Barn Doors
There’s an old “country” expression, it’s no good closing the barn door after the horses are out”. The United States original strategy in dealing with the Corona-Virus was “closing the barn door”. We tried to close our borders and stop travel from China and ultimately Europe to prevent the COVID-19 virus from getting here. But, like the proverbial “barn door” it was too late. The virus, perhaps in non-symptomatic travellers, was already here.
Why didn’t we know that? Epidemiologists will tell you, if you can’t “close the barn door,” then the next step is containing the contagion. Containment is simple: you test until you find the infected, you contain (quarantine) those who are positive, and you trace all of their contacts. Then you test them, and go through the entire process again.
The key to that is you have to have a test. If you can’t test, then you are just guessing; guessing that flu-like symptoms are in fact COVID-19, and hoping that everyone who might be asymptomatic recognize they have been contacted. If this sounds like a lot of maybes and “could be’s” it is. The formula is simple: if you can’t test, then you don’t know. If you don’t know, you can’t contain.
Mitigation
So what’s the third step? You’re living it: social isolation to slow the spread of the disease, keeping the volume down (mitigating) so that hospitals don’t get overwhelmed with patients. COVID-19 can kill people, even those who don’t fit the age, immunity or underlying issues profile. But many of those who might die could be saved, as long as there is hospital space, equipment and care available. Slowing the spread, or colloquially “flattening the curve” saves those lives.
There was an alternative: let COVID-19 “burn through” our society. Eighty percent are likely to survive without serious consequences. Out of the rest, many will be hospitalized, and because of the numbers crowding in, many will die. But by letting it burn through, ultimately a large percentage of the population will have had the disease, and therefore be, at least temporarily, immune. Then we don’t have to “social distance”, our society can go on about our economic life. We will have “herd immunity”. But many people will die who didn’t have to die: they would have been sacrificed “for the common good,” the good of “the herd;” whatever that means.
Of course all bets are off when there’s a vaccine, but that’s still twelve to eighteen months away. So whatever we’re doing, keep in mind that it isn’t forever. An effective vaccine and we can have herd immunity, and be literally “back in the ballgame”.
Testing –Testing –Testing
But many aren’t willing to wait for eighteen months to start life back up again. Politically the President can’t stand for it. He has to prove that our current economic and medical condition isn’t anything more than a temporary set back. If he is unable show that, it’s unlikely there will be a second Trump term. That’s a huge consideration in what decisions the President will make.
Now you could do this, by going back to step two, containment. You have a cadre of folks who have had COVID-19, but we don’t know who they are. Test them, and find out. We have a group who clearly have had the disease and survived. Certify them, and let them out. Those that are still at risk, keep them “distanced”. But we can’t do this by guessing, or taking temperatures at the front door of the school, or by listening for dry coughs and seeing if you can wake up and smell the coffee. If we don’t test, then we are effectively going to a “burn through” strategy.
So “opening up” our economy without a testing regimen in place is simply “rolling the dice” and waiting for the “burn through” to start. Then, it’s social distancing all over again. That is, except for the bodies sacrificed so that we can say we “opened up”.
So, now that we are building hundreds of thousands of ventilators and millions of gloves and PPE, why aren’t we producing the machines to test the hundreds of millions in our country? We literally put “a man on the moon” and can watch a movie or do the quadratic equation on a box in our pocket: we surely can build testing machines that can test many millions.
Why Not Test
But if you build all those testing machines, isn’t that admitting that we should have tested in the first place? By making testing the strategy, is this an admission that we missed the opportunity to contain COVID-19 in the beginning? And if this is that admission, then the ultimate question is: who’s to blame?
President Trump is not interested in that conversation. He’s not interested in testing, because it raises the question of his original response to the pandemic. And that response is a campaign issue: the question of the Presidential competency in the face of an existential crisis.
But it shouldn’t really matter. This isn’t about the election; who will be the President come November. This is all about May 1st, three weeks from now, and the risks we are all assuming if we “open up” without the knowledge of who is sick, who is immune, and who is at risk. If we don’t test, we know what the result will be. We would be making a sure bet on losing lives, maybe others, maybe our own. Either way, it’s a sure loser.
