This is a confusing and honestly, kind of scary, time. So we're BACK! With pediatricians answering your toughest questions about the delta variant, kids and COVID, breakthrough infections, masks and more. Find answers! Go to BetweenUsAboutUs.org to watch, share and learn. Looking for information in Spanish? We got you!

https://twitter.com/RheaBoydMD/status/1395454329008517121

Black folks have the LOWEST COVID vaccination rate of any racial/ethnic group in the country. Not for a booster dose, for the FIRST dose.

As a nation, a TOP priority has to be to protect those who don't have a single dose, not the general public who may want/need a 3rd. (1/x) To be clear, boosters for the immunocompromised and those whose immunity against severe illness and death is low or has waned (like those > 65yo), is important and must be prioritized.

But we ALSO have to urgently address the ongoing vaccine inequities in the US (and globally).

This is not a "pandemic of the unvaccinated." It's a pandemic of the unequal. As a result, COVID is surging globally because of inequality.

Just look at "the unvaccinated" in the US, most are our nation's working poor - the folks our health care system chronically neglects. When we talk about the *choice* to vaccinate, we have to acknowledge that choice, within the US health care system, has always been constrained by forms of inequality and their profitability. The reason is because the US relies on the insurance market to distribute care.

It's time to set new expectations of what "normal" will look like in the coming weeks and likely months.

First, we need to normalize masking.

Masking is normal in a pandemic where a highly contagious infectious disease (the delta variant) is spreading across the country. Second, we need to re-think what "normal" classrooms look like during a pandemic.

Universal masking, smaller class sizes, and high ventilation must become the norm.

Vaccine mandates in schools can also ensure that COVID vaccination becomes a normal back to school activity.

This is not now, nor has this ever been a "pandemic of the unvaccinated."

New evidence shows individuals who are vaccinated AND infected with COVID are JUST AS LIKELY to transmit to others, as the unvaccinated. So EVERYONE has to take more precautions.

Why? Delta is different. Many of us long suspected the vaccinated *could* transmit COVID to others. But early evidence, gathered when the alpha strain was dominant, indicated that if infected, the vaccinated were less likely to transmit to others. This had 2 major impacts:

I've spent the past 7 months talking to folks across the country about the COVID vaccines. Typically, I speak to the unvaccinated.

Today, I want to talk to the vaccinated too.

As delta surges, EVERYONE needs to take additional precautions to protect themselves and others. As you likely know, today the CDC recommended those who are vaccinated WEAR A MASK in areas with high community spread. That includes most of the US. Here is a map from NYT of cases per capita. As it shows, odds are, you live in an area that has seen a recent spike in cases.

Unpopular opinion: There is no such thing as a “pandemic of the unvaccinated.” That is not how pandemics work.

While the unvaccinated remain at greatest risk for COVID, rising cases renders EVERYONE vulnerable to exposure and disease, including some people who are vaccinated. The COVID vaccines are highly effective at preventing COVID infection, complication and spread. But folks who are vaccinated AND immunocompromised or vaccinated AND living/working among those who are largely unvaccinated will also be affected by (and contribute to) surges.

Last week I spoke to over 5000 people in rural Georgia. Most were not vaccinated because they still had questions. EVERY question they asked was legitimate and important.

Stop telling people to “just get vaccinated” if you aren’t willing to put in the work to help them do it. That “work” is MUCH more high touch than spouting condescension online.

“The unvaccinated” are not a monolith of defectors. They are people our health care system has long underserved - Black folks, rural folks, un and un/under insured folks and young folks.

Fam -

Child care providers across the country are offering FREE child care to all parents and caregivers getting vaccinated OR recovering from vaccination from NOW until July 4th!

Here is a list of participating organizations (please share!): KinderCare and Learning Care Group locations across the country will offer FREE, DROP-IN appointments to ANY parent or caregiver who needs support to get vaccinated or recover from vaccination! If you live near these organizations, drop by or give them a call to learn more.

My latest is out today in @TheHillOpinion!

It’s about our two Americas - one that is vaccinated and the other, includes most of our nation’s our kids.

It’s about why vaccine equity remains critical and how to achieve it (spoiler: Family Vaccination!) thehill.com/opinion/health… While others have argued that vaccinating children is important to increase rates of population protection (kids make up 20% of the US population) I argue that it is also critical to protect the Black and Latinx children who have suffered inordinate COVID complications and death.

In medicine, the people who know the least about structural racism have the most power to control how our field understands and addresses racism's impact on health. These folks are hospital executives, NIH leaders, journal editors, and chairs. They are also mostly white (men). As a result, the medical canon remains in this perpetual cycle of racism 101, where scholars are asked to simply explain racism. So rather than funding, publishing, and implementing critical work that might address (or even eliminate) racism and its impacts, we just describe it.

Spending my adult life in large cities has taught me how to assess the level of neighborhood tension based on the position of clothes in and near laundry mats. Based on my experience, here is how to recognize brief insults, signs of escalation and when folks are all out BEEFING. If you see an entire load of laundry on the floor, this is probably a one-off offensive, the kind that transpires in response to someone removing their things from machine before they returned. This brief insult may not escalate beyond this load. Proceed with your washing.

Just reviewing some of the national vaccination data by race and ethnicity and WOW the inequities are alarming!

Look @KFF data for Black folks as of March 3. In Washington DC, Black folks make up 45% of the population, 76% of COVID deaths (!!), and only 26% of those vaccinated. You see similar, but not as striking, racial inequities in states like Alabama, Mississippi, Delaware, North Carolina, and Maryland. These states have sizable Black populations who have suffered disproportionate rates of COVID deaths and yet have lower COVID vaccination rates.

I've been wanting to scream this from the top of my lungs for a while: STOP CALLING BLACK PEOPLE VACCINE HESITANT

But now, I can also say, read why in my first ever article in @nytimes!!!!!!!!!!!!!!!!!!!!!!

Short thread (with less exclamation marks lol)
nytimes.com/2021/03/05/opi… The truth is, Black people don't hate vaccines. We hate exploitation, experimentation and neglect. And many of us, need not resurrect the ghosts of Tuskegee to recall moments in which we’ve endured such abuse.

Hello Black America! Black health care workers across the country and I hear your questions and concerns about the COVID vaccines and we're bringing the information right to you. It's time for us to have a conversation Between Us About Us. Watch and share now! #BetweenUsAboutUs @BCAgainstCOVID @greaterthanCV19 @KFF and I have co-developed more than 50 FAQ videos answering the top questions and concerns we hear from Black communities. Visit BetweenUsAboutUs.org to watch and join the conversation!

The very first Black doctors, back in the 1800s (!!), argued that racial health disparities were driven by racism (and more precisely racial capitalism).

That I have to argue this same basic fact in 2020, doesn't make me my "ancestors wildest dreams." My ancestors already knew. And you don't need to be a doctor to know racism harms Black folks' health. Black people who are not doctors, know too!

Here is recent data from the @KFF and @TheUndefeated poll asking Black folks how racism shapes their outcomes. They know.

I'm going to say something that might be hard to hear, but I'm going to say it anyway.

To those who continue to decry the thin margins in this election, you need to de-center whiteness in your analysis.

Brief thread. These takes, that lament "how close this presidential race is" as some referendum on the nation and it's progress effectively ignore the populations for whom this election was not close at all.

Let's briefly review some of those groups.

This quietly dropped in @TheLancet 2 days ago.

Joining voices across medicine and public health, Dr. Nancy Krieger, Dr. @CamaraJones and I lay out the stakes of this election, as we see them.

I’m going to briefly list them here, as a reminder.

thelancet.com/journals/lance… 1. In a departure from takes that decry the lack of leadership in the current administration, we call attention to the dangers of white supremacy, authoritarianism, and nationalism-lethal threats to our democracy, our lives and the viability of the planet. nejm.org/doi/full/10.10…

Did everyone see this paper by @ProfDesmondAng called The Effects of Police Violence on Inner-City Students??

It documents how living in proximity to policing killings increases student absenteeism, decreases their GPA and their likelihood to graduate! Thread (with pdf link) I want to list some of the findings because they are significant and alarming.

The study looks at 700,000 high school students in Los Angeles from 2002-2016 and their proximity to a local police killing (based on their home address).

Here's the pdf: scholar.harvard.edu/files/ang/file…

Public schools are a critical terrain of struggle for equality in the US. They are spaces where kids AND communities access the resources vital to health, mobility, and longer life spans.

Here's what I think it takes to *safely* re-open schools. Thread. thenation.com/article/societ… 1. A robust social safety net.

The US is a deeply unequal country. That inequality is growing and it impacts everyone, including kids. In the face of chasms between the richest and the poorest, schools have served as both a remedy to and a reflection of unchecked inequality.

Schools are critical sites for children's learning, development, social and emotional well-being.

@AmerAcadPeds wants to ensure our kids have access to the vital resources schools provide.

This administration does not.

As a pediatrician, I want to talk about schools opening. Decades of work has placed critical supports inside of schools.

Let's review some examples.

1. Food - Schools feed 35 million kids a day. These meals make up more than 2/3rds of their nutritional needs. School closures threaten that vital food source.
nejm.org/doi/full/10.10…