[blueplum]

As much as I badmouth CCPChina, I will offer up some tentative acknowledgement of our American Chinese Californians, Oregonians and Washingtonians - who knew what they were fleeing from and hunkered down (with a little help from inter-Chinatown peer pressure and mandatory airport-assigned quarantines which went north of 20K combined). There were jerks who didn’t, to be sure, but I’m thinking our slow numbers are proof the majority did. However, I reserve a caveat, depending on release of the numbers we need:

Oregon at 548 13 deaths - Oregon not releasing hospitalization rate/ICU rate/beds occupied
https://www.wweek.com/news/state/2020/03/25/oregon-health-officials-arent-telling-the-public-how-severe-the-covid-19-outbreak-is-they-should/

Washington State at 4310 189 deaths 700? hospitalized?
https://www.seattletimes.com/seattle-news/health/more-than-250-people-in-washington-hospitalized-last-week-with-covid-19-like-symptoms-as-part-of-monthlong-upward-trend-state-data-shows/

California at 4543 101 deaths

San Diego - 69 hospitalizations

In LA, 317 hospitalizations:

Santa Clara, 154 hospitalizations

Santa Barbara 3

San Luis Obispo 5

Sacramento UC Davis 9 ?

Placer County 54 ?

Orange County, Riverside County, San Francisco County, and San Bernardino. not reporting

Yolo County, Dignity Health, Kaiser Permanente and Sutter Health declined to say how many COVID-19 patients they are treating

https://www.nbcsandiego.com/news/investigations/covid-19-how-san-diegos-hospitalization-rates-compare-with-other-counties-across-california/2294626/
https://www.latimes.com/california/story/2020-03-24/coronavirus-hospitals-los-angeles-county
https://www.sacbee.com/news/coronavirus/article241560391.html

[BusterDog]

Eric Feigl-Ding (@DrEricDing) has a plan for what we do after we got over this initial curve: Massive "frontier testing" and contact tracing.

CHINA KEEPS FINDING #COVID19 CASES, BUT FAILS TO OFFICIALLY REPORT THEM. A little known but documented fact is that China doesn’t count lab🧪 positive cases if no symptoms. (Verified by @lwcalex). So no surprise- Wuhan is still finding lots of cases...🧵

2) Notably, “according to a member of ID prevention&control team in Wuhan, every day continues to have “several or more than a dozen asymptomatic infected individuals,” which are people who tested positive #Covid19, but do not feel ill and are excluded from published numbers.”

3) What does this mean? The Wuhan epidemic is not over year, despite China’s rosy official numbers. Anywhere in the world, a lab 🧪 positive case is counted as an official case. But China’s own guidelines excludes them. China cannot and should not exclude positive #COVID19 cases.

4) What lessons can other countries draw? That long term mitigation measures are not nearly enough to truly put out the wildfire of #COVID19 epidemic. Mitigation is like dumping aerial water drops via a plane- it’ll slow it down but it can’t put out every last flame on the ground

5) Thus, what will it truly take? According to @devisridhar (Chair of Global Health at @EdinburghUni), the only way is via MASSIVE TESTING on a grand scale, the likes of which only been seen in S Korea—need #COVID19 test + CONTACT TRACING, or else no hope.

6) At the same time, perhaps we can combine going back to work to a limited degree later with + MASS TESTING + MASS CONTACT TRACING - but likely only AFTER STRONG CONTAINMENT to minimize the #COVID19 wildfire down to manageable levels for mass testing & contact tracing. But wait-

7) ... NOT ALL TESTING IS THE SAME. We need to be “testing at the epidemic frontier” not merely clearing testing backlogs and late stage hospitalization testing. most countries are not testing “the frontier” but merely doing catch-up test & hospital tests after 2-4 weeks illness.

8) Testing at just the hospital means we have already lost 2-4 weeks of community spreading (likely longer given asymptomatics transmit before symptom onset). Such reactionary #COVID19 defensive backlog test is subpar- we need to battle at “frontier” of new cases as they emerge.

9) Even if asymptomatic transmission with lower viral might be slower than fully symptomatics, we are still losing precious time by testing the backlogs and hospital cases. #COVID19 has a doubling time of 6.2 days, sometimes much shorter, and so every week we lose is precious.

10) Thus, massive “TESTING AT THE FRONTIER” immediately as soon as new symptomatic #COVID19 cases emerge is critical. And it allows contact tracing to be much more effective as it is easier to find recent contacts, fewer contacts, it puts close contacts into quarantine earlier!

11) BOTTOMLINE: We know mitigation strategies only mitigate, and buying time to flatten curve isn’t enough. Let’s stop doing just hospital tests only. We can only put out the #COVID19 wildfire w/ massive FRONTIER testing of cases and massive FRONTIER contact tracing & quarantine.

https://twitter.com/DrEricDing/status/1244168120727724032