National changes

Reinforcement is coming.

And we need it. We have already lost 229,724 souls (an underestimate) and find ourselves in a medical, social, and financial catastrophe. For the past week, the U.S. has consistently reported more than 100,000 cases per day. Per capita, this is 32 daily new cases per 100,000. The hardest hit area has 206.8 daily new cases per 100,000. To control this pandemic, we need to be <10 cases per 100,000.

We know the increase isn’t due, solely, to testing. The national TPR has hovered >10%. We need this below 5%. Also, hospitalizations are increasing. In hot spots, we are running out of space for patients (just google El Paso). 

Deaths are rising (deaths follow a 22-day lag behind cases) but fatality rates are steady (thanks to our research in clinical treatment). Fatality rates may increase soon though: 1) More hospitals may get overwhelmed; 2) holidays are coming and older adults will be exposed to younger populations. Also, remember, mortality isn’t the only COVID19 outcome; COVID-19 causes morbidity among mild and severe cases. 

However, like I’ve said before, pooled national numbers aren’t useful because we don’t have a national, coordinated response. COVID19 doesn’t see state or county borders, and neither can we. We knew this back in August when scientists published a paper showing that a fragmented national response (like the US) is just as good as no response at all. 

A new approach seems to be on the horizon. Yesterday, the newly elected administration appointed three co-chairs to a new COVID19 task force: 

  • Dr. David Kessler: Professor of pediatrics and epidemiology and biostatistics at the University of California, San Francisco, U.S. Food and Drug Administration commissioner from 1990 to 1997.
  • Dr. Vivek Murthy: U.S. surgeon general from 2014-17, who commanded public health force that dealt with Ebola, Zika and Flint water crisis.
  • Dr. Marcella Nunez-Smith: Associate professor of internal medicine, public health and management at Yale University and associate dean for health equity research at Yale’s medical school specializing in health care for marginalized populations.

Where is Fauci? There may be political reasons why he’s not included. I’d be shocked if he isn’t invited in January. 

What does this task force need to accomplish? This is my wish list:

-We NEED on the ground representation heavily advising these new co-chairs: physicians, infectious disease epidemiologists, and virologists. It looks like this was accomplished while I was typing this up, with others quickly added to the list (see link below for full list)

-Public health campaign with consistent messaging (yes this would include universal mask wearing). South Korea ran a brilliant, effective campaign for their country

-Start working again with the WHO. Yes, they aren’t perfect, but we can learn from other countries. Also, distance the CDC from government. Yes, I know the CDC IS the government (i.e. funded by them) but we need them to become bipartisan again. Distancing themselves from the executive branch (at least publicly) will improve trust. I would also in loop Tom Frieden.

-Deploy (or at least support!) targeted testing to hard hit areas. This federal support was removed in August 2020.

-A national contact tracing program. This would have to be a tiered response given our large population. Others have drafted what this could look like (see link below)

The question is whether it’s too late. Has there already been too much damage? We’ve already lost trust of communities, already have pandemic fatigue, already have false narratives circulating, all public health workers are burnt out, and quite frankly, we need to build an infrastructure quickly (Obama started building this pandemic infrastructure, but I’m not sure what is left of it). ALL of these aspects are important for effective public health responses.

This task force has an uphill battle. But if anyone can do it, it’s them. They are drafting up implementation plans as we speak. I look forward to seeing these plans soon (and so should you), as this will give us more clarity to what the next year may look like. And although their plan won’t help the current wave, it will help future waves and certainly help with the rollout of vaccines in 2021. And (should I say it?) will help with future pandemics WHEN (not if) they come. 

Love YLE

Data Sources:

-Graphs and numbers: COVID19 tracking project

-Entire new COVID19 task force team:

-Fragmented responses not effective:  

-A possible scale up racing approach:

7 replies on “Reinforcement is coming.”

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