Government Response to Covid 19, part 1

 It's probably too early to post this as Coronavirus Disease 2019 ("Covid-19","the rona") isn't finished yet and there's no telling when it will be.  But in light of the Physical Activity Guidelines and Dietary Guidelines that I've already gone over I wanted to put some thoughts done about the similarities and differences with the Covid responses.  It's a useless exercise, as I have no influence over the decisions made, but it was a major upheaval for the past (almost) two years and some things about it stick out to me.

Early on in the Covid Pandemic, there were two basic recommendations:

• Stay at least 6 feet away from other people
• Wash your hands

Pretty soon after that, government ordered lockdowns started, originally in specific states and then nationwide (the infamous "15 Days to Slow the Spread"), so that was added to the list.  Equally infamously, the various public health authorities, including Dr Anthony Fauci and the Surgeon General of the US did not recommend masks.  The Surgeon General even went so far as to tell people to NOT buy and wear masks.  The Surgeon General tweeted that out on February 29, 2020. However, by April 3 2020, the CDC was recommending masks.  So that brought the recommendations to 4:

• Stay at least 6 feet away from people
• Wash your hands
• Don't leave home
• Wear a mask

These made up the so-called "Non Pharmaceutical Interventions" (NPIs) that we have been living with during the epidemic.

The "Don't Leave Home" message is mainly directed at work and social activities.  Many big box stores, including grocery stores were exempt.  But some very large percentage of people were told to work from home.  Children were told to learn from home.  Restaurants only operated on a take-out basis. Most churches were closed.  It was a quiet time. 

Early on, I posited a few requirements for a successful campaign (from the standpoint of the campaigners).

• It has to be easy to understand and remember.
• It has to be within the reach of most people.
• It has to be widely communicated.
• It has to be be medically effective. 

I can't imagine any scenario where I would give the NPIs anything but an A++ with regards to the 1st and 3rd recommendation.   The recommendations are about as simple to understand as can be and they were communicated non-stop.  Every store had a poster up reminding people to wear masks and they put lines on the floor to keep people 6 feet apart.  Some went so far as to make their aisles one-way (with arrows to indicate which way was which) so people would cough their corona-bugs into each other's faces.  The message was on PSAs on TV and on the radio.  The news shows tut-tutted over people failing to adhere to them.  TV shows produced during the pandemic incorporated the NPIs into their story lines.

With regards to the "within reach" part, it's important to note that the restrictions were put in place in 2020, at a time when most people in the white-collar and professional class (that is, the same class as the  people making these decisions) had high-speed internet and online conference calls were feasible.  During the early days of the lockdown there were a lot of problems as companies had to scale up their servers and VPN systems but after a week or three those were mostly worked out.  However, not everyone was in that situation.   Blue collar jobs were typically considered "essential" and thus not subject to the lockdown.  This would be your electricians and plumbers, store clerks and delivery drivers.  And what would we have done without them?  Further down the food chain were poor children who didn't have access to laptops or high speed internet and so were excluded from school.  School districts had to scramble to distribute laptops and many had to get creative to provide mobile hotspots so their kids could connect.  It's doubtful that these kids learned anything and many simply never logged in.

But it was 2020 and that's how things worked.  Had this happened in 2010, things would have of necessity been different.  In fact, in 2009 there was a pandemic of swine flu, which elicited a much different response.  During that event, when a school was hit with the flu, it would be closed for a week or two to disinfect it, then kids would be let back in.  There was no online learning due to the state of technology.  Kids just got a vacation.  When schools finally let  out for summer, there were no more schools to close, so the story kind of went away.  At some point people just quit getting the swine flu, but it's hard to say when.  The next fall, schools opened as normal.

Quite different!  With the Covid-19, news channels breathlessly reported how many new cases there were every day.  And how many people were in the hospital.  And how many people died (I have no recollection of the last two at all during the bird flu epidemic.  According to the CDC over 12,000 people died from the swine flu, but they died quietly.  Looking at the Covid NPIs, the difference is stark.  

As an anecdote: during the swine flu epidemic, a coworker had to leave early because his kid was sick and he had to pick him up at school.  He took his child to the doctor and he tested positive for the H1N1 virus (the swine flu).  I know this because I was talking to him about it afterwards in the hall at work while standing 3 or 4 feet in front of him.  Neither one of us got sick and it never occurred to either one of us that he could be breathing H1N1 viruses that he picked up from his boy all over me.  If that had happened during the Covid pandemic, he himself would have quarantined for two weeks and possibly fired he he showed up to work after having been exposed.

Even the CDC estimate above shows how different things were.  The CDC estimates that 12000 people died, but they don't really know.  In the Covid times, there was more testing than I'd ever seen.  Tens of Millions of tests a day.  If  you had even half of a rona virus in your blood, the test would pick it up, it seemed.  We even had the phenomena of "asymptomatic" virus carriers.  People testing positive who don't have symptoms.  While this may be a common occurrence, it's not commonly known because people who don't have symptoms of a disease typically don't get tested for that disease.

Now I'm not here to say that the Covid NPIs should have been different simply because the Swine Flu NPIs were different, nor that the Swine Flu response should have been the same as the Rona Response.  My point is just to say that what happened in 2020 was a combination of the technological, political and moral situation in the country.  During the Swine Flu there was no technological way that school could be carried out online so it wasn't.  There was for sure a moral panic, but not 10% of the panic that came from Covid-19 but that didn't extend to anything other than schools.

By way of comparison, as I write this more than 700,000 Americans have died of Covid19 and many more have been sickened by it and had to go to the hospital.  The 2009 Swine Flu was not actually any worse than a normal Flu season, but the excess deaths from Covid-19 are pretty undeniable.

It's been widely reported that a lot of "Covid-19 Deaths" are deaths among people that had Covid, but didn't necessarily die of it.  There have been reports of people who died in motorcycle accidents being listed as Covid deaths, for instance.  And the government was offering extra payments to hospitals for each rona patient which undoubtedly pushed up the numbers a little.  That's what we call The Chicago Way.  However, the excess deaths can't be solely attributed to unscrupulous administrators putting their thumbs on the scale.  Even if half of the number was inflated, it's still a noticeable number of people dying.

An argument has been made that these deaths largely represented people that would have died anyway.  In other words, perhaps someone had a terminal condition and was expected to die in the next 6-12 months, but the rona took him out early.  He could honestly be said to have died as a result of the virus, but he would have died anyway in a year.  So his death was passed forward into 2020-2021.  It will take a few years to see if that's the case.  If 2022 or 2023's numbers are suspiciously low, then that may be the case.  But I suspect the overall trend will be an unmistakable increase in mortality due to the virus.

Also yet to come is a proper accounting for the effects of the lockdown.  Cases of depression, alcoholism, drug use and suicide are all up.  Those effects as well as the effects of poor education will, again, take years to fully understand.  And hopefully they will help form the response for the next pandemic when it hits.

A final note before I move on.  During the pandemic, there were many people claiming to be "Following the Science".  In fact, most it not all of the controversial things that happened were done in the name of "Following The Science".  Needless to say, I quickly got tired of that phrase and began to hate anyone who said it.  In truth, when people said they were following the "science", they really meant that they were following the "scientists" ("Listen to the Experts" was another worn-out slogan during the pandemic).  But there are clear problems with that.

1. Every action taken in the course of the pandemic had medical, social, moral, political and economic consequences.  Politicians, who are experts in one of those dimensions, would invoke experts in the medical dimension to the exclusion of the rest.  But normal people mostly live in the non-medical and non-political dimensions so they naturally suffered.
2. Scientists are naturally single-issue people.  A medical researcher cares about medical research, not any of the other issues listed above.  A medical researcher may, in fact, not care that much about the actual practice of medicine, but only on his research.  His research may indicate a treatment is effective, or safe, but someone else has to worry about how to deliver it and how to deal with the side effects.  There's nothing wrong with that, but it does open one up to problems when these people are consulted for society-wide problems.  Their recommendations are formed by idealized scenarios, of the type they normally carry out in the lab.  But people are hardly ideal subjects, being uncooperative and distrustful in the best of circumstances.  You'd think that politicians would be aware of that, but a politician's solution to a truculent population is always the same: persuade through sound bites or control is that doesn't work.
3. There was no actual science behind a lot of the actions taken.  It would be unethical in the extreme to conduct an experiment where some people were exposed to the virus while wearing a mask (for instance) with a control group and count up the number of dead or hospitalized as we result.  And so, proxy tests were done, like fitting mannequins with virus sprayers and receptors to count the viral load in different scenarios.  But then there's the question of how much viral load a person needs to get infected, the only way to know is to deliberately expose a person to that load.  And that's unethical.  
4. Politicians don't know about percentages, they know about numbers.  If they win an election, it doesn't matter if they win by 1 vote or 100,000,000.  A win is a win.  Therefore, they are by profession incapable of understanding the risk/reward of a 1% reduction in illness vs a 10% reduction vs a 100% reduction.  Meaning any action, even if it has a small benefit, can be legitimately be seen as a silver bullet and there is no cost too high to implement it.  And with a virus that, by definition, spreads virally (that is, exponentially), "small" doesn't cut it.

Ultimately,  the reliance on the experts indicated to me the intellectual and moral bankruptcy of our political class.  They are simply incapable of making a decision and standing by it.  They have to hide behind someone else. By claiming to "follow the science", they are really saying "don't blame me, blame the science".  That's understandable to an extent, but it's not leadership.  There have been some leaders during the pandemic that actually did consider the political, moral, economic and social issues in addition to the medical when making decisions but they were very few and far between.

Next time, I'll start to work through the rona NPIs in light of what I've already covered for the Physical Activity Guidelines and the Dietary Guidelines.