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Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
@celinegounder
Oct 2, 2022 • 30 tweets • 16 min read • Read on X
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1/ Must read by @TheAtlantic's @edyong209:
theatlantic.com/health/archive… Image
2/ Why did the United States of America🇺🇸 fail so spectacularly?

The Death Toll Says It All
by me for @TheAtlantic last December:
theatlantic.com/health/archive… Image
3/ The American healthcare system is designed for profit-making, not to care for patients & to help them stay & get healthy.

The point is to monetize every box, circle, arrow, & line in the flow chart: Image
4/ But we, the United States of America🇺🇸, refuse to learn.
theatlantic.com/health/archive… Image
5/ We have a once-in-a-generation opportunity to fix our crumbling schools
thehill.com/opinion/educat…
by me & @j_g_allen in @thehill Image
6/ Pandemics are by definition a collective action problem, not a problem for individuals to solve on their own.
theatlantic.com/health/archive… Image
7/ How America Can Rebuild the Community Bonds It Needs to Face the Next Pandemic
time.com/6138465/covid-…
by me, @RobertDPutnam & @shaylynromney for @TIME Image
8/ We need to build a sense of community because we have MANY more "we" problems ahead of us.
time.com/6138465/covid-… Image
9/ How can we build that sense of community?
time.com/6138465/covid-… Image
10/ How can we build that sense of community?
time.com/6138465/covid-…
(continued) Image
11/ How can we build that sense of community?
time.com/6138465/covid-…
(continued) Image
12/ How can we build that sense of community?
time.com/6138465/covid-…
(continued) Image
13/ How can we build that sense of community?
time.com/6138465/covid-…
(continued) Image
14/ We are not all free to protect ourselves & live healthy lives.
theatlantic.com/health/archive… Image
15/ In the United States of America🇺🇸, we blame people for getting sick & dying.
theatlantic.com/health/archive… Image
16/ Sickness & death are divine punishments for being somehow less deserving.
theatlantic.com/health/archive… Image
17/ Epidemics & pandemics are SOCIAL problems.
theatlantic.com/health/archive… Image
18/ "Medicine is a social science, & politics nothing but medicine on a grand scale."
onlinelibrary.wiley.com/doi/pdf/10.111…

But neither healthcare providers nor public health workers are armed with the tools for this work.

We're often ACTIVELY DISCOURAGED from doing such work. #ThisIsOurLane Image
19/ Americans are blinded by scientific & technological progress, not realizing that too few us of are benefiting from it.
theatlantic.com/health/archive… Image
20/ When we need public health most, our leaders are waging war against it
washingtonpost.com/outlook/2020/0…
by me for @washingtonpost Image
21/ Tools don't work if you don't have them & can't use them.
theatlantic.com/health/archive… Image
22/ The United States of America's🇺🇸 racist history has left us blind to policies that other developed nations have adopted, like paid sick & family medical leave or universal health insurance. Image
23/ When we need public health most, our leaders are waging war against it
washingtonpost.com/outlook/2020/0…
by me for @washingtonpost Image
24/ How can we put covid behind us without guaranteed paid sick leave?
washingtonpost.com/opinions/2022/…
by me & my @KFF colleague @Mollybrodie in @washingtonpost Image
25/ The pandemic isn't over.
26/ Even when we do make the transition to endemic, it does NOT mean COVID will have come to an END.
theatlantic.com/health/archive…
27/ It's in OUR POWER to decide at what levels to control COVID:
🔹at high levels of endemicity
(e.g. HIV or tuberculosis in parts of Africa)
🔹or low levels of endemicity

It's in OUR POWER to shape the "new normal. Image
28/ What might our "new normal" with COVID look like?
29/ What might our "new normal" with COVID look like?
30/ What about 300-500 deaths per day?
or 150K deaths per year?

Is that our new normal?

The United States of America🇺🇸 can do better.

That starts by imagining better.

That should be Our American Dream.

• • •

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 1
1/ Why the confusion over COVID vaccines now?

What’s changed isn’t the science. It’s the process.

Policy is increasingly announced by officials online & outside the usual evidence review, creating mixed messages for families.

on @CBSMornings with @edokeefe @TheKellyOGrady
2/ Normally, FDA reviews products, then CDC’s vaccine advisers (ACIP) publicly weigh evidence & vote.

CDC adopts guidance, which insurers & programs like Medicaid, the Children's Vaccine Program (CHIP), & Vaccines for Children follow.

That process has been corrupted.
3/ This season, the FDA narrowed COVID vaccine approvals:
🔹People 65+
🔹People 6m to 64y if they have at least one risk factor for severe COVID (including pregnancy)

Off-label use:
🔹Healthy people 6m to 64y in consultation with your doctor
Read 10 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 1
1/ It’s been a chaotic week at the CDC.

The director was fired less than a month into her tenure, four senior leaders resigned in protest, & the agency is still reeling from a shooting at its Atlanta HQ.

on @CBSNews @FaceTheNation with @EdOKeefe
2/ These aren’t just headlines about “palace intrigue.”

What’s unraveling is the basic machinery that keeps Americans safe: vaccines, outbreak detection, lab guidance, and expert support for state health departments.
3/ Within hours of the firing of CDC Director Dr. Susan Monarez’s, 3 leaders—responsible for vaccine safety, respiratory diseases, & the chief medical officer role—resigned.

Earlier that week, CDC’s head of data systems also stepped down.

More departures are expected.
Read 14 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Aug 22
1/ After the shooting at CDC earlier this month, employees sent a blunt letter to HHS Secretary Robert F. Kennedy Jr.

They said that instead of standing with them, RFK Jr. is spreading conspiracy theories about the CDC & their work.

on @CBSEveningNews with @jdickerson
2/ They called this dangerous & made 3 requests:
🔹Stop spreading inaccurate health info
🔹Affirm CDC’s scientific integrity
🔹Guarantee safety of the HHS workforce

savehhs.org/letter/hhs-sta…
3/ Since the shooting, CDC staff say they’ve been harassed with phone calls.

Callers mockingly ask, “Are you resilient?” before playing gunfire sounds, echoing CDC’s own post-shooting messaging.
Read 12 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Aug 20
1/ For the first time in decades, US pediatricians have released their own vaccine schedule, separate from the CDC.

Why? Because they no longer trust the government’s process.

Here’s what parents need to know. 🧵
on @CBSEveningNews with @jdickerson
2/ Earlier this year, the CDC’s vaccine advisory committee was overhauled.

All 17 experts were dismissed & replaced with just 7 appointees—several with a history of spreading vaccine misinformation or skepticism.
3/ The Vaccine Integrity Project was established to fill the void & brings together many of top vaccine experts.

Today, the Vaccine Integrity Project reviewed the most up-to-date science on the safety & effectiveness of flu, RSV & COVID vaccines.
Read 15 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Aug 8
1/ New CDC data show just how much ultra-processed foods dominate U.S. diets.

Americans get ~55% of daily calories from UPFs.

Almost 2/3 of what kids & teens eat is ultra-processed.

on @CBSEveningNews with @TheKellyOGrady
2/ The biggest sources?

Sandwiches, sweet bakery goods, packaged snacks, & sugary drinks. 🥪🍩🥤
3/ So why does this matter?

Because a major new U.K. clinical trial—the largest & longest yet—found that even “improved” UPFs can’t match the benefits of minimally processed meals. 🍎🥗
Read 14 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jul 29
1/@DeionSanders’ bladder cancer diagnosis was caught by chance, during a CT scan for an unrelated issue.

with @nateburleson @vladduthiersCBS @AdrianaDiaz on @CBSMornings
2/ Most bladder cancers are found when people notice blood🩸 in their urine, the hallmark symptom.

But early cancers can be silent, as in Sanders’ case.
3/ His scans, done for blood clots, ended up saving his life.

Even though his cancer was high-grade, it hadn’t invaded the bladder muscle.

That allowed surgeons to remove his bladder & cure him.
Read 18 tweets

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