Shira Doron MD
@ShiraDoronMD
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Chief Infection Control Officer at Tufts Medicine health system. Boy mom. Lead singer of band Off Label.
Boston, MA
Joined April 2009
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Last Seen Profiles
This is what leadership looks like.
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“Doron offered the sole dissenting opinion, arguing that masks likely won't make a difference considering that the general population has largely returned to pre-pandemic era socialization and interactions...”
…as they should.
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I am becoming increasingly concerned about
#punitivemaskculture
in schools. And yet how do we move forward when people have different risks and different risk tolerances?
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Why I believe it is simultaneously true that masks work and mask mandates do not work. The reasons form the basis for our ability to move forward together. A long🧵
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Imagine if, instead of shame, blame and new rules and restrictions, school officials responded to new COVID-19 cases with the following: 🧵
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We published this piece last week as a suggested way forward. We have been called “white supremacists”, “death cultists” and “eugenicists”. We are doctors and mothers. This has to stop.
@ElissaPerkins
@BranchWestyn
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The COVID NPI wars on Twitter are tiresome and a waste of energy. No one is going to convince anyone to come over to their “side” with data. We are all looking at the same (always at least somewhat flawed) data and we all know we can spin it to fit our narrative. 🧵
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At my hospital, every COVID+ inpatient is evaluated by an Infectious Disease specialist. We are seeing more fully vaccinated patients admitted now than a few months ago. But it turns out many are in the hospital for reasons *other than* COVID. Why does that matter? 🧵
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Yes
@MonicaGandhi9
. I’m an MD who takes care of immunocompromised pts & oversees infection control at a children’s hospital. I never want to see anyone sick. But this divisiveness is untenable. If we get to ⬇️ cases & ⬆️ immunity, we need to find a way to scale back restrictions
And
@ShiraDoronMD
& colleagues convincingly argue here that CDC guidance makes clear that one-way masking works once masks mandates for children lifted & masks optional: 1) N95; 2) KN95; 3) FFP2; 4) KF94; 5) double; 6) cloth with filter in pocket
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Uptake of the bivalent
#COVID19
booster has been slow. But I’m even more worried about the declining rates of routine childhood vaccinations. Both say something about trust in public health and its messengers.
@MonicaGandhi9
and I propose a solution.
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Why I like 5 days of isolation, with no test, as recommended by CDC and now MA DPH. 🧵
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“Now it can be said week”…if you are a scientist who has not wanted to say out loud that it is ok if masks are optional in school one day (even if you aren’t sure when that is), it’s ok to say it now. Then we can at least have the respectful discussion.
.
@michelleinbklyn
calls for end of mandatory masking in schools post-Omicron, citing
@ElissaPerkins
@ErinBromage
and recent writing on limited mask efficacy + costs to kids.
Making this the indisputable “Now It Can Be Said” week.
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Concerns about long COVID in children have led to continued restrictions even where immunity is high.
@ShelFarFar
and I explain why peer reviewed studies *with control groups* reassure us that long term effects are unlikely.
Opinion: Children are more likely to suffer from pandemic-associated symptoms than from infection-associated symptoms. School policies should reflect this reality.
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(1) wishing those who are sick a speedy recovery (2) acknowledging that getting infected is inevitable and not a moral failure or a failure of school mitigation measures …
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Your child may be totally fine with masks. But some are really not fine at all. “Our children have sacrificed a lot to protect us. Now it’s time for us to give them their childhood back”.
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Getting COVID is inevitable, so I’m not willing to hide my face forever. Let’s get back to a place of mutual respect. Of evidence-based science rather than ideology. *That* is how we take care of each other.
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If you aren’t seeing patients in the hospital, it can be hard to understand how much things have changed.
Overcounting
#COVID19
hosp and death undermines vaccine efficacy and confidence (and uptake).
Thanks
@DrLeanaWen
for a great summary of the issue
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It’s hard to do nothing, but travel bans are likely to cause more harm than good. They will keep people apart, impact livelihoods, and disincentivize future transparency about findings. Meanwhile the variant has unfortunately probably already spread far and wide.
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We are silencing each other. We are creating echo chambers in which our opinions are validated. We are not engaging in respectful discourse. This is not science. This is not public health. We have to change it. Who is with me?
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This op-ed resonated with me. I believe we are heading into the most divisive phase of the pandemic. Unlike the early days, the division is not across party lines. 🧵
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We’ve reached a point in the pandemic where it’s become unsustainable to depend on others for protection. Luckily, if you want to avoid COVID at all costs, you don’t have to rely on anyone else’s mask compliance. 🧵
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What does this mean? It means mandates are not effective or necessary, even when cases are rising. They cause rifts in society for no reason. If you’re high-risk or risk averse, a medical grade mask will protect you as well as it would if others were wearing it too.
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I direct an Antimicrobial Stewardship program, so I am familiar with the strong human urge to *act* when there is a problem, even if the available solution might be more harmful than the issue at hand. This is especially true of doctors and scientists. 🧵
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Can we please get rid of the punitive mask culture in schools? Kids are suffering, and getting yelled at, threatened with detention, & accused of perpetuating the pandemic due to their mask slippage is not ok. We will look back on these days and wonder how we allowed it.
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I have had several requests for media interviews regarding “an outbreak of white lung syndrome”.
There is indeed a newsworthy story here: a made-up term that sounds scary enough can spread even more quickly than a virus.
We’ve seen this before:
Tripledemic
Kraken
DeltaCron
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(3) thanking those who got vaccinated for doing their part to stay out of the hospital and prevent, to the extent possible, even larger outbreaks (4) celebrate that with each additional student and staff member who survives COVID-19, community immunity is growing…
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I believe masks work. You could even convince me, with a well designed study, that mask mandates can work in certain settings.
But given everything I have seen, it would be hard for you to convince me that mandating masks in school again is the right thing to do.
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…bringing us closer to the end of this highly disruptive and frightening phase of the pandemic.
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You’re not anti-mask just because you acknowledge that masks impact the learning experience and think setting a metric for removal is important. In the last 4 min of this interview, I and 2 other experts agree on this point. Could the tides be turning?
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Please…before you attack next time, try to open your mind to others’ opinions and thought processes. Give people the benefit of the doubt. I promise to do the same. End.
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A (hopefully) reassuring reminder:
When people say “
#COVID19
hospitalizations are rising” today that means something very different than it did even a year ago.
🧵
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Proud to live and work in the Bay State, where our leadership prioritizes the health, well-being and education of children. It’s time to take these important next steps:
Masks optional
No quarantines
Remote school is not school
Test only symptomatic
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The differences in “opinion” are actually differences in values. We cannot and will not change each other’s values. In the meantime, we are making enemies, burning bridges and destroying potential future collaboration between scientists with complementary expertise.
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For some moms, like me and
@BranchWestyn
and
@ElissaPerkins
and so many others…we don’t need a study to tell us what impact COVID restrictions are having on our kids. We feel it every day. That doesn’t mean we don’t care about protecting the unvaxed and medically vulnerable.
“For almost 2 years, many of us told our children that once they were vaccinated, they could reclaim many of the ordinary joys they’d sacrificed. Omicron postponed that…. It shouldn’t be postponed a moment longer than necessary.”
@michelleinbklyn
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But just as not every suspected infection in a patient should be treated with an antibiotic, not every rise in COVID cases needs a public health policy change. Not every identification of a new variant needs one either.
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So if masks work, why don’t mask mandates?
Because:
a. Most spread happens in places you wouldn’t wear a mask (at home, at social gatherings with friends etc, not at the grocery)
b. People are wearing cloth masks (which don’t work)
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The 5-day isolation requirement for Covid is disruptive. Other countries have done away with it. It’s time we did too.
My latest with
@wbranchelliman
and
@ElissaPerkins
.
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It’s even easier to see at the single-hospital level. Note the downward trend at my hospital in the proportion who have received dexamethasone. And the much lower numbers overall from a year ago. We are clearly in a very different place. Please no more fear mongering.
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After so much darkness, a hopeful milestone: no COVID patients in the hospital at
@TuftsMedicalCtr
today.
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Excited to tackle new challenges.
I would love to connect with other healthcare epidemiologists working at the system level to share ideas and strategies. Please message me or tag a friend.
We're proud to name
@ShiraDoronMD
#TuftsMedicine
's Chief Infection Control Officer. Dr. Doron has been an invaluable resource during the pandemic. We feel so privileged that she'll now oversee issues related to both infection control & antimicrobial stewardship across our system.
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2 big
#COVID19
policy changes this week for the children of MA.
1st, an end to the state’s school testing program, which was always a national leader.
Now MA will lead in emphasizing symptomatic testing for the purpose of treatment rather than disruptive asymptomatic testing.
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I and others have been saying that in a post-vax era, with cases de-coupled from hospitalizations, we need to shift our focus from cases to hospitalizations as a measure of risk and for the purpose of policy-making.
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... That’s not political nor is it prioritizing the economy over public health. It’s reality. We need the lights on and food on the shelves. Everyone is essential to someone. Education is essential.
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4. A 5-day rule acknowledges an unfortunate reality: everyone has COVID right now. The person you don’t know has COVID poses a greater risk to you than the one you do know has it who is on day 6. This new rule moves us closer to “living with” the virus.
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So if you’re not visiting elderly or unvaccinated relatives, ask yourself if you’re willing to do that for years. Same with movies, concerts, restaurants. And if your child can’t see his or her friends’ and teachers’ faces, are you ok with that being the way it is indefinitely?
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I’m baffled at the degree to which the reaction is out of proportion to the data this time around.
Gradual and minor ups and downs are normal and expected at this point.
We will see this forever.
"An upswing is not a surge; it's not even a wave," Dr.
@ShiraDoronMD
...told ABC News. "What we're seeing is a very gradual and small upward trajectory of cases and hospitalizations, without deaths really going along, which is great news."
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I fully support this school plan from
@j_g_allen
in
@nytimes
.
The impacts on mental health and long-term wellbeing from learning loss have been unacceptable and reversing them must be the
#1
priority.
Closing a school should not be an option (and is not permitted in MA).
🧵
The crisis kids face at this point is not the virus, but the cost of many years of disrupted school. The overriding goal should be to maximize time in the classroom and make school look and feel much like it did before the pandemic started
Me for
@nytimes
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We need accurate data and metrics so we can understand the landscape of the pandemic and make appropriate decisions. I suggest that hospitals report COVID hospitalizations split into those who do and those who do not require supplemental oxygen. It’s not perfect, but it’s better.
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In Massachusetts we have been reporting a daily count of patients in the hospital who have tested + for COVID who have and have not received dexamethasone, which is the standard of care for COVID pneumonia.
The % of patients who have not been treated is growing over time.
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If you wear an N95/KN95/Kf94/P100/snorkel mask, you do not need to worry about what anyone else is wearing. Mask mandates can be dropped in towns and in schools, and you should not care.
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In this
@washingtonpost
op-ed,
@BranchWestyn
,
@ElissaPerkins
and I outline a strategy: As the Omicron wave subsides, “we urge public health and school officials to educate communities on one-way masking, emphasizing personal choice regarding self-protection…”
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Thank you,
@dscharfGlobe
and the
@BostonGlobe
editorial staff for your honest and balanced views on this important topic. Even if cases in MA are rising, with all school children & staff eligible for vaccine, it is time to shift to mask optional. 🧵
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…we actually need isolation to be shorter for reasons 1-4 and I worry that requiring a test would threaten that. We can tolerate some transmission in the post-vax era. Containment is no longer the strategy. Happy New Year! Here’s hoping for more steps forward like this in ‘22!
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Why is this type of fearmongering dangerous?
1. Fear drives bad decisions (like closed schools and avoidance of socialization)
2. Fear makes the worried not-so-sick flood the ERs
3. Fear spurs inappropriate testing which results in increased healthcare costs
and more…
I have had several requests for media interviews regarding “an outbreak of white lung syndrome”.
There is indeed a newsworthy story here: a made-up term that sounds scary enough can spread even more quickly than a virus.
We’ve seen this before:
Tripledemic
Kraken
DeltaCron
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1. Remember when
#MedTwitter
rallied together against outdoor masks? Because when the “rules” are overly broad one loses sight of where the greatest risk lies. Energy is not unlimited. A 5-day rule concentrates energy on minimizing risk when risk is greatest.
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In response to this study, and the ensuing backlash, I hear people on both sides of the mask debate calling for RCTs.
Of mask effectiveness and of mask harms.
I like high quality research as much as the next girl, but I don’t agree we need RCTs. 🧵
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That’s not to say that we need to tighten the mandate & require continuous wearing of N95s. Countries/cities/schools with mandates haven’t had different shaped curves than those without, even if they required N95s. Plus if you mandate medical grade PPE, you’d better provide it.
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“…and supporting those who choose to remain masked. Time and energy that staff spend policing mask use is far better spent on teaching and supporting children.” I realize people are scared. But we all have the tools to protect ourselves, namely vaccines and high quality masks.
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I don’t feel the need to wear an N95 or a KN95 in public, because I am pro-vax and trust my vaccine. I trust my kids’ vaccine to protect them too, along with their youth. And the tradeoff (eg increased work of breathing) is not worth it to me. But I respect you if it is for you.
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But if the hospitalization metric captures people admitted both *with* COVID and *for* COVID, decision-making will be based on flawed data. In August, Massachusetts DPH added a question about presence of symptoms to the daily reporting requirement. This isn’t working.
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c. People aren’t wearing them right
d. It’s not realistic to expect that people keep a mask on all the time, because they need to eat and drink (traveled by air before the mandate lifted? people are eating and drinking every second in airport and plane)
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@JenniferNuzzo
in this
@landmanspeaking
interview hit the nail on the head. There are more important things we should do to protect the public, like vaccinations and testing to treat.
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2. A 5-day rule incentivizes people to test because the harms from finding out you are infected are less. 3. A 5-day rule could prevent society from grinding to a screeching halt over the next week or two when everyone gets infected at once…
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The breakdown of civil scientific discourse that has characterized the
#COVID19
pandemic has been bad for public health. I outline some strategies to fix this problem in
@CommonWealthMag
. Experts with alternative perspectives must not be silenced.
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In fact, the phrase “N95 mandate” is like an oxymoron. We do not need to insist that kids in school wear higher quality masks. They can if they want to, or if their parents want them to, but it does not need to matter to anyone else.
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I haven’t been active on Twitter long & I’m pretty horrified at the name calling and personal attacks that scientists/experts are subject to…often from other scientists/experts. We all care about the same things: health and well-being. Can’t we be respectful?
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What would an RCT on mask harms tell us? That these people’s experiences don’t matter? That they are lying? That they are in the minority and the minority doesn’t count? That when they say they can’t bear the thought of going back to that, we shouldn’t care?
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I understand the fear of this deadly virus. I take care of COVID patients. But if the time to switch to optional masking is not now, then I worry it is never. And never is not acceptable. Our children deserve better. If you are saying “not yet”, then you must also specify when…
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Crying wolf is an excellent analogy.
If another BA1-like event were happening, you’d never know the difference given how alarmist today’s headlines are and those surrounding every small uptick and new subvariant.
With all of due respect, there is absolute NO CONCERN of Omicron EG.5 in South Africa or most of the world. It would be a good idea if people STOP to spread alarm when a lineage of Omicron emerge or giving SILLY NAMES, this one is called 'Eris' by a single scientist, that has no
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Our latest
@GlobeOpinion
op-ed. The time has come to start the shift away from asymptomatic testing in MA schools
@BranchWestyn
@ElissaPerkins
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The
@TuftsMedicalCtr
pharmacy will honor a Rx from any prescriber and will deliver 💊 to the patient’s home in the greater Boston area. Supply is plentiful. Nearly everyone qualifies based on the current list of risk factors.
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Little known fact: the patients, for the most part, are not wearing masks. One-way masking is how we have always used them. On the sick person or the HCW, not both. Oh, and if you’re worried the holes are too big? That’s ok. The electrostatic charge is part of the mechanism.
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@BranchWestyn
and I and others looked at inpatients with COVID in a large VA database. By defining moderate to severe COVID as low oxygen or use of supplemental oxygen, we were able to show decreasing severity of illness in the post-vax era.
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As the end of school vacation approached, many wondered: do vacations/holidays cause subsequent
#COVID19
spikes or have they just happened to coincide with new variants in the past?
Here is MA waste water data. North and South system.
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This is not how it works. I and others have advocated for a sense of normalcy for kids and low-risk adults. Not because the pandemic is over (it isn’t) but because we have in reach the tools to protect ourselves. 🧵
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As I told
@politico
, this new mask study, again, doesn’t answer the question “do masks work?”
But it can help answer “what would happen if we stopped using them?” and the answer, as we have seen now in many hospitals, is reassuring.
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2nd, the end of post-exposure quarantines which keep healthy asymptomatic children from attending school, daycare and other programs.
This is how to prioritize children and working families. This is
#leadership
.
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These are sick people admitted to the hospital with a variety of conditions (heart failure, appendicitis, etc) with symptoms that overlap with COVID, and the people entering the data are not clinicians.
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Rather, it is now between those who are more vs less risk averse, those who are more vs less able to frame risk in context,…
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They told me that masks affect socialization and language learning. That they’re particularly difficult for people with speech impediments and hearing impairment and those who are neurodivergent. That disciplinary action re masks becomes a focus of the day.
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I never had any interest in politics.
In 2020 I realized not only do I have something to offer, but I *need* to feel less helpless and more heard.
In addition to advising state officials, I’ve attended every meeting of my town’s board of health. And now I’m an elected member.
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I’m noting a lot of confusion about how it could be that a death is counted as a COVID death when it’s incidental.
It’s important to understand the HHS definition of a COVID death. It doesn’t have to be on the death certificate.
If you aren’t seeing patients in the hospital, it can be hard to understand how much things have changed.
Overcounting
#COVID19
hosp and death undermines vaccine efficacy and confidence (and uptake).
Thanks
@DrLeanaWen
for a great summary of the issue
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@davidzweig
reported on this in
@TheAtlantic
but there was confusion among readers…to be clear, acknowledging that some patients with COVID are in the hospital for other reasons isn’t meant to minimize the suffering and death of others.
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This is so concerning and I don’t think we can chalk it all up to misinformation. When I speak to people about vaccination, I learn that they have experienced a profound loss of trust in public health.
NEW: More than 4 in 10 Republicans – and a third of parents – now oppose schools requiring children to get vaccinated for measles & other childhood illnesses. That’s up since the COVID-19 pandemic began.
More in our latest Vaccine Monitor report:
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Despite prolonged close contact (we practically bathe in 🦠 all day), seroprevalence rates among HCWs were consistent with the surrounding community, and patient facing HCW were not at greater risk than non patient facing.
@ericashenoy
summarized it in these slides in 2020.
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It gave me a weird kind of hope that maybe one day we can all learn to “live with” COVID. We need to vax, boost, and take reasonable precautions. But we must stop succumbing to knee-jerk fear-based decision making (both personal and policy) and remember the importance of living.
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N95s were in disgustingly short supply that first spring. Many hospitals reserved them for COVID patients undergoing high risk procedures only. We wore surgical 😷 for the rest. And we found something amazing: HCWs weren’t higher risk than other essential workers.
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5. Why no test? I’m not convinced antigen tests measure “contagiousness”. I agree that data suggest you are more likely contagious when pos and less likely when neg. But there are many tests out there with different characteristics. What proportion are neg on day 5? On day 10?…
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As the pandemic gained speed, so did another phenomenon: the silencing of scientific opinion.
I spoke with
@IDSAInfo
staff in the early days to encourage our society to lead the way in fostering respectful debate on
#COVID19
. Kudos to
#IDWeek2022
organizers for doing so.
Want to deeply thank
@MatiH_ID
@DLeonhardt
Baruch Fischhoff
@ProfEmilyOster
and
@CarlosdelRio7
for joining us at
@IDWeek2022
, and providing such thoughtful commentary on how to communicate about tough topics during this pandemic. 👏👏👏
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First, masks. I don’t pay attention to simulations and mannequin studies. Those of us who write COVID policies for healthcare settings started with this systematic review and meta-analysis which used data from COVID and other 🦠s.
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It’s simply not appropriate to describe increases in terms of percentages when you are starting from such low numbers.
Also, the “percent positivity” metric is virtually meaningless.
We need to adapt the way we frame these things to the changing times.
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It is absolutely critical that we learn from this tragic mistake.
Those of us who fought to reopen schools were called racist on social media and in the comments after our opeds.
But we predicted exactly this.
"So, not only are the study’s results bad news for kids overall — for many reasons, not the least of which is physical health — but the interruption to normal schooling, and its association with increased screen time, harmed kids from minority and lower [SES] families the most."
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Kids belong in school. We demonstrate that the MA test-to-stay program saved nearly a 1/2 million days of school & demonstrated low transmission. Now it’s time to shift focus & resources to symptomatic testing.
@BranchWestyn
@ElissaPerkins
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It’s been a week since this article by
@DrLeanaWen
ignited a firestorm of anger from all sides.
To some extent I think what is happening is a *false controversy* stemming from the fact that we are not speaking the same language
Definitions matter.🧵
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…those who believe strongly that we must maintain a red-alert all-hands-on-deck approach to public health vs those who believe a shift to personal responsibility is more sustainable.
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As mask mandates are reimplemented in more schools (and only schools), it’s important to remember:
what was true yesterday may not be today (and maybe never was).
Don’t get “stuck”.
The variant tracking is modeled, not real. And is often corrected later.
Other examples: 🧵
New
@CDCgov
variant data is out
A good time to remind everyone the last 3 WEEKS numbers are a ‘nowcast’ (modelled, not real data)
Last wk 41% estimate of XBB.1.5 has been revised down to 18% (to 31 Dec)
The curse of the overestimated early growth rate strikes AGAIN.
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Again I must draw a connection. These things are not unrelated. Students have sacrificed enough. Let them learn. Let them interact.
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National wastewater data.
Even the zoomed in version is looking good!
A short and uneventful uptick.
Watching BA.2.86 but my blood pressure remains normal so far.
There is 1 COVID+ patient in my hospital.
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School is essential. Remote school is not school. Vaccines are widely available and they work. Closing school to stop COVID transmission should not be on the table. My latest with
@BranchWestyn
and
@ElissaPerkins
for
@washingtonpost
.
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