We’re likely to be dealing w/ covid in some form for years to come. We’ve basically known this since the beginning. The good news is we have to the tools to save lives in ways that minimize disruption & even have side benefits. The bad news is we’re not good at long-term thinking
Global eradication of a respiratory virus that spreads in the absence of obvious symptoms & has an animal reservoir is extremely unlikely, even with highly effective & widely accepted vaccines. Opposite of smallpox, the only virus to be entirely eradicated through vax.
When I say we have the tools to manage life with covid long-term, I’m not talking about physical distancing & masks for the general population. Those are for when all else fails, as it has in 2020.
When I say we have the tools & those tools have side benefits, I mean this: to prevent & quickly contain outbreaks (of covid & whatever’s next) we must address workplace protections like paid sick leave & healthy housing that eliminates overcrowding....
We know how to ramp up universal, easy access to rapid test strips. Vaccines aren’t perfect, not all will accept them, rolling out new vaccines for new variants will take longer than ramping up new tests. We still need better testing & will need it for a long time to come.
We need public health infrastructure in place to quickly ID cases, trace back to find clusters & forward to stop onward transmission & provide wrap around social supports (paid leave/income replacement, food delivery, medical care) to enable the infected & exposed protect others.

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More from @ProfLWiley

22 Dec
K-12 schools, colleges & universities need to be planning for reopening in August/Sept 2021 assuming many staff & faculty will have access to vaccination (though some will decline) but most students will not have the opportunity yet.
3 reasons: 1) even on most ambitious Trump admin timeline (which doesn’t appear to be backed up by purchase agreements or distribution plans) *beginning* to offer vaccination to the general population in late spring doesn’t mean most will actually have access by August.
2) To actually *start* vaccinating the general population by late spring will require everything to go perfectly, as Murthy & others are pointing out. Less than 10% of nursing homes have been able to start vaccinating residents so far.
Read 4 tweets
9 Dec
Here’s the text of Trump’s “America First” vaccine EO. I read it to direct admin officials to allocate vaccines *owned by the federal govt* for use on US residents prior to distributing any US federally-owned doses to other countries. whitehouse.gov/presidential-a…
I don’t read it to invoke export controls to prohibit vaccines produced in the US (eg Pfizer’s Michigan facility) from being sold to other purchasers.
I don’t read it to invoke the Defense Production Act or any other possible authority to “jump the line” of contracts Pfizer has entered into with other countries.
Read 12 tweets
6 Dec
Not sure how an order to stay at home adds much to closure of high-risk settings plus gathering ban when nonessential retail is still open. I assume this is just a messaging tactic, given that the order itself amounts to “stay at home unless you feel like shopping at the mall.”
The prohibition on outdoor dining & closure of outdoor playgrounds, etc. is also an odd move.
I assume part of the thinking is that closure of (low risk) non-essential retail doesn’t provide much benefit & disproportionately harms small businesses b/c most big box stores can stay open by selling some essentials.
Read 4 tweets
25 Nov
@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
Read 10 tweets
24 Nov
This is key to @EpiEllie's point in @apoorva_nyc's article: It's not that small family/friend gatherings aren't a problem. It's that the most effective way to address them is by addressing risks in other places where restrictions/supports/legal protections are more feasible.
When governors say "the problem is small private gatherings so our plan is to tell people to stop" they're essentially giving up on implementing an effective response. Yes, comms/guidance telling people to stay home can be part of a plan, but if it's the whole plan, we're doomed.
There's nothing surprising about most transmission happening within households/among close friends/family. That's been true from the start. But one friend/family member picks it up elsewhere & brings it home. Institutional/governmental responsibility is needed to break the chain.
Read 5 tweets
24 Nov
Here’s a good example of a health department sharing survey data while pointing out the limits of what it can tell us. washingtonpost.com/local/coronavi…
Asking people who test positive about whether they’ve worked on-site, eaten at a restaurant, attended a small gathering, or large party, etc. is better than nothing, but it doesn’t tell us much - especially when there’s no comparison to people who haven’t tested positive.
Epi investigations to identify clusters & break chains of transmissions also provide critical data to inform government interventions (both restrictions & supports). Those are rarely happening now, partly b/c test results are so slow the disease control function is stymied.
Read 4 tweets

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