Updated Covid booster recommendations and the unwinding of the public health emergency in the United States have raised questions and highlighted lingering challenges. How should we be thinking about these developments? Who should get a booster this spring? 1/thread Covid hasn’t gone away, but it no longer poses the same threat to most people it did in the first years after its emergence. This is due, in large part, to lifesaving vaccinations and treatment, and also to prior infections, which reduce the risk too. 2/

In New York City, Covid killed more people than any other cause in the pandemic’s first year and caused life expectancy to drop by 4.6 years on average, according to the newly released annual report of NYC vital statistics. Confirmation of a devastating toll. 1/thread What gets measured can be managed, which is why reports like this are crucial. More than 200 New Yorkers die every day, including >50 people under age 65, a data point I tracked closely as NYC Health Commissioner and focused intently on bringing down. bit.ly/41cFZcm 2/

The past three years of fighting Covid feel like a fog of war. Although everyone wants to move on, we must reckon with how bad the pandemic was—and how much worse it could have been. 1/thread 20 million excess deaths have occurred during the Covid pandemic—more than all but the two other leading causes of death, cardiovascular disease and cancer. Without vaccination, measures to reduce infections and lifesaving medical care so many more lives would have been lost. 2/

Masks have been an effective tool throughout the Covid pandemic, despite erroneous claims to the contrary. 1/thread The widely cited Cochrane review on masks was poorly done and even more poorly communicated. Regrettably, researchers analyzed the wrong datasets, in the wrong way, and overstated their conclusions—leading to sweeping and inaccurate characterizations. 2/

Over the past decade, global smoking rates dropped by 23% and 750 billion fewer cigarettes are sold annually. But despite this progress, tobacco is still the world’s leading cause of death and unless we do more, will kill ONE BILLION people in this century. 1/thread The FDA recently announced a national ban on menthol cigarettes and a new California law to curb flavored tobacco was overwhelmingly affirmed by voters in November. Big Tobacco's reaction to these two recent public health wins underscores the fight we have ahead of us. 2/

Amid discussion of the future of Covid vaccination, we can’t lose sight of the present: Only 1% of immunocompromised people in the US received a full set of Covid vaccinations as of Aug. That’s a colossal failure. The 5 steps to avoid failure in public health explained 1/thread 500 people are still dying from Covid every day. That’s not normal and it doesn’t have to happen! Immunocompromised people—along with the elderly—are at the highest risk of dying from Covid. 2/

In 2018, @WHO set an ambitious global goal to eliminate artificial trans fat by 2023. Despite significant progress, five billion people remain unprotected from this toxic substance in their food supply today. The world still has a way to go—countries must take action. @WHO Trans fat, put into packaged foods, baked goods, cooking oils and spreads, kills up to half a million people per year.

Rather than make America safer, recommendations in this piece would endanger the health of people throughout the country. Here are six (of many) particularly dangerous factual and conceptual errors. 1/thread Error 1: Misunderstanding CDC’s role. Infectious diseases such as Covid and flu are far from the only diseases that kill people, and the core mission of CDC reflects that: protect people from ALL health threats. 2/

An early, severe flu surge in the United States, together with increased spread of Covid, could put a damper on the holiday season. To mask or not to mask? Here's what to consider in the days and weeks ahead. 1/thread Masking up is a risk/benefit calculation. If you’re young, healthy, up-to-date on your vaccinations and you're not worried about long Covid, it may be reasonable to unmask. But if you're medically vulnerable or around people who are, or worried, you might want to adjust. 2/

Reflecting on those who have died this year, including the wonderful Mike Pertschuk.

When I started working on global tobacco control, I read Mike's eye-opening book, Smoke In Their Eyes, called him, and learned more in a few hours than I could have learned in months. 1/ Reflecting on health progress, including promoting primary health care, I learned so much from his book The DeMarco Factor. What a difference one committed person can make, working as part of a team and movement. 2/

Risk of myocarditis after receiving an mRNA vaccine is rare in teens and young men. Among males ages 12-17, the risk of heart problems was 1.8 to 5.6 times higher after a Covid infection than after mRNA vaccination, according to CDC data. There are risks with any vaccination, but vaccination benefits far outweigh risks. bit.ly/3f9WEuZ

Screening for non-communicable diseases such as cancer, diabetes, and heart disease is a major focus around the world. But a revealing new study from Denmark found screening for heart disease has little value on its own—it must be tied to effective management. 1/thread The study, published in @NEJM, was designed to maximize the likelihood that screening for heart disease would improve health outcomes. bit.ly/3VOnQjw 2/

The world failed to prevent millions of deaths and trillions of dollars in economic damage from Covid. We wouldn’t do much better if a disease threat of similar or larger magnitude emerged tomorrow. That’s a big problem. Here’s a solution. 1/thread First, we need a renaissance in public health. Faster and more effective public health action at all levels, with real-time disease surveillance, better communication and community engagement, and rapid response. 2/

In India, @ResolveTSL partners to support the government’s goal of improving hypertension control and preventing deaths from heart disease. This photo represents the highlight of my 7 weeks of travel to 7 countries, including 5 states of India. Here’s why. 1/thread I first traveled to India in 1995 to work on tuberculosis control and had the honor of living and working in the country, on secondment from @CDCgov to @WHO from 1996–2002. I’ve traveled back for work just about every year—until the pandemic. It was great to be back. 2/

The next pandemic could come from anywhere. The world must improve public health protection—before it's too late. New support from @jack through #StartSmall will enable @ResolveTSL to increase our partnerships supporting governments and communities in Africa. 1/thread By partnering with governments, communities and organizations, @ResolveTSL has helped countries respond to Covid and strengthen systems to find, stop and prevent new disease threats. We're excited to expand this work with the new funds from #StartSmall. resolvetosavelives.org/prevent-epidem… 2/

As monkeypox cases rise, it's important to be clear about how we got here, how this virus spreads, and who is at risk of infection *now*. We must act fast—and work together globally to find and stop health threats BEFORE they get out of control. 1/thread Unlike Covid—which was novel—monkeypox has been spreading for more than three decades in Africa. Unfortunately, scientists' warnings about the virus weren’t heard and they didn’t get the resources needed to better understand and stop this neglected disease. 2/

The BA.5 subvariant is causing a new Covid wave in the US and far too many older adults are not as well protected as they could be. Unfortunately, that means we'll see more hospitalizations and deaths in the coming days and weeks that could have been prevented. US adults aged 50 and older with two booster doses had 4X less risk of dying from Covid, compared to people who received one booster dose. Compared to unvaccinated people in the same group, people with two booster doses had 42X (!) less risk of dying. bit.ly/3wq3wsI

Independence Day Thoughts on Freedom and Health 🇺🇸
U.S. history has many wrongs, including genocidal treatment of original inhabitants, slavery, persistent racism, discrimination against women & more

BUT: there’s also lots to celebrate, including progress toward freedom.1/thread FDR famously committed to Four Freedoms: Freedom of speech, freedom of worship, freedom from want, and freedom from fear. @AmartyaSen_Econ extended these: Political freedoms, economic capacity, social opportunities, transparency guarantees, and security. 2/

Which of these statements is NOT true?
A. High blood pressure kills 10 million people/yr.
B. Hypertension is #1 cause of shorter life expectancy in Black people in US.
C. The US has made progress decreasing sodium intake.
D. People in communities consuming low sodium have no HTN. Results are in, and most people got it right!

A is true: High blood pressure is the world's leading killer, and yet it's preventable through reduced sodium intake and treatable with effective, low-cost medication.

Detection of monkeypox is a timely reminder that preparedness is crucial. A new health threat could emerge anywhere in the world at any time. Countries need to respond quickly and effectively. Here’s what you should know now. 1/thread Monkeypox is a rare viral disease endemic in West and Central Africa. It spreads mostly through direct contact with infected animals and can spread from person to person. It may also be able to be transmitted through the respiratory route. bit.ly/3sL0P48 2/

More public figures have announced they’ve tested positive for Covid in recent days, correlating with yet another rise in US cases. Who’s at risk of getting infected, reinfected, hospitalized, and deathly ill? How well do vaccination and prior infection protect us now? 1/thread Test positivity has risen to 10% in the US, indicating that transmission is increasing—and that a lot of infections aren’t being diagnosed. bit.ly/3kWoNVx 2/