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Adam W Gaffney Profile picture
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23 Aug, 4 tweets, 2 min read
Our new study just up @JAMAPediatrics: the number of inadequately insured children in the US rose to 24.4 million in 2019, based on our analysis of the National Survey of Children’s Health

jamanetwork.com/journals/jamap…
We used the definition of under-insurance of Kogan et. al (and others), who found 14 million underinsured in 2007 (we classified children as “inadequately insured” if they underinsured or uninsured within the last year”)

nejm.org/doi/full/10.10…
We found that the number of underinsured children rose from 16.2 to 18.1 million from 2016 to 2019; in addition, there was a rise in the number of uninsured children (the latter finding was also seen in analyses of the American Community Survey).
Finally we looked at inadequate insurance among children with serious chronic illnesses. For 2016-19, for instance, an average of 154,349 children with diabetes were inadequately insured each year, 304,292 with heart disease, and 1,902,839 with attention-deficit disorder.

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More from @awgaffney

Adam W Gaffney Profile picture
31 Aug
New study in NEJM provide further support for more aggressive blood pressure control. The prevention of stroke would be enough for me.

There are few recent advances in medicine that delivers such big population health gains as blood pressure treatment.

nejm.org/doi/full/10.10…
Julian Tudor Hart famously emphasized the critical importance of blood pressure control on the population level, noting the "rule of threes" - a third didn't know they had high blood pressure, a third knew but wasn't treated, and a third was treated but not controlled.
He personally measured the blood pressure of every person in the Welsh community he was responsible for, and his control of BP may have contributed different mortality trajectories in his vs. neighboring communities.

pubmed.ncbi.nlm.nih.gov/4193685/
Read 4 tweets
Adam W Gaffney Profile picture
24 Aug
It first seemed like ivermectin was one more low-evidence-based drug, albeit with a curious degree of politicized enthusiasm. It is far worse. Its evangelists appeared to have convinced some, perhaps many, that it is a substitute for vaccination.

washingtonpost.com/nation/2021/08… Image
Pierre Kory, the most prominent physician backer and head of the ivermectin enthusiast group FLCCC, has been cagey about this at times, but here he is posting a slide "Pfizer v. Ivermectin" suggesting superiority of ivermectin vs. vaccine in Covid prevention. Image
However, even worse is that the FLCCC Alliances' COVID-19 "prevention" protocol includes ivermectin (as well as vitamins, mouthwash, etc.) but ... no mention of vaccination. Maybe it was just an innocent oversight? Hmmm...

covid19criticalcare.com/wp-content/upl… Image
Read 7 tweets
Adam W Gaffney Profile picture
21 Aug
Great article detailing the sabotage of a highly successful program that repopulated the endangered Red Wolf population, which has now erased all progress. Count me “Team Red Wolf” on this one. thenation.com/article/enviro…
Meanwhile, however, Biden is allowing Trump’s decision to lift protections for Gray Wolves to go forward. I’m also Team Gray Wolf.

npr.org/2021/08/20/102…
I frankly don’t understand anti-wolfism, which is apparently a thing.
Read 6 tweets
Adam W Gaffney Profile picture
11 Aug
I'm as enthusiastic a COVID vaccine proponent as you will find, but it is egregiously unethical to threaten those on probation w/ literal prison for declining vaccine.

The headline: "Get a Covid-19 Vaccine or Face Prison, Judges Order in Probation Cases"

nytimes.com/2021/08/09/us/…
The public health justification here, even from a strictly utilitarian perspective, is an absolute joke. If you thought someone was at increased risk for Covid the last place you would want them would be prison.
This is part and parcel of an approach that wields repressive tactics against migrants and asylum seekers in the name of “containing disease spread”
Read 4 tweets
Adam W Gaffney Profile picture
9 Aug
I support dramatic public health interventions in hard hit areas to slow Covid (and buy time to vaccinate everyone possible) but I strongly dislike this irresponsible mode of reporting which will scare the shit out of every parent with a kid with a cold. nytimes.com/2021/08/08/hea…
The hypothesis that a mild upper respiratory tract infection - even if caused by a new virus - causes a chronic dementing illness in children is a sweeping, massive, frightening claim. It is unlikely to my mind, given what we know about mild upper respiratory tract infections …
… but like all things, it is possible. Yet it is an extraordinary claim, and requires robust evidence which is thus far lacking. Our mantra that correlation does not equal causation goes out the window on this particular topic.
Read 6 tweets
Adam W Gaffney Profile picture
25 Jul
Anti-vaccination crew blather endlessly about how breakthrough infections prove uselessness of vaccines — neglecting the fact that they basically eliminate severe disease.

Compare surges last winter vs. this summer in the UK, with cases on top and hospitalizations on bottom.
Yes, severe COVID (pneumonia / acute respiratory distress syndrome) is what really matters. From a syndromic perspective, mild COVID-19 is typically a cold, or a flu-like illness, which of course can be miserable but is not what makes this a once-in-a-century pandemic.
Truth is that breakthrough *mild* infections are far more common than we realize, as many people are not getting a COVID test if they develop a cold (although doing so can help protect others). Otoh, we're not undercounting breakthrough severe infections - mostly can't be missed.
Read 4 tweets

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