THREAD 1/ Have spent the last few weeks working on research examining early #covid19 spread globally. One of the articles needs to be re-shared again.
It looked at how Hong Kong, which had experience from SARS in 2003, kept its epidemic from getting out of control in March.
2/ They focused on intense surveillance not only in incoming travelers, but also in the community setting, testing 400 outpatients and 600 inpatients daily in *early March 2020*
If positive, patients remained isolated in hospitals until recovered/no longer shedding
3/ Close contacts were traced, from 2 days before illness onset.
They were quarantined in special facilities, so outside of the home.
By doing this well, they were able to avoid more intense lockdowns.
They also cite Singapore and Taiwan in this group of strong responders.
4/ Not only that-- they also drove down influenza activity at the same time.
And phone surveys in February and March reported 97-98% face mask use!
And 85-90% reported avoiding crowded places (also in Feb-March).
5/ At times, this epidemic can feel like its unstoppable. But that is not true.
Many other countries have shown this can be stopped if we have strong public health focused policies, & we all do what we can at an individual level-- particularly wearing masks & avoiding crowds
A traveler who tested neg 48 hrs prior to flight was infectious by day of flight, pre-symptomatic; using genomic analysis, traced to 4 cases of in-flight transmission
2/ I don’t say that lightly. I know that this is a big sacrifice; but we were just shy of 200,000 new #covid19 cases yesterday. Hospitals will *not* be able to handle a holiday superspreading disaster happening simultaneously around the country.
3/ The problem with prevention is that it is hard to appreciate disasters that we avoided. This has been a challenge since the days of #stayHome - it can feel like a thankless task. But as a healthcare worker, I am thanking you right now. Please.
1/ The single most important lesson I learned working on a state #covid19 response for 7 months: there is nothing worse you can do in an epidemic than waste time
2/ We have an intervention that we know works, that is of immense benefit w/ little to no cost. Yet we are still leaving that up to choice in so many parts of this country.
Don't ask me to say #MaskUp again- we need a national mask mandate for indoor spaces, now.
3/ We have thousands of Americans (maybe more) who are thinking about flying around the country for the holidays.
This is a true catastrophe waiting to happen. This is an epidemic slingshot being stretched, & will fire off more cases than we can handle.
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.
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