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

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
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
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/
Read 26 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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