Abraar Karan Profile picture
doctor @brighamwomens @harvardmed | next @stanford infectious diseases | global health, epidemics, ethics
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8 May
1/ Three Cs from Japan- avoid crowds, prolonged close contact, & closed spaces (poor ventilation)

These fundamental principles must be the core of reducing transmission during #covid19 surges in large unvaccinated populations

Adhering to these requires serious social supports
2/ There will still be a number of essential activities that must be done for survival.

The safest way to do these is with the best personal protective equipment available: namely, high filtration masks, whether N95 or reusable eN95 respirators, or equivalents KF94, KN95, FFP2
3/ Beyond these, rapid at-home POC diagnostics (cc @RanuDhillon @sri_srikrishna) at scale could be key; ideally, these should be available universally before surges happen--> these can quickly remove highly-infectious people from the pool daily before they become superspreaders
Read 11 tweets
7 May
The whole time I was reading this piece, this was the thought that was on my mind — & then @zeynep literally had it written out right here:

2/ @zeynep - one of the best pieces you’ve written on this IMO. & some of the best in infection prevention- the team I am researching & writing w/ now from Brigham & Women’s similarly have shifted toward short range aerosols likely being dominant mode of transmission. Big shift
3/ From perspective of @RanuDhillon @sri_srikrishna and myself- we focused on the worst case scenario as it related to precautionary principle & PPE which is where #bettermasks came from

& we were criticized first by academics who held on to dogma of droplets as rationale
Read 7 tweets
4 May
FDA is getting ready to clear Pfizer vaccinations for children in the US.

High risk unvaccinated adults are dying in surges in India.

This is not what equity looks like. #covid19
2/ This is the reality of trade offs. No one said there were going to be easy decisions. And with limited vaccine supply, & monopolization of that supply— these are the moral dilemmas that the world must grapple with. Extremely low risk children here v high risk adults elsewhere
3/ Yes, there are high risk kids here & they should be vaccinated. Yes, global vaccine monopolies are not the fault of American parents- no one is saying they are. Nonetheless, vaccine inequity is real. And it’s going to cost us all big time. #covid19
Read 4 tweets
2 May
1/ In speaking with multiple NGOs on the ground in India just this morning:

“the government has abandoned us”

The capacity to quickly scale up high grade surgical + N95 masks is there; why isn’t it being utilized?

#IndiaCovidCrisis #covid19
2/ With high-grade mask protection, you can functionally stop transmission both ways. This means that if you’re infected, you can stop spreading to others; and if you’re not yet infected, you can be better protected while doing daily essential activities that can’t be stopped
3/ this is of course with the goal of getting vaccinated; but as is known, immunity post-vaccination is not immediate; during a surge like the one in India, better PPE is the most immediate solution
Read 5 tweets
24 Apr
1/ One of the biggest reasons why we had been pushing for #BetterMasks was because when you have a catastrophic surge like we are seeing in India-- you need the best personal protection you can get, *immediately* #covid19
2/ This was *always* about staying prepared.

Yes, we will have government leadership to blame. Yes, we need support from the state. Yes, epidemics are complex social, man-made disasters.

But at the end of it, if you can't breathe and you can't access a hospital bed- that's it.
3/ I'm a physician. Even now, in Boston, I have sent #covid19 patients to the ICU.

Every physician remembers the surges here. Every doctor and nurse knows what it is like to be at the bedside during times like this.

Watching videos out of India are frankly triggering for many
Read 8 tweets
21 Apr
This- right here

When we immediately reach for security (close borders, ban travel, hoard vaccines) as our guiding principle, instead of solidarity, we will all suffer the consequences.

India is running into vaccine & supply shortages; lockdowns will also impose harms on poor
2/ “But recent US and European limits on the exportation of critical Covid-19 vaccine production materials have resulted in a severe vaccine shortage throughout the country.”

3/ “India is also a major manufacturer supplying COVAX, the international #Covid19 manufacturing and distribution agreement. SII had originally committed to manufacture up to 200 million doses for 92 countries. Those plans are on hold for now.”

What happens in India affects all
Read 4 tweets
20 Apr
Thread: we are celebrating all US adults having open access to vaccines; globally, countries are now being decimated with little to no access even for very high risk citizens who will die.

This matters. This should matter to every single person here. This will affect us all.
2/ Remember- the more the virus rages uncontrolled around the world, the more variants we will ALL see just by virtue of more replication events; if you don’t think this matters here, think about B117 from the UK, B1351 from South Africa, P1 from Brazil. There will be more.
3/ India is getting slammed right now. I have heard from friends there who have posted grim realities on the ground- family members getting sick/dying; them being reinfected despite having had #covid19 within a few months- the situation here is bad.

Read 7 tweets
14 Apr
1/ Sharing a piece I wrote @latimes

As doctors, an act that can potentially do harm dissuades us more than if we do nothing, even if *more harm* happens as a result of the latter

The active v passive cognitively biases us heavily

2/ In one study I reference, doctors would be less likely to give clinically-indicated blood thinners if they caused a bleed in the past on a different patient; but would not be any more likely to give them if they did not do so & their patient had a stroke as a result.
3/ Thankfully w/ the J&J clotting issue right now, we have alternatives like Moderna/Pfizer

We are moving away from the potential of doing harm (even though it is exceptionally rare) to patients

But the lack of vaccinating patients also does harm if they get #covid19
Read 4 tweets
9 Apr
Was invited to speak next week, & I’m looking forward to it—but I cannot imagine giving this talk without referring to @seyeabimbola seminal paper on the foreign pose & foreign gaze in global health. This will frame much of the discussion. Read it.

2/ As I think about this talk- an Indian born, American doctor giving a talk to a number of American researchers about why the way we approach global health can be deeply problematic, can think more about how to classify this talk in terms of foreign/local - pose/gaze
3/ Would then also ask us to consider how different the talk would be if we had a researcher from a non-American context speak to this same audience about these topics; the pose would be very different; it would offer something critically important—would urge @ceid_uga to do this
Read 6 tweets
7 Apr
🧵🧵Australian church choir singer #covid19 outbreak now in CDC EID
•no masks
•no ventilation systems
•transmission >50 feet—> airborne
•confirmed via genome sequencing
•12 secondary cases detected out of 508 (2.4%), although only 434 were tested

Source: CDC EID journal
2/ So the index case was a choir singer who started to feel sick on July 16th; sang at four 1 hour services on the 16th & 17th from a choir loft elevated 11.5 feet above the congregation #covid19
3/ The secondary cases reported no other contact with the singer.

Video recordings were also used to confirm their seating positions relative to the index case as well. #covid19
Read 10 tweets
5 Apr
🧵1/ This is a tragic story in @washingtonpost — we have seen, treated, & continue to treat many cases just like this.

When people share their tragedy, they are sacrificing to remind us all that the epidemic is not just numbers; those numbers are people. They are families. Image
2/ Who do we blame?

Many who got sick *couldn’t avoid it*- they weren’t protected.

Others had the privilege to avoid risk- worked from home, had $ etc.

And some blatantly chose to actively go against advice like wearing a mask, hurting themselves & others.
3/ The piece here specifically implicates the latter groups- where there is some truth to the idea that people’s choices contributed to spread. How much is unclear- partly because many infections are actually in the former group- that couldn’t stay home, that worked frontline etc
Read 5 tweets
4 Apr
🧵1/ In a pandemic, we have two urgent interests: that life saving vaccines/ treatments be created, manufactured, & distributed, and that the disease be quickly contained/eliminated worldwide without a potentially catastrophic resurgence. #covid19
2/ The financial interests of pharmaceutical shareholders accord with our first interest, but not always with the second.

Product allocations go to the highest bidders, rather than to where need is greatest or the pandemic may be contained most effectively. @ThomasPogge
3/ The system as it stands is designed to fail, because public health is a secondary goal behind financial recuperation & explicitly financial profit

In a pandemic, it can’t be that way.

But I don’t need to tell you all this- you have been watching it unfold already. #covid19
Read 10 tweets
1 Apr
“While more than six million of the country’s 18 million people have been vaccinated, a surge in infections has left intensive-care units operating with few beds to spare and the system at a breaking point.” From Chile @nytimes

2/ “Dr. Francisca Crispi, a regional president of Chile’s medical association, said that 20 to 30 percent of medical professionals in the country had gone on leave because they are so exhausted.”
3/ “No one questions that the vaccination campaign is a success story,” she said. “But it conveyed a false sense of security to people, who felt that since we’re all being vaccinated the pandemic is over.”
Read 4 tweets
30 Mar
1/ Sharing new piece: we have learned a lot this year about the deficiencies of the ‘test,trace, isolate’ system, but it is still going to be needed to burn out the epidemic once case numbers are brought down further.

W/ @RanuDhillon
washingtonpost.com/outlook/2021/0… Image
2/ With most of the focus on 💉💉 right now (as it should be)— our other pandemic tools like Test, Trace, Isolate (TTI) have taken a backseat.

Yet, they are still crucial to stopping the #covid19 epidemic- but we need to do each of them better.
3/ Having this infrastructure in place will be essential for future infectious disease outbreaks/pandemics.

I expect TTI will become especially relevant again this summer to stop ongoing transmission chains once we have vaccinated a majority of country

Cc @cshea4 @PostOpinions
Read 4 tweets
29 Mar
Hoping for less deadly surges

1/ An important piece of the puzzle that some have pointed to: 49% of 65+ in our country have been *fully vaxx*; 73% have received at least 1 dose

We know age is single most significant risk factor in mortality. #covid19

2/ While proposed plans to simply isolate the elderly are largely unachievable/ not how societies fundamentally function-- what many of us do agree on is that vaccinating the elderly as a priority group is critical; and we are doing it well.

3/ With real world data from @CDCMMWR today showing significant protection even 2 weeks after just the 1st dose of mRNA vaccines, I am optimistic that we should see a further notable reduction in mortality even w/ subsequent #covid19 surges

Read 5 tweets
29 Mar
Excellent news from @CDCMMWR today!

Under real-world conditions, vaccine effectiveness of mRNA (Moderna, Pfizer) vaccines:
-90% after 2 doses
-80% after one dose (both measured 14 days after dose) #covid19

2/ "Prospective cohorts of 3,950 health care personnel, first responders, and other essential and frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks."

Data collected from eight U.S. locations during December 14, 2020–March 13, 2021 #covid19
3/ "CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19–associated illness."

Gets at one of the biggest questions since the vaccines came out: extent of reduction in asymptomatic cases
Read 6 tweets
29 Mar
1/ The key bottleneck to scaling mRNA vaccines is a "worldwide shortage of essential components... nucleotides, enzymes, & lipids", according to this piece.

But...companies that can do this are not licensing their manufacturing so that others can join in nature.com/articles/d4158…
2/ So, once again, the issues we are facing are *man-made*

They are issues with how financial incentives overpower global health equity

There are ways that we could scale up more right now; but that won't happen because it threatens wealth

@gregggonsalves @PeterHotez
3/ These are complicated matters. But the system as it stands is not designed for health emergencies: it generates products (i.e. vaccines) for the few who can afford them; everyone else is subject to 'charity'

Even during a pandemic.
Read 4 tweets
28 Mar
1/ As I reflect on the arguments people have put forward regarding individual rights...

Those opposed to masks likely would *not be opposed* (before #covid9) to a restriction of someone coughing/sneezing in your face if they were sick

Yet, we know the logic here is the same
2/ With asymptomatic spread, it doesn’t take coughing/sneezing; it just takes talking/breathing in a public space near others to infect them

So- the rules of the game haven’t changed here

Your right to do certain things is still limited by how they harm other people
3/ Yet their seems to be a perception/misperception that having people wear a mask in public spaces during a respiratory pandemic is somehow a restriction on freedoms

It is not

It is a restriction against harming others

We were never free to do that #covid19
Read 5 tweets
28 Mar
-The reversal in #covid19 trends in Michigan & the Northeast seen below

~15% or so of the country is vaccinated
~30m confirmed cases from natural infection

-some overlap between those two groups (recovered who got vaxx)

-*many* still susceptible

npr.org/816707182 Image
2/ Seroprevalence studies also indicate that we are under-detecting cases based on discordance b/w rtPCR and antibody studies; these numbers have varied at different time points in the year- all the way up to 10x by some measures at some time points #covid19
3/ One of the big questions is to what extent we have underlying immunity from un-detected cases, & to what extent that contributed to rapid declines in case numbers in January/Feb. Even so, that wouldn't be the whole story; physical distancing & other control measures matter.
Read 10 tweets
27 Mar
Was interviewed for this @NPRGoatsandSoda piece on how pandemics exacerbate racism & xenophobia; these are not new forces- they constantly are brewing underneath & within our day to day lives. They were amplified during a global crisis. #covid19

2/ Also gets into forces within the global health sector that are both remnants and repackagings of our history of colonial exploitation— we need to more deeply reckon with this as US/European based “global health doctors”; during Covid19, many of us paused overseas work.
3/ This is not a criticism against individuals; it is a call to more deeply reconsider what outcomes academic global health systems are designed to create; and whether they are doing enough to promote global health equity. #covid19
Read 7 tweets
24 Mar
1/ Treated multiple #covid19 cases today.

Only when you hear actual stories of the struggles people are going through does it make it clear how problematic it is when we blame those who got sick because of what externally seems like “irresponsible” behavior.
2/ Caregivers of disabled family members who did not have the luxury to stay home; those working in factories where outbreaks are prevalent; we are still seeing these cases and treating them. This isn’t about lockdowns or no lockdowns- this is about creating better public health.
3/ This is about creating systems that can protect us during crises.

The false choice of lockdowns v no lockdowns has been birthed from politics, not public health.

Why is the idea of an actual public health strategy not being brought up in these debates? #covid19
Read 6 tweets