In late February I contacted a former colleague, who lives in Hong Kong with her family, asking what it was like to live in a place under siege by a pandemic. She replied it was "like living in slow motion". We now know how that feels. I wrote some initial reflections on COVID on March 8 and added some more comments on March 20 both of which feel like months ago. While the world around us is hurtling even faster, our day to day lives have slowed down, spending most of our time in or around the house.
ROOT CAUSES
Having done many accident/incident investigations during my career, it is important to separate proximate causes (the close in time actions that triggered the specific event) from root causes, the embedded people/process/system issues that most often initiate the train of events.
With the COVID-19 pandemic the proximate cause was the mishandling of the outbreak in Wuhan by the Chinese city, provincial and national governments which started in December 2019, a mishandling that included suppression of evidence and misleading of the world about what was going on. In turn, that caused delays in the response by other countries contributing to the spread of the virus. And, as we've more recently learned, it was even worse. Even as the Chinese government kept maintaining into the 3rd week of January there was not human-to-human viral transmission (a message reinforced by its stooge, the World Health Organization (WHO)) it was frantically urging Chinese owned companies in the West to scour markets for personal protective equipment (PPE) which was shipped back to China. (1)
To this day, we cannot have any confidence in numbers of cases and deaths China has reported, just as we cannot have any confidence in the quality of the masks and other equipment it has more recently sent to impacted countries.
The root cause of the pandemic was China's failure to close its wildlife farms and wet markets, which its government has told us was the source of the virus. With the emergence of SARS in 2003, the world awakened to the threat of coronaviruses created in wet markets. Traveling in China after SARS I was told that the markets would not be shuttered because the government feared the social disruption that would ensue. This even though health experts around the world predicted future pandemics caused by the markets. (2)
The government of China bears direct responsibility for what has happened. We must not forget and the world must insist these markets be closed. The next pandemic could be even worse. (3)
Whatever else you think about the U.S. response, or domestic politics, do not forget the root cause.
PANDEMIC PREPAREDNESS
The U.S. has had a flu season preparedness program for many years. In fact, our budget has a specific line item for purchasing enough eggs with which to culture the vaccine. As I understand it, more specific pandemic planning began with legislation passed in 2003 (and amended in 2007 and 2013), enacted in the wake of 9-11 and fears about bioterrorism attacks (and, as I've more recently learned, an intense personal interest of President Bush after reading about the Spanish flu pandemic). Over the years billions were spent on federal planning and stockpiles, while grants were made that should have helped states and healthcare providers plan and prepare for a pandemic. What happened?
One would have expected a great deal of planning based upon evaluation of different pandemic scenarios and with drills to test assumptions. Much of the medical equipment and supplies needed to deal with a pandemic are similar regardless of type. And the scale of some of the anticipated pandemics is much greater than the worst case with COVID-19. With almost any situation we would not have been fully prepared but should have had enough supplies to hold the fort until the cavalry arrived with more supplies. To that end, were logistics experts and project managers in place who knew all the major manufacturers of equipment and their capacities and capabilities? Had they thought through global supply chain issues in a world that looks much different today than it did in 2005?
The federal government does have a pandemic response plan geared to an influenza epidemic which you can find her. However, many of the response actions required would also be needed in the event of a coronavirus threat. The initial plan was issued in 2006 and updated in January 2009. It was not updated during the Obama Administration, with the next version not issued until June 2017 after the Trump administration took office. My quick reading of it gives the impression that it consists mostly of bureaucratic goobledygook and more aspirational than concrete. What I would like know is what, if any, actions were taken, based upon its recommendations over the past 2 1/2 years.
UPDATE: As I trawled through the internet I came upon several federal government pandemic emergency plans and found the relationship between them confusing. According to this article, published after I originally posted, my confusion was understandable since there is a plethora of such plans and a lack of coordination between them. We have a government so big and so complex it is impossible to understand, let alone manage. We also have mission drift for our agencies like the CDC. Some of it is inherent to bureaucratic modes of operating but another big contributor is Congress which likes to add missions to federal agencies. It's an easy way for elected officials to demonstrate they are "doing something" but they don't have the responsibility of actually executing which is left to the agency. I'd prefer a government with fewer agencies focused on a few key tasks. We'd all be better off. Fat chance of that happening.
I've been unable to find any history regarding numbers and timing on specific equipment except for N95 masks. In 2006, the Bush Administration began stockpiling N95s. That stockpile was drawn down during the H1N1 flu in 2009 when the country used 104 million masks. The information I've seen is that 3/4 of our stockpile was used at the time and it was never replenished, leaving the U.S. stockpile with about 12 million N95s early in 2020. Those facts raise a series of questions to which I've been unable to find the answers; did the Obama and/or Trump administrations submit budget requests to rebuild the stockpile?; if such requests were made, how did Congress respond?; were the funds made available but not spent? According to this USA Today story, the Obama Administration had depleted the stockpile in 2009 and it, and later the Trump Administration, took no steps to replenish it.
Beyond the supplies issue were capacity - both equipment and people. How many hospital beds and ICUs would be needed in an emergency? Ventilators? And even if the equipment were available would we have the trained people to operate them in the case of ICUs and ventilators? New York Governor Cuomo and a state task force were faced with this issue in 2015. The task force report concluded that in the event of a major pandemic the state would need an additional 16,000 ventilators but since there were not enough trained personnel to operate them, a different solution would be needed. Instead the task force issued guidelines for hospitals to use during a pandemic to decide which patients would get access to ventilators. Although the task force did not answer the question of whether an additional 1,000 or 2,000 ventilators could have been staffed, it should not have been a surprise to the governor when, in the current crisis, though one of less scale than a major pandemic, that New York hospitals had a ventilator shortage.
According to the New York Times, the federal stockpile at the beginning of the year consisted of 12,700 ventilators which has now increased to 16,600. In addition, in December 2019, the Trump administration ordered an additional 10,000 ventilators from Philips with delivery scheduled in mid-2020. The Times article states that a 70,000 ventilators would be needed in the event of a "moderate influenza epidemic" and for a while we had press reports on the need for a million ventilators (for how that story got started read this). However in the case of COVID-19 the most detailed projections on hospital bed, ICU, and ventilator needs I've seen is the model done by the University of Washington Medical School which predicts a peak demand of 26,381 ventilators (most recently reduced to 15,414) during the current epidemic. If the 10,000 recently ordered ventilators were available now the stockpile would match demand, and that does not take into account the 62,000 ventilators already available in hospitals and state stockpiles. All of which brings us back to the issue addressed in the New York report - does the U.S. have the available trained personnel to operate all the needed ventilators (though, as reported below, the need for ventilators in this crisis may have been substantially overestimated a month ago)?
It looks like we had failures all down the line, from the federal and state governments to individual hospitals. Maybe the planning and the operational structure that should have been ready to go when the word came did exist, but I've seen little evidence of it so far.
Having discussed some federal shortcomings above, here is just one state example to fill in the picture. In 2006, California Governor Schwarznegger announced a program to provide emergency response in the event of disasters, including pandemics. The state established three 200-bed mobile unit hospitals and purchased protective equipment, including 50 million N95 masks, and stockpiled enough supplies to set up 21,000 additional hospital beds. In 2001, Governor Jerry Brown cut the program for the mobile hospitals and for restocking the equipment. Over the years, the existing masks were used, many became unusable, and now the state faces significant shortfalls (for more detail, read here).
In an ideal world, after this crisis passes, we would have a learned inquiry into the state, federal and local response that could identify the shortcomings in planning and preparedness and make concrete recommendations so we are better prepared in the future. Perhaps an independent agency with a strong reputation for integrity, like the U.S. Chemical Safety and Hazard Investigation Board (which investigates industrial chemical accidents), to conduct the inquiry.
In the real world I fear we will end up with a Congressional inquiry and despair at the inevitable descent into partisan warfare with no productive end, just another example of our dysfunctional 21st century federal government. (4)
THE U.S. RESPONSE
Two observations before getting to the American reaction going back to January of this year.
1. Even a well-designed preparedness plan never operates flawlessly. You need a strong operational team, capable of quick response, to adapt, modify, and act in real time.
2. A look at what has happened globally provides very few examples of timely responses to control this pandemic. Europe provides no positive examples that can be used by the U.S. (5); the only question is whether we can avoid the worst that has happened there. For much of the rest of the world where there are still relatively low case counts - Latin America, Africa, some Asian countries - it may be an artifact of lack of testing, lack of time for the virus to take root, or specific geographical considerations. However, in East Asia there are three relevant examples to look at; Taiwan, South Korea, and Japan (I exclude Hong Kong and Singapore from this analysis because of geographical size and population).
Taiwan has been the most successful country in controlling the virus. As of April 10 it has 382 cases and 6 deaths among its 24 million people. How has a country with so much direct contact with China done it? After SARS in 2003, Taiwan set up a specific command center to monitor and track potential outbreaks in China. In December, the command center became aware of the Wuhan outbreak and starting on December 31, Taiwanese officials boarded all incoming flights from Wuhan to check passengers from symptoms and travel to and from China was halted at the end of January. Widespread testing, tracking of cases with quarantine and isolation became common in early February. You can find a more complete list of actions here.
South Korea got off to a rockier start and, for a brief time, it looked like the virus would explode in its population, before a quick and firm response allowed for the regaining of control. As of April 10, the country (population 51 million) has 10,450 cases and 208 deaths, with the increase in new cases declining for the past month. The country had the advantage of the initial outbreak being confined to one city and the Christian group which was the source having a very young profile. However, like Taiwan, South Korea put in place widespread testing, case identification, quarantine and isolation for not just confirmed cases but for anyone in contact with infected people.
The tools both countries are using to track, quarantine and isolate affected individuals are beyond those that are legal or even publicly acceptable in the United States. [UPDATE: Doing further research after this was posted I learned that when S Korea and Taiwan do isolation it means taking any positive individual (whether or not they have symptoms) and removing them from their home and family. It also appears that, to some extent, this is being done with individual who've had contact with infected individuals, regardless of whether they test positive.
Japan is harder to explain, and I have my own suspicions about the data based on my personal experience with the opaque nature of Japanese society to outsiders. As of April 10, Japan (population 126 million) has 5,530 cases and 99 deaths. However, unlike Taiwan and South Korea, Japan is doing very little testing and the country's schools, mass transit, and businesses had continued operating. However, three days ago Japan's prime minister declared a state of emergency requesting people to stay at home and businesses to close, indicating all is not well (the government lacks the legal authority to impose the restrictions).
One thing all three countries had in common before COVID-19 was the widespread practice of wearing surgical masks when an individual was sick and the mass wearing in the midst of influenza epidemics. Although Americans were told, and continue to be told by the CDC and public health experts that the wearing of masks by the public is not protective, I believe the real reason for this messaging was the fear that Americans would buy masks, creating a supply problem for healthcare personnel (which goes back to the stockpile failure). I am confident American health experts have seen the same studies I have documenting the effectiveness of mass wearing of surgical masks in East Asian countries to curtail influenza epidemics.
The history of CDC guidance on masks is interesting. In 2007 the CDC issued guidance on using facemasks and respirators in public settings during a flu epidemic:
If people are not able to avoid crowded places, large gatherings or are caring for people who are ill, using a facemask or a respirator correctly and consistently could help protect people and reduce the spread of pandemic influenza.Two years later the CDC changed its recommendation during the H1N1 epidemic:
In community and home settings, the use of facemasks and respirators generally are not recommended.It is this guidance that remained in place until last week.
Having said all that, "being no worse than most of our peer countries" is not what I expect from us. I'm a fan of American exceptionalism, but we can't just get by on reputation.
Looking back at an alternative path here are several actions that might have prevented COVID-19 from spreading in the United States to the extent it has.
1. At some point between January 15 and February 15 impose a ban on travel into and out of the United States and keep it in place until the pandemic was controlled elsewhere in the world. And probably suspend domestic air travel as well.
2. Have available. as of the first half of February, the ability for widespread testing for the coronavirus, with the ability to ensure quarantine for both impacted cases and those with direct contact.
3. As of mid-February end all major sporting events, concerts, shows etc, adopt social distancing and wearing of masks (not N95s) by the general public.
4. As of the beginning of February to have in place project managers and logistics experts to begin identifying existing stocks of PPE and other essential equipment, manufacturing capabilities of domestic suppliers, and distribution chains, in advance of anticipated needs, and ban export of any such equipment.
Let's look at the chances of those events occurring in the real world. I will try as much as possible not to make this about President Trump, the Trump haters, and his fervent admirers, the latter two of which have tied themselves into knots over the past three months trying to follow Trump's twists and turns in order to make sure they fanatically oppose or fanatically support whatever the President says at any particular moment. Otherwise this all becomes just about Trump, which the President, his opponents and supporters would be all be happy with. (6)
The importance of the travel ban was that we now know from genomics research, that the initial virus source on the West Coast entered the country in mid-January via Seattle while the seeds for the New York metro area outbreak were planted by travelers from Europe and Iran who arrived in February.
The President did impose a travel ban with China on January 31. This was not done with the support of public health experts. According to a recent New York Times article it was Trump's trade advisor, Peter Navarro, who pushed for it over the objections of the President's public health advisors. We also saw at the time, several statements and published articles by public health experts who, while declaring the virus posed a danger, dismissed the value of travel bans as a tool. If you read those articles what you observe is ideologically based reasoning in which the value of "open societies" is rated more highly than travel bans, which are therefore summarily dismissed. And, of course, many of his political opponents denounced the ban as racist and xenophobic. We saw this in New York, where both the governor and mayor made it a point of political pride to reinforce the openness of New York to visitors, in supposed contrast to the President, throughout February and into the beginning of March. For a general discussion of media coverage, as well as expert advice, during this period read this article from Vox.
The President had the authority to stop all international travel and given his noted germaphobia I thought he might. Again, his public health experts were not advising such a move and it would have been attacked as just another erratic and xenophobic act by his political opponents, particularly when it would have had to be at a time when there were virtually no COVID-19 cases yet in the U.S. (we did not have our 20th identified case until March 1- the first reported deaths were the day before - as of April 10 it's 502,049 cases and 18,719 deaths). I am not sure whether the President has the authority to shut down domestic air travel but it would have been good to do so in order to halt the spread of the virus. You may remember that President Bush shut down air traffic on 9-11 but he had the authority to do so in his role as Commander in Chief with the nation under attack.
Early, and widespread, availability of coronavirus testing could have been used to monitor entry points in the U.S., perform random testing across the country, and then isolate any affected people and their recent contacts. The only chance of this happening was if someone on the President's political team was astute enough to quickly override the public health experts who bungled this, both at the CDC, which insisted that it was the only institution capable of developing a test and refused to give exemptions to allow private labs to develop tests, and at the FDA which actively throttled attempts in places like Washington to develop innovative testing schemes.
Whether such political intervention could have been effective quickly enough to fix the problem remains unknown but it would have been good to see an attempt made. The reality is such an effort would also have prompted a response by the bureaucrats, triggering a deluge of protests by Democratic politicians and massive negative coverage by its media allies, alleging that the safety of the American public was being placed at risk by illegal actions by the President who was overriding public health experts and existing government regulations and guidelines. Much also would have been made of the fact that allowing more freedom by the states and private labs would also have probably resulted in a significant number of false positives and false negatives in the testing process. In a situation like this it would still have been the best course of action to seek more information, more quickly, even with that risk.
But that is only the first part. You then need people and resources to follow up on the data and isolate and quarantine. The Federal CDC and Public Health Service are not set up to do that on a nationwide scale, so the next step would be up to states and local officials, and I am not sure we had the infrastructure in place to carry out that mission. If the people, resources, and cooperation were available in the states it would have been our best chance to slow the spread down since the cases entering the country would have been few at that point. (7)
As to stopping major events, sports, social distancing, and mask wearing, the Federal government does not have the ability to impose that, although it can make recommendations. I would have liked to see the President urging all of these actions much earlier than he did, as I wrote in a previous post. It might have had some positive impact on the public as well as on some governors and would have been important at a time when each day counted.
The professional sports leagues eventually halted their own seasons on March 11 through 13, once Rudy Gobert of the Utah Jazz was diagnosed with COVID-19 (thank goodness this happened and started the ball rolling, as I think the sports league decisions along with the new Tom Hanks was infected brought home the reality of the situation to many people). It would have been even better if it had happened weeks before. But in the real world, President Trump would have been ridiculed for doing so in mid-February. The same holds true for other mass attended events. Nonetheless, I think the path was clear as of the week of March 10 for the President to urge such actions by the states and use the bully pulpit to put pressure on private entities, as well as announcing he was cancelling all of his political rallies and urging other politicians to do the same. This topic is one where no one, neither the experts nor the politicians, showed their best. The mayor of New Orleans went ahead with the Mardi Gras celebration, the mayor of New York urged the public to go out to bars and restaurants even in early March, and the governor of Florida left the beaches open for Spring Break.
While we know from the East Asian studies that public mask wearing, if done by the majority of the public, can be effective, once again public health experts warned against this strategy, and the President would have been cast in opposition to his experts to have urged otherwise.
As to the last item, having in place the proper logistical and project management team to implement a response program, perhaps I'm wrong but my impression is the team has been cobbled together in recent weeks, rather than pre-existing.
Would any of this have significantly changed the trajectory of COVID-19 in the U.S? I'm not sure that even if those steps had been taken it would have based on the experience of most other countries (You can read about the difficulties even when the original source of the Seattle outbreak had been identified - contact tracing is extremely difficult). What I am convinced of is that there is no practical realistic scenario under which would could have taken these actions in time, given the lack of preparedness and the likely lack of needed public support though, as mentioned above, the use of the bully pulpit by the president may have accelerated things by a few days (though there is a counterargument that his political opponents would have been prompted to therefore resist him and since the major outbreaks have been in Democratic cities and metro areas it might not have done much good). No one comes out of this looking good whether it be politicians, media or the experts. For some reflective musings on this topic read this.
We also need to remember that although everyone in hindsight remembers they predicted all this in January and February the story is different. Remember that through January, China and WHO were denying there was evidence of human-to-human transmission, many of our media outlets were running stories downplaying the threat, saying we should be more concerned with the flu, attacking Senator Tom Cotton as a crazy man for talking up the threat, and even Dr Fauci, for whom I have great respect, stated on January 21 regarding COVID-19 that "we need to take it seriously . . . but this is not a major threat to the people of the United States." I think this all fed into the President's inclination and hope, abetted by his lack of focus, that this would not turn out to be serious.
It's difficult to look at this as alternative history, but what is the likelihood any President would have taken the four steps discussed above in a timely manner, given the initial lack of planning and preparedness, the lack of U.S. cases in February, the extensive reliance on action by the states on critical points, the advice of public health experts at the time, and the drastic and economy crippling measures needed? While critical of the President, very irritated by many of his mannerisms, and his lack of self-discipline and control, I am not sure whether, on substance and given where the major outbreaks have occurred to date, the path of the virus would have been substantially different.
From my perspective there was one event in early February that alerted me that this was not just another of the many scares we've had about pandemics and other supposed world-shaking events. It was the Chinese government taking steps to quarantine sixty million people and effectively hobble its own economy. I don't trust what the Chinese government says but it's actions are important to watch. This is a regime that historically has done no more than the minimum necessary on the health side to keep its population working. Economic growth has been prized above all else. For the government to have taken these drastic steps signaled to me that this was not just a flu epidemic. Beijing saw something that truly scared it and was willing to pay a high price in response. I can't pretend I saw its ultimate impact on the rest of the world but knew what was happening in China was way out of the ordinary.
And even with that I waited a while before realizing how serious this might get and taking personal action. At the beginning of March I mentioned to my wife that we should begin stockpiling supplies in the event we were confined to the house or got sick but I didn't attend my last spring training game until March 6. I had lunch with a friend on March 9, though we went early and sat in an uncrowded part of the restaurant. I even hesitated later that day before recommending to other members of our Board that we cancel our Civil War Roundtable Meeting scheduled for March 17. On March 13 we had one last restaurant lunch with a friend. Decisive action is not easy.
WHAT WE KNOW AND WHAT WE DON'T KNOW
Estimates. On March 20 FiveThirtyEight published an article titled, "Infectious Disease Experts Don't Know How Bad the Coronavirus is Going To Get, Either", reporting on a survey of experts in the field and their lack of consensus about how many deaths the U.S. would see in 2020 from COVID-19. The estimates ranged from 4,000 to over a million with a most likely in the range of 200,000. A cautionary note as we try to assess how much any of us know. (8)
Ventilators. For several weeks the availability of this piece of medical equipment, about which most of us knew very little until recently. dominated the news. It was going to be critical in battling COVID-19. Ventilators have played an important role but as emergency medicine and ICU doctors are gaining experience they are learning that COVID-19 doesn't act like the flu or the pneumonia they are used to and the immediate resort to ventilators may be having some adverse impacts. For more read this article summing up current thought. One by-product is that the ventilator mega-crisis we feared may not happen.
Cause And Effect. The four most populous states are California, Texas, Florida and New York (and the gap between the New York and #5, Pennsylvania, is bigger than the gap between #5 and #23). New York is at the epicenter of the nation's worst outbreak of COVID-19, yet the other three are relatively untouched despite also being destinations for international travel. All the three followed very different strategies in fighting the virus. California early on imposed massive statewide restrictions. It seems to have worked so far with the state having on a per capita basis only 6% of the cases and 3.5% of the deaths of NY. Texas was slower moving and less restrictive, leaving much of the decision-making to its counties and cities and has also been successful with 5% of the cases and 2% of the deaths per capita compared to NY. Florida was the slowest moving of all, late to restrictions, letting Spring Break proceed, a large and vulnerable elderly population, and a popular destination for those in the New York metro area. Many, including me, thought it would be the place where the next big outbreak would occur. Yet, to date, it has only 10% of the cases and 5% of the deaths per capita compared to NY and its recent rate of increase has been fairly low.
Could weather be playing a part? Could it be, as some have speculated, that the virus does not do well in warm and humid weather? Are there other explanations for the disparity? Or, have we just not waited long enough in one or more of these states for the curve to increase? We simply do not know at this point clearly have a lot to learn about this coronavirus.
Timing. We are making decision based upon imperfect knowledge in the midst of an evolving situation. Who would have predicted on March 1 the massive outbreak in the New York area? On the same day, the Seattle area looked like a disaster but within two weeks it was under control. How many of us thought by now we would have seen a similar outbreak in Florida? But what the numbers tell us now may not be what happens two weeks from now. There are probably some states and cities which are doing well now but could quickly move in the wrong direction. For a while those in America who objected to the lockdown strategy pointed to Sweden which took the opposite approach and where cases and deaths were low nonetheless but over the past week the situation in that country has deteriorated and now the government is seeking emergency powers. Be cautious on making judgments on the data you have right now.
How To Get Out Of This. We are in a devastating economic situation. Figuring out how to only have a recession, not a depression is a major challenge. The long-term destruction of lives and livelihoods from economic turmoil could be much greater than the havoc wreaked by COVID-19. We have to emerge from the lockdowns soon, even if it entails risk. The question is, what are the precautions and conditions under which we do so?
Will There Be A Second Wave? If we control the current outbreak over the next month it also means we probably will not have achieved enough general immunity to forestall future outbreaks (unless antibody tests show that the asymptomatic penetration of the virus is much higher than currently thought). When we stop the lockdowns do we see a resurgence? Or do things stay quiet until the fall when COVID-19 returns? What do we do then? Which brings us to the next issue.
Testing And Therapeutics. The answers to the proceeding two topics in part depends on this subject. Can we get into place readily available coronavirus testing as well as coronavirus antibody testing? Will any of the treatments currently being tried prove effective, even in part, or in combination with other treatments in alleviating the symptoms of COVID-19 and saving lives? Assuming this current wave recedes by June can they be deployed this summer in the event we face a second wave in the fall?
PREDICTIONS
As of yesterday, the countries we are most like from a per capita basis on cases and deaths are Portugal, Ireland, and Denmark. Excluding the NY metro area, the rest of the U.S. is slightly worse than Canada and somewhat similar to Norway. What path we and those other countries will follow is unknowable, though Ireland just reported a one day increase of 25% in detected cases!
Countries I suggest keeping an eye on going forward are Mexico, Ecuador, and Peru. In addition, Brazil and India have done virtually no testing to date so something big could be brewing there. As to the U.S., though the worst of the outbreak is mostly confined to a few metro areas right now, I suspect we will see some further surprise outbreaks, not just in other metro regions but in some more rural areas, before this phase is over.
I have no idea what may happen next. My instinct is to discount some of the more extreme estimates in either direction. We've already learned the ones that posit a 60-80% infection rate and high mortality fail to take into account the intervention and social distancing measures that are actually being taken, while many of the analyses predicting very low naturally-occurring infection and mortality rates ignore that fact that these very same interventions are actively underway (for instance they often try to draw parallels to the South Korea experience with the U.S. predicted path, without acknowledging that Korea achieved that path by aggressively taking actions early that are no longer available to us).
Let's hope, but not plan for, one of the drug combinations being tried in New York or elsewhere prove effective or that the heat of summer makes a difference. I will be pleasantly surprised if a vaccine becomes available before the fall of 2021.
And we need to take the opportunity to learn some lessons from this on the planning, execution, and quick reaction fronts. It would also be particularly useful if we can ultimately better understand how the outbreaks in New York, Detroit, and New Orleans started, why they got out of control, and why we have not seen, at least as of now, some of the predicted outbreaks in other locations.
Next: The longer-term geopolitical and economic implications of the pandemic.
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FOOTNOTES
1. The role of the WHO in this matter is a disgrace. This is yet another corrupt UN organization, in this case run by a non-doctor and political hack whose appointment was engineered by China. Ironically, it is the United States that provides the most funding for WHO with China paying very little, yet WHO has taken on the role of China's defender and apologist. While WHO and China were denying human-to-human transmission in January, Taiwan provided information to WHO that it had evidence such transmission was occurring. To be more accurate, Taiwan attempted to provide information to WHO which refused to recognize it, because at China's insistence, WHO has refused to let Taiwan join or participate in any form in the organization.
I will save my larger rant on the moral stain on America due to its continuing membership in the U.N, an immoral and corrupt organization run by authoritarian states, for another time.
2. There is also a possibility that the virus may have originated via an accidental release from a Wuhan BioLab located near the wet market. See this article from the Washington Post (which was late to acknowledge the possibility). Turns out Senator Tom Cotton who raised this possibility in late January and also tried to get the Trump Administration to take quicker action to prevent the pandemic was timely in retrospect. At the time he took a lot of abuse from the Post and other media outlets who deliberately misconstrued what he was saying into an allegation of a deliberate release from a China lab. For more background read this.
3. Wet markets are a potential source of coronaviruses but health officials have been even more worried about a flu pandemic. Most of these also originate in East Asia, often because of farming practices, but are much harder to control.
4. The 9-11 Commission is a prime example of this dysfunction. While the Commission's report was decent, it remains mostly unread on bookshelves, its primary shortcoming the games played by the intelligence community and the Bush Administration to keep certain information from its investigators, including the long-redacted 28 pages on Saudi involvement also kept out of the Senate Intelligence Committee Report. In 2016 the Obama Administration made the correct decision and dropped its objections to publishing the redacted pages. You can read more about them here and here.
When I refer to dysfunction and partisanship regarding 9-11 I mean the hearings that drew the public and media attention. From the start, the Democrats knew the hearings were really about politics and the 2004 election, making sure to strategically place two members on the Commission. The first, Jamie "Mistress of Disaster" Gorelick, had been the Assistant Attorney General who, during the Clinton Administration, put the "wall of separation" in place between foreign and domestic intelligence that hampered our ability to track foreign terrorists once they entered the U.S. Gorelick earned her nickname because her public service consisted of a string of unmitigated disasters. But don't feel bad for her, after leaving government she joined one of the nation's preeminent law firms, WilmerHale (also home to Robert Mueller) where she's made millions and maintains her sterling reputation among Washington insiders.
The other was Richard Ben Veniste, former Watergate prosecutor, and longtime Democratic political hack and attack dog. Gorelick was appointed for defensive purposes, to prevent inquiry into some of the embarrassments of the Clinton Administration. It worked because the Bush administration stupidly appointed a bunch of GOP "moderates" to the panel who wanted to be nonpartisan. Because Gorelick was a fellow panel member they politely pushed aside any serious inquiry into the "wall of separation" memo and its impacts. Ben Veniste was there to play offense, while no one on the Republican side had the necessary temperament to play that role.
The highlight of the public hearings and the part that received the most media attention was the testimony of Richard Clarke who worked on counterterrorism in both the Clinton and Bush White Houses. Clarke's testimony, helped along by Ben Veniste, focused on his claims that the Bush administration ignores his warnings of an impending attack by Al Qaeda, while soft pedaling the actions of the Clinton White House. John Lehman, one of the GOP appointees, at one point remarked how Clarke's testimony was quite different from what he'd told the committee privately. It was, but it created the overriding impression that the Bush administration was solely at fault for what happened, when the truth is both administrations made some bad mistakes.
The truth was more complicated as Clarke's own book, Against All Enemies, made clear. In that book (which is quite good) he forcefully criticized shortcomings of both the Clinton and Bush administration when it came to taking Osama bin Laden seriously, yet for political reasons his testimony deliberately left a different impression. One interesting tidbit I learned from the book is that, contrary to what I was being told by the media, the godfather of American rendition policy (the turning over of terrorists to security police in their country of origin) was Al Gore! In the book, Clarke, who advocated the policy writes of a critical meeting at the White House on the proposal and how he contacted Gore, who was on a trip to South Africa, to urgently return to counter the arguments of White House Counsel that the policy was illegal. Gore cut short his trip, returned and carried the day with President Clinton who approved the policy.
The determination by the Democratic Party to rewrite the history of 9/11 was further demonstrated in the response to the two-part Disney/ABC series, The Path to 9/11, which aired in 2006. The series made the terrible miscalculation of portraying mistakes by both the Clinton and Bush administrations leading up to 9/11 which was not the narrative Democrats wanted going into the 2006 election. This prompted an unprecedented letter from 19 Democratic senators, including Harry Reid and Chuck Schumer with this threat:
Presenting such deeply flawed and factually inaccurate misinformation to the American public and to children would be a gross miscarriage of your corporate and civic responsibility to the law, to your shareholders, and to the nation. The Communications Act of 1934 provides your network with a free broadcast license predicated on the fundamental understanding of your principle obligation to act as a trustee of the public airwaves in serving the public interest. Nowhere is this public interest obligation more apparent than in the duty of broadcasters to serve the civic needs of a democracy by promoting an open and accurate discussion of political ideas and events.In other words, "nice little network you have there, shame if something happened to it" once we control the Executive Branch again.
Disney got the message. The Path to 9/11 was never rebroadcast, and never released on DVD or in any other format. It is like it never existed. When Democrats wail about censorship, repression, and authoritarianism it is because they project their own desires on to others about how they would govern, and will govern, when they have the chance.
5. Until recently, some observers had called out Sweden as a good role model, based upon its restrained response with few legal requirements related to lock down. However, in the last week Swedish cases and deaths have surged past its Scandanavian neighbors and the government is seeking emergency powers which would allow it to impose restrictions. A relatively bright spot in Europe is the Czech Republic which very quickly instituted travel bans and required wearing of masks in public. For more on the Swedish approach read this.
6. It's all very tiresome and leaves us less well-informed and even more agitated than we would be in any event. As mentioned in one of my earlier posts on this topic I am tired of the President's bragging, boasting about his TV ratings, his lack of attention to details and accuracy, engaging in stupid back and forth with idiot journalists, and talking too much (I realize Trump thinks by talking aloud and tweeting which works sometimes, but not in these circumstances - musing aloud about possibly quarrantining the New York metro area is not good - in a crisis like this he looks like a person who cannot control himself which is not reassuring).
I'm tired of the Trump acolytes justifying his every move, even if it is completely different from his position the day before. I'm tired of the Hydroxychlorquine Wars and hearing that it is a completely proven therapeutic that needs to be given to everyone NOW, all because Trump supports it. And no, there is not a conspiracy to overcount COVID-19 deaths.
On the other hand:
Yes, these press conferences would go much smoother if Obama were still President:
Jim Acosta (CNN): Mr President, what has most enchanted you about being able to demonstrate your leadership during this national crisis?And imagine the coverage in the Times, Post, CNN, MSNBC, NPR if the epicenter of the outbreak was not New York, but Montgomery, Alabama or Boise, Idaho.
President: Well, Jim . . .
I'm tired of the Hydroxychlorquine Wars and hearing that it is a bogus, completely ineffective, and dangerous medication that should not be given to anyone EVER, all because Trump supports it.
And it would help if at least half of what I see flooding the media about outrageous Trump statements were not deliberate mischaracterizations of what he actually said (see, for instance, the "coronavirus hoax" and the "you are on your own" stories.)
Between press bias and the innumeracy of most reporters we've had some awful reporting about basic facts.
This, from Brit Hume, gets it about right, though I think, as stated above, some of the President's actions should have been taken more quickly:
President Trump's Covid 19 actions have been sensible and in some cases bold. His WH virus task force briefings have been extensive, credible and informative. His own statements have been rambling, boastful, vague and imprecise They do not inspire confidence.7. That a federal system need not be a bar to effective implementation of testing and tracking is shown by the example of Germany. When it comes to pandemics it does not have the equivalent of a CDC or FDA with legal enforcement powers. It has a public health organization which can make recommendations, but not require anything of the German states. Furthermore, unlike the American government which requires its permission before private or state labs can develop tests, in Germany the states can do so on their own without federal permission. In this case, a German research institute quickly developed a test which the individual states then quickly deployed, making Germany the most aggressive European state in testing and case identification. There is a further irony here in that the fanatically anti-Trump New Yorker published an article claiming it was Germany's universal healthcare system that made the difference, when it was actually Germany's decentralized system that made its quick response possible. As to the benefits of universal healthcare systems in Europe, please take a look at the COVID-19 statistics in Spain, Italy, France, UK, Belgium, and the Netherlands and get back to me.
8. I haven't spent much time on the controversial models developed to track and predict the course of the epidemic. That's because theories and models while, at their best and used properly, can help us think through problems more clearly, do not represent reality, whether developed by epidemiologists or economists (I exclude the hard sciences from this since I don't know enough to characterize them). Reality is messy. Life is hard. The social sciences aren't sciences. Political Science should be called Political Arts, because politics, practiced well, is an art. The problem with theories and models is too many in the audience think they do represent reality and often their own developers fall into the same trap.
Get used to the real world. Don't believe me? Sorry, but welcome to the party, pal!
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