Thread by @ASlavitt

COVID Update July 12: Just because things will get worse before they get better doesn’t mean they won’t get better.

They will! But let’s take it in order. 1/

Three things are going to happen next.

-In phase 2 states (AZ, FL, TX, Southern CA) the death rate is going to start moving up the back half of July
-Phase 3/4 states (the rest) will begin to follow the path
-Phase 1 (NE) will have a constant vigilence for the Fall Wave 2

2/

Observing what’s happened in AZ, FL, TX is instructive.

Even though with COVID-19, one thing ALWAYS leads to the next, at each stop, there was strong denial that the next step would happen. 3/

Denial pattern, pt 1
We opened— but not so many cases
We open more— bars/churches/indoor dining
Cases grow— but only young people
Hospitalizations grow— but the cases are younger! And we can handle it!
Hospitals begin to fill— Maybe a little caution is in order folks 4/

Denial pattern, pt 2
Tests run low, start to test only symptomatic
Testing lines & backlogs grow— now you can’t tell where the case growth is
Deaths start to rise— but it’s not an onslaught
Spread to nursing home, older populations— we thought we protected them
Deaths climb 5/

Somewhere along the way the governor decides to take taken. In baby steps. And the later & more baby the steps, the worse it is.

-Most importantly, close the bars. See my call today.
-Mask policy
-Close other indoor public spaces
-If all else fails, shut down 6/

https://twitter.com/aslavitt/status/1282428602588569600

Eventually the crest occurs. Either the state finally gets tough or even people in denial start to get scared.

But even here 20% of the public— young & invincible, “essential” workers (essential to serve others that is) keep the virus circulating. 7/

These people: some by choice. Others forced to— are the reason cases decline slowly on the backend. It’s why we dropped to 20,000 instead of 0. Alone in the world.

Then 1 of 2 things happen. The gov either has religion & plays it cautiously like Murphy/Cuomo/Lamont. Or...8/

Or a series of factors caused them to rush the re-opening.
-Eagerness for economic activity/jobs
-Pressure from Trump to drive up job numbers
-Mistaken belief that the worst is over. They have it licked.

In this scenario, hot spots will spread cases fast 9/

Indeed today in these states, deaths have started to climb. Cases are flattening— but only because testing is grinding to a halt.

Now nursing home infections & deaths are climbing. 10/

If you are sitting there saying that was all predictable but like me, are sitting in a Phase 3/4 state where the bars are open, whoa there.

Indeed the breadth of the virus is beginning to grow (not the good news yet.) 11/

What do I mean? One way to look at things is how many states have over 1000 cases/day.

At the 3rd week in May, 4 highly populous states did.
By July 1, it was 9.
This week it was 11.
By this weekend, it was 15.

12/

1000 cases/day may be arbitrary & mean different things in different states. Certainly 300 in Montana worries me more than 1000 in Texas but it does mean that Phase 3 states are growing even before the Fall.

By the way 15 in most countries constitutes a national emergency.

13/

And states that have long testing backlogs (most) & high test positives are very understated.

People aren’t testing as much.

Our visibility is lessening.

(Not at the good news yet) 14/

Phase 3 & 4 states will have challenges when the whether gets cold (& hopefully FL, AZ, TX get a reprieve) and people are indoors. Flu season will mask who has it & who doesn’t.

Forced openings of schools & businesses for political reasons would add fuel. 15/

How will Phase 3 states react? Two choices. Or more likely when?

-Now (which very few are)
-Like Phase 2 states but with even lower visibility

16/

If they react now, how should they react?

Like the Phase 1 states are now— only before the fact, not after it.

The 3 Cs approach from Japan now being used in Massachusetts. Uses a cluster based approach.

What is that? 17/

A cluster based approach first traces all sources of infections to common hot spots using contact tracing. 80% of the spread is coming from 1-10% of super spreaders. Find them, find the hot spots.

18/

Second, Japan did the 3 Cs approach. They focused all efforts on:

-Closed spaces
-Crowded places
-Closed contact settings

Public awareness & public health measures there have crushed the virus in a targeted way without any need for a full lockdown 19/

Now is where I get into the things getting better. (Have a drink, a smile or a breath)

They will get better for 3 reasons— and the first is our public health response will improve as we know more. 20/

Some of you might be thinking that can’t happen while Trump is president. And you might be right.

The chances of him surprising us are low. He normally starts paddling after the boat has sunk.

But that doesn’t mean most states can’t get to this level of vigilence. 21/

When things start to work & more people know people who are impacted, our response will improve.

The 20-somethings who feel immune or people who just don’t care?

See my MN recommendations tweet 6. Close the bars. Structure a payment to them. 22/

(Aside, bartenders my whole adult life could look right at me waving a credit card for 90 minutes, clutching my throat from thirst, look right at me & keep calling on the people around me who just walked up. Close those bars first please.) 23/

The second reason things will get better is testing innovation will eventually propel us.

Mass produced, saliva-based, highly convenient, low cost & more rapid testing will eventually get here. It will add millions more capacity.

After things get worse, they will improve.24/

When testing improves, so many activities will open up. School, work, social gatherings, and while maybe some things won’t be safe right away, we will be able to figure it out for most of the people most of the time. 25/

Feel free to stretch your legs. I have like 10 more. I feel badly. But the good news took a little while to get here.

If you’ve fallen asleep, have someone slide a pillow underneath. 26/

Sadly this means accessibility issues & equity issues will exist.

Since “most people” likely means already privileged healthy people. And we can’t tolerate inequities in this recovery. So until proper accommodations are figured out, it’s a fail.

That tweet for another day. 27/

Everyone of us who claimed last month to be turning over a new leaf with equity & justice and an end to racism will have a chance to put it in action. 28/

The third reason things will get better is science is battling the virus. Tomorrow on #inthebubble I release my interviews with scientists on what you need to know about a vaccine.

You have to listen. Like wake up at 4 am to listen. 29/

29:

Smarturl.it/inthebubble

I gave a preview last week which you can find here.

Convalescent plasma, vaccines & other therapies will be great tools that are beginning already but could have broad impact as soon as next year. 30/

coronavirus.medium.com/there-is-a-lig…

A vaccine won’t bring one single game changing day, certainly for everybody and will be part of a path, but will provide step function changes.

Here again for most people most of the time. 31/

While there will always be a tail of new cases & new infections, it is realistic that COVID-19 should become both less deadly & the disease becomes less infectious. 32/

Maybe less lethal than a long tweet thread. 33/

(And yet I continue)

A combination of masks, testing, vaccines, therapies & hot spot controls are not very far in our future.

34/

In relative terms, when we look back this period will certainly be seen as one where we struggled mightily at first— particularly compared to the ROW.

But we will see that we did contain it. 35/

Right now we have to stop making things worse.

We have to close breeding grounds knowing it’s temporary.

And stop wearing masks around our chin & lower lip. 36/

If we can live without a year of college football, some online learning, drinking at home (or GF abstinence), more Zoom & manage to take a deep breath, get our wits & keep doing our part, this will be a memory at some point. It will. 37/

The business setbacks this entails for most of us are horrible. Congress needs to keep stepping up.

The alternative is far worse. That we remember this time for more unnecessary losses. 38/

If I were in Congress or President, I would sell our f’ing monuments and anything else I needed to to pay to keep people afloat & not worrying during this crisis. 39/

So even as it gets worse in the next few months, I’m not losing hope. I do see the things that will swing this around. Most of them are not coming from executive offices— corner or oval.

They’re in labs. And hopefully in our own hearts, our minds & our spine. /end

To close on an even better note, I heard from a governor’s office tonight that they are announcing the closure of bars and a number of other things tomorrow.