Epi Weekly. 40 million plus 1. And…NYC is on the brink of a precipice.

A minimal estimate is about 40 million infections in the United States with the virus that causes Covid. The infection of President Trump is the most prominent, and one of the most telling.

First of thread/

My thoughts are with the President, First Lady, family, and all others infected with and affected by Covid. The President’s infection is a reminder that Covid is an ongoing threat. No one is safe – not even heads of state – until everyone is safe. https://fxn.ws/3ioVuaG 
2/16

Risk of severe illness and death increases with age. A 74-year-old has approximately 3% chance of death, higher in males and people who are obese, and much higher if hospitalization is required. 85-90% of those infected in their 70’s will have no, mild, or minor illness.
3/16

People who get prompt medical care likely have better outcomes. Remdesivir may reduce the duration of illness. The data on convalescent plasma are contradictory. Monoclonal antibodies, which the president received, are promising, especially early in illness, but unproven.
4/16

Testing is only useful as part of a comprehensive strategy. What’s important isn’t how many people are tested or how often, but what is done with testing to reduce risk. Testing doesn’t replace wearing a mask, watching your distance from other people, and washing your hands.
5/16

It’s a plain truth that face masks protect others, and almost certainly protect yourself as well. The more people wear masks when we’re near others, the safer we’ll all be. Did the extensive testing done at the White House give a false sense of security? Absolutely.
6/16

We need to rebrand contact tracing. Let’s call it what it is: supporting people who have and who were exposed to Covid. Are Vice President Biden and Chris Wallace at risk from debate? Maybe. The louder someone talks the more chance virus will spread. 7/16 https://go.nature.com/34f6lig 

Every person infected with Covid is a step backwards in our effort to slow the pandemic and reopen society. We are nowhere near herd immunity, and getting there without a vaccine would cost hundreds of thousands of lives and millions of jobs.
8/16

We must better prevent and treat this virus. We’re all in this together, and the better we prevent and fight it, the more lives we can save and the sooner and safer we can get to the new normal.

Now on to the weekly tradition: Reviewing epi of Covid in the past week.

9/16

Overall in the US, most states had increases during September. New trend feature on the exit strategy website is helpful, although the trends are discouraging. 10/16 https://www.covidexitstrategy.org 

Really the only states reassuringly low are Maine, Vermont, New Hampshire, perhaps Connecticut. Many, like Florida, continue to have high positivity rates, are opening, and will inevitably have increases in the coming weeks. Intentional or just neglect of science?
11/16

Closer to (my) home…. NYC is on edge of a precipice. Extensive, ongoing spread in religious communities, very high risk of a resurgence. From Governor Cuomo: (NYC’s media statements have shockingly lacked basic information on the number tested and positive, and on trends). 12/16

Parts of this community had extensive spread in Spring. If it's being hit hard again either herd immunity hard to reach or immunity wanes.

For more than a month NYC has had 300 or so diagnosed cases a day. But we still lack basic information about how the city is doing. 13/16

What proportion of each week's cases were previously identified as contacts and were in quarantine already?
For how many was the source identified?
What's the average time from symptom onset, or test taking, to isolation?
Are cases isolating? Contacts quarantining? 14/16

Challenging to work with religious community that doesn’t trust government. How about hiring 1,000 people from community through acceptable intermediary organizations to fight Covid? Key to start ASAP, standardize training & performance monitoring and get community buy-in. 15/16

Today is Gandhi’s birthday. I think about his call to empathy, and to recognize that the enemy is hate.

16/Final