COVID Update September 14: For every 10% of people who won't take a vaccine, that leads to about 100,000 more deaths over 4 months. 1/
I spent the day playing with a new toy: a model engineer and pandemic expert Bill Joy built for me. It's rough numbers and filled with a lot of assumptions, but it divides the country into groups: Cs and Ns.

Cs where a mask & take a vaccine when available.
Ns don't do either. 2/
The more people that become Cs, the quicker we move on & the fewer people who will die. This assumes that Ns spread COVID at an R of 1.4 & Cs at 0.4. That is, a vaccine or mask won't work perfectly & people who aren't compliant only spread the virus above average, not wildly. 3/
Those numbers-- some people spreading the virus to 1.4 people & some to 0.4-- work out about right at today's level of cases if 60-70% of people are relatively compliant today. 4/
I should also add that there are two types of non-compliant people

--those who voluntarily non-comply-- anti-vaxxers, fauxers, young people at parties & bars.
--those who don't comply unvoluntarily because of exposure-- essential workers, farm workers, multi-gen households 5/
If 10% more people become compliant, it saves about 100,000 people's lives in 4 months. If 10% of people become less compliant, 100,000 more people (or so) die. (This model uses a death rate of .8, but gives an answer over 100,000 so this is rounding if .6 is more accurate.) 6/
The actions of 1% of the population effect 10,000 lives over the next few months. 6/
Now let me pause here before I go onto the implications.

It was only a few months ago when we watched TV solmenly as the first 1000 people died. And I'm aware that analyses like this only coarsen us to accepting large numbers of deaths-- which I think is a very big problem. 7/
So I'm really hesitant to write about this work because when I stare at the spreadsheet my eyes glaze over. It makes me feel hollow. I don't want to lose the ability to mourn a single death or to somehow feel relieved if the death rates drop to a few hundred per day. 8/
I also add that its really a bad idea to think of people with COVID as living or dying (which I am doing here). More people are surviving, but chronic COVID conditions are relatively serious cardiac, kidney, brain & lung function. Long haulers episode. 9/

smarturl.it/inthebubble
We have people who are not only growing numb but are mocking these losses openly.

People who mocked @larrybrilliant and @mtosterholm for years as fear mongers you would think would be saying-- well, "I guess they were right," are instead doubling down. 10/
If ignorant and selfish had a baby, the baby's first act step would be to threaten a public health commissioner for promoting masks. 11/
What are the implications of this model?
1. The first lesson is for the @US_FDA. Vaccine trust. You roll out a vaccine and if 20% more people don't trust it because you politicized it, 200,000 more people die.

Roll out the vaccine the right way and save lives. 12/
This has nothing to do with the effectiveness of the vaccine BUT the process by which it is rolled out. Consistent transparent data on safety will make a big difference.

If we wait 1-2 months to roll out the vaccine but do it with high trust, you could save more lives. 13/
2. A vaccine matters for different groups for different reasons.

-Compliant groups need it because they won't build immunity
-Non-compliant groups need it to save their lives

All of us need it because reaching a certain level of immunity brings the virus to a negligible level14
3. As we know we take action for others here, not just ourselves.

In a greater good or "all boats" society like Japan, this fact raises compliance & lowers death tolls quickly
In an individualistic society, it likely means prolonged agony & death 15/
The number of people who die every day, while monstrous, is apparently not high enough to make the individualistic (or self-centered) people worry the Russian roulette bullet will end up in their chamber. 16/
4. Most of the people who die are non-compliant people. And it would be tempting to say-- "individualist" + "knowingly tempting fate" = "they made their own bed."

But remember all of the involuntary non-compliant people. 17.
Who are these people. Chances are they work for you.

They're growing our food.
They're packing & distributing it.
They're working in stores.
They have lower incomes & live in more crowded settings.

And... 18/
They are people we label vulnerable--

In nursing homes, vulnerable to spread
With illnesses or disabilities
In congregate care settings

They are the people society always victimizes & we're victimizing them again 19/
5. Our policies towards essential workers in any just society would dictate our behavior.

If we have a lot of people working for us so we can keep the economy (& our basic systems) moving, that obligates us to compliance-- masks, social distancing, vaccinations. 20/
In a nutshell, if you want to be "individualistic," don't actually depend on people.

Go hunt rabbit, live in the woods, pee outside, don't collect social security and sure, be free not to wear a mask. 21/
However, stop with the phony individualism.

This is the final conclusion that the model leaves me with. If you want to go see the Alabama-Auburn game, but a hot dog, have people pick up your litter, you're dependent on about 1000 people. Go to the grocery store & its 100,000.22/
Bottom line: science will get us out of the mess we couldn't manage to get ourselves out of. And with a vaccine we can trust, that can happen in 2021.

But we can choose the cost in lives. That's the power we have. 23/
That's how I spent my Sunday. How did you spend yours? /end
By the way, more than 80% of the time I get the date correct on my threads. #BeforeYouJudgeMe

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More from @ASlavitt

17 Sep
COVID Update September 17: Putting the pandemic in its place. 1:
We haven’t had one here so we think “this has never happened before.”

The rest of the world thinks— “to you it hasn’t.” 2/
“Where’ve you been? We’ve had SARS. We’ve had MERS. We’ve had Ebola. We’ve still got polio. We’ve got HIV. Guinea worm. Do you need us to go on?

You guys have been lucky and don’t even know it.” 3/
Read 19 tweets
16 Sep
COVID Update September 16: If Trump wins re-election I don’t see a path towards ending the pandemic end here in the U.S. without continual ongoing damage. 1/
Let me take the politics off the table.

I care A LOT less about who becomes president than hundreds of thousands of people dying.

I care about who is President BECAUSE I don’t want hundreds of thousands of people to die. 2/
I will also add I do not plan to serve in a new Biden Administration.

I certainly want the very best people in the key health care jobs & I’m confident that would happen in a Biden Administration. But that is not what motivates me. 3/
Read 25 tweets
16 Sep
Thank you
Thank you
Thank you

Thanks to all the listeners of #inthebubble today we sent a check for $19,000 to Project Ayuda in the Central Valley of California.

centralvalleycf.org/project-ayuda/
Let me tell you why.

Project Ayuda offers disaster relief payments to undocumented residents, many of them farm workers & their families.

Make no mistake. They are in this country to pick our crops & grow our food that we all take for granted. And they are dying in record #s.
COVID is ravaging these areas. And now the orange skies and unhealthy air is too. The nature of the work is ungodly heat, backbreaking manual labor & poor living conditions.

And the Central Valley, CA among our country’s biggest hot spots.
Read 5 tweets
15 Sep
BREAKING: I am talking to scientists about this right now and will provide an update, but all media reports on clinical issues should be viewed very cautiously.

Follow if interested. cnn.com/2020/09/15/hea…
There are a few things I am picking up that lead me to a broader point having to do with disclosure, transparency & the media and our breathless interest in these clinical trials.
First it is not at all uncommon for there to be adverse events during a trial. They have to be made public and reviewed independently as this one was.
Read 12 tweets
14 Sep
NEW: There are now over 60,000 new COVID cases on college campuses since August.

This only accounts for ~1/4 colleges.

Our new hot spots.
This has been a failed experiment as predicted by @profgalloway and discussed here.

podcasts.apple.com/us/podcast/in-…
At this point, all universities must have effective isolation procedures.

At least 60 people died (mostly non-students so we shall call them people) from campus outbreaks in the Spring.
Read 7 tweets
13 Sep
GOOD NEWS: The US is finally on the cusp of the test positivity rate declining below 5%, a key WHO guidepost.

Some thoughts.
This may happen as we cross the grim 200,000 official death milestone. An incredibly expensive price to reach this milestone. 2/
The impact on mental illness & addiction has been hard as well. All of these are part of the cost of the pandemic & our poor response. 3/
Read 11 tweets

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