10 years ago today I walked out of the hospital after surviving Ebola.

Back then I begged the world to strengthen our response to that crisis and prepare for others.

I’ve been reflecting on what we’ve learned over the last decade.

And the role of the U.S. in global health🧵 The international response to Ebola in 2014 was way too slow and weak.

Too many people died because we didn’t have the experience, coordination or willpower to address the crisis quickly and head on.

In the aftermath, we focused on lessons learned. We made changes.

As news of the Marburg cases in Rwanda spreads, I want to share some thoughts on where the outbreak stands, what will likely come next, and why this outbreak may (hopefully) end up being unlike other viral hemorrhagic fever outbreaks in the past 🧵

https://twitter.com/Craig_A_Spencer/status/1839771511894253999

For those just tuning in, Marburg is a viral hemorrhagic fever, very similar to Ebola.

This is the 18th Marburg outbreak since 1967.

Most outbreaks fizzle out fast. This one, despite being just announced days ago, is already among the largest.

https://x.com/HelenBranswell/status/1840159105513668672

I teach a class on the history of humanitarian response.

We talk about how a field full of dead soldiers in 1859 in Solferino led to the ICRC, Geneva Conventions, & international humanitarian law.

Every year, my students always ask “the ICC seems useless, why do we need it?” 🧵

https://twitter.com/ft/status/1792971076701491550

In the aftermath of World War II, the Nuremberg Trials was the first international war crimes tribunal.

I think we can all agree that prosecuting those responsible for the atrocities of the Holocaust was an important endeavor.

There were calls for a more permanent tribunal…

cfr.org/backgrounder/r…

I can’t stop thinking of a baby girl I treated, just minutes after grenade shrapnel tore through her brain…🧵 I was in Burundi working as a trauma doctor in 2016.

Civil conflict enveloped the country. I was training local physicians to treat and stabilize life-threatening injuries.

Most of our patients had gunshot wounds

or had been pierced by grenade shrapnel

Sometimes both.

Four years ago today, I walked into the apocalypse.

Crossing the line in the ER felt like entering a whole other world.

Frenetic alarms.

Patients strewn about, struggling to breathe.

Too few staff. Too many deaths.

Covid was everything.

It had completely taken over our ER Covid inundated NYC a week prior.

And many of our staff fell ill.

Especially the nurses.

We had only a fraction of those we needed.

Too few to notice when the oxygen tanks under patients’ beds ran out.

So we did something kinda insane.

Actually unbelievable

How much do you know about food and drug safety?

Where did our current regulations come from?

And what were some of the greatest scandals that forced change?

We covered everything from swill milk, patent medicines, and thalidomide in our class today.

Here's what we covered 🧵 We started with smill milk.

This was a massive problem that few—including in public health—have ever heard of.

In New York (and elsewhere) in the mid-19th century, milk was a big part of the daily diet, especially for children.

But people didn't realize how deadly it was.

Hey my medicine and public health people!

How much do you know about eugenics?

Just old pseudoscience, you say?

Any idea how much it continues to influence us?

Answer: A LOT.

I taught a class on the history of eugenics and public health today. Here's what we covered: 🧵 Eugenics is Greek for 'well-born'. But it wasn't coined by the Greeks. It's a late 19th century term made up by Francis Galton. He LOVED data. We will come back to that.

Eugenics had the biggest impact on the approach to mental illness, immigration, and reproductive justice.

Having worked in conflict zones, I want to share a bit on humanitarian response in Gaza, as aid starts to trickle in.

This isn’t a thread on how to end the war, or hostages, or any of the other very important things. Those are critical too. But they’re not at all my expertise 🧵

https://twitter.com/secblinken/status/1715720843081163241

Over the past week, shortages in food, water, and electricity have exacerbated the humanitarian and health challenges.

This creates new problems, as well as worsening chronic issues.

Without gas, generators can’t run. Newborns on life support in intensive care can’t survive.

Today I spoke in a colleague’s class about the COVID-19 pandemic.

He asked me to talk about what it was like in NYC’s emergency rooms in March and April 2020. Seemed easy enough.

But revisiting the trauma was really hard and painful.

I’m still not sure we’ve fully processed. It really hit me when I described how we strung oxygen tubing from the wall outlets up through the ceiling so it reached patients in the middle of the ER who were suffocating when the canisters under their bed ran out…

We all normalized something that just wasn’t normal, at all

You know why we intubated people for Covid in March 2020?

Because otherwise they were going to die. Full. Stop.

I remember a patient rolling in with an oxygen saturation of 42%, breathing twice as fast as normal,struggling on a face mask with oxygen all the way up.

What to do? I’m sick of seeing people trying to relitigate 2020 through the eyes of 2023.

If you miraculously know everything now, why didn’t you tell us so then?

So over a million Americans didn’t have to die of Covid.

So we didn’t have to put ourselves at risk every time we went to work

3 years into the pandemic, it’s incredible to see the revisionism, lamenting how we ‘over-reacted’ to Covid.

In March 2020, many of my patients died every single day. No matter what we did. 4 one shift. 6 the next.

Often more than when I worked in West Africa treating Ebola. This isn’t an apologists take on medicine or public health over the past 3 years.

Every field and every person whose had something important to say about Covid has made mistakes along the way.

But don’t confuse initial transmission dynamics for political dynamics.

Based on what we’ve seen in this pandemic and what we’ve learned from prior respiratory outbreaks, I think it’s extremely unlikely that this policy—especially with implementation delayed by a week—will have any meaningful impact on the arrival or spread of variants in the U.S.

https://twitter.com/cdcdirector/status/1608956958912155648

After South African scientists alerted the world to the Omicron variant in Nov 2021, an entire REGION of Southern Africa was subject to a devastating travel ban with huge implications for their economies & tourism.

Of course, the ban made no sense.

Omicron was *already* here.

https://twitter.com/craig_a_spencer/status/1466547784484544515

Todays announcement of NYC Mayor’s plan to involuntarily remove those ‘deemed mentally ill’ from the streets might sound like a smart idea.

But Ive worked in the psych ER for more than a decade and have a bad feeling about how this’ll play out in reality…nytimes.com/2022/11/29/nyr… To be very clear, I’m in full support of providing the emergency care everyone & anyone needs in crisis. That’s especially true for mental health crises.

And it’ll probably be no surprise to hear that the NYC mental health system is dramatically understaffed and under resourced.

Something I've been meaning to do for a long time is to revisit all the things I was wrong about during the pandemic.

There's quite a bit.

And if this place is going down, well I guess this might be my last chance. So, let's do it: 🧵 1. I had no idea it would last this long.

We're at this weird 'Covid-adjacent' phase of the pandemic, but it's clearly still a big part of our lives—Covid will be the #3 cause of death in the US in 2022—even if many have moved on.

I wouldn't have predicted this ~ 3 yrs ago.

Merck recently 'discovered' ~100k doses of a vaccine candidate for Sudan Ebolavirus, the species behind the outbreak in Uganda, as reported by @sciencecohen,

And now @IAVI will help to further develop and deploy it.

Here's what that could mean: 🧵

iavi.org/news-resources… We already have a remarkable vaccine for Zaire ebolavirus (ZEBOV), the species that caused the big 2014-2016 West Africa outbreak and recent outbreaks in DR Congo.

It was made by Merck as well, as @HelenBranswell detailed in this great piece from 2020.

statnews.com/2020/01/07/ins…

I've responded to disease outbreaks all around the world.

And I've seen what happens when the lessons from them go unlearned.

For @nytimes I wrote about how there's a small window right now to prepare for the next pandemic.

But it's closing fast: 🧵 nytimes.com/2022/10/24/opi… Covid is often labeled a 'once-in a-century' pandemic.

But that doesn't mean another isn't on the horizon.

Climate change, population increases, and global connectivity are all increasing the risk of deadly pathogens spilling over into people.
nytimes.com/2022/10/24/opi…

So you've seen there’s an Ebola outbreak in Uganda?

What I’ve heard so far really worries me.

We have a history of responding slowly and imperfectly to Ebola outbreaks.

And I worry we’re walking into the same mistakes:

Here’s what concerns me most: 🧵
nytimes.com/2022/10/06/hea… There's been 63 confirmed and probable cases and 29 deaths reported so far.

And 10 cases in healthcare workers, including 4 deaths.

As someone who contracted Ebola myself while treating patients in 2014, I feel so sorry for their families & loved ones.

https://twitter.com/JaneRuth_Aceng/status/1577520639640051714?s=20

A few years ago I worked as a doctor on a ship rescuing migrants in the Mediterranean.

With the recent flying and bussing of migrants across the country, I’ve been reminded of what we overlook when we treat migrants as political pawns instead of actual humans.🧵

📷Bruno Fert In 2017 and 2018, I provided medical care to thousands of migrants rescued on the perilous route between Africa and Europe.

In my clinic onboard a ship, they told me of their time in detention.

Almost all experienced torture, rape, and abuse that most of us could never fathom.

I’m visiting family in Cincinnati—you should visit sometime, it’s gorgeous.

Tonight I’m taking a short break from the fam to join @maddow to talk about all things Covid. So join us, the show’s starting now and I’m on around 9:30pm! When you’re not staying at your place, you gotta get creative.

This is what I call the ‘make a tripod out of diapers’ and a ring lamp diffuser out of a mask. 💅

Lots of uncertainty around what’s happening with Covid in the Northeast right now. Are we at the start of another surge, or will the slow rise continue a little longer and then drop off?

After a string of telehealth and hospital shifts in NYC recently, here are some thoughts: 🧵 First, regarding cases:

A look at @nycHealthy data makes it clear there’s been a rise in recent weeks.

Compared to the January Omicron tsunami, the number of new cases might look small…

Worked a telehealth shift today. Most of my patients were young, vaccinated & very healthy w/ Covid, requesting Paxlovid ‘to feel better faster’.

A reminder that oral antivirals are for preventing severe disease—especially in high-risk populations—not for symptom improvement. 🧵 The eligibility criteria for ‘high-risk’ is very broad—everything from cancer to obesity. But many people requesting oral antivirals today weren’t eligible.

One patient in her 30s, a bit frustrated, asked ‘what’s the downside?’.

cdc.gov/coronavirus/20…