Caitlin Rivers, PhD+ Your Authors @cmyeaton Outbreak science + epidemiology + health security. Assistant professor at Johns Hopkins Center for Health Security (@JHSPH_CHS). ELBI alum. Jun. 01, 2020 3 min read + Your Authors

I’m not usually a reactive tweeter but this caught me off guard yesterday. I wrote “wait, that can’t be the plan.” 1/

And then I deleted it because I wasn’t prepared to explain my thinking and it’s not fair to just throw that out without a justification. But now I am ready. Thanks @nataliexdean for sending the Hancock tweet. 2/

The actual change in guidance is that medically vulnerable people in the UK are allowed to go out to meet one other person, with proper social distancing. This is ok, I guess. One new contact, with distancing and masks, is lower on the spectrum of risks. Especially if outside 3/

And the num of daily new cases in the UK has fallen from 4-5k to ~2k (per NYT), so that’s progress. But as I’ve said many times, it’s better to gain control through testing and tracing. Without that, 14k cases per week is cold comfort for people at high risk of severe illness 4/

It will not be safe for vulnerable people until the virus is not spreading unmanaged in the community. Other countries have gained control through test, trace, isolate. Their vulnerable people are undoubtedly safer. We could have that. 5/

Two other things bothered me. One is the congratulatory tone. Reading the tweet, you would think they were calling the whole pandemic off. I do see value in celebrating successes along the way. But most people, quite reasonably, do not have an intuition of how outbreaks unfold 6/

I think every health comm shld have a clear message of risk. Like “now that we have reduced transmission, medically vulnerable people can consider meeting one other household, while distancing and wearing masks. We’ve come a long way, but the risk remains. Please be cautious.” 7/

The other thing is the word shielding. For a time, that word was part of a (proposed?) strategy to have vulnerable ppl remain at home while others went and…got infected, basically. It’s not clear to me whether that was actual policy, but the idea & word were widely discussed 8/

Many have articulated, incl @nataliexdean and @devisridhar, why getting to herd immunity is a bad idea, and why shielding isn’t practical. All those points are still valid, and I think fairly widely accepted. So using shielding to describe vulnerable people here is confusing. 9/

This gets to public health communications. I’ll switch to the US context now, bc I’m not as familiar with the UK on this point. 10/

Break time. To be continued.

Normally in a crisis we wld have a trusted voice who spends a great deal of time explaining to the public what is going on and what to do. Think of the meteorologists on TV talking about an incoming storm. The updates and recomd actions (“evacuate the area now”) are constant 11/

Drs. Fauci and Birx do this well but they don’t spend as much time on this as CDC would, given political constraints. There are effective state leaders, like Gov Cuomo and Dr. Amy Acton, but we could stand to use a lot more given the gravity and complexity of the situation 12/

Scientists and other leaders have been doing some (I had around 2,000 followers in Jan) but we don’t have the same nationwide platform or credibility as CDC. And I personally never set out to write long tweet threads while cooking dinner. 13/

CDC is said to be resuming briefings soon, which is great. I hope they spend time not defending past decisions – there will be time to reflect later – but on informing the public where we are in the outbreak and how we can keep ourselves, and each other safe. 14/14

And to clarify, because Twitter is not the ideal medium for this, I want journalists to give CDC et al the space to do this. Don't force them into political reactions. One of the advantages of moving briefings back to CDC is we can get health reporters back on board. 15/14

You can follow @cmyeaton.


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