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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
Jul 26
1/ New Hope Against Dementia: study says singles vaccine also appears to delay onset of dementia
with @CBSMornings' @tonydokoupil @AdrianaDiaz @nateburleson
2/ A study published yesterday in Nature Medicine found that the new Shingrix vaccine was more protective than the old Zostavax vaccine in delaying dementia.

The Zostavax shingles vaccine was discontinued after the Shingrix vaccine was approved.

nature.com/articles/s4159…Image
3/ The Shingrix vaccine is also more protective than Zostavax in preventing shingles.

Shingles is caused by the varicella-zoster virus (VZV), a herpes virus that also causes chickenpox.
Read 15 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 19
1/ Why are People Promoting Raw Milk?
by @elizabethics for @RollingStone


If you drink unpasteurized milk, you don't just risk getting #H5N1 bird flu.rollingstone.com/culture/cultur…
2/ Image
3/ Image
Read 5 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 19
1/ Tick-borne infections are on the rise around the country

with @CBSMornings @GayleKing @tonydokoupil @nateburleson
2/ A unique collaboration among hunters,
the Texas Parks & Wildlife Department @TPWDnews,
& researchers at @Baylor University
is helping to map what tick-borne diseases can be found where.
3/ Lyme disease is the most common tick-borne infection in the US, but it's far from the only one.
hopkinslymetracker.org
Read 13 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 14
1/ #H5N1 bird flu update on @CBSMornings with @GayleKing @vladduthiersCBS @nateburleson

Who's at risk for bird flu right now?
🔹You're at risk if you're a dairy farmworker &/or if you drink raw milk.
2/
🔹If the virus mutates (which is what viruses do!) & becomes transmissible between humans, we could have a pandemic virus on our hands.
3/
 🔹Flu viruses can mutate incrementally (drift) or dramatically (shift).
🔹We see dramatic shifts when 2 flu virus strains infect the same animal or person.
🔹Those 2 flu strains can swap "body parts" & form a Frankenstein virus.
Read 9 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
May 30
1/ #H5N1 bird influenza is deadly to birds.

Most of our flu vaccines are manufactured using eggs.

Birds lay eggs, but they can't do that if they're dead.

Houston, we have a problem.

cbsnews.com/video/scientis…Image
2/ Influenza virus is grown in eggs.

Then the virus is inactivated (i.e. killed) & formulated into flu vaccine.
3/ Cell-based vaccines (e.g. mammalian cells, insect cells) elicit better immune responses, but egg-based manufacturing has cornered the market on flu vaccines.

Pfizer & Moderna are developing mRNA vaccines for influenza.
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
May 13
1/ What is H5N1 bird flu costing dairy cattle farmers?

Let's say you have a 5,000 cow dairy.

Those cows produce an average of 85 lbs of milk per day
= 425K lbs of milk/day x 7 days/week
= 2.975M lbs of milk/week
2/ Milk producers are paid by "hundredweight" (cwt).

The current class III price is $18.66/cwt of milk. Image
3/ So the gross revenues of the farm per week are:
2.975M / 100 x $18.66
= $555,135/week

The breakeven price
i.e. Gross revenue - Input Costs = 0
is between $17 & $21.
Read 7 tweets

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