I am pleased to share with you the Testing Playbook for Biological Emergencies produced by collaboration between @pandemiccenter @aphl @MaraAspinall & STAT Public Health Network. 1/ shorturl.at/uN167
We created the Testing Playbook for Biological Emergencies to guide and increase transparency around decisions to establish and scale-up testing in a crisis. 2/

We have to talk about this Cochrane review of masking and handwashing that found “little to no evidence” masks (surgical & N95) reduce viral infections at the population level and some evidence that handwashing may help. Let’s dive in to understand why 1/ cochranelibrary.com/cdsr/doi/10.10… First, it’s important to point out that Cochrane reviews are very serious undertakings. They use rigorous methods to systematically review evidence regarding safety/efficacy. It's been called the gold standard of reviews. 2/ cochranelibrary.com/about/about-co…

It appears some believe there was this grand conspiracy where the US protocols for responding to pandemics were jettisoned in responding to COVID-19. Let me unpack why this is not accurate. 🧵 1/ First, it's important to recognize that disease control efforts must in part be tailored to the specific pathogen. The virus that causes COVID-19 (SARS-CoV-2) is quite different than the virus that caused the 2003 SARS epidemic. Both differ from flu. 2/

I got the updated COVID booster last week. I had been planning to get it closer to the holidays, but there started to be enough infections in my extended network such that benefit of waiting was getting lower. The best time to get a booster is before you get infected. 1/ Boosters are best at reducing severe illness. I wasn't too worried b/c I'm not high risk (<50yo) and already have 3 doses. But it had been a year since my last vax & as a busy mom, I welcome boosters' additional help to reduce symptoms. I had no side effects w/ the vaccine. 2/

I am seeing some sorry attempts to undermine the US Monkeypox Response Deputy Coordinator, Dr. Demetre Daskalakis. Let me use this thread to explain why efforts are ignorant of the facts and incompatible with the goals of ending the MPXV outbreak. 1/ Anyone who knows outbreaks knows that having responders who have knowledge of affected communities is essential. As the outbreak is currently disproportionately affecting gay and bisexual men, Dr. Daskalakis’s experience living as a gay man is an asset to this response. 2/

Our new study, led by the amazing @a_aliseda and team, raises deep concerns about how the US is collecting COVID-19 demographic data. ajph.aphapublications.org/doi/full/10.21… 1/ 1) We found that CDC's COVID demographic data represents only a subset of the case data that states report on their websites. Specifically, as of 6/21, the CDC’s public demographic data set included 80.9% of total cases and 46.7% of total deaths reported by states 2/

1 million covid19 deaths.

Someone recently reminded me that when asked at the beginning of the pandemic if the US could see more than a million deaths I said yes.

At the time, we had no long-term control strategy and no vaccines. Respiratory viruses are hard to stop. 1/ But by early 2021, I was feeling a bit more hopeful. Thanks to decades of prior research and unprecedented political commitment we had multiple safe and effective vaccines that could prevent most deaths. 2/

With a rise in cases in a few parts of the US, people are asking if we'll see a rise in hospitalizations. Short answer is yes, but on a delay. Reasons and implications of this are multifold. 1/ Hospitalizations for #COVID19 typically lag an increase in cases by several weeks. We see this happening in NY's data. Hospitalizations took a few weeks to rise. coronavirus.health.ny.gov/daily-hospital… 2/

Getting people vaccinated must be our top priority. So how do we do it? In this thread, I'll share some innovative practices I've come across. Please reply with others! 1/ My friend @ARobertDrPh's FQHC employed active measures to get their patients vaccinated. Instead of just offering appointments and hoping their patients would show up, they called them and got them scheduled. 2/ johnshopkinssph.libsyn.com/-303-a-digital…

In my experience, people who are on the fence about covid vaccines have a long list of questions that require nuanced answers. Most of these reasonable questions stem from disinformation spread widely on-line. But they must be answered. Much of the vaccine communication campaigns I’ve seen are very summarized and glib. Vaccines are safe! Vaccine work! They don’t provide answers the ?s that so many have.

I am deeply worried about political interference at FDA and CDC. But I do not believe these agencies have “lost all credibility” as so many are alleging. Though the appointees at these agencies have made bad decisions, there are thousands of excellent civil servants working hard, doing the right things.

A long thread about test positivity: Tracking positivity is important. Unlike number of tests, positivity is linked to the number of infections out there. It can help give us a sense of whether a state or country is doing enough testing for the size of its epidemic. Positivity can be a measure of whether we are doing enough tests. As a standalone metric, it is NOT a measure of prevalence or incidence of infection.

A THREAD ON TESTING: I am deeply worried about the serious testing delays and bottlenecks being reported throughout the US. It will only get worse when flu season starts.

https://twitter.com/JenniferNuzzo/status/1280853497068519424

The US has greatly expanded the number of tests it can conduct. We went from ~25,000 tests per day in March to well over 500K tests per day. But it is still not enough because spread of the virus outpaced these efforts.

Interested in promoting social justice but worry it conflicts with your desire to protect public health? Good news! Social justice <=> public health! A thread with resources. Please RT or reply with additions. Overview of Social Justice and Health from the American Public Health Association @publichealth apha.org/what-is-public…

We can't just lock down society without also drastically ramping up case finding and isolation and contact investigations, otherwise cases will rise as soon as restrictions eased sayc @who's @DrMikeRyan “What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,” says @DrMikeRyan

With evidence of local transmission in multiple US states, it’s time to end quarantine of well travelers. These measures are not working as divert sorely needed public health resources from community preparedness I’m often asked if travel bans and associated can buy time to get ready. The answer is they only help if we know what countries have disease and what don’t. And if we use that time to actually prepare.

With ongoing transmission in multiple @who regions, it hard to argue that COVID-19 doesn't meet definition of pandemic. Here's WHO's language on classifying geographic spread: who.int/csr/disease/sw… In 2009, when there were <30,000 global cases @who told countries that influenza A/H1N1 was unstoppable and told countries to "recalibrate their strategies to minimize the harm" from the virus. cnn.com/2009/HEALTH/06…

Don't understand this. We have seen sustained H2H transmission outside of China. In multiple countries. cnn.com/asia/live-news… In 2009, @WHO was criticized for having too many pandemic phases. We were well into pandemic when phase changed, which made it seem like risk increased. Really, only change was more WHO regions were involved. That had organizational impacts, but not too meaningful for public