Thread by @JeremyKonyndyk

The USG wasted February, and the new White House guidance on "opening up" leaves me worried that we're about to waste April too.

The document lays out a vision for the WHAT, but that's far less important than the HOW. And on the HOW it is nearly silent. washingtonpost.com/context/presid…

Let's start with the WHAT.

The document outlines a series of "Gating" criteria. These are mostly reasonable, though far too vague. Need metrics and targets, not just 14-day trajectories.

Trajectory is important but it's not sufficient.

Why? Because other places that have moved past the peak were still seeing pretty high new-case counts at 2 and 3 weeks post-peak.

Italy and China's curves are below (via JHU tracker). Red circles are peak; 2wks post, and 3wks post.

China:
Peak - 4.7k cases/day
Peak+14 - 2.1k
Peak+23 - 513 (did +23 b/c day 21 was anomalously low; day 23 more on-trend)

Italy:
Peak - 6.6k cases/day
Peak+14 - 4.8k
Peak+21 - 4.7k

Point here is that 2 and even 3wks post peak, cases were still at a dangerously high level.

Now the WH doc doesn't say "post-peak", it says "downward trajectory". But in lieu of clearer guidance, states may be tempted to treat those as interchangeable.

Far better to add in a target threshold, such as doubling rate >20 days, R0<1, or total new cases <20/day.

My other concern on the WHAT - the targets are mostly epi-based, not capacity-based. The only capacity criteria are hospital testing and avoiding crisis care standards.

Widespread testing, tracing, surveillance systems, etc are not cited as pre-conditions. That's a problem.

Until those things are in place, lockdowns remain the only tool for slowing transmission. Those other items are mentioned later as "Preparedness Responsibilities" but need to be explicit baseline conditions for relaxing lockdowns.

Otherwise cases will just shoot right back up.

So I fear the guidance could be seen as a green light to start relaxing lockdown measures once a state is 2+ weeks into a sustained post-peak decline, whether or not they already have sufficient testing, tracing, PPE, hospital readines, etc in place. That would be a disaster.

My next (and bigger!) concern: the HOW.

The document outlines where we need to get to; it is silent on how to get us there. And that's the far bigger obstacle.

This slide is the crux of the problem.

I fully agree that everything on this slide is needed. Testing. Surveillance. PPE. Hospital capacity. Protecting health & other frontline workers. Protecting high-risk facilities. Etc. Etc.

Only problem: saying these are needed tells us nothing about how they will be achieved.

And that's the far bigger issue. Nearly every item on the slide is a necessary precursor to restoring our economy. But on most, we're nowhere close to ready, and have no viable path to getting us ready.

THAT is what we need the govt to outline. THAT is the plan we need.

It's no great insight to say we need more testing, tracing, PPE. It's been obvious for a month and a half. But each of those face huge bottlenecks.

The document doesn't acknowledge those bottlenecks, much less propose how to resolve them.

More concerning still: it seems to pass responsibility for implementing these functions (and thus resolving those critical bottlenecks) almost entirely to the states, while remaining nearly silent on the federal role.

That's....crazy.

There is no - zero, zip, zilch - way to upscale testing, PPE production, hospital readiness, the public health workforce...without robust federal leadership. States don't have the capacity or resources to achieve these things on their own.

So again my fear is that after wasting February, we're about to waste April. We need the federal govt to be bulldozing the bottlenecks that hold back progress on all these mission-critical items.

Instead the President's plan abdicates and defers that responsibility to states.

The states will do their best but look - they're not built to do all this without federal support.

FEMA exists for a reason. CDC and NIH exist for a reason. The national stockpile exists for a reason. They have tools the states just don't have.

So until the federal govt agrees to take ownership of this crisis, we're going to struggle to achieve the re-opening that this document envisions. And that means more preventable deaths and more avoidable economic pain.

/end