THREAD

1/ We *need* clearer leadership on what our goals are as communities (neighborhood, city, county, state, country)

Because our goals as individuals are all over the place & this will be a disaster on all levels

#Covid19
#Omicron
2/ For some people it seems the goal is to avoid any disruption in their lives from ‘restrictions’— they are “over it”

On the other end it is people who want to avoid any and all possible exposures however long it takes (without a clear end)

And then a big group in the middle
3/ fundamentally I think this becomes really tough

from a public policy perspective, & a political, economic & social one as well

Some have predicted this surge will be a lot of infections, far fewer hospitalizations (hoping this as well)
4/ Others have responded that goal cannot be low % hospitalizations— must be low infections because

• threat of Long COVID

• even a low % of hospitalizations among a huge number of infections = too many hospitalizations to handle
5/ To me— this again comes back to leadership & clear communication about goals, how to achieve them, and why we are choosing what we are choosing

@POTUS @VP @Surgeon_General @WhiteHouse

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More from @AbraarKaran

17 Dec
Upgrade your masks

The single best way at an individual level- even once vaccinated- to prevent infection is to upgrade the mask you have and make sure it is on when you are near others in public, esp indoors

Tight fit, high filtration. We can’t wait for the government on this
Cc @projectn95 @FixTheMask @sri_srikrishna @masknerd @larmbrust

There are a number of folks who have done extensive research into different brands of masks tagged here: please share on this thread
2/ For those new to the #BetterMasks push, it has been something we have been yelling for a long time

Last year we argued for Biden administration sending high filtration masks to people’s homes or make them way more accessible & free statnews.com/2021/01/07/nat…
Read 5 tweets
6 Dec
One thing we learn as doctors early on is that being able to place your health as your number one priority in life is a privilege afforded to very few of the patients that end up hospitalized

If we approached #covid19 policies w this in mind, we could meet people where they are
2/ Put another way— do not assume that people that got sick were being careless

For many, the need to feed themselves & their families will come above avoiding infection

Failing to help them is a failure of the system, not the individual
3/ We saw this early on in the epidemic.

The people that could work & tweet from home did so.

Many of the people that ended up in the emergency room didn’t have that luxury. #covid19
Read 6 tweets
5 Dec
1/ "Masks reduce transmission risk by decreasing the quantity and velocity of respiratory emissions and increasing their dispersion. They do not eliminate trans- mission risk, however, because pathogen-laden aerosols can enter or exit the gaps between masks and faces"
2/ Again-- why *fit* is so critically important

The fit on N95 masks is better than ear loop masks. The latter can be augmented using mask braces @FixTheMask

In the hospital, we undergo fit testing for N95. Can approximate this in the community too

acpjournals.org/doi/pdf/10.732…
3/ Not completely fool-proof but one quick measure could be to check on how much glasses are fogging as a very general estimate of how much you are exhaling (& potentially inhaling)

In hospital, I use this to re-adjust my own fit as well

#covid19 #OmicronVariant
Read 4 tweets
4 Dec
When you really think about vaccine inequity…

It’s a lot of the same excuses we have heard in global health for decades…

When it’s really about profits

We have to recognize that all the noise is gaslighting by pharmaceutical companies & everyone they own
2/ “People are hesitant anyways”

“other companies can’t make these vaccines”

“Tech transfers are too complicated”

“Supply chain is too difficult”

The list is endless but I don’t think any of it is true

If the money was there, it would be done …like two years ago
3/ Honestly— it would be easier if the Bancels and Bourlas of the world just said “yes we are going to sell to the highest bidders— we don’t care about anything else”

Then we could start realigning the system; &/or finding other ways to hold big pharma accountable
Read 6 tweets
15 Nov
Framing of vaccines must be that they are a critical tool in a larger toolbox- not a means to throw the toolbox out altogether

Why?

As we start rolling out boosters again to wider population, we must still have ways to slow spread (now & future) with other interventions
2/ Too often, I am seeing concerns that if we push vaccines plus other interventions, we will lose people on the vaccines front

That is a failure of messaging and expectation setting

Public health experts may have to do better on communicating what each intervention can do
3/ There are of course many people for whom the incentive toward getting vaccinated is getting back to 'life as usual' without masks or taking precautions

Critical to appreciate how much vaccines have already done to prevent severe disease/deaths
Read 4 tweets
3 Nov
1/ In 2019, I led the American Medical Association @JournalofEthics issue on epidemic response; it was published right when #covid19 was beginning.

So many of these articles are relevant to what we are dealing with now.

journalofethics.ama-assn.org/issue/culture-…
2/
3/
Read 12 tweets

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