1/ So important to acknowledge that when we tweet or share recommendations for how to stay safe or what to do at an individual level, these have drastically different implications based on our socioeconomic privileges. #covid19

2/ I’m sure everyone would love to “stay home”

I’m sure everyone would love to just order take out & have food delivered home

This isn’t the case.

And the patients we see are often the ones who can’t do either of those things #covid19

3/ So I can understand the frustration when onus is placed back on individuals over failing systems

But here too there is nuance. Our capitalism has led to stark inequities- where some portions of society do have $ protections & privilege of choice

And many don’t #covid19

4/ Both during April #covid19 surge & trickling of cases through summer, & resurgence now, **most** patients infected w/ the virus that I’ve treated were patients of color, living in crowded homes, working frontline jobs who didn’t have the luxury of many choices #covid19

5/ Thus- the response has many necessary parts

•It demands that we have better systems that can protect all of us, but esp those who need it most

•It also needs those of us that can use our $ & privilege to use it for good- if we can afford to make a “safer” choice, we should

6/ The dichotomizing of failing systems & individual responsibility (& agency) should be rejected

Both of these things matter- millions of individuals taking control over how they live matters

Demanding better systems from our political leaders matters

Two are also intertwined

7/ Individuals can only do so much — at a point, lack of systems & resources limits what can be done at an individual or community level

This again depends also on one’s socioeconomic privilege

I have friends running boutique #covid19 testing businesses in LA for the wealthy

8/ If you have enough $$, someone can come to your house, swab you and get you results the same day

Must be nice

I can’t even get that done as a practicing doctor

My patients definitely can’t get that. #covid19

9/ So when we communicate to the public— including myself in this— our messaging will need to be nuanced to who is reading it. For instance, I recently wrote an op ed trying to encourage people that their small decisions matter; meant to empower people https://www.wbur.org/cognoscenti/2020/12/09/covid-19-virus-cough-masks-holidays-abraar-karan

10/ Some people took great offense to it; saying that it was short sighted of me to write about personal responsibility during a time when systems were failing so many people. I agree that the latter is true; I see it every day at the hospital. #covid19

11/ I also have met/spoken w/ many people— incl the two who I highlighted in the story— who began to feel like their small actions no longer mattered w/ the amount of viral spread that we have in the community. I wholeheartedly disagree w that. The moment we surrender, we lose

12/ So both things are true; for many, calling for individual responsibility is short sighted when they are struggling to do everything they can;

and for others, reading this may have empowered them to believe their actions still matter for epidemic control #covid19

13/ I say all this bc recognizing our privilege is immensely important; and writing for one audience can become an attack on a different audience;

often times writing for a privileged one becomes an unintended attack on a less privileged one, for instance #covid19