(1/x) I had been fairly optimistic about covid in US starting a few weeks ago as deaths/hospitalizations/confirmed cases started declining in Europe, suggesting significant declines in R0, thinking that similar declines would happen here.

(2/x) But US covid numbers *haven’t* substantially declined in many states and a few are experiencing rising numbers.

(3/x) The reason why US (per capita) numbers are on a worse path than Europe’s seems to be that our lockdowns/social distancing have been less stringent/effective/complied with than theirs on average.

(4/x) This is really really unfortunate as the economic consequences from the US’s lockdowns are not likely much better than those in Europe.

(5/x) And because our efforts have been less effective, we have the difficult choice of extending the status quo for a long time, or “reopen” and allow the epidemiological situation to worsen.

(6/x) This choice is one that all countries must make except the “status quo” is much more epidemiologically favorable in most countries than the US (notable exceptions are Russia and Brazil which are political basketcases)

(7/x) Additionally, covid testing and quarantine/isolation enforcement is less effective in the US than many/most high income countries (and many many low income ones too)

8/x This means optimal policymaking is harder for the US than other countries even before considering Trump/WH ineffectiveness and political polarization.

9/x Therefore, US decision makers are likely to make many “mistakes” in the months ahead.

10/x The likely result for the US is many, many months (and possibly years) of relatively poor performance—economic, epidemiological or both.