As US hits new highs in national and state COVID cases, and rising hospitalizations, some leaders say we're rounding the corner. Others offer fatalism that there’s nothing more to be done to control this US epidemic now that winter is coming. Both positions are just wrong. 1/x
US had 99,155 cases yesterday (559,124 cases over the course of the week) with about 800 people dying from it every day. There has been no turning the corner for the good. The trendlines are going in the wrong direction. 2/x nytimes.com/interactive/20…
And compared to rest of the world, the US is not doing well. US has about 1 in every 5.5 new cases globally. More total cases and daily cases than any other country. And It’s in the bottom 5th of countries globally in terms of new cases and deaths per day per 100,000 people. 3/x
US hospitalizations from COVID are rising nationally, as are COVID pts on ventilators, with numbers this high last seen in second week of August. 4/x covidtracking.com/data/national/…
The epidemic is most badly affecting states across Midwest and Mountain west, though many other states not doing well either, including TN, KY, RI, AK, AR, MS, AB. 5/x
These rapidly rising cases - particularly where there's no new policy direction or strong communication w/ public - will lead to more people sick and dying from COVID, more hospitals filling, degrading their ability to care for COVID pts and others who get hospitalized. 6/x
If you hear governor’s say something along the lines of “there is nothing more that we can do to control this epidemic,” that’s wrong. 7/x
One example of this is in N. Dakota which has 122 new COVID cases per day per 100,000 people. Compare this to Louisiana which has about 12 new COVID cases per day per 100,000 people. 8/x
If N Dakota were a country, there is only one country in the world that has a higher daily incidence (Belgium). If you look at the incidence map for ND, its nearly all red. nytimes.com/interactive/20… 9/x
Despite all this, this week WH Coronavirus Task Force lead Dr. Birx, said she found Bismarck’s COVID-19 protocols to be the worst she had seen anywhere in the country. 10/x bismarcktribune.com/news/local/hea…
And even now in North Dakota, there is no state wide mask mandate and wearing a mask remains a "matter of personal choice." 11/x
We don't say its a personal choice for people to speed through neighborhoods with small children at 80 MPH. State policymakers put in place rules that help us all stay safe together, so that one person doesnt threaten the safety and health of another. 12/x
Another example is South Dakota, which has a daily incidence of 118 new cases of COVID per day per 100,000 people. Also higher than any country in the world other than Belgium. 13/x
But Maggie Seidel, “senior adviser to Gov Noem, said the governor has no opinion on whether people should wear masks while in close proximity to others in public locations and ".... 14/x
"...and that the governor’s response is a measured one to a virus that she said will spread with or without governmental restrictions.” 15/x wsj.com/articles/covid…
That kind of statement – that basically says that government restrictions will do nothing to slow the spread of COVID – is false. Governments around the world have used restrictions to help countries get control of COVID. 16/x
Countries around the world have seen that physical distancing, masking, limits to indoor gatherings have had major impact in controlling COVID. As have testing, tracing, isolation and quarantine. More ventilation in buildings will also help decrease risks. 17/x
If all leaders had been strongly promoting all of these interventions all along, many states would not be in the position they are in now. But now that they are, those are the kinds of actions that need to be taken around the country. 18/x
And in places where the epidemic is worsening despite those measures in place, governors should shut or reduce density of higher risk organizations, such as indoor bars, restaurants, entertainment, religious orgs, as well as place sharper limits on social gatherings. 19/x
We don’t see leaders of other high income countries saying there is nothing they can do to stop the spread. Or saying that they are rounding the corner even as their numbers break higher records nearly every day. 20/x
Some countries have had to put in place “lockdown” measures for 2nd time. When they say “lockdown” this time, its mostly closures of higher risk orgs and settings like restaurants and bars, as opposed to the more extensive restrictions from March through early spring. 21/x
In the US, it’s wrong for political leaders to portray the choices ahead as either doing nothing vs full lockdown. There are many valuable measures individuals should be taking that will decrease spread. As well as useful restrictions that are far short of "total lockdown". 22/x
Sadly, governors that are not willing to take practical evidence based restrictions to slow the spread are in fact imperiling the progress made in opening schools and the economic growth that had been returning. 23/x
Epidemics that spread out of control in 1 state can spill into others. So all gov's should be encouraging each other to act in the interest of the whole country. We won't need to act like this forever. Vaccine is likely coming and will help change things for the better. 24/x
Meantime, if the epidemic is brought under better control, not only will less people get sick and die, but economic activity will be better, schools will be safer, hospitals less likely in crisis, health care workers less at risk. Goals which we all are likely to share. 25/end

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More from @T_Inglesby

28 Oct
US now has daily average of 71,000 cases, all time high for the pandemic. And trends are pointing higher. Nearly 1 in 6 new daily diagnosed cases in the world is in the US, even though we have only 1/24th of the global population. nytimes.com/interactive/20… 1/x
People have asked this week whether we are now at the peak of this new COVID surge because we are now higher than the summer surge. The answer is that there is no pre-defined peak. There is no plateau. No set upper limit the epidemic will hit and turn around. 2/x
The rise of COVID will only stop when individuals and leaders take actions together to slow it down. 3/x
Read 21 tweets
19 Oct
A state official working on COVID asked this week: given the number of deaths per 100 cases seem be lower than March, is the needed government response now similar to that which we need for a particularly strong strain of flu? Answer: definitely not, and here's why... 1/x
Yes COVID clinical case fatality rate has been moving lower as compared to early on in the pandemic. @WHO has noted that this past week and attributed it largely to improving medical response. 2/x urdupoint.com/en/world/covid…
The improved care seems a combination of dexamethasone (perhaps to small extent remdesivir, though new trial results suggest effect is small if at all) and better medical care in general as clinical world figured out how to deal w/ disease better (e.g. prone positioning) 3/x
Read 19 tweets
16 Oct
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
Read 21 tweets
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

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