Thread by @T_Inglesby

The course of the US pandemic is not set or inevitable. we need to recognize how dangerous this epidemic is now and how much worse it can get. But we still have power to change its course, diminish some of the most dire consequences, stop this terrible slide downward. 1/x

First -- the dangers and consequences of what is happening now. More than 159,000 new cases yesterday, a speed which will give us 1M new cases in less than a week. More than 1500 deaths yesterday, more than 8000 Americans dead from COVID in a week. 2/x nytimes.com/interactive/20…

More than 76,000 people hospitalized with COVID, with 10,000 new patients hospitalized a day, in recent days. theatlantic.com/science/archiv… 3/x

Every US state is on the rise, with some of the states epidemic curves nearly vertical upwards. Many are not only setting daily records, but also showing the fastest, steepest rise since this pandemic started in March. 4/x

For every hundred patients that get sick, a lower percentage are dying than did in March, which is amazingly good news we can attribute to incredible, self less med care by health care workers around the country, new approaches, dexamethasone, experience with this disease. 5/x

But that improvement is being offset by extraordinary rise in case numbers overall. Even if mortality rate is lower, if the numbers of people getting sick are high enough, the deaths in the US per day will exceed those of the earliest darkest days of March. 6/x

When numbers of people are dying in such high numbers, it can distract from the tragedies happening in individual lives. One example of the hundreds of thousands: this little boy lost both parents to COVID cnn.com/2020/11/17/us/… 7/x

Hospitals are filling up w/ COVID pts. It's what's been feared around the world since this began: so many people would become sick at once that hospitals would be overwhelmed, care would break down, hospitals would be unable to care for pts under the stress. 8/x

That happened to some hospitals in NYC in March. And in other countries. In Belgium, a country of great resources, they had to impose major restrictions at end of October “if they were to prevent the hospital system collapsing within days.” bbc.com/news/world-eur… 9/x

If you are not frightened by what COVID is doing to the US, then google “hospital Covid” in any particular state in the Midwest or Mountain West and read what is going on. People are dying, health care workers are exhausted, some leaving the profession. Systems are breaking. 10/x

All of this is not inevitable. We still have the ability to change directions. We know what kinds of actions can drastically slow this pandemic down. 11/x

As a baseline for action, all of us should be wearing masks when in public spaces, distancing, avoiding indoor gatherings, resisting travel for family events, telecommuting whenever possible, improving ventilation in indoor spaces, washing hands frequently. 12/x

We need to increase testing – huge positivity rates mean we/re finding smaller % of cases. Need to rapidly expand testing (in schools, universities, prisons, nursing homes) but also in homes as soon as FDA authorization, manufacturing at scale, distribution allows.13/x

Those actions are the foundation for control. They won't be enough to slow an out of control epidemic in many places now, but are central part of what we need. Because not enough have been following that path, it will require more now for a period of time to get control. 14/x

Other countries have been in similar spot and taken steps that controlled their epidemics. 15/x

In September, Israel had a deadly and rapid surge of the disease, and took a series of restrictive measures, limitations on businesses, travel and gatherings. In a matter of weeks, they had turned around the epidemic there. 16/x

In Belgium, instead of letting their hospital system collapse, they took a series of restrictive measures, limitations on businesses, travel and gatherings, and had a turn around of their epidemic start in less than two weeks.17/x

In France, the same is true – terrible surge of cases, followed by serious restrictions for a period of time, and now starting to see a substantial reduction of cases. 18/x

So in the US now, we need to stop gathering in big groups, stop attending restaurants and bars and other entertainment settings where people are in high numbers, close-in, without masks. Avoid being in buildings with others when they don’t need to be. 19/x

Of course many things require people go to indoor spaces, including groceries, pharmacies, retail, medical care. In those cases, people should be wearing masks and staying distant. But if you don’t need to go to an indoor space for something important, then avoid it for now. 20/x

These principles for action are clear and are being used around the world, where there is little debate or controversy around them. That there is debate about whether these things work in the US is a self inflicted national wound we need to heal. 21/x

Of course, we need to deal with the economic consequences of these actions, and that is on national policymakers to develop relief for those whose businesses need to be limited or closed to protect us all during the worst moments of the pandemic. 22/x

This is also the critical time for Governors to work together to get us on a better path. If they're able to work together with a common set of proven principles for action, they can move their states, and the country as a whole, to a safer far less dangerous place quickly. 23/x

Governors can help us to save countless lives, bring out hospital system out of crisis, bring more normalcy back to our communities, and with that, more economic recovery. 24/x

The situation we're in will not last forever – vaccine is now coming. It'll take months – at least all of winter, possibly much of spring or beyond to get large portion of country vaccinated. Meantime, we all need to work closely together to bring this epidemic under control /end