We might yet stave off pandemic

Public health agencies might yet prevent Covid-19 from becoming a world pandemic. Robert Walker dives into the details:

Flu spreads communally. Flu spreads through children. Roughly 1 in 3 of those who get flu are a non symptomatic spreaders, who never show any symptoms. All that makes it just about impossible to use this method to contain flu, and that is why you can declare an influenza pandemic at an early stage. However COVID19 has none of these characteristics as we will see. It spreads typically through households and close or prolonged contact, and typically the contacts know each other. Unlike flu, other forms of transmission are rare to nonexistent and are not driving the spread. This is why case finding and contact tracing has proven to be so effective in stopping COVID19.

He argues that there is enough international medical presence in China to corroborate what is happening there. And if that model of the disease proves out, it is contact tracing, not travel bans, that are key:

Italy is not only tracing contacts within Italy. The Italians are tracing contacts through to other countries. Take the two cases in Mexico, say. They are not only tracing all their contacts in Mexico. They are tracing all the contacts of the person who infected them in Italy—or wherever the original contract-point areas for the cases happen to have been around the world. This is why it really doesn’t matter whether you have travel bans or not, so long as you have co-operation of countries in contact tracing.

Viruses don’t care about national borders.

Of course, it’s not certain that these efforts will work. This disease might well turn into a pandemic, either because of gaps in the efforts to contain it, or because it has characteristics, some yet unknown, that defeat those measures. Public health officials face what I call the infectious disease Catch-22. When they succeed in stopping a new disease, what they do always seems too much, their early concerns excess fear-mongering, the receding threat not worth the trouble. When they fail, what they do always seems too little or misdirected. Everyone in retrospect thinks they would have known better, and overlooks that when a disease is new, we have less knowledge of its character.

More, people hate that real uncertainty, and demand answers that don’t yet exist. Dr. Tony Fauci speaks in the hedged terms that someone knowledgeable does:

It could be really, really bad. I don’t think it’s gonna be, because I think we’d be able to do the kind of mitigation. It could be mild. I don’t think it’s going to be that mild either. It’s really going to depend on how we mobilize.

Right now, that mobilization is more important than where the Dow Jones goes in the next month. Dr. Fauci works under a deceitful and narcissistic president, who thinks he knows better than everyone else, who is concerned solely with his own power, and who leads a party that targets expertise as something suspicious. Fortunately, Dr. Fauci is accustomed to thankless tasks.

The current uncertainty will amplify the voices of those less rational and less knowledgeable than Dr. Fauci. Some will pretend that everything is under control. Some will preach a coming plague worse even than what is even plausible. Those shouting will be driven by political expediency, by the desire to fix the future, and by the desire to claim a false kind of leadership. Strangely, all those claiming to know now will somehow also claim to have seen correctly, regardless of what happens. The reality is that it may be weeks or months before there is much clarity to the direction this disease will take. Which makes Camus’s book all the more relevant. And well worth reading.