His main point is the only thing that works is aggressive containment based on exhaustive testing and contact tracing requiring a truly enormous amount of manpower. He elaborates in 3️⃣
Watch any epidemic movie, and you'll see this. This is an epidemiologist's viewpoint: Continuously find the sick and who they came into contact with, isolate them all. Large-scale extreme lockdown quarantines do this more simply, but have obvious downsides.
So his stages could really just be said to be "keep working containment until we get it right while we wait for a vaccine."
If I would make one point that I feel he misses, it's that prevention in all aspects is important, not just planning.
Another point is that it's misleading to say "the U.S." since there federal, state and local levels can act independently of one another. That said, that is also true in much of world, but the U.S. is one of the largest and most fragmented countries in the world governmentally.
========================
He says 1️⃣ is containment: "try to stop from entering, try to stop from spreading" — that usually involves exhaustive testing to allow contact tracing and isolating.
1.1 Very difficult to do, and the U.S. didn't even remotely achieve, primarily due to lack of testing.
1.1.1 This is however difficult to well, because leaders have to take strong action early, and then continue for a long time. Manpower and PPE/testing infrastructure need to be in place in advance (not true in the U.S.) or at least attempted. The U.S. failure at the federal level to even place any orders for months was insanely poor, but it still wouldn't have allowed containment, because of the initial lack of testing ability.
1.2 Many countries attempted this and did much, much better than the U.S. (an admittedly low bar).
1.3 How well has it worked where it was attempted well, and what does it bode for the future in those locations? This is a tough one, because
1.3.1 Exhaustive tracing is the first step, but must be followed by CONTINUOUS contact tracing and isolation, possibly for years, until a STRONG vaccine is WIDELY AVAILABLE
========================
2️⃣ He calls "slow the spread", distancing, general quarantines.
2.1 Again, the U.S. has done this very, VERY poorly.
========================
3️⃣ He says is containment again, to be able to "restart the economy".
We have to "target new infections more aggressively" using "greatly expanded lab testing" to create "surgically applied social distancing measures" via "isolating those [who are infected] and do contact tracing. It takes a lot of resources to do that. Our public health authorities don't have the manpower to do this. We need a lot more public-health soldiers."
3.1 It's somewhat artificial to say that 1️⃣ and 3️⃣ are the same step. He's coming back to it because the U.S. failed at 1️⃣ and 2️⃣.
More simply put, he's saying, as I pointed out initially, that containment is really all we have as a tool, and SOMEDAY we have to get it right. Everything until we do is stage "bad", everything after we do is stage "good"
3.2 He's also making these somewhat artificial "stage" distinctions to be able to address "restart[ing] the economy" after it partially shut down by failing at 1️⃣
3.3 What he doesn't point out is that how containment is made nearly impossible by failing to do it initially, and then also failing to follow up by slowing the spread strongly.
3.4 He does point out that eventually, we have to accept a "new normal" of cough etiquette, hand washing, public disinfecting.
3.4.1 Here I strongly disagree: the new normal for the short- and medium-term is based around wearing masks.
3.5 He probably consciously chooses not to discuss advances in treatment much anywhere in this article, other than to say here "I’m optimistic that in three to six months we’ll have (a better treatment for coronavirus symptoms), a therapeutic in our toolkit that can rescue those who become severely ill."
3.5.1 I think he should have also pointed out that many treatments being studied are to PREVENT those with the virus from BECOMING seriously ill. That's why so many health care workers have taken things they haven't taken in the past.
3.5.2 Treatments that prevent are the biggest hope we have for the future, in my opinion at the moment. Related: the new normal (hopefully) of wearing masks.
========================
4️⃣ is "more containment...once we have a vaccine...to deal with this virus as it evolves". He says it's likely that we'll see "seasonal periodicity with COVID-19"
4.1 So you can see his stages are really "keep working containment until we get it right while we wait for a vaccine."
4.2 His main point here is that it's likely never, ever going away.
I think he does a poor job of making that point. It's not clear enough what he means when he says "but we know how to live like that. Coupled with our personal hygiene,we’ll be in a much better place."
========================
5️⃣ is preparation for the next pandemic.
5.1 I appreciate that he clearly points out, and provides examples, of how "we've entered a period where emerging infectious diseases are increasing with alarming frequency."
5.2 He says Bush-Obama was the "first time in human history that a society made a commitment to try to be as prepared as we can for a pandemic."
5.3 He points out how important infrastructure is, focusing on supply chains, and give examples.
5.3.1 Here I think he fails to point out that congress under the administration repeatedly stopped funding the plans that were in place. Funding made it into bills repeatedly, and was removed. So the existing "plan" had been essentially defunded.
5.3.2 Which made it CRITICAL that the current administration start placing order for PPE and ventilators as soon as it saw that the plan had been defunded—that what had been determined to be needed was missing.
5.3.3 Many politicians are not managers, and are barely leaders. They are politicians, rarely having any understanding of managing infrastructure, making and implementing strategic plans, etc. So government is lousy at getting things done because many of the people in charge are politicians with few relevant qualifications. Under 3️⃣ he pointed out "Our public health authorities don't have the manpower to do this. We need a lot more public-health soldiers." I think he should have repeated that here. Just having a plan for the next event did NOT work in this case.
5.4 Big missed point here. I'm going to go ahead and again call it a "failure" of his message here: WHY is the frequency of "emerging infectious diseases ... increasing"?
5.4.1 First step is to say "Let's address CAUSES, not EFFECTS". PREVENTION, not mitigation. The wet markets and lack of international coordination would be points to bring up.
Overall, (as noted in 3.5.2 and 5.4.1) I think he misses too many opportunities to talk about prevention.
His main point is the only thing that works is aggressive containment based on exhaustive testing and contact tracing requiring a truly enormous amount of manpower. He elaborates in 3️⃣
Watch any epidemic movie, and you'll see this. This is an epidemiologist's viewpoint: Continuously find the sick and who they came into contact with, isolate them all. Large-scale extreme lockdown quarantines do this more simply, but have obvious downsides.
So his stages could really just be said to be "keep working containment until we get it right while we wait for a vaccine."
If I would make one point that I feel he misses, it's that prevention in all aspects is important, not just planning.
Another point is that it's misleading to say "the U.S." since there federal, state and local levels can act independently of one another. That said, that is also true in much of world, but the U.S. is one of the largest and most fragmented countries in the world governmentally.
========================
He says 1️⃣ is containment: "try to stop from entering, try to stop from spreading" — that usually involves exhaustive testing to allow contact tracing and isolating.
1.1 Very difficult to do, and the U.S. didn't even remotely achieve, primarily due to lack of testing.
1.1.1 This is however difficult to well, because leaders have to take strong action early, and then continue for a long time. Manpower and PPE/testing infrastructure need to be in place in advance (not true in the U.S.) or at least attempted. The U.S. failure at the federal level to even place any orders for months was insanely poor, but it still wouldn't have allowed containment, because of the initial lack of testing ability.
1.2 Many countries attempted this and did much, much better than the U.S. (an admittedly low bar).
1.3 How well has it worked where it was attempted well, and what does it bode for the future in those locations? This is a tough one, because
1.3.1 Exhaustive tracing is the first step, but must be followed by CONTINUOUS contact tracing and isolation, possibly for years, until a STRONG vaccine is WIDELY AVAILABLE
========================
2️⃣ He calls "slow the spread", distancing, general quarantines.
2.1 Again, the U.S. has done this very, VERY poorly.
========================
3️⃣ He says is containment again, to be able to "restart the economy".
We have to "target new infections more aggressively" using "greatly expanded lab testing" to create "surgically applied social distancing measures" via "isolating those [who are infected] and do contact tracing. It takes a lot of resources to do that. Our public health authorities don't have the manpower to do this. We need a lot more public-health soldiers."
3.1 It's somewhat artificial to say that 1️⃣ and 3️⃣ are the same step. He's coming back to it because the U.S. failed at 1️⃣ and 2️⃣.
More simply put, he's saying, as I pointed out initially, that containment is really all we have as a tool, and SOMEDAY we have to get it right. Everything until we do is stage "bad", everything after we do is stage "good"
3.2 He's also making these somewhat artificial "stage" distinctions to be able to address "restart[ing] the economy" after it partially shut down by failing at 1️⃣
3.3 What he doesn't point out is that how containment is made nearly impossible by failing to do it initially, and then also failing to follow up by slowing the spread strongly.
3.4 He does point out that eventually, we have to accept a "new normal" of cough etiquette, hand washing, public disinfecting.
3.4.1 Here I strongly disagree: the new normal for the short- and medium-term is based around wearing masks.
3.5 He probably consciously chooses not to discuss advances in treatment much anywhere in this article, other than to say here "I’m optimistic that in three to six months we’ll have (a better treatment for coronavirus symptoms), a therapeutic in our toolkit that can rescue those who become severely ill."
3.5.1 I think he should have also pointed out that many treatments being studied are to PREVENT those with the virus from BECOMING seriously ill. That's why so many health care workers have taken things they haven't taken in the past.
3.5.2 Treatments that prevent are the biggest hope we have for the future, in my opinion at the moment. Related: the new normal (hopefully) of wearing masks.
========================
4️⃣ is "more containment...once we have a vaccine...to deal with this virus as it evolves". He says it's likely that we'll see "seasonal periodicity with COVID-19"
4.1 So you can see his stages are really "keep working containment until we get it right while we wait for a vaccine."
4.2 His main point here is that it's likely never, ever going away.
I think he does a poor job of making that point. It's not clear enough what he means when he says "but we know how to live like that. Coupled with our personal hygiene,we’ll be in a much better place."
========================
5️⃣ is preparation for the next pandemic.
5.1 I appreciate that he clearly points out, and provides examples, of how "we've entered a period where emerging infectious diseases are increasing with alarming frequency."
5.2 He says Bush-Obama was the "first time in human history that a society made a commitment to try to be as prepared as we can for a pandemic."
5.3 He points out how important infrastructure is, focusing on supply chains, and give examples.
5.3.1 Here I think he fails to point out that congress under the administration repeatedly stopped funding the plans that were in place. Funding made it into bills repeatedly, and was removed. So the existing "plan" had been essentially defunded.
5.3.2 Which made it CRITICAL that the current administration start placing order for PPE and ventilators as soon as it saw that the plan had been defunded—that what had been determined to be needed was missing.
5.3.3 Many politicians are not managers, and are barely leaders. They are politicians, rarely having any understanding of managing infrastructure, making and implementing strategic plans, etc. So government is lousy at getting things done because many of the people in charge are politicians with few relevant qualifications. Under 3️⃣ he pointed out "Our public health authorities don't have the manpower to do this. We need a lot more public-health soldiers." I think he should have repeated that here. Just having a plan for the next event did NOT work in this case.
5.4 Big missed point here. I'm going to go ahead and again call it a "failure" of his message here: WHY is the frequency of "emerging infectious diseases ... increasing"?
5.4.1 First step is to say "Let's address CAUSES, not EFFECTS". PREVENTION, not mitigation. The wet markets and lack of international coordination would be points to bring up.
Overall, (as noted in 3.5.2 and 5.4.1) I think he misses too many opportunities to talk about prevention.