I spent the entire month of February 2020 in a state of silent panic.
Watching Europe + US outbreaks play out, I knew something terrible was coming. But few of my colleagues shared the depth of my fear.
It feels like this again. And I think the public still has no idea.
🧵
Just. look. at. this. graph.
Did late March feel terrible and apocalyptic? We are FAR past that point right now.
And guess what? We have not yet reached the BUSIEST HOLIDAY TRAVEL WEEK OF THE YEAR
My patients are asking me about travel plans. They have no idea what is coming
And how can I blame them? Even *I* am uncertain about how to best counsel them.
Honestly guys ... as a PCP my best source of COVID-19 guidance is #epitwitter and #medtwitter.
If this is how I feel, as a PCP and a professor at @HarvardChanSPH then I fear for our country.
@HarvardChanSPH Of the many many failures of US govt in the pandemic, total lack of consistent public messaging might be the worst
The CDC, White House, local public health depts. issue conflicting, changing and confusing messages daily.
People simply do not know what behavior change to follow
@HarvardChanSPH Because there is no clear guidance, I am confident that at least tens of millions of Americans will travel for Thanksgiving. During the worst peak of COVID-19 in history. With many states' hospital systems already overwhelmed.
December will be a very dark time.
@HarvardChanSPH A vaccine distributed in April or May will not help us now. We need UNCEASING and CONSISTENT messaging for people to STAY HOME and wear masks or else nothing will change.
Some say that high COVID-19 case counts are from testing. But this does not explain what is happening.
Hospitalization counts are at or approaching their highest level EVER in the US across many states and we have just entered the exponential growth part of the infection curve.
This is not a drill. This is a profound crisis approaching.
And the most vulnerable will suffer most
Remember nursing homes? The where 5% of the population has been decimated by COVID-19? Things have never gotten better there. And they are about to enter the most perilous threat of their existence.
@JAMA_current@kejoynt@DavidCGrabowski A little discussed bundled payment model run by CMMI from 2013-2018 was focused on nursing facilities as risk-bearing providers - so called "BPCI Model 3"
How did this program work for total joint replacement - the most common surgery in Medicare?
Part of the challenge has been persistent PPE and staff shortages. These are widely reported but there hasn't been much data on what is happening.
@Health_Affairs@CMSGov@McGarryBE@DavidCGrabowski We looked at nursing homes' answers about whether they had 1 week or less of 6 critical PPE supplies (e.g. gloves, N95, gowns) and whether they had shortages of staff in 4 categories (e.g. nurses, nurse aides).
@JAMAInternalMed The first study by @eric_t_roberts@Ateevm uses Census data from 2018 to ask how many Medicare enrollees have access to: 1) any computer with high speed internet 2) smartphone with data 3) any digital access
Proportion that lack digital access:
- 50% of those 85+
- 45% of those with less than HS education
- 50% of those below the federal poverty limit
- 36% of those on Medicaid
Clearly video telemedicine won't be accessible to wide swaths of vulnerable older adults