Physician, epidemiologist, infectious diseases, #outbreaks, public health, #globalhealth, related topics - opinions all my own. @WCMPopHealthSci Professor
Aug 9, 2022 • 14 tweets • 4 min read
Having now read the one study on intra-dermal #monkeypox vax & spoken with a few folks more knowledgeable than me about immunology, some thoughts below on @FDAgov@CDCgov approach
Level of neutralizing antibodies from intra-dermal should be equivalent to subcutaneous. This switch should both expand vax supply & increase protection in those most at risk - critical goals right now.
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Aug 9, 2022 • 5 tweets • 2 min read
Concur with discussion below. Adds to weight of evidence that direct inoculation via receptive intercourse (anal, oral) likely primary route of infection for many patients
Helps explain why >10K cases globally during 2022 outbreak remain tightly connected to gay men & their sexual networks: transmission via anal/oral receptive intercourse far more efficient than other routes.
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Aug 9, 2022 • 4 tweets • 2 min read
I’m really surprised by this & don’t agree. Unlike a drug, vax are given to healthy people w/expectation they’ll be protected from future disease. We know little about efficacy of even standard dosing. Why not at least measure immune response in volunteers before using?
Ethics of this seem weirdly out of synch with Tpoxx, which is used to treat sick people who have no other options. Yet @US_FDA insists animal model clinical trial insufficient. Yet animal model for vaccine is acceptable when given to healthy people?
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Aug 1, 2022 • 4 tweets • 2 min read
A lot of people do not understand how worrisome the #polio case in NY.
Based on what's been discussed publicly:
-the person with paralytic polio got infected in NY
-for one person to get paralytic polio, it means that 100s were infected, b/c only ~1 in 200 develop paralysis
-since case was detected in early June & weeks have gone on before vax catch-up campaign, likely means 1000s of infections cumulatively to date
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Apr 13, 2022 • 4 tweets • 1 min read
I get that public health folks (myself included) are getting their moment in the sun, but is it really necessary to ape political & sports pundits with hot takes?
Some perceive widespread mask use as unacceptable, particularly in children.
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Apr 11, 2022 • 8 tweets • 5 min read
One (of many) limitations of @CDCgov & @nycHealthy#COVID19 levels is that they tell you where epidemic has been, not where it might be going.
As of today, there’s a 33% chance #NYC will move from low -> medium citywide in one week (by April 18, 2022)
🧵⬇️
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My colleagues @WashburneAlex@WCMPopHealthSci Nathaniel Hupert have developed a forecast based on observation that outbreaks of new #COVID19 variants have growth rate & duration that is similar regardless of where outbreak occurs worldwide. Methods at bit.ly/3vajeHH
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Dec 22, 2021 • 15 tweets • 3 min read
In this OpEd (nytimes.com/2021/12/20/opi…), I argued that we should reduce the recommended isolation period for #COVID19 in vaccinated persons. This is how I think through a problem like this. 🧵⬇️
Call it #ThinkLikeAPublicHealthPractitioner, which is different than thinking like a virologist, epidemiologist, or clinician.
Virology helps us answer: how infectious are people with COVID-19 based on duration of infection, vaccination status, symptoms, and other factors?
Dec 20, 2021 • 4 tweets • 1 min read
In the age of #Omicron, we have a more transmissible virus and waning public resolve to reduce human contact. For the US, a large number of infections is now inevitable. A large number of hospitalizations and deaths is optional. /1
nytimes.com/2021/12/20/opi…
Elected officials must adopt vaccine-first policies, because a layer of vaccine-derived immunity is the safest, most durable & effective way to avert mass hospitalization and death. But vaccines-first is not vaccines only. /2
Nov 29, 2021 • 5 tweets • 2 min read
I worry that many commentators who opposed the Biden booster plan in the US succumbed to the same problem that mucked up mask guidance in Spring 2020: framing a supply-based recommendation (we don't have enough) as an evidence-based recommendation (you don't need it) 1/
I think it's much more credible to say "We wish everyone could wear a medical-grade mask, but we simply don't have enough right now so you need to sacrifice for healthcare workers" VS. "You don't need a medical-grade mask" (unspoken: because we don't have enough). 2/
Oct 24, 2021 • 17 tweets • 4 min read
1/ Always enjoy and learn from reading @edyong209 essays, but I disagree with the thesis that US public health agencies need to return to the early 20th century approach of social reform to be more effective. 🧵⬇️
2/What is the “public health” referenced throughout the essay? I assume @edyong209 is primarily referring to government agencies in the US often called “Health Departments.” Or does it also refer to govt programs that regulate food, medications, water, sanitation…
Sep 3, 2021 • 15 tweets • 4 min read
There seems to be a lot of misunderstanding about how to make indoor air safer to prevent #COVID19 in @NYCSchools. Much of this argument is about terminology, science, technology, evidence, and how to turn evidence into policy (1/n)
In infectious disease epidemiology:
Ventilation = bring new air into a room, send old air out of a room
Filtration = pull old air through a machine, filter the old air for small particles, push the newly-filtered old air out (2/n)
Aug 16, 2021 • 21 tweets • 4 min read
This @politico article is thankfully generating interest in public health data systems, an area many of us have been trying to sound the alarm about domestically & globally for decades. For context, let’s #ThinkLikeAPublicHealthOfficial /1 politico.com/news/2021/08/1…
As a public health official, what do I need for something as seemingly basic as counting all lab-confirmed #COVID cases? /2
Mar 3, 2021 • 12 tweets • 4 min read
.@NYCHealthCommr and I held a technical briefing for the media this morning about #COVID19#variants in #NYC. Important summary points in this thread 1/12
People are increasingly worried whether they should do something different. This is very reasonable, b/c we’ve all seen stories worrying abt #variants & we may someday need to change what we do. Right now, the answer is: there’s nothing different we should be doing 2/12
Mar 2, 2020 • 5 tweets • 3 min read
With rapid spread #COVID19, @AfricaCDC needs to prepare clinicians to
-rapidly identify patients at risk
-triage to home vs. hospital
-manage severe disease according to best available evidence
Brief summary of what's planned in this thread. More details later.
(1/5)
Online webinars using @WHO curriculum to promote discussion in real-time by clinicians about existing recommendations & to debate complex scenarios
Lots of Twitter chatter across globe about “suspect cases” or “confirmed case” in [insert] country, and Tweets being released about “confirmed case in [insert country],” then retracted.
Please consider….
(1/5) #coronavirus#nCoV
Not all of those being quarantined &/or tested meet @WHO definition of suspect case. Some countries quarantining & testing (as is their right) anyone w/history of exposure. Better to talk about ‘# people being tested,’ rather than ‘X suspect cases.’
