“It took me a relatively short time in Haiti to discover that I could never serve as a dispassionate reporter or chronicler of misery. I am only on the side of the destitute sick and have never sought to represent myself as some sort of neutral party.” Dr Paul Farmer. 1959-2022
I saw rumours of the loss of Paul Farmer early this morning, and sadly they have been confirmed. I know so many who have been inspired by his example nytimes.com/2022/02/21/obi…
He also wrote beautifully about the ugly subject of inequities in healthcare. Read this on “Stupid deaths” (incidentally every time I am on Huron ave I think of this piece, for reasons that will be obvious) lrb.co.uk/the-paper/v37/…
Paul Farmer’s life and work show us what *is* possible, and that should inspire us to redouble our efforts across public health. I can think of no better tribute than working to erase those inequities. To lift those unable to access better health to a place they can do so.
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Vaccines that protect against severe illness and death have been available for more than a year. In this we estimate conservatively that in the US ~135,000 lost their lives to covid over the Delta wave for lack of vaccination medrxiv.org/content/10.110… 1/n
Because vaccines were not immediately available to all we only look at 5/30/21 to 12/4/21, after which omicron rapidly took over and the situation changed (again). By the start of that time even I (youngish, not in a priority group) was vaccinated 2/n
All this makes use of data from covid.cdc.gov/covid-data-tra… vaccine-status. Please read the preprint for full details, but a few major points follow 3/n
I’ve been thinking the last few days how it’s hard for non-specialists, watching a twitter spat between apparent experts, to know who to believe. Here are a few things I bear in mind when following people outside my own field. A far from exhaustive list 1/n
The person who posts the most is not necessarily the one with the most or the best evidence. They may simply be the person with the most time. Once I'm done with this I will be making my kids dinner and spending time with them, so don't expect me to notice twitter😊 2/n
The person with the fancier credentials is not always right. Nor is it the case that every loud voice with narrow experience is bravely telling truth to power 3/n
This is a completely reasonable request about what recent UK (and other) data means for the pandemic, and in particular BA.1 and BA.2 (let alone BA.3 which, yes, is a thing). Here goes 1/n
BA.1 and BA.2 (leaving 3 aside for this) are *both* omicron. They are deep branching cousins within the lineage, separating almost a year ago (phylogenetic types don't at me, this is in general terms) 2/n
Now they can be distinguished using this neat property of one of the diagnostic tests. BA.1 has a mutation which means some tests produce a weird characteristic result called Spike Gene Target Failure or SGTF. Most other circulating viruses (including Delta and BA.2) don't 3/n
Despite the very sharp drop in wastewater numbers in the Boston area, daily covid deaths are ticking up towards last winter's peak. What can we learn from elsewhere? Well let's compare with the UK, which is a little further along the epidemic curve 1/n
I pick the UK not only because it's where I was born, but because the population is about 10x that of MA, meaning it's easy to do the math in your head, look at this 2/n
So per capita, MA is seeing roughly twice as many daily covid deaths as the UK right now. Lots of possible reasons for that, but this one is important. About 36% of the population in MA is boosted (from mass.gov/doc/daily-covi…) 3/n
What did I say last Friday about the Boston area peaking? The wastewater data are in, and the news is good. @MWRA_update and @BiobotAnalytics providing solid evidence, that importantly *can't* be put down to exhausted testing capacity or other factors 1/n
this is obviously good, but it's not out of the woods good. Many of these infections were in younger age groups. We are now starting to see more infections in older folks, who are more likely to require hospital care 2/n
this would be expected to lead to fewer but more consequential infections in terms of healthcare, and a curve there closer to a plateau. They might drop more quickly than that, and they did in S Africa, but there are more older people here (albeit they are more boosted) 3/n
Why are we not all chilled given vaccines work against severe illness even with omicron? Well in the US (and pretty much anywhere) we are yet to see infections of large numbers of older people, and healthcare is already stretched. Here goes 1/n