Thread by @ProfLWiley

@WFrancisEsq @sdbaral Which is why a strategy built on convincing individuals to “do better” - whether by threat of criminal penalties or education/urging - is a concession to defeat. That’s where the social-ecological model comes in...

@WFrancisEsq @sdbaral Effective pandemic response requires governmental & institutional responsibility: 1) strong protections for on-site workers: high-quality PPE, easy-access testing, privacy & whistleblower protections, paid sick leave, income replacement for ppl in higher risk groups to stay home.

@WFrancisEsq @sdbaral 2) strong protections & supports for safer housing: eviction/utility shut-off freeze plus rent-relief for landlords, (rapidly transmitted) positive test results trigger immediate offer of strong supports for isolation from other household members, including hotel accommodation

@WFrancisEsq @sdbaral 3) rapid scale up of resources for local health departments to perform full-service contact tracing, epi investigation, cluster busting & supported isolation (not just exposure notification & “good luck self-isolating”)

@WFrancisEsq @sdbaral If plans for the above are in motion, THEN institute short, sharp restrictions & financial assistance to affected workers & businesses to bring the rate of community transmission down to meet rising public health capacity for TTSI to pick up when restrictions are eased.

@WFrancisEsq @sdbaral In the absence of any federal plans for the supports & protections described above, the best state & local governments can hope to do on their own is to blunt peak impacts on health care capacity. Best way to do that is 2-4 weeks of closures for indoor gathering places.

@WFrancisEsq @sdbaral Closing indoor gathering places + urgent calls for the well-intentioned to alter behavior (including good harm-reduction advice for making risky activities safer) can mitigate peak impacts/flatten the curve, even if a significant chunk (but still a minority) disregard all advice

@WFrancisEsq @sdbaral It’s totally unrealistic to expect perfect compliance from individuals. That’s why good public health campaigns don’t depend on that. Mitigation (blunt peak impacts/flatten the curve) requires widespread changes among the well-intentioned, not perfection.

@WFrancisEsq @sdbaral Anything more ambitious (suppression, crush the curve, get back to normal without hundreds of thousands of deaths) is not attainable through individual behavior-change efforts alone (whether criminally enforced or messaging or harm reduction)...

@WFrancisEsq @sdbaral If people are facing eviction, hunger, economic devastation for their families, they’re going to go to work in high-risk settings, they’re going to bring the virus home to family/friends & the pandemic is going to rage on, no matter how much we threaten/cajole for behavior change