In a harrowing series of tweets, a senior health official in the Obama administration has outlined how the largest US cities and hospitals will be overrun with coronavirus cases by 23 March and a million may die.

Andy Slavitt, the former acting administrator of Medicare and Medicaid under President Barack Obama, consulted with state and local officials and took to Twitter to outline the main points from a memo he is preparing.

He advocates for a complete and strict policy of social isolation, and for hospitals to move quickly to reorganise and prioritise resources. Mr Slavitt emphasises that expanding medical capacity won’t make much of a difference without social distancing as for every person that contracts the virus, two more will be infected.

“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.”

Describing the situation in Italian hospitals and what that means for the US, he says: “Every report describes this as a tsunami. And if it happens like a tsunami, in major cities we will have 10s of thousands more cases than we have beds & we will have 1 ventilator for every 8 people who need one.”

Mr Slavitt says that the only way to prevent a similar situation in the US is to socially isolate and he links to another Twitter thread in which he predicts 1 million deaths because of the lack of containment and inability to test for the virus.

His advice for authorities and medical facilities is blunt. “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 4 every front line worker, get masks [and] other supplies even on black mkt.”

He also says that others should draw from the experience of Seattle and see what people there went through, as well as instructing hospitals to: “Build tents to spec, commandeer hotels and arenas. Hire ppl losing work to sanitise everything.”

“Many cities & states are considering calling in hell from the national guard. Alarmed? My view at this point is better them now than the Red Cross later,” he says.

Mr Slavitt is clear where the focus of blame lies: “The original sin is Trump’s months long denial and his dismantling of public health and response infrastructure. That wasn’t all, but it led to other fatal mistakes.”