1/ The US #covid19 dialogue is overly focused on how restrictions are being lifted and what experts think about that
The questions I care about right now:
-what are we doing for preparedness?
-what are we doing for health equity?
2/ I want specifics from my government and leaders
How is indoor air/ventilation going to be improved in schools, businesses and public places? What's the timeline? What's the cost? Who is paying? What's the accountability mechanism if this doesn't happen?
3/ When will N95 mask supply be increased and to what extent? How will it be distributed? What were previous bottlenecks & how have they been addressed? When will more comfortable options be added? Will poorer communities have more access & supply? What about the terrible comms?
4/ What's the plan for future vaccines? How are we addressing distribution shortcomings? What about ongoing vaccine hesitancy or resistance- what efforts are in place to address this? And what about further closing vaccine inequities globally- what are we doing about this?
5/ Incidence is getting lower and lower in the US. This is the time to prepare and demand; this is the time to focus on how to protect the communities that are going to be hit hardest and hit first the next time around, again.
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2/ Earlier in the epidemic, @MonicaGandhi9 & Dr Rutherford from UCSF brought up variolation hypothesis as it relates to masking
Could masks have the benefit of reducing the viral load you are exposed to & could this potentially lessen severity of disease + prime immune system
3/ What is concerning now— if you pull back on mask mandates with high community incidence, especially in places with low vaccination / low booster rates
Lots more unmasked viral spread
Higher potential proportion of #LongCovid cases esp in these areas
More hospital-based spread of #covid19 during #Omicron than any prior waves. We knew this was a problem from prior waves— yet there is ongoing resistance to acknowledge it, to test for it, or do more to prevent it.
“The total # of people who contract Covid-19 while in the hospital remains unclear bc these figures only count patients who were in the hospital at least 14 consecutive days & don’t account for people who test positive after leaving.”
In our @JAMA_current piece, we lay out a few key reasons that hospital-based #covid19 transmission is likely underappreciated.
1/ few hospitals systematically test patients throughout and following their hospital stays. jamanetwork.com/journals/jama/…
2/ “Most hospitals only test patients for SARS-CoV-2 at the time of admission and therefore may miss some infections acquired after admission, especially because approximately 40% of SARS-CoV-2 infections are mild or asymptomatic and thus do not trigger repeat testing.”
3/ “Furthermore, hospital stays for many non–COVID-19–related conditions are short, so some infections will only develop after discharge and will be missed or misattributed to posthospital exposures”
1/ The biggest confounder in this study was the possibility that those who were more likely to mask in 2021 were more likely to only be doing lower risk indoor activities vs those without masks who were more likely to be doing higher risk ones.
2/ For example, it is possible that those who reported not wearing a mask indoors were also more likely to be eating indoors or drinking at bars indoors near others
while those reporting wearing masks indoor may have been shopping for essentials in less crowded settings
3/ Unfortunately, we don’t have that information (authors could run this analysis though)
We only know that those who reported always wearing a face mask were much less likely to test positive than those who reported never wearing a face mask
2/ The data in favor of using N95 respirators for shared air / public indoor spaces during surges will continue to grow. Those who are skeptics will eventually come around. But the time lag will result in many needless infections, hospitalizations and deaths. It already has.
3/ Limitations of studies are always important.
Authors mention: “First, this study did not account for other preventive behaviors that could influence risk for acquiring infection, including adherence to physical distancing recommendations”