Excited to be watching this #WeSupport #CovidSafeWork Teach-In by @MarkedByCovid.
@MarkedByCovid Great point by @gregggonsalves: it's not about a microbe, it's about the environments we live and work in, and it's about which people are considered disposable. It's also how we want to end the pandemic, who we want to include/exclude in the response.
Recounting his history in the HIV epidemic, @gregggonsalves says we have to be careful whom we write off. Those with multiple medical conditions, front-line workers, teachers, those in warehouses, high-proximity nonWFH jobs -- for so many, vaccines are not enough.
@gregggonsalves We need

Epidemics are a human creation, their end is also a human creation

Environment matters - can make us sick or well
@gregggonsalves Deshira Wallace PhD (can't find her on twitter) talks about her experience with the Zika pandemic and how it illuminates Covid.

She draws on 3 lessons
1. Delays in recognizing covid as an emergency, delays in response (cf Zika). Lack of leadership. Poor data. Vested interests.
@gregggonsalves Poor coordination and inaccessibility to testing. Testing often prohibitive. Those with most access can protect selves. The opposite of an equitable PH approach.

Need to strengthen coordination channels bt states, counties, cities.

Another point: poor risk communication
@gregggonsalves Zika was framed as an issue only for women of reproductive age, cf how Covid is framed as an issue only for the unvaccinated.

Similarly, response has been plagued by inconsistent /untransparent comm around masking and other things. Trust-reducing.
@gregggonsalves Last theme Dr Wallace brings up - financing.

Out of pocket costs for tests and specialized care.

If we could allocate funds to make sure there's a plan without Congressional delays, incl free/low cost masks/tests, this would increase equity.

@gregggonsalves Need to update OSHA laws incl filtration and ventilation systems.

Need NOT to leave behind most vulnerable
@gregggonsalves Next up is MD and activist @lzj961. She reports that she got a work email saying ppl shd return to wrk post covid after 5 days, with a limit of 40 hr of allowed covid time off (!). Something inside her broke.
@gregggonsalves @lzj961 "Two years later we are drowning in email and phone messages." YES I AM TESTIFYING TO THIS - ZB

"people with chronic dz haven't had sufficient care for the past 2 years. ... More than half of my 20min visits need an hour"

@gregggonsalves @lzj961 "Of late we've all been hanging by a thread and then Omicron hit."

Instead of mandates, "the White House sent mixed messages. They reduced the isolation days to five, knowing full well they'd be sending ppl back to work contagious."
@gregggonsalves @lzj961 "Public health messaging can't be one and done. It is must be consistsent and clear."

She points out weakness of masking messaging.
@gregggonsalves @lzj961 She reports about ambulances being turned away from hospitals. 45 ppl died in KS in December waiting for hospital transfer.

The message is clear. Despite the hashtag health care heroes, Dr Jirmanus says, "our lives are disposable."

Billionaires get richer, people are dying.
@gregggonsalves @lzj961 Step 1, she says, is a billionaire tax.

(ZB editorializing - 100%!!! and needs to be a consistent @MarkedByCovid demand going forward)

She says we need to boost production of lifesaving drugs
@gregggonsalves @lzj961 @MarkedByCovid There's a light at the end of the tunnel, she says, and that tunnel needs to be a path towards social equity and justice
@gregggonsalves @lzj961 @MarkedByCovid Next is @JuliaRaifman talking about data-driven, science-based policies around workplace protection, testing, and masking
@gregggonsalves @lzj961 @MarkedByCovid @JuliaRaifman Raifman points out enormous income gradient among the vaccinated.

Essential workers are less likely still today to be vaccinated. Administrative burden is significant.

Among lowest income workers there are more who would consider vaccination than those opposed.
@gregggonsalves @lzj961 @MarkedByCovid @JuliaRaifman "We are all in a pandemic together. We are all in a society together. We need a response that does not people against one another but supports the underserved in accessing vaccines, masks, tests, and in safety standards reducing exposure for workers." - @JuliaRaifman
@gregggonsalves @lzj961 @MarkedByCovid @JuliaRaifman Today's SCOTUS decision was a setback but a lot can still be done. Trust and accountability can be restored. "Epidemic of the unvaccinated' language pits people against the underserved. We are in this together.
The sooner we invest in scaling up results of local, popular organizations, the better. We need a vax-plus strategy. We still need masks, tests, ventilation.
We can't get normal done on our own. Covid control is only something we can achieve together. Raifman is glad Biden is taking note of Defense Production Act and she hopes he will deliver tests directly to low-income communities. We shd prepare, she says, also, for next surge.
"We'll be doomed to keep doing this until we take steps to control the pandemic." -- @JuliaRaifman
@JuliaRaifman Now @asosin talks about what is meant by #CovidSafeSchools.
@JuliaRaifman @asosin "We see persistent racial disparities for outcomes of Covid in children."

Children, schools, and day care centers have been afterthought. Only 16 states mandated masks in schools. There have been only patchwork improvements, if that, in ventilation and building improvements.
@JuliaRaifman @asosin We have seen a retreat from the best practices that were adopted last year. During the Delta surge we saw many closures of schools. During this surge, many states have eliminated mitigation strategies.

We need to reject false choice between health and education. Most agree.
@JuliaRaifman @asosin 5 policy priorities -- @asosin

1 Aggressive attention to community transmission
2. School mitigation strategies (masking, testing, ventilation, lunch planning....)
3. Suff resources to impl mitigation
4. Remote alts to high risk students and fams
5. Mobilize comm sch support
@JuliaRaifman @asosin @RoriSamantha, Calif Teachers Assoc state rep, math teacher, talks about looking for masks/tests, not finding any. "How do you go to work when you don't have them?" Called sickout. We have power/leverage. One change.org petition and FB page. Very lib SF embarrassed.
@JuliaRaifman @asosin @RoriSamantha Greg McGarry, also a SF teacher, points out commonality bt Trump and Biden admins - desire to sacrifice people to the needs of the market.
@JuliaRaifman @asosin @RoriSamantha Children want to trust adults but they have no reason to do so. The heartlessness of the capitalist economy and what it does to parents/students. Kids warehoused so their parents can keep the economy running.
@JuliaRaifman @asosin @RoriSamantha Susie Kameny, another SF teacher, points to magical thinking saying that kids are somehow safe when they make it to school
@JuliaRaifman @asosin @RoriSamantha Kameny filed a grievance regarding absence of masks.

Teachers in SF feel abandoned by Democrats, those who are suppoed to be on their side.
@JuliaRaifman @asosin @RoriSamantha @thephatic says he and other teachers don't trust the DC school district to tell them what is going on. He learned he was exposed a few days ago. Asked for a rapid test and no one knew where to get one. He tested neg, the n developed sx and asst principal told him to come to wk
@JuliaRaifman @asosin @RoriSamantha @thephatic This is a great webinar, it's still going on, but I got messages and patient paperwork piling up! Thanks again to @MarkedByCovid for making this happen, let's work together, organize together. @kdurquiza lost her dad, we're in no better place 2 years later
@JuliaRaifman @asosin @RoriSamantha @thephatic @MarkedByCovid @kdurquiza now mike is being turned over the students in boston and oakland who are organizing....
@JuliaRaifman @asosin @RoriSamantha @thephatic @MarkedByCovid @kdurquiza Oakland students walkout, they are speaking now, so admirable

@JuliaRaifman @asosin @RoriSamantha @thephatic @MarkedByCovid @kdurquiza Rima Samman lost her brother in May, 2020; he was 40. She is trying to get support for a memorial - private donations have made possible first natl memorial (in NJ) despite lack of support from Trump or Biden admins. She unfortunately got Covid, has #LongCovid. Financial burden.
@JuliaRaifman @asosin @RoriSamantha @thephatic @MarkedByCovid @kdurquiza Low-income people, essential workers, teachers, health care workers, veterans, even children, says Samman, considered expendable. Even if pre-existing conditions, every life is valuable. Our nation is falling apart, very slowly. The long-haulers have been screaming last 2 years

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More from @DrZackaryBerger

13 Jan
I really admire all those on the front lines of this surge (ED, ICU, etc etc). I'm on the primary care middle-lines and I've aged a decade in the past six months.
This pandemic *has* made me think a lot about a joke people tell, ruefully, in medicine, especially primary care, after doing something trivial (filling a Rx for a statin, or taping someone's toe): "another life saved."

Primary care saves lives, ideally, in a lot of ways....
although not directly, immediately, like in the acute care specialties I mentioned above. But we refer, diagnose, treat, image, test, & sometimes pull people away from the jaws of death.

I like to think that being there for them is a life-saver too, sometimes. It's hard to know.
Read 4 tweets
13 Oct 21
Emily Oster is still making categorical judgments about how we should approach age differences in Covid risk -- even as we lack information about case transmission from schools to communities.
And all the Osterites saying "Covid risk is the same order of magnitude as other respiratory viruses, but we're treating it SO DIFFERENTLY" are the same people who go gaga over contextless p-values. Stats means nothing without a brain and a heart. Use them.
Not only *should* we care about child mortality out of proportion to the number, but we *do* evince such disproportionate care when kids die of other things, too. And we change society around to address it.
Read 4 tweets
12 Oct 21
Food manufacturing workers are striking.

Media workers are negotiating better contracts.

And health care workers?

Told to live off resilience.
Part of the reason has to be doctors.

For too long now we've thought the world of ourselves. We're a guild!! We're autonomous!! We're independent!!

Except we haven't been that for a while. (Nor should we be.) We're health care workers getting a bit less shaft.
Can MDs stop being lackeys of medical centers and start working in solidarity with colleagues from other disciplines?
Read 6 tweets
14 Oct 20
"I encourage everyone to continue to live the healthiest life they can. A balanced diet, fresh air, and vitamins really are vital to keep our bodies healthy" -- so about this/1
encouraging a "healthy lifestyle" is really a moral directive unless ppl in power address the things that make healthy living possible. a "balanced diet"-- for those without $ to shop?; "fresh air" except when people put incinerators in ppl's back yards?; "vitamins" -- are BS/2
this is a capsule of what it means to conceptualize health as wholly dependent on the self. her son is a "strong teenager" so did well; she "lives healthy" & took vitamins, so got better. no mention of the fact that they direct gobs of resources and have doctors down the hall/3
Read 4 tweets
24 Aug 20
I have nothing against #PlasmaTherapy for Covid. I've looked at the data. It might be helpful. We need a trial.

Now, imagine if the attention paid to this *one potentially marginally helpful therapy*....

...was devoted, as well (not even "instead") to those sick with Covid. /1
What I mean is this. I'm a believer in biomedical interventions. Heck, I'm a board certified internist. Biomedicine is part of what I do.

But only a part.

So much of the help I try to give patients is not available./2
Not because "it's not my expertise" or any such Pinkerian BS. It's because our priorities are off.

Can we pay workers to stay home?

Can we cancel rent?

Can we give food to the hungry?

Can we make Covid care free?

Darn right we can. /3
Read 5 tweets
2 Jun 20
Someone asked how I could go to a protest today. Wouldn't Rona be there? Thread:

In general -- in my practice as a physician and in my educational/research/books -- I have tried to be as comprehensive in my understanding the possible reasons that lead people to weigh risks. /1
Because the tricky part about epidemiology and public health is this. Risks are population-based. Decisions are individual. In time of Covid, I have tried not to wax snarky about people seeking haircuts. People have reasons, they always do, even if they are not your type./2
From a public health perspective, would there have been more careful ways, a priori, to organize a demonstration like that? Perhaps (I have seen pictures from Israel of a demonstration with people separated by 6 feet). /3
Read 5 tweets

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