1. The Chinese government could have prevented this. I'm not talking about its handling of the virus when it broke out in Wuhan; the origin is years ago. After the SARS outbreak in 2003 everyone was aware of the potential danger of a coronavirus pandemic and everyone knew SARS originated, and future coronavirus epidemics likely to originate, from the wildlife farms and wet markets of China. I spent a lot of time in China from 2000 to 2011 and after SARS I was told the government would not shut down those farms and markets because it would cause too much social turmoil. In investigating accidents we try to get to the root cause. The root cause of this pandemic is the Chinese government's failure to take action years ago. The world should demand China shut these farms and markets down*.
2. Currently Chinese government media is sending three messages to its citizens and to the world. First, that the government's handling of COVID-19 was a success. Second, that China's action bought time for the rest of the world to get ready. Third, the virus may have been caused by the United States.
The truth is China's bungled handling caused suffering for its own people and delayed recognition by the rest of the world about this dangerous situation. The deliberately misleading messages by China's government only amplifies its responsibility for this outbreak.
3. I believe if China is successful in reopening its country and economy can be done without another major outbreak of COVID-19 that is a good thing for the world because it shows it can be done. I'd also felt confident we would know in a timely manner if there was a resurgence of the virus, despite China's efforts to control information.
I still feel we will know but we may learn less timely. China's recent expulsion of Western reporters is critical, because they relied on a large string of Chinese stringers to help gather information and stories and try to figure out what is really going on. Most of that is now gone. In addition, China is taking even more steps to control all media and information in the country and going after dissenters more quickly than even a few months ago.
4. With the exception of a few East Asian city-states and countries the rest of the world seems to have been caught flat-footed by the pandemic. The United States passed legislation in 2003 (in response to the threat of bioterrorism after 9/11), subsequently amended in 2007 and 2013. Over the past 17 years billions have been spent in what we were told was preparedness for a pandemic. Yet, as we find now, the basics of medical response and care are completely inadequate. Where are the stockpiles of N95 masks, surgical masks, face shields, respirators and many other basic items that would be required for any type of pandemic? And this pandemic, as bad as it is, is far from the worst case. We were woefully unprepared at so many levels for this.**
5. Societal and business shutdowns are unsustainable for more than 2-4 weeks. If we can buy a little time by slowing down the increase in cases in order to build up critical supplies, make progress on evaluating potential treatments, and plan better that's fine, but it is not a long-term solution. To do this we need more than public health experts. We need people experienced in logistics and project management. And we've a history of incredible improvisation and creativity under pressure - we need to eliminate any roadblocks to unleash it.
The economic and human costs of shutting down are simply too great. We are going to have to plan to phase in reopening the economy starting no later than mid-April. While social distancing remains important, some semblance of normal life has to resume, even at potential risk to some (and as someone who is close to 70 with one of those underlying conditions placing one at higher risk, I still think it needs to be done). It may mean older people and/or those with underlying conditions may have to remain relatively confined but the rest of the country cannot continue in shut-down mode because while, if successful, we can somewhat control the spread of COVID-19, it is not going away.
In announcing the New York shutdown yesterday Governor Cuomo made a grave mistake in describing his intent in doing so when he stated, “I want to be able to say to the people of New York — I did everything we could do, and if everything we do saves just one life, I’ll be happy.” Lives will be lost if no actions are taken but lives will also be lost whatever course of action is chosen. That is why these are terrible times - there is a cost to any choice we make. But choose we must.
And, longer term, some changes will be coming regarding globalization as well as requiring people across the political spectrums to rethink their prior assumptions. More on that in a future post.
Some thoughts below from John Cochrane and Arnold Kling about both the "return to normalcy" and to what I think of as things that will not return to normal.
First up, Mr Cochrane
Shutting everything down and staying home for a few weeks is a sledgehammer. OK, our leaders have to hit a virus with a sledgehammer when they have nothing else up their sleeve. But it cannot last. Businesses will close, people will lose jobs, the economy will not be there to start up again.And now for Mr Kling
Needed fast: a plan to open up the economy again in a virus-safe way. Every business should be (and likely is) working hard to figure out how to operate in a virus-safe way. Federal state and local government need to be working 24 hours a day during the next few weeks to promulgate virus-safe practices. Not because they are particularly good at it, but because they are the ones shutting things down, and their permission is needed to reopen, fully or partly. People also will want the confidence to know that businesses they patronize are compliant. You've got two weeks -- figure out what combination of personal distancing, self-isolation, testing, cleaning, etc. will allow each kind of business to reopen, at least partially.
The option to force everyone to stay home and close all "non-essential" business for three or six months is simply not viable, at least for a disease something short of the bubonic plague. The option to wait two or three weeks and then start thinking about what it takes to allow, say, the local dry cleaner to reopen, which will take another month or so, is simply not viable.
Take two weeks. Find out who has it and who doesn't. Test test test. Isolate, put out the embers. And reopen. Slowly, cautiously, partly. But reopen.
I have kept public health and economics separate, but they no longer are. Shutting down the economy is a public health measure. The costs of this measure are astronomical -- at least a trillion dollars per month. As yourself what the government could have done with a trillion dollars to nip this in the bud. Please, next time, be ready. Massive testing, identifying cases, contact tracing, isolating areas with known cases, early and hard might have cost a lot of money and disruption. Even 100 billion dollars now looks like a very small sledgehammer.
Game 1 is figuring out a winning strategy and executing it.
Game 2 is figuring out what you need to do to get a promotion.
In peacetime, the generals who rise to the top are the ones who play Game 2. In wartime, you need to find the Game 1 players.
The peacetime bureaucrats seem to be causing a lot of difficulty for the folks who are trying to play Game 1 against the virus. You need to find a way to route around them. There should be a Game 1 player to head up each of the following:
1. Hospital Logistics. Their job is to get hospitals the equipment they need, whatever it takes to do it. Presumably someone with a military background, although there is some expertise at places like Amazon.
2. Treatment Protocols. They should issue a “default protocol” for doctors to use if they want to use it. But they should encourage doctors who want to try different protocols to try them and document the results. You want to revise the “default protocol” as new information comes in.
3. Testing Strategy. Their job is to see that testing yields useful overall information in addition to information that is useful for individual treatment decisions.
4. Vaccine R&D. Eliminate roadblocks, direct funding.
5. International liason. Ensure that we learn from other countries and help them as much as we reasonably can.
6. Public Communications. Make sure that communication is clear and credible.
7. Financial Maintenance. Make sure that the priority is forbearance that works its way through to individuals and businesses. Not following the standard rule book.
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*Though the high probability is the source of this particular coronavirus was a Wuhan wet market, there remains the possibility it originated in sloppy handling practices at China's only Level 4 Safety Biolab, which is known to have been doing research on coronaviruses, and is also located in Wuhan.
China has a string of incidents regarding safety failures at lower level labs, including the sale of lab animals by low paid technicians to local wet markets.
Research on coronaviruses, which is also done at labs in the U.S., Canada, and elsewhere is conducted for purposes of developing vaccines and also can be done for bioweapons purposes.
** Some good news for Arizona today. Gov Ducey announced arrival of first shipment from national stockpile including 60,000 N95 masks and 26,000 face shields. According to news reports this is 25% of AZ's allocation from the stockpile. If the stockpile is based on population that means it contains about 12 million N95 masks and 5 million face shields. This sounds like a lot, but because this is one-use PPE it will be used up quickly if COVID-19 is a big as feared. Hopefully, it is enough to buy time to get supply chains running at max in a few weeks.
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