A COVID-19 update from Andy Slavitt

I’m going to try to do a better job of passing along information about the coronavirus response that I think you might find valuable. Here, for example, slightly edited, is a tweet thread from Andy Slavitt, the former administrator of the Centers for Medicare and Medicaid Services under Obama. It’s a little rough, as I suspect he was trying quickly, but there’s some good information to be had in it..

COVID-19 Prep Update- March 14:

Last night I was on with state and local officials around the U.S. well into the night. By March 23, many of our largest cities & hospitals are on course to be overrun with cases.

I am going to prepare a memo for them. I will share highlights here.

They are highly dependent on the public response, so I will start there. We have no immunity to COVID-19, people who get it don’t know for a while, and for each person that gets it, they infect 2+ people.

You may have seen graphs that look like this. It shows how far behind Italy we are tracking in days, and how our trajectory compares. The U.S. and every country that hasn’t taken better preventive measures, like South Korea & Japan, is directly on (the same) course, lagging 2 weeks behind.

This is what it looks like in Italian hospitals. Every report describes this as a tsunami. And, if it happens like a tsunami in major cities, we will have 10s of thousands more cases than we have beds, and we will have 1 ventilator for every 8 people who need one.

What are mayors, governors and their staffs reporting? That people are jamming the bars.

I get it. Home from work. Cooped up. Crisis mentality. We need to let steam off. Shared experience.

But stop that. All the bars and restaurants are closed now across Europe.

The only way to prevent (a situation like in) Italy, given our lack of testing, is to socially isolate. Congress even allocates money for people to stay home. That rarely happens. But we blew our chance at containment.

If you want to see a thread on how we got here, and what to do as of 36 hours ago, I tried to be complete here. The thread does not contain predictions, but frames the course experts think we’re on without action.

Currently experts expect over 1 million deaths in the U.S. since the virus was not contained & we cannot even test for it.

This will be recorded as a major preventable public health disaster. I will try to relate what I learned from a long day of calls about what is happening.

— Andy Slavitt (@ASlavitt) March 13, 2020

Let me flip to my advice to mayors and governors. The first thing I’m going to start with— expanding medical capacity— has to be done, but will only make a tiny difference if we don’t self-isolate.

Hospitals must get rid of elective procedures, expand negative pressure rooms, move ventilator capacity to hot spots, and seek additional where possible, create isolation negative pressure rooms, get tests for every front line worker, get masks and other supplies, even on black market.

Get on the phone with someone from Seattle ASAP to talk through everything they went through, ran out of, and wish they had done.

Build tents to spec, commandeer hotels and arenas. Hire people losing work to sanitize everything.

State officials in some states wanted to screen at their international airlines and the Trump Admin did not/could not support them. Now we must consider stronger measures: for stage 3 countries, auto-quarantine. Consider shutting airport(s) temporarily for 30 days.

Many cities & states are considering calling in help from the national guard. Alarmed? My view at this point is better them now than the Red Cross later.

We can’t afford 10,000s of thousands to be hospitalized at once, so we need to prevent & slow down the pace. And if this sweeps through nursing homes, it is fatal to our loved ones.

Nursing home infection control is terrible to begin with. And they are better than elder care or senior living facilities. The death rate among those >80 who contract COVID-19 is 18%.

And, look, this is where we are…

NURSING HOME REGULATIONS:

The Obama Administration implemented them before a pandemic.

Trump eliminated them before the pandemic. And is trying to reinstate them now.

— Andy Slavitt (@ASlavitt) March 13, 2020

From every expert I have talked to, I am less convinced that schools should be closed. Either way, open or closed, there are about 8-10 items that need to be considered including meals, childcare (keep granny away), parent sanity, etc. I recommend giving parents the option.

Give the germ spreaders a place to go, feed them, teach them to be smarter than us when they grow up, and then protect the teachers. We need sufficient testing for that.

The Federal government did (a few) good things yesterday. It finally got the supply chain to produce tests figured out. Testimg availability should double in the next week. It is unlikely to be sufficient for a number of weeks beyond that— at least 4, but up to 8 I’m told privately.

I talked to several on the White House team who went from 0 to 50 at lightning speed. Why they were at 0 weeks into an outbreak when South Korea was 10 days before is a topic for another time (e.g., November) but the labs, mobile testing & supply will be straightened out.

But, testing in a few weeks will be like a sports team scouting college players after the draft. It will help us, but it won’t diagnose & prevent if we are following the Italy curve (above).

I need to close with (a few) messages: First, stay socially isolated, for real. Not for you, but for everyone. And if someone minimizes this all, patiently listen & explain. People can’t be bullied.

Second, root for the government to succeed here whether you like them or not. The stakes are higher than most of us have ever experienced: wars, 9/11, whatever. Let’s have an election with this behind us having pulled together. This does spread from Republican to Democrat.

I think this small thread from Emily Barson at @USofCare says it well.

In @USofCare 's 40 hours+ of talking to people across the country about their health care experiences, we heard time and again stories that boiled down to people feeling alone. Our health care system creates and reinforces seclusion and shame.

— Emily Barson (@ebarson) March 13, 2020

I can’t express enough gratitude to the frontline health care workforce. We need to do what we can to make your jobs easier. There’s no roadmap— only your training, commitment & undiscovered capacities that we are relying on. You are heroes.

Apple just closed all stores outside China. They know what’s in this thread. That’s a major signal.

NYC just had its first death & there are major concerns hospitals will be overwhelmed. If you live in NYC, stop any social contact.