Thread by @ASlavitt

COVID Update: August 31, 2020: Each month I give a sense of what to expect the following month.

This ought to be entertaining because I'm not sure anyone can tell you what happened this month. 1/

The good news is as I and others suggested would happen the Southern states got their rising curve under control. Things flattened. 2/

Some people will tell you its because we hit some magic herd immunity level in the South. There is no evidence of that. Not even circumstantial.

Here's what we learned about Southern Spread... (fav Neil Young song? Mine too.) 3/

Arizona went from a 25% test positive ratio down to 5%. How?

-Retail can stay open if bars and indoor dining are closed/severely restricted
-Personal social gatherings of no more than 10
-Full mask mandate

In other words, people started behaving. 4/

Governors in Southern states were slow-- some unforgivably slow-- to respond.

They saw the Northeast as a city problem.
Southern spread was different. Every county had spread. 5/

Texas and Florida did not follow Arizona's course as much. Cases flattened and declined some but there are still thousands of new cases every day. 6/

As September starts, the first worry is interstate spread.

Turns out Memorial Day travel was heavy down to the Florida panhandle and Louisiana. Labor Day travel to hot spots is a concern.

But Labor Day travel FROM hot spots is a bigger concern. 7/

The CDC said quarantining on interstate travel is no longer necessary. While I realize that drives a lot of tourism dollars, we don't need the CDC to be our Chamber of Commerce. We need the to prevent diseases. This is "junk advice" not written by epidemiologists. 8/

Key people in the Administration think this is horrible advice.

But if they didn't give that advice, not only would commerce have suffered, but many parents wouldn't send their kids to college. 9/

Speaking of college, we now have outbreaks now in 36 states. That we know of.

COVID became even more of a silent killer when colleges were given permission not to do surveillance testing of asymptomatic kids. 10/

If you don't know there is a national rebellion at colleges to refuse to do contact tracing. People don't want to be responsible for getting their friends in trouble. And since schools have to isolate, they can't send kids who test positive home. 11/

Surveillance testing is the only weapon colleges have (and a weak one at that). So kids traveling from and to all over the country. Limited testing. Kids in dormitories. Not only will there be outbreaks.

But the outbreaks we don't know about are going to be the worst. 12/

But wait, "Dr." Atlas says we can just isolate the old folks. Kids aren't in any danger. What to worry?

First of all, Donald Trump may listen to Atlas, but LITERALLY no one else does. 13/

Atlas's dog runs the other way when he calls. When he yelled "hi mom!" as a kid in the playground, she would say "did someone say something?" When he yells BINGO during Friday night BINGO, they keep the game going. 14/

(I have more of these. Stop by some time.)

Hospitalization rates track community spread. Old or young. You can't cocoon old people. Or everyone with a pre-ex condition. Or any public facing worker.

So colleges and Labor Day mean a dormant period of modest cases relative to what we saw in July but still higher than May.15

I predicted death rates would begin to drop in mid-August. They didn't drop for another week after that. More people still dying than most countries in the world combined. But we're long used to that. 16/

Mask wearing, though, will help. Keeping bars closed will help. Staying in and socially distant will help.

But college kids-- through the fault of the schools-- will need to isolate. And that will be hard. 17/

Colleges need to take accountability for the entire community they live in. This means every person associated with the school. On or off campus. 18/

What else happens in September?

As absolutely off-the-wall as the last few weeks have been, the FDA no longer regulating, the CDC actually pushing disease, I have a feeling-- we all must-- that we ain't seen nothing yet. 19/

What does that mean? Think of the most disturbing, hard to imagine, awful thing. If you can dream it, it will happen.
And when things happen, we will only kick ourselves for our lack of imagination. 20/

We all know October 23 or so, Trump will announce a vaccine. That vaccine likely will not be through Ph 3 trials, but:

what about combining data from different vaccines? Yes
what about press releases with no or fake data? Yes
what about distributing the vaccine? Yes 21/

Imagine Trump having vaccines delivered to black and brown communities & suburban battle ground states. (He's already hired McKesson.)

Think of the visuals. But that's lightweight compared to the theater we are likely to see. Data hidden. Reports faked. Conspiracies amplified.22

Most importantly we are equally likely to end the month on another upswing. And God help us if we don't focus on preventing every death. September is only the lead up to October which will multiply September in many ways.

The sad part for all of us is imagining all this energy spent on reducing case counts, actual scientific discovery, the serious business of getting the country moving.

The work Biden and team is already doing. /end