COVID Update September 6: This bug is beatable.

I talked to 3 lab directors, the FDA, 2 former FDA commish, 3 epis, 2 virologists & a senior White House scientist so I could give you a consensus on what we know. 1/
Much of the spread is highly highly clustered. Everyone who gets the flu is more or less evenly infectious. Here a small number of people are highly infectious. And there a small number of places where the virus is highly spreadable. 2/
Compared to other viruses, we would much much much rather not have asymptomatic spreaders and pre-symptomatic spread, but fortunately not everyone coming in contact is getting it. Its not the measles. 3/
Knowing WHO and WHERE are the important mysteries to solve. The WHERE we have figured out. Cramped places, indoors, with poor circulation, and loud talking & laughing.

WHO is trickier (no WHO jokes, no Abbott & Costello jokes-- surprised at my discipline?). 4/
We know kids shed the virus. We know adults shed the virus. We know some people shed a lot more. There's a mixed view as to who that is.

The view towards kids is we know they shed but have little idea why they don't shed to adults very often. 5/
One person said don't be surprised if it is their height relative to ours and that their particles drop.

We could of course be facing a virus that is much more devastating to kids than this is. We are all grateful & a few people worried that next virus we might not be so lucky.6
One pretty hardened scientist made that comment with a quiver in their voice.

In fact, I heard "I don't know" a lot. 7/
Another piece of good news I describe this way-- although none of the scientists used this language. For this virus, God gave us the gifts to fight it. Respiratory means avoiding those places & masks & social distancing. 8/
Social distancing is a privilege. We forget because it feels like a hassle. But the reason more time goes on, the more this is afflicting immigrant, Latinx, and essential workers is essentially that.

So places & jobs stack the deck-- public housing, factories, farms...9/
Sociologists tell me that as people feel less personally at risk, the pressure on them to stay safe subsides. White communities, suburban communities, college kids don't keep the difficult habits up. 10/
A lot of this explains why hard hit communities see a sustained drop in cases, often commensurate with how bad it was. New Yorkers are scared straight (old TV show reference); Phoenix too. Places with mild cases like Charlotte or Minneapolis can't get cases all the way down. 11/
In those places you're more likely to see the hundred person gathering, the bar open, the people going maskless. As time passes, we will see how long the affect lasts. 12/
The better the informed, the less the scientists pretend to understand about immunity. All the certainty we have is Twitter certainty.

Can people get re-infected after a period of months? We now know they can. How likely? How bad? We don't know. 13/
Will all New Yorkers have lost their immunity in a year? No one really knows. They don't think so, but obviously it can't be known.

When does herd immunity slow down the virus? Is there a cross immunity benefit? Unknown, but consensus is likely small if at all. 14/
Asymptomatic testing? Everyone believes it is vital until we have the virus well under control.

The next big innovations in testing? Saliva test prevalence is growing. And at home testing is a month or two away. 15/
Therapies: not much enthusiasm for convalescent plasma. Much excitement about monoclonal antibodies.

Steroid treatment (Dexa) > Remdesivir
Cookies & milk > Hydroxy

16/
Long haulers. This will be the subject of Monday's #inthebubble.

More is known by looking at past viruses than this one. Research centers are getting set up. The physical and the mental health effects are quite real and you will hear. 17/

smarturl.it/inthebubble
We will need to stop discussing COVID-19 as alive or healed and start measuring chronic as well. Somewhere between 10-50% of COVID cases report not being back to normal within 2 months. 18/
Many long-haulers are having trouble being believed.

Just like with the bug, people in our country have a tough time believing things they can't see with their own eyes.

We may be the most literal people on the history of the planet. 19/
I asked every scientist the question-- from March, are we as far along as you would have thought or further behind?

Everyone was disappointed in one way or another, some very disappointed. 20/
I asked a few if they were fear mongers. Everyone of them to one degree or another was personally somewhat scared of COVID.

But all agreed: this isn't the killer bug, 21/
In fact, COVID-19, is more of a test run bug. San Francisco, Hong Kong, and Singapore are experiencing COVID-19 with much more capability because they have had their viruses and they have real public health systems. 22/
Come listen to @larrybrilliant , @DavidAgus , Mark McClellan, @mtosterholm , @DrTomFrieden , @cmyeaton , @vivek_murthy & @Farzad_MD on past episodes of #inthebubble.

Even better... 23/
Monday episode on Long Haulers, Wednesday on The FDA, then on innovations in testing.

So all of this will come to you first-hand. 24/
Here’s a full list of shows. Smarturl.it/in the bubble

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