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/
So let me tell you here’s why I think we will be in bad shape should Trump get re-elected. 4/
1. THE SILVER BULLET. Trump’s entire strategy is a vaccine which in his mind ends this thing. And that’s a problem for a few reasons...

-The bar for a a vaccine is 50% improvement & likely temporary. It is part of a strategy. Not A strategy. 5/
-A vaccine needs to be developed that is safe, effective & trusted. Trump’s mettling with the FDA & Hahn’s willingness has eroded trust significantly.

For every 10% of the population that doesn’t take a vaccine equals another 100,000 deaths. 6/
2. MASKS & DISTANCING WILL STILL MATTER: Whether Trump likes it or not NPIs must be part of the solution if we care about who lives and dies.

Hot spots get created randomly— with super-spreaders who don’t distance or where masks. 7/
Trump is still staging indoor rallies without masks. Hot spots will continue to burn. If his supporters don’t take tests & don’t contact trace or isolate, none of those innovations will matter. 8/
3. A PLAN: Defeating the virus requires a simple plan we can stick to.

Africa has 1.3 billion people & has had fewer than 30,000 deaths. A plan does not require big resources or American style genius. But it requires rock solid implementation.

Trump has no patience for it. 9/
Biden has a plan and experience. But this thread isn’t about Biden.

This is probably a lot like what a Romney plan would look like. 10/
4. A SECOND TERM TRUMP WILL CARE EVEN LESS: Trump has said some version of “some day this will magically just go away” every month.

That’s the effort he puts in BEFORE a re-election. With the affirmation of a second term, the word pandemic wont cross his lips. 11/
He will rightfully assume everything he did & didn’t do was approved of by the body politic.

He will ask Congress for nothing and they will give nothing. McConnell were he to also win would feel safe for another 6 years. 12/
5. CAST & CREW: Rather than @RonaldKlain @vivek_murthy or dozens of other great qualified people I could name, you will have Redfield, Azar & Hahn. And the like. People who will get pushed around or gratefully submit. 13/
Even worse those institutions will empty. The CDC and FDA, with a few big leaks in their credibility already, would start to submerge as worthless. 14/
Public health officials across the country already under threat and burned out would be more in the wilderness— those that didn’t call it quits. Many are already needing to hide from view under threat. 15/
6. “LIVE WITH IT”; Through all of this American patience would run out. We would be in official “you just have to live with it” mode. Even as we gradually made gains through vaccines the fires would never be put all the way out. COVID would be pitched as an acceptable risk. 16/
Trump yesterday said what we need is a “herd mentality.” He couldn’t have described it more perfectly. Unfortunately the mentality would be “at this point we have to move on & live WITH the virus.”

Sure, OK, but who is we? 17/
One could imagine *living* with the virus is accepting COVID as one of the leading causes of death— 100,000 people a year dying— many of them a combination of old, poor & sick.

And an infectious disease economy is the end of a record robust economy. Disneyland anybody? 18/
It would be odd because we would be one of the only nations in the world where this was a leading cause of death. And we would have to live with travel restrictions like 5 day quarantines when visiting another country.

Sad thing is we would probably get used to it. 19/
7. THIS IS A GLOBAL PROBLEM: Even with gradual & meaningful reductions in spread & only occasional “hot” seasons, without an eradication plan for the world, every time we think we have it, it comes back. 20/
What about immunity? Young people get old, new people are born, we know immunity isn’t perfect. Those are realities no matter who is president. All the more reason we need both a global AND a national plan.

With Trump we have neither. 21/
We can’t address a problem we won’t admit exists. And a virus that drops some but not all the way, that only impacts some people, but has perpetual seasons of growth wouldn’t be viewed as a problem. It would be “it is what it is.” 22/
The death rate will also continue to decline which is wonderful news but will also lessen any urgency to focus on it. 23/
Yes science will eventually make a dent in COVID-19, but without even a little help from a unified populous, we don’t eradicate, we accept the kind of death toll we never should. The kind that “shithole countries” accept. 24/
Trump isn’t the reason for the virus. But he’s the reason too many people are dying and the reason it won’t go away. /end

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More from @ASlavitt

Jan 16
COVID Update: Why I still don’t want to get COVID, thanks. 1/
I like parties as much as anyone but an omicron party doesn’t do it for me.

Messing around with a contagious disease is like playing with matches at the gas station. 2/
I don’t want COVID. But even more than that, I don’t want to give someone COVID.

If I get it, I could be contagious before I even know I’m sick. 3/
Read 13 tweets
Jan 14
COVID Update: One thing I’m glad about— the people who think the pandemic should focus on paying people not to get vaccinated aren’t in charge.

From DeSantis to Rand Paul, nearly daily there’s a reminder of the difference between the first year of the pandemic and now. 1/
We have many challenges facing us in responding to the pandemic. But the contrast in how Biden is responding ,when I see the people who want the pandemic to be over but will only act to elongate it lead, I’m only grateful they’re not in charge. 2/
It is true we don’t have enough tests to handle the crush of new cases per day.

But while Joe Biden runs towards the problem w a billion free tests, a new testing czar & 8 free tests/person/month, Roger Marshall thinks the priority should be Tony Fauci’s financial statements. 3/
Read 22 tweets
Jan 8
COVID Update: We now understand the difference between a wave and a tsunami.

What I’ve tried to understand is how big it gets & what things look like afterwards. 1/
When the scales of the graph have to change, things that look big begin to look small by comparison. But this graph is about to get outdated… 2/
A number of experts are writing that the actual number of cases in the US is now 4-5x the reported cases.

In the past the assumption was it was more like twice the reported cases.

Why? 3/
Read 25 tweets
Jan 6
I am still doing my best to try to understand the meaning of the events January 6, 2021.

I think January 6 . . . .
was a day of martyrs, of heroes, of victims, of villains, and of clowns…and in votes taken soon after, many of the victims turned into clowns
was yet another reminder that the things we take for granted are not promised to us, they are earned
Read 12 tweets
Dec 31, 2021
Roller coasters give us fewer twists & turns than we’ve had in the last 2 years. 1/
Coming to grips with each new reality of the virus itself as we experience it— contagiousness, illness, symptomatic spread— is hard enough.

Yet each time we do, it seems to make new versions with different features an ever harder adjustment. 2/
We have seen a string of new news over 2 years that still manages to surprise as much as the first wave itself. It’s deadliness has been replaced by its fitness as perhaps its most enduring feature. 3/
Read 23 tweets
Dec 30, 2021
COVID Update: Tens of millions could get COVID in the US this winter omicron wave.

What are the chances of getting infected during this wave? How much different from “normal” pandemic times?

1/
Let me try some basic math. This isn’t big math with log scales but the kind where the numbers are round enough because there are enough assumptions to make precision feel false. 2/
There are 250,000 recorded daily infections now. Actual estimates are that it’s actually about 4x higher counting for rising test positivity, test shortages & at home tests. IHME projects well over 1 million/day. 2/

covid19.healthdata.org/united-states-…
Read 18 tweets

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