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Welcome to May.

As I feared, the federal government wasted April much as it wasted February.

That is a harsh assessment given how much the country has been suffering. But without competent federal leadership, the best we are managing is to tread water. Some stats:
US cases, April 1: 25.1k
US cases, April 30: 29.5k

We have spent the month of April on a plateau. Daily counts fluctuating between 25-30k, no longer rising but not definitively declining.
Testing has been stuck as well. After surging in March, growth slowed in April (per @COVID19Tracking data):

First week of April averaged 144k tests/day.
Last week of April averaged 220k tests/day.

At those levels, antibody surveys suggest we're only finding <1 in 10 cases.
As @trvrb laid out here, this leaves our national R0 stuck at around 1, despite the immense pain the lockdowns are imposing.

That's certainly better than an R of 3 (3 new cases for each existing). But it doesn't put us on a path to containment.
Rather, it looks like US-style lockdowns are enough to freeze transmission in place (R=1) but not enough to drive it down (R<1).

Which suggests that without further measures (more on that in a sec), we could remain on this plateau for quite a while.
That of course would be devastating. This plateau produced nearly 60k American deaths in March, just from the officially recorded figures. Actual excess mortality was considerably higher.…
So for each month we remain on the plateau, we risk losing more Americans than we lost in nearly a decade in Vietnam. If we spend May like we spent April, we will blow past 100k dead in weeks.

If we relax the restrictions too early, death tallies could be much worse.
There is simply no way out of our current predicament without a much more aggressive approach. Distancing, as painful as it is, is not enough.

We must, must, must scale up testing and tracing as well. Without that we are stuck.
And alongside that, we must surge attention and support toward the kind of places that are now producing the largest volumes of new cases - unsafe workplaces and unsafe care facilities.

This amazing thread lays it out clearly.
The frustrating thing about all this is - none of these points are new. It's been clear for over a month.

@ScottGottliebMD @cmyeaton @C_R_Watson and others laid this out in late March:…
The way forward is very clear: test, trace, isolate, protect. Putting that infrastructure into place can bring down cases to a manageable level, enable us to relax lockdowns, and move to a posture of sustainable suppression.

But that will be tough to deliver without the feds.
The states have vital roles, but they can't do it on their own. They need a functioning federal partnership - resources, guidance, technical advice, operational support.

Instead they have to hide their tests and PPE to avoid the feds confiscating them.
So it is hard to be optimistic (I'm sorry). We are stuck in an untenable holding pattern as long as federal leadership means vague slide decks and empty assurances rather than test kits, PPE, and accountability.
The feds lost February by ignoring the domestic threat and failing to prepare.

They've lost April by failing to lay the foundation for a safe exit from the lockdowns.

Will they lose May as well?
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