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Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
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Oct 2 • 30 tweets • 16 min read
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 30
1/ Doctors & other healthcare providers should be prescribing Paxlovid more aggressively.

Less than 30% of 80-85 year-olds with COVID are getting prescriptions for Paxlovid.
2/ The older the patient, the more co-morbidities they have, & the more drugs they're on.

But there aren't that many drug-drug interactions to worry about!
3/ Among the top 100 prescribed drugs, only 2 have interactions so severe that Paxlovid should be avoided altogether:

Xarelto = rivaroxaban
Serevent = salmeterol

idsociety.org/globalassets/i…
Read 8 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 30
1/ @CDCgov is warning about a Listeria monocytogenes outbreak in 6 states:
🔹California, Georgia, Massachusetts, Michigan, New Jersey, Texas
🔹5 have been hospitalized
🔹Brie & camembert🧀made by Old Europe Cheese may be contaminated & making people sick.

cdc.gov/listeria/outbr…
2/ Old Europe Cheese has recalled more than 20 brands of brie & camembert cheese.

Recalled cheeses🧀 were sold nationwide in the US & Mexico.
3/ Do NOT eat recalled cheese.🧀🤢 Throw it away.

Clean your refrigerator, containers, & surfaces that may have touched the recalled cheese.

Listeria can survive in the refrigerator and can easily spread to other foods & surfaces.
Read 7 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 30
1/ Here are the latest @KFF Vaccine Monitor survey results that so many of you have been asking about!

kff.org/coronavirus-co…
2/ 77% of adults say they've gotten at least 1 dose💉 of a COVID vaccine.

26% say they've gotten 2 doses💉💉.

47% say they've gotten 3 doses💉💉💉.

23% say they're unvaccinated, of whom 88% say they definitely won't get vaccinated.
2/ The @US_FDA has authorize both Pfizer & Moderna's COVID vaccine boosters, which have been updated for Omicron BA.4/5.

Only half of adults have heard much of anything about these boosters.

20% have heard nothing at all about them.
Read 12 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 30
1/ Hurricane🌀 health & safety tips

Climate🌎 change➡️More frequent & bigger hurricanes

🔹People should avoid walking through flood waters, too.

These waters can be contaminated with sewage💩, hazardous chemicals, dangerous debris or electrical lines, & wild animals🐍🐀.
2/
 🔹If you are wounded by debris, you should clean the wound thoroughly, get a tetanus shot💉, and monitor for signs of infection.
3/
 🔹Exposure to floodwater can cause skin infections, gastroenteritis, tetanus, and leptospirosis (with exposure to rat urine).

🔹People who must wade into flood water should wear rubber boots🥾/gloves🧤 & eye🥽 protection.
Read 15 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 25
1/ Great interview with Dr. @_danielle_carr on @NPR @wamu885's Consider This about her brilliant @nytimes guest essay (see🧵below).

npr.org/2022/09/21/112…
2/ It might sound like a good idea for health care providers to screen everyone for mental health issues on the face of it.
medpagetoday.com/psychiatry/anx…
3/ But what are the drivers of increasing depression, anxiety, substance use, overdose & suicide?
Read 6 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Sep 21
1/ What works to prevent long COVID?

Here's a study of 2560 healthcare workers in Italy.
29% got COVID, of whom 31% got long COVID.

pubmed.ncbi.nlm.nih.gov/35796131/
2/ The prevalence of long COVID went down with each pandemic wave: 48%➡️36%➡️17%

which implies that immunity vs COVID is protective vs long COVID.

But if you get your immunity through infection, you also run the risk of getting severe COVID or long COVID from that infection.
3/ The prevalence of long COVID also went down with each dose of COVID vaccine:
42% in unvaccinated
30% with 1💉vaccine dose
17% with 2💉💉vaccine doses
16% with 3💉💉💉vaccine doses

which also implies that immunity vs COVID is protective vs long COVID.
Read 5 tweets

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