Thread by @ASlavitt

COVID Update April 30: Today an hour with the head of vaccines at WHO. Much more if I can fit it in without too many tweets.

Coming soon with a couple potential small interruptions. 1/

QUIZ:

Which has declined more since its baseline? Driving, walking, or transit and each by about how much?

Extra credit: How long was April— closer to 30 days or a century? 2/

Let’s sum up April before I get to the vaccines. I anticipated April would be one of the worst months in American history. 58,000 Americans died from COVID-19 (likely at the low end). And more are sick who we will lose ahead. 3/

There hasn’t been a month like this in my lifetime or the life of anyone I know. About 1/10 know someone who has died.

We are a little numb to it. The numbers seem to have lost a little meaning. If I didn’t know several people who died maybe it would seem a bit abstract to me.4/

April also saw a decline in our R to about 1.0. This is both a big accomplishment & also a big warning.

We curtailed our activity fairly dramatically. And yet we our flat as a country, not down like Europe or Asian countries. 5/

Hong Kong has had no cases for several days running. Everyone wears a mask & practices good hygiene. 6/

An R at 1 means we will continue to have 30,000 new cases a day and several thousand deaths a day (depending on if these are in nursing homes or with teenagers).

That’s if r stays like it is. A flattened curve. But there’s reason to wonder if R will grow in May. 7/

-natural restlessness
-political pressures felt everywhere (not just GA)
-no/low herd immunity
-inconsistent mask use
-a growing sentiment that this is happening to “other people” 8/

There are reasons not to be pessimistic
-Densely populates areas more cautious
-Growing r & case counts may be in more rural areas (except for VA & MN)
-New meat plant & nursing home safety (we can hope)
-Masks 9/

.@trvrb makes this point quite well. 10/

https://twitter.com/trvrb/status/1255976678783774721?s=21

https://twitter.com/trvrb/status/1255976678783774721

As bad as it was I can imagine a world April could have been a lot worse that it was. The public response to #StayHome was shocking. And it still has 80% support. 11/

And a 1.0 r is no way to go through a pandemic, let alone higher. Several governors— of both parties— are feeling enormous pressure to “open up.”

Governors should be considering loosening outdoor restrictions some, excluding large gatherings. The benefit outweighs the risk. 12/

May and June must see a continued ramp of testers & contact tracers. On testing, talked to the WH to see what’s possible. We must move 3 #s— volume from 150k to 1mm/day
— test sensitivity from 80% to 100% — contact tracers from 7500 to 100k+ 13/

On to my WHO conversation.

The WHO is participating in a global initiative called ACT (Access to COVID Tools Accelerator). The focus is on the development, production & equitable access of:
-diagnostics
-therapeutics
-vaccines

The US is not participating.
14/

I will discuss the merits of US participation in a bit. But first on to the work itself. 15/

Other organizations involved include Gates, CEPI, Gavi, the coalition of manufacturers & a few others. The EU & the Foundations are providing significant funding. EU due to vote on Monday on funding. 16/

If you don’t know them, @CEPIvaccines develops vaccine candidates.17/

cepi.net/covid-19/

In each area— diagnostics, therapies & vaccines— they are focused on 3 problems. I will use the example of a vaccine, though it applies to all areas:
1- developing it
2-manufacturing it
3-distributing it

Most of the public dialogue is on number 1 but that’s a mistake.18/

1- Development— WHO approach to developing the vaccine is a portfolio approach. Pool money, bet on 20 or more promising approaches.

A very small % of vaccines make it all the way through human trials. So they make lots of bets (ie, not putting all their eggs in one basket). 19/

Timeout— why is the expression “put your eggs in one basket?” Is that an old-timey Easter egg hunt problem for kids. Do they now carry 2 baskets. If you know (or even if you don’t), I’d be interested.

OK— back to global vaccines! 20/

I think it’s fair to say that the US strategy is closer to putting their eggs in the most promising basket (I wish I’d never gone with the basket but I’m stuck with it now. 😔)21/

There are a couple of trials that are promising a potential vaccine in September— IF everything foes right. One is German with Pfizer & one with Oxford.

That would be great news but important— long long way to go AND that still leaves parts 2 & 3, which gets interesting. 22/

As you might expect I’ve gotten notes & papers today both on why it’s promising & why they may not work.

So decide what you prefer to believe. Or, better, don’t focus too much on it. 23/

2- Manufacturing— well that seems easy right? Just crank up the factories as soon as we have a vaccine.

Wait? What happens in the case?

Actually— a sh*t show is what happens. 24/

Cranking up the factories takes time. And while we wait for the first call it 50 million doses to come off the line, people are dying. Countries are throwing their weight around. Black markets develop. L

The wealthy countries & people find a way to get access. They always do.25/

How to avoid the sh*t show? (OK, it feels stupid not to spell it out but your 6 year old could grab your phone.)

Same strategy as with development— a portfolio approach. 26/

That means start building manufacturing now. Lots of it. The world is very different if we have 50 million vaccines— basically nothing- vs 10 billion. 27/

How much different would manufacturing need to be for different vaccines? The basics turn out to be very similar for most types of vaccines. Downstream components are a little more customized. 28/

This decision to build lots of manufacturing capacity in advance is what’s called a no-brainer. For the EU and the major foundations, this could speed return to the economy up by months and months. Trillions of dollars in difference. (Oh, it saves many more lives.)29/

Overproducing— creating a glut— is how to kill a black market before it opens. 30/

I’ve reached 30 tweets, haven’t covered part 3, haven’t answered the quiz & haven’t asked you to listen to Tina Fey on #inthebubble. 31/

#BeMoreEfficientAndy

3- Distribution— this is physically hard. But the bigger challenge is what to do with the first batches. Seniors? Health care workers? People with high blood pressure?

How many will have doctors’ notes? I’m not accusing anyone but I am picturing Vietnam draft bone spurs.32/

And which countries? The wealthy countries bid up the price?

This starts to get the US strategy here. 33/

By participating with the Accelerator, you get a piece of what works. But by definition, you have to share it. So America has a go it alone strategy with no hedge here. 34/

So I asked the obvious question— how will the IP work? Can the US license winner & start manufacturing even if it doesn’t participate?

This hasn’t been worked out. 35/

I can’t imagine the US not trying to swoop in & make a deal. Protecting our citizens is our government’s job. 36/

I estimate 8-10 more tweets. Will try for less. I understand if you if you take a rest or set your phone on fire. 37/

Where the US has a big advantage if we do participate is we can scale up manufacturing fast. And I suspect a deal can be struck if we do that. 38/

There’s a more fundamental reason for the US to participate. I’m old fashioned enough to believe that wealthy countries have to do their share to help the poorer countries. 39/

There’s a 150 poor countries in the world. They have little health care infrastructure. The EU & Asia are picking up this slack.

I had the temerity to tell several leaders in Congress that we should allocate funds. Small$ go a long way. And people do travel. Sure we won’t.40/

A nice thing happened today. I got this text. A state with a lot of nursing home problems. I matched them to a lab to do testing now.

Ppl ask if I get paid for this stuff (maybe w some suspicion). I get paid with notes like this. 41/

Got this from a governor tonight.

It is so incredibly minor compared to the sacrifices so many people are making. 1/3 not able to pay the rent. 40 million not eating. Tens of thousands gone. Health care workers risking their lives. People worried about the future.42/

April is a month where things got worse. But seeds were planted for things to get better. Most incredibly by health care workers, the public response, elected officials, science, and more. 43/

The quiz— driving is down 29%, walking 42%, and transit 73%. There are very safe ways to walk & be outside.

Look forward to starting the century of May. If we are patient & still careful, it can be a better one. /end