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
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
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
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
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
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.”
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.
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
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
🧵🧵Australian church choir singer #covid19 outbreak now in CDC EID
•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
🧵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.
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
🧵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 blogs.bmj.com/bmj/2021/04/02…
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
“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 #covid19
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.”
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.
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
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'
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.
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
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