On 9/23, Indiana's @GovHolcomb lifted nearly all COVID19 restrictions

wfyi.org/news/articles/…

This struck me and other public health folks as dangerous

A month later, how's it gone?

Pretty badly. Like really badly.

Don't take my word for it.

Let's look at data!

Thread
First, let’s look at Infections over past 2 months

All numbers 7-day moving avg from @COVID19Tracking

Between August 1 and September 23, cases fluctuating between 700-900 per day

Restrictions lifted 9/23

Infections start to take off by Oct 1

By 10/19, over 1800 cases per day
Test positivity was around 9% on 9/23

Today? Around 18%

Meaning Indiana missing way more cases now than they were a month ago

So identified infections AND missed infections way up

Ah you say, but what about hospitalizations?

Isn't that what matters?

3/n
Actually, infections matter too.

But, let’s look at hospitalizations

There were about 750 people hospitalized in Indiana on 9/23.

Today, its 1350

hospitalizations bouncing around from 12 to15 per 100K during Aug/Sept.

Around October 5, it breaks free and starts climbing
OK fine, but what about deaths?

During much of September, between 8 and 11 people died daily in Indiana from COVID

Now, number has more than doubled to 24 deaths per day

Deaths bouncing around -- but really breaks out around October 8 or 10

Graph
So this strategy of open everything up is not going particularly well

Cases have more than doubled

Hospitalizations have doubled

Deaths have doubled

Obviously, we can't be sure its because of loosening of restrictions

But timing sure looks like it

6/7
The bottom line is this

Indiana's current strategy is not working

There is no backstop -- it won't magically end unless people, policymakers act

We all know what to do

Its time for our political leaders to do it

Fin

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More from @ashishkjha

19 Oct
You know about dramatic increases in cases, hospitalizations across US

Surge began after labor day

But one state has done well during this time

Big state that would move national numbers

And what they've done holds a lesson for all of us

Yes -- let's talk California

Thread
Walk down memory lane:

California early to act in March, preventing surge of cases that affected many others

Over April/May, CA cases were low

But California had an awful summer surge, especially in SoCal

Cases peaked in late July: over 12,000 cases, 150 deaths / day

2/6
But in August, strong leadership from @CHHSAgency Health Secretary Mark Ghaly and @GavinNewsom

What did they do? Huge increases in testing including bringing new capacity online

Created highly customized approach on a county by county level -- micro targeting policies

3/6
Read 7 tweets
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
12 Oct
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
Read 11 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

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