Into and after the viral storm

The path forward now seems pretty clear. First we get through the grim month-and-more ahead, supporting health care workers in any way we can. (Tip: findthemasks.com lists where to donate PPE, personal protective equipment, in the US. If you have any, do so. We are very literally all in this together, and they need it a lot more than you do.) Then we ramp up massive, pervasive, frequent Covid-19 testing infrastructure everywhere. Then we take stock.

Things will get worse before they get better. Hospitals in some places are already creaking at the seams. The patients entering the ICUs today were infected 3-4 weeks ago. Those infected the day of your local lockdown will reach ICUs 3-4 weeks from that day … and their number doubled every several days between the former batch of infections and the latter. The math is bleak. Many places haven’t locked down yet. They will, hopefully sooner rather than later.

This is the greatest challenge I have seen in my lifetime to public health. Governments, you will be remembered for how you help all your citizens, and the most vulnerable are the first you should be thinking about https://t.co/6J5v5F5J2B

— Bill Hanage (@BillHanage) March 22, 2020

What can we do in tech? Well, here’s an NYC doctor saying “We need our technology friends to be making and testing prototypes to rig the ventilators that we do have to support more than one patient at a time.” Here are the UK government’s specifications for Rapidly Manufactured Ventilator Systems. And here’s a suggestion that people ramp down their Dunning-Kruger armchair epidemiology a little–or a lot. Also:

Please do not misuse hydroxychloroquine. This med is critical for people who have SLE, like me. I was told today that my prescription cannot be filled because the suppliers are completely out. Now I do not have the meds I actually need for an incurable disease I actually have. https://t.co/dlwuWCwVZk

— Anna Valdez, Ph.D., RN (@drannamvaldez) March 21, 2020

It’s beyond appalling that the US government is only now realizing that they would more need personal protective equipment, but here we are, beyond appalled. Anything we can do to provide more PPE will be hugely beneficial as well.

Read this paragraph.

In mid-Feb, the WHO warned that shipments of personal protective equipment was seriously lagging. There was a months-long backlog.

And yet:”Federal contracting data shows there was no big effort at that point to submit orders.”https://t.co/k7tCuMHwMq pic.twitter.com/7L8HcjQqV8

— Eric Umansky (@ericuman) March 21, 2020

Then we need to test, test, test. It is also beyond appalling that America has only recently started testing at scale, and that testing is still hugely restricted, but again, here we are, beyond appalled. We need nationwide, or better yet planetwide, ubiquitous testing.

What will go down as the biggest breakdown in the US response to #COVID19 is the lack of test kits. South Korea and the US had their 1st patients on Jan 20 and Jan 21, respectively. Look at the difference in daily testing. By March 4th, SK was ~18,000 per day. pic.twitter.com/466Du8Iq2V

— Eric Topol (@EricTopol) March 17, 2020

Ideally we’d want everyone to get tested regularly, maybe weekly, symptomatic or not. Realistically, right now we need to massively expand and expand and expand our testing, and trace the contacts of those who test positive, so we know where the virus is and how many people have it. At the moment we’re all but blind.

Remember: Lockdowns and distancing are what suppress the total caseload.

Test-and-Trace is what gets us out of lockdown.

— We need 120k tests a day (@Noahpinion) March 20, 2020

Once we know, on a quasi-real-time basis, the numbers of the infected in a given area, we’ll be able to talk about lifting the lockdown. Maybe only for temporary periods, in certain areas, for people who don’t have a fever, lest the virus come roaring back. But the point of pervasive testing-and-tracing is that we’ll know whether that risk exists, and be able to respond appropriately.

Happening across industries: restaurants, hotels, movies, etc. Can’t do this forever, people going bankrupt.

To get out of lockdown we need massive testing. That lets us identify red & green zones, with high/low virus. And let negative people in green zones go back to work. https://t.co/aeemRzXWgH

— Balaji S. Srinivasan (@balajis) March 17, 2020

Currently we’re making overall progress with testing, but at the same time, in places we’re dialling it back, and we’re limited by test kits, by swabs, by testers, and more. We need much, much more testing capacity to come online in the following months. Once we get there, once the blinding lights of pervasive testing have lit up the virus for us and we can watch it in near real time, then life can slowly begin returning back to normal. Ish.

Great news. However we also need things to take samples (swabs), isolate RNA and so on. Also the dedicated pros who actually run the testshttps://t.co/K58MIidM16

— Bill Hanage (@BillHanage) March 21, 2020

Maybe then we can start thinking about how, in many places, and in many ways, the pandemic has forced us to start doing the right thing as a temporary emergency measure – everything from housing the homeless, to realizing that it’s grocery workers / janitors / drivers / nurses who are actually essential to our civilization and should be celebrated and rewarded accordingly, to admitting that the liquids limit on airplanes is meaningless, and almost everyone can do their office jobs from home.

Let’s bear that in the back of our minds: but right now, we have a very hard month–and likely months–ahead. I am sorry to be the bearer of bad news, but it is already later and worse than you think. Whatever we all can do to help, we should.