Cases and hospitalizations are rising across the US

And I’m getting asked repeatedly whether we're heading toward lockdowns

Short answer – no – not if we are smart

Long answer? Its complicated

So let’s talk about lockdowns – and how we get through next few months

Thread
Lockdowns – shelter in place orders – are extreme

And awful. Super costly and usually not necessary

We locked down in March/April because virus spread across US in Jan/Feb

And we were blind. We had no testing. We had little choice

Situation now different. We know more

2/n
First, let’s talk about why everyone is concerned:

Cases rising in most states

Hospitalizations rising in most states

Test + going up too

As weather gets colder, expect things to get worse in much of nation

Why?

People will spend more time indoors. But not just that

3/n
Colder, drier air spreads SARS-CoV2 more efficiently

And here's the problem:

States across political spectrum too relaxed

Many loosening restrictions on bars, indoor dining

And, lot of spread happening in homes via gatherings

Home unfortunately, not safe from virus spread
Oh – you know where we are NOT seeing a lot of spread?

In K-12 schools

Schools aren't immune but we are likely overestimating their danger.

We really do need to open more schools

BTW private schools across nation largely open, public not. But I digress

5/9
Key failure of our pandemic response is we always act while looking in rear view mirror

We consistently act too late

We wait until cases rise, % positivity rises, before we pull back

And we are doing that now

And here’s another problem – the time period we are in

6/9
All of our political leaders are focused on the election

Makes sense

But that means we are not hearing much clear communication about the virus

You know the old saying:

Never have a pandemic during a Presidential election year

7/9
So here's our job:

Avoid lockdowns, get through next few months without another 100,000 Americans dying

How?

It’s the old boring stuff, with some twists

So let's make a list:

1. Be diligent about masks. Indoors whenever not home. Outdoors when close to people, speaking

8/10
2. Avoid indoor bars/restaurants. Outdoors or takeout

3. Stay in as small a bubble as you can tolerate

4. Avoid house parties / gatherings

Want to see friend? Outside

Too cold?

Indoors: wear mask, stay apart, open windows even little (Not year to be energy efficient)

9/10
4. Push for more testing

We hear tests coming. Where are the tests??

And if you get called by contact tracer, please respond

5. Push local leaders – mayors, governors – to prioritize schools, not bars/restaurants. Lets provide B/Rs $ so they can survive

10/11
There is a light at end of tunnel, I swear

We have zero national leadership so WE need to step up

Election coming – please vote

But don't lose sight of the virus

Lockdowns are awful, fully preventable

But they require that we be smart. And demand more from our leaders

Fin

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More from @ashishkjha

12 Oct
So this tweet is getting me lots of flak

Few points

I've become more optimistic that with proper masking, some distancing, more schools can open safely

Why? Because evidence base changing

Schools open in many places and aren't generally seeing large outbreaks

Short thread
I've been particularly swayed by work of the brilliant @ProfEmilyOster.

She brings evidence, not bluster, to this topic. Its inspiring

She's actually tracking data (!!). Yup, its not perfect. But its the best we have

Read her in @TheAtlantic

theatlantic.com/ideas/archive/…
Will we see some spread in schools?

Sure

Will it be worse than spread happening outside of school?

Not that we see in the (limited) data

But isn't it just "safe" to keep kids online until some unspecified future time?

No

So let's talk costs of keeping kids remote only

3/5
Read 5 tweets
8 Oct
Have been getting asked a lot about whether its safe for President Trump and VP Biden to debate in person on October 15.

So here are some thoughts.

Bottom line: depends on how luck we feel

But here's a bit more detail

Thread
CDC recommendations for isolation for people with mild to moderate disease is 10 days after symptom onset.

If we assume symptom onset was October 1, then debate Oct 15 should be fine

But for "more severe" disease, infected people remain infectious out to 20 days

2/n
But there's a twist

President got steroids early in disease course (day 3) which likely affects duration of viral shedding

Steroids likely extend shedding of SARS-CoV2

We saw this with MERS (another coronavirus) and have some evidence with COVID

frontiersin.org/articles/10.33…

3/n
Read 5 tweets
7 Oct
While nation is distracted with Presidential tweets, FDA rules and CDC guidance...

COVID cases are continuing to rise

Today's numbers are out and they are heading in wrong direction.

Averaging close to 45K cases a day

But underlying data more concerning

Thread
All data from @COVID19Tracking using 7-day moving averages

White House Task Force designates states as red, yellow, or green based on cases over the past week

Based on their cut-points

25 states are now in red zone

25 states + DC in yellow zone

No greens

2/n
In red zone, out of 25 states

18 have rising cases over past 2 weeks

15 have rising test positivity

13 have test + > 10%

20 have increasing hospitalizations

So in red zone, states have lots of cases and are getting worse

Not good. Need action to stem tide

3/5
Read 5 tweets
2 Oct
President was diagnosed with SARS-CoV2 infection evening of Oct 1.

First and foremost, we wish him and FLOTUS a speedy recovery

We also need to sort out who else has been infected

Incubation period of the infection is 2-14 days but reality is that its usually 3-5 days

Thread
So, depending on when he was previously tested, reasonable to assume following:

He was likely infected between Saturday and Monday.

Could have been earlier or possibly Tuesday (though unlikely)

If he was infected over w/e, he was infectious to others Tuesday on

2/4
It is not clear who infected the President

It might be Ms. Hicks but also possible they had common source

So what does that mean?

This will be a big contact tracing effort.

Everyone who has been near the President at least from Saturday, on needs to be identified

3/4
Read 6 tweets
1 Oct
Was on @CNN talking Wisconsin, campaign rallies coming up this weekend

So how are things going with COVID in Wisconsin?

Pretty bad

New daily COVID cases per capita is 3X the White House threshold for a “red zone”

So let's talk data

Thread

So some data:

Wisconsin currently generating 42 cases/100K/day.

That’s # 3 in the nation after the Dakotas.

And things have been getting worse all month.

2/6
Sept 1:

750 cases
8.8% test positive
305 hospitalized
5 people dying daily

Sept 30:

2400 cases
21% of tests positive
595 hospitalized
10 daily deaths

Staggering changes in a month

More than tripling of cases, doubling of test positivity, hospitalizations and deaths.

3/6
Read 6 tweets
30 Sep
About to testify to to House @EnergyCommerce committee about a pathway to safe effective vaccines

3 key points:

1. Science has gotten us here so fast.

People are losing faith in vaccines because of politicization. We must not let that happen.

Thread

We must let science, not politics drive the timeline to EUA

2. We need to ensure equitable distribution -- not repeat our mistakes from testing where pro teams, WH get testing but teachers and nurses don't

2/4
3. We need to eliminate financial barriers to the vaccine. A third of Americans say they won't get the vaccine for financial reasons. We can't allow that to be a barrier.

If we do our job, we can have safe, effective vaccines that are widely available sometime in 2021

3/4
Read 4 tweets

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