I spend a lot of time thinking abt how scientists measure "health," & the benefits, limitations, & trade-offs of various measures (mortality, diagnosis, self-reported, etc.). Each tells us something, but none tells us everything. This has become even clearer in the pandemic. 1/

A key reason I use biomarkers is to reveal processes that are sometimes hidden when using diagnosis outcomes (given disparities in hc access, bias in diagnosis, etc.). Mortality is typically measured well, but masks lots of heterogeneity & sickness & pain among the living. 2/

Much work on COVID has been on mortality for GOOD reason. Mortality is recorded well & captures a most severe outcome. Lots of great work using excess mortality to better capture COVID deaths (see thread by @AndrewNoymer for a great explanation). 3/ https://twitter.com/AndrewNoymer/status/1241620288825167874

Still, in my discussions w non-scientists, I find myself trying to explain that death is not the only outcome we should be concerned abt when assessing risk & estimating impacts on health. Lots get left out when the focus is only on death. 4/

Being or seeing a loved one gravely ill can be traumatic, even when one survives. Emerging work showing long-term effects on lung, cardiovascular function. All of which is not included in mortality estimates. 5/

Last week I saw this article abt amputations. This piece is so emotional & hard to read. So much preventable, avoidable, & unnecessary suffering & pain—physical, emotional, psychological. Not about mortality, but still a severe, traumatic outcome. 6/ https://twitter.com/mdhayward/status/1263283979794427904

This is by *no means* a critique of the rigorous, careful, & essential work of those of us engaged in estimating COVID mortality. This work is critical. But its to say that this is the tip of the iceberg in terms of impacts, & I wish that was better communicated to the public. 7/

Scholarship must also capture & communicate the non-mortality health consequences of COVID (so many of them severe & long-lasting). This is needed to better honor the lived experience of so many & provide a more complete picture of the toll of the pandemic on pop health. 8/8

And I know I said this was the end, but I just saw this thread, which perfectly & painfully captures the need for better public communication abt COVID risks & impacts. Lots of outcomes besides death & survival. https://twitter.com/SherriSantosMSN/status/1264685911314444294