In the age of #Omicron, we have a more transmissible virus and waning public resolve to reduce human contact. For the US, a large number of infections is now inevitable. A large number of hospitalizations and deaths is optional. /1
Elected officials must adopt vaccine-first policies, because a layer of vaccine-derived immunity is the safest, most durable & effective way to avert mass hospitalization and death. But vaccines-first is not vaccines only. /2
We need additional layers of protection (masks, testing, ventilation) & intensive government coordination and support, particularly focused on hospitals, congregate settings, & schools. This is crucial, because vaccines take time to work & Omicron moves faster than humans do /3
In large swaths of country, however, elected officials have accepted mass hospitalization and death as inevitable. Sadly, individuals have no choice but to try to protect themselves. Hospitals, nursing homes, & schools risk complete collapse from ill and absent personnel. /4
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In this OpEd (nytimes.com/2021/12/20/opi…), I argued that we should reduce the recommended isolation period for #COVID19 in vaccinated persons. This is how I think through a problem like this. 🧵⬇️
Virology helps us answer: how infectious are people with COVID-19 based on duration of infection, vaccination status, symptoms, and other factors?
Epidemiology helps us answer: what is the impact on community disease transmission for different isolation policies and different levels of adherence to those policies?
I worry that many commentators who opposed the Biden booster plan in the US succumbed to the same problem that mucked up mask guidance in Spring 2020: framing a supply-based recommendation (we don't have enough) as an evidence-based recommendation (you don't need it) 1/
I think it's much more credible to say "We wish everyone could wear a medical-grade mask, but we simply don't have enough right now so you need to sacrifice for healthcare workers" VS. "You don't need a medical-grade mask" (unspoken: because we don't have enough). 2/
In the first framing, you can then follow up by saying "We are working to produce more, and we think that by X date we will have enough for everyone." 3/
1/ Always enjoy and learn from reading @edyong209 essays, but I disagree with the thesis that US public health agencies need to return to the early 20th century approach of social reform to be more effective. 🧵⬇️
2/What is the “public health” referenced throughout the essay? I assume @edyong209 is primarily referring to government agencies in the US often called “Health Departments.” Or does it also refer to govt programs that regulate food, medications, water, sanitation…
3/…and air since these are often (though not always) in other agencies? I think making these agencies (even) more politically active would jeopardize their credibility & funding, as we have seen with the politics of the FDA and EPA, for example.
There seems to be a lot of misunderstanding about how to make indoor air safer to prevent #COVID19 in @NYCSchools. Much of this argument is about terminology, science, technology, evidence, and how to turn evidence into policy (1/n)
In infectious disease epidemiology:
Ventilation = bring new air into a room, send old air out of a room
Filtration = pull old air through a machine, filter the old air for small particles, push the newly-filtered old air out (2/n)
For ventilation in school, there are 2 approaches:
“natural” = windows & doors that use air currents to pull new air in & push old air out
“mechanical” = central heating/ventilation/AC that pulls new air in & pushes old air out (3/n)
As a public health official, what do I need for something as seemingly basic as counting all lab-confirmed #COVID cases? /2
First, you need a law passed by a state/local legislature or regulation from an administrative body with force of law (eg Board of Health) that requires all clinical labs to report confirmed cases /3
.@NYCHealthCommr and I held a technical briefing for the media this morning about #COVID19#variants in #NYC. Important summary points in this thread 1/12
People are increasingly worried whether they should do something different. This is very reasonable, b/c we’ve all seen stories worrying abt #variants & we may someday need to change what we do. Right now, the answer is: there’s nothing different we should be doing 2/12
Wear a well-fitting mask (even 2), maintain distance, wash your hands, get tested. When your turn comes up, get vaccinated: it’s the best way to protect yourself against being hospitalized or dying from #COVID19 & it’s the path to getting back to the things we love doing 3/12