Note: “TL;DR” means, Too Long; Didn’t Read, and indicates a summary to follow.
Only ONE active option!
Every nation and leader in the world is working with the very same solitary option for an active response with regard to the novel coronavirus Covid-19. Everything after that is a matter of method and execution.
Last week I tried to appeal to a shared sense of common decency with regard to wearing masks. I did so on the premise that our decency transcends our divided opinions, or ought to. This week, being eternally optimistic, I am writing to make an appeal to a seemingly elusive plain common sense.
The public health mission of controlling Covid-19, e.g., ‘containment,’ is not complicated. Neither is it easy, although it may be TL;DR-ed with a single word: quarantine.
It’s in no way a new idea. However, presently quarantine is all we’ve got. Sadly, until such time as we are able to produce reliable therapeutics or develop vaccines and vaccinate the nation (and world), there are only a couple of approaches to coping with a deadly pandemic. We can passively allow the infection to spread like wild fire and let the chips fall where they may, or we can actively attempt to contain the virus with some form of quarantine.
With roots reaching back to medieval times (e.g., controlling black plague) and even ancient times (e.g., controlling leprosy, cf. Leviticus, chapter 13), quarantine is an active, albeit low-tech, response to infectious disease. Short of vaccines and/or therapeutics, quarantine, or a variation of it (e,g., masks), is actually the only tool in our public health toolkit to control a novel virus pandemic.
Quarantine, as a policy, exists on a spectrum. From
- the (not-smart quarantine) blunt-instrument approach of mass mitigation [e.g., stay-at-home lock-down, or less stringent, safer-at-home shutdown]
- to the (smart quarantine) laser-focused rapid-response containment approach of an effective test—contact-trace—treat program. So,
- Blunt-instrument mass mitigation means quarantining everyone (not-smart quarantining)
- Laser-focused test—contact-trace—treat containment means quarantining those who have been infected and isolating their contacts (smart quarantining)
- Additionally, vigorous targeted and randomized testing for surveillance is an adapted form of force multiplier as it discovers and isloates people who have pre-symptomatic and asymptomatic infections, and their contacts (smart quarantining)
Test—contact-trace—treat focused containment does require a low case count in any community that wishes to initiate a smart quarantine approach. The case count must be such that it is possible to trace all infection contacts. By the time our administration began to take the threat seriously it was already far too late to initiate smart quarantine containment and we were left with mass mitigation as our only option. The price? Our economy.
OK, what we know for sure is that we have no effective national program of test—contact-trace—treat, and there is no plan for one. And yet, nearly every state has initiated open-up plans. Besides our early minimizing of the threat, how/why did we get here?
President Donald J. Trump’s frequent childish simplicity makes him mostly transparent. Most people usually have a filter that determines which thoughts merit gaining voice. Politicians, especially, need to be able to keep track of the things that may be said out loud and those things never to be said out loud. Obviously, not Trump.
Of course, we recall when, in February, President Trump said, “I’d prefer they [Americans] stay on the ship, I don’t want them to double our numbers.” And, recently he actually said, “Maybe testing is not so good” and “When you think about it, doing all this testing really makes us look bad, we get these high case numbers.” All that, and more, could give one the feeling that President Trump doesn’t really like testing. Well, from this president’s seat, testing probably looks a lot like accountability, and, thus, a dangerous conflict of interest. Tragically, this creates an existential problem for those Americans most vulnerable to the potential ravages of being infected by Covid-19.
So, as a nation we squandered the first ten weeks of knowing we faced Covid-19, then, in mid-March, the administration did an abrupt about face, recognized the threat, and called for a mass mitigation that nearly flat-lined the economy—essentially placed Main Street economies in induced comas. Sadly, a colossal failure of leadership at the very highest level has meant we have now also squandered the eight weeks since mid-March that we’ve been practicing safer-at-home restrictions. This has meant that we still do not have an effective program of test—contact-trace—treat containment in place, nor even a plan for one. Trump has passed the buck to the state governors and washed his hands of all things testing and containment. If only that were all. As our president has passed the buck back to the governors, he has simultaneously encouraged his supporters to rally protest against the public health directions of state and local officials. Trump encouraged his supporters in Democratic governor states to ignore the very same stop-the-spread “directions” that the White House pandemic task force had been recommending. Included in Trump’s messaging was a wink and a nod for protesters to arm themselves with long guns for their State House protests. At many protests, they did.
So, our sacrifice wasted?
We as a people have sacrificed greatly by following the mass mitigation plan. Now, with our movement to an abrupt opening-up, that sacrifice may well come to naught.
Physician, and professor of public health, Leana Wen had an article published last week for the Washington Post in which she describes the shift in public health strategy the administration has taken (“We’re Retreating to a New Strategy on Covid-19. Let’s Call It What It Is.“).
So, our strategy has been one of ‘containment.’ In other words, a strategy to use testing—contact-tracing—treatment to identify and isolate those infected with the virus. To contain the virus and not allow it to gain exponential growth. Never mind the U.S. has been more ineffective at executing containment than almost any other nation.
Perhaps the administration thinks that making containment work effectively, as other nations have, is simply too hard. So, policy is now moving to a strategy of ‘harm reduction.’ There will likely be no formal announcement of this, however, when the administration has no effective test, trace, and treat program in place, and no plan for one, then ‘harm reduction‘ is our strategy by default.
Presently, the administration is unapologetically indicating that the harm it’s now prioritized on reducing is the economic harm Covid-19 is doing.
I do find it particularly troubling that the administration is making reducing harm to the economy the top priority. I say this, not out of some naïve failure to understand the importance of our economy, rather, out of the sense that we can’t skip over re-establishing a healthy and confident work-force (and population) to get to a functioning economy, no matter how much we wish we could.
Gaslighting with chutzpah
Of course, I hope and pray that what Vice President Mike Pence has said (see here) about the U.S. getting Covid-19 mostly behind us by Memorial Day (yeah, the one in under two weeks) will come to pass. I’m just having a great deal of difficulty seeing that as a real possibility. Of course, because our mass-mitigation efforts have been effective, and our sacrifices have born good fruit, it’s created the sense in many that Covid-19 is winding down and will just go away. However, that “sense” is wishful and not grounded in science.
I do feel that one very important indicator is that even many businesses are beginning to stand up for the fact that without an effective test—contact-trace—treat program in place, then there is no way for them to plan for, or manage, a business for the medium or long term.
Not all businesses have been effected equally by Covid-19. However, those who operate a business that was hard hit by the pandemic, well, they are society’s canaries, and are on the leading edge of understanding the gravity of the situation. Many business owners/leaders cannot see a future without first establishing an effective test—contact-trace—treat environment. The administration has passed the buck on that. Now we are opening-up without the means in place to do so safely. Makes one wonder about the events defining the 1918-19 pandemic. [see Bonus video below]
The choice being offered by this administration between health and a functioning economy is a false dichotomy. Without a handle on this virus, business might be able to open up, but it’s rather unlikely it will be able to prosper.
[this post approx. 1,550 words (6 mins)]
I never know what I’ve said till I hear the response. What did you hear me say?
Note: I know, trying to introduce a big-picture idea like Spiral Dynamics (a complex developmental anthropology) in this format is ambitious. So, I’m using a serial-approach. Blog introduction (June 30, 2018). First in series (July 1, 2018).
Interesting interview done recently in the context of the Covid-19 pandemic with John Barry who wrote the book, “The Great Influenza” about the 1918-19 pandemic.