapest are NPIs (masks, hand hygiene, distancing, ventilation), then more expensive (testing, I&Q, contact tracing), then most expensive (treatments).
Cheapest are "easiest" to enact and yet take behavior change (e.g. masking) so is that so easy? Not really, it is why we came up with prevention strategies for HIV ("biomedical prevention strategies" like PrEP) that didn't rely solely on behavior (condoms)- then it turns out
PrEP ALSO relies on behavior (mainly daily pill taking- this is what I study, adherence in HIV). So, I am not saying behavior change (masks) is easy, I am saying that we as a populace have to trust tbose who recommend them and I so I think we have to turn to building trust
I & my co-authors suggested a hypothesis, acknowledged limitations, and we & others are trying to study it further (inoculum & severity of disease). Science has never been a fixed thing – people got KILLED for thinking of scientific ideas that didn’t fit the predominant paradigm.
A hypothesis is based on an idea; a theory gathers more (but indirect) evidence for the hypothesis; a fact has been proven by usually experimental means (and even that can be disputed based on bias)
There are two things that masks may do- decrease transmission and decrease severity of disease by decreasing viral load. Even decreasing transmission has been questioned because physical sciences can show that a virus can leak around a mask.
How do we show viral inoculum related to severity of disease? We can't do this with dangerous viruses like SARS-CoV-2 (only animal models like this one): pnas.org/content/117/28…
Don't think this relationship is true of all viruses, but seems to be true of some viruses where human experimentation was possible because they are not as dangerous (e.g. giving human volunteers doses of virus and showing that a higher dose gives more symptoms).
Nice data from Arizona on the power of mask mandates, CDC, MMWR in controlling surge. Our group analyzing mask mandates and disease severity across counties in U.S. now cdc.gov/mmwr/volumes/6…
Nice paper also showing blocking of virus with cloth masks: Aydin O et al. Performance of fabrics for home-made masks against the spread of COVID-19 through droplets: A quantitative mechanistic study. Extreme Mech Lett. 2020 Oct;40:100924. doi: 10.1016/j.eml.2020.100924.
5 more papers around hypothesis of reduced viral inoculum -->less severe disease if exposed (and strong T-cell immunity w/ mild infection). 1) Ferrets given higher viral dose more sick: Dose-dependent response to infection with SARS-CoV-2 in ferrets: doi.org/10.1101/2020.0…
Asymptomatic infection with #COVID19 is a problem since it can be spread when you are well so masks prevent that. The reason asymptomatic infection is a good thing is that not having symptoms and not getting sick is good! washingtonpost.com/health/2020/08…
So the ? becomes how do we increase the rate of asymptomatic infection with #COVID19 or how do we decrease its morbidity? One way is to wear masks which likely reduces viral #inoculum. A 2nd way is having cross-reactive T-cells from other coronaviruses (though can't control that)
A 3rd way may be being vaccinated for other infections as suggested by Dr. Andrew Badley. In my opinion, reducing morbidity is just as important than tracking cases as high contagious potential of this virus may mean contact tracing not possible. So focus on reducing inoculum.