Will not be time for many of these and please understand may well be distracted so will miss put too many but given the thanksgiving holiday would like to should out to those like @ImpactMovie who have been admirable friends for months. Happy thanksgiving to you and yours!
I would add @SFDukie happy thanksgiving to you and yours - hopefully in a non generation mixing setting
Or the extraordinary @EIDGeek - this had been a bad year. Getting to know you better has been one of the better parts. Look forward to meeting in person, one day
The fact this is pausing now reflects that I’m going to bed. Look forward to talking more tomorrow
Want to mention the remarkable @yellingatwind who has been consistently sensible, which is basically a gold medal so far as I am concerned
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First this is good news in that it shows yet more evidence efficacy can be achieved, and in a vaccine setup we understand better than mRNA vaccines - no disrespect to any platform, but having more weapons in our arsenal is always going to be better
But what’s bad is the relentless media focus on the “up to 90% efficacy” which makes me irritable. This was a result from a mistake in the vaccine trial regarding dosage. Vaccine trials are not the sort of places you want to make mistakes
A comment (to complement some parallel threads from @michaelmina_lab) on the value of rapid testing, even if it is imperfect. So how do you re open say... movie theaters in the midst of a pandemic where anyone could be infected, and many are at risk of fatal outcomes? 1/n
So bad things are that most movies theaters are indoors, probably poorly ventilated. Crowds. Lots of opportunities for close contact. A person at the peak of infectiousness could kick off a Superspreader event 2/n
If you could present reliable evidence you have been -ve in the last 24 hrs, well that would obviously be transformative. But wait - what if that test result is a false negative and there is a resulting false sense of security? That’s where the masks come in 3/n
The reason for the test was exposure to a suggestive but non-specific symptom in a member of the household who was also tested 2/n
While waiting for the test result, all members of the household quarantined. Child did not go to school. Prevented any risk of transmission outside the household 3/n
There's a lot of talk about 'preserving healthcare' as a primary goal of pandemic management. That's not wrong, but it begs the question of what exactly we mean by 'preserving healthcare'. I recommend this article in the @NEJM & will add a couple comments nejm.org/doi/full/10.10…
So for some 'preserving healthcare' means avoiding all ICU beds being occupied by the pandemic. This is obviously bad. It's also a very low bar. If we get even close to this, where do you put patients recovering from surgery? Or emergency ICU admissions for other things? 2/n
This is not a hypothetical☝️🏽. So let's say we stop short of crashing the ICUs with patients - we would still end up with shortages of skilled nurses elsewhere in the system, compromising healthcare. When they are redirected at the pandemic other care is affected 3/n
Some of the replies to this have made it clear people still think Covid tests are all painful, and would avoid them. That's *not true*. This👇🏽is a swab for a Covid test, and a PCR test at that. And that's as far as it got into my nose 1/n
We've come a long way since the early days of the pandemic. Then, concerns about sensitivity meant that tests were done on nasopharyngeal swabs, because we were not confident that a nasal swab like this would be accurate enough 2/n
The nasopharynx is right at the back of the nasal cavity, a swab like this is the sort of thing you'd remember. And if you don't know much about test sensitivity it is the starting point. As time goes on, we can ask whether you lose sensitivity with other sampling methods 3/n
On the eve of the election, this paper from me and others lays out the impact of the federal government on the pandemic, it's not good link.springer.com/article/10.100… 1/n
1st the failure to prevent introductions. Lots of dramatic posturing against China, while the virus found ample opportunity to enter the country from Europe. Pandemics are, by definition, global 2/n
2nd Have you noticed the appalling numbers of healthcare workers who have lost their lives? We have known all along one of the most important ways to help them is Personal Protective Equipment or PPE khn.org/news/lost-on-t… 3/n