I've been wondering for a while what lessons we should take from the COVID pandemic. We've had three years to collect data, after all, and another pandemic is likely to come along someday.
Nobody with real expertise seems to have written about this, so I figure I'll take a crack at it. If nothing else, maybe we'll learn something just from all the different ways that people call me stupid.
Note that this is generic advice. Obviously it will change depending on the viral characteristics of the next pandemic.
Things we should be doing now
- Improving ventilation in interior spaces like schools, churches, and so forth.
- Installing far UV lamps in places where they'd be effective.
- Improving our emergency vaccine production ability.
If a pandemic occurs, things we should emphasize less
- Cleaning hands and surfaces. As far as I know, there were virtually no cases of COVID from touching a contaminated surface.
- Worrying about the outdoors. With a few isolated exceptions, it's mostly OK to go outside normally with or without a mask.
- Closing schools. The bulk of the evidence suggests that with proper safeguards it's safer to keep schools open than to close them.
Things we should do differently/more of
- MAGA crackpottery aside, masks work. But we should be stockpiling N95 masks and insisting on them right out of the gate if a new virus starts to spread.
- Superspreader events were a major cause of large scale spread, and there's no real way to address this except by shutting down indoor events where lots of people sit near each other. This includes movies, live theaters, sports events, and, I'm sorry to say, churches. The virus doesn't care why you're packed in together, and superspreader events hurt everyone, not just the people who attend them. Needless to say, these rules can be relaxed or made more specific as more becomes known about the new virus.
- Encourage outdoor seating at restaurants and, where possible, allow it to happen with a minimum of red tape.
- Do everything possible to approve and distribute home testing kits as soon as possible.
- Social distancing . . . I'm not sure about. What's the evidence for or against it in places like malls and supermarkets?
What else?
The public messaging should be a loud and clear WE DON'T KNOW. Because we don't know we are going to try a bunch of different stuff. Some of it may work and some of it won't work. Once we know more we will let you know the things that are working.
That would only say to social conservatives their hysteria and fantasy is the same thing as serious thought.
There are some things that "we" (ie science) appear to know that "we" (ie the public) do not, and which may be useful.
I'm specifically thinking of wearing masks outdoors. This superficially seems dumb because virus concentrations, blah blah. But throw in two facts:
- there is a part of the immune system that operates in your nose and that is extremely susceptible to low temperature.
https://hms.harvard.edu/news/why-upper-respiratory-infections-are-more-common-colder-temperatures
- masks keep your nose a lot warmer in winter
I've worn my mask outdoors throughout this winter and have not picked up my usual two or three winter colds (so we have iron-clad proof right there!) Generically I suspect that if society as a whole pivoted to wearing masks outdoors in winter (simply on the grounds of "keeps me warm, same reason I wear a hat") we'd be a lot better off, pandemic or not.
Improve the data collection systems. We seem to have relied on improvised systems created by universities, etc. on a volunteer basis, layered on top of a CDC system not designed to keep up with a pandemic. If the govt doesn't do it all, there should be a coordination mechanism and some advance design work
Perhaps the govt should d a systemic testing of sewage systems for viruses.
You could reinvent the wheel, or you could use the 69-page Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents that the Obama administration had prepared before it left office.
There's one important addition to that plan:
***NEVER ELECT ANOTHER REPUBLICAN PRESIDENT***
(or all your preparations will be ignored).
Plus 10.
Never elect another Republican president, or Congress.
+1 (for the bit in stars)
Echoing the comment about sewage testing. It's been the most reliable source of data on COVID, and we can put fund research and organizations now that will both provide data on COIVD and other diseases, and be ready to quickly scale up for the next pandemic.
Also the hygiene theater around disinfecting surfaces was overhyped, but handwashing is too generally useful to lump in with that.
Two main things: first: make a plan now that allows for uncertainty in the exact nature of the next pandemic and do it in consultation with a bi-partisan group of politicians (probably senators given the looniness of the house). The plan needs to consider various types of outbreaks and have a game plan for each. There certainly should be constantly refreshed stockpiles of things like masks, etc. on hand to cover the country. Second: have a communication plan in place and communication experts to work with the scientists and doctors to develop this communication plan…relying on scientists or a dopey president to try and explain something complicated was destined to fail. The communication needs to be simple and easy to follow.
Shut down Fox News. In fact that would be a good idea even if there was no new pandemic.
This is what I logged in to say.
Cram all the loonies into the former confederacy, save for Georgia.
And shut down Fox News, yes.
Fun side note. Tucker Carlson texts on Trump:
"He’s a demonic force, a destroyer."
"I hate him passionately."
Now he tells us.
The best way to prepare for the next pandemic is to overhaul the FDA. For details, refer to multiple posts criticizing the FDA on the blogs Marginal Revolution and on Don't Worry About The Vase. Also, listen to the podcast where Balaji trashes the FDA: the podcast is 'Moonshots and Mindsets', hosted by Peter Diamondis, EP #6 Abuses of the American Regulatory State w/ Balaji Srinivasan.
The FDA actually did pretty well. Marginal Revolution is for people who don't know the difference between a drug or vaccine candidate and a drug or vaccine. Early in the pandemic, the site was full of "We have a drug/vaccine. Tell the FDA to authorize it." well before anyone had a drug or vaccine. The site is run on a troll to play basis, so it's entertaining but don't take it too seriously.
Marginal Revolution is for people who like rightist propaganda but think that Fox News is a little too extreme.
Around here, mentioning Marginal Revolution as if they were remotely credible sources is the kiss of death to your reputation.
Based on this https://khn.org/news/article/over-half-of-states-have-rolled-back-public-health-powers-in-pandemic/, the first thing we should do is realized we're likely on our own.
Some of your recommendations need to be modified to be more general. For instance smallpox was/is communicable through surfaces and clothing and other cloth that has come into contact with an infected person. This was a fast Google search. but this is the type of thing that can vary by virus.
Why assume that children will be less susceptible, as in covid? If they aren't, keeping schools open would be disastrous - there would be few better ways to transmit a pandemic.
What is relevant in this respect for initial stages of an epidemic is not so much what happened in covid, but the overall susceptibility of children in historical epidemics. There should probably be more research into what types of epidemic are likely to affect different ages and how to identify them on this basis.
And even if children ARE less susceptible, we have to realize that children don't live on their own. They go home to parents and grandparents, they interact with adults in all kinds of settings.
It's almost as if some folks don't understand what "contagious" actually means.
Given our experiences of both SARS and COVID, we need to spend some time and money on improving safety for residents of nursing facilities. It is likely we'll have either a SARS or Flu pandemic in the next 20 years, and the elderly are sure to be at high risk again.
That means a) limiting the number of facilities that workers go to (higher pay! full time hours!), so it can't spread between facilities, b) better ventilation, c) more protective gear for workers and health professionals who visit facilities, and d) interim housing for patients released from hospitals so they don't go directly to the main nursing home population.
For schools, there will be massive pressure to close no matter what. But there will likely be daycare open for the children of health and public safety workers. We need close monitoring of what happens in those daycares to see if it is possible to open schools, and that data should be made public. It is ridiculous that thousands of American kids went to daycare throughout the pandemic, but the only info about school transmission we had was from foreign countries.
We also need a way to open up more housing to limit overcrowding in individual apartments and houses. Optional quarantine housing and care might be a good choice as well. Too many families struggled to stop spread within their own homes because they lived in overcrowded housing or had extremely vulnerable family members.
Many of the homeless may be better off continuing to live outside. Provide masks, mobile hand-washing stations, etc, but don't crowd people into makeshift shelters.
Ditch the team sports!!!! From high school hockey practice to stadiums full of fans, sports was a major cause of spread.
Church, concerts, etc can move to a drive-in model with people in their cars with appropriate spacing between vehicles or fully outdoors if spread is like that of covid. Unless it spreads like measles. But if it spreads like measles, we're just doomed.
These measures are fantastic, presuiming the next pandemic is a related virus.
Otherwise, with something truly novel, we may well have to figure it out as we go. We forget the incredible leg-up we had because we had already studied the SARS virus.
This is a great summary, though as others have noted, schools are a tough one. Ventilation/air cleaning is the core component but there's more to say about that. For one, that's not easy an easy setting, even *if* schools have the funds and commitment. Early on, when being extra cautious and containment oriented, more schools should go the restaurant route: go outside (covered canopies, severe weather excepted). That's not an ideal academic environment, but perfectly good for all the other things that schools do. Was surprised and sorry to see so few schools meet outdoors in 2020, though some private schools did.
Would help for more institutions to act similarly and demonstrably -- the DMV, social services, libraries, etc.
We need better data systems to understand the dynamics of the pandemic and the outcomes from hospitals. We need more robust public health infrastructure - to be able to respond rapidly. Our healthcare data in this country is laughable compared to many European nations.
Fomite transmission msy be more of an issue with a different germ.
Also mske sure people have medical leave to stay home when sick and relax requirements for things like food assistance.
Re: Stockpiling masks.
I recall that the Obama administration found that N-95 masks have a very limited shelf life. You'd spend a fortune stockpiling them as you'd be throwing them all away after nine months or so and restocking.
Turns out that the raw materials can be stored almost indefinitely, so they spent money to get mask making machinery designed that could be stored at government warehouses and deployed by untrained people to make N95 masks. The idea was that we could then afford to store enough raw materials to make huge numbers of masks.
Everything was ready to go early in the Trump administration, but they canceled the whole thing because...well you know, some credit might go to Obama.
Not my parents' church. The constructed a building about 30 times larger than the size of the congregation. It's a vast echo chamber in more senses that the usual.
For me, I still wear a mask in places where I don't know the other people there. Teaching class, going to the store, that sort of thing. I take every vaccination they'll let me have. And I don't worry about anything else.
Contact tracing, especially for identifying and analyzing where people are catching it as opposed to just notifying people of exposures after the fact.