THREAD
1/ I asked people to be outraged that our epidemic disaster continues. Complacency now will kill us later.

Someone replied that they were outraged, but now what?

Outrage isn’t enough if it doesn’t translate into action.

Tweets that change nothing are just tweets. Truth.

1.5/ The key focus in my mind & the minds of many is how we *crush* transmission w/ the goal of getting as close to 0 as possible *within weeks*, not months; how we do it safely (lockdowns impose extreme stress on many); & how we get Governors to actually do it given the politics

2/ The red circle highlights what happened when we reopened too early.

At our peak this summer, we hit 60-70,000 new cases per day.

What happens when we head indoors w/ folded t-shirts on our faces this winter?

I am worried about an even more monstrous peak that follows

2.5/ The privileged hold power in this country.

They hold $, influence, connections to our highest leaders.

But, the need for change doesn’t affect most of them *urgently*

They can actually afford to "stay home", obtain private testing, & access high-filtrate masks already.

3/ As a doctor who worked during our state surges, the vast majority of my #covid19 patients were people of color &/or frontline workers.

Most were poor w/ few social protections and/or limited social capital/financial reserve to tap into during a time of crisis.

4/ Today, we are still seeing and treating many patients who had #covid19 earlier in the epidemic.

We are witnessing the aftermath of the disaster. I’ll share a story (have had multiple like this, so not tied to one single patient for privacy)

(See @RanuDhillon tweets too)

5/ I had the privilege of caring for a gentleman who worked in the back of restaurant--he got #covid19 months ago during the wave here; lost his job in lockdown as many did; entire family was eventually infected, as many were; later ended up relapsing to a prior alcohol addiction

6/ The story shared is really not of one person, but of many; different frontline jobs, same virus; different addictions or relapses or struggles to cope with, same despair & lack of support

We treated so many patients whose entire lives were destroyed & haven’t come back fully

6.5/ Most of my most vulnerable patients are largely unconcerned about what goes on in this virtual twitter world

Real concerns: where next meal will come from; how they will be able to isolate safely in a tiny apartment; how they will keep working if they get sick
Cc @atheendar

7/ Some of the stories we encountered on the wards/in the emergency room were insane.

If you don't believe it, ask any doc who cared for #covid19 patients during surges, or afterwards.

I rmr @jeremyfaust one shift intubating someone whose family we literally couldn't reach.

8/ The team had to video record a message so that the man could say something to his loved ones before being sedated and put on a ventilator.

I cared for a woman w/ #covid19 on Mother’s Day who was dying— I held an iPad in front of her so she could talk to her daughter again.

9/ We aren’t going to forget that here— but we also don’t want to be doing that again this winter.

Tweeting angrily isn’t enough.

I’m a doctor, & I think that what we really need are *organizers* who can push a serious, sustained movement forward this summer

Cc @gregggonsalves

10/ I was talking to a friend recently; as we reflected, I am realizing more & more that what we need is a real fire under the asses of those who have the power, influence, experience, & political weight to change things quickly-- 4 strong weeks could do a lot here

@JuliaLMarcus

11/ @ASlavitt has tweeted about the 4 weeks timeline many times & I agree.

Abrupt, focused efforts on the highest transmission counties + social protections for those who are vulnerable; employing those w/o jobs to help on the response; mandate masks; move things outdoors etc

12/ Personally, I'm getting tired of the granular aerosol/droplet debates; the face shields/masks duel; the "hygiene theater" mockery--to me, that pales in comparison to what could happen if we refocus all efforts to *use the knowledge we have* to stop transmission rapidly *now*

13/ While I am all for small, incremental change on the #covid19 long-game (approving vaccines safely etc), here & now we need urgency that leverages public health measures to **crush** transmission; Governors whose states have counties that are on fire must act immediately.

14/ Does this call for pressure from Governors in states that have controlled transmission on their counterparts? It very well might. Does it call for a return to the streets (w/ masks on) to protest? Cost/benefit could be worth it if it worked.
Other ideas welcomed/encouraged