05-29-2020, 08:13 AM
(05-28-2020, 12:10 PM)BostonCard Wrote: I think the disconnect between us is that based on your post, it looks like you see a binary state: "containment" or "out of control", and that any country that didn't reach containment failed, and thus the fact that the US didn't reach containment is not a big deal, since no other industrialized country in Western Europe and North America was able to reach containment.BC, you're giving me more credit for subtlety than I actually possess. As I think you know, I'm philosophically trained and historically inclined. Many of you write with bitterness or exasperation of some window of opportunity that was missed early on. That made me wonder, because I wasn't sure exactly what then that was, or if it even existed. So I went looking for it, checking the Wikipedia accounts for various countries. I didn't know what I would find. I was not terribly surprised to find that - excepting the Asian anomalies - the Western pattern was just about identical - a high degree of confidence in January, which gradually erodes in February, and collapses in early March. That conformed to my own experience. I just don't see any window of opportunity in that time frame, not that anyone recognized at the time. When no one recognizes the opportunity, given that there are any number of competent people involved, it's intuitively plausible that the gating factor is increasing information - and I believe that is the case.
If that is your metric, then I agree with you. The fact that we didn't achieve early containment in the US was almost inevitable. The fairly non-specific presentation of COVID-19, the fact that you can get presymptomatic and asymptomatic transmission, and the relative high reproductive rate means that traditional means of containment are much harder for COVID-19 than a lot of other infections. To be clear, I don't blame Trump for the fact that there is community transmission of COVID-19.
However, within the "out of control" category, action to bring down the transmission rate early makes a big difference in the ultimate mortality rate. As I've mentioned in another post, a delay of one week in implementing shelter in place measures meant an additional 36,000 deaths in the United States. Moreover, actions are not binary either, a choice between lockdown and doing nothing; there is a lot that could have been done short of shelter in place to reduce the spread of COVID-19.
Let's compare the action of two governors (both Democratic).
On March 4, with 53 confirmed cases and one death from COVID-19 in the state, Governor Gavin Newsom declared a state of emergency.
On March 12, with 252 confirmed cases and four deaths, Governor Newsom announced that mass gatherings over 250 people were banned until the end of March and issued an order to permit the state to commandeer hotels and medical facilities to treat coronavirus patients.
On March 15, with 478 confirmed cases and six deaths, Governor Newsom called for voluntary closure of bars and in-home self-isolation of seniors 65 and older, as well as persons at-risk due to underlying conditions.
On March 19, with 1067 confirmed cases and nine deaths, Governor Newsom announced a statewide stay at home order with all residents except those working in essential occupations urged to stay at home. The state has asked the Department of Defense to deploy the USNS Mercy hospital ship in California.
On the other hand
In New York Mario Cuomo issued the state of emergency when the case count was at 89.
Cuomo announced bans on gatherings on the same day as Newsom, but set the threshold at gatherings of 500 people instead of 250 (326 cases in)
It doesn't look like Cuomo issued a call for voluntary closures
On March 19, when Newsom announced the shelter in place order in California, there were 4161 confirmed cases and 39 deaths.
When Cuomo announced the SiP order for New York, there were 7113 cases and 68 deaths. Moreover, the order wouldn't go into effect on March 22, by which time there 15,188 cases and 142 deaths.
Every step of the way, Cuomo was only a couple calendar days behind Newsom, but when you add in the fact that New York was further ahead in the pandemic, the cumulative effect was that New York putting its shelter in place order into effect March 22 was the equivalent of California putting its order into effect April 6. That effective two week delay meant that New York wound up with over 250,000 more cases and 25,000 more deaths than California.
So is Cuomo blameless for his delay, because look, California also would up with an out of control pandemic? Does that mean that Cuomo couldn't have been better, because Newsom wasn't perfect either? Does this mean there was nothing New York could have done better, because look, every state has been affected? Does it not matter all that much, because they responded more or less at the same time?
No, at every step of the way, New York was slower to react than California, despite the fact that the epidemic was more advanced in New York than California (and growing faster), and for the COVID-19 pandemic, days, let alone weeks make a really big difference in how the pandemic plays out.
Of course there are things you can question about California's response. It might have seemed like an overreaction at the time, but even Newsom could have been more aggressive and realized that even though there were "only" 250 cases on March 12, the rate of increase was 4 - 5x fold per week. He could have been more aggressive about limiting large gatherings earlier. But the fact that Newsom could have been more aggressive doesn't excuse the lackadaisical response by New York.
BC
From March 10th on, I really don't have much to say, except that no window of opportunity exists. Various governmental, and regional, and even municipal, responses are too idiosyncratic to categorize. Some work better than others. If you want one observation that might or might not be significant, just eyeballing the basic Google graph, the Old World in continental Europe and Asia seems to be coping a lot better than the New. It could be that the diversity and polycultural character of the New World is a negative in this situation.
The ultimate point is a rejoinder to the cultural clash that has developed between Blue (SIP) and Red (re-opening), polarized as always by Trump and his opponents. It begins with what to me is a useless exercise in error analysis, after which the various factions group in support of one position or the other. But Covid-19 seems to me a phenomenon way beyond political calculus. We're going to have to live with this maybe for half a generation or more, and find solutions that compromise both Blue and Red positions.
I wouldn't give you two cents for all your fancy rules if, behind them, they didn't have a little bit of plain, ordinary, everyday kindness - yeah, and a little looking out for the other fella, too.
