1/ There have been so many propositions of “if we just do x y z, the pandemic would be over”

Far fewer have dug deeply into why x, y, z is never actually done

Namely how our political, public health, & economic systems are not designed to ensure x, y, z gets done
2/ This matters because it can become another form of gaslighting

Proposing ideas without any means of them being executed & then sticking by those ideas anyways

“Focused protections” was one version of this
3/ In theory it was a good idea to protect older people (although never a good idea to let the young get sick)

But there was little to no attention as to how this would actually have been implemented

And no accountability when that plan did not hold up to scrutiny
4/ I don’t think those proposing ideas are always doing so maliciously (I too have proposed many throughout the year)

But actually carrying them out is a different beast altogether & who this falls on (public health departments? Private sector like vaccine companies? Governors?)
5/ who this responsibility falls on is a complicated question.

Who suffers most from the lack of accountability is less complicated— predominantly our poorest communities first, & over time many others
6/ Seemingly once it threatens the powerful/wealthy is when things get done *fast*

And so it ends up being less about what we need to do

Or even whether we can actually do it

More so, it becomes a question of whether those who can do it care to do it or not

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More from @AbraarKaran

10 Oct
1/ At our hospital we use airborne precautions if someone has active #Covid19 infection

We did at my previous hospital too

Because the virus is airborne

And we wear N95 masks

Because it’s airborne
2/ Hospitals have better ventilation

They have better masks

They have better testing

They have all the protections that are needed to prevent transmission of the virus

(& still have nosocomial outbreaks)
3/ And in hospitals we are often seeing patients when they are even less contagious than they were when they’re in the community or in their homes

Yet we have done far less to prevent community spread esp before vaccines were available
Read 5 tweets
24 Sep
A few things on my mind
-#SARSCoV2 is spread by aerosols at short and long range— not sure why there is still debate about this. Seeing tweets from Canada that this is still up in the air- no pun intended cc @DFisman @kprather88 @linseymarr
-global vaccine equity is an afterthought for rich countries; this is exactly how we thought this would go— for pharma, it’s about $$ & always was. Charity won’t solve this issue. It’s a structural problem cc @ThomasPogge @amymaxmen @RanuDhillon @rajpanjabi
Boosting fully vaccinated folks w/ mild co-morbidities won’t stop the epidemic here — fully vaxx’d transmitting much less

Need to vaccinate the unvaxx’d— still far too many holding out cc @MonicaGandhi9 @Craig_A_Spencer
Read 5 tweets
20 Sep
From @linseymarr excellent piece in @IDSAInfo CID journal, re transmission of respiratory viruses

"This dichotomy overlooks the reality that respiratory droplets of all sizes, incl aerosols, are most concentrated close to the source (i.e., the infected individual) and that..."
"exposure at all but uncomfortably close distances is dominated by inhalation rather than the impaction of large droplets that are sprayed onto mucous membranes"

Why does this all matter? Because functionally it changes the type of protection that is most needed
And it is critical to acknowledge that there has a been a paradigm shift on this topic.

At my old stomping grounds @BrighamWomens our excellent infection prevention team shifted their views over time, as more evidence emerged that short-range aerosols contributed the most
Read 8 tweets
18 Sep
1/ At the FDA meeting— the topic of global vaccine equity was pushed away as an irrelevant consideration to their decision making

This is reflective of a deeper problem— wealthy countries truly believe they can win if they just continue to protect themselves
2/ while the US is going to be purchasing “hundreds of millions” more doses to donate— winning a pandemic that hinges on the generosity or altruism of wealthy countries w/ histories of exploitation is problematic & likely short lived.

3/ The global vaccine supply issue & need for more decentralized production + technology transfers for scale up is likely the most urgent global dilemma facing the world.

Is it being regarded with the same level of urgency?

It doesn’t seem or feel like it but hard to say
Read 6 tweets
15 Sep
People who test positive for #SARSCoV2 with a high viral load who are sent back home to isolate should be given a box of surgical masks for their family members to reduce home-based cluster spreading.

I wish we had done this last year. We can still do this now.
2/ Ideally this would be N95 masks— if we can get there, that would be ideal.

But at minimum, surgical masks which I think can be done immediately; & equipped with mask fitters, if possible.

This is most important in crowded homes with high risk folks, & poor ventilation
Read 4 tweets
13 Sep
1/ As much as people push the “personal responsibility” narrative, so too should they remember when we were telling people to “stay home” when their very livelihoods depended on not staying home— the same low wage workers who ended up being the majority of patients we treated
2/ Personal responsibility to avoid getting infected with #covid19 - for many of my patients last year- ended when it meant they couldn’t get a living wage. For them, the decision was really health v health- w/ no good options.
3/ We are quick to view the lives & challenges of others through our own lens of responsibility- one that is often biased towards the privileges we have in our own lives. This is precisely how “stay home” became a social media movement early on by those who could stay home
Read 4 tweets

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