Viruses have been around forever and will be around forever. They are part of our ecosystem. That said, if we can avoid unnecessary morbidity (sickness) and mortality (death) related to them, then I'm supportive. In fact, that has been the basis of my professional life for many years. However, 99.9% of the population never noticed my work since it didn't affect them. The work was focused on providing evidence-based services to people that wanted and would particularly benefit from these services rather than trying to restrict the general public as a means of limiting exposure. And I remain committed to that work.

It has been fascinating to see virologists, psychiatrists, journalists, and beyond claim that there was an archetype of a COVID-19 response represented by harsh punitive and regressive strategies. And that any deviation from recommending a harsh response suggests that one was fringe and responsible for the deaths of many. These folks regularly suggest that lockdowns, vaccine passports, and school closures are standard in public health emergencies. But that simply is untrue. What is true then? In the first few days of a highly localized outbreak of new symptoms, it would be reasonable to recommend highly localized limitations on movement in and out of a city for example. This might be a few days or up to a week for the investigation to take place to keep localizing the source and ideally avoid a broader outbreak, epidemic, and even pandemic. This is more of a pipedream than reality, but if symptoms were caught early enough, then this could help. Interesting anecdote? The statistic that we use to detect significant excesses of cases is the Kulldorf's spatial scan statistic. Yes, that Kulldorf. (ie, Martin Kulldorf). But during COVID-19, the outbreak likely started in late summer or early fall of 2019. People had been flying out of the international airport in Wuhan for months by the time the travel restrictions were put in place. By that time, the virus was effectively all over the world though there was no testing in place. And the ways that most of the world implemented lockdowns was the most bourgeois way possible where it just meant that wealthier folks ordered stuff to their homes. Or where restaurants were closed for in-person dining, but their kitchens busy preparing home deliveries and streams of delivery teams in and out of the building. I don't know if absolute risks decreased during that time, but they did further concentrate among economically marginalized folks who were already at higher risk of both infection and ultimately morbidity and mortality. What about vaccine passports? People would go online and show their yellow fever cards and thus suggest that this is a common tool in public health which simply is untrue. So what is true? There are some occupational mandates for influenza but even then it generally doesn't mean being fired if unwilling but rather restricted working conditions (ie, dont work if an outbreak underway and/or wear a mask. But no, we have never required vaccination to enter a mall or sit in a coffee shop or to stay employed in the context of effectively every industry. What about having police doing public health work? In the extremes, police have gotten involved in public health. For example, if there was evidence of an outbreak related to a setting like a tattoo shop or restaurant, public health may order it to close. If they refuse, can ask police in exceptional settings to enforce closure. But this is exceedingly rare and normally public health works with the vendor to fix the issue. Police serve all kinds of critical roles in society, but I see an extremely limited role for them in the context of public health. The issue is that editors of even prestigious legacy media entities know very little about public health. So it is difficult for them to effectively fact check when someone writes an editorial or goes on the news to say that this is standard public health practice when it is anything but. Anyhoo, so it goes.

My Public Health Truths (a "living" thread). There are few "truths" in public health, but the following include those I have observed in quantitative & qualitative studies, community engagement, and program implementation independent of socioeconomic or geographic contexts.

If the coverage of an intervention is suboptimal, key to consider both determinants of provision and uptake. Determinants of provision include system and provider issues whereas determinants of uptake focus on users. If you focus only on uptake, likely missing half the story.

Why not compare HIV and COVID: HIV eventually kills all people infected by it. HIV is preventable. HIV treatment allows people living with HIV to live normal lives. Why compare HIV with COVID: Shock factor. Shoddy preprints. Clicks, likes, and retweets.