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Abraar Karan Profile picture
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Feb 25 • 4 tweets • 2 min read
1/ It's difficult to see the pictures of severe #monkeypox infection in patients with uncontrolled HIV/AIDS in this Lancet case series. These patients are at high risk of death. These cases remind me of @NickKristof work on deaths of despair.

thelancet.com/action/showPdf…
2/ While these aren't the diseases that the term usually describes, the same social and economic despair underlies these infections as well. I have followed these cases in LA County as part of surveillance efforts for the past 6 months. Patients who were homeless, who had...
3/ significant mental health issues; substance abuse; relied on transactional sex for survival; and had other co-morbid sexually transmitted infections. These were patients who, because of these challenges, also were not consistently taking antiretroviral treatment for their HIV.
4/ With every outbreak, we see similar patterns of disease spread along the fault-lines of deep social and health inequities. Even when diseases spread more broadly, they most deeply affect those with the least power. These are the challenges that remain unsolved.

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More from @AbraarKaran

Abraar Karan Profile picture
Feb 4
This. In these mask RCTs, what’s rarely accounted for & hard to determine is when transmission happened. If it happens mostly when masks are off & that is happening way more than you account for in your analysis, you likely have significant misclassification of exposure bias.
2/ This doesn’t mean masks don’t work. What it might mean is that masks aren’t worn at all times they need to be in order for them to work. So pragmatically an intervention may need to increase compliance at specific high risk times when they are being removed.
3/ And when I use the word "work" here, it is really not a binary. The trial would be set up with an estimated effect size of the intervention. You are looking to detect that effect. That estimate is based on people complying with the intervention. But compliance is complex here
Read 9 tweets
Abraar Karan Profile picture
Feb 3
1/ "We identified high loads of #monkeypox virus DNA by qPCR in 35 (85%) of 41 saliva samples. Infectious monkeypox virus was recovered from 22 (67%) of 33 saliva samples positive for monkeypox virus DNA."

Interesting study but transmission more complex

thelancet.com/journals/lanmi…
2/ Detection of viral DNA in various samples is not equal to transmission. We often say that culturable virus is a proxy for transmission potential, but even this doesn't mean transmission routes from those specimens are inherently effective ones.
3/ We saw this epidemiologically play out during the current #monkeypox outbreak. We did not see major spillover outside of MSM sexual networks. If there was substantial droplet transmission, transmission patterns would likely have looked different than they did.
Read 7 tweets
Abraar Karan Profile picture
Jan 20
1/ Also, the move recently has been away from screening asymptomatic patients who are being admitted to the hospital. This will reduce burden on hospital/labs to process tons of samples, many which will be negative. It will miss some cases who are incubating + infectious
2/ I appreciate costs/benefits of this. On one hand, missed cases could transmit to staff who may be wearing surgical masks (still some protection but less than N95). For shared rooms, more concerning (see our paper) so would definitely screen prior

academic.oup.com/cid/article/74…
3/ In times of low community incidence, screening all asymptomatic may put strain on lab capacity for small benefit. If symptomatic or in shared rooms, would definitely advocate for testing in this scenario though as outlined above. Benefit of hospital is you can identify quickly
Read 4 tweets
Abraar Karan Profile picture
Jan 20
1/ I was asked yesterday by @mehdirhasan about the ‘with v for’ argument on #covid19 hospitalizations/deaths which has been used by some to argue that hospitals are over-counting @MSNBC
2/ One of the arguments is that we have 'over-screened' because many infections aren't leading to 2020-21 pneumonia syndromes. Or, that screening can/does sometimes pick up persistent positive on rtPCR representing old infections
3/ This is true to an extent. But the other side of this is that screening during times where there is high level of community spread still helps identify cases who would likely benefit from antivirals. And, to reduce spread to other hospitalized patients and staff.
Read 12 tweets
Abraar Karan Profile picture
Jan 20
Spoke to @mehdirhasan today alongside @jeremyfaust ⬇️

CDC has public facing data on excess deaths during the pandemic— they specifically highlight that it’s still likely an undercount given covid-related complications aren’t always accounted for in the reporting.
2/ Many of us who have worked on primary teams in the hospital during the pandemic have filled out death certificates. We put thought into this when referring to the primary cause of death as well as contributing causes.

3/ It’s true that covid19 as a clinical syndrome has presented differently over time. In the beginning we saw mostly covid19 pneumonia. Over time, we have seen the clinical syndrome change as more have been vaccinated & have survived prior infections.
Read 4 tweets
Abraar Karan Profile picture
Jan 18
Many postmortems of the first years of the pandemic clearly point to social inequities as the biggest driver of rapid pathogen transmission. What have we done to change this for the next time we are dealing w a highly transmissible pandemic-prone pathogen?
2/ We were able to stop covid19 transmission in 2020…with enough money and resources, the NBA did this, creating a literal bubble to allow their business to continue as frontline workers couldn’t even get proper PPE to protect themselves and families from dying. Think about it
3/ We now are watching a struggle between advocates who are pushing for public health institutions in this country to do more & others who are tasked with protecting the status quo. There’s no way forward until we fix the major fault lines that allowed covid19 to hit us this hard
Read 4 tweets

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