2/ What's the natural response then, from those all the way down the distribution chain, from state administrators to hospital execs worried about "wrong people" getting vaccinated first?
You spend more time collecting data, parsing into finer and finer gradations
You slow down
3/ Hospitals and nursing homes don't release more to staff until every i has been dotted.
States don't release more to hospitals and nursing homes until they've used up allotment
feds don't release more to states
Amidst a vaccine shortage, available supply sits in warehouses.
4/ this is a good thread by @ashishkjha about the cascade of failed accountability and the last mile problem.
And I have my own indignation about how distribution has been prioritized.
Frontline PCPs can't get vaccine while SNF HVAC techs get it 😤
5/ But the fact remains that we have millions of doses sitting in warehouses because people are worried about screwing up prioritization
The system is stopped up, and needs disimpaction, not surgical precision
...and we should use the normal channels we use to give vaccines
6/ I hope that @choucair and the incoming team consider how they can normalize these processes as vaccine supply ramps up even further (and I believe it will)
7/ and to return to where I started, we have to do this while deeply appreciating just how primal and powerful our reactions are to injustice.
If you haven't seen the cucumber-grape experiment video, it's worth a look :-)
8/ I appreciate the DMs from public health and hospital leaders saying in essence "this is exactly the problem we are having, but we can't talk about it publicly"
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1/ Opening schools in the midst of a COVID surge is a hard problem with unavoidable tradeoffs.
There are absolutist statements on either side of the debate, so I expect passionate rebuttals, but let me lay out a decision-making framework, from an epidemiologists' perspective
2/ First off, we have to make sure that the schools have the resources and space to implement the 5 key mitigation
strategies correctly and consistently.
Not a given.
*Masks
*Social distancing
*Contact tracing
*Hand hygiene
*Cleaning and disinfection
first 2 >> last 2
3/ Let's say we have some resources for testing, how does that contribute?
What we are trying to achieve?
Do you think the goal is Screening (identify asymptomatic infectious cases before they can expose others) or Surveillance (understand incidence to inform policy)?
1/ It's indescribable seeing results from NYC EMS ambulance runs showing how cardiac arrests skyrocketed during COVID
(I started a program to monitor these symptoms in real time--among the very first application of syndromic surveillance in public health, 2 decades ago)
2/ Every day, crews from @FDNY are called to 20 to 30 patients who have collapsed, and attempt resuscitation. Can you imagine?
It's never like the movies. Most patients die, ribs cracked. 75% of the time you never get a heart rate back.
On April 6, there were 305.
305.
3/ In the dry language of medical research the researchers describe the horrible statistics.
During the peak, most patients had nonshockable presenting rhythms of asystole and pulseless electrical activity. 92.2% of the time they called off the resuscitation without a pulse.
1/ I've been feeling more and more disengaged from COVID work, disillusioned with the growing realization that all the smart research and policy doesn't make a damn bit of difference
Not for the 1st time, I've seen that what I thought was an information problem is something else
2/ I so admire those public health Cassandras who've been unrelenting, continuing to beat the drum of science and policy for the past 9 months
repeating over and over again what must be done, as the cases and deaths mount, with no strategy in sight
tweets, interviews, articles
3/ It's perhaps no accident that they (and I) are "formers"
People who ran the agencies, who know the pain of the experts and scientists working inside, and are free to speak
2/ To test hypothesis that health systems provide better care to patients w high needs, diff in quality b/w system‐affiliated & nonaffiliated physicians
ED visits were significantly *different* in system‐affiliated (117.5 per 100) & nonaffiliated POs (106.8 per 100, P < .0001).
3/ I love how delicately the RAND researchers approach this in their conclusion: “Health systems may not confer hypothesized quality advantages to patients with high needs.”
2/ When CMS first released their public use files, I ran some analyses looking for aberrations-
One thing that jumped right out was...Repetitive non-emergency ambulance runs- often for the same person going back and forth to dialysis 3 times a week.
"Medicare and law enforcement officials will need to create new processes for dealing with a potential flood of outlier reports from amateur sleuths like me."
2/ @AledadeACO is proud to be the largest, most successful nationwide enabler of physician-led ACOs, delivering better care at lower cost for >340,000 Medicare beneficiaries, saving Medicare and American taxpayers nearly $180 million in unnecessary health care spending last year!
3/ Here's the list of the physician-led ACOs we are supporting, and our performance data.
* It doesn't matter if you're urban, rural, suburban, or in which state
* It gets better. The longer you work, the more the chances of success