Thread by @DrTomFrieden

Covid Epi Weekly: The First Cluster

Cluster at White House is symptom and symbol of the failure of Federal response. Overconfidence in testing. Lack of basic safety precautions in crowded indoor places. Delayed isolation. Incomplete contact tracing. Failure to quarantine. 1/13

Testing only useful as part of a comprehensive strategy; it doesn’t replace safety measures. There are false negatives, and even if accurately negative in morning someone can be highly infectious hours later. Also need 3W’s: wear a mask, watch your distance, wash your hands. 2/13

Masks are important. Worth reading science review by the wonderful @CyrusShahpar. I learned from it. In addition to protecting others & yourself, masks may reduce inoculum and make it more likely that if you do get infected you won’t get severely ill. 3/13 bit.ly/36UK4tb

Rapid (and complete) isolation reduces secondary cases. There’s strong evidence paid sick leave reduces risk that people work while infectious from flu, almost certainly the same with Covid. The only valid reason to leave isolation is for a medically necessary procedure. 4/13

Contact tracing needs to be done quickly and expertly to find all exposed, trace source, expand circle of those warned, quarantine, test, stop outbreak. Let’s rebrand (accurately): case investigator-> patient support specialist, contact tracer -> Covid prevention specialist. 5/13

Quarantine means not exposing others after you’ve been exposed. Testing negative is not a get-out-of-quarantine-free card: you can be infectious soon after a negative test. But we should be able to optimize conditions and duration of quarantine based on data. 6/13

Here’s the epi-curve of the White House outbreak, from what has been publicly reported so far. Strongly suggests a common exposure on Sept 26 or 27. An investigation should be able to determine the likely source and identify, warn those most at risk. 7/13 tabsoft.co/3iLeGiX

The White House cluster is not over. There are likely to be additional cases. Great graphic from Cleveland Clinic. A series of measures needed to reduce risk, prevent illness and death, and accelerate economic recovery. Anyone have a better term for “comprehensive approach”? 8/13

In the US, hospitalizations, deaths trending downward slowly, but cases steady or increasing in most of the country. Only Maine and Vermont are reassuring. Anticipate continued case increases and eventual death increases. There will be 230,000 reported deaths by Nov 3. 9/13

In NYC uncontrolled spread in religious communities, increasing risk elsewhere. The ONLY way to stop it is to engage community, support and collaborate on education from within, appeal to and support religious leaders to establish and manage acceptable isolation facilities. 10/13

Schools, run well, don’t appear to be major amplification points. At Resolve, we’ve been saying since March, we must keep in-person learning as available as possible. Requires reducing spread in community, adapting school environment and policies. 11/13 bit.ly/2SHPdME

Moynihan: You’re entitled to your own opinion but not your own facts. Farr: The death rate is a fact; anything beyond this is an inference. The cumulative US death rate has now passed the UK's, approaching Spain's, highest of high-income countries. Read the graph, and weep. 12/13

We cannot become hardened to the horror of continuing, preventable Covid deaths. A death in the U.S. every 2 minutes. A death globally every 10-15 seconds.

Every life is precious.

Who saves a life, saves a world.

/end