COVID-19 March 14 Update

Without urgent action we will have tens of thousands more COVID-19 cases than we have beds, and we will have 1 ventilator for every 8 people who need one.

Andy Slavitt
Medium Coronavirus Blog
5 min readMar 14, 2020


By Andy Slavitt (Former Medicare, Medicaid, and ACA head for Obama)
Pulled from my
daily COVID-19 updates on Twitter.

Last night I was on with state and local officials around the US well into the night. By March 23 many of our largest cities and hospitals are on course to be overrun with cases. I am going to prepare a memo for them. I will share highlights here.

They are highly dependent on the public response so I will start there. We have no immunity to COVID-19, people who get it don’t know for a while, and for each person that gets it, they infect 2+ people.

You may have seen graphs that look like this. It shows how far behind Italy we are tracking in days & how our trajectory compares. The US and every country that hasn’t taken better preventive measures like S Korea & Japan is directly on course, lagging 2 weeks behind.

This is what it looks like in Italian hospitals. Every report describes this as a tsunami. And if it happens like a tsunami, in major cities we will have tens of thousands more cases than we have beds, and we will have 1 ventilator for every 8 people who need one.

What are mayors, governors & their staffs reporting? That people are jamming the bars. I get it. Home from work. Cooped up. Crisis mentality. We need to let steam off. Shared experience. But stop that. All the bars & restaurants are closed now across Europe.

The only way to prevent Italy given our lack of testing is to socially isolate. Congress even allocates money for people to stay home. That rarely happens. But we blew our chance at containment.

If you want to see a thread on how we got here and what to do as of 36 hours ago, I tried to be complete here. The thread does not contain predictions but frames the course experts think we’re on without action.

Let me flip to my advice to mayors and governors. The first thing I’m going to start with — expanding medical capacity — has to be done but will only make a tiny difference if we don’t self-isolate.

Hospitals must get rid of elective procedures, expand negative pressure rooms, move ventilator capacity to hot spots & seek additional where possible, create isolation negative pressure rooms, get tests for every front line worker, get masks and other supplies even on black market.

Get on the phone with someone from Seattle ASAP to talk through every thing they went through, ran out of & wish they had done. Build tents to spec, commandeer hotels and arenas. Hire people losing work to sanitize everything.

State officials in some states wanted to screen at their international airlines and the Trump Admin did not/could not support them. Now we must consider stronger measures: for stage 3 countries, auto-quarantine. Consider shutting airport temporarily for 30 days.

Many cities and states are considering calling in help from the national guard. Alarmed? My view at this point is better them now than the Red Cross later.

We can’t afford tens-of-thousands to be hospitalized at once so we need to prevent and slow down the pace. And if this sweeps through nursing homes, it is fatal to our loved ones.

Nursing home infection control is terrible to begin with. And they are better than elder care or senior living facilities. The death rate among those older than 80 years old who contract COVID-19 is 18%.

And look this is where we are regarding nursing home regulations: The Obama Administration implemented them before a pandemic. Trump eliminated them before the pandemic. And is trying to reinstate them now.

From every expert I have talked to, I am less convinced that schools should be closed. Either way, open or closed, there are about 8–10 items that need to be considered including meals, childcare (keep granny away), parent sanity, etc. I recommend giving parents the option. Give the germ spreaders a place to go, feed the, teach them to be smarter than us when they grow up, and then protect the teachers. We need sufficient testing for that.

The Federal gov did a good things yesterday (March 13, 2020): It finally got the supply chain to produce tests figured out. Testing availability should double in the next week. It is unlikely to be sufficient for a number of weeks beyond that — at least four, but up to eight I’m told privately.

I talked to several on the WH team who went from 0 to 50 at lightning speed. Why they were at 0 weeks into an outbreak when South Korea was 10 days before is a topic for another time (e.g., November). But the labs, mobile testing, and supply will be straightened out.

But, testing in a few weeks will be like a sports team scouting college players after the draft. It will help us, but it won’t diagnose and prevent if we are following the Italy curve.

I need to close with three messages:

  1. Stay socially isolated for real. Not for you, but for everyone. And if someone minimizes this all, patiently listen and explain. People can’t be bullied.
  2. Root for the government to succeed here whether you like them or not. The stakes are higher than any most of us have ever experienced: wars, 9/11, whatever. Let’s have an election with this behind us having pulled together. This does spread from Republican to Democrat.
  3. I can’t express enough gratitude to the frontline health care workforce. We need to do what we can to make your jobs easier. There’s no roadmap — only your training, commitment & undiscovered capacities that we are relying on. You are heroes.

I think this small thread from Emily Barson at @USofCare says it well: