Thread by @sdbaral

As a physician, and public health specialist, my job is to empower and educate people to make the best decisions for themselves.

Risk tolerance varies by person.

Some folks have extremely high risk tolerance in their lives and others less so.

films.nationalgeographic.com/free-solo

1/x

I believe that 2 weeks after 2nd dose, people are protected from serious cases of COVID-19 as defined by hospitalization or tragically causing death.

Again, the vaccine may not prevent from infection as much as severity of that infection consistent with influenza vaccines.

2/x

Even with that info, someone may or may not yet feel comfortable doing something and one shouldn’t feel pressured to do anything.

Over time, I think people will increase their contact rates with strangers—meeting a stranger, having dinner, elevators, social gatherings, etc.

3/x

Many risk assessments assume that one’s risk is directly related to the COVID-19 prevalence in the general area.

I think that's part of it, but believe that one’s living and working conditions define risks for COVID-19 far more than the general prevalence in the community.

4/x

To me, COVID-19 is a network issue—if people in your network are more likely to be essential workers (defined as people who cannot work remotely) or they are more likely to live with people who are essential workers, then your network risk is high.

5/x

For example, if someone has dinner with 5 people including 2 people who work at an Amazon distribution site, the risk of that gathering could be high.

If someone has dinner with 10 people who all work remotely, then their risk for COVID-19 from that gathering is low.

6/x

So while we have focused on community prevalence, it has erased the inequities that defining COVID-19.

I sometimes think of this as an “all lives matter” public health response—ie, not paying attention to pre-existing inequities that increase risk for some and not others.

7/x

I have always believed that COVID-19 risks are driven far more based on where people have to be (based on where they live and work) as compared to where they choose to be (social gatherings).

Ultimately, as a service provider, I’m a pragmatist at heart and in practice.

8/x

I could tell people that they should sit home and do nothing, but all that will happen is that they will still do it but just not tell me about it.

To me, harm reduction isn’t being happy or ok with a behavior, but it is about understanding it to give advice if it's sought.

9/x

So I would rather people be open with me in terms of what they are planning on doing rather than telling me what they think I want to hear.

10/x

And more importantly, I think critical that in 2021 we not let the question of social gatherings or quadruple masking take our eyes off of the socioeconomic inequities and structural racism that is such a critical driver of disparities in COVID-19.

11/x

Summarized some of this here:


And then wrote about some of this recently with @mugecevik and others here:
bmj.com/content/372/bm…

Fin