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his week and the next month are going to be hard. We have to do our best to protect vulnerable populations and health care workers. But a couple states I talked to today feel there is a real fork in the road. I will share what the paths seem to be.

I think this is the week when we start talking in millions and never look back. Only a few weeks ago, we were breaking a thousand cases. We have a lot more testing now so we have likely been in the millions for a while.

That is somber.

Remember the lag that occurs. What shows up as reported cases could be new or could be weeks old. But the hospital beds don’t fill up for a couple weeks and casualties don’t happen for a few more weeks after that.

So it’s easy to see what’s coming in the near term. Millions of cases will mean tens of thousands of losses (probably around May). It depends on where the infections are (nursing homes vs. college kids) and what shape the hospitals are in in a few weeks.

If the hospitals are over-crowded in some areas, 10k deaths could become 20k or 30k or more. So job #1 is protect our frontline health care workers, get them equipment and ventilators, keep them safe and on the job. Sorry I have to pause here. We’ve reached 2000 deaths in the US and in a couple days will be passing 9/11 totals. And 10s of thousands is unheard of.

Mr. President, fly the flag at half-mast. Acknowledge our losses.

What happens beyond that point is history not yet written. We know #StayHome works. It’s working in Seattle, in California, in New York, in the UK, in Wuhan. The more strict, the better it works. If we had the data, we would measure it in R0 (how many people each person infects).

This is where the tree branches. If we buckle down (6-10 weeks?) with social isolation, the curve flattens and in a really strong effort, can decline. If we let up, we are in for a very rocky and lethal extended period of time.

So job #1 is support the front line workers and to figure out how to sustain the next few weeks. Job #2 is to bend the curve with social isolation. Most scientists believe it is both completely necessary and that we are incapable of doing it. It is most scientists’ belief in human behavior and economic challenges that drives death toll estimates in the hundreds of thousands or higher. It’s both on us, which is good, and a tricky puzzle on how to sustain. But if we can through the Spring, there is a better phase two.

If we did this we could begin in the Summer to test aggressively and contact trace like in South Korea. Earlier in the week (feels like a century), I sent a letter to 59 governors about creating three South Korea’s at that point.

As of today, three states have gotten back to us with preliminary interest. After the Coronavirus-3 package just signed, states now have the money to put these plans together if they have the bandwidth. Many are prepared to help.

The key in the next stage is broad community testing. And the ability to contact trace. This is a great resource for states on how to do it. Imagine a world where the virus is dying off and then you did this?

Our #3 job after helping front line health care workers and bending the curve through #StayHome is easy because it happens automatically if we do the first two: give the scientists time.

I’ve talked about how you can’t catch up to something exponential. It’s like swimming after a speedboat (I borrowed that). But scientists can. A large portion of the labs around the world are being converted to focus on COVID. Therapies. Rapid tests. Antibody tests. Work towards a vaccine. Other things I’m hearing whispers of. These are the optimist scientists to counter the really dark momentum of a virus.

Life would feel better but not perfect in this second stage. Some areas opening. Some periodic waves. But done right, measured, traced, and with a tight circle around infections. And we can’t do it perfectly. People will travel. There will be super-spreaders. And jobs.

We could need 3 or 4 more Congressional packages to get us through. And not everyone will agree to maintain this all the way to a vaccine. And that will mean a lot of lives with a virus hard to control.

So getting through these months will mean adjustments, will mean agility, will mean finding a new rhythm. Personal disappointments but also new types of opportunities. That’s why I decided to start this podcast. You can subscribe. Like many of you, I’m spending more time with family. And this was one of our son’s idea. We’re going to work on it together.

You will also find great resources at While At Home. In the meantime, remember it’s going to get ugly next week. And we have to make it through these three jobs before we get to the 4th stage where life goes in in a slightly altered way.

Focusing on the safety of nurses/docs, ventilators, and protecting our seniors. That’s where we are now. Many people are working at it. And it will take our untapped capacities to help get ourselves and each other through it.

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