Course corrections in the US response to COVID are seriously needed. The national and state rising numbers unfortunately speak for themselves. National leaders, state and local leaders, and the public all important roles in helping us change directions. 1/x
More must be done to slow spread in congregate settings – nursing homes, prisons, factories – where so much spread is happening. In general they need better PPE, strong infection control and mitigation practices, better testing, better worker protections.2/x
CDC and others have written clear recommendations on slowing transmissions in each of those high risk settings, and they need to be followed. If outbreaks continue in those settings, we need rapid analysis on why, and more detailed plans to fix persistent problems. 3/x
Governors in states where COVID hospitalizations are consistently rising, COVID ICU rates increasing, diagnostic test positivity going up, need to shift policy. Full reopening happened too quickly and without recognizing that some reopening decisions posed too much risk. 4/x
If they haven’t already, governors in those states should suspend large indoor gatherings – whether casinos, large indoor restaurants, bars, conventions, entertainment venues, indoor churches etc – and explain to public the high risk of getting COVID in those settings. 5/x
Governors should make clear that more informal large gatherings like large parties, have been the site of big outbreaks, and so they are places where risk is high of spread. The public should be aware of those risks and make personal decisions to avoid large gatherings. 6/x
State leaders should convey that mask wearing is required in public spaces, and communicate it is a nonpolitical, preventive measure made with the goal of reducing the chance someone will spread COVID to one’s neighbor or get it one's self. 7/x
States need to press full steam ahead on expanding Dx testing and contact tracing efforts. Those strategies have been backbone of successful response in other parts of the world. Building capacity for contact tracing is not moving fast enough in many places in the country. 8/x
There is nothing political related to mask wearing in other countries, and there is no reason it should be here. It just is the right thing to do to slow the spread of COVID. 9/x
Federal leaders shouldn't say things going well when they aren’t. Undermines credibility of federal response and is confusing to the public. With highest daily national numbers, highest daily numbers in many states with increasing hosp rates, things are not going well. 10/x
Political leaders shouldn't hold large gatherings, like rallies or conventions. We've too much disease spread in the country for those now. It poses risk for attendees. Attendees that get COVID in those events then pose risks to their families and coworkers and others.11/x
Federal leaders need to hear -- from local leaders and hospitals that are saying it – that PPE supplies are still fragile in some places in the country. We need more public data and dashboards to be able to gauge PPE supply. Fed agencies need plans to respond to shortages.12/x
State, local political leaders should support and commend the work of their public health teams. Pub health officials in some places have been scapegoated by the public or their own political leaders. Our response will suffer badly without the best talent in public health. 13/x
State health agencies should move ahead with transparent measurement of how contact tracing efforts are going. @NYChealthy’s efforts to do that are good example of transparency and efforts to make week to week improvements. 14/x
Doing things above will hopefully be enough to slow acceleration in places w/ rapid rising disease, and avoid reimposition of stay at home directives in most places. But govs will need to move quickly, and monitor carefully. Time will tell in days and weeks ahead. 15/x
States that are doing well with falling cases now should closely study what has gone wrong in states that have had rapid acceleration of their COVID epidemics and not do those things. 16/x
And all of us in the US should look overseas to see countless examples of countries that have gotten comparative control of COVID and take those lessons to heart. 17/x
In general, almost all had combo of strong public health leadership supported by political leadership, a public that wears face coverings and physically distances, extensive diagnostic testing, effective contact tracing, a recognition that large gatherings pose high risks. 18/x
We can do these things in the US and we need to. Otherwise we will have continues reemergence and spikes of disease around the country in the time ahead and we wont be able to move toward better normalcy in the economy or our lives. 19/end
