FIRST SUBJECT Keep your heads up, hold them high, stick out your chest. The American public deserves to be very proud. You have embraced self-isolation and social distancing. This has accomplished exactly what it was designed to do. The curve has been flattened. Sacrifice, patriotism, cooperation and empathy will be written in our history for the next 200 years.
How do we know that these actions have worked? There are two clear metrics. First is the death rate in the US. Since April 10, thru May 8, the 7-day rolling average of deaths has remained between 1,800 and 2,200. The 7-day rolling average is an important way of looking at the data because it takes into account the normal variations that occur in reporting, particularly through weekends. This method smooths out those daily variations.
Had we not begun social distancing in early April, we would have expected to be seeing over 5,500 deaths per day now.
The second metric is a little more subtle, but no less important. Consider for a moment that you are in a concert hall; the hall is filled, and everyone is waiting for the concert to begin. Everyone is talking to their neighbor. You can’t possibly make out the conversations of anyone more than a couple of feet away from you. Now, the concert is about to begin and most of the people in that hall stop talking. If some people continue to talk, it is very easy to identify who they are. By reducing the overall “noise”, you can more easily identify where sounds are coming from.
The same is true for virus data. If you can eliminate the noise, you can more easily see where the hotspots are. And that is what we are seeing. The noise, in this case are the single or small virus outbreaks that occur on a random basis on the street, in shops, restaurants and malls. These are the infections that have been curbed through our isolation efforts. When that noise is reduced, suddenly those situations that are most likely to generate larger amounts of infections are high-lighted. When people are closely packed, for long periods of time, without protective measures in place, they are more likely to generate infection clusters. That is why we see Nursing Homes, Prisons and Meat-packing plants as hot spots. We can expect to see other similar locations beginning to emerge such as migrant worker camps, schools that have already reopened, churches that did not stop assemblies, etc. The simple fact that we can now so easily identify these emerging sources confirms that the curve has been flattened.
SECOND SUBJECT Keep your head up, your eyes open and your ears perked. There has begun a move towards “identity-attribution”. This reveals itself in the way some people will talk about a racial link. The fact that African Americans and Hispanics are overrepresented in the statistics for hospitalizations and death is often misread. You will hear that it is because there is a racial/genetic link; that the link exists because these “people” have a higher degree of co-morbidities, particularly obesity and diabetes; that it is because these “people” do not live with the same standards of health and sanitation than the “rest of us”.
Keep your head up. These arguments are completely simplistic, but they are false; they play to our inherent need to project a sense of our own safety; that WE are more likely NOT to be infected, NOT to be hospitalized and NOT to die. It is self-protective. It is wrong, but I sincerely hope that although it is vile, it is not malicious (if such a duality is even possible).
The truth is that the virus has no racial, genetic or sex-linked objective. However, hourly employees who work in “essential” venues, who travel on urban transit, who are potentially more easily exposed and exposed while they are in a diminished health state due to stress, exhaustion or close proximity to others, those who live in concentrated buildings that are not well maintained and that have many people entering and exiting. Those people will be significantly more likely to become infected. And in our society, that cohort is more likely to be made up of racial minorities.
THIRD SUBJECT Here is a head’s up.
Focus on the disease, treatment, survival and cure. You will be tempted to get side-tracked by “blame seduction”. It doesn’t matter if China acted badly (they are a repressive autocratic society, DUH), or if the current administration was slow to react. It doesn’t matter if the WHO was imperfect in its response, or if the CDC was incompetent in its test production. It doesn’t matter if Korea, Singapore, Taiwan and Hong Kong have kept their total infection under 140 per million while the US is over 4,000 per million. It doesn’t matter if the US is doing 25,000 tests per million while Lithuania is doing over 66,000 tests per million, Denmark is doing over 53,000, Spain is doing over 52,000 and Germany is doing over 33,000.
It doesn’t matter. What matters is how we control the spread.
Focus on the month of June. During that month the first of the real placebo-controlled human studies with drug treatments will begin to be reported. We will get the first true indications of which drug regimens will merit follow up and further clinical study.
Focus on the secondary population centers. The biggest coastal cities seem to be getting ahead of the infections, with new cases, new hospitalizations and deaths decreasing while recoveries are increasing. What we can now expect to see are those population centers that have lagged behind the initial infections in NYC, San Francisco, Los Angeles and Seattle. We can now see rises in Houston, Chicago, Indianapolis, Cincinnati, and hundreds of smaller cities and towns, particularly those surrounding meat-packing plants and prisons. Outbreaks in nursing homes will begin to spread to the local population centers. Without quick isolation and testing, those hot-spots will expand to hot-blotches, then hot-areas and hot-regions.
Even in Korea, which has done so remarkably well, the reopening of their society has now resulted in 15 new cases. Fortunately they have quickly identified that outbreak to a few nightclubs; those nightclubs have now been shut and the Korean, identify/track/trace/isolate/treat is in effect and they will probably stop the new threat of spread.
We have learned in the last 24 hours that at least 3 people in the White House, who were, at least in proximity to cabinet officials, advisors and the President and Vice President. The spouses, children and close contacts of these new cases are now potential new infections. The White House has instituted daily testing of everyone, particularly those who are asymptomatic. This is the right move. Identify. Isolate. Contact-trace. Isolate. Treat. We should work towards doing that everywhere. Just ask yourself if you would feel safer if you knew that each day your family, friends, golfing buddies, co-workers, service staff, etc. were tested and were negative.
Focus on the plateau. Does the curve remain flat, or with people entering the society again, does the curve begin to rise, as I have strongly argued it will?
This is an easy experiment for each of you to do yourself. Watch the daily numbers of deaths. If the plateau remains constant, with 1,800 deaths per day, then by June 1 (23 days) we will have an additional 41,000 deaths, for a total of 120,000; and by June 30 (52 days from now) we will have an additional 53,000 additional deaths, for a total of around 170,000. If the plateau begins to decline, we will see less, if the “opening up” increases the total, as the CDC has been warning may result in a rate of up to 3,000 deaths per day by June 1, we may see as many as a total of 210,000 deaths.
Numbers are not magic. The virus does not listen to reason or hope. The numbers will tell us how we are doing.
FOURTH SUBJECT Keep your heads up and cover your mouth and nose.
It is not courageous, brave, patriotic or heroic to appear in public without a mask.
It is irresponsible.
Over and over and over, I keep reminding everyone that you wear a mask NOT to prevent YOU from getting infected, but for preventing YOU from infecting someone else.