Thread 🧵

So what causes #obesity ?

I recently attended a meeting in London @royalsociety about this deceptively simple question.

And what was the conclusion? “There’s no consensus whatsoever about what the cause of it‌ is," as @JohnSpeakman4 put it. Over 3 days, some of the world's top obesity researchers gathered to present their hypotheses explaining a global uptick in obesity rates that began in the 1980s.

Their ideas were bewilderingly diverse:

Austria — with the 2nd highest #covid19 case rate in the world right now — will go into another nationwide lockdown starting Monday, plus compulsory vaccination starting next year. So how did this happen?
bbc.com/news/world-eur… Not sure we fully understand the causes yet but one big one seems to be the low rate of vaccination here, among the lowest in Western Europe. ft.com/content/f04ac6…

We talk a lot about the toll the health system takes on patients but we talk way too little about its impact on doctors.

One of those was Dr. Scott Jolley. It is with a very heavy heart that I share this @voxdotcom report about him.

A🧵...

vox.com/22439911/docto… Dr. Jolley, father of three, husband, friend to many, avid fly fisherman, was based in Salt Lake City, Utah. He worked as an emergency room MD for nearly 30 years. He loved helping his patients — or really, anybody. That's why his friends called him "the Patriarch."

Before #COVID19, the thinking in global health was that travel measures carried harms for little benefit.

Then the pandemic happened and turned that upside down. Why? I took a look at Vietnam, a country of 97 million with 2700 Covid cases & 35 deaths 🧵
vox.com/22346085/covid… For context, lots of countries did travel measures - they were the 2nd most common policy govs adopted when the pandemic took hold - so what was diff about Vietnam? nature.com/articles/s4156…

*New from me* Of all the people I talk to on #covid19 vaccines, @hildabast is consistently the most insightful and correct.

In our conversation here, you can see why I think she's become a @zeynep of the pandemic vaccines:

vox.com/22285256/covid… From noting that Pfizer/BioNTech was the vaccine group to watch when a ton of focus was on AstraZeneca, to being early to point out problems in the AstraZeneca trials & drawing attention to the more severe side effects Covid-19 vaccines can cause -- she's called a lot right.

What should we learn from the nearly 500,000 US #covid19 deaths to date?

@zhoyoyo and I teamed up for a deep dive into the data.

The big takeaway: the virus spared no one — no community, no age cohort, no part of the country. 🧵1/11

vox.com/22252693/covid… At the same time, some groups have been hit way harder than others.

At the start of the pandemic, a trend emerged that's held: people of color of overrepresented in both US #covid19 cases and deaths.

NEW: We've gotten better at treating #covid19 but there was some Q about what would happen to mortality as hospitals filled up again

Researchers incl @Bilal_A_Mateen @segal_eran have answered that Q in two new pre-prints. My story here:

vox.com/2021/1/13/2222… TLDR: Death rates start to rise even before ICUs hit capacity. The finding is grim at a time when one-fifth of hospitals with ICUs are reporting ICU occupancy rates of 95 percent or greater.

Have a new story out about the scientific reasons why the UK (B.1.1.7) and South Africa (501Y.V2) variants are so deeply concerning, even for vaccine protection.

A short 🧵to summarize:

vox.com/22213033/covid… The variants carry many mutations, and specifically on the spike protein -- the part of the virus that fits into the receptor in human cells and also the target for the first approved vaccines.

With the S.A. variant, one mutation is of particular concern: the E484K mutation.

Reporting on the new #covid19 variants of concern B.1.1.7 & 501Y.V2 — and what they might mean for the vaccine — drove me to despair like no other reporting in this pandemic.

vox.com/22213033/covid… We still don't know for sure whether the vaccines will become less effective, but they might.

But the sheer speed at which these new variants appear to be spreading — against the fatigue people feel — is so deeply concerning.

We've got #Covid19 policies backward in a lot of places:

Those least likely to get sick and die from the virus are most likely to be able to social distance & isolate.

Vermont is a place that did things differently. Check their daily case rate relative to other states. 1/ So what's the key to their success? From the start of the pandemic, they prioritized their most vulnerable populations. 2/

vox.com/2020/11/19/215…

Breaking: Trump did get supplemental oxygen Friday but for "about one hour," according to his doctor. #COVID19 In response to transient low oxygen levels - he got his first dose of dexamethasone yesterday.

Here in Austria, and across Europe, #COVID19 cases are rising fast. Today @WHO_Europe called it “very serious situation” unfolding on the continent.

The case tally today looks about as bad as the last peak, in March/April.

But is it really? /1

vox.com/21435868/coron… As usual, it's a nuanced story. But it ends the same place as last spring: with exponential growth, @redouad @BristOliver + others warned.

Just look at the situation in France. In July, cases started increasing in a way that couldn’t be explained by testing alone... 2/

And it’s official: @sebastiankurz just announced Austria will be the first EU country to begin easing #covid19 lockdown and restart the economy

Small shops open with restrictions on April 14; by May 1, all shops open.

https://twitter.com/juliaoftoronto/status/1246379262367670272

Even on May 1, there will still be restrictions on shops — limits on numbers of people in, masks etc.

And government says they don’t yet know the end game for restaurants and hotels. They’ll announce a decision before end of April.

🎉🎉Got the first sign of good #covid19 news here last night:

Austria — one of the first Euro countries to shut down after Italy — may soon be one of the first to ease social distancing measures and restart the economy.

news.google.com/articles/CAIiE…

1/5 Social distancing appears to be working. People are staying home, following the rules.

Cases have gone from doubling every other day to every 12 days — maybe even more slowing by next week.

Austria also has 100s empty ICU beds.

See chart here:
sueddeutsche.de/thema/Coronavi…

2/5

Personal news:

My husband and I welcomed a baby into the world last week. I’ll be taking a break from Twitter/writing... but not without one last #covid19 dispatch:

Spoiler: son makes pod debut @today_explained

open.spotify.com/episode/4ZOIPx… I know there are many families grappling with medical care in this pandemic. My ❤️ is with you. This is a time of great uncertainty and stress. (Most of our childbirth/postpartum plans have been upended.)

vox.com/2020/3/18/2117…

.@WHO press conference today: countries must learn the lessons of others. "There are things we can all do," @DrTedros

- Clean your hands
- Cover nose or mouth w/ elbow if you cough/sneeze
- Stay home if you're sick
- Avoid unnecessary travel/large gatherings This is an important shift:

"Europe ...[is] the epicenter of the #covid19 pandemic, with more reported cases and deaths than the rest of the world combined, apart from China," @DrTedros said.

More cases reported here every day than from China at the height of its epidemic.

This reminds me of a conversation I had in Vienna: A #covid19 dispatch:

In a German lesson recently, another student — who had high fever, sore throat — fainted.

Teacher called the Covid hotline, student was taken away w a doc. Scary. I’m now 9 months pregnant &...

https://twitter.com/juliaoftoronto/status/1236311041086193664

Naturally I was concerned about flu or worse. So I rang the school admin to followup.

Admin told me they wouldn’t release info about the student but also said I didn’t have to worry.

Pregnant women are at no increased risk if it was Covid, she said.

Highlights of the @WHO #covid19 presser today:

@DrTedros Covid19 is becoming increasingly complex.
In the past 24 hours:

- China reported 129 cases -- the lowest number of cases since Jan. 20.
- 1,848 cases were reported in 48 countries outside China. 1/ @WHO @DrTedros - 80 percent are from 3 countries: Iran, Italy, S. Korea
- 12 new countries reported first cases
- 21 countries with 1 case only
- 122 countries have not reported any cases

(I should have said highlights and lowlights in first tweet) 2/

Buried good news: China seems to have altered its #covid19 epi curve through a vast toolkit of public health measures

Cases have been dropping there while they surge in rest of the world

Here's @WHO mission chief to China on what he saw 1/

vox.com/2020/3/2/21161… One of the important insights Bruce Aylward shared:

While much focus has been on China's vast lockdown/quarantine measures-rightfully so since they raise urgent human rights questions-that was not the main story in 30 provinces that stopped their #Covid19 outbreak

Thread: @WHO presser starting now with @tedros: the number of cases in China continues to decline.

Outside China 8739 cases from 61 countries with 127 deaths.

In last 24 hours "almost 9 times more cases reported outside China than inside China."

1/ @WHO @tedros Epidemics in South Korea, Italy, Iran and Japan are the biggest concern for WHO right now.

Korea has now reported more than 4,200 cases and 22 deaths — meaning it has more than half of all cases outside China.

Good news? Korea cases coming from known clusters, not community.

THREAD: On my mind now as #covid19 panic ratchets up:

We need to separate out the market/social effect, from public health response, from health impact of #covid19 when we talk/write/think about the virus. With the outbreak in Wash. state and more US cases discovered in weeks ahead, the public health response is going to ramp up fast. Public health has to prepare for the nightmare scenario.