1/ COVID has been a public health catastrophe

500,000 extra deaths, taking an average of 13 years each- 6.5 million years of life lost

That dropped US life expectancy by a full year

Did we erase a decade of progress? Will a child born today live a year less than last year?
2/ At first blush, it can seem confusing.

If life expectancy dropped by a year for 320 million Americans, shouldn't that translate to 320 million years of life lost, not 6.5 million?

OTOH, I trust the CDC. Here's the paper cdc.gov/nchs/data/vsrr…

seems legit. so what gives?
3/ Here's some more data- why did life expectancy plummet in 1917-1918 (by 10 years!) then rebound completely?

Life expectancy is the average number of years a group of infants would live if they were to experience prevailing age-specific death rates throughout their life
4/ In other words, if the baby were to live life as if it were the first half of 2020, FOR EVERY YEAR OF THEIR LIFE, they would live to 77.8 years on average (can you imagine a more horrible existence?)

[side note- I would totally read that sci fi novel]
5/ So, when we get past this effing pandemic (and we WILL), then the age-specific death rates should go back to where they were- we have not erased a decade of progress.

And that should also go for the widened racial disparities in life expectancy too
6/ As my 9th grader put it- if there were an extra 500,000 deaths a year for the next 60 years, then a child born today would have one fewer year of life expectancy, as lived.

This doesn't minimize the catastrophe that is COVID- its to appreciate the miracle of public health
7/ That also shows how hard it is to ADD a year to life expectancy

Public health has added millions of years of life to born and unborn children over the past century

Through a cleaner environment
Through sanitation
With vaccines

And yes, by attacking smoking, and car safety
8/ I love my mom, and I missed her birthday today.

She lost a sister before her fifth birthday, to pertussis.

A baby girl born in Iran in 1940 had a life expectancy of 27 years. A baby born today can expect 76 years.

Don't take that progress for granted.

Public health 🙏

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More from @Farzad_MD

29 Jan
1/ Please send all your #HealthIT eAsy fiXeS to @mickytripathi1

He'll love receiving & responding to them

The more the merrier! Make sure to include "just"

I'll start! ("likes" will demand a thorough response from @ONC_HealthIT)

>You should just get everyone on the same EHR<

>You just need to create a universal patient identifier<

>You just need to stop messing with the free market, industry will figure it out<

And introducing my guest speakers @DavidBlumenthal @HealthIT_Policy @HealthPrivacy @Fridsma @amalec @claudiawilliams
Read 5 tweets
23 Jan
1/ The Denmark variant story was pointed out by several people as being quite concerning- this line struck me - "Cases involving the variant are increasing 70 percent a week in Denmark, despite a strict lockdown"

But the actual data was hard to pin down- so I dug it up
2/ "The U.K. variant was 2 percent of sequenced coronavirus cases the last full week of 2020. By the second week of January, it had risen to 7 percent."

But in the context of declining cases what does that mean?

No link to data in article but it's here: covid19genomics.dk/statistics
3/ But those aren't actually the true cases, cause despite the headline "Denmark is sequencing all coronavirus samples..." while they are *trying* to sequence all, the number of cases with a genome of sufficient quality relative to the total number of cases ranges w-w from 10-36%
Read 7 tweets
11 Jan
1/ read this @adamcancryn @tylerpager piece, and let's discuss some of the points raised

‘There is a palpable concern’: Biden presses advisers over 100 million Covid shot goal politi.co/2XHhk1f
2/ first, I am so glad @JoeBiden *is* putting a hard to reach goal out there

When @matkendall and I set our first public targets
@ONC_HealthIT a longtime fed told us "never give them a date AND a number"

It's risky, it's gutsy, and it's the right thing to do for the country.
3/ It will be very hard to hit 100M in 100 days

But the very fact that this article was written EVEN BEFORE THEY START points to the intense focus it brings.

The new admin may miss their first big test, but vaccinate tens of millions more than if they shunned responsibility

Read 12 tweets
30 Dec 20
1/ People are hardwired to get infuriated when they see injustice.

But I fear that applying this lens to covid vaccine distribution will lead to more deaths not fewer.

Stanford has screwed up, again. Some people who shouldn't have gotten it, did.
2/ What's the natural response then, from those all the way down the distribution chain, from state administrators to hospital execs worried about "wrong people" getting vaccinated first?

You spend more time collecting data, parsing into finer and finer gradations

You slow down
3/ Hospitals and nursing homes don't release more to staff until every i has been dotted.

States don't release more to hospitals and nursing homes until they've used up allotment

feds don't release more to states

Amidst a vaccine shortage, available supply sits in warehouses.
Read 8 tweets
29 Nov 20
1/ Opening schools in the midst of a COVID surge is a hard problem with unavoidable tradeoffs.

There are absolutist statements on either side of the debate, so I expect passionate rebuttals, but let me lay out a decision-making framework, from an epidemiologists' perspective
2/ First off, we have to make sure that the schools have the resources and space to implement the 5 key mitigation
strategies correctly and consistently.

Not a given.

*Social distancing
*Contact tracing
*Hand hygiene
*Cleaning and disinfection

first 2 >> last 2
3/ Let's say we have some resources for testing, how does that contribute?

What we are trying to achieve?

Do you think the goal is Screening (identify asymptomatic infectious cases before they can expose others) or Surveillance (understand incidence to inform policy)?
Read 22 tweets
15 Nov 20
1/ It's indescribable seeing results from NYC EMS ambulance runs showing how cardiac arrests skyrocketed during COVID

(I started a program to monitor these symptoms in real time--among the very first application of syndromic surveillance in public health, 2 decades ago)
2/ Every day, crews from @FDNY are called to 20 to 30 patients who have collapsed, and attempt resuscitation. Can you imagine?

It's never like the movies. Most patients die, ribs cracked. 75% of the time you never get a heart rate back.

On April 6, there were 305.

3/ In the dry language of medical research the researchers describe the horrible statistics.

During the peak, most patients had nonshockable presenting rhythms of asystole and pulseless electrical activity. 92.2% of the time they called off the resuscitation without a pulse.
Read 7 tweets

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