Thread by @DrTomFrieden

Covid Epi Weekly: Scariest. Halloween. Ever.

Hard to imagine a worse confluence. Cases surging in much of US. People are tired of limitations the virus is imposing. Economic harm is real, painful, and persistent. White House communications continue to mislead, divide, deny. 1/

Bottom line (almost) up front: there IS one thing that can stop Covid. For months I’ve said there isn’t, but there is one thing. Not masks. Not travel limitations. Not staying home. Not testing. Not contact tracing. Not isolation. Not quarantine. Not even vaccine.

It’s TRUST.
2/

Around the world, the best predictor of controlling Covid is social cohesion. The understanding that we’re all in this together. We’re all safer when we all mask up, support tracing, and, eventually, get vaccinated. No group can get infection without endangering others. 3/

That’s why the unspoken advocacy for herd immunity by the White House is so revealing. “Protect the vulnerable” sounds great. But doing that while allowing the virus to spread among the young is an impossibility. It’s a scientific blunder emanating from a philosophical error. 4/

When we understand we’re all connected, we can win. Prioritize services to people and communities most in need. Protect ourselves, our families, our community. There’s only one enemy: a virus. White House divisiveness is the best ally the novel coronavirus could possibly have. 5/

Now, the disheartening numbers. Detected cases up 3x more than testing. Testing up 8.6%, cases up 24%. Positivity up 6.6->7.1%. PULEASE. Saying cases are up because of more testing is like saying gravity isn’t real. Good tho depressing graphic from The Covid Tracking Project. 6/

Good way to show that cases are increasing much faster than testing in every state. Case growth has been much higher than test increase in all states. (Mississippi's published data has been whipsawing.) 7/

Anticipatory guidance: expect lower case numbers over the weekend. Fewer tests, fewer office visits. Weekends are time off for many people, but not for the virus. This won't reflect progress, just lack of vigilance. 8/

Hospitalizations are, of course, increasing, following case increases. It’s SHAMEFUL that the federal government is not publishing data it has on the pandemic. Inexcusable! @NPR posted one of the internal daily reports; here’s a screenshot showing hospitalizations increasing. 9/

Will deaths increase? Does night follow day? Of course. We hope, ardently, deaths increase less than in the past. Better care. Fewer overwhelmed hospitals. Dexamethasone. Maybe some other treatments. But only time will tell. Deaths follow case increases by about 3 weeks. 10/

Wisconsin is a bellwether….

for Covid deaths. Huge increase in Covid deaths. Many other states, sadly, won’t be far behind. 11/

As an epidemiologist, I think a lot about numbers. This week two numbers made a big impact on me: 13 and 9. 13 years of life lost on average for each of the 230,000+ Americans killed by Covid. And 9 people on average grieving for each of those deaths. bit.ly/3mHDpXB 12/

We public health specialists must never underestimate the health and social impact of economic harm. We’re heading into a dark winter. We can limit harm with more outdoors, schools, social connections, shopping. And less indoor maskless contact in poorly ventilated spaces. 13/

Good news interlude. 9 of 10 people understand the importance of masking up. Those who don’t are a minute, misguided minority. Masking up correlates well with lower case counts. Mask mandates, if done well, increase mask use and save lives. bit.ly/34GFI7e 14/

More good news. Increase in telemedicine. Primary care is the most underfunded, neglected, and important part of our health care system. Telemedicine, if we get the regulation and reimbursement right, will be an important part of fixing health care. bit.ly/2TFX5ik 15/

Interesting survey data, summarized on covidexitstrategy.org. In states with >90% mask wearing, less than 20% of people know someone who is sick. In states with 80% or less mask wearing, 30-54% know someone who is sick. Look at the top and bottom. Striking! 16/

One of the many, many failures of this administration in its Covid response has been insufficient protective equipment for health care workers. Makes me SO ANGRY. Sending our troops into battle without the armor a competent government would provide. bit.ly/35OrUHl 17/

Cases increases→vicious cycle: longer test turnaround, overwhelmed public health, less isolation, more cases. Reduce cases by wearing masks, watching distance, washing hands, avoiding risky indoor spaces to create a virtuous cycle: fewer cases, better tracing, stop spread. 18/

Why the scariest Halloween? Thanksgiving in Canada. wapo.st/3ebw7sg. In US: Case increases. Divisiveness. Undermining science. Denying reality. Even countries which did relatively well struggling; the US, with a completely failed federal response, faces devastation. 19/

Tell it like it is: If US had a competent response we could have Covid death rate of Canada, Germany, & >100,000 Americans would still be alive, 1 million fewer people would be grieving, and our economy would be recovering faster. Facts matter. Science matters. Truth matters. 20/

Ending the COVID-19 pandemic? Orwellian. Reality and hard truth: The pandemic will not end any time soon. But maybe, soon, and end to the completely dysfunctional national response. 21/end