In an op-ed in the Wall Street Journal Scott Gottlieb offers his take on the proper national course of action in dealing with COVID-19. Many of these have been mentioned in comments here. Here’s his plan in outline form:
- Containment where that still makes sense.
- Mitigation tactics for places, e.g. New York, Seattle, where the virus is in all likelihood already widespread.
- Widespread testing for epidemiological purposes rather than diagnostic ones. That would require a national testing plan rather than placing the decision of whether to test or not in the hands of individual physicians.
- Serological surveillance which would mean identifying those who have already recovered from the virus whether they have been symptomatic or not.
- Effective therapeutic strategies. IMO this is the highest priority. Regardless of how many tests are administered unless cases are cleared more rapidly the healthcare system will inevitably be overwhelmed.
- Regulatory reform. That should not be a one-time process or undertaken as-needed. It should be ongoing, incremental, and iterative.
He also recommends ramping up the production of “promising” drugs in anticipation of demonstration of their effectiveness. How one would quantify “promising” is unclear to me and, frankly, I’m skeptical. Each decision to increase production of one drugs means something else is decreased or at least de-emphasized.
I would also mention that we need to optimize processes beyond regulatory ones. We need to change how healthcare is delivered in this country and how it is measured. I would also take preventive measures but I’ve been posting about that for the last fifteen years.
On the subject of containment.
Even if testing is sufficient, the way the US is doing contact tracing means containment will fail. For an example, look here.
https://www.scmp.com/week-asia/health-environment/article/3076477/coronavirus-us-officials-overruled-expert-advice
The fact that it took a Hong Kong newspaper to point out a deficiency in contact tracing in the first confirmed case (and every case since) in the US speaks volumes. Especially when evidence mounts that (a) people are infectious are far longer than are symptomatic (b) that the virus can survive 72+ hours on surfaces that are touched by infectious people.
I understand that there are privacy implications from revealing historical location data of confirmed cases, but they are less worry-some than the civil rights implications with months long “shelter in place” orders.
On regulatory reform, here is an article on the FDA’s role in the testing debacle.
https://thedispatch.com/p/timeline-the-regulationsand-regulatorsthat
It is practically a comedy if the results were not so tragic.
And guess what, it is the FDA who has to approve any therapeutics to treat the coronavirus.
If only we had someone who doesnt like regulations in charge who was willing to cut through the FDA regulations and instruct them to adopt the same kits they use in South Korea.
Steve
That’s why finding therapeutic uses for drugs that have already been approved by the FDA is so prudent.
I have seen several articles today with people beginning to question the orthodoxy of the last couple weeks.
1. Separate the old.
2. Mass quarantine doesn’t work. At least quarantine the hot spots, if not the vulnerable.
3. If mass quarantine doesn’t work, we can’t sink the (economic) ship trying.
Almost tripled the number of people on vents in two days. Really, really dont want to hear anyone say this is just like the flu. We haven never seen anything like this.
“3. If mass quarantine doesn’t work, we can’t sink the (economic) ship trying.”
And as a bonus by letting all of the old and sickly folks die we make Medicare solvent. Maybe our entire health care system!
“Rep. Alan Grayson: GOP health care plan calls for sick to “die quickly”
“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”
Steve
Just saying a lockdown is too strict without an alternative that keeps workers safe from the disease is useless.
One could lift all the lockdown orders tomorrow, then my guess is a crippling number of workers won’t show up – because they are scared they will catch the virus, end up in the ICU and suffer permanent lung damage.
Until the fear dissipates because people believe the outbreak is over or under control they won’t have the animal spirits to get the economy going.
The money before people BS is trite, steve.
Where were you last year with 60,000 flu deaths? The last 40 years? When do you start dictating diets to prevent diabetes, cancer and heart disease? Want a 15 mph speed limit to eliminate motor vehicle deaths…….?
” suffer permanent lung damage.”
I haven’t sen anything on long term effects. There are always some issues that occur with long term intubation and ventilation, but I dont know if there is anything unique to this virus.
Steve
“Where were you last year with 60,000 flu deaths? ”
You clearly have much more ICU experience than either I or any of my critical care colleagues. We have never seen anything like this escalation even in the worst flu years. I guess your experience is different.
“Want a 15 mph speed limit to eliminate motor vehicle deaths…….?”
How about a risk/reward evaluation? Why not set the speed limit at 200 mph?
Vietnam we 58,000 US deaths, IIRC, and it cost in today’s dollars over a trillion. Iraq War cost several trillion in response to a bit over 2000 US deaths and we lost another 4000 plus US soldiers. Now we are trying to reduce deaths from what we think would be 600,000-1,000,000 and you are not willing to suffer what should be temporary losses? Just throw in there towel now and dont even try? Maybe we dont find a cure or vaccine and maybe this becomes the new normal. Every year we get 600,000 death each of heart disease, cancer and Covid, but we arent even going to try?
Steve
For lung damage, I should have phrased it more carefully. Coronavirus is too new to state the long term effects for seriously ill patients.
But there is strong evidence from SARS (the original one) of long term damage . Here is a Canadian survivor cohort study of those who were in the ICU that showed reduced lung function at 1 year.
https://www.nejm.org/doi/full/10.1056/NEJMoa022450
I don’t know if those results are worse than patients who went on a ventilator for other diseases.