Thread by @kakape

Hard to believe that it is a month ago today that I wrote this thread. Feels like yesterday but also like eons ago. Looking back, it is clear that time really was up and we live in a different world now. So let me try and give you an idea of where I think we are now with #covid19

https://twitter.com/kakape/status/1231193492002611200

The virus has gone around the world at astonishing speed. @WHO wrote in its situation report Thursday that it took 3 months to reach the first 100,000 cases, 12 days to reach the second 100,000. Tomorrow’s sitrep will probably have more than 300,000 cases. That’s four days.

@WHO From the beginning everyone’s biggest worry was always that we would see more Wuhans. There was a weird complacency in many places thinking that #covid19 would not lead to the same situation in other countries.

@WHO Bruce Aylward told me: “I think there was a sense that this took off in China because they are not prepared, and they don't have the kind of systems that we have. That reflects a lack of understanding of just how sophisticated Chinese public health and health care system are."

@WHO Bergamo was the place that proved his point. And what a devastating way to do it: Overwhelmed hospitals, exhausted doctors and nurses pleading for help in letters and editorials, military trucks transporting the dead to other cities because crematoria cannot cope.

@WHO There will be other Bergamos. News from New York or London is dire. Governments there acted late. There was less #physicaldistancing and less testing in UK and US than in other places. And we are barely beginning to see the extent of #covid19 spread in Latin America and Africa.

@WHO The US was on notice ever since it became clear there was undetected spread in Washington State. @trvrb tweeted about the “enormous implications” of the first two genomes from that outbreak on 1.3. So much time wasted, so many lives.

https://twitter.com/trvrb/status/1233970271318503426

@WHO @trvrb The peak in ICU need in Wuhan came four weeks after the peak in #covid19 cases, so it will take weeks to see the full cost of that inaction. And it feels like that simple fact STILL has not quite sunk in.

@WHO @trvrb Everyone knows there are some places that managed to suppress #covid19: China, Hong Kong, Singapore, South Korea. We have talked a lot about what worked there and what lessons countries have or haven’t applied. (@sciencecohen and I wrote about that here: sciencemag.org/news/2020/03/m…)

@WHO @trvrb @sciencecohen For now, consensus is to do the same and try to suppress #SARSCoV2 completely. We are all Wuhan now. Aggressive action is needed to reduce transmission of the virus through society-wide measures, identifying cases and isolating them, finding their contacts and quarantining them.

@WHO @trvrb @sciencecohen It will be a struggle, but we know that it can be done. At great cost. The question is what happens then. It’s clear we cannot keep this up for 18 months. So how are the countries doing that have been doing this for a while?

@WHO @trvrb @sciencecohen China: Wuhan is still on lockdown. Other places are slowly re-starting life. China has gone to extraordinary lengths to manage imported cases, diverting flights, testing all arriving travellers for #COVID19 and putting them in quarantine whether the test is positive or not.

@WHO @trvrb @sciencecohen Even with all that, the virus may well resurface in China. We are all watching and hoping. What happens there will be as much of a lesson as what happened in Wuhan earlier this year. Let’s hope we are more attentive this time.

@WHO @trvrb @sciencecohen Singapore is struggling. #Covid19 cases have gone up in recent days. The country has now banned all foreigners from short visits to the country. (They already had to stay home 14 days after arrival.)

@WHO @trvrb @sciencecohen Hong Kong is also seeing more cases. Models suggests the reproductive number there has been above 1 for several days, which means the virus might be spreading. "I anticipate that we might be on the brink of a local outbreak”, @gmleunghku told me.

@WHO @trvrb @sciencecohen @gmleunghku What is happening in Singapore and Hong Kong? @gmleunghku thinks it is “response fatigue”: "We were the poster children because we started early. And we went quite heavy, right? And so it's two months already, and people are really getting very tired."

@WHO @trvrb @sciencecohen @gmleunghku This will be the next challenge once countries hopefully reduce the spread of #SARSCoV2. Eventually we will have to strike a balance and it is time to think about that NOW.

@WHO @trvrb @sciencecohen @gmleunghku Once the virus has been suppressed, if we can keep the reproduction number around 1, an outbreak won’t grow into a catastrophe quickly. So are there measures we can lift without the virus resurfacing? Are there ways of making others more sustainable? Those are the next questions.

I really hope there are people out there with the bandwith, the brains and the experience to think about this. Also: We need data!