Thread by @ASPphysician

Why does global governance of infectious diseases matter? Let's talk about how we are going to get out of the #COVID19 #COVIDtorium with a thread on getting back to normal.
@LabonteRonald @shoffmania @ColleenFlood2 @picardonhealth @BogochIsaac @drsanjaygupta

Step 1 will be to get agreement on what is #COVIDfree. We usually decide that occurs when the appearance of disease goes back to "baseline rates". In the case of #COVID19, this will mean 0--unless it has developed the ability to mutate and becomes endemic or seasonal (like flu).

To be able to state that we are at zero, will require surveillance and case-finding, as beautifully discussed today @globeandmail by Michael Wolfson theglobeandmail.com/opinion/articl…? But this will require standards @AccredCanada @HSO_world @WHO to be set and agreed upon.

Taking our feet off the gas pedal with social distancing will threaten to delay getting to zero. Without getting to zero, we will not be able to comfortably get out of #COVIDtorium, and we will not be able to get to Step 2. There will also be pressure to prematurely let up--dont

Step 2 will be that countries will re-open internal life according to their local epidemiology. If cities are totally shut down, they will gradually open them up and try to get back to normal.

Step 3 will be that borders will open up. When will those be opened up? When adjacent jurisdictions are #COVIDfree. If trade and travel depend on being declared #COVIDfree, there will be a strong motivation to meet these standards.

The problem: this will most harm the countries who are least able to declare themselves #COVIDfree: low- and middle-income countries. With our currently globalized world, there is economic need to help these countries. Regardless, ethically, it is our obligation.

Life will return to a #newnormal when more and more countries can reliably and verifiably claim that they are #COVIDfree. This will almost certainly will require international agreements and governance for infectious diseases...which takes time and should be pursued immediately.