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joshmich's profile
Josh Michaud
Josh Michaud
Josh Michaud
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@joshmich

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Josh MichaudVerified account

@joshmich

Associate Director Global Health @KFF. @SAISHopkins Prof. U.S. & International Health Policy, Health Security, Infectious Disease Epidemiology

Washington DC
kff.org/person/josh-mi…
Joined April 2009

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    1. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      With community transmission of #COVID19 in multiple countries it appears that containment of the virus in China will not happen (this outcome was not unexpected). Emphasis in many places could turn from containment to “mitigation”. What does mitigation mean?

      35 replies 418 retweets 725 likes
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    2. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      First, to be clear: it’s not either/or, because containment efforts and mitigation efforts encompass a spectrum of activities, are complementary and can occur at the same time.

      1 reply 25 retweets 123 likes
      Show this thread
    3. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      Still, we can contrast their goals: containment is meant to halt transmission, while mitigation is meant to reduce negative impacts of transmission.

      1 reply 26 retweets 104 likes
      Show this thread
    4. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      For the U.S., CDC has long had recommendations for how communities can use mitigation to address pandemic influenza. A revision to this guidance came in 2017, incorporating lessons learned from the 2009 H1N1 influenza pandemic.https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm?s_cid=rr6601a1_w …

      1 reply 47 retweets 137 likes
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    5. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      Not all guidance from pandemic influenza is applicable to #COVID19 because the epidemiology and circumstances differ, but countries face similar challenges with both.

      1 reply 20 retweets 90 likes
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    6. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      For example, both are highly transmissible, and in both cases we have no specific countermeasures available at first (e.g. vaccines). Containment is difficult if not impossible in both cases.

      1 reply 20 retweets 86 likes
      Show this thread
    7. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      The 2009 H1N1 pandemic is often remembered as being “mild”, but there was a quite a significant health impact: an estimated 43-89 million people in the US were infected and 12,000 people died between Apr2009-Apr2010.

      5 replies 54 retweets 145 likes
      Show this thread
    8. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      CDC talks about mitigation in three buckets: 1) individuals behaviors (hand hygiene, staying at home, avoiding ill people); 2) “social distancing” (closing schools and public gatherings, and 3) environmental mitigation (surface cleaning efforts). Let’s focus in 1 and 2.

      1 reply 65 retweets 160 likes
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    9. Josh Michaud‏Verified account @joshmich 22 Feb 2020

      Encouraging better individual hygiene behaviors is cornerstone of mitigation. Good hand hygiene (wash those hands!), and voluntary home isolation when ill (and even home quarantine when potentially exposed) are recommended.

      3 replies 39 retweets 120 likes
      Show this thread
      Josh Michaud‏Verified account @joshmich 22 Feb 2020

      Many studies show the effectiveness of hand hygiene; one study on H1N1 from Egypt highlighted by CDC showed 47% fewer cases of influenza occurred after twice-daily hand washing and health hygiene instruction was provided in elementary schools.

      9:33 AM - 22 Feb 2020
      • 85 Retweets
      • 213 Likes
      • Snow ❄️ The Long View 🌑 冥王人 Turboschnecke...ist geboostert 🥳🥳 Tobias Fiebig wildprotons Nicholas G John Zwicker 🔬Samantha Yammine, PhD
      7 replies 85 retweets 213 likes
        1. New conversation
        2. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          Studies of the US public during H1N1 found that people actually did change their hygiene behaviors: in one survey 59% of Americans reported washing hands more frequently and 25% said they avoided public places like sporting events, malls, and public transportation.

          1 reply 27 retweets 102 likes
          Show this thread
        3. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          CDC guidelines also support social distancing in some cases, including school closures, canceling public gatherings, and workplace closures/telework.

          1 reply 23 retweets 99 likes
          Show this thread
        4. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          During H1N1, CDC recommended communities with confirmed cases consider closing child care facilities and schools. From Aug–Dec 2009, communities in 46 states implemented 812 dismissals (in a single school or all schools in a district), affecting 1,947 schools.

          2 replies 30 retweets 101 likes
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        5. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          This number of schools represented 0.7% and 3.3% of all urban and rural schools, respectively, in the U.S. Evidence from TX indicated school closures there reduced acute respiratory illness in households with school-age children by 45%–72%.

          1 reply 21 retweets 93 likes
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        6. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          Interestingly, surveys of parents whose children were affected by school closures found strong support for, and belief in the effectiveness of these measures: 90% of parents agreed with dismissal decisions, and 85% believed dismissals reduced transmission.

          1 reply 21 retweets 94 likes
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        7. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          Even so, closing schools was disruptive, and a systematic review of US school closures during H1N1 was not able to determine whether the benefits outweighed the cost in this “mild” epidemic, though they did recommend such measures during a “severe” pandemic.

          1 reply 16 retweets 79 likes
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        8. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          CDC guidelines also note there are practical obstacles to asking people to stay home from school and work: in 2009 a major difficulty was that many people did not have access to paid leave, and therefore had a hard time following guidance.

          3 replies 28 retweets 118 likes
          Show this thread
        9. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          Another challenge for mitigation in the U.S. is that while CDC can offer recommendations and guidance, implementation of these policies mostly occurs at local district, county, & state levels. This can lead to a patchwork of different mitigation approaches across locations.

          3 replies 27 retweets 86 likes
          Show this thread
        10. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          A recent publication looked at US local health department decision-making around social distancing during outbreaks, and concluded resources available and actions implemented are inconsistent and unpredictable across the country. …https://journals-sagepub-com.proxy1.library.jhu.edu/doi/pdf/10.1177/0033354918819755 …

          1 reply 22 retweets 76 likes
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        11. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          CDC guidance urges flexibility in implementing mitigation measures, and continual re-assessment of their effectiveness as new information comes in. A “targeted, layered” approach that addresses current circumstances is the best practice.

          1 reply 18 retweets 74 likes
          Show this thread
        12. Josh Michaud‏Verified account @joshmich 22 Feb 2020

          The ultimate goal of such measures is to reduce the intensity of an outbreak, flattening out the epidemic curve and therefore reducing strain on the health system, and on social economic well-being (see this graphic representation).pic.twitter.com/fWOCq453Bx

          16 replies 121 retweets 338 likes
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        13. Josh Michaud‏Verified account @joshmich 24 Feb 2020

          I would add that because these activities happen at the local level, mitigation also implies every jurisdiction, school district, business, and even every household could have a role to play.

          1 reply 1 retweet 18 likes
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        14. Josh Michaud‏Verified account @joshmich 24 Feb 2020

          Josh Michaud Retweeted

          For businesses for example, here are a few things to think about (thread also contains a link to CDC guidance for businesses) https://twitter.com/marcelsalathe/status/1231828462735896577?s=19 …

          Josh Michaud added,

          This Tweet is unavailable.
          1 reply 4 retweets 15 likes
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        15. End of conversation

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