Back when we were well in
to the initial stage of lockdown during the first part of 2020 I posted the “Random Ramble” set out below which
addressed the steps taken to deal with the pandemic and tried to cut through
some of the “myths” that were arising in connection with the same. I thought it would be useful, as we in
Ireland sit through another lockdown, to go back through and try to figure out
what was right and what was wrong in that original post, to see what had stood
up to the test of time over the past months and where various parties may have
fallen short of the mark. These comments
will, like this section, appear in red. There are a few assumptions I’m going
to make going into this – so it’s only fair to set those out beforehand:
1. I am not
going to be proceeding from the assumption that, in Ireland, “we opened up too
soon”. I actually am one of the few who
do not take issue with the fact that for much of the summer and autumn the
country was operating within much looser parameters. I happen to feel that the numbers fully
justified opening up and that there would have (justifiably) been wholesale
rebellion if that path had not been followed.
I do feel that the re-opening and subsequent monitoring, while not
“wrong” in itself – was handled exceptionally poorly. I’ll set out why in the text below.
2.
I will not
assume that anyone knew or could have known when the vaccine’s that were being
developed would be rolled out. Yes, in
retrospect, people may have done things differently if the fact that a Q1 2021 vaccine
would appear – but there is no way to fairly penalise anyone for failing to be
clairvoyant.
3.
The situation
in the United States will be treated as something of an anomaly – it would be unfair to
saddle the current administration, in office for only three weeks, with any
blame for the idiocy that came before. This won’t always be the case – but for
now they get a pass while we see how things work out in the coming months.
So – here’s the
predictive grades for Covid 101.
The Ramblings turns 21 with this post and
so it’s time to be a bit more adult about things.
Don’t worry, this won’t last long.
Nothing is more frustrating, I’m sure, than
looking at something on the internet, whether it is on a social networking
site, a video, some random tweet or a (supposedly) legitimate media outlet and
seeing something that you know is either (1) wrong; (2) misleading; (3)
uninformed; (4) inciteful; (5) just plain stupid or (6) some combination of all
of the above.
Each of those sorts of infuriating
characteristics has its own reason for being infuriating. For example, something that is inciteful (as
opposed to “insightful”) is designed to provoke – so it doesn’t necessarily
even have to be wrong – it could just be phrased in such a way that is designed
to get a response out of people – like “anger”, at a time when “angry” might be
the least productive thing to be. How
about this excerpt from a recent news story:
He said: "It’s not only China, you
take a look at Ireland. They make our drugs. Everybody makes our drugs except
us."
He then repeated his promise to move US
pharmaceutical manufacturing back to America.
"We’re bringing that whole supply
chain back," he said.
(The “He” who said this is, of course,
Donald Trump. When he says Ireland
manufactures a lot of drugs – he’s not wrong, and when he says China is also in
the drug manufacturing business, he’s also not wrong. But to mention those two countries in the
same breath, while technically not “wrong” is inciteful. He’s just trying to rile people up - and not
for any particular purpose. China wants
to manufacture drugs in order to compete with the United States, Ireland
manufactures drugs in order to help make the United States competitive. Here’s a description of the REAL reason U.S.
companies establish themselves in Ireland:
“19 of the top 20 global pharmaceutical
and biopharmaceutical companies are based in Ireland for a good reason. By
establishing their manufacturing here, this industry has great geographical
proximity to the mainland European markets. Easy international shipping across
the Atlantic is very beneficial for pharmaceutical exports to North America.
Five of the world’s eight top-selling drugs are produced in Ireland, making it
the world’s largest net exporter of pharmaceuticals and a globally
recognised centre of excellence in pharma.”
So, what’s the real
reason drug companies locate in Ireland? Turns out it’s not so that American companies
can go somewhere and cheaply manufacture drugs to ship back home - it’s so U.S.
companies can go somewhere to manufacture drugs which have proximity to OTHER
markets, like continental Europe. If
they did not have that foothold in a geographically advantageous spot there
would be lots of other countries that would then gain that advantage – and one
guess as to which one would benefit the most.
Ding! You got it in
one – China
So, stating something
like this just serves to incite – rile people up – without really informing
them. Those sorts of things are
bad. However, when it comes to getting
under my skin nothing tops the “uninformed” opinion. Mind you – I have split “uninformed” off from
the category of “wrong” because, while someone can be informed but draw an
incorrect conclusion – at least they tried.
An uninformed person just has no fucking clue what they are talking
about, but they will happily tell you how certain they are with no
constraints.
Also – they must come
from a place where everyone oversleeps because they seem to always be telling
us all to “WAKE UP PEOPLE!”. Here is a
video of uninformed people proving my point:
https://www.youtube.com/watch?v=VYi4fkmyIP4
I don’t know how we
will EVER fight off the great conspiracy of 5G, crypto-currency, radiation
poisoned, new world order driven conspirators who are doing this all with a
virus THAT HASN’T EVEN BEEN PROVEN TO EXIST! (Said through a mask).
Look – it’s not all
one way either. Slate magazine, increasingly
the purveyor of National Enquirer like stories such as “My Sex Resort of Choice
Has A Racist Themed Night” have decided that they know the only way to recover
from the lock down – which in an enormous coincidence happens to line up almost
exactly with the economic agenda they have been trying to sell for years. Goodness, what are the chances?
https://slate.com/news-and-politics/2020/05/covid-19-recession-new-deal-plan.html?via=homepage_recirc_engaged
No – a new New Deal isn’t the ONLY way to
recover – but using the crisis as a way to insist upon advancing your own
agenda is one sure way to get more people to buy in to those ideas because of
the crisis, not because of the value of the idea itself.
There are, of course, attempts to combine
elements of the above – for instance, you can be both uninformed AND
inciteful. Here’s a dead give-away. If the content you are reading seems to
follow the same path as an urban myth – it’s not to be trusted. For instance – when you see a post about how
“I know someone whose mother-in-law’s friend had a husband who died of a heart
attack, and the hospital insisted on listing it as a Covid related death in
order to keep this FAKE pandemic going” you have essentially just been fed the
equivalent of the following stories:
·
The Vanishing Hitchhiker
·
The Mexican Pet
·
The Choking Doberman
·
The Guinea Pig in the Microwave
The person or persons who are feeding you
those stories are doing it because they are not taking the time to check
whether what they are saying is true.
There is a very simple reason for that – they could not care less about
whether the story is true – they are trying to provoke and incite.
So how do we cut through the bullshit? The best way is to just deal rationally with
what we actually know. Not what we think
we know, what we wish we knew or what “someone’s mother-in-law’s best friend’s
uncle” says they know. Let’s just take a
deep breath and take stock.
Wow – maybe I was
clairvoyant. I don’t think I need to
remind anyone how dangerous perpetuating an ongoing lie turned out to be in the
United States. The “election fraud”
debacle perpetrated by the disgraced former President makes his lies about the
Irish pharmaceutical industry pale by comparison, but this is not, primarily, a
political review. Let’s just say this
section turned out to be pretty spot on.
1.
THERE IS A PANDEMIC. IT IS CAUSED BY A
VIRUS. WE KNOW WHAT THAT VIRUS IS. THIS
PARTICULAR STRAIN IS NEW AND SO IS DIFFICULT TO DEAL WITH THROUGH THE EXISTING
MEDICAL TOOLS AT OUR DISPOSAL.
This pandemic not “made
up” and it is not the result of 5G technology being beamed into our
skulls. It is from a virus designated
Covid-19 and we know the family of viruses from which it springs. Unfortunately, this is a “novel” virus, which
in this case does not mean it is a long piece of prose written by Stephen King
(again) but is “novel” in the sense that it is “new”. This means that when treating or coming up
with ways to treat the virus science and medicine are starting from further
back in the field than they would like to.
As hard
as it is to comprehend there are still people who insist that the pandemic is
largely a media creation, that the whole crisis was a “plandemic” and that we
would have been better off just going about our lives without acknowledging the
virus’ existence or making any changes.
To those people I only have one thing to say:
https://www.youtube.com/watch?v=Kd-Sa_3iBVA
2.
THE VIRUS IS ONLY LIKE THE FLU IN CERTAIN
WAYS. IT IS UNLIKE THE FLU IN TWO
EXTREMELY IMPORTANT WAYS. FIRST – IT HAS
A HIGHER TRANSMISSION RATE OF INFECTION.
SECOND, IT HAS A LONGER INCUBATION RATE ONCE IT HAS BEEN TRANSMITTED. BOTH OF THOSE THINGS ARE NOT GOOD.
I debated
whether to use numbers in this section but, in looking them up, I realised that
they often varied from source to source.
Not enough to undermine the basic statements above but enough to make it
deviate from the basic premise of this article, which, you’ll remember, is to
talk only about WHAT WE KNOW. We know
that, like the flu, this is a virus – and in real terms that’s about as far as
the comparison should go in terms of trying to understand things about what
we’re facing. Oh, sure, you could get
into how the virus attaches to a cell and replication rates – but that is like
knowing the theory of relativity as opposed to Newton’s physics. Einstein’s is correct but for everyday life
Newton’s is more useful. Let’s stick
with the useful. So, both are viruses –
important to know for some basic approaches – like antibiotics aren’t a primary
way to fight the illness. Antibiotics
are primarily for bacterial infections.
Otherwise this
virus is more infectious than the flu, meaning that it’s going to spread more
rapidly. You know how those charts show
how quickly one pair of breeding rabbits can quickly become thousands? This virus breeds like a rabbit, while the
flu breeds like – well, like cats. Don’t
get me wrong- there’s a hell of a lot of cats out there – but put ten cats in a
field and ten rabbits in the field next to it – as long as the goddamn cats don’t
eat the rabbits there’s gonna be a hell of a lot more rabbits when you come
back in six months.
The second part
of the above statement is even scarier.
When you catch the flu you typically get sick in a day or two. You then stay at home (or you should, cuz,
dipshit, you’re sick) and remove yourself from the population for the time that
you’ve got the bug, and then go back out when you are no longer transmitting
the disease. Sure, for a half day or
maybe a couple of days at most you’re infectious and out in public, but that’s
a transmission rate that the medical system can absorb if someone gets really
sick from catching the flu. (I’m not talking mortality here yet – that’s coming
up).
But with
Covid-19 you can be infected, transmitting the disease and SHOW NO SYMPTOMS for
up to about 6 days. That’s at least three times as long as the typical flu case
– so you’re a walking petri dish of disease for that whole time – and –
remember, it’s with a disease that’s more infectious than the flu to begin
with. That’s why this is worse than the
flu – people who are transmitters are generally walking around longer, thus
infecting more people - at a higher rate – and this is something that medical
systems CANNOT handle. This will come up
again in the section about what “flattening the curve” really means.
Not really much to say about this other than to point out
that as the variants of the disease become known the factor of enhanced
transmissibility becomes even more important.
Before we go
there however – let’s talk about what we can do to stop a disease like this and
what each one of those options means,
3.
THERE ARE BASICALLY THREE WAYS
TO FIGHT THE DISEASE, ISOLATION, IMMUNIZATION OR MEDICATION.
OK – the first
of those is easy to understand – you’re probably already doing it right
now. Isolating people from each other is
a way to fight ongoing transmission and people have been doing that for
centuries. Back in the middle ages,
during the plague, towns would be quarantined for months – sometimes it worked,
other times when people went to check there would be no one left in the
town. The concept is easy to understand
– if you keep people from contacting each other in ways that spread infection –
you slow the spread of infection. This
is even better in these days when we know about such high tech things as
“washing your hands” and “don’t throw your feces out in to the middle of the
street”.
Ain’t science
wonderful.
But look – even
if it traces back to the dark ages isolation remains a vitally important part
of this effort. Remember how we said at the beginning of this article that
medicine and science were starting from about the two yard line because this is
a novel virus? That’s true – which means that in many ways isolation is the
best weapon we’ve got right now. It’s
like a fighter who doesn’t have a great left, and doesn’t really have too much
of a right either – the best strategy is to stay the hell away from the other
fighter until he’s tired enough to not need a great punch to knock him out.
(Note to reader
– in this case the “other fighter” is Covid-19).
This section remains true – isolating populations and
“lockdowns” are an important aspect of containing the disease. However, further along we will talk about
over-emphasising lockdowns as a means of excusing ongoing ignorance – that is
where things get complicated.
Now let’s talk
about the second weapon – immunization.
There are two classic ways of gaining immunity. One is by getting the disease in the natural
course, not ending up dead, and coming out the other side with the anti-bodies to
fight off any further infection. Let’s call that “natural immunity”.
The other way is
to trick your body in to doing that very same thing. That’s “vaccination”. Here’s the dirty little
secret – it ain’t that different from natural immunity other than there is
supposed to be a much better chance of you not dying.
I hear all those
people in the back row jumping up and down and saying “Wait dummy, you’re
forgetting “herd immunity”, what about “herd immunity”?” (not “heard immunity”
as I’ve seen some on Facebook refer to it).
No, I’m not. Here’s another dirty
little secret “herd immunity” IS natural immunity. It’s just another way of referring to it. The idea of “herd immunity” is that if you
had a herd of cattle, and they come down with a disease, the best way to get
them immune in a hurry is to let the disease race naturally through the herd,
accept the inevitable fatality rate (as long as it’s not inevitably fatal for
all) and then, once the disease has gone through everyone, the herd is immune
and life goes on. Sounds really easy.
It’s not – we’re
still not at the point where we talk about mortality but let’s at least think
about the concept for a bit. Letting
immunity “come naturally” is the way to go if you are willing to simply accept
that people will die in increased numbers and that doesn’t cause you undue
concern. No lock down, no “social
distancing”, you’d probably still wash your hands but why wear a mask? And listen – I’m not saying that this
shouldn’t even be considered – in fact I believe it to be something that HAS to
be considered. Moreover – I will tell
you right now that it is an option that is reviewed almost every year by the
various agencies like the World Health Organization and Center for Disease
Control when deciding how much to spend on that year’s flu vaccine
program. If they think the strain they
are going to face is not that bad – they will channel some of that money in to
other projects,
Happens every
year.
What I am saying
is that for a disease like what we are facing now the inevitable decision
should be to not just allow herd immunity to proceed. This pandemic is too deadly and we are not
set up as a society to allow for the number of deaths that will result. Other societies might be, but not anyplace
where this post is likely to be read. We
care too much about people to just consign them to death.
Britain actually
considered the herd immunity approach for a period – not because they are
heartless bastards capable of turning out the likes of Martin Johnson (see one
of my prior posts) – no – they care about their people as much as anyone. It was because they wondered if the
disruption might be worse than the actual rate of infection – maybe, could be –
let’s just see…
Then people
started actually getting sick – including the Prime Minister. Herd immunity experiment over.
So, it was back
to isolation – but here’s dirty little secret number three – all natural
immunity, even if you apply other methods of control, eventually becomes “herd
immunity”. The herd just gets there over
a longer period of time.
Now, about that other
type of immunity – vaccination. If I was
really trying to torture you I would go in to the history of vaccination and
Edward Jenner and how his greatest work other than vaccination was to write the
first explanation of how the cuckoo hijacks other bird’s eggs and how the first
vaccinations probably took place in Turkey anyway – but no, I won’t do that.
Instead, I will simply say this – vaccination has probably saved more lives
than any other medical advance in history.
Anyone who is a straight out “anti-vaxxer” is an idiot. There is always a case for exercising
substantial care before proposing a vaccine as safe – but there are safe
vaccines and if they find one for Covid-19 we should rejoice.
The complication
arises from that “substantial care” bit.
You gotta be careful with a vaccine, and even if you stretch the rules
you have to cover off at least three big, time consuming, concerns:
1.
You have to be sure the vaccine won’t kill
more people than it will save. A “cure”
requires that taking it isn’t like asking for a hit when you have 15 and the
dealer is showing 6. It takes some time to figure this out.
2.
You have to be sure the vaccine
will actually make you immune. You must
check the reactions of the people who have been tested with the vaccine. It takes some time to figure this out.
3.
You have to be sure that the immunity
will last a reasonable period of time. It takes some time to figure this out.
Sensing a common theme here? Yes, it’s TIME. Vaccines don’t just pop up and get thrown in
to the market. That’s why you keep
hearing about the “18 to 30 month” period for an accepted vaccine – people who
know how this stuff works know how long this takes. People who know how this works are
doctors. They are not real estate
developers.
A vaccine would be great – but it is
(hopefully) not the option that will most effectively get us out of the current
pandemic state. That is going to take a
couple of things. One is re-defining
what “effectively” means (that’s when we’ll talk about mortality). The other is the third leg of fighting the
disease – medication.
By the term “medication” I mean something
that fights the disease or its impacts without imposing immunity. We all know a classic example of how this can
work – his name is Magic Johnson, and the disease is HIV.
There is no HIV vaccine, and Magic has been
diagnosed for decades. When I first
heard that he had HIV I remember thinking “Oh my God – Magic is gonna
die”. Everybody loved Magic. I’m the biggest Celtics fan in the world, and
I loved Magic. This is how Larry Bird
reacted to the news about Magic:
https://www.youtube.com/watch?v=1JWQoZNQ-Gs
We all thought Magic was gonna die, because
HIV/AIDS back then was, in the public’s eyes, a death sentence.
Magic is still alive. Thank God.
And medicine.
He is alive because of the creation of a
“cocktail” of medications which reduced the impact of the virus and the viral
loads in his body. He is alive not
because of any isolation or immunity but because even though he has the virus
he can live with it.
That’s what the proper medicine can do with
any virus – it can allow the body to fight off the worst effects and thereby
increase survival rates until the body fights off the disease and becomes
immune or it is time to take the next round of meds.
To be clear – in the short term this is the
thing we should all be rooting for.
There are some encouraging signs in certain areas – for example, Remdesivir
is one of the drugs showing some positive results (and why you see lots of
articles like this:)
https://www.nature.com/articles/d41586-020-01295-8
The idea here is to make Covid-19 a disease
you can have but, with medicine, you can walk in to the hospital, be given a
prescription for a drug or cocktail of drugs that makes you less sick, keeps
you out of the ICU, keeps you off a ventilator, gets you the hell out of the
hospital quicker (if you even have to check in) and makes way for the next
person to be treated. The drug doesn’t
“cure” you, you’re not vaccinated, whatever immunity you get comes from having
survived the disease – but less people will die and the strain on the health
system is less.
Downsides?
Well, there are a few – some quite concrete, others more abstract. The
most immediate problems are these:
·
Ummm – there is no such drug or
combination of drugs yet. They’re working
on it – but nothing yet.
·
Once you find the drug you have
to make it, and sometimes there just isn’t the capacity to make it fast enough.
·
Not every story will be a Magic
Johnson happy ending story. Sometimes the drugs don’t work.
https://www.youtube.com/watch?v=ToQ0n3itoII
The more “abstract” problems are these:
·
Drugs are typically owned by
the company that makes them, so someone is likely going to get filthy rich off
this disease if the drugs to treat it are ever invented.
·
The transport of drugs might
not be that easy – there is no guarantee that the breakthrough won’t come from
somewhere that makes it difficult to move the drugs around. You might think this is not an “abstract”
concept – trust me, the reason for lack of mobility often stems from who is
getting along with who politically at the moment.
·
The combination of the above
factors can lead to the proliferation of conspiracy theories. If drugs are found to treat the Covid-19
pandemic brace yourself for the inevitable “this was all a set-up” stories.
Still, all things considered I would be
watching the medication space most closely over the next few weeks. If there is going to be a meaningful
breakthrough that has an immediate impact on how this disease is being handled
I think this is the sphere where it is going to come from.
Okay – there are some
hits and misses in here. The accelerated
effort to come up with a vaccine was successful – so we’ll probably get a
significant number of people vaccinated before the 18 month period arrives (but
it won’t be by that much). The
development of medical approaches to treating the disease has proven somewhat
disappointing. While medical procedures
have improved (thanks to front line workers), medicines themselves have
remained underdeveloped, expensive or both.
We know there are drugs that can get people out of the hospital in a
hurry (Donald Trump’s experience is an example) – but those are out of the
reach of the larger segments of society.
So – if you go in to a hospital your chances of coming out are better –
but you still have to go in. That
becomes a problem when considering the ability of the system to cope with
increased rates of illness, as is described further along.
4. THERE
IS A NEED FOR AN ACCELERATED PACE OF RE-OPENING SOCIETY, BUT IT IS NOT BECAUSE
ANYONE’S “RAHTS” ARE BEING INFRINGED.
In the movie “Gettysburg” there is a scene
where a rebel and a Union soldier meet up.
They exchange views on why each is fighting. The man from the north says he is fighting to
end slavery and preserve the union. The
southerner says that he’s fighting for his “rahts”. Why can’t we all just live and let live he
asks. It is meant to be a touching scene, but the point about “rahts” is carefully
undercut when the next scene introduces an escaped tortured slave.
https://www.youtube.com/watch?v=Q-Fj478kozs
I get kind of the same feeling when I watch
people rant about their “rahts” these days.
When I say that everyone seems to assume that means I dismiss them out
of hand. I don’t. The scene from the movie is meant to reflect
the sincerity of the soldier’s feeling about his rights, and how he does wish
to be “left alone”. The reality,
however, is that his being “left alone” means someone else is suffering
greatly. He doesn’t grasp that “some
darky” is an actual human being who is suffering and being hurt – and for the
people currently whining about their “rahts” I think they are very often failing
to grasp the same thing.
I also think they are being manipulated by
others who are simply trying to self-aggrandize. Take a look here at Exhibit A for that
case. It is a clip of journalist Gemma
O’Doherty being pulled over by the Gardai in Dublin while on her way to a court
hearing to secure her “rahts”:
https://www.youtube.com/watch?v=BXLEiUPax2c
I cringe in embarrassment every time I
watch that. It is so obviously a planned
and scripted confrontation, with lines like “I pay your wages”, “you will see
who your masters are” and “you are a disgrace to that uniform” being so
straight out of the cliché machine, that it’s hard to believe anyone claiming
to be literate could spout them. It’s
also a perfect example of privilege masking itself as populism.
A note of update on this
section. One of the officers who appears
in this video and who was subjected to this abuse has subsequently killed
himself. Part of the reason appears to
be the enhanced pressures that this confrontation brought down on him. Shame on the people who somehow felt this
exercise in self-aggrandisement was worth the suffering it caused. Shame on them.
Much the same is evidenced in the protests
that have erupted in U.S. states like Michigan, where middle aged women lean
out of their pickups and bemoan their inability to go to the hairdresser while
overweight “patriots” shout “lock her up”, because, you know, that’s so
original.
https://www.youtube.com/watch?v=4b6GvszlkR0
God forbid that something as
inconsequential as possibly prolonging a pandemic should stand in the way of
someone getting their roots done. Still,
I can’t see this rising to the level of the institution of a “police state” or
that the measures taken are overly burdensome.
Consider the following:
·
In Britain, during WWII, people
kept off the streets with the lights off or huddled with their families in the
underground tube stations for months.
They did this while family members died in their thousands around the
globe. That’s sacrifice. Having to stay
home and watch “Tiger King”? Not so
much.
·
In America during that same
period, you were told how much and how often you could buy meat, bread, sugar
and gasoline. That’s sacrifice. Having
to wait in a line five minutes to choose between 400 types of breakfast cereal? Not so much.
·
In parts of Ireland, as recent
as the late 1980’s, the announcement of a waitress job opening up would result
in lines of applicants. That’s economic
hardship. To accept a furlough (with pay) in order to ensure that a nurse or
doctor who is working around the clock to keep people alive isn’t put in
further danger? Not so much.
All those things are, I admit, not normal
and extremely frustrating. But they are
not infringements of fundamental human rights under anyone’s constitution. At most some legal niceties were dealt with
in unconventional (but not unconstitutional) ways.
The right most often cited as at risk as a
result of the measures taken to shut things down and socially distance is the
“right to assemble”. If people had an
unfettered “right to assemble” this would be an open and shut case. But they do not. For instance, the first amendment to the U.S.
constitution states that:
“Congress shall make no law…abridging the
freedom of speech, or of the press, or the right of the people peaceably to
assemble, and to petition the Government for a redress of grievances.”
Let’s cut the demonstrators seeking to
secure their “rahts” a bit of slack and skip the fact that a comma and not a
semi-colon is used in that last bit. We
all know that the right of free speech, the first one enumerated in the above quote
is not absolute. You can’t yell “fire”
in a Bernie Sanders rally, and commercial speech is always heavily controlled –
you can’t advertise cigarettes on television or promote sugar and water in a
bottle as “Grampa Joe’s Cure Fer Cancer and Warts”. The press cannot libel someone, even if the
“absence of malice” standard is pretty loose (but a good movie with Paul Newman
and Sally Field).
https://www.youtube.com/watch?v=wlv5cB74KEg
Assembly?
Well, that’s pretty much the red headed stepchild of first amendment
rights. Think there is an unlimited
right to assemble? Tell that to the
restaurant owner who has a fire safety limit on his head count. Or the festival promoter who could sell
100,000 tickets and easily fit them in the field he has lined up - but is
capped at 20,000 for “safety” reasons.
In the times where those limits were set the government decided what was
safe in terms of assembly and they are simply doing the same thing now. It’s just that the number that is now deemed
safe is, often, zero.
The same thing with regard to that poor
Garda who stopped O’Doherty. If that
stop had been made because it was believed there was a bomber headed towards
the Four Courts – no one would question the rationale behind the detention. Right now, instead of a bomb, we are all
potentially carrying what might be a lethal weapon in the form of the virus –
so we all have to put up with the inconvenience. If the measures were truly oppressive you
would think the populace would voice their displeasure or at least evidence
discontent – but when 80% of the people agree that the measures are appropriate
– you’re not the voice of the voiceless, you’re just a feckin’ loudmouth.
The key to all this is the concept of
“peaceable” assembly. Peace in this
context is not simply the absence of people throwing rocks or Molotov cocktails
through windows. Instead it means “peace” in the sense that such assembly will
not lead to the unreasonable or unintended but foreseeable disruption of
people’s lives. It is not a peaceable assembly if it can reasonably be seen to
land people in the hospital, or take away their chance to go to that hospital –
or kill their elderly mother.
That said – it is time to cast a stone or two
in the direction of those who are directing the shut down. I’ve seen and heard of numerous instances
where, without any concern about the facts or science behind such conclusions,
people are being labelled “selfish” for doing such acts as:
·
Hiking a mountain trail (https://www.irishtimes.com/news/ireland/irish-news/people-branded-selfish-over-lack-of-social-distancing-in-mountains-1.4209793)
·
Jogging without a mask; https://www.outsideonline.com/2411720/mask-while-running-coronavirus
·
Wanting to go for a walk when
you are supposed to “cocoon”; https://www.dailymail.co.uk/news/article-8116899/Ministers-say-older-people-walk-dog-amid-coronavirus-outbreak.html
·
Not understanding why
it’s okay for a restaurant that sells all sorts of drinks to open with
restrictions while a pub that would agree to all those same restrictions must
stay closed. (Is being able to buy a
burger that much of a reason to support such a difference?) https://www.independent.ie/business/irish/pubs-want-to-reopen-like-restaurants-but-not-with-alcohol-cap-39169012.html
·
Fishing – maybe the most
solitary of outdoor pursuits. Even
opening it up there is a five kilometre limit imposed – is that really
necessary? https://www.rte.ie/news/coronavirus/2020/0507/1137028-anglers/
·
Here is a personal one – this
past Mother’s Day the weather was beautiful, there were no travel restrictions
in place, I thought it would be nice to talk my wife, son and dog for a walk on
a beach. For my American readers – know
this is the way you usually picture what a beach is like:
An Irish beach actually
looks like this (on a day that’s considered “crowded”):
Yes, those are horses – they
were probably the least socially distanced group on the beach. Get this – the next day, when you turned on
the radio, you would’ve thought that anyone who had gone out for that walk was trying
to brew up some Covid soup to force feed to all of Ireland’s grannies. The
overreaction was unbelievable – I can’t tell you how many fingers were sprained
due to them being wagged – but it must’ve been substantial. The real question is “why”? That walk was fine – but people want to feel
superior.
Asking questions about these matters and
advocating that they should be allowed is not “selfish”. It is simply necessary social discourse. All of the self-righteous prissy scolds who
immediately label anyone who questions the rationale behind a measure or the
value of maintaining a restriction well after it has been proven to not be that
effective (usually just because that is the “new normal” or “the way things
need to be”) is playing right in to the hands of the conspiracy theorists.
We now know that transmission outdoors is
an extremely rare occurrence, and getting people outside to walk, run, cycle,
climb or kick a ball around with the kids will not bring about the decline of
civilisation. We know that the elderly
need to get out and take part in that exercise.
We know that masks are good when indoors, OK when outdoors in some
circumstances, but probably not so good when they can become sweaty or moist
(such as when on the face of a jogger).
Here’s the thing – imagine society right
now as being at a giant company picnic.
What do you do at a company picnic – you eat, you drink, you make fun of
the pink argyle socks that Herb from accounting wore. You also play games – hopefully team building
games. Tug of war – that’s kind of a
team building game – but at the end the two teams are the same distance apart
and one is sprawled in the mud. But
there is another game – the three legged race (or “sack race”) that does build
a team. One player can’t go faster than
the other, or both fall over. Think of
what we need now as a good sack racing team – the “stay at homers” have to keep
up with the “open things uppers” or things fall over. The “open things uppers” have to slow their
gallop in order to allow for the “stay at homers” or – same thing. We need the gadflies on both sides to get to
the end of the race – but we need them to act together to do so.
We also ought to know that striving to
re-open things, rather than casting about for reasons not to, is and should be
the ultimate goal. This is where you say
“BUT PEOPLE COULD DIE!!!”.
I know they could.
Of all the matters
currently under review I think this is the one that remains the most
relevant. The overwhelming view of the
press in Ireland appears to be that we screwed up the approach taken to
re-opening the country and now find ourselves unavoidably back to the stage
where we must fully lock down the country until we get to some promised land of
“zero Covid”. There’s just a few things
wrong with this.
First – the original
opening of the country was not “screwed up”.
Ireland maintained a reasonable infection rate for months following the
initial re-opening. Indeed, the country
was viewed as a model case for how to deal with the pandemic in a rational
manner. There was a problem bubbling
beneath the surface however – but it did not have much to do with the
re-opening of the country – it had more to do with what was done while it was
closed.
More specifically it has
to do with what was not done while the country was closed. Further along this article you will see a
plea that was made to expand drastically the data gathering capabilities within
the country. To put those people who
were out of work and collecting ongoing payments from the government back in to
business collating every scrap of data that could be found on where people were
being infected, what contacts they might have had and how those contacts tied
together. Exactly none of this was done.
Instead, we wasted an entire period of time which could have been used to
determine where and how the actual risk of infection and transmission came from
and how it could be muted when it (inevitably) arose again.
As an appendix to the
original article I cited to an article called “The Hammer and the Dance” –
which basically advocated for dramatically shutting down and containing the
virus in the first instance (the “Hammer”) – and then taking calculated steps
to shut down, re-open, shut down again, modify, re-assess and continually
monitor the population following these original steps (the “Dance”).
Ireland – in its
approach, hammered like this:
Unfortunately – it danced
like this:
We’ll talk further about
what this means in terms of next steps, but here are some things to consider as
we sit at home. We are told that we need
to stay in a situation where the vast majority of us may not travel beyond a 5
kilometre distance beyond our home. But
does that make sense when a 5 kilometre journey in Dublin, with a typical urban
population density, brings the traveler into contact with thousands and
thousands of potential transmitting individuals, whereas a 25 kilometre journey
in someplace like Leitrim may bring you into contact with less than 10 percent
of that?
Maybe it does, but we
don’t now because we don’t have the data to make that conclusion – we’re just
guessing.
Does it make sense to
close one of the major centres of physical well-being that managed to operate
all through the summer and up until the holidays – public and private
gyms? I know for a fact that these
establishments monitored members temperatures, enforced ongoing cleansing,
reduced capacity, established strict rotation and time limited usage rates and
limited visits to no more than one per day.
Despite all of this were these establishments responsible for Covid
transmissions at an enhanced rate? Should
they remain closed down?
Maybe they should, but we
don’t know because we don’t have the data to make that conclusion – we’re just
guessing.
We have now instituted a
blanket prohibition against all outdoor sporting activities except such things
as recreational jogging or cycling (within the 5K limit) and “elite”
sports. Does keeping large numbers of
people circling standard paths and roadways within this confined space actually
do more to shutdown transmissible events than would allowing limited numbers of
people to make use of hiking trails, greenways and beaches? Should these exponentially larger (and
presumably less contact-friendly) spaces really be treated as the type of
disease-ridden petri dishes that they have been. Should people in a given household be
prevented from traveling in their cars (with immediate family) to partake in
these amenities? Should they be treated
as the pariahs they have been on the nation’s airwaves when they are caught and
fined hundreds of euro’s for daring to undertake such egregious efforts?
Perhaps they should, but
we don’t know because we don’t have the data to make that conclusion – we’re
just guessing.
Does it make sense to
shut down the golf industry rather than let spaced groups of up to four out
twenty minutes apart? I’ll be honest – I play golf and I spend more time alone
in the woods by myself on a typical round than I ever would walking the loop
outside my house. Does the number of
transmissions attributable to golf justify shutting courses down and leaving
scores of hackers to wander aimlessly without a club in their hand rather than
aimlessly wandering with such a stick?
Perhaps they should, but
we don’t know because we don’t have the data to make that conclusion – we’re
just guessing.
That’s the problem –
governments and experts will tell you that “best estimates” indicate that the
type of lockdown we are now in is the best route to controlling the
pandemic. Really what they are not
acknowledging is the fact that we should be doing a hell of a lot better than
“best estimating” right now. We had a
chance to know, with a reasonable degree of certainty, what behaviours led to
increased risk of transmission – and we blew it.
You might remember this diagram
from the first weeks of the pandemic:
That was generated in
China – before any of the contact tracing tools we now have were implemented,
and it showed how a single case (A1) transmitted in one restaurant. Have you seen anything like that in
Ireland?
Not really – but if we
had been properly tracing and collating data like we should have been there
would be much more knowledge of how the disease transmits than currently
exists. We are, whether we wish to admit
it or not, currently flying blind – and that is why schools, gyms, parks,
beaches, golf courses, restaurants, bars, shops and rest homes are closed. Not because of what we know – but because of
what we don’t know.
But should.
It is now time for us to talk honestly
about mortality.
4.
IT IS INEVITABLE THAT PEOPLE
WILL DIE FROM COVID-19. WE CAN ONLY
REDUCE BUT NEVER ELIMINATE THAT FACT. WE
WILL THEREFORE HAVE TO REACH A CONSENSUS ON WHAT LEVEL OF REDUCED DEATHS WILL
BE DEEMED ACCEPTABLE.
There have been a number of phrases that
have popped up over the last few months that had not been in general
circulation just a short time ago.
“Social distancing” would have previously been assumed to be the space
that was required between couples at a junior high dance (known as “leaving a
little room for the holy spirit” at Catholic schools). Corona was a Mexican beer that you sometimes
drank with a lime. A “novel virus” was
something that attacked your computer from that e-book you downloaded.
And “flattening the curve” was most likely
associated with a nose job.
You heard lots about curve flattening back
at the beginning of this thing, and not as much since. That’s mostly because once you’re on the
tilt-a-whirl it doesn’t require anyone to give you an explanation of what the
tilt-a-whirl does – you’re on for the ride.
It’s worth a refresher course, and I promise – I’ll only use one picture.
This one: (thanks CNBC/CDC)
See that red bubble? That’s the total number of cases if we were
all still going to the movies. The blue
one – that’s being stuck inside making a giant hit out of a show where one of
the main characters just might’ve killed her husband and fed him to a tiger.
There are three important lines in that
graph. One is shown – it goes straight
across and is labelled “Capacity of health care system”. The other two are not shown – those are the
lines depicting the total number of deaths per day. The first would relate to the red curve, and
it would start out fairly flat and then would start to go up at a steeper angle
as the health care system capacity got stretched. The other would relate to the blue curve and
it would stay at pretty much the same angle – reflecting the mortality rate
that we’ve established as applying to all Covid-19 related infections.
The reason for this is that if you exceed
the capacity of the health care system, go beyond the number of beds,
ventilators, drugs, nurses and doctors available for basic treatment, people
who would be expected to live with a normal level of care will die.
Let’s do a little math – nothing too
hard. Using this model and making some
assumptions, if you had a million cases under the blue bubble and there was a 2%
fatality rate – you’d have 20,000 people die from the virus regardless of how
well the health system functions. If you
were to operate under the red model you might have to double the fatality rate
associated with the virus, since a large chunk of people wouldn’t get
treated. So – at 4% you’d have 40,000
dead. That’s too low though – because
with the system maxed out you’d also have people dying from untreated trauma,
chronic disease, lack of access to needed operations -so add another 5,000 or
so dead.
That’s an extra 25,000 dead without
assuming a single additional infection.
I could go in to why that itself would be unlikely, and about how the
chart is a bit deceptive because the back end of the curve would never go down
that fast -but I think we get the picture.
That’s a curve that wants flattening.
You do not want to follow the red model.
Here’s the part that doesn’t get discussed
as much, but which we need to start talking about more. See the word “measures” in the middle of the
blue part of the graph. If you follow
that up you will see that it roughly coincides with the highest infection rates
that are still within the capacity of the health system. That higher rate (even though it is within
health system capacity) does equate to an increase in mortality, both because
of numbers and the fact that “capacity” is not a geographically static
measure. If you get sick in the
Louisiana bayou you’re probably more likely to die than if you’re ill in
Greenwich Connecticut, even if the U.S.A. as a collective shows itself “within
capacity”.
The thing is – if you start opening bits of
society you are going to flatten the curve in a way that probably makes it
truly flat, rather than a bell curve.
The arc starts to come down, then you open up fishing, walking limits,
some retail outlets, and it stays up at around where it was and then it maybe
stabilises and you open up shopping malls and theatres with social distancing –
and it flattens again – then after a while when immunity rates match infection
rates it drops so you open up restaurants and pubs. You see what I mean – it’s the sort of phased
planning that many governments are introducing.
What isn’t being openly said is that in
doing this those same governments are accepting the fact that more people will
die. If you kept everybody shut down for
months – more people will live out the pandemic and the cost – in lives – WILL
go down. The problem, of course, is that
the cost in money, quality of life and public confidence will most definitely
go up.
A friend of mine put it very succinctly
early on in the crisis. A health care
professional, when he was asked what would have to be considered when moving
towards getting things back to normal (in this particular case “normal” being
playing softball) said the following:
“There needs to
be a fine balance of 3 things: Viable Economy/Societal Fatigue from
restrictions/Acceptable Death Toll”.
I think that’s pretty spot on. I also think there is one thing in there that
needs to be openly discussed and hard questions asked – and that is the
following:
“Acceptable Death Toll”.
The questions in respect of that very scary
statement have to be asked in a particular way.
One should NOT ask someone if they are willing to risk death
themselves. People can be straight out
arseholes when confronted with that proposition – just drive the M50 at rush
hour some day. The other is NOT to ask
the question this way:
https://www.youtube.com/watch?v=DF9gSyku-fc
(By the way – Dukakis should have answered
“Yes Bernard, as long as I could kill him myself and then rip his arm off and
beat you to death with it for asking such a stupid question.”)
Of course, none of us would want to open up
more of society, be it softball, or fishing, or restaurants, or “the economy”
if it we knew it meant a loved one would die. The thing is – we don’t know
that. We have to look dispassionately at
probabilities and the factors listed above and make a reasoned judgement as to
whether the risk is worth taking as a group – and there is only one thing to
say about making that kind of decision.
It sucks.
But the truth is people make those
decisions all the time – increase the speed limit from 55 to 65? Statistics show that will result in more
deaths – but people will get to where they are going quicker. Approve a drug that results in reduced pain
but creates a fatal side effect in X% of the people taking it? OK – as long as you inform them before they
decide to sign up. Not require helmets
for motorcycle riders? Mortality rates
for that go through the roof – but – live free or die.
The natural inclination is for people to
accept or reject that sort of decision based upon the way the question is
asked. I will demonstrate:
“Should retail store capacity be increased
to 100 per hour if statistics show that chances are one of those people will
come down with the potentially deadly corona virus?”
“Should retail store capacity be increased
to 100 per hour if statistics show that less than one percent of all of those
people will come down with the corona virus?”
See what I mean.
So here are some primary rules I think
should be followed when assessing what an “acceptable death toll” should be
(there would be lots of “sub-rules – but these are the four biggies).
1.
It should never be a number that exceeds the
health systems capacity (no red bubble shit).
2.
The tendency should be to favour
re-opening things, rather than keeping them shut down. This does not mean the default should be to
re-open something – but if you have a 50/50 call – re-open.
3.
Don’t be afraid to go
backwards. I hear lots of politicians
saying “We need to go slow re-opening because we never want to have to go
backwards”. Sounds good – but – here’s
where I can be a real pain in the ass – I ask that most annoying of questions –
“why?”. Why can we never go back? If you’re in a maze and find you’re going down
the wrong way – would you just plow into a dead end because “I can never go
back?” Of course not. If you re-open
restaurants, and things are cool – then you reopen pubs. If things are still cool you can re-open
hotels. Should things still seem to be
OK – try and re-open concerts and sporting events with less than 10,000 people. Oops – there’s a spike there? Close those
suckers back down and maybe throw a few other restrictions back in place to
slow things down. But now you know how
far you can go. Otherwise – you’re going
to be creating huge pressures on two key elements (viable economy and societal
fatigue) without really knowing WHY you are doing it. Which brings us to the fourth and fifth rules.
4.
Collect data every freaking way
you can. That deserves a discussion of its own.
5.
Then accept that more people
will die because of what you are doing than might otherwise have died. Accept that this does, indeed, suck. Then move on and try to do better.
This is the section of
the article that is the most disappointing to me. Not because I think any of it
is incorrect (I think it stands up quite well), but because I see in the various
matters discussed a reflection of the greatest failures of the past year. In the United States the failure was obvious –
it was reflected in the continuous level of deaths and transmissions well above
those to be found anywhere else in the world.
The failure was shocking because it was one of denial – people absolutely
refused to accept reality, and lots of other people died as a result.
In Ireland the failure
was different. The reason the social
norms have been so greatly disrupted is because of a failure to prepare. If there is one thing that should have been
done, above all others, during the first wave of the pandemic it was to get
ready for the next wave of the pandemic.
Instead, that line in the graph that represents “the capacity of the
health care system” has never really moved here. There was no creation of Covid centric health
centres, no additional recruitment of staff, no requisition of additional
ventilators, no data gathering to allow for structured response (as discussed
above), no different response (other than the randomly implemented “5 kilometre”
measure used previously), nothing done which indicates we have learned
anything. As pointed out earlier – we hammered great but did not dance well at
all.
And that is extremely
frustrating. Let’s face it – we were all
caught flat-footed when this originally hit last January. There is very little to be gained in pointing
fingers, assigning “blame” or calling names.
That is why Donald Trump’s “China virus” rants appeared so silly – everyone
knew that the reason we reacted as if we’d never seen something like this
before was because – we’d never seen anything like this before. But what is the excuse for not coming up with
a better way of addressing the threat in the year plus that has taken place
since?
What might be even more
frustrating is the manner in which the presence of a vaccine is being
treated. I have heard more politician’s pontificate
about “international trade barriers”, “intellectual property rights in a time
of crisis”, “temperature sensitive goods in transit” and other highly technical
matters than I ever want to hear again.
There is no shortage of junior members who represent the good people of “East
Inner Limerick” or “North-Central Donegal/Sligo” sagely wondering about the “genetic
impact of viral variations on transmission rates”, all of whom no doubt believe
that their sagacity will put them in line for a Nobel Prize in Medicine. Unfortunately, there is a complete shortage
of representatives from those same areas explaining how and when the people in
those constituencies will be receiving a needle in their arm.
There is no reason why,
since the pre-Christmas news of the discovery of a workable number of vaccines
broke, nothing has been done to assign priorities and localities for people to
receive their shots. Note that I do not
say “dates” – at least not specific dates.
There are obviously many factors that will be in play as to when a
vaccine will be available – but a location, distribution process and priority
grouping can be set up NOW. Once
people knew that there were vaccines on the way infrastructure for dispersal
should have been constructed. (To tell the truth – this probably should have
been done even earlier, but why beat an even colder dead horse). Everyone should now be in possession of
something that looks like this:
Dear [ ] – Our records indicate that you reside in the
Dublin 15 (Ongar) region, are X years of age and we are not aware of any
pre-existing medical conditions that would cause a change in priority from that
which would apply to a person of good to average health. Accordingly, we have assigned you the following
designation for the receipt of Covid vaccine:
Region D15 O – Week 7 – Afternoon Grouping - General
Recipient Age [X to X] – Location:
[ ].
Please note this designation is subject to change and the
actual date and time of the assigned week is yet to be determined. If you have any of the mitigating medical
conditions listed in the attached form please contact us at: [ ] in order to adjust
your designation. For general
information in respect of this plan please refer to the website at: [ ].
Has anyone seen anything
like that? Yeah – neither have I. But I’ve heard plenty of politicians tell me
about the horrors of “Article 16” and why it may mean the end of civilisation
as we know it. Look, the sexy stuff is
always what is going to be what gets people on the news, the useful stuff is
what will save lives and get us back to normal.
No politician wants to be the one to get down in the weeds – but we need
a lot more gardeners in office if this is going to work.
5.
THERE MUST BE AN ACCEPTANCE AND
RELAXATION OF THE BARRIERS TO COLLECTING DATA DURING THE TIME OF THIS
CRISIS. SORRY – BUT THIS MUST HAPPEN.
Look – I understand how much people hate
the idea of our lives being broken down into algorithms and tendencies by
fleets of market analysts and consumer behaviourists. I understand how the fear of governmental
interference in our private lives needs to be taken seriously. I understand how technology can easily cross
the line from useful to intrusive. But
if someone gives me a choice between an old manual typewriter and this computer
to compose this ungodly long post – I’m taking the computer every time. It’s a better tool. And we have better tools to fight this
pandemic and we should be using those as well.
Example number one – there is an app which
can be placed on people’s phones that traces contacts with infected people. In one of those amazing coincidences it’s
called a “contact tracing app”. I won’t
go in to too much detail about how it works, but here is an explainer:
https://tech.newstatesman.com/security/nhs-covid-19-contact-tracing-app-rollout
True, it is somewhat intrusive, but
measures can be taken to limit that. No
one should be forced to download it but the following measures should be
approved which will make that more likely:
·
If you have a mobile phone you
will not be eligible for unemployment benefits or other government funds
specifically provided for corona virus relief unless you have the app.
·
Employers should be able to bar
employees who do not have the app on their phone from entering a place of
work. If working from home is not a viable
option then failure to upload the app should be grounds for dismissal.
·
All government employees should
be required to have the app uploaded.
·
All elected officials should
have the app or they will not be allowed to vote in assembly, attend any legislative
proceeding or draw their salary. Any
official deciding not to upload is free to do so under those conditions, but
will be subject to a recall election. If it’s good enough for the public it’s
good enough for them.
·
Any students of adult age
receiving government assistance to attend college or university should have the
app. Any campus should be entitled to
require having the app as a requirement for attendance at any campus event.
You want to go off the grid – fine, but
there are consequences. And more data
points should be collected. Where are
people shopping, where are cars travelling, are there infectious “hot spots”,
what type of payments are people making – how much is cash, what is via remote
payment, how much contactless – is there a correlation with the use of any one
of those and infection? What type of
HVAC units are in various buildings? Any
correlation there? Does weather impact
infection rates? Is it more or less after a rainy day/night? We should be analyzing EVERYTHING.
Unemployed people should be offered and
trained for temporary positions as analysts for the purpose of putting these
numbers together. We should try to know
everything so we are less afraid to try something. During the time of this pandemic we should be
hoarders of data, tracking everything we can, not just for this pandemic – but
for the next one – and it should be clear now – there WILL be a next one.
Then, after this is over – all of these
measures should be subject to “sunset” – ended, hopefully never to be seen
again. Extraordinary measures should be
seen as just that – extraordinary.
So – that’s it. I have been writing shite about Hostess Fruit
pies, Seinfeld fan fiction, Luis Tiant being unfairly kept out of the Hall of
Fame, beginners’ guides to softball, and all the other stuff for so long in an
effort to get through this that I thought it was time to actually write more
about what is actually happening. Then,
8000 words later I wonder if I’ve said enough or if I’ve just loaded on more
shite. (Don’t worry, I do know that
either way I’ve said enough). The bottom
line is that, hopefully, there are going to be good people out there making the
right choices for the right reasons. For
me – I think the next ramble will be about a turtle recently discovered living
in the Royal Canal here in Ireland. He
(or she) must’ve been brought here involuntarily because turtles are not native
to Ireland but this one seems to be taking his isolation in stride, making the
best out of the situation and using it as an opportunity to lie out and get
some sun.
We all might do the same.
Oh – if only getting some
sun were an option. I don't think I'll be spotting any turtles anytime soon. The best part of
lockdown last year was that, for a good, long stretch, the weather was
amazing. “Amazing” is not the adjective
I have been using in connection with the last month or so when I look out the
window. I think we all need to get outside - but the contact tracing efforts that have been put in place are woefully inadequate. We still need enhanced data. We still need enhanced analysis. We still desperately need good
people making good choices – and we need to make the goal of an open society “opening”
society. There are affirmative steps
that need to be taken to make that happen – and we knew what they were way back
when this started. We still know what
they are. Let’s push people to do them.
Oh, and here is the link to "The Hammer and the Dance" - still think this is a very relevant discussion of how to attack pandemics:
POSTSCRIPT: In the days since this was first posted an approach to the response to the disease that is very similar to what I set out here has become widely accepted. Called the "Hammer and the Dance" this view of how to treat the disease essentially follows much of what is said above - that you make sure (through the use of the "hammer") that the spread of the disease is contained in a defined region, and then you begin the "dance" - the sort of well documented and observed re-opening that I advocate - without the fear of having to "go back". "Going back" is part of the dance - just ask Ginger Rogers. Anyway - the link to this very important and well thought out approach is attached. Makes almost as good a read as mine... https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56