Thread by @AbraarKaran

1/ This is a very important article that brings up a number of critical points-I have a few thoughts after reading it.

First, thanks to @apoorva_nyc whose coverage/writing has been incredible for months now.

#covid19
nytimes.com/2020/11/23/hea…

2/ @RanuDhillon & I wrote about an aspect of this back in September; one of the problems is that tracing spread to pinpoint exactly where transmission happened is actually not that straightforward which makes policy making difficult for #covid19

washingtonpost.com/outlook/2020/0…

3/ We are left w/ tough choices, but as with everything, inaction has a serious cost

Decisions need to be made via risk (or cost)/benefit— if the possible benefit outweighs the poss cost, then the choice may make sense. For epidemic control, this calculation is key (but complex)

4/ So the recommendations re not gathering in close crowded poorly ventilated settings- many intimate social gatherings- comes from this line of thinking. We can’t pinpoint how much spread is happening here. We can take an educated guess that transmission does happens here

5/ This also may change quickly-it’s possible these gatherings weren’t driving the spread, but that they will be after Thanksgiving- that is the worry for many of us

I agree that telling people not to meet for Thanksgiving but leaving indoor dining/bars open doesn’t make sense!

5.5/ I also definitely agree that blaming people for gathering is an easy way to turn the blame back on the public when the real underlying issue is that we should never be in this situation in the first place, but we are bc our leaders didn’t do what they needed to.

6/ All of these high risk public settings should be closed & private gatherings with folks outside your “bubble” should be discouraged at this time.

And we need better contact tracing + outbreak investigation to understand where and how spread is continuing. #covid19

7/ I would not conclude, however, that small gatherings are *not* playing a notable role in transmission.

I would say that we are not quite sure what their relative contribution is compared to other high-risk settings at this time. #covid19

8/ The current title is sort of doing what the excellent article is recommending against- claiming certainty one way or the other about where transmission is happening when the answer is- we don’t know for sure bc the data that we have are really not very good.

9/ The problem is that we won’t have that data to the precision we need & we need to act now. The focus on small gatherings makes sense now bc thousands of them are about to happen this week. If this week were restaurant week, I would be tweeting about restaurants.

10/ The counter to my argument (in my head) is that we have limited energy; if we focus that energy in the wrong places (example- telling people to mask outdoors and not focusing on indoors), then we are also not optimizing our response.

11/ But this week, focusing on small indoor gatherings because they are about to happen at scale seems like the right use of our attention; sadly, we don’t have strong data one way or the other and I’m not sure we will have it soon w/ this level of viral transmission. ///