🧵1/ When we don’t get #SARSCoV2 transmission low, the most vulnerable - the old, the immunocompromised, the just plain unlucky whose bodies can’t mount a robust immune response to vaccines - they pay a high price
🧵2/ I know many people in US see #COVID19 primarily in personal terms. Their risk to others is not a main priority…
Others argue that the unlucky vulnerable should just “shield” themselves indefinitely, as if being old or sick means that you are no longer a social being
🧵3/ And others argue that the shortening of life for the old in particular is not that great a tragedy bc they would have died soon anyway*
🧵4/(*I have strong feelings about this one. My grandfather is 94 yo. When he passes, we will be sad but know that he lived a full life. I’d like him to have the dignity & comfort of dying in his home peacefully, not suffocating in a hospital, tended by exhausted strangers)
🧵 5/ I know that there are different ways of seeing the world and that we come to our decisions about policy bc our life experiences lead us to weight valid competing values differently.
Daily I learn from people who see the world differently than I do
🧵6/ But I’m still sad. These vaxxed deaths make me especially sad bc they are a foreseeable consequence of a policy of promoting high-transmission among the “young and healthy”. That transmission eventually reaches the unlucky whose bodies can’t fight off this virus
🧵7/ I do not envy people in charge of setting #COVID19 policy in the US: in our polarized environment, it’s hard trade-offs all the way down
But I wish we in US could more honest with the fact that trade-offs are being made
And it’s sad, a lot of it is really sad
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🧵 1/ I really like the idea of “test to stay” in US K12 schools
There are actually several different policies called this, but a big one is testing to reduce K12 quarantines when a person/group is a close contact of positive case. I think that’s a great use of “test to stay”
2/ One confusion I see in comments on Dr. Mina’s post is people thinking of very sensitive PCR testing, which can pick up infections in days when people are no longer contagious
“Test-to-stay” typically uses Rapid Antigen Testing: RAT finds those who are actively contagious
3/ One drawback is there will be occasional false positives with widespread use of rapid antigen tests. So a fast, easy protocol for additional testing to confirm (or refute) positives needs to be in place
2/ Re: p-hacking: I was really lucky to learn about dangers of p-hacking/selective reporting/publication bias early when I took Charlie Poole’s meta-analysis class in my MSPH at @UNCSPHResearch
Seeing the funnel plot assymetry in study estimates was powerful!
3/ We even published this study 👇🏾 years later.
If I’d known how much work it was going to be, I may not have done it! But I was young & energetic & totally in love with Epi Methods 😍…
🧵2/n To my knowledge, my kids haven’t been infected with #SARSCoV2 - but I’ve accepted that they probably will at some point because of where we live (US)
🧵3/n So then my decision is whether I’d like that first infection to be in a naive immune system or in one already primed by vaccination for a quicker immune response
1/ This article does a good job presenting several foundational public health tenets that I’ve felt frustration at not communicating earlier and better:
A disease that hurts a small % of a huge population can hurt a LOT of people
Small increases in risk for a person can seem relatively inconsequential but still have big, longterm effects on a large group of people
3/ It’s a mind-bending way of thinking that I see people grappling w in real time re: COVID
That self-learning is cool to watch from a teaching & learning perspective but scary when critical decision-making depends on understanding the implications of this seeming contradiction
🧵2/10 This quote from @oni_blackstock (starts with “In our community…”) especially hit powerfully. I’ve rarely felt my experience of the pandemic articulated with such precision. bit.ly/3DikPP3
🧵3/10 Scholars like @JessicaCalarco have done beautiful work describing the key role that US women play as “family health managers” and how the pressure of that role has often translated into vaccine skepticism, etc, especially among White politically conservative women in US
These scientific-sounding lies lowered rates of vaccine uptake & NPI. After all, prominent people said everyone already had protection from infection & cross-reactivity w other viruses
🧵 3/ In India & the rest of South Asia now, we see that words matter, that scientific-sounding distortions of reality matter
I remain enraged & heart-broken bc that scale of outbreak absolutely didn’t have to happen in a vaccine-exporting & scientifically rich country in 2021