For decades, the @WHO has defined health as more than just the absence of disease. But epidemiologic research typically focuses on disease and risk factors, not health and health assets.

New paper, short thread. 🧵 Take sexual health. Researchers and clinicians tend to focus on preventing unwanted outcomes, like STIs. But this picture of health is incomplete: people with STIs can have robust sexual health, while people who don’t have STIs can lack sexual well-being. 2/

I wrote about our collective underestimation of people's drive to see loved ones, the limits of lecturing, and how all I want for Christmas is a new public health strategy. theatlantic.com/ideas/archive/… People are lonely, scared, exhausted, grieving. Our leaders have abandoned us, so of course we're turning on each other. But shaming doesn't deter risky behavior—it just perpetuates stigma, which is counterproductive to containing the pandemic. theatlantic.com/ideas/archive/…

What is #covid19 stigma, why is it toxic to public health, and what can we do about it?

A short thread. 🧵 Without federal support, it feels like "personal responsibility" is what will save us—so of course people are trying to shame each other into healthier behavior. But shame and blame perpetuate stigma, which can have the *opposite* of the intended effect. theatlantic.com/ideas/archive/…

In contrast to #COVID19, there are powerful pharmaceutical interventions that can prevent HIV transmission: #PrEP is ~99% effective and #UequalsU is 100% effective.

So why has HIV incidence essentially flatlined in the U.S., and what does this mean for COVID19?

THREAD. Structural inequities ensure that HIV prevention strategies are used least by those most in need. That's why incidence is *increasing* in young Black gay and bi men while stable or declining in other groups.

The result: highly effective interventions, limited population impact.

As @BillHanage has written, hybrid schooling may be the worst of all worlds. I'd like to walk you through a week in the life of my first grader to illustrate why. washingtonpost.com/outlook/2020/0… For context, my city has very low community spread: test positivity is 0.16%. Public high schools are fully remote, middle schools will be remote until at least November, and elementary schools are using a hybrid approach. (Many private schools are opening full-time in person.)

🚨NEW: I wrote this piece for @TheAtlantic about the latest weapon being unleashed in the war against #COVID19: the cops. Crowded indoor parties need to be avoided during a pandemic, but policing people’s behavior will be toxic to public health efforts. 1/ theatlantic.com/ideas/archive/… Enforcement may be ramping up now, but let's be real: we’ve already spent months policing each other. People have been widely shamed for enjoying themselves—even when their fun is low-risk. The message is clear: pleasure is not essential in a pandemic. 2/ theatlantic.com/ideas/archive/…

Many people have seen this new @CDCgov statement on the importance of opening schools, which is watered down and likely politically driven. But there was also some useful guidance that was posted today.

I'll try to link each item in this thread. cdc.gov/coronavirus/20… Here's the guidance for K-12 administrators on preparing to open schools, including considerations related to community spread and best practices for prevention. cdc.gov/coronavirus/20…

Since writing this piece for @TheAtlantic, I've been contacted by a whole lot of dudes who won't wear masks. I've had some good conversations with them.

Here are a few things I've learned. 1/ theatlantic.com/ideas/archive/… These men were universally grateful to read something about anti-maskers that didn't shame or demonize them. It made them want to hear what else I had to say about why it might be worth wearing a mask. Compassionate public health messaging builds trust. 2/

I've been writing about the need for empathetic public health messaging, which is more effective than trying to shame people into changing their behavior. Some have asked what exactly that looks like.

Here are a few simple examples. It's easy to call people selfish for going to brunch in a pandemic. But messages about the risk of gathering indoors will be heard much more clearly when they come from a place of compassion.

https://twitter.com/uche_blackstock/status/1277581998773751810?s=20

People want to socialize – and not just outdoors, masked, and 6 feet apart.

We're craving a sense of normalcy. We desperately want to forget we're living in a pandemic.

So why aren't we talking more about social bubbles?

1/ The idea with bubbles is that people have just a handful of social contacts, maybe a few friends or one other household.

Everyone keeps up the masks and distancing outside of the bubble, but there's normalcy within it: dinner parties, playdates.

2/
slate.com/human-interest…

You may have seen the "shocking" survey that found 66% of NY's #COVID19 hospitalizations were people who'd been staying home. News stories are concluding we can easily get infected from packages, grocery stores, or walking outdoors.

I have questions. 1/ cnbc.com/2020/05/15/peo… Does the 66% from a "home" setting include household contacts? Rather than telling us that people are picking up the virus at grocery stores, this would be consistent with what we know about transmission: it often occurs in households. 2/

Quarantine fatigue is happening, whether we like it or not.

Is it time to consider a harm reduction approach to #COVID19?

A thread. 1/
bostonglobe.com/2020/05/04/nat… Our messaging so far has focused on #StayHome, but risk isn't binary.

We know the highest risk of transmission is in crowded and enclosed environments, while casual interaction in outdoor settings seems to be much lower risk. 2/

https://twitter.com/mugecevik/status/1257392347010215947?s=20