Dear @amy_harmon, so, a few things. First the piece is entitled The Last Holdouts, which although you didn't write the headline indicates someone at the @NYTimes thinks those who mask are outliers, a small group who are out of step with America. 1/
Yes, you do give voice to those who still feel like they need to mask but the framing of what is happening is problematic. 2/
You characterize "the last holdouts" as "the vulnerable and the risk averse." This contains two categories those with underlying conditions & those who are fearful (i.e., risk-averse). Nowhere does the idea emerge that some of us masking is about our compassion for others. 3/
Thus all of this thus gets collapsed into individual choice, rather than any sense of common good, it's the you-do-you frame. 4/
Now let's talk about numbers--I looked at the poll you cite--the country is split in this poll with 50% saying they mask always, often or sometimes and 50% rarely or never in public. This doesn't suggest that the last holdouts are a small bunch. 5/
And you note: "The risks fall most heavily on those who are immune-compromised, over age 65, or lack the resources to treat infections or take time off work..." 6/
And you continue: "A Kaiser Family Foundation poll this month found that Americans making less than $40,000 per year were on average much more likely to express worries about getting seriously ill from Covid than those with higher incomes." 7/
43% of Americans make less than $40K/year. Add "the immune-compromised, over age 65, or lack the resources to treat infections or take time off work"
and you're describing more than 1/2 of America. This makes the always/often/sometimes group not a marginal demographic. 8/
Then there is this: "Public health experts emphasize the need for staying current with booster shots..." 9/
Sounds good, except about 14% of Americans are boosted. Then you go on to say: 10/
"But while many recommend masks indoors, they also say individual risk calculations should take into account that the virus is almost certainly here to stay and people need to ask: Do I want to mask, perhaps, for decades?" 11/
Actually this is what the consensus is from public health experts. There is little consensus on "you-do-you" and the public health of private risk. 12/ nature.com/articles/s4158…
And exactly no one says: "Do I want to mask, perhaps, for decades?" In fact, there are ways to combat the pandemic outside of masking that we have deferred, under-invested in or ignored, which could make masking less important in protecting ourselves and others. 13/
But: "Do I want to mask, perhaps, for decades?" does a lot of work for the argument you're making. It creates this idea of the cotton "iron" curtain, masks lowering down onto our lives for years and years, rather than being one small part of our mitigation efforts. 14/
So wrapped in a human interest story, cloaked in what is meant to pass for compassion, are quotes from others that pathologize your subjects: "Sometimes family members and friends can get a little exasperated by the hyper concern." 15/
Or: “People are constantly commenting about how I must just be scared, there must be something the matter with me...” Of course you don't say this but the entire piece is framed casting those who mask as an out-group for Times readers. 16/ en.wikipedia.org/wiki/In-group_…
Masking isn't a civic virtue, or even a simple public health intervention like seatbelts in the piece, it's either a private burden or a sign of risk aversion. That is why I and others are reacting so strongly to it. 17/
Your newspaper the @nytimes has enormous cultural power and political influence, you should not be surprised that criticism comes when you write about public health and public policy issues even embedded in what is cast as a human interest story. 18/
And I wish you well, we don't know each other and I am reacting to the words on the page, what they say and connote, and the narrative they advance in the middle of a pandemic. end/
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This thread by @EpiEllie is important & it points to a fundamental difference in training, outlook and incentives. The examples Dr. Wachter uses related to individual risk and he frames COVID choices in this way because many physicians don't think about population health. 1/
After three years of watching many people talk about risk in this way, it may be a structural feature of both the medical profession & the history of the medicalization of public health, which drove the field towards an individual-based approach. 2/ (see: ncbi.nlm.nih.gov/pmc/articles/P…
But the individual, patient-based approach to health leaves too much on the table because "Medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population." 3/ nam.edu/social-determi…
Any infectious disease doctor mocking people for wearing masks, giving a thumbs up to Vinay Prasad’s grotesque behavior really needs to consider who they serve and what they think the hell they’re doing. You disgust me.
As for @SHEA_Epi guidelines. What if we actually looked to see if nosocomial infection was happening in hospitals? Risk of SARS-CoV-2 Transmission from Patients With Undiagnosed COVID-19 to Roommates in a Large Academic Medical Center. 1/ academic.oup.com/cid/article/74…
As @dr_kkjetelina has mentioned and @AdeleGroyer has reported hospital based infections have spiked in the NHS. 2/
Yes PCR is a blunt instrument & testing everyone with it doesn’t pinpoint infectious cases, but would love to see @SHEA_Epi’s analysis of the data they used to make the decision to stop asymptomatic testing in healthcare facilities because this will now become national policy. 3/
Just a winter warning. We’re getting better at preventing #covid hospitalizations & deaths when people are optimally boosted, have access to treatment & care, but the Omicron variants are especially efficient spreaders, which means absolute numbers this winter could be bleak. 1/
.@germanrlopez‘s piece in the @nytimes yesterday makes the mistake of treating endemicity as a fact of life where #COVID19, #influenza, #RSV are just with us, sometimes one will be bad one year, sometimes another. 1/
As @ArisKatzourakis said in January, the set-point for viruses is not just fate, there is the potential for human agency here, where we can affect the levels of human suffering and death. 2/ nature.com/articles/d4158…