Imagine two scenarios. In Scenario A, back in March, US decided to impose extreme #SocialDistancing short-term while immediately investing in massive roll-out of infrastructure to #TestTraceIsolate, i.e, what every pre-pandemic plan envisioned & several countries achieved. THREAD
2/ It would have made all the sense in the world to impose tough restrictions if we could’ve emerged with public health infrastructure in place to #TestTraceIsolate that let us resume a lot of economic/social/cultural/educational activity safely.
3/ In Scenario B, back in March, we have a crystal ball that tells us the president and Congress are NOT going to invest what's required for a massive roll-out of public health infrastructure to #TestTraceIsolate any time in the next 6 months.
4/ With no hope of #TestTraceIsolate for at least the 1st 6 mos. of pandemic, it would still make sense to impose extreme social distancing short-term to ramp up #PPE & let officials to get a handle on where hot spots are & direct resources (field hospitals, ventilators) to them.
5/ We might have hoped we were in Scenario A, but it turns out we were in Scenario B all along. Even if Congress allocated sufficient funds for a mass #TestTraceIsolate today (and there's zero indication they're anywhere near doing that), it wouldn't be fully implemented til Sept
6/ I want Scenario A so bad I can taste it. I've shed tears of frustration and despair over not being there. From day one of #BayAreaOrders, I called on leaders to USE THE TIME bought at great cost by social distancing to implement a long-term plan.
7/ So here we are. No hope of mass #TestTraceIsolate - which is what's required to actually bend the curve downward by reducing cases - for at least the first 6 months. I'm not giving up. I'll keep pushing for mass testing. But for now we have to choose the least-worst option.
8/ The most extreme social distancing measures can't be left in place for years. By themselves, w/o #TestTraceIsolate, the benefits are marginal. Refusing to permit ANY degree of nonessential economic, social, medical, cultural activity to resume long-term is harmful.
9/ I worry attention-seeking grandma killers, science deniers & haircut protesters might be pushing the mainstream to fight for “endless lockdowns." 1-3 more mos. of harshest restrictions won't end this. But that doesn't mean we should give up, flip a switch & sacrifice lives.
10/ To be clear: some states are moving way too fast. Places people tend to congregate indoors (theaters, bowling alleys) need to be closed long-term. Local authority to impose greater restrictions as needed should not be taken away by governors.
11/ But some states are easing carefully, moving toward a more sustainable, locally driven approach to easing the harshest restrictions. We shouldn’t lump these states together.
12/ When we were in containment mode - trying to stop the spread of infection from initial hotspots to the rest of the country - near perfection was required to make it work. One governor's mistake could lead to hundreds of millions of deaths nationwide.
13/ But for anywhere in the US that's not remote/isolated containment has failed. We're in mitigation mode - trying to slow down the spread from person to person to reduce peak impacts & save lives by buying time.
14/ In mitigation mode, perfection isn't required. Decisions in one state don't have the same all-or-nothing impacts on the entire nation. We're still interconnected, for sure, but not in the same way as in containment mode.
15/ National coordination is still critical, but for different reasons. This chaotic situation we're in w/ states going so many different ways makes clear communication difficult. It puts public trust & cooperation at risk.
16/ Widespread public trust & cooperation are even more critical for mitigation than containment. For containment, the number of individuals who must cooperate is relatively small. Real enforcement is feasible. Mitigation requires widespread (not perfect) *voluntary* cooperation.
17/ The harshest restrictions can't be forced on an unwilling populace & be effective. Depending on widespread & willing cooperation means having a clear plan & asking for sustainable sacrifices long-term, saving harshest restrictions for short-term use when they're most needed.
Yeah, sorry. Typo there. Meant to say hundreds of thousands, or maybe a million. But not hundreds of millions. I hate Twitter.
