My concern about the almost-complete lockdown order in 5 counties in Bay Area is that it is similar to March, but we have learned so much about the virus since March! In March, a complete lockdown was indicated because we didn’t know if the virus was spread from surfaces;
we didn’t know if it was spread from asymptomatic individuals (it is); we essentially treated the infection as if it was radioactive. At this point, we have learned a lot about how to mitigate spread, including masks, distancing, ventilation and hand hygiene.
Therefore, to institute the same measures as in March, including shutting down of playgrounds (despite lack of evidence on surface transmission), outdoor dining (where there has been no data to show that this is unsafe), and prohibiting members of different households to gather
outside, is not data-driven. Decisions that are non-data driven, despite the public knowing so much more about the virus as well, will erode trust in public health officials and foster noncompliance with such orders. This can drive people indoors who used to gather outdoors
and foster spread. This is one of my biggest concerns. Therefore, some counties (e.g. San Mateo) did not join yesterday’s 5-county Bay Area stay-at-home order. Perhaps playgrounds, zoos, outdoor activities can be re-instituted. We are lucky with Bay Area weather.
Luckily, whatever happens, those vaccines are COMING and this nightmare will be over soon; so continued (and within scientific reason) caution is indicated until widespread vaccination achieved. There is light and hope and so please hang on!
And one more thing but after the phrase "we are going to lockdown", the next clause should be "and this is how we will support workers/businesses". At federal, state, city level.
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Wanted to explain a bit about the vaccine trials (Pfizer/BioNTech, Moderna, Astrozeneca) endpoints and what people mean when they say "we don't know if vaccines will prevent asymptomatic disease" (and why we need to wear masks until we reach equitable widespread vaccination).
The endpoints of Pfizer (full trial results Nov 18 via press release) and Moderna (interim results Nov 16) were both symptomatic COVID-19 cases - they didn't say they were swabbing weekly (like Astrozeneca) did to rule out asymptomatic disease.
So, can't tell if prevented infection altogether or prevented symptomatic cases only. At end of day, latter is what matters for individual but former can have implications for asymptomatic spread so continuing NPIs until we get to mass vaccination will be helpful
In terms of type of mask, seems to be 3 types of masks that work well for the public (after asking physical scientists!) in terms of comfort and protection (both filtration efficiency for wearer and "source control" for others): 1) Surgical mask-melt-blown non-woven polypropylene
2) 3-ply with outer and inner layer made of cotton and middle layer of a filter material (many masks have places to inert that filter- like a vacuum bag filter) 3) At least 2-ply but with high thread cotton like tested by CBC Marketplace: cbc.ca/news/canada/ma…
Agree that standardization of masks may help increase protective efficacy but also help convince public to wear. I don't buy this argument that it makes you "cavalier" or "take risks" to wear a mask; giving someone a sense of self-protection (masks protect you and others) is a
Our group including the very smart @MattSpinelliMD was asked to comment on the DANMASK study found here: acpjournals.org/doi/10.7326/M2…. Others have already smartly commented that implementation science is the way to study mask wearing but here goes:
First the study team (many cardiologists in Denmark) should be commended for performing a randomized controlled trial of a non-pharmaceutical intervention (mask-wearing) in the early days of a pandemic; there are study design flaws that will impair our ability to draw conclusions
The study was a non-blinded study of providing 50 surgical face masks tor community participants spending >3; hours outside of the home in April-May (intervention group) versus the standard of care of Denmark not recommending widespread use of face masks in the community at time
Got a call from science reporter about what we hope & expect from Biden administration on COVID19 response, should be organized and consistent on NPIs and testing. But HIV expertise from advisors is essential to inform public health messaging, I think.
Why? Because HIV doctors have learned over many years and in close contact with their patients to NOT use stigmatizing messaging ("you got COVID? what were you doing??!) and to use kind, harm-reduction-based ways to message on prevention and adherence
I have so many patients right now (I treat patients with HIV) who are totally traumatized by the punitive and harsh aspect of public health messaging right now and make suggestions on how to make messaging more effective via gentleness, kindness, acknowledging loneliness and pain
The interim results of the Moderna vaccine trial released this morning are thrilling. Like the Pfizer/BioNTech vaccine, the Moderna vaccine (called mRNA-1273) is an mRNA vaccine and this trial enrolled 30,000 participants, 42% of whom were high-risk (7000 over 65 years and 5000
<65 years old with comorbid conditions) and 11,000 of whom were from communities of color. The press release of the interim results of the phase 3 trial of the Moderna vaccine shows a 94.5% efficacy rate at 95 infections (e.g. 5 infections in the vaccine group; 90 in the placebo
group). Vaccine trials often have a secondary endpoint of mitigating severe disease and all 11 of the severe cases of COVID-19 occurred in the placebo group. The vaccine trial will go up to 151 infections and 2 months for safety data before Moderna will file for an emergency use
HI all, we submitted a paper on this today but we want to go from cheapest interventions to most expensive in our response. Cheapest are NPIs (masks, hand hygiene, distancing, ventilation), then more expensive (testing, I&Q, contact tracing), then most expensive (treatments).
Cheapest are "easiest" to enact and yet take behavior change (e.g. masking) so is that so easy? Not really, it is why we came up with prevention strategies for HIV ("biomedical prevention strategies" like PrEP) that didn't rely solely on behavior (condoms)- then it turns out
PrEP ALSO relies on behavior (mainly daily pill taking- this is what I study, adherence in HIV). So, I am not saying behavior change (masks) is easy, I am saying that we as a populace have to trust tbose who recommend them and I so I think we have to turn to building trust