Jerri-Lynn here. As COVID-19 cases spike in the US and among European countries that had seemed until recently to have the pandemic under control, I want to reiterate what policies we know work to stem to spread of the virus.
At the risk of sounding like a broken record, I repeat these tried and tested messages.
Yet at the moment, these policies are all we have. These basic elements of pandemic control are well and widely known, and that has been so for quite some time. Indeed, they have again been successfully deployed to arrest the spread of COVID-19 by many Asian and antipodean countries, some of which have far less resources to devote to health care than in either the US or Europe.
Lockdowns also have can be effective, yet the World Health Organisation (WHO) says they need to be short and sharp, and are of much less utility if they are loose and open-ended. The reputation of the WHO has taken a beating throughout the pandemic – aided and abetted by hostile Trump administration criticisms – so it’s important to drill down to figure out what the WHO is actually saying.
Well-done contact tracing has been an effective policy, deployed by some Asian countries which still enjoy admirable infection rates. In some cases, these model countries never implemented full lockdowns. Yet countries that have adopted the neoliberal playbook have demonstrated their inability to do contact tracing effectively, largely because they cannot figure out a way to monetise. the process (see here for a representative criticism, among the multiple posts I have written on the topic).
By Hassan Vally, associate professor LaTrobe University. Originally published at The Conversation.
Last week the World Health Organisation’s special envoy on COVID-19, David Nabarro, said:
We in the World Health Organisation do not advocate lockdowns as the primary measure for the control of the virus.
This has created confusion and frustration, as many people have interpreted this as running counter to WHO’s previous advice on dealing with the pandemic. Haven’t most of us spent some or most of the past few months living in a world of lockdowns and severe restrictions, based on advice from the WHO?
Dig a little deeper, however, and these comments are not as contrary as they might seem. They merely make explicit the idea that lockdowns are just one of many different weapons we can deploy against the coronavirus.
Lockdowns are a good tactic in situations where transmission is spiralling out of control and there is a threat of the health system being overwhelmed. As Nabarro says, they can “buy you time to reorganise, regroup, rebalance your resources”.
But they should not be used as the main strategy against COVID-19 more broadly. And the decision to impose a lockdown should be considered carefully, with the benefits weighed against the often very significant consequences.
Lockdowns also have a disproportionate impact on the most disadvantaged people in society. This cost is greater still in poorer countries, where not going to work can mean literally having no food to eat.
So if lockdowns are best used as a short, sharp measure to stop the coronavirus running rampant, what other strategies should we be focusing on to control the spread of COVID-19 more generally? Here are four key tactics.
1. Testing, Contact Tracing and Isolation
The key pillars in the public health response to this pandemic have always been testing, contract tracing, and isolating cases. This has been the clear message from the WHO from the beginning, and every jurisdiction that has enjoyed success in controlling the virus has excelled in these three interlinked tasks.
No one disputes the importance of being able to identify cases and make sure they don’t spread the virus. When we identify cases, we also need to work out where and by whom they were infected, so we can quarantine anyone who may also have been exposed. The goal here is to interrupt transmission of the virus by keeping the infected away from others.
Time is of the essence. People should be tested as soon as they develop symptoms, and should isolate immediately until they know they are in the clear. For positive cases, contact tracing should be done as quickly as possible. All of this helps limit the virus’s spread.
2. Responding to Clusters
Responding to disease clusters in an effective, timely manner is also vitally important. We’ve all seen how certain environments, such as aged-care homes, can become breeding grounds for infections, and how hard it is to control these clusters once they gain momentum.
Bringing clusters under control requires decisive action, and countries that have been successful in combating the virus have used a range of strategies to do it. Vietnam, which has been lauded for its coronavirus response despite its large population and lack of resources, has worked hard to “box in the virus” when clusters were identified. This involved identifying and testing people up to three degrees of separation from a known case.
3. Educating the Public
Another crucial element of a successful coronavirus response is giving the public clear advice on how to protect themselves. Public buy-in is vital, because ultimately it is the behaviour of individuals that has the biggest influence on the virus’s spread.
Everyone in the community should understand the importance of social distancing and good hygiene. This includes non-English speakers and other minority groups. Delivering this message to all members of the community requires money and effort from health authorities and community leaders.
After some confusion at the beginning of the pandemic, it is now almost universally accepted that public mask-wearing is a cheap and effective way to slow disease transmission, particularly in situations where social distancing is difficult.
As a result, masks — although unduly politicised in some quarters — have been rapidly accepted in many societies that weren’t previously used to wearing them.
On WHO – it’s not only Trump beating up on WHO. WHO was its worst enemy for quite a time this year.
– it was very likely influenced by China early on (or, at least very much looked like that and wasn’t willing to go toe to toe with China making clear it’s not), quite possibly delaying response and toning down the problem;
– the message on the masks (and other things) was contradictory, unclear and well, realy bad.
It’s pretty hard to take WHO seriously now, given it spent the first half of the year undermining itself.
I think its important to make the distinction between WHO as a politicised bureaucracy, and WHO as a scientific body. Neither aspects have covered themselves in glory (I think the political side led to the excessive deference to China, and the bad science led to the refusal to face facts on masks), but it is still a body full of top class scientists with a dedication to health. The problem is deciding on who is talking when they give advice. In this case, I’m inclined to believe that there is no reason not to accept their most recent recommendation on this, as it seems to be based on hard experience, in particular in Asia.
For what its worth, my own view is that the evidence points to the conclusion that the only lockdown worth doing is a very strict, time limited lockdown, with the prime purpose being to minimise spread and stopping infection rates going out of control. The reality is that very strict lockdowns have worked in China and Vietnam and (at least initially) worked in Europe in the most hard hit areas. I think the evidence strongly supports the view that a very hard, short term lockdown is better than a longer term weak lockdown. Weak lockdowns seem to have the effect of protecting those who can protect themselves, while leaving vulnerable populations prone to the virus. Its hard to prove, but I also suspect that hard, time limited lockdowns are likely to be less economically damaging.
Outside of lockdowns, its pretty clear that we have to learn to live with the virus for the periods of a few months when things go back to normal. This means living with masks, working from home when at all possible, travel only when necessary, and constant hygiene. Public health authorities have to be allowed very aggressive track and trace (its pretty obvious that in most societies it simply doesn’t work to trust people to isolate or identify themselves). Vietnam, South Korean, and Japan have shown that this can keep a lid on existing infections – but there really can be no half measures (and certainly no neoliberal infestation permitted). I don’t think its a coincidence that those three countries always put public order and health above private profit, albeit in differing ways and for different reasons.
The big caveat on all this is coming soon – winter in the northern hemisphere. I strongly suspect that this could be highly problematic in Asia and parts of northern Europe/north America as people hunker down for the cold weather, especially in those climates where the air is dry in winter. I think that quite a few of the Covid success stories may well have been aided by summer heat and humidity. Time will tell.
I’m not disagreeing with the advice.
My point is that the public perception of WHO (and the public doesn’t care who spefically speaks when the news article says “WHO”) has been damaged badly earlier this year.
Which makes it harder to get the advice across.
IMF has some great research but admin has blinkers on …
These recommendations are also a list of things the US can’t do. Lacking “operational capacity,” as Lambert says. A clearer sign of a collapsing society could not be found.
Here is the strategy that matches both the current capabilities of the U.S. and what is historically normal:
“Normalize the crisis as part of daily life and gradually define it out of existence.”
We will end up dealing with COVID-19 the same way we deal with drugs, poverty, international conflict, climate change, corruption, etc…
If you think I am wrong say the phrase “The War on COVID-19”, look at the events of the past 6 months, and ask yourself if the current response to COVID-19 has been truly uncharacteristic for the U.S.
The only issue with this approach, and it is a major one, is the rest of the world may close its doors to the US until it cleans up its act.
While I agree the US may try to do as you describe, this is not something that can be easily accomplished as COVID-19 can directly affect other nations and we can’t simply force them to open.
Other nations have no mitigations for a collapsing United States. For the short to medium term nothing is available.
The entire global supply chain that turns their surplus goods into our currency (thereby reducing the surplus itself) hinges on our involvement.
Everyone is along for the ride even if our decision (like so many of the past) are monstrous and destructive.
Maybe, maybe not.
The rest of the world can accept US goods and certain services that can be provided remotely, but prevent movement of people or face to face services. The days where the US can determine and dictate what happens to the rest of the planet are over. While the US still has great influence, we have seen via recent events the power it held in the past is gone.
They types of isolation the world can impose, even if is just in certain areas, will force the US to adapt, or slide further into the failed nations pit.
“When we identify cases, we also need to work out where and by whom they were infected…”
If you read this carefully you will notice that this is often what is not being practiced in many western counties. This is backwards tracing… find the person who is spreading it. Most people don’t spread the virus, but a few people spread it a lot so it’s important to identify THAT PERSON and then get everyone who has been in contact with them to quarantine.
What often is practiced in western counties is forward tracing. When someone tests positive you try to identify all the people who have been in recent contact with the positive test person (from the estimated time that person was contagious) and have them quarantine. This potentially leaves the “super spreader” out there to continue to spread the virus as they were in contact with the positive test person days before they became contagious.
You’re making a meaningless distinction. If you identify an infectious person and trace everyone who was in contact with them, one of those people is the spreader. If you follow the chain two degrees, you reach those infected by the original spreader as well. Since people are most infectious for about a week to ten days, and we trace back 3-5 days of contacts, following the chain three degrees you go as far as it makes sense to cover the whole infection chain, going further back will take you to people who are not infectious any longer which is probably why they stop at 3 degrees (that’s my guess).
In my experience, the problem in western countries (when there’s a problem, I found the response varies within the same country, from region to region) is that getting a test can take anything between 24h to a week. Getting the results back can take anything between 2 to 5 days. Contact tracing may or may not happen at all. This is what I’ve seen in the countries where I live or good friends of mine are living. “Sloppy” and “half-assed” is what comes to mind when I think about these countries’ responses to Covid-19.
With respect, I do not think the distinction between backwards and forwards is meaningless.
R is “over-distributed” in SARS-Cov-2, i.e. the mean number of transmissions per patient is not representative of the actual distribution.
To illustrate with dummy numbers: if R is 3, that is the mean of one patient infecting 26 others and 4 infecting 1 one other and five infecting nobody. So, logically, if you identify a case, you can assume:
– they are unlikely to infect anybody else (50% chance of infecting nobody, 90% chance of one or none)
– the person who infected them is likely to have infected many people (20% chance they infected 26 people, 80% chance they infected 1; weighted infection of 6 others)
Assuming patient X is successfully isolated, it is more important to find out who infected patient X, because they were clearly very infectious, and bust that probable cluster, than to find who is maybe exposed to patient X.
I am sure a Bayesian could rationalise it better with priors but backwards tracing is more important than forwards. And if you do this effectively, you will traverse the infection tree more widely than following a single patient forward, and that means you will squash more clusters and reduce R faster.
There is a a very comprehensive review by a multi-disciplinary committee of the Royal Society – still an effective organisation – of the UK R number and the effectiveness of measures. My friend is a contributor but not a committee member.
It contains the rather withering paragraph on UK contact tracing: “The NHS Test and Trace system is designed as a crude form of contact tracing to facilitate stopping the spread of coronavirus. The NHS argues that tens of thousands more people who may have otherwise unwittingly spread the virus are now remaining safely at home because of this system. The evidence on its effectiveness is unclear at present.”
While I agree that the testing delays are a disaster, you’re missing the purpose.
Somewhere around 70% of people don’t transmit covid-19, but about 20% of people maybe responsible for 80-90% of all cases. You want to devote your resources to finding that spreader. Everyone these days knows about R0, but the degree of dispersion is called the k value. The flu has a fairly bell-shaped k-value. Covid-19 is highly skewed. Great article about it here…
If someone let’s say averages 5 contacts a day. In your 3-5 days of forward tracing that’s 15 to 25 contacts. What if this same person, upon reflection, can identify one or two venues where they could have been infected and it may have been 6 days ago? Why call 25 people that probably are not infected? You might only need to call 10 and once you identify the spreader you can insure they quarantine. You’ve just saved 15 calls that could be used for other contact and traces – many states aren’t even managing 30% of cases. Or you can forward contact from the spreader with those saved calls.
While this is all well and good, the biggest barrier to this method working is something Carla brings up below: asymptomatic cases.
Until this can be nailed down, effective tracing is going to be a tricky process, and only nations/regions with very serious and strict methods will have success.
Tracing requires testing. You identify an index case, you work through their past contacts, you test them, you test *their* contacts and so on.
At the moment we have plenty of testing in the UK. The test results come back late and most people are warned of contact by a call centre with no decent follow up or paid isolation.
We would be better off with fewer tests, returned faster and with paid and verified isolation.
Since so many with Covid-19 are asymptomatic, it seems to me that test, trace and isolate will not really work until we have a cheap, self-administered, universally available test — the kind of thing Harvard epidemiologist Michael Mina has been beating the drum for for months now:
Of course, Dr. Mina’s approach depends on a responsible, public-spirited population and a responsible, public-health dedicated government.
So it probably wouldn’t work in the US of A anyhow…
Thanks for that article. I have felt for a long time that fast and cheap testing was the basis for a Covid solution. Not dubious, maybe, partly effective vaccines given over and over at great profit.
In my jurisdiction, it is always “until there is a vaccine.” No other solutions even considered. This by scientists.
The fact that all the Loot has gone to Big Pharma indicates there is a big deception here. Further, the fact that these scientists and experts cannot see that fast and cheap testing is the possible solution indicates willful blindness.
Hopefully, there will be jurisdictions within the US and the World that will see and implement a testing solution. Sweden may already be partly on its way to such a solution.
it will surely be easier to do then but test trace quarantine have already been demonstrated to work in a lot of settings. Notably NOT the US.
I have encountered a LOT of frustration at carrying these steps out by State Epi programs. It is a lot of work. the work is Sisyphean in nature. CDC was never on board. Resources are inadequate. There is no trust in Public Health employees etc etc
Yes, lockdowns are a good tactic but they work best when you go in early and go in hard. But that is not enough. You need a coherent strategy for which lockdowns would be a part of. Otherwise you will undermine yourself and waste your efforts along with the goodwill of the population. As an example, lockdowns will not work if you still have thousands or tens of thousands of people arriving at your airports on a daily basis.
And you need to support those people in lockdown along with the businesses which too are temporarily putting into deep freeze. And you need constant testing to find out where the virus is and then use contact tracing to identify further threats from people that they came into contact with. You also need stockpiles of medical equipment so that you can protect your healthcare workers while they try to do theirs. But you get the idea.
So here is the thing. I have read of accounts over the years how they have all these plans on what to do when the next pandemic hit. You had people dedicated to developing them based on the experiences of past outbreaks. But as we have seen in so many countries, especially advanced ones, it is like they did not have a clue as what to do and were making it up as they were going along. So what happened to all these so-called plan that they supposedly had? Why was so much done on an ad hoc basis? I suspect that the reason was that too many people and corporations were pushing their own ideas forward in order to monetize the virus fightback instead.
Your comment applies certainly for much of Europe and for the U.S. But several Asian countries did have plans, and recent experience, both pro and con, with SARS. And they put their plans in place and they have largely managed the pandemic well. Their emphasis was to safeguard public health and mot monetize anything.
If our monopolized economy monetizes anything it should be quick, accurate home test kits. Distributed to every porch or lobby. We should do this to incentivize the manufacturing of this important tool. And in the “monetizing” of this essential item we will see how important it is to cooperate – not just compliant citizens who agree to be taxed for this essential thing – but between the government and the corporation. Settle on a fair price for everyone. The absurdity of our “government” is that it will take them 5 years to agree on a “fair price” and then it will take another 5 years for the corporations to comply.
The “fair price” question was floated earlier when the federal dollars were guaranteed to pharma cos working on a vaccine. The question: “You’re getting federal dollars to develope this, so if you find a vaccine will it be available to everyone for free or at low cost?” Answer: :”No, not necessarily; it could cost $3000- $4000 per vaccination, that seems reasonable to us. [- pharma rep]”
America. The Decline and Fall.
The US had an excellent plan.
But did not follow it.
Care to share any links to said plan?
“lockdowns are a good tactic but they work best when you go in early and go in hard.”
The point I was going to make. Once the bug has had a chance to get hold, lockdowns can only be holding actions because the infection is already established among essential workers – food supply, police, hospital staff, et al who must keep working. So they spread the bug amongst themselves and their locked-down families, and for those who face the public such as supermarket till operators, to and from the public on essential food shopping trips.
New Zealand eliminated the virus because it went hard, and more especially went early before the virus became established in the population, and especially among essential workers. Now it’s too late for most places and the author is correct that lockdowns can only slow things down for them. But as a lesson for the future perhaps a globally instituted lockdown – organised by the WHO when the bug first appears and its potential to become a pandemic is recognised? – could nip it in the bud.
The big advantage of lockdown is that if you’re caught completely with your pants down, it’s something that you can implement quickly to stem the bleeding while you look for a better solution. Of the four points listed, only #4 (masks) can be implemented quickly and with minimal preparation, and even that requires sufficient masks to be available, which challenges the supply chain. Contact tracing and cluster management take time, resources and focus to learn how to do well. As for educating the public, you need to educate yourself first so that you know what advice is good and what isn’t, and in the early days of a pandemic that may be easier said than done.
The big disadvantage of lockdown is that, unlike the other four, it’s not sustainable in the long term. It should therefore only ever be presented as a stopgap measure, never a solution in itself (Trump opponents in the US are constantly making this mistake). If you deploy it as a response without actually having any kind of long term plan that it’s supposed to transition to, people will quite rightly view it as doomed to fail and compliance will be poor.
I think it’s the wrong link in the “the Consersation” since that goes to recycling rather than the proper page: https://theconversation.com/who-is-right-lockdowns-should-be-short-and-sharp-here-are-4-other-essential-covid-19-strategies-148175
Thanks – Fixed it. (I had imported the header from a past post, and I simply forgot to update the link.)
This paper describes another useful strategy called pool testing. This was part of Uruguay”s successful strategy, a country that did not impose a mandatory lockdown
This I believe is what China does – and why they can test so many people so quickly. When the pool test throws up a positive, they can do further tests to figure out who has the virus.
Vietnam does this as well.
Thanks for this link. I’m unfamiliar with the term “pool testing”. It sounds a little bit like a form of binary sorting in computer data sorting. Makes sense.
Apologies if I’ve missed this in the links or coments, but I found this SARS-Cov-2 piece interesting regarding false-positive rates of PCR tests. It doesn’t challenge the accuracy/specificity of the test mechanism, but draws attention to possible false-positive effects in clinical use (FPs from cross-contamination, lax-practices, outsourced crapification etc)
The authors note that the WHO/CDC recognised FP rates as an issue for both SARS-CoV-1 and ebola outbreaks in their guidelines, but not so for Cov-2. Make of that what you will, but their use of External Quality Assessments (EQAs) results from PCR tests for those previous outbreaks to infer FP rates for CoV-2 seems pretty convincing to me. FPs are likely a problem here, no matter how sound the mechanics of the test.
False Positives are always a problem TBH, but this was discussed to death in the spring already.
False positives matter in inverse proportion to the real positives. I.e. if your real-positive is 1 in 100, and false positives 5 in 100, your test is not very useful.
If your real-positives is 10 in 100, and false postitives 1 in 100, the test actually means a lot.
Also, the stability of the results matters here, because test dominated by false-positives will be, over time, pretty stable. So if you’re running say 0.5-2% positivity on 1% false-positive test, you likely have few problems. But at the same time, you can probably affort to put in those false-positives to a quarantine at a relatively low societal cost.
But if you have results where the positive rates says is 5+% and tends to increase, you know you have a problem.
As an aside, in general PCR false-positives are most usually from contamination, but in CV case the much larger problem is that PCR can’t tell between a viable virus and a viral debris, so someone who was infected but didn’t fall ill (infected = virus entered the organism, didn’t fall ill = but immune system stopped it before causing any troubles, i.e. all working normal) can very well test positive. So you get sort of a self-contamination. But I know of no fast test that would be inexpensive, mass applicable, and able to identify only a viable virus.
@vlade – quite so. However much of the debate on the accuracy of the tests has extrapolated from results found in what one might expect to be the more rigorous/robust institutions. We’ve moved to a much larger scale scenario now, with increased demands for faster turn arounds which might be a reason to suspect that FP rates need not be stable. The Cov2 EQAs will eventually tell us more about these kind of FPs, but table at the very end of the article I linked to shows just how marked the variation in FP rates can be across and within viruses.
FYI from the paper I linked to, the EQAs they identified for Cov1 (2004) were 2.8-6.3%, Mers (2014-17) produced 0.6-1% FP with various other FP rates for different outbreaks of other viruses (including influenzas, dengue, hepatitis, measles etc) reported. They did some analysis using a ‘conservative’ use of the lowest quartile figure across these EQAs of 0.8% which is well worth following up. The rapid expansion of PCR test implementation might lead one to be less conservative than this figure – either way, FP rates are going to be a significant figure for any mass testing regime.
False positives can be and are to be dismissed by a second test on the same sample tested firsthand – you can suppress the false positive rate of a PCR test under the nominal statistical rate. Here in Germany, if the test outcome is in doubt, the second test is applied. Don’t know if it’s done also in other counties, but here the false positive rate is below 0.5%.
Section 3 might just seem kind of patronizing to NYC “essentials” who’d been told repeatedly to, “Just go on about your lives,” that MTA was safe, testing to verify paid sick-leave or reimbursement of all diagnostic and treatment expenses simply involved staggering about sick, for hours, in icy rain, packed triage lines to be sent home since they’d not met CDC criteria? Black, Hispanic, refugee, sero-prevalence of ~26% (as opposed to ~6% for work-from-home “white” Manhattanites, skedaddled upstate) might have some effect on their perspectives?
Lockdowns that are short and sharp are a very good thing to learn how to do. We would see other benefits from having this protocol. There’s no particular reason for objecting to “lockdowns” except it sounds so draconian. Lockdowns can protect the entire town including the essential workers who are in harms way every day. The idea, yesterday, of adopting a new work schedule – a two on – two off month – two weeks on and two weeks off – made good sense because a 2-week quarantine is what is now recommended for anyone testing positive or with symptoms. That some people cannot afford the test is just about the most disgusting thing America ever foisted on itself – it’s at least half the problem. The other half being that people literally have to work to eat. If we adopted this schedule permanently and made the lockdowns “sharp” it would produce other benefits, like saving on gas, eliminating commuter time, saving on massive heating costs for office buildings/factories/stores. During the lockdown weeks just think how much good sleep we could all get. And during the open weeks everything could go 24/7 which would also save on energy costs because starting and stopping the use of fuel is more wasteful than just going continuously at a lower setting (at least with a home furnace it is). And leisure time. That could be given a “value” finally. We humans weren’t born with a driving instinct to work like maniacs for 5 days and then take two off. But we are creatures of habit and we could certainly habituate ourselves to a two on – two off schedule. But I think it might fail if we just do it temporarily or arbitrarily because then it would be too disruptive.
The Mask Mandate from the perspective of the virus.
“I believe we are in as great a crisis as a species as we have ever been. The crisis is not from some seasonal virus (which is a health issue), but it is from ourselves and what we have devolved into as a species (social, cultural, ideological issues).”
“It has been clear from the start that the modelers have NO idea of how a virus works in the natural world. They have based their modeling on the assumption that the culprit is the human being. The human being must be controlled in order to control the virus. This is completely wrong. ”
Great read if you want to really understand the biological nature and societal impact of this pandemic.
Why has the US not Implemented Countrywide COVID 19 “Test and Trace?”
The following is pure speculation as to why this did not happen:
South Korea has a very successful test, trace and Isolate program for managing the Covif 19 Pandemic.
Why did the US ignore it, and not Implement such a program?
Let’s first observe the US is a litigious country, and litigation involves pointing a finger and lawsuits for collecting damage.
Some quotes of a legal nature:
“A person whose intentional or reckless behavior spreads an infectious disease, such as HIV, SARS, or COVID-19, could face criminal charges.”
In test and trace, the infector knows they are infected, and if others become after the infected knows they are infected, then people who become infected might have the basis for legal action.
Implementing a Test and Trace program would supply evidence in, and the consequent litigation in the US could only be enormous.
Based on the litigious nature of the US, Test and Trace would pepper the pandemic management of the disease with a huge number of legal landmines, and propel an enormous number of lawsuits.
A test and trace program could be an open invitation for massive legal action.
Would the US government would wish a second plague, of Lawyers, to accompany pandemics, and the Politicians be blamed for a second pandemic of lawsuits?
I think not – Could they provide an interest in NOT creating countrywide a test and trace program in the US?
I think you are giving leadership too much credit here. Many politicians are lawyers, and they would love the increase in business for their profession.
Where is the official federal scientific recommendation to the president stating we must implement testing and tracing as soon as possible at all cost? I’m not blaming our federal medical community or Trump on either side, as I don’t know what has actually happened. Maybe there was a clear recommendation and it was suppressed somewhere along the way into the Trump administration. Maybe the federal medical community had little intention of submitting any recommendations that would rock the boat politically.
All I know is our inability to do the intelligent things that initially seemed like good ideas and now have had obvious success, is incompetence in execution by the US government.
Trump is the president, leader of the executive branch, and this will be a gateway issue for many voters. Trump sold himself as a winner in 2016, and yet we end up a big loser with COVID19.
Serco has monetized tracing just fine: it just did a poor job of it and is getting rewarded for that with fresh contracts! For the right cronies there is nothing that can’t be monetized and you don’t even have to actually do the job anymore: just show up to collect your check. So I think the problem is far worse than Jerri implies.
We now lack the will and ability to take meaningful and effective action in the face of challenges. This is what the ongoing collapse of civilization (aka the long emergency) looks like. Say a mass for the West: it is done for.
Thanks for this post.
last week, from FT Alphaville:
What if both the lockdowners and the anti-lockdowners are wrong?
the argument from John Hempton is that R0 tends to equal 1 either way…
Hempton misses the point, but unfortunately, it’s pretty common. R0 is a global number, or, if you want to put it differently, an average.
He actually even notes it – some people will take more risk, some less. It may even mean that the R0 average will be 1. But that may mean part of population uninfected, and part infected through and through. And for mortality matters massively _which_ part of the population is infected. So R0 doesn’t give you anything there.
You need to look at how the infections are distributed, and how they spread, because that will give you the mortality. If the high infection rate is in population that has low risk of mortality, yes, there will be deaths, but relatively few. If the infection rate is high in very suspectible population, there will be a lot of deaths.
As an example, take CZ now vs Italy in the spring.
Czech Republic right now has WAY higher infection rates than Italy had during its worst times (CZ has now the second highest positive rate in the world, almost 900/100k). But the number of deaths is not (yet. Unfortunately, it’s very likely to go up, the ratio of positive people older than 65 is growing) is still relatively low. Czechs have less than half of Italian cumulative positive-tested (180k vs 420k), but less 20th of their cumulative mortality (1500 dead vs 36k).
So looking at R0 gives you half a chicken.
If you want to look into the future, you can use the covid-19 simulator from the University of Saarbrücken, Germany. Ok, for the german part of the future… You don’t need to play with the software, it’s better to read the reports, especially the report from the 14th of october. There you can read that the case numbers will go up exponetially but the death rate will rise with a delay of 3-4 weeks. But then…
@eyebear – Thanks – but wouldn’t that be a problem if the sample was contaminated some how? Yes the tests once the samples get to the labs, but cross contamination can happen anywhere along the chain from nose to test-tube to paperwork. The performance of PCR testing regimes from previous outbreaks as tested by external labs suggests caution may be required in dismissing FPs until such external validation is available for SARS-CoV2.
It’s basic probabilities – if you take two independent samples, unless your process has systemic problems that introduce high chance of contamination, the likelyhood of both samples being contaminated is low.
As I wrote above, much larger problem with CV is that it cannot tell viable virus from a debris, which may lead to “false-ish positives”, i.e. people who are not viable spreaders identified as spreaders.
If we make an assumption that “asymptomatic cases” mean really “virus entered, but was defeated by the first line of immunity defences” (innate immunity), there will be some viral debris in the system but no viable viruses, and it could mark many people like that. So we might be putting as “positive” a lot of people who dealt with the virus ok – but we can’t tell them from people who did not, and are ill with the virus.
And IMO that’s a critical problem.
Or someone (Ingacio?) can tell me my assumptions are all wrong here and it doesn’t work like that.