Thread by @ASlavitt

March 21 COVID Update: I had an scientists & innovators trying to get as good a projection of the future that I could. It is wrong be definition. No one knows the future.

I also heard some about present: the Congressional bill, Admin plans & hospital realities. Here goes... 1/

Let’s start with a piece of positive news. Scientists see rapid testing/intelligence, a vaccine, and herd immunity as the combination we need to return to complete normalcy. 2/

(By the way, by definition if I’m asking people and tweeting about the future, how the hell do I know. So feel free to call me alarmist if you don’t like it or tell me I’m wrong or that something’s obvious & I will take your feedback but I’m not claiming magic powers.) /3

Here’s my summary of a bunch of voices: we go through this period of shock and lack of context & occasional disbelief. Many follow instructions to #StayHome. A number of people don’t. We’re not trying to reduce the spread just slow it on behalf of the frontline health workers./4

During this period we see horrific numbers on TV, horrific images of hospital scenes. It’s tough to watch. But it may not be happening in your city/town.

And this phenomenon is both good news & a problem. /5

This bit is newsworthy: I took a look at real time data today of the fever levels reported in two areas: SF, CA where there are strict controls & an area of Florida where people are completely mixing it up. It’s real time data & it makes a comparison to normal fever levels.6/

Here is the good news. It appears that the measures in SF (please appreciate that I would never shorten to “Frisco” even when running out of Twitter room) are working. I’m asked for a summary analysis in simple form which I will show.

Good job Bay Area. I know it’s hard. 7/

Here’s the hard part. It’s completely re-enforcing. Usually we like to see a visual of our progress. People in SF are seeing less of a crush as a result & are wondering “why are we doing this?”

That makes it harder to sustain. If they could teleport to NY, they would know why.8/

So it becomes hard to sustain. It would be different if we had enough testing. If we knew we were infectious, we would stay in. And we have 5 asymptomatic days on average when we get COVID-19. As a result of all of this, people will be inclined to break the social isolation.9/

But there are other reasons:

-Something I learned today was how much the virus hates ultraviolet light. So Rnaught goes down by an estimated 1/2% point. (So from 2.3 to 1.8 for example.

Skip the next tweet if you already know what Rnaught is (but stop being so smug 😉). 10/

Rnaught is the number of people each infected person infects. It is a critical factor in how fast the disease spreads. 80% of people or so who test positive don’t where they caught it.

Rnaught x herd immunity needs to be reduced below 1 for the virus to begin to die.11/

So this summer as some cities get past the bad part, as R0 goes down & people don’t believe don’t see problem, they feel fin hardship, there will be a clamoring for normalcy.

And for social reasons. We like each other. Or we like drinking alcohol together. 12/

I believe there will be another reason— the election. No matter what the scientist tell him, Trump will fixate on any good news and declare things over. Go back to work! Play baseball! Invest in stocks!

Scientists I mentioned this too were horrified.13/

If this happens with no access to testing, it would be a very bad thing in their view.

So, one idea instead, is let businesses open if they install non-contact thermometers or require termperatures be taken prior to entry, while limiting capacity.14/

The next phase, likely in the Fall, many believe that like the flu COVID-19 will be seasonal and as things cool down & R0 skyrockets with the summer & some schools open, it could come back, possibly worse. 15/

But here’s the thing: we aren’t avoiding the spread. We’re trying to slow it down. Both to avoid the crush AND to create solutions for testing & prophylaxis & therapies while we advance the vaccine.

So we could have many more tools then & social protocols. 16/

Next phase: we have a lot of cases, but by this time if we’re thinking ahead, we’ve got great PPE manufacturing, more hospital capacity, an immune population, more ventilators, and we are beginning to know how to deal.

But my guess is we’re probably also a little numb. 17/

A strange argument begins to dominate (it’s already started). That treating COVID-19 is actually worse than not. That the economic consequences aren’t worth it. That 60k people die from the flu every year & we can’t shut everything down.

As a matter of fact...18/

People in the WH say right now the Larry Kudlow crowd is driving this argument in the White House. I’ve heard the health people are pretty frustrated. Because the immediate issue is the crush n the hospital system. 19/

This is going to run longer than normal so feel to take a hand washing break. 20/

Sometime during the Fall phase is @somuchweirdness and my 24th Anniversary. 24– the hand sanitizer anniversary. I’m saving up now. 21/

By early Spring 2021 we know whether we have a vaccine that works. We hopefully have nationwide testing and a system for identifying people with immunity.

I’ve heard nothing to worry me that won’t. And it becomes widely available Fall 2021. Because of that... 22/

The combination of immune people & people who have the vaccine climbs to 80%.

At that point Rnaught could be as high as 5 and 4 of those people wouldn’t get infected. Awesome!

But what then? 23/

We would have “high COVID-19” seasons ongoing (as someone on the call said, like High Smog Days) when older or at-risk people stay inside. We may have masks and testing sites and fever camps as well. 24/

Viruses hate vaccines and so they mutate, but at this point we’ve got a thousand Jonas Salk’s searching for innoculations and creating vaccines.

In a good world, we have a presidency & Congress who invest on public health & the CDC & the NIH and health care coverage. 25/

In the other world, we don’t and spend $5 trillion on the next disaster plus an economic depression, job loss, and death.

Speaking of Trump his tweet today on how you can mix 2 drugs & they will work was worse than irresponsible. It was destructive. 26/

Hospital CEOs called to tell me they have long lines asking for these drugs. Even if they worked, they are in ridiculously short supply. He sees popularity bumps as indicators of if he’s doing the right thing.

War time presidents can’t be snake oil salesmen. 27/

I have more on the but I can tell I’m wearing out my welcome. I can hit a Congressional state of play tomorrow. Pelosi, Schumer & McConnell are hashing things out. McConnell is checking in with the WH.

Will give more when I get it./end