Thread by @PardisSabeti

Over the last 48 hours I have been asked the same question many times in many ways - ‘Is the Provincetown outbreak due to this being a largely LGBTQ+ community?’ It is NOT. A thread on the dangers of #othering in outbreaks. #ptown #delta #covid 1/14

It comes as both direct attacks and in tepid questioning like ‘You know Ptown is well a special community, could this be more about how they socially interact?’ or ‘There is a lot of HIV in the gay comunity, could they just be more immunocompromised?’ 2/14

To be clear -- the Delta variant is highly transmissible and breaks through our vaccines, and what is going on in Ptown is happening all across the US and the world right now, and could be in your backyard. 3/14

What is special about Ptown is not its outbreak, but its rapid detection and unprecedented tracing thanks to the ptown community and govt as well as MADPH @Massgov @broadinstitute @PIH and others. 4/14

The #ptown community is exceptionally public health and community oriented. They reached out to each other on social media and through private chats to tell each other about their diagnoses, encourage each other to get tested, and support each other through the process. 5/15

It is a model that I wish we all followed and that enabled the @CDCgov and MADPH @MassGov to obtain real-time actionable information for the entire country. 6/15

And July 4th weekend in Provincetown this year was not marked by intense revelry, but by RAIN, driving people indoors, into restaurants and shops during the day. 7/15

Fact is 42% of the breakthrough cases were residents of Barnstable County, that is locals. The population of ptown is 3k, with~60k overnight visitors per week, that would mean, residents/workers may have a ~10x higher risk of exposure. Tx to @ReillyLikesIt 8/15

The residents can work 3-4 jobs due to a labor shortage often in dense poorly ventilated places. They are dosed by a stream of travelers working a shop during the day, serving food in the afternoon & bartending in a club at night. That likely underlies their heightened risk. 9/15

So far, the investigation has reported that 30 of the cases, or 6%, were among people with confirmed HIV infections. None were hospitalized. So immunocompromised status also does not explain the outbreak. Tx to @carolynyjohnson 10/15

I understand that it is a natural response to want to think this is an outbreak that only affects others. We are scared, we are tired, we want to see our friends, and we don’t want to think this could be our problem. The outbreak has been hard on all of us. 11/15

But by #othering, we make the year even harder on each other, bringing stigma where there should not be any. And overlooking facts that could help us. 12/15

If we had paid closer attention to dispatches from India in early May, we would have seen they were reporting vaccinated individuals falling to the disease, and that once one person in a household gets infected, the rest of the household almost always falls ill. 13/15

We othered India as well. ‘They don’t have a good healthcare’ ‘They don’t have vaccines.’ ‘They don’t have sanitation’. Many different ways to say, this is YOUR problem. We have done the same dance in every outbreak I have ever witnessed. And we have always paid the price. 14/15

The next time you hear a dispatch, please start with empathy, curiosity, and kindness. It is not just the human thing to do, but the smart one. 15/15

--- Responses -- Thank you those who shared my thread and who appreciated it, and thank you to those who asked me hard questions back for another opportunity to learn and think. 16

I will do my best to respond, though to be transparent, I am not currently active or versed on twitter & just trying to understand this unfolding story, but I try to come on from time to time to contribute & learn where I can. Here is my attempt to address questions raised. 17

The @CDCgov did not change its mandates based on the ptown event. This was a well documented early outbreak of delta in the US, for the reasons I described in the thread, and they took it into context of other data that was coming together at the same time across the country. 18

See for example this important piece from our terrific colleagues in Wisconsin with a different population demographic and set of circumstances and similar conclusions. medrxiv.org/content/10.110… @dho 19

I expect that over the coming weeks, you will see many reports of rising cases counts, and similarly high viral loads in vaccinated and unvaccinated individuals. 20

What the preliminary data are also showing though is that the viral loads drop far more quickly in vaccinated individuals, meaning there are likely fewer days they could transmit & that they are greatly protected from severe infection.

https://twitter.com/erictopol/status/1421526589766979586?s=21

@erictopol 21

So there is reason to be hopeful, but also reason to stay vigilant for a bit longer, to protect the most vulnerable amongst us, including children under 12 who can not be vaccinated, and who could be at greater risk as the virus continues to mutate. 22

I did not mean to say that the 85% number of males is not something that should be noted or looked further into. For brevity in twitter I had added this as a response to a conversation already ongoing where this fact had been previously shared. 23

But even that # should be taken into context that it is the proportion of reported cases in the area at the time. More male individuals in town that week affects numbers, regardless of those individual’s activities, as the @cdcgov report notes 24

And what it appeared to an investigating public health expert I spoke w/ is that LGBTQ+ members, being primed by the HIV epidemic, had a public health mindset, testing themselves & sharing with each other, so they may be reported disproportionately to the true distribution. 25

There was similar gender imbalance in COVID cases @EUROCUP21 in UK, men were getting it at crowded events & pubs. The answer wasn’t to blame folks for doing something public health said was ok, it was to take the new info and adjust going forward. nytimes.com/2021/07/01/wor… 26

These are just some thoughts to share, but all must wait the full data and analysis, which we will soon have thanks to the terrific work most importantly of the affected COVID individuals as well as the ptown community and govt, MADPH @Massgov @broadinstitute @PIH and others. 27

I respect that some active LGBTQ+ members like @peterstaley own that this could be due to their own behaviors and to be proud of them. But each of us are speaking for ourselves and not every member of our communities, and we are all learning as this outbreak unfolds. 28

I hear and understand that gaslighting can be done subtly even when intentions are good. I do not in any way want to stifle questioning or debate. I apologize if it seemed I did. Anyone should feel free to ask away. 29

And I agree that any kind of othering is counterproductive as we all do our best to navigate these trying times. 30