madgesiq92
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Post by madgesiq92 on Aug 31, 2022 21:31:47 GMT -5
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DanMcQ
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Post by DanMcQ on Aug 31, 2022 21:32:55 GMT -5
All I can tell you is we will be having our first in person professional conference (yes, 12000 infectious disease professionals) in the DC Convention Center in October and we are requiring masks indoors. Y’all may think it’s over but none of us do. And sorry, the half and half dynamic is still a thing. Might be more 60:40 but still a huge problem. The notion that masking indoors must remain until the virus is "over" is a troubling one, considering all evidence points to the fact that SARS-CoV-2 will never be over, it'll be with us for the rest of any of our lives, much like (insert your favorite coronavirus here). But I don't need to tell you that, obviously. Clearly the partisan/left-right divide remains... but the bigger shift isn't in a simplistic, binary "Is Covid a big deal or not?" but in what methods of suppression are considered justified given the costs. And pretending there are no costs, or aggressively minimizing them despite the evidence, is not being intellectually honest. And I will again say that, even as CDC admits it made serious mistakes, it's a real problem for public trust when there is a general refusal from the public health community to go back and examine any past guidance or messaging. People remember being told for over a year that it was so dangerous to have any public gatherings - despite zero evidence of outdoor transmission - that it was necessary to shutter public facilities, shame people for going to the beach, etc. etc. Show me where I espoused masks "forever". Given the current variants that are more contagious and which even full vaccination cannot prevent infection (and they were not designed to do so) masking makes eminent sense in enclosed spaces at least until the upcoming binary vaccines (and one hopes, intranasal vaccines) are shown to be more effective. Large crowds in small enclosed spaces are higher risk so masking makes more sense. I personally am not minimizing costs. We've done an excellent job of eliminating death from COVID with vaccines; not so successful in preventing long COVID which we are finding has a higher cost in many than expected. I do not disagree that our public health system overall is broken. I guarantee the CDC did not direct burying a skate park with sand. If I look hard enough i can find a nutty example for almost everything (and after all, it was in Venice Beach). Did the COVID guidance change a lot as we learned more about the virus and how it was transmitted? Yes it did, but recall that this was at a time when the Trump administration was rewriting CDC guidance before it was publicly issued. (I know that for a fact - I saw guidance from the CDC professionals who wrote it - then saw things published that bore little resemblance to that guidance get issued.) My friend Rochelle said she was going to transform CDC. She is well on her way to getting there. It will take time, effort and money. Rebuilding our public health systems that were underfunded and ignored for decades then attacked under the last administration is a huge task. There is also quite a lot of examination of what did not work and what needs to be fixed by the current administration - and my professional society is participating in the discussions that will drive a lot of that. Bonus: the study Dr. Walensky commissioned to examine what's right and what's wrong with the current CDC will likely be released Friday. More transparency.
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DanMcQ
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Post by DanMcQ on Aug 31, 2022 21:56:38 GMT -5
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RusskyHoya
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Post by RusskyHoya on Aug 31, 2022 22:11:31 GMT -5
Show me where I espoused masks "forever". *shrug* You're the one who connected the notion of "we are requiring masks indoors" at your gathering in October (if the guidance says to follow the community levels, then how can you make that decision now? How do you know what community levels will be in October?) with the idea that it's not over - "Y'all may think it's over but none of us do." Smallpox is over. HCoV-OC43 has been around since at least the late 19th century, HCoV-HKU1 since 2004, etc. They are not over. It is true that SARS-CoV-1 is, I think we can safely say, over... but we understand why the sequel is highly unlikely to follow in its predecessors footsteps. But that's my definition of "over." Your definition may vary. I do not disagree that our public health system overall is broken. I guarantee the CDC did not direct burying a skate park with sand. If I look hard enough i can find a nutty example for almost everything (and after all, it was in Venice Beach). Well, right - we don't have a national public health system, we have thousands of systems through SLTT public health officials. So the charge here is leveled at the system as a whole, not just the Federal figurehead. But you've sort of made my point - people are seeing very little admission that officials across the country implemented those nutty examples of almost everything, all in the name of public health. If something was wrong/nonsensical/based on an understanding that was Best Available Data at the time but then later proven incorrect, it is critical for authorities to explicitly say that. Instead, we continue to mostly see resolute defensiveness of any and all measures as justified on the basis of the precautionary principle - very flawed logic. Did the COVID guidance change a lot as we learned more about the virus and how it was transmitted? Yes it did, but recall that this was at a time when the Trump administration was rewriting CDC guidance before it was publicly issued. (I know that for a fact - I saw guidance from the CDC professionals who wrote it - then saw things published that bore little resemblance to that guidance get issued.) CDC was a mess before Trump, a mess during Trump, and remains a mess for any number of reasons. But again, it does little good to focus on them - they are not who has direct control over the public health measures to which people are subjected. The issue instead is the wide disparity in those measures across different jurisdictions (and jurisdictions around the world) and the dearth of: 1. Honesty on the part of officials and others in the field that those measures are a *political policy judgment* based on perceived cost-benefit 2. Transparent discussion of the evolution of those judgments over time, including both new scientific information (e.g., the evolution in understanding of transmission you mentioned) and other kinds of new information, such as the costs of suppression measures and people's reaction to them In the absence of those discussions, you're going to continue to see further reductions in public trust from *all* sides, not just the science-allergic Trumpers or the Covid Zero neurotics.
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DanMcQ
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Post by DanMcQ on Aug 31, 2022 22:31:13 GMT -5
Russky - I think we both want the same thing. It's easy to pick an example here or there and broad brush everything. My point about our professional conference is exactly that there is still risk and such a congregation is a big enough risk that mitigation is warranted. And I meant what I said, it's not over (now). Someday it may be, but not when case rates are still as high as they are. As for Georgetown, they're just like public health agencies - whatever they choose will get lampooned from either side. They're just trying to do the best they can given the available data. Those decisions are made in consultation with the Infectious Disease group at the med school, who are more than competent.
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Bigs"R"Us
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Post by Bigs"R"Us on Sept 1, 2022 10:20:27 GMT -5
In the real world, Goldman Sachs and Morgan Stanley are dropping all Covid protocols and requiring workers to return 5 days per week after Labor Day.
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hoopsmccan
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Post by hoopsmccan on Sept 1, 2022 10:32:17 GMT -5
In the real world, Goldman Sachs and Morgan Stanley are dropping all Covid protocols and requiring workers to return 5 days per week after Labor Day. I’m not sure what side you are advocating for by citing working conditions at investment banks. hm
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DanMcQ
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Post by DanMcQ on Sept 1, 2022 20:54:38 GMT -5
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Post by hoya305 on Sept 1, 2022 21:52:06 GMT -5
And the number of vaccinated & boosted 18-22 year olds that contribute to that total is .....
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DanMcQ
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Post by DanMcQ on Sept 1, 2022 21:55:17 GMT -5
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DanMcQ
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Post by DanMcQ on Sept 3, 2022 11:33:35 GMT -5
For an actual discussion of public health and masking rather than quick hit blanket statements, this piece is quite good: www.nejm.org/doi/full/10.1056/NEJMp2207670“It would behoove public health practitioners to stop suggesting in social media posts that nuanced questions have universally correct answers.” Same goes for anyone else staking out absolute grounds on social media platforms.
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SDHoya
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Post by SDHoya on Sept 3, 2022 18:27:35 GMT -5
Where is that number from? Per Worldometers there were 508 deaths in US on 8/31. And that was far and away the highest daily figure for the week. CDC website shows 818 deaths on 8/31, with 7 day rolling average around 400.
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madgesiq92
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Post by madgesiq92 on Sept 6, 2022 8:04:04 GMT -5
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prhoya
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Post by prhoya on Sept 6, 2022 8:15:12 GMT -5
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RusskyHoya
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Post by RusskyHoya on Sept 17, 2022 10:58:38 GMT -5
Russky - I think we both want the same thing. It's easy to pick an example here or there and broad brush everything. My point about our professional conference is exactly that there is still risk and such a congregation is a big enough risk that mitigation is warranted. And I meant what I said, it's not over (now). Someday it may be, but not when case rates are still as high as they are. As for Georgetown, they're just like public health agencies - whatever they choose will get lampooned from either side. They're just trying to do the best they can given the available data. Those decisions are made in consultation with the Infectious Disease group at the med school, who are more than competent. Yes, I am fairly confident we do indeed want the same thing and agree far more than we disagree. The main reason I am so 'stuck in' on this topic is that I see public health making many of the same exact mistakes that I have seen my own field of emergency management make - and in both cases, the consequences have been very costly and will only become more so. In fact, this is one of the key contributors to my leaving said EM field, at least for now. The crux of those mistakes is the unwillingness or inability to deal with the fact that public health in practice is inherently political. Not inherently partisan, but inherently political. Like EM, the implementation of public health measures entails the application of the state's claimed monopoly on the legitimate use of force - that is, the police power - as well as the power to redistribute resources in furtherance of the collective good, as understood by the body politic. Admitting this is uncomfortable, because in the U.S. more than in most democracies, we have denigrated politics and made it a dirty word. For that reason, I am sympathetic to the temptation to avoid affirming the political nature of the work and instead hiding behind a veil of technocracy, as is typical in EM, or science, as the "follow the science!" mantra has come to symbolize for public health. But there is a real and damaging dishonesty to sticking to a story that everything you do and advise is because "we're the disaster pros, we know best" or "we're following the science, we know best" when in reality, what you are implementing is a politically negotiated compromise that cannot help but be dictated by what the people, and their elected representatives, are willing to bear. The attitude that '50% of people will hate us for being too strict, 50% will hate us for not being strict enough - that must mean we're doing a good job!' is exactly the kind of bothside-ism we mock in the likes of CNN and smarmy centrist bloviators. If everyone thinks your story doesn't make sense, it may not be because that's some kind of iron law of the universe - it just might be because your story is incoherent. Rather than trying to construct a more coherent program, one that internalizes the inherently political and consensus-driven nature of the task and focuses on measures where broad or at least majority support is viable, far too many have decided to pursue an approach of "Let's just throw restrictions against the wall and see which ones stick politically." What this has lead to is a perverse situation in which the vast majority of the NPIs that stick are ones imposed on those least able to resist, i.e., small children, even though they are the ones at least personal risk from Covid and at greatest personal harm from interventions that limit unobstructed socialization: When Americans look at this mess, they quickly recognize that there is no pure, untainted 'science' and accompanying set of evidence-based prophylactic practices that one must robotically follow if one wants to remain a Covid-free member of the reality-based community in good standing. They see that 'the science' is in many ways as stochastic as the virus itself, and while there are some very strong patterns (e.g., vaccination = massive reduction in morbidity and mortality), most things are not deterministic and dispositive in real-world conditions. The public health field, like all public policy practitioners, must recognize, openly accept, and adapt to this reality. Every day it fails to do so, digs in its heels, and insists, "No no, we've always been right all along about everything, it's you stupid public and politicians that have messed up our flawless suppression measures" is another day down the path of public distrust and societal atomization.
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RusskyHoya
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Post by RusskyHoya on Sept 17, 2022 11:03:00 GMT -5
I'm finally uncorking that post now, btw, because there's a non-zero chance Georgetown is going to be in the public spotlight for a test case of the contours of our new normal: is moving a class entirely online an appropriate - nay, required - form of reasonable accommodation?
Already you are seeing battle lines being drawn and people lining up to argue that any claim that in-person instruction is superior to Zoom School is unsound, empirically unproven, and therefore motivated by MAGA anti-intellectualism and hatred of people with disabilities.
As with most things, I pin far more blame for this dynamic on the right in this country than I do the left, but those of us on the left must take care to make sure we don't go down the same path of epistemic closure that the conservative movement did.
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DanMcQ
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Post by DanMcQ on Sept 17, 2022 11:42:08 GMT -5
Public health is only inherently political when those in the community make it so. Public health guidance has to mesh the science with what the community will accept. To be clear, by political I mean the current divide between guidance that encompasses the good of all including protection of the vulnerable (older people, the immunocompromised and children, to name a few) versus those who shout the false equivalence of “oppression” when mitigation measures like masks are put in place, likening it to a restriction of “freedom.” For example, when the CDC first changed to less universal restrictions taking into account how they affect businesses and the public’s general acceptance/compliance, they were immediately criticized as abandoning science due to being in the pockets of big business and the airlines. Bullsh!t. Sadly our current culture is all about me and actually makes doing what public health should do all that much more difficult.
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SDHoya
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Post by SDHoya on Sept 18, 2022 0:22:49 GMT -5
I'm finally uncorking that post now, btw, because there's a non-zero chance Georgetown is going to be in the public spotlight for a test case of the contours of our new normal: is moving a class entirely online an appropriate - nay, required - form of reasonable accommodation? Already you are seeing battle lines being drawn and people lining up to argue that any claim that in-person instruction is superior to Zoom School is unsound, empirically unproven, and therefore motivated by MAGA anti-intellectualism and hatred of people with disabilities. As with most things, I pin far more blame for this dynamic on the right in this country than I do the left, but those of us on the left must take care to make sure we don't go down the same path of epistemic closure that the conservative movement did. As an employment attorney, in my professional opinion the answer is 🤷🏻♂️
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DanMcQ
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Post by DanMcQ on Sept 24, 2022 9:48:48 GMT -5
Contrary to popular opinion, COVID NOT benign in young people.
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RusskyHoya
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Post by RusskyHoya on Nov 5, 2022 17:23:58 GMT -5
For what it's worth, Scott Gottlieb has a thread that grapples with the loss of faith in the public health establishment that I spoke to earlier and how that is exacerbating the current situation with flu and RSV
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