Abdul El-Sayed Profile picture
Public Health Doctor. Epidemiologist. Progressive. Author, https://t.co/NACQms6cng & https://t.co/avmXp8QZnl. Host #AmericaDissected. Commentator @CNN.
22 Jul
When you read #COVID19 headlines like this, the key takeaways should be that:

1) we’re not testing enough
2) we’re testing the wrong people
3) asymptomatic & low symptomatic spread are a big issue

1/
statnews.com/2020/07/21/cdc…
Our lack of testing has been a consistent problem (nevermind what the politicians tell you) since day 1.

But it’s also about *who* gets a test. A test is only as good as the info it tells you. So you don’t want to use it to tell you something you already know.

2/
For example, if I told you I had a test to tell you your eye color, would you take it? No. Because it doesn’t tell you anything new.

But testing strategy in the US has been used this way too.

Especially early on, but even now, we mostly test symptomatic ppl w/ exposure.

3/
Read 6 tweets
21 Jul
Fascism is a word so often misused, that it immediately elicits eye rolls from serious ppl.

But it has a meaning: ultranationalist, dictatorial gov’t that deploys fear of the other, both inside & outside the nation, to consolidate power.

Trump is accelerating fascism.

1/
Think about the way Trump talks about #BLM protests as an “anti-American” Force, not out to promote racial equality, but to tear down American “heritage.”

His deployment of CBP paramilitary on the streets in #Portland is a profound escalation acting on that narrative.

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Consider the fact that he continues to call #COVID19 the “China virus” and stoked conspiracies that it had been developed in a lab in Wuhan to reinforce the narrative that they are the enemy abroad.

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Read 20 tweets
19 Jul
A thread of @realdonaldtrump quotes about #Coronavirus in chronological order for context the next time he calls #DrFauci "alarmist":

1/30 - "We only have five people. Hopefully, everything’s going to be great."

2/2 - "We pretty much shut it down"
2/10 - "Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away."

2/24 - “The Coronavirus is very much under control in the USA."

2/26 - “When you have 15 people...that’s a pretty good job we’ve done.”
2/28 - "Now the Democrats are politicizing the coronavirus...And this is their new hoax.”

3/6 - "Anybody that wants a test can get a test."

3/10- "we’re doing a great job with it. And it will go away. Just stay calm. It will go away"
Read 7 tweets
13 Jul
No, scientists & doctors didn't "lie" to you about #masks.

To think so requires a fundamental misunderstanding of science & public health policy.

Scientific knowledge changes. Public health policy changes with it.

Mask policy is an example.

A thread:

1/
Science is not a body of knowledge. It doesn't *say* anything.

Science is a process.

We propose hypotheses about how something works in the world, then use experiments that try to disprove those hypotheses. If we can't disprove them, we assume them to be true--for now.

2/
The novel #Coronavirus is "novel" because it only emerged in humanity at the end of last year. Obviously, that's not a lot of time to study & understand this virus.

When it first emerged, the science community reasonably inferred it would behave like other coronaviruses...

3/
Read 10 tweets
8 Jul
I support #MedicareForAll. It's why I supported @berniesanders. It's why I co-authored "Medicare for All: A Citizen's Guide" w/ @micah_johnson_.

And it's also why I agreed when Bernie asked me to join the Unity Task Force on healthcare.

A thread:

1/
Joe Biden isn't Bernie. He does not support #MedicareforAll—we deeply disagree on this.

But he does support universal coverage, expanding public coverage, reining in Pharma, & health equity—things we DO agree on.

Our Task Force recommendations build upon these aims.

2/
Our Task Force worked hard & I'm grateful to the team & Co-Chairs @PramilaJayapal & @vivek_murthy.

We didn't agree on everything, but we came to recommendations that will yield one of the most progressive Dem campaign platforms in history-tho we have further yet to go.

3/
Read 19 tweets
26 Jun
Usually it takes more than 4 months for history to repeat itself. But here we are.

THREAD

Politicians still haven't wrapped heads around the dynamics of #COVID19.

Some truths:

1) You aren't seeing what's happening *today* you're seeing what happened 5-7 days ago.

1/
2) The number of cases isn't as important as the speed of spread. Once you have several days of increasing cases in a row, you've got a big problem...

3) ...because when it hits peak spread, it doubles in 2-3 days.

Put all that together...

2/
...and it means that by the time your daily case numbers show a week of increasing cases, you're WAY behind on trying to curb it.

In fact, you could be looking at an undercount by a factor of 4-16x because of points #1 & #3.

You need to act. You needed to act 1-2 wks ago.

3/
Read 6 tweets
13 Apr
I interrupt your regularly scheduled #COVID19 programming to offer some reflections on @berniesanders, @JoeBiden, and beating @realDonaldTrump.

THREAD.

First, there's no way around the disappointment that Bernie Sanders won't be President.
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As a global #pandemic exploits the DEEP insecurities in our society, it's clear that the policies @BernieSanders fought for have NEVER been more important.

I think many of us will reflect for a long time on what might have been--what COULD have been.

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Ideally, elections are a battle of ideas...

But this primary was fought on the singular terrain of defeating @realDonaldTrump. It was the Democratic party's fight or flight response to an existential threat to Democracy in the form of Trump.

3/
Read 16 tweets
27 Mar
I've been asked how I'd respond to #COVID right now:

a THREAD:

5 goals:

1) See curve: deploy tests efficiently
2) Flatten curve: Reduce transmission
3) Prepare for curve: Increase healthcare capacity
4) Catch curve: Contact trace below a threshold
4) Save livelihoods

1/
GOAL #1: SEE CURVE -

We don't have good visibility for 2 reasons:

a) our tests are being used mainly on ppl who already presumptive(+) because we're using them at point of care for sick pts.
b) there's a huge gap btwn when ppl are infected & when we get their test outcomes

2/
So instead of using tests at point of care when it doesn't change management:

1) I'd be saving 5-10% of our #COVID tests to deploy in a small representative sample of the population to better understand the spread of disease, and the burden that's on its way

3/
Read 21 tweets
24 Mar
Last night the CEO of @BCBSM (Blue Cross Blue Shield) took over my TV screen in an ad to tell me about all they're doing re: #COVID19.

He didn't answer a few other questions I have about helping hospitals and low-income ppl in MI as this #CoronavirusPandemic rages:

1/
1) @BCBSM (Blue Cross Blue Shield): Hospitals rely on you to reimburse services they provide. They can't do elective surgeries that keep them afloat.

How are you helping them stay open through the #CoronavirusPandemic? Will you keep them open?

2/
2) @BCBSM (Blue Cross Blue Shield): how are you supporting low-income ppl who AREN'T suffering #COVIDー19 but ARE struggling with the other diseases humans get, like diabetes, heart disease, or cancer and lost insurance right now?

Will you extend their coverage?

3/
Read 8 tweets
20 Mar
THREAD on what’s wrong w/ #testkits right now:

A friend had a patient w/ chills/cough, plausibly w #Covid_19, but w/o known exposure.

He requested a #coronavirus test. He was denied.

Then he tried an X-ray to rule out pneumonia, but he was denied for possible #COVID

1/
So this poor guy can’t get a #Covid test because he had no travel history or known exposure to #coronavirus.

And he couldn’t have pneumonia ruled out because a doc thinks he might have #Covid_19.

He’s caught in a testing catch-22

2/
The OBVIOUS first issue is that we STILL don’t have enough #testingkits otherwise this guy would get one.

But there’s a second issue: we’re not using them correctly either.

In medicine/public health you never run a test that won’t change your management.

3/
Read 6 tweets
17 Mar
This graph is CHILLING. Let me explain:

It shows the number of #COVID cases by age in S. Korea (red) vis Italy (green). And there are WAY more young cases in S. Korea.

Why? NOT because younger ppl get it in S. Korea. But because S. Korea TESTS young ppl.

THREAD

1/
In Italy (like the US), they're only testing ppl w/ symptoms. And the ppl who show symptoms w/ #COVID19 are older and sicker. That's why their numbers are skewed by age.

But in S. Korea, they're testing everyone, meaning their catching the young, asymptomatic cases, too.

2/
So remember the pics of all those kids partying this weekend? Well, they think they're not going to get the #Coronavirus. That's not true, they're just not going to get SYMPTOMS of #Covid_19. But this graph shows that they might still get it--and unknowingly pass it on.

3/
Read 4 tweets
15 Mar
I keep hearing #herdimmunity is going to solve #COVID. Here's why IT WON'T WORK:

First, a primer on what "herd immunity" is:

Getting an infectious illness requires contacting people who are infected. If ppl are immune, they can't carry the virus.

SO...

THREAD

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The more people who are immune in a "herd", the less likely anyone in the herd is to contact anyone who is infected--the less the disease spreads.

You're protected by the immunity of ppl around you.

Herd immunity is a key reason why vaccines are so powerful.

2/
But there is no #COVIDー19 vaccine. And the only way to obtain herd immunity is for ppl to GET THE DISEASE.

Ppl telling us that the solution is "herd immunity" are literally saying that we should encourage more people to get sick.

That's CRAZYTOWN for three reasons:

3/
Read 6 tweets
14 Mar
Young people! I’m hearing one of three things re: #COVID19:

1) “I’m not in the high risk zone, so I’m good, nothing changes.”

2) “I have an underlying condition so I’m so screwed.”

3) “I am healthy but I am still SUPER anxious about all this.”

THREAD

1/
If you’re in group 1:

Remember, the greatest risk to you may not be to YOUR body—but it may be THROUGH YOUR body to someone else’s—that would be devastating.

We practice social distancing, great hand hygiene, & vigilance not just to protect ourselves, but folks we love.

2/
If you’re in group 2:

First, you’re not screwed! We’re doing all this to make sure of it.

What CAN you do? The same thing as everyone else (social distancing, great hand hygiene) + stock up on supplies. Don’t buy a ton of TP, do get 2 months of your meds/canned foods.

3/
Read 4 tweets
13 Mar
A challenge w/ #COVID is that panic, itself, is contagious—an “infodemic.”

Without strong, evidence-driven leadership, local leaders default to the most stringent policies.

We’re seeing this at all levels—from banning travel from Europe to shutting down schools.

Thread:

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For example, School closures MAY be right, but we don’t have any evidence; & they could do harm:

1) healthcare workers who are needed on the front lines have to scramble for care

2) it forces seniors—at most risk—to care for kids.

3) tons of kids rely on school lunches.

2/
AND we know that kids actually have low risk of serious #COVID. Only 2.4% of all cases in one study.

Rather than make policy specific to #COVID, ppl are borrowing policy from other infectious epidemics, like flu, which is super deadly for kids.

3/
washingtonpost.com/health/2020/03…
Read 7 tweets
8 Mar
Never mind what the insiders & powerbrokers tell you, if you’re SERIOUS about solving Michigan’s problems, @BernieSanders is THE ONLY real choice for
- union rights
- healthcare
- racial justice
- education
- Great Lakes protection
And SO many more...

A thread:

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Nobody stands with unions like @BernieSanders. He opposed NAFTA, recognizing it would fundamentally destroy our manufacturing economy by giving corporations carte Blanche to exploit foreign labor.

He came to Detroit to picket w/ @UAW & helped put #Fightfor15 on the map.

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Even after our “comeback,” economists estimate we lost 250K jobs during the recession that are NEVER coming back.

Why? Wall St played fast & loose w/ our economy.

@BernieSanders wants to hold them accountable so it never happens again.

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freep.com/story/money/bu…
Read 14 tweets
26 Feb
Want to understand why we're dealing with the scepter of serious #Coronavirus #COVIDー19 outbreaks in the US?

The @realDonaldTrump admin's profound mismanagement.

A Thread:

The public health approach to stopping an infectious disease is about "contact tracing."

1/
Contact tracing is painstaking work. It involves identifying all of the known or potential contacts of someone who has the disease in question, finding them, and then isolating them--and then rinsing and repeating.

It's a serious test of your gov's abilities.

2/
It requires that:

1) Gov't is funded appropriately to do this work
2) Gov't employees trust higher-ups to give them bad news, rather than pretend that cases don't exist.
3) Ppl trust their gov't to protect them--and to share information with them

3/
Read 10 tweets
25 Feb
A thread on @MikeBloomberg’s history w/ #Flint:

He donated $3M to help elect Republican Gov Rick Snyder who passed the emergency manager law.

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.@MikeBloomberg-backed Snyder had his original emergency manager law repealed in a REFERENDUM - like Michigan voters literally voted to repeal it.

But he passed a second version which couldn’t be repealed.

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.@MikeBloomberg-backed Snyder directly oversaw the Emergency Manager who made the decision to change #Flint water source to corrosive Flint river water, despite many pleas not to.

It would save the city money, they decided.

It ended up poisoning 9000 kids.

3/
Read 4 tweets
16 Feb
By now, you've heard about the @thelancet analysis from @yalesph led by @Alison_Galvani with some rather impressive, predictable top-line findings:

#Medicareforall would save:
$458 Billion/year (13%)
68,500 lives/year

But let's dig in. A thread 1/
thelancet.com/journals/lance…
Let's look at the cost estimates first.

They built a model called "single-payer healthcare interactive financing tool" which allows users to toggle between various assumptions about the savings, costs, revenue w/ #MedicareforAll. Check it out:

2/
shift.cidma.us
Savings:
- Reducing Pharmaceutical prices (by negotiating)
- Reducing Hospital prices (by setting them lower)
- Reducing clinical service prices (by setting them lower)
- Reducing overhead (Medicare's overhead is ~2%, private insurance is ~15%)
- Reducing fraud

3/
Read 13 tweets
26 Nov 19
A THREAD on #MedicareForAll and “choice”:

I’m not a huge fan of polls, especially when they're squeezed into headlines or used to support arguments like this one:

1/ nytimes.com/2019/11/26/us/…
We’re told that the “polls tell us” that #m4a support is fragile when people realize that it’ll take away their insurance. So, let's take a look at what may be driving #MedicareforAll polling using one @KFF poll earlier this month.

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@KFF This Kaiser poll found that 53% or respondents supported #MedicareforAll at baseline.

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kff.org/slideshow/publ…
Read 9 tweets
21 Nov 19
Honored to support the next #POTUS: @berniesanders. A thread on why:

1. Bernie has CREATED the political conversation we’re having now. #MedicareforAll, #GreenNewDeal, #FreeCollege, #NoCorpMoney—all because of Bernie.
2. Bernie’s #MedicareforAll plan is the most honest. It trusts the American ppl to understand that we get what we pay for AND that we can do better than the insurance corps that are dragging us for their profits.

2/
3. Bernie’s Politics are honest, upfront, and truly inclusive. When you raise the most money out of all candidates on the hard-earned contributions of teachers, nurses, and line workers, it’s because they FEEL your politics. We need that right now.

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Read 10 tweets
17 Nov 19
A thread on @mikebloomberg & #stopandfrisk:

When I was a med student in NYC, I was stopped/frisked. I was a young, brown man in a hoodie in Washington Heights.

In 2012, he spoke at the @PDSoros conference. I took the Q/A opportunity to bring it up.

1/
nytimes.com/2019/11/17/us/…
He called the idea that I would question this racist policy “dumb” and proceeded to ask if I thought he should be stop/frisking rich old white ladies with handbags on the upper east side.

He couldn’t imagine that maybe he just shouldn’t be stop/frisking ANYONE.

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In his pursuit of power now, he wants us to forgive and forget. But that’s the thing - so many young black and brown men in NYC didn’t get that option.

In his eyes, they were guilty until proven innocent. There was no forgive and forget for them.

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Read 7 tweets