Through their votes, the American people have decided they want a new approach to the pandemic

But we have 73 days until new President takes office

73 hard days

Without action, additional 100,000 Americans will die by inauguration day. At least

So we can't wait to act

Thread
The key is that we are not likely to get much action from the Trump Administration

So we need to look for leadership elsewhere

But first, a little data on how we got here

Let’s talk about this moment.

All data from @covid19tracking using 7-d moving avgs

2/n
First, the current surge started soon after labor day.

We went into labor day with about 35K new cases/day

And now, we are at about 100,000 per day New infections in the US from September 11 through November
And as you’d expect, increases in hospitalizations followed about 2 weeks later

We had about 28,000 people in the hospital in mid-September

Now we are at 50,000 people hospitalized
And sure enough, increases in deaths followed 2+ weeks after that

We started October with about 700 Americans dying daily

Today, we are at about 1000 Americans dying daily
So now, we are identifying 100K-120K cases / day

This is the acceleration phase. Infections are rising fast

But there is one more piece of bad news:

% of tests coming back positive has risen a lot

It was around 5% in early September, now it is closer to 9%
That means we are missing many more infections today than we were 2 months ago

Here's the kicker:

Suspect the true number of new infections in US now is somewhere between 300K and 400K. Per day

I know. Depressing. But bear with me

Will get to what we can do shortly

7/10
And 1,000 deaths a day today?

Represents infections from a month ago

Today's infections are 3X that

Would not be surprising to get to 2000+ deaths a day in December

So when public health experts say they're worried.

This is why

So can we avoid this?

Absolutely!

8/10
So what do we need to do?

5 things

1. We should not accept that Trump team will do nothing. We pay them. We need to find ways to get them to do more

2. Congress should get $ to states for testing, schools, etc

3. States need to ramp up testing

They can with more money

9/10
4 Everyone just needs to wear a mask

Come on people. To save tens of thousands of lives? No brainer

5 the biggest problem is indoor gatherings – formal (dining) and informal (house get-togethers)

To quote @GovRaimondo people need to knock it off

We all have to do more

10/11
We have hard couple of months ahead

In 73 days, we'll have a team in place that has promised to use science to drive policy

Good

But they won't be able to fix things on day 1

There is a lot we can do now

All of us: Congress, governors, mayors, us as individuals

11/12
If we do those 5 things: push for more federal action, get congress to provide $, governors to push testing, we wear masks and avoid indoor gatherings

We can keep schools open, save lives, prevent healthcare system from collapse

And that would make for a much better 2021

Fin

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More from @ashishkjha

10 Nov
Biden team won't have formal power to manage COVID until January 20

71 days

Between now and then, we may see additional 100,00 deaths from COVID

Its a horribly high number

Why do I say that? Heres the math

Right now, 1000 people dying every day

That number will rise

Thread
The 1,000 deaths represents infections that happened 4-5 weeks ago

So how many infections happened 4-5 weeks ago?

On October 7, we had about 45,000 cases with 5% positivity rate

Yesterday, we had 110,000 cases with 10% positive rate

These are 7-d moving averages

2/6
So number of identified infections 2.5X

And % positive doubled.....meaning we are missing MANY more cases today than on Oct 7

We're missing so many cases today b/c of our wholly inadequate testing

So I suspect true number of infections at least 3-5X what it was on Oct 7

3/4
Read 6 tweets
27 Oct
President keeps saying we have more cases because we are testing more

This is not true

But wait, how do we know?

Doesn't more testing lead to identifying more cases?

Actually, it does

So we look at other data to know if its just about testing or underlying infections

Thread
Easiest is to wait 2-4 weeks

If underlying infections stable but you test more, hospitalizations and deaths will remain stable

But what if you don't want to wait?

Look at test positivity

As testing increases, becomes harder to find the next case

So test positivity drops
Best example is NY, which tests more than 100K people daily, test + of about 1.3%

So now, let's look at where we are as a nation vs 2 weeks ago

All data from @COVID19Tracking using 7d moving avg

Yesterday, did 960K tests
2 weeks ago, 898K tests

So testing is going up

3/n
Read 6 tweets
25 Oct
President Trump, advisor @SWAtlasHoover arguing there's lot of false coding of COVID

This is junk news

Like junk food, junk news tastes good but has no nutritional value

So what are the facts?

Don't hospitals get more $ for COVID?

Thread on hospital billing, COVID, and fraud
Our payment system is insanely complex

So this is a simplification

Hospitals get paid based on what condition patient has

A patient with pneumonia?

Typical hospital might get between $8K to $11K from Medicare, depending on whether pt has major comorbid conditions or not

2/n
So what happened in COVID era?

Cares Act gives hospitals a 20% bump (to about $9600 – 13K) if pneumonia is from COVID

Additional $1600 - $2200 for a typical COVID pneumonia patient

To get this bump, hospitals must document that patient is COVID positive

3/n
Read 11 tweets
25 Oct
I tweeted data from @MWRA_update on amount of virus in wastewater in Massachusetts starting to spike

What about more traditional metrics like infections, hospitalizations and deaths in Massachusetts?

Let's compared today's number with where we were after labor day

Short thread
All data from @COVID19Tracking. 7-day moving avgs

6 weeks ago, Massachusetts had:

323 daily new infections
331 people in hospital
12 people dying every day

Today?

937 daily new infections (up nearly 3 fold)
532 folks in hospital (up 58%)
17 people dying daily (up 37%)

2/3
What's driving this?

Indoor dining recently expanded

House gatherings/parties big driver

Disinformation makes it harder for people to stay focused

And complacency settling in that we did well over summer so we're all good.

We aren't

3/4
Read 4 tweets
21 Oct
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
Read 7 tweets
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

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