Thread by @ASlavitt

COVID Update April 15: I worked on some visible problems & dove into some less visible ones. Visible— the infrasructure needed to contain future outbreaks. Less visible— prisons, what’s happening to primary care & the health care system.

And more from scientists. 10 minutes. 1/

I woke up to try to understand why am I uneasy with the curve flattening? I called 3 of the scientists who are most visible, public & credible to check myself & ask the question what are we really learning.

This virus is an evolutionary powerhouse in ways we are figuring out.2/

My summary— it is embedding itself inside people that can carry it most effectively— young people. And it imbeds itself in people who it gives no motivation to stay in.

And it carries its highest viral loads when or before people know they have it. Earliest days.3/

I tried a little exercise in contact tracing today by lightly interviewing someone who was positive for a week before he knew it. He came into contact with dozens of people.

I know one of the people he had breakfast with. He went into a conference room w 24 ppl. Post-bkfst. 4/

That night he visited his elderly mom.

I got frustrated at how hard it was so later in the day I called a public health data scientist. He told me it would take 5 of me to properly track one case over 3 days. A single case. 5/

Would phone based technology help?

If 40% of people opted in and you needed both sides of the equation to opt in, then here’s only a 16% chance of the technology working.

So the technology doesn’t solve the problem— you need public health workers. 6/

Of course, there isn’t enough testing to know how much we’re slowing. Only symptomatic & hospitalized people are being tested.

Until the % of positive test results declines, we are working through our backlog of sick people. 7/

The virus lives in these unknowing people until they find people who the virus is lethal to. And it attacks hard, in the worst cases, fooling your immune system to start working until it goes into overdrive with a cytokine storm. 8/

But for now we have slowed down the cases enough so that people aren’t dying in hospital hallways.

That’s the next thing that’s devilish about the virus. If fools you into thinking you’ve beaten it. Letting up without the right tools means it doesn’t grow, it explodes. 9/

Before I talk about the tools we need, I will talk about one other property of this that’s most despicable— who it preys on.

The weak, the sick, the old, the poor, those with less space.

Who it spares: the gated communities, the healthy, the young. Their just spreaders.10/

“They’re” 😕

I got a lesson in what’s going on inside jails, prisons, and immigration detention centers today. The answer is no one knows, but what we do know is not good.

People were not sent to jail to get sick, suffer & die. Our society should not support Dickensian pandemic hotspots.11/

We should pay as much attention to people in prisons as we do to people on cruise ships. 12/

In Cook County jail in Chicago we know that 2 cases became 250 cases in a couple of weeks. It has since doubled. Plus over 100 staffers (who go back home every night). That’s over 10% of that prison.

2.5 million are behind bars, not counting immigration centers. 13/

While we #StayHome, many are sitting ducks. It’s not hard to imagine 10s of thousands of cases or more.

Many are high risks, old, with chronic conditions & limited access to care. 14/

Even leaving aside the ethical question of why so many non-violent people & people who can’t make bail & many others are unjustly behind bars, this cannot be ignored.

What to do? 15/

All facilities should be required to:
-Report and disclose all cases & ensure proper treatments
-Require sanitary living conditions & proper distancing
-Ensure PPE & proper Medical treatment
-Depopulate prisons or transfer to safer locations where that can’t be done 16/

If someone says, of all the people we have to worry about, people behind bars shouldn’t be a priority, I ask why. Why?

At least 2400 people have died from COVID-19 in prisons. And unlike the rest of us, nothing is changing to make this better. The prisoners are powerless.17/

Save every life possible. Thanks to @verainstitute for helping educate me.

Thanks to everyone else who will help bring pressure here. 18/

Homeless shelters are finding 1/3 or more are testing positive for COVID-19. Thanks to @pbleic for passing this along. (He’s a good follow if you like health data geeks.) 19/

Another “hidden” problem is what’s happening to family physicians, mental health professionals & Medicaid providers— particularly in rural areas.

As people stay home and electives are reduced, many will go out of business. 20/

healthlandscape.org/covid19/

The ask is to set aside somewhere around 30% or the CARES Act funds first safety net & Medicaid providers.

The next bill should add another $100 billion in care provider payments to continue to hit hot spots.22/

21 tweets so far (yes, I misnumbered) and it wasn’t even half my day.

Most of the day was spent on infrastructure planning to allow states to know where they are & what they will need to do to contain the spread when they decide to relax stay at home orders. 22/

States do need to prepare now the way the country should have been preparing in January & February.

Case counts will need to drop but plans must be underway.
23/

The core elements of the plan:
-begin with manageable num of cases
-test all symptomatic ppl
-contact trace (what I couldn’t do) & offer isolation in hotels & wage protection
-protect vulnerable people (see: nursing homes, prisons to start)
-build capacity for sudden outbreaks24/

Details are coming together on these plans in many states. Federal dollars will be required from Congress.

After Trump gets through adjourning them. 25/

And having enough testing won’t happen any time real soon. But a lower case count and continued #StayHome will help in the meantime. 26/

The best case testing plan will have us at 5 million/week sometime over the summer. We are going to need to keep case counts much lower and reduce hot spots for that to get us there. 27/

Those are in states that are planning for the future.

Then there is our neighbor to the west, South Dakota. South Dakota has refused to take any measures to protect the public.

South Dakota’s meat plant is now the top hot spot in the country. 644 cases in one plant. 28/

And to combine my themes of the day— under-served populations with under-prepared states and under-thinking governors— the Indian reservations in South Dakota & other states are a focus for tomorrow & ahead. 29/

30 is more than enough tweets so I don’t even get to tell you about Larry King. But if you want to hear the one about the Pope, the Surgeon General & the 11 year old, download this & have a good peaceful night. /end

Listen now: smarturl.it/inthebubble