Doing a Postmortem on the Pandemic

I ran across an interesting piece by Matthew Yglesias, What I got wrong about Covid - by Matthew Yglesias (slowboring.com).  It sparked an examination of what we did right, and what we did wrong, during the pandemic. Covid isn't over yet, but we are past what we would call the pandemic phase.

From the article:

"The SARS-CoV-2 pandemic left a lot of obvious scars on the country — death, Long Covid cases, lost jobs, shuttered businesses, and the loss of valuable learning time in school..."

Yglesias said, "My goal in this piece is to recount the evolution of my own thinking in an honest way, reflecting on what I think I got right and on my current retroactive view of things, but also owning up to the fact that, like most people, I was making assessments in real-time with imperfect information and minimal experience. In other words, what I got wrong...As the events of February 2020 played out, it became clear to me that the pandemic was going to go global (the correct call) and my view was that basically nothing would be done to halt it (incorrect)."

"I thought the pandemic would play out essentially as it did in March of 2020. The virus was spreading rapidly in the tri-state area and as governors there imposed heavy restrictions, many of the region’s more skeptical residents departed for Florida. Ron DeSantis responded by trying to impose mandatory quarantines to prevent northern transplants from spreading the virus locally."

"...My thought was that during the peak of the crisis, it might be important to shut ourselves up at home for a while, so I went to Costco to stockpile stuff — dried pasta, jars of Rao’s, frozen vegetables, canned beans, over the counter medicine, first-aid supplies (including surgical masks), bottles of water and purification tablets, batteries, and everything else we’d need to ride out a disaster....Meanwhile, I was waiting to ride out an inevitable crisis because I didn’t expect any policy response at all."

"...It was soon after this that I learned about the idea of flattening the curve.

The idea — which I think is still underrated — is essentially harm reduction for pandemics. The point is that while there probably isn’t a cost-effective way to prevent a new disease from coming to your city, you can avoid the crisis situation I was worried about and make sure that everyone who’s sick gets treated.  The way you achieve this, to quote a March 10 Vox graphic, is by trying to impose enough restrictions on activity to slow the spread of the virus and distribute the caseload over time. This ensures that everyone who needs treatment gets treatment and prevents the infection fatality rate from soaring."

"My worst call of the year, though, came about six weeks after that piece ran when I got a bad case of Taiwan envy and called for the United States to try to emulate Asian-style total suppression of the virus."

I think that if you read the specific arguments of that piece, it sort of makes sense. I was saying, basically, that a super-intense total suppression lockdown could be relatively brief and then allow more freedom (as well as more lives saved) than a prolonged period of curve-flattening. But it was totally detached from political reality. Not only was the consensus in favor of pandemic-halting action already breaking down in conservative areas, but progressives would never in a million years license things like cops kicking in doors to bust up illegal house parties.

I pretty soon started writing more pragmatic pieces about how we should reopen parks and encourage people to do stuff outside (April 30) and make reopening schools in the fall of 2020 a top priority in our social and economic planning (May 28)....

...But what I never did while I was still at Vox was write clearly about how, in practice, that all meant giving up on suppression and returning to curve-flattening as a standard."

"....Once vaccines were approved in November 2020, I think I consistently had the correct high-level view:  

• "It made sense to be very cautious in your personal behavior until you could get the vaccine.  

• "It made sense to have a simple prioritization scheme for scarce doses — give it to old people — so as to maximize benefits.  

• "Vaccination reduced society-level vulnerability so much that it made sense to lift all restrictions once the shots were widely available.

• "In curve-flattening terms, the point was that a highly vaccinated population was just extremely unlikely to develop crisis-level case volumes. The benefits of non-pharmaceutical interventions became much lower, while the costs remained high.

• I was very frustrated, intellectually and emotionally, with school closures. I argued against closing schools before the vaccines were available, but had lost that argument internally to the politics of blue states. I wanted vaccination to be the game-changer that ended NPIs, so I expressed erroneous overconfidence about the vaccines’ ability to block transmission. And because I overestimated vaccines’ ability to block transmission, I overestimated the case on the merits for mandatory and quasi-mandatory means to promote vaccination. A lot of conservatives see arguments for vaccine mandates as an example of Covid hawk extremism, but I think a lot of us embraced them as an alternative to Covid hawk extremism."

• ....But factually, though the vaccines are very useful, their impact on transmission (especially post-Delta) was limited. Mandates turned vaccination into a wedge issue that advantaged Republicans rather than Democrats.

• "... looking back on it, I think the best course of action for the United States was the one embedded in that March 10 Vox article about curve-flattening. I really think it’s worth everyone’s time to revisit commentary from that early March 2020 era, because it’s strikingly different from what eventually emerged out of a very polarized debate. There’s no dismissal or denialism of the severity of the virus in the piece, none of Trump’s false assurances and none of the biting mockery of people for being concerned about it. But relative to what would later become the Covid hawk position, it’s incredibly moderate."

• "...From a US standpoint, you want to prevent any place from becoming the next Wuhan,” said Tom Frieden, who led the CDC under President Barack Obama. “What that means is even if we’re not able to prevent widespread transmission, we want to prevent explosive transmission and anything that overwhelms the health care system.”

• "...Importantly, the reason public health professionals converged on this curve-flattening idea in early March 2020 is that it’s what the pandemic response playbook written in the period between 9/11 and the swine flu scare of 2009 said we should do. Most of us did not pay a lot of attention to that pandemic planning work, but it resulted in some pretty good ideas and we should have stuck with them. I’m not 100% sure why we didn’t. ...But my best broad guess is that two factors drove the dysfunctional response. One is that Trump is an undisciplined guy whose go-to political move is driving polarization rather than consensus. The other is that social media totally wrecked America’s epistemic institutions....In the media, the number one constituency for clicking on and sharing Covid-related articles was the most neurotic super-doves, and the number two was nut-job conspiracy theorists."

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• A few personal notes; for us, at least, the strategy of mask wearing, getting vaccinated and boosted, and being cautious about exposure worked.  We eventually did get Covid in December of 2022.  But by that time it was the less dangerous Omicron version, and the antiviral Paxlovid was available if you were part of a vulnerable demographic, which we were, since we were over 65. 

• Even though our governor had not always made the best decisions, he stuck with the strategy of curve flattening to avoid overwhelming the medical system.  It wasn't perfect, but it got our state through the worst of the pandemic.

• I think as a society we need to let go of the idea that there was any perfect solution to this virulently contagious virus. What we should do is learn from it, in order to apply the lessons to the future.  This is something that perhaps AI could help with, to make sense of all the data, and develop strategies to deal with future virus breakouts to hopefully avoid a pandemic situation.
  

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