Extracting a gloss from the editors of the Washington Post’s denunciation of the choice between people contracting COVID-19 and letting the economy collapse:
The quick and certain result of a damn-the-torpedoes approach would be to overwhelm and break the health-care system. Hospitals would fill to overflowing. Those in need of ventilators would be out of luck — not only covid-19 patients but also babies, children, tweens and anyone else in respiratory distress. People who suffer strokes, heart attacks, broken bones and gunshot wounds would arrive at hospitals — if they were lucky or rich enough to find ambulances — to find emergency rooms resembling Grand Central Terminial at rush hour. Doctors, nurses and medical technicians would face extraordinary risks; many would not be spared.
That’s not an “exchange,†as Mr. Patrick simplistically imagines. It’s a social, political, moral — and economic — cataclysm.
The costs of the pandemic-induced shutdown are colossal — to the economy, society and the nation’s collective emotional and mental health. As dangerous as that is, it is more dangerous still to pretend the pandemic can be harnessed by diktat and wishful thinking.
The irony of their closing trope is that the governors and mayors who are issuing “stay at home” directives are relying on precisely that: diktat and wishful thinking. Sadly, in the near term that is all they or we have. I think we need a much clearer, more committed notion of just how long that “near term” might be. Eventually it will become a “Friedman interval”, a continually expanding horizon. While Scylla might be preferable today, in the long term Charybdis might have been more merciful.
It isn’t merely new cases of the disease that threatens to “overwhelm and break the health care system” but also the inadequacy of supportive care in treating it. But in every country I have been able to identify the numbers of those who have contracted the disease dwarf the number that have recovered from it by at least 4:1. I’m skeptical that prevention, the goal of those searching for a vaccine, will be feasible in the foreseeable future. To date no effective vaccine has even been produced for any coronavirus. And avoidance, which is what the governors and mayors are attempting to accomplish with their “stay at home” directives, is futile as a long term strategy. I have more confidence in better treatments being identified than that avoidance will “bend the curve” sufficiently to achieve its presumed goal or that a preventive vaccine will be invented.
President Trump’s supporters wanted him to “drain the swamp”. I don’t believe that he actually knew enough about the swamp to accomplish that. It takes an alligator to drain the swamp. Only a swamp-dweller has the necessary understanding. In retrospect good places to start might have been the Food and Drug Administration and the Centers for Disease Control.
Some red tape cutting in approving therapies using methods or pharmaceuticals that have already received approval from the FDA is an urgent necessity. And Abbott has developed a COVID-19 test that takes minutes rather than hours or days. Clothing manufacturers, idled by the directives, are ready, willing, and able to produce face masks in the millions but are stymied by state and local regulations. We’ll soon see if he’s the man for the job.
We need competent leadership. Regulations usually have a purpose in normal times. During an emergency someone needs to monitor events and intervene to eliminate regulations as needed. The tests are a good example. In normal times taking an extra 6 months to make sure a test is really, really safe and effective makes sense. In an emergency you accelerate the process and you monitor to make sure it gets done.
“Abbott has developed a COVID-19 test that takes minutes”
Nice, but S Korea had this long ago. We should have had it sooner if only someone were willing to make it happen. This is something we would use daily at our hospital at least dozens of times and would help greatly with conserving PPE.
Steve
‘It takes an alligator to drain the swamp.’
No, an alligator lives in the swamp and requires a swamp for it to live. An earthmover is indicated. But the logjam it’s facing is pretty thick and long and deep and defended by a lot of gators and moccasins and other ornery creatures.
‘While Scylla might be preferable today, in the long term Charybdis might have been more merciful.’
I’m doubtful that the 100% mortality Charybdis promised is really more merciful than the 50% Scylla delivered. (I personally doubt we are facing anything even close to that dire choice). It would have been best to avoid both hazards but that horse left the gate when the Chinese lied and hid the evidence until it was far too late to confine it to Wuhan or even Hubei. Frankly in hindsight from looking at the spread I doubt anything short of a nuke could have stopped it once the Chinese started traveling without impediment during the New Year festivals.
Steve: You may have posted this earlier on an older thread, but what would have been your idea of effective methods to handle the outbreak that would have worked?
I am also curious if SK had an accurate test that delivered results same day why it was not adopted in the US. I can’t find anything on-line as to why. I personally suspect bureaucratic foot-dragging but that is just speculation. You’re closer to the situation than I am so I would have a better idea.
Follow up on Japan. Quote from Abe
Japan’s PM Shinzo Abe: “At this point, we are not going to declare a state of emergency but we are barely holding on. And we believe that we are still on the brink and this situation is continuing.”
“Steve: You may have posted this earlier on an older thread, but what would have been your idea of effective methods to handle the outbreak that would have worked?”
Not my area of expertise, but I would have done the following, I hope.
1) Cutting off travel from China should have also included Americans. I am guessing we don’t hug a lot of Chinese tourists. We do hug grandparents, brothers, sisters and children who went to China and came back.
2) Reconstitute the pandemic response team into its own unit. They shouldn’t be working through more levels of bureaucracy than necessary.
3) Testing. Should have given FDA/CDC 2 weeks to develop a test. If they couldn’t then use the WHO approved tests. Get us a S Korea style 10 minute test.
4) Wide testing in areas we think most vulnerable with tracking on positive tests. Go into lockdown in areas with outbreaks.
5) PPE gear/vents- Recognize other countries probably will keep their masks and vents and not sell them to us. Start domestic effort on a massive scale.
6) Immediate safe harbor laws for drugs deemed worth investigating. Announce bounties for development of vaccine and therapeutics.
By “worked” I think this would have slowed things down to a manageable level. Let us figure out long term solutions.
On the S Korea test I don’t know. I don’t have that kind of high level access so my opinion probably isn’t worth more than anyone else’s. My guess would be that they didnt see a need for it and/or wanted to have a test developed here in the US. Just a guess.
Steve
Looking through those 6 points:
1) cutting off travel with China was done in late January, along with quarantines, and was heavily criticized by both the Dems and media. Throwing in Americans with that ban is a nice Monday morning quarterbacking suggestion. However, it would not have flown, in real time, considering the enormous pushback the China travel ban initially encountered. BTW, if HRC had been president, what are the chances she would have even done the early steps restricting China travel!
2) the pandemic team was blended into a bigger team of experts to handle such a crisis. Unfortunately, much of the lack of preparedness was spread out among states who disbanded their own pandemic plans and supplies, like CA in 2011, or refused advice to amplify their stockpile of ventilators, like NY, in 2015. Add on the to fact that protective gear was not replenished after the swine flu, to be on hand, nationally, for the next epidemic, coupled with the growth of bureaucratic regulations in the CDC & FDA, under the prior administration, we had a very flawed basis point at which to adequately address this totally new kind of epidemic.
3) testing foot-dragged largely because of the inflexible posturing of the CDC & FDA and their initial refusal to work with the private sector. Once the president intervened, this blockage was removed and testing progress truly begin. Also, Dr. Fauci has repeatedly asserted the unfamiliarity with this virus presented more time-consuming factors in creating a test kit with the accuracy and protocols desired. In fact, many of the early tests were flawed by false negatives and positives. Even today, test kits, sent to other counties by China, have proven to have an 80% failure rate, and are being returned.
4) wide testing couldn’t be done without plentiful kits on hand, which was already explained, Governors are the ones in charge of state lockdowns, not the federal government.
5) there has been an energized, massive response by the public/private partnership created and promoted by this administration. In fact, support of private sector innovation is in the wheelhouse of this president, and he has been personally involved in meeting with and cultivating such indispensable partnerships.
6) a year ago The Right To Try Act created a way around today for people to try unapproved drugs. And, this administration, with again much criticism from his critics, has been ahead of events by pointing to the efficacy of drugs not having all the clinical trials in tow for approval.
IMO, what “slowed things down,†was China not being an honest player, on the world stage, in failing to report this virus early, accurately and cooperatively. A second stumbling block was congress being more engrossed with impeachment antics in January, than addressing the possibility of an impending pandemic in January. Third, if medical supplies in our strategic supplies of PPE gear had been restored after being earlier depleted, with ventilator numbers updated and maintained, both by the states and the federal government, we would not be suffering as much by the immediacy of “shortages.†Finally, media hype, especially their elevated noise about worst-case-scenarios, fashioned along with predictive studies, now significantly being walked back, all mixed in with regurgitated hatred of the president have produced toxic fear mongering instead of calming stability in these uncertain times.