COVID Update April 18: States are assuming they must figure out how to ramp testing capacity & manage contact tracing with little support more than they’re getting now.

How are they doing? Coming in a few. A short one I promise. 1/
I know last night went too long. So tonight will be better. Plus I worked out for the first time in 2 weeks so I’m feeling very good about those 20 minutes. Plus stretching. 2/
There’s a new project called COVID exit strategy. The aim is to help states & the public see which steps toward protecting the public to open the economy have been taken.

Brought to you by the amazing @rypan. 3/
That’s Ryan on my right. Or your left. Well, on the end.

He was one of the key people on the ACA turnaround team. He does in hours what armies of people take months to do. 4/
Ryan, with a little help from @USofCare, accumulated the various metrics organizations have put together to make progress in the states. 5/
Interventions that have been identified. 6/
For each state, there is a Laurian if testing, case acceleration, deaths, and an overall composite of progress.7/
Most valuably, there is a layout of missing actions.

And a process for states to report updates. 8/
This is by no means complete & there are already things that will need to be added as they are available.

I think it can be a big help. 9/

covidexitstrategy.org
There is more we don’t know than know about COVID-19. We are running so many hypotheses right now?

-How many positive cases are there?
-How many asymptomatic?
-What accounts for severity of symptoms?
-Who is most infectious?
-Which drugs work when?
-How does immunity work? 10/
There are different kinds of people working on COVID-19: those who say they “know”, those who say they “think”, and those who say “we don’t know.”

I’m excited to talk to @NateSilver538 on #inthebubble this week about it. 11/

podcasts.apple.com/us/podcast/in-…
In the meantime we will be jumping on data & studies where we can find it. We don’t have time for peer review or double blind studies in a crisis.

Here @ScottGottliebMD points to a study on 1 of the major curiosity points— asymptomatic spreaders. 12/

twitter.com/scottgottliebm… twitter.com/scottgottliebm…
The picture of a large number of asymptomatic hosts is a chilling one.

One asymptomatic spreader can spread CV to 9537 patients in 40 days. (Using 10 generations & r0 of 2.5).

If 40% of those people have no symptoms, the impetus for them to continue to stay home is lower. 13/
With more asymptomatic people, some would argue that means it’s less deadly since the CFR is lower. I would argue that feature makes it more deadly. Cognitively when we come in to contact with asymptomatic people, we feel less reason to worry. 14/
If the report is correct, asymptomatic people are just as contagious.

To restate me earlier point, we don’t know. We just don’t. But it pays to prepare for the worst & that’s why all those measures on covidexitstrategy.com are so important. 15/
There is one topic I raised a month ago. I’ve raised it but not loudly enough, saw an article on it, and now I fear I should be beating the drum more loudly. 16/
The issue is the spread of COVID-19 into places without any health fare infrastructure to handle it— Haiti & their neighbors, countries on the African continent, parts of Latin America. 17/

nytimes.com/2020/04/18/wor…
Maybe the humidity and UV light will help in these warmer climates. Again, I don’t know. I do think CDC and WHO should be fully armed & collecting intelligence & NGOs at the ready. 18/
It’s hard for people to focus on other people’s problems when we have our own fears— that’s human nature. But that’s exactly the opportunity to show human greatness— at these moments. 19/
We don’t know what we don’t know. We need to go to school on this virus. Collect information. Not jump to conclusions. And be as safe as possible in the meantime. That’s all we can do. 20/
It will be increasingly tempting to get back into political back and forths, criticize & mock people who are either impatient or too cautious (depending on your view), to find people who are “wrong.”

I’m guilty of some of those things from time to time. 21/
We will be glad each time we showed humility for how little we know & patience when could have been provoked.

State & local leaders, health care workers & scientists work against long odds & often w/ no playbook. We will succeed because of their unwavering perseverance./end

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