It's been one year since the World Health Organization officially declared #covid19 to be a #pandemic.

What have we learned? Where do we go from here?

A thread. /1
5 key lessons:
1) Importance of a national, coordinated response. Piecemeal approaches to PPE, testing & vaccination do not work.

2) Without data, we are flying blind. A year ago, every detected case was a canary in a coal mine. Same issue with lack of genomic surveillance. /2
3) Hospitals are the last line of defense, not the first. The community, through preventive measures, are the frontlines.

4) Public health depends on public trust. Mixed messaging erodes trust & leads to politicizing of basic measures like masks./3
5) The pandemic didn't create disparities but did unmask them. Those hurt the most are those who already bore the disproportionate burden of disease & lack of access.

Inequities won't correct themselves; it takes specific intention.…
Under the Trump administration, the strategy was one of capitulation. It’s like knowing a foreign enemy was going to invade and kill hundreds of thousands of Americans, and our elected leaders know how to stop it — but simply decided not to.

The Biden administration has already done remarkable work, including establishing a clear national strategy, ensuring regular communication by scientists, rapidly ramping up of vaccination, and embedding equity in all its work. /6
Looking forward, 3 key areas:

1) Tie vaccination with reopening policies, recognizing hesitancy will be #1 barrier soon…

2) Reopen schools for in-person instruction (with teacher vaccinations as a crucial path there)…

3) Emphasize that masks + vaccines will be ticket out of this pandemic.

A year later, we have had unfathomable suffering. But the end is in sight. We are all in this together. Whether we end the pandemic, and how many more lives we will lose, is up to us.


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More from @DrLeanaWen

9 Mar
Today's CDC guidelines on what fully vaccinated people can do are too timid, too limited & fail to tie reopening guidance with vaccination status.

As a result, we are missing a critical opportunity to incentivize Americans to be vaccinated. @PostOpinions…
I know this is a difficult needle to thread. What I want to see is nuance & risk estimates instead of taking an absolutist approach. Healthcare providers must help people exercise good judgment while considering each person’s individual values, or else we lose their trust.
Also, people need to be given incentives to get vaccinated As reopening occurs & people return back to normal, we are losing the opportunity to tie reopening to vaccination. At some point soon, everything will be fully reopened anyway, and there will be no carrot left to offer.
Read 4 tweets
16 Feb
This is the #1 question I get asked: What can newly vaccinated do? Is it safe to see grandkids?

Though there are still unknowns, we need to give a better answer than "follow all precautions".

My dos/don't in this week's @PostOpinions column:… (1/5)
The #covid19 vaccine is extremely protective against severe disease. There's growing evidence that it may reduce the likelihood of people being carriers.

People should resume essential activities but were being put off--like cancer screenings & dental screenings. (2/5)
It's probably fine to resume some non-essential activities, like going to the gym & out to eat. People should still abide by masking & distancing in case they can infect others. I'd still avoid crowded bars--& be extra cautious if others in your home are unvaccinated. (3/5)
Read 5 tweets
4 Feb
Here’s my best-case scenario: With existing vaccines, we turn #covid19 into an illness akin to the seasonal flu. By the end of 2021, we can resume much of our pre-pandemic lives.

This @PostOpinions column explains how this could happen:…

I’m optimistic because of a specific result in the vaccine trials that, so far, has received little attention: very few vaccinated people have become severely ill to the point of requiring hospitalization.

This one measure could change everything. Families could safely spend holidays together again if the worst-case scenario shifted from being put on a ventilator or dying to possible fever and body aches. Schools could reopen and much of the economy could return to normal.

Read 4 tweets
27 Jan
Many Qs about why it is that new #covid19 variants that are more transmissible will cause exponentially more infections (i.e. why something that is 70% more transmissible doesn't just cause 70% more infections & deaths). 

A thread with an illustrative example (1/5):
Let's say that R0 (virus reproduction number) is 1.1

In the first round of infection, number of people infected = 1 (original person) + 1.1 =2.1

Next round = (2.1-1)*1.1 + 2.1 = 3.3
Third round = (3.3-2.1)*1.1 + 3.3 = 4.6

After 9 rounds, we get to 15.9.
Now, let's say a new variant is 70% more transmissible--say the R0 for the new strain is 1.1*1.7.

You still start out with 1. Then:

First round = (1)*1.1* 1.7 + 1 = 2.9
Second round = (2.9-1)*1.1*1.7 + 2.9 = 6.4

After 9 rounds, we get to a whopping 600 infected.
Read 5 tweets
9 Jan
While I applaud pres-elect @JoeBiden's commitment to speeding up vaccinations, I'm concerned about the new policy to release all available doses without guarantee of timely administration of 2nd doses for all 1st doses given.

My @PostOpinions op-ed (1/6):…
First, the bottleneck now is not supply, but the "last mile" between getting the vaccine to distribution sites & injecting it into people's arms. Speeding up this process should be the focus, or else vaccines will just sit in different freezers.

I'm also deeply troubled by the idea that we could be rushing first doses out without a guarantee of timely 2nd doses. Clinical trials were conducted with 2nd dose 3- or 4-weeks after the 1st. If we deviate from science, this could fuel vaccine hesitancy.

Read 6 tweets
29 Dec 20
At the current rate of #covid19 vaccinations, it will take the U.S. 10 years to inoculate 80% of Americans.

Instead of obfuscating & deflecting responsibility, the federal government needs to take 3 urgent steps.

My @washingtonpost op-ed (1/6):…
I know ramping up a complex operation is hard. It's possible 2 million is an undercount.

What concerns me most is that officials are backtracking on their promises. It's giving me flashbacks to the testing debacle (remember "everyone who wants a test can get one")? (2/6)
So what can be done? 3 things.

1) Set up a real-time public dashboard to hold the right officials responsible and to target additional resources to where are most needed. (3/6)
Read 6 tweets

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