It is honestly astonishing how bad America's response to covid was. From public health and epidemiologists, to politicians and media, all the way down to the public. If Biden had been in charge, sure seems like we would have been just as likely to bungle it. Maybe the only institution to come out looking like they exceeded expectations is Big Pharma?
Having spent all of March having every public health expert say masks are bad and travel restrictions don't work and xenophobic was an absolute disaster.
It is not a good idea to apply lessons from the Ebola policy response to a coronavirus. It's a category error. Ebola is a very deadly disease. COVID-19 is infectious but not severe (disparate risk profile). The Swine flu pandemic in 2009 would be a better comparison. To make a very long lecture as short as possible: viruses cannot be infectious and deadly simultaneously as sick hosts do not move around. Social behavior is the dominant variable that determines the speed of infection spread. When I taught pandemic response during my doctorate, I taught policy using two classes of viruses. First, there are very deadly diseases like Ebola. These viruses are easily contained because all carriers are symptomatic. Travel bans are unnecessary because it is easy to know where the disease is at any time. In the other category, of which influenza is the best example, we have no successful methods to contain the virus except perfect isolation indefinitely (even after vaccination) as people are asymptomatic or mostly healthy while spreading. Small island nations like New Zealand and Iceland can do well due to geography alone; it has little to do with government travel policy. Remember that animals also spread disease, so it is not just humans that are hosts and need to restrict travel across borders—Oceans help.
*****If you happen to fit in one of the categories of people who are allowed to go to New Zealand...you need to book yourself a 14-day stay in a managed isolation facility. Before you board a flight you’ll need to prove that you have such a booking.*****
I arrived in China from the US in mid-October. In China, in case anyone's wondering, there's no need to pre-book quarantine accommodation. You're simply automatically brought from the airport to a nearby quarantine hotel. In my case in Shenyang (most Beijing-bound travelers are routed to nearby cities - the Chinese are pretty careful about protecting the capital). Not sure what they do in the case of people who arrive at the hotel without the means to pay. It probably happens very rarely. Also, in China, at the option of one's residential compound, extra time might be tacked on post-hotel. That is, when I finally finished my Shenyang quarantine and arrived in Beijing, I was obliged to stay in my apartment for an additional seven days.
I'm of the Cowen/Tabbarok point of view that the biggest scandal has been the tight-ass FDA getting in the way of testing and quick vaccine approval. If they had found a way to approve high-false-negative, low-false-positive rapid tests the US could've actually made a real attempt at following the South Korea suppression model. And if they had encouraged, or at least permitted, challenge trials or at least larger trials with 6-figure numbers of participants, we could've had a vaccine at least a month ago already and maybe spared ourselves the worst of this giant peak we're in now.
Instead they insist on taking almost a month to review the obviously great news from the trials, while other countries begin to speed past us in approving the vaccines.
There were two sets of opposing public opinion that make the government response doomed. Liberals instinctively don't like any restrictions on a specific subset of people (reminds them of fascism/racism) and conservatives instinctively don't like restrictions on citizens (reminds them of communism/big government).
Any full-scale travel ban/restriction wholesale would trigger both. Any international travel ban would trigger the former. Any domestic travel restriction would trigger the latter.
Finally, there's the whole issue of sob stories of constituents. In Canada, public opinion here is very in favour of keeping the US/Can border closed but we still got politicians on both sides writing to governments for exemptions (for students in the fall, for marriages, etc, etc).
It remains utterly bizarre to me that Trump, the germophobe president who railed against the Obama administration during the Ebola outbreak, failed to take even the most basic of measures against the virus after the initial China travel ban. I just don't get it!
You seem to miss a key point though. The centralised quarantine required for effective suppression of the virus is not restricted to international travellers. It is also required for ALL locally infected cases, and their direct contacts. This is what China did, and why it controlled the virus successfully. And all across Asia Pacific, including Australia and New Zealand.
Are these measures likely to be capable of effective implementation in a continent-wide, freedom loving country, with diffuse layers of governmental authority and political control like the USA?
Can you imagine a federal government agency that is tasked with requisitioning hotel capacity and forcing citizens to reside there for two weeks at a time? Can you imagine? The complaining, the rants, the social media. The overblown "1930s Germany" bleating. The lawsuits. The protests. The riots. The grandstanding politicians staging press conferences and media stunts. The yellow snake flags. The Open Carry guys storming Motel 6.
Yet this is what is needed. Every country on Earth that has successfully controlled the virus has done this.
But an America where people are made to stay in a government-mandated hotel-cum-prison for two weeks at a time? It's not just that it hasn't been tried; it's unimaginable. Any president who tried to impose it would get so much blowback ... the personnel do not exist to enforce these kinds of mandates. Even Martial law wouldn't work. It would have to be imposed everywhere. Logistically Martial law is a localised measure; there is no possibility of nationwide Martial law. Not in a country the size of the USA anyway.
And that's the terrifying thing. Because this virus is actually not *that* bad. Yes, the early commentary that "it's just flu" was really stupid. But the comparison is not invalid: COVID-19 is 1-2 orders of magnitude worse than flu, in terms of fatalities. Y
The next pandemic could be far worse than that. Imagine a virus with 5 or 10% fatality rate. It would cause tens of millions of deaths across America. Or imagine one with a 1% fatality rate that (for some reason) disproportionately affected children rather than the elderly. Imagine 250,000 miniature coffins.
If a centralised-quarantine mandate were needed to control such a pandemic, it still seems unimaginable that this would happen. Americans would tolerate the deaths. It's terrifying.
For proof that Americans are prepared to tolerate huge numbers of preventable deaths rather than tolerate perceived government encroachment on personal freedoms, look at the gun death statistics.
Hey Matt, I wanted to share some additional context with you I think is missing in some of the reporting about the issue now, including yours here.
So the older evidence on travel restrictions — which showed they don't generally work — that we drew on in the earlier stories was based on the kinds of targeted travel restrictions people imagined and tried in the past (like the temp screening at airports, visa restrictions, etc).
The total restrictions now in place in many countries you point to -- with pre-screening, border closures, airport screening, strict quarantining, fines -- are unprecedented. Even at the start of the pandemic, I don't think anyone imagined countries would follow China and impose such restrictions and all at the same time. If for example countries had locked down during Sars1 the way we saw Vietnam or NZ or China locking down now, the evidence might have looked quite different. But that seemed unimaginable a year ago. And what we knew of the restrictions of the past was that they could be harmful (to economies, or even smaller things like hampering the ability of aid workers/supplies to get into troubled places.)
Perhaps we should have imagined these scenarios -- the broad border closures around the world. But it truly seemed unfathomable. As the co-author on one of travel bans pieces you point to, Steven Hoffman, noted recently, "No one in public health ever thought that the world would be willing to impose health interventions like total border closures that cost the global economy $400 billion each month. We have a hard time raising $400 million for HIV or polio eradication."
The reactions to Trump's response would have been negative, regardless of what he actually did. Vox, the NYTimes and most other media outlets long ago decided (correctly) that Trump was bad and therefore anything he proposed was to be resisted. The long-running assumption that Trump would take moves to become dictator were never supported by any evidence of his ability to do so, but that informed all the early takes against his pandemic response.
Trump will be gone from the Presidency in January. But the lasting damage to trust in the continuing institutions of public health, news media and some local governments will endure for far longer.
1. Why did Trump go mostly unpunished for his clownish management of COVID? (He did win 47% of the vote)
2. Why did the Spanish flu have such a small impact on historical memory both immediately afterward and in the longer term?
I think that what connects them is a general social psychological tendency regarding epidemics to think, well, this is bad, but there's not much you can do, so just endure it and then move on when you can.
People got scared early and deserted restaurants, bars, etc before official restrictions were put in place. They stayed really scared for a few weeks. And then, well, they got used to the idea of a contagious virus existing amongst us and decided there was generally not a whole bunch you could do about it. (OK, most people did wear masks.) And the "not much you can do about it" extended to Trump as well, no matter his crazy antics. And so we wait for it to go away, because it mutates or otherwise burns itself out, or there's a successful vaccine.
But blame Trump? Not really. It's just a thing that happened.
And once it's over, it will be over. I find all these premature articles about how COVID will "permanently change X" to be off target. I know what COVID will permanently change: nothing. We'll be like Americans in the 1920s, perfectly happy to get back to normal life, even to party a bit more. It was a bad thing for a while but it didn't actually *mean* anything. It came, we suffered, we endured, it's gone, and now let's forget it.
And for Trump? In the longer run regarding COVID, he may be remembered (if at all) much more for Operation Warp Speed than all that crap we endured from him. Unfair, but that's life.
I found this to be a much bigger incitement of the system than the decisions on travel.
"To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began."
My son has a rare medical condition ( very mild version... don't worry he's fine) and we've had extensive genetic testing done to learn anything we can. A small fraction of the testing is done at a "clinical" level... where they can share the results. However anything else is viewed as "research data" and they're unwilling to share. The thought process being I'm not mature enough to handle the uncertainties involved in the accuracy and lack of proven treatment options.
There are times when I understand why the medical field is so hesitant to provide unproven half answers... and there are other times I'm infuriated by the (apparently not so) white lies around masks and the idea I shouldn't be given all information because I may react poorly.
Your "closed the border entirely when it was clear the virus was in many countries" statement is vague. What date do you think he should have closed the border entirely?
I think that if your answer is later than "early February", then it would have been too late. Youyang Gu (https://covid19-projections.com/ ) that the US had over 250 infected people by 14 Feb., and we had over 15,000 cases on Feb 26 when Trump made his "You have 15 people, and the 15 within a couple of days is going to be down to close to zero" comment.
Gu's estimates may be off, but it is pretty clear that we had plenty of cases in early February to fuel a massive outbreak Feb+March if we didn't have a strategy to control the spread within the country.
The City of Chicago actually had a centralized quarantine facility from March until June or July and then shut it down. It was also extremely underused when it was open. Just absolute incompetence at every level of government.
This is a very much too narrow criticism. A policy of restricting entry without being part of a systematic strategy to test and isolate asymptomatic infected people would be a very limited value.
It is honestly astonishing how bad America's response to covid was. From public health and epidemiologists, to politicians and media, all the way down to the public. If Biden had been in charge, sure seems like we would have been just as likely to bungle it. Maybe the only institution to come out looking like they exceeded expectations is Big Pharma?
Having spent all of March having every public health expert say masks are bad and travel restrictions don't work and xenophobic was an absolute disaster.
It is not a good idea to apply lessons from the Ebola policy response to a coronavirus. It's a category error. Ebola is a very deadly disease. COVID-19 is infectious but not severe (disparate risk profile). The Swine flu pandemic in 2009 would be a better comparison. To make a very long lecture as short as possible: viruses cannot be infectious and deadly simultaneously as sick hosts do not move around. Social behavior is the dominant variable that determines the speed of infection spread. When I taught pandemic response during my doctorate, I taught policy using two classes of viruses. First, there are very deadly diseases like Ebola. These viruses are easily contained because all carriers are symptomatic. Travel bans are unnecessary because it is easy to know where the disease is at any time. In the other category, of which influenza is the best example, we have no successful methods to contain the virus except perfect isolation indefinitely (even after vaccination) as people are asymptomatic or mostly healthy while spreading. Small island nations like New Zealand and Iceland can do well due to geography alone; it has little to do with government travel policy. Remember that animals also spread disease, so it is not just humans that are hosts and need to restrict travel across borders—Oceans help.
*****If you happen to fit in one of the categories of people who are allowed to go to New Zealand...you need to book yourself a 14-day stay in a managed isolation facility. Before you board a flight you’ll need to prove that you have such a booking.*****
I arrived in China from the US in mid-October. In China, in case anyone's wondering, there's no need to pre-book quarantine accommodation. You're simply automatically brought from the airport to a nearby quarantine hotel. In my case in Shenyang (most Beijing-bound travelers are routed to nearby cities - the Chinese are pretty careful about protecting the capital). Not sure what they do in the case of people who arrive at the hotel without the means to pay. It probably happens very rarely. Also, in China, at the option of one's residential compound, extra time might be tacked on post-hotel. That is, when I finally finished my Shenyang quarantine and arrived in Beijing, I was obliged to stay in my apartment for an additional seven days.
Great stuff.
I'm of the Cowen/Tabbarok point of view that the biggest scandal has been the tight-ass FDA getting in the way of testing and quick vaccine approval. If they had found a way to approve high-false-negative, low-false-positive rapid tests the US could've actually made a real attempt at following the South Korea suppression model. And if they had encouraged, or at least permitted, challenge trials or at least larger trials with 6-figure numbers of participants, we could've had a vaccine at least a month ago already and maybe spared ourselves the worst of this giant peak we're in now.
Instead they insist on taking almost a month to review the obviously great news from the trials, while other countries begin to speed past us in approving the vaccines.
There were two sets of opposing public opinion that make the government response doomed. Liberals instinctively don't like any restrictions on a specific subset of people (reminds them of fascism/racism) and conservatives instinctively don't like restrictions on citizens (reminds them of communism/big government).
Any full-scale travel ban/restriction wholesale would trigger both. Any international travel ban would trigger the former. Any domestic travel restriction would trigger the latter.
Finally, there's the whole issue of sob stories of constituents. In Canada, public opinion here is very in favour of keeping the US/Can border closed but we still got politicians on both sides writing to governments for exemptions (for students in the fall, for marriages, etc, etc).
Thats so cool that u went on Joe Rogan! very based
It remains utterly bizarre to me that Trump, the germophobe president who railed against the Obama administration during the Ebola outbreak, failed to take even the most basic of measures against the virus after the initial China travel ban. I just don't get it!
Great article.
You seem to miss a key point though. The centralised quarantine required for effective suppression of the virus is not restricted to international travellers. It is also required for ALL locally infected cases, and their direct contacts. This is what China did, and why it controlled the virus successfully. And all across Asia Pacific, including Australia and New Zealand.
Are these measures likely to be capable of effective implementation in a continent-wide, freedom loving country, with diffuse layers of governmental authority and political control like the USA?
Can you imagine a federal government agency that is tasked with requisitioning hotel capacity and forcing citizens to reside there for two weeks at a time? Can you imagine? The complaining, the rants, the social media. The overblown "1930s Germany" bleating. The lawsuits. The protests. The riots. The grandstanding politicians staging press conferences and media stunts. The yellow snake flags. The Open Carry guys storming Motel 6.
Yet this is what is needed. Every country on Earth that has successfully controlled the virus has done this.
But an America where people are made to stay in a government-mandated hotel-cum-prison for two weeks at a time? It's not just that it hasn't been tried; it's unimaginable. Any president who tried to impose it would get so much blowback ... the personnel do not exist to enforce these kinds of mandates. Even Martial law wouldn't work. It would have to be imposed everywhere. Logistically Martial law is a localised measure; there is no possibility of nationwide Martial law. Not in a country the size of the USA anyway.
And that's the terrifying thing. Because this virus is actually not *that* bad. Yes, the early commentary that "it's just flu" was really stupid. But the comparison is not invalid: COVID-19 is 1-2 orders of magnitude worse than flu, in terms of fatalities. Y
The next pandemic could be far worse than that. Imagine a virus with 5 or 10% fatality rate. It would cause tens of millions of deaths across America. Or imagine one with a 1% fatality rate that (for some reason) disproportionately affected children rather than the elderly. Imagine 250,000 miniature coffins.
If a centralised-quarantine mandate were needed to control such a pandemic, it still seems unimaginable that this would happen. Americans would tolerate the deaths. It's terrifying.
For proof that Americans are prepared to tolerate huge numbers of preventable deaths rather than tolerate perceived government encroachment on personal freedoms, look at the gun death statistics.
Hey Matt, I wanted to share some additional context with you I think is missing in some of the reporting about the issue now, including yours here.
So the older evidence on travel restrictions — which showed they don't generally work — that we drew on in the earlier stories was based on the kinds of targeted travel restrictions people imagined and tried in the past (like the temp screening at airports, visa restrictions, etc).
The total restrictions now in place in many countries you point to -- with pre-screening, border closures, airport screening, strict quarantining, fines -- are unprecedented. Even at the start of the pandemic, I don't think anyone imagined countries would follow China and impose such restrictions and all at the same time. If for example countries had locked down during Sars1 the way we saw Vietnam or NZ or China locking down now, the evidence might have looked quite different. But that seemed unimaginable a year ago. And what we knew of the restrictions of the past was that they could be harmful (to economies, or even smaller things like hampering the ability of aid workers/supplies to get into troubled places.)
Perhaps we should have imagined these scenarios -- the broad border closures around the world. But it truly seemed unfathomable. As the co-author on one of travel bans pieces you point to, Steven Hoffman, noted recently, "No one in public health ever thought that the world would be willing to impose health interventions like total border closures that cost the global economy $400 billion each month. We have a hard time raising $400 million for HIV or polio eradication."
It's also worth noting there's a debate about the legality of the overly broad restrictions being used now: https://brill.com/view/journals/iolr/aop/article-10.1163-15723747-2020023/article-10.1163-15723747-2020023.xml?language=en And we don't yet know the impact of them. They probably worked to shut out the virus and keep it from spreading -- especially because so many countries did them at once and they were so severe -- but we still need to understand their full impact.
The reactions to Trump's response would have been negative, regardless of what he actually did. Vox, the NYTimes and most other media outlets long ago decided (correctly) that Trump was bad and therefore anything he proposed was to be resisted. The long-running assumption that Trump would take moves to become dictator were never supported by any evidence of his ability to do so, but that informed all the early takes against his pandemic response.
Trump will be gone from the Presidency in January. But the lasting damage to trust in the continuing institutions of public health, news media and some local governments will endure for far longer.
Joe Rogan? That's crazy, man- but have you ever tried DMT?
I have two closely connected questions:
1. Why did Trump go mostly unpunished for his clownish management of COVID? (He did win 47% of the vote)
2. Why did the Spanish flu have such a small impact on historical memory both immediately afterward and in the longer term?
I think that what connects them is a general social psychological tendency regarding epidemics to think, well, this is bad, but there's not much you can do, so just endure it and then move on when you can.
People got scared early and deserted restaurants, bars, etc before official restrictions were put in place. They stayed really scared for a few weeks. And then, well, they got used to the idea of a contagious virus existing amongst us and decided there was generally not a whole bunch you could do about it. (OK, most people did wear masks.) And the "not much you can do about it" extended to Trump as well, no matter his crazy antics. And so we wait for it to go away, because it mutates or otherwise burns itself out, or there's a successful vaccine.
But blame Trump? Not really. It's just a thing that happened.
And once it's over, it will be over. I find all these premature articles about how COVID will "permanently change X" to be off target. I know what COVID will permanently change: nothing. We'll be like Americans in the 1920s, perfectly happy to get back to normal life, even to party a bit more. It was a bad thing for a while but it didn't actually *mean* anything. It came, we suffered, we endured, it's gone, and now let's forget it.
And for Trump? In the longer run regarding COVID, he may be remembered (if at all) much more for Operation Warp Speed than all that crap we endured from him. Unfair, but that's life.
I found this to be a much bigger incitement of the system than the decisions on travel.
"To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began."
https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.html
...
My son has a rare medical condition ( very mild version... don't worry he's fine) and we've had extensive genetic testing done to learn anything we can. A small fraction of the testing is done at a "clinical" level... where they can share the results. However anything else is viewed as "research data" and they're unwilling to share. The thought process being I'm not mature enough to handle the uncertainties involved in the accuracy and lack of proven treatment options.
There are times when I understand why the medical field is so hesitant to provide unproven half answers... and there are other times I'm infuriated by the (apparently not so) white lies around masks and the idea I shouldn't be given all information because I may react poorly.
Your "closed the border entirely when it was clear the virus was in many countries" statement is vague. What date do you think he should have closed the border entirely?
I think that if your answer is later than "early February", then it would have been too late. Youyang Gu (https://covid19-projections.com/ ) that the US had over 250 infected people by 14 Feb., and we had over 15,000 cases on Feb 26 when Trump made his "You have 15 people, and the 15 within a couple of days is going to be down to close to zero" comment.
Gu's estimates may be off, but it is pretty clear that we had plenty of cases in early February to fuel a massive outbreak Feb+March if we didn't have a strategy to control the spread within the country.
The City of Chicago actually had a centralized quarantine facility from March until June or July and then shut it down. It was also extremely underused when it was open. Just absolute incompetence at every level of government.
This is a very much too narrow criticism. A policy of restricting entry without being part of a systematic strategy to test and isolate asymptomatic infected people would be a very limited value.