So many stories on reaching vaccine herd immunity! But there's a massive dilemma. Here's a 🧵on what I mean...

About 50 countries have fewer than one nurse per 1000 people. Israel has 6x that rate. UK has 10x. US has 15x. Belgium has 20x. Guess which countries want it all?
Have you seen what 1 nurse/1000 looks like?

Picture people hurt in car accidents who die by the road when wounds could have been stemmed; women dying in childbirth; untreated diabetes; children dying from infected wounds, burns, stomachs. A lack of healthcare is palpable.
What do most countries few nurses have in common?

Many are former colonies, where colonizers subsidized just enough medical care to ensure that people were healthy enough for labor, but they didn't invest in national health systems. Slave traders did less.
These are also post-colonial countries, many forced to abide by the World Bank & IMF austerity measures that restricted public expenditures for nurses, doctors & hospitals, just as newly independent countries were growing.
eg
sciencedirect.com/science/articl…
We know healthcare workers have higher rates of Covid around the world, and this means that painfully under-staffed health systems will be eroded further, which equals more deaths from Covid & other causes. Forget your Sustainable Development Goals...😢
It also means that when a new virus, say *SARS-CoV-3,* spills over from nature, and a person dies of an unknown disease, nurses aren't around to diagnose it until the disease has killed an overwhelming number of people & the outbreak can spread internationally.
Attn #BiOsEcuRity
COVAX aims to vaccinate 20% of people in low/middle-income countries, healthcare workers likely first. But rich countries seem to want >70% vaccinated before they donate vaccines & push for changes in patenting & manufacturing to help countries that granted them their wealth.
It’s a moral dilemma indeed, and the variants that undermine our vaccine grabs can feel like karma*

*Just kidding about karma. This is evolution. Soap box over. Refs: data.worldbank.org/indicator/SH.M… & kff.org/racial-equity-… & who.int/initiatives/ac…

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More from @amymaxmen

24 Jan
There's a persistent myth that pathogens become less deadly over time.

@rkhamsi & @dylanhmorris just reminded me of this since people are apparently acting assured that SARS2 can't become more deadly? Psh.

Short 🧵of history beginning w/hopes of an end to infectious disease
According to Frank Snowden's "Epidemics & Society", 'eradicationists' of the 60s & 70s foretold the end of infectious disease. We had some cures, and they said the bugs become less deadly over time. But like evolutionary psychologists(dis!), they didn't study evolutionary biology
If they had, they'd realize that evolution doesn't have directionality. Anyways, time proved them wrong. eg New strains of dengue evolved, and a second infection with a new strain can be deadly. The HIV epidemic showed that unknown viruses emerge from nature fairly regularly.
Read 4 tweets
15 Jan
Azar just released a delusional, alternative history of Covid testing in the US. I’m mad because our testing failures allowed this outbreak to blow-up. We can’t fix our system if we ignore where it is broken. I suspect @PublicHealth agrees.

My fact-check on remarks @HHSGov 🧵
“It is indisputable that the United States has built the most extensive testing system and strategy of any major country,” says Azar.

False. Several countries have had percent positivity ~1% whereas US has never been below 5% and is >10% today. Refs KCDC & USA @JohnsHopkins
"The federal government got out of the way of test development in safe and sensible ways,” says Azar.

False. In Feb, CDC & FDA blocked labs from testing as the disease spread exponentially. I broke this story👇🏼& wrote more like it as the year wore on. nature.com/articles/d4158…
Read 12 tweets
14 Jan
First 20 min of this delusional evaluation of the Trump Admin's response to Covid is all about blaming China, with some vitriol for WHO. "If a novel virus like this emerged in a Democratic nation, this epidemic would have never happened," says Azar.

So much for lessons learned.
As Covid spread in March, Azar says the government acted swiftly to control spread (they definitely did not). He says the key driver of the pandemic -- ready for it -- was thousands of Chinese workers flying to Italy.
Azar says it's a myth to say that if we had a better testing and surveillance system we could have curbed the virus in February.

(Why is this session even called 'lessons learned'?)
Read 5 tweets
31 Dec 20
I've reported on the ground from many epidemics, but this is the first one I'm really living through. A 🧵 of memories to follow...

For me, this got real when I met @HelenChuMD in Seattle on March 1 2020 -- Day Zero in the US. nature.com/articles/d4158…
That month, my stories documented my disbelief. How big was the underground US outbreak? nature.com/articles/d4158… Where was contact-tracing? nature.com/articles/d4158… And WTF! Labs had thousands of tests going unused because of a lack of a national strategy. nature.com/articles/d4158…
In contrast to the US, many low income countries were scaling up tests, building isolation centers, & enforcing quarantines BEFORE THEY EVEN HAD A HANDFUL OF CASES.

They don't have the luxury of relying on hospitals to care for floods of patients. nature.com/articles/d4158…
Read 11 tweets
30 Dec 20
Incredible story behind the #Ebola drug "Ebanga" approved today by the FDA. fda.gov/drugs/drug-saf…

In 1995, Congolese Ebola discoverer @MTamfum treated Ebola patients with blood from survivors, despite being told not to by the CDC & WHO. 7 of 8 survived. nature.com/articles/d4158…
The NIH failed to replicate his findings in monkeys, but @MTamfum, "Professor Muyembe", didn't give up. “There should be a truth in here,” Muyembe told me.

He hired one of the survivors in his lab & convinced him to fly to the NIH in 2006, along with his sister & a grad student.
At the NIH, the student & other researchers isolated the survivors' antibodies. These antibodies became the basis for an experimental drug, mAB114, that @MTamfum pushed to test in the 2019 outbreak. It was HARD to conduct this trial. nature.com/articles/d4158…
Read 6 tweets
12 Nov 20
☹️One of the most upsetting CDC reports yet: Wedding leads to 177 Covid cases & 7 deaths among people who weren’t even there.

Aug 7. Wedding w/55 guests in a Maine town with no corona.

A guest goes to a school meeting. Others go to jobs at a nursing home & jail, with symptoms.
Wedding screened for fever but guests don’t wear masks indoors. Wedding hosts don’t give health dept a list of phone # of guests. So contact tracing isn’t fast enough to stop spread.

After 23 days health dept determines that 30 of 55 guests were positive. By then it’s too late.
Because of the wedding:
-120 staff & residents of a care facility & correctional facility were infected & scared & may have long term health issues.

-27 people not at the wedding +

-2 people who served wedding guests got Covid

-Many mourn the early deaths of 7 loved ones.
Read 5 tweets

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