Thread by @eatcookwrite

DIFFICULT CONCEPTS OF COVID-19 PANDEMIC RESPONSE

1. TRANSMISSION
It's all about transmission. Especially for lower risk citizens, it's not as much about whether catching the virus puts you at serious risk ...

... it's about whether you are helping to multiply it in the population and putting lots more high-risk people in harm's way.

2. EXPONENTIAL GROWTH
Starting with a small number, doubling each week or so doesn't seem like that big a deal. 2—> 4 —> 8 ––> 16.
That's not too scary a month.

Let's let 3 months go by and check back in. 139,072—> 262,144 —> 524,288 —> 1,048,576.

Whoops, now we're at a million and the next month looks a lot like just 4 months ago, but with 6 more zeroes. 2M—> 4M —> 8M —> 16Million.

If only we'd done something back when we had 2 or 4 cases so that we weren't doubling every week or so.

3. SOCIAL DISTANCING

Exponents work both ways. If we can slow the rate of transmission, the earlier the better, we end up in radically different places.

4. LONG FUSE

This virus has a 'long fuse' (and Americans have a short attention span). It can take as long as two weeks after contracting the virus to show symptoms — during which time you are spreading the virus —

... and it can take another two weeks to go from showing symptoms to being in critical condition. So while Mardi Gras left Bourbon Street a month ago, it's just showing up at the hospitals now.

This means regions can be in deep crisis well before the 911 calls start coming in. This breeds a complacency we can't afford.

5. MILD. YOU KEEP USING THAT WORD. I DO NOT THINK IT MEANS WHAT YOU THINK IT MEANS.

The technical designation 'mild case' refers to cases that don't require hospitalization. They can include cases that develop into pneumonia and leave permanent scarring on the lungs.

Even cases that go don't get as bad as that can be quite harrowing and taxing on a family.

nytimes.com/2020/03/24/mag…

We keep acting like only the cases that result in death are grave. That's not the case.

We also tend to act like 'low risk' = 'immune'. There have been young and seemingly healthy citizens, even children who have died from the virus.

6. TIPPING POINTS AND CASCADING EFFECTS

The point of all the talk of 'flattening the curve' is to reduce the RATE at which people require hospitalization. It's the difference between a mob showing up and a long line in orderly single file.

Because we still don't have adequate testing capacity, every patient is treated as infectious and require full Personal Protective Equipment for each encounter with medical staff. So we have burned through our stocks of PPE ...

... That puts medical staff at risk. Medical staff starts getting sick. Now we have a shortage of PPE AND a shortage of medical staff.

Likewise, meds that are useful for COVID-19 are being rationed and denied to people who need them for other ailments. In turn, people start trying to hoard those meds leading to deeper shortages.

buzzfeednews.com/article/tanyac…

7. PUBLIC HEALTH IS NOT A MORALITY PLAY

Successful public health systems don't work by assigning blame or worrying very much about moral hazard. (nor is the macro-economy a morality play, but that's a related but different discussion)

They just try to make good health outcomes the default by shaping the environment that individuals operate in to make it harder for faulty individuals to fuck up and easier to succeed.

But we love to moralize and assign blame to faulty individuals. That's not helpful in public health (except for holding public officials and our leaders responsible for failures of policy and inaction).

Related to this, personal responsibility is less important in a pandemic than social solidarity.

That's hard for a lot of Americans to wrap their heads around and we are currently asking a lot of social solidarity from people who the United States doesn't usually offer much social solidarity.

We are asking a lot of young, healthy low-income workers to stay home from work at a real sacrifice on their part. But the US is the stingiest nation among our peers towards low-income citizens. That's made responding to the crisis harder and a lot less fair.

8. IF WE DO THIS RIGHT IT SHOULD FEEL LIKE A BIG WASTE IN THE END

For communities that get an early start in taking the crisis seriously, the whole thing should end up FEELING like a big nothingburger for a lot of disruption, sacrifice, and suffering.

This creates really bad incentives for elected officials. The public will 'understand' better why they have to make sacrifices if the crisis starts to have serious consequences in their community. That is, it will be more intuitive if they wait until it's too late.

But if they get out ahead and have far fewer cases, few mortalities, and lower rate of infection that is easily dealt with by their local healthcare system, ...

... then all the rigamarole of social distancing, home isolation, shutting down businesses, etc. will seem like overkill in retrospect.

That won’t actually be the case. The reason why there will have been so little drama in terms of infections will have been because of the dramatic preventative actions that were taken.

But for politicians, it could be better to let the crisis build before taking action and get credit for addressing something that people felt concretely, ...

... while the politician who acts early and decisively could be punished for crying wolf and unnecessarily disrupting people’s lives.

WRAPPING UP
These are concepts that can be counter-intuitive or opaque that I see people struggling with. Sometimes in not taking this seriously enough, sometimes to buttress outright denial.

If you have people around you hitting these stumbling blocks, I hope this thread offered a little clarification that you can pass on.

Stay safe and wash your damn hands!