Have We really Thought This Through?

What are we hearing? Hospitals are in danger of being overwhelmed, resulting in needless deaths. We are going to spend trillions of dollars to offset a near shutdown of our country. Who are the ones needing acute care threatening to swamp our medical facilities? As we pointed out in our last post, the vast majority are the elderly and those already compromised. This at-risk population is the one contributing by far the most to the death tolls. Common sense cried out; these were the ones to protect and segregate from the carriers. After all, this has been true in every epidemic experienced. Identifying those infected and putting distance between them and the most endangered is the first thing to do. In response to past epidemic experience, countries such as Singapore and South Korea moved immediately to widespread testing. They enlisted all public and private resources to make testing kits available as widely as possible. Blocking travel with infected areas was a given. President Trump acted with reasonable speed in shutting down travel with China buying precious time. The time that should’ve been used to test widely and protect and segregate the vulnerable. Instead of following countries such as South Korea and getting widespread help in producing and using test kits, our CDC and FDA refused help in favor of their own paltry number of test kits. Then theirs proved faulty. We slipped behind the testing curve. The CDC has offices all over the world, so they were well aware of what others were doing and experiencing. They just elected to go their own way and do inadequate testing.

It’s a good idea when faced with an attack to take stock of your arsenal to see what works. With this Coronavirus attack, we have to look to what has worked on virus-immune assaults in the past. There seems to be quite a list of possibilities. For instance, a 70 yr old malaria drug, Chloroquine, seems to show some promise. Sadly it was the French initially tested it, not the US. Again the CDC and FDA were slow off the mark.

Still, one would expect we would have robust procedures to alert and segregate the compromised and those close to them. They are the ones filling the ICUs. They are the ones most in danger of dying. Even today, we haven’t taken many of the most straightforward targeted measures to protect the most vulnerable. For instance, Honeywell and 3M are increasing the production of n95 masks by 1 1/2 million a day. Wouldn’t it make sense to make some of these available to 1-2 % most at risk? These could be used whenever they have to interact with others. Older people and others at high risk still need to eat and procure necessities. One would think they could get delivery and avoid contact, but this is spotty at best. Fresh produce, an immune enhancer, for delivery service has been overwhelmed by demand. Even “pick up and go” when available have extended lead times. A week seems a minor miracle. Many grocery stores have tried to accommodate seniors with special early shopping hours. Now we have a mass gathering of the vulnerable. Just one infected person could wreak havoc. How could this happen? An 86 year old acquaintance went to Costco for needed hearing aids and also went shopping at the local grocery. Maybe masks might’ve prevented a potential virus hot spot. Governor Cuomo of New York fears health care in his state will be swamped by a flood of the sick One of the best ways to prevent a flood is to build a dam in the narrows upriver. Once you have a torrent, you have a vastly more extensive problem. Our leaders have been thinking Macro when micro might’ve have given better results.

It’s hard to believe we have no communication lists of those most at risk in an epidemic. After all, every one of them is under a doctor’s care. Someone writes their prescriptions. In talking with 80 yr, old people many with underlying conditions, It’s apparent, they weren’t individually contacted. Oh, some received from emails telling the to avoid crowds. What they didn’t get was instructions of what someone in their condition must do. How they can actually prevent contact with others. Advice for multi-generational households. They didn’t receive anything identifying them as needing segregation. A note to excuse asthmatic students from class. Workers treated for Psoriasis with immune-suppressing drugs to stay away from work. A code for putting the vulnerable at the top of delivery lists so they could avoid contact. How to obtain n95 masks. All the information they or their caregivers would need to avoid life-threatening illnesses. If they received anything, it was very general or possibly wrong. One couple, 81 and 79, contacted the wife’s oncologist in February about a May Iceland cruise. She had completed immune therapy over a year ago. “Go and have a good time,” was the answer. Apparently, doctors were out the loop just when they needed to engage high-risk patients. How could they give guidance when there was little or none from the top. Maybe you could justify this in February, but not at the end of March.

So here we are, a nation mostly shut down and in a deepening recession. New York’s healthcare system almost overwhelmed, with California and Washington not far behind. Congress about to throw trillions we don’t have at the problem. Should we have gone down the path of high protection and segregation for the endangered and l the rest going on as regularly as possible? Pres. Trump early on seemed to lean in that direction. In the UK, the original coronavirus plan was to take this road. The idea was to protect the at-risk and let the virus pass through the rest. An infection reaching 70% of the population would confer herd immunity. The epidemic would run its course in a shorter time, resulting in much less dislocation. Some areas, such as the travel industry would still experience pain, but support wouldn’t be required across the board. This was a sensible plan in light of there are only two ways to get rid of these epidemics. Come up with a vaccine or develop herd immunity by letting it spread widely. With a vaccine at least a year away, locking down most of the population that long would be ruinous. On the other hand, do your very best to protect those in the most peril. Look at everything in your arsenal that might mitigate the severity and continue on with your life s best you is the only other option.

The UK appeared well-positioned to execute this plan. Unlike the US, where healthcare is decentralized, everyone there is in the same single-payer system. In theory, the at-risk would be known and quickly reachable. This would enable swift action to protect the genuinely vulnerable One might question whether the overworked Health Service would be actually up to the task, but we’ll never know. Before the plan was implemented, it was overtaken by events. Northern Italy’s hospitals were overwhelmed. Unlike the US, the EU failed to halt air traffic with China. As a result, they suffered severe coronavirus outbreaks. Italy has an unusually high number of multi-generational households, making it much easier for the virus to spread to the elderly. This resulted in a shockingly high death rate. While this was making headlines, Prof. Neil Ferguson’s Imperial College Report on the coronavirus was issued. The models they used predicted that unless drastic measures were taken, a 1/2 million would die from the virus in the UK. It also predicted 2.2 million under the same circumstances would die in the US. A hundred Doctors petitioned the UK Government to take far-reaching measures. The panic was on. Politicians fell in line. Trump in the US and Johnson in the UK joined in shutting down countries.

We have always have been skeptical of modeling to predict the future ever since Long Term Capital Management almost sunk the economy in 1998. The Hedge Fund’s actions were based on the modeling work of two Nobel Prize-winning economists. They and other supposedly smart people attracted vast amounts of capital, which they promptly lost destabilizing the markets. If the models’ Al Gore relied on for his book “An Inconvenient Truth” were right on, we literally would be toast. Computer modeling is always subject to “garbage in garbage out.” With this in mind, Ferguson’s Imperial College Report invites us to question its findings. For instance, the 1/2 million deaths in the UK are in a present population of 68 million. The modern era epidemic champ, the 1918 Spanish Flu, killed 250,000 out of a population of 44 million. That means a doubling of deaths on only 1/3 more population. This signals a much higher death rate than our worst flu epidemic ever if we do as little prevention as we did then. Yet, data from the nations infected early, China, Singapore, South Korea, and Taiwan show nothing close to that rate. Their findings are supported by the inadvertent large test group aboard the Diamond Princess. Their experience indicates only a death rate of 0.05%. It is also well to remember the ventilator wasn’t even invented until 1929 (it was then called the iron lung). How much weight was given to efforts to protect those in the most mortal danger?
It’s important to know what the choices made and why. Why didn’t we make other choices? We need to do this to understand where we go from here. Each day we stay in lock down, we slide from recession to depression. We’ll take up which way to go in our next post.

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