All we want is life beyond the thunderdome

Axios is reiterating what I said last week.  We wasted a season:

America spent the spring building a bridge to August, spending trillions and shutting down major parts of society. The expanse was to be a bent coronavirus curve, and the other side some semblance of normal, where kids would go to school and their parents to work.

The bottom line: We blew it, building a pier instead.

There will be books written about America’s lost five months of 2020, but here’s what we know:

We blew testing…

We blew schools… 

We blew economics…

We blew public health…

We blew goodwill….

The objective of sheltering in place for the spring was two fold. First, give the hospitals a chance to not get slammed in the first wave. That mostly worked everywhere except Metro-New York City. We also bought time for learning and development to happen. We know a whole lot more about how to clinically approach severe COVID with better tools now than in March.

The second objective was to buy time to moblize other resources that could successfully suppress and minimize viral spread with tools that are more precise and less costly than what we had to do in the spring. We failed at that.

Harris County + #Houston together can contact trace 600 COVID patients a day.
But the daily average is 1,500+.
This means tracers often miss a critical window to warn potentially pre-symptomatic COVID carriers to isolate away from family and coworkers. ➡️https://t.co/CDjTSrHSwc

— Zach Despart?️ (@zachdespart) July 19, 2020

If there are 900+ people a day who are not being contact traced, that invites either massive community spread or necessitates wide spread shut-downs again until the number of new cases per day are back within the capacity to aggressively, quickly and comprehensively contact trace and isolate anyone who was likely to have been exposed to an individual.  Contact tracing is a combination of public resources which, if they are state or locally funded, extremely scarce and social behavior.  It is far easier to  contact trace someone who walked to a mail box, drove to the store for a once a week 30 minute in and out and then stayed home then someone who ha a full and active social life.  Precise tools get overwhelmed with high prevalence and increasing social mobility so the only tools left are either riding things out with massive death and suffering OR blunt tools.

My wife and I spent most of the weekend talking about the schools.  Our school system had planned initially on a hybrid model and then switched to a full remote model for at least the first quarter.  Duke University is still planning on having students on campus in under a month.  The NFL is meandering towards an attempt to start training camps.  All of this is happening in the context of significant community spread and a haphazard policy response.

The question being asked right now is “When can we do X?”

The question that we should be asking and solving for is:  “What are the conditions needed to do X, and what do we need to do now to make those conditions happen?”

If we want kids in school, if we want students on campus, if we want live sports, then we need to clamp down on community spread.  That means massive increases in testing.  That means massive expansion of PPE distribution.  That means aggressive and prompt contact tracing. That means making isolation a non-ruinous proposition for working families. That means a ton of hard work.  But the choice is either doing the hard work to get what we want, or not doing the hard work, seeing massive suffering and not getting what we want.

We blew itPost + Comments (121)

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.

Misplaced March optimismPost + Comments (90)