Finding a Better Path

I’ve learned that the safest path is not always the best path and I’ve learned that the voice of fear is not always to be trusted.

Steve Goodier

If COVID-19 returns in the fall, do we really want to go down the same path we’ve been taking? In the US, we have focused on “flattening the curve” – not reducing the total number of deaths directly due to COVID-19, but rather spacing them out so that “indirect” deaths due to insufficient health care system capacity have been minimized. We took this path because our models initially predicted tens of millions of cases – and millions of deaths – that would have overwhelmed our emergency rooms. In taking this approach, all of us were faced with a situation for which we were unprepared – we had never been faced with this kind of crisis. Our stocks of many critical resources had been depleted but never replenished. The “Triple Header” of hurricanes almost three years ago had hinted at what we now know – our EM doctrines are clearly inadequate to handle disasters that go beyond the regional. We acted largely out of caution and a fear of the unknown.

Things will be different the next time. We know that the approach we’ve taken to the pandemic is fraught with unintended consequences – impacting our economy, our social compact and our mental health. We will have much greater testing capability and probably sufficient PPE, and capable supply chains for each, the next time. With luck, we may also have more effective treatments available for those infected.

The problem we face in crafting a new approach is simply that too much conflicting “information” is being fire-hosed at us; it’s damned difficult to find the nuggets of truth in the rushing torrent so that we can plot a better path for the future. I strongly believe we should empanel a national Board of Inquiry for the coronavirus chartered to develop a better approach for nationwide disasters such as this. It is important that we do this for next fall, but also because this crisis may impact our ability to manage severe weather events starting this summer.

Rather than bipartisan, the Board should be non-partisan – focused on policy and planning rather than personalities and politics; lasered in on developing a better approach rather than playing the Blame Game. Such a Board needs a strong chair, versed in both the strategic and operational aspects of dealing with crises; Craig Fugate, Honore Russell or Thad Allen come to mind. The Board should be independent of both the Executive and Legislative Branches, perhaps under the National Academies. The Board should include expertise in economics; health and health care; law; and federal, state and local decision-making.

Such a Board should pursue lines of inquiry such as:

Situational awareness. Whatever plan we develop, we can be sure that it will have to be modified once case numbers start to rise. Those changes will be informed by the data at hand. I’m sure I’m not the only one who can’t figure out whether we’re severely undercounting or overcounting cases and deaths (My guess is undercounting cases and overcounting deaths, but who knows?). The federal government should provide useful guidance in terms of how to count and report, esp. considering that both the pub;lic and private sectors are likely to be involved.

Federal, state, community and private sector roles. There seem to be as many opinions about who should lead and how, who should follow, and who should get out of the way as there are politicians and pundits, i.e., way too many. We need simple efficient processes at all levels, minimizing paperwork, and clear on what they are and how to follow them. We really began to have success when we let the private sector get involved. Our processes need to stop stymieing and start encouraging private sector participation.

Urban areas. Most importantly, we need to understand why urban areas such as NYC were hit so hard. Less than 3% of US counties – all urban and accounting for half of our nation’s GDP – have had 60% of US cases. If NYC was a separate country, its mortality rate would exceed Italy’s! Over one-third of US deaths occurred within a 30 mile radius of NYC. We have to understand what happened in these urban areas to perform better next time.

Foreign experience. The Board should consider successful responses from other countries. As of today, Taiwan has had only six deaths and less than 450 cases out of a population of 23+M. They learned some hard lessons from SARS – and acted on what they learned; we apparently haven’t.

Lockdowns. Singapore, South Korea and Sweden all have approached the “Wu Flu” very differently than we have in the US, with arguably better results. One element these have in common is aggressive contact tracking; it seems that we can learn from what they have done. In these countries, the elderly and those potentially at greatest risk were urged to quarantine, but schools weren’t closed; restaurants weren’t closed; retailers weren’t closed. If we look at the responses across our states, lockdowns don’t seem to have had a quantifiable impact on health outcomes; population density does. Conversely, we will likely pay a terrible price later in deaths of those who didn’t go for their cancer treatments, who couldn’t afford to pay for their medications, who didn’t get the proper exercise. This doesn’t begin to address the incalculable impacts on our kids’ educations and future employability, or the millions of children worldwide who the UN estimates are going to die of starvation.

Next points of attack. We now know that urban centers were the hardest hit in this first round. We need to determine whether this has resulted in “herd immunity.” The potential vulnerability of more rural populations also needs to be addressed.

There are other issues (e.g., border security and immigration) that also should be considered. What we need most now, however, is the wisdom to find those nuggets of truth, the wisdom to use them as signposts toward a better path, and the courage to follow those signs onto that path. Given our highly partisan polity, wisdom, will and courage will all be needed. The GOP and the Dems have both contributed to the problems; the best ideas from both are needed to solve them.

3 thoughts on “Finding a Better Path

  1. Dr. John: As always I find your thoughts to be thought provoking. I appreciate your looking into this epidemic and your thoughtful response.


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