How the Epidemic Reaction Could Have Been Handled Better

It is obviously easy to be critical of actions in hindsight, but it is also important to conduct such post-mortems to understand how to avoid similar mistakes in the future.  Many companies now conduct “pre-mortems” with the intent of saying, “if this action goes wrong, why will it go wrong.”  Such exercises can help identify flawed assumptions or potential problems that could be avoided by changing course.  Nothing of the kind happened in regard to this epidemic.  Instead we saw a classic herd mentality response, without any gathering of important and relevant information.

A more measured, and ultimately far less damaging approach, would have been for the public health “experts” to recall their basic epidemiology.  Here, for example, right in the first part of chapter 1 of Gordis Epidemiology, a common textbook, we find the following:  “Why does a disease develop in some people and not in others? … Each of us has certain characteristics that predispose us to, or protect us against, a variety of different diseases.”  And right at the start of chapter 2, in discussing the dynamics of disease transmission, is found  “Human susceptibility is determined by a variety of factors including genetic background and behavioral, nutritional, and immunological characteristics.”

Apparently, no consideration was given to these basic precepts.  Even though it was apparent in China, and had been reported, that the elderly appeared especially susceptible, and that some people, especially younger ones, did not become infected even when another member of the household was, the modeling did not account for this possibility at all.  And anyone with any background in infectious disease had to be aware of the variation in influenza strains and the possibility of cross-reactive immune defenses.  It would have been easy and sensible to explore these possibilities early on by a quick study of such cross-reactivity, which would have been informative both in regard to extent of spread and seriousness of disease.  The same studies that are being done now, could have been conducted then.  And those studies are confirming that in fact, large numbers of people don’t get infected and the vast majority of those infected have no or mild illness.

And since it was also apparent that the elderly, especially in congregate care living settings were especially vulnerable (remember the first outbreak in the US was in a nursing home), it might have been prudent to be more measured in the initial response, to focus on protection of the elderly, while encouraging the rest of the population to be more vigilant in hygiene, testing, quarantining and other basic spread preventing tactics.

What sources of data should be relied on?  To trust case numbers, death numbers and hospitalization and death rates from China and to use them as a basis for modeling was unbelievably naive and ultimately stupid.  To not even mention that the data might be untrustworthy and present alternative scenarios is simply unforgivable.  And for politicians, to just blindly accept the results of these models and the advice of public health experts is unfathomable.

The consequences could not be higher.  The actions taken have caused unprecedented and massive damage to the economy, to jobs, and to people’s health.  How could we should down an economy cause serious harm to the health system and to health, on such sketchy data and so little analysis of those harms.  Every politician who participated in these actions should be held accountable, and so should the supposed experts who provided the wrong and worthless data and opinions.