Relying on the 2020 playbook as we head into 2022 is as foolish as relying on the 2019 playbook as we entered 2020. The game has changed. Given the availability of vaccines, here are 10 updates to the playbook for 2022 (from 12/15. Still holds.)

1: “Fully vaccinated” should mean you’ve received a booster shot.

Your body needs to “see” the signature of this virus again to restore protection against the delta and omicron variants.
2: Stop equating all control strategies.

Haphazardly providing the public with a long list of controls without any order or logic is confusing and harmful.
3: Where all people are vaccinated, we should do away with mask mandates and distancing requirements.

Post-vaccines, the control strategy should look like what New York recently adopted
4: Yes, ventilation still matters.

High ventilation essentially shrinks the pool of susceptible people in a room.
5: CDC must update metrics for when to mask.

Test positivity, for example, was never an indicator of community spread and is even more flawed now due to the millions of at-home rapid tests that don’t make it into the tally.
6: One-way masking is fine.

Anyone who fears moving away from universal masking, the great news is that they can continue to wear an N95 mask — along with being vaccinated and boosted — and live a low-risk life regardless of what others around them are doing.
7: Make rapid antigen tests the gold standard for testing instead of PCR tests.

From a public health standpoint, what matters is not whether you test (+) days or weeks after you’re recovered; it’s whether you are actively infectious, which is what rapid tests tell us.
8: Isolation periods should be reduced from 10 days to five.

We should allow people to test out of isolation with two negative rapid tests. Current guidelines unnecessarily disrupt work, school and travel, providing a strong disincentive for testing.
9: Close contacts should not be sent home for quarantine.

Quarantine is a blunt instrument when you have no information on who is actively infectious.
10: Masks for kids in schools should be optional in the new year.

Risk of hosp to kids remains low, as it always has been. Plus, all school-age kids now have access to vaccines. Parents who don’t feel comfortable can always have their children wear high-grade masks (see #6)
Before vaccines arrived, the best public health strategy against covid was to throw everything we had at the virus — masking, distancing, hand-washing, cleaning, ventilation. That was the 2020 playbook, essentially an admission that no one strategy in and of itself was sufficient
Public health’s credibility is on the line now. The public and businesses see that public health guidance isn’t keeping up with the times, and they’re right.


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More from @j_g_allen

11 Jan
8 degrees in Boston. No outdoor activities at school.

My 9 year old: "So no mask breaks today? That's worse than freezing."

Don't tell me 2 years of masking doesn't impact kids. Their risk is low, vaccines avail for all adults and kids, anyone who wants can mask. It's time.
Read 10 tweets
3 Jan
Make no mistake, the costs of closing schools is high. Too many have gotten casual about this.

A thread.…
"Even short-term closings have steep consequences. Schools are the place where we first detect trouble at home, including neglect and abuse."
"An analysis of data from New York City found a drop of nearly 8,000 in expected reports of allegations of child maltreatment. When researchers extrapolated that to the rest of the country, they estimated that more than 275,000 cases would have otherwise been reported."
Read 14 tweets
29 Dec 21
I see a lot of people - on both "sides" - making simple mistakes about masks. I've studied PPE, taught PPE, and overseen PPE programs, including teams implementing fit testing in hospitals, long before covid.

A thread
1. Masks work

It's basic physics.…
I made one of the earliest calls for universal masking, for that reason.

April 2, 2020…
Read 17 tweets
20 Dec 21
1. Vax/boost are key (I said about 40x...)
2. Not reckless for NFL to stop routine testing of vaxxed. Were doing 1x a week which is a surveillance strategy, not a control strategy. (you've seen viral kinetics of Omicron, right?)

3. Overestimating transmission risk on the field (they have good ventilation/filtration in locker room, trainer, weight room...right? RIGHT??)
4. Overestimating superspreader risk in large volume spaces, like outdoor stadiums (and even indoor arenas)

5. Not just a $ issue. (So easy to attack in this way.) Many tens of thousands of incomes and livelihoods on the line (which, is, you know... public health), and what the sports leagues do influences what schools and others do (see: NBA closing, March 2020)

Read 4 tweets
4 Dec 21
It was never a question of if, only a question of when. And when that when happened, we knew buildings would play a key role in the a response.


1. ANTICIPATE (Dec 2, *2019*)
2. RECOGNIZE (Feb 9, *2020*)

"Even with this uncertainty, it is clear that we can enlist buildings to help us in this fight."…
3. EVALUATE (March 4, 2020)

"there is still some debate about how the new coronavirus that causes Covid-19 is spread. This has resulted in an overly narrow approach taken by the federal CDC and WHO. That’s a mistake."…
Read 6 tweets
29 Nov 21
This picture is creating misplaced outrage bc Biden is in a surgical mask instead of an N95.

1. Yes, N95s or KF94s are better if you need to wear a mask


2. Everyone is fully vaxxed and boosted, so masks provide limited benefit (especially considering 5 and 6)
3. Even though surgical mask has lower efficiency, the combined efficiency of two 70% masks is 91%. Saying they’re useless is incorrect.
4. In addition, surgical masks get dinged bc ‘leaky’ out the sides, but this misses point that they still help lower the concentration in the cone of emissions directly in front and slow the speed of the emission jet. (particularly relevant when you factor in 5 and 6 next…)
Read 5 tweets

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