THREAD
1/ Important article by @skarlamangla

Some of the key factors with what went wrong in LA

Fundamentally, LA county was set up to do poorly- structural inequities (surprise) were almost a guarantee of this

But this is unacceptable

#covid19

latimes.com/california/sto…
2/ “But in L.A., it is common for a working-class family of four, five or even more to share a costly one-bedroom apartment.

Among the 25 biggest metropolitan areas in America, L.A. has the highest percentage of overcrowded homes”

*Need safer isolation options*
#covid19
3/ “L.A. County has a huge manufacturing sector and two of the biggest ports in the nation — industries staffed by people who work in the kind of close quarters that can facilitate spread of the virus”

Article notes big outbreaks here. Why weren’t these workers protected?
4/ @MayorOfLA “Los Angeles has the combination of poverty and density that leads to a virus like this being able to spread much more quickly”

Ok— but we knew this all year. Why, at the end of 2020, is this a reasonable explanation rather than a sign of negligence?

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More from @AbraarKaran

3 Jan
1/ I wish we could get better masks for frontline workers.

I had another patient test positive unexpectedly for #covid19 who had presented for something unrelated.

Thankfully I had the right protection- an N95 mask & a face shield on the entire time.
2/ Throughout this epidemic, from March until today, I have directly taken care of more #covid19 patients than I can count. Since day 1, I have worn an N95 mask + face shield w/ every encounter. I have been w/in inches of those infected & coughing for several minutes at a time.
3/ In multiple hospitals where I work, staff & friends have gotten infected.

Many of those infections may have been acquired in the community; but some were in the hospitals themselves.

Some of these were well publicized in the media as well.

bostonglobe.com/2020/10/19/met…
Read 10 tweets
1 Jan
Spending this New Years Eve in my apartment getting ready for several days back on the medicine wards starting tomorrow morning. Grateful to have a roof overhead, to have health, to have received the vaccine. So many of the patients we care for don’t get any of these luxuries.
2/ The perspective that we get in caring for people who are sick & struggling is so important. In a year when we have been primed to judge others & fight w/ one another, the hospital reminds me what humanity & empathy look like. We need these values front & center, which is hard
3/ It’s hard bc lives are on the line- many of us have lost loved ones to the epidemic already, & many others will in the coming weeks. I understand this; there were times I have wanted to judge or shame people for making “selfish” decisions when I had to go work in a hospital
Read 8 tweets
31 Dec 20
As a healthcare worker, I think there is a big assumption here that all healthcare workers have familiarity with vaccines, vaccine research, virology, or even clinical trials & how to read or interpret them etc

That is frankly not the case, nor is that a reasonable expectation.
2/ The hospital is a complex place. There are healthcare workers of all different backgrounds w/ different levels of expertise & knowledge. The vast majority of us are not experts in mRNA vaccines. Blaming healthcare workers for hesitancy is uncalled for.
3/ We (public health experts) have warned for months & months that vaccine deployment would be extremely complicated. I have had numerous healthcare worker colleagues ask my opinion of the NEJM trials for Pfizer & Moderna, & I have shared my interpretations of the data.
Read 7 tweets
31 Dec 20
1/
mRNA1273 (Moderna) vaccine- Phase 3 trial

2 doses, 28 days apart (black arrows)

28,207 in per-protocol analysis

Primary end-point: preventing symptomatic infections w/ onset at least 14 days after 2nd dose

Overall: 94.1% vaccine efficacy

nejm.org/doi/full/10.10…
2/ Key secondary end-point: preventing severe #Covid19 disease

Vaccine group- 0 severe cases

Placebo group- 30 severe cases

Vaccine efficacy of 100% in preventing severe disease
3/ "In addition, although our trial showed that mRNA-1273 reduces the incidence of symptomatic SARS-CoV-2 infection, the data were not sufficient to assess asymptomatic infection" (cont)

#covid19
Read 7 tweets
29 Dec 20
First reported case of #COVID19 #B117 variant in the United States in a Colorado man with no relevant travel history to UK. What this suggests is community transmission of new variant.

latimes.com/world-nation/s… Image
2/ New variant is thought to be more transmissible but not more severe in terms of the disease it causes. BUT- more transmissible can very much be more problematic than more fatal (see thread/tweets below)

3/ Longer thread here linking to a number of articles as well as different responses by various countries in terms of travel restrictions (which ultimately make less sense/are less efficient for control when you already have community transmission) re #b117 #covid19 variant
Read 6 tweets
29 Dec 20
THREAD

1/ Read this. This is "global health"? This is our "solidarity"? This is extractive.

Vaccines produced in South Africa & tested on South Africans are then deemed safe, & first given to Americans, British, & others in wealthy countries.
nytimes.com/2020/12/28/wor…
2/ "Poor & middle-income nations, largely unable to compete in the open market, rely on a complex vaccine sharing scheme called Covax."

But as the article mentions, this 'aid' is conditional; some countries are not "poor enough" to qualify, but also can't afford enough vaccines
3/
Within South Africa (& many countries), the wealthy will buy vaccines to protect themselves.

The poor are in a gamble w/ their lives.

**“We’ll all be dead then,” said Prudence Nonzamedyantyi, 46, a housekeeper from the same township.** (quote from the article)
Read 10 tweets

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