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Jeffrey Duchin, MD

12 Jan, 11 tweets, 2 min read

In 2010, I noted lessons from the 2009 H1N1 influenza pandemic, incl. epi/surveillance, healthcare system response, communication, mitigation strategies, & the vaccination program. Regrettably, most are just as relevant today, many opportunities missed. 1/
nap.edu/read/12799/cha…

In 2010, I described racial & ethnic disparities, inadequate public health resources/funding; value of enhanced surveillance methods; hospital overload & PPE shortages; drug distribution problems & perhaps most noteworthy at the moment, challenges w/ the vaccination program. 2/

A few key points on vaccination follow. "The need to rapidly plan and implement a large-scale vaccine distribution & administration system severely taxed local public health capacity..." 3/

"Because there is no national program for adult immunization delivery...healthcare providers...are unfamiliar with procedures for ordering vaccine through the public health system & the associated administrative requirements." 4/

"Ongoing uncertainty regarding the timing of availability & expected quantities of specific vaccine formulations...presented significant problems for local immunization." 5/

"Misperceptions about vaccine safety among the public as well as among healthcare professionals have added to the complexity of the...vaccination program..." 6/

"Misinformation about the manufacturing process, use of adjuvants, risk of adverse events, & inadequate safety testing circulated for months prior to the release of the first doses of vaccine..." 7/

"Vaccine supply shortfalls further complicated local vaccine delivery & public messaging. Optimistic national forecasts for vaccine availability raised expectations among the public & influenced public health vaccination program strategy." 8/

"Due to repeated funding reductions in recent years, the [public health] department has minimal capacity to provide clinical immunization services...As a consequence, the department does not have the ability to staff community school-based or other vaccination clinics." 9/

"Federal...stimulus funding helps mitigate additional unbudgeted expenses but does not provide real-time capacity or sustainable resources." 10/

And, "Local public health capacity to respond to...large-scale health emergencies is tenuous & unstable, waxing & waning with availability of year-to-year grants & other short-term funding supplements."

Let's not let the COVID-19 pandemic's lessons go similarly unheeded. End

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More from @DocJeffD

Jeffrey Duchin, MD

@DocJeffD

10 Jan

What went wrong in SoCal? "Part of the reason for the new surge appears to be the Thanksgiving effect. Many Californians, particularly those in & near LA, held small gatherings for Thanksgiving with family & friends, despite warnings from officials." 1/ nytimes.com/2021/01/09/us/…

"...the state’s early success in the pandemic may have given Californians a false sense of security...The very successes that we had built in a potential complacency from the part of people thinking it’s maybe not that severe.” 2/

"Young people who had isolated themselves gathered in large groups & stretched the limits of what constituted outdoor dining to include rooms with large windows. The taboos of the first months of the pandemic, like meeting friends inside their homes, fell away." 3/

Read 4 tweets

Jeffrey Duchin, MD

@DocJeffD

3 Jan

Straight Talk About the New Variant COVID-19 Strain. As much as I regret saying it just when so many need & deserve a break, the new variant COVID-19 strain is a serious problem. It’s likely a matter of time before it arrives here & we need to beware & prepare. Here’s why. 1/

All viruses mutate resulting in new strains that vary from their ancestors. These are called variant strains. Most coronavirus mutations don’t fundamentally change how the virus behaves or affects us. 2/

However, at least one newly recognized strain, often called B.1.1.7., “SARS-CoV-2 VOC 202012/01” or an "N501Y" strain, has been shown to have multiple mutations that are changing the way the virus behaves in important ways. 3/

Read 21 tweets

Jeffrey Duchin, MD

@DocJeffD

21 Dec 20

From a celestial perspective, the darkest days of the year are behind us & we can look forward to more sunlight each day. Let's do everything we can to put the darkest days of COVID-19 behind us as well. 1/n

What we do for the last few days of 2020 (good riddance!) will determine what 2021 holds in store. It’s especially important to double-down on CoV-19 prevention now, when the virus has the advantage as we spend more time indoors & environmental conditions favor transmission. 2/n

Our hospitals are strained. New variants of the virus have been identified in other countries that seem to spread more easily and may appear here as well. But the basic COVID-19 prevention steps are just effective against all COVID-19 viruses. 3/n

Read 14 tweets

Jeffrey Duchin, MD

@DocJeffD

9 Dec 20

@CDCgov

FDA will review data for authorizing the 1st vaccine to prevent COVID-19 tomorrow. The vaccine is made with an exciting new technology, mRNA. I'm sharing some information from @CDCgov about mRNA vaccines & how we got here so quickly without compromising effectiveness & safety. 1/

What is mRNA? It's a "molecular blueprint" for a cell to make proteins. In this case, mRNA instructs our own cells where the vaccine is injected to make a protein found on the surface of the SARS-CoV-2 virus. Our immune system then develops a protective response against it. 2/

In contrast, most vaccines use weakened or inactivated versions or components of a virus or bacteria to stimulate the body’s immune response. Weakened live virus vaccines like MMR & varicella work by replicating in our cells using the vaccine virus' mRNA. 3/

Read 10 tweets

Jeffrey Duchin, MD

@DocJeffD

11 Nov 20

@CDCgov

Significant update from CDC states mask use protects not only others but the wearer: "Masks also help reduce inhalation of these droplets by the wearer (“filtration for personal protection”)." 1/n

Coronavirus Disease 2019 (COVID-19) cdc.gov/coronavirus/20… via @CDCgov

"The community benefit of masking for SARS-CoV-2 control is due to the combination of these effects; individual prevention benefit increases with increasing numbers of people using masks consistently and correctly." 2/2

Masks should be well made & fit well (snug w/out gaps) "Multiple layers of cloth with higher thread counts have demonstrated superior performance compared to single layers of cloth with lower thread counts, in some cases filtering nearly 50% of fine particles less than 1 micron."

Read 4 tweets

Jeffrey Duchin, MD

@DocJeffD

11 Nov 20

I'm worried about the direction our COIVD-19 outbreak is heading and the increasing impact on the health of our community, our healthcare system and our economy. COVID-19 is a viral wildfire, and we are the fuel. kingcounty.gov/depts/health/c…
1/n

The pandemic fatigue that we’re all experiencing is real. I’m certainly feeling it and I want this outbreak to end yesterday. I also understand that it’s hard to make sacrifices when things may seem OK in your own personal circles. 2/n

Everywhere we gather, especially indoors – at work or socially, in groups for any purpose – recreation, worship, dining, social event or party – poses a risk for spreading COVID-19 = stepped up precautions are needed. Let’s not throw more human logs on the fire. 3/n

Read 9 tweets

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