1/ I was glad to be asked by @ScottGottliebMD & @ASlavitt to sign on to this important bipartisan proposal to Congress

Let me tell you why I liked this proposal, and some of my calculations for why the financial requests and structure proposed are reasonable

(views my own, etc) https://twitter.com/ASlavitt/status/1254736756710268929

2/ First-what's the bottom line?

By definition, to safely reopen we need to replace some of the reduction in R we've achieved through physical distancing with something else

It doesn't have to be panacea, but ramping up traditional public health contact tracing is our best best

3/ From an epidemiologist's point of view, there are several ways that contact tracing reduces the force of the epidemic:

*interviewed cases are more likely to isolate
*quarantined contacts spread less
*tested contacts diagnosed sooner, isolated, contact traced sooner (goto10)

4/ w COVID-19 we face a handicap- people seem to be infectious during a pre-symptomatic phase, and a number (maybe up to half) have mild symptoms

The only way to reduce these infections is to identify and isolate them as contacts early in their infection https://twitter.com/Farzad_MD/status/1249337825843167232?s=20

5/ Here's an illustration

let's say a case
is infectious on day 3
gets symptoms on day 4
is tested on day 6 (TESTING)
is interviewed, contact traced, isolated day 7

Infections they would have caused Day 7->14? prevented

The people they infected Day 3-7 are still presymptomatic

6/ None of this is easy

But unlike some other proposals, it's a hard problem of scaling what we already know how to do, that we know works

It's not hard like biotech is hard, or hoping that never-before tested bluetooth apps will save the day is hard

It just needs grit. and $

7/ One of the challenges with contact tracing is the ABILITY of people to isolate themselves for 14 days.

We know how crowded conditions can create pockets where outbreaks smolder and flare. People who work with their hands have to feed their families https://twitter.com/Farzad_MD/status/1245317678270746624?s=20

8/ That's why the proposal calls for funding for contact tracers ($12B), but also for hotels as a place for voluntary self-isolation for those who need it ($4.5B) and being able to offer the equivalent of federal jury duty income replacement x 14 d ($30B) esp imp. in these times

9/ These numbers are obviously imprecise, but let me break down the math I did to convince myself that they are reasonable

How many contact tracers needed?

If you add up the time to find, interview case, identify contacts, and followup with everyone x 14 days, it's ~ 6 FTE/case

10/ How many cases should we be planning on managing per day?

We have 30,000 new cases diagnosed a day right now, but we will hopefully not reopen until the cases have fallen substantially

OTOH we'e under-diagnosing by 5-10x and we need more cases diagnosed

Call it even-30k/d

11/ What portion of the ~200k daily cases and contacts will need hoteling for 14 days?

You can look at census questions on crowded households (more people than rooms), income levels, household structure~14% seems reasonable

Could find motels at $20 gov't rate!

~$4.5B x 18 mos

12/ What portion of ~200k cases and controls will need income support?

Given the economic situation, I would think that 40% is not too high (that's probably close to what portion of people keep jury duty pay)

at $50 a day, that's $20B a year, $30B in direct financial assistance