Thread by @ASlavitt

COVID Update July 31: We have spent months in the US being perfect hosts to the virus while most of the world has flattened it.

What will change in August? 1/

I will call it at the end but first focus on key areas:

-Hot spots
-Kids/schools
-Testing
-Scientific learning
-Politics

2/

Hot spots: Southern/SW cities are now going through a large amount of deaths. These losses stem from June activity & 4 factor contribute to them:
-Opening bars in June
-Hot spots along the border/minority communities
-Late/never to NPIs like masks
-No testing increased spread 3/

We shouldn’t forget that there’s something to the physics of the virus. It goes from big cities to small cities to places where people congregate indoors. That made Phoenix, Houston, Miami, Charlotte, etc natural hot spots. 4/

There are 25 cities on the White House next hot spot list and they’re adding another 25. They’re further north. 5/

It is good news that Birx is now officially focusing on new cities after being basically asleep or with her hands tied until now.

But the bad news is that their recommendations to these cities are too weak & often contradicted by the president. 6/

The White House “embers strategy” for these cities will not reduce the spread enough.

It’s like the strategy of when I was a kid & wanted to look like I ate my dinner so I pushed the food around my plate for a bit & took an occasional nibble.

We are the peas in the analogy. 7/

They are going to recommend masks & social distancing & handwashing.

They say the stuff in August that the rest of the world was saying in May.

They carefully predict what already happened. 8/

Meanwhile Trump who has sanctioned these activities— because his polls tell him to, not because the crisis is new— undermines this at every step.

He demands all schools be open.
They refuse to demand that hot spots like bars be closed even though they should know better. 9/

I led a major national crisis response once. Not as big as this one but big and scary. They are getting the first principle wrong.

It is this: pick the most important thing you want to solve. Solve that & do the best you can with the rest. 10/

Trump & the economists & team refuse to call on any businesses (like bars) or schools to be temporarily closed. He counts on a third quarter jobs & GDP growth which he wants to call the largest ever.

Because we’ve had a 10% drop, even he can grow the economy from here. 11/

Final point on this is the city strategy doesn’t expressly account for border towns & farm labor.

Understand that if you don’t have EVERY hot spot identified, community spread goes everywhere.

And there is no noticeable concern about marginalized communities.12/

Kids & schools: I am 100% positive about this:

No one knows yet how much kids get infected or spread, how accurate nasal testing is, viral loads, or age breaks.

I’m also sure there is a lot of false confidence & study cherry picking. These people don’t care about kids.13/

Can we stipulate that of course it’s better for kids to have in person school? And better for the economy? And those aren’t small things.

But stop saying that.

People fighting to open all schools nationally are defending a difficult & shrinking hill with 280 characters. 14/

In fact, Trump has now seen data that 10 yo transmit like adults.

Coward that he is, the best he can do is not tweet any more about schools instead of correcting his past tweet. His followers listen to him & his tweets. Which will undermine everything. 15/

If we open up colleges (the subject of this Monday’s #Inthebubble) & schools, we will likely be creating new major hot spots. Colleges in seem problematic.

College is giant bar in a giant dorm with hormones.

The decisions will be made in August. 16/

Smarturl.it/inthebubble

Testing: (Other than the 3rd largest cause of death) the biggest disappointment in the last few months is the lack of visibility we still have into the spread be side of no testing capability— our backlog & lack of asymptomatic testing hampers us. 17/

Each month we don’t have enough testing or tracing is a lost month.

Here’s what a single asymptomatic person does. 18/

There are some very good rapid tests— saliva, paper, quicker-home— but they won’t be here in August.

Most importantly they won’t be here in time for schools. BUT WE MUST NOW MAKE IT A NATIONAL PRIORITY TO HAVE ENOUGH TESTING BY JANUARY. 19/

The country has to stop thinking about things a week in advance & then wondering why they don’t work. If they wanted schools to open in September, May. May was the time to work on this. Not August. 20/

My hope is the FDA announces approval of some of these tests in August. That will be good news for the future.

One thing I think people miss: unless we reduce cases, we will NEVER have enough testing. 21/

SCIENCE: Every month we learn a lot.

Some disappointing.
Some positive.

Even disappointing learnings are good news if we learn early. They just become new problems to solve. Which we can. 22/

Science area 1 is immunity: we are learning that B cells don’t hold immunity long. But that w CV, T cells are impacted which lasts longer.

We are also learning that there are likely people that have prior T cell immunity. @VincentRK has been saying this for some time. 23/

This is potentially GOOD news. It could be why kids don’t have symptoms & why there may be some more immunity.

But scientists I talked to today think this is more marginal than it is considered to be. 24/

What we lack is a scalable diagnostic for T-cells. Right now it’s a bespoke 3 day, $1000 assay. This is an area where we need to make major progress. 25/

Science area 2 is understanding susceptibility. We are beginning to see genomic reasons that explain why males are more susceptible. We are understanding how exposure level translates to viral load. But there are a ton of mysteries. 26/

Science area 3 therapies: We have several therapies that have mild impact so far. But no game changers.

We need game changers. Early word is that convalescent plasma will not be that game changer. We could learn more but the first 2 studies were questionable. 27/

This is disappointing because we should have better therapies by now. Still better ICU treatments are making COVID more survivable. 28/

Monoclonal antibodies are still very promising. Other therapy trials are moving forward. So far nothing major. 29/

Science area 4 vaccines: I think we will continue to hear positive news on the vaccine front. We have three strong candidates.

In August we must expose ourselves to the big questions: effectiveness, safety, trust, dosage, population targets, length of protection. 30/

I suggested these recommendations to the vaccine team yesterday to build trust:

1- put out & socialize the metrics that will matter in advance of getting the data
2- hold Moderna to a higher standard. There are conflicts or interest, stock sales & press releases w scant data31/

3- transparently report on a regular cadence vaccine results. No polish. No shine. No promotion. Just data
4- convene 10 outside scientists with no political or economic stake to review data & publicly evaluate the key metrics.
5- keep the president away from the topic 32/

6- have a public discourse over the distribution of vaccines. To ensure there’s enough, enough supplies, that marginalized population gets the vaccine@and spread & risk are reduced as much as possible. 33/

Science area 5– understanding disease: we have a very low understanding of the “nose to toes” impacts as @larrybrilliant calls them.
34/

Smarturl.it/inthebubble

This is one of the most significant places for the CDC to help right now. Tracking, studying, sharing symptoms.

The @CDCgov must do separate daily pressers from Atlanta with no political interference. 35/

We need to stop this false view of COVID as either death or recovered. A 25 year old with lifelong lung problems. Chronic kidney or heart disease seems increasingly likely. Mental illness is already prevalent.

The risks to everyone, including young ppl must be understood.36/

POLITICS: every story, every eviction, every food line Mitch McConnell and the GOP Senate own. 36 Senate races.

Each day McConnell doesn’t act, the Democrats will demand more. 37/

Cratering the country is one thing. Not recovering is another. Refusing to provide a safety net at the same time is historic malpractice. 38/

What to expect:
-1st wave continues to roll through the country
-Areas where schools & bars are open will be new hot spots
-Weather events will be a huge risk
-A bad flu season can be avoided with masks. Southern Hemi was mild.
-Baseball & football & NCAA will be a disaster 39/

-Vaccine trials struggle to enroll people of color
-Rest of the world gets more and more back to normal, widening the gap
-Most K-5 returns. Most high school is hybrid. Many that open close. 40/

By the middle of August things should be marginally better. But Southern states don’t drop as fast as the Northeast.

Southern governors may open too quickly again. 41/

The biggest change will be the increasing definition of COVID as a disease of the poor, immigrants, & POC.

This further lessens then pressure on Senate/WH policy response. 42/

We could approach 1750/2000 deaths again. And with testing & hospitalization data hard to visualize the Midwest needs to be careful.

Overall national numbers will blind us to new hot spots. 43/

If this sounds dire, remember that this is mostly self-inflicted. Which means we have the ability to stop it.

Our biggest concern is our leadership. /end