In a tweet thread follow-up to his big COVID-19 piece in New York yesterday, David Wallace-Wells comments on something that ought to be obvious to everyone by now:
But the farther along we've gotten on the pandemic timeline, the clearer it's seemed that America is not nearly the outlier Americans — especially liberal Americans horrified by Trump — have believed it was.
— David Wallace-Wells (@dwallacewells) March 16, 2021
A year on, with vaccines mercifully delivering us into a pandemic endgame, our problems actually responding to the virus seem much bigger, more common and more complicated than Trump. Our journalism should begin to reflect that. (x/x) https://t.co/dcTq3G9euF
— David Wallace-Wells (@dwallacewells) March 16, 2021
A few weeks ago I wrote a post arguing that our response to COVID-19 had actually been pretty good. Unfortunately, I did a lousy job of explaining exactly what I meant by that, and my follow-up post a few days later was only a little better. David's tweet gives me an excuse to give it another try, so here I go.
To put it plainly, I think his first tweet is absolutely right but his second tweet is dead wrong. When I say that our response was "pretty good," what I mean is that I think the basic public health infrastructure of the US responded fairly well. They made mistakes, but for the most part these mistakes were in the very early going when we were truly in the dark about the extent and seriousness of the coronavirus. What's more, it's genuinely unclear whether those mistakes had much of a long-term effect. Does anyone think, for example, that if the CDC had developed a reliable test a few weeks earlier than it did that our mortality spike in December would have been lower? Or that our cumulative death rate would be much different than it is today? I doubt it.
We have a tendency to go nuts over every little thing these days. Our vaccine rollout, for example, has been spectacular, but every day there are multiple stories about how some aspect or another has been mishandled. This kind of constant micro-criticism is understandable when you're dealing with life and death, but that doesn't make it true in any useful sense. The big picture is plain: Generally speaking, we've done really well both in carrying out our plan (healthcare workers first, followed by the elderly) and in our overall speed of approval and delivery (one of the best in the world).
This really and truly does leave us with only one thing that potentially had a large and long-term impact on our response to the virus: Donald Trump. He's the one who initially downplayed it; who touted a wide range of quack cures; who made mask-wearing into a culture war battle; and who insisted on opening up the economy before we were ready—which kept our mortality rate high during the summer while other countries were pushing it down nearly to zero. Trump's malign influence spread to nearly every red-state governor, most of the Republican caucus in Congress, and of course to Fox News. This is truly the big difference between the US and the rest of the West, and the reason that our mortality rate was eventually one of the worst—though not the absolute worst—among our peer countries. Under any other president, things would have been very different.
As for the overall difference in mortality between Asia and the West, the most popular explanation is cultural: following the SARS outbreak of 2003, every country in east Asia became hypersensitive to any viral outbreak centered in China. This wasn't because SARS ended up killing all that many people. It's because China lied so egregiously about what was going on that nobody trusted them anymore. In the aftermath of that, countries in the region got serious about responding instantly to a possible pandemic at practically the first sign that something was happening in China.
That didn't happen in the West, which suffered virtually no SARS fatalities outside of Canada. In fact, it had just the opposite effect: it was widely viewed as just another false alarm. This attitude carried over to 2020, which is why western countries reacted more slowly and more loosely than countries in the vicinity of China.
Needless to say, those days are long gone. Every country in the world is now on high alert, and the mistakes we made in the early days of COVID-19 are unlikely to be repeated thanks to the fact that our public health infrastructure is, in fact, pretty good. The only thing that remains an open question is whether the residents of western countries will put up with the kind of strict lockdowns that have apparently been the key to success in Asia. My personal feeling is that I doubt it. For better or worse, it's just not something we're willing to endure even when the alternative is a higher chance of death.
Shirley it was Trump wot done it! Just like it was Comey wot done it, or the Russians or Facebook or ...
Considering Trump moves money for the Russian mob, which does business with the Oligarchs, Trump can be blamed for many things
None untrue, especially given the ODNI report released today about Russian propaganda.
Shirley knows that most things have multiple, generally many, explanations. It's rarely the one big thing.
Again, stringent lockdowns were never enforced, economically impossible in truth. Especially since the elderly, elderly were the only one dying in large numbers. 1957esque it was, with a much slower vaccine rollout.
I would have ignored it and started removing State officials and private sector actors who pushed lockdowns in the spring of 20. Pushed the medical system to create shelters for the sick while working on a vaccine to be mandatory for anybody 65+. The disease simply should have gone through like any normal infectious disease without the confusion. Much less fallout.
So you would have killed millions. Got it.
"Much less fallout."
Stunning.
Kevin, at one level you're right. At another, you're wrong. Is the choice between "eradicate the bug" or "live with the bug" a public health decision? Or is it political?
I remember Tom Ricks wrote a book about generals, and how badly-served the US has been by generals. He wrote that they say yes to wars, without explaining or having any strategy for actually achieving national goals. He gives many examples, and of course the Iraq War and Af-Pak are great examples. The point is, that the military is supposed to say "no sir, we cannot achieve your stated national security goals, and you can fire me, but that won't change this fact". Notice that that's precisely what Eric Shinseki did, and he got fired for it. But then his replacements toed the line.
And in this sense, the military *as an institution* failed. B/c that's what the military is for: to translate national security goals, into coherent plans to achieve them, and then go execute to deliver on those goals.
In that same sense the public health infrastructure failed. Now, you can say [and probably rightly] that given the criminal bosses to whom they reported, they did the best they could. But as Wells points out, this failure to actually achieve the right public health goals, was common to the entire Eurosphere (minus AU/NZ). So it's not just about Trump. We failed as societies to achieve these public health goals.
Public health is more then federal officials.
This discussion on pandemic response covers public health infrastructure and political leadership, but the big thing is social behavior, which public officials can't very well control. And it seems to be nearly the same in every state.
I really agree with this post. I wish we had the conservatism of China and other countries that experienced SARS, etc. so that we would have reacted better.
Trump was so bad in so many ways but if he acted as Biden is with promoting masking and vaccination it would have been a decent effort given our culture.
Trump needs to be recorded as the absolute worst president ever.
Rather than China, I like to cite South Korea. They're a democracy, and SK public health officials were interviewed early-on about why they chose such aggressive lockdowns, mandatory quarantines for possibly-infected (with support), and super-aggressive contact-tracing. The one guy I remember, said, basically:
South Korea is a democracy; the population will not put up with long-term restrictions, so we had to come up with a strategy that would allow the population to live normal lives, while dealing with this epidemic. This is what led us to the strategy of eradication: because to not eradicate, was to condemn us to either mass death and collapse of our public health system, or on-again/off-again lockdowns that would stretch for months and months.
We could have emulated South Korea, but, sure, with Trump, it wasn't going to happen. The real question is why the EU did not emulate South Korea. There's a few thousand PhD theses in that question.
& that's why the KBO had an almost normal 2020 season, as opposed to MLB's 60 game sprint.
(Still have Shane Bieber Fever, though.)
I agree with this post completely. The lesson I have learnt is quick decisive action is critical. I disagree with Kevin because the shutdowns in Asia were less severe than those in Western Europe and North America. They were started much sooner and were much better focused on eradication so the virus never got established. We focused of cure rather than prevention and thought of vaccines as the preferred prevention route. I think than was the fundimental issue with the Western approach.
1918 flu 675,000 Americans estimated to have died. 2020 flu approaching 600,000 dead and who knows how many more to come.
In 1918 they had no clue what a virus was and only a vague notion of prevention and no way to treat. 2020 we have our science and therapeutics undermined by a clownish leader, ridiculous notions of "freedom" and treatment (hydroxychloroquin, etc) by rumor and anecdote.
I'd say we did poorly.
1.9 million died adjusted for population, 1.6 20-40 age group. It will always be the goat of modern pandemics because of the age factor.
Viruses had been discovered before the turn of the century. They knew they existed and needed living cells to propagate. The first isolated and examines was the bacteriophage in 1915, but they had show several other diseases to be viral in nature in the decades prior.
So they knew was a virus was.
You're right of course should have read barely knew.
That chart is not very persuasive. Belgium, the UK, and Italy have (or had) even worse leaders than Trump? Give some examples of the really bad things they did. And France, Switzerland, and Germany have better leaders, who would have saved tens of thousands of lives had they been in charge of the US? Again, give some examples. Be specific: what did Merkel and Macron do, in particular, that Johnson and Conte did not do, and that Trump did medium?
...promote masks and social distancing. Next?
"The only thing that remains an open question is whether the residents of western countries will put up with the kind of strict lockdowns that have apparently been the key to success in Asia. My personal feeling is that I doubt it.": we need only look at the experience of both Australia and New Zealand to see the answer to this question. While the oceans help in other ways, they don't affect that aspect, and it worked just fine in two heavily urbanized western liberal democracies.
You're absolutely right - although Australians and New Zealanders (like Canadians) are generally a very compliant lot. Americans and Brits are much less so. But it did help that we could see an end game. Being a remote island nation we have been able to strictly control our borders and keep the virus out. I'm not sure how well we would have accepted those rules if there was little prospect of eradication.
I think a big part of the problem early on was the early failure to acknowledge the efficacy of masking and the failure to have enough masks available. Those things, along with Trump and his whacked out fans trying to pretend that the danger was overblown made things much worse than they should have been.
Asian countries are much less mask averse and they had them available for everyone. And they didn’t have government officials their efficacy.
This is right -- the Trump approach from the get-go boiled down to three elements of either magical thinking or straight-up bullshit that doomed us to fight a rearguard action against the virus for the past year:
1. a half-assed "travel ban" on air travel from China that was more about political preening than public health strategy (while sitting back for weeks while thousands streamed in from Europe and elsewhere with little or no screening.)
2. refusing to endorse strict lockdowns, maskwearing and distancing and predicting that it would all just magically "go away" somehow if we did nothing
3. Hoarding PPE for profit and political leverage rather than doing everything humanly possible to produce testing kits and PPE for frontline workers when it might have actually made a difference. Instead Kushner and Trump focused on the grift and making blue state governors look bad instead of tackling the problem -- a massive pandemic that would kill hundreds of thousands of Americans. Of course most of the victims weren't the "right kind" of American, so they didn't give a shit.
These ghouls belong in the dock at a Nuremberg-style trial, not yukking it up on some golf course.
Exactly. The magical thinking and avoidance of basic methods to deal with spreading infectious disease doomed us to see so many die.
This post is mere revisionist history and the linked "article" isn't much better than a "we don't know". Everytime it says some country did well or poorly it admits it doesn't have an explenation for why and is just guessing.
Eitherway, arguing we have had a "good" or even mediocre COVID response is like arguing we did well during the Vietnam War. Take the defeat, admit the loss and learn.
How are we supposed to learn if you find the lesson is 'dunno'?
The only way common sense actions like masks and lockdowns would have been accepted across the board would have been if we had had a sensible Republican president. If this had happened under HRC or Biden the Rs probably would have politicized things even more. If we'd had a semi-reasonable Republican in the White House like Romney or even GWB I think everyone would have fallen into line. But alas!
The Democrats support good governance, the Republican decry any governance. A semi-reasonable Republican proposing reasonable action would be supported by the Democrats. Any action proposed by a Democrat must be opposed by the Republicans at all cost.
Yes. This.
"Does anyone think, for example, that if the CDC had developed a reliable test a few weeks earlier than it did that our mortality spike in December would have been lower? Or that our cumulative death rate would be much different than it is today? "
Well, given that once we did have a workable test available we more or less didn't even bother with testing, evidently no. But it will not do to look at each of the long chain of mistakes that led to the catastrophic failure of our overall public health response and see that each alone was understandable or of small impact. That is how complex systems fail: by the simultaneous (or sequential) failure of multiple components. The catastrophic failure of a single component seldom brings a system down the way ours was taken down by SARS-CoV2.
Every single aspect of our response was wrong. Although we had a couple of months notice that this was coming our way, we did nothing until it was already well entrenched on our shores. We let people continue to import the virus from all over the world, especially from Europe long after it was clear that this was insanely dangerous. Clearly we learned the wrong lesson from SARS: we had been shot at, and missed by a hair (Canada had a small outbreak, successfully contained). That is like somebody coming to my door and shooting at me, missing, and me concluding when he returns, armed again, the next week, that he is not a threat.
We never mounted a serious test and trace program anywhere in the US. We never enforced isolation of the infected or quarantine of the exposed. Our lockdowns were begun too late, contained too many exceptions that had no real relationship to health reasons, and ended too soon. We were more worried about getting bars and restaurants open again than schools. We turned masking into the latest round of the culture wars.
The only really good thing we did was rapidly ramp up development and production of vaccines. That was a stroke of genius that will salvage us and benefit the entire world. But when you fail every assignment and interim exam, getting an A on the final isn't much to crow about.
Look, it could have been worse. I suppose we could have done nothing at all, and had a death tool of a million or two. By that standard, I suppose we can say we have something to show for our meager, pitiful efforts. But that is not the standard we should hold ourselves to. Nor is Western Europe--they, too, colossally failed in this. Some did a bit better than us, some a bit worse. But these are just minor, probably random, distinctions among levels of extreme failure.
Our mortality rates are over 1,000 times higher than those of the successful countries of Asia. They are the standard to which we should be comparing ourselves. There is no good reason we cannot do what they did. There are a million excuses, but no good reasons. They took it seriously as soon as they could see it coming, they responded quickly and thoroughly, they were able to effectively douse the big flames and stomp out the small subsequent flareups, and in the process they did far less damage to their societies and economies than we did and saved an enormous number of lives.
Let us never forget who the competent countries of the world have proven to be. And let us resolve never to let this happen here again.
+1
Mostly +1. I'm not convinced that we "rapidly ramp[ed] up development and production of vaccines". We advertised this as "operation warp speed" but we weren't able to construct 10 manufacturing lines in parallel over the 9 months we were testing vaccines?
Also, +1, except... every vaccine has its own unique manufacturing line. So we built dozens, but only a few panned out. We couldn't have built ten times more, there wasn't the resources.
We could have planned our roll-out groups and identified people and wait-lists better, tho.
Comparing the u.s. to other counties is not very useful. Whatever happened on other countries for whatever reason, the only question that matters: would the u.s. have done better without trump? It’s not “would the u.s. have done better than the u.k. Without trump?.” Or whatever. It’s “would the u.s. Have done better with a different president?” That question and only that question is the only one that matters. And the answer is an emphatic YES! Even almost any other Republican would have saved lives.
Damn straight! We're Murcans, dammit. We don't learn from other countries, cuz they're full of furriners. We do it ourselves, cuz we're rugged individualists.
+1
It's time to retire the phrase "to avoid something like the plague" because we've learned this year that people don't actually avoid the plague.
This is trite, but unfortunately true.
There you go again, praising with faint damns. While I had left SE Asia before the serious lockdown began, I don't think Thailand was substantially different than here, although we had already developed a working test for them, and they were not trying to kill off their (liberal) big cities the way Herr Trump and his mininions were here. They were also well aware of it by the end of January when I first got to Thailand and running temperature checks at the airport as well as screening for COVID-19. Even the big shopping centers were screening by temperature and hand sanitizer was everywhere. Coming back to Minneapolis on March 6th was like entering another century where COVID-19 did not exist. Thailand too touted drugs that did not work, but at least they were experimenting with HIV medications and other drugs with known efficacy on some viruses.
Covid-27 hits our shores. It behaves exactly as Covid-19, except it kills 60% of those infected, and it kills at equal rates among all ages.
What's the plan? Do e have one?
Americans still refuse to stay home? Or is there a run on all survival supplies, including duct tape to seal up home windows for a month?
Yes, this is my deepest concern from covid19. Looking at the general public reaction across the country, I find it very hard to believe that even something as deadly as your putative covid27 would change that reaction very much.
It is true that an awful lot of people did do some stuff because of covid19. It's also true that we did nowhere near enough as a population, and none of the reasons for that seem to have been addressed or changed.
Add me to the dissenters.
KD: "As for the overall difference in mortality between Asia and the West, the most popular explanation is cultural.... every country in east Asia became hypersensitive ... because China lied so egregiously ... nobody trusted them ... countries in the region got serious about responding instantly....
Oh, for crying out loud, hypersensitivity, suspiciouns, getting serious = no! These countries had specific plans and preparations in the wake of SARS, which had an order-of-magnitude higher case fatality rate than Covid-19. We definitely need to learn the lessons they learned, stockpile and secure sources for needed equipment and supplies, train public-health personnel in the the appropriate skills and techniques, etc. Benchmarking (identifying and adopting the practices of best performers) was a management fad that actually made sense.
I don't believe that most of the highly successful countries imposed widespread, prolonged lockdowns. Instead, by acting swiftly with localized restrictions when cases were few, they kept outbreaks limited in place and time. They used screening and testing of every arriving traveler; followed by mandated, monitored isolation or quarantine as indicated. They had the human and material infrastructure to track and trace effectively, and again, applied it before the number of cases could overwhelm their capabilities. We need to stand up these and other response systems, whatever proves to have been effective.
+1
This sounds right.
Here’s an interesting story about the lessons learned from The Atlantic’s COVID Tracking Project.
"Why the Pandemic Experts Failed"
https://www.theatlantic.com/science/archive/2021/03/americas-coronavirus-catastrophe-began-with-data/618287/
In a nutshell, the US did a really lousy job collecting data about the pandemic:
"Yet the federal pandemic response was built on the assumption that those data were fundamentally sound, and that they could be fed into highly tuned epidemiological models that could guide the response. Inside the government, the lack of data led to a sputtering response. “What CDC is not accounting for is that we have been flying blind for weeks with essentially no [testing],” Carter Mecher, a medical adviser at the Department of Veterans Affairs, wrote to an email list of federal officials on March 13. “The difference between models and real life is that with models we can set the parameters as if they are known. In real life, these parameters are as clear as mud.”
"We now know that early case counts reflected only a small portion of the true number of cases. They were probably 10 or even 20 times too small, according to later academic studies. The government missed the initial explosion of COVID-19 cases because, despite its many plans to analyze data, it assumed that data would simply materialize."
Yeah, I read that the yesterday. It says the opposite of Drum, lol.
I skimmed the article. I love wallowing in data as much as the next research worker, but more data would not have solved the PPE shortage, or the poor infection-control practices in congregate-living facilities, or the underfunding of public health programs, or the process failure that resulted in the first, flawed CDC test, or the lack of test materials and reagents, or any of a number of other problems that the last year has exposed. There are many, many lessons to be learned, and they span many issues and functions.
I've been reading articles about how the Covid Tracking Project and Johns Hopkins data collection got started. It mainly boils down to the fact that we had no reporting of the data, so those organizations (and others) went out to collect and digest that information on their own. The was a gross failure of our public health infrastructure--not to mention the testing debacle. This pandemic revealed our failings--big time. You may want to argue that that problem was there all along--but it was not really fixed under Trump once the pandemic started.
Your "not much of a difference" could easily translate to 200K fewer deaths and hospitals not running out of beds. It would still be bad, but not nearly as bad.
Except these are examples of 'public health infrastructure'. The feds are not the entirety of our public health infrastructure.
^^^Does anyone think, for example, that if the CDC had developed a reliable test a few weeks earlier than it did that our mortality spike in December would have been lower? Or that our cumulative death rate would be much different than it is today?^^^
Reliable testing kits alone? No. But as part of an overall competent response in the first few months? Very likely, yes.
What I mean is: if you look at the countries or regions -- New Zealand, Taiwan, China, South Korea, Australia, Nova Scotia -- that have done the best wrt covid, they've all squelched their respective outbreaks very early one. I can't think of a single country that has merely done a "semi" strong job of fighting the pandemic (in the early stages) that hasn't suffered serious episodes of deterioration (a spike in cases, that is) in the latter going (think Germany).
So, my sense is once the virus reaches a tripping point of endemicity, you're goose is cooked. You have to prevent this from ever happening.
Even if America had gotten a lot of other things right, an early lack of reliable testing supplies would have represented a very serious impediment to getting control of the pandemic.
Yes. The most successful countries acted swiftly on each case, and kept community spread to manageable handfuls of cases, dealt with by contact tracing, isolation and/or quarantine
"The only thing that remains an open question is whether the residents of western countries will put up with the kind of strict lockdowns that have apparently been the key to success in Asia."
Naw, dawg, that's not quite right.
When you talk about strict lockdowns, you're just talking about China. Nowhere else did they have that kind of strict lockdown at the front end. Japan, South Korea, and Taiwan didn't impose lockdowns. It wasn't about strict lockdowns; it was about masks.
MASKS
The leader of the US could have triggered the DPA early on to pour money into domestic mask -- and PPE in general -- production then just give it away to all Americans. Had he done that, we wouldn't have been stuck in isolation. Had he cared about "essential workers" including and specifically those in healthcare front lines, they would have had masks to protect themselves.
In all of those Asian countries I highlighted, they gave out free masks. Yes, you read that right, Taiwan, Japan, and South Korea gave out free masks.
What did we do? Americans were told that they were on their own. I wrote early on in the pandemic, that the US ought to produce masks and hand them out to everyone for free. This isn't that hard to figure out.
Okay, I oversimplified. Asian countries imposed temperature checks, too. Lots of places in Hawaii also imposed temperature checks.
Not sure their effectiveness, but it was one more layer they had that you wouldn't find in the mainland US.
Hmmm... The weather is different in hawaii compared to the mainland. And it's easier to isolate.
If masks is the answer, then we would expect to find negative excess mortality in Japan, South Korea, and Taiwan in March as the masks would reduce R0 for flu as well as reducing R0 for Covid. South Korea and Taiwan don't follow that pattern...
See: https://bityl.co/61YU
If disparate policies on lockdown have similar R0/low Influenza rates this year, what common trait do all these countries and the US have?
MASKS
South Korea did have lockdowns. Some were neighborhood scale, otherrs were limits on travel, and others were limits on dining or bars. They had then, they were enforced, and with vigorous case-tracking, they were short-lived.
New Zealand? Australia? I understand the point you're making, but this just isn't true at all.
> the reason that our mortality rate was eventually one of the worst
If you were talking about the economy, you would adjust for inflation. But here you don't want to adjust for age or tobacco consumption. Why is that?
The US uses less tobacco than these other countries?
Given that success or failure with covid is based mostly on deaths, and that deaths are highly concentrated among the elderly, perhaps we should focus more on differences in eldercare. Having employees with multiple jobs, little PPE, little infection control training for staff, moving residents between hospitals and nursing homes, and keeping sick residents in nursing homes were all contributing factors here.
I was trying to figure out what percentage of US nursing home residents died of covid, and I think it may be above 10%. In many states they account for half or more of deaths.
Wow. Impressive. This is totally wrong.
Cmon man (to coin a phrase), if our death rate is nearly three times higher than that of Canada, then we are an outlier. We're America!
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The reason the entire world's response has been much worse than it should have been can be tied to one factor: intellectual property law. Trump compounded the problem by negotiating away any rights the government would have had to the Moderna vaccine, including, allegedly, march in rights. The end result of "operation warp speed" is that there are billions of doses of vaccine that could have been produced, at lower prices, but won't be because profits are more important than human lives.