Dr. Tara C. Smith Profile picture
Professor, infectious disease epidemiologist, writer, K & teen wrangler. Antibiotic resistance, zoonotic disease, scicomm, zombies. She/her. No one's sweetie.
Ross Grayson, MPH, CIH Profile picture Christoph Altheim Profile picture Patrick D. Profile picture B Raynor Profile picture Timothy McDonnell Profile picture 14 added to My Authors
19 Feb
And we see you over there on the internet
Comparing all the girls who are killing it
But we figured you out
We all know now, we all got crowns
You need to calm down
(I post these occasionally not because they bother me anymore--20+ years as a Woman on the Internets with Opinions makes for a thick skin--but as examples for men of what their colleagues are dealing with, & for new folks to #scicomm so that unfortunately they see the downside).
Also I block creepy stalkers. You want to mislead people, do it on your own timeline.
Read 5 tweets
19 Jan
Raising this up into a thread because it's a concern I've been asked about more than once. It is certainly hard at times to defend an industry with a reputation for issues with some products (deserved or not). But here's why I'm not concerned about these vaccines. /1
One, ingredients. For the Pfizer & Moderna vaccines (where I'll focus), they are little more than mRNA (which our body produces anyway) w/some lipids & sugars. Even though I'm not concerned about other vaccine ingredients, these vaccines are about as minimalist as they come. /2
Two, transparency. There are many documents you can read from both companies that detail their study procedures and results. But also, these studies have been done in the era of social media. Many participants have shared their experiences. Makes it tougher to hide anything. /3
Read 7 tweets
5 Jan
Thread examining effect of mutations in the variants seen in the UK (B.1.1.7) and South Africa (501Y.V2) on immune response (especially neutralization by antibodies). Cliff notes follow. /1
Definitions: RBD= receptor binding domain; NTD=N terminal domain. Both refer to parts of the virus's spike protein (schematic ). /2
First, mutation E484K (in S.A. variant) seems to reduce antibody recognition better than N501Y (in UK variant). But lots of variation among individuals. And remember this isn't on/off; it's a gradient in binding, & response changes over time even in single individual /3.
Read 5 tweets
19 Dec 20
Scare-mongering about the #COVID19 #vaccine: a thread.

The scare posts about the vaccine have begun. You may have seen video of a Tennessee nurse, who felt light-headed and then passed out while giving an interview about her injection. /1

/2 She's fine, and some of the clips don't show her recovery or update on her condition. *This reaction is completely normal* and really has nothing to do with the vaccine, per se, but moreso with the process of being vaccinated (needle injection, possible pain).
/3 This is a vasovagal reaction. I've had these as well, starting when I was about 12 and had a penicillin shot for strep throat. I felt OK for a few minutes, then passed out in my pediatrician's waiting room and woke up to smelling salts. mayoclinic.org/diseases-condi…
Read 9 tweets
12 Nov 20
We're now two weeks out from U.S. Thanksgiving. Do you have a plan? A thread.
First, given record case numbers across the U.S., the best thing to do is simply not have an extended family gathering, full stop. My family is keeping it to immediate households only this year. We'll probably video chat with my nephews and nieces but that's it for 2020. /2
If you're determined to have a larger gathering, today is the day for everyone attending to start quarantining if possible. Have groceries delivered, stay home and avoid others not in your household if you can. This will reduce your chance of exposure between now and Tday. /3
Read 8 tweets
11 Nov 20
So @GovMikeDeWine gets down to changes in Ohio. Masks will be required in businesses and will be inspected for compliances. Second violation will bring about store closure. I hope this isn't it... 1 of ?
2/ new order on gatherings. Requires everyone to be seated & wear masks unless actively eating/drinking. Prohibits dancing. Limits of 10 still in effect (but nothing about enforcement here?)
3/ Looking into re-closing restaurants, bars, etc. one week from tomorrow (that's they may be doing it, or may be looking into it? Unclear).
Read 9 tweets
29 Oct 20
We've seen a helluva dramatic increase in cases here through October, starting the month with about a thousand cases per day and ending with a 7-day average 2.6x higher (& daily numbers far exceeding that average). /1
My hometown hospital (BVH) is starting to feel the strain, after going through the pandemic to date with relatively few #COVID19 cases. County next door has no hospital but highest per capita rate in state, so many cases end up at BVH. /2 13abc.com/2020/10/28/rur…
With 3590 new cases today, that means there are a lot of exposed people out there who will be diagnosed in the next 5-10 days. We're already double our summer peak without any additional interventions on the way. /3
Read 8 tweets
20 Oct 20
Absolutely. Measles can cause SSPE up to a decade after infection (ncbi.nlm.nih.gov/pmc/articles/P…), universally fatal. Then you have those that cause cancer, like HPV, HBV, HHV-8 and more. Truth is we won't know the extent of this pandemic's health outcomes for years. /1
/2 Perhaps one of the strangest (possible) connections between a pandemic and lingering effect was encephalitis lethargica after the 1918 influenza pandemic (academic.oup.com/brain/article/…), featured in "Awakenings" by Sacks and "Asleep" by Caldwell Crosby.
/3 MS is another condition that's been associated with just about every infection out there, including other coronaviruses (jvi.asm.org/content/74/19/…)--again, not definitive because they're tough studies to do.
Read 4 tweets
9 Oct 20
I wrote about the pending epidemic in rural America back in May. I think it's safe to say it's now here; a thread. foreignaffairs.com/articles/unite…
An enormous chunk of the country is seeing rising numbers of cases. You can see "uncontrolled spread" through much of the Midwest and Great Plains, the Southeast, and into many of the Western states. facebook.com/kristof/photos… /2
Many of those lack mask mandates (Idaho, the Dakotas, Iowa, Nebraska, Missouri, South Carolina, Mississippi, Tennessee, Oklahoma, Utah, Florida) and are led by GOP governors. Some cities within these states have mask mandates, leaving the rural areas more vulnerable. /3
Read 16 tweets
10 Jul 20
New @JAMA_current publication looking at recovered #COVID19 patients in Italy. The outcomes are concerning: a thread. /1
First, should note: these were all hospitalized patients, so those who were very ill. Bias right there: we don't know as much about those who rode out the illness at home or otherwise had more mild symptoms not requiring hospitalization, so need more data on those folks. /2
Second, the time point examined was ~60 days after onset of symptoms, and patients "were offered a comprehensive medical assessment with detailed history and physical examination." So not only self-report of symptoms; makes it more rigorous & repeatable. /3
Read 7 tweets
6 Jul 20
As Marc notes, helloooo, John Snow. I think epidemiologists know a bit about natural experiments. And for those who say "no, Snow had an intervention: he removed the pump handle!," y'all don't really know the whole story. /1
/2 Yes, the pump handle was removed, but by that point the epidemic was already waning and the cholera bacteria probably dying out in the well. That wasn't the experimentum crucis he'd been looking for (though it makes for a nice tale).
/3 Rather, the critical part that allowed a test of his water-borne hypothesis was that residents of the same neighborhood, breathing the same air and sharing the same environment, *were using different water sources.* That was the key, not the removal of the pump handle.
Read 4 tweets
24 Jun 20
Didn't have a chance to discuss this yesterday, but I think it emphasizes again just what is still unknown about "asymptomatic" infections: a thread. (Link to research paper: nature.com/articles/s4159…) npr.org/sections/goats…
First, we generally rely on people to self-report symptoms. This introduces biases: some people may be more "in tune" with their bodies & notice very minor symptoms. Some might not have access to a thermometer--how to know if they had fever? Not as straightforward as it seems. /2
This paper looked at 37 "asymptomatic" individuals. 60 were initially examined as lacking symptoms, but 23 ended up having symptoms dx'd by doc at enrollment or within next few days. Which brings us back to self-reporting: symptoms underestimate the severity of the disease. /3
Read 11 tweets
16 May 20
Ohio's problematic messaging about reopening and contact tracing: a thread. /1
I think many in the public don't understand what will be asked if them re contact tracing, and we're not explaining it well. First, note what is missing in the graphic above: what do contacts do in that 14 days after exposure? It's not noted. /2
If you go to the link, they have a bit more info: "those who have been exposed will self-quarantine and monitor their symptoms...". Do people understand that they may have to go back into an individual lockdown for 2 weeks at a time if they're exposed? /3
Read 8 tweets
12 May 20
So let's talk a bit about R0 and superspreading events, because I guess we're returning to February. Remember that R0 is not an intrinsic factor of the virus--it's dependent on host behavior, population immune status, and other factors. /1
This is why distancing & hygiene have reduced spread in some areas to ~ or below 1, meaning it's either steadily spreading in the population but not yet decreasing, or slowing a bit in some areas where it's hovering less than 1. This is what we want--decreased transmission. /2
But keep in mind R0 is an average over the population. Some people may be responsible for a disproportionate amount of spread, and some may never spread it at all. /3
Read 8 tweets
5 May 20
Orville, Ohio. Not sure if this is chain-wide. @GioninosO Image
This is what I've received from the Gionino's Facebook account thus far. The Governor's order only applies to employees, not customers, so they're still putting their employees at risk. Image
More. Image
Read 5 tweets
4 May 20
Let's talk a bit about what reopening ("responsible restart") looks like in Ohio. As of today, the following can be open: dental clinics, vet clinics, med facilities, manufacturing & distribution, construction, offices. Distancing, masks, cleaning, temp checks all required. /1
We've somewhat plateaued here as far as new case detection. Had a large bump because of testing in our prisons where we found a huge load of cases, but are flat-ish other than that. But, we're also still limited in tests & testing primarily the sickest cases & exposed HCWs. /2
Still lots of issues with wearing people wearing masks, staying away from groups despite the continuance of our "stay home, stay safe" order through May 29. One GOP rep refuses to wear a mask & many constituents I'm sure agree: /3
Read 12 tweets
18 Apr 20
20 experts apparently shared thoughts for this article by Donald McNeil Jr. Two women are quoted. Both speak about their families. Do better, @nytimes. nytimes.com/2020/04/18/hea…
Gonna turn this into a thread. Here's another, @nytimes. Five modelers quoted, all men (h/t @Caroline_OF_B). nytimes.com/interactive/20…
And another @nytimes article on the heroes of the outbreak, all men. nytimes.com/2020/04/05/wor…
Read 8 tweets
26 Mar 20
#Pandemic scenes from a rural area. We don't have starkly empty streets, but most of our key institutions have closed. Pic 3: local meat store where everyone is apparently now socializing instead of the Moose & VFW. ImageImageImage
Read 5 tweets
24 Mar 20
Quick thread on today's @CDCMMWR paper on #coronavirus infections and transmission on cruise ships (cdc.gov/mmwr/volumes/6…), including the Diamond Princess (DP). /1
From the top, the basic numbers: "Among 3,711 DP passengers & crew, 712 (19.2%) had positive test results for SARS-CoV-2... Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died. /2
The "asymptomatic" number is getting play already, but note the qualifier: "AT THE TIME OF TESTING." They didn't report follow-up to show how many eventually developed symptoms. So many possibly still in incubation period. /3
Read 9 tweets
22 Mar 20
@JoshCrawfordNE Tired of Silicon Valley tech guys thinking because they're smart overall that they're suddenly experts in epidemiology. But @CT_Bergstrom already has started a thread here and I gotta put my kid to bed.
@JoshCrawfordNE @CT_Bergstrom Two other assessments: cherry-picking & Gish gallop. It's like the manifestos that antivaxxers put out about vaccine-preventable diseases. They superficially look ok until you recognize they're picking 1 source & eliminating everything that disagrees w/ pre-determined conclusion.
@JoshCrawfordNE @CT_Bergstrom See also: Brandolini's law, aka the bullshit asymmetry principle: The amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it.
Read 4 tweets