Science, Experience, and Hope

I agree with the general thrust of the Washington Post’s latest editorial. Reopening the economy will be an enormous task:

Tom Frieden, former director of the Centers for Disease Control and Prevention, has usefully outlined four tasks. First, wide-scale testing must be deployed to know who is sick and who is not. Second, those infected must be isolated from the healthy and susceptible. Third, everyone who had been in contact with the sick must be traced. Fourth, those contacts have to be isolated to prevent further spread. All four have to be accomplished to box in the virus, he says.

Where I differ from them is more in this paragraph:

Unfortunately, there are stubborn, unresolved problems with all four. It will be catastrophic if the next phase unfolds with the kind of chaotic supply shortages and lack of leadership we have seen over the past few months. Diagnostic tests, to see whether people are sick, have been running at about 140,000 a day reported by the states, only a fraction of what is needed for phase two. Serological testing, to see who has recovered with antibodies that might confer immunity from reinfection, has never been done at this scale. Many tests are in the works, but technical and biomedical uncertainty remain, including regarding how long the antibodies last and how strongly they may protect. Former Food and Drug Administration commissioner Scott Gottlieb and former FDA chief of staff Lauren Silvis have suggested that employers ought to take on some of the burden for testing, bringing it into workplaces, making it more routine and widespread.

Rather than the universal testing that they seem to imagine I have been advocating a well-designed, systematic system of sampling. Much depends on what level of certainty and risk you require. If you require 100% certainty and 0% risk, we will never reopen the economy, at least not until a vaccine and treatments are found for SARS-CoV-2 and COVID-19. At some point the food supply chain will break down and we will have much, much more serious problems than hospitals strained beyond their capacity. There will never be a large enough supply of tests and their precursors, enough compliance with directives, or enough people to trace contacts for the entire human population many times over which is what such certainty and risk avoidance would require.

Once you decide you’ve willing to settle for something less than 100% certainty and 0% risk, the matter becomes a political issue rather than a technical one.

Science tells us that we may be able to develop an effective vaccine for SARS-CoV-2. Experience tells us that either we will not or that it is likely to take a long time to do so, longer than we have. Hope tells us that we will.

I think we would be prudent to rely on experience but different people take that to mean different things. I guess that’s why I have been harping so much on the slow pace of recoveries and finding a treatment more effective than supportive care.