Here's a question for you:
- Knowing what we do now, what would the public health community do differently if a new pandemic broke out? (For purposes of this question, assume the new pandemic is basically identical to COVID-19.)
- How many lives would this save?
As you can probably guess, my answer is:
- Not much.
- Not many.
Go ahead, prove me wrong. I want to be proven wrong. I'll acknowledge up front that having a president not named Trump would help immensely, but that's not really a policy thing. I'm more interested in drilling down a little further. What would the CDC do differently? Would we speed up vaccine testing? Would we handle shortages better? Etc.
FWIW, I'm not asking for your personal hot buttons here. If you think we should vaccinate with half doses, that's fine, but the question is whether the CDC and FDA are likely to allow it based on our experience with COVID-19.
'Knowing what we do now, what would the public health community do differently if a new pandemic broke out? (For purposes of this question, assume the new pandemic is basically identical to COVID-19.)'
If a Republican is President, Impeach him and remove him from office immediately thereby saving hundreds of thousands of lives.
I wasn't aware the CDC had impeachment powers.
What we would do is institute mask-wearing earlier. That would have a modest beneficial effect.
There are a lot of things that could be done to accelerate vaccine development, testing, and approval. Those things would have a significant beneficial effect if they were done, but I share Kevin's view that none of them would be done if there were another pandemic.
Not just mask wearing but maximum telework and more quickly using emergency powers to stop events with large crowds so they are not super spreader events.
A number of countries had "fever hotels", to lessen the odds that a sick family member would infect the rest of their family. We didn't do that.
Seriously, Kevin, you didn't even MENTION Trump or the criminally negligent propaganda his administration was responsible for.
Estimates of lives lost due the manner in which Trump "handled" the epic crisis, run from 100K to 400K.
Want to do better next time? Prevent the POLITICIZATION of the pandemic. And we all know what that requires: crushing the GOP into irrelevance.
Very simple
If a Democrat is in the White House,
we could do A LOT by following the Obama provided pandemic playbook.
The lives saved would be several 100k.
Easy peasy.
These. Among other things.
I think those 100k-400k numbers are themselves politicized.
MAYBE we do better on masks and banning international travel earlier if it happened again.
MAYBE.
But the basic reason so many Americans died wasn't Trump. It's because America is a country full of selfish douchebags who make everything into either a partisan issue or a pointless individualism issue, or both. Large parts of the country refused to distance, refused to give up indoor gatherings, refused to wear masks, refused to vaccinate, even as 600,000 Americans were dying.
And before you tell me that was all Republicans: plenty of the unvaccinated are traditional Democratic constituencies. And all sorts of politics were played on the Democratic side too, most notably condemning Republicans for wanting to go to the beach, and then three weeks later having scientists seriously argue that protesting was different because the cause was so important it justified gatherings. Or VP candidate Harris saying she wouldn't take a vaccine from the Trump Administration.
We are incapable of dealing rationally with a pandemic because we, as a society value our tribalism and our shallow freedoms more than we value sacrificing for the common good. Had the current America been called on to fight World War II, we would have lost.
By "basically identical to COVID-19" do you mean similar to COVID-19 in the same way seasonal flu viruses are similar to each other? If so, FDA should be able to speed up approval for vaccines similar to those for COVID-19 on the assumption they have similar safety and efficacy profiles.
Yup, having basic vaccine technology ready and tested should get us to approval in a fraction of the time.
But we clearly can't do tracing and testing in the west.
The mRNA technology was in place and it's fundamentals were fully tested. It's not going to b possible to speed it up.
We probably can't speed up the vaccine development process, but the approval process was unnecessarily drawn out. The FDA needs to treat these things like the emergencies they are. Meetings should be held as soon as the needed information is available, not scheduled for the following week. At least two weeks were lost just due to scheduling delays--and at the time we were experiencing around 3,000 deaths *every day.*
The other thing the FDA needs is to get some people who understand public health principles on board and let them run the show. The way they handled the approval of tests, making the perfect the enemy of the good, was disgraceful, and to anybody who's been through public health 101, laughably stupid. We should have had quick, cheap tests out there as fast as possible, and not had long debates about whether it was OK to use a test that was a little less sensitive, at certain points in the viral life cycle, than the "gold standard" PCR test.
The FDA's incompetence in this area built upon the CDC's screwup in developing the first test, which itself led to losing precious weeks during the rise of the first wave. While the CDC dithered, the virus was spreading rapidly, to the point where by the time we actually had the first practically usable tests, the magnitude of the problem was beyond what could possibly be managed with a feasible test-and-trace program.
The CDC and the FDA have both proven that they are currently incapable of responding appropriately to a pandemic. They need to get their act together, or for a new separate epidemic response agency with powers to overrule them during emergencies needs to be created.
Argubly right now we are at the height of "Pandemic Exhaustion". People are eager for the fight to be over and to get back to normalcy. So the answer to this question is going to be negative - people will probably not listen to public health directives to the extent they should which means the virus will spread regardless of what those directives are.
But after things have settled down for 3-4 years? I'd say yes. While the US lost of the Pandemic War, other countries had much more success. In a new pandemic they will be well suited to take early and decisive action.
I don't think the outcomes would differ significantly in a new, Covid-19-like pandemic. By autumn 2020, the world knew what could be done to diminish the spread of Covid-19, but failed to do so and endured the worst portion of the pandemic during that time. Although Murdoch media played a role in hampering response in the US, even many Murdoch-free regions of the globe did not do a particularly good job of mitigating the harm of the virus.
Those open to science, and capable of weathering the economic disruption, would likely take steps to protect themselves, but many won't be willing or won't be able to.
Kevin wrote: "I'll acknowledge up front that having a president not named Trump would help immensely, but that's not really a policy thing. I'm more interested in drilling down a little further. What would the CDC do differently?"
Well, with Trump in the White House, CDC leaders and CDC spokespeople walked on eggshells. They couched every information release and every advisory in terms that wouldn't anger the Fuhrer, lest they be summarily relieved of duty. So what they would do differently, because they could do it differently, is to be totally honest and forthcoming.
Sure, they'd still make mistakes, and their advice would sometimes work and sometimes not, but at least 300 million Americans (not to mention a few billion other folks who look to the USA for expertise and guidance) would have the best available information and advice at that point in time.
No.
The CDC is in a worse place than it was previously:
- There is now an established pattern of second-guessing them at every turn, with cottage industries profiting from it. This means they will be gun-shy and publicity-obsessed until they learn how to operate in the spotlight.
- There is now competition for some aspects of the response from other agencies that they are not prepared to fight. Expect a lot chaos similar to what happened when the Heimlandsicherheitsdienst - sorry, Department of Homeland Security - was created.
1) Have our scientists in a position where they can study the outbreak quickly, which hopefully will lead us to figure out whether masks are more important than handwashing
2) Prioritize testing more than we did (One failure shouldn't lead to delays that last months, and getting tests easily available is a high priority)
3) Better mathematical modeling so we can better analyze the threat
4) Better mathematical modeling so we can approve the vaccines faster--we could have saved a lot of lives by approving the vaccines for 90+ year olds during Summer 2020 and slowly moving down from there
5) Have a vaccine distribution plan in place that is an actual plan by the time the vaccines get approved, and it should include high risk people first
We could have reduced deaths by 50% at least. Over half of the deaths have occurred since December, which was ten months in.
Pretty much agree. The next pandemic might not be airborne exactly like this one so we have to be flexible and adapt to that. It may be difficult to follow the science quickly. It seems that even the scientists were caught a bit off guard. My guess is they see new viruses popup time to time and die off without causing a pandemic. By the time you see it starting to spread it is already fairly well established.
Anyway, yes, strengthen the CDC. Keep good stockpiles of PPE. Start investing in DNA sequencers. You can't jump on this too quickly or you wind up with a pile of obsolete devices in a few years.
Aggressive testing, mathematical modeling, contact tracing and some social distancing would definitely slow down the spread of a new disease till we could fine tune the response.
It is an interesting idea to constantly monitor the sewage systems of many cities, if only to maintain a baseline idea of what is normal.
Probably moderately better. Mask-wearing may be a culture ware issue in the U.S., but that does mean that at least *some* of the culture recognizes that it's a good idea when respiratory virii are on the loose.
Beyond that, keep in mind that the pandemic has cost humanity literally trillions of dollars. Whether or not your average joe or jane has learned anything, there is a colossal economic incentive of a scale never seen before on planet Earth for all sorts of entities to become more resilient (companies rethinking supply chains, institutions assessing how to operate while people are remote or distancing, etc.)
We're now able to make vaccines against SARS viruses quickly and efficiently.
A better question would be what happens when we have to deal with something entirely new where research has to start from almost scratch. It would take at least a year longer for a vaccine, maybe two, and every person freaked out now about a mask will be freaked out then, but even worse.
Last week there was a great article about how mask wearing provokes anxiety, but there's another element where the mask also promotes anonymity and the psychopathically conceited are completely offended that people might not recognize them and admire their glory. Bill Maher, for instance.
Unless it's really dramatic, and really fast spreading, like the zombie virus or spontaneous human combustion, the reaction will be just the same if not worse and nothing can help until these people die off sufficiently.
Biggest success of all pandemic responses was vaccine development & deployment. That is also the best area for improvement.
11 Jan 2020: Chinese publish map of coronavirus genome
13 Jan 2020: Moderna completes design of its mRNA vaccine
24 Feb 2020: Moderna ships first batch of vaccine for testing
16 Mar 2020: Researchers launch first clinical trial
[9 months go by]
18 Dec 2020: FDA approves Moderna vaccine for use
How can the trial & approval process be sped up? That will have the biggest impact on how we and the world fare during the next pandemic.
The longest portion of the testing was determining if the mRNA tech would work. Now that has been proven out, getting vaccines into arms should take about half the time. That would save a bunch of lives.
Relatedly, in Michigan, I am anticipating a new wave to hit in July, as we have now fully opened. I also expect that wave to hit unvaxxed folks. Who will then try to claim that Gov. Whitmer wanted them to get sick.
Simply not true. Stage 1 clinical trials started by March. It simply takes a lot of time to recruit thousands of people and get vaccines into their arms and have sufficient number of the placebo class get sick.
There is talk of "approving the technology", so next time they could just insert a new sequence and then be off to the races.
Not sure if we're there yet with mRNA vaccines in general, though it might hold for variants of Covid-19.
https://www.theatlantic.com/health/archive/2021/06/novavax-now-best-covid-19-vaccine/619276/
(valid points in that write up, but too much of a hard sell, and not sure why, for Novavax, though I think that technology is good too)
If we didn't have a narcissistic buffoon and crass populist like Trump, we would presumably have a centrist technocrat like Macron (sort of like Clinton), or a cultured conservative like Johnson (sort of like Romney), or a techno-populist like Conte (maybe like Yang?), or some other recognizable political type. None of them produced any noticeable good result.
I liked this long interview at 80,000 hours: https://80000hours.org/podcast/episodes/andy-weber-rendering-bioweapons-obsolete/
A Summary:
He thinks there is an overwhelming case to increase our investment in two new technologies that could dramatically reduce the risk of bioweapons, and end natural pandemics in the process: mass genetic sequencing and mRNA vaccines.
First, advances in mass genetic sequencing technology allow direct, real-time analysis of DNA or RNA fragments collected from all over the human environment. You cast a wide net, and if you start seeing DNA sequences that you don’t recognise spreading through the population — that can set off an alarm.
Andy notes that while the necessary desktop sequencers may be expensive enough that they’re only in hospitals today, they’re rapidly getting smaller, cheaper, and easier to use. In fact DNA sequencing has recently experienced the most dramatic cost decrease of any technology, declining by a factor of 10,000 since 2007. It’s only a matter of time before they’re cheap enough to put in every home.
In the world Andy envisions, each morning before you brush your teeth you also breathe into a tube. Your sequencer can tell you if you have any of 300 known pathogens, while simultaneously scanning for any unknown viruses. It’s hooked up to your WiFi and reports into a public health surveillance system, which can check to see whether any novel DNA sequences are being passed from person to person. New contagious diseases can be detected and investigated within days — long before they run out of control.
The second major breakthrough comes from mRNA vaccines, which are today being used to end the COVID pandemic. The wonder of mRNA vaccines is that they can instruct our cells to make any random protein we choose and trigger a protective immune response from the body.
Until now it has taken a long time to invent and test any new vaccine, and there was then a laborious process of scaling up the equipment necessary to manufacture it. That leaves a new disease or bioweapon months or years to wreak havoc.
But using the sequencing technology above, we can quickly get the genetic codes that correspond to the surface proteins of any new pathogen, and switch them into the mRNA vaccines we’re already making. Inventing a new vaccine would become less like manufacturing a new iPhone and more like printing a new book — you use the same printing press and just change the words.
So long as we maintained enough capacity to manufacture and deliver mRNA vaccines, a whole country could in principle be vaccinated against a new disease in months.
Nothing Orwellian about that …. But then again a non-trivial number of people seem to be willing to exercise in front of the viewscreen, er The Mirror and its competitors…
It would be great if mRNA vaccines worked that well. I linked to an article in The Atlantic in a reply to a post above. It pointed out that most of the mRNA candidate vaccines didn't make to clinical trials, and one (some?) had poor efficacy in fighting Covid-19.
And it wasn't just the Trump administration that failed, wingnut state governments everywhere have been massively intransigent about even the most trivial public health measures.
Social conservatives are corrupt in a genetic way that is obviously a medical issue.
It's pretty clear we'd probably do somewhat better: I believe that the FDA would approve vaccines months earlier, since the basic platform for mRNA vaccines has been established to be safe.
But we failed miserably to establish any plans during the first lockdown to actually do contact tracing and isolation, and without that, we'd have essentially the same problems as we did with Covid-19 until there is a vaccine.
So, maybe 200-300K deaths instead of 600K. Maybe a bit fewer still because the president is no longer actively trying to screw things up.
Hopefully vaccine approval will be slower as the speed of this one was primarily based on the out of control spread last fall.
It mostly depends on when the next virus happens. Any virus in the next five years is likely going to be treated as if it's covid. If it's 30 years, institutional memory will be lost so we'll be dependent on scientific advances, not better management:
But some possibilities:
Maybe CDC would apply KISS when they develop a test for the virus.
We'd be more open to aerosol transmission and worry less about fomites.
We might follow Britain and delay the second dose of a vaccine in order to maximize initial coverage.
The EU might follow the US and throw money at the vaccine makers.
Maybe we'd see more global coordination on vaccine development and distribution? Not hopeful on that.
Likely most vaccines would be mRNA.
Atlantic looked at this today.
https://www.theatlantic.com/politics/archive/2021/06/are-we-ready-another-pandemic/619285/
1. Increase public health capacity. A steady increase in funding to hire public health workers.
2. Testing reforms: allow tests based on gene sequence not just live, have testing regimes for sewage in place and coordinate testing anong the various labs, public/private/academic. This is very much a public health guys have to concretely do better, not a resources thing.
3. Replenish and rotate out national stockpile of PPE and create an office to take on counterfeits.
4. Paid leave so people can quarantine
5. Pass laws giving federal health authorities more power to enforce a floor on health restrictions on ignorant states
6. Improve the health of the US population
Of these things, most of these are things the admin has to do not public health authorities. But they are what the experts the Atlantic talked to think is the key changes that need to be made
#3
Paper masks are easy to re-sanitize with ethylene dioxide. My son did some work at a Texass plant that used it to sanitize bandages in sealed packages. He said the workers there Never caught a cold.
Stop the silly waste of materials in hospitals by not putting pull by dates on sealed bottles of saline solution.
Hospitals used to have their own facilities to clean their materials.
The article reference is to the masks expiring not sanitation.
In fact the masks themselves don't go bad but the elastic ear loops and metal nose pieces DO making it harder to impossible to achieve a proper fit. Poor fit is why they'd need to be rotated out.
1) CDC should strive for a single message from only one person or PR department. And not change that message on a daily basis. It only confuses the public.
2) Fauci should not be a messenger. He's bad at it and already has a poor reputation because *when the means of COVID transmission were largely unknown*, he advocated hand washing but not mask wearing (March '20). If you don't know the means, then you should advocate all possible mitigation approaches - but he didn't want the public to go out and hoard masks, to the detriment of healthcare workers. He didn't want to tell the public the real reason he was discouraging mask wearing, so he told them it wouldn't help.
Infectious diseases are hard to stop. Many Democratic Govs didn't follow science either with their excessive lockdowns and restrictions, which in the summer season, made little sense. They tried to act like strong men, but came off like wimpy boobs, a problem Democrats have had since they let the Republican McGovern take the nomination. This actually weakens your message.
The Federal Government should have run the show totally.
Sure, Bro. Or is that Vlad?
Washington state says your analysis is moronic. Much like all your posts.
Washington State says my evidence is right.
How does someone become as stupid as you?
Very simple
If a Democrat is in the White House,
we could do A LOT by following the Obama provided pandemic playbook.
The lives saved would be several 100k.
Easy peasy.
I would hope that if Covid happened again in 20 years the CDC would:
1) have enough PPE stored away and a good plan for disseminating it, so they can encourage masks right away
2) be able to get approval for vaccine challenge trials (which can massively speed them up, leading to faster approval)
3) have clear guidance for nursing homes that actually slows spread, and enough power to make the needed changes
The thing is, if this happens again in 10 or 20 years, most of us will respond heavily based on our experience of this pandemic. That will likely result in a lot of people masking up immediately, while simultaneously causing a large fraction of others to fight any and all public health measures as hard as they can. The next pandemic could be extremely regional in its path of destruction.
No more forced closings or pretend “lockdowns”. The purpose of these was to prevent overwhelming hospitals and not necessarily anything else. I did my part and stayed home. My employer did their part too. But it was silly to force business closures. It didn’t work. If it did, there would never have been that awful winter surge which killed my own mother.
Let the disease run wild next time. It’s not worth trying to contain. It’s just not.
My mother died in a nursing home in December 2020 which had been locked down since March 2020. It just didn’t work.
Yet another Bro I blocked over on MJ. For, as you can say, very good and very obvious reasons.
Apparently you want millions to keep your mother company.
Considering millions would join his mother no matter what, your post doesn't make much sense.
The only lockdown that matters is a Federal Lockdown and that is for hollywood moves like Contagion.
Another COVIDish pandemic? Do what worked for this one. All the western countries screwed up, S. Korea, Vietnam, other E. Asian countries had amazing success. Do what they did (serious contact tracing plus mandatory government-supplied quarantine & isolation).
How many lives would it have saved? More than half a million. Check the stats. They crushed it.
The right answer but not something that could occur in the US. Requires pretty much the entire population to buy in.
Well, yes. We know the answer but supposedly aren't willing to do it. Kevin's question is strange,l he asks what we can do and shrugs, figuring there isn't much we can do. The answer to him and the answer to everyone is to stop shrugging and promote what has been shown to work.
I would be a lot happier if that is the approach he took: We know what to do, let's stop pretending we don't.
The unstated (in Kevin's case) and explicit (in your case) contention that politically or culturally we can't do the right thing might be true (we don't know for sure because we didn't try).
Fatalism isn't very effective, it is usually a bad plan. Who knows what would happen if the conversation instead took the form of 'we know what works, let's do it'. A year ago we didn't know how successful the Asian approach would be, now we do.
All year I have been frustrated by Kevin's graphs with all Western countries. A lot of people don't know just how vastly better some countries did, why hide it?
Agree.
Another thing that the successful countries did was close their borders early on, giving them time to build up their testing and tracing and quarantine and isolation capacity before things were already out of control. And it needs to be pretty much a total closure--by the time we halted travel from China, the virus was already spreading in Washington state. We were lucky with that part and we pretty much contained it at the time. Meanwhile, during that same time period, and even after we closed off travel from China, New York City was being heavily seeded by travelers arriving from Europe--where the pandemic wasn't yet really recognized. Once a highly-lethal respiratory virus is identified anywhere in the world, all international travel should come to a halt until a good response is in place.
The evidence seems to indicate that activities done in areas of adequate ventilation have a very low risk.
My hope is that if COVID-like event were to be repeated, that outdoor activities would be encouraged. If BLM protests were COVID-safe, I would think that we could host outdoor concerts, etc.
Humans are social animals; encourage them to congregate outdoors rather than imposing a lockdown mentality.
No one said BLM were safe. Just that the people involved minimized risk by have universal masking and good spacing.
I just said that BLM were safe and I am some one. I am not alone.
https://news.northeastern.edu/2020/08/11/racial-justice-protests-were-not-a-major-cause-of-covid-19-infection-surges-new-national-study-finds/
Outdoors events are *not* safe when they involved large numbers of people crowding together (even if they are wearing masks). Most outdoor events normally have people spread out, social distancing without a mandate in a sense. But when you cram people right next to each other, as typically happens at concerts, you disrupt the natural ventilation that lends relative safety to the outdoors.
More states would hopefully react as well as DeWine did in Ohio, i.e. quicker to pull he trigger on lockdowns. The politicians would pay more attention to the CDC and be on top of the testing disaster. These two alone would cut down deaths by half. There is no reason that the US couldn't have as good a result as Canada.
I think the federal government might try taking the approach that Singapore, New Zealand and other states have taken and enforce quarantine upon entry in conjunction with lockdowns. That's one thing the Trump Administration didn't really do ever - though if the virus arises domestically, we'll probably still be just about as FUBAR as we were this go-round.
For the CDC and FDA:
1. CDC: Don't futz around for a couple of months waiting to determine whether masks prevent the spread of a particular virus. Start with assumption that they do. And don't get all tangled up on whether masks have to be N95 quality or not. The SF Bay Area proved that when we started our lockdown at the beginning of March 2020 that our homemade cloth masks did a pretty good job of inhibiting the spread of the virus. Masks are a cheap and easy prophylactic measure. Maybe the next pandemic won't be spread by saliva aerosols, but there's no harm wearing them until you know.
2. FDA: Don't wait 3 weeks to round of the committee to approve the EUA for a vaccine! Dr. Marty Makary from Johns Hopkins pointed out, that for a EUA, the committee receives two reports from the vaccine manufacturers—data on efficacy of the vaccine and data on the potential side effects of the vaccine. Each report is about a hundred pages. The data is presented in an easy to digest form. The committee could have read the reports in a day and held their hearing the following day. But in the case of Pfizer and Moderna, they waited 3 weeks! People were dying an average rate of 10,000/day while the committee was sitting their asses. That's about 210,000 who died in those three weeks. If anyone wants links I'll provide them.
3. CDC: Come up standardized methodology for case and death tracking—and mandate that state and counties use that system. If you can't mandate that states use it, get Congress and the President to make it law. Valuable time was lost at the beginning of this epidemic trying to integrate incompatible reporting systems. And some states are still fudging their numbers for political purposes.
News Organizations:
4. If you have a reporter who covers science and health, can't you make sure they have a masters degree (at least) in the subject matter? Also, take a careful look at the "expert" who you're interviewing. For instance, a military historian from the Hoover Institute, even though he has an appointment at Stanford, is NOT an expert in herd immunity. Or, just because an immunologist at an emergency room at second tier hospital tells you that the suicide rate is going up because of the lockdown, maybe just maybe you should check their numbers with independent sources before you publish said MD's claim? And just because a noted public health MD says he doesn't think masks work, maybe get a second opinion from the scientists who were diligently testing the effectiveness of masks?
Politicians:
5. You're very likely going to encounter a lot of differing opinions from you expert advisors. Indeed, even 18 months into this pandemic, there are still significant issues were the experts still haven't come to any consensus. But if you've got one expert saying "assume the worst" and another expert saying "don nothing", you probably should assume the worst and implement the appropriate policies to deal with that worst case scenario. You may end of with egg on your face for overreacting, but that's better than letting people die if you underreacted.
FEMA and State Emergency Management Orgs:
6. Start stockpiling masks, PPEs, portable hospital units now! Don't try to stock up on this equipment when the epidemic is spiraling out of control (when everyone else is competing for the allocations). Think ahead. Plan ahead.
Spot on!
You're telling me that if a "crazy old codger with a cane shows up" and hands you a book that'll tell you the "outcome of every sporting event 'til the end of the century", you wouldn't somehow end up filthy rich?
I mean c'mon, the idiot tried to open up the country by Easter 2020, contributing to the second wave. Then, even after running into his own problems, he still downplayed the threat, contributing to the third wave.
Delayed Response
Policy
Hello, you might remember that in late January and early February, I was sounding the alarm that the US and everyone else was downplaying the threat of what was going on in Wuhan. If you left it up to me, I would have acted sooner to (a) speak to Congress, my cabinet members, and governors to prepare for a global pandemic, then to (b) speak directly to the American public that we need to start preparing for the possibility of a global pandemic.
Effect
The sooner we ran into problems from a resource standpoint, the sooner we could resolve them, even if you didn't know which resources would be constrained. You didn't need to know that a global pandemic was coming; you merely needed to be scared to hell that a global pandemic might be coming -- you know, like me. But, knowing that a global pandemic was coming, you could have produced those supply constraints ahead of the epi curve, which would have allowed you to resolve them sooner in the pandemic. Lives saved = ~20-40K, on the basis of flattening much of the excess deaths in the first wave.
Politicization
Policy Knowing now that in a pandemic public health would become extremely politicized, I would coordinate with Republican leaders to find suitable people (both Democrats and Republicans) to appoint to newly created czar positions: Vaccination Czar, PPE Czar, Public Health Czar, Economic Czar, and Pandemic Response Czar. Their function would be to coordinate different parts of the federal and state gov'ts, to streamline and problem-solve. The Pandemic Response Czar would be the primary coordinator and would function as the go-between of the group and the Executive. While similar to Pence's COVID group, this would be a bipartisan group and would help depoliticize the pandemic.
Effect
Though there will always be a large group of far-right extremists (think Gosar, Hawley, etc.), the mainstream will find it much more palatable to have a policy implemented by a Democratic president, if the team were bipartisan and built through coordination with Republican leaders. They'd still get lots of things wrong, but at least the politicization of the pandemic would be lessened, and the messaging would get through the ears of people who'd been driven by Trump to close them to his own government. Lives saved = 1/3rd of what we've lost.
Testing
PolicyKnowing now that the CDC would initially fuck up its product (but still not knowing who to blame for the fuckery), I would have used the DPA to trigger, early on, private partners to speed up commercial testing capacity and commercially-available products. Knowing the FDA approval red tape, I would have also directed the FDA to streamline all processes for a pandemic.
EffectIt's a cumulative knowledge issue, here. Absent widespread testing, we had extremely limited knowledge for a month. The sooner and greater amount of cumulative knowledge we had, the faster we could respond by directing resources and changing policy.
PPE, Ventilators, and the DPA
PolicyRelated to acting sooner *and* knowing that PPE would become the very first and most critical supply constraint at the start, I would have immediately moved in late January to trigger the DPA and pour $1B into domestic manufacturing of all sorts of PPE and ventilators. I would have directed a separate policy designed to support that domestic expansion of PPE by a separate policy to manufacture and provide (free) 5 N95-level masks for every American by the end of March. Knowing now exactly how many pieces of PPE and ventilators were needed at peak, I would have directed contracts to meet those targets, knowing that those targets would be effectively flattened by the effects of the other policies, thus allowing me to redistribute the excess to Americans for free.
Effect
Knowing now that N95 masks were (a) constrained at the start and remain constrained and (b) they were probably the most effective tool in the public health toolset to address COVID-19, an over abundance of masks that were free to all Americans would have saved a lot of lives. Lives saved = ~100-200K.
Vaccinations
PolicyI didn't even need to know back then what we know now. To refresh the memories of people about what I said over one year ago, I would have (a) invested way more money into many more groups trying to produce a vaccine, knowing that much of it would have gone to waste, (b) invested billions into manufacturing capacity of the different types of vaccines, from production capacity to the precursors, by triggering the DPA, and (c) had hundreds of millions of doses ready of each of the leading candidates, even if they proved ineffective and wasted, on the first day that the FDA approved the vaccines.
Effect
Unknowable at this point, as we're still in a global pandemic, but assuredly, having millions of doses available from multiple vaccines back in December would have made a dent in the third and fourth waves. But so far, I think we could have saved ~10-50K lives, easily.
yep
Next time: First, we know that mrna vaccines work pretty well. So we will be more confident developing and testing them. And a lot of the infrastructure to manufacture these vaccines is now in place.
Operation warp speed 2 will emphasize:
* The initial reaction will be faster. Next time, we will think we are being hit by a covid-19-like virus and act like it instead of expecting sars/nile/swine flu and not doing much.
* License more testing faster. A bunch of people knew how to test for covid early on, but weren't allowed to.
* test a protocol for one dose early and a second dose about 6 months later;
* plan on manufacturing enough doses to fully vaccinate 7 billion people in a year. (We won't get everyone; that's just a fact of life.)
When dealing with exponential growth, small improvements lead to much better outcomes.