Thread by @yaneerbaryam

No Surrender - Where There's a Will There's a Way

@TheWHN

@smbilodeau @CecPhil @M_F_Schneider Sunil K Raina @DrEricDing @nntaleb @ShutiChiou

JAMA released Comment on:
A National Strategy for ... COVID
jamanetwork.com/journals/jama/…

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Emanuel, Osterholm, Gounder (EOG) propose that, in contrast to a zero COVID policy, we surrender to the pandemic, setting an acceptable level of deaths as policy success.

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In an accompanying article Michales, Emanuel, and Bright propose this can be achieved by improved vaccination, testing, surveillance, masking, ventilation and distancing.

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Preventing exponential growth is key to any control strategy, including EOG’s. There is no “level control”— the control variable is growth rate R. Staying at a given level requires R=1, and if we can keep R=1 we can equally set R a bit lower and go down to any level we choose.
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A surge mentality might reduce impact of variants or seasons. However, once that can be achieved, it is not only possible to reach elimination, it is easier, just as fire control is easier when smaller. Easiest by far is elimination, even if new fires arise from time to time.
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EOG may have the misconception that there is a tradeoff with economic costs or individual freedom, debunked by economists widely, including those of IMF

1] elimination, not mitigation, creates best outcomes for health, the economy and civil liberties doi.org/10.1016/S0140-…
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2] The Zero Covid strategy continues to protect people, economies and freedoms more effectively institutmolinari.org/wp-content/upl… 

3] Chapter 2: Dissecting the Economic Effects imf.org/en/Publication… 

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Economic losses are higher and freedom restrictions more severe due to the need to eventually control a conflagration rather than relying primarily on contact tracing for a limited number of local outbreaks.

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Indeed, states in Australia that abandoned elimination aren’t returning to pre-pandemic mobility (Capital territory -27% in Q4, Victoria -20%, New South Wales -19%) measured by Google mobility data (Workplace % change from early 2020).

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Deaths are up and mobility is down. They are losing on all fronts. On the contrary, where elimination continued to be the goal, mobilities in Q4 had a slight increase (+2% Northern Territory or Queensland vs 5 weeks in early 2020) or a slight decrease (-3% South Australia).

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Also missing from their considerations is accumulation of long covid over time, with widespread loss of normal life, organ damage, and disability.

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Or perhaps EOG are fatalistic about elimination. Despite the rapid transmission of Omicron, the recommendations they make—a surveillance system with widely available testing—are sufficient. Testing four times a week with self-isolation is enough.

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Even better would be twice daily saliva tests leading to a more rapid decline than Omicron’s growth. Combining this with other mentioned methods—N95/KN95 masks, distancing, ventilation—would make this even easier.

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We are proposing the same actions, but with a different goal: more ambitious, more compassionate, and more, rather than less, feasible—and a strategy for this pandemic and the next one.

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Not everyone may participate, but all-in participation is unnecessary for success, which is not guaranteed. Still, this is a robust strategy. Even if not all goals are reached, striving for elimination is the path paved with greater success along the way.

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Where there is a will, there is a way.

We cannot surrender to COVID. A level of “acceptable deaths” is a euphemism for saying it is acceptable that immunocompromised people and those with risk factors that make them vulnerable to severe disease can die.

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One more critique: EOG say Covid is a respiratory disease, it isn’t really. I think it will become recognized as a vascular (blood vessel) disease. Direct access to blood vessels in lungs makes it appear respiratory. The ACE2 receptor regulates blood pressure everywhere.

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