Dr Alexandra Phelan
@alexandraphelan
Followers
32,782
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Statuses
22,259
Associate Professor @JohnsHopkinsSPH Senior Scholar @JHSPH_CHS International Law, Planetary Health, Pandemics & Equity 余雪莲 She/They 🏳️🌈
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Joined January 2009
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Pinned Tweet
"However, equity is an ethical imperative and is fundamental to accurate, representative, and actionable pandemic science"
My new piece with Anita Cicero
@JHSPH_CHS
in
@ScienceMagazine
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I didn’t realise the noise I was hearing outside: the National Cathedral is tolling its bell 800 times to mark 800,000 deaths.
i don’t even know what to say right now and am going to just sit and listen. my heart goes out to everyone who has lost someone over the last two years
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This morning Dr Fauci presented the US’s remarks to the
@WHO
Executive Board meeting. The US will:
- join COVAX
- strengthen IHR
- fulfill financial dues
- counter erosion of global health inc HIV, malaria
- support women’s rights & undo Global Gag Rule
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Italy is extending its lockdown to all of Italy (60m people) Tuesday.
(updated)
This includes:
- restricting all movement to only work, and family emergencies
- ban on all public gatherings (inc. cinemas, gyms, weddings, funerals, sports events)
- schools & unis closed
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Watching cases climb in 30 US states, I'm filled with the same sense of horror I felt on 23 Jan with cases surging in Wuhan & on 23 Mar as cases climbed in NYC.
There's utterly no excuse for leaders to not have learned those lessons yet. It's indefensible.
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Overnight we lost a family member to COVID.
The pandemic is not over.
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Yesterday, my brother’s heart stopped.
Passersby performed CPR on him until paramedics arrived. We don’t yet know if they saved his life as he’s still in critical condition.
But this is your reminder to learn CPR.
You save more than one life.
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The Australian government has just announced a change to bring forward third doses due to omicron.
I just received this message from a close friend who is a doctor responsible for Covid vax in their area in Australia. I don’t think I’ve ever heard them swear before.
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As a pandemic law expert, I’m telling you now: these laws will undermine public health and make Victorians less safe from future pandemics.
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The US President has banned all travel from Europe for 30 days, excluding UK.
This is a distraction:
- US has local transmission already
- we’re struggling to even conduct surveillance to know our burden
- ignores vital mitigation steps we know we need to do now
#COVID19
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"You’ll be pleased to know that, rather than double down on our containment efforts, we’ve decided to dissolve the velociraptor containment task force altogether, and focus instead on how we can get people back into the park as quickly as possible."
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Bubonic plague cases are completely normal & expected.
China – esp. Inner Mongolia province – as well as US southwestern states regularly have cases.
Bubonic plague is 1 of 3 plague forms, typically caught in IM from contact w dead marmots.
It's treatable with antibiotics.
Authorities in the Chinese region of Inner Mongolia are on high alert after a suspected case of bubonic plague, the disease that caused the Black Death pandemic, was reported Sunday.
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Waking up to 9 million US cases and counting: a daily case count of more than 90,000. This is a shocking dereliction of duty to protect public health by US governments. I deeply worry what a contentious or petty lame duck period could bring.
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Beijing has rapidly activated its response:
– travel from Beijing suspended w/out test
– lockdown in high risk areas (no clarity yet on essential reasons/worker exemptions)
– work from home encouraged across Beijing
More below:
Reuters: BEIJING CITY GOVERNMENT RAISE COVID-19 EMERGENCY RESPONSE LEVEL TO II FROM III - STATE MEDIA
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Incredible video by Sophie-Marie Aicher & Dr. Delphine Planas showing SARS-CoV-2 causing syncytia (cell fusion that is part of its evasion of the immune system in humans) and cell death (red) in bat brain cells.
Honorable mention Nikon Small World competition.
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New research in from Germany on face masks
– reduced incidence 15% and 75% over a period of 20 days after mandatory introduction
– reduced daily growth rate of reported infections by ~ 47%
Critically (often ignored point): v. low cost measure
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Legally, can President Trump withdraw the US from membership of the WHO?
– The WHO Constitution is a treaty.
– Membership of WHO requires signing the WHO Constitution & completing state domestic ratification processes (art 4).
– US has ratified the treaty.
(1/3)
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It’s time for a Pandemic thread for
#COVID19
(prompted by questions from the excellent
@MackayIM
&
@onisillos
- thank-you)
🌏What is a pandemic?
🌍Are we in a pandemic?
🌎How do pandemic and PHEIC declarations differ?
🌏What is the impact of declaring a pandemic?
(1/?)
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I’ve had this photo up for 10min & am already receiving questions about why I’m masking.
1. Amtrak & interstate travel still has a mask mandate
2. Folks may be immunocompromised, live w folks who can’t vaccinate or in low vaccination rate areas, or choose to mask for reasons.
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It's unconscionable that Africa doesn't have a single dose of monkeypox vaccine, despite being the only continent with deaths from the virus.
Charity not only fails but is paternalistic.
Independent manufacturing capacity (not just for COVID or monkeypox) is health justice.
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Today marks the official end of the Ebola outbreak in Equateur Province, DRC.
Ebola vaccine was central to this w similar logistical challenges to
#covid19
mRNA vaccines (-80 degrees storage).
Strengthening health systems = pandemic preparedness.
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My new piece in
@TheLancet
:
Govts are looking for ways to "return to normal".
Immunity passports are not an acceptable solution for scientific, equitable & legal reasons.
In contrast, vaccination certificates may be a vital tool for global recovery.
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Waking up to news that I’m effectively exiled from my country is a wild way to start a day.
Ppl who praise Australia’s use of border controls to respond to COVID don’t understand its barbarity, racist roots & how it squandered any public health benefit.
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The most concerning aspect of this morning's H5N8 news is not necessarily that we now have evidence of human infection from H5N8 influenza, but that it took ~two months to report it to WHO.
This is what noncompliance with international law or weakened legal norms look like.
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Speaking straight to the souls of so many outbreak responders
@CT_Bergstrom
From
@edyong209
’s piece on monkeypox today:
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Nearly 2,000 Americans died yesterday from COVID-19.
How is this nation cheering football when it hasn’t even mourned for the 647,000 dead, and counting.
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One year ago today
We are not prepared for a pandemic. Trump has rolled back progress President Obama and I made to strengthen global health security. We need leadership that builds public trust, focuses on real threats, and mobilizes the world to stop outbreaks before they reach our shores.
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The Lancet has issued this rapid and immediate response to comments in President Trump's letter to
@WHO
Director General Tedros, correcting false statements about The Lancet.
There were no reports in The Lancet in December 2019 about the outbreak.
Statement from The Lancet in response to President Donald Trump’s May 18 letter to Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization
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Colonialism was/is one of the greatest causes of environmental destruction; exploiting natural resources and engaging in crimes against humanity in the process.
We didn’t need any further evidence that the British Monarchy continues to be a racist institution, but here it is.
Prince William has renewed his attack on population growth in Africa, blaming it for destroying wildlife on the continent
Critics have accused the Prince of hypocrisy for making such claims while expecting his third child
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A doctor in Victoria, Australia has tested positive to
#SARSCoV2
. He appears to have been infected in the US and travelled to Denver, Vale, SF & LA.
Not only are travel bans ineffective, especially as we see widespread transmission, they can give a false sense of safety.
Health Minister Jenny Mikakos and Chief Health Officer Brett Sutton confirm Victoria’s 11th coronavirus patient is a doctor from The Toorak Clinic who consulted around 70 patients while infected before going into home isolation.
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I can't begin to capture the level of dispirit & exhaustion among pandemic response experts right now: we are on track with some worst case scenario models for the coming months (poss. going above Jan hospitalization peaks) as leaders unwind basic public health measures.
e.g:
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You only see where you're looking: South Africa has excellent genomic surveillance, benefitting the world.
Now countries know to look for Omicron, we will likely start identifying cases already transmitting around the world.
If the Belgian Omicron case had no contact or link with anyone from or neighboring countries it suggests, which is almost always the case with respiratory viruses, that it escaped from where it originated even before noticed. Travel bans don’t make sense.
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Here it is:
@POTUS
's letter to UN Sec-General
@antonioguterres
retracting the US's withdrawal from
@WHO
h/t
@jenkatesdc
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When delta models were predicting 200,000 cases a day again here in the US by the end of August, it seemed incomprehensible. But here we are with more than 178,000 cases today.
Get vaccinated.
Get vaccinated.
Get vaccinated.
U.S. COVID update: More than 1,000 new deaths for 3rd day in a row as Florida reports backlog
- New cases: 178,700
- Average: 145,402 (+4,853)
- In hospital: 92,912 (+1,778)
- In ICU: 22,887 (+378)
- New deaths: 1,765
More data:
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The international movement of medical supplies is one example of solidarity in the
#COVID19
response. Yesterday, Iceland Air transported 18 tons of medical supplies from Shanghai to Iceland. The flight path drew a thank-you to health care workers before landing at Keflavík.
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An important addendum:
Precisely because the WHO Constitution is silent on withdrawing, the US Congress included a provision that the US must pay any outstanding dues before withdrawing.
(thanks
@crisveijk
for reminding me about the reservation)
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It is an absolutely catastrophic tragedy what is happening in India.
This pandemic is not over.
We need to immediately remove every potential barrier to manufacturing: We need global equitable distribution of vaccines, treatments and oxygen.
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SA🇿🇦 should be commended for sequencing & rapid reporting of new variant B.1.1.529.
Travel bans may chill future reporting & distract from other useful measures.
Reupping our piece in Cell on this
@NathanGrubaugh
@firefoxx66
@JosephFauver
@mugecevik
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Big day yesterday: I became twitter verified & signed an offer letter for promotion to Assistant Professor, tenure-track
@georgetown_ghss
I'm honored to work in a brilliant team led by
@RebeccaKatz5
in the global response to Covid19 and other infectious disease challenges.
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There's no formal process under international law or governance for declaring a pandemic over.
For influenza, the post-pandemic phase is defined by a return to seasonal levels, but we don't know (1) if that will occur for COVID19 (albeit likely) & (2) what those levels will be.
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Today’s emergence of regional governance blocks in US is fascinating.
Blending localized needs w benefits of unionization: a founding rationale for federalism.
This fragmentation has arisen from failure of national leadership and governance.
cc
@ClaireJStandley
@maike_voss
Monday afternoon update: Massachusetts has joined the Multi State Council. We now have bipartisanship.
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On the day before the new Biden Administration takes office, the US has passed 400,000 deaths from
#COVID19
.
The institutions could never save us from failed leadership from the President, from Congress, and from many other officials across all levels of the nation.
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In just days, nearly $1 billion has been raised to restore
#NotreDame
after the fire. ()
@WHO
is asking for *only* an additional $104 million for the
#Ebola
response. Not only is this in the interest of the whole world but it will save lives.
Thank you
@PennyMordaunt
for your outstanding support to end
#Ebola
in
#DRC
. You rightly said - ‘It is in everyone's interest to support efforts to contain this highly contagious disease that does not respect borders.’ We hope others will follow your lead.
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*Public health actions to control new SARS-CoV-2 variants*
Our paper just published in
@CellCellPress
w wonderful co-authors
@NathanGrubaugh
@firefoxx66
@JosephFauver
&
@mugecevik
We describe actions govts should urgently take to protect health.
🧵1/7
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There have been at least 600,000 deaths from COVID19 – at least 589,000 [JHU] with one estimate up to 900,000 [IHME] – in the United States.
There can – and must – never be a return to normal after this.
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please.... please speak to health & human rights lawyers before you say things like this...
maybe we need a federal law making it a felony to knowingly expose someone to a deadly disease.
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This article might do more for social distancing than any public health message.
I don't recommend reading if you're feeling anxious about this outbreak. Instead the tl;dr: wash your hands, don't touch your face, stay >6ft apart
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I am absolutely delighted to share that I have joined the
@JHSPH_CHS
&
@JohnsHopkinsSPH
!
The incredibly warm welcome I've received so far is a testament to the wonderful team I'm so lucky to join as I continue my work on global health law, infectious diseases & planetary health
We’re thrilled to welcome our new Senior Scholar Dr.
@alexandraphelan
!
Alexandra brings multidisciplinary expertise across
#globalhealth
#law
,
#infectiousdiseases
and
#climatechange
.
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Don’t “flip the old sexist script. After centuries of dogma that men are naturally better suited to leadership, the opposite is not suddenly true. Women leaders aren’t the cause of better government. They are a symptom of it.”
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It’s deeply concerning that there’s a persisting idea that this pandemic can be over for Americans while it rages elsewhere.
Not only is it unjust - repeating global health histories w cholera, malaria, HIV, TB - but misunderstands *this virus* and pandemic epidemiology.
I ask why the ACIP didn’t discuss global supply:
“The ACIP makes decisions for Americans.”
She only had 2 minutes and our conversation abruptly ends.
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"Economy v Health" is such a foolish & false dichotomy: if govts allow a virus to spread unmitigated, without safety measures, people will self-regulate as much as possible. If they don't, they're more likely to get sick.
Either way, demand collapses.
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I get paid a little over $2,000 a year to teach an Epidemiology course at a T14 university
(I didn’t leave a job as a lawyer at a top tier corporate law firm to go into global health for the money)
And we wonder why public health is where it is at.
(inspo from
@MCBazacoPhD
)
Anti-vax grifter Alex Berenson admits 10,000+ have subscribed to his $6 a month Substack, which adds up to $60,000 per/month or $720,000 A YEAR (not counting $300 "founding members" & book sales at $26.99 a copy.)
Going anti-vax seems to pay well!
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Delta demonstrates the importance of the layering of multiple public health interventions (vaccination + masks + distancing + ventilation etc).
In Florida:
only 50% fully vaccinated
+
bans on mask mandates
+
unwinding distancing
=
daily deaths exceeding both previous waves
Florida becomes first US state where the daily deaths in current wave have exceeded previous waves.
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Turns out the liminal space between Christmas and New Years - where dates and days of the week delightfully disappear - is much less fun when you’ve already been experiencing it for two years.
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If you punish people when they report outbreaks, they simply won't report outbreaks.
Not smart --> "Cambridge college threatens to evict students if a Covid-19 outbreak occurs"
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For those unfamiliar with Australia, it is hard to comprehend the scale of the ongoing bushfires - currently “too big to put out”.
Here are two maps - New York & London - to show the scale of what has burnt since the start of the fire season (Aug 2019) in NSW & QLD
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I do not celebrate the cancellation of life saving vaccines to people. This actually makes me feel ill.
BOOM!
#Lithuania
has canceled a planned shipment of 440,000
#COVID19
#vaccines
to
#Bangladesh
after that country refused to join other nations at the UN in condemning
#Russia
for its invasion of
#Ukraine
. Actions, meet Consequences.😉
#StandWithUkraine
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Amazing news!
The US government has reportedly just rescinded the ICE directive requiring F-1 international students to be on-campus full time.
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Governor Cuomo has requested the President mobilize the military to respond to
#Covid19
in New York.
What's this mean? This is for the Army Corps of Engineers to equip facilities to serve as temporary medical centers to reduce overwhelming of hospitals.
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The UK detected this variant because of rapid and more comprehensive sequencing and data sharing.
US scientists & experts (inc
@theNASEM
) have called for exactly this since the early in the pandemic: the frameworks for what to do are ready to go
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A survey that asks “would you get vaccinated if you didn’t have to wear a mask?” is not sufficient data for public health policy.
In real life, there isn’t the dichotomy the question poses. Instead there’s a third (more likely) option: those unvaccinated just take off the mask.
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have to update my university bio from 2019 as apparently a couple of things have happened since
is it acceptable to have your puppy in your official university profile photo y/n
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First human case of H10N3 influenza reported in Jiangsu, China.
▪️one case, no evidence of human to human potential at this stage
▪️man in stable condition
🌐 Emergence of novel human influenza cases = alert but not alarmed
🌐 Spillover ≠ epidemic risk
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Incredible photo.
Vanda Ortega, 33, a member of the Witoto ethnicity and nurse technician is first person to receive
#covid19
vaccine in Manaus, Brazil.
H/T
@BogochIsaac
Story by
@msilvadesousa
at
Credit: AP Photo/Edmar Barros
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As a global health lawyer it's really easy to get into the semantic & legal technicalities of "pandemic declarations".
But this misses the real question: what are governments doing to protect the most vulnerable who are at risk?
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Thinking rapid home testing would’ve saved US from this disaster ignores pre-COVID American realities of:
-being sick w/o sick leave or UHC
-losing your job for missing 1 shift
-having an unwanted positive pregnancy test
Stop suggesting individual actions for a systems failure.
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The Texas Attorney General wants to end access to health care. In a pandemic. Where more than 2,200 Texans have died, and cases are rising:
Obamacare has failed, and the sooner it is invalidated, the sooner each state can decide what type of health care system will best provide for those with preexisting conditions, which is the way the Founders intended.
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Was just charged $60 for a rapid COVID test in nyc…
I really didn’t expect to be at October 2021 wondering if “availability & cost of rapid tests for all” is a better indicator of pandemic response capability than any of our other metrics…
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Really useful new piece: Inferring the effectiveness of government interventions against COVID-19
"Closing all educational institutions, limiting gatherings to 10 people or less & closing face-to-face businesses each reduced transmission considerably"
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📰New Study🔬 out in
@TheLancet
!
By building a moment by moment chronology, we analyze how an outbreak became a pandemic & priorities for international reform.
So excited to share this huge team effort led by the amazing
@sudhvir
!
Link:
Explainer🧵1/8
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Watching public health experts become the next target of ire is just extraordinary. And deeply troubling.
Expecting experts to know everything about a novel emerging disease misunderstands how science is generated & implications of years of actively defunding scientific research
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I hope that this is the beginning of more US governors taking the urgent action needed to protect the health of their people.
Utah governor declares
#COVID19
emergency, issues mask mandate: ‘We cannot afford to debate this issue’
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Unfortunately, I share
@DFisman
's experience over the pandemic:
i absolutely forgive & have radical compassion for: missed deadlines, dropped projects, no replies, bad days
i absolutely will not: racism, misogyny, anti-semitism, ableism, homophobia, neocolonialism, cruelty
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A big win and huge shift: China joins Covax initiative to distribute coronavirus vaccines
The US & Russia remain out of this critical multilateral mechanism.
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There are reports out of Ranchi, India of 8 human H5N1 cases: 6 poultry farm workers & 2 doctors (which is of particular concern if accurate as canaries of H2H spread)
Clusters of limited H2H H5N1 spread are not unheard of: v. different to sustained H2H.
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There was an imperative: I am proud to have joined the
#JohnSnowMemo
with other
#covid19
experts around the world about the evidence-based and ethical path forward in the months ahead.
Public health works.
Epidemiology matters.
NEW Correspondence—80+ researchers warn that a so-called
#herdimmunity
approach to managing
#COVID19
is “a dangerous fallacy unsupported by the scientific evidence”
#WCPH2020
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As we wait to hear if the WHO Director-General will declare
#monkeypox
a Public Health Emergency of International Concern, it’s a good time to reflect:
What happens when a PHEIC is declared?
tldr: 🚨💰🧾🌎⚖️
🧵 1/7
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2019 gives us “just one more thing”.
Cluster of unknown viral origin pneumonia in Wuhan (pop: 11m)
🦠27 sick (7 severe), inc seafood market stallholders.
🦠No human to human recorded yet.
Tests for Flu & SARS likely but not yet confirmed.
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It’s been a lovely few weeks recuperating on leave.
Decided to follow the CDC’s advice that pets are good for ❤️ health:
Introducing my little 9 week old puppy - Saga.
She’s a pomsky: half husky, half pomeranian & (as payback to the statisticians on here) 100% cute.
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*US side*
Legally it's murky if the President can withdraw. While Exec has power to sign treaties, ratification follows advice & consent of Senate.
– Some argue Exec thus retains power to exit treaties
– Others argue it requires Congress consent:
(3/3)
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Spread vaccines, not variants.
Donate doses now.
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Here’s the piece, with
@gregggonsalves
quote taking the headline: “What else do you call mass death by public policy?" & brilliant
@cmyeaton
“We risk complacency in accepting the preventable deaths of 2000 Americans each day”
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It’s only official when the twitter bio is updated: Dr Phelan.
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Portugal is reporting 5 monkeypox cases and 20 suspected cases.
All cases are young men, healthy and stable, presenting with lesions.
With outbreaks in UK and Portugal, Europe needs to enhance surveillance, with non-stigmatizing public health comms.
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I opened Twitter, saw what you’re all talking about, and am going to leave again
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It is unfathomable that the US would deny people access to a future
#COVID19
vaccine on the basis of socio-economic status, violating the right to health.
In a pandemic, a vaccine is a global public good & must be made globally available & accessible. We are in this together.
‼️
Azar refuses to promise a coronavirus vaccine will be affordable for anyone:
"We would want to ensure that we work to make it affordable, but we can't control that price, because we need the private sector to invest.. Price controls won't get us there."
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At
@TheAtlantic
#covid19
coverage is unparalleled:
–
@edyong209
's beautifully researched & written pieces w diverse voices
–
@alexismadrigal
&
@yayitsrob
's crucial investigations into US testing
–
@olgakhazan
unveiling the obscured
Quality journalism saves lives: subscribe.
It's a really sad day. A lot of amazing colleagues have lost their jobs, all of whom exemplify the generosity of spirit we try to inculcate in the Atlantic newsroom. We'll continue to give you our best. But we're grieving today.
Re-upping this:
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The
@WHO
is advising against the issuing of immunity passports as there’s no evidence presence of antibodies demonstrates immunity.
There’re also many legal & equitable reasons immunity passports are bad: I’ve a submitted paper I hope to share soon.
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Correspondence in
@TheLancet
from the Director of Al-Shifa Hospital:
“This … is a plea to every human being to help stop this genocide right now—we cannot live like this; the world should not be silent about the killing of civilians in the thousands.”
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Borders do not stop infectious diseases: strong health systems do.
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Anne Schuchat has reportedly resigned from her role as deputy director of CDC, following Nancy Messonnier's resignation from CDC last week.
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The quarantine on this ship is unacceptable: it’s concentrating people into what is increasingly looking like an environment that’s facilitating transmission. Whether a city of 11 million or a ship of 3000, simply cordoning people off is not an ethical or effective quarantine.
Japan's health ministry confirms 39 more cases of the novel
#coronavirus
on board the quarantined
#DiamondPrincess
cruise ship, bringing the total number of cases to 174
#COVID19
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if you wanna know how the epidemiologists are feeling with regard to a fifth wave, email lists and group chats that have been quiet for the last few months are coming back to life
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An important paper (preprint) has just been put up from
@c_drosten
& team.
Critically they found no significant difference between age categories including children of
#SARSCoV2
viral load.
Image: viral load categorized by (A) age
(1/3)
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