Thread 🧵
1/ Have been thinking about this story all night (was working overnight at the hospital).

Japan appointed a Minister of Loneliness. So much of this year has been a deep well of isolation.

For some of my patients, this was worse than #covid19…
2/ I have treated people who have suffered from #covid19 but said that actually losing their job, relapsing to substance abuse, being afflicted by depression/suicidality was even worse.

For some, it was not even a life worth living at all.
3/ I have also seen a ton of shaming around social activities on Twitter.

“Can’t believe this person did that” etc

We don’t know what other people are going through.

That doesn’t mean condoning all social activities- but it also doesn’t mean stigmatizing all of them either.
4/ Many patients even before #covid19 lacked the deep social connections needed to survive through devastating illness

I don’t mean having someone that checks on you every few days

I mean someone literally taking over the wheel like family. Often, this is what is *needed*
5/ As we come out of another #covid19 surge, let’s refocus some of our energy on kindness, & being there for our neighbors.

Esp as more are vaccinated, safer socialization must be seen as a necessity.

The lack of it is actually an assault on our health.…
6/ New @npr "A report released by Making Caring Common, a Harvard Graduate School of Edu Project, indicated that more than 1 in 3 Americans said they experienced "serious loneliness" during the pandemic, but young adults are feeling it the most at 61%."…

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More from @AbraarKaran

25 Feb
🧵1/ Sometimes when you push for an idea for long enough (#BetterMasks) & when the logic makes sense to you- but you are continuously told by other “experts” (CDC leadership) that it’s not needed; you begin to wonder if you yourself are missing something. #covid19
2/ But- the other factors at play- the political ones- make me think otherwise.

If CDC said “yes better masks are better; yes they protect you more”, they are now on the hook for getting these to people.

But- if they don’t have the bandwidth or political backing to do it...
3/ Then they can’t acknowledge it.

But- because we (many of us) pushed for #BetterMasks incessantly, they probably had to do something.

So they did a study with two masks, which worked better than one mask; two masks is easy bc it’s still on the public to figure it out.
Read 7 tweets
24 Feb
Another @CDCgov report today on #covid19 from unmasked exercise classes

The secondary attack rate of infection from instructors to class participants for classes taught within 1 day of symptom onset was 95% (20 of 21)!

And again here, we have CDC 🗣 about aerosol transmission Image
2/ Transmission despite 6 feet apart w/ instructors yelling during stationary cycling class #covid19 Image
3/ One of the instructors was teaching kickboxing & personal training - two of the infected participants wore masks and were *still infected*
#BetterMasks Image
Read 4 tweets
24 Feb

1/ New CDC report on #covid19 outbreak -55 cases in a week- among those attending an exercise facility in Chicago in August 2020...

22 people (40%) attended on or *after* the day their symptoms started

76% reported wearing masks *infrequently*…
2/ Right in the abstract here under "implications for public health practice", CDC says:

"To reduce SARS-CoV-2 transmission in fitness facilities, attendees should wear a mask, including during high-intensity activities when ≥6 ft apart."

So the 6 foot rule has limits...why?
3/ Because of smaller particles- aerosols- that spread farther than six feet, & hang around for more than 15 minutes.

And CDC acknowledges that; but is still hesitant to send people #BetterMasks (announced today they are sending cloth masks)? C'mon man. What is going on?
Read 8 tweets
24 Feb
1/ Last night had a conversation w/ a close friend about #covid19 & life— one of the points we kept coming back to—> risk aversion is a *privilege*

The risk you are willing to take at the end of the day depends on how badly you need to get food on the table. Period.
2/ When we think about #covid19 & we look at who was getting sick, we saw two main groups emerging early on— vulnerable nursing home residents and essential frontline workers w/o the privilege of ‘staying home’

Folks w/ either high health risk or high exposure risk
3/ From that latter group, many who ended up being my direct patients— life wasn’t about how do I avoid #covid19 as much as it was about how do I keep the lights on; how do I continue to feed my kids; how do I find another job if this one is shut down etc
Read 12 tweets
22 Feb
1// “In seven clusters (A, B, C, D, E, F, and I), transmission among educators and students might have occurred during small group instruction sessions in which educators worked in close proximity to students”
2// “However, information obtained during interviews indicated that specific instances involving lack of or inadequate mask use by students likely contributed to spread in five clusters (A, C, E, G, I). Students ate lunch in their classrooms, which might have facilitated spread”
3// “Although plastic dividers were placed on desks between students, students sat <3 ft apart. Physical distancing of >6 ft was not possible because of the high number of in-person students and classroom layouts.” #covid19
Read 4 tweets
21 Feb
A year ago, rhetoric was no mask

A few weeks after that, masks

Months later, finally started talking about #BetterMasks in mainstream #covid19 response

Then came double-masking as a backstop

Now- more pragmatic articles on how to get certified Hi-Fi masks ⬇️
2/ In @washingtonpost this week, we proposed how the Biden administration could actually operationalize a strategy to get #BetterMasks to the general public quickly. #covid19…
3/ As w/ most parts of the response, it’s not a lack of ideas but lack of actually doing them consistently, effectively, for long enough, with enough understanding of local public health & norms that determine the uptake of interventions. This isn’t new. It’s basic public health.
Read 4 tweets

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