In the comments thread of James Joyner’s latest “grim milestone” post at Outside the Beltway this comment caught my attention:
It didn’t have to be this way.
which I think is probably right but possibly not in the way in which the commenter meant it. I’ve done a lot of reflecting on it and I think it’s darned hard to come up with different policy choices that would have led to a substantially different outcome in the U. S. that don’t fit into one of the following categories:
- Science fiction
- Requires knowledge we just didn’t or don’t have
- Requires political heroism
- Requires foresight and spending the Congress wasn’t willing to exercise
- Speculative
They’re sufficiently rare that I can only come up with two. I don’t think it’s too much to think that if the Chinese authorities had suspended travel to/from Wuhan as soon as they had received reports that SARS-Cov-2 was spreading person to person, it would have at the very least slowed the spread of the disease outside China. It would have been based on knowledge they had and wouldn’t have required heroism or extraordinary foresight. It might be a little speculative. Any statement about the future inevitably is.
The other is that I think that if New York Gov. Andrew Cuomo had not sent COVID-19 patients into nursing homes, the death rate in New York, a third of the total U. S. deaths, would have been somewhat lower. That would have been based on knowledge, not required heroism, and would at least have been a bit effective. How effective is speculative.
Everything else I can think of violates one of those criteria. Shutting down all foreign travel to/from the U. S. on January 31 would have required some heroism and, indeed, its benefit is speculative. Shutting down travel as early as December 31 might have been at least a little more effective but was outside the knowledge that we had at the time. Mayor DeBlasio could have shut down New York’s subways but that would have required heroism.
Stockpiling PPE might have had marginal benefits but Congress wasn’t willing to do it and it would have needed to have been on the federal level. Vaccines or treatments are science fiction. A directive to wear facemasks would have been speculative and would require heroism. Nationwide contact-tracing (Congress, heroism, and speculative).
Maybe a narrower definition of “essential workers” would have had a little effect but I doubt it would have been material.
What measures that could have been put into effect based on the knowledge we had at the time when it would have been effective would have had a material change in the outcome? I’m not being argumentative. I really would like to know.
Update
While I was taking my morning walk with Kara (2.5 mi bearing 30 lb. of weights), I came up with a few additional things that might have been done that satisfied my criteria. First, President Trump could have taken the development of an effective test out of the CDC’s hands a couple of weeks earlier or had better managers in charge of the agency. Second, he could have invoked the Defense Production Act earlier to get more ventilators, PPE, and tests produced earlier. I think that each of those would have resulted in marginal improvements. By “marginal” I mean it might have saved some lives. It’s speculative on my part but I doubt it would have made an order of magnitude’s worth of difference.
Every single government and agency that confronted COVID-19 failed to react in time or effectively, even after weeks of warning. Almost all, if not all, made things worse. There are no exceptions.
The lockdowns themselves were an added disaster. We are still technically in a great depression, waiting to see if we will recover. If we get a second lockdown, the current depression will last a decade or more.
Depressions kill people, too. So do lockdowns. How many people without the virus died because of lack of medical care?
Almost all the deaths have been among the elderly who had serious illnesses. Nationally, some 43% of the deaths have occurred in nursing homes. In some states, like Ohio, the percentage is much higher, one estimate being 80%. (Hard to believe, but out there)
COVID-19 is only the third most deadly pandemic since WW II. Corrected for population growth, the 1957/58 Asian Flu killed over 223,000 people in the US, and the 1968/69 Hong Kong flue killed and equivalent 165,000.
No emergency measures were taken. Life went on.
The people making the decisions, both the politicians and the medical people, are among the worst of us. Many, like the Governors of NJ, NY, PA, IL, MI, CA are outright psychopaths. The medical people in the public health agencies are second raters, who could not function as practitioners. Fauci, for example, has a sordid history. Look up Robert Gallo, and the Fauci coverup. Neil Ferguson, author of the discredited Imperial College model, also has a history of near fraudulent modeling going back decades.
The next pandemic will be handled the same way with the same disastrous results. It is built into the human genome.
I can only think of one. Sort of a canary in the mine.
China had purchased the production assets of Louis Vuitton (sp) and was still running workers on flights back and forth to Italy resulting in that Italian meltdown. Could that have caused an earlier shutdown in incoming China flights to the US? Maybe, but the usual suspects were screaming Trumps a racist as it was. (And this of course never really got much media exposure to protect the China not at fault narrative).
I think maybe you underplay the Cuomo nursing home debacle. Speculative? Maybe. But some of us were sounding the alarms on vulnerable almost from day one. You didn’t have to be an epidemiologist.
If China had cut travel earlier it would have slowed down spread. However, the history of the world suggests that responding too slowly is probably the norm at the very start of a pandemic. I suspect we probably do have a few more deaths in NYC, but then you need to remember that at that time the hospitals were pretty much full and the new places they had opened up weren’t that functional yet. Would it be better to send an old person recovering to an inadequate new hospital or to a nursing home that has adequate facilities? For any individual pt I suspect they were better off going back to the nursing home. For the overall population it might have been better to go to the inadequate new hospital. Note that death rates where they supposedly didn’t have that policy are not that much different. Even Florida, lauded here, now has higher than the national average rates of death in nursing homes. Which all goes back to the point I have made many times, we really dont know to stop spread in nursing homes in any realistic way.
What could have been done was to have tests that worked and in quantity much earlier. We could then have tracked spread and caught it much earlier. We could have tested more pts and not have missed some assuming they had other infections. We could have tested hospital staff from the beginning so that they did not become vectors for spreading the illness (which would apply at nursing homes if you are saying that you care about them).
We should have accelerated production of PPE immediately. We still dont have enough. If you really want to target old people then if you want to have a chance of success you probably need to upgrade their PPE to N 95s, especially since so many other people refuse to wear masks. This needed to be done at the federal level. Some companies were willing and had the means to produce PPE but did not as they, correctly, assumed that once the crisis was over they would be stuck with a factory and no market.
Overall, I think that once we got past the early ineptitude, especially on the part of the CDC and FDA, we have done OK considering it is a new virus. Kind of ironic that the party which was willing to deregulate banks, the EPA, etc was not willing to let academic institutions develop their own tests.
“Corrected for population growth, the 1957/58 Asian Flu killed over 223,000 people in the US, and the 1968/69 Hong Kong flue killed and equivalent 165,000.”
Those numbers were for the whole outbreak. We are just finishing, we think, the first wave. We also didnt have even the minimal treatments we have now back then. No Hi flo O2 or BiPap. Ventilators were pretty primitive. No one had thought of proning. Just to remember how primitive medicine was back then the richest family in the world had a child die when it was born a few weeks early.Those are routine now. We also dont have the statistics, or at least I cant find them, on how often people were hospitalized or for how long. So in all probability we have saved thousands, probably hundreds of thousands, that would have died in the 50s or 60s.
Steve
Anecdotal but so far the best strategy seems to have been to quarantine the caregivers in nursing homes along with their charges.
“Anecdotal but so far the best strategy seems to have been to quarantine the caregivers in nursing homes along with their charges.”
As I’ve pointed out, once you are in the business of violating civil liberties at least be effective. Quarantine the nursing home et al facilities. I know a guy in Naples who owns several homes, and his biggest gripe was the families who wouldn’t comply. Letting people in the side doors etc. (so steves argument fails on the implementation issue) But it could have been contained. If you can fine or arrest people for giving haircuts you can do same for nursing homes. We chose to focus differently.
If you can prosecute
‘First, President Trump could have taken the development of an effective test out of the CDC’s hands a couple of weeks earlier or had better managers in charge of the agency. ‘
OMB would have been denounced and perhaps even impeached for not listening to the experts and taking rightful authority away from them. Which would of course nclude the substandard managers, who were not known to be substandard at the time. It also would have taken prescience, otherwise known as science fiction.
And don’t forget Pritzker and Wolf in Illinois and Pennsylvania for imitating Cuomo’s disastrous edict. I think there were other governors who did the same. Put all those states together and you easily have more than half of the fatal cases in the US.
“Anecdotal but so far the best strategy seems to have been to quarantine the caregivers in nursing homes along with their charges.”
Comes under science fiction or heroism. Not many nursing homes have staff who can/will do that or facilities that would support it. Probably limited to homes with healthier patients. Certainly looks that way for staffing ratios where there are articles about this happening.
Steve
I agree that it’s heroic.
I am just going to go on record that guarding nursing homes is quite possible.
My prime example is Singapore. They have 41000 cases of coronavirus, and only 26 deaths. That is an CFR rate of 0.06%. Given the median age in Singapore is 42 (older than the US or NY or Illinois), the only way the deaths were so low was Singapore managed to keep the infections away from the elderly.
The things that could have been done but were not:
Remove medicare / medicaid incentives to keep hospital stays as short as possible
Force nursing homes to transfer COVID-positive or suspected cases to the hospital ASAP, and refuse to admit recovering patients until they tested negative
Purposefully redirect PPE / testing to nursing homes instead of directing it to hospitals only
Other things that could have helped.
Don’t cutback mass transit due to reduced demand. That would help with social distancing on mass transit.
Designate hospitals as COVID-only / no-COVID. It is pretty clear there is substantial fear in visiting hospitals and catching COVID there. Heart attacks and strokes didn’t drop by 50/60% in the last 2 months, who knows how many died from not visiting the hospital when they should have.