Thread by @rplenge

Here is a great talk from @XihongLin at the Broad Institute about the Wuhan outbreak. There are many important messages. @broadinstitute

The goals of the presentation: What can we learn for the Wuhan experience in controlling the COVID-19 outbreak? What worked and what did not work?

A complete description can be found in this medRxiv post.

medrxiv.org/content/10.110…

The lecture starts with a positive message: the COVID19 outbreak can be stopped if we can get ourselves together to do it right.

Wuhan experience tells us that the outbreak can be controlled with mitigation and suppression. There were three phases: Rt from 3.88 (no intervention) to Rt=1.25 (mitigation [Jan. 23-Feb. 1, traffic ban, home quarantine]) to Rt=0.32 (Feb. 2-18; centralized quarantine).

Dec. 8 was first case (Huanan Seafood market). Jan. 11 was the start of the Spring Festival. Jan. 20th, confirmed human-to-human transmission, and the government recommended mitigation. Lock-down occurred on Jan. 23, including traffic ban and asking residents to shelter in place.

On Feb. 2, concern about medical surge resulted in two new hospitals being built in <2 weeks and 16 field hospitals launched (stadiums converted to hospitals for medical treatment). Hotels and university dorms were used for additional beds for presumptive cases & close contacts.

First take-home: lockdown with mitigation (traffic ban, social distancing) helped but was not enough

Wuhan went to centralized quarantine on Feb. 1. This meant control source of infection (e.g., take infected family members out of the home) and drastically reduct the number of new infections; Rt to 0.3. Worth noting Group 4: close contacts of those infected were quarantined.

Mitigation continued for everyone else.

Second take-home message: mitigation plus centralized quarantine worked; process was heavily orchestrated and aided greatly by availability of diagnostic tests and a coordinated triage system.

Third take-home: protection of healthcare workers was critical to the success of the strategy. This required appropriate protective gear.

Fourth take-home: testing, testing, testing!

Repeat: testing, testing, testing.

Early on, Wuhan had insufficient testing capacity; they devised a tiered approach.

Fifth take-home: a multi-pronged approach, including centralized quarantine.

Sixth take-home: protect vulnerable populations.

Some centralized quarantining is happening in the US; state of GA and some college dorms.

Severity was directly proportional to the availability of medical care. Over time, severity decreased because of field hospitals and preparedness of the health care system.

Seventh take-home: early diagnosis and treatment important in caring for patients.

The US is in a race against time.

Finally, some thoughts on what the US should do.