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We learned last night from @trvrb that COVID-19 may have been circulating in the Seattle area for several weeks. This thread details some possible implications if that finding is confirmed. 1/
@trvrb If that scenario is occurring in Seattle, it could be true elsewhere in the US. With narrow testing criteria and limited diagnostic capacity (both now improved), we may have missed sparks. 2/
We need to move directly to understand the burden of community transmission in the US. We should do that by testing hospitalized patients with ARDS or pneumonia of unknown etiology. 3/
This is now possible with the recent expansion of diagnostic capabilities to state and local public health labs. This effort is underway but it should be expedited. 4/
This data is needed to inform hospital preparedness. If there is a large burden of COVID-19 in the US, we should move quickly to implement the recommendations of my colleagues @JHSPH_CHS, outlined here:… 4/
On the one hand, if it has been circulating here for weeks without being noticed, it could mean that severity is lower than feared, which I hope to be true. It would be important to know that soon. 5/
On the other hand, the doubling time of the epidemic in Wuhan was originally around a week, so it takes time for case counts to build and severe cases to be detected. 6/
We must learn from the experience of China, South Korea, Iran, Italy that this outbreak can be impactful, so we should accelerate surveillance and preparedness work. 7/7
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