Thread by @ASlavitt

COVID Update June 15: I did a quick roundup of a number of experts on what they see/whats next. I have overlaid my own read too. I learned a ton/here’s my summary.

I asked about:

R0 or case growth
State spread
Therapies
Fatality
Long term Effects
Herd immunity
Vaccine

1/

The view I got on case growth is it will be inevitable through the Fall. That we could or could have crushed this like other countries (China, Greece, NZ, Vietnam, S Korea) but opted not to do the tough things.

Cases will decline in the NE but overall stay at 20k/day plus.2/

Why plus? Because we could see it grow to 30-40k new cases with more testing or currently dormant cases.

Most states that haven’t had community spread are considered more lucky than good.

So states who don’t keep R0 down with masks and social distancing will have cause growth. That’s the biology of the virus. It is what happens.

There are a handful of states with low R, but most are in the NE or recovering. Those are “religious experience” states.

Many of the ones with high R0, the “rabbits” from yesterday are “low imagination” states: if it hasn’t happened here, how do I know it’s real?

There are several therapies, platelet replacements, anti-coagulant approaches (believe me, I’m well over my head on the details) thst are being used or are in trial.

Bottom line, they should make the disease less fatal that when this thing ran through Italy and NY.

Read the last one again. It’s awesome news if it proves to be true.

And it stands to reason that with less overwhelmed staff, more PPE, more resources, and more knowledge, we will see more survivors.

Early therapies however didn’t sound promising yet.

That will bring the CFR down. Estimate of true fatality rate 0.7, but no one knows for sure. Bring that down further & further step by step & this becomes a little less scary.

The death rate will be lower for other reasons. At this point, FOR THE PEOPLE WHO CAN, those at higher risk are isolating. And those sneezing & coughing are more likely to isolate.

Bottom line 30,000 new cases in June are better than 30,000 in April.

Younger people at bars are still of concern because of asymptomatic, low-symptomatic, and President-symptomatic spread. We know there are super spreaders and bars and people in their 20s and 30s seem like higher infectors.

Here is where I will add an overlay of my own.

It feels like a push to a 2 tiered society of young healthy people living their lives VS cashiers, nurses, ppl w high blood pressure, cancer, or older. Even middle aged older being careful.

A culture in the short term where mask wearers resent the hell out of others. And those who think they have nothing to lose don’t much care.

Believe me, in Greece, NZ, Singapore, Hong Kong, Czech Republic, Vietnam— they don’t stand for this kind of society.

They crushed the virus quickly by pulling together.

The most challenging question I asked— and one where I didn’t get a good answer— is the long term effects of COVID-19.

The @CDCgov must do a better job here of reporting out what’s going on. The implications also make a vaccine more complicated. Will explain.

What is population immunity level? Convergence around 5-7%. Obviously biased by 20% or so in NY, so could be 1-3% many places.

Right now we’re doubling every 2 months or so. So immunity could be 10-15% by the end of the summer.

Here is where I piece together math that is really ballpark.

10-15% immunity and let’s say there are some who are not susceptible to infection. True of other Coronaviruses & there’s some cross immunity.

If R is even up from where it is today (1.2), that could mean if a vaccine worked in 30-40% of the population (like an influenza vaccine), you could effectively get to .6-.7 transmission. Lots of assumptions, lots of ifs and would vary hugely regionally.

Of course we could get to .6 just by wearing masks.

Either way we would catch up to better performing countries and begin to crush the virus at .6.

So a vaccine, 3 candidates of which will begin enrolling Phase 3 trials next month, could be an added tool. Not a cure all. But a tool to really slow transmission. It wouldn’t have to work on everyone (it probably wouldn’t) & wouldn’t need to be taken by everyone (it wouldn’t).

A vaccine from the mRNA platform is considered likely. And it would likely be safe although side effects would be unknown past a few months. And because the virus has tricky side effects, the vaccine could as well.

That’s why the Phase 3 trial & time are important.

There is a possibility that the FDA, possibly prior to the election, faces pressure to grant emergency authorization before the data is in.

If we’re in the middle of a big wave & essential workers & health care workers are at risk, it might make limited sense.

But more likely people will be suspicious and it will be important to get impartial scientists to lay out the risk. The FDA and CDC may not be seen as trustworthy.

Overall what I heard is: more cases (inevitable), reducing fatality rate (hopeful, but likely), illness complications (scary), and scientific progress (rapid).

Of course these are scientists and they hope they can rescue us from our lack of strategy & political leadership. Either them or better political leadership. /end