What has the COVID-19 virus made you realize?
- Different countries have had wildly different rates of success in containing the epidemic. It is apparent that early, strong action to contain the spread of the virus, along with a culture of civil obedience, are extremely impactful.
- Public health agencies around the world need to be funded adequately enough to plan in advance for what to do when a pandemic strikes. What we saw instead was that, although some countries responded more decisively than others, no one was truly ready. We saw various leaders drag their feet, deny that there was an issue, minimize the gravity of the situation, and then adopt inadequate measures. All this would have been less likely if there had been more preparation.
- For instance, how do we determine what the actual fatality rate is? In the beginning of epidemics, fatality rates commonly appear high, because the people most likely to be tested are the most gravely ill. But if we’re going to use data on the fatality or hospitalization rate, we need to know what I will call the serepositive fatality and hospitalization rates. That is, what percentage of all people infected by the virus actually need hospitalization?
- We also need to have specific metrics for how and when we decide how much physical distancing to impose, and when those restrictions are to be lifted. The earlier we make those decisions, the more rational they are likely to be. But when we wait until after a pandemic as already started, the risks of overreacting or underreacting are much higher. Perhaps there are clear answers. I haven’t seen them. It appears to me that there is much too much winging it for my tastes, at least in the US.
- People really love conspiracy theories and explanations reinforce pre-existing biases. The idea that viruses mutate all the time and that some mutations are bound to be much more virulent and dangerous than others is deeply unsatisfying. A culprit must be found. It must be that someone was developing this virus for biological warfare. If you’re American, that someone is China. If you’re Chinese, that someone is the US. If you don’t like Chinese people, but overt racism is no longer Kosher, the virus must have spread because Chinese people have unhygienic habits and eat bats. If you’re anti-government, the pandemic—or the response to it—is a hoax to enable the government to encroach on your liberties.
- The Republican Party in the US is apparently not opposed to passing a stimulus to support the economy, as long as there is a Republican in the White House and an election they stand to otherwise lose. Interesting. Very interesting. Good thing the Democratic Party actually believes in governing rather than using crises as an opportunity to obstruct governance and blame the party in power for any calamity that befalls the nation.
- Panicked people are very poor decision makers. They are often more interested in finding comfort than in finding accurate information. In such environments, it’s easy for charlatanism and misinformation to spread. A few days ago, I had walked more than 5 miles and I was too tired to walk home. So I took a Lyft. My driver was convinced he had a sure way of avoiding the virus, because he watched some videos on YouTube and was now an expert on virology. I didn’t have the heart to tell him his theories were nonsensical. I didn’t mention that I was a doctor. I told him I would look it up to end the conversation, and at that point, we were already at my destination, so I left. Maybe I should have argued with him. But I didn’t think I was going to convince him. So I didn’t bother trying.
- Sometimes an idiot or an inarticulate person makes a pronouncement that is easy to ridicule but nonetheless contains some wisdom. This crisis has shown the limits of internationalism. Had you told me 18 months ago that Donald Trump had said that we needed to make sure we were manufacturing drugs and hospital supplies at home rather than in China, I would have rolled my eyes. It would have been impossible for him to present the argument cogently or without some racist or nationalistic attack against China. He would have sounded like he had just heard something from some commentator on Fox News, which he was just regurgitating in his 4th-grade-level vocabulary, without being able to explain the intellectual underpinnings of the argument. And yet, the argument would have been sound at its root. The underlying assumption of internationalism is that we are all stronger when we cooperate. Faced with a pandemic, governments were in theory supposed to coordinate their responses, and to be as concerned with sick people outside their borders as they were with the health of their own denizens, if for nothing else because of enlightened self-interest. But in practice, it was everyone for themself. Borders were closed more to keep others out than because anyone was concerned about global public health. Countries found themselves competing for masks and ventilators. Many Western nations realized just how vulnerable their supply chains were. No one wants a war with China, a powerful nuclear-armed nation with an economy that will soon surpass that of the US. But it’s not inconceivable that at some point in the next few decades, there could at least be a full scale trade war. A lot of countries are realizing that there is a strategic benefit to being able to fully control your own access to certain goods, even at the cost of higher prices. I expect more countries to move to reassert control over the access of such strategic goods as pharmaceuticals and medical equipment in the years to come.
