Thursday, March 12, 2020

The post on COVID-19 that nobody asked for

The last thing anyone needs is another post on this topic. But, at this point it is therapeutic for me to try and connect and resolve the many conflicting pieces of information I've absorbed from the five sources of quality news that I pay for, together with the highly interesting and insane cross-section of information gleaned from free clickbait sources and back-alley slums of ill-repute like reddit.

Plus, it'll be interesting to look back and see how wrong or naive I was in retrospect.

What have I learned about COVID-19?
The fact that I've learned it doesn't mean it's true, but this is where I think it is at:
  • When the virus first appeared in China, efforts were focused on quarantine and elimination of the virus.
  • Most people who get the virus are no worse off than if they'd got a cold or the flu. Some people have an extremely serious infection that requires mechanical ventilation and intensive care facilities.
  • Mechanical ventilators and intensive care facilities are in short supply around the world. This is reasonable.
  • Global efforts are no longer focused toward elimination of the virus, but instead on controlling its inevitable spread so that it doesn't overwhelm healthcare resources such as available ventilators and intensive care units.
  • If healthcare resources are overwhelmed, triage will determine who will live and who will die. More people will die than would die if resources were unoccupied. The deceased may include among them people who did not have COVID-19 but had another serious accident or illness at the wrong time - for example, a severe case of regular influenza or an unrelated heart attack that required intensive care facilities.
  • Healthcare systems have generally have not been good custodians of the supply chain. Important tools in the pandemic toolkit such as masks and other protective equipment have not been stockpiled. Further, many are produced in China along with certain important medications and these supplies are now quarantined along with a large chunk of the Chinese population.
  • With all of the above in mind, reducing the opportunity for all types of illness, injury, and accident while COVID-19 is a clear and present risk makes sense, and to me this is why shutting down events and travel makes sense. If you have a serious car accident travelling to an event when COVID-19 is in full swing, you may be out of luck.

What I don't understand: why not inverse quarantine?
I don't fully understand why we are roping everyone into the cancellations and restrictions that are now becoming widespread. There is a clear profile of the type of person that is vulnerable and they are in the minority: older people with existing health conditions. These are the people who have the most self-interest in protecting themselves, and they are also the reason that everyone else should be trying to avoid catching the virus - not so much for themselves as for someone who is vulnerable that they may pass it on to.

Why wouldn't we get in touch with the most vulnerable people, have those people quarantine themselves with supports to ensure they have what they need for the duration, and let it blow through everyone else as quickly as possible - the vast, vast majority of whom will not suffer greatly though may be contagious for 2 weeks? Perhaps it is too large of an effort to orchestrate reliably and quickly, but it seems that most people are hyper-aware of this issue so the communication would surely not be a problem. If there is a vulnerable person that does not know that they are at risk from this virus by now, I would be extremely surprised.

I can't help think, in the back of my mind, that this has largely become one big exercise to see how quickly and deeply governments can bring people under control should a more serious emergency or outbreak warrant it in future. How often does this opportunity come along with commensurate public support? The largest social experiment ever conducted - so much will be learned from this.

Ontario schools closed for 3 weeks - where do the kids of healthcare workers go?
March Break - an annual week off school in March - was to begin next week. It happens every year and parents plan around it. Parents have now been told that schools will be closed for an additional 2 weeks after March Break to reduce the chances of propagating COVID-19. Fair enough, but I can't help wonder what this does to healthcare workers with children not old enough to stay home alone. A great government support would be to do everything it can to provide free, priority daycare for children of healthcare workers. If this virus kicks off, the last thing you will want is healthcare workers torn and stressed between home and work-life issues.

The logic of closing down schools for 2 weeks after March Break appears to be that children returning from March Break travel to locations where the virus is more prevalent than in Canada will not have a chance to spread the virus among their classmates on their return. After 2 weeks, it'll be clear who does and does not carry the virus but immediately after March Break it will not.

Donald Trump and US Election 2020
It seems to go without saying that Donald Trump's prospects of re-election look worse at the moment than they did at the beginning of the year. I'm not sure they were ever that great - he won in 2016 by an extremely slim margin and lost the popular vote. It's hard to imagine that he has brought more people onto his side in the last 4 years, but there's no accounting for public affinity for an opponent who is older, appears confused a lot of the time, and will not bring out the youth vote... and that is what you have in Joe Biden.

If you look at the core of this COVID-19 issue and the havoc it has wrought in general to the economy and healthcare system so far, you see a fundamental issue of over-dependence on China both in the supply chains of every day products and in medical supplies that are critical to the health of the country. It really does seem feasible at this point that even the US military may not be able to function completely without the Chinese supply chain being intact, which seems unimaginable.

So, all I want to say here is that Donald Trump has made reducing dependency on China a central and highly-visible part of his presidency for the duration. He has been attacked from all angles for doing it, and primarily by his opponents (some of whom had a direct hand in implementing the over-dependencies). There is political gold to be mined for Donald Trump if done in the right way and at the right time, though I'd still have doubts in his ability to sway such a polarized population.

Donald Trump and the ban of EU travel
It was wrong to impose such restrictions without letting his counterparts know it was coming. But the immediate cries of "this won't work!" were really strange. China did it, and was praised for it. Granted, the US will not be able to be so draconian and complete in their shutdown. But how do the EU naysayers know that it won't work, and what position are they in to say so with all of their most prominent countries grappling with this virus more severely than is the US?

The US has some unique healthcare struggles with such an apparent lack of integration or common goal of public good within its fragmented healthcare system, and I have to wonder whether border restrictions may really be the best (if not the perfect) approach for that type of system.

Over-reaction and stockpiling
I went to the supermarket on the evening of March 12th to pick up a few things, but none of them were must-haves. It was worse than the height of Christmas. All aisles packed with shoppers and shopping carts going queued around the perimeter of the store waiting to be checked out. I've never seen anything like it, and I can't imagine what could be so urgent for so many people! I left.

I went back the following morning at 7:00am. Not as bad as March 12th but definitely abnormal - more on the scale of a busy Saturday afternoon, though with very few checkouts open.

India
I am absolutely amazed that this virus hasn't kicked off in India yet. but here you have it - as of today, only 73 cases and 1 death in an extremely crowded country of 1.3 billion people.

But life goes on...
For the most part, people I interact with on a daily basis are going about their day and getting things done. There's such a sharp contrast between portrayals in the media of absolute chaos at every turn and the calmness of every day life.

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