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.
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