Thread by @dan_diekema

Since this is apparently the "day of a thousand hot takes" (most of which will be wrong), I'll interrupt my Twitter hiatus to highlight some things that this teachable moment should drive home. Because what's happening now reinforces several points often lost re #COVID19: 1/10

First are the timelines: INCUBATION period of up to 14 days means all the "X is negative today" stories are dumb, as X could still be incubating the virus. INFECTIVITY is likely highest prior to symptom onset, and infected persons can transmit for 2-3 days before sxs and... 2/10

...for several days after sx onset (infectivity dropping rapidly after ~days 5-7). Thus anyone can start shedding at any time (even between tests for those tested daily), so repeated daily testing does NOT reduce importance of distancing and mask use. This gets at the...3/10

..mildly ridiculous debate about "testing our way out". Repeated regular testing can help (provided contact tracing in place & ability to adhere to isolation/quarantine) but it is not a miracle solution and in this situation may have had opposite effect--false reassurance &..4/10

...refusal to adhere to recommended prevention measures cleveland19.com/2020/09/30/som… 5/10

Now for the COVID-19 illness timeline: We all hope everyone infected recovers quickly, but current stories about how X has "mild symptoms only" during early stage of infection do not tell us much about what may lie ahead. 6/10

https://twitter.com/dan_diekema/status/1244447071660277760

..those needing hospital care for COVID-19 (fortunately a minority, even in older age groups) don't typically worsen until a week or more after symptom onset. That's when "inflammatory" or "cytokine storm" phase of illness starts, if it occurs, hypoxia being early harbinger..7/10

...those at highest level of government will obviously get close monitoring and likely also early treatment with antiviral and immunotherapy (e.g. remdesivir, monoclonal Ab, steroids), so have reduced likelihood of adverse outcomes. 8/10

Next: a false dichotomy b/w "opening up" and "controlling the virus". Sure, you can ignore this virus if you'd like--meanwhile it will do what viruses do, and in the process fill hospitals, disrupt the economy anyway, & also find you if you ignore basic prevention measures 9/10

We can have an economy while also controlling COVID-19, but that takes leadership and a massive and well-coordinated response. That's what's been lacking in the US and explains our historic failure--perhaps this sequence of events can begin to change that. End on that hope 10/10