I was the pessimist in my office cluster when we left the office for the last time in mid-March. The ACC basketball tournament in Greensboro, NC had just been cancelled midway through a play-in game. The news coming out of New York City was looking grim and and we knew that we had totally blown the early ability to test and trace as we had nowhere near enough testing capacity. Some of my colleagues thought we would see each other in person again after Easter. The median guess was around Memorial Day that we would be back in the office. I thought I would be back on a regular basis and working with my colleagues, getting cups of coffee with collaborators and brain storming with co-authors starting again today.
I had thought that we would mostly get the logistics of massive testing figured out. We have done that. However we are now running into significant logistical bottlenecks again and slowing down the test-assess-inform cycle makes each test far less valuable now than it could and should be.
BREAKING: Testing is about to reach capacity again nationally.
LabCorp the biggest lab has capacity for 130k tests/day (out of the 500k+/day) but with the run up in cases are now running 5 day wait times.
At 7 days, testing stops being of value. We may get there soon.
— Andy Slavitt @ ? (@ASlavitt) July 2, 2020
I had thought that late March and April would suck as we had built up a big base of unobserved and unknown cases that were actively infectious and those individuals were infecting new people until we had a massive bolus of future hospitalizations and deaths built up. At the same time, I had hoped that we would be able to rapidly respond to a disease with a well-established play-book: Break infection chains, first with overwhelming brute force of a sharp and near total lockdown where in person social interactions become rare and distant events and then once the infectious base shrinks, aggressively test-trace-isolate any individuals suspected of being plausibly infected. It would not be a pleasant lock-down period to get to the point where testing and tracing could be the effective and dominant control strategy while we waited for therapeutic, prophylatic and vaccine development, but the playbook has worked well in numerous settings and diseases.
Back in March we proposed our outbreak be managed by driving down transmission through stay at home policies while scaling up test trace isolate infrastructure until a handoff could be made. https://t.co/ESW3mZue22
— Caitlin Rivers, PhD (@cmyeaton) July 5, 2020
And that worked for April. We as a society did a damn good job of being careful and staying home. And it worked. We started breaking infection chains. We as a nation brought the Reproductive rate of the virus to well under one. We gave non-NYC metro area hospitals the breathing room to learn, to evolve, and to prepare without being overwhelmed.
And then we threw it away.
"I think right now we're where we were when New York City was having its peak epidemic," @ScottGottliebMD delivered one of his more dire forecasts of the #COVID19 pandemic on today's @FaceTheNation. We now have 4 major epicenters of spread: FL, TX, AZ, CA. Georgia a worry. pic.twitter.com/Le5xs0fNnQ
— margaret brennan (@margbrennan) July 5, 2020
Over the holiday, I was in a funk, a malaise. I was the pessimist in March and I was way too optimistic. We talked a lot about what the schools will do in the fall and how will the universities and colleges function? I don’t know. My wife and I are privileged enough that whatever the elementary and middle schools do, we can go with those decisions. Some decisions will be easier than others; my seven year old son really would benefit from being in a classroom at least some of the time. My eleven year old daughter can probably do well enough no matter what. I hope that my kids are in a classroom at least a week or two a month. But we can handle another semester of stay at home instruction or full return to school or the most likely hybrid mixture. I was the pessimist and I was way too optimistic.