1/ One of the issues w/ public health policy making is the lack of accountability or even full understanding of the effects of those policies. Yesterday was an example of this when #LACounty@lapublichealth@MayorOfLA restricted outdoor TVs from playing the #SuperBowl.
2/ I personally know of multiple unvaccinated friends who decided to gather indoors as a result.
It was 70 degrees & sunny in Los Angeles yesterday.
The state already opened outdoor dining & made people feel like it was 'safe' to do this.
But then- they ban TVs outside.
3/ What they are essentially telling the public is that they aren't responsible enough to do this.
That the government decides how responsible you are, rather than mitigating risk & giving you ways to socialize more safely.
And then they wonder why...
4/ People don't trust them. Public health paternalism is detrimental.
There are many safer alternatives that could have been done.
They could have limited number of beverages per person; limited capacity; instated distancing measures; or put screens out in parks- many options
5/ But to ban TVs while simultaneously telling people its ok to dine out; & then to tell people not to socialize when apparently it is safe enough to do so at restaurants all of a sudden...this is bad messaging. And ultimately, the risk is that people gather indoors instead but..
6/ It will be hard to know for sure how many people did that
It will be hard to know for sure if allowing more people to have gathered outdoors would have made a big dent in transmission during this event
We don't know for sure & probably won't. Have to act either way
7/ From what we know & understand of the virus, outdoor transmission is several fold lower than indoor.
Time around & distance to others also matters.
Ultimately, public health functions not as the dominant force in people's lives, but another consideration.
8/ I think #LACounty had the chance to do better; get creative; leverage the advantage of the weather & the outdoors.
We can't control what people do in private settings, but helping them safely socialize can also help them understand *how to do this* even in private. #covid19
9/ And we often won't know the true effects of one policy decision v the other, but we (as public health departments) have to act either way.
Acting according to both our understanding of the science + our understanding of how our public socializes w/ one another is critical.
10/ Putting in place large sweeping policies that have the potential to backfire (more indoor gatherings, less trust in the policies themselves) is not the way to go IMO.
And this seems to be done over and over again. #covid19
Short Thread 1/ Another must-read piece from Dr. Mike Klompas @BrighamWomens - lead author of the recent #covid19 outbreak study from our hospital in @AnnalsofIM- I've been lucky to call Mike a mentor this year & have learned a lot from him
What is an AGP? jamanetwork.com/journals/jamas…
2/ "It has become clear that the traditional dichotomy b/w droplet vs aerosol-based transmission is overly simplistic. In practice, people routinely produce a profusion of respiratory particles in a range of sizes that incl both droplets & aerosols as well as particles in b/w"
3/ "Respiratory particles of all sizes can carry virus and all are potentially capable of transmitting infection. The amount of respiratory particles one emits varies by activity. Quiet breathing generates a small but steady flow of aerosols." #covid19
1/ The major #covid19 outbreak from @BrighamWomens where I work is now published in @AnnalsofIM — definitely worth a read. Phenomenally detailed work here from many smart people.
2/ “The virus was likely introduced into the facility by a symptomatic patient who tested negative twice on admission but in retrospect was contagious from at least hospital day 3 and infected staff and patients for at least a week before detection” #covid19
3/ The infection control team & overall program at our hospital is awesome. They are among the smartest people I know. And despite all of the protective measures in place, transmission & a serious #covid19 cluster still happened.
"And there’s another problem: too much filtration becomes unbreathable. “Are you breathing through the material, or are you breathing through the gaps in the material?” Zangmeister says.
3/ "In lab settings, Zangmeister and his team have found these areas where air escapes tend to be behind the cheeks, or right above the bridge of the nose, which can look like a droplet exhalation geyser, he says. "
The messaging from #LACounty is ridiculous. On the one hand, they opened up all of these restaurants for outdoor dining & made people feel like things are getting better- but they aren’t allowing outdoor TVs to play the Super Bowl? People are going to meet indoors instead...
2/ This is bad public health. It’s just like when beaches were closed during July 4th. We need to mitigate risk & create safe options for socialization - bc people have shown time & time again that they will socialize either way (not blaming them)
3/ Alternatively they could have set up outdoor viewing sites at parks etc; created distanced pods— many ways to get creative here as was done in other places. But just assuming that people won’t congregate when they have been told it’s getting much safer now...?? #covid19
1/ This story saying that a local health dept has changed their exposure time to any contact without masks ("1 second") doesn't mean that you will get infected in one second- but it does point out that 6 feet/15 min is not a hard/fast rule & never was.
2/ There are many possibilities for why new variants are "more transmissible"; but in the real world, figuring out the "why" takes time- and we don't have time. We must utilize the best protections we can right now- mitigation of risk is name of the game
3/ With vaccinations, it seems like our attention to other protection measures have fallen to the side- understandably bc there are only so many resources that public health departments have. Doing one often means not doing another (staff, funding etc)
I think of masks the same way I think of any risk mitigation. Better is better. Unregulated cloth masks not the bar to settle on
2/ we even specifically asked CNN to change the headline (they initially chose N95 masks) bc the idea behind this movement was always to provide folks w/ a multitude of options- N95s are one of those. But so are high grade surgical masks w/ mask fitters
3/ The arguments saying “just get more people to wear any mask”- guess what?
We should do both
& getting “anti-maskers” to wear a mask is actually IMO a harder problem than getting someone who already believes in masks a #BetterMask (which helps them around those who don’t)