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COVID Update May 11: Mondays I am going to give my sense of the state of the union of COVID-19. Where we stand.

5 categories: the virus trends, fed & state response, science, economy, & the analysis of the week. 1/
THE VIRUS: The state of the virus is “impossible to know.”

Months in, we are nearly blind. We know how we did weeks ago— we reduced transmission & leveled off cases. But except in the Northeast, & a few other states, we never decreased cases. 2/
What we can surmise— we have 1.3 million cases & a positive rate of 15%. When the positive rate under 10%, that will mean we have a handle on case count growth and are starting to test closer to enough people. 3/
The good news however is that 15% positive is better than the 20% at peak. And this rate is falling in 37 states.

About 1% of positive cases end up in the ICU. If there is an uptick this is a number to watch. 4/
The best you can do is labeling the virus impact as regional.
NY, NJ, CT: high cases but declining
South: rising, but unclear how much
Known hot spots: nursing homes, meat processing, MN
Unknown hot spots: new mobility since opening across the country 5/
What we don’t know is what will happen in states that are opening. We can only track their time since opening & watch. A reasonable case would be that in May, r is rising > 1 on average. I’m still hopeful ppl will show more caution than their leaders. But we will see in June.6/
There are several comprehensive sites which focus on state opening readiness so you can check out your state on a number of dimensions. 7/
FED & STATE RESPONSE: The state of our policy response is “denial.”

The president says the virus will just go away. States are opening before they have met the gating criteria to reopen.8/
I did a radio piece on @npr this morning along with @ScottGottliebMD on the topic of federal response. Hear what we had to say.9/
Governors think they’re making it easier on themselves but they’re not. They open 10% of things 25% of the way and turn into scolds when beaches & restaurants get too crowded. So they get a 2.5% economy & a higher r-naught.

Doesn’t feel like a smart trade.10/
Smarter? Take the areas within the state with no or few cases & allow them to open if they have the ability to test for & track outbreaks & close down within 2 days. 11/
Tomorrow I talk specifically about Texas with @BetoORourke who is on #inthebubble.

@DanPatrick is also on. OK. He’s not. But Beto is. 12/
NEW: We just released the first set of recommendations for state legislatures when they convene. From @USofCare. 13/…
For the second weekday in a row, I testified in front of a Congressional committee today. Both talking about testing & contact tracing.

A $1.2 trillion bill is coming out of the House. I expect McConnell to reject it. 14/
SCIENCE: The state of science is “promising.”

Warning: science is one step forward, 2 steps back; early results are over interpreted; EUAs are variable; much out is non peer reviewed; and studies are more observational rather than using double blind trials. 15/
Even with that disclaimer
-Immunization unknown but seems positive
-Diagnostics — more and faster tests coming, including antigen. But also less sensitive.

A bit like that old saying— you can have speed, service or price but not all 3. 16/
Advances are coming in therapies— feels like a reasonable path could be combining faster testing with early therapy.

And the path to vaccines, while also promising, is too early to pay too much attention to. 17/…
Herd immunity, still an unknown, is likely no more than a couple percent unless you’re in NY. 18/
Science has to keep up with mysteries which in and of itself is a challenge. Each week there are more & more mysteries & it’s going to be that way.

Kawasaki Disease hit us this week. Hard. We don’t know what it means. There will be more mysteries to come. 19/
ECONOMY: Couldn’t be worse. Except that it will be worse.

GDP growth could be down 20% in Q2. More importantly unemployment is 20% & could be 25% soon. 20/
Efforts to open the states up are driven by the hope of fixing this. It won’t as long as case counts are as high as they are & there aren’t enough tools for containment. 21/
The economy is going to be bad for a little while. The stress is high. And there’s an urge to blame someone— China maybe? Blue states if you’re red. Red states if you’re blue. Plenty of blame to go around. Trump.

But we gotta also blame the bug & let up on each other a bit.22/
FINAL ANALYSIS: Our best hope is for just more cases not outbreaks.

And patience enough to let science make advances.23/
On a human note, I alternate between worrying that as we adjust we’re losing some of our humanity & amazed at how we are doing some extraordinary things. 24/
The macro picture is numbing. People want to move on. The numbers are too large to conceive. When we feel less personally threatened, it makes sense to try to forget or even deny what’s happening. 25/
If we must zig zag our way through this a bit, we must find a way not to leave people behind or forget who is impacted & who is lost.

Some things we will be able to recover when this is over. The things we will not are the things we need to fight for. /end
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