#COVID19 1st wave or 2nd wave is a dangerous semantic game. From medical perspective, it is absurd. The upswing in some states is first. Calling it 2nd makes it seem they succeeded at something they didn't. And it really matters for planning purposes.
A thread on operations 1/
A thread on operations 1/
It all looks like madness, but every state in this 50 state disaster has established an incident command structure (ICS) to deal with the operational response. This is a tried and true crisis management framework that is utilized to guide response and eventual recovery. 2/
An ICS is just a template, used every time and everywhere. It works as a plug-and-play framework, universally accepted, so that for example firefighters from California can go to Australia and help without needing any additional training. 3/
In its most basic structure it looks like this, used for every type of crisis from hurricanes to terrorism response. So if you are wondering how this is all working, its based on this plan: 4/ 
More complicated can look like this (this was us for BP oil spill) but it is basically the same if you look closely. 5/
There are always four sections: finance (self-explanatory); logistics (supply chain, getting stuff to the right place); operations (the response apparatus, the first responders in the field) and planning (what's next, what will we need, what will happen, look ahead.). 6/
It is the planning section that is key here. It removes a group of crisis managers from day-to-day madness of saving lives and isolates them to make sure we know what's next. For Covid-19, that would mean, ideally, that there is a group that is preparing for the next wave, 7/
driving resources, planning, etc., based on lessons learned from the first one -- testing and tracing a priority, PPE and hospital capacity, protecting vulnerable populations, treatments and other techniques that minimize hospital stays, stockpiles, etc. 8/
In other words, it matters for planning purposes whether a state is in first or second wave, whether there is a first wave or there was a lull and potential uptick to prepare for and get ready. For states in the first wave, they will be dealing with response as, potentially, 9/
they should be planning for Fall. The Planning Section for these states is focused on getting through the first wave, not getting ready for the second wave. And that's not ideal. 10/
Ideally, a federal gov ICS would exist and be guiding this; it does not so we aren't positioning for wave 2, should there be one, by focusing on logistics and supplies. We've learned so much, but if it's not memorialized in operational planning it's useless. 11/
I know; I'm fixated on operations. We can hope, like VP Pence, that 2nd wave doesn't come. But hope isn't a known 5th Incident Command section and nobody in field has trained for it. Brutal reality of where we are, and what we need to plan for, is the life-saving course. End
