I’m preparing a status post on COVID-19. There is pretty obviously another surge going on but its contours appear to be quite a bit different from the one in the spring.
There’s also an interesting discussion going on in the comments of this post, having to do with pandemic preparedness. I don’t think that people have really processed what’s been happening for the last nine months. Let me just put it this way. Don’t be surprised if the next pandemic starts while this one is still under way. That’s what happened in the version of globalization that happened in the 16th century and the next phase that started during the 19th century. While I agree with, for example, Bill Gates that we need to be better prepared, I think that whatever your political ideology you will be deeply dissatisfied with some of the measures we’ll need to take. I am greatly skeptical that we can prepare for the next pandemic and pursue a “Green New Deal” simultaneously, just to pick one example.
While I collect my thoughts, what should we be doing if anything to prepare for the next pandemic?
Basically, nothing. Or just a few basics. Maybe better masks, a very marginal suggestion? Protect the vulnerable, which is largely their self responsibility. Stay at home if you wish.
Life should go on. No one, and I mean no one, has a rational strategy to “stop the virus.”
I understand that sounds fatalistic, but it happens to be reality. Sometimes reality is, uh, reality.
On the easy side, stockpile masks, bleach, keep an extra week or three’s food on hand, avoid crowds and other mass events.
On the difficult side, legal authority (laws) to impose nationwide curfews, masks, etc. Developing one authoritative source of info (e.g. the Surgeon General) on what we face and how to stay healthy. Recognize what works for Pierre SD won’t work in say St Louis MO. Negotiate the general contours of the inevitable relief bill. Maybe look up those old Civil Defense plans for dealing with bacteriological warfare.
1) Make preparation a national priority. US deaths due to a pandemic are more likely than us being attacked by a foreign country. Probably higher than significant terror attacks. Yet, our national preparations hav always been pretty minimal. (Maybe due to the fallacious belief that we cant do anything?) Stockpile and maintain adequate supplies. Train people so that we are prepared. Maintain adequate research.
As part of this we need to realize that not every pandemic will be like every other one. If this virus had, say, primarily affected young kids and/or killed more people and/or left people severely incapacitated (think polio) our response would have been different. Note that polio didnt actually kill that many people but it was highly feared.
2) We should have adequate foreign intelligence so we can get a head start. WHO is dependent upon donations from member countries so it will never fulfill that role. We need people stationed everywhere or have an international organization that can investigate without fear of losing funding.
3) We need good leadership and regional, at least coalitions. We need to not have mixed messages from leadership and we need coordination so states arent competing against each other. We also need to have planned out some kind of economic response.
Lots more but can start there.
Steve
Observations from this pandemic.
Except for South Korea; no country successfully suppressed the pandemic with test, trace, contact and mild social distancing. The most successful countries (China, HK, Taiwan, New Zealand, Australia) utilized/relied on mandatory, centralized quarantine. There have to be appropriate facilities across the nation for enforcing isolation and the will to utilize them.
Revamped laws, regulations involving privacy (basically no privacy) with communicable diseases.
A Manhattan project investment in immunology. This vaccine took at best 1-2 years of development. The goal should be to shorten it to 4 months from virus detected to phase 3 trials finished.
Stricter oversight of research involving viruses and especially “gain of function” research. While this virus was most likely natural, the ease to which the next virus could be bred would shock people (it can be as simple as having bat and minks mixing together in a room).
Fund a study of building ventilation systems and code requirements that place health and fresh air over efficiency.
If virus can be filtered, require that. If not, eliminate recirculated heat or cooling.
Experts in the field can fill in the details here, I’ve done the heavy lifting.
And. I have nothing against constant vigilance by WHO or whoever, but no one is prescient.
No one knows when to take drastic steps like halting international travel until it’s too late . I’m sure many potential viral candidates arise yearly. How often can you cry wolf and retain credibility?
In the 13th century, if rulers had known that bubonic was related to trade, would they have shut it down? Could they? Should they have?
The science may be easier than the policy.
It is important to remember that masks, separation, and shutdowns were not intended to prevent deaths or cases, merely spread them out to ease the load on the medical establishment. That was the publicly stated plan. The measures imposed (and still in place) did not prevent one death or one case. By limiting access to health care, the measures imposed may have killed some people.
The number of cases and deaths in any pandemic depend upon the number of susceptibles originally present. The progress of the pandemic eliminates susceptibles, by death or recovery, until there aren’t enough left to sustain it. Right now, the number of new daily cases is about 5 to 6 times higher than at the peak of the death rate back in April and May. But the number of daily deaths is a very small fraction of what happened in the spring.
Scientific studies indicate that the infection death rate for COVID-19 is less than 0.2%, which makes it about twice as deadly as the annual flu. For details see,
http://viableopposition.blogspot.com/2020/11/what-is-infection-fatality-rate-for.html
The psychological damage done by our Ruling Class is enormous. I have a niece with 15 to 20 years teaching experience who is about to permanently quit her job out of sheer panic. Her husband also quit his job. Their age group has a negligible death rate. They are keeping their kids out of school, even though her school system has reopened, and the death rate among children is essentially zero. They are more likely to die in a school bus accident.
Our current unemployment rate is more than twice what is was before the panic. If the current wave in new cases (which is due to increased testing, well over 1 million tests per day) is used as an excuse for new shutdowns, the economy may never recover.
So what will happen in a new pandemic? What just happened this year. We might or might not get a reliable vaccine for COVID-19, most likely not, but every new pandemic, with a novel virus, will play out the same way: panic, hysteria, lies, fraud, mass unemployment…
Contrary to what seems to be believed we’ve had one for the last 50 years. That’s how long we’ve been spending 30% or more on health care than the market clearing price would have been. That in turn has resulted in a lot more investment in health care and more people entering the field, including immunologists, than would otherwise have been the case. What we haven’t done is expanded the number of people practicing medicine proportional to the increase in population over the last half century.
Recently, Rahm Emanuel said that the unemployed fast food workers should become software coders. Why not immunologists? I think the question answers itself. Not everyone is equally able to create computer software and not everyone is equally able to become a physician or an immunologist.
If we increase spending without increasing the supply of workers, it will not result in more results. It will result in higher incomes for those who are in the field which may actually result in fewer results. The Manhattan Project took place over three years. That’s neither long enough to train new young workers or retrain workers from other fields who actually have the ability to do the work.
“The measures imposed (and still in place) did not prevent one death or one case. ”
Absolutely untrue. The fatality rate now is about 1/3 to 1/2 of what it was in March and April. May lives were saved.
“Contrary to what seems to be believed we’ve had one for the last 50 years. That’s how long we’ve been spending 30% or more on health care”
That has not all been spent on immunology. Certainly has not been spent on research.
“If the current wave in new cases (which is due to increased testing, well over 1 million tests per day)”
The positive rate of the tests has also greatly increased.
Steve
Immunology not as in medical doctors diagnosing and giving people treatments – but fundamental research.
Immunology was a terribly under-invested research field till about 10 years ago; when researchers found cancer is in part tied to failures of the immune system.
The fundamental fact is all pandemics are caused by viruses/bacteria that utilize some weakness in the immune system. If we don’t understand the immune system; we will always be behind the next virus.
The career path to becoming an immunologist, at least in the U. S., is:
1. Be admitted to and graduate from medical school.
2. Pass a state licensing examination.
3. Complete a residency program in internal medicine or pediatrics.
4. Complete a fellowship in immunology.
5. Pass additional examinations to become board certified.
It cannot be considered separately from medicine. Increasing the cost of health care increases the cost of immunology right along with it. If you’re saying we need to sharply increase the number of medical doctors being graduated, I’ve been saying that for decades. Today although we have twice as many people in the U. S. as we did in 1960 we only graduate half again as many physicians as we did then and they thought there was a critical shortage then. Sharply increasing the number of physicians being produced would not only require a sharp increase in federal subsidies but a complete reversal in the the philosophy of medical education that has prevailed for the last century.
An immunologist is not a research scientist.
I am talking about investing in basic science, the science of immunology.
An analogous situation is an actuary vs a theoretical mathematician.
The actuary is apply existing knowledge to a discrete realized instance of the problem using known techniques.
A theoretical mathematician is looking at unsolved problems; looking for new knowledge; using perhaps novel techniques.
I am saying we need to invest more in gaining new knowledge in immunology rather then investing in immunologists to practice medicine on people.
In answer to your question about preparing for the next pandemic: pray.
The intangibles have as much an impact as the virus itself. Mitigate panic, provide clear and consistent messaging about what is known about the virus and admit what is not known, cultivate trust and cooperation with the public through such messaging, and acceptance that regardless how prepared we are for the next pandemic some people are going to die. I therefore pray that government, the media, and leaders keep this in mind for the next time.