Update on #Coronavirus response. Three days ago, I tweeted the U.S. was poised to take the lead in coronavirus cases, and noted it was reasonable to plan for the US to top the list of countries with the most cases in ~1 week. Today, it appears we have met that sad milestone.
As I said then, and will say again, this does NOT make social intervention futile. It makes it imperative. Don't give up.
Also today, @POTUS sent a letter to all Governors foreshadowing the federal government's plan for the period that follows the 15 day social distancing guidelines (which ends in 3 days, on March 30th). There are three operative sentences in the letter. They follow:
"...my Administration is working to publish new guidelines for State and local policymakers to use in making decisions about maintaining, increasing, or relaxing social distancing and other mitigation measures they have put in place."
"This is what we envision: Our expanded testing capabilities will quickly enable us to publish criteria, developed in close coordination with the Nation's public health officials and scientists, to help classify counties with respect to continued risks posed by the virus."
"This will incorporate robust surveillance testing, which allows us to monitor the spread of the virus throughout the
country. Under these data-driven criteria, we will suggest guidelines categorizing counties as high-risk, medium-risk, or low-risk."
country. Under these data-driven criteria, we will suggest guidelines categorizing counties as high-risk, medium-risk, or low-risk."
I know there is an initial negative reaction to this, but there is a lot of good here. First, the letter acknowledges some places will need to maintain or increase, not just relax social distancing.
Also, the U.S. is a big country and a community-based approach is appropriate. We have to be careful not to be overly rigid, of course. Some counties are linked daily by commuting realities, for example. Others, not. And, the messaging will have to be highly nuanced.
We also have to be careful not to overpromise and underdeliver -- saying our testing capability will "quickly" enable us to publish criteria could be misleading. This is the MOST important detail.
To unwind in a careful, community-based fashion will require a significant surveillance capability and a common, uniform standard. In other words, a lot more tests and agreement on who gets tested and why. Many unanswered details here.
We should establish an objective requirement for needed surveillance capacity AND a responsible screening standard, and be wary of a date driven approach that accepts the number of available tests and backs into the surveillance we can achieve rather than the surveillance we need
Remember, it took 4 months for the world to get to 250,000 cases. It took one week to go from 250,000 cases to 500,000 cases.
The point to remember when setting reliable county risk scores is that the need for testing capacity will grow exponentially as cases increase exponentially. It's a moving target.
