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

We had over 187,000 new cases yesterday

What the hell are we doing?
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.
4/ We know this, yet we are "advising" that people don't do it.

That's leadership?

That's recklessness. You will not find a single public health expert advising travel right now; we are consistently saying do not do it. Do not endanger your families

Viral spread is too high
5/ Our public messaging on this needs to be much more direct

We might all be tired; most of us are. I am.

But the reality is what it is

We are in the situation we are in

We need to step up now

We cannot propagate this further; it will break down our healthcare system
6/ Not only should you be "hunkering down" as @zeynep said; you should see it as a public service to convince friends, neighbors and others who trust you to do the same.

This has always been a community response. It will take all of us working *together*
7/ One of the most important things I could do this week was to call some of my own family members in other parts of the country & reinforce this to them.

They canceled their trip.

If each of us can do this, we can avoid *a lot* of transmission. Don't underestimate it.
8/ The epidemic seems largely out of control right now; except that it really still is in our hands.

Every day is a day we can stop a new transmission chain from starting; a new day we can avert another super spreading disaster.

We have to believe that our actions *matter*
cc thread- what we do is still in our hands right now @ChelseaClinton @drsanjaygupta @mtosterholm

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More from @AbraarKaran

21 Nov
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

This doesn’t mean don’t get tested; it means *don’t travel unless an emergency* #covid19
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.

Read 7 tweets
19 Nov
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.
Read 6 tweets
15 Nov
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.

We are all struggling in different ways.

Read 9 tweets
14 Nov
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)
Read 5 tweets
14 Nov
Are you quarantining correctly?

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
Read 7 tweets
13 Nov
1/ Excited *& frustrated* to share this new work

*This is the epidemic* — inequity is the driver of #covid19. It has been since the start

It’s not surprising- it’s how every infectious disease outbreak spreads

And it isn’t central enough to our response
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
Read 10 tweets

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