Why Flatten the Curve When You Can Crush It?
Dr. Harvey Fineberg proposes a “take no prisoners” approach to “defeating” Wuhan CoV-19. Consider it yet another alternative that should be considered seriously.
“The aim is not to flatten the curve,” Dr. Harvey Fineberg, president of the Gordon and Betty Moore Foundation, a philanthropic organization in Palo Alto, California, and past president of the U.S. National Academy of Medicine, wrote in an editorial published Wednesday (April 1) in the New England Journal of Medicine. “The goal is to crush the curve.”
Fineberg argues we can defeat COVID-19 in just 10 weeks if we take a “concerted and determined” approach.
- First, President Donald Trump should appoint a commander in charge of the coronavirus response. This person is not a “coordinator,” but rather someone who has the authority “to mobilize every civilian and military asset needed to win the war,” Fineberg wrote. Each governor should also appoint a commander with similar authority at the state level.
- Second, America needs to carry out millions of diagnostic tests in the next two weeks. Such a strategy was successfully used in South Korea to contain COVID-19. These tests are needed to “trace the scope of the outbreak” and make informed decisions about managing patients, he said. “Testing is our form of intelligence” in the military sense, Fineberg told Live Science.
- Third, all health care workers should have access to ample supplies of personal protective equipment (PPE), Fineberg said. “We wouldn’t send soldiers into battle without ballistic vests; health workers on the front lines of this war deserve no less.”
- Next, the population should be [classified] into five groups, Fineberg said. These include those infected with COVID-19; those presumed to be infected based on symptoms but who initially test negative; those exposed to someone with COVID-19; those who are not known to have been exposed to or infected with COVID-19; and those who recover from COVID-19.
People in the first two groups can be hospitalized — if they are very sick — or placed in “infirmaries” (such as a converted convention centers) if they have mild to moderate disease, he said. People who have been exposed to COVID-19, but don’t yet show symptoms, may be quarantined in hotels for two weeks.
Finally, those who have recovered from COVID-19, and are, in theory, immune, may be able to go back to work. This category, which would require the use of antibody-based tests to identify, “would be a game-changer in restarting parts of the economy more quickly and safely,” Fineberg said.
- Fifth, intense efforts should be made to “mobilize the public” in the fight against coronavirus. “Everyone has a part to play and virtually everyone is willing,” Fineberg wrote. For example, the U.S. postal service and other delivery companies could deliver surgical masks and hand sanitizer to every American household, Fineberg said. If everyone wears a mask, people who are infected but don’t yet show symptoms would be less likely to spread the disease, he added.
- And sixth, researchers should continue fundamental, “real-time” research into COVID-19 to examine questions such as who is at higher risk of death from the disease and whether those who haven’t yet caught the virus could safely return to work under certain conditions.
It will also be critical to learn from our experiences in real time — for example, when we start to open up parts of the economy in different parts of the country — and adjust responses accordingly.
“Different communities will be at different stages of success and readiness,” Fineberg said. We can see how well and safely certain strategies are working and then “crank it up more widely throughout the country.”
Another important issue is that, even if we get the number of infections down so that containment is possible, we will need an “army of efficient, effective public health workers” to perform contact tracing, Hutton said. This involves tracking down contacts of patients, testing and isolating them, “to stop this virus from spreading like wildfire again,” he said.
Disease models seem to be getting it wrong — while creating havoc across society. The “Helter-Skelter in Place” based upon these models, is devastating the working classes, while the wealthy elites sit safe and secure in their home offices.
What is wrong with the models? Their assumptions are ignorant guesses! And so far, the modellers show little sign of learning from their mistakes. Some of the many things they need to know before asserting their models to policy-makers:
- 1. Asymptomatic spread
People who have the virus but don’t display symptoms are known as asymptomatic patients. There’s some evidence that these people can still spread it to others, but we don’t know how infectious these people are.
- 2. Mode of contact
Our understanding is that after the initial spillover – when the virus first jumped from an animal to a human – the virus only travels between humans, but we don’t yet have a full picture of how the virus spreads. To what extent can it be transmitted by people touching surfaces, for example? If modellers incorporate these other modes of contact with the virus, they are likely to see faster spreads as a result.
How long does the virus linger on surfaces, and how might this accelerate the spread of the virus?- 3. Flouting the rules
In the UK a new set of rules have only just been introduced (stay at home except for essential shopping and exercise and travel only to work if you’re a key worker). We have no idea how many people are planning on actually following them.
- 4. Hotspots
We know epidemics flare up earlier and more intensively in certain places, for instance diseases such as Ebola never spread fully around the globe. But we don’t know how tackling these hotspots early affects the spread of the virus later on.
- 5. The incubation period
How long does it take between you getting exposed to the virus and you becoming infectious to other people? We don’t know either, and the WHO mentions that “most estimates of the incubation period for COVID-19 range from one to 14 days”.
- 6. How the spread differs between countries
The virus doesn’t necessarily behave the same way in every country, or every area of a country. In some cultures, older people socialise a lot, whereas in others, they spend much of their time alone. A higher than average population density in cities, or on public transport, could influence how quickly the virus spreads.
Assuming the virus works the same everywhere could produce wildly inaccurate predictions. Understanding the spread at the local, regional and national level is needed to make the best models possible.
We’ll be hearing a lot about models and simulations over the coming months as they begin to play an ever more influential role in our lives. But it’s important we never forget to ask – what information did they use to get their answer, and can they show their results still hold if the reality turns out a little different from what they assumed?
___ https://www.realclearscience.com/articles/2020/04/06/six_unknown_factors_in_coronavirus_models.html
The anti-malarial drug which Trump famously touted as a “game-changer” in the fight against coronavirus is now being prescribed to thousands of patients, and anecdotal reports indicate that the drug is effective. The number of COVID-19 hospitalizations may have been reduced by this treatment and, if so, chloroquine was probably a variable not factored into the models that projected a shortage of ventilators and ICU beds. __ S
The tragedy unfolding in addition to the horrid takeaway of our liberties and right to work is that while more and more Americans can work from anywhere, tens of millions cannot as evidenced by the layoffs. Though coronavirus is surely a rich man’s virus that 99.9% of Americans would have endured when Dargis was a child, not everyone in the U.S. is rich today. Not everyone has the means to wait out the curve’s “flattening.” And so they suffer the actions of politicians who just don’t get it.
__ Source
How the “certified recovery” could start getting the economy moving again
Someday soon there will be millions of people in the U.S. who have recovered from Covid-19. The best evidence suggests that they can’t get infected again soon and won’t infect others by shedding the virus.
That suggests a path to run essential services more safely and to reopen sectors of the economy faster than would otherwise be possible. New York, Washington, California, and other states with high caseloads should rush to set up credible, verifiable, and voluntary programs to identify individuals as “certified recovered” from Covid-19.
Time to figure out a rapid timeline for re-starting essential (and other) businesses
Clueless models are putting societies in a world of hurt:
According to the Murray model’s late-March forecast, as many as 75,000 patients would be hospitalized in New York by April 11, the predicted “apex.” During his Sunday briefing, however, Cuomo acknowledged that the “curve” already appears to have reached a “plateau.” Hospital admissions for COVID-19 decreased from 1,095 new patients Friday to 574 on Saturday, and new ICU admissions also declined, while the number of patients discharged went up, from 1,502 Friday to 1,709 Saturday.
Cuomo was cautious in saying it’s still too soon to tell whether his state will continue this encouraging trend, but clearly if more coronavirus patients are being discharged from hospitals than admitted on a daily basis, the total number of hospitalized patients is not currently on an upward trajectory, contradicting the Murray model projection. As of Sunday, 16,479 COVID-19 patients were hospitalized in New York, which is about 22 percent of what the IHME model projected as the “apex” peak on April 11. While a sudden surge in cases cannot be ruled out — we can’t predict the future course of the outbreak — it now seems unlikely that New York’s hospital load will ever reach what the model predicted in late March.
New York is the epicenter of America’s coronavirus outbreak, with nearly 40 percent of all U.S. cases and the highest per-capita infection rate (632 cases per 100,000 residents). So if the computer-modeled projections have failed to accurately predict the course of the pandemic in New York, what about the rest of the country? __ https://spectator.org/coronavirus-the-wrong-numbers/
We will keep watching the numbers unfold, closely. And now that the models are in the spotlight, we will need to hold the model-makers to account for the impact their work is having on societies.
In the meantime, we must devise ever more alternatives to the helter skelter quasi-house arrest policies that have captured the enthusiasm of politicians and media hacks. Poorly thought out policies to “flatten the curve” that are based on ignorant and sloppy models, are more likely to merely postpone the day of reckoning to a worse time.
The model is not the reality. The government is not the country.
Since science has now become the ultimate arbiter of how we determine most public policy debates adjudicated in the press, coronavirus forecasting is a cautionary tale to reporters who easily confuse what is science and what is conjecture. __ Source
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