1/ The year before #covid19, my academic focus was largely on Ebola & epidemic response in the global health setting. From Feb 2019 to Jan 2020, I worked as the editor of the @JournalofEthics theme issue on the ethics of pandemic response.
2/ We had the great privilege of contributions from many experts—- and we covered topics ranging from how anthropology can help us better understand how to work alongside communities during an epidemic...
3/ to the ethics of emergency vaccine distribution— both immensely relevant again. (@BhadeliaMD co-authored the latter; @Real_Ironist - you may find the former ⬆️ interesting)
6/ Particularly lucky that we had the chance to interview Dr. David Heymann— one of the world experts on epidemic containment & someone who has become a mentor over the past year. See podcast interview w him:
Cc @DrTomFrieden@DrNancyM_CDC journalofethics.ama-assn.org/podcast/ethics…
7/ Many ways this theme issue could have been improved— while this was a US focused publication, we would only have benefited from having more international voices here; many of the most experienced world experts on epidemics are *not* in the US or Europe. Cc @gabbystern
8/ Also would have been awesome to have had voices of brilliant folks I have only now met virtually through #covid19
9/ & most of what I’ve learned about epidemics over the yrs I learned from my colleague/mentor/friend @RanuDhillon who is one of the few people probably in the country that has true ground experience in stopping intl epidemics - the US response would be better from his wisdom.
10/ & of course immense thanks @IngridKatzMD - my mentor who helped me & guided me through this project & the staff @HarvardGH — we had many meetings putting this issue together to try & capture the complexity of epidemics; and we see all of these playing out again w/ #covid19
11/ One of big takeaways: history repeats itself, esp when we fail to learn from the experience & respect the work of our intl neighbors; the US response would have been all the better if we followed the expertise of countries that had dealt w/ this before #covid19
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“The CDC is urging “universal mask use” indoors for the first time”
This is pretty unbelievable if this is 1st time they have recommended this. For *months* many of us have been pushing for a mask mandate for indoor spaces. #covid19washingtonpost.com/health/2020/12…
2/ While we can’t regulate what people do in private settings — although even here masks are so important— a public indoor mask mandate is long overdue
3/ We know spread is most efficient indoors, yet our current mask mandates end up leading to people masking outside where risk is much lower, and then taking those masks off either in the workplace or during social gatherings #covid19
2/ I have seen this happen over and over; almost every patient I cared for in the #covid19 ED in April was infected by someone who had the virus that they lived with.
This is why we tried to implement isolation options outside the home like Boston Hope
3/ But- we can't force people to leave their homes; & a number of patients did not feel comfortable or safe going to outside facilities/ many preferred to stay at home
I can understand this sentiment, & building that trust is key/is hard to do in an emergency
THREAD 1/ This was tough to read— everything from threats of violence against scientists- some who I know personally- to real feelings of despair from others
2/ Pandemic nihilism will affect every single one of us at different times & different ways. Change happens slowly even when we need it to happen quickly. It will probably take saying the same thing over & over again but in different ways until something actually gives. #covid19
3/ As a global health doctor, the most important lessons I ever learned in the field taught me unending optimism- you begin to focus on the specific people, families, communities that you care about most & you support them in the ways that you can, no matter how “small”
1/ One of the challenges we will see more of -- as #covid19 finds its way into hospitals discretely (patients coming in for other conditions & initial test negative)- we will have exposures that furlough healthcare staff quickly who were seeing patients w/ only surgical masks on
1.5/ Its unclear how much discrete spread as described is happening, but anecdotally this type of exposure has already happened to me & others; & with more spread in the community overall, this type of discrete spread will increase as well. #covid19
2/ Being able to get exposed staff tested quickly; & to serially test them even if first test neg is critically important
We can't afford to lose limited staff for 7-10 day quarantines at a time; we also can't afford to have unknowingly infected staff working on wards #covid19
1/ With high rates of viral transmission all over the country, people who have traveled should be advised to quarantine when they return. Many people will not know that they’ve had an exposure, but they can still stop onward transmission chains by quarantining. #covid19
2/ But important to remember that quarantining does not mean walking around your house as if things are normal.
It means avoiding contact with others in the home and wearing a mask if you need to leave your separate space.
3/ Some places allow people to end quarantine if they have had one negative test. Important to remember that one negative test does not mean you are “safe”— the best bet would be to get tested upon return and again within a few days to cover a longer incubation period. #covid19
Back again to stigma— have had multiple friends disclose in confidence to me in different states that they contracted #covid19 but didn’t want to tell anyone because of the fear of how they would be perceived. This is a real problem, & it *will not be solved by judgment & shame*
2/ If this makes you angry—this won’t be solved by your anger. In fact, that will make this worse. How someone else got infected is not for you to judge even if you feel like it is. That’s a tough thing to hear when people are making sacrifices.
3/ I get that- I’m a doctor, I too have sacrificed. But when I treat patients, if I sat there judging them/how they got sick— I’d quickly become a pretty bad doctor. So let’s start reframing this as something that no one wants to get- even if they sacrificed “less” than you did