Covid Epi Weekly: Death Won’t Take a Holiday this Holiday Season

Divided government. Divided country. Just when we most need unity to stop the pandemic. Covid skyrocketing. 100-fold difference between S Dakota and Vermont, and 10x between northeast and upper midwest. 1/thread

How bad is the increase? Bad. Doubling, tripling of cases or more in many communities and states. Much of the country is in the exponential increase phase. Every day of delay cost lives. Basic concept: 1-2 punch. 1: Knock virus down, minimizing social harm. 2: Keep it down. 2/14

First, the numbers. Bad almost everywhere. CDC understatement: “Percent positivity increased [7.2% to 8.2%] among all age groups ... in all regions.” Horrifying. National tsunami. Hospitalizations up 14%, deaths up 8%. Deaths follow hospitalizations by a week or two. 3/14

Huge thanks to http://www.covidexitstrategy.org  for great work. We hope site and others will be put out of business by a competent Federal response that demonstrates the only enemy is a virus and gets us all on the same page. The more we work together, the more we can control Covid. 4/14

Hospitalization increases required exit strategy team to add a new color. Upper midwest is in the exponential increase phase. Here’s the key point: per capita hospitalization rates for Covid range from 500 per million to <50/million. 10-fold difference. Policy matters!! 5/14

One of the most frustrating aspects of the attention to Covid has been continued focus on the wrong numbers. Cases are only about one fifth of infections, and vary based on testing. Test-intensity weighted ranking/incidence helps. Varies 100-fold from S Dakota to Vermont! 6/14

We are waking up to truth: we need to shut down. We can do this sensibly. Keep schools, childcare, universities, shopping, ?barber shops, other areas open - ONLY with rigorous safety measures & modification. Reduce travel, risky indoor gatherings. Great example from Ireland. 7/14

Like oh-so-much-too-much in our society, Covid hurts the most vulnerable most. Rates vastly higher in American Indian, Latinx, Black/African American people. The virus doesn’t stay in any group - we’re all connected. The more safe we all are, the more safe we all will be. 8/14

Punch 1: Knock the virus down with strategic closures. We’ll do that sooner or later. But we need to vastly up our game with Punch 2: Reduce the time from infectivity to isolation. Paid sick leave for all. Rapid testing, rapid isolation - reduce infectious burden. 9/14

Stunningly study. Very high attack rate among children in families with Covid: 77%! https://bit.ly/3k0pdr6 

Other studies find lower rates, but bottom line: not helping Covid patients relocate during maximum infectivity extends explosive spread by weeks or months. 10/14

We must discover more. How to not leave infectious people at home. https://bit.ly/3mSeKzM  How to best use tens of millions of antigen tests being sent out. Validity? Utility? How to scale production of N95 (including safely reusable) and surgical masks? 11/14

Important: Success is possible. It takes rigor, discipline, patience, and working together. Good article in today's @CDCMMWR showing impact of closures, masks. Not as fast as we'd like, but it works. https://bit.ly/3p1oGsB  12/14

Covid fatigue is understandable. We all feel it. Excellent report from WHO EURO:
* Understand and empathize
* Engage communities to find solutions
* Reduce restrictions but protect lives
* Be transparent, consistent, predictable, and fair.

https://bit.ly/38r3y9c 

13/14

The sooner we shut, the softer and shorter we can shut. We can minimize disruption to holiday shopping, jobs, and education, and also find and reduce the major drivers of spread. To have happier holidays at the end of the year, we must stay much safer for next 6 weeks. 14/end