Thread by @ASlavitt

6 months in 400,000 people have died around the world and it is still making its way around the globe. Currently experiencing the highest daily case growth.

More than 1/4 of the deaths are in the US when population is 4% of the world. 2/

There are 6 million global cases, 2 million in the US. 1/3 of the cases and 4% of the population.

Poor countries in Africa, Caribbean & Central Asia & Latin America have not been hard hit yet. Most of the US has still been spared. 3/

There are 2 important measures of an infectious disease— how infectious and the fatality rate.

Diseases like Ebola have much higher death rates
Measles has with much higher infection rates.

But COVID-19 has a combination of both that Fauci calls his “worst nightmare.” 4/

It’s infectiousness is challenging. 80% of people with COVID don’t know where they’ve caught it. It has a long pre-symptomatic phase & is mildly symptomatic with many. 5/

It is more dangerous as people age. It is more dangerous for people w/ chronic conditions & the Black population. It is more dangerous for men.

Far worse than the flu, if you’re 50, you have a 5% chance of being hospitalized. A very small number of kids have severe symptoms. 6/

The 2 ways to manage the virus are to reduce the infectiousness or reduce the deadliness.
Infectiousness— NPIs, prophylaxis, vaccines, reduce hot spots
Deadliness— (best guess is .7) therapies, early discovery, treatments, protect vulnerable 7/

Because we don’t understand how it spreads & have no working vaccine or effective therapies, we have depended on NPIs (#stayhome, social distancing, masks, hand washing, avoiding crowds).8/

3 vaccines enter phase 3 in July & 10s of thousands of people in hot spots around the world will be needed to test the vaccine.

While this is quite fast vaccines will be only a part of the arsenal as many won’t or won’t be able to take them. And likely not avail until next yr.9/

The infectiousness has been significantly reduced through NPIs. Instead of infecting 2.3 people, the average infected person infects 1.1. This difference in cases & deaths from this is profound. 10/

If infectiousness can be reduced through a combination of factors to below .5, as has been done in a number of countries, it can be defeated.

But even if it isn’t, reducing the lethality is another angle. Requires drug development & early testing/diagnosis.11/

It has taken sacrifice from so many, but the impact of reducing the R0 has been profound. Recent studies have estimated how many millions of cases have been prevented around the world.

Prevented or delayed (will come back to that). 12/

https://twitter.com/tmprowell/status/1270035584237670402

Some things are safer than we originally thought. Outdoor activities. Quick interactions. We will learn more all the time as we open up. 13/

Other areas are rife for infections. Nursing homes, jails, shelters, choirs, meatpacking plants & congregate living settings.

It spreads in crowds, poorly ventilated areas & to family members easily.

And superspreaders are a significant source & important mystery.14/

When this began, this looked like a respiratory virus. Now it appears to impact blood vessels— and travel everywhere to the gut, brain, sinus, kidney, & heart. It can cause dangerous clots & immune system overreactions. 15/

The good news is the Coronavirus can be almost entirely contained with a national strategy. Vietnam, Czech Republic, New Zealand, Italy, Germany, S Korea, Hong Kong have all showed coordinated strategy works. 16/

Best global strategies
-Universal testing, tracing & isolation
-Universal high quality masks
-Color coding systems
-Quick reactions & intelligence 17/

Leadership has also been in the spotlight.

Johnson, Bolsanaros, Trump— arrogance, indifference

Merkel, Audurn— humility, transparency, science, public buy in

Outcomes show the difference. 18/

But for what we know there are major gaps in our knowledge.
-Who are superspreaders?
-Who is most succeptable?
-Differences in asymptomatic transmission
-Why some have worse symptoms
-Long lasting clinical effects (more) 19/

-Length & amount of immunity from antibodies
-How much can children spread
-Impact on children in utero
-Are there people not succeptable?
-Seasonal effects on R0
-Mutation properties & strains
20/

We need deep focus on learning—
-Rapid instant testing
-Household biosecurity
-Genetic research
-Surveillance— digital & syndromic
-Radical parallel development
-Global data sharing
-RWE and double blind trials
-National bio-preparedness 21/

The virus has yet to visit and infect much of the US and most the world. Maybe 1-2% of the world have been infected.

That can’t continue to grow to 10-20% at current fatality rates w/out a lot of loss. 22/

Patience with social distancing is running thin & political leadership to hold it together is uneven throughout the world and weakening throughout the US.

People are growing numb to the growing body count & we haven’t seen it hit the least developed part of the world. 23/

Six month in & patience is already thin. Learnings pounced on as mistakes. Progress proof to some of incompetence. Fear has turned to anger. 24/

We can see leaders who haven’t seemed to care. So many places to point fingers. But that will bring nobody back.

We will only win by elevating our fight against the virus. Our fights with each other will only be a sad footnote. /end