The Light at the End of the Tunnel is an Illusion

As the percentage increase in new cases and deaths starts to decrease in some cities, I like many people have been heartened and have seen the numbers as an indication of the light at the end of the tunnel.  But today I realized why that is probably an illusion.

I live in an area of Massachusetts where people have been sheltering at home even before required.  Social distancing is the general rule.  But even after the CDC advisory about wearing masks when out in public, there has been little increase in people wearing masks.

I have asked staff at the local grocery and the hardware store why they aren’t wearing masks.  Sometimes they give me a shrug.  Or they just laugh it off.  When I tell them the facts about asymptomatic infected people spreading the virus and the percentage of false negative tests, they seem surprised.  But they don’t react with, “I’m going to wear some kind of mask.”  

They seem to feel they are impervious to the virus; it’s all about whether they need protection.  Wearing a mask is inconvenient or uncomfortable.  There seems to be no concern that they might possibly be asymptomatic and infect other people unwittingly.

Today at the hardware store I asked a manager and he said that he would only wear a mask if the CDC mandated he wear a mask.  When I said that the CDC advised that everyone should wear a mask when in public, he said it was voluntary.  That he didn’t want to wear a mask and instead of breathing the air, breathe in something from the material the mask was made of.  He also said that my assertion that wearing a mask prevented someone from unwittingly spreading the virus was false.  That he followed the 6’ rule and that was enough.  And finally that he’s gone through all the flu seasons and has not gotten sick.

This is an intelligent, thoughtful, careful man.  I don’t know what his politics are, but if someone like him doesn’t see why it is his duty, his responsibility, as a citizen to wear a mask after the CDC advice, then I fear that the light at the end of the tunnel is a mirage.

It is true that the percentage increase has gone down, but it needs to go down a lot more before we can even think about returning to normalcy.  If many people refuse to follow the advice from the CDC, as well as the advice on social distancing (and I’ve seen a good bit of that especially among younger people, and I don’t just mean spring break partying), then the numbers aren’t going to go down far enough.

What would change these attitudes?  I know that pleas from Dr. Fauci or Dr. Brix have had no impact.  There is only one person who perhaps might make a difference … the President.  If Trump finally really understood the danger we were in, understood his vital leadership role and wore a mask whenever he was in public, that would be a powerful symbol and without question many more people would wear a mask.

Republicans have been behind two major attitude changes that impact our ability to contain and survive the virus.  The first is the disrespect for government that Republicans have fostered for the last several decades beginning with Reagan’s “Government is not the solution to our problem, government is the problem.”  The second is the disrespect that Trump has sown towards science and facts.  And it is only Trump and his fellow Republicans that can turn this attitude around.

Even Now Trump Doesn’t Get The Pandemic

President Trump still doesn’t get it.  To contain the pandemic we must be ahead of the epidemic, not behind it.

Unfortunately, from the start, Trump has been behind.  First he belittled the threat and did nothing.  During the month before he restricted travel, 380,000 Chinese entered the country with no screening, many unwittingly bringing the virus with them.

Second, we didn’t have enough tests and so we turned to lockdowns, at a huge cost to the economy and the welfare of our citizens.  

Third, we still don’t have enough tests or testing capacity or tracing capacity.  We really don’t know what the scope of infection is in the U.S.  There are critical states, like California, which have done much less testing per capita, yet looking at the volume of passengers that flew into LAX during January, it is hard to believe that the numbers aren’t much worse than they are reported.

Fourth, he continues to refuse to order a nation-wide shelter-in-place policy.  Doesn’t he understand that people travel, and when people travel so does the virus?  Remember that 25% of infected people don’t know it because they have no symptoms.  And false negative test results are a troubling 25%.

Fifth, it’s critical that everyone follow the new CDC advisory and wear a mask when out in public.  But our President says he’s not going to do it; it’s completely voluntary.  He neither has any concept of leadership nor an understanding of the danger we face.

Finally, when the numbers stabilize and talk turns to returning back to normalcy, all experts agree that can only happen if we have the testing and tracing ability to examine all new cases of virus infection.  Otherwise we risk having another explosion of cases and a return to lockdowns.  What is the plan to achieve that capacity?  There is none.  Again, Trump just doesn’t get it.

Trump's Responsibility for U.S. Exposure to the Pandemic

Yes, Trump is responsible.  How has Trump failed each and every one of us, just as regards the coronavirus pandemic?  Let me count the ways.

1. In 2018, the Trump administration dismantled a group with the National Security Council charged with preparing for when, not if, another pandemic would hit the nation.  When it came, we were unprepared.
2. Last September, the Trump administration eliminated the position of a CDC expert embedded in the Chinese disease control agency.  She would have known almost immediately when the virus was first reported internally to the Chinese agency and allowed the U.S. and all governments to move much faster.  Instead, at least a month was lost, as well as us being dependent on Chinese information rather than having our own person on the ground.  (See Reuters report, March 22, 2020)  When it came, we were unprepared.
3. Last September, the White House Council of Economic Advisors released a report that stated that the economic damage of a pandemic influenza would be $413 billion to $3.79 trillion, with up to 500,000 deaths and between 670,000 and 4.3 million requiring hospitalization.  When it came, we were unprepared.
4. Last October, the U.S. Dept. of Health and Human Services reported on a pandemic simulation it conducted in real time between January and August 2019 on a fictional respiratory virus that began in China and quickly spread around the world by air travelers.  The results were catastrophic:  11 million Americans infected, 586,000 dead.  The draft report on “Crimson Orange,” the code-name for the exercise, showed how underfunded, underprepared, and uncoordinated the federal government was for this eventuality.  A final report appears not to have been issued and the Trump administration took no action based on the report.  When it came we were unprepared.
5. Once China reported in early January that there was a new coronavirus that had infected hundreds of people (the first case actually appeared in mid-November but the virus wasn’t identified until late December), given the fast and vast potential for the virus’ spreading, Trump should have immediately started temperature screening all flights arriving from China, and all passengers arriving from other countries who had been in China during the previous month.  That would have prevented, or at least greatly limited, the spread of the virus to the United States.  
6. Instead, travel restrictions from China were imposed on January 31, prohibiting all who had been in China within the past 2 weeks from entering, except for U.S citizens. Unfortunately, in the previous month, roughly 300,000 people entered the U.S. from China, so the virus was already among us.  Americans could inexplicably still go back and forth to China with no restrictions.
7. Despite his own administration’s pandemic report (which as stated above was never finalized), Trump continued to minimize the risk to the U.S., citing the small number of cases.
8. The U.S. was unprepared for a necessary massive testing and contact tracing effort.  For some reason, no one with any clout in the administration seemed to realize early on the critical nature of massive testing and follow-up tracing and quarantine to containing the virus.   But his is Infection Disease 101; basic.  Across-the-board social restrictions would slow but not stop the virus.  The emphasis seems to be on insuring we have enough medical supplies, ventilators, etc.  That is certainly important.  But testing and tracing (which requires a large labor force) is critical.  Yet the testing gap is hardly mentioned.  Though it is on Dr. Fauci’s mind.
9. The administration, and admittedly most scientists, told the American public that if they were healthy they would not benefit from wearing surgical/construction face masks and should not wear medical N95 masks because they were limited in number and needed to be reserved for health-care workers and those who were infected.  Of course there was a run on masks of any type regardless.  But still, you see almost no one wearing any type of mask.  

           Recently, The New York Times reported that some U.S. scientists are saying that 

           even regular masks can be helpful because some protection is better than none.  A 

           lead Chinese scientist has said that a major problem is that people in the U.S and 

           other countries are not wearing masks.  And the latest, the CDC is reviewing 

           whether to recommend broad use of masks because of asymptomatics' spreading 

           the virus.

           Masks serve 2 functions.  If you are infected or possibly infected, the N95 mask 

           traps droplets in the mask so others won’t be infected; the regular masks at least 

           interfere with the emission of droplets, some protection again being better than 

           none.  If you are healthy, even the simple masks provide at least some protection 

           from droplets and also make it less likely you will touch your mouth and nose while 

           you are out and your hands have not been washed.

Looking back on this chain of events, there is no question that Donald Trump, and his administration, are responsible for the rampant spread of coronavirus in the U.S.  Both by acts of omission and commission, Trump has left the country totally exposed to this pandemic and we the people will as a result suffer in innumerable ways.

The Need for a National Health Policy

When it comes to controlling a pandemic, the fact of states’ rights makes no sense.  Since all states are connected in many ways, but especially commerce and freedom of movement, it is critical that there be a national policy controlling the actions of people.  

For those who say that under the constitution states have to be left to go their own way … nonsense!  The interstate commerce clause allows the government to regulate anything that impacts interstate commerce.  This has been read broadly and is the basis, for example, for federal civil rights laws.  Certainly it would provide a basis for a national mandated policy on efforts to control the coronavirus pandemic.  To not have a mandated national policy in this situation would be madness.

People are the key to either containing the virus or spreading it.  There is thus only one effective way of controlling the virus.

That is testing and contact tracing combined with quarantine.  Everyone who has symptoms should be tested, and if that is not available, should self-isolate on the assumption that they have the virus.

Every contact an infected person has had (which could be as minimal as being in the same room or talking) needs to be traced and told to self-isolate for 14 days, the incubation period, and be tested before being free to be out and about since one could be asymptomatic and still pass the virus to others.

Everyone arriving in the U.S. by plane or any means of transportation must at a minimum be temperature screened for the virus before being allowed to enter.  Interstate travel should be restricted to critical travel and all arriving passengers should be temperature screened.

Initial testing and tracking should occur within a short period of time.  Ideally, during that time people should be told to shelter-in-place and non-essential business closed to minimize the spread of the virus before everyone is tested and tracked.  Once that has happened, life can go back to normal for all but those who have been ordered to self-isolate.

We have not been able to follow that scenario because we were  not prepared; testing capacity was minimal.  The virus therefore has spread unrestricted for probably 2 months.  We also had a very unscientific attitude about the virus … there’s only a few cases, what’s the big deal.  Well, every epidemic starts with only a few cases, and that’s when one has the best chance to contain it.  

We instead waited till there was obviously a serious problem and then resorted to restricting the movement of everyone, indiscriminately.  There was no other choice.  Much of the country is now locked down and we have only begun significant testing in New York City and a few other places.  

The rest of the country needs to be locked down as well.  As soon as the testing capacity is available, the above steps should be followed.  

Once most everyone has been tested or contact traced. and appropriately isolated, business can go back to usual.  There will still be some new infections, but that’s just the way it is.  With continued testing and contact tracing the virus will be contained.

Self-Responsibility during the Pandemic

Each of us has a responsibility to ourselves, our family, our friends, and everyone who comes across our path.  It is only people who can either contain the virus or spread it.  If all people acted responsibly, the virus would come to a halt.

Therefore all people should follow these rules:

1.  If you have any of the following symptoms, stay home and call your doctor.  If you can, get tested.  If you are around other people, wear a face mask.

- loss of sense of smell

- diminished sense of food taste

- fever

- dry cough

- difficulty breathing, shortness of breath 

2.  If you have been exposed to someone who is infected, stay at home for 14  

     days and check for the symptoms.  The virus takes 2-14 days to incubate.

3.  Regardless whether you are infected or not, wash your hands frequently for at 

     least 20 minutes, or use generous amount of hand sanitizer.

4.  Regardless whether you are infected or not, wear a face mask whenever you 

     are in an enclosed space (store, office, public transportation) with other 

     people.  Although a regular face mask is not the best, it will help protect you 

     from air-borne droplets.

The Proven Way to Contain Coronavirus

Most of the world is struggling to contain the coronavirus,  With most countries approaching the coronavirus in a decidedly low tech and not very effective way: limiting the mass movement of people.  

The problem is that the people whose movement you really want to limit are those that are infected, but since there is inadequate testing, you don’t know who they are.  So you have to resort to mass shutdowns. Which helps but doesn’t stop infected individuals unwittingly infecting others in non-mass settings, for example the local grocery store.  

What shutdowns do effectively instead is strangle the economy, hurting almost everyone.  This should be the last resort of government, not the first resort.

But other countries - South Korea, Taiwan, Hong Kong, and Singapore - have successfully used the high tech way to contain the virus: aggressively test and then track the contacts of those who test positive.  Free testing must be provided to all individuals who think they might have the virus or have been exposed to the virus.  You can’t have a successful quarantine and tracking program without adequate testing.

The companion to testing and tracking is low tech face masks.  Free face masks should be provided for all individuals who test positive or who have any kind of respiratory problem.  Face masks for those infected are essential to inhibit transmission.

What about face masks for the rest of the population?  If you live in an area of medium to high population density, and there are reported cases, then everyone should wear a face mask when they are out and about.  It makes it less likely that you will contract the virus.

Certainly no one should be allowed on public transportation … whether a bus, subway, train, plane, or ship … without wearing a face mask.  In each of these situations, you have people packed in a confined area.  Since there’s always the possibility of having contact with someone who is infected but asymptomatic, everyone should wear a mask.

So what do we need to do, at a minimum?  

1. We need to have millions of tests available ASAP, and the lab capacity to handle tests in large numbers.  All testing should be free.
2. Quarantine and tracking should be rigorous.
3. Daily temperature taking should be universal.
4. We need to assure an adequate supply of face masks and they should be supplied for free at convenient locations.
5. We need a smart nationwide marketing campaign to encourage people to practice good hygiene, get tested and to wear masks; mandatory on public transportation.
6. People need to take responsibility and self-isolate and report themselves if they feel they may have the virus, even if testing is not available, or if they have come into contact with someone who is infected.
7. Screen everyone coming into the country.

Yes, the Coronavirus Is Different from the Flu, but Acting out of Fear Is Not Smart.

I live in Massachusetts, in the Berkshires ... 7 cases as of today.  When I went to the supermarket today, the place looked like it had been ransacked.  The shelves were almost bare of canned goods, paper products, broth … all kinds of products.  What is going on?

The President has basically said, what’s the big deal?  Each year we see deaths from the seasonal flu of between 12,000 and 60,000, but the media mentions not a word about it.  In this case, even if you look at China, deaths are at around 3,100, Italy 600.  Why is the media making such a big deal about this?  It reminds me of what they do these days with bad weather events; everything is catastrophized.

There is one big difference between the seasonal flu and the coronavirus: there is a vaccine each year for the flu.  Millions of people, around half of the U.S. population, get their flu shot each year.  Because of that, people feel comfortable engaging in all normal activities during the flu season.  And because of that, there is no slowdown in production, travel, events, etc. and thus no major economic consequence, despite all the deaths.

But because there is no vaccine for the coronavirus, it’s an unknown, and it can result in death, albeit in only 1-2% of cases, people are very leery of going about their usual activities.  Especially since undoubtedly many people are walking around infected because they don’t know they are as testing is hard to come by and there is much confusion.  This fear, and the fear of countries, leads to drastic measures.  It is these measures, not the deaths or illness, that cause the economic disruptions that investors fear.

A recent article raised the question, specifically regarding China, whether the “cure” of lockdowns is worse than the danger.  That is a very good question.  If people went about their business as usual while being very conscientious about washing their hands frequently and thoroughly, you would almost certainly have more spread than with a lockdown, and more deaths,   But you would have to have 500,000 cases of virus before hitting the lowest number of deaths from the seasonal flu.

It really comes down to fear … on the part of individuals who don’t want to get sick and possibly die, and by governments that don’t want to see their citizens overwhelmed with this new “plague.”

If I look at the situation rationally, on balance I would say that healthy people should go about their business as usual unless they live in a virus “hot spot,” but they should maintain social distancing, that is not go to crowded bars or theaters ... actually such places should be closed ,,, and not go on a cruise or fly in an airplane, both of which pack people in intimate quarters.  And they should wash their hands often and thoroughly.  If you use public transportation, wear a mask.

People who think they may be infected or have had contact with someone who is or may be should be tested immediately.  People who are infected or think they may be should self-isolate so that they do not transfer the virus to others and they should wear a mask, both at home and if they do go out.  Shutting down the country is not necessary if people act responsibly.

Think about it.  You have a greater chance of dying or being seriously injured from a car accident or the flu than from the corona virus.  You should act accordingly.  For once, Trump has the right idea, even if for the wrong reason — his political self-preservation.