Getting Ahead of COVID-19

Bill Gates has some thoughts about getting ahead of COVID-19, expressed in this Washington Post op-ed:

Through my work with the Gates Foundation, I’ve spoken with experts and leaders in Washington and across the country. It’s become clear to me that we must take three steps.

First, we need a consistent nationwide approach to shutting down. Despite urging from public health experts, some states and counties haven’t shut down completely. In some states, beaches are still open; in others, restaurants still serve sit-down meals.

This is a recipe for disaster. Because people can travel freely across state lines, so can the virus. The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere. Until the case numbers start to go down across America — which could take 10 weeks or more — no one can continue business as usual or relax the shutdown. Any confusion about this point will only extend the economic pain, raise the odds that the virus will return, and cause more deaths.

Second, the federal government needs to step up on testing. Far more tests should be made available. We should also aggregate the results so we can quickly identify potential volunteers for clinical trials and know with confidence when it’s time to return to normal. There are good examples to follow: New York state recently expanded its capacity to up to more than 20,000 tests per day.

There’s also been some progress on more efficient testing methods, such as the self-swab developed by the Seattle Coronavirus Assessment Network, which allows patients to take a sample themselves without possibly exposing a health worker. I hope this and other innovations in testing are scaled up across the country soon.

Even so, demand for tests will probably exceed the supply for some time, and right now, there’s little rhyme or reason to who gets the few that are available. As a result, we don’t have a good handle on how many cases there are or where the virus is likely headed next, and it will be hard to know if it rebounds later. And because of the backlog of samples, it can take seven days for results to arrive when we need them within 24 hours.

This is why the country needs clear priorities for who is tested. First on the list should be people in essential roles such as health-care workers and first responders, followed by highly symptomatic people who are most at risk of becoming seriously ill and those who are likely to have been exposed.

The same goes for masks and ventilators. Forcing 50 governors to compete for lifesaving equipment — and hospitals to pay exorbitant prices for it — only makes matters worse.

Finally, we need a data-based approach to developing treatments and a vaccine. Scientists are working full speed on both; in the meantime, leaders can help by not stoking rumors or panic buying. Long before the drug hydroxychloroquine was approved as an emergency treatment for covid-19, people started hoarding it, making it hard to find for lupus patients who need it to survive.

We should stick with the process that works: Run rapid trials involving various candidates and inform the public when the results are in. Once we have a safe and effective treatment, we’ll need to ensure that the first doses go to the people who need them most.

He also talks about producing a vaccine in quantity. I tend to believe that an effective vaccine will be much more elusive than he seems to.

Those all appear to be sensible suggestions, based on certain assumptions. The question I would ask is for the avoidance strategy of the “stay at home” directives to be effective how complete a compliance is necessary? If your answer is “100%”, we should be implementing another strategy as quickly as possible. We can’t get 100% compliance with anything. If something below 100% compliance would be sufficient, what will be necessary to achieve that level? Just as an example here in Chicago, the number of shootings was actually greater during the week following Gov. Pritzker’s statewide “stay at home” directive than it had been the prior week. Criminals are notoriously observant of rules. Additionally, something between 5% and 10% of the U. S. population is composed of people who are here illegally. The one thing they have in common is that they’re not predisposed to follow the rules if the rules stand in the way of what they want to do.

I’m sad that he doesn’t mention emphasize finding effective treatments in his op-ed. Unless you assume zero new cases, the very slow rate of recovery from serious cases of COVID-19 tells us that “bending the curve” is a much lengthier process than would otherwise be the case. We need effective treatments urgently. Supportive care is not enough.

8 comments… add one
  • steve Link

    We have daily reports on not just our numbers but also some of the hospitals in between us and NYC. The rate of ICU admissions in those furthest to the east of us are slowing. Dont know if this is due t fewer pts or if people are fleeing west. (A lot of our pts have NY and NJ addresses.)

    “ust as an example here in Chicago, the number of shootings was actually greater during the week following Gov. Pritzker’s statewide “stay at home” directive”

    If I had been locked in the house with my daughter when she was a teenager, I think I could understand those numbers.


  • Jan Link

    What state are you based in, Steve?

  • He’s in Pennsylvania.

  • CuriousOnlooker Link

    I am increasingly convinced the Federal government needs to pass laws/regulation updating HIPAA that is required for effective contact tracing for this disease.

    Given evidence to 20% of carriers are asymptomatic and symptomatic carriers are infectious 5 days before symptoms — public health officials need the ability to find and inform anyone a carrier may have come in contact with — that includes using location data from cell phones. There probably needs to be clarity that this info can be shared among different jurisdictions.

    They can start by looking at the laws Taiwan and South Korea passed in response to SARs / MERs — since those countries are democracies and had relevant debates on liberties, privacy, safeguards, public health.

  • GreyShambler Link

    furthest to the east of us are slowing.
    Full up?

  • Greyshambler Link

    What control does HHS have over religious gatherings? This was a problem in South Korea. There are groups of good people who believe that God’s healing is exactly the answer.

  • Not much. If martial law were declared, the National Guard could be sent in to enforce temporary closures. That’s pretty much it.

  • Icepick Link

    I am increasingly convinced the Federal government needs to pass laws/regulation updating HIPAA that is required for effective contact tracing for this disease.

    No one seems to want to mention that we have massive regulatory hurdles to leap over to do the things that need to be done.

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