1/ I was glad to be asked by @ScottGottliebMD & @ASlavitt to sign on to this important bipartisan proposal to Congress
Let me tell you why I liked this proposal, and some of my calculations for why the financial requests and structure proposed are reasonable
(views my own, etc)
Let me tell you why I liked this proposal, and some of my calculations for why the financial requests and structure proposed are reasonable
(views my own, etc)
2/ First-what's the bottom line?
By definition, to safely reopen we need to replace some of the reduction in R we've achieved through physical distancing with something else
It doesn't have to be panacea, but ramping up traditional public health contact tracing is our best best
By definition, to safely reopen we need to replace some of the reduction in R we've achieved through physical distancing with something else
It doesn't have to be panacea, but ramping up traditional public health contact tracing is our best best
3/ From an epidemiologist's point of view, there are several ways that contact tracing reduces the force of the epidemic:
*interviewed cases are more likely to isolate
*quarantined contacts spread less
*tested contacts diagnosed sooner, isolated, contact traced sooner (goto10)
*interviewed cases are more likely to isolate
*quarantined contacts spread less
*tested contacts diagnosed sooner, isolated, contact traced sooner (goto10)
4/ w COVID-19 we face a handicap- people seem to be infectious during a pre-symptomatic phase, and a number (maybe up to half) have mild symptoms
The only way to reduce these infections is to identify and isolate them as contacts early in their infection
The only way to reduce these infections is to identify and isolate them as contacts early in their infection
5/ Here's an illustration
let's say a case
is infectious on day 3
gets symptoms on day 4
is tested on day 6 (TESTING)
is interviewed, contact traced, isolated day 7
Infections they would have caused Day 7->14? prevented
The people they infected Day 3-7 are still presymptomatic
let's say a case
is infectious on day 3
gets symptoms on day 4
is tested on day 6 (TESTING)
is interviewed, contact traced, isolated day 7
Infections they would have caused Day 7->14? prevented
The people they infected Day 3-7 are still presymptomatic
6/ None of this is easy
But unlike some other proposals, it's a hard problem of scaling what we already know how to do, that we know works
It's not hard like biotech is hard, or hoping that never-before tested bluetooth apps will save the day is hard
It just needs grit. and $
But unlike some other proposals, it's a hard problem of scaling what we already know how to do, that we know works
It's not hard like biotech is hard, or hoping that never-before tested bluetooth apps will save the day is hard
It just needs grit. and $
7/ One of the challenges with contact tracing is the ABILITY of people to isolate themselves for 14 days.
We know how crowded conditions can create pockets where outbreaks smolder and flare. People who work with their hands have to feed their families
We know how crowded conditions can create pockets where outbreaks smolder and flare. People who work with their hands have to feed their families
8/ That's why the proposal calls for funding for contact tracers ($12B), but also for hotels as a place for voluntary self-isolation for those who need it ($4.5B) and being able to offer the equivalent of federal jury duty income replacement x 14 d ($30B) esp imp. in these times
9/ These numbers are obviously imprecise, but let me break down the math I did to convince myself that they are reasonable
How many contact tracers needed?
If you add up the time to find, interview case, identify contacts, and followup with everyone x 14 days, it's ~ 6 FTE/case
How many contact tracers needed?
If you add up the time to find, interview case, identify contacts, and followup with everyone x 14 days, it's ~ 6 FTE/case
10/ How many cases should we be planning on managing per day?
We have 30,000 new cases diagnosed a day right now, but we will hopefully not reopen until the cases have fallen substantially
OTOH we'e under-diagnosing by 5-10x and we need more cases diagnosed
Call it even-30k/d
We have 30,000 new cases diagnosed a day right now, but we will hopefully not reopen until the cases have fallen substantially
OTOH we'e under-diagnosing by 5-10x and we need more cases diagnosed
Call it even-30k/d
11/ What portion of the ~200k daily cases and contacts will need hoteling for 14 days?
You can look at census questions on crowded households (more people than rooms), income levels, household structure~14% seems reasonable
Could find motels at $20 gov't rate!
~$4.5B x 18 mos
You can look at census questions on crowded households (more people than rooms), income levels, household structure~14% seems reasonable
Could find motels at $20 gov't rate!
~$4.5B x 18 mos
12/ What portion of ~200k cases and controls will need income support?
Given the economic situation, I would think that 40% is not too high (that's probably close to what portion of people keep jury duty pay)
at $50 a day, that's $20B a year, $30B in direct financial assistance
Given the economic situation, I would think that 40% is not too high (that's probably close to what portion of people keep jury duty pay)
at $50 a day, that's $20B a year, $30B in direct financial assistance
13/ Note that this *is* well-targeted economic stimulus-
Money in the pockets of deserving working people who will use it
Money supporting hotels and hospitality workers hit hard
Money to hire contact tracers making an average of $44k a year
Money to support state/local health
Money in the pockets of deserving working people who will use it
Money supporting hotels and hospitality workers hit hard
Money to hire contact tracers making an average of $44k a year
Money to support state/local health
14/ But as the letter says "Control of the outbreak will constitute the strongest possible stimulus to the U.S. economy"
We need to get back to work. safely.
Reopening without safety will just lead to continued economic pain and hardship as we are forced to close again.
We need to get back to work. safely.
Reopening without safety will just lead to continued economic pain and hardship as we are forced to close again.
15. One more thing-
To control the outbreak we have to diagnose the cases
To diagnose the cases we need testing of every symptomatic person in primary care
To test their patients, primary care needs PPE, tests, payment for specimen collection, and to have their doors stay open
To control the outbreak we have to diagnose the cases
To diagnose the cases we need testing of every symptomatic person in primary care
To test their patients, primary care needs PPE, tests, payment for specimen collection, and to have their doors stay open
