Thread by @ASlavitt

COVID Update May 7: The happy talk from the White House is hurting Americans who are being led to expect miracles like a vaccine by Fall rather than face the challenges head on. 1/

With thousands of people dying every day, cases climbing across the country & an economy frozen for lack of a commitment to a safe reopening plan, false hope isn’t our friend. 2/

The idea that the end is in sight, that the economy is ready to rebound, and we are close to having packed Alabama football games will prolong the virus, the death toll & our misery.
3/

It is true that 2 vaccines are in human trials. But we need to tell the difference between hopes & prayers and things we should plan on.

We make many of the wrong decisions by thinking in weeks & months instead of a year or years. 4/

If you listen to Tony Fauci, who leads vaccines for the NIH, he always adds the words “best case” to his answers.

And when Trump’s not around, Fauci follows “best case” with 12-18 months. Meaning we could be in 2022 & still working against this enemy. 5/

It’s true that there is a vaccine in human trials in the US & it’s true we could even be in parallel manufacturing soon— while we wait to test it.

But it’s also true that this company has never made a vaccine before & that it’s the type of vaccine (RNA) is promising but new. 6/

Injecting the virus in hundreds of millions must be done safely. And importantly even if the vaccine works, it’s dosing is safe, and it’s side effects minimal, the immunity could potentially be 30-40% like a flu vaccine not 97% like measles. 7/

Sadly the vaccine likely won’t be available to everyone including some of the people who need it most— like people with significant immune system issues. 8/

A combination of a partially effective vaccine and many being excluded could mean social distancing significantly into the future beyond a vaccine. 9/

There are 6 other vaccines in process but of all 7 only 2 of the developers have actually made a vaccine before— Pfizer & Sanofi. These will take longer to start but could accelerate. 10/

What isn’t said out loud is that the furthest along of the trials are the Chinese. Don’t expect us to see that vaccine any time soon in the US. 11/

While they have promise, the most likely case is that the early vaccines are unlikely to pan out or if they do that more vaccine work will still be needed for new strains. Even then we are well into next year before enough manufacturing capacity is added. 12/

In the meantime there is discord on how to begin manufacturing & trial design which would need to begin immediately to have a vaccine even early next year.

13/

Of course, if those trials fail, there are about a dozen more vaccines that haven’t yet entered into trials & 80 more where work has begun. There will be a vaccine but the question will be when. 14/

While we aim for a big early win, we should know that if a vaccine didn’t materialize in 2021 it would be much more typical. 15/

People sometimes say “we must do x until there’s a vaccine” as if we’re standing on one leg and it will be over soon.

But we need to think differently and plan for the marathon. What would we do differently with this knowledge? 16/

-Stick to our plan of creating comprehensive testing, tracing & isolation capability
-Plan an economy & jobs around needed industries (manufacturing, science, tech, food distribution, public health)
-Retrofit public areas for safe entry 17/

-Expand safety of small businesses & small gatherings
-Invest in interventions to reduce transmission like reusable high quality masks
-Create flux capacity for all medical centers
-Provide health coverage
-Build remote services for high risk patients 18/

-Improve food supply chains
-Upgrade safety of work environments
-Temporarily close & retrofit meat factories
-Create grants for small businesses to go on line
-Plan for year round blended distance/in person school environments 19/

The most important thing we can do in planning for an extended bout with COVID-19 is simply to make the disease less lethal by continually investing in new therapies & prophylaxis. 20/

This would change the equation on herd immunity: at today’s fatality rate, getting 10% immunity means hundreds of thousands additional deaths.

But imagine if the virus were treatable. Then the risky ideas of the herd immunity crowd would make more sense. 21/

If we knew we could be tested & get early treatment, living with COVID-19 would be more like living with a bad, but not fatal virus. It would still do damage, but not enough to really slow us down much. 22/

Today’s treatments like Remdesivir aren’t going to be the ones that do that. But the good news is therapies & prophylaxis can be tested much more quickly & manufactured more easily. 23/

Trump either won’t face or doesn’t think we can handle the truth of the challenge of COVID-19.

But the truth actually isn’t scary. It’s more manageable than lies. 24/

15 cases, testing is overrated, the virus is disappearing, 60,000 total deaths.

We shouldn’t live by these extemporaneous & thoughtless guideposts. A vaccine before we know it is a different song of the same tune. 25/

We can do-exist with viruses like COVID-19 a lot better if we give ourselves the tools. And also if we adjust our mindsets so we don’t feel like we face constant disappointment. 26/

We all want to be hopeful. And we all occasionally fall into the trap of believing what makes us feel better.

But we also stomach bad news better than we stomach lies. 27/

None of us remembers the exact month the 1918 flu was defeated. We remember the high death toll & that once it was, a period of prosperity followed.

Patience is hard but it’s an asset is getting through this successfully. /end