COVID Update May 25: State of the Union: as expected the early May openings are increasing hospitalizations.

Topics: the spread, science, the politics, the globe.1/
State of the spread in May: as expected

It’s moving South and Midwest as the Northeast improves. Why? Because that’s what outbreaks do. They find the open areas. Good early states— like WV and MT— are seeing growth now. AL, WI, TX are seeing growth. 2/
The most concerning development is pointed out here by @ScottGottliebMD. Hospitalizations, after a decline, are moving back up. With 20,000 new cases, this means 800 new hospitalizations/day. If this continues, it will put hospitals in some areas under pressure. 3/…
Since 20 states don’t report, and it’s hard to get a complete picture of ICU beds, if hospitals in a state get 70% full & cases are growing, it’s a concern. This is a list I monitor. 4/
The cause and effect of states loosening up their standards may be seen in Wisconsin. The Supreme Court overruled the Governor & people were forced to vote in person in early April.
-Cases up 42% over last 2 weeks
-Symptom monitors are off the charts 5/
The best look at who is dying from COVID-19 is to look at NY.
-52% of the deaths were people under 75
-28% were people under 64
-~4 out of 5 had an underlying medical condition
-In every age group, more people of color 6/
State of Science: Our understanding of this disease we knew nothing about is advancing!

Why are we able to reduce R0 so quickly? Big events & super spreaders May hold the key. 7/
It looks like a small number of people in large concentrated events are bigger drivers. Cancelling flights, closing bars, halting sporting events & religious services likely was responsible for a large number of the 20,000 lives saved in May. 8/…
Super-spreaders. As the attached report from Israel shows, and as @EricTopol summarizes, a small number of infected people do most of the spreading.

This would mean that 80-95% of infected people are not very contagious or don’t behave in a manner which increases spread. 9/…
If true, this would make COVID-19 much easier to control. It doesn’t reduce the risk when someone’s infected, but it does mean we can learn to live with & control COVID-19.

And avoiding large gatherings is key. 10/
In his state of the union the dumbest thing of the week is Trump turning COVID-19 into a culture war by declaring houses of worship an essential service.

Please have faith. But put some of it in good science. 11/…
When bars and restaurants closed in March, transmissions dropped significantly. Old hot spots will become new again.

Even while we haven’t made nursing homes, jails, & meatpacking factories safe, we risk adding to the list. 12/
On vaccines, I have been quite purposely not falling into the optimism that many are, but i have moved from a 5 to a 6 on the optimism scale.

To be clear, vaccines are a 2021 event. Mid-2021 if things are going well. But so far things are going well.13/
The reason it’s hard to get past a 6 is despite Moderna’s & Oxford’s and Pfizer’s and Sanofi’s rapid work, in the end how many people the vaccine works for & who can take it will be unknown for some time. 14/
The state of discourse is: dishonest.

An example. Suicide has been en epidemic for the last 2 decades, growing to record numbers each year. 47k died from suicide & 70k from overdoses in the US in 2017.

And support to fund mental health during this time has been just a joke.15/…
But now, Trump says more have died from overdoses and suicide than COVID-19. Recall that 100,000 people & likely a lot more have died in the last 2 months.

It’s a cynical lie on the backs of people with mental illness. And the lie is filled with fake sources & fake data.16/
Please listen to @JasonKander as we talk about the real issues that are sadly ignored. Ignored for the purposes that this crisis too can be ignored. 17/…
The state of the world, particularly in South America, is frightening. 18/
Brazil is now going through its peak season and yesterday Brazil almost precisely equaled US case count on the way to surpassing it.

20803 Brazil
20806 US

Chile, Peru and Mexico are in real trouble as well. Having seen hospitals in all 3 countries, I am profoundly worried.19/
The death toll projection in Brazil is now 125,000 by August 4th. 20/…
This is supposed to be our off season. And it’s too active. On the other hand, spread is going to occur and cases will occur. We have the ability to reduce it by what we are learning about how it spreads & by making it less lethal. 21/
We make decisions now in the name of the economy that can be made wisely if we follow the #OpenSafely guidance. 22/
Reason for optimism is science, altered a bit by human behavior. Always the hard part. /end

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