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Andrew Goldstein @andrewmakebluesky.bsky.social Profile picture
Andrew Goldstein @andrewmakebluesky.bsky.social
@AndrewMakeTweet
Primary care doctor at a public hospital, in a health worker union. Activism and organizing.
Mar 3, 2022 • 5 tweets • 1 min read
"Protecting the vulnerable"
"Protecting hospital capacity"
"Preventing variants"

Are good rhetoric, but do the policies make sense for these goals? Are these goals enough?

No. A mini-🧵. The policies don't live up to the words once we consider the realities of:
– US healthcare inaccessibility
– pre-/asymptomatic spread
– people living with others
– chains of transmission
– exponential growth
– levels of immunity
Feb 25, 2022 • 24 tweets • 6 min read
CDC mask guidance change 🧵

1) Hospitalizations lag test positive cases which lag actual cases

2) Guidance based more on hospitalizations means willfully abandoning critical windows to act

3) So this guidance is less about new science or better public health, and more about… ... both justifying the relaxation of public health protections now and about justifying too little, too late policy responses in the future when surges re-emerge.
Feb 24, 2022 • 5 tweets • 2 min read
War is bad for everyone except the wealthy and powerful.

It's pathetic and tragic that most of humanity has little it can offer except condemnation.

We deserve democratic global institutions capable of preventing and dealing with conflict. 1/ Borders and nations are artificial.

Powerful nations and the powerful within all nations use to these constructs to their advantage.

But there are other constructs that show how ridiculous this is. 2/
Feb 5, 2022 • 10 tweets • 2 min read
Let's highlight how "civility politics" operates in pandemic discourse. 🧵

1) Highly platformed health "experts" drive policy negligence with their incorrect, harmful messaging. They get bylines, journalist interviews, TV appearances, book deals, and wide rightwing celebration. 2) The health "experts" face a backlash. Some of it is admittedly unkind and personal, but most was civil, valid criticism or very fair sharing of real and raw emotion from people who have endured awful policy violence these experts have fostered.
Dec 12, 2021 • 21 tweets • 7 min read
Here's a 🧵 reviewing this op-ed from @MonicaGandhi9 and @LeslieBienen.

Spoiler: incoherence, obfuscation, and omission that feeds pandemic inaction + promoting a data reporting approach that destroys opportunities to save lives and prevent suffering.

First off, why is the NYTimes continuing to platform voices that have consistently been incorrect?

Premature optimism, essentially calling the pandemic over, has driven real harm by degrading policy protections and public behavior.

Who was the editor here?
Dec 11, 2021 • 5 tweets • 1 min read
Rapid test are probably able to catch about half of presymptomatic cases.

They're neither perfect nor insignificant, which makes them a great layer of protection to use with others. 1/ That means at the population level, pre-gathering rapid tests may halve the rates of infectious people attending. 2/
Nov 13, 2021 • 16 tweets • 5 min read
This is sociopathic punditry. Here's a 🧵 going through it. Laughable but telling to admit that Wachter is the most cautious he spoke with.

When Wachter is the most cautious, you're acknowledging how skewed your sample of "health experts" is toward do nothing.
Nov 13, 2021 • 5 tweets • 1 min read
Case are rising.

*Now* is the critical window to use the *full set* of *policies* to halt a winter surge.

Delaying action…

Ignoring all but 1 or 2 tools…

Making suggestions to individuals instead of policies…

…will result in tens of thousands of needless deaths. The worst are not the vaccine hesitant or even those who outright oppose masks and vaccines in all forms.

Sure, they're loud and they are harmful and they must be opposed, but they are a small fringe.

The absolute worst are the powerful people who are *policy complacent.*
Oct 5, 2021 • 23 tweets • 7 min read
This anti-public health op-ed is an intellectual nightmare. Let's go line by line... 🧵 First, the title, which is often on editors and not on the writers.

"Quarantining kids doesn't stop COVID" is patently false.

Children spread and quarantine stops spread.

Debate other aspects of the complexity of quarantines, but this is just preposterously unscientific.
Oct 5, 2021 • 8 tweets • 2 min read
While outright COVID denialists are utterly wrong, most people dismiss them out of hand.

The more savvy (and more dangerously able to get popular acceptance of their views) are the minimizers who constantly pick away at the margins, eroding our approach. 🧵 Some populations are extremely high risk.

Beware the minimizers who use this to suggest that protecting lower risk groups is unnecessary.

Lower risk groups still have some severe COVID risk, have high risk of pandemic effects (parental loss), and can spread to high risk people.
Oct 4, 2021 • 5 tweets • 2 min read
Across the planet, community health system inadequacy is the norm.

1) Where community health workers do exist at scale, too often they are underpaid and undersupported: 2) Other times they simply do not exist at the scale of the need.

The US, according to the @BLS_gov has only about 60,000 CHWs, which translates to approximately 2 per 10,000.

Other countries with far less wealth have 10x that.
Oct 4, 2021 • 11 tweets • 4 min read
There is a lot to unpack and debunk here. A short 🧵 The misframing begins in the setup:

"In the history of epidemiology, experts have never counted individuals without symptoms into these definitions."

Which is easily disproven looking at how HIV cases are defined.

Here's an old document from the WHO. who.int/hiv/pub/guidel…
Oct 2, 2021 • 8 tweets • 1 min read
🧵 of bullshit ideas I'm glad haven't happened during the pandemic, but easily could have (or might have but I missed them). Feel free to add your own. Kiva but for global vaccine equity.

= platform matching people in impoverished countries (who are forced to share a sob story or otherwise pitch their deservedness), with a microloan donor in a rich country. Platform skims off the top, gets social enterprise awards.
Sep 16, 2021 • 5 tweets • 1 min read
Media reporting on boosters
Scientific discussions on boosters
Booster approval
Clinical and public health guidances on boosters

These are all being based on evidence of "waning immunity" which itself is predominantly based on reduced vaccine effectiveness.

🧵 Big problem is... Vaccine effectiveness is contingent on many things.

Not just immunity.

So reductions to effectiveness can not be assumed to be due to waning immunity.
Sep 16, 2021 • 5 tweets • 1 min read
Here's the NEJM study of the data. A few thoughts

1) Big risk rate differences but dataset appears to lack behavioral/social data that would help identify potential confounders related to differences in exposure/viral dose at exposure

nejm.org/doi/full/10.10… 2) Lacks safety outcome data, so hard to discuss risks vs. benefits
Sep 15, 2021 • 6 tweets • 2 min read
🚨 FDA booster data up.

1) Surrogate marker trial data is not useful clinically or for public health.

2) Real-world data shows massive effect in terms of reducing infections (suggest big public health benefit in stopping spread) and severe COVID.

Link: fda.gov/media/152161/d… The real-world data controlled for some confounders but no suggestion they controlled adequately for things that might make someone more likely to pursue a booster but also less likely to be exposed and/or exposed to high viral doses. E.g. community factors, mask use, etc.
Sep 14, 2021 • 5 tweets • 1 min read
I would like to see a book on how careerism, personal brand-building, and book deals are harming public health. Gottlieb clearly understood the underlying public health dynamics in the pandemic (chains of transmission, exponential growth, presympomatic spread).

Relative to so many (a very low bar), he called for needed policies.
Sep 13, 2021 • 7 tweets • 4 min read
Spraying is not evidence-based and is potentially harmful.

School safety science is clear:
– masking
– vaccines for all 12+
– ventilation/filtration
– screening testing
– controlling community spread

@NYCSchools @DOEChancellor's plan is inadequate for *all* of these measures. It's good there's a mask mandate, but @NYCSchools @DOEChancellor are not adequately:
– providing masks
– educating on or requiring masks of sufficient quality: medical grade at least, better to double mask or N95
– set up to monitor/ensure correct use
Sep 12, 2021 • 4 tweets • 1 min read
Centrist Democrats, progressives, and the left should be ashamed.

Scott Gottlieb, corporate law firms, and McDonalds are leading more on public health than they are.

Sorry to be harsh but we need a reality check and a principles check. Law firms lead on remote while anti-worker de Blasio and sycophantic unions force workers to return in-person needlessly, while parents aren’t given remote options for school. wsj.com/articles/covid…
Sep 9, 2021 • 24 tweets • 9 min read
Cases are surging.
10,000+ people are dying each week.
Thousands of people are developing long COVID.
Schools and businesses disrupted.

We needed a course correction.

Instead it's another round of too little, too late from @POTUS @WhiteHouse @WHCOS @CDCDirector. 🧵 The vaccine-focused approach of the last 8 months has failed.

It overly focused on vaccines to control spread and stop severe illness. It ignored and relaxed NPI (non-pharmaceutical interventions) policies e.g. mask mandates, venue restrictions, and contact tracing.
Sep 9, 2021 • 5 tweets • 1 min read
🧵 of views I agree with on Biden's Delta surge response announcement today. On overly focusing on vaccines and on NPI policies beyond testing: