For everyone coming to #AIDS2022, the Canadian gov't has reintroduced mandatory random arrivals testing.

The process will likely be convoluted for people staying in hotels as kits will need to be shipped to you or maybe can get one at airport and then returned somehow.

(sorry) Most people attending #AIDS2022 will be flying into YUL/Montreal Airport.

I contacted Biron (the federal testing contractor in Quebec) and there are 3 options for testing.

1) At airport
2) Locations in Montreal where nurse will take swab
3) Shipping self-collection swab.

2/x

A public health program implemented without a detailed plan is no more likely to succeed than a house built without a detailed blueprint. Epidemiological data is one of many inputs into public health recommendations.

Others include:
1) knowledge, attitudes, and practices of affected communities
2) human rights
3) legal contexts
4) human behavior and desires

A pragmatic PH recommendation integrates more than data.

Paper 19:

Led @Mat__MG, @mishrash, we studied structural risks for #COVID19 in 16 cities across Canada.

Critical for resource-driven interventions to address unmet needs as hypothesized "trickledown benefits" from protecting some folks was insufficient.

cmaj.ca/content/194/6/… Paper 20:

Led by Barlo MS Center, we studied the prevalence & severity of #COVID19 in 7000 people with multiple sclerosis (PwMS).

No clear increase in burden of #COVID19 in PwMS, but trend of increased severity with certain disease modifying therapies.

msard-journal.com/article/S2211-…

I'm going to start a living thread summarizing all of the #COVID19 papers that I have been part of--both data-driven and commentaries/editorials.

Ultimately, anything I say here is based on what I've seen play out in studies around the world.

20 months in...we know a lot.

1/x Paper 1:

In working with our colleagues at @amfar, we described the disproportionate effects of #COVID19 on disproportionately Black counties across the US.

Drivers of disparities were related to living & working conditions at the ecological level.

2/x

pubmed.ncbi.nlm.nih.gov/32419766/

Just a FYI that one can be very pro-vaccination and appreciate that immunity from infection is real.

Thoughts:
1) No sane folks seek to be infected
2) Immune system is more than a few antibodies
3) Downplaying infection-derived immunity is an unnecessary battle that burns trust.

https://twitter.com/sdbaral/status/1385613870761488384

Let's pretend every business implements a #vaccinepassport.

Stay with me and let's think through some logistics.

1/x

(I'm not gonna edit as need to do kiddo bedtime stuff...but just to say, anyone who thinks this is easy has not really thought about that much at all) Entering business

Does business scan your passport at the front door? If so, do they place an employee by the front door? If not, is the door locked and then unlocked via QR code? If so, does it only allow one person in at a time? If not, do they have a person watching?

2/x

Glossary of Faculty Titles

There is significant interest these days in the titles that university faculty have so thought I would provide some background on some key terms like:

- Tenure-track and tenure
- Affiliate
- Adjunct
- Lecturer
- Assistant/Associate/Full Prof

1/x Tenure-Track

Some positions are on the tenure-track and some are not even if they carry the same title.

The key difference is that there is a pathway to tenure which represents an indefinite academic appointment where one can only get fired for extraordinary reasons.

2/x

My Public Health Truths (a "living" thread).

There are few "truths" in public health, but the following include those I have observed in quantitative & qualitative studies, community engagement, and program implementation independent of socioeconomic or geographic contexts. In the immediate term, you cannot educate someone out of being hungry or needing a place to sleep.

I want to document grave concerns with vaccine passports

TL:DR
Inequitable global vaccine distribution combined with immunity passports suggests to me unidirectional travel in the future for people from higher income settings into lower income ones challenging development.

1/x

https://twitter.com/sdbaral/status/1253744419947372546

Disclosures:
1) For the last ~15 years, I have been travelling internationally about 200 days per year.
2) I love working with people from all over the world and am incredibly fortunate to have the opportunity

LMIC - Low and middle income country
HIC - High income country

2/x

Additional context as why I have more optimistic view of variants of #COVD19 over the next six weeks across North America/Northern Europe

Host-Agent-Environment is commonly used framework for infectious diseases

Host -- us
Agent -- SARS-CoV-2
Environment -- conditions around us

https://twitter.com/sdbaral/status/1358774006258798594

With introduction of the #COVID19 variants

Agent -- Increased transmissibility with variants (more likely to bind receptor cells, higher VL, ? longer infectiousness)

Host -- increased immunity, ? increase in contacts with release of restrictions

Environment -- seasonal changes

As a physician, and public health specialist, my job is to empower and educate people to make the best decisions for themselves.

Risk tolerance varies by person.

Some folks have extremely high risk tolerance in their lives and others less so.

films.nationalgeographic.com/free-solo

1/x I believe that 2 weeks after 2nd dose, people are protected from serious cases of COVID-19 as defined by hospitalization or tragically causing death.

Again, the vaccine may not prevent from infection as much as severity of that infection consistent with influenza vaccines.

2/x

Why was #COVID19 seasonality so controversial?

Respiratory viruses are seasonal 2ary to immunity, population, and environmental determinants.

However, I was unprepared for how controversial discussing potential seasonality of seasonal hCoVs would be

1/4
Goals of discussing seasonality:

1) Facilitate empiric interpretation of the effects of Wave 1 restriction-based strategies
2) Prepare for Wave 2 with data-driven interventions responding to inequities nearly universally observed explained by living and working conditions.

2/4

#COVID19 and #HumanRights

Invited by @CPHHR at @JohnsHopkinsSPH for brief talk on #COVID19 and #HumanRights frameworks.

Outline:
Bill of Human Rights
Human rights during emergencies
Country Examples
Governance and Freedom of the Press
Conclusions

Slides
1drv.ms/p/s!Au5JH22b5W… Slide 1/16

Welcome to an opportunity to document your guess in first gen #COVID19 vaccine efficacy and proportion of adverse events (Grade 2-5)

Grade 2-Moderate Sxs
Grade 3- Hospitalization
Grade 4- Life Threatening
Grade 5- Death

Bonus points study on A/E:
fda.gov/media/84954/do…

1/8 Oxford Non-Replicating Chimp Adenovirus Vaccine

Vaccine Efficacy - VE
Grade 2, G2
Grade 3-5, G3-5

Clinical Trials Link for Protocol:
clinicaltrials.gov/ct2/show/NCT04…

2/8

Restriction-Driven Responses Make No Sense (to me)

Wave 1 Ontario Data
170k tested & 16k #COVID19 diagnoses

Rate of positive test
64x in long term care (LTC)
19x in shelter

Age-Adjusted Mortality
40% higher in LTC

Txs @mishrash for including me:
cmajopen.ca/content/8/4/E6…

1/4 As of Oct 11 in Ontario, 58 LTC facilities in outbreak.

What did we need to do?

Paid leave for part-time staff if need to quarantine or isolate
(Seriously, how has this not happened yet? WTF!)

Overcome barriers to testing/symptom disclosure
(see note about PAID-LEAVE???)

2/4

Quantitative Study Designs and Critical Appraisal

Intended to help to do independent critical appraisal of the data being released in #COVID19 including an overview of study designs.

Also to help you assess whether "experts" did critical appraisal or are just repeating abstract Quantitative Study Designs

Only covering studies where unit of analysis is an individual person.

There are also ecological studies which use a population as the level of analysis and systematic reviews & meta analyses which quantitatively combine results of several studies.

Public Health Practice Gems

#COVID19 has increased the general interest in public health.

So I thought it worthwhile to provide some framing for folks new to this field.

The goal is to provide an overview of public health:
1) Principles
2) Intervention Strategies
3) Actors Public health practice is a service industry.

Similar to other service industries, the customer is always right.

If we don't understand our customer and empathetically address needs, people vote with their feet.

ie, PHP is Public Health Practitioner, not Public Health Police

Are we testing #COVID19 vaccines for kids?

I often see an assumption that the COVID vaccines being trialed will be available for kids at the same time as adults assuming efficacy. And that's a big (HUGE) assumption.

Let's take a look at the Oxford, Moderna, and Pfizer trials Oxford Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

Two things:
1) Efficacy doesn't appear to be primary outcome for kids as they are only getting one dose
2) Where are the 13-17 yo kids

If I am missing something, happy to be corrected

My dream response:
TAGOPIE
Team, Analysis, Goal, Objectives, Planning, Implementation, Evaluate

Team -- what competencies should be in the emergency operations center (EOC) making decisions (methodologists, practitioners, clinicians, gov't, lawyers, clinicians, economists)

https://twitter.com/sujayjaswa/status/1304833570469376000

TAGOPIE
Analysis

Stakeholder Analysis (who will be affected/needs representation)
Epidemiological Analysis (CFR, IFR, RR, etc)
Situational Analysis (decision tree with different response models of expected benefits and costs. Costs include human, financial, and institutional.

Warning!!!!

Unpopular #COVID19 opinion:

Testing is not an intervention
Diagnosis is not an intervention

Testing and diagnosis will only have as much public health and clinical impacts as they facilitate decreasing onward transmission risks or access to care, respectively

1/6 For sexually transmitted infections, testing and diagnosis are critical because they are linked to interventions or actions that directly decrease onward transmission risks including:

1) Curative antibiotics
2) Antiretroviral therapy for HIV
3) Condoms
4) Avoid sex

2/6

Lockdown Thread #2

Was invited to provide a brief presentation on concerns with #Lockdowns today and hopefully works to post here

Outline of Talk:
Inequities in #Covid_19 Acquisition and Transmission Risks
Inequities in the Enforcement of Lockdowns
Competing Health Risks