And as awful and intentionally horrific as Trump’s COVID-19 non-policy has been, there’s plenty of bad governance to go around.
As of Sunday evening, the two-week prevalence of SARS-CoV-2 in D.C. breached 0.1%, meaning D.C. is back to where we were in mid-June. This also represents, city-wide, a twenty percent increase in prevalence in one week. Here’s the prevalence by ward and for the whole city:
Ward 1: 0.103%
Ward 2: 0.090%
Ward 3: 0.054%
Ward 4: 0.107%
Ward 5: 0.121%
Ward 6: 0.109%
Ward 7: 0.158%
Ward 8: 0.129%
D.C. is clearly heading in the wrong direction. From the Director of DC Health (boldface mine):
D.C. Health Director LaQuandra Nesbitt said three measurements in the city are cause for concern: the rate of transmission, a caseload that is not declining and a high prevalence of cases seemingly unconnected to one another, rather than traceable to one cluster of infections.
“Our inability to consistently see declines in new cases and community spread is not what we would like it to be at this point,” Nesbitt said.
Other than that, things are great! Snark aside, we’re left with two options.
The first, and the one I favor, is we roll back to Phase 1, and we stay there until the prevalence in every ward is below 0.05% percent. But that’s not going to happen, given Bowser’s New Democrat, pro-business predilections and the Council’s gormlessness. So we’re left with the second best option–and it’s second best because D.C. hasn’t been able to show that it works to date.
Testing and tracing needs to be improved. Right now, it’s very shallow–close contacts aren’t good enough. Compared to a typical food-borne outbreak investigation, that really doesn’t qualify as contact tracing. Unless the dynamics of spread for COVID-19 have fundamentally changed, the majority of the ‘unknown’ cases are still the result of superspreading events: it’s just that we haven’t been able to identify the particular superspreader(s)*. Take a handful of cases and do a deep dive–and move rapidly. Find the contacts, go to them, and then have a rapid turnaround time–one day–for results. While this might seem like putting fingers in the dike, it actually serves the goal of intelligence gathering. Superspreaders are out there and we need to identify what the circumstances of that spread are.
In addition, any time someone tests positive in a place of business or an apartment building (or group house), test everyone–and, again, you have to go to them. At this point, the prevalence is high enough that you’ll get positives, even if they aren’t related epidemiologically to the source case.
Here’s the problem: what I’ve described in the previous two paragraphs is a can opener. That is, given the (un)realities of rapid testing and deploying tests to people who need them, it’s the equivalent of saying, “Between the pandemic and the economy, I know things are bad right now. Have you tried being rich?” It’s fantastical. So until we can do a lot more deployable and rapid testing, D.C. should roll back to Phase 1, especially if we’re going to restart schools.
So let’s talk about schools. If D.C. continues on the current trajectory of Rt = 1.1 (which is what two different sites estimate–1.08 and 1.11 if you want to get picky), in five weeks’ time, the prevalence in D.C. will be somewhere north of 0.015%. Given the number of teachers and essential staff (over 4,000 teachers alone), that means we’re pretty much guaranteed a couple teachers or staff will not only be infected but could be presymptomatic and not detected by testing on the very first day (even assuming a capacity to test a few days before opening, which, as noted above, is fantastical). And that’s before we consider the students.
Unless D.C. has A Secret Plan to lower the prevalence, and there is no reason to think this, we need to roll back to Phase 1.
What shitty, impatient governance.
*Yes, I know we’re not supposed to stigmatize people, but the point is that there are a small number of individuals who are the source of these infections.