Note: This thread is related to #Coronavirus #COVID19

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1/ Frequently clean hands by using alcohol-based hand rub or soap and water.

2/ When coughing and sneezing cover mouth and nose with flexed elbow or tissue - throw issue away immediately and wash hands.

3/ Avoid close contact with anyone that has fever and cough.

Caitlin Rivers, PhD+ Your Authors @cmyeaton Outbreak science + epidemiology + health security. Assistant professor at Johns Hopkins Center for Health Security (@JHSPH_CHS). ELBI alum. May. 03, 2020 4 min read + Your Authors

In April an average of ~2,000 people died of coronavirus in the US each day. That is more than daily average from cancer or heart disease. I fear there is growing complacency that this level of loss is a new normal. Are we really ready to add a new leading cause of death? 1/

This notion stands in contrast to incredible lengths humanity has gone to in the past to defeat infectious diseases. Time and again we have weighed the costs of inaction against infectious diseases and have come down on the side of public health. 2/

There are many, many examples to choose from, but here are three of my favorites. They are all very different but instructive. *Also I am not a historian so these are the Wikipedia takes.* 3/

In 1925 an outbreak of diphtheria struck Nome, Alaska in the dead of winter. We don’t hear much about diphtheria anymore thanks to an effective vaccine, but it used to be quite deadly. By the time the outbreak was recognized, several children had died 4/ 

There was a treatment then, but this isolated little town in far-north Alaska did not have a fresh supply. But leaving the outbreak unchecked was not an option. So a massive operation to obtain antiserum was organized. But how to get it to Nome? This was in 1925, remember. 5/

Overland, that’s how. 20 dogsledders and 150 sled dogs covered 674 miles in 5-6 days. In northern Alaska. In January. Temperatures were in the -30 to -60F range. Mushers suffered injuries and many of the dogs died. But they did it, against all odds. It was an incredible feat. 6/

Antiserum was delivered to Nome at 5:30 am on February 2 and the outbreak was stopped. And that is how the Iditarod Trail Sled Dog Race was born! It originated as a heroic race against time to stop an outbreak. Inspiring. 7/ 

Here’s my 2nd example. Little known fact, the military has been a leader in public health innovation for a long time. Acute resprtry diseases used to be a major threat to readiness. Some military settings are perfect for outbreaks – close quarters, difficult living conditions. 8/

One advance was the advent of an adenovirus (adv) vax. Adv usually causes mild illness, but severe illness and death is possible. The vax was used by the military from 1971 until 1994, when the manufacturer stopped production. The vax was gone by 1999. 9/ 

Febrile respiratory illness spiked. Still mostly mild, but the DoD wasn’t having it. They commissioned a new vaccine at the cost of 100 million dollars. It was reintroduced in 2011 and rates of adenovirus again fell. 10/ 

In the gap 12 years, there were, sadly, 8 adenovirus-associated deaths (and many cases). DoD did the math and decided the investment in a new vaccine was worth it. That’s usually the conclusion when it comes to prevention. 11/

This tweet thread is already long and I’m only 2/3 of the way done. I’ll post more later. To be continued...

And finally, the eradication of smallpox. It is one of humanity’s greatest feats, and I’m sure I can’t do the story justice. But consider for a moment that smallpox caused an est 300M deaths in the 20th century alone. It was deadly (~30% CFR) and disfiguring and much feared. 12/

After millennia of being at smallpox’s mercy, the world hatched a breathtakingly ambitious plan: root out the virus from every corner of the planet, once and for all. Even though similar efforts are underway for polio and guinea worm, it’s still hard to grasp the enormity. 13/

There is no “close counts” with eradication. If you succeed you have won forever. Even if you get 99% of the way there, you have to keep vaccinating in perpetuity. New (susceptible) people are always being born, so before long you have conditions for the disease to roar back. 15/

And in a feat that now seems to me somehow both inevitable and highly improbable, we did it. Humanity defeated smallpox, led by our @JHSPH_CHS founder Dr. D.A. Henderson while at WHO. “Never again!” says the commemorative print hanging in our office. 16/

And so, it is with all of that in mind that I look on the current discussions around covid control with dismay. We (the country, the world) have made enormous sacrifices already to flatten the curve. But I sense a growing apathy. 17/

We cannot accept 2,000 US deaths a day as the new normal. We have to balance public health and economic considerations – there are many dimensions of health and well-being, “not merely the absence of disease,” as WHO says in their definition of health. 18/ 

The path forward for doing both - controlling the outbreak while resuming economic activity - has been well described, by us & others. Diagnostic testing and contact tracing on an ambitious scale. States are making progress in these areas, but more is needed. 19/

We need to summon the energy and commitment that inspired a 674-mile journey across frozen Alaska and the relentless pursuit of the “death of a disease”. We should be moving mountains for this pandemic. It will be hard, but we’ve done hard things before. We can do it again. 20/20

You can follow @cmyeaton.


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