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News-Nugget About The Coronavirus Pandemic
Excerpts from three current pieces about the novel coronavirus pandemic.
NPR: White House Knew Coronavirus Would Be A 'Major Threat' — But Response Fell Short
In the case of Alex Azar, [the head of Health and Human Services], he did go to the president in January. He did push past resistance from the president's political aides to warn the president the new coronavirus could be a major problem. There were aides around Trump – Kellyanne Conway had some skepticism at times that this was something that needed to be a presidential priority.
But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that's partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear – the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.
So how did that worst-case scenario look?
NYT: The Worst-Case Estimate for U.S. Coronavirus Deaths
Officials at the U.S. Centers for Disease Control and Prevention and epidemic experts from universities around the world conferred last month about what might happen if the new coronavirus gained a foothold in the United States. How many people might die? How many would be infected and need hospitalization?
One of the agency’s top disease modelers, Matthew Biggerstaff, presented the group on the phone call with four possible scenarios — A, B, C and D — based on characteristics of the virus, including estimates of how transmissible it is and the severity of the illness it can cause. The assumptions, reviewed by The New York Times, were shared with about 50 expert teams to model how the virus could tear through the population — and what might stop it.
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Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die.
And, the calculations based on the C.D.C.’s scenarios suggested, 2.4 million to 21 million people in the U.S. could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill.
That is why we argued that only an early and lasting lockdown can prevent that the health care system goes into overload and that many people who would ordinarily survive would otherwise unnecessarily die.
A U.S. op-ed writer, who was in China during the lockdown, repeats our criticism of the racism that led to the still sluggish response in 'western' countries.
NYT: China Bought the West Time. The West Squandered It.
[F]or weeks now, the attitude toward the coronavirus outbreak in the United States and much of Europe has been bizarrely reactive, if not outright passive — or that the governments in those regions have let pass their best chance to contain the virus’s spread. Having seen a kind of initial denial play out already in China, I feel a sense of déjà vu. But while China had to contend with a nasty, sudden surprise, governments in the West have been on notice for weeks.
It’s as if China’s experience hadn’t given Western countries a warning of the perils of inaction. Instead, many governments seem to have imitated some of the worst measures China put in place, while often turning a blind eye to the best of them, or its successes.
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In my experience living in China for weeks during the peak period of the lockdown and talking to various groups beyond the disgruntled elites, people were frustrated, even exasperated, by the containment measures — but they largely supported them, too.
And while some in the West fixated on how China’s system failed to stem the outbreak at first, they were ignoring the aspects of it that worked. There’s nothing authoritarian about checking temperatures at airports, enforcing social distancing or offering free medical care to anyone with Covid-19.
Your host is currently working on a piece about the social, political and geopolitical consequences the pandemic is likely to have. My first outline says that these will be huge and will reverb over several decades. I will have to tone that down.
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Previous Moon of Alabama posts on the issue:
@Jackrabbit, #460
I don’t think you read what I wrote carefully, and I very much doubt you read Professor Donald’s excellent explanation of the policy. (You really should. It’s a very encouraging example of a government making policy on the basis of a rational calculation of the benefits and costs to its people, rather than on emotion or for the benefit to powerful insiders – a rarity in the West these days.)
Moving from ‘containment’ (in the hope of eliminating the disease) to ‘delay’ (in the hope of keeping the number of people needing intensive care beds within the available capacity) is not the same thing as the onset of community spread. (After all, every patient after Patient Zero was infected by community spread.) You might have argued that the UK moved to the delay phase too early, (and I might have agreed with you, given some evidence), but you seem to be saying that you just never should make that move.
In the containment phase, there is hope of eliminating the disease (globally, or in a country which is sufficiently isolated from potential re-infection). Obviously, you quarantine those with the disease, and their contacts who might have it. In Wuhan, the Chinese didn’t have a test for the disease, so they initially shut everything down and banned movement, to prevent mixing the healthy with any carriers. Right decision. The South Koreans had thousands of test-kits available, so they didn’t need to quarantine whole areas, with the resulting economic damage – they went with tracing and testing all contacts, and testing anyone worried they might be infected. Probably the right decision.
The UK initially adopted the Korean approach to containment, with some success. I don’t know whether they eventually decided that they had failed, or whether they gave up on containment because of developments abroad. Either way, the aim has now changed to reaching a steady-state situation where the disease does as little damage as possible each year, and to incur as little damage as possible in getting there.
That steady state is attained when enough people are resistant to infection to make the R0 fall below 1 (i.e. each person with the disease infects less than 1 new person on average) so that any outbreaks naturally die out. That could mean waiting for a vaccine. But there is no guarantee that one with no unacceptable side effects can be found – nobody has ever created a practical vaccine for any of the half-dozen or so existing corona viruses. People hope there might be one in 12 to 18 months – but hope isn’t a plan of action, and anyway, lock-down for that long could cause complete economic collapse. The other option is to build up what is traditionally called ‘herd immunity’, but which some people now call ‘community resilience’. Each person who has already recovered from the disease becomes a block to its further propagation, as they are immune to catching it again (at least till it mutates sufficiently some time years down the line). Having people catch the disease is no longer considered a disaster – so long as they recover, it becomes part of the solution.
Achieving community resilience would be simple if you had infinite medical resources and if there were no difference between different sections of the population in susceptibility to the disease. There would be no better solution than “letting it go wild”, as ‘Smith’ wrongly accused Boris of doing. But intensive care units are limited, and a proportion of those infected will require treatment in an ICU. If the supply of ICUs is overwhelmed, as happened initially in Wuhan and in Lombardy, some of those people will not get the treatment they need, and will die. It is therefore sensible to aim for (just under) 100% demand for the available ICUs until population resilience is achieved. Anything more causes unnecessary deaths, and anything less delays achievement of resilience, and extends the crisis for no advantage. Further, there are some groups – the old, the immuno-suppressed, those with pre-existing heart or respiratory problems and so on, who are more likely to die if infected. For their own sake, it is best for them to self-isolate until community resilience is achieved – they may then never get the disease, and if they do, they will have ICUs available without depriving anyone else. But their self-isolating also helps everyone else. For they are not only much more likely to die if infected – they are also much more likely to need an ICU. The young and healthy will generally get through the disease without medical attention, and only a tiny proportion will need an ICU. So, if the oldies keep out of the way, there can be a very large flow of young people from susceptibility to illness to immunity without overloading the ICUs, thus helping end the crisis as quickly as possible.
The British scheme consists of several pieces of advice, aimed at keeping the ideal flow through the ICUs, and achieving population resilience and an end of the crisis as soon as possible. (It also gives emergency help for people and firms that are financially endangered because people follow that advice). Practically nothing is banned outright – in fact, in the models used for predictions, there are guessed parameters for rates of compliance with the advice. At the coming height of the crisis, there may be some curtailment of liberty, but it is being kept as small as possible, and will be clearly temporary as it will be justified only by reference to avoiding overwhelming the ICUs. This precludes the resentment expressed by the young in some other countries, who say that their lives are being put on hold to save the lives of useless and scared boomers. As the boomers are keeping out of the way as much as possible, the lives being saved by managing the flow through the ICUs are largely young ones.
In contrast, the strategy of locking everything down straight away, whilst sensible in the containment phase, is pointless and disastrous once hope of eliminating the disease has passed and you are in the delay phase. It is pointless because it delays everything, including the achievement of community resilience, which is the only way out of the crisis except for the hoped-for distant and uncertain promise of a vaccine that does more good than harm. Models show that if you end the lockdown because of the economic and social disaster it causes, the medical disaster just starts up all over again. The social strains, the destroyed firms and jobs and families, the delayed or abandoned projects will all have been for nothing.
Just for once, Britain is doing something better than most other countries. After the embarrassments of the dodgy dossier, the Skripal affair, the White Helmets, Bellingcat, the Steele dossier, etc etc, I’d like to take a smidgen of satisfaction from that fact. Please don’t just dismiss it without argument as a “callous neoliberal policy” because there will be some deaths – any policy available in the delay phase necessarily involves deaths. Carrying on with policies designed for containment would be worse. If it’s your position that we should still consider Europe to be in the containment phase, I’d be interested to hear your arguments. But I think they’re going to need to be extra-ordinarily good, since Europe had already got many times China’s infections before Britain changed strategy.
Posted by: kgbgb | Mar 18 2020 1:06 utc | 458
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