With the election behind us, it’s time for the US to summon its best, unified effort to contain COVID. So many have been at that since the start, w/ heroism and sacrifice. But the pandemic is now taking full advantage of confusion, anti-science, misinformation, fatigue. 1/x
Things are moving rapidly in wrong direction. Time to set a new path to controlling this pandemic. 2/x
Its easy to see the current US path is failing. National case numbers higher than ever. Many hospitals under rising pressure. More people w/ COVID in ICUs than since early May. >1,000 deaths a day. US in worst 6th of world in daily incidence. National % positives nearing 8%. 3/x
Down this current path lies continued rapid rise in cases. More people on ventilators. Higher numbers of people dying. More survivors with long term consequences. Hospitals under pressure until they can’t provide care for everyone anymore. Shortages of tests, PPE. 4/x
This path will push schools to close where they are now open. Will expose more teachers, essential workers, health care professionals to risk of dying. Higher risks to people of color. Will damage economic recovery and any return to normalcy. Time to set a new path. 5/x
Governors should start by speaking loudly, unequivocally about dangers of COVID, how it's getting worse, not better. Too many have been led to believe there's a hoax or that deaths are inflated. We need governors across political spectrum to put an end to those falsehoods. 6/x
Governors who've not required masks for people in public should do that now –evidence is clear masks lower transmission risk. Govs don’t let people drive cars in ways that endanger or kill others, they shouldn’t let people be out in in public near others without masks. 7/x
Govs should suspend indoor gatherings of > 10 people given risks of transmission, superspreading. Govs should emphasize physical distancing. No large indoor or outdoor events w/ people very close together over time. And need better guidance + $$ for better indoor ventilation. 8/x
Where virus is surging, and that's a lot of the US now, bars should be closed, restaurants limited to outdoor seating and take out. Provide economic assistance programs to help owners of those businesses. That’s the deal we owe them as they close in order to help all of us. 9/x
Governors should use data they are getting from their disease investigation teams to suspend other activities at highest risk. E.g. see LA's valuable site tracking sources of outbreaks ldh.la.gov/index.cfm/page… All states need this kind of data and should respond to it. 10/x
Testing of symptomatic people will have to be surged higher quickly to keep up w this surge. Frequent rapid testing (molecular+antigen) should be brought on line for universities, schools, nursing homes, prisons, other big institutions, et al as rapidly as possible.11/x
Planning for vaccine distribution is under way around the country, but there has been no money provided by Congress or the Administration for the huge vaccination effort needed. 12/x
If we have a safe, effective vaccine come out of clinical trials in the coming weeks, but we are not fully ready for a vaccination program, that will be a self inflicted national wound. A delay that could cost many thousands of lives. 13/x
We will need clear, science based national messaging on vaccine in the coming weeks and months. No more interference in the scientific process or artificial timelines for products that haven’t been proven safe and effective. 14/x
Time for all leaders to come together on communicating about the vaccine. The public was subjected to chaotic inconsistent messages earlier in the fall, and that hurt vaccine confidence. We need to rebuild that confidence now, with science and truth. 15/x
President-elect Biden called for unity last night. He said the US is not blue states or red states, but we are United States. COVID shows us that to be so deeply true. All states are vulnerable to this virus, and all states need to use the same principles to control it. 16/x
Fortunately, the new Administration has publicly committed to a huge new effort to contain COVID. But that Admin does not start for >2 mos. Meantime, the pandemic is moving badly in the wrong direction, and we will need collective action across the country to slow it. 17/x
The country can get control of this pandemic. Other countries have done it. We need to rely on science, civility, pub health, common sense. Leaders need to help people make wise, informed decisions, and to encourage all of our people to act w/ unity of purpose. /end

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More from @T_Inglesby

31 Oct
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
Read 25 tweets
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

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