Dangerous rise in COVID cases around US. We need to strengthen containment efforts and change directions. But it’s not inevitable that COVID cases will inexorably grow thru winter, sweep all parts of the country, or that our fate is sealed. We can change directions. 1/x
First – need to take serious look at the really concerning trends: > 65,000 cases nationally yesterday, the most since mid August, with average of 700 deaths a day. 2/x
Hopkins site shows 37 states rising in the last week. coronavirus.jhu.edu/testing/tracke… Many states, particularly in the Midwest and plains are seeing highest numbers of cases and highest numbers of deaths per day since the start of the pandemic 3/x
If you look at the NYT incidence map, many many counties in the middle of the country are bright red, which on that map means more than 56 cases per day per 100,000 people. 4/x nytimes.com/interactive/20…
To put that in perspective, the White House coronavirus task force said in a recent report that counties that received a green designation in their rating system (presumably the goal) should be less than or near 1 case per day per 100,000 people. 5/x
And, according to the WH task force, a county with > 14 cases per day per 100,000 people was classified an area as being in their red category, highest risk. Very high number of counties are now way beyond that. 6/x
The number hospitalized for COVID in the country is >37,000 which has risen from a low of about 28,000 about a month ago. 7/x covidtracking.com/data/national/…
Impact on Wisconsin health care system is serious and could get worse – with WH coronavirus task force reporting “extreme concern” 9/x postcrescent.com/story/news/202…
What is happening in Wisconsin’s health care system could be foreshadowing for other states around the country. On a normal day, Wisconsin considered to have a high ranking health care system 10/x wpr.org/federal-report…
We are not turning the page, rounding the corner, or near the end of this pandemic. We will get there one day, but we not close now and it's irresponsible for leaders to suggest we are. 11/x
Its important for the public to know exactly where things stand, without attempts to paint a rosy picture. If the public gets clear and factual information, people will be empowered to make good decisions. 12/x
Which gets to 2nd of the thread: Our fate with this virus is not inevitable. Yes the US has done poorly compared to most countries in the world since the pandemic started, but it's in no way too late to change how things go in the months ahead 13/x
I’ve heard a number of senior people involved in COVID response look at current conditions and winter ahead and say that a worsening slide seemed inevitable over the winter. 14/x
Its true that winter months will drive people indoors and if they gather indoors in large numbers, that will increase risk of transmission. But that is widely known now. And we can react and plan accordingly and make good decisions. 15/x
What happens in the coming months of the pandemic, depends directly on what leaders say and do and what actions the public takes. 16/x
Need to wear masks, physical distance, avoid big gatherings, do outdoor things when we can. Improve indoor ventilation whenever possible. People who can telecommute should. Good hand hygiene. Extensive testing, tracing, isolation/quarantine. 17/x
If we all do these things, they'd turn the pandemic in far better direction. In some places, if the epidemic can't be controlled by those things, more closures of higher transmission risk activities might need to happen for a while. But we're not yet all doing the basics 18/x
Saying it is inevitable is giving up on having the power to make a change. 19/x
Other places in the world have shown it is possible to have entirely different experiences than the US has had and is slipping towards. Since May, NZ has had 3 COVID deaths, Thailand and Taiwan have had none. 20/x
The continent of Africa (1.26B people) has reported 27,255 deaths. The US has about a quarter the population people, but about 217,000 (8 times) the deaths. 21/x who.int/docs/default-s…
We need to find resolve to take action to slow the spread of this pandemic and not let statements about inevitability discourage us from doing the right thing. Let's act with as much urgency+commitment as those living in countries that have managed to control their COVID /end

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More from @T_Inglesby

4 Oct
Ramifications of the COVID events in the White House of the last week for the public: 1/x
Its not right to say that the pandemic is turning the corner. We continue to be in the dangerous middle of it. 2/x
There are average of 43,000 new COVID cases happening every day, That’s 20% higher than 3 weeks ago. Cases are rising in >2/3rds of states. nytimes.com/interactive/20… Hospitalizations on the rise for first time in long time. An average of about 700 deaths a day. 3/x
Read 6 tweets
4 Oct
Anyone in close contact w president in time in which he was deemed to be contagious should be quarantined and tested. 1x
If president’s symptoms started Thursday, anyone he was in close contact with on Tuesday onward should quarantine for 2 wks. From this account that includes VIce President Pence nytimes.com/2020/10/02/us/… 2/x
Given Vice President Pence’s close proximity to the president - as per the NYT - the VP debate should be virtual. This debate could be done easily by a videolink and it would reduce risks to all concerned. 3/x
Read 7 tweets
4 Oct
President’s doctors’ briefing today presented some encouraging news. They reported he was breathing w/out oxygen and feeling well. They reported normal cardiac, liver and kidney fxn. But some news raised concerns. And other key information hasn’t yet been presented: 1/x
They reported president needed oxygen twice since symptoms started, which would likely mean he has underlying pulmonary involvement. The results of Chest X ray(s) and Chest CT(s) would provide specific information about the level and kind of pulmonary disease 2/x
In addition, Chest X ray and Chest CT at time of presentation with COVID has been shown to be predictive of a patient’s future course. Such as in this study ncbi.nlm.nih.gov/pmc/articles/P… 3/x
Read 12 tweets
2 Oct
Its terrible to see the President, First lady and other(s) in the White House staff sickened with COVID and I hope they recover quickly. It is important to consider and respond to the implications of their illnesses: 1/x
As with all people who get sick with COVID, it will take days or possibly weeks to know how it will affect any one individual in the White House who has become infected. 2/x
The fact that the President is going to Walter Reed may mean his symptoms are now concerning enough to his physician team for him to be hospitalized or that he is going to get a specific treatment, or that they just want him there to be closely monitored as a precaution.3/x
Read 12 tweets
29 Sep
We're now passing very sad milestone of 1 Million deaths from COVID in the world. Its worth thinking about what is working effectively internationally, and what isn’t, esp in terms of global cooperation and systems. Here are some thoughts on that: 1/x
.@WHO and most countries in world have joined together to jointly plan and buy vaccine via the COVID-19 Vaccines Global Access [COVAX] Facility. There has never been an effort like this before. This has potential to do enormous good. pulitzercenter.org/reporting/who-… 2/x
If it succeeds as planned, it'll accelerate vaccine development + allow access to vaccine to high income + low income countries. But it'll require substantial fundraising. Unfortunately neither China nor US are partners in it, which is leadership failure on both their parts. 3/x
Read 14 tweets
29 Sep
White House press conference today on 150M Abbott rapid antigen tests. whitehouse.gov/briefings-stat… Some reactions to what was said at the event: 1/x
As background: coming arrival of the Abbott rapid antigen testing was previously announced by White House on Aug 27th. washingtonpost.com/health/white-h… 2/x
150M is substantial number of Ag tests. Their arrival will be very welcome. Important to plan for how these and other Ag tests coming on line should best be used. It’s a very big supply of testing, but not enough to meet range of potential public and institutional needs. 3/x
Read 15 tweets

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