Public health recommendations for the next pandemic, made in 2006
This article was written in 2006. One of the authors was Donald Henderson, the physician who headed up the WHO project that eradicated smallpox. He died four years ago. In addition:
From 1977 to 1990, [Henderson] was Dean of the Johns Hopkins School of Public Health. Later, he played a leading role in instigating national programs for public health preparedness and response following biological attacks and national disasters.
So Henderson’s credentials were impeccable.
Here are some prescient and cautionary quotes from the 2006 article, which discusses possible public health reactions to a future flu pandemic (up to and including something of the magnitude of the 1918 pandemic). But I see no reason it wouldn’t also apply to COVID:
…[T]here has been interest in a range of disease mitigation measures. Possible measures that have been proposed include: isolation of sick people in hospital or at home, use of antiviral medications, hand-washing and respiratory etiquette, large-scale or home quarantine of people believed to have been exposed, travel restrictions, prohibition of social gatherings, school closures, maintaining personal distance, and the use of masks. Thus, we must ask whether any or all of the proposed measures are epidemiologically sound, logistically feasible, and politically viable. It is also critically important to consider possible secondary social and economic impacts of various mitigation measures.
Note the balanced point of view, and the recognition that there are definitely costs to such mitigation measures that must be factored in. More:
A number of mitigation measures that are now being considered could have a serious impact on the ability of the health system to deliver adequate care and could have potentially adverse consequences for the provision of essential services. Many could result in significant disruption of the social functioning of communities and result in possibly serious economic problems. Such negative consequences might be worth chancing if there were compelling evidence or reason to believe they would seriously diminish the con-sequences or spread of a pandemic. However, few analyses have been produced that weigh the hoped-for efficacy of such measures against the potential impacts of large-scale or long-term implementation of these measures…
It has been recognized that most actions taken to counter pandemic influenza will have to be undertaken by local governments, given that the epidemic response capacity of the federal government is limited.
And yet, of course, with COVID Trump is being blamed for not having somehow figured out exactly what measures would stop the pandemic in its tracks and then implemented them by executive order.
The authors then discuss computer modeling to help with decision making, and they are somewhat skeptical about its efficacy:
No model, no matter how accurate its epidemiologic assumptions, can illuminate or predict the secondary and tertiary effects of particular disease mitigation measures. Nor,for example, can it assess the potential effects of high absentee rates resulting from home or regional quarantine on the functioning integrity of essential services, such as hospital care or provision of food and electrical service to the community. If particular measures are applied for many weeks or months, the long-term or cumulative second- and third-order effects could be devastating socially and economically. In brief, models can play a contributory role in thinking through possible mitigation measures, but the cannot be more than an ancillary aid in deciding policy.
We relied on models heavily, however, especially in the earlier reaction to the pandemic. Now we seem to be relying mostly on politics and hunches.
Here, the authors correctly foresee the possibility of closing schools and some of the attendant problems [emphasis mine]:
Some have suggested closure might be recommended for as long as a pandemic persists in a single community (perhaps 8 weeks) or for as long as a pandemic persists in the country (as long as 8 months).18Therationale for the strategy is to diminish contacts between students and so retard epidemic spread. However, if this strategy were to be successful, other sites where school-children gather would also have to be closed: daycare centers, cinemas, churches, fast-food stores, malls, and athletic arenas. Many parents would need to stay home from work to care for children, which could result in high rates of absenteeism that could stress critical services, including health care…
Political leaders need to understand the likely benefits and the potential consequences of disease mitigation measures, including the possible loss of critical civic services and the possible loss of confidence in government to manage the crisis.
The part that I highlighted is a very real consequence that we’ve been experiencing with COVID. But what the authors didn’t foresee was that this loss of confidence in government might be used as a political football by the party opposed to a president who is defined as not having responded to control the pandemic at the outset. Right now for the Democrats, loss of confidence in the federal government may be seen as a feature rather than a bug, if it hurts Trump’s chances of re-election.
The article then goes into a discussion of various strategies such as handwashing and quarantines, and adds that travel restrictions have not been found to be effective in the past. Here’s the discussion of prohibiting large gatherings:
Were consideration to be given to [banning large gatherings] on a more extensive scale and for an extended period, questions immediately arise as to how many such events would be affected. There are many social gatherings that involve close contacts among people,and this prohibition might include church services, athletic events, perhaps all meetings of more than 100 people. It might mean closing theaters, restaurants, malls,large stores, and bars. Implementing such measures would have seriously disruptive consequences for a community if extended through the 8-week period of an epidemic in a municipal area, let alone if it were to be extended through the nation’s experience with a pandemic (perhaps 8 months). In the event of a pandemic, attendance at public events or social gatherings could well decrease because people were fearful of becoming infected, and some events might be cancelled because of local concerns. But a policy calling for community wide cancellation of public events seems inadvisable.
Inadvisable. And yet it’s been going on now for close to half a year.
About distancing:
It has been recommended that individuals maintain a distance of 3 feet or more during a pandemic so as to diminish the number of contacts with people who may be infected. The efficacy of this measure is unknown. It is typically assumed that transmission of droplet-spread diseases, such as influenza, is limited to “close contacts”—that is, being within 3–6 feet of an infected person. Keeping a space of 3 feet between individuals might be possible in some work environments, but it is difficult to imagine how bus, rail, or air travelers could stay 3 feet apart from each other throughout an epidemic. And such a recommendation would greatly complicate normal daily tasks like grocery shopping, banking, and the like.
Well, we seem to have figured out a way around that, by making people wait in lines while standing on those little circles that designate the distance deemed proper. But what science is that distance based on? As the article states, “the efficacy of this measure is unknown.” And as far as I can tell, it’s still unknown.
Masks?:
In Asia during the SARS period, many people in the affected communities wore surgical masks when in public. But studies have shown that the ordinary surgical mask does little to prevent inhalation of small dropletsbearing influenza virus. The pores in the mask become blocked by moisture from breathing, and the air stream simply diverts around the mask. There are few data avail-able to support the efficacy of N95 or surgical masks out-side a healthcare setting. N95 masks need to be fit-tested to be efficacious and are uncomfortable to wear for more than an hour or two. More important, the supplies ofsuch masks are too limited to even ensure that hospitals will have necessary reserves.
And that is more or less how it has played out – first we were told not to bother with masks, and also that there were shortages of the N95 masks for healthcare workers. Now we are told we must wear masks even if they are makeshift and made of cloth.
The article ends this way:
Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted. Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen to be less than optimal, a manageable epidemic could move towards catastrophe.
Cooler heads did not prevail, fear has been heightened, most of the suggestions in this article have not been followed, and we have moved towards catastrophe.
Only thing they missed was the use of insanely fraudulent data collection being used to keep us locked down and masked up forever.
My state of WA hasn’t reported a negative test since August 1.
Science!
As I commented before, I recall the 1968-69 Hong Kong flu because I was in the Navy and we made a port call in Hong Kong. Nobody was concerned about catching the flu. Healthy young sailors evidently were immune to the HK flu despite the fact that it killed an estimated 100,000 people in the USA. I don’t recall anybody getting excited about the HK flu or the government trying to manage it. Looks to me like the more the government gets involved, the worse the results.
“Everything government touches turns to crap.” Ringo Starr
The current pandemic is only valuable and important in it’s ability to injure Republicans, and to that end it is of infinite value. That the policies implemented by Progressives kill and economically destroy their own constituents is of no consequence; those costs are for the greater good. Much like the race card.
Modeling is a statistical disaster in every field. As an elderly who started in with computers back in the cpm days, it was always GOGO, garbage in garbage out. Models are usually what the modeler wants them to be.
Covers what we know, don’t know, cannot know, and implies a direction to risk management that can be reconciled with rational, practical, reality. Yes, collateral damage matters, and show be minimized in an optimized strategy.
Remdesavir, beta interferon, dexamethasone, Vit D, probably zinc, probably hydroxychloroquine if taken early, convalescent plasma; interleukin 6 drugs, living vaccines like oral polio vaccine and BCG and measles vaccines probably improve innate immunity to Covid even though they are aimed obviously at other diseases. All the above drugs have evidence of improved survival in Covid 19 cases if used at correct time. RNA vaccines are coming shortly and are in phase III trials.
Don’t fret.
The US response was an indirect result of the impeachment trial that the Democrats ginned up as a desperate attempt to take Trump down. Initially he pooh poohed the virus as a really bad flu.
However with the horror stories coming out of Europe he was persuaded to attempt an Ebola response to the flu. Imagine that he didn’t take active steps right after an impeachment. He would have been impeached again.
We fumbled and we sputtered at first and I think that most people agreed to the 15 day to flatten the curve that went to 30 days because we had to reset our public health system to handle the pandemic. But after that other than the NYC and Detroit Metropolitan area the country should have re-opened up in stage one immediately.
I had a boss who said “we are not a learning organization but a re-learning organization.” I find these words to be very true.
Now we are stuck in a meme of “panic porn” because of “orange man bad” syndrome.
I suggest folks look up the mortality data for the pandemics of 1958 and 1968 – and make sure you adjust for population.
The 58 and 68 pandemics were on par , if not worse (after adjusting for population) , than the coronavirus.
Back then, nothing was shut down.; economies were not shut down.
I hate to sound like some wacko conspiracy nut, but the reaction today to the corona virus has been and is being informed by factors that have nothing to do with medical science.
IMHO and without any evidence whatsoever, if the corona virus had emerged during Obama’s presidency, there would have been ZERO shutdowns of the economy.
As for BiteMe and his running mate, Camilla — oops, Kamala Whoress , claiming their policies to address the corona-virus would be determined by the scientific experts , ask yourself, how many times have experts (not just in the medical/epidimological arena) been wrong??
(Lower Manhattan , 5 years ago – or was it 10 years ago? – , should have been permanently inundated under 10 feet under water according to world class climate scientists.
Speaking of climate, check out the 1975 – ish Youtube news-documentary predicting with a very high level of reliability, the coming ice age. By now, Manhattan, according to those experts, should be sitting under a few hundred feet of solid ice).
I won’t waste your time talking about the prognostications of Paul Ehrlich).
To reference Neo’s article, all decisions have trade-offs. Yet depending on which political party sits in the White House what is considered an acceptable trade-off can vary from “hey, it’s OK,” to “that is totally unacceptable,” for the same exact set of trade-offs.
And some folks wonder why during revolutions members of the ruling class wind up without their heads.
How much has changed since 2006!
Non (directly) political: I watched how Washington, DCers reacted to snow over the years that I lived there (1991-2020). They were always exceptionally wimpy, which I quickly figured out had two causes: that risk-adverse people were drawn to Washington, and that the government wasn’t losing any money through shut businesses on snow days. Yet, over the years, they became still more cautious. The mere forecast of snow started to bring cancellations, which weren’t lifted when no snow materialized (and in later years threats of heavy rain also closed the federal government!). They began suspending the buses (which previously were fitted with chains, and both cleared the roads and provided a way for those without AWD vehicles to get to work if they had what would today be called “essential” jobs). Politicians and all local news in lemming fashion began urging everyone to “Stay At Home.” Mayor Bowser acquired some sort of large Lincoln Navigator and with a huge entourage drove around to demonstrate “leadership” while the rest of us were all “safe at home.” So useful.
Some of this was the “culture of safety” feeding on itself. Some of it was the further decline of any consideration for the importance of private business (very evident during Obama). Some of it was a theory I have, although I can’t prove it, that George W. Bush made a deal after 9/11 that he wouldn’t look too carefully at anything bureaucrats did in return for military spending (a lot of flat screen tvs and laptops walked out of federal office buildings during this period), so they felt free of criticism for their slacking. And I wonder how much the fear of lawsuits when protected classes feel “uncomfortable” has led to a decline in the quality of decision-making as well.
When such a culture met Covid and a political opportunity started to appear….
Little notice is given to Biden’s recent position: “Joe Biden says he will close the country down to stop the spread of the coronavirus if scientists recommend he do so.” (NY Post, 8/21)
This is one of the evils of the Democratic Party today, relying on “science and scientists”. It is the heart and soul of Progressivism, turning people into sheeple.
We have seen what the Democrats and their media have made of Dr. Fauci, a 79 year-old Deep Stater who has never offered facts, just his personal opinions, but he is “scientific”.He has become Saint Fauci.
So president Joe will shut down the country if some, a few, all Democratic, “scientists” tell him to. Never forget that epidemiology is the management of populations, not individual ill patients as a physician does, and thus draws Leftists like flies to honey.
Democrats, spuriously “led” by Biden, will raise taxes, oppress Big Oil beyond the negative effects of current market forces, increase our present massive unemployment, push many, many more businesses into bankruptcy, reopen all doors to China, and give us stagflation.
Catastrophe awaits.
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Excellent and prescient insights. The other point that could be made is that all the distancing measures do is prolong the time until we get herd immunity. The number of cases will likely be roughly the same, just spread over a year instead of a few months, with catastrophic economic and social consequences because of the duration. To paraphrase: A virus can stay viral longer than we can stay solvent.
The Hoover Institution’s Goodfellows group video addressed this last month. There are at least a dozen pandemic plans on the shelf at the federal level. They are still there. Petty much unconsulted.
The complete failure of the bureaucracy was agreed to, then kicked around. Theorists theorised solutions and improvements. But none of these supposed experts had much practical to say.
Oh. And two of them, Niall Ferguson and the General turned historian, both have new books forthcoming on the crisis-challenge and solutions for the next pandemic. I am not optimistic that these elite thinkers will have any improvements to recommend.
Even opinions posted on YouTube reacting to this video was not just divided but all over the place. Opinions all over the place, but no direction or consensus.
Beyond this demonstrandum, we have the teaching virologist at Columbia and at YouTube who hosts the podcast TWiV — This Week in Virology, Vincent Rac…ello [Italian name I cant remember, sorry].
He clearly reads the NYTimes and echoes the Left’s demand for Strong Leadership! We Need Strong Leadership! Trump failure….
Except I cannot recall this in the histories of past epidemics, heroic leaders? Strong leaders? I only recall Salk and Sabin vaccines with polio, medical scientists became the heroes. Not politicians.
I don’t think our experts are capable leaders in pandemics; they may be deluded by their own wishful rhetoric.
Neo summarises the absence of evidence for masks and social distancing.
True, but there is some hard evidence. And I was posting this link in May at many places for the many doubters, demonstrating microdroplets: the aerosolation of mucusol droplets through which we definitely know Covid-19 spreads.
If this slow motion graphic visualisation is not compelling evidence of the problem in viral transmission, what would be? from Japanese TV
https://www.youtube.com/watch?v=_BnECQbdjPg
Just this week, a staff member caring for the infected and quarantined to hotel in Auckland, New Zealand contracted Covid-19 by using a hotel elevator after a subject exited the lift.
What to do? Ventilation, open windows, masks.