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COVID-19 Prep Update- March 14:

Last night I was on with state & local officials around the US well into the night. By March 23 many of our largest cities & hospitals are on course to be overrun with cases.

I am going to prepare a memo for them. I will share highlights here.1/
They are highly dependent on the public response so I will start there. We have no immunity to COVID-19, people who get it don’t know for a while, and for each person that gets it, they infect 2+ people. 2/
You may have seen graphs that look like this. It shows how far behind Italy we are tracking in days & how our trajectory compares. The US and every country that hasn’t taken better preventive measures like S Korea & Japan is directly on course, lagging 2 weeks behind. 3/
This is what it looks like in Italian hospitals. Every report describes this as a tsunami. And if it happens like a tsunami, in major cities we will have 10s of thousands more cases than we have beds & we will have 1 ventilator for every 8 people who need one. 4/
What are mayors, governors & their staffs reporting? That people are jamming the bars.

I get it. Home from work. Cooped up. Crisis mentality. We need to let steam off. Shared experience.

But stop that. All the bars & restaurants are closed now across Europe. 5/
The only way to prevent Italy given our lack of testing is to socially isolate. Congress even allocates money for people to stay home. That rarely happens. But we blew our chance at containment. 5/
If you want to see a thread on how we got here and what to do as of 36 hours ago, I tried to be complete here. The thread does not contain predictions but frames the course experts think we’re on without action. 6/

Let me flip to my advice to mayors and governors. The first thing I’m going to start with— expanding medical capacity— has to be done but will only make a tiny difference if we don’t self-isolate. 8/

(yes my tweet numbering completely sucks)
Hospitals must get rid of elective procedures, expand negative pressure rooms, move ventilator capacity to hot spots & seek additional where possible, create isolation negative pressure rooms, get tests 4 every front line worker, get masks & other supplies even on black mkt. 9/
Get on the phone with someone from Seattle ASAP to talk through every thing they went through, ran out of & wish they had done.
Build tents to spec, commandeer hotels and arenas. Hire ppl losing work to sanitize everything. 10/
State officials in some states wanted to screen at their international airlines and the Trump Admin did not/could not support them. Now we must consider stronger measures: for stage 3 countries, auto-quarantine. Consider shutting airport temporarily for 30 days. 11/
Many cities & states are considering calling in hell from the national guard. Alarmed? My view at this point is better them now than the Red Cross later. 11/
We can’t afford 10,000s of thousands to be hospitalized at once so we need to prevent & slow down the pace. And if this sweeps through nursing homes, it is fatal to our loved ones. 12/
Nursing home infection control is terrible to begin with. And they are better than elder care or senior living facilities. The death rate among those >80 who contract COVID-19 is 18%.

And look this is where we are... 13/

From every expert I have talked to, I am less convinced that schools should be closed. Either way, open or closed, there are about 8-10 items that need to be considered including meals, childcare (keep granny away), parent sanity😐, etc. I recommend giving parents the option. 14/
Give the germ spreaders a place to go, feed the, teach them to be smarter than us when they grow up, and then protect the teachers. We need sufficient testing for that. 15/
The Federal gov did 2 good things yesterday. 1- It finally got the supply chain to produce tests figured out. Testimg availability should double in the next week. It is unlikely to be sufficient for a number of weeks beyond that— at least 4, but up to 8 I’m told privately.16/
I talked to several on the WH team who went from 0 to 50 at lightning speed. Why they were at 0 weeks into an outbreak when South Korea was 10 days before is a topic for another time (e.g., November) but the labs, mobile testing & supply will be straightened out. 16/
But, testing in a few weeks will be like a sports team scouting college players after the draft. It will help us, but it won’t diagnose & prevent if we are following the Italy curve in Slide 3.

(Yes I know about the tweet numbering issue I have). 18/
I need to close with three messages: 1/ stay socially isolated for real. Not for you, but for everyone. And if someone minimizes this all, patiently listen & explain. People can’t be bullied. 19/
Second, root for the government to succeed here whether you like them or not. The stakes are higher than any most of us have ever experienced: wars, 9/11, whatever. Let’s have an election with this behind us having pulled together. This does spread from Republican to Democrat.20/
I think this small thread from Emily Barson at @USofCare says it well. 21/

3/ I can’t express enough gratitude to the frontline health care workforce. We need to do what we can to make your jobs easier. There’s no roadmap— only your training, commitment & undiscovered capacities that we are relying on. You are heroes. /end
I’m going to add: 11:20 Eastern

Apple just closed all stores outside China. They know what’s in this thread. That’s a major signal.

NYC just had its first death & there are major concerns hospitals will be overwhelmed. If you live in NYC, stop any social contact.
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