THREAD
Even with cases surging, we can get control of this

We need a coherent national plan based on 5 priorities

1. Mask use is rising but not fast enough. We need to determine the exact groups/places with low uptake, the reasons why & tailor ways to engage them & change that

2. We need to use pool testing to screen (as frequently as capacity allows) all high-risk groups - congregate settings, essential workers, others that are getting infected at higher rates based on location-specific epidemiology

With pool testing, we could test >5 million per day

3. For hi-risk settings - nursing homes, jails, bars, meatpacking plants - develop definitive solutions to eliminate transmission & do whatever it takes to implement them

Some may need more staff, PPE, oversight etc; some may need to be closed til transmission is more controlled

4. Conduct an 'epidemiological autopsy' of every case to understand how, why & where it happened

This will let us see what is driving transmission in a location-specific way & guide additional interventions needed & where to focus more effort (ie, masking, congregate settings)

5. Imagine if everyone had a forcefield around them that blocked virus going in & out?

We need definitively protective masks for the public that protect the wearer & are breathable

This isn't a pipe dream - there are prototypes that could work

We need to focus & get this done

All of this is very easily said but very hard to do

With the lack of political & institutional leadership, we need to keep pushing for that to change but we can't keep waiting for them to wake up & take the right steps

We need to start doing it ourselves

Many health depts are doing heroic work. We need to meet them halfway

We are overdue for a civic revival in the US & it couldnt come at a better time

We need our universities, private sector & community institutions to organize around what needs to get done & will a way forward

From working in countries where government systems often don't perform, the pressure created by all of us taking the initiative can be the most effective way to push our political & bureaucratic institutions into action

The stakes couldn't be higher

So many are struggling with economic uncertainty
Our children may not be able to go back to school
Our businesses are collapsing because of this

We are where we are but we know what to do. Just as epidemics grow exponentially so too can they be made to shrink

Let's get to work

@DrTomFrieden @cmyeaton @ScottGottliebMD @JeremyKonyndyk @T_Inglesby @Atul_Gawande @ashishkjha @JoiaMukherjee @s_keshavjee @kj_seung @PIH @BhadeliaMD @CT_Bergstrom @paulmromer @DrSoniaAngell @yhgrad @edyong209 @alexismadrigal @nataliexdean @rajshah @CIDRAP @gregggonsalves