What Ought We to Do to be Ready Next Time?

The Quarantine Zone
21

The commercial infrastructure for the dissemination of drugs is already licenced and regulated. A few huge stockpiles of critical supplies will sit and age, and experience spoilage over time that will make the paperwork preparedness a very dangerous illusion. Instead regulate the medical equipment, and pharmacological retail industry to include tax deductible first in, first out inventories of immediate care supplies in large enough amounts to cover the first month of epidemic demand. Producers would be required to increase their own inventories by proportional amounts. Costs would be frozen at the declaration of an emergency. The total additional loss from over-supply inventory could well be ameliorated by donation to charitable medical uses, after the initial tax deductible purchase increase. The limits on purchase of all emergency supplies should be in place permanently before the emergency occurs.

This method places emergency distribution a month after the epidemic begins and allows manufacturers a month to begin higher volume of production to match needs and distribution to match hot spots of usage. The cost of the initial increase in inventory and storage cost being made tax deductible, and required for the existing licensure of medical supply infrastructure ensures that pass through costs are mostly pre paid, and distributed by need.

22

Traditional Chinese Medicine.

23

Oh…okay. Does anyone outside of China take that seriously?

China is certainly a hotbed for superstitious beliefs and dubious health practices, but then, the United States is the king of the anti-vaxxer movement with everyone from crazy religious cults to ultra-left conspiranoists claiming that vaccination is some kind of fundamental evil. I’m not sure I’d point that finger too far lest it wrap around the globe. Note that some of the efforts at rooting out terrorist cells in Pakistan have totally undermined efforts at polio eradication, and of course our glorious president has spread misinformation like Miracle Whip across an Oklahoma pie-eating contest so the US has a dubious claim to any moral high ground in this regard.

Stranger

24

Miracle Whip? I though that was for sun protection!

25

It’s Miracle Whip! It’s good for everything. Copper solvent, paint stripper, hair mousse, fake snow, anal lube…”I enjoy the tangy zip of Miracle Whip!” Just don’t actually eat it; it’s basically aerated fluoropolymer.

Stranger

26

My understanding is that the Chinese had an excellent system for tracking problems, where diagnoses typed in by a doctor when to a central location where it could be monitored and trends determined.
Why didn’t it work? Because local officials in Wuhan prevented the doctors from entering the data so they wouldn’t look bad. (This according to the Times a while ago.)
I’d worry that any specific remedies might be fighting the last war. My short suggestion would be to listen to the science and be ready to act on the science.
The next disaster we can expect is not a pandemic but the effects of climate change. When that happens, after I’m dead if I’m lucky, it will due exactly to not believing in and acting on the science.

27

I will doubtless be shouted down by the boards resident Sinophobes, but from what I have read, Voyager’s post is essentially correct. It was not like the Central Committee was sitting on top of the doctor’s heads saying “you must not report comrade”. The fuckup, as it was, was done by local officials and was a mix of CYA and understandable skepticism:- just because you have a handful of strange pneumonia cases, you don’t declare a strange new disease.
Not entirely sure how that can be fixed.

28

We are largely learning a bunch of “I told you so” lessons that hopefully will actually stick in people’s heads now.

Chiefly: Political incentives are fundamentally misaligned with pandemics. If you solve a pandemic too early, all you get is blame because it looks like you spent a disproportionate amount of resources on something that didn’t happen. The “ideal” political time to solve a pandemic is to swoop in just as it’s getting serious and then clamp down hard but this is an impossible line to ride. If you swoop in too late, then you’ve opened Pandora’s box and millions of people die.

Decisions around infectious diseases need to be removed from the normal political process and handed over to an independent group of scientists and public health experts who have broad authority to override political leaders. If this sounds perversely difficult to set up, that’s because it is. China tried to set up such a system in the aftermath of SARS and all the expected political type corruptions that the system was designed to circumvent ended up causing it to fail this time around. But to my point of nobody getting credit for stopping a pandemic, at least China has a system like this. How many other countries have tried to even solve this problem? How many times did this system work and stop the next great pandemic? We’ll never know because stopping pandemics is an invisible, unsexy process.

Secondly, global public health is truly global. People are realizing just how much easier it is to stop a pandemic at the source. Sending medical aid to a country is not “charity”, it’s a prudent investment in resources to solve the problem there before it becomes a problem here. We can’t expect any local government to bear the economic brunt of an infectious disease by itself, otherwise it simply isn’t motivated to pour the necessary amount of resources onto the problem. There needs to be a global fund set up that more than makes whole any country that has to deal with the aftermath of a pandemic so countries are actually motivated to reveal problems rather than hide them.

Thirdly, societies in general are unable to take tail risks seriously. So much attention has been focused on wild animal eating in China because that’s the tangible cause of this pandemic. But like, Americans have been told for decades now that animal farming practices and especially the overuse of antibiotics have the potential to cause the next disease outbreak. Or that the anti-vax movement could cause a human reservoir of measles to develop that could mutate into a strain people aren’t immune to. Chinese society has been warned about the dangers of wild animals in the medicine supply in the exact same tone and the response is always the same “yeah, yeah, but what are you going to do about it?”. Removing one tail risk does not meaningfully decrease the chances of the next pandemic, we need to build systematic capability in both attacking all tail risks and mitigating the consequences. Think about it in firefighting terms, at some point in our history, entire cities like Chicago or Seattle would regularly burn down. We’ve stopped that from happening through a combination of fire codes that systematically address bad building practices as well as firefighter response teams that can rapidly move in and prevent fires from getting out of control.

Finally, universal masking might be up there as one of the highest ROI public health interventions ever invented. One major reason Asian countries have had such a better response is because the average citizen had a cache of masks at home like an American would have a box of bandaids and people could get masked up immediately without having to worry about supply disruptions. Meanwhile, Western governments have been steadfast in claiming masks don’t work because they were caught flat footed without enough masks to give to everyone. I hope to see a future world where cheap surgical masks are as abundant globally as a box of Kleenex is and they become a standardized reaction to any infectious disease.

If there’s one bright light at the end of this tunnel, it’s that before this pandemic, nobody believed it would ever be realistic to completely rid the world of influenza and rhinoviruses. If it turns out to actually be feasible and simple interventions like masking, widespread testing and forcing anyone confirmed positive to actually stay at home could bring the number of global influenza cases down to zero, then over a long enough timespan, the lives saved from this will exceed the lives lost from COVID 19.

29

Yeah, it’s important to emphasize that nobody is eating pangolin in China for the taste. It’s the same group of people who, in the West would believe that crystals have special healing power or whatever GOOP’s latest form of quackery is. It’s another form of alternative medicine quackery that makes rational Chinese as infuriated as anti-vaxxers do for Americans.

30

On a personal level, we were fairly well prepared as we had just done our bulk shopping [2 households of TP, paper towels, kleenex and cleaning supplies, 1x month. We just sort of combined almost everything in the western NY house as there are 3 of us sheltering here, and mrAru in the CT property so he doesn’t need as much] We already have a strong pantry, comes from midwestern farm girl mothers who believed in being able to ride out some of those early 1900s/depression era blizzards that used to sweep down out of Canada and lock people in for weeks at a time. We actually have about 3 months supply of pantry stock. Freezer stuff is sort of hit or miss, but we have enough stuff in the freezer to make boring meals for about a month. It is the fresh stuff - butter, eggs, milk that is short. We have around 50 pounds of flour, and a pound of yeast that we can turn into a sourdough culture and continue having wheat bread, or other flour based products.

In the future - we have discussed buying a 3 month supply of vacuum and nitrogen packed flour, legumes, dehydrated assorted ingredients - all stuff we use in our normal cooking, and every Jan laying in a new stock and putting the previous years stock into pantry use. This way we would have a good solid 3 months supplies. We also noticed that fishing season started April 1, and we have fishing gear. 2 of the 3 of us qualify for resident licenses - so we could easily stretch our protein out with fish, and what varmints are non-season [I have a decent squirrel recipe, though honestly I would probably poach rabbits instead. I really wish they would consider making Canada Goose a resident invasive species with a 2 bird bag limit weekly or something.]

31

Gwyneth Paltrow

She steals from a lot of traditional medicine woo including Chinese. Yoni steaming, as an example, came from other traditions but she added herbs with claimed health benefits based on TCM. Cupping is from a traditional Chinese tradition and she encourages that. Paltrow takes a fusion restaurant approach to her woo.

Based on the amount of money the Goop network is bringing in and her getting a Netflix show to spread her nonsense, I would say there are a decent number of people taking it seriously.

32

It’s interesting how a lot of people are intepreting this as bieng about what they should personally stockpile, which isn’t at all how I interpret it, and is clearly not how we should deal with these things.

Obviously, it’s the stuff we’re short on now that we need more of. The health care industry was operating on a relatively short turnover, based on the assumption that future demand was a relatively predictably thing based on current demand plus organic growth; when a crisis hit that resulted in massively increased demand in the short term no one was ready. It is now plainly obvious that that’s a bad idea.

It’s bad enough there may not be enough ventilators; I can understand, though, why a hospital would not invest in fifty ventilators that might stay in a storage room for so long they’re not used for the entire career of anyone working in the hospital when they’re bought. Not have enough masks and gloves, though, is profoundly inexcusable.

33

Gloves and masks amounts are linked to the same calculus which dictates optimum number of ventilators, assessment of needs based on past surge capacity. This is beyond what anyone has ever seen, so I am not sure “inexcusable” is an appropriate or fair description.

How many global pandemics have there been*. Spanish Flu. The Black Death. Plague of Justinian. It a handful of times a millennium. Epidemics are most common, but they are regional and the practice of transferring resources and material from unaffected areas which is so successful for Ebola, isn’t feasible when it’s hitting every place more or less the same time.

*There were some other Plague outbreaks and Cholera contigons which spread widely in the 19th century, but those toook years and in some cases decades to spread. We have spread times of weeks or even days here.

34

Accept the fact that airlines should be shut completely down from any spot designated a hotspot. Whether national, regional, or global. Nations chartering flights to get citizens home is one thing. Delta doing business as usual on slightly emptier flights is another.

35

I think improving supply lines would also help. Redundancy seems like it was a bad word before Covid-19. I think it should now be something we value, even if it results in higher prices. We should have factories here in the US (and whichever country any non-Americans are from as well) for things like medical supplies and medications as well as the basic necessities. If this means we have to subsidize domestic production to compete with Chinese factories then so be it.

36

Bill Gates, in his TED talk from a few years ago, was recommending to have a sort of “reserves” system like the military has for epidemics.

Probably good to have but, I suspect, less useful in tamping down on things if the nucleus point is anywhere other than a small, third world country.

37

The first thing we should do is implement UHC. The second thing we should do is stop our nation’s wealth from accumulating in so few places.

38

Here is the least sensational recap I could find of why the testing was so slow to get off the ground: What Went Wrong with Coronavirus Testing in the U.S. | The New Yorker
These are lines of authority/procedure issues which can be streamlined and optimized, without significant cost. There also needs to be a paradigm shift: much of the testing now available is despite the procedures: I.e. organizations asking (often expecting little success) for authorization to develop tests, rather than clear leadership from either the CDC or the FDA in driving this. While you need to make sure tests are accurate and useful, more flexibility is clearly needed. Perhaps having a point person in charge of driving test availability within the FDA, who can help potential test developers clear the admin maze, would be a low cost/high payoff move.
Without testing, you cannot control. Testing doesn’t necessarily mean control, but not testing necessarily means no control.

39

What methods are there to do this? I have read that smart thermometers that upload your temperature readings can predict coronavirus and flu outbreaks, but what other tools are out there to have better prediction capabilities?

Can thermal cameras in public spaces be used to detect fevers to get an idea if an illness is spreading?

A company called bluedot said they were able to predict the spread of the virus.

40

Fever is a pretty non specific symptom.