I have been thinking a lot about what we, as a society, can do to reduce the probability of future pandemics & their severity when they do occur. What I've stumbled upon is a recognition that we teach our children an incomplete picture of infectious diseases 1/n
We teach our children about infections as if they were chronic disease-entirely from a protect yourself framework. Don't eat that M&M you dropped on the floor, you might get sick. Wear your coat, you might catch cold. The focus is nearly always on the kid's or person's health 2/n
We rarely teach about preventing infection in others. Yes, we tell kids to cover their mouth when they sneeze/cough but we don't really say why. And when we have a child stay home from school, we couch it as being about them. 3/n
What we rarely say, is "we need you to protect others." Stay home so your class doesn't get sick. Wash your hands after you blow your nose so others don't get sick. The example we set is to go to work & power through illness, forgetting that doing so puts others at risk. 4/n
We've lost the sense of interdependence--our communal health. Infectious diseases are dependent happenings: my health affects your health, your health affects my health. We have to teach kids (& adults!) to care about their impact on others. Wishful thinking on a Tuesday morn 5/5

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More from @BillMiller_Epi

19 Jun 20
1/ In the mid-1990’s, I gave a talk called “I am racist” to an audience of about 120 pacifist, progressive, white people. It was one of the most difficult talks I have ever given. (I am a hetero white man)
2/ I shared about white privilege. I shared about power. I shared about the biases I had and how I repeatedly uncovered more. I shared that I felt it was impossible to grow up white in the United States and not be racist.
3/ I had expected that day to change people’s minds. I had expected that they would feel challenged but encouraged to uncover their biases & recognize their privilege. And some responded with words that suggested exactly that. But others…
Read 7 tweets
2 Apr 20
A few summary thoughts about test performance. 1/
First, keep in mind that no diagnostic test is perfect. Clinicians always have to interpret the test in context. Tests can be wrong for a number of reasons. 2/
False negatives can arise from, among other things, poor sampling (how the swab was collected), a small # of viruses present (an asymptomatic but infected person), or a faulty test. 3/
Read 7 tweets
16 Mar 20
As we think about COVID-19, a basic tweetorial about R0 (basic reproduction (or reproductive) number) and Re (effective reproduction number).

R0 = average # of people who will be infected by an individual in an entirely susceptible population. #EpiTwitter #FlattenTheCurve 1/n
R0 is a function of 3 key factors:
c = Contact rate: how often people are close to other people
p = Probability of transmission given contact with infectious person: how infectious the virus is
D = Duration the virus can be transmitted

R0 = c*p*D
2/n
Re (effective reproduction #) adds in the proportion of people who are susceptible (s):

Re = R0 * s = c*p*D*s

If everyone in the population is susceptible, s=1, & Re=R0
3/n
Read 7 tweets
16 Dec 19
I promised @LSadinski some thoughts about working with co-authors, esp. as a early career investigator. I hope the following thread provides some useful insights. #epitwitter 1/11
Working with co-authors is a bit like Goldilocks & the 3 Bears. You are Goldilocks. Your co-authors are the 3 bears: either too little, too much, or just right. Your job is to help them all to be just right. 2/11
Your goal is to get the feedback you need, when you need it, in the right quantity, and with the right guidance. That can be a challenge! 3/11
Read 11 tweets
17 Oct 19
When and how should you protest a journal’s rejection of your paper? And how about for a desk rejection? Here are a few thoughts on the issue. Thanks to @lbodnar for the push to do this. @TimothyLash @nicolamlow please comment! 1/n
Sending a request to reconsider a journal’s decision can be effective, but it should be rare. And you can do it with either a post-review rejection or a desk rejection. Just don’t expect the decision to be reversed. 2/n
If you have what you feel is a strong paper and the journal seems truly to be the best choice for that paper, you might consider an appeal. You should plan on making three key points in the appeal. 3/n
Read 9 tweets

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