March 28 COVID Update: This week & the month are going to be hard. We have to do our best to protect vulnerable populations & health care workers.

But a couple states I talked to today feel there is a real fork in the road. I will share what the paths seem to be.1/
I think this is the week when we start talking in millions and never look back. Only a few weeks ago, we were breaking a thousand cases. We have a lot more testing now so we have likely been in the millions for a while.

That is somber. 2/
Remember the lag that occurs. What shows up as reported cases could be new or could be weeks old. But the hospital beds don’t fill up for a couple weeks and casualties don’t happen for a few more weeks after that. 3/
So it’s easy to see what’s coming in the near term. Millions of cases will mean tens of thousands of losses (probably around May). It depends on where the infections are (nursing homes vs. college kids) & what shape the hospitals are in in a few weeks. 4/
If the hospitals are over-crowded in some areas, 10k could be come 20 or 30k or more. So job 1 is protect our frontline health care workers, get them equipment and vents, keep them safe & on the job. 5/
Sorry I have to pause there. We’ve reached 2000 deaths in the US and in a couple days will be passing 9/11 totals. And 10s of thousands is unheard of.

Mr. President, fly the flag at half-mast. Acknowledge our losses. 6/
What happens beyond that point is history not yet written. We know #StayHome works. It’s working in Seattle, in California, in NY, in the UK, in Wuhan. The more strict, the better it works.

If we had the data, we would measure it in R0 (how many people each person infects).7/
This is where the tree branches. If we buckle down (6 weeks-10 weeks?) with social isolation, the curve flattens and in a really strong effort, can decline. If we let up, we are in for a very rocky and lethal extended period of time. 8/
So job 1 is support the front line workers and job is to figure out how to sustain the next few weeks. Job 2 is to bend the curve with social isolation.

Most scientists believe it is both completely necessary and that we are incapable of doing it. 9/
It is most scientists’ belief in human behavior & economic challenges that drives death toll estimates in the hundreds of thousands or higher.

It’s both on us which is good. And a tricky puzzle on how to sustain. But if we can through the Spring, there is a better phase 2.10/
If we did this we could begin in the Summer to test aggressively and contract trace like in South Korea.

Earlier I’m the week (feels like a century), I sent a letter to 59 governors about creating 3 South Korea’s at that point. 11/
As of today, 3 states had gotten back to us with preliminary interest. After the Coronavirus-3 package just signed, states now have the money to put these plans together if they have the bandwidth.

Many are prepared to help. 12/
Yesterday, we (@usofcare) sent all 50 states a first round of best practices and priorities. 13/…
This 10 page checklist is especially helpful for states that have yet to face what NY and early peak states have. 14/
The key in the next stage is broad community testing. And the ability to contact trace. This is a great resource for states on how to do it.

Imagine a world where the virus is dying off and then you did this? 15/

A digression? You might imagine a lot of people are starting to send me stuff. It’s wartime so I can’t fully check everything out. Better to be fast than perfect. That said I only want to put things up that I understand. If you have something useful get it to @SaraLederman. 16/
Back at it. Our third job after helping front line health care workers & #StayHome is easy because it happens automatically if we do the first 2: give the scientists time. 17/
I’ve talked about how you can’t catch up to something exponential. It’s like swimming after a speedboat (I borrowed that). But scientists can.

A large portion of the labs around the world are being converted to focus on COVID. 18/
Therapies. Rapid tests. Antibody tests. Work towards a vaccine. Other things I’m hearing whispers of. These are the optimist scientists to counter the really dark momentum of a virus.

Yes this sounds like a rejected script of a bad movie spot. 19/
Life would feel better but not perfect in this second stage. Some areas opening. Some periodic waves. But done right, measured, traced, and with a tight circle around infections.

And we can’t do it perfectly. People will travel. There will be super-spreaders. And jobs. 20/
We could need 3 or 4 more Congressional packages to get us through. And not everyone will agree to maintain this all the way to a vaccine. And that will mean a lot of lives with a virus hard to control. 21/
So getting through these months will mean adjustments, will mean agility, will mean finding a new rhythm. Personal disappointments but also new types of opportunities.

That’s why I decided to start this podcast. You can subscribe: 22/
Like many of you, I’m spending more time with family. And this was one of our son’s idea. We’re going to work on it together. Here we are starting. 23/
You will also find great resources at 24/
In the meantime, remember it’s going to get ugly next week. And we have to make it through these three jobs before we get to the 4th stage where life goes in in a slightly altered way. 25/
Focusing on the safety of nurses/docs, ventilators, and protecting our seniors. That’s where we are now. Many people are working at it. And it will take our untapped capacities to help get ourselves and each other through it. /end

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