Thread by @T_Inglesby

Recent days have brought new highs in COVID case numbers nationally, 30 states w/ cases rising and many states with high test positivity, near peak hospitalizations, >1,000 deaths a day. We need to reset response, and we have a new report proposing how to do that. 1/x

Our @JHSPH_CHS report: Resetting Our Response: Changes Needed in the US Approach to COVID-19. @cmyeaton @Elena_Martin33 @C_R_Watson @MSchochSpana @anita_cicero
and I recommend what needs to happen now.2/x centerforhealthsecurity.org/our-work/publi…

1) Encourage, and where needed, require the fundamental interventions that lower risk of spread. Face coverings, physical distancing, limiting the size of gatherings (<10 in places where transmission high, 25 in places where disease under control).3/x

National, state, local leaders need to speak in unison about the importance of these measures. Political leaders should work hand in hand with scientists, both in development of policy and in communicating about and modelling that policy.4/x

2)Re-close higher risk activities and settings in jurisdictions where the epidemic is worsening and reinstitute stay-at-home orders in jurisdictions where healthcare systems are in crisis. Rising diagnostic test positivity is a warning that the epidemic is worsening.5/x

Signs of a hospital system under rising COVID stress include significant rises in hospitalized pts, pressure on ICUs, need to cancel elective procedures to make room, the need to surge up beds and staff, relocate patients out of the area, and/or start to ration medical care.6/x

Federal and/or state relief should be provided for those whose businesses rely on activities that increase risk of transmission and are closed in order to bring the epidemic under control. 7/x

3)HHS/ASPR should report publicly on the PPE manufacturing base, supply chain, overall capacity and projections for time ahead. We need to substantially increase national supply. 8/x

3)HHS/ASPR should report publicly on the PPE manufacturing base, supply chain, overall capacity and projections for time ahead. We need to substantially increase national supply.8/x

Healthcare workers, including nursing home staff, are a top priority because of both the nature of their work and their critical contribution to the pandemic response. There are shortages that continue to be reported. 9/x

But there are people in other high-risk occupational settings who should also have access to and be supplied with PPE, if PPE needs of healthcare workers can be met. 10/x

Examples: workers in manufacturing+meatpacking, educators in schools, incarcerated people and staff in those facilities, farm workers in congregate housing, grocery and pharmacy workers and others who interact closely w/ each other and the public indoors on regular basis.11/x

Also - Individuals at high risk of severe illness because of age or underlying health conditions may benefit from more protective PPE than the nonmedical fabric face masks that are now available for public use.12/x

4) Bolster test supply chains, plan for shortages, and collaborate with states and commercial laboratories to expand capacity and improve test turnaround times.13/x

Without a reliable and rapid testing system, the US response will be severely constrained. New serious rise in cases in states across the country in June and July have slowed testing broadly.14/x

Demand for testing will intensify as efforts are made to get control of the epidemic and to test asymptomatic people returning to school, universities, work.15/x

Results are taking 7 days or more to process in some national labs. To be useful in controlling the outbreak they need to be returned in 48 hrs, even better in 24 hrs.16/x

Need to understand source of delays and need a national plan for fixing them. HHS should conduct and make public an end-to-end analysis of the diagnostic testing supply chain pipeline to better direct efforts to enhance testing capacity.17/x

5) Conduct and make public analyses of epid data collected during case investigations and contact tracing. It will be difficult to improve control efforts if we don’t understand source of new cases and can’t measure where we need more public health resources.18/x

This list of essential indicators is a good synthesis of the kinds of information that is needed. 19/x
@RSTL resolvetosavelives.org/about/press/mo…

Data on the source of new cases should be made public. For public health agencies that don’t have the resources to collect and disseminate that kind of data, they need more federal and or state resources to hire people or acquire the necessary technology.20/x

6) NIH or NSF should fund the study of urgent research questions that are core to efforts to control COVID, including: How can public communications around reducing risk of transmission be improved? How can mask use behaviors be improved and expanded?21/x

Are there engineering solutions to improve ventilation systems in buildings that can be done quickly and inexpensively? Can face coverings be improved to make them more comfortable and improve filtration? 22/x

And --what do families and school communities need in order to facilitate safe and effective learning, and how can vulnerable children and families be supported? What is the role of children—particularly asymptomatic children—in transmission? 23/x

7) Scale-up contact tracing and continue to improve performance. Case-based interventions— interventions that include diagnostic testing, contact tracing, and isolation and quarantine—continue to be gold standard for controlling SARS-CoV-2 transmission around the world.24/x

Scaling up case-based interventions is central to an exit strategy that will allow the country to reopen its businesses, schools, and economic activities more broadly over time, while continuing to manage cases of the disease at some low level.25/x

Most states and communities in the United States have not been able to successfully implement the full spectrum of case-based interventions for COVID-19. The reasons for this are many. 26/x

Current burden of COVID in many places has outpaced what even a very strong contact tracing program could reasonably manage. Testing, racing alone will not bring down disease where there is high transmission. Reclosures or stay at home actions likely to be needed there. 27/x

Even successful contact tracing programs have identified big challenges in keeping up with accelerating cases, reaching people quickly, gaining the trust needed to effectively conduct interviews, and being able to facilitate quarantine for those contacts.28/x

Public health departments, many of which are chronically under-resourced, require additional financial support for this huge and complex effort.29/x

8) Identify and disseminate best practices for improving the public health response. What’s working and what’s not? Use the best of public health and social science to understand the efforts that are working around the country and globally.30/x

9) Start or accelerate planning for mass vaccination program now --including production, allocation, distribution, and community engagement-- to ensure a successful rollout. Enormous amount of complex work to do on these issues. See centerforhealthsecurity.org/our-work/pubs_… for details.31/x

10) Strengthen policies and practices to better protect group institutions. Settings such as nursing homes, manufacturing facilities, and carceral institutions (eg, prisons and jails) are foci of transmission, contributing a large proportion of cases and fatalities. 32/x

Most responsibility for implementing interventions falls on individual facilities. Often, they are chronically under-resourced. Relying on them to fund, implement appropriate measures to reduce spread is not sufficient to ensure safety of individuals in these settings.33/x

HHS should strengthen its policies and recommendations, drawing on best practices that have emerged, data from around the country, and expert analysis, in order to reduce risks of SARS-CoV-2 transmission in group settings.34/end