What Would You Do?

By November 13, 2020Commentary

A housekeeping note–all comments are now sitting and waiting my approval, which I try to do quickly.  I will probably go back to just letting them post without approval once it appears that the ones put up for the sole purpose of calling me an idiot have disappeared.

A followup note on whether changes in the population’s behavior are responsible for the case surge versus seasonal, geographic related factors.  This surge isn’t just occurring in Minnesota, it is occurring widely across the Midwest and Rocky Mountain states and even in some others.  How likely is it that all of sudden in all these states, people just uniformly stopped complying with mitigation measures?

Interesting to go to the Worldometers site and look at the specific graphs for European countries.  What you see is that cases are at a level 5, 10 times or more than in the spring, but deaths have not reached the levels of the spring, in fact in most countries are well below the spring levels.  This is partly a reflection of far more testing, but it does give you a better sense of what the actual case fatality rate for this pathogen is, and it isn’t very high.

The title of this post is a fair question, which I am occasionally asked and I am sure many others are as well.  And it is a timely question given the case surge in many states.  One thing I learned in  my early career as a lawyer (a calling which I hereby renounce, since most politicians appear to be attorneys) and a litigator was that most questions have unstated assumptions in them and that when you answer the question you may be affirming the unstated assumption without meaning to do so.  So I am always very careful to parse questions for those unstated assumptions.  This question has several very large unstated assumptions and a couple of smaller ones.  One of the small ones is that “you” actually means the government.  As individuals we all can, and all have made our varying choices about how to respond to the epidemic, which is a good thing and a reflection of democratic freedom.  And then of course the government imposes limitations on that freedom of choice in how to respond.  And only government, not individuals, can enforce restrictions on freedom, usually in the name of the greater public health good.  So I take the question to mean, if you were in charge of the government response, what would you do.

A bigger unstated assumption is that we should “do” something and an equally big assumption is that whatever we might “do” has on balance a more beneficial than harmful effect on the population as a whole.  And of course the really big assumption is that there is something we can “do” that actually will have an effect on the course of the epidemic, and that effect will be to lessen the morbidity and mortality imposed by CV-19.  Just thinking about all those assumptions mentally wears me out, but then I am old, my neurons are likely full, and they are definitely tired.

I honestly struggle to answer the question, because I don’t think the answer is do nothing, just let it take its course, but I also have difficulty identifying measures that meet that criteria of being more beneficial to the population than harmful.  I believe strongly in the concept of hubris, so I believe that we need to be willing to accept the limitations of human action and not imagine that we can control or fix everything.  Sooner or later a large meteorite is going to hit the earth and there is nothing we can do about that right now.  Other catastrophes are equally likely and out of our control such as the big one hitting California, but Gov. Newsome assures Californians that as long as they are wearing masks, stay in their homes all the time and don’t interact with any other people, they will be fine.  And epidemics happen and will happen.

Any decisions made now also have to deal with all the decisions made since the start of the epidemic and the consequences of those decisions.  From a big picture perspective, it seems to me that we would have been better off to not try to suppress spread to the extent we did, and we certainly  should not have engaged in heavy suppression during the summer months when the environment was less favorable to the virus.  Spread in the summer would naturally have been lower and would have led to fewer transmission targets for the virus now.  Schools should have been opened and run all summer long.  But I understand, to some extent, that at the start of the epidemic people may have been less confident in the relatively non-lethal nature of the pathogen to the general population.  And we now how the benefit of much more science and data about transmission of the virus than we had at the start.

So without meandering too much, what would I recommend now.  One thing the current administration doesn’t get enough credit for is the efforts made to find and improve treatments and care guidelines.  At the start of the epidemic we were killing people by putting them on ventilators; we are much more cautious in their use now. We have some ability to identify patients most likely to develop severe disease.  We have identified some drugs that appear to make a difference in severity and mortality.  We are developing vaccines at a very rapid pace.  So I would continue to place a very heavy emphasis on those efforts–develop risk markers for severe disease, get a good, safe vaccine and get better therapeutics.  I would insist that schools be kept open, the risk to children is low and the damage we are doing to their development cannot be justified.  We can do the best we can to protect teachers and staff but they may have to accept some risk for the greater good of protecting our children’s development.  Colleges should definitely be open and those students should be kept on campus and allowed to go about their usual activities but confined to the campus space.  That is a large pool of people with very high contact levels with low risk of serious illness.  If they develop high prevalence, that is very protective of the rest of the population.

I think businesses should generally be open, with appropriate mitigation measures, mostly avoid crowding for any length of time.  People can make their own judgments about their comfort level in patronizing public businesses.  What to do about vulnerable populations is trickier.  We are killing the elderly with isolation.  So the best I can come up with for vulnerable populations in congregate care settings–nursing homes, assisted living, behavioral health homes–is to give the patients and their families a choice, and segregate the population accordingly.  Those who want to be able to have visitors and see people can be in one section.  Those who want maximal protection can be in another.

And since I believe in individual freedom, I also believe strongly in the flip side–individual responsibility.  It is incumbent on all of us to especially get tested if we have symptoms or know we have been in close contact with someone who is positive.  If you are positive or have symptoms while awaiting test results, avoid others and stay home.  Follow basic hygiene practices.  Personally, I would avoid crowds with strangers and lots of close contact.  If you have clear risk factors, be extra careful.   Seems like a pretty minimal list of measures, but they can help slow spread, at low cost.  All of this is predicated on my perception that there simply is no easy way to stop transmission of this virus.  Really extreme lockdowns, which might slow transmission somewhat more, have an incredibly high cost that I don’t believe can be socially justified.

This is a pretty modest approach, but given the actual risk to the general population, and the harms done by more extreme measures, it is about the best I can come up with.  Always welcome other opinions.

Join the discussion 19 Comments

  • Brenda says:

    I appreciate your science-based analysis & find I do agree with most all of your posts! I just wish you had a larger platform! I am sickened by what Walz is doing to our state, for many reasons, but I also have 3 kids that are paying the highest price for his love of power. Keep telling the truth!

  • Ellen says:

    Case surge? How are they measuring that? I thought the PCR test is generally a fail for proving anything. How do we know President Trump had COVID and not some other microbe going?

  • Peter S. says:

    I came across this study today:

    https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30378-7/fulltext

    Which was interesting for something that wasn’t any part of their hypothesis. The study pulled the medical records of almost 200k Britains who had the ICD codes for covid (U07.1 or U07.2) and who had either Lupus or RA. The point of the study was to see if people on HCQ for reasons other than covid did any better than those not on HCQ (they didn’t).

    But, along the way, they gave the IFR for the two groups: 0.23% for those on HCQ and 0.22% for those not on HCQ. That’s among people with immune diseases.

    This strikes me as the best estimate of IFR to date: 0.23%. That’s a far cry from the Imperial College’s estimate of 1.15%, which is five times higher than the Lupus/RA IFRs from the Lancet.

  • Emmett DeMundi says:

    If the plural of anecdote is data, then the singular of data is anecdote. So here’s mine.

    Back in the spring, when (as far as I know) nobody was sure about the seriousness of Covid-19, I took all the recommended steps. By summertime, I had started to suspect that the risk was exaggerated, but I was still careful. At present, I look at the death rate (low); I look at how Covid-19 fear-mongers ignore the rules that they dictate to everyone else; I look at how the people who have always wanted arbitrary power are gleefully taking it; and I look abroad at places like Taiwan or Sweden that never locked down, and China, which has opened up again. My conclusion: Covid-19 is a real illness that I don’t want to get, but the risk is not large enough for me to stop living and cower inside my home.

    Most of all, I’m fed up with the fear-mongering and the loss of freedom. I’m disgusted by the cowardice with which so many people view a pathogen that is real but hardly among the worst. I’ll continue to take reasonable precautions, but that’s it. I might die of Covid-19, but until I die, I’m going to live. Gavin Newsom et al can kiss my mask.

  • James Alt says:

    This makes sense so that means that any Democratic governor will ignore it.

  • Lee says:

    I found this article today and rather liked it as it was written before COVID, so no judgement there. If viruses can be spread that way, seems difficult to control https://www.sciencedaily.com/releases/2018/02/180206090650.htm
    and then I found this and wondered how the first link could apply
    https://medicalxpress.com/news/2020-11-marine-reveals-asymptomatic-sars-cov-transmission.html

  • Alex says:

    Well. the First thing I’d do is shove a mask up a politicians’s ass.

    I keep hearing virologists say the ‘messaging is off’. But what they mean by that is different from mine. They mean, social engineer people’s habits into the measures currently in place. I personally think they don’t work and come with pernicious effects. Among them, it keeps people in a perpetual state of fear and allowing for Stockholm Syndrome to set in.

    My messaging comes from, in part, from the spirit of Calvin Coolidge. Stay conservatively calm. Lead quietly but be firm and consistent in your message. My message would be make sure to maintain a healthy diet and get some sleep. Exercise. Make sure your immune system is strong. If you have underlying medical issues take whatever guidelines we recommend. Because we’re a free and ostensibly responsible and strong society, we can’t enforce you to do anything against your will because doing so is ILLEGAL if not immoral. It is not the responsibility of the rest of society to protect you at the expense of their lives. Move to protect the vulnerable. Support public health workers any way you can.

    I’d repeat this message.

    I’d stick to the actual data and science. Political machinations, though inevitable, has to be kept at bay. I won’t bend to the demands of people if I feel they’re wrong. For example, masks. They want to wear a mask, go ahead. But I’d state the actual science behind it. People deserve the truth and facts; not what they want to hear.

    I’d remind the population the best way forward is to learn to cope with it. Follow the protocols where necessary. Other than that, there’s not much more we can do lest we lose sense and proportion.

    No lockdowns. Perhaps some temporary surgical shutdowns but none of the open-ended and confused non-scientific stupidity we see in places like NY or closer to home here in Ontario or Quebec.

    I would not tolerate rioting in the streets but shutting down Churches as we’ve seen. This is criminal and thuggish behaviour to do this to people. I’d avoid playing with the mental health of children at all cost. I would explain firmly schools are to remain open and all activities too. Don’t mess with the kids based on the science.

    No masks. Reasonable social distancing. Don’t harass them. The lesson here is to teach them to be calm and be leaders. Not cower before a virus. You shouldn’t be telling people to hide from it. You should be telling them to go on with their lives but be attentive and cautious. ‘Do something’ for its own sake will lead to the cure being worse than the disease and this is the situation now.

    Avoid propaganda and empty jargon. ‘Flatten the curve’. ‘Mask is liberty’. ‘Wear a mask, save a life’. ‘Overwhelm the system’ etc. as well as arbitrary decrees: “Ye shall have no more than (sticks thumb up ass and hoist in the air to judge the wind) 10 – no six persons – within ye homes we now for the good of public health control – temporarily of course!”

    This is pernicious nonsense. I’d assuage people’s concerns about ‘new normals’ and that the goal IS to get back to normal. Guiding people with the vaccine in mind is wrongheaded and potentially leads to false hope and paints you in a corner you won’t be able to get out of. Your framework is to aim towards full normalcy with the vaccine being an added plus. You don’t extort people with ‘if you don’t wear a mask, we lockdown’.

    You NEVER blame the people for spikes or spread. EVER. This promotes distrust and fraying of the social order.

    Tell the media to pipe down.

    You do NOT use coercion and threat of fines. You must carefully weigh civil liberties and the mental health of people with any decision. Using threats and coercion is the last refuge of bullies. Here in Quebec, the Public Safety Minister held a press conference with an armoured police vehicle behind her to use intimidation. It was grotesque and unnecessary. It’s the sign of terrible leaders. The public health boss – a doctor – turned to talking like a cop as opposed to maintaining a medical disposition. Both looked like fools. NEVER treat people like they’re criminals. Never elevate a health threat to one where people perceive one another as a threat. None of their laws are constitutional but mere decrees from false Kings.

    These measures and empty ‘enforcement’ rhetoric are designed to get people to comply lowers morale and elevate mistrust and ill-will.

    Do NOT let medical doctors dictate social and economic policy.

    I’d remind over and over, it is not the right of society to ask one portion or segment to pay for their safety. If a hair salon has to close so too will Wall-Mart. You are either all essential or you’e not; we’re all in this together or not.

    Lead by example. Not by cheap words. It risks patronizing people and reeks of weakness. Never ever never ever prey on people’s fears. Be extremely wise and consider all of public health.

    Leaders right now talk out of their asses and project cowardice. I personally have no respect for them as they hide behind medical bureaucrats.

    In short, I’d avoid the drastic and pathetic actions of New Zealand and Australia and follow closer Sweden (and to a lesser extent Norway) and the Great Barrington Declaration.

    Stay firm. Believe in your decision. But pivot if you must. Be agile and humble enough to shift should the data demand it. There is no justification to lockdown again. It’s foolish to stick to a bad script Great business leaders cut their losses and adjust.

    If your message is clear and you’re honest with the people, they will understand and oblige.

    But what do I know?

    I’m just a man with a dream.

  • Dan says:

    Kevin. It sounds like your advice is to take a positive test result seriously even without symptoms? I seem to have read over and over in your posts that PCR tests are not that accurate? Have studies shown that asymptomatic people are really infectious? Thanks.

  • Kevin Roche says:

    I would advice people who are truly asymptomatic and have a positive test to get a retest because of the possibility that they are positive but asymptomatic. While there are significant numbers of false positives and low positives in a low prevalence environment, there are also true positives. I don’t think most of us would want to potentially expose family, friends, co-workers if we were truly positive.

  • SteveD says:

    This strikes me as the best estimate of IFR to date: 0.23%.

    The ages and disease percentages look high. Since they were testing only people with rheumatoid arthritis or systemic lupus erythematosus, that might mean their IFR is higher than in the general population.

  • SteveD says:

    ‘If viruses can be spread that way, seems difficult to control’

    The question is whether any proposed mechanism of viral spread can deliver the necessary viral loads to cause 1) an infection or 2) an infection serious enough to cause sickness.

  • Rob says:

    The damage began decades ago when many states instituted Certificate Of Need laws in order to restrict the number of hospitals and nursing homes.

    Limiting supply creates shortages which create crowding. When a virus pandemic hits a crowd of 3000 people at a concert is not a problem but 200 people in a crowded LTC is a huge problem. The difference in ages should be obvious. But also the spread at a concert is minimal because the infectious people are only there for a few hours, the spread at a nursing home is maximal because the infectious people are together 24/7 (in poorly ventilated areas). Limit the number of nursing homes and you increase the crowding at most of them.

    The question should not be what would you have done differently in the past. The question should be what are we going to do differently starting now? The answer appears to be “double-down on ideas that have already failed”. Because the authorities never admit they made mistakes, they attribute all of their failures to taxes being too low.

  • Dave Nelson says:

    Thanks for your updates Kevin! Sensible recommendations – especially about schools. Keep it up!

  • Chris W says:

    Well said, Kevin and I’m with Emmett DeMundi. I’m really sick of all of this. We take measured risks every day in everything we do and act accordingly. Let us get back to having that personal freedom.

    One huge impediment to getting back to “normal” is the constant fear mongering. Government, media, and big tech have pushed “us” to the edge with fear through misinformation, information suppression and one-sided reporting. Talking people off that edge at this point is no small task, and I see no reason for the aforementioned to change their message. Anecdotal case in point of the edge: A well-educated, perfectly healthy, 40 year-old coworker who flies single engine planes and powered parachutes as a hobby told me he was foregoing haircuts until C19 was over because it wasn’t worth risking his life every 6 weeks to get one. Unbelievable!

Leave a comment