Wed. Sep 28th, 2022
Image of President Trump gesturing during a press conference.
enlarge To call the government’s response to the pandemic unstable would be an understatement.

In difficult and terrifying times, it is normal for a degree of confusion and misinformation to spread. The existence of social media and partisan “news” channels no doubt exacerbates the problem, but even those are just exaggerated versions of things that have been with us for a while.

But two things make the deluge of misinformation about the coronavirus clear. The first is simple: Much of the misinformation starts at the top, where President Donald Trump seems willing to say whatever comes to his mind when he stands in front of a microphone.

But the second is trickier: Unlike a national disaster or terrorist attack, we don’t have models for how long the coronavirus pandemic will last or how we’ll recover from it. There’s no “we’ll rebuild it” mentality that people can use to understand what’s going to happen and steer their expectations.

Here’s how we can make one.

No miracle cures

There are many really promising leads for possible treatments that could reduce the impact of the coronavirus on those infected. While many of these involve screening or developing new chemicals and thus take months, others involve testing drugs already approved for human use. Many of these tests are just shots in the dark — chemical X inhibits a protein from an unrelated virus, so maybe it’s blocking a protein coronavirus uses. But several drugs have solid biological justifications.

The good news is that many of the tests are being conducted by private companies and taking place in other countries, freeing them from the chaotic US response to the pandemic. Even within the United States, much of the effort is being coordinated by agencies like the FDA and NIH, which have largely been able to do their own thing during the period when official US policy seemed to reject the threat of the virus. As a result, we are already getting some preliminary results back from small trials.

But these trials are still so small that the results are no more than an anecdote. Many, including President Trump himself, are enthusiastic about the early results of using chloroquine, a drug originally developed for malaria. Still, a more recent trial now shows that chloroquine is no better than doing nothing. So what’s right? Combined, these two studies involved barely more than 100 people—not enough to tell us anything useful.

Still, the president has gone on television to tell everyone how excited he is about the drug. And that has had consequences. Chloroquine and its derivatives are standard treatments for things like malaria and lupus, and now they’re in short supply because people — doctors included — panic buying and hoarding. Unfortunately, chloroquine is also very dosable and the side effects have already proved fatal here and abroad.

Meanwhile, medical experts within the US government must spend time pointing out that we don’t really know if these drugs work. Not only is that confusing to the public, but it also means that expert authorities like Dr. Anthony Fauci, who has served in the US administration since Ronald Reagan’s presidency, could become unemployed.

For now, talking about specific treatments must stop. It will be months before we know if something is really safe and effective.

It’s hard to restart an economy during a pandemic

The US government’s public response to the pandemic has been to downplay its significance. Several statements by Trump have suggested that the problem could go away on its own once the weather warms. Then the coronavirus was declared an emergency, beginning a brief period in which the pandemic was taken seriously. But torn between grim news of skyrocketing infections and a collapsing economy, Trump is already pushing for limiting isolation, restarting businesses where people interact and pushing the US economy back to something near normal.

But during a pandemic like this, there is no such thing as a normal economy.

By now everyone in government should know that easing restrictions will result in an increase in the infection rate, making what is happening in New York City look like a warm-up. There are two ways to look at this, and we’ll do both.

The first way is for people to look at the death rate from the virus so far, as well as the high-risk populations, and suggest that it isn’t too much of a sacrifice to let some people die. (The Texas lieutenant governor has embraced the possibility.) But the whole point of the epidemiological studies that have been done is that the infection will exceed our ability to care for someone with the disease — so that people who might otherwise survive, will die from lack of medical care. This means that more people outside the risk group will die and that the death rate directly attributable to the corona virus is rising.

Such a course also means that anyone who needs critical care for other reasons may not receive it, so there will be many deaths that are not directly attributable to the virus, but are caused by it. Trying to facilitate normal economic activity will also increase the number of people who need critical care because of the risks of daily activities: car accidents, accidents at work, and so on. Easing restrictions thus risks a death rate higher than the worst-reported death rate for the virus — which is why public health experts are vehemently against it.

In addition to fatalities, there are major economic risks. What happens if the virus rages through the staff of a nuclear power plant and the plant has to be shut down? What about the people who run public transport? These kinds of problems will flow through the economy. Our reliance on interdependent supply chains means that a single company shutting down due to widespread infections can have consequences far beyond that company.

On an individual level, withdrawing these restrictions will force each company to make decisions about whether or not to resume normal operations, and each company will likely come to a different decision. With every sniff, each employee must also make decisions about things like whether they can put a high-risk family member or the rest of their office at risk, or whether they’re feeling normal seasonal allergies. Many employees will make the wrong decision.

That is why even economists say we will face chaos and economic disruption even if social distancing and shelter were to end.

We have no testing policy

One good news amid this mess is the rapid expansion of testing for the virus. The bad news is that the expansion took hold almost immediately against a rapidly growing infected population (more than 50,000 cases confirmed in the United States at the time of writing) and a shortage of raw materials for the tests.

Despite the shortfall, there is evidence that the rich and powerful, e.g. NBA players, have managed to get tested despite not meeting the recommended criteria for using these tests. And the federal actions that allowed for more testing have also given us a patchwork of local regulations for using this still scarce resource.

Who gets tested when may seem like a secondary issue, but it is central to the issue of restarting the economy. Countries that have managed to quickly restart their economies or mitigate the disruptions have done so because they have tested strategically: to identify new cases and then to monitor all those who may have been exposed through newly diagnosed individuals.

This is or should be the end point of the severe restrictions many states now impose: new infections are limited enough and testing capacity is high enough to control the problems caused by each newly identified infection. We’re nowhere near this point, but without a national testing policy, we’ll never get there, even if shelter makes it an option.

We need a plan – and some clearly marked lanes

The fact that there is a potential way to end severe disability before a treatment or vaccine is administered is likely news to people. After all, nobody has bothered to explain to the public what our options are and what the risks are.

Trump’s press conferences on the subject were messy, ad hoc affairs with no clear structure. In addition to producing statements to be corrected by medical experts, Trump has announced programs that were closer to half-baked ideas and seemed to surprise the companies involved. If we have a broad plan that reflects our actual options — and to be clear, we could if we wanted to — it hasn’t been communicated by someone in charge.

Having and communicating a plan is critical to any public crisis like this. But it’s especially important for a crisis with no real antecedent in more than a century. The most obvious model for a pandemic like this is the 1918 flu, which happened decades before we even confirmed DNA to carry genetic information and when the economy and travel were far from globalized. So the public doesn’t know what to expect. That’s in stark contrast to things like natural disasters, where we have a lot of previous examples, so a recovery framework doesn’t have to be provided to the public.

In the absence of a clear national plan, governors have been able to make decisions about how to handle the crisis that have varied widely in quality to say the least. And the public has responded to the leadership vacuum with confusion and uncertainty.

With a plan in place, anyone communicating aspects of it will have a simple role: stay in their jobs. Anyone who is not a medical expert should not communicate anything about the prospects for treatments, a vaccine or the capacity of a hospital system. At the same time, medical experts are not allowed to promote specific policy decisions. Policymakers must weigh matters beyond a physician’s expertise, including deciding whether lives are worth the price it takes to save them.

Anyone involved in public communication must recognize the limits of their expertise.

A reality-based plan, clearly communicated by people who understand it, will help the public understand three things: what sacrifices are to be made, what will we get in return, and most importantly, how these sacrifices will be made to an end. Tragically, almost three months after this growing crisis, we still do not have such clear communication from our leaders.

By akfire1

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