Sophia, MPH
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sophiacbess.bsky.social
Sophia, MPH
@sophiacbess.bsky.social
1.1K followers 2.4K following 550 posts
public health person, data scientist, GenAI refuser digging in my heels. I ❤️ vaccination.

personal account; views my own, not my employer’s
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sophiacbess.bsky.social
Bring it!
Evidence of calls made. Screenshot of call log showing Rep Foushee, Senator Tillis DC Office, and Ugh Budd at 12:34, 12:26, and 12:38 pm.
August 29, 2025 at 7:44 PM
sophiacbess.bsky.social
So good. I thought Karen Hao’s Empire of AI made a superb pairing!!
Lavender-to-bright orange color gradient cover art for Karen Hao’s Empire of AI: Dreams and Nightmares in Sam Altman’s OpenAI.
August 27, 2025 at 11:35 AM
sophiacbess.bsky.social
Lots of interesting reflection on this very thing from McCoy et al in their 2024 paper. You might appreciate if you haven’t come across it! pubmed.ncbi.nlm.nih.gov/39465898/

Their ideas on potential impact of LLMs on clutter and information density in the medical record were compelling to me.
Second, LLM use could undermine clinical reasoning. The notion that transcribing encounters and summarizing charts are relatively low-risk uses of LLMs is predicated on a misunderstanding of the cognitive complexity of these tasks. Note writing both triggers a clinician’s reasoning and reflects the results of that reasoning. Choosing which information is pertinent for inclusion in the note is as important as knowing the underlying facts. It is also a deceptively complex task to generate and justify a written “clinical impression” that clearly and concisely summarizes the clinician’s thinking while reflecting an appropriately calibrated degree of confidence. Particularly in complex cases, the process of performing these ostensibly clerical tasks is not epiphenomenal to clinical reasoning but inherent to it. Health systems seeking to implement LLMs in note writing need to thoroughly evaluate these models’ effects on reasoning and decision making; such uses should not be automatically treated as low risk.
August 13, 2025 at 1:03 AM
sophiacbess.bsky.social
And the author very clearly recognizes the work that conflation is doing.
Once AI scribes have been fully integrated into standard clinic workflows, it seems all too obvious what we can expect to happen to those “protected” chunks of time: They will disappear, only to be replaced by four (or more) additional patient appointments. Why should administrators protect doctors’ time for note-writing when we have AI scribes to write notes for us? Why, indeed, should we be paid to do anything other than those tasks for which we can code and bill: performing exams and procedures, prescribing medications, ordering and interpreting tests? What value is being placed on my capacity for reflection and meaning-making, and on my relationships with my patients? The answer is obvious: The value of that time, and of that very human work, is being rapidly reduced to zero.
August 13, 2025 at 12:30 AM
sophiacbess.bsky.social
Would we sign our kids up again for the trials Makary and Prasad are proposing? Here’s why my answer is no:
A new trial today would not add anything we don’t already know,” Bessias said. “It would feel like actually participating in a project of undermining the existing evidence, rather than contributing new evidence.” And the whole point of updating the vaccines is to counter new strains, Matthias said. Those vaccines would be out of date by the conclusion of a new study, which could take years. “People should have the option” to get Covid vaccines, Matthias said. “The people who don’t want it don’t have to get it.”
June 2, 2025 at 3:43 PM
sophiacbess.bsky.social
Not sure about Canada specifically. But some clues about what may happen elsewhere:
Earlier this month, the World Health Organization’s Covid vaccine advisory committee recommended that manufacturers could either stick with JN.1 or KP.2 strains of the virus, or update to LP.8.1. All these versions of the virus are in the JN.1 family of subvariants, and data presented to Thursday’s VRBPAC meeting suggested that vaccines that target any of these viruses would offer solid protection against related viruses. Last week the European Medicines Agency recommended that manufacturers move to production with the LP.8.1 version of the virus.
June 2, 2025 at 1:48 PM
sophiacbess.bsky.social
Still, the move to shared decision making will complicate access in other ways. AAP calls out implementation challenges here: 4/
www.aap.org/en/news-room...
The Advisory Committee on Immunization Practices (ACIP) has been considering a move to a risk-based recommendation for Covid vaccines to guide doctors and families. The American Academy of Pediatrics Committee on Infectious Diseases will also be examining the evidence to determine the Academy’s recommendations, as is our usual process. While the shared clinical decision-making model in the updated immunization schedule preserves families’ choice, this model has consistently proven challenging to implement because it lacks clear guidance for the conversations between a doctor and a family. Doctors and families need straightforward, evidence-based guidance, not vague, impractical frameworks.
June 2, 2025 at 12:54 AM
sophiacbess.bsky.social
Reference

www.cdc.gov/acip/downloa...
Line graph showing Covid hospitalization rates for different age groups over time with dominant variants labeled above the x axis. The title reads, “infants <6 months old had similar Covid-19-associated hospitalization rates to adults aged 65-74 years old”
May 15, 2025 at 11:05 PM
sophiacbess.bsky.social
Veg Wellington components before baking: bowls of butternut squash, mushrooms, and cheese blend on the stove top Final result, fully baked! 5 wellingtons of assorted sizes
November 28, 2024 at 11:49 PM
sophiacbess.bsky.social
It does seem possible that this is related. From 2022, but without state-level changes in the years since, this may be what NY would be defaulting back to 😩. The PREP act doesn’t officially expire til December but in my area CVS seems to be implementing changes now.
State-level vaccination authority for pharmacists (2022) - without PREP Act. NY age minimum for pharmacy vaccination is 18 for Covid and 2 for flu
September 29, 2024 at 8:22 PM
sophiacbess.bsky.social
I’m honestly not sure. it’s hard to find more granular details at the state level. As of 2022, quite a few states had restrictions of various kinds for vaccinating younger kids. naspa.us/wp-content/u...
Screenshot of slides showing state-by-state pharmacist privileges with about half of states having special considerations for children under a variety of ages
September 29, 2024 at 11:25 AM
sophiacbess.bsky.social
TLDR, if you’re used to getting your pre-or elementary schooler vaccinated against flu and covid at a pharmacy, that’s no longer an option in most states.
Since 2020, the Public Readiness and Emergency Preparedness (“PREP”) Act has provided temporary, expanded authority for pharmacists to administer vaccines during the COVID-19 public health emergency. As 2024 comes to an end, so will the final remaining authorities extended by the PREP Act authorizing pharmacists to administer COVID-19 and seasonal influenza vaccines to individuals 3 years of age and older. In expectation of this change, state pharmacy associations have been fiercely advocating and passing legislation to make these authorities permanent in their state, ensuring patients do not lose access to these valuable healthcare services.
September 28, 2024 at 4:43 PM
sophiacbess.bsky.social
But the problem is not skepticism. Nor is it only that anyone can create and widely distribute a faked image. It’s that this ability has given everyone a permission structure to doubt. Everyone, in other words, has been granted license to choose which images they will and will not believe, and they can elect to unsee an image simply because it doesn’t confirm their priors: the mere possibility of its algorithmic generation opens it to suspicion.
September 26, 2024 at 5:28 PM
sophiacbess.bsky.social
You’ll appreciate this comment on the NYT article:
Well this explains a recent response I got from my NYU doctor that had generic and irrelevant information related to a specific question I sent through the MyChart portal. It resulted in a lengthier back and forth correspondence that wasted everybody's time (except the computer's, I suppose).
September 26, 2024 at 4:18 PM
sophiacbess.bsky.social
🚩This is a great example of a significant error that could easily slip through clinician review. Catching it requires knowledge of data the tool has access to and/or cross-checking the vaccination record (which defeats the intended purpose of the AI draft). www.nytimes.com/2024/09/24/h...
Dr. Vinay Reddy, a family medicine doctor at U.N.C. Health, recalled an instance in which a patient messaged a colleague to check whether she needed a hepatitis B vaccine. The A.I.-generated draft confidently assured the patient she had gotten her shots and provided dates for them. This was completely false, and occurred because the model didn’t have access to her vaccination records, he said.
September 26, 2024 at 1:35 PM
sophiacbess.bsky.social
Reskeet with a favorite book from your childhood

Wise child by Monica Furlong
Book cover showing a woman and a young girl, both with olive skin and long dark hair, dressed in flowing robes, staring directly ahead and holding a bouquet of flowers against a golden backdrop
August 24, 2024 at 1:18 AM
sophiacbess.bsky.social
#durham wastewater hits all-time high 1.5 weeks before public school start covid19.ncdhhs.gov/dashboard/wa...
A plot of wastewater levels in Durham, NC from 2020 to present with all-time peak the week of August 7, 2024
August 14, 2024 at 5:11 PM
sophiacbess.bsky.social
I ❤️‍🔥 my local health department
Durham, NC Health Department post screenshotted from the other site: “COVID-19 is currently surging throughout the state and country, so be sure to get the facts and take steps to keep yourself and others safe. Wear high-quality masks, test repeatedly if you have symptoms or were exposed, and stay home if you test positive or feel sick.” Accompanying image debunking 4 myths: 1. Covid is over, 2. It’s just a cold, 3. Updated vaccines aren’t necessary, 4. Wearing a mask is useless if no one else is wearing one
July 29, 2024 at 2:53 PM
sophiacbess.bsky.social
The comparison to 1976 seems really off given that no one is talking about a broad recommendation. This is about highly exposed workers with few/no other options for protection given the heat. But I sense from this discussion that vaccine hesitancy is top of mind.
In considering vaccines, the agency takes a cue from a 1976 outbreak of the swine flu. Officials initially feared a repeat of the 1918 swine flu pandemic that killed roughly half a million people in the United States. So they rapidly vaccinated nearly 43 million people in the country within a year. But swine flu cases turned out to be mild that year. This made the vaccine seem unnecessarily risky as several reports of a potentially deadly disorder, Guillain-Barré Syndrome, emerged. Roughly one of every million people who get influenza vaccines may acquire the disorder, according to the CDC. That risk is outweighed by the benefits of prevention. Since Oct. 1, as many as 830,000 people have been hospitalized for the seasonal flu and 25,000 to 75,000 people have died.
July 18, 2024 at 1:59 PM
sophiacbess.bsky.social
Hey #durham, our summer Covid wave has landed. Free tests still available through the health department! 😷
A screenshot of the DPH Covid wastewater dashboard showing a steep increase in Durham as of the last days in June
July 10, 2024 at 5:57 PM
sophiacbess.bsky.social
RAT positivity is strongly correlated with culture positivity (best indicator of spread potential) regardless of what day it is! www.cdc.gov/mmwr/volumes...
Figure from CDC’s Morbidity and Mortality Weekly Report (MMWR) showing Covid test positivity by PCR, RAT, and culture by days since onset.
July 8, 2024 at 9:49 PM
sophiacbess.bsky.social
👋🏻
Woman sitting in the window seat of an Amtrak train, wearing a black kn95, watching scenes of NC forest go by
June 29, 2024 at 5:24 PM
sophiacbess.bsky.social
Swarm! Beautiful, although it may mean no honey this year.
Honey bee swarm high in pine branches
March 18, 2024 at 3:45 PM
sophiacbess.bsky.social
Are hospitalization rates *low* — or just *lower* than their peak during the first Omicron wave? 3/ www.cdc.gov/respiratory-...
Figure from CDC titled, “Cumulative annual rates of COVID-19-associated hospitalizations (Oct. 1–Sept. 30 to align with start of typical fall and winter virus season) have declined since 2021–2022”
March 8, 2024 at 8:01 PM
sophiacbess.bsky.social
Is mortality from Covid similar to mortality from flu, or are they “at the same order of magnitude” [if you use estimation to address underreporting for flu but not covid] 2/ www.cdc.gov/respiratory-...
Table from CDC, “COVID-19-associated deaths based on reports on death certificates declined over 5-fold since their peak in 2020-2021 and are now at the same order of magnitude as estimated influenza deaths”
March 8, 2024 at 7:59 PM