With the president and his henchmen starting to waver on combatting the public health crisis in favor of prematurely lifting the CDC guidelines so potential carriers can get out there and infect untold numbers of people unnecessarily, this piece in the New York Times over the week-end is very sobering. They would be doing exactly the opposite of what needs to be done.
Terrifying though the coronavirus may be, it can be turned back. China, South Korea, Singapore and Taiwan have demonstrated that, with furious efforts, the contagion can be brought to heel.
Whether they can keep it suppressed remains to be seen. But for the United States to repeat their successes will take extraordinary levels of coordination and money from the country’s leaders, and extraordinary levels of trust and cooperation from citizens. It will also require international partnerships in an interconnected world.
There is a chance to stop the coronavirus. This contagion has a weakness.
Although there are incidents of rampant spread, as happened on the cruise ship Diamond Princess, the coronavirus more often infects clusters of family members, friends and work colleagues, said Dr. David L. Heymann, who chairs an expert panel advising the World Health Organization on emergencies.
No one is certain why the virus travels in this way, but experts see an opening nonetheless. “You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”
But doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.
In interviews with a dozen of the world’s leading experts on fighting epidemics, there was wide agreement on the steps that must be taken immediately.
Those experts included international public health officials who have fought AIDS, malaria, tuberculosis, flu and Ebola; scientists and epidemiologists; and former health officials who led major American global health programs in both Republican and Democratic administrations.
Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home. Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.
But tactics like forced isolation, school closings and pervasive GPS tracking of patients brought more divided reactions.
It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.
“The American way is to look for better outcomes through a voluntary system,” said Dr. Luciana Borio, who was director of medical and biodefense preparedness for the National Security Council before it was disbanded in 2018.
[…]
What follows are the recommendations offered by the experts interviewed by The Times.
The White House holds frequent media briefings to describe the administration’s progress against the pandemic, often led by President Trump or Vice President Mike Pence, flanked by a rotating cast of officials.
Many experts, some of whom are international civil servants, declined to speak on the record for fear of offending the president. But they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.
Just as generals take the lead in giving daily briefings in wartime — as Gen. Norman Schwarzkopf did during the Persian Gulf war — medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.
The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.
[Some of them say there should be no discussion of what went wrong which might make sense if the president were someone other than Trump. But because he is an inveterate liar, that would be giving in to his propaganda which will kill people.]
The next priority, experts said, is extreme social distancing.
If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.
The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.
The crisis would be over.
It’s pulling teeth to get some people to abide by the voluntary guidelines. Cities are having to close down public spaces because people simply refuse to observe the social distancing rules that say you need to stay 6 feet away from anyone you don’t live with when you go out in public. If the administration and the Republicans decide that it’s “worth it” to let the virus run wild it will mean culling the herd by forcing the health care system to make the horrifying decision to allow the elderly and already infirm to die for lack of resources. In America. In 2020.
Here’s what’s happening in Italy already:
The mayor of one town complained that doctors were forced to decide not to treat the very old, leaving them to die. In another town, patients with coronavirus-caused pneumonia were being sent home. Elsewhere, a nurse collapsed with her mask on, her photograph becoming a symbol of overwhelmed medical staff.
If not, even hospitals in developed countries with the world’s best health care risk becoming triage wards, forcing ordinary doctors and nurses to make extraordinary decisions about who may live and who may die. Wealthy northern Italy is facing a version of that nightmare already.
“This is a war,” said Massimo Puoti, the head of infectious medicine at Milan’s Niguarda hospital, one of the largest in Lombardy, the northern Italian region at the heart of the country’s coronavirus epidemic.
He said the goal was to limit infections, stave off the epidemic and learn more about the nature of the enemy. “We need time.”
Italy’s experience has now underscored the need to act decisively — quickly and early — well before case numbers even appear to reach crisis levels. By that point, it may already be too late to prevent a spike in cases that stretches systems beyond their limits.
With Italy having appeared to pass that threshold, its doctors are finding themselves in an extraordinary position largely unseen by developed European nations with public health care systems since the Second World War.
Regular doctors are suddenly shifting to wartime footing. They face questions of triage as surgeries are canceled, respirators become rare resources, and officials propose converting abandoned exposition spaces into vast intensive care wards…
Giorgo Gori, the mayor of Bergamo, said that in some cases in Lombardy the gap between resources and the enormous influx of patients “forced the doctors to decide not to intubate some very old patients,” essentially leaving them to die.
“Were there more intensive care units,” he added, “it would have been possible to save more lives.”
Dr. Di Marco disputed the claim of his mayor, saying that everyone received care, though he added, “it is evident that in this moment, in some cases, it could happen that we have a comparative evaluation between patients.”
On Thursday, Flavia Petrini, the president of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care, said her group had issued guidelines on what to do in a period that bordered on wartime “catastrophe medicine.”
“In a context of grave shortage of health resources,” the guidelines say, intensive care should be given to “patients with the best chance of success” and those with the “best hope of life” should be prioritized.
The guidelines also say that in “in the interests of maximizing benefits for the largest number,” limits could be put on intensive care units to reserve scarce resources to those who have, first, “greater likelihood of survival and secondly who have more potential years of life.”
This could happen anyway since the Trump administration already screwed the pooch on this. He refuses to invoke the Defense Production Act because his big business buddies want to price gouge the states and municipalities. But this outcome is guaranteed if he follows through on lifting the guidelines and issuing bogus happy talk that we’ve “turned the corner” or that they’ve found a “new way” to combat the virus.
Trump doesn’t listen to Lindsey Graham, he just pretends to when Graham says something he likes. But Graham is right about this: