Thread by @ASlavitt

COVID Update July 16: Anyone can tell you the controversies of today: masks, schools, bars & what to leave open.

But we haven’t seen anything yet. What about the controversies of tomorrow? 1/

Hard vs soft lockdown?: We went through a “soft” lockdown in April. It may not have been everybody’s first choice way to spend their Spring but we kept a high % of the economy circulating to take care of us, bag our groceries & bring us pizza.2/

Forcing so many to work, coupled with skeptics & the rolling nature & air & car travel, our lockdown was soft & so were our results. We lessened the pain, but extended it.

Another word for soft my dad would have used is “half-assed.” 3/

Asia and Europe went through hard lock downs. Once/week shopping, fines for not distancing, no BS mask policies. Not fun. But done & the economy back & way fewer lives lost.

It also kept the public with more reserve if this has to happen again. 4/

As Wave 1 rolls and Wave 2 comes, this hard/soft rip the band-aid off needs to be on the table. Most would take the shorter-tougher route.

The White House is unlikely to be in that camp & discredit those that are. 5/

National vs state: I had a conversation with someone who had been in the White House about what would have happened if Merkel had told Bavaria to do as it pleased & Hamburg to do as it pleased.

“It might not have worked out as well.” 6/

I’ve been asked twice today why the US hasn’t done that. (Since it actually worked.)

If you’ve ever had this conversation, you probably heard someone say “federalism” & “local control.”

Oh, so it’s a principal. Got it. Our principal of self-governance. 7/

You mean federalism & local control like “All schools must open or I’m taking your money?” Or federalism like suing to eliminate the ACA in every state, when some want it?

Here’s a secret...Come closer...federalism is a cop out for no accountability. 8/

It’s all very weak. Interstate activity, travel, coordination, commerce, purchasing, distribution in a 50 state crisis.

It requires equal accountability & partnership with the states. We crave a unified response. Not uniform, but unified. 9/

Immunity length & from where: B-cells vs T-cells. How long do they last? How much virus do they fight off? And how do we tell?

Do we have 7% immunity going on 15% or do we have 7% going on 7%? Or with T-cells do we already have 30% with some cross-immunity? 10/

This will be a big question with a vaccine. Dosing, type & effectiveness could differ based on these answers.

Likewise will there be age cut offs where a vaccine won’t work or will cause side effects? 11/

What happens If a vaccine doesn’t work for a certain group?

We know the virus hits gender, age, illness burden, race & environmental factors differently. What if a vaccine only elicits an immune response from some but not all groups? 12/

This is one of the most worrisome scenarios for me (but not one to worry about today!). What if the vaccine is ineffective or less effective with people over 55? Or certain races?

I can’t begin to consider the societal implications, the behavior, the cleaving of the country. 13/

Do we tell people they can’t attend large events again? Huh their parents? Can immune compromised kids not attend school? Will racial profiling worsen? The sea of ethical questions would be real and some novel. 14/

Is any non-death not to be worried about?

Because the virus has started out so lethal, we don’t much worry about long term illness. But without the time to observe the consequences, we don’t really know how bad it will be.

Therapies will reduce fatalities. But then what? 15/

Cancer is more survivable. HIV is more survivable. In fact many painful, debilitating diseases are. COVID will hopefully become more & more.

We will need to start measuring outcomes with more care. The president says 99% of people will be fine. He’s not much for facts. 16/

How will we distribute vaccines?

There are tricky questions: According to the most likely to spread? According to the most likely to die? According to people with the most exposure. Kids first? Elderly people first? Black & Hispanic? 17/

That is one set of questions if we only have hundreds of millions cs billions. Virtually every developed country has committed part of their allotment to developing countries. The US has not.18/

Flu vs MMR? What type of vaccine will we have? 40-50% or 97%? Learn all you need to know here: watch the Toolkit episode on vaccines. 19/

Smarturl.it/inthebubble

Vaccine: EUA or wait? Challenge trial?

A big question that may be on us soon is if a vaccine is made available for Emergency Use? Will people consider it safe? Will people suspect political interference? Who can be trusted to present the data since there may be questions. 20/

This list is a sample. I can think of 5-10 more that I’ve been presented with this week alone. And many will come from circumstances as they evolve.

Whatever the questions, we’ve got to improve our discourse. 21/

The conversations around masks. Around schools. Our treatment of public health officials. Of Fauci. The hiding of numbers. The spin. Congress’s role.

The neighbor against neighbor. The internal family squabbles. 22/

We are just beginning. The questions don’t get easier. But we’re going to have to get better as a society at answering them.

These are existential times & the questions are ethical, practical, prioritization. They will define who we are. 23/

The Depression shaped us. The War. Vietnam and the 60s. 9/11.

Our responses. Whether we pulled together or apart. Whether we supported. Whether we unified. Whether we ultimately prevailed. What we ended up squandering. 24/

Many people feel alone & anxious because the waters are uncharted. And no one seems to be holding an oar. Steering. Looking ahead. Watching out for them.

That feeling is beyond the virus. It’s about whether we feel like we have anything any more. 25/

Society, government, the good will of neighbors. These are things we have tacitly counted on. Assumed would be there at rough times.

There’s a lost feeling among many when we’re left on our own. 26/

Some will say bad leadership is making it impossible. Harder for sure. But our bad leaders can’t define us. 27/

Even in a society that values rugged individualism, rights & freedom, there are times when that collective bond is needed. 28/

Times today and times ahead are tough and asking for the best of us. We need to show if we still have it.

We will need to navigate what’s ahead. /end