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DiseaseEcology's profile
A Marm Kilpatrick
A Marm Kilpatrick
A Marm Kilpatrick
@DiseaseEcology

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A Marm Kilpatrick

@DiseaseEcology

Disease Ecology, Population Biology

Univ California Santa Cruz
kilpatrick.eeb.ucsc.edu
Joined August 2013

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    A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

    Is re-instituting lockdowns necessary to stop rapidly rising #COVID19 cases globally? Answer: No. But we're failing at 2 other approaches, due to poor messaging, human behavior & limited public health capacity. Deaths & lockdowns are unnecessary but we'll have both again. Thread

    1:54 PM - 14 Jun 2020
    • 777 Retweets
    • 1,702 Likes
    • Jan Hubálek Kelly-Anne Bryan, RN Jennifer Derr Jitka Polechova Vaxxed AND Masked (She/Her)😷🏳️‍🌈⚖❤🌊 Healight™..Cedars-Sinai, MAST & Aytu Bio followers Dr. Ulrich Pongs Michael David Sy Michelle Wong #MaskUp 💙#MakeSchoolsSafe #FreshAir
    49 replies 777 retweets 1,702 likes
      1. New conversation
      2. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Well-known: if we live our normal lives SARS-CoV-2 spreads exponentially with R=2-3 cases/case every 5-7 days until herd immunity builds up. This leads to huge # of deaths (early UK & US estimates: 500K, 2.2M). Warning: Things can get bad quickly! https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf …

        14 replies 70 retweets 301 likes
        Show this thread
      3. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Note: total deaths would be less than these early predictions due to interventions we've taken: less overshoot. (Lockdowns have already paid dividends, but aren't enough!) See nice work @DeirdreHoll on impact of temporary interventions for flu (Fig 3).https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1001076 …

        1 reply 26 retweets 187 likes
        Show this thread
      4. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        A Marm Kilpatrick Retweeted Samir Bhatt

        We're sadly nowhere near herd immunity in 99% of world yet, so returning to normal life will put us back on an exponential trajectory which will overwhelm hospitals and lead to carnage.https://twitter.com/DrSamirBhatt/status/1271233923599785990 …

        A Marm Kilpatrick added,

        Samir Bhatt @DrSamirBhatt
        https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31357-X/fulltext#coronavirus-linkback-header … Have deaths from COVID-19 in Europe plateaued due to herd immunity? pic.twitter.com/jej7lsQP8L
        Show this thread
        8 replies 59 retweets 232 likes
        Show this thread
      5. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        The main strategy used in most countries to stop exponential rise in cases were lockdowns, including closing a large fraction of businesses. Lockdowns were very effective in stopping the exponential rise in cases but devastating to economies and society.

        4 replies 26 retweets 199 likes
        Show this thread
      6. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Most countries are now re-opening businesses, which is badly needed, but carries the risk of returning to exponentially rising cases & disaster. Can anything prevent us from having to go through lockdown all over again? For many people & businesses it would spell financial ruin.

        2 replies 24 retweets 174 likes
        Show this thread
      7. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        A Marm Kilpatrick Retweeted Ben Cowling

        Evidence clearly shows there are 2 ways to reduce local transmission, neither of which require lockdown: 1) test-contact trace-isolate (T-CT-I) 2) personal behavior (masks, social distancing including 6'/2m, telework, hygiene) https://twitter.com/bencowling88/status/1270548060653776897 … https://doi.org/10.1016/S0140-6736(20)31142-9 …

        A Marm Kilpatrick added,

        Ben CowlingVerified account @bencowling88
        (1/10) Just posted our new preprint on the successful suppression of first wave of #COVID19 in Hong Kong with @gmleunghku https://www.researchsquare.com/article/rs-34047/v1 …
        Show this thread
        3 replies 177 retweets 430 likes
        Show this thread
      8. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        The problem is that in most places we aren't doing either well. Effective T-CT-I requires people get tested very soon after symptom onset. For 3 months limited testing capacity has led to people being told opposite message (stay home unless severly ill).https://science.sciencemag.org/content/368/6491/eabb6936 …

        1 reply 71 retweets 252 likes
        Show this thread
      9. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        We need huge public health messaging effort to get people to get tested at the first sign of (any) symptoms. Given the wide variety of COVID symptoms this will require ample testing capacity. Testing newly symptomatic people should be top testing priority. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html …

        6 replies 71 retweets 282 likes
        Show this thread
      10. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Next testing priorities: 2) contacts of cases who can't isolate for 14d 3) high risk individuals for onward transmission (those with many close contacts), especially those that could transmit to those at high risk of severe illness. Examples: health care, elder care staff

        2 replies 30 retweets 160 likes
        Show this thread
      11. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Many places have insufficient testing capacity, make testing too hard to get, or give results back too slowly to stop spread. Part of problem is reliance on NP swabs when other methods are better when weighing sensitivity-logistics tradeoff. e.g. saliva https://doi.org/10.1101/2020.04.16.20067835 …

        2 replies 36 retweets 175 likes
        Show this thread
      12. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Pooled testing is another approach that could greatly increase testing capacity at a relatively small cost in terms of sensitivity for infectious people, but has yet to see widespread use.https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30362-5/fulltext …

        3 replies 19 retweets 151 likes
        Show this thread
      13. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        (Note: capacity gains through pooled testing could, in some settings, enable high frequency testing (i.e. every 1-3d) & isolation that could also limit transmission).

        1 reply 10 retweets 107 likes
        Show this thread
      14. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        It's shocking to say it, but we are still woefully short on testing capacity, and we are not using it well and we are not combining it with key public messaging to make it effective. Some places also need more CT. Free training created by @EmilyGurley3:https://www.coursera.org/learn/covid-19-contact-tracing?edocomorp=covid-19-contact-tracing …

        3 replies 36 retweets 199 likes
        Show this thread
      15. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        We also need more and better isolation space. Many families live in high density housing and this makes them highly vulnerable to COVID outbreaks. We need safe space for infected people to isolate. Migrant labor & farmworkers are key groups:https://www.latimes.com/california/story/2020-06-09/salinas-covoronavirus-monterey-county …

        4 replies 47 retweets 213 likes
        Show this thread
      16. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Second strategy, changes in personal behavior (inc. masks, social distancing including 6'/2m, telework, hygiene), can also be very effective in reducing transmission. Lots of evidence for this cited above.

        4 replies 25 retweets 166 likes
        Show this thread
      17. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        A Marm Kilpatrick Retweeted Adam Kucharski

        Also, see nice summary by @AdamJKucharski of recent article suggesting that human behavior often changes before lockdown to slow transmission:https://twitter.com/AdamJKucharski/status/1272228227336089600 …

        A Marm Kilpatrick added,

        Adam KucharskiVerified account @AdamJKucharski
        This paper on the timing of COVID peak in UK has been getting a bit of coverage, so I think it's worth taking a closer look... https://arxiv.org/abs/2005.02090  1/ pic.twitter.com/jAGtHvwWyo
        Show this thread
        1 reply 20 retweets 103 likes
        Show this thread
      18. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Unfortunately, human behaviors are now changing in the wrong direction, due to a huge public messaging failure in re-opening businesses. This is a disaster.

        4 replies 58 retweets 290 likes
        Show this thread
      19. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Critical point: most business activities can be done safely (exceptions: large indoor gatherings), but need to maintain social distancing in personal lives! We don't need lockdown to limit transmission but our brains can't seem to separate open businesses & personal behaviors.

        2 replies 66 retweets 271 likes
        Show this thread
      20. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        As businesses have re-opened there needed to be a clear message: re-opening safely is only possible if people take actions in personal life to limit transmission (masks, 6'/2m, hygiene), including, critically, no close contacts w/ other people in other households.

        4 replies 84 retweets 265 likes
        Show this thread
      21. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        A Marm Kilpatrick Retweeted

        This messaging did not occur, and people are not taking personal actions to limit transmission. We've translated: businesses open = go back to normal social interactions. Here's one tiny example, but we have all seen the pictures/videos: https://twitter.com/lrentzsch13/status/1271802917499142148 …

        A Marm Kilpatrick added,

        This Tweet is unavailable.
        1 reply 48 retweets 176 likes
        Show this thread
      22. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Another example: Many very well informed people (including older at-risk people!) are now going to indoor dinner parties at other households. In my county there were many mothers' day gatherings & spreading events at 4 of them led to >50 cases so far.

        2 replies 37 retweets 171 likes
        Show this thread
      23. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Some are saying masks and distancing are a hassle & want to have lots of unmasked close contacts again. But these seem like small prices to pay for jobs, economy, activities we all love. Why can't we see this trade-off and choose the far better option?

        4 replies 49 retweets 249 likes
        Show this thread
      24. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Conclusion: We must change our personal behavior (in small ways!) & get effective T-CT-I going or else we will have to re-institute lockdowns and lose jobs again, or have huge deaths, or both. Please, please, let's not go backwards after all we've endured.

        6 replies 73 retweets 277 likes
        Show this thread
      25. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        Addendum: If I had $100M I'd spend every penny on public messaging to tell people: 1-jobs&economy depend on their actions & small things (masks, distance, hygiene) can make all the difference 2-get tested at earliest onset of any COVID symptoms & isolate until they get results

        4 replies 91 retweets 318 likes
        Show this thread
      26. A Marm Kilpatrick‏ @DiseaseEcology 14 Jun 2020

        & I'd beg anyone with influence (athletes, actors, authors, politicians) to release messages/videos demonstrating how much we can do safely (outdoor activities w/ friends 6'/2m apart; eat at restaurants w/ household members; etc.) & how much will be lost if we don't act safely.

        14 replies 64 retweets 293 likes
        Show this thread
      27. A Marm Kilpatrick‏ @DiseaseEcology 14 Jul 2020

        Key Message to reduce #COVID19 transmission in 7 words: Meet outside, give space, wear a mask!

        2 replies 15 retweets 58 likes
        Show this thread
      28. End of conversation

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