COVID Update October 24: I spent the day reviewing data with & from the White House team in the spread of COVID-19.

The latest rush of new cases is very concerning. There are new insights as well. Will finish posting shortly.1/

I’m not going to pull punches. It’s a shit show. Here’s the quick overview.

April: intensely local
May-June: locale-based spread
July: entire South. Every county
August: some easing
September: South better, rise if cases in heartland

That leads us til Now and Next. 2/

Now: Deeply penetrated in rural communities. Only counties w/ <1000 are spared. Heartland on fire, but just beginning. College spread story (I will come back to this as a main event). Testing leveling off. Southern states & East beginning to get concerning again. 3/

Also, hospitalizations up 40%. While not at Spring capacity, they believe this is worse. Because of elective surgeries, staff pulling themselves out, rural hospitals telling ambulances not to bring patients.

Once we’re here, we have the best of what medicine can do.4/

We have to stop getting our health care workers to that point. In that position. 5/

Next: The cold in the heartland is a precursor for the rest of the country. 200 million tickets for Thanksgiving. Americans will unite old and young around the table. Travel from college towns with rampant spread to local towns.

Deaths which are flat will rise. 6/

This will get worse and worse and worse before it gets better.

For those who this makes anxious, there ARE vaccines coming. Will come back to that. 7/

Many Americans are not up to keep up the battle. They have been misled by the President continuously that this is almost over instead of being told the truth. They feel hopeless and lied to. They are feeling fatalistic. That quickly becomes self fulfilling. 8/

Learnings from limited data (could still learn more:

Not much spread for elementary school
High school more concerning as a source of spread
Offices & small shops not a big source
Masks work but are not a substitute for isolation 9/

Colleges. Very interesting. 2 case studies. Both public data.

Boston University - best practices
U of Wisconsin - mmm, not so much

BU 150 cases
Madison 3500

Why? One simple reason. 10/

BU tests everybody on and off campus once/week & isolates positive cases
Wisconsin - tests if you’re sick. So 3500 is probably very light.

Guess what MANDATORY testing & isolation work. 11/

Is that transferable to other parts of our society. Some, like workplaces & health care settings maybe

But most don’t get paid if they don’t work. So a positive test is not something they can deal with. Since most of the spread is asymptomatic, we got a problem. 12/

Biden-Harris are promising paid medical leave.

As clear as I can be— without it, this doesn’t stop. Don’t give a society a safety net, don’t be shocked that a virus continues to spread. 13/

One of the key lessons of inequality coming home to roost. Ignore the poor working people and expect consequences.

If COVID-19 doesn’t teach us that, nothing ever will. 14/

Some people can’t afford to isolate. Without the isolation paid for (like @ScottGottliebMD and I proposed in the summer), it doesn’t stop. 15/

A humane country will make sure you are cared for, provide child care, make sure you can eat. Yes, they pay more taxes in many parts of the world, yes there are fewer billionaires, but the government has your back in tough times.

We just kick people in the front.16/

High school kids, particularly athletes, won’t contact trace or test. No one wants to be responsible for the game getting cancelled. That’s why there’s never 1 kid with COVID, but 30 by the time we find out.

Hey, they model their behavior on the White House. 17/

Trump says I won’t isolate, I won’t take a test, I won’t agree to contact tracing for people here. What do you expect the average high school athlete and parent to do?

This kind of behavior can make you president after all. 18/

Small family gatherings are driving significant case growth. There will be 35 million Thanksgiving dinners, all of the size and composition that should make us worried.

There’s a deep-seated and sad irony to spreading the plague to loved ones on this holiday. 19/

A vaccine, or vaccines, will have enough data to be approved & begin to roll out early next year. Who knows when it will get to you, but THERE IS A LIGHT AT THE END OF THE TUNNEL. 20/

I believe we will learn that our science is great and our society and politics are in need of deep deep repair. We’ve got to be willing to do it. We’ve got to get each other through these next few months. 21/

I want a spring and summer we can enjoy together. If you want that maybe start by having turkey over zoom. And voting your ass off. /end