Thread by @MonicaGandhi9

Someone asked me yesterday why schools aren't mainly open in San Francisco (despite 30 cases in city of 896K yesterday (& they test), <10 hospitalizations) or California (hundreds of thousand of tests done, 1400 cases in state of 40 million, lowest case rate in nation).

But do think clear why. We took a very partisan approach which - in this case- meant we used a fear-based, exaggerated approach to pandemic management without principles of #harmreduction (harm reduction reduces risk to a pathogen by sensible messages)
nytimes.com/2021/03/18/bri…

And, understandably, if we scared people more and took a fear-based approach, we could hopefully reduce infections by getting people to stay away from each other (a common tactic: people used to use scare tactics with HIV as well) instead of #harmreduction
nytimes.com/2020/12/07/opi…

Scare tactics with HIV says oral sex carries same risk as other types of sex (untrue); #harmreduction would say oral sex safe. Scare tactics with #covid19 says the only way to stay safe is to stay home; #harmreduction says masks, distancing, ventilation work- here's how to apply

So, why parents/teachers still scared of returning to school with such low case rates? Because that was the message for so long (unsafe). Hard to reverse if you start from this position. Those who advocate for school openings (scientists) branded as not being scared of #covid

So by not using #harmreduction, we made people think this virus radioactive, not respiratory virus. This overcaution led to true fear, so that we cannot even think we are safe after vax. People love children; this approach made people think schools unsafe.
theatlantic.com/ideas/archive/…

Please look at links in this article- they are all true facts, links to real data; true epidemiologic facts but still considered controversial that schools should open and scientists that advocate for openings told they aren't fearing #covid enough
usatoday.com/story/opinion/…

And same here- this is declared as a national priority to reopen schools so long ago but schools not open in so many places especially for middle school/ high school. Especially in California.
thehill.com/opinion/health…

And then we thought- okay, cut the Gordian knot. Vaccinate teachers and then K-12 schools can open right away. But fear is very deep for parents/teachers and that fear is very hard to shake.
missionlocal.org/2021/03/oped-i…

Then we saw (especially low-prevalence regions) that false positives with widescale surveillance testing keeping cohorts closed and that testing had not resulted in mitigation of low rates of in-school transmission so we wrote this, but called cavalier
washingtonpost.com/outlook/2021/0…

And then we saw that fear of variants or that children were driving infections in adults were raising fearful narratives that schools could not open or had to close so we looked at publicly-available data to show not true but still fear statnews.com/2021/04/23/use…

So, not sure anything more than the fear-based approach we chose to use (instead of #harmreduction) that kept schools closed (more in West Coast than elsewhere, partisan too); Hope fervently we can change this esp with incredible vax; ok taking 2 day twitter break to work!

And please know that #covid19 is very scary and terrible indeed. It is just that harm reductionists want the same thing as fear-based messengers do: reduce #covid19 infections. But using fact-based messaging on risks, data, #factsnotfear. Okay off twitter to work until Friday.

1 more thing re: fear-based messaging (instead of #harmreduction which aims to achieve same goal of reducing transmission) influencing school closures: when public health officials don't model effectiveness of vaccines (yesterday speech good opportunity to show more could gather)

When officials don't say huge # tests in CA/SF show few cases because vax rates high (70% 1st dose in SF!); when officials still discuss surge when know vax work & only way to get out of pandemic, public confused, think they know something we don't, fear/ school closures continue

When officials say variants can evade immune system w/o data; when officials wear double mask outside after vax which belies science; when officials do not discuss studies on vaccines blocking transmission, school closures post vax will continue. Model vaccine effectiveness

Indeed, SF may be at herd immunity now with 21 cases in city of 896K despite massive testing, 70% 1st dose vax rate, but middle/high schoolers out of school (and limited visitation in hospital). Vax work; this is not due to restrictions; vaccines DO THIS
aamc.org/news-insights/…