Viral Reflections

President Trump's first move in response to Covid-19 was a good one - stopping air travel from China.  We now have enough global experience to show that taking actions to reduce exposure early (see, for instance Taiwan and Hong Kong) is more effective than waiting and reacting (see, for instance, Italy).  For more on the comparison read here. This is critical - Covid-19 is going to spread but the speed and extent of its spread impacts whether the healthcare system can withstand the strain and the outcomes for those infected.

Since then the response has not been as good.

The testing fiasco (that is, the lack of testing) seems to have derived from post 9-11 legislation designed to give FDA more control over developing tests for new emerging biological threats.  When Covid-19 emerged labs were forbidden from developing and using tests for detection without FDA approval and, as with any bureaucratic procedure that is time consuming.  As a result, a crucial month was lost before FDA granted an emergency exemption from its rules, published in early January 2017.  This letter of February 28, 2020 to Congress from a coalition of testing labs explains the dilemma.  On March 4, the Administration granted waivers.

In addition, though this is more unclear to me, it appears that the CDC is still unduly restrictive in the criteria it is setting for testing potential infected people.

The President also needs to change his tone.  I don't care whether the CDC people think he is brilliant, as he recently boasted, nor that his Gallup poll numbers on his handling of the crisis are above the comparable ones for President Obama, as he recently tweeted.  I also read the transcript of his recent interview with Sean Hannity.  Although he came in for unjustified criticism of the substance (I thought his statements were literally accurate and/or reasonable) the overall tone was this was not going to be serious or long-term and I think that a bad mistake.

President Trump needs to take some immediate actions that will establish the correct tone and encourage state and local governments as well as other institutions to take action on preventative measures.  First, announce he is cancelling his rallies for the next two months and urging all other politicians to do the same.  Second, build upon the guidance CDC issued on its website on Thursday urging older adults and those with chronic conditions to stay at home as much as possible, and state that publicly as well as urging them to not fly.

Here in Arizona the first "community" case was identified two days ago - a women who works in a healthcare facility in Maricopa County (Phoenix metro) and has now infected her family.  It's clear that Covid-19 is here yet as of this morning only 56 people in the state have been tested (I don't know whether this is because of restrictive CDC criteria or decisions at the state level).  The good news is the state is publishing updated statistics every morning on a dedicated website.

As for us, we are hunkering down, laying in some supplies, trying to avoid large gatherings, and going to stores either early in the morning or later in the evening.  And, worst of all, it looks like I attended my last spring training game of the season on Friday.

On a longer term note, this experience also points out our vulnerability with global supply chains, particularly those portions located in China.  It turns out that a very high percentage of our pharmaceuticals and intermediates are manufactured in China and that supply could easily be disrupted.

For many years, as part of economic development for Puerto Rico, American pharmaceutical companies were given tax breaks for locating manufacturing facilities on the island, a tax break eliminated in the 1980s resulting in most of those companies leaving.  It's time to reconsider that strategy both for Puerto Rico and other economically challenged areas in the United States.