My weather app buzzed my last night with the breaking news that the USA had passed everyone in the number of corona cases. And, while I don’t watch the major networks, I see clips of their coverage and I’m guessing this was the lead story. Normally, being number one is good but this is really not one of those cases. Yes, it is important but the raw number of cases is not the whole story.
Disclaimer – none of this is an attempt to make light of the situation which is serious. The stresses to the worldwide medical system and economy are going to be felt for a long time.
It is clear that things in the US have been hurt by our inability to test although it is also totally fair to say that the experience here and in Europe has been dramatically different than South Korea or Japan.
And we can line up and toss blame around for why we weren’t more proactive in testing. As with most things, there is not a single reason or person. But it can be said that our government bureaucracy played a big part. See below for an article from Seattle (the initial ground zero) that outlines some of the problems.
The real issue is that bureaucracy is not set up to move quickly and decisively. Regulatory bodies in the US move slowly and cautiously along the avenue that provides the least risk. According to the CDC website, they only stopped requiring confirmatory tests on March 14th. (I’ve tried to find out more but their note says it was an FDA requirement that was relaxed). It shouldn’t be a shock then that the number of tests done in private labs exploded after that date. It is also why some pressure was put on the FDA to fast track some of the newer tests.
This is not to say that we don’t need regulations because someone looking out for public health should be a good thing. It is that we need the ability to act quickly in a crisis and the current framework doesn’t provide that.
Take the whole freaking thing around whether a certain malaria drug can be used. The people who are saying there is no evidence are just wrong. What they really mean is that we haven’t done the classic case/control type studies with a large enough sample size to truly prove that this work. But if you want evidence, here is the original study from France.
In a crisis, the people on the front lines (doctors) are pretty much going to try anything that might have a chance of working. Is there time to do a randomized study? (And, yes, I do have some experience with this type of study). No, of course not. You act and hope for the best. If you haven’t seen it yet, there was news today about a study in China concluding that the malaria drug doesn’t work. (see link below)
I suspect this will get some play in our media today. The study is very small (which the article admits). The problem is you can’t necessarily prove a negative with a small study. The other thing is that it appeared to just be the anti-malarial drug and not the combination which might be the thing that does the trick.
This is one of those strange cases where both sides are right but neither side is giving you the whole story. Should we conclude from one small study in France that this is the magic bullet? Of course not. Should we simply ignore that study because this drug isn’t FDA approved for treating corona? I’d also say no. Its a risk/reward thing. Probably not something that should be widely used on minor cases due to the unknown side effects. But if you are dealing with cases that aren’t responding and likely to die, why not give it a shot.
If there is any good news on the horizon, it is that officials in Italy say things could be peaking in a couple of days. There were similar statements out of the UK. What we really need to root for is a vaccine because “experts” are warning this could bounce back in the fall.
There is another point I want to make in my rant. If we want to look for blame, then we also have to accept that the US is a very open society and clamping down on that is difficult. Even today, around 45% of the cases are in New York state. If you add in New Jersey, you get to over 50%. The vast majority of these are around New York City. That includes a few counties in Connecticut that are right next to New York. So, would we accept a total quarantine of the area around NYC? Nobody in or out? Think about all the people who are now “working from home” in areas outside NYC who were in NYC. Are they now spreading it?
We effectively have that anyway but, right now, there is nothing preventing folks in NYC from taking off and heading somewhere else. There are places around NYC asking for travel restrictions. When this got out of control in China, they basically sealed the area around Wuhan. Did it reduce the spread? Who knows? Would those type of restrictions fly here? Absolutely not. And, to be clear, I’m not calling for that either. I mean we don’t really need to reenact “Escape from New York”. It is just to point out that it is going to be harder to control in a more open society.
Am I still wearing my Rose colored glasses? Sorry but yes I am. This is going to be a long slog but with the combined effort of the world working on it, we’ll get though and figure out a way to fight this.
On a totally unrelated note, I’m still watching the Facebook live things from the studio. But I’m finding that my ability to learn from video is limited. I guess I kind of need to actually do something to figure out how it works. I’ll still keep watching though just to keep a connection to the studio.