The Administration today made the important right decision to extend social distancing guidelines. Its worth underscoring why those measures are so critical, and considering the conditions in which they might be able to be relaxed safely sometime in the future. 1/x
Large scale social distancing measures – no gatherings >10, telecommuting + closure of non-essential business, closed schools + universities, only leave home for highly compelling reason – are the strongest tools we have to slow spread of COVID in US. 2/x
This is a highly transmissible virus. We wont have vaccine for some time. We don’t have proven medicines to treat it. In China's experience: approx 80% of recognized COVID cases got well w/out hosp care; remainder needed hosp care, w/ approx. 5% overall needing critical care. 3/x
If we don’t take society-wide serious measures to continue to try to slow the spread, the virus will spread widely and rapidly and too many of those people needing hospitalization will need it all at the same time. 4/x
As we are seeing in NYC, in cities where spread is rapid and fast, we can run out hosp beds, ventilators. Could have too few doctors and nurses. This could all substantially increase the mortality of this virus. 5/x
Hospitals overcome by the burdens of very high numbers of COVID pts could also be unable to provide the life saving care for other medical conditions and illnesses that they usually offer. 6/x
There are places in the US where there are now very few cases of COVID. That is good news for the moment in that it will give those places more time to prepare and more time for social distancing to slow the virus down.7/x
But the virus will not stay where it is now, it will move around the US. Italy had no cases of the virus until 36 days ago and now has cases throughout. opendatadpc.maps.arcgis.com/apps/opsdashbo… Social distancing is the most important prevention tool for all communities in the US now. 8/x
There are many urgent needs for responding to COVID right now, starting w/ need to get our doctors, nurses, hosp staff the masks and equip needed to protect themselves, more vents where they're needed, expanded hosp capacity, rapid diagnostics in hosps, long term care. et al 9/x
Much more logistical and manufacturing power is needed to address rising needs of health care facilities in many places around the country. We need countless great developments like this one: Toyota to Make Face Masks in US to Aid Coronavirus Battle nytimes.com/reuters/2020/0… 10/x
Even as these efforts go on, given the very serious societal and economic consequences of these social distancing measures, it is important to think about a time when they might be relaxed. 11/x
A very well done report addressing conditions needed for relaxing social distancing came out today called: National Coronavirus Response: A Roadmap to Re-opening. aei.org/research-produ… written by @ScottGottliebMD @CMYMAMark M McClellan, L Silvis, @C_R_Watson 12/x
I was an advisor to the report so I'm biased in its favor. I agree w/ recommendations. It sets out conditions necessary to consider relaxing social distancing in the US. The whole report is worth reading in entirety. But I'll summarize key recommendations below: (13/x)
For a US state (or region) to re-open, there should have been at least a 14 day steady reduction in daily case numbers of COVID. [That does not appear to be happening anywhere now in the US. We'll need to see better state by state daily case counts to track this over time.]14/x
AND, same day diagnostic testing will need to be available for 4 key categories of possible COVID pts: 1) hospitalized pts 2) HCWs and workers in essential roles 3) close contacts of confirmed cases and 4) outpatients w/ COVID symptoms, which can resemble the flu. 15/x
4th category is not tested now in many places given insufficient diagnostic bandwidth. This is necessary now in order to focus testing on the most sick, but to ever have handle on size+location of COVID spread in a state, we'll need to get capacity to test outpts w/ COVID sx.16/x
All of that diagnostic data should be part of national surveillance system that gathers data and trends, and combines with state and national seroprevalence data. 17/x
AND another condition: sufficient critical care bed capacity and ventilators and staffing to meet all critical care needs in that community without resorting to crisis standards of care and having to ration ventilators.18/x
And another condition: huge increase in the supply of personal protective equipment to cover the current and anticipated needs of the health care workforce and emergency personnel involved in the response.19/x
And another condition: tremendously scaled up isolation, quarantine, case-finding capacities in states; to get new cases isolated right away when they are sick. Plus ability to provide isolation or quarantine facilities if needed to care for people outside their homes. 20/x
This kind of very strong active case management capacity, and the use of isolation and quarantine facilities were big element of the response effort in Asian places where COVID has been most successfully managed so far. 21/x
Will take $$, and great effort to build this kind of pub health capacity in US, and pub health in many places in US is far beyond capacity to do that now given great challenges of COVID. But case numbers can be driven way down, case finding could become possible again. 22/x
Once all of the above conditions are in place in a state (or a region), then it would be a safer time to consider the beginning of relaxing social distancing measures, one step at a time, with careful monitoring. 23/x
If monitoring shows the disease is starting to spread again quickly with relaxing of measures, states should be prepared to reestablish large social distancing quickly. 24/x
Meantime, 1 more important Rx in this report: given growing evidence that asymptomatic transmission is contributing to COVID spread, it's now time for CDC to make recommendation for public, non-medical mask use to try to diminish asymptomatic people from spreading the virus.25/x
It's critical that all medical masks (N95, surgical, procedural) be given to health care workers and emergency personnel – there is a terrible shortage of these masks, and so all of them need to go to those caring for COVID pts.26/x
But members of the general public should wear non-medical fabric face masks when going out in public in one additional societal effort to slow the spread of the virus down.27/x
While past studies have shown no evidence that wearing a mask in public is protective to an individual, given the spread of COVID, there is conceptual basis for covering the mouth/nose of members of the public w/ non-medical masks to lower risk of asymptomatic transmission.28/x
Face masks are used widely by the public in places that have successfully managed their outbreaks, incl So Korea, China, HK, Taiwan. It is often considered collective social responsibility to wear a mask to reduce disease transmission in East Asia scmp.com/news/china/soc… 29/x
Again-all med masks should go to hospitals/EMTs. @CDCgov should issue guidelines on proper design of non-medical fabric face masks. The public could make non-medical masks themselves using available washable materials, or they may become available in the consumer marketplace.30/x
Sorry about typo in above author line. I typed CMYMAMark but really meant to type @cmyeaton who is Dr Caitlin Rivers, the second author on this valuable report aei.org/research-produ…
