1/ It is *problematic* how quick people are to judge how other people may have been infected by #covid19.
This judgment re-enforces stigma; this is a destructive force that makes viral spread even more hidden.
This is *not helping*. It dissuades testing and disclosure.
2/ I am not trying to defend carelessness. But I am also not trying to be the judge of it. As doctors, we hear deep and personal stories. As much as I have had patients who got sick on the job, so too have I had patients destroyed by social isolation--> depression, alcoholism etc
3/ In this CDC report, 1 in 4 respondents aged 18 to 24 had *seriously considered suicide in the last 30 days*
Along with viral spread, there have been significant mental health epidemics as well.
4/ Trust me when I say I am hearing/seeing the other side of this; that our most vulnerable communities are being destroyed, having to work the frontline w/o protection.
I am aware of this; these are the patients we have been treating for months.
5/ One must then ask if having empathy for those who got sick "socializing" rather than working is justified at all.
And others may go as far as to say that these privileged people deserve scorn or judgment, not empathy.
6/ But I would say that this way of thinking is probably not helpful.
This reminds me of medicine in important ways.
As doctors, we have to care for patients that we may have negative feelings toward; some may be racist, sexist, or discriminatory in some other way.
7/ Yet we still must rely on empathy; if we don't, it becomes hard to be a good doctor.
Similarly, if we tap into judgment & anger more than we tap into empathy, forgiveness, & support, we will continue perpetuating stigma; losing chains of transmission & control of the epidemic
8/ I am sure this thread will still get responses or reactions saying that privileged people don't deserve empathy; & I won't be able to change that, but as a doctor on the frontlines, I need to amplify the message that this judgment may not actually be helping us.
cc thread; have been trying to make sense of how to lean into empathy before we judge 'how' someone got infected
1/ Really appreciate @DrTomFrieden piece on more nuanced epidemic control based on local epidemiological data. @RanuDhillon & I wrote a similar piece back in August called “Smarter Lockdowns”— the problem is implementation. So many ideas, so little action
2/ At a point, we recognize that there are so many ways to get R<1; the issue is that doing any of them well and consistently requires coordination, the right policies, & enforcement of those policies. We don’t have that. We needed that for 9 months.
3/ We wrote a follow up piece @WBUR@NPR ⬇️— but admittedly, writing op eds generates ideas but if those ideas end up in a Twitter abyss, then they fail to influence what actually happens (hopefully @DrTomFrieden excellent piece gains traction/moves dial) wbur.org/cognoscenti/20…
For people that have been exposed to someone with known #covid19 or with symptoms and are awaiting a test result— you need to be quarantining *as if you have #covid19*
This doesn’t just mean stay home. It means stay away from people *at home*
2/ With incubation anywhere from 3-14 days (median ~5), one single negative test is not enough evidence that you are “safe”
I’m not sure this message has been clear. And I fear that many people think their home is “safe”, yet we have been seeing home based clustering since April
3/ If you’re not staying in a separate room and masking any time you are outside of that room, you are introducing possible viral spread if in fact you are infected.
This has been a problem for many of my patients that didn’t have multiple rooms or spaces to quarantine in
2/ cc @RanuDhillon@drdavidwalton@IngridKatzMD ; as global health doctors, inequity is the focus of how we fight poor health outcomes. It isn’t some sub-plot; this is the whole damn story. And we have seen this play out in #covid19 from the start.
3/ From when we said “stay home”— there were so many people that could never afford to stay home; that were expected to show up and keep working without PPE, paid time off, hazard pay, or any other protections. I know- many of these people ended up being my #covid19 patients
1/ True story of two personal friends- let's call them Jim & Bob- & #covid19. I share this not to shame but to say-- this is likely happening more than we are acknowledging because there is stigma associated with having #covid19 in many social circles.
Short thread
2/ Bob was exposed to a #covid19 case recently while socializing.
He didn't quarantine, nor did he tell Jim that he had been exposed.
While they were hanging out, he was notified by phone that his partner tested positive- & he still didn't say anything about it to Jim.
3/ When Jim asked, Bob eventually revealed that he had an exposure (while still not revealing his partner had just tested positive).
Jim was pissed & told Bob to immediately get tested.
Bob did-- & ended up testing positive for #covid19.
There should be no talks about schools closing until every bar and restaurant and gym is put on pause & there is a mask mandate for public indoor spaces.
We have been through this before; every single day we lose is worse than the last!
2/ This is *not* to say that businesses should tank or people should be out of jobs. The economy matters. The government needs to step up; one time stimulus checks aren't enough.
But if spread is happening at these venues, then alternatives need to be implemented ASAP.
3/ Keep in mind that this wasn't a surprise that is suddenly popping up. We have been through this twice before already.
We knew this was coming again.
And yet we are once more faced with politicians who are *stalling* when the epidemic is running away again.
THREAD 1/ A reminder that the epidemic won't be solved by people around a table in the White House. Yes-- we do need that as well; and we need those people to know what they are doing; & it looks like we finally have that now.
But the epidemic will be solved in our communities.
2/ From the start of the epidemic, there have been battles between experts; battles over who is & isn't an expert; battles b/w political parties; battles between fringe ideologies- these battles are actually important-- they should remind us that the opposite-cohesion- is the key
3/ We need not defer the solving of problems to elites somewhere else-- when the solution is actually going to come down to us; our families; our communities; our neighbors; our neighborhoods.
W/ the right support from our leaders, the epidemic will be solved by us.