Thread by @AbraarKaran

1/ One of the MOST critical systems responses for controlling #COVID19 as it spreads more will be making sure that young, healthy patients DO NOT go to emergency rooms if they have mild symptoms. They should call their doctors to discuss & likely self-isolate.

2/ Deaths have been most common in elderly and those w/ other medical co-morbidities. These people are likely to be in our emergency rooms. Some of them won't be infected w/ #COVID19; we need to minimize unnecessary exposures to this vulnerable group.

3/ We do NOT have the hospital capacity if 15-20% of cases require hospitalization, and 15-25% of those require the ICU, which are the numbers we are seeing from major studies in @JAMA @NEJM.

Hospital capacity needs to be reserved for those who truly will need it.

@jama @NEJM 4/ Communication will be critical, including text message systems to proactively reach large numbers of people; open hotlines to so people can call healthcare providers to talk through symptoms & run checklists on age/comorbidities/basic vitals that can be measured at home etc.

@jama @NEJM 5/ Making sure everyone can easily reach a doctor/nurse/healthcare provider over the phone will be critically important-- keep in mind that many people don't have primary care providers.

Self-isolation will go a long way --> it will minimize spread & increase hospital capacity

@jama @NEJM 6/ In conversations, @RanuDhillon has rightly pointed out that large-scale self-isolation will be have ripple effects as it pushes people out of work for a significant amount of time-- large economic implications of this that could have major consequence.

Cc @BhadeliaMD @syramadad @CarlosdelRio7 @IngridKatzMD @RanuDhillon @cbpolis @k_stephensonMD @PaulSaxMD @aetiology @T_Inglesby

@BhadeliaMD @syramadad @CarlosdelRio7 @IngridKatzMD @RanuDhillon @cbpolis @k_stephensonMD @PaulSaxMD @aetiology @T_Inglesby 7/ This strategy is going to be most critical when we have a *large number of cases*. At the early phase, such as now, when we have very few cases, we need to catch these cases early to avoid further spread. But patients should still call their doctors so they can be triaged.

Cc @BillGates @ChelseaClinton @Atul_Gawande @DrMikeRyan @melindagates @trevormundel @MSuzman @CassSunstein @SylviaBurwell @richardhorton1

@BillGates @ChelseaClinton @Atul_Gawande @DrMikeRyan @melindagates @trevormundel @MSuzman @CassSunstein @SylviaBurwell @richardhorton1 8/ Many responses asking what to do if you don't have a primary care doctor. Departments of public health *need* to create call-in lines by which people can call a number and be immediately connected to a doctor/nurse/other healthcare professional to get screened.