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A Public Health Perspective on the Potential Harms of #COVID19 #Elimination (my first thread)
I have provided a reference for each post which I think should be the standard moving forward for public health/clinical posts for @Twitter
Set up as assumptions and reality
I have provided a reference for each post which I think should be the standard moving forward for public health/clinical posts for @Twitter
Set up as assumptions and reality
Assumption: Using a forecasting model to guide intervention strategies is appropriate. A single counterfactual (ie, the hammer) vs exponential epidemic growth
Reality: Mathematical models guiding programs should provide different scenarios, competing health risks, and uncertainty
Reality: Mathematical models guiding programs should provide different scenarios, competing health risks, and uncertainty
Reference for above:
https://www.sciencedirect.com/science/article/pii/S1047279720301721?via%3Dihub https://link.springer.com/article/10.1057/jphp.2009.13
https://www.sciencedirect.com/science/article/pii/S1047279720301721?via%3Dihub https://link.springer.com/article/10.1057/jphp.2009.13
Assumption: All efforts to prevent and mitigate COVID-19 will be associated with a net gain in healthy years of lives saved
Reality: Multiple levels of prevention services are interrupted in the context of lockdowns with predictable and grave associated morbidity and mortality
Reality: Multiple levels of prevention services are interrupted in the context of lockdowns with predictable and grave associated morbidity and mortality
Refs for above:
A lecture on levels of prevention in the health care system as part of a surveillance course we offer on Coursera (warning a little dry) https://www.coursera.org/lecture/epidemiology-surveillance-systems-analysis/chronic-disease-prevention-strategies-gr0hc
A lecture on levels of prevention in the health care system as part of a surveillance course we offer on Coursera (warning a little dry) https://www.coursera.org/lecture/epidemiology-surveillance-systems-analysis/chronic-disease-prevention-strategies-gr0hc
Assumption: Parameterizing transmission dynamics of COVID-19 with same numbers globally was appropriate
Reality: Heterogeneity in transmission by communities, neighborhoods, cities, countries, and regions has defined this and other lipid-enveloped RNA respiratory viruses.
Reality: Heterogeneity in transmission by communities, neighborhoods, cities, countries, and regions has defined this and other lipid-enveloped RNA respiratory viruses.
Refs for above:
Canada: https://www.cmaj.ca/content/cmaj/early/2020/06/03/cmaj.201112.full.pdf
Asia: https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25557 Africa: https://www.acpjournals.org/doi/10.7326/M20-2628
South Africa: http://www.samj.org.za/index.php/samj/article/view/12952
Global: https://www.medrxiv.org/content/10.1101/2020.06.18.20134346v3
Canada: https://www.cmaj.ca/content/cmaj/early/2020/06/03/cmaj.201112.full.pdf
Asia: https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25557 Africa: https://www.acpjournals.org/doi/10.7326/M20-2628
South Africa: http://www.samj.org.za/index.php/samj/article/view/12952
Global: https://www.medrxiv.org/content/10.1101/2020.06.18.20134346v3
Assumption: The only competing consideration is the economy and with elimination, the economy rebounds
Reality: Interrupting diagnostic, prevention, and treatment services has consequences related to specific existing causes of mortality with those most marginalized most affected
Reality: Interrupting diagnostic, prevention, and treatment services has consequences related to specific existing causes of mortality with those most marginalized most affected
Refs for above:
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30345-4/fulltext
https://time.com/5864803/oxfam-hunger-covid-19/
https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(20)31356-8
https://www.sciencedirect.com/science/article/pii/S0741832920302391?via%3Dihub
More and more available each day--and increasingly painful to read
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30345-4/fulltext
https://time.com/5864803/oxfam-hunger-covid-19/
https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(20)31356-8
https://www.sciencedirect.com/science/article/pii/S0741832920302391?via%3Dihub
More and more available each day--and increasingly painful to read
Assumption: The lockdown protects all
Reality: COVID-19 has exposed many preexisting inequities around the world that result in suboptimal living & working conditions. Lockdowns have reinforced socioeconomic disparities given it represents a regressive (non-adaptive) approach.
Reality: COVID-19 has exposed many preexisting inequities around the world that result in suboptimal living & working conditions. Lockdowns have reinforced socioeconomic disparities given it represents a regressive (non-adaptive) approach.
Refs for above:
https://www.sciencedirect.com/science/article/pii/S1047279720301769
https://www.sciencedirect.com/science/article/pii/S1047279720302672?via%3Dihub
https://ebm.bmj.com/content/early/2020/06/03/bmjebm-2020-111426
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3573609
https://www.pnas.org/content/117/33/19658
https://www.sciencedirect.com/science/article/pii/S1047279720301769
https://www.sciencedirect.com/science/article/pii/S1047279720302672?via%3Dihub
https://ebm.bmj.com/content/early/2020/06/03/bmjebm-2020-111426
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3573609
https://www.pnas.org/content/117/33/19658
Assumption: No chance to prepare for how best to implement a lockdown. Ie, shut it down.
Reality: Documents describe empathetic implementation, adaptive strategies responsive to emerging data, protections to avoid discrimination and undue harms and provision of equitable support
Reality: Documents describe empathetic implementation, adaptive strategies responsive to emerging data, protections to avoid discrimination and undue harms and provision of equitable support
References:
https://papers.ssrn.com/sol3/Papers.cfm?abstract_id=3634997
https://www.documentcloud.org/documents/6841076-2006-11-Disease-Mitigation-Measures-in-the.html
https://stacks.cdc.gov/view/cdc/11425
https://papers.ssrn.com/sol3/Papers.cfm?abstract_id=3634997
https://www.documentcloud.org/documents/6841076-2006-11-Disease-Mitigation-Measures-in-the.html
https://stacks.cdc.gov/view/cdc/11425
Assumption: COVID-19 is unprecedented, and we had no alternative
Reality: There has been decades of preparation for respiratory pandemics, studying individual-level determinants of acquisition and transmission, network-level dynamics, and structural factors
Reality: There has been decades of preparation for respiratory pandemics, studying individual-level determinants of acquisition and transmission, network-level dynamics, and structural factors
Refs for above:
https://www.ecdc.europa.eu/en/seasonal-influenza/preparedness/influenza-pandemic-preparedness-plans
https://stacks.cdc.gov/view/cdc/45220
https://www.cdc.gov/mmwr/preview/mmwrhtml/su48a7.htm
https://www.ecdc.europa.eu/en/seasonal-influenza/preparedness/influenza-pandemic-preparedness-plans
https://stacks.cdc.gov/view/cdc/45220
https://www.cdc.gov/mmwr/preview/mmwrhtml/su48a7.htm
For COVID-19, disparities in transmission dynamics were evident early with socioeconomic inequities a common and global theme
Ie, occupational acquisition risks and household transmission risks, transmission networks, and inequities, and structural racism.
Ie, occupational acquisition risks and household transmission risks, transmission networks, and inequities, and structural racism.
Moving forward necessitates application of an equity lens in terms of how to address the determinants observed with empathy -- optimizing IPAC, supporting people not to work, minimizing household transmission with housing support, facilitating access to health care for everyone.
None of this is cheap, but it is feasible. Then again, social collapse isn't cheap either.
The next wave of COVID-19 will start soon in most places, and the next major pandemic will happen during the 2020s.
We need to do better.
The next wave of COVID-19 will start soon in most places, and the next major pandemic will happen during the 2020s.
We need to do better.
