Abdul El-Sayed, MD, DPhilCompte certifié

GOAL #1: SEE CURVE - We don't have good visibility for 2 reasons: a) our tests are being used mainly on ppl who already presumptive(+) because we're using them at point of care for sick pts. b) there's a huge gap btwn when ppl are infected & when we get their test outcomes 2/

So instead of using tests at point of care when it doesn't change management: 1) I'd be saving 5-10% of our #COVID tests to deploy in a small representative sample of the population to better understand the spread of disease, and the burden that's on its way 3/

2) I'd screen every responder/provider on the frontlines of #COVID-care by testing at 5-day intervals. They'd be isolated if (+) so not to spread. Not a perfect screen, but better than no test or symptomatic tests. 3) Most tests would deploy at triage in goal 3 (see tweet 12) 4/

The random sample tests may sound like a waste of resources. But they're CRITICAL: they help to model where the disease is headed, which allows us to "skate to where the puck is going," rather than just where it is right now. That way, we're not constantly catching up. 5/

GOAL #2: FLATTEN CURVE - I agree w/ "Stay at home" orders. Would add: 1) require curbside protocols + no touch payment (online/phone) + social distancing workplace rules 2) require gas stations to wipe stations between customers 6/

I would also set a clear guideline for a phased let-down of #socialdistancing protocols as we meet certain points on the epidemic curve on the way down--creating a transparent, science-based answer to "when are we done with this" that the community can track and understand 7/

GOAL #3: PREPARE FOR CURVE - The whole point of #SocialDistancing is to reduce the peak of the crest of #COVID patients. But the other thing we have to do is INCREASE the # of patients we can care for. That's the whole point here. We have to PREPARE for the rush. 8/

At BEST, that means setting up an alternative #COVID-care system. In every major metro + some rural communities, I'd ID a hotel, a dorm, or convention center to start preparing as a hospital now. No one in the state should be more than 1 hr from a #COVID-care facility. 9/

That's where I'd be sending all the #COVID patients. There, a team of MDs/NPs/PAs would oversee a team of folks trained specifically to manage #COVID19 patients. Could train EMTs, MAs, and other health pros. If well managed, a few MDs/NPs/PAs could manage many others. 10/

How to decide who goes to #COVID-care? An algorithm and a system of triage centers in front of every ER + urgicare. First, set up triage centers to segregate folks into the usual healthcare system (for non-COVID) vs. the #COVID19 system 11/

Second, create an algorithm to ID #COVID probability. Using temp, # of COVID exposures, & chest x-ray/CT result--calculate probability score For very high/low #COVID probability, no test. Test mid-range probability. All high probability & (+) patients go to #COVID-care. 12/

Segregating #COVID has several advantages: 1) We don't overwhelm usual healthcare system 2) We reduce contamination of COVID(-) sick in the usual system 3) We concentrate where we send COVID resources (#PPE, #ventilators) to facilitate logistics 13/

Resource procurement for #COVID-care is key. First, #POTUS needs to activate #DefenseProductionAct, which appears to be happening now for #ventilators. But we also need it for #PPE and #tests. Most of my messaging/time would be focused on getting resources to COVID-care 14/

GOAL #4: CATCH THE CURVE It's a misnomer that we can't "contain" #COVID19. We just can't contain it NOW. Once case # falls, contact tracing/containment can begin again. Along w/ transparent easing of #SocialDistancing as cases fall, I'd ramp containment up, a new phase. 15/

We'd need to start stockpiling tests & training up a large staff of contact-tracers beforehand to be ready to contact-trace at scale once case # falls below a certain number. That would require us to contact-trace all new cases beyond a point on the epi curve. 16/

It would mean a new strategic deployment of tests vs what I discussed above, focusing on testing contacts of cases who aren't already recovered (and presumed immune--though need more data on this point). Would enforce isolation for all exposed & (+) so no rebound case jump 17/

GOAL #5: SAVE LIVELIHOODS: Along w/ resources, I'd be spending a lot of time lobbying for relief on the economic front. That's full UBI, waived healthcare costs, small business grants. That's holding corps accountable for lost jobs/broken bargaining agreements/buybacks. 18/

I'm grateful to the state & local public officials on the front lines rn. I wish I were there with you. I can only imagine the stress & sleepless nights. Thank you - you're heroes. I hope this can be a helpful resource from one epidemiologist/former health director. 19/19