Thread by @TorontoIDDoc

I've been wanting to write this thread for a while. It has been inspired by hearing a common thought: why can't people just "listen"? If people just followed the rules, we wouldn't be in this mess. I think this is oversimplification of the problem with COVID: 1/

It is true, there are people who haven't been following guidelines (by definition that happened a LOT at Christmas/NYE in my region), but even before, we know transmission in private gatherings happens. 2/

These private gatherings are pictured to be big raucous parties, but in reality, even before lockdown, this is just people having dinner, watching TV, doing things we did before on a daily basis. These little ripples when added across the country make a big wave.. 3/

...and little can be done about this apart from positive messaging. You can't very well have police patrolling neighbourhoods across the country. 4/

Next thing is we keep hearing over and over and over, stay home. There are diminishing returns with this advice, but also, most people who can stay home ARE. So what's the issue? There are a HUGE # of people who can't stay home because they work in essential jobs 5/

These are jobs in factories, warehouses, transport companies, etc. What's worse is that many people who work in these sectors have large households so it can amplify to many people all at once. Neither of these are prevented by lockdown or curfew. 6/

Many workers here go to work feeling unwell (when quite contagious) because the alternative is being off for several days and potentially not having money to pay for essentials. 7/

When compared to the message "Stay home!" we don't hear about the (huge) issue in tweet #6&7, though we are starting to: paid sick leave, community testing blitzes, isolation centres. 8/

Another factor is winter. SARS-COV2 is a resp virus, and like other resp viruses, its spread happens best indoors with prolonged, close contact (enhanced by poor ventilation). This is why historically we see flu or common cold outbreaks especially in winter. 9/

A common thing I hear is that what's happening to us right now is because we "just didn't do enough" or we were "reckless". Sure, some of the problem could be ways we handled outbreak, but there is a lot that was not in our control. 10/

A resp virus which spreads best at and just before the onset of symps (often very mild) means that it's not something we could ever contain in most circumstances. Yep, some countries were successful, but it's complex and goes beyond just, "everyone followed the rules" 11/

Now on to the lockdown: there is a lot of criticism that we "just haven't locked down enough". That may be the case, but going beyond the restrictions we already have, apart from closing essential services, there are few options left. 12/

The curfew in Quebec seems like it would work if your impression of the situation was that spread is happening because people are not staying home. But as I mentioned above, it is much more complex, and this does not address some of the major drivers... 13/

...some that we could act on (occupational safety, paid sick leave, isolation centres etc) and others we can't do much more about without getting heavy-handed (indoor transmission in private gatherings) 14/

Ironically, a curfew could potentially worsen things if more people on average are gathering inside. Unintended consequences are important to consider. A large intervention is often like squeezing a balloon. 15/

Oh and by the way, though no one likes restrictions and lockdowns, it should be said that at some point it definitely becomes necessary to attempt to slow spread and reduce eventual strain on hospitals. 16/

Summary:
1. Pandemic is complex and much more than just people not listening.
2. We should think about things lockdowns/curfews don't address like occupational exposure
3. Advice to reduce contacts currently is important, but is not the only focus of public health response 17/

4. There are many factors we can't control (e.g. weather) that play a big role, so to blame current situation squarely on failure on something we did or didn't do, is not accurate. 18/

This past year I've learned so much about public health and infectious diseases (i'm a specialist in latter, and work closely with former), and I'm still riddled with uncertainty! Ecstatic that vaccination is here and we can see that light at the end of the tunnel! 19/19

@ryanbroll here’s the start of the thread. 💯 agree that it’s very multi factorial. That’s my point.