By skyforbes 
A daily Covid-19 update from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services
Pulled from my daily COVID-19 updates on Twitter
In many ways today is the day we’ve been waiting for: We are between two and three weeks out from when the country went on lockdown. The big question is what is happening to the growth in new cases? I decided to try to find out.
The best way to find out is to look at data. And our national data showed that right on time, our growth rate in new cases has slowed.
Data people might say “great, one in a row”. And cases are still growing exponentially. 30,000 new cases/day is a lot. And it could just mean a day of lower testing not fewer cases.
Testing is still a big issue, but we’ve gone from doubling every three days or so to doubling every six or seven days, in large part due to the #StayHome measures we put in place. Look at the states with the most cases and the slowdown that occurred after lockdown.
I wanted to make some calls on the ground to each of these states to see if what the data was saying is what they are seeing and feeling on the ground. So I did.
When California had about 1,000 cases they moved aggressively to lock things down. They experienced one death. People thought they were being rash. When New York had 1,000 confirmed cases, they waited another week to shut things down. Mayor deBlasio suggested people enjoy another night out.
Can that be explained because New York has tested way more people? (They have.) But if you look at hospitalizations, it also shows a big difference.
During that week in NY, some people saw what was happening. @CoreyinNYC was worried, calling for bars & restaurants to shut down. He connected with me at 2am because he saw what was happening. That week cost New Yorkers dearly.
On Saturday March 7, I sent a two page note to every governor. My first point to them was: “Prevention now will be easier than clean up later. Controlling 10 people is easier than 100, or 1,000–100,000. That’s how it vectors. Act while your job is easier. You are not over-doing it.” My point is not that I was clairvoyant. I’m no scientist. Lots of people saw it before then. I just wanted to put something actionable for them. I only talked to 5 or 6 of them.
New York had 105 cases. California had 88. It took 10 days for California to act — they are now over 10,000. Another 6 days and New York is now over 100,000. People in California reported to me that cases were still growing but the clip was manageable & hospital capacity was holding up in many counties. New York was seeing a flattening, but at a level that requires a Navy hospital ship, a 2,500-bed hospital conversion at the Javits Center, and more health providers than they have.
Detroit is in the same boat as New York, just scaled down. Louisiana also seems to be flattening. Ochsner Health, the biggest healthcare system in Louisiana, seemed to have done very good forward planning. But other parts of the system are scrambling.
Let’s look at testing.
In most places we are only testing front line health care workers, or people in the hospital. That explains why the positive rate is increasing from 10–20% since testing started to ramp
This implies that we have a much higher case count and a larger number of asymptomatic people. We produce about 1 million tests/week, but we’re not getting that many results. We have big backlogs. People are making homegrown reagents. We entered the global market late.
Optimists say the flattening around the world and the potential beginning in the US — where it took us 5 days longer because our measures are more porous — is because we have higher herd immunity than we think. There’s some evidence. But even in the best case, there’s not enough.
We need to increase the capacity of testing to put ourselves in a position to not just flatten the curve but do what the Asian countries have — where we can track and contain. Our mortality rate is higher because of a combination of the lag and possibly tightening our testing.
What we don’t understand is why certain people get sicker than others.
- There is some evidence around body ache symptoms and hemoglobin
- There is data which shows male fatalities are 3:1 men to women
- And there is early data that racial disparities are at work
I saw a report that 70% of the deaths in Louisiana are African Americans. African Americans are 32% of the population. It will be a dark stain on an already tragic period if people of color die at a higher rate. A stain on all of us.
Meanwhile science has a multi-pronged approach:
- The FDA approved is first anti-body test
- It’s next and highest priority must be to accelerate the development of early-acting therapies
- The is funding vaccine development to speed the manufacture to market
A Senator I spoke to today reminded me that states can allow SNAP benefits to be used at local restaurants. California has. Other states need to do the same.
Frontline Family recently launched. It is a service that allows anyone to help healthcare workers on the front line.You can help get them equipment, give them access to wellness services, food, child care, and lots of local things: