1/ Over the past two years, we have discovered therapeutics that work for #covid19 such as Remdesivir; later we figured out the optimal time to use them. Months from now, we will have even more data & meds to use.
Delaying infections does have a benefit
2/ Over the past two years, we have discovered that #covid19 has effects on the body that are significant, even if they don’t kill you. The virus affects the heart, brain, vascular system & more. The costs become clearer over time.
Delaying infections makes those costs clearer
3/ When big waves of infection come down, the chance of getting infected during any given activity also goes down. We have certain measures— such as high filtration masks— which, if used right, can protect you through a wave. There are many who haven’t been infected.
4/ Essentially, getting infected need not be a guarantee, at least in the short run.
And delaying getting infected has many benefits, namely that we will have more biomedical advances, & the costs of infection on our health will also become more clear with time.
5/ None of these ideas should be controversial. Nor need they lead to judgment on people who have gotten infected, nor those who have given up on mitigation bc their governments & other pundits said to do so. As a doctor, of course I will bring forward a cautious view on health
6/ There are others who bring forward a more cautious view on the effects of #covid19 mitigation measures more generally, which also have had costs in their own ways. We are dealing with trade offs. But the costs of covid will become less over time for reasons mentioned above
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Perhaps unsurprising, those most readily downplaying the risks of #covid19 infection, incl #longcovid, have also never treated a covid patient.
You’ll be hard pressed to find many doctors doing this— we have seen enough patients die, or survive & still suffer afterwards.
2/ We have had a lot of spread — & we are at risk of a lot more (unmasking of course not helping). Telling ourselves it is mild doesn’t make that true, esp re more chronic health consequences.
Masking alone won’t solve this either. There’s a lot more needed than that.
3/ While many have been infected with #Omicron, there are likely many who have not been. With increases in BA2 variant, I suspect we will have enough susceptible people to sustain some level of resurgence soon, but unclear what that will look like. I hope I’m wrong. @jlsalinas7
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?
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”