COVID Update October 10: I had a call with a Republican governor of a state in trouble and gave me a sense of where we are.

Here is what I learned...1/

1- The biggest concern is in rural communities.

90% of people in urban areas are wearing masks and spread is in better control. Rural community spread is large family & community gatherings without masks. 2/

This compares to the spring in the Northeast where spread was almost entirely in urban areas and to summer when it spread in southern states more evenly.

Governor believes masks & public health compliance are the biggest difference. 3/

2- No expectations from the Federal government.

Interaction with FDA, CDC, and WHTF were suprisingly limited. The sense of "we are on our own" was complete & final. 4/

This was a marked difference from the Spring when states were still hoping for Federal government support of some kind.

Trump wanted 50 states, with 50 sets of resources, bidding for the same things against one another with no central guidance. That's what we have. 5/

3- States are more on top of the data we lacked in the spring and watching things closely. Testing, test positivity rates, hospitalizations are all being tracked locally. That's the good news... 6/

But owing to a lack of federal resources for contact tracing and other state support, the real data states should know isn't easily available.

Hard to pinpoint hot spots. Don't knew whether cases are isolating. 7/

4- They are hearing calls in the state to "just isolate the old people" and stop focusing on public health. I've yet to meet anyone who has looked at the data, including this governor who believes that works.

It's viewed almost entirely as a political argument of convenience. 8/

It is an argument that gives up on people:
-"Old people" live in the community, only a few million live in congregate care
-Many live with younger family who work & go to school
-Many vulnerable people are not old
-Those in congregate settings have staff in the community 9/

Governors have seen the results. When cases go up in a community, hospitalizations & deaths follow. Yes, the death rate is improving & will continue to improve-- but it is still multiples of the flu & many multiples for older people. 10/

5- There is no disputing the science & data on masks, but huge concern about the blow back and non-compliance in rural communities. The wisdom of a statewide mask mandate was unquestioned, but the well has been poisoned from DC (my opinion). 11/

Not wearing a mask is no longer just a freedom of expression, but a way of identifying and protesting all sorts of wrongs. Even among a Republican political leaders, they are frustrated and at a loss.

Trump ripping of his mask felt like a message many saw as encouragement. 12/

If people need a place for their fatigue, frustration & anger, the mask is it.

So the conversation became what to do about it. How to communicate. How to prevent large gatherings in rural communities. 13/

To me, a mandate is only a start. And if that's all it is, we will have the split this governor is facing. Here are some lessons we have learned.... 14/

Why are people ignoring reason?

In Hong Kong & Taiwan & Korea, people know when to put masks on because they've been through SARS & MERS. This is new to us & we are experiential learners.

People aren't frightened & are in disbelief that COVID can happen to them. 15/

And if people are ignoring mandates, it's a good bet that glaring at them harder won't work.

Plus I think all the glaring is wearing us out. Its also surprisingly hard to glare with a mask on so you have to double glare. And reverse glare when people without masks glare. 16/

Someday someone will write a whole effective double blind study on how to glare on people effectively. But until that time, let's try another route. I'm going to try smiling.

It also won't work, but I will feel better. Will let you know. 17/

In the meantime there are some useful thoughts I talked to the governor about. (I did not bring up "smiling" because I wanted him to have no cause to hang up.) 18/

1- Governor Beshear (KY) made a point that its easier to ask people to "do something" than "do nothing."
2- Colleges which have safe planned activities have reduced the amount of unsafe activities
3- Frustration needs an outlet
4- Someone needs to sell against Trump 19/

So my suggestion? Get creative and engage the community. Plan safe local activities. Have local people talk to local people. Use self-effacing humor instead of shame.

In other words, even laws & mandates need to be sold when they're new. 20/

Its easy to be frustrated by people who are choosing their own comfort over the safety of others. At this point, many of us are out of patience.

But we need something other than frustration if we want to gain ground. 21/

It's October. And the states are dealing with different forms of the same virus. The science & public health response are less of a question. The data is better, but not perfect.

The culture, the politics, and the lack of federal leadership are now the greatest difficulties.22/

See a bit of how long we will likely be at this and how different elements are likely to evolve over the next year. I talk about this with @ZekeEmanuel. http://smarturl.it/inthebubble 

If we are going to sustain another several months to year of this marathon, we need better ways of coping. We need to communicate. We need to try to break down barriers. And we need people who make this a game & perpetuate the problems to get off the stage./end