Thread by @ShellenbergerMD

US CONGRESS MUST ACT TO KILL THE VIRUS

US facing 1M+ deaths

Demand for ICU beds est. to be 8 - 10x of supply

State, individual, corporate action critical but not enough

Congress must enact "no regrets" actions & policies

Starts with a radical mental shift

THREAD

1. Vision: Kill the virus. Improve treatment. Ramp up testing.

There was a natural experiment and South Korea won. There are 30x more people dead in Italy than SK, even though SK population is 85% the size of Italy’s.

An aggressive attitude is essential. We must kill, not accommodate, the virus. It is our common enemy.

East Asian nations like South Korea were more aggressive on testing, transparency, monitoring, and self-isolation than US & Europe.

Deaths have peaked and declined.

South Koreans have been aggressive while maintaining democracy and individual freedom. Indeed, strong early action made it easier to preserve civil liberties by returning to normal more quickly.

While spread of COVID-19 will continue in SK, and death toll may rise again, infections & deaths are unlikely to reach the levels seen in Italy

Even if infection rates rise, their growth will be more gradual and pose less risk of overwhelming South Korea’s health care system.

We can learn many important and specific things from South Korea, but the most important thing we can do is embrace its “kill the virus” attitude.

2. Get manufacturing of critical goods on wartime footing.

President @realDonaldTrump acknowledged the need for this and asked for the states’ help.

Now, Congress should call on automakers, jet plane makers, and other American manufacturers to convert their factories

It is unacceptable that, in a civilized country, people should die because we lack the masks and gloves to protect health care workers and the ventilators to save the lives of people whose lungs are collapsing.

We need ventilators, masks, gloves, beds, and other critical items.

Congress should authorize an arrangement similar to the one adopted in World War II when car companies converted their factories for bomber and jet plane construction.

Every patriotic manufacturing CEO in America will say yes.

3. Stimulate the people. The Federal Government should, for at least one year, send every American over the age of 18 years-old a check for $1,000 a month for the next 12 months. Such a "freedom dividend) will offset inevitable lay-offs, and create certainty for the future.

Past one-time stimuli, including 2007, had limited usefulness.

What all Americans, including business and investors, need now is greater certainty about the future. This is a cheap way to secure such certainty.

In 12 months, Congress can revisit to decide whether to reauthorize. The Freedom Dividend should be financed by a small tax on all Internet transactions. But the finance mechanism should not interfere with the passage of the legislation.

Nor should this proposal be necessarily viewed as an alternative to expanded paid leave and unemployment insurance.

4. We should radically increase testing, tracing, and transparency.

State governments and the testing industry are offering conflicting numbers but it appears millions of tests should be possible by early April.

Our goal should be mass testing as soon as possible.

The oft-repeated claim that “40 to 70%” of the public will get coronavirus is unproven and contradicted by actions by East Asian government actions. WHO says the virus can be contained, not perfectly, but still more contained than would be otherwise.

Widespread testing is key to restricting & slowing spread of C19 and allowing people to return to normal life

South Korea shows that massive use of testing is a critical element to retaining freedom while protecting public health

Aggressiveness saves lives, fatalism is deadly

5. Expand emergency “right-to-try” laws.

America is the most innovative nation in the world. Innovative entrepreneurs are one of the main sources of our greatness. This asset must be unleashed.

- Adults or their next of kin must always give their consent to medical experimentation

- Radical transparency so such experiments are monitored is crucial.

There are real possibilities of abuse. There have been ugly periods in our past.

Congress can find the right balance

6. Unleash FEMA, Army Corps, & Nat Guard for staffing hospitals, testing, & more

We are at the beginning of the crisis

A huge influx of very sick will go to hospitals

Many health care workers will get sick

We must train workers & build & scale-up temp hospitals now

7. Temporary universal health insurance for uninsured for all COVID-19 related medical care

It will be deadly if people hesitate to get testing or treatment b/c of lack of health insurance

Congress should cover all medical treatment of COVID-19 for the uninsured immediately

More than what is above will be needed, and hopefully the above list will be temporary

What we have learned from C19 crisis is that fatalism & inaction are deadly, while aggressiveness and innovation save lives. We must build on the strengths that make America great.

We must come together and consider policies that are in the human interest

Around the world, political leaders were slow to respond, often for understandable reasons

That's the past

We need to re-set our mentalities, face forward, and work together and #KillTheVirus

/END

The best estimate of US death toll = 1M+ from Imperial College London

That's if we stay on our business-as-usual trajectory

This scientific paper was the basis for the reversal of UK's failed "herd immunity" policy

imperial.ac.uk/media/imperial…

Low estimate for global death rate for Covid-19 = 1% (link below)

Here’s future US deaths — with constant 1% death rate — and different rates of infection

% of pop infected : # deaths

10 : 334k
20 : 629k
30 : 961k
40 : 1.3M
50 : 1.6M
60 : 1.9M
70 : 2M+

nytimes.com/interactive/20…

“1% seems reasonable estimate of case fatality rate in high-income country in absence of major failures of the hospital & care system”

“1% CFR estimate is close to what Dr. Jeremy Faust has been suggesting based on the Diamond Princess cruise ship case”

medium.com/@andreasbackha…

“The president’s guidelines appeared driven by a new report that predicted that without action to stem the spread, the virus could cause more than 2 million deaths in the US, and the most effective way to reduce that is to limit interactions among people”

nytimes.com/2020/03/16/us/…

“The lead author of the study, Neil Ferguson, an epidemiology professor, said in an interview that his group had shared their projections with the White House task force about a week ago”

nytimes.com/2020/03/16/us/…

“‘States frankly don’t have the capacity or the power to make up for the federal government,’ he said, warning of a rapidly approaching shortage of ventilators for sick people.”

nytimes.com/2020/03/16/bus…

“Imminent failure of hospital systems is all but certain. As many as 214M in US could be infected.. as many as 21M could require hospitalization. This would crush nation’s medical system. NY state has just 53k hospital beds, only 3k of which are ICU beds”

nytimes.com/2020/03/15/opi…

“In a telephone conference with the heads of big engineering companies on Monday evening, Boris Johnson, the prime minister, called for 30,000 to be made within two weeks, according to two executives with knowledge of the discussion.”

giftarticle.ft.com/giftarticle/ac…

This in the *Financial Times*:

“Governments should throw caution to the wind & spend massively... as big as the drop in GDP.... Speed is of the essence when the goal is to reassure people they will not be poorer. Universal transfers to all Americans...“

giftarticle.ft.com/giftarticle/ac…

- NY may need 19k ventilators but just 2k available

- “25% of cases have been hospitalized & 44% have required ventilation”

- “At some point I may look a daughter in the eye and tell her that I don’t have a ventilator for her father.”

nytimes.com/2020/03/17/nyr…

https://twitter.com/ShellenbergerMD/status/1239931340163710981

“The federal government needs to step up at times like these. There needs to be an emergency injection of funding to expand our strategic national stockpile of ventilators.”

Excellent @GYamey @TIME

time.com/5804899/u-s-co…

AP: Italian Hospitals Breaking Down

- Deaths increased 25x in 13 days

- 2,300 health care workers — 1,900 MDs & RNs — infected

- Desperate for 20M undelivered masks

- Mass ventilator shortage

- Makeshift conditions

- 12 - 18 hour shifts

apnews.com/f9355fa6104c67…

@realDonaldTrump New @ProPublica study finds US hospitals will be *over-capacity*

- if 20% of public is infected over next 6 months

- if 40% of public is infected over 12 mo.

- if 60% of public is infected over 18 months

Over-capacity = mass, unnecessary death

projects.propublica.org/graphics/covid…+

New Study finds bringing pharma manufacturing back to US from China “could create 804,000 US jobs and add $200 billion to annual GDP in the first year.”

prosperousamerica.org/reshoring_us_p…

- Trump admin. has still not given orders to DoD, Army Corp of Engineers, Dept of Veterans Affairs, FEMA, & National Disaster Medical Staff

- Oregon & New York have not received viable masks

- Health care workers at severe risk of infection

nytimes.com/2020/03/17/us/…

Coronavirus hitting nursing homes

- 74 newly infected discovered in Korean home

- first death of 22 infected in Illinois home

- second death in NOLA home

All in last 24 hrs

We are in v. early days of pandemic

Call your elderly parents and grandparents to express your love

BREAKING

- German PM Merkel calls C19 "biggest challenge since World War II

- Global death toll = 8,248

- 200,000 confirmed cases

- true # could be 2M - 4M

- Italy deaths jump 475 — largest daily # anywhere to date

- Italy death toll nears 3,000

theguardian.com/world/live/202…

UK “National Health Service has just 5,000 ventilators.... The target is to manufacture 5,000 ventilators as soon as possible, with a goal of a further 30,000 eventually. Manufacturing is expected to start within a month”

giftarticle.ft.com/giftarticle/ac…

https://twitter.com/shellenbergermd/status/1241009198978093057?s=21

https://twitter.com/ShellenbergerMD/status/1241009198978093057