Agreed about Iceland, in some sense. In general I am not a fan of such comparisons, but actually their per capita international travel exposure is far higher than ours. They had a lot of separate introductions of the virus, and they were travelers from many countries. The useful bit of the comparison is as a model of what a public health response should look like. Let the health department solve communicable public health problems. For more details of their experience, see:
https://www.newyorker.com/magazine/2020/06/08/how-iceland-beat-the-coronavirus The problem with the CDC is that they were not allowed to play their normal role in either the public facing side of this or in the response. They normally tell the administration what to say, rather than vice versa. Had they been in control the response would have been far more classic "ramp up the testing". True they messed up testing assay selection in the beginning, but they should have moved immediately to a back up plan for increasing the testing and this was not done. We can speculate about why this failure to increase testing occurred, but I would submit that it was not because a bunch of people at the CDC who basically live for epidemic response suddenly decided it was not necessary. As mentioned, neither De Blasio nor Cuomo listened to the NYC health department, who were telling them for over three weeks that they should be closing schools etc. before NYC did so. Finally when deblasio agreed to close schools, Cuomo stated he had no authority to do so because new jersey and CT needed to be involved as well and only the state can coordinate that. So they got into a pissing match after delaying longer than they should have. The results were clear. The lesson should be: listen to your technocrats and do what they tell you to do. There will always be disagreements about why things happen but this is how I see it. The CDC is world renowned or has been. It has played huge roles in outbreak investigation and control around the world for decades. How this epidemic could be unfolding as it has under the CDC's nose in its own backyard is a huge black eye for the organization and I would argue for the country. It is sad state of affairs. For whatever reason they have not been able to lead a world-class response to something that is their bread and butter. Happy to contribute whatever I can in terms of practical steps. On Tue, Jun 16, 2020, 10:57 AM Scott Ritchey via Mercedes < mercedes@okiebenz.com> wrote: > Karl, > > Thank you for your thoughtful and extensive reply. The personal-protection > guidance (masks, groups, outdoors vs indoors, etc.) is particularly useful. > I agree that we need a much better National response for the day a truly > evil bug comes along. > > I don't think the Iceland experience is comparable to the US; Iceland is a > remote island with little international travel and a population smaller > than > Bakersfield, CA. > > I find it hard to reconcile the NYC COVID experience and preparedness with > a world-class health department. > > Finally, being retired and having a smart phone, I watched the daily > briefings from the COVID Task Force and Cuomo, at least until they became > redundant. My recollection of the CDC doctors' role is quite different > from > your description. > > Thanks. > > Scott > > -----Original Message----- > From: Karl Wittnebel > Sent: Monday, June 15, 2020 2:04 PM > > At their root level, public health crises driven by highly infectious > diseases are a national problem. The response alwys needs to be carried out > by state and local entities, but particularly when dealing with a novel > pathogen, allowing the best scientific and public health experts to drive > the response is critical. That is what Iceland did. The public health > department drove the entire thing. Politicians were not involved at all in > telling them what to do or how to do it. There will always be political > ramifications from any action, but those cut both ways and if the > politicians drive it and get things wrong, they pay the price. So I would > argue it is best to just rely on the public health experts and let them > take > any heat. Best for the politicians and best for the country in terms of > disease control. > > Anyway State departments of health are highly variable in their resources > and levels of expertise and will therefore depend to varying levels on > national resources and guidance for their reponse plans and policies. New > York City is a world class health department on its own, for instance. > Their politicians chose not to listen to their public health officials > initially, and look at the result. Those few weeks of political dilly > dallying could have saved a lot of older people's lives, and some younger > people also, in and around NYC. But I digress. The main point is that most > of the country is not as well equipped as NYC. So their heaalth departments > need help with technical aspects as well as guidance on what policies are > most effective. Not that the guidance will always be perfect, but a > consistent, unified voice is always more reassuring during a crisis than a > fragmented response where politicians undermine what the public health > people say, whether it be about masks, treatments, business closures, > travel > restrictions etc. You want the public to see everyone working together > consistently in an apolitical fashion to manage the problem. > Centralized, national leadership is a key part of getting the response > entites on the same page. Telling the states to figure it out for > themselves > isnt using the available resources very well. Both FEMA and the CDC have > considerable expertise and resources that could be used in ways they have > not been so far. > > Re The Prez: he would have been better served to stay out of the limelight > on the whole thing. Committing hard to specific ideas when the state of > knowledge is poorly developed is kind of like putting all your money on red > 22: not likely to pay out. He made a lot of foolish statements that painted > him into a corner. He doesnt have enough technical depth to comment and > doesnt seem to appreciate how out of his depth he is. He should have relied > more on the CDC people to lead the response, but they were pretty much > muzzled. They would literally normally be telling everyone what to do, > mobilizing considerable resources to facilitate testing and telling states > what the test and trace policies and targets should be. Instead we have had > the JK crew telling everyone that the states are on their own for stockpile > and other resources and POTUS telling everyone the states are responsible > for dealing with their own epidemics and lockdown policies. CDC has > definitely been told to stand down or they would be out in front on all of > it. FEMA would definitely be driving the stockpile distributions and > policies, which should be transparent and non punitive. Basically this was > a > big political opportunity for DT to let the machinery work and then declare > victory. Instead the epidemic is poorly controlled, dragging on into > election season, the economic impact is dragging on longer than it should, > and there is a high chance it will all get worse again. There is a strong > chance we will end up doing the usual public health test and trace > interventions anyway. > > The lockdown was super draconian and largely unprecedented. It was never > going to be a workable long term strategy. The best thing for the economy > would have been to tell the nation that everyone needs to do their part to > fight this thing, train up contact tracing teams, ramp up testing on a > national level with proven tests and defined targets for positivity rate, > and push CDC people and federal stockpile resources into state and local > health departments as needed to provide support. Instead, testing lagged > behind tremendously for unclear reasons while the disease became more and > more established and the lockdown dragged on with no clear national > strategy > or even any defined national goals for controlling the disease. > E.g. Do we tolerate a certain infection rate, or try for zero? Work it > through with the states until everyone has a set of goals they can live > with. > > I think it is a mistake to look at this through a political lens primarily. > The virus doesnt care. The two sides in this are pro human and pro virus. > Yes the talking heads will try to score political points but trying to say > the CDC or doctors or hospitals acting deliberately to achieve political or > financial goals first ignores the reality which is that even though > everyone > has political views, most of us don't talk about them at work. We put that > crap aside and do our jobs. Public health professionals, doctors, hospitals > etc. just want the disease to go away as much as possible. It has been a > huge pain in our asses and in our pocketbooks. > > For now, wear a surgical mask when near other people if you can get them. > Try to limit indoor exposure to large groups of people unless there is > really good crossflow ventilation. We all take some personal risks in terms > of who we alllow inside our bubbles of exposure, but this should be > deliberate. Social interactions and larger group functions should be > outdoors as much as possible. Thankfully young kids do not seem to pass the > virus to adults very often, so granfkids seeing grandparents is less of an > issue than grandparents seeing their adult kids (adults should all mask up > during visits.) > > Tbe surgical masks of spun polypropylene carry electrostatic charges and > are more comfortable to wear if you can get them fyi. Cloth is betterr than > nothing however. Airliners have ventilation systems that mix the air; > fixing > it requires redesign of aircraft. Everyone should be wearing masks on those > planes. We are not flying commercial any time soon. > > All this is meant to be a response to Scott's questions. We are driving to > the midwest in later this summer and I think we are going to camp the whole > way up and back. We will sleep downstairs at my folks place. Life goes on. > Hospital is quieter but we are all half expecting another uptick in cases. > We are at about half of what we were at peak in terms of numbers in the > hospital. 15% of people who are intubated die. Some studies going on e.g. > use of estrogen that will be interesting to follow. > _______________________________________ > http://www.okiebenz.com > > To search list archives http://www.okiebenz.com/archive/ > > To Unsubscribe or change delivery options go to: > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > _______________________________________ http://www.okiebenz.com To search list archives http://www.okiebenz.com/archive/ To Unsubscribe or change delivery options go to: http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com
