Sunday, July 5, 2020

Four things covid-19 related

The second wave is now here. New infection rates are rising fast with Anthony Fauci predicting that without a change in behavior we could quickly reach a hundred thousand  new cases a day.  It's worth reflecting on what that number means in terms of a containment strategy. If it takes a week for contact tracers to track down all those who have been exposed to a new case, we'll need three quarters of a million contact tracers. If we don't trace contacts effectively, if some get through the net, the number of cases will continue to grow. Eventually, perhaps quite soon, the prevalence of infection we will be such that we will no longer be able to get ahead of it; simply put, it will be out of control.

We got here through a series of miss-steps and missed opportunities. First, we did not act soon enough. Had there been a focused, coordinated effort at containment early on, with rapid tracing and isolation, we might have crushed the curve while it was still small; now it's a monster.

Second, was the problem of "mixed messaging". That's simply GOP spin to placate Trump as the messaging wasn't mixed at all. Fauci was clear from the outset about the need to wear masks. Trump was equally clear, just on the wrong side of the issue, and remains he there six months into the crisis. Masks are essential to slowing the spread. Fauci told us this, science told us this but Trump thought he knew better.  But the result was that one message went to Trump supporters, amplified by the GOP and red state governors, and a completely different message went to those who have inherited the legacy of the enlightenment.

Third, Trump failed to mobilize any coordinated fact-based response, choosing to abdicate responsibility to the governors, some of whom acted, many of whom (those in red states) who didn't. And because covid-19 doesn't have a party affiliation, it wasn't simply a blue state problem as many red states, like Texas and Florida, are belatedly discovering.

Fourth we squandered the time the eventual lock-down afforded us and failed to make the investment in resources needed to make reopening safe. We don't have enough contact tracers or have sufficiently clear guidelines for how reopening should take place.

And finally, many states (the red ones again) reopened to early, leading to a resurgence in transmission. And because people in states that did have lock-downs saw others taking a less onerous approach, the incentive to stick to the guidelines or ordinances was undermined. That, combined with the eroding trust in critical institutions (like science) and the libertarian streak that is part of "American Exceptionalism", not to mention, in many cases, a refusal by law enforcement to enforce state and county ordinances (so much for our law and order society when the police get to pick and chose which ordinances they implement), resulted in widespread disregard for measures that would have slowed covid-19's progress. As people cheated on their diet of social distancing and mask-wearing, the infection continued to spread largely unabated.

Understanding the metrics makes a big difference. Happy talk from Trump is, of course, getting in the way. He boasts that deaths are going down and claims credit for having gotten the pandemic under control. That's nonsense.  First, death rates lag infections by two to three weeks so the recent spike in infections will soon manifest as a rise in mortality. Second, infections are being seen in higher proportion in the young and less vulnerable, so while the number of deaths may not rise as quickly, the infection is still circulating ever more widely in the community. Third, if the mortality rate is falling because of an improved understanding of the way covid-19 acts and more effective medical interventions, there is no policy that Trump's administration is remotely associated with that in any way connects to better treatment. His only claim to fame with regard to the practice of medicine is to have recommended the drinking of disinfectant. And one can't forget his ridiculous claim that more testing leads to more cases. Infection density is not a function of testing; only our understanding of where cases are.

While we're talking about metrics, the June job numbers came in over expectations. Two points; first, much of the data was collected before the recent spike and subsequent re-imposition of lock-downs and similar restrictions to combat spread, so unemployment will go back up again in July.
Second, the "expectation" was based on sober predictions about reopening happening at a relatively measured pace; instead states opened quickly, so while employment recovered quickly so the covid-19's spread.  It it that rush to reopen in the hopes of a V-shaped recovery that will bring about a W-shaped (or even a VW shaped) recovery.     

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