Quick Comments on the Biden-Harris Covid Plan: Not Much Sizzle and No Steak

Lambert and I both recognize the need to provide a serious treatment of the so-called Biden-Harris Covid plan. However, the new, improved transition version of the scheme is so threadbare compared to the extensive, full bore assault campaign version that the shared elements are few and far between.

First, this new plan isn’t the same as the one on the Biden campaign site. The campaign version had no mention of contact tracing, while this iteration does. But if you simply skim the campaign version versus the president-presumptive one, you’ll see tons of program proposals from the campaign have vanished, like emergency paid leave (with reimbursements to employers), income support for gig workers whose pay has declined, rental assistance, and support for small businesses.

The campaign plan also had sweeping promises about paying for all Covid treatments, not just testing. For instance, this section, by using the term “balance billing” clearly meant it included hospitalizations and emergency room visits:

All copayments, deductibles and any cost-sharing for treatment for COVID-19 for insured. Providers will submit cost-sharing claims to NDMS that document private insurance contractual arrangement for co-payments. To ensure maximum provider participation and minimum billing abuses to consumers, current Medicare law’s “conditions of participation” and system-wide prohibitions against balance billing and surprise medical bills will apply. To guard against fraud and abuse by bad-apple health care providers, harsh civil and monetary penalties under the False Claims Act will apply.

There’s not a peep about any of this in the new version. All it has regarding “treatments,” in context, is new medications to reduce the severity and/or length of a Covid infection, and not, say, being administered oxygen in a hospital:

Plan for the effective, equitable distribution of treatments and vaccines — because development isn’t enough if they aren’t effectively distributed.

The lack of financial support for workers to stay at home because they are sick, quarantined, or just waiting for test results makes it difficult to treat this scheme as serious. And the failure to even ask for the government to cover all Covid treatment costs, not just the kind that can be administered with a needle means a lot of people who have or think they have Covid won’t seek treatment until they are really really ill, increasing the load on hospitals and producing worse outcomes.

And the severe downgrading of his Covid plan shows Biden embracing the Obama playbook: meet the Republicans 75% of the way when you start negotiating, with the expectation that the final deal will move even more in their direction.

Needless to say, leaving financial and health victims of Covid more or less on their own makes it impossible to implement something like the UK’s four-week national lockdown, which shuttered gyms, pubs, restaurants, and non-essential shopping (which includes non-essential goods at retailers like Tesco). Many parts of the US are at or nearing the point where hospitals are getting strained. Once we pass that level, Covid direct and indirect death rates will spike (more will avoid anything short of absolutely essential medical treatment).

And as we’ve previously pointed out, one of the real reasons for the earlier lockdowns was to protect medical professionals. Recall that in many hospitals, doctors of all sorts were pressed into Covid duty. If the US can’t get Covid infection rates down to where hospitals can handle the load, the need to defend the medical system necessitates lockdowns, even if it has only temporary success. It’s too bad no one has a remedy for Covid fatigue.

Let’s now turn to one new wrinkle, contact tracing. From the Biden-Harris Transition site:

Establish a U.S. Public Health Jobs Corps to mobilize at least 100,000 Americans across the country with support from trusted local organizations in communities most at risk to perform culturally competent approaches to contact tracing and protecting at-risk populations.

Hoo boy. First, where did the 100,000 number come from? Admittedly, it’s “at least” 100,000. The US has been at over 100,000 new infections per day since November 4, and that’s with our spotty testing. Health officials are bracing for things to get even worse due to the latest spike continuing (say Halloween parties plus more people going indoors as the weather gets colder) and then worsening after Thanksgiving. How many contact tracers would be needed per infected person to do an adequate job, when we know from Jerri-Lynn’s reporting on contact tracing in Hong Kong, that the contact tracers identified as many as 5,000 contacts from a single case?

Oh, but not to worry. The contact tracing isn’t intended to be comprehensive. It’s only going to target “communities most at risk”. That presumably means the urban poor….but what about American Indians? Rural communities with high outbreak levels due to having the big employer be a transmission vector, like a meatpacking plant?

And that’s before getting to the elephants in the room that we’ve discussed previously. One is that contact tracing is effective when:

1. There is a relatively low overall infection rates so that the cases that are tracked down represent a high proportion of total exposures. That is, it’s possible for the contact tracing exercise to have a serious impact on total contagion levels

2. The contact tracers can find most of the people who were exposed quickly

3. The people who are identified as exposed to Covid isolate for 11-14 days

None of these conditions apply. Even if you generously assume that the new Administration enlisted a big enough contact tracing army to overcome the numbers problem of #1, the other elements needed for a successful program are absent. Most Americans won’t answer a call from an unknown number. Most Americans won’t install a contact tracing app. And governments in South Korea, Singapore, and Australia, where citizens are more cooperative, concluded the apps don’t work. From Foreign Policy:

When a person tests positive for the coronavirus, tracking apps notify other people who have been near the infected person in recent weeks. Singapore’s tracking app is supposed to notify all people who have been within 2 meters of an infected person for at least 30 minutes, while Australia’s app claims to notify people who have been within 1.5 meters for at least 15 minutes. Since Bluetooth can’t actually be used reliably to measure distances, these figures suggest an illusory precision.

The inconsistency between what the apps measure and how the virus spreads puts governments in a bind. Set the time window too narrow, and the app will classify millions of people as possibly infected, requiring the government to track down everyone who has ever passed a coronavirus carrier on the street. Set the time window too wide, and the app will flag too few exposures to the virus. There is no “Goldilocks” zone in the middle of these two extremes.

Set the threshold at 15 or 20 minutes of close proximity to an infected person, and the coronavirus app will identify a moderate number of people for health authorities to contact. But most of the people who have contracted the disease from the infected person casually—that supermarket sneeze comes to mind—will be missed. The other problem is that actual transmission events are rare compared to the number of interactions people have. To find those transmissions, you have to wade through an enormous number of casual contacts, and that means tracking down virtually everyone. Once governments reach that point, they’re no better off than if they had simply relied on effective but labor-intensive human contact tracing in the first place, without the app.

An October New York Times story on why contact tracing was failing in most states confirmed our view that it’s not productive when infection rates are high and highlighted other problems:

Contact tracing, a cornerstone of the public health arsenal to tamp down the coronavirus across the world, has largely failed in the United States; the virus’s pervasiveness and major lags in testing have rendered the system almost pointless. In some regions, large swaths of the population have refused to participate or cannot even be located, further hampering health care workers.

Similarly, a CDC study published last Friday on Delaware’s success in lowering Covid rates found an over two-month “stay at home order” and mask mandate appeared to be effective, with an 82% fall in infections and a reduction of deaths to zero, although the analysis could not parse out the impact of each measure on a stand-alone basis.

By contrast, contact tracing was a bust:

Among 9,762 laboratory-confirmed COVID-19 cases reported during March 11–June 25, 2020, two thirds (6,527; 67%) of patients were interviewed, and 5,823 (60%) reported completing isolation. Among 2,834 contacts reported, 882 (31%) were interviewed and among these contacts, 721 (82%) reported completing quarantine….The median interval from receiving a positive test result to interview was 8 days…Among 6,527 interviewed patients with laboratory-confirmed COVID-19, 5,390 (83%) either refused to name contacts or could not recall contacts.

An eight day delay to the interview? With viral shedding peaking around symptom onset, and then new infections taking an average of five days to incubate, you’d expect the contacts to typically have infected new people even if the tracers had gotten to them immediately. And that’s before getting to 83% of the interviewees not providing contact information.

And we get to the final leg of the contact tracing fail: what happens when people are asked to quarantine? The CDC reports a high compliance rate in Delaware among the very few who actually got the request, but this took place while a lockdown was already on, so slightly stricter compliance presumably would not have been too painful. And the CDC charitably assumes that the self-reported quarantine adherence levels are accurate.

By contrast, with most states largely back to normal, asking someone to quarantine will often imply an income hit. And are they in a housing setup where this is even possible, with a separate bathroom and bedroom and someone able to drop off food at their door? In South Korea, people returning from overseas who had to quarantine were each assigned a public health official who’d check up on them, deliver food, water, cleaning supplies and medication as needed, and would even be housed temporarily if they couldn’t isolate. The US isn’t willing or able to take effective measures.

And don’t get too hopeful about the Pfizer vaccine. Aside from the distribution issues resulting from the need to keep it super cold (discussed at length yesterday in Links), Bloomberg flagged another wee problem:

It’s also important to continue watching those who received the vaccine for years. The messenger RNA technology used in the Pfizer/BioNTech vaccine has never been deployed in humans before.

A Pew survey in September found that about half the Americans would not take a Covid vaccine out of concern over side effects and safety. Relying on a heretofore unused method isn’t a way to encourage confidence. Admittedly there are other vaccines in the pipeline, but the Pfizer vaccine doesn’t look like a magic bullet.

That means the Biden-Harris Administration, like Trump, can’t over-rely on a medical industry save. They need to do some Covid heavy lifting. “Better than Trump” doesn’t cut it. Their current scheme isn’t close to adequate.

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82 comments

  1. Winston Smith

    For whatever reasons one wants to bring up, the virus has been left to run rampant in the US for the greater part of its stay. it is everywhere and infection levels are high in practically all regions of the country. The situation is such now that it will be difficult for any program or set of programs to truly “help” (and help who?). I am not sure any president could do very much of substance at this point. The political situation, institutions and by its very nature (individualism vs collective action), the US is ill-equipped to handle the situation.

    Reply
    1. Yves Smith Post author

      Yes, this is similar to the argument that I think Jerri-Lynn made first: that neoliberal systems aren’t equipped to handle Covid because effective responses don’t have enough profit mechanisms/opportunities.

      Reply
      1. Winston Smith

        Quite so. The false optimism generated by the hopes invested in vaccines does not help much. It is but one of the tools to be used in fighting the virus. The “positive” Pfizer news is a case in point. (1) based on mRNA technology-never tried in humans (2) necessitates -80C storage !. What could go wrong given (2): “stationnary’ -80C freezer breakdown is common and what is the reliability of mobile units? Nightmare for distribution and tremendous added cost

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      2. campbeln

        There is though! Just not immediate, direct profits.

        Look at New Zealand’s economy versus most others. The lockdown had high initial costs (almost) evenly spread across all parties but medium to long term it pays off for everyone. However, from the short term view (I’d argue the neoliberal view) there’s no way to position yourself better (relative to your competitors) so “why should I be shouldering any of these costs?”

        It all comes back to working together versus elbowing past your competitors no matter the cost. It feels to me that for neoliberals, what’s most important is that they are “in front”, even if that means they only make it 50ft (but in first place) rather than 100ft as part of the crowd.

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      3. rd

        Its why the Defense Production Act is necessary. Biden should be implementing that Jan 20 for testing supplies, PPE, and cold storage/transportation for vaccines.Even if vaccines are successfully distributed to much of the polulation by summer, the national defense stockpiles need to be completely rebuilt. If 2020 made nothing else clear, North America needs to be self-sufficient for at least a significant percentage of pandemic demand for these types of supplies.

        Reply
  2. carl

    COVID is just accelerating the impoverishment of the US population which was already going on, and so it’s going to continue. That’s why there’s no support for individuals or populations who need to stay home. If the billionaires don’t want it, it won’t happen. The disappearance of such things from the Biden plan is the tell.

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    1. cocomaan

      That was the most interesting part of the article to me, too. Giving benefits, even modest benefits, to gig workers would help you out electorally. Why leave them out? There’s a ton of gig workers out there looking for the lifeline.

      Reply
  3. vlade

    The US is now past where tracing would help, as it’s over the 10% of positive tests (from all tests). Experience in other countries show that tracing can work if you can keep the number around 3-5% (assuming reasonably proportional tests to the population of course, if you’re doing 10k tests in the US, of course tracing will be able to cope), but the moment it gets > 10% the tracers tend to get overwhelmed.

    The US seems to be a few weeks/month behind Europe in the spread. In Europe, the grow of cases and deaths lasts up to 2-3 weeks of taking some fairly drastic measures. I doubt the US will take any such, except for locally, so I’d not be surprised if the US situation was growing worse for another 1-2 months. Which, at the current trend, will translate to about 100+k hospitalised, and another 50-80k deaths.

    Given the fragmentation of the US health system, I’d not be surprised to see locally overwhelmed hospitals, where the death rates will be much higher than elsewhere. Rural centres (small towns/cities of up to 100k people or so) w/o a large city next to them will be IMO most vulnerable, as they will have enough people to get a spike, but not enough beds to cope nor an option to move the ill to a large centre next door.

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    1. David

      FWIW the French government doesn’t believe that contract tracing will be of much use until the number of confirmed cases is down to about 5K per day. The current figures have oscillated wildly over the last few days, from just over 20K to more like 60K and, with a public holiday tomorrow, will take some time to settle down. But there are some encouraging first signs of the results of the curfews and the re-confinement. At the moment, confirmed cases are running at about 20% of all tests, which is far too high to do contract tracing properly. But France, like other European countries, does have a reasonably efficient and properly enforced lockdown procedure, and general adoption of mask wearing, which seem to constitute the sine qua non for any other policies.

      Reply
      1. ChrisPacific

        I think they are correct. Beyond a certain point the contact web expands too rapidly and it becomes infeasible to do, even if you have good procedures. That’s the point where you need to implement society-wide measures (lockdowns, masks, gathering restrictions etc.) to reduce the rate of spread.

        What (good) contact tracing can do effectively is allow you to live with a low, but non-zero, rate of transmission without costly measures like lockdowns.

        Reply
        1. OpenThePodBayDoorsHAL

          I was struck by what the CDC says about H1N1, 60 million infections in the U.S. but luckily not very deadly.

          “The H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide.”

          When does Covid 19 get the same designation? What are the metrics for that? And will that be allowed to inform public policy?

          https://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm

          Reply
          1. rd

            Because H1N1 goes around and it is part of the flu vaccine in some years, there is now a fair amount of immunity in the population where it is usually not a bad case if you get it, and there is a good chance you won’t get it. The H1N1 flu virus mutates a bit, so immunity is often not perfect, but your body recognizes it and the immune system doesn’t go nuclear on it while still addressing it.

            Covid-19 would need to have effectively gotten to herd immunity stage (60%-80% of population) where much of the population has seen it live or in vaccine form. Then as it mutates and can re-infect or if the body’s immune response weakens, it is still recognizable so the body does not deal with it as a novel virus. There are fewer cases. Cases are milder when they happen. Hospitalization and death rates drop dramatically as well because there are fewer cases and they are not as severe.

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        2. Tom Bradford

          That has been New Zealand’s experience. A hard, early lockdown extirpated the virus from the community but also gave a breathing space for a contact-tracing network to be built from scratch. Subsequently a few outbreaks in the community emanating from the interface between infected incomers in quarantine in hotels and the workers servicing them, have been dealt with by contact-tracing leading to income-supported voluntary isolation, although an outbreak centered on an Auckland church did require a limited local lockdown.

          Without a hard lockdown to stop community transmission, using contact-tracing just to snuff out the embers afterwards, you’re tackling a forest fire with a butterfly net.

          Reply
  4. Amateur Socialist

    I was interested to learn yesterday that GOP governor Phil Scott, just re-elected here in my newly adopted home state of Vermont, has proposed a small stipend to be paid to people who are required to self quarantine. He mostly won re-election on his response to the pandemic which has worked out well here.

    I haven’t seen a lot of details yet and the state isn’t in great financial shape so I expect a lot of “how to pay for that” but maybe this will work out and become a model for state/local level response.

    Reply
    1. Amateur Socialist

      VPR coverage revealed that he is asking for $700K to provide stipends of “up to $1000 based on individual need”. Not a lot of money in a program that doesn’t provide much to individuals to support 14 day self quarantine. But it’s something.

      If the hotels get locked down again there may turn out to be a bailout scheme available to quarantine people in them(?) I know this has been done short term elsewhere. It may need to be a lot larger. Even without a lockdown I expect occupancy rates to stay fairly low in the face of this third wave.

      Reply
  5. timbers

    IMO contract tracing can’t work in the US because too many might evade/resist tracing due to possibility of being ruined with bankruptcy from healthcare they can’t afford and loss of income. There are lots of ways to evade tracing it can only work with the cooperation of pretty much everyone.

    I’ve pointed this out on libertarian oriented blogs in favor of contract tracing and suggested MedicareForAll as a step towards a solution. I get crickets.

    It would be refreshing if our free press would ask how can contract tracing even work when so many don’t have healthcare and would be ruined by a positive test? In their world, taking one’s chances by riding it out is a rational option. And did you rule out fixing that, Mr Biden, when you said you would veto MedicareForAll

    Contract tracing is for the rich only.

    Reply
    1. anon y'mouse

      even worse, with a possible flag on your health you won’t be able to go in to work. many places are doing the pre-screen questionnaire to allow you on-site, and if that place is your workplace you don’t want any kind of possible tags on you that you are sick or likely to become sick. so, even if notified that they might have been in contact with a sick person, many will not even go for testing nor admit that they might need it. and the greater “why” is the same reason that so many people go to work knowing they are sick (to the sometimes conflicted ire of their coworkers and managers–seriously, i had a boss who would be mad at you for coming in while sick and also mad at you for having the nerve to GET sick)—they can not afford to stay home even one day, or the fridge will stay empty.

      so, i would guess that, for those who are down to the wire they are going to actively avoid all notifications and all possibilities to get tested.

      Reply
      1. Arizona Slim

        Back when I was a twenty-something Slim, I worked in an office with a boss who took management lessons from Attila the Hun.

        She was especially merciless about illness.

        According to a coworker, we were to come into the office and die at our desks. Not that I ever did, but that was the rule.

        Reply
    2. Sutter Cane

      Another reason contact tracing can’t work is that people won’t answer the phone anymore because of rampant spam robocalls. Since this “industry” that provides no benefit to anyone and only exists to prey on the gullible was allowed to run rampant, any attempts at contact tracing are going to be severely handicapped.

      I also think this is the reason political polls aren’t accurate anymore. Who would answer a phone call from an unknown number nowadays? Those who would are probably not reflective of the electorate.

      Reply
      1. Harry Shearer

        The polling industry provides no benefit to the general public, only to the pols and their “strategists” in trying to decide what to spend where. Media focus on polls because it’s a cheap way to fill space and time.

        Reply
  6. The Rev Kev

    This article is nothing less than a horror show. Old Joe did say that nothing will change and it looks like the same will be true of the pandemic a well. I guess that the calculation is that since all their supporters have already voted them in, they are now no longer needed and can be safely ignored. See Lambert’s second law of neoliberalism

    I would not be pinning any hopes on an app to help out. Australia brought one out a few months ago and really pushed people to install it on their mobiles. It has been months now since I have heard mention of it in the media and the last time I did, it was to say that it was not as good as traditional tracing. But as vlade has pointed out, the US is long past the point where contact tracing will be really effective. No good answers here.

    Reply
  7. dcblogger

    great analysis. with Trump out of the way it will be possible to focus on how for profit healthcare makes coping with a pandemic impossible.

    Reply
    1. Big River Bandido

      Don’t bet on it, with the PMC rushing to defend “their President”. Any who voice any criticism whatsoever of Biden or Democrats will be shouted down, shunned, shamed, and cancelled for demonstrating insufficient fealty to the regime.

      Reply
  8. Edward

    I have a question; can this virus can be transmitted through food? Even if one isolates, unless you have a garden and a cow, you can’t avoid eating food that has been exposed to other people.

    Reply
      1. campbeln

        This is what I understand based on my reading as well.

        FWIW, we tend to only get hot food and toss it in an oven on Bake for 5-10 minutes when we bring home the rare purchased meal (or nuke it for 20-30sec for smaller meals) but that might just be medical theater.

        Reply
        1. RMO

          That’s what we’ve been doing with any take out food – into the pre-warmed oven for a bit, just in case. It seems to be very unlikely to contract the virus through any means but breathing the same air as an infected person but I’ve gotten into the groove with the over the top measures and they’re largely automatic now. I still strip in the garage and shower in the bathroom adjacent whenever I come home too.

          On the other hand, here in BC, where even in the virus hotspot of the Province where we are, the numbers in summer were zero new cases quite a few days, we’ve now hit days of nearly 600 new cases in 24 hours – more than five times as many as the worst days of the initial wave. Most of this appears to have been caused by truly stupid things like many more people showing up to a wedding than were invited, unprotected spin or other excercise classes and party buses.

          My supply of N95’s (from before this all started) is getting low despite carefully sterilizing them. If they run out I suppose I’m on to the 3M half-mask or Scott full-face (with a filter fixed over the exhalation valve). It will look weird but at least I can buy filters for them whereas the N95’s and P100’s are still unobtanium nearly a year into this pandemic.

          Reply
          1. George

            RMO, sorry to hear your mask situation. I have been using Honest PPE in Texas for my supply where they have N95, KN95, and several PPE for sale with fast delivery, at least in the states. Office supply also carries KN95, Staples, etc, still don’t know the availability to Canada though. I hope this helps you. https://honestppe.supply/

            Reply
    1. rd

      I have been looking carefully at the published case histories of transmission. I don’t believe a single one has been traced to ingesting something. Even contact with food and passing it by had to the face does not appear to be a route. There appears to be little transmission due to casual contact with most surfaces, although it appears that surfaces in cold storage or cold processing (meat packing) may increase the likelihood of getting it from surfaces – I think they believe that was a potential source for the recent New Zealand breakout. High touch rate surfaces in busy places have some potential for that. Frequent handwashing and hand sanitzer use largely eliminates that risk.

      Mainly seems to come from breathing the air. Getting coughed on or sneezed on can give you a high viral load and a bad case. Aerosol transmission indoors gives highly variable severity of cases depending on numerous factors. Masks and decent building fresh air and filtration ventialtion (at least 3 air changes per hour, preferably 6 or more) drops transmission potential dramatically for frequency and severity. frequent hand washing and hand sanitzer prevents high concentrations on your hands that can then be transferred to your face and into your eyes, nose, and mouth.

      Reply
      1. Lambert Strether

        > I don’t believe a single one has been traced to ingesting something.

        I did post a study on oral tranmission, but ingestion was not a pathway. I can’t recall such an ingestion study either.

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  9. Ep3

    First, you are not going to get ppl to stay home, wear a mask, and reveal where they have been. Look how stubborn they have already been. Look at Michigan, where they wanted to remove the governor over the mask and shutdown mandate. These ppl are so scared to risk their “freedom” that they would rather see ppl die of a preventable disease.
    Second, all of these proposals sound like “lets give money to the app company, lets give money to Pfizer to work on a vaccine”. Free monies to businesses that don’t need free money.

    Reply
    1. tegnost

      “Second, all of these proposals sound like “lets give money to the app company, lets give money to Pfizer to work on a vaccine”. Free monies to businesses that don’t need free money.”

      yep.

      Reply
  10. Pat

    I am sure if someone not on Vlad’s payroll points out these changes, the changes will all be the fault of the mean Republicans. Highly unlikely but if that bad journalist/pundit/commentator is really appalled, they should point out you don’t go into a negotiation with your bottom line list but with the one loaded to the gills with everything you need, everything you want AND everything you can think of to add. And then ask why the Biden administration is hiring such novice or failed negotiators.

    But we would need a functioning press for that to happen.

    Reply
  11. AnonyMouse

    For the Biden team, a combination of factors:

    1) They can effectively blame the hangover from the pandemic and any continued outbreaks of the virus on the previous administration

    2) Anticipation that the second wave this winter will be particularly bad and may result in a greater build-up of immunity by the spring

    3) Low expectations set by the inept response of the previous administration

    4) Prospect of a vaccine giving hope for a swift resolution (albeit it’s a lot more complicated than that)

    5) “Pandemic fatigue” and resignation to continued death and destruction

    Leads me to think that they will not do anything substantially different to the previous administration. All you need to do is to make a big show of “listening to the science and the scientists” and making an example of wearing masks.

    With respect to the lack of financial support for people who are self-isolating, here in the UK where the self-isolation statistics have been truly shocking, i’ve been tearing my hair out over this. Frankly to me it seems to demonstrate the bizarre relationship the neoliberal governments have with money and who “deserves” it. People asked to self-isolate under our system are only entitled to statutory sick pay (£95/week, equivalent to a laughable £2.40/hr assuming a 40hr week), and I bet they have to jump through unbelievable hoops to get it, too.

    Is it therefore any wonder that so few people, on having symptoms or on testing positive, can afford to self-isolate or wish to do so? Which makes the entire scheme to prevent future infections futile.

    During our lull before the second wave, there were around 500-600 cases a day. Clearly this was the moment of maximum leverage to try to prevent any kind of resurgence, and the people who must be effectively targeted are those who are actively spreading the virus. Assume each case requires a household to isolate with two working adults. Giving them £1000 for compliance with the self isolation would cost a tiny, tiny amount compared to the renewed lockdown.

    It seems like when it comes to money for the “undeserving”, even when it’s so clearly the most cost-effective way to prevent the pandemic from spreading, our systems are so terrified of a tiny bit of fraud or exploitation, or god forbid redistribution, that they are happy instead to have to pay billions to avert economic catastrophe later. Or perhaps that’s the point, given that the latter billions can preferentially be funnelled towards mates of the Tories, as has been relentlessly documented with seemingly no political consequences whatsoever

    Reply
    1. Brooklin Bridge

      Look on the bright side. Biden won’t poo poo wearing masks.

      Of course Biden may be overlooking the biggest concern of some which is that without socialized medicine (my smelling salts please – can’t they call it something else?), those poor rich folks can catch whatever that disease is that everyone keeps talking about from all those horrid deplorables, such as one’s chauffer, that simply haven’t the decency or even primitive intelligence to go off to some very private resort or even to get medical help-. Beasts of burden indeed, but it’s maddening.

      Alas, it really is harder than one might imagine to mingle only with those who have freezers crammed with ice cream and hearts with ice cubes.

      Reply
  12. Thor's Hammer

    Cuba: 139 total deaths to date:
    New York: 33,853 total deaths to date:

    There are a number of key elements that distinguish success from total failure:

    Among them is the fact that Cuba didn’t just do contact tracing at a time in the early stages of pandemic when it really mattered. They used universal observation and monitoring. They mobilized every nurse, med student, vet student and para-professional in the country to monitor everyone with a fever or any other early signs on a daily basis. Those that did develop Corvid19 were treated with antivirals proven in the past, and almost all recovered.

    In New York every patient in respiratory distress had a ventilator tube crammed down their throat resulting in an 80% death rate for which the hospitals collected a $39,000 Corvid bounty. Those that were still breathing but obviously ill were warehoused in aged care facilities where they could infect the maximum number of the most susceptible. And Big Pharma created a disinformation campaign against all antiviral medicines that were too cheap and not part of the hoped-for patent medicine vaccine bonanza.

    Medicine with the goal of maintaining the health of the people vs Medicine with the goal of maximizing profit and graft.

    Reply
    1. flora

      Cuba also has single-payer healthcare. So, no fear of personal bankruptcy for using the healthcare system, no reasonable incentive to avoid the healthcare system, every incentive to cooperate with the system since it’s goal isn’t PE stock price boosting.

      Reply
  13. Jamie

    How strange that this humble blog can quickly breakdown the differences between Biden’s campain coronavirus plan and his president-elect plan and yet the triumphalist media has done no such thing. Not even hostile Fox can bring itself to do so, probably for its own uniquely twisted reasons.

    Reply
  14. Anonymous in Michigan

    There’s a distinction being made in epidemiological circles between isolation and quarantine:

    Social distancing. Keeping space between yourself and other people outside your household to prevent the spread of disease.
    Quarantine. Separating people and limiting movement of people who have or may have been exposed to the disease to see if they become ill.
    Isolation. Separating people who are ill from others who are not ill to keep the disease from spreading.

    Reply
  15. ProNewerDeal

    States/counties/cities can implement a lockdown but afaict likely do not have money for temporary UBI. These subnational governments are already in budget deficit from the 2020 recession & per economist Dr Dean Baker have already laid off many workers.

    If Biden does not support such a UBI with a lockdown, the lockdown will not be effective because many people desperately need to work for the next month rent & other bills.

    A second requirement for adequate competent Federal response I see is in that a State that is decent by COVID (by US horrid standards, not actually good like New Zealand or Cuba), could be surrounded by fugazi neighbor States. I don’t see a US State closing its borders ala in “The Contagion” movie for COVID regardless of hospital overloading.

    The existence of the 40 year old PM Ardern of New Zealand & their competent COVID response makes me have no patience for these self-congratulating arrogant incompetent decades-older jokes like Biden/Harris/Trump/Pence/McConnell/McCarthy/Pelousy/CuckSchumer.

    COVID #4 in US (1776-now) mass deaths & “rising the charts”. WW2 may lose its #3 spot. 1918 H1N1 Pandemic & Civil War will likely keep the Top2 spots.

    Reply
      1. ProNewerDeal

        To me it is relevant in that it shows that if Ardern with decades less experience can competently supress COVID, there is no excuse for the TrumPelosis for not doing so. Hell the TrumPelosis could just copy Ardern policy. Or hire 10 of the New Zealander COVID team on H1-B visa & give them sufficient funding, which would be much less than the 5T corporate welfare of the CARES v1-4 acts.

        Reply
        1. Basil Pesto

          Ardern could be president of the US, it’d probably be an improvement but it’s hard to believe it would make a huge difference. There are so many differences between the US and NZ that the comparison is futile.

          Reply
  16. landline

    The US needs a universal healthcare system (single payer, Medicare for All…..), a robust public health system for quarantining ill people and tracing their contacts, income support for people who can’t work because of COVID-19 or the next pandemic, a living minimum wage…..

    None of these reforms will happen under either ruling class party’s administration.

    So we are f—ed.

    Reply
  17. larry

    Given Biden’s pick for Sec of Defense and this new covid response text, he seems to be going full bore neoliberal, which I almost predicted he would. Were he to continue in this vein and with the party’s support, he will make the Dems unelectable. AOC is fed up with the party, claiming, among other things, that it considers progressives like her to be the enemy. She is not the only voice coming out with this sort of critique. Time for the Dems to change or become irrelevant and die. (Biden’s win is really an anti-Trump win. The next Trump would likely be worse unless the Dems change their collective mental state and, hence, their course.)

    Reply
    1. vlade

      The best we can hope out of this US elections is that both major parties fall apart. It won’t be this elections, but maybe the 2022 holds some hope.

      Reply
      1. Thor's Hammer

        Vlade

        We could start by banning the criminal Demonic Party and imprisoning for life all those convicted of designing and carrying out the massive voter fraud and treason of Election 2020. Ban all forms of inherent fraud like gerrymandering, vote suppression by district, using Electors instead of Democracy, and voting by state instead of nationally, Let’s start over again in two years with a national election system based upon the principle of One Person One Vote. A multi-stage runoff voting system in which the first ballot includes every prospective candidate who can amass 100,000 signatures.

        While we are at it, lets set a maximum age for Presidential candidacy of 70 years.

        Reply
    2. worldblee

      I wouldn’t hold my breath waiting for AOC to be the savior of the Dems. She talks a lot but actually rolls over for “Mama Bear” Pelosi with regularity. Bernie, unfortunately, is the same–talks a good game on social media but in terms of fighting for control or contesting in a legislative sense he does next to nothing. The “progressives” in Congress exist, in my view, as a pressure relief valve to keep the left wing in the party in line while offering false hope that keeps them tethered to the DNC.

      Reply
      1. Big River Bandido

        That would change if enough of them were elected to block must-pass legislation. Teddy Roosevelt’s tenure in the NY legislature (1880s) is instructive in how a small group of committed rebels holding the balance of power can force change by *withholding* their support at critical moments.

        Even if all four members of “The Squad” (misnomer) votes as a unit, it‘s not enough. (It’s a misnomer because Pressley isn’t really part of that group). But a dozen or so? If the party margins are close, that’s enough votes to deny the will of the majority, drive hard bargains, and force substantive concessions from “leadership” in exchange for support on party-line measures.

        Reply
  18. anon in so cal

    The *only* thing that would change under a Biden admin is:

    a rapid escalation of new wars.

    Not to be flippant, but, seriously, what were all of you expecting? Did Obama and Biden follow through on a single campaign promise? Did they not do the opposite of what they campaigned on? (Obama, “any healthcare bill I sign will have a public option” and be negotiated with full transparency……).

    Just hoping these election “irregularities” pan out. Trump keeps things in a holding pattern. Biden and Harris foreclose on any chance of beneficial change until 2032.

    Reply
    1. RMO

      I’ve reduced my aspirations for Biden policy to just hoping that for the inevitable new war they’ll pick a country which is unable to defend itself on any scale larger than Afghanistan. If they take on a country that manages to send a few aircraft carriers to the bottom of the ocean or shoot down a substantial number of US aircraft my fear is that would lead to nuclear strikes.

      Reply
      1. Waking Up

        While I understand your sentiment to some degree, when are we ever going to simply stop bringing about chaos, destruction, and death to other countries simply because we can. As for a nuclear war, anyone who would be surprised by our ending up in a major confrontation hasn’t been paying attention to what the Democratic party or Joe Biden in particular are all about these days.

        As for this “bait and switch” regarding the Covid response by Joe Biden, it is exactly the type of action he would make based on his behavior over decades. I never believed Biden or Harris were the “lesser evil” and frankly was angered by people who called themselves “progressives” yet told us how we MUST vote for the “lesser evil”. It was a HUGE tell that Joe Biden doesn’t care about most people when in the middle of a pandemic he still refuses to support Medicare for All.

        Reply
    2. Shtucb

      The only hope I have voiced to my wife is that Biden won’t actively and deliberately sabotage the CDC as the Trump administration has done. That’s my only hope, and it may well be overly optimistic.

      The Biden crew could well tweak what’s coming out the CDC, although in more subtle, less directly offensive ways.

      Reply
  19. LAS

    The only way I can see contact tracing working is for people to sign-in or swipe a passcode that will record their presence every time they enter a building, store or facility, including name, phone #, address, and time of entry. Oh, they’d also have to report on their health. This would generate essential data for a rapid response, presuming people don’t lie if/when a case is identified. This will also slow everyone down, add administrative/security work, and raise hackles about surveillance. It won’t be complete. But it could be effective if you want to live that way. I suspect most Americans would rather NOT live that way.

    That’s why a lot of public health is nothing more than simple public relations appeals. It is like an ad agency that tries to sell you on healthy behavior as opposed to cigarettes, sugar and liquor. As pathetically weak as that sounds, it sometimes works.

    Reply
  20. cnchal

    Jawb one is do not get it. Society wise, total fail.

    Jawb two is accurate testing. Total fail.

    It does not matter what jawb three is, when jawb one and two are roundly ignored.

    Jawb four is for the billionaires to mop up the trillions to be spilt, to “fight the pandemic”.

    Reply
  21. Jason Boxman

    So this is just like Liberal Democrats on climate: Trust the science, but don’t actually take any meaningful steps! So the to-be Biden administration has a strategy that is going to leave people dead because of at best benign neglect, and that’s apparently better than Trump’s strategy, because liberal Democrats trust science or whatever.

    Awesome!

    I’m sure none of this comes as a surprise; A big reason NYC didn’t want to close the schools is impoverished children have access to meals, and that was true long before the pandemic, and neither political faction particularly cared. Why would they care now? As I said at the onset, they’re going to leave everyone to die.

    Biden is the serious, normals restoring face of that death and callous disregard.

    Reply
  22. PeasantParty

    I hate the thought of contact tracing. It is just too sci-fi, State takeover for me. As far as Biden’s campaign promise plan, and what he is now considering, all I can do is shake my head. Do you remember the car insurance commercials where the little older fellow is dangling a dollar bill off the line of a fishing rod? Yeah, bait and switch. Man, we really have a system of falsehoods in this country!

    Reply
  23. Lex

    The bulk of the deaths in the U.S. have been among the 55-85+ demographic, also poor and POC. They probably worked and paid into Social Security and Medicare. They may own their homes, and not wanting to leave their assets to the state, they have wills. Where does this stuff go? What happens to unclaimed SS/Medicare benefits? Personal assets? What if there’s no will or no family? Who benefits from all these deaths? Do the benefits from the federal government’s POV outweigh the liabilities? If yes, does it serve the feds to let this virus run it’s course, with little intervention? I don’t know the answer to these questions, but they won’t go away.

    https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

    I think neither party and the Vested Interests they represent are motivated to help the most likely victims of covid. This is the shock doctrine at work, where they’d already weighed out the pros and cons of a pandemic with cold logic and arithmetic. They weren’t unprepared; they just couldn’t pinpoint when this particular opportunity would present it self. Now that it’s here, they’ll mostly stand on the sidelines and watch, and throw the press the odd bone.

    Reply
    1. Yves Smith Post author

      This is not an accurate picture of the consequences of infection. You have long Covid, which people who are young with no pre-existing conditions regularly get. A new study found that 1/5 of the people who get Covid develop mental health problems. Over 60 % who IIRC had symptomatic cases showed heart abnormalities. Another study found brain abnormalities. Others have found lung and kidney damage.

      Reply
      1. Waking Up

        Just something to ponder…will there be an earlier onset of dementia, specifically “Sporadic Alzheimers” in the future by those who survive coronavirus?

        Reply
  24. Elizabeth

    I agree with this post that to do contact tracing at this point is fruitless. This is something that should have been done in the early days when the virus was more manageable, but of course we have no public health system. One reason contact tracing is problematic is because if someone tests positive and must quarantine, many people who live in households with different generations or no place to go to self isolate won’t. Also, if a person did self quarantine, who would check on them and bring them food, and other basic necessities during that time. The U.S. just doesn’t operate that way – it costs too much money and takes away from making big profits on sick people..

    I live in Iowa where cases have been skyrocketing,(4th highest in the nation) and our governor has now issued new “strict” guidelines. In home gatherings of more than 25 people must be masked, and outdoor gatherings of more than 100 must wear masks!! How in the heck is this supposed to even work? It’s utterly useless to me. Why put a number on the number of in home gatherings? All it takes is one person to transmit the virus and spread it around countless others, I’ve met many people here who think the virus is all a hoax – even a nurse who works in the local hospital thinks that! She never wears a mask – like she’s bragging.

    People ask me if I see any light at the end of this tunnel – at this point, no.I don’t.

    Reply
    1. Cuibono

      It is NOT fruitless. Those who know this best (leaders at Partners in Health foe example) say that in fact we do NOT know that

      Reply
      1. Elizabeth

        I’m not against contact tracing – the U.S. should have done this back in the early days of the virus. I don’t think 100,000 people doing it would be enough. Also, for the reasons mentioned in the post, contact tracing issues (people not answering their phones, where to self-isolate if one can’t do it at home) who would pay for hotel/motel and who would look after them – etc. These issues need to be fully explained and worked out. Contact tracing works well if done properly, as we’ve seen in other countries.

        Reply
      2. Yves Smith Post author

        Partners in Health is a boots on the ground organization. It does not specialize in epidemiology. Their position amounts to a handwave.

        And did it not occur to you that it would be high on the list of the sort of “culturally correct” organizations that could go out in poor communities? In other words, it has a very big financial incentive to take this line.

        Countries with much better medical systems than we have and access to free tests have concluded that contact tracing is not productive when the infection level is too high. There are too many cases to track down. Taleb reached a similarly conclusion early on based on the math: too much disease in the community makes it computationally overwhelm to do contact tracing.

        Reply
  25. William Hunter Duncan

    “There’s not a peep about any of this in the new version.”

    So basically, a classic “bait and switch.”

    Just a hint of what is to come from the Biden Admin, I suspect. I read something recently about all the things he would accomplish in his first 100 days. It sounded like a progressive wish list, most of which I have never heard from Biden unless he was denigrating it. If I expect anything “surprising” at all in the first 100 days it is an announcement that Biden will restore the TPP Trade Agreement to bring China “back to the table and assure they follow global trade norms.” That and maybe confronting Russia in Syria.

    Reply
  26. Cuibono

    100,000 new contact tracers placed in the most at risk communities would make some difference I can assure you as someone one the ground . It would provide jobs!
    But as you can see here:
    https://www.gwhwi.org/estimator-613404.html
    it is likely about a 1/4 of the needed number

    And yes, hotels for isolation are badly needed.

    Fact is, the US does not have the will to do this right.

    Reply
  27. Mike G

    I love to live in a fully functioning nation-state! Nothing better than letting poor and elderly people die under the guise of productivity and “personal freedom”!

    This place sucks ass lol

    Reply
  28. Ronn

    Not to question the points of the article but could someone explain to me the mindset of people when the polio vaccine came out with very little controversy or concern of side effects compared to today’s mindset of questioning everything?

    Reply
    1. Big River Bandido

      It’s one of the effects of institutional decline. At a certain point the machines stop working, and people blame the systems. In reality, it’s that the machines were run improperly for so long that people have forgotten how to run them so that they work.

      Today’s 30 year olds have good reason to disbelieve in the power of institutions. They have never seen it with their own eyes. I’m 53 and I only vaguely remember government that functioned, and people having trust in that fact.

      Reply
    2. Yves Smith Post author

      Why should people trust doctors when most people can now only see them for 6 minutes and get cookie cutter treatments? When going to a hospital can lead to bankruptcy? When we’ve had fresh instances of Big Pharma putting profits over lives, namely the opioid crisis and Vioxx?

      Reply
  29. VietnamVet

    The first cases of coronavirus appeared in Wuhan exactly a year ago. China, Cuba, and New Zealand show how to control the virus. It is simple; test, identify and isolate. Point one of the Biden Pandemic Plan should have been to straighten out the testing morass and find a cheap daily antigen test that identities the who is shedding the virus and who is not. Trust Americans to test themselves before going out in public and provide paid isolation for two weeks for those who test positive and free treatment for those who fall ill. The virus will be controlled within months, with or without a vaccine. The science, the know-how, the ability of Americans is here right now, and we can do it. All that is needed is to restore democracy and the national public health system.

    The reason why it is not being done is so plain, simple, and damning. Ending the pandemic will cost the Elite money and end the exploitation of Americans by the healthcare and pharmaceutical industries. Around half million Americans will die of COVID-19 to preserve the ruling class’ wealth before the pandemic waxes and wanes away; many more will be killed if the USA devolves into chaos as the result of the current dysfunctional neoliberal government.

    Reply
    1. Yves Smith Post author

      First, China did a massive lockdown to get contagion levels down. It did not use tracing as a primary measure.

      Second, the big cost isn’t testing. The big cost is paying people who were exposed to quarantine to not work. And many people can’t effectively quarantine, if they share a bedroom or a bathroom. They’d need to be provided with quarantine housing.

      Reply

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