2/ Dr. Walensky's counterpoints to this idea seem to be:
- N95-caliber masks aren't necessary; multi-layer cloth + 6 feet is good enough
- access to masks is not a bottleneck
- N95-caliber masks are hard to wear for long periods
3/ For the 1st point, we know that Covid can spread via aerosols indoors & in crowds
Cloth masks only variably block (~50-70%) & surgical masks up to 80%
People -especially essential workers, those at high-risk- need better protection particularly in poorly ventilated scenarios
4/ For 2nd point, @CDCDirector seemed to think @andersoncooper was asking about masks in general & not specifically high-caliber masks
Access to *high-caliber* masks is a challenge & people don't know which ones & where to get them & some may not be able to afford them
5/ For 3rd point, I agree that N95s are hard to breathe in for long periods
But most people though would only need to wear for shorter periods (eg, grocery store) & there are more comfortable options such as KF94s, elastomerics & others close to NIOSH approval (eg, @one_canopy)
6/ This is why a number of other countries are moving to also promote or mandate such masks for their populations
7/ We need to do everything we can stop transmission to save lives now, prevent the emergence & spread of faster-spreading deadlier variants & time to get vaccination up to scale
If supply is the reason we're hesitating on doing this, then let's solve it (ie, invoke DPA)
We're deploying vaccines like we do annual flu shots rather than the mass vaccinations done in Africa & Asia where millions are vaccinated in weeks
Years ago, Joe Rhatigan & I studied these campaigns. They offer several lessons that can inform what we need in the US now
THREAD
1/ Be proactive
Instead of passively waiting for people to come get vaccinated, we need to search them out & go to where they are & keep following up until they opt out or are vaccinated
We should be rolling out the vaccine like we do the Census, even going door-to-door
2/ Remove barriers & be redundant
In each community, have multiple ways to get vaccinated including CVS/Walgreens, pop-up sites & near high-throughput places people have to to go like grocery stores
Make some venues 24/7 so people can get vaccinated anytime that works for them
In 2014, I was on a 'task force' convened by Guinea's President to forge a nat'l Ebola response
Cases were spiking, it was a polarizing election year &, though many efforts were happening, there was no overall strategy or unified response
Here's how we set up the response
1/15
The first step was to establish a clear chain-of-command leadership structure under the National Ebola Coordination Cell with Dr Sakoba Keita as its head
All partners (eg, WHO, MSF, other ministries) & all response activities had to go through the Cell
2/15
We then created an overarching national strategy that included all interventions (eg, testing, contact tracing)
This wasn't just a laundry list of things that could help but aimed to spell out the combo of measures needed to actually reach zero within a defined timeframe
(2/3) #1 can be achieved by merging best practices that thus far happen in isolation into integrated systems that leverage technological- connectivity, AI, automation- tools to orchestrate/facilitate high-quality replicable execution at scale
(3/3) #2 is less of a technical & logistical challenge than a human, social & political one & therefore much more complicated to find a clear path towards achieving but achieve it we must
(1/5) To put Trump being started on dexamethasone in perspective, we do it for patients when they become hypoxic
Some patients I've had are on remdesivir/dexa like Trump is now & only require a touch of oxygen (eg, 2L) for a day or two & then come off it.
(2/5) Even when on oxygen, they may look, feel, talk etc. like they're fine & you wouldn't know they were hypoxic unless you took off the oxygen & saw their O2 saturation
(3/5)Others on remdesivir/dexa end up as sick as anyone can be including on a ventilator, paralytics, etc & either pass away or recover after a prolonged & arduous course
Bottom line: there's huge variation which makes it tough to pinpoint where someone might be on that spectrum
(1/4) Other than the experimental antibodies, Trump has gotten what - remdesivir, dexamethasone - we give to our Covid patients with hypoxia
(2/4) From the way questions were answered, the fact that dex was started (which can have side effects including confusion) & he was on supplemental O2 suggests to me that his O2 may have been lower than they are letting on
Supplemental O2 usually isn't given unless O2 sat <90%
(3/4) With Covid19 & pneumonias in general, you typically don't get 'transient' drops in O2 as much as persistent (& potentially progressive) hypoxia lasting for at least hours
Transient drops usually happen from mucous plugs or aspiration
1/ A hang-up on rapid tests that I've heard is that it'll be difficult for health depts to track results
Decentralized screening makes that difficult but stopping spread should be the overwhelming priority; monitoring indirectly helps stop spread but is a secondary consideration
2/ We shouldn't hold up something that can stop transmission because it will be harder to monitor or collect data on
The current counterfactual is that we're missing most infections anyway & neither stopping onward transmission from them or getting any data on them
3/ What's generally been missing from the rapid testing discussion are counterfactuals
Anyone can point out issues that arise if using them but that is meaningless without considering what is happening w/o them & thoughtfully strategizing on how to address potential downsides