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.
There were a lot of issues with the CDC's response, but I don't think it's fair to tarnish them with the same brush as many of the other actors. The CDC was effectively muzzled by the administration starting in late February when Dr. Messonier held that press conference to announce that things were about to get very bad. Actual public health messaging has been pretty consistent since April; the problem is that it's not being platformed by its own government.
As for masks, they clearly shouldn't have lied about it, but they also clearly never believed that masks didn't work. It was transparently an attempt to save desperately needed resources for healthcare workers. A bad one, to be sure.
RE: the travel restrictions, we know that COVID was already in the US and spreading rapidly by early February, so while they're undeniably effective if used well, I'm not sure whether they would have done much good here even if implemented a bit earlier. Travel restrictions only would have worked to avert the crisis in the presence of a political will to eradicate the virus domestically, and that's just not present in the US.
That's to say nothing of the question whether it'd even be moral or right in the first place for the US to strand its own citizens overseas with a draconian and total travel restriction in late January. I could maybe see something like that happening in the future in the wake of COVID, but there's just no world in which there'd the political capital in a Western society to implement a total travel interdiction based solely on the Wuhan outbreak, and if you waited till mid-February in the US it'd already be too late.
These are good points, but I'd counter that just because the failure of the US and most western democracies to contain COVID was due to multiple interacting mistakes, that doesn't mean the mistakes should be ignored or excused.
What would the result have been if western governments had implemented a strategy of lockdowns, travel bans (including local travel), and universal masking starting in February or March?
In the US, we probably still would have been doomed due to the political climate, but I wonder about other western countries. It's possible they may have had very different outcomes if the scientific/medical consensus on travel bans and masks were correct from the start.
Western Europe seems to exist in a similar unreality as America does with regards to believing they have to work to make the world a better place. My priors are that Western Europe would have had the same problems America would have even if the public health experts hadn't dropped the ball.
Probably true. Although it seemed to take a while for the anti-lockdown/anti-mask protests to get organized and I wonder if more success on the initial response would have created more political will for a more targeted but still strong response later on.
That was an issue, but even had that test worked immediately rather than causing ~2 weeks worth of delay, it would have done very little to arrest the epidemic. We needed the top levels of the government to engage private actors to deploy tests at massive scale in January (this is what South Korea did) and it just didn't happen. State public health labs running ~10k tests a week using the CDC test was never going to cut it.
My understanding is the flawed tests actually did work. The CDC test used three probes, whereas the WHO test used two. One of the three probes on the CDC test was flawed -- the other two were fine. Ultimately, the FDA in June finally authorized using the original flawed tests when they could have done so to begin with.
The healthcare workers I talked to early on really did believe masks were worse than nothing, even ones who were Asian and whose relatives in Taiwan/Japan put on masks whenever they have a cold.
Mostly they'd tell you it's hard to wear a mask properly, it's a fomite you could touch and then infect yourself, and there isn't proof it catches anything (which is true - there isn't proof surgical masks even work for surgery.)
They were of course wrong and a week later they'd all suddenly changed their minds and now thought the exact opposite thing just as strongly. Doctors don't seem to be taught the precautionary principle.
It seems the lab testing was bad as well, but it just may have been that our testing has been inaccurate throughout and they were used to more accurate tests.
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.
The island thing just seems like a total red herring to me. The virus arrived in the United States on planes from Italy. There are also plane flights to New Zealand. The difference is New Zealand told the planes to stop landing and the United States did not.
Absolutely. Vietnam and Thailand are good non-island examples with 14-day quarantines and are both great success stories.
Also, Australian states made themselves into "islands" by introducing hard inter-state border closures. These protected other states from Victoria's outbreak of up to 750 cases per day. Most other states had zero cases during this period, while NSW got a minor outbreak due to being slow to close the border.
Spread via animals is big too. Animals don't respect borders. Traditionally, the difference between a virus that can be eradicated and one that can't is whether or not humans are the only vector. New Zealand and Australia are very careful about importing livestock and other animals. This helps. Over all, better to think about this as probabilistic system. It's about odds of otherwise unlikely events (like super spreaders) happening at sufficient frequency to seed the virus. Nothing can be absolute, but things like oceans make it a lot less likely.
Ok Matthew Yglesias, you win. This comment thread motivated me to pay to be able to comment. Nicely played! Clare, you are clearly presenting yourself as an expert in this field. And that is really good, I have been dismayed and confused by a lot of the guidance provided by some of the epidemiological community. I would appreciate it if you clarify your points. Are you saying that the travel ban is a bad idea in the current pandemic unless you happen to be "an island nation"? Can you please then answer Bruce who pointed out examples of countries with land borders? I don't think anyone disagrees with you that animals can spread disease but are you really going to tell us that the types of travel restrictions should not be pursued because certain small to large mammals can cross our border from Canada from Mexico? Again I do not doubt that anyone disagrees with you that oceans help. But you aren't really making (to me anyway) clear points about what should have been done nor are you responding to fairly compelling points above in this thread. Thanks!
You are correct, I forgot to make the critical point about why the differences matter to policy. Travel bans and other containment strategies are Sisyphean labor against a highly infectious virus. We suffer but don’t change the outcome. Here's the argument. Sorry for the length.
How pandemics start:
Asymptomatic spread, infection without disease, is a feature of a virus capable of causing a global pandemic. By its nature, this spread is hard to observe. We don't know a novel virus exists, and it causes minimal or no visible indications. From our perspective, there is no problem at all.
We find these new viruses after a chance event, a spreader event that infects enough high-risk people that it causes an observable disease outbreak. In the first outbreak, viral diseases like Ebola/MERS (usually symptomatic) are indistinguishable from influenza/COVID-19 (often asymptomatic, rarely severe) because we only observe symptomatic cases.
Early evidence we expect to be available to justify a travel ban is subject to a strong observability bias. At the point where a ban could be impactful, we expect to be uncertain about both the virus's origin, extent, and severity. We may not even yet know it exists. Chance plays a significant role in how we learn about the virus. There is no guarantee the first observable outbreak occurs in the same city or country where the virus originated.
Practitioners point of view, it's best to assume we are dealing with a containable virus until there is evidence it is not. Broad travel bans are unnecessary for containable viruses like Ebola because we know exactly where the virus is and have more targeted and effective policy interventions available. Epidemiologists have been criticized in the past (reasonably) for crying wolf and causing unnecessary panic, so the decision threshold and timing for implementing an effective travel ban is fraught. Doing this early enough to be effective would result in the regular occurrence of false positives. People would stop trusting the alerts and eventually scientific institutions themselves. This early detection problem is common in many fields (including cancer detection and cybersecurity) and is called alert fatigue.
Much like with polling data for elections, what we observed in the early data was never our reality. This virus was always going to cause a pandemic; we never had control or the ability to contain it. Early on, we didn’t know that, hence China’s response. The first evidence of the infectiousness of a virus is usually the presence of global outbreaks. At that point, it’s too late. New Zealand, Iceland, etc., had the option to close borders effectively (because oceans) but most countries did not. That's assuming the island nations hadn’t been unlucky already (the virus could have originated within their borders by chance).
As far as the variability in outcomes in other countries, the differences are usually due more to chance and natural effects, not policy interventions. Much of what I see pundits attribute to policy or human failures is explainable by nature alone. It's tough to make causal inference in stochastic systems, and cherry-picking examples using hindsight bias (knowledge of the outcome) is never good evidence to make a case that a policy invention is causal. For example, we expected the wave over the summer in Arizona because people are inside to avoid heat. We expected islands to fare better early on even by chance. We didn’t need to blame the local governments or our fellow humans. That was fear and anger at something outside our control.
We cannot contain viruses with high levels of asymptomatic spread. At least, it has never been done. Many believe it cannot be done and should not be tried because of massive second order consequences (not a consensus opinion, but one I hold).
This is a consensus perspective. Pandemics end with endemic disease. The virus does not go away. It becomes a background infection risk with less disease. Spanish flu is the same strain as swine flu, and both are now considered part of the seasonal flu. You have had the Spanish flu. You may still die of the Spanish flu despite the lapse of a century since the pandemic and the presence of a vaccine. This counterfactual matters to the travel ban argument because New Zealanders too will be infected eventually with SARS-COV-2, starting the moment they open the borders. It’s just a matter of time.
Commonly misunderstood, vaccines reduce risk of disease given an infection, they do not directly prevent infection itself. With a virus like this, odds are everyone is going to get infected multiple times in their life. Many of us are already at low risk from disease. Vaccines in healthy low-risk people are extra security (and good for herd immunity) but don’t dramatically change our risk profile. Immunity decays with time, the virus mutates. Time constants for this virus are unknown, it's a fair prior to expect seasonal recurrence of COVID-19 like the common cold we see from other coronaviruses. It could be less frequent if the new vaccines are more effective than average. Beware-- early clinical trial data usually overestimates the end efficiency of a vaccine.
New Zealand has at best delayed the inevitable of widespread infections in their borders, but I’d argue that a “travel ban” around nursing homes is a less costly policy solution to prevent disease and harm than a ban for an entire country that keeps family apart for years at a time, disrupts critical supply chains including for medical treatments and and clinical trials, and destroys global economies causing numerous other public health crises of its own, but that wasn't the claim Matt made so I won't argue that now.
Travel bans work in theory, but not according to the Slow Boring ethos of truly effective policy. We would need to be able to observe the unobservable before we even know a problem exists, and we don’t have the tech for that yet.
Wait, are you suggesting there's significant evidence of covid-19 spread via non-domesticated animals? (I know there's the mink thing in Europe, but that's a relatively recent development.)
Agreed. Aside from the forced errors by the Trump Administration, one of the toughest things for me to grapple with in this pandemic is that it appears the US public health consensus provided devastatingly wrong guidance on two of the most consequential disease control questions of at least the last 25 years (travel bans and masks).
Yup. I live in Thailand and we've been COVID free since about May. There are severe travel restrictions, even though tourism is about 20% of GDP.
Everyone wears masks most of the time, and there are temperature controls everywhere. Not much social distancing. Otherwise, all is pretty normal.
Since the only experience of COVID here is through media, the impression is that the disease is deadly so every time there's news about a potential case, people freak out.
Agreed. This is evidenced in Canada when you look at the success of provinces such as New Brunswick and Nova Scotia (neither are islands) - who implemented wide-ranging travel bans, compared to Alberta - who had the most "American-like" approach and is setting up field hospitals.
That seems to be true. But Mexico is hard-hit by the virus, and so is Canada. We might have avoided the initial spread of the virus back in the winter via plane travel restrictions, but wouldn't we have just inevitably had it spread across the land borders eventually?
Also, sorry, this should've been part of my above comment, but we also have a LOT of travel because we're a large country. Travel controls are necessarily imperfect in a variety of ways. We're 75x the size of New Zealand and I would guess probably have more travel per capita. That means that there's maybe a 100x chance that something will slip through our travel restrictions compared to New Zealand, and once it gets out in the wild in the country past the travel restrictions the fact that it's a small infection in a larger pool is more-or-less irrelevant given exponential growth. Maybe that wouldn't be true if our contact tracing game was great, but it's not.
but, we never even tried, and that's the point. Might have not worked given the scale, but it might have! Promise you that NZ's contact tracing was No.8 wired on the fly just as much as NYCs was. Also NZ has had numerous cases of community spread. It's not like it never got there.
Do you think that if NZ had 100x as many cases of community spread, they would've been able to contain it? It's clear that we aren't able to lockdown-and-contact-trace once things get past a certain level of spread (I mean, we tried. We failed). There's a numbers game here that's in favor of small countries.
I think we aren't able to succeed because the California Gov isn't allowed to close state borders and the state/county governments are the only entities driving meaningful containment response. Montana's case load went up because NoDak's case load was crazy high. Then Idaho's went up, then Nevada's. Scale would make it harder, but we also have literally unlimited dollars to throw at the problem. NZ's debt tradeoffs are much more severe than ours and downside economic risk to eliminating tourism exports much larger.
"Small island nations like New Zealand and Iceland can do well due to geography alone; it has little to do with government travel policy."
But how do you reconcile this with China's experience after their initial wave?
It appears that their combination of strong infection control measures at home coupled with very strict travel policies has provided outstanding results.
It is much more likely to me that China's data is fraudulent than all experience with infectious disease from human history is wrong. I have no special knowledge, but I'd bet lots of money on it.
I don't doubt that local governments aren't reporting full figures, but if you follow China issues on a regular basis it's pretty clear that there's no epidemic spread inside China right now. The scale and breadth of the Party's authoritarian powers are really unprecedented, so it's perhaps not too surprising that they managed to control this once they finally swung into action. If you had to design the ideal government for virus suppression I'd imagine that it'd look a lot like the CCP.
Worryingly, given the nature of the CCP and the current international environment, you have to wonder if they're asking themselves some questions about bio-warfare right now given what they no doubt perceive as their immense success in combating pathogens vs. their likely future antagonists.
The notion that the party's "authoritarian powers are really unprecedented" is off. It's true the party enjoys surveillance technology far more advanced than anything Mao dreamed of (although ordinary human snitching can accomplish a lot!). But it's also true the party presides over a very large, very sophisticated, very complicated and open economy, and as such necessarily accepts a lot of freedom of action by ordinary people.
I think the better analogy would be, say, Taiwan or South Korea pre-democratization. Or maybe Franco's Spain. (Indeed from what I can see the modern CCP pretty neatly fits the textbook definition of "fascist.").
An interesting thought experiment for me is to consider what would have happened if western democracies had taken the lockdown, mask up, restrict travel approach that I think is behind the successful containment of the disease that we're seeing in many Asian countries.
In other words, how much of this success is due to cultural differences (eg individualism vs collectivism), how much is due to effectiveness of govt. policy implementation (eg high trust in government versus low trust), and how much is because the medical/scientific establishment in the east was correct from the start on travel bans and masks (versus bad initial guidance from the western medical/scientific establishment on these questions).
I think it's true that the current political environment in the US makes trying to emulate the successful strategies of Asian countries in fighting Covid basically impossible.
Republicans would focus on government overreach and the harm done to businesses, progressives would fixate on particular groups they think were disproportionately harmed by the lockdowns. Neither of the dominant political movements in the US believe in individual sacrifice to help the nation overall (at least for their own supporters, personal sacrifice from the other side is totally ok).
I'd politely disagree that it's off. I'm not suggesting that ordinary Chinese are unfeeling 1984-style automatons or that it's a command economy, obviously, but the use of advanced surveillance technology on a massive scale combined with traditional authoritarian control methods is what makes it unprecedented. This kind of stuff has only even really been made possible in the last 10 or 20 years.
I'm not sure that I'd call the CCP fascist. There's no clear-cut definition in the first place, which does make things difficult, but the CCP lacks an analog to the party militias of the historical fascist states, which existed outside the state apparatus. As far as I'm aware there's no "Communist Party" militia, since the CCP has taken pains to inextricably interweave itself with the state apparatus. To me it simply seems like an authoritarian government. Authoritarianism and extreme nationalism are by no means limited to fascism, although both are present within it.
China is a dystopian techno-authoritarian police state unlike anything the world has ever seen, with a built-in contact tracing infrastructure at massive scale thanks to the local Party cells present in each neighborhood which already perform the job of monitoring their citizens on a regular basis. Any government which can order its citizens to remain in their apartments for *six weeks* and enforce that order has the tools necessary to choke off circulation of a virus.
Additionally, it's worth noting as well that there's a growing scientific consensus around the idea that the virus mutated to become more infectious after arriving in Italy. China was acting to suppress a less-virulent version of the virus, and after doing so successfully, really need only keep their borders closed to avoid the more-infectious version getting in.
Why the asterisks on "six weeks?" Makes it seems like you are trying to suggest the duration of China's lockdown was especially long. Not so. A number of countries' lockdowns went beyond the two month mark. Australia's Victoria experienced, what, 15 + weeks of lockdown cumulatively?
You may have better information than I, but from the on-the-ground Wuhan & Beijing reporting in January-February & from the Twitter feeds of Westerners in China at the time, my understanding is that many people in China literally did not leave their apartments for a month or more, relying entirely on contactless delivery. That's an entirely different animal from even the stricter lockdowns in Western nations where you'd still be permitted out to get groceries, exercise, etc.
Even in Wuhan most people were allowed a weekly/biweekly trip to the supermarket (one per household). I've heard anecdotal stories that in some of the worst-hit communities (basically a large, gated apartment complex), authorities welded doors shut. But that could be urban legend. In Beijing, though, things definitely weren't anywhere near that strict. I have expat colleagues who tell me Beijing was very close to "back to normal" early in March.
South Korea is a much smaller quasi-island nation, so comparisons to China aren't really germane, but they also benefited from grappling with a less-infectious version of the virus.
Smallpox is a very instructive example, actually. It is one of only two viruses to be eradicated. This success was possible only because it fit key categories: 1) there was minimal to no asymptomatic spread; 2) it only infected humans and not any other species, 3) the most common strain wasn’t very deadly (something like 1% while ebola is closer to 90%). It's the perfect example that proves the overarching rule. Smallpox was possible to contain, hence requires a different response. It’s a perfect example of the practicality of this approach.
But to your larger point, I’m under no illusions that biological theories operate like physics. Most require extensive expertise.
I’d say that the development of a smallpox vaccine probably had more to do with it being eradicated. But in any case, it shows that it is possible for a virus to be both very infectious and also very deadly. And that’s not the only virus for which that’s the case.
smallpox eradication was finally achieved via ring vaccination of everyone around an outbreak, not vaccination of the entire world. The ability to do effective contact tracing and containment was key.
There's obviously a large difference between 1% or 90% fatalities that may impact your approach, I don't know why we're collapsing this down to "very deadly".
*****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 find Western reportage on much involving China to be ludicrously inaccurate or incomplete. But in a word, no, it's not true they're not "letting their own citizens back in." Provided Chinese citizens test negative and are willing to put up with high air fares, they can go back (quarantine still required, mind you: almost all my fellow quarantining returnees were Chinese). Still difficult for foreigners to enter/return, of course, but those with residence permits can generally pull it off.
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.
The lack of challenge trials is an absolute scandal. They are so difficult to get past "ethics committees" that it is seldom even tried. (I don't know whether a challenge trial was proposed for any of the current vaccine candidate. But even if not, it is still the well-understood obstacle of the ethics committees that prevented it.)
This whole system of "ethical approvals" needs rethought following this years experience. Challenge trials - with financial compensation for volunteers - should be a matter of course for infectious disease vaccines.
I think those of us without backgrounds in vaccine development of clinical trial management should be a little more humble in our thinking about challenge trials. Yes, it was definitely a topic worth raising, but standing up a brand-new testing methodology in the middle of a time sensitive crisis is always going to raise complexities and surprises that we're not in a position to understand or judge the risk of on any meaningful level.
Can I exclude the possibility that the whole problem was institutional inertia plus no real incentive for the drug companies to rock the boat? No. But I also don't think we're in a position to declare it was obviously the correct approach and that it's a 'scandal' that no-one did it.
The fact that there was/is clearly absurd institutional inertia in the case of tests makes it seem more likely that there's also been an unacceptable amount of inertia where vaccines are concerned.
I think the key difference there is the views of political leadership. It's not a coincidence that the country that fucked up its testing is the one where the political leaders didn't want people to get tested.
That's right, but I do think there's also something to the narrative that says the FDA was simultaneously under political pressure of a different sort, to the effect that a vaccine had better not be approved before the election lest that get Trump re-elected.
I mean, you've lost me at the point where you're suggesting that an organization overseen by republican political appointees was somehow under pressure to ensure that a massively important vaccine didn't get approved on a timeline that would help the republican president that they work for.
I think that's one of those strong-claims-require-strong-evidence sort of situations.
I was in favor of challenge trials early on. But after looking at the results of the non-challenge trials that we did have, I think that challenge trials would not have helped much. We got statistically significant results about 3-4 months after enrollment started - I think challenge trials might have sped that up to 1 month. But challenge trials would *not* have answered the question that most people are worried about (and which I've seen a lot of skepticism about even with these ecological trials) which is that challenge trials don't tell us whether or not the virus protects against ecologically realistic viral exposure. It's quite conceivable that a vaccine that protects against injected virus fails to protect against bits you inhale in the wild - and perhaps more importantly, a vaccine that *fails* to protect against the kinds of challenges provided in a trial might nevertheless be quite effective against the kinds of exposure we get in the wild.
So with challenge trials we would have gotten results a few months earlier, but without the contextual knowledge that we need about whether it would protect people in the wild. And the other main advantage of challenge trials is that they need fewer participants - which is a *dis*advantage when it comes to understanding broader safety issues with a vaccine candidate.
Clinical trials allowing for direct exposure of trial subjects to the virus could and should have gone way beyond double-blind vaccine trials (although they should certainly have included that).
What shape is the curve between concentration/ duration of exposure and risk of infection? Between ingested viral load and infection severity? Our refusal to perform well-designed clinical trials involving exposure of volunteers to the virus has denied us this knowledge - needlessly. We still don’t know the answers to these questions. Possibly we will never know.
Gaining such knowledge would enable all sorts of social benefits to flow quickly, cheaply and effectively — even before a vaccine was proven out. The only way to do it is to expose volunteers to the virus. And (presumably) pay them handsomely.
Yes, this seems right. It *would* be very helpful to have challenge trials for many aspects of this virus. Particularly to figure out the effectiveness of various non-pharmaceutical interventions. Don't just look for the natural case of two infected hairdressers treating 150 clients while wearing masks - do actual experiments where *known* infected hairdressers and *known* uninfected ones treat clients (both with masks and without) and see how many test positive.
You don't think, though, that challenge trials showing 90+% effectiveness would've been sufficiently strong evidence that it's at least 50% effective in the wild (which they've said was their standard for approval)?
I think that would be sufficient for the approval angle. And now that I think about it, speeding up approval by a month or two really does seem quite good right about now.
But even if approval was faster, it would leave unanswered the deeper question, of how effective the vaccine is in ecologically valid interactions. (And it would also run the risk of a perfectly effective vaccine being denied because it was ineffective against the types of challenge it was presented with, even though it's effective against what actually happens in the community.)
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.
I mostly agree with your comment with the following caveat: I think it's possible to imagine a robust and comprehensive quarantine regime being enacted/enforced in US *if* the country had gotten on top of the outbreak quickly enough so that case counts were very low. But the US case count was probably in the six figure range by early March. No way we were going to force tens of thousands of people into quarantine hotels.
It not having been possible for Trump to produce an effective 14-day quarantine on the fly isn't a good reason for us to not discuss the problem. So you are right, we need to address this problem with a new consensus on pandemic response.
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.
It looks like there's a chrome plugin that let's you speed up audio podcasts, but I don't see any way to do it with video. The spotify community area shows a request for this feature with response from spotify (from September) that they're looking into adding the capability to their player.
I have no idea how Spotify videos work, but you can speed up Youtube videos as well and Rogan releases all his podcasts on Youtube. It's under settings and you can go up to 2x.
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.
(1) I think he was punished. I'm convinced he would have won the election.
(2) I think there will be so many lasting impacts here. I own a small restaurant services business - chemical fire suppression. Our book was down 25% by July from locations that had already permanently closed. We have another 10-15% past due on inspection who have temporarily closed or can't afford the inspection fee. We think Chicago will end up losing 40% of restaurants. Then too you have all the job market disruption from an accelerated physical to digital transformation (e.g., KAR took out 30% of their workforce by shutting down physical auctions, insurance companies are eliminating field adjusters, eMedicine is real trouble for doctors).
I wish you success with your restaurant business and I *am* concerned about the impact of the recession on small businesses. But we've had recessions before and they haven't transformed the country. We'll return to the natural path of economic growth sooner or later (I suspect sooner).
As for your first point, Herbert Hoover was elected President in 1928 with 58% of the vote. In 1932, he received 40% of the vote. Trump won 46% of the vote in 2016. This year he got 47% of the vote.
I think the American people know how to punish a President if they really want to.
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.
You can do research level genetic testing and actually get the results yourself with a 30x or 100x WGS test from Nebula and then a report from Promethease - however they're at least half right that you won't be able to read the information properly, and it's not very actionable even if you get perfectly accurate information out of it.
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.
Go to March 12 when Trump announced limited restrictions on travel from Europe.
By then it was obviously "too late" to stop the virus from existing in the United States. But allowing a continued inflow of people from around the world, including Americans from Europe, clearly seeded our country with additional cases over and above what we were already dealing with.
March 12 is way too late to have had a noticeable effect. I agree that we were still importing cases from elsewhere then. But I think people haven't processed that we probably had close to 500,000 people infected at that point (Gu's 95% confidence interval is 435K-980K infected on Mar 12). We were domestically producing *far* more cases than we were importing at that point.
Indeed! The travel ban would have had to be on Europe in late January in order to actually matter, as we imported our outbreak from Europe in February. There's just no world in which the political capital for that would have existed, especially when it'd entail also not permitting American citizens to return home. In the future, we may see Western governments willing to preemptively enact draconian bans like this now that the public has a clearer picture of the stakes (whereas Asian populaces were already primed to understand the need thanks to SARS).
Would've still been a wise policy at that point, given the information everyone had at the time, since we weren't in a position to know about the 500k cases.
Hey buddy! Yeah, fair enough, it all depends on how reasonable it was to assume different scenarios and so on. Like the same might have been true in Australia at the time, but it just turned out there weren't that many cases there.
I shouldn't have been surprised to discover after I started typing that the first comment on MattY's blog that I wanted to reply to was written by someone I already know.
But my thought about Australia is that initial travel restrictions probably didn't do a lot, but once they got their case counts low enough to trace every case, at that point the travel restrictions were very important for maintaining the low numbers. (Or perhaps the more important part about travel restrictions was to enable contact tracing to have a fixed pool of people to work with.)
I certainly think that travel restrictions can be a key part of a complete, competent strategy. I don't think they would've hurt if implemented then. But we didn't have a competent strategy to control spread in US communities.
The last 2 paragraphs of this piece state that Matt guesses that they would have been sufficient to control the US epidemic ("My guess is... it would've worked..."). I don't think that stands up to any realistic consideration of the size of the epidemic by late Feb.
State-level travel restrictions were clearly underrated as an option once the virus was already in the US. Queensland, Aus - a state about 2.5x the size of Texas, with the climate of Florida and politics of Montana - introduced laws that could put people in jail for up to six months for trying to cross the border without a permit when they had had just *6* deaths state-wide. They haven't had a single death since.
Yes but they could restrict travel into and out of the state, and they could set up quarantine checkpoints at the state border, if that was a necessary and justified response to a threat like COVID.
What states cannot do is discriminate between state residents and non-residents, e.g. by set up checkpoints which only pull over drivers with out-of-state license plates.
I think the date that China restricted travel from Wuhan into China (but not internationally) or immediately thereafter would have been the logical date to restrict travel of foreigners and institute a 14-day quarantine from China. So 2/22/2020. If the US and Europe would have implemented that policy the outbreak would have had a greater chance to be contained. I don't see how anyone reasonable foresees the issue we had with it hitting NYC, so Europe would have needed good measures as well as us. As Matt said, policy consensus around pandemic response was just not very good.
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.
Sam can you pass along the information on this? I vaguely recall something. Was it shut down because it wasn't utilized? Too expensive? I'm easily persuaded by city incompetence but I don't know if its fair to blame them for this particular case.
The one I know of was at the Hotel Julian but I'm having trouble finding any news stories or information about it other than that it existed. I heard from friends that it was severely underused when it did exist. Not sure if that's because they didn't do enough to publicize it or didn't tell the people giving out information to communicate it to people who tested positive or what.
FWIW, I had, at the beginning, been rather happy with the Mayor and Gov's efforts (I'm in Chicago so this is why I care). But as time has gone on, I've found most of the Mayor's efforts just not really enough. A benchmark of 4,500 tests a day in a city of 3 million is just pathetic. As is the set up of city testing sites that require a car, run MWF from 10-4 only, etc.. And then her attitude with the schools' teachers union, the fact that it still isn't legal to walk on the beaches or use the playgrounds. Her chief health officer has steadily depreciated the goodwill we had for her at the beginning...
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.
There were a lot of issues with the CDC's response, but I don't think it's fair to tarnish them with the same brush as many of the other actors. The CDC was effectively muzzled by the administration starting in late February when Dr. Messonier held that press conference to announce that things were about to get very bad. Actual public health messaging has been pretty consistent since April; the problem is that it's not being platformed by its own government.
As for masks, they clearly shouldn't have lied about it, but they also clearly never believed that masks didn't work. It was transparently an attempt to save desperately needed resources for healthcare workers. A bad one, to be sure.
RE: the travel restrictions, we know that COVID was already in the US and spreading rapidly by early February, so while they're undeniably effective if used well, I'm not sure whether they would have done much good here even if implemented a bit earlier. Travel restrictions only would have worked to avert the crisis in the presence of a political will to eradicate the virus domestically, and that's just not present in the US.
That's to say nothing of the question whether it'd even be moral or right in the first place for the US to strand its own citizens overseas with a draconian and total travel restriction in late January. I could maybe see something like that happening in the future in the wake of COVID, but there's just no world in which there'd the political capital in a Western society to implement a total travel interdiction based solely on the Wuhan outbreak, and if you waited till mid-February in the US it'd already be too late.
They didn't lie about masks. They just convinced themselves they did the noble lie because they can't admit to themselves they were wrong.
These are good points, but I'd counter that just because the failure of the US and most western democracies to contain COVID was due to multiple interacting mistakes, that doesn't mean the mistakes should be ignored or excused.
What would the result have been if western governments had implemented a strategy of lockdowns, travel bans (including local travel), and universal masking starting in February or March?
In the US, we probably still would have been doomed due to the political climate, but I wonder about other western countries. It's possible they may have had very different outcomes if the scientific/medical consensus on travel bans and masks were correct from the start.
Western Europe seems to exist in a similar unreality as America does with regards to believing they have to work to make the world a better place. My priors are that Western Europe would have had the same problems America would have even if the public health experts hadn't dropped the ball.
Probably true. Although it seemed to take a while for the anti-lockdown/anti-mask protests to get organized and I wonder if more success on the initial response would have created more political will for a more targeted but still strong response later on.
The CDC screwed up the testing early on did they not though? https://www.npr.org/2020/11/06/929078678/cdc-report-officials-knew-coronavirus-test-was-flawed-but-released-it-anyway
That was an issue, but even had that test worked immediately rather than causing ~2 weeks worth of delay, it would have done very little to arrest the epidemic. We needed the top levels of the government to engage private actors to deploy tests at massive scale in January (this is what South Korea did) and it just didn't happen. State public health labs running ~10k tests a week using the CDC test was never going to cut it.
My understanding is the flawed tests actually did work. The CDC test used three probes, whereas the WHO test used two. One of the three probes on the CDC test was flawed -- the other two were fine. Ultimately, the FDA in June finally authorized using the original flawed tests when they could have done so to begin with.
The healthcare workers I talked to early on really did believe masks were worse than nothing, even ones who were Asian and whose relatives in Taiwan/Japan put on masks whenever they have a cold.
Mostly they'd tell you it's hard to wear a mask properly, it's a fomite you could touch and then infect yourself, and there isn't proof it catches anything (which is true - there isn't proof surgical masks even work for surgery.)
They were of course wrong and a week later they'd all suddenly changed their minds and now thought the exact opposite thing just as strongly. Doctors don't seem to be taught the precautionary principle.
It seems the lab testing was bad as well, but it just may have been that our testing has been inaccurate throughout and they were used to more accurate tests.
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.
The island thing just seems like a total red herring to me. The virus arrived in the United States on planes from Italy. There are also plane flights to New Zealand. The difference is New Zealand told the planes to stop landing and the United States did not.
Absolutely. Vietnam and Thailand are good non-island examples with 14-day quarantines and are both great success stories.
Also, Australian states made themselves into "islands" by introducing hard inter-state border closures. These protected other states from Victoria's outbreak of up to 750 cases per day. Most other states had zero cases during this period, while NSW got a minor outbreak due to being slow to close the border.
Spread via animals is big too. Animals don't respect borders. Traditionally, the difference between a virus that can be eradicated and one that can't is whether or not humans are the only vector. New Zealand and Australia are very careful about importing livestock and other animals. This helps. Over all, better to think about this as probabilistic system. It's about odds of otherwise unlikely events (like super spreaders) happening at sufficient frequency to seed the virus. Nothing can be absolute, but things like oceans make it a lot less likely.
Perhaps a better way to say it — oceans are the most effective implementation of a travel ban. There are no land crossings to protect.
Ok Matthew Yglesias, you win. This comment thread motivated me to pay to be able to comment. Nicely played! Clare, you are clearly presenting yourself as an expert in this field. And that is really good, I have been dismayed and confused by a lot of the guidance provided by some of the epidemiological community. I would appreciate it if you clarify your points. Are you saying that the travel ban is a bad idea in the current pandemic unless you happen to be "an island nation"? Can you please then answer Bruce who pointed out examples of countries with land borders? I don't think anyone disagrees with you that animals can spread disease but are you really going to tell us that the types of travel restrictions should not be pursued because certain small to large mammals can cross our border from Canada from Mexico? Again I do not doubt that anyone disagrees with you that oceans help. But you aren't really making (to me anyway) clear points about what should have been done nor are you responding to fairly compelling points above in this thread. Thanks!
You are correct, I forgot to make the critical point about why the differences matter to policy. Travel bans and other containment strategies are Sisyphean labor against a highly infectious virus. We suffer but don’t change the outcome. Here's the argument. Sorry for the length.
How pandemics start:
Asymptomatic spread, infection without disease, is a feature of a virus capable of causing a global pandemic. By its nature, this spread is hard to observe. We don't know a novel virus exists, and it causes minimal or no visible indications. From our perspective, there is no problem at all.
We find these new viruses after a chance event, a spreader event that infects enough high-risk people that it causes an observable disease outbreak. In the first outbreak, viral diseases like Ebola/MERS (usually symptomatic) are indistinguishable from influenza/COVID-19 (often asymptomatic, rarely severe) because we only observe symptomatic cases.
Early evidence we expect to be available to justify a travel ban is subject to a strong observability bias. At the point where a ban could be impactful, we expect to be uncertain about both the virus's origin, extent, and severity. We may not even yet know it exists. Chance plays a significant role in how we learn about the virus. There is no guarantee the first observable outbreak occurs in the same city or country where the virus originated.
Practitioners point of view, it's best to assume we are dealing with a containable virus until there is evidence it is not. Broad travel bans are unnecessary for containable viruses like Ebola because we know exactly where the virus is and have more targeted and effective policy interventions available. Epidemiologists have been criticized in the past (reasonably) for crying wolf and causing unnecessary panic, so the decision threshold and timing for implementing an effective travel ban is fraught. Doing this early enough to be effective would result in the regular occurrence of false positives. People would stop trusting the alerts and eventually scientific institutions themselves. This early detection problem is common in many fields (including cancer detection and cybersecurity) and is called alert fatigue.
Much like with polling data for elections, what we observed in the early data was never our reality. This virus was always going to cause a pandemic; we never had control or the ability to contain it. Early on, we didn’t know that, hence China’s response. The first evidence of the infectiousness of a virus is usually the presence of global outbreaks. At that point, it’s too late. New Zealand, Iceland, etc., had the option to close borders effectively (because oceans) but most countries did not. That's assuming the island nations hadn’t been unlucky already (the virus could have originated within their borders by chance).
As far as the variability in outcomes in other countries, the differences are usually due more to chance and natural effects, not policy interventions. Much of what I see pundits attribute to policy or human failures is explainable by nature alone. It's tough to make causal inference in stochastic systems, and cherry-picking examples using hindsight bias (knowledge of the outcome) is never good evidence to make a case that a policy invention is causal. For example, we expected the wave over the summer in Arizona because people are inside to avoid heat. We expected islands to fare better early on even by chance. We didn’t need to blame the local governments or our fellow humans. That was fear and anger at something outside our control.
How pandemics end:
We cannot contain viruses with high levels of asymptomatic spread. At least, it has never been done. Many believe it cannot be done and should not be tried because of massive second order consequences (not a consensus opinion, but one I hold).
This is a consensus perspective. Pandemics end with endemic disease. The virus does not go away. It becomes a background infection risk with less disease. Spanish flu is the same strain as swine flu, and both are now considered part of the seasonal flu. You have had the Spanish flu. You may still die of the Spanish flu despite the lapse of a century since the pandemic and the presence of a vaccine. This counterfactual matters to the travel ban argument because New Zealanders too will be infected eventually with SARS-COV-2, starting the moment they open the borders. It’s just a matter of time.
Commonly misunderstood, vaccines reduce risk of disease given an infection, they do not directly prevent infection itself. With a virus like this, odds are everyone is going to get infected multiple times in their life. Many of us are already at low risk from disease. Vaccines in healthy low-risk people are extra security (and good for herd immunity) but don’t dramatically change our risk profile. Immunity decays with time, the virus mutates. Time constants for this virus are unknown, it's a fair prior to expect seasonal recurrence of COVID-19 like the common cold we see from other coronaviruses. It could be less frequent if the new vaccines are more effective than average. Beware-- early clinical trial data usually overestimates the end efficiency of a vaccine.
New Zealand has at best delayed the inevitable of widespread infections in their borders, but I’d argue that a “travel ban” around nursing homes is a less costly policy solution to prevent disease and harm than a ban for an entire country that keeps family apart for years at a time, disrupts critical supply chains including for medical treatments and and clinical trials, and destroys global economies causing numerous other public health crises of its own, but that wasn't the claim Matt made so I won't argue that now.
Travel bans work in theory, but not according to the Slow Boring ethos of truly effective policy. We would need to be able to observe the unobservable before we even know a problem exists, and we don’t have the tech for that yet.
Wow, this is such a great set of responses, Claire! There ought to be a way to highlight high quality comments like this on substack
Wait, are you suggesting there's significant evidence of covid-19 spread via non-domesticated animals? (I know there's the mink thing in Europe, but that's a relatively recent development.)
Agreed. Aside from the forced errors by the Trump Administration, one of the toughest things for me to grapple with in this pandemic is that it appears the US public health consensus provided devastatingly wrong guidance on two of the most consequential disease control questions of at least the last 25 years (travel bans and masks).
Lets not forget about testing, and the almost total lack of screening based strategies...
Yup. I live in Thailand and we've been COVID free since about May. There are severe travel restrictions, even though tourism is about 20% of GDP.
Everyone wears masks most of the time, and there are temperature controls everywhere. Not much social distancing. Otherwise, all is pretty normal.
Since the only experience of COVID here is through media, the impression is that the disease is deadly so every time there's news about a potential case, people freak out.
Agreed. This is evidenced in Canada when you look at the success of provinces such as New Brunswick and Nova Scotia (neither are islands) - who implemented wide-ranging travel bans, compared to Alberta - who had the most "American-like" approach and is setting up field hospitals.
That seems to be true. But Mexico is hard-hit by the virus, and so is Canada. We might have avoided the initial spread of the virus back in the winter via plane travel restrictions, but wouldn't we have just inevitably had it spread across the land borders eventually?
Also, sorry, this should've been part of my above comment, but we also have a LOT of travel because we're a large country. Travel controls are necessarily imperfect in a variety of ways. We're 75x the size of New Zealand and I would guess probably have more travel per capita. That means that there's maybe a 100x chance that something will slip through our travel restrictions compared to New Zealand, and once it gets out in the wild in the country past the travel restrictions the fact that it's a small infection in a larger pool is more-or-less irrelevant given exponential growth. Maybe that wouldn't be true if our contact tracing game was great, but it's not.
but, we never even tried, and that's the point. Might have not worked given the scale, but it might have! Promise you that NZ's contact tracing was No.8 wired on the fly just as much as NYCs was. Also NZ has had numerous cases of community spread. It's not like it never got there.
Do you think that if NZ had 100x as many cases of community spread, they would've been able to contain it? It's clear that we aren't able to lockdown-and-contact-trace once things get past a certain level of spread (I mean, we tried. We failed). There's a numbers game here that's in favor of small countries.
China's pretty much not a small country.
I think we aren't able to succeed because the California Gov isn't allowed to close state borders and the state/county governments are the only entities driving meaningful containment response. Montana's case load went up because NoDak's case load was crazy high. Then Idaho's went up, then Nevada's. Scale would make it harder, but we also have literally unlimited dollars to throw at the problem. NZ's debt tradeoffs are much more severe than ours and downside economic risk to eliminating tourism exports much larger.
"Small island nations like New Zealand and Iceland can do well due to geography alone; it has little to do with government travel policy."
But how do you reconcile this with China's experience after their initial wave?
It appears that their combination of strong infection control measures at home coupled with very strict travel policies has provided outstanding results.
What am I missing?
It is much more likely to me that China's data is fraudulent than all experience with infectious disease from human history is wrong. I have no special knowledge, but I'd bet lots of money on it.
I don't doubt that local governments aren't reporting full figures, but if you follow China issues on a regular basis it's pretty clear that there's no epidemic spread inside China right now. The scale and breadth of the Party's authoritarian powers are really unprecedented, so it's perhaps not too surprising that they managed to control this once they finally swung into action. If you had to design the ideal government for virus suppression I'd imagine that it'd look a lot like the CCP.
Worryingly, given the nature of the CCP and the current international environment, you have to wonder if they're asking themselves some questions about bio-warfare right now given what they no doubt perceive as their immense success in combating pathogens vs. their likely future antagonists.
The notion that the party's "authoritarian powers are really unprecedented" is off. It's true the party enjoys surveillance technology far more advanced than anything Mao dreamed of (although ordinary human snitching can accomplish a lot!). But it's also true the party presides over a very large, very sophisticated, very complicated and open economy, and as such necessarily accepts a lot of freedom of action by ordinary people.
I think the better analogy would be, say, Taiwan or South Korea pre-democratization. Or maybe Franco's Spain. (Indeed from what I can see the modern CCP pretty neatly fits the textbook definition of "fascist.").
An interesting thought experiment for me is to consider what would have happened if western democracies had taken the lockdown, mask up, restrict travel approach that I think is behind the successful containment of the disease that we're seeing in many Asian countries.
In other words, how much of this success is due to cultural differences (eg individualism vs collectivism), how much is due to effectiveness of govt. policy implementation (eg high trust in government versus low trust), and how much is because the medical/scientific establishment in the east was correct from the start on travel bans and masks (versus bad initial guidance from the western medical/scientific establishment on these questions).
I think it's true that the current political environment in the US makes trying to emulate the successful strategies of Asian countries in fighting Covid basically impossible.
Republicans would focus on government overreach and the harm done to businesses, progressives would fixate on particular groups they think were disproportionately harmed by the lockdowns. Neither of the dominant political movements in the US believe in individual sacrifice to help the nation overall (at least for their own supporters, personal sacrifice from the other side is totally ok).
I'd politely disagree that it's off. I'm not suggesting that ordinary Chinese are unfeeling 1984-style automatons or that it's a command economy, obviously, but the use of advanced surveillance technology on a massive scale combined with traditional authoritarian control methods is what makes it unprecedented. This kind of stuff has only even really been made possible in the last 10 or 20 years.
I'm not sure that I'd call the CCP fascist. There's no clear-cut definition in the first place, which does make things difficult, but the CCP lacks an analog to the party militias of the historical fascist states, which existed outside the state apparatus. As far as I'm aware there's no "Communist Party" militia, since the CCP has taken pains to inextricably interweave itself with the state apparatus. To me it simply seems like an authoritarian government. Authoritarianism and extreme nationalism are by no means limited to fascism, although both are present within it.
Same with South Korean, Taiwan, Vietnam, Thailand, and Cambodia?
They all seem to have successfully combined effective infection control at home with very restrictive travel policies.
China is a dystopian techno-authoritarian police state unlike anything the world has ever seen, with a built-in contact tracing infrastructure at massive scale thanks to the local Party cells present in each neighborhood which already perform the job of monitoring their citizens on a regular basis. Any government which can order its citizens to remain in their apartments for *six weeks* and enforce that order has the tools necessary to choke off circulation of a virus.
Additionally, it's worth noting as well that there's a growing scientific consensus around the idea that the virus mutated to become more infectious after arriving in Italy. China was acting to suppress a less-virulent version of the virus, and after doing so successfully, really need only keep their borders closed to avoid the more-infectious version getting in.
Why the asterisks on "six weeks?" Makes it seems like you are trying to suggest the duration of China's lockdown was especially long. Not so. A number of countries' lockdowns went beyond the two month mark. Australia's Victoria experienced, what, 15 + weeks of lockdown cumulatively?
You may have better information than I, but from the on-the-ground Wuhan & Beijing reporting in January-February & from the Twitter feeds of Westerners in China at the time, my understanding is that many people in China literally did not leave their apartments for a month or more, relying entirely on contactless delivery. That's an entirely different animal from even the stricter lockdowns in Western nations where you'd still be permitted out to get groceries, exercise, etc.
Even in Wuhan most people were allowed a weekly/biweekly trip to the supermarket (one per household). I've heard anecdotal stories that in some of the worst-hit communities (basically a large, gated apartment complex), authorities welded doors shut. But that could be urban legend. In Beijing, though, things definitely weren't anywhere near that strict. I have expat colleagues who tell me Beijing was very close to "back to normal" early in March.
Same for South Korea?
South Korea is a much smaller quasi-island nation, so comparisons to China aren't really germane, but they also benefited from grappling with a less-infectious version of the virus.
“To make a very long lecture as short as possible: viruses cannot be infectious and deadly simultaneously as sick hosts do not move around.”
I would say the existence of smallpox invalidates this theory.
Smallpox is a very instructive example, actually. It is one of only two viruses to be eradicated. This success was possible only because it fit key categories: 1) there was minimal to no asymptomatic spread; 2) it only infected humans and not any other species, 3) the most common strain wasn’t very deadly (something like 1% while ebola is closer to 90%). It's the perfect example that proves the overarching rule. Smallpox was possible to contain, hence requires a different response. It’s a perfect example of the practicality of this approach.
But to your larger point, I’m under no illusions that biological theories operate like physics. Most require extensive expertise.
I thought smallpox killed about 30% of those from groups with no history of smallpox exposure?
I’d say that the development of a smallpox vaccine probably had more to do with it being eradicated. But in any case, it shows that it is possible for a virus to be both very infectious and also very deadly. And that’s not the only virus for which that’s the case.
smallpox eradication was finally achieved via ring vaccination of everyone around an outbreak, not vaccination of the entire world. The ability to do effective contact tracing and containment was key.
There's obviously a large difference between 1% or 90% fatalities that may impact your approach, I don't know why we're collapsing this down to "very deadly".
*****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 surprised you managed to get into China! I'd heard that they weren't even letting their own citizens back in.
I find Western reportage on much involving China to be ludicrously inaccurate or incomplete. But in a word, no, it's not true they're not "letting their own citizens back in." Provided Chinese citizens test negative and are willing to put up with high air fares, they can go back (quarantine still required, mind you: almost all my fellow quarantining returnees were Chinese). Still difficult for foreigners to enter/return, of course, but those with residence permits can generally pull it off.
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.
The lack of challenge trials is an absolute scandal. They are so difficult to get past "ethics committees" that it is seldom even tried. (I don't know whether a challenge trial was proposed for any of the current vaccine candidate. But even if not, it is still the well-understood obstacle of the ethics committees that prevented it.)
This whole system of "ethical approvals" needs rethought following this years experience. Challenge trials - with financial compensation for volunteers - should be a matter of course for infectious disease vaccines.
I think those of us without backgrounds in vaccine development of clinical trial management should be a little more humble in our thinking about challenge trials. Yes, it was definitely a topic worth raising, but standing up a brand-new testing methodology in the middle of a time sensitive crisis is always going to raise complexities and surprises that we're not in a position to understand or judge the risk of on any meaningful level.
Can I exclude the possibility that the whole problem was institutional inertia plus no real incentive for the drug companies to rock the boat? No. But I also don't think we're in a position to declare it was obviously the correct approach and that it's a 'scandal' that no-one did it.
The fact that there was/is clearly absurd institutional inertia in the case of tests makes it seem more likely that there's also been an unacceptable amount of inertia where vaccines are concerned.
I think the key difference there is the views of political leadership. It's not a coincidence that the country that fucked up its testing is the one where the political leaders didn't want people to get tested.
That's right, but I do think there's also something to the narrative that says the FDA was simultaneously under political pressure of a different sort, to the effect that a vaccine had better not be approved before the election lest that get Trump re-elected.
I mean, you've lost me at the point where you're suggesting that an organization overseen by republican political appointees was somehow under pressure to ensure that a massively important vaccine didn't get approved on a timeline that would help the republican president that they work for.
I think that's one of those strong-claims-require-strong-evidence sort of situations.
Sir, this is the internet. Take your nuance and leave.
I was in favor of challenge trials early on. But after looking at the results of the non-challenge trials that we did have, I think that challenge trials would not have helped much. We got statistically significant results about 3-4 months after enrollment started - I think challenge trials might have sped that up to 1 month. But challenge trials would *not* have answered the question that most people are worried about (and which I've seen a lot of skepticism about even with these ecological trials) which is that challenge trials don't tell us whether or not the virus protects against ecologically realistic viral exposure. It's quite conceivable that a vaccine that protects against injected virus fails to protect against bits you inhale in the wild - and perhaps more importantly, a vaccine that *fails* to protect against the kinds of challenges provided in a trial might nevertheless be quite effective against the kinds of exposure we get in the wild.
So with challenge trials we would have gotten results a few months earlier, but without the contextual knowledge that we need about whether it would protect people in the wild. And the other main advantage of challenge trials is that they need fewer participants - which is a *dis*advantage when it comes to understanding broader safety issues with a vaccine candidate.
Clinical trials allowing for direct exposure of trial subjects to the virus could and should have gone way beyond double-blind vaccine trials (although they should certainly have included that).
What shape is the curve between concentration/ duration of exposure and risk of infection? Between ingested viral load and infection severity? Our refusal to perform well-designed clinical trials involving exposure of volunteers to the virus has denied us this knowledge - needlessly. We still don’t know the answers to these questions. Possibly we will never know.
Gaining such knowledge would enable all sorts of social benefits to flow quickly, cheaply and effectively — even before a vaccine was proven out. The only way to do it is to expose volunteers to the virus. And (presumably) pay them handsomely.
Yes, this seems right. It *would* be very helpful to have challenge trials for many aspects of this virus. Particularly to figure out the effectiveness of various non-pharmaceutical interventions. Don't just look for the natural case of two infected hairdressers treating 150 clients while wearing masks - do actual experiments where *known* infected hairdressers and *known* uninfected ones treat clients (both with masks and without) and see how many test positive.
You don't think, though, that challenge trials showing 90+% effectiveness would've been sufficiently strong evidence that it's at least 50% effective in the wild (which they've said was their standard for approval)?
I think that would be sufficient for the approval angle. And now that I think about it, speeding up approval by a month or two really does seem quite good right about now.
But even if approval was faster, it would leave unanswered the deeper question, of how effective the vaccine is in ecologically valid interactions. (And it would also run the risk of a perfectly effective vaccine being denied because it was ineffective against the types of challenge it was presented with, even though it's effective against what actually happens in the community.)
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!
He thought reelection was in the bag, and that focusing on the outbreak would spook financial markets, thereby reducing his reelection odds.
No, he's not very bright.
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.
I mostly agree with your comment with the following caveat: I think it's possible to imagine a robust and comprehensive quarantine regime being enacted/enforced in US *if* the country had gotten on top of the outbreak quickly enough so that case counts were very low. But the US case count was probably in the six figure range by early March. No way we were going to force tens of thousands of people into quarantine hotels.
It not having been possible for Trump to produce an effective 14-day quarantine on the fly isn't a good reason for us to not discuss the problem. So you are right, we need to address this problem with a new consensus on pandemic response.
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.
"Trump would take moves to become dictator were never supported by any evidence of his ability to do so"
What does his ability to succeed in doing so have to do with his actions to do so?
In both cases there is no good evidence.
In that case, Biden and the Dems should probably have as much respect for the next few election cycles as Trump does.
Respect for the cycles?
Respect The Cycle!
Joe Rogan? That's crazy, man- but have you ever tried DMT?
Is there a way to control video playback speed with Spotify?
I'd love to watch the Rogan/Yglesias convo once it drops, but there's no way I'm doing it at 1x speed.
I've sped up Spotify podcasts before, so, yes, it's possible.
With video or just audio?
It looks like there's a chrome plugin that let's you speed up audio podcasts, but I don't see any way to do it with video. The spotify community area shows a request for this feature with response from spotify (from September) that they're looking into adding the capability to their player.
I have no idea how Spotify videos work, but you can speed up Youtube videos as well and Rogan releases all his podcasts on Youtube. It's under settings and you can go up to 2x.
I see. Missed the "video" part -- my bad.
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.
Two thoughts here:
(1) I think he was punished. I'm convinced he would have won the election.
(2) I think there will be so many lasting impacts here. I own a small restaurant services business - chemical fire suppression. Our book was down 25% by July from locations that had already permanently closed. We have another 10-15% past due on inspection who have temporarily closed or can't afford the inspection fee. We think Chicago will end up losing 40% of restaurants. Then too you have all the job market disruption from an accelerated physical to digital transformation (e.g., KAR took out 30% of their workforce by shutting down physical auctions, insurance companies are eliminating field adjusters, eMedicine is real trouble for doctors).
I wish you success with your restaurant business and I *am* concerned about the impact of the recession on small businesses. But we've had recessions before and they haven't transformed the country. We'll return to the natural path of economic growth sooner or later (I suspect sooner).
As for your first point, Herbert Hoover was elected President in 1928 with 58% of the vote. In 1932, he received 40% of the vote. Trump won 46% of the vote in 2016. This year he got 47% of the vote.
I think the American people know how to punish a President if they really want to.
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.
You can do research level genetic testing and actually get the results yourself with a 30x or 100x WGS test from Nebula and then a report from Promethease - however they're at least half right that you won't be able to read the information properly, and it's not very actionable even if you get perfectly accurate information out of it.
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.
Go to March 12 when Trump announced limited restrictions on travel from Europe.
By then it was obviously "too late" to stop the virus from existing in the United States. But allowing a continued inflow of people from around the world, including Americans from Europe, clearly seeded our country with additional cases over and above what we were already dealing with.
March 12 is way too late to have had a noticeable effect. I agree that we were still importing cases from elsewhere then. But I think people haven't processed that we probably had close to 500,000 people infected at that point (Gu's 95% confidence interval is 435K-980K infected on Mar 12). We were domestically producing *far* more cases than we were importing at that point.
Indeed! The travel ban would have had to be on Europe in late January in order to actually matter, as we imported our outbreak from Europe in February. There's just no world in which the political capital for that would have existed, especially when it'd entail also not permitting American citizens to return home. In the future, we may see Western governments willing to preemptively enact draconian bans like this now that the public has a clearer picture of the stakes (whereas Asian populaces were already primed to understand the need thanks to SARS).
Would've still been a wise policy at that point, given the information everyone had at the time, since we weren't in a position to know about the 500k cases.
But I think at that time we *were* in a position to at least *strongly suspect* that there were far more cases than we already knew about.
Hey buddy! Yeah, fair enough, it all depends on how reasonable it was to assume different scenarios and so on. Like the same might have been true in Australia at the time, but it just turned out there weren't that many cases there.
I shouldn't have been surprised to discover after I started typing that the first comment on MattY's blog that I wanted to reply to was written by someone I already know.
But my thought about Australia is that initial travel restrictions probably didn't do a lot, but once they got their case counts low enough to trace every case, at that point the travel restrictions were very important for maintaining the low numbers. (Or perhaps the more important part about travel restrictions was to enable contact tracing to have a fixed pool of people to work with.)
I certainly think that travel restrictions can be a key part of a complete, competent strategy. I don't think they would've hurt if implemented then. But we didn't have a competent strategy to control spread in US communities.
The last 2 paragraphs of this piece state that Matt guesses that they would have been sufficient to control the US epidemic ("My guess is... it would've worked..."). I don't think that stands up to any realistic consideration of the size of the epidemic by late Feb.
State-level travel restrictions were clearly underrated as an option once the virus was already in the US. Queensland, Aus - a state about 2.5x the size of Texas, with the climate of Florida and politics of Montana - introduced laws that could put people in jail for up to six months for trying to cross the border without a permit when they had had just *6* deaths state-wide. They haven't had a single death since.
US states may not "abridge the privileges or immunities of citizens of the United States."
Yes but they could restrict travel into and out of the state, and they could set up quarantine checkpoints at the state border, if that was a necessary and justified response to a threat like COVID.
What states cannot do is discriminate between state residents and non-residents, e.g. by set up checkpoints which only pull over drivers with out-of-state license plates.
That's a big "if."
I think the date that China restricted travel from Wuhan into China (but not internationally) or immediately thereafter would have been the logical date to restrict travel of foreigners and institute a 14-day quarantine from China. So 2/22/2020. If the US and Europe would have implemented that policy the outbreak would have had a greater chance to be contained. I don't see how anyone reasonable foresees the issue we had with it hitting NYC, so Europe would have needed good measures as well as us. As Matt said, policy consensus around pandemic response was just not very good.
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.
Sam can you pass along the information on this? I vaguely recall something. Was it shut down because it wasn't utilized? Too expensive? I'm easily persuaded by city incompetence but I don't know if its fair to blame them for this particular case.
The one I know of was at the Hotel Julian but I'm having trouble finding any news stories or information about it other than that it existed. I heard from friends that it was severely underused when it did exist. Not sure if that's because they didn't do enough to publicize it or didn't tell the people giving out information to communicate it to people who tested positive or what.
FWIW, I had, at the beginning, been rather happy with the Mayor and Gov's efforts (I'm in Chicago so this is why I care). But as time has gone on, I've found most of the Mayor's efforts just not really enough. A benchmark of 4,500 tests a day in a city of 3 million is just pathetic. As is the set up of city testing sites that require a car, run MWF from 10-4 only, etc.. And then her attitude with the schools' teachers union, the fact that it still isn't legal to walk on the beaches or use the playgrounds. Her chief health officer has steadily depreciated the goodwill we had for her at the beginning...
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.