Top Public Health Expert Offers Stark Warning About The Human Toll Of Prematurely Ending Social Distancing

COVID has been spreading w/ exponential growth in US for some time, and we're just beginning to get an understanding of how extensively. There
are nearly 40,000 cases recognized in the US as of today, w/ ~100 deaths
today. A few weeks ago, we had recognized 70 cases total. 2/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

Some hospitals have said publicly that within a week they will not have ventilators to treat everyone with COVID anymore. 3/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

There continue to be big diagnostic limitations. Shortages in reagents, swabs. Don't have rapid diagnostics in many hospitals yet, so it can be days before doctors and nurses can find out if a pt in front of them has COVID. 4/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We don't have capacity to diagnose many of the COVID cases that are not sick enough to be in the hospital, so those numbers aren't counted in our national totals. 5/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

There continues to be terrible shortages in the masks that health care workers need to keep from getting sick with this disease. 6/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We don't have capacity to diagnose many of the COVID cases that are not sick enough to be in the hospital, so those numbers aren't counted in our national totals. 5/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

There continues to be terrible shortages in the masks that health care workers need to keep from getting sick with this disease. 6/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

How do we gain time to let hosps get more supplies & prepare for high number of pts? How do we lower the speed of spread of COVID in US? How do we lower odds that ICUs will run out of vents, hospitals run out of space? The answer for now is large scale social distancing.7/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

In Asia, we've seen these interventions work to lower
pace of the epidemic, lower numbers of critically ill, lower
the number of people who get COVID. In
Asia where big social distancing measures have been in place for two months,
they have had very strong impact. 8/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

In Asia they've slowed the disease by slowing social interaction. Left to its own, this disease spreads from 1 person to about 2.5 people, and then they do the same, and so on. For this disease to stop, we need to make it so that the avg person spreads it to <1 other person. 9/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

These big social distancing measures take time to work. The impact of big interventions in Wuhan China took about 3 wks to start to reverse things. And then everyday after the situation got better. In the US, we're about 7 to 10 days into this, depending on the state.10/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

To drop all these measures now would be to accept that COVID pts will get sick in extraordinary numbers all over the country, far beyond
what the US health care system could bear. 11/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

Many models report that health care systems will be completely overwhelmed/collapse by the peak of cases if major social distancing is not put in place. 12/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

If a health care system in a given community stops working, can no longer provide care to the ill, the case fatality rate for COVID will be far higher than 1% - we would not be able to care for some or all of the expected 5% of recognized cases that get critically ill. 13/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

Beyond that, if hospitals were completely overwhelmed, they may struggle
to provide even oxygen for some or many of the 15% of recognized cases expected to be “severely ill". let alone provide care for other life threatening conditions. 14/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

Anyone advising the end of social distancing now, needs to fully understand what the country will look like if we do that. COVID would spread widely, rapidly, terribly, could kill potentially millions in the yr ahead with huge social and economic impact across the country. 15/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

Before considering big changes to social distancing measures
now, we should as quickly as possible get to strongest possible position for COVID response – we're no where near that now. We'll need rapid Dxs in place almost every location where a pt can be seen for care.16/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We'll need extraordinary quantity, reserve+production lines
of masks, PPE so that shortages at hosps and clinical sites around country
are no longer possible. We'lll need to have more vents on the way. We'll need capacity to provide med care to many more that we can now.17/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We'll need to reduce the # of cases to such a low
level that we could again do contact tracing & isolation of cases around
the country (as they can in many countries in Asia now). 18/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We'll need to reduce the # of cases to such a low
level that we could again do contact tracing & isolation of cases around
the country (as they can in many countries in Asia now). 18/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We will need system of screening at airports
so that no person comes into the country with the disease without being
diagnosed and isolated. 19/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

We'll need a serology test that can be used to identify those that have been infected and recovered already, and to know how prevalent disease is in the US. We would hopefully have therapies developed and in a quantity that we can treat at least the sickest pt w COVID. 20/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

Once we have those things in place, it would be a far less risky time to take stock of social distancing measures in place and consider what might gradually be reduced with trial and error. We would have learned more about the experience
in Asia as they try to do that.21/x
— Tom Inglesby (@T_Inglesby) March 23, 2020

For now we need to keep production running, doctors offices working, groceries, pharmacies, banks open. It is ok to have science informed dialogue about which businesses need to be closed vs what can stay open in some way if social distancing can be put in place in them.22/x
— Tom Inglesby (@T_Inglesby) March 24, 2020

But we need to press ahead for now w closed schools, mass
telecommuting, no gatherings, strong advisory to stay home unless you need to
go out – all are needed to slow this epidemic. 23/x
— Tom Inglesby (@T_Inglesby) March 24, 2020

We also need to put every conceivable econ program in place to help those being hurt by these social distancing measures. And move ahead rapidly to get our country far better prepared to cope w COVID before people recommend we abandon our efforts to slow this virus. 24/x
— Tom Inglesby (@T_Inglesby) March 24, 2020