🧵 The best solution to a complex problem is often the simplest.

If you went to engineering school in America in the last few decades, some frustrated professor probably told you 50 times to

Keep It Simple, Stupid!

KISS

The underlying tenet of successful engineering design.
2/ The SARS-CoV-2 pandemic is one of the most complex problems modern society has faced.

It is multifaceted.

It’s global.

There are both short and long term consequences for every aspect.

It’s a Gordian knot that requires a multi-disciplinary team to even begin to ponder it.
3a/ There are hundreds of aspects we could list, but just a sampling of how deep that rabbit hole could be:

Public health. Individual health. National and global economy. Individual financial stability. Healthcare system capability and overload. HCW death, disability, burnout.
3b/ Harmful lobbying by airlines and other corporate interests.
Mass infection and death. Human rights violations. Mass disability. Politicized public health. Propaganda and disinformation. Big pharma influence, control, and profit grabs.
3c/ Long term, potentially permanent heath issues (incl. KIDS). Forced repeat infections. Worker protections. Reversing work-from-home policies that helped climate change, the existing disabled community, and will be critical for the millions (and more) newly disabled by COVID.
3d/ Cumulative harm from repeat infection. Increased cardiac events and sudden deaths in kids, and people of all ages. Plummeting life expectancy and healthy workforce. Long term loss of workforce as kids die and are disabled. Viral mutations and inevitable antibody evasion.
3e/ Total lack of diagnostics and treatment. Need for universal healthcare and long term continuation of pandemic emergency provisions. Social and psychological support for death and disability survivors. Indoor air quality reform. Pandemic data gathering and reporting.
4/ The COVID problem is also fraught with inherent contradiction and opposing priorities, like:

Nat’l economy vs. individual income to survive
Political goals vs. protecting individual health
Touting jobs growth vs. establishing a robust program to support and treat long COVID
5/ There’s a long, detailed list that could be made, but you get the idea
6/ It’s a severe disease that people underestimated + misunderstood from the beginning.

Yes, it can spread by contact, but airborne is the big enchilada

Yes, it’s a respiratory disease, but mostly it’s a vascular wrecking ball

Yes, it’s a coronavirus but mutates like lightning
7/ Global leaders were terrified of implications, acted out of fear, made bad decisions that only worsened the problem

Certain facts and likely outcomes were obscured or twisted.

There was a fair amount of political spin and “public fear management”

Messaging was corrupted.
8/ “It’s airborne” should have been immediately noted

It’s a “SARS” virus, by definition “severe”

There’s no containing it

There was always potential for long term sequelae, like SARS 1

Rapid, widespread mutation was likely by infecting millions globally
9/ Our world is highly interconnected, so there is no way to stop spread of disease using travel bans.
10/ There are massive economic pressures, but keeping the economy going short term actually undermines long term economic stability by increasing post-acute disease, harm, disability, and death.

This is exacerbated by rapid reinfection and cumulative damage from each infection.
11/ Lockdowns help break spread of transmission, in hopes of regaining some control, but are difficult for multiple reasons.

Lockdowns are least effective when there is no cohesive strategy for what will be accomplished by the lockdown or specific, targeted measures to follow
12/ Vaccines help reduce hospitalizations and deaths associated with acute infection, but are not enough alone.

mRNA vaccines aren’t updated quickly enough and are not adequate.

They do not stop spread, prevent long Covid, or prevent post-acute severe outcomes.
13/ Masks help significantly but are undermined by lax public health policy that does not mandate use of, and make available, well-fitted, high-filtration masks

Such policy must be in tandem with robust public education on how/why masks work and how to properly fit and use them.
14/ Testing is absolutely critical, including equitable, affordable access to both rapid tests AND PCRs.

Requiring test-to-enter with verifiable results for school, work, leisure, travel — any activity — significantly increases the safety level by reducing likelihood of spread.
15/ Accurate, accessible data are the linchpin of pandemic management.

We need more data, not less.

We need case transmissions, not misleading green maps.

A federally managed, robust mandatory data collection and reporting effort should be the minimum standard.
16/ The US should have a federally standardized method of counting “COVID” cases, hospitalizations, deaths, long COVID cases, post-acute COVID hosp. and deaths, and wastewater.

This should be consistent with a global standard, so all data and reporting are “apples to apples”.
17/ Ventilation is critical and helpful, but many, especially schools, believe changing an HVAC filter is all they need to do.

This puts everyone, including kids, in even greater danger, because people believe there’s no risk.

This is on your watch, @CAPublicHealth @GavinNewsom
18/ Poor indoor air quality was a major issue before the pandemic.

If we’d addressed it sooner, we would’ve fared much better during the pandemic.

We need federal minimum standards, mandatory improvements *and* verification, with real time IAQ monitoring on a public dashboard.
19/ Distancing and reducing density are very helpful, but these measures were quickly discarded, especially in places like CA where space comes at a high $ cost.

Kids in CA sit at desks lined up edge to edge, with zero space.

Yes, this is on you, @lapublichealth @vcpublichealth
20/ The “Swiss Cheese Model” is spot-on, but public health officials have not embraced it, organized plans to effectively integrate it, even step-wise, and have not developed communications plans for the public.

The general public remains unaware

virologydownunder.com/the-swiss-chee…
21/ Together, the Swiss Cheese model protections can solve this problem, but only if it comes from the very top, as a focused, no-negotiation plan with funding + resources.

It would start with @POTUS @VP @WHCOVIDResponse @WHCOS and be universally supported by @dscc @dccc @DNC
22/

The virus is mutating rapidly, outpacing all tools and vaccines. We have unsustainable mass death and disability, sharp drops in life expectancy. Actuaries are alarmed. Kids are being harmed, and this will get worse.

Reducing this complex problem to a list:
23/ We must prevent infections. Urgently.

It’s necessary to protect national security, prevent healthcare system collapse, slow mass death and disability (there will be lag), long term economy, moral/ethical reasons, avoid future political catastrophe, preserve int’l respect.
24/ We must extend the pandemic emergency, support, and protections until we have a functioning, effective system in place to prevent infections.

Until we do, the virus will continue to mutate unchecked, and there is no survivable outcome. It’s not evolving to be “milder”.
25/ We must organize a funded, robust, globally-coordinated effort to understand, diagnose, and treat long COVID and post-acute sequelae.

This is like climate change. There will be a large, lagging wave of disease and disability even after we stop transmission, for years.
26/ We must have federal reform of worker protection laws in tandem with schools, for protection of students and staff. Same guidance, same protections. Everyone must have protection and legal options if workplaces and schools do not comply.
27/ We need urgent federal reform of the disability system to accommodate the mass influx of COVID disability.

COVID disability may be permanent. Kids being repeatedly infected in schools may be disabled or dead before college.

Programs are already inaccessible and unavailable.
28/ The fastest way out of this complex problem with hundreds of variables, global and international aspect, multiple inherent contradictions and opposing goals, with a rapidly mutating SARS virus is to take a step back and look at the big picture.
29/ We MUST go back to basics, right now.

Immediately.

We need to go back to KISS

KEEP IT SIMPLE, STUPID
30/ We must stop transmission

Any way, every way

Federally mandated

We need a public campaign that tells people

DO NOT SHARE AIR

With a media blitz and a 100 simple videos on social media

This must be an urgent message, and people need to know why

31/

THIS is what we need @JoeBiden @POTUS @VP @KamalaHarris @WHCOS @WHCOVIDResponse @CDCgov @CDCDirector @dscc @dccc @DNC @nirav_mainecdc to do.

THIS is what we need you to say:
32/

DO NOT SHARE AIR

COVID is a wrecking ball, destroying more of your body every time you’re infected

Some people live in houses of straw, some bricks. They will all fall eventually.
33/

DO NOT SHARE AIR

COVID wrecks immune systems like HIV. Every infection increases your chances of becoming immune compromised. You don’t want that. Look it up.
34/

DO NOT SHARE AIR

We are already on the road to overwhelming mass death and disability. The personal, moral, ethical, financial, societal, economic, political, and long-term costs of this are unfathomable. You don’t want this. You don’t want to be responsible for it either.
35/

DO NOT SHARE AIR

We knew it was important before, but there were a lot of things that were impossible to know, until we saw what this virus could do. We tried to hope for the best, but we have bad news. In fact, it’s dire. Grim. Way worse than we expected.
36/

DO NOT SHARE AIR

Science is not black or white. Science is about facing uncertainty, asking questions, testing theories, and gathering data to help inform decisions. We did our best, facing the most complex problem in our modern age, but this virus is formidable.
37/

DO NOT SHARE AIR

SARS-CoV-2 has much in common with some of the worst viruses we know. It is mutating rapidly, so we are adapting our strategy. Our public health agencies will protect public health. Our federal government will lead and establish federal programs.
38/

DO NOT SHARE AIR

While we do this, we ask you, urgently, to do your part.

DO NOT SHARE AIR

We are hastily revising and publishing guidance and establishing programs to support this.

DO NOT SHARE AIR

39/

Does anyone see a better way out of this?

The path we are on does not lead anywhere we want to go, but the public has been so misled and uninformed they are blindly running off the cliff.

If the public were aware, they could protect themselves, and help solve the problem.
Exhibit A:

We need honest, detailed and rapid tabulation and reporting of data.

Public health agencies can’t function properly without it, and laypeople forced to “do their own risk assessments” sure as hell can’t.
Exhibit A:

Long COVID is indeed the bulk of the iceberg that @JoeBiden’s pandemic response has neglected.

You should already be contemplating gapless transition from the current public health emergency to a future one for long COVID, @POTUS @VP @RepJeffries @dscc @dccc @DNC.
Exhibit A:

COVID and its related causes of death are responsible for increasing years of life lost (YLL) as it relentlessly circulates through the population, and reinfections do greater harm

Imagine if we were accurately and consistently tabulating data
acpjournals.org/doi/10.7326/M2…
Exhibit A:

Some world leaders (@WHO 👀) continue to fail at clearly and consistently stating that COVID is primarily airborne, and do not demonstrate proper understanding or PPE use.

How embarrassing.
Exhibit A:

Read this and give me one good reason why @POTUS @VP @WHCOS @WHCOVIDResponse @CDCDirector @dscc @dccc @DNC @GavinNewsom shouldn’t be on TV around the clock warning of new scientific findings, imminent risk to long term health and the economy.
Exhibit A:

The COVID pandemic, and the long COVID public health emergency that is hot on its heels, are every bit the national security risk that climate change is

@POTUS @VP @dscc @dccc @DNC should be coordinating with global experts like @Globalbiosec

smh.com.au/culture/books/…
Exhibit A:

The US pandemic policy failed. Big time.

Even worse, @POTUS @VP @WHCOS @WHCOVIDResponse @CDCgov @CDCDirector @dscc @dccc @DNC haven’t changed course, acknowledged the mistakes and fixed it.
Exhibit B:

Don’t catch it. COVID damages the immune system worse than HIV, causing immune deficiency in previously healthy people.
Exhibit A:

We unequivocally need to overhaul pandemic communications, admit lies and misdirections, and adopt a very clear, HONEST, communication strategy that acknowledges uncertainty and sticks to a simple message:

DO NOT SHARE AIR

Vax-only FAILED, @POTUS @VP @AshishKJha46
Here’s the link back to the beginning of the 🧵
Exhibit A:

Yes, wash your grubby hands, people, but follow this one simple rule:

DO NOT SHARE AIR

do whatever you want, wherever, whenever, indoors or out, as long as you

DO NOT SHARE AIR
Exhibit A:

We need a federal standard for mandated gathering and reporting data, with standard definitions, all coordinated with global efforts so worldwide data are “apples to apples”

We need to see excess deaths, total hospitalizations, and wastewater data, AT LEAST

@CDCgov
Exhibit A:

Moving goalposts, shady definitions, refusing to gather or report segments of data, manipulation, minimizing the impact of the pandemic

All of these increase transmission and reinfections➡️ increase long COVID➡️increase post-acute harm➡️damage the economy

@BEA_News
Exhibit A:

Dead and disabled people can’t work

Unchecked spread will continue this downward economic spiral for years

@POTUS @VP @JoeBiden @KamalaHarris @WHCOS @WHCOVIDResponse @nirav_mainecdc @dscc @dccc @DNC @CDCgov @CDCDirector @AshishKJha46 @ashishkjha
Exhibit A:

If you think we have a functioning disability system in America, you are woefully incorrect

If you’re in a position to make the urgent changes needed as millions are disabled by long COVID, you must act NOW. It’s an emergency

@dscc @dccc @GavinNewsom @NIH @POTUS @VP
Exhibit A:

Testing programs and funding are already being destroyed. People cannot reasonably or equitably access them, which undermines data collection and reporting, access to treatment, increases transmission.

It is IMPERATIVE that we have accessible testing

@nirav_mainecdc
Exhibit A:

It’s 2023. We should not *still* be here, in the mode of helping with very basic education about dangers of SARS-CoV-2 and how it spreads.

This is the job of @CDCgov @POTUS @VP @WHCOVIDResponse. Every day this administration fails at their job does exponential harm.
Exhibit A:

Rapid reinfections causing mass disability, wrecking immune systems.

Rapid reinfections of healthcare workers put the healthcare system at risk of collapse. How long will it take to replace highly trained HCWs? Will that even be possible with mass cognitive deficit?
Exhibit B:

Infection #3 while having long COVID from infection #2

Harm and risk from reinfections are cumulative.

@POTUS @VP @CDCgov @NIH @WHCOS @WHCOVIDResponse @AshishKJha46 @CAgovernor @JoeBiden policies are a direct path to mass disability, healthcare collapse, and death
Exhibit A:

Naive T cells absent following “recovery” from COVID infection. Just one of multiple ways COVID is damaging immune systems

what doesn’t kill you destroys your body’s defenses so every infection can have another go

@AmerAcadPeds @NationalNurses @KPSCALnews @EricTopol
Exhibit A:

This whole excellent 🧵 by Dr. Bari warns of these same threats.

We *cannot* continue on this path. If @POTUS @VP @WHO @WHCOVIDResponse @CDCgov @CDCDirector @nirav_mainecdc @AshishKJha46 @WHCOS @GavinNewsom @CAPublicHealth do not change course NOW, it’s disastrous
Exhibit B:

The pandemic response is failing at its most basic level if people are being infected by GOING TO THE ER.

This is unacceptable and 100% unsustainable, @JoeBiden @KamalaHarris @GavinNewsom @CAgovernor @WHCOS @WHCOVIDResponse @AshishKJha46 @nirav_mainecdc @NIH @ACLU
Exhibit B:

If you think our current broken, dysfunctional disability system will “tide us over” or “be fine” as millions become disabled by COVID, you should take a look at this.

We are careening off a cliff without a parachute.

@JoeBiden @KamalaHarris @WHCOS drive the bus ☠️
EXACTLY!

Toshi gets it ❤️

DO NOT SHARE AIR

COVID is the most dangerous disease in modern history. Continued transmission is a ☠️ end road

There is only one solution

This is not complicated #DoNotShareAir

@WHCOVIDResponse @PressSec @JoeBiden @VP @CDCgov @NIH @CAPublicHealth

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More from @StoneColdPillar

Jan 13
🧵Let’s do a thread on how often COVID and long COVID are trending

Maybe this will help @JoeBiden @KamalaHarris @POTUS @VP @WHCOS @WHCOVIDResponse @NIH @CDCgov @CDCDirector @dscc @dccc @DNC take this more seriously

Dead, disabled, sick people don’t work and aren’t happy voters.
Jump in, add your own anytime!
Read 11 tweets
Jul 27, 2018
THREAD
1/
How many times have you seen a map like this? Do you take it at face value?

Here’s why maps like this one, published by @nytimes, might be lying to us all.
nytimes.com/interactive/20…
2/
These maps are made using election results data. These are numbers all tallied up in a database or spreadsheet summarizing how many people cast votes for each party's candidates on election day, by precinct.

The maps are only as good as the data.
3/
If the data are correct, the map is correct.
If the data are wrong… you get the picture.
Here’s summary level info for Raleigh, for example.
Read 27 tweets
Jun 4, 2018
I am so disappointed in our country, but I know I am partly to blame. I was angry and disillusioned about the level of corruption in our government, at all levels, but I did not know how to change it. I became complacent and took too many things for granted.

NOW WE ARE AWAKE
I will never be complacent again. This corruption is completely intolerable. I am ANGRY + I will fight until we permanently change this country for the better.

I know you feel the same way. Our strength is in our numbers. We must stay united, strategic, and relentless.
#SKorea
Step 1: It is URGENT that we get Dems to the polls in record-breaking, shocking numbers.

That is what it is going to take to overcome all the GOP cheating, hacking, propaganda, and election fraud. Go door-to-door. Talk to your neighbors. This is absolutely critical.

#GOTV
Read 12 tweets
Nov 30, 2017
🔥👇READ THIS👇 🔥

NYU School of Law's @BrennanCenter Comments to @FEC on transparency of who is spending BIG BUCKS for online political ads

🚨Google, Twitter, Facebook🚨

@SenateDems @HouseDemocrats @SenateGOP @HouseGOP @StopBigMoney @maddow @ACLU @AP

brennancenter.org/analysis/brenn…
The internet is "a ripe target for foreign adversaries seeking to meddle in elections." The widespread effort by Russian state proxies to influence American politics included covert expenditures on political ads online.

Online political spending, is likely to increase.
#REGULATE
We MUST have transparency for all sources of spending on political ads, regardless of the medium.

🚨FEC has not updated regulations for current realities of internet use.
🚨Congress has also failed to modernize campaign finance rules.

WE WANT ACTION!
@FEC @JudiciaryDems

@CNN
Read 22 tweets
Nov 3, 2017
CALL TO ACTION
🚨🚨🚨🚨🚨
Pick up the ☎️ + let Trump sycophant MATT GAETZ know we want #FireproofMueller
202-225-4136
850-479-1183
850-479-1183
🚨🚨🚨🚨🚨
Time to #FireproofMueller
Trump water boy MATT GAETZ of #Florida 👇👇 wants Mueller out.
facebook.com/CongressmanMat…
Read 14 tweets
Oct 19, 2017
1/ Did you wake up on Nov 9, 2016 with a gnawing disquiet in your gut?

Me too.

Something wasn't right. It still isn't.

#unhackthevote
2/ Did you seriously question how in the hell election "results" could vary so widely from poll results?

Me too.

So did @mikefarb1.
3/ While the gov't was doing whatever it was doing, in a quagmire of political bullshit, @mikefarb1 + his Unhackthevote team stepped up.
Read 23 tweets

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