We are nearing 6 million cases in the US:
2% of the population.
1 in 50 people.
Staggering.

182,000 deaths
560 deaths per million

What went wrong?
Some things are clearer in hindsight. Nevertheless here are some key factors. #COVID

Thread.

1) Border control: I think in hindsight this could have made a big difference. Closing borders early, and then permitting carefully screened entry with testing and mandatory quarantine helped many countries dramatically reduce cases.

2) Universal Masks: Seeking information & advice on universal masking from Asian countries would have helped a lot. Required humility to learn from health authorities from other countries. They had task forces of multidisciplinary experts; they followed precautionary principle.

3) Testing and Tracing: For whatever reason we didn’t have enough testing at start of the pandemic. And still don’t. What you don’t know you can’t prevent.

We were also never prepared for large scale human contact tracing— a critical requirement to reduce transmission

4) Inadequate PPE: The lack of national reserves, and inadequate domestic manufacturing capacity was exposed by COVID. We lost a lot of lives. And we still hear reports of insufficient PPE.

5) Overwhelmed hospitals: Mortality rates in the early hot spots were among the highest in the world. Despite witnessing the events unfold in Wuhan and Lombardy we didn’t prepare in February. The case fatality rate (CFR) that should have been 2% became 10-20% in some places.

6) Mixed messages: In words and in actions. This led to a loss of trust. I really don’t know where to start on this one. But it was and is one of the fundamental problems that led to the current state.

7) Our unique geography as a huge country with different weather & travel patterns meant that we were at risk of being hit harder than many other countries. Hard to contain.

8) In terms of air travel, we are the most connected internationally. So the entry points of the virus into the country was from all directions, and into multiple highly populated metro areas. Made it much harder to control than most other countries.

9) We also have more inequalities and more problems with health care access than other developed countries. This plays a role in our ability to detect persons with the infection early, isolate, contact trace, and provide best quality care.

10) Im sure there are other factors. Some of which are more hypothetical including proportion of persons with preexisting cross reactive immunity of some kind; some may be real: like proportion with comorbidities.

Couple replies to this thread worth discussing:

1) Yes. We are a free country. But we are not the only free country. Many countries enjoy the same freedoms, and managed to control COVID.

2) Yes. Many of these factors represent a failure of leadership. https://twitter.com/vincentrk/status/1279077585830502406