Sunday, March 29, 2020

Trump pandemic plan wins very guarded support

Two Johns Hopkins University experts yesterday backed an approach to curbing the Covid-19 epidemic that has been outlined in a White House plan sent to the nation's governors without in any way endorsing President Trump's public statements.

Last week, Trump sent governors a letter outlining a plan to use Big Data methods to rope off contagious individuals in areas that had not flared into hot zones, though the press has not followed up on that letter.

Trump backs Big Data method, eased social distancing
https://invisiblepaul.blogspot.com/2020/03/trump-favors-targeting-of-hot-spots.html

Dr. Thomas Inglesby and Dr. Amesh Adalja said that once massive testing is up and running, and other actions are taken, public health authorities will be able to use traditional track and trace methods to curb contagion in areas that have not become hot zones. Neither expert would commit to a target date as to when the virus would be brought under control. The two university experts appeared to disagree on the necessity of continuing draconian shutdowns.

But Adalia, an infectious disease expert, said that with an experimental vaccine in its initial trial and with experimental antiviral drugs coming into play, there is a good chance of getting ahead of the virus. He said that, because the virus will not strike everywhere simultaneously, many areas still have time to prepare by deploying widespread testing and track and trace methods of isolating and treating infected persons.

Adalia saw a "false alternative" in a "Wuhan-style lockdown" versus an out-of-control virus. Even so, he said, the United States had lost its chance of clamping a lid on the virus because Congress had let public health funding erode, meaning insufficient testing available at a critical time period. The doctor also said the virus had very likely been infecting people in China back in November with light cases, before much was known, which were then brought to America.

Adalia also pointed out that U.S. testing was mishandled because people with mild symptoms were not being tested, meaning they were unwittingly spreading the virus. On the other hand, because of a shortage of test kits, officials initially limited tests to those with severe symptoms.

"So it's going to not be simultaneous," Adalja said. "So you may be spared in the first part of this wave of maybe later on you may get more, more cases. And it's important that you prepare in that time. And you set up processes to be able to detect these cases, isolate them and prepare your hospitals while you have time in some of the smaller cities."

"We're going to see cases in every city and every location around the country. This is a community-spreading respiratory virus and it's going to reach all the corners of this country," Adalja said yesterday. "That being said, it doesn't mean that every city is going to have a New York City-style outbreak."

"We're going to see this kind of cascade across the country at a stuttered approach with certain kinds of cities having a peak there and other cities having to go, getting over their peak."

Inglesby, director of the university's health security center, said that once sufficient testing is in place and medical workers and hospitals have the gear they need and once case numbers begin to fall in certain regions, then  trace and track methods can be used and social distancing can be eased. But he was cautious about the timing of any easing of social distancing.

Inglesby said that testing is in good shape and "when we have masks available for all of our doctors and nurses who are putting their lives at risk to take care of sick patients," when hospitals are geared up and when public health system are poised to track down individual infections "like they do in Asia," then "we might experiment" with eased social distancing.

But, Inglesby cautioned that America is  "still at the beginning" of the virus crisis. He said that much remains unknown, which makes it "hard to predict" a date for eased restrictions but that he anticipates that the United States could have a better grasp of the situation in another two weeks.

“At that point, I think we could begin to look for the conditions that might make it safe to begin to lower our social distancing, but not until then.

Inglesby disagreed with Trump’s suggestion that certain parts of the country that have not been hit as hard should begin resuming normal life soon. Later, Trump said that virus casualties were expected to peak in two weeks, meaning that it would be necessary to extend social distancing guidelines to the end of the month.

“At this point we are seeing numbers go up around the country pretty consistently — there isn’t really any place in the country where we are seeing numbers go down. And we wouldn’t expect to have had enough time for social distancing to change the numbers. So I don’t think we have had nearly enough time for these measures to take full effect.”

The President, who is surrounded by noted medical advisers, has said that in some areas people would be able to return to work as long as they take social distancing precautions and remain vigilant about hygiene. Asked about whether the White House experts' idea could be effective, Inglesby pointed to Italy as evidence for why he thought it would not work.

"I don’t think so," he said. "I think we’ve seen in Italy, for example, which is a number of weeks ahead of the United States in terms of its epidemic, that even with very serious, very aggressive social distancing measures where people have been kept at home, schools have been closed, everyone is recommended not to leave their homes, that this disease has continued to spread and is causing a national crisis.”

Inglesby did say that when the situation sufficiently improves, some parts of the country could reopen sooner than others.

In a related matter, after Trump declined yesterday to impose a martial-law style quarantine on the New York City metro region, the governors of Florida and Texas issued orders that people coming in by road or otherwise into their states from the hot zones be checked by police and required to self-quarantine.

In addition, New York Gov. Andrew Cuomo, threatened to sue a fellow Democrat, Rhode Island Gov. Gina Raimondo for requiring state troopers to halt cars with New York plates and ordering occupants to self-quarantine. Raimondo responded today by requiring troopers to issue her self-quarantine order to anyone entering the state in a vehicle with any out-of-state plate.
The Johns Hopkins experts were interviewed by Fox News reporters.

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