Justin Feldman Profile picture
Epidemiologist of social inequality and state violence. Health & Human Rights Fellow @fxbharvard
Episurgeon Profile picture 1 added to My Authors
3 Oct
Okay let's take a look at this one. Public health measures will lead us towards Nazism? Hmm lets take a look because I'm feeling masochistic...
Surely Prasad is talking about Title 42 being used to detain asylum seekers and send them to their death under the pretext of public health. That's historically rooted in the same eugenic policies that Hitler cribbed from. But no, that's not in the piece at all.
The continued incarceration of millions of disproportionately Black people during a deadly pandemic? Sounds fascist to me. Also not in here.
Read 9 tweets
19 Sep
CDC estimates 30% of covid deaths are not counted as covid deaths. So while the US death toll is reported at 675,000, it is really more like 875,000.
Source: "1 in 1.3 covid deaths were reported" cdc.gov/coronavirus/20…
Read 4 tweets
15 Sep
Okay this thing isn't going away so let's talk about why 1 in 5000 is actually meaningless and, despite vaccines' relatively powerful protection against hospitalization, breakthrough infections aren't "rare" when community spread is high.

Short thread
The figure comes from the NYT newsletter (reported as the individual *daily* risk of infection among the vaccinated). It was cited by Biden in his new covid response plan (somehow reported as a *weekly* infection risk) and has been otherwise making the rounds.
Where does the number come from? NYT guy David Leonhart apparently looked at data from a few arbitrary jurisdictions that track breakthrough infections (UT, VA, King County WA) and decided the numbers were trustworthy and could be applied nationally.
Read 16 tweets
24 Aug
Until pretty recently it was hard to find a political message about addressing climate change in the US that went beyond consumer choice (or worse, overpopulation). Now it's much easier to come across messages, even campaigns that call for regulation, planning, policy change...
That shift reflects years of organizing and education. With covid, the pandemic hit much faster than the left's ability to organize around it, and that first step of internal education is still far from complete.
I was naive bc I assumed that commited leftists would look at the pandemic response through lens of class power, structural racism, intertwined fates. But maybe most people need to be specifically organized around each new issue
Read 4 tweets
21 Aug
Is it just me or did CDC go from "breakthrough infections are rare" to "we need boosters to prevent breakthrough infections" in like a week? And I'm not sure if the first talking point was rescinded.
And please take a moment to consider before you get mad at this
"What was previously uncertain is now revealed to be extra risky and we didn't prepare for it" is called not following the precautionary principle and that is a political stance
Read 6 tweets
6 Aug
Black and Indigenous people are being hit hardest by delta, with 2.4 and 1.8x the hospitalization rate of whites in the US, respectively.

These figures actually understate the inequalities because populations of color are younger than the white population.
Screenshot from CDC's COVIDnet gis.cdc.gov/grasp/covidnet…
COVID-net only covers 10 states, and some states that are being hit particularly hard right now like Florida are excluded
Read 5 tweets
22 Jun
1/ I'm gonna use this to lay out a messy, preliminary version of an argument here. The question I'm trying to answer:

Why did US public health experts generally not push for the kinds of broad shutdowns that our counterparts advocated in many other countries?
2/ The answer is manifold, but I want to focus on one particular aspect here.
3/ Shutdowns are big, blunt instruments of the sort US scientists are socialized to eschew in favor of lightweight, targeted, local intervention. We're told to be pragmatic, that only micro-interventions will actually get adopted bc they’re palatable to politicians and the public
Read 21 tweets
5 Apr
The unstated US pandemic strategy:
- Strongly disfavor policies that interfere with business
- Favor individual behavior change
- Tolerate an unlimited number of deaths
- Intervene more strongly to avoid exceeding ICU capacity (sometimes)
- Rely nearly exclusively on vaccination
Most social distancing in the US has been voluntary. In Jan 2021, you could've eaten indoors in 46 states.

Social distancing has been about individuals choosing to avoid risk to themselves and others. This is far less effective than govt policy and not everyone has a choice
Despite the lax government response, we see a weird type of 'inventing a guy to get mad about' response, wherein people (mainly elites) are upset about social distancing and still want to blame government for doing *too much*.
Read 5 tweets
19 Mar
On Jan 21, Biden signed an executive order stating OSHA would issue an emergency covid regulation by March 15 "if such standards are determined to be necessary". Guess that's not happening.
Apparently they've opted instead to focus inspections on the highest-risk covid sites. But that leaves the vast majority of workplaces unprotected. And without a regulation, it's easier to fight citations under the less specific "general duty clause" osha.gov/enforcement/di…
Can a worker who refuses unsafe conditions then collect unemployment? Biden promised this, but details are still unclear (please let me know if you know something I don't) archive.is/M9RUT
Read 9 tweets
18 Mar
What accounts for racial and economic inequality in covid-19 deaths?

Is it due to differences in health care access? Co-morbidities?

I think the evidence points to differences in exposure as the main cause of inequalities. Some evidence:
There's no nationally representative surveys of SARS-CoV-2 infection by race. But there's evidence from smaller areas.

In RI, Black people were 5x more likely & Latinx people 9x more likely, to have antibodies vs whites (Large confidence intervals though) ajph.aphapublications.org/doi/abs/10.210…
Another random sample in 2 Georgia counties. Black people had 17x the seroprevalence of white people cdc.gov/mmwr/volumes/6…
Read 5 tweets
16 Mar
The magnitude of inequality in covid deaths is almost unbelievable. It's not something we see with other major fatal disease.

The age-standardized death rate for college-educated whites is roughly a tenth of what Black, Latinx, and indigenous men are experiencing.
When we see the response of politicians and public health opinionators that we shan't be too cautious or too pessimistic, it's important to realize that these people are largely living in a parallel universe with a different pandemic that really isn't nearly as deadly
* Sorry, that should be a tenth of what Black, Latinx, and indigenous men WITH A HS DEGREE OR LESS are experiencing.
Read 4 tweets
14 Mar
Okay this study is getting a lot of attention, here's a quick critical review. The tl;dr is that the study does not really provide evidence that 3ft is 'just as good' as 6ft. I'll focus on two points.
First, the "3ft" schools may have 6+ ft of distancing (many have low in-person attendance). The study uses policies, not actual conditions.

The authors identify this limitation. But they don't note that the effect of the limitation would be to understate potential risks of 3ft.
Second, the interpretation of results. The confidence interval for students is IRR: 0.62, 1.33. This roughly means students in "3ft" schools might have anywhere between a 38% lower risk and 33% higher risk, than in 6ft schools
Read 6 tweets
22 Dec 20
I’ll take this as an opportunity to talk about this study, why I think in-person instruction amid high community spread warrants much caution, triangulating evidence, and thinking about population health effects /1
To clarify, this study wasn’t done by CDC but by academic researchers in Miss., published in CDC’s MMWR journal. It’s a case-control study of a few hundred kids, with all the limitations that entails. /2 cdc.gov/mmwr/volumes/6…
What did it find? The confidence interval for the effect of attending schools is wide, ruling out neither an increased nor decreased odds of covid /3
Read 21 tweets
5 Oct 20
A lot of people asked for a tweetorial on how to do this sort of thing. I'll be relatively brief and leave a resource at the bottom for people who want code. 1/n
First we want individual-level data on deaths with variables on geography and demographics. Normally you'd apply for these from CDC or state health depts. Here we'll use the Cook County Medical Examiner case archive datacatalog.cookcountyil.gov/Public-Safety/… 2/n Image
We can filter for deaths than contain "COVID" in any cause of death field and download that subset. They come already geocoded. You'll want to match these lat-long pairs to census tract ID numbers, which you can do in GIS or using a service like geoservices.tamu.edu 3/n
Read 12 tweets
5 Oct 20
Are racial inequalities in COVID-19 outcomes really just class inequalities?*

Mary Bassett and I look at this in a forthcoming preprint of COVID-19 mortality in Chicago/Cook County, IL. Some findings:
For under-65s:

White people in high-poverty neighborhoods have very high mortality rates, similar to those of black people. High-poverty whites die at 13.5x the rate of low-poverty whites.

But in the lowest-poverty areas, black/latinx mortality is still high.
For those over 65, there is a clear white advantage across all poverty categories.
Read 11 tweets
4 Oct 20
I don't think most academic epis look down on govt epis because most of us don't even think about govt epis. We are mostly untethered from reality.
That's how you get Respectable Epidemiologists saying we should somehow identify and protect those at highest risk of severe covid while letting everyone else get infected.
Some of the greatest minds don't understand that we're not as important as we think, those papers we publish rarely result in material change, we're mostly employed in a federal make-work program for the professional class
Read 4 tweets
3 Sep 20
In light of Graeber's death & right-wingers alarmism over "Marxist" academia's mild expressions of disapproval towards racists, I think it's worth looking at how Graeber was expelled from the US professoriate. publicanthropologist.cmi.no/2017/10/11/aca…
His politics (an open anarchist whose views were explored in his activism and work) ruffled feathers at Yale. He also came to the defense of a student who was facing retaliation for union organizing, which the admin rly detested.
It's been a long and bitter union fight going on since the 90s. Corey Robin writes how he himself was almost fully blacklisted for his role as a union organizer. Same deal with the Graeber advisee.
Read 5 tweets
26 Aug 20
I'm researching how actors in law, medicine, corporations, & epidemiology created a system where deaths in police custody nearly always get attributed to drugs (or mental illness) rather than police themselves. 1/ fox9.com/news/court-fil…
The defense in the criminal case against George Floyd's killers will be that he died of a fentanyl OD rather than Chauvin's knee on his neck. This has a wider context. /2
In the late 70s, a SCOTUS decision paved the way for civilians to sue police depts in much greater numbers. Lawsuits mounted in the 80s, also a time of growing cocaine use. A Miami medical examiner came up with a condition called 'excited delirium' in 1985... /3
Read 11 tweets
22 Aug 20
It's possible to believe that a study has far better methods than the median study in that field but also not believe the findings while still appreciating it and also recognizing the bad faith of other critics send subtweet.
I don't know what people think epidemiology is about. Can we ever get effect sizes right with observational data? Rarely, I think.
But I'm a nihlist and try to stick to descriptive research so take this with a grain of salt
Read 6 tweets
20 Aug 20
Big Name Epidemiologists:

The point of our field is to estimate the effects of interventions (in RCTs, or hypothetical interventions w/ observation data) that improve health so then policymakers can implement those interventions.

The real world:
To be less nebulous: causal questions can be about looking backwards in time and assigning responsibility to people and institutions and practices that harm health in order to get redress through legal, political, regulatory systems.
Also remember when Obama drank a glass of water while addressing an audience of community members in Flint... as a stunt to show it was safe when it actually wasn't? That was really something.
Read 4 tweets
11 Aug 20
My vision for an agenda for public health scholarship and action aimed at ending police violence:
1. Document harms of policing, in terms of deaths, injury, trauma to individuals, their families, communities. Develop ongoing monitoring systems for police violence. This has been the focus of most of the existing critical public health & policing work (my own & others).
2. Interrupt public health systems that snitch on people. This happens formally (e.g. "Weapons Related Injury Surveillance Systems" reporting from EDs to probation depts) and informally (ED physicians calling cops to alert them of discharge at police request)
Read 6 tweets