Pandemic Wish List – 2020 Hindsight Edition

As every regular reader knows, I’m not a medical expert of any sort. However, I’ve done a ton of research this year and learned more about epidemiology and virology than I thought I’d be capable of at my age. With that in mind, here’s my list of things that I hope are really different when the next pandemic rolls around. “When,” because “if” isn’t an option. There will be another worldwide pandemic, and perhaps even much worse than this one.

1. Cooperate with, and improve, worldwide health organizations

Withdrawal from the W.H.O. at the start of the pandemic was one of the most foolish decisions made. It’s a cliche that viruses don’t care about international borders. They must be fought on a global scale. Of course there are reforms to fight for. For example, there should be some mechanism to dissuade recalcitrant local officials from fudging data — whether they’re lower level Communist Party cadre in Wuhan or governors in Florida or Georgia. I realize this is a “pie in the sky” wish, but it’s something we can at least aspire to.

2. Establish a “Pandemic Steering Group” that can’t be eliminated

Before the pandemic started, Trump fired the entire pandemic response team to “cut costs.” I believe we need a pandemic response team that is impervious to presidential whims. For a model of this, take a look at the vaccine approval process with the FDA. In particular, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) plays a critical role in vaccine approval and is fairly well protected from political manipulation.

3. Mobilize national resources at the initial onset of a pandemic

What do the countries that successfully contained the pandemic have in common? They all wasted no time in attacking the virus very aggressively with testing, tracing, and isolation. They enacted public health measures with teeth to make sure the measures weren’t ignored. I realize this will be difficult in the U.S., but it sure is a lot easier and cheaper than spending trillions of dollars to fix a shattered economy.

4. Institute totally transparent national data collection and definition standards

One of the reasons my posts became popular is that in many cases there was neither transparency nor consistency. There were various definitions of what a “case” was. There were silly arguments over what a “COVID death” meant. Some states, like Florida and Georgia, intentionally obfuscated their data. Testing data in some cases only meant PCR tests on unique individuals; in other cases meant tests as a whole, including individuals who had been tested multiple times; in other cases, test data included diagnostic as well as serological tests.

5. Do extensive randomized population testing and genetic sequencing

One of the first principles of a good dataset is to get a decent random sample of the population. When samples are self-selected, you run into problems with interpretation. For many months, testing was limited to those who felt symptoms. This not only excluded asymptomatic and presymptomatic carriers of the disease, but also made it impossible to ascertain how widespread the virus was.

As for genetic sequencing, there are vast differences between a country like England, where there’s lots of sequencing, and the U.S., where there’s very little. Some people speculate that it’s perfectly possible that the new variant discovered in England could have actually started in the U.S. We will never know that, because of the dearth of sequencing. This is needed not just for improved virological knowledge, but also to understand whether a virus is changing enough to warrant changes in public health measures or vaccines.

6. Establish a national pandemic relief fund

When Social Security started in 1937, the average lifespan was 61 years. More and more people were outliving their working years, only to face a retirement in poverty. Today, about 40% of seniors rely exclusively on Social Security for retirement income. More importantly, seniors were no longer required to work themselves to death just to survive.

If there is no financial support system during a pandemic, people are forced to choose between economic survival and public health. This is a false choice, because it’s impossible to have a vibrant economy when disease is everywhere.

Just as seniors need a guaranteed source of income like Social Security, the nation’s small businesses, employees, gig workers, etc., need financial support in the middle of pandemics. They should not be subject to the power hungry whims of a Senate majority leader or a President more interested in overturning an election than stemming a pandemic.

Yes, a fund like this would have to be paid for over time, just like Social Security. It can be done, though, if we just have the will to do it. Not having a fund like this is like going without home insurance. You hope you never need it, but if you do, you’re not destitute.

7. Strengthen the FDA

COVID has been a woo practitioner’s wet dream. From vitamin cures to hydroxychloroquine, thousands of enterprising businesses have preyed on public ignorance of science to promote quackery. The supplement industry, through extensive lobbying, has prevented the FDA from ensuring the safety and efficacy of its products.

8. Strengthen the public heath care system

One of the reasons we’ve done so poorly as a nation with COVID is our health care system. According to the Organization for Economic Co-operation and Development (OECD), we spend just over $11,000 per capita for healthcare, almost twice the average of $5,500 for other wealthy countries. Belgium, Germany, Sweden, Switzerland, and the Netherlands all spend over $1,000 per person on long term health care, while we spend just over $500 per person. Our administrative costs of $937 per person are around five times the average of $173 per capita for other wealthy countries.

This is a broken system. COVID didn’t break it; it simply exposed its rot.

On a state and local level, we have been stripping funding from public health departments for decades. We have no compunctions about adding to police budgets, but adding to the public health department budget is always a struggle. Again, COVID exposed the fallacy of this policy in sharp relief.

9. Develop a nationwide system of mitigation efforts.

Imagine if we had different colored traffic lights and different shapes for road signs in every state. The result would be chaos. This is what we all experienced during 2020. Sometimes there were even differences from county to county within a state. A “red” zone in one area might represent the most stringent standards; in another, it might mean a relaxation. This sort of confusion engenders distrust of public health measures as a whole. While localities should have a great deal of input into what “tier” they fall into, the tiers should be uniform from state to state.

I’m sure there’s more to add to the list. There’s no doubt we’ll go through a pandemic again. But we don’t have to make it this painful. We didn’t learn much as a nation from the pandemic of 1918. Let’s hope we can learn from 2020.

Happy New Year to all my readers!

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