The wide dispersion in models forecasting the Delta wave, released by CDC, are deeply disappointing and not actionable. The huge variance in the estimates shows CDC doesn’t know how to model this wave, and has little practical idea whether we’re at beginning, middle, or end 1/n Image
It’s another symptom of a more systemic bureaucratic disease. CDC has a retrospective mindset, it’s not a prospective agency resourced and poised to mount operational responses to crisis. The need for such capability is a big focus of my forthcoming book, Uncontrolled Spread 2/n
The CDC’s models on Delta wave underscore this point. For the week ending August 14, CDC estimates there will be either an average of 10K infections a day, or more than 100K. Either the infection wave will be largely subsiding, or will be raging out of control. The CDC isn’t sure ImageImage
What’s needed? This isn’t CDC’s job alone. We lack an organized infrastructure to mobilize a response to public health crisis. We need a JSOC for public health response. For two years, HHS did not operationalize this kind of effort aside from Warp Speed. 4/n
For its part, CDC isn’t a prospectively-minded agency. They don’t do horizon scanning, make predictions and tie to policy recommendations, coordinate heavy lift capabilities like vaccination campaigns, engage in risk estimates, or collect intelligence on foreign areas of concern
We need such a capability. An action-oriented agency able to engage in assessing and mobilizing preparations against future risks. Able to coordinate assessment of intelligence that informs on these risks. Able to become a clearing house for intel and operational direction. 6/n
Could a reformed CDC play such a role? I outline in detail how in my book. But it’ll have to go back to its roots aimed at disease control and empower a new agency (maybe a new NIH institute) to take on many current “prevention”functions. CDC will need a national security mindset
The bottom line: CDC data has consistently been thorough, meticulous, and late. In other words, it wasn’t actionable in setting of fast moving crisis. That’s not the business CDC was in. They provide definitive answers, not partial info to inform current decisions in a crisis 7/n Image
In closing: we’ll need such an agency somewhere. It can be a CDC retasked with a greater focus on the national security dimension of its mission. It can be a new joint operational command. We’ll have to view these risks, the ability to horizon scan - and prepare, through new lens

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More from @ScottGottliebMD

Nov 27
🧵What happened in 3/22 when Omicron hit Hong Kong, illustrates challenge China faces

Hong Kong like China had low vaccination rates; especially among elderly

In face of much more contagious variant, low pre-existing immunity in HK was devastating 1/x

bloomberg.com/news/features/…
When Omicron hit Hong Kong, only 72% of residents were fully vaccinated, 30% boosted

By comparison, in China, 88% were fully vaccinated, 40% boosted; a figure that hasn't changed much

Hong Kong, unlike China, deployed vaccines that have proven more effective against Omicron 2/x
Yet over first three weeks of March, HK reported 456,305 cases and 4,103 deaths; a tragic case fatality rate. Here’s the rub: Elderly residents had disproportionately gone unvaccinated for a variety of reasons; in HK it was young people not the old who had been vaccinated 3/x Image
Read 6 tweets
Nov 24
🧵 Important new study shows high frequency of virus co-infection and species spillover among animals bats; with 12 viruses shared among different bat species, which in turn facilitates virus recombination and reassortment, and new genetic diversity 1/3

biorxiv.org/content/10.110…
h/t @MichaelWorobey

Fantastic work from Mang Shi and scientific colleagues:

"A novel recombinant #SARS-like coronavirus...with only five amino acid differences between its receptor-binding domain sequence and that of the earliest sequences of SARS-CoV-2" in Yunnan, #China 2/3
“This revealed a high frequency of virus co-infection and species spillover among the animals studied, with 12 viruses shared among different bat species, which in turn facilitates virus recombination and reassortment….” the authors write. 3/5
Read 6 tweets
Nov 23
#FoodSafety 🦃🥘🍽️

The @CDCgov estimates 48 million people get sick from food borne diseases every year in US, many outbreaks occur around #Thanksgiving. Here are a few cooking practices to keep your family safe and healthy this holiday season ⬇️ today.com/health/top-rea…
👉🏻 Always wash your food, hands, counters, and cooking tools.

👉🏻 Keep raw foods to themselves. Germs can spread from one food to another.

👉🏻 Foods need to get hot and stay hot. Heat kills germs.

👉🏻 Put perishable food in the fridge right away.

fda.gov/consumers/free…
Make sure a turkey reaches internal temp of 165°F to kill germs. Check with a food thermometer; always avoiding bone. Check at:

👉🏻 thickest part of breast

👉🏻 where body and thigh join, aiming toward thigh

👉🏻 where body and wing join, aiming toward wing

bit.ly/2OSgp9o
Read 4 tweets
Nov 5
Will be interesting to track development of this psychedelic by Lusaris and @rfsquared and how regulators approach compound. Sublingual, fast acting formulations of controlled substances have faced close scrutiny in past owing to risk of diversion, abuse thedalesreport.com/psychedelics/p… Image
Recent controversies around at home Ketamine and history related to sublingual formulations of opioids could inform how @US_FDA considers issues related to drugs with characteristics like the new compound being developed by @LusarisTx @rfsquared
psychiatrictimes.com/view/virtually…
In the past sublingual delivery of controlled substances raised significant scrutiny (for example Dsuvia) over abuse and diversion concerns. Psychedelics also in spotlight on similar concerns. How will @US_FDA approach this @rfsquared RA Capital compound? statnews.com/2022/11/03/ket…
Read 5 tweets
Nov 5
🧵Will discuss decisions made during Covid that impacted families; some of hardest were school closures. In WSJ I wrote in 2020 here wsj.com/articles/schoo… and here wsj.com/articles/want-… that states should open schools. Many like my state CT made it top priority, others didn't
My argument Summer 2020, after first wave, was: "Schools should open in the fall. It’s critical for meeting the educational and social needs of children. But local officials should have the discretion to take tailored actions to help keep children safe" wsj.com/articles/schoo…
Concerns were many. As I wrote month later "Social and educational costs of keeping children out of the classroom is enormous. Lost learning can translate into fewer opportunities...later in life. Virtual learning is especially hard on low-income children" wsj.com/articles/want-…
Read 13 tweets
Oct 27
We shouldn’t underestimate how much the predictable backlash to the failed 2021 mandate that businesses require employees to get vaccinated, using a contorted reading of OSHA provisions, is going to - regrettably - bleed into broader opposition to vaccines thelancet.com/journals/lance…
Read 6 tweets

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