Abraar Karan Profile picture
Jun 29 5 tweets 2 min read
1/ Important announcement today from @WhiteHouse on #Monkeypox response

Focus on vaccine supply & delivery, increasing testing, & working within communities

@rajpanjabi knows how to get this done— he has done it before in his career in global health
whitehouse.gov/briefing-room/…
2/ As a clinician & public health researcher, I think that testing — especially decentralizing this as much as possible such that people can pick up kits, swab suspected lesions, & drop samples off through safe collection sites, will be key to controlling this outbreak.
3/ What is also tough here are cases that don’t have visible lesions; on prior CDC clinician call noted some cases only had proctitis; & others had no viral prodrome, so they didn’t know they were sick until later. This makes controlling transmission difficult
4/ Working within communities to get both vaccines & tests out — actually implementing this— is crucial & definitely more than half the battle.

Understanding more about transmission dynamics also really important; yes close contact but w/ a more transmissible strain, what
5/ does this look like in real world during this specific outbreak?

Need to be able to advise people accordingly — & early messaging shapes a lot around what happens later, as we saw w covid19

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More from @AbraarKaran

Jun 30
1/ If people could see virus in the air the way we can see when a surface becomes soiled & dirty, it would be beyond obvious why we have ongoing surges, and more so how ridiculous it is to frame transmission as acceptable when we are not addressing this
npr.org/sections/goats…
2/ For many, it can be difficult to conceptualize how transmission is happening via airborne spread (near & far), & as a result efforts to do something about this haven’t gained enough momentum in the general public— politicians feel that they can move on without fixing this
3/ thanks @m_scribe @NPRGoatsandSoda for writing this piece. @CorsIAQ @linseymarr

We are starting up some work @Stanford very soon looking into how well low cost devices can slow transmission - more on this next week
Read 4 tweets
Jun 24
1/ My new piece in @bmj_latest — public health innovation, not clinical tools, can end the #covid19 pandemic. Step one was reducing deaths urgently; now, we must reduce transmission or we’ll remain vulnerable to big surges.

bmj.com/content/377/bm…
2/ In here, I discuss my recent personal bout w/ infection/ reinfection within 5 months. And, how the recent surge had left us with a short-staffed team at one of the community hospitals where I work.

I also highlight some work from colleague @sri_srikrishna on ventilation
3/ @sri_srikrishna essentially took matters into his own hands to protect his child’s classroom in SF. He has outlined many excellent threads on this (one that is linked in the piece). @RanuDhillon Sri & I have some pieces in the works with more details to come soon.
Read 4 tweets
Jun 20
1/ The combination of the following is what is changing the discourse around Covid:

-people are being told it’s time to move on because we have excellent clinical tools

-people are starting to believe there’s little more our government can or will do to prevent transmission
2/ As a clinician, I’m thrilled that we have far fewer hospitalizations & deaths from Covid

But I’m not convinced we have moved the dial on preventing transmission at all

The clear weakness of a clinically-focused strategy is that it depends heavily on variants
3/ And what variants we are dealt next are largely out of our control. What we can predict is that the key transmission routes—the air— will not change.

This is why our government’s focus should be equally on how to upgrade public ventilation/filtration systems.
Read 5 tweets
Jun 19
1/ The idea that individuals can indefinitely protect themselves breaks down quickly. Both times I was infected, my likely exposure was from a loved one who became sick first & was visiting my 1 bedroom apartment. How they got infected was less clear. It doesn't matter.
2/ What matters is that high community transmission means people will eventually get infected unless they cut out most if not all social interaction or ensure every single person in their circle utilizes all precautions perfectly at all times. It shouldn't be this way.
3/ Each time I was sick, another infectious disease doctor had to cover for me. For them, this meant having to leave their research work on pause

This week while I was working, other doctors were out sick meaning two of us had to cover the work of a 5 person team for a few days
Read 7 tweets
Jun 15
1/ As shared recently, surge of infections has truly affected us all once again. At one of the hospitals I work at, enough residents are sick such that we have reduced staffing on our very busy infectious disease service. I got sick again (2nd time this year) in May as well.
2/ This required having a backup ID physician cover for me. Thankfully I caught my infection before I had gone into the hospital that day using rapid tests that morning. On top of this, I wore N95 in the hospital the days before diagnosis— no one I worked w contracted infection.
3/ However you might feel about severity of covid & whether it’s a problem worth solving or not, having multiple doctors out of work sick at the same time is not a good thing. And that too multiple times in a year. As we saw, @SecBecerra now seems to have been infected twice
Read 5 tweets
Jun 4
1/ Just got off a flight where we ran into heavy turbulence. The pilot quickly told us to buckle up. Seatbelts clicked immediately.

It got me thinking about trust & how it was so automatic to listen to the pilot in that moment.

For covid, who is flying the plane?
2/ We have gone through two administrations, who at different times and for different reasons, lost trust.

Most recently, it was for not being clear about the risk of infections, instead pushing forward maps of green that represented hospital capacity which were misunderstood
3/ The pilot had us put our seatbelts on *before* the turbulence started. He didn’t wait until some of us were flying out of our seats to do so.

Prevention, folks.

And no one protested! It built trust for me knowing there was communication, & a tangible benefit.
Read 4 tweets

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