Thread by @DrTomFrieden

1/25 Weekly Covid epi. Lean into a punch, get hit hard. States that opened while cases increasing predictably having big increases. Increases will continue weeks more, longer without more distancing. The virus does not just go away - we have to stop it! bit.ly/30Fj11C

2/25 Big picture: overall, national test positivity is increasing, as are case counts. Bad news. Dangerous. Avoidable. Predicable. Predicted. A massive viral reservoir that will continue for a long time.

3/25 Cases don’t always reflect spread, but this graph tells the story. American exceptionalism means many things to many people, but shouldn’t mean this. The US has become a global laggard. Travel restrictions. Economic harm. Deaths.

4/25 Emergency department visits for influenza- and Covid-like illness are up. These should be available publicly for every state and city. Southeast, Southcentral, and Southwest all increased most. Common denominator?

5/25 One out of every 1,000 Americans has now been hospitalized for Covid, and 1 of every 330 people over 65. Hospitalizations continue to show stark racial disparities.

6/25 In many states, Hispanic/Latinx populations are increasingly hard hit. More workplaces with insufficient protection, more essential workers, more crowding. Urgent need for effective community outreach and support. NYTimes graphic:

7/25 Hospitalizations are down overall, but that masks big increases in some states.

8/25 Deaths continue to decline but still above baseline and more than 600/day. Only a matter of time before they increase again, although less so with younger average age of recent cases. Maybe older people are wiser and more shielded?

9/25 But the real story is at the state level. Not much joy on this map. Only 6 states are green: NY, NJ, NM, ND, IL, CT. covidexitstrategy.org

10/25 Last week we were most worried about AK, AL, FL, SC, TX. Alabama looks a bit better this week but cases increasing - we shall see. The others, especially Arizona, are in trouble.

11/25 Arizona is deeply concerning. Highest rate in country. Nearly 1 in 4 tests positive. No way they can keep up with contact tracing. Will take months to cool down, even if physically distance a lot more right now...which they haven’t.

12/25 Let’s get this straight. The NUMBER of tests isn’t what’s most important. Are you testing
The right people
In the right way
And doing the right things with the results.

13/25 Right people: those most at risk of either severe illness (elderly, underlying conditions) or spread (nursing home, jail, prison, homeless shelter, contacts), plus all with symptoms if you can.

14/25 Right way: all at risk isolate until test results back - taking days for many people. Get detailed, accurate contact information from the patient and submit it to the lab. Effective information and communication so the patient understands and protects self and others.

15/25 Right things with results: rapid isolation. Support patient needs. Voluntary out-of-home isolation especially if there are older or medically vulnerable people in the home, or if unable to isolate at home. Rapid contact elicitation and tracing. Supportive quarantine

16/25 Texas, South Carolina, Florida of great concern. GA, MS, NV, UT not far behind. Well, most states may not be far behind. With this kind of spread, even with quarantine of travelers, the 6 states doing well are also at risk.

17/25 And let’s be clear. At low case rates, it’s ESSENTIAL to do 2 things. 1. Prevent outbreaks, 2. Box It In. Strategic testing. Effective isolation. Rapid contact tracing. Supportive quarantine. Again, the virus does not just go away, we have to stop it!

18/25 Deaths lag infections by about a month, so we don’t know what the trend will be. Younger age of cases means initially lower case fatality ratios. But what starts in the young, doesn’t stay in the young.

19/25 50% of detected and reported cases in US in 4 states: CA, FL, TX, AZ. Two thirds in top 10 states: those four plus GA, NC, SC, TN, AL, IL. In terms of rates, corrected for testing intensity, top 10: AZ, MS, SC, FL, TX, UT, NV, GA, AL, AK.

20/25 Thanks to Maricopa County (Phoenix area) for this website and this figure, which is worth looking at closely. Stop distancing, virus explodes. bit.ly/2NAiDde

21/25 Bad as AZ is, it’s nowhere near the actual rate of NYC at the peak ... yet ... then again, AZ is still in the exponential growth phase.

22/25 South Korea has 30 cases and takes urgent action to control Covid so they can save lives and resume economic growth. US has 30,000 cases and …. ?

23/25 If you had moved to South Korea from the US on January 20, the date both South Korea and the US had their first cases, you would have been 70 times less likely to be killed by Covid.

24/25 Granular distancing. Bars? Are you kidding? Choirs? Very risky. Comes down to:
How many people
How crowded
Local incidence
Duration of exposure
Mask wearing
Ventilation

25/25 #COVID19 is spreading more in the US. More risk, especially for healthcare workers, older Americans, and most adults - most have at least one underlying condition. More travel restrictions (pariah status). Less economic growth. Welcome to non-independence-from-Covid week.