We're about to pass the deeply tragic milestone of 200,000 deaths from COVID in the US. What have we learned about COVID and our response to it over the last 7 months? So much. Here is a start: 1/x

When a new epidemic shows signs it'll become a terrible pandemic as COVID did in China in Jan – healthy people dying, HCW infections and deaths, hospitals filling w/ critically ill, et al – countries should recognize a pandemic is coming + emergently prepare themselves 2/x

Government needs diagnostic manufacturers to be ready to prepare to develop & mass manufacture diagnostic tests (PCR and rapid Ag) – to Dx the sick and their contacts, to screen asymp in higher risk environments, and for surveillance. We need a national testing strategy. 3/x

Need sufficient stocks of ventilators, masks, gloves, gowns etc ready ahead of time – there'll be no warning before the next pandemic. Need capacity to surge manufacture all of
what US needs (and logically more to be able to help others 4/x

No more reliance on international supply chains. No more laissez faire approach to ‘letting market handle it” because it won't 5/x

Physical distancing worked to control resp spread far better than seemed feasible or probable. Most countries has them as backbone of response. But they come at very high societal, economic cost. Need plans for how to maximize their benefits and minimize their consequences 6/x

Data shows outdoors far safer than indoors – don’t lock people in homes. Lockdown is wrong term. Data shows large indoor gatherings are highest risk, so prevent those from happening. Activities have different risks associated with them. That should drive decisions. 7/x

Data shows masks decrease risk of transmitting the virus. This is not controversial in most parts of the world. It didn’t need to be here. Wearing a mask doesn’t stop the return of economic activity. They will slow COVID spread and accelerate the return of activities. 8/x

Diagnosis, isolation, contact tracing, quarantine are core elements of response. In US states, there is range of capability and commitment to these and to physical distancing, masking, and communications about large gatherings. That became clear over time w patterns of spread 9/x

You can see the result of that in the widely varying incidence around the country - from @nytimes 10/x

We have seen that there vulnerable groups that need special plans, resources and protections – nursing homes, prisons, food processing facilities, congregate living settings, immigrant detention centers. No modern precedent for how this virus has spread in these groups 11/x

People of color disproportionately being sickened and killed by this virus. Reasons inc. higher representation in essential jobs, greater incidence of underlying conditions, less access to medical care, et al 12/x

National and state response efforts -- including access to testing and vaccine development process - need to be guided by this increased risk and severity of this disease in people of color 13/x

Impact of this virus has been repeatedly underestimated. At the start of this. Again in spring when some said it'd be gone by summer. Or that it'd be burned out in the heat. And now we are hearing that again this fall. We should stop underestimating it.14/x

Early comparison of COVID to a bad flu season were terribly wrong even in the early weeks. That was really very clear then, and it is only more so now. One useful comparison: flu causes between 12000 and 61,000 deaths annually. https://www.cdc.gov/flu/about/burden/index.html 15/x

This past week COVID killed on the order of 5600 people, making it the second leading cause of death in US after heart disease, killing more than lung cancer which causes nearly 4,000 deaths a week. http://www.healthdata.org/sites/default/files/files/Projects/COVID/briefing_US_091820.pdf 16/x

The number of deaths caused by COVID are higher than deaths that had definitive diagnosis. On order of 225,000 excess deaths have occurred from mid Mar to Aug 29. Often takes weeks to enter deaths into national databases, so this is serious undercount 17/x https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Also clear now there are many survivors of COVID who have serious long term complications. We don’t have clear statistics on them, and need to get them. Learn how to best care for them. 18/x

Reporting on COVID has been often reduced to counting those who live and those who died. We need far more focus on the long term complications of this disease. 19/x

Some good news is that clinical medicine has made substantial improvements in ways people are cared for during serious COVID hospitalizations. You can see that w/ rising survival for critically ill pts in number of places 20/x

But the toll on health care workers has been terrible. Very high numbers of infections, many deaths. Still reports of PPE shortages even recently. HCWs deserve the nation’s deep gratitude for the risks they've taken in this response. And they need PPE that protects them 21/x

We've seen that global partnerships can be badly damaged without much notice. That our generations long work with WHO and other countries' science agencies can be badly fractured with no real basis. 22/x

Its been very encouraging to see the strong partnership between government and industry move vaccine development faster than ever seemed possible. A safe and effective vaccine could emerge this winter, perhaps ~ a year from discovery of a new pandemic. 23/x

But also have seen politics could derail the success of this unprecedented vaccine effort. That many Americans are concerned about safety and don’t plan to take it. Political interference in the process could end up sabotaging the greatest tool we have for controlling COVID. 24/x

Imagine what it would have been like to deal w/ COVID, w/out cutting edge science. The daily discoveries and analyses in epidemiology, viral genetics, immunology, clinical response, therapeutics, infection control, diagnostics, aerosols, social science, and so much more. 25/x

Unfortunately we've seen scientists, public health officials and our government science agencies can be badly undermined. We've witnessed scientific recommendations get changed by a political process. 26/x

We've learned there’s no guarantee that US science will be left to get to the truth, that it will be allowed to communicate freely what the evidence shows. It's fragile in a way that didn’t seem possible in a democracy. 27/x

Manipulation of science seemed like it was only possible in other places and times. Need now to stand up for science to operate w/out interference. Need to stand up for work w/ international health organizations and other countries who are fighting against same challenge 28/x

The good news now is that we know what we need to do to bring this virus under control. We have seen other countries do it successfully, and we are starting to see it in places in the US (e.g. Vermont, only 3 hospitalized, and no deaths since July). 29/x

Our work now is to take all we've learned and make sure we apply it to the pandemic work ahead. 30/end