Truth, or Consequences

It’s been proven true once again: “We can ignore reality, but we cannot ignore the consequences of ignoring reality” – as just shown by the COVID-19 diagnosis of Donald & Melania Trump. But let’s hope for the best out of this lesson: more people believing the Virus is not a Hoax, and wearing masks, and maybe, some real attention to Contact Tracing – and an understanding of the real risk factor behind this Virus – Super Spreaders.

In fact the emphasis on Contact Tracing started Thursday night, when the Biden Campaign refused the request of a pool reporter to travel with them because she had just traveled with the President’s travel party. Informal as that public health measure was, it underscored that everyone at the last Presidential Debate, and all those who work in the White House, are potentially part of a Super Spreader Event, like the Sturgis Motorcycle Rally, or the South Korean church in Daegu city. And one expects a wave of COVID concern about Biden since he was unmasked so closely to a virulent President at the last debate and to all the Trump attendees, who disobeyed the Cleveland Clinic guidelines and took their masks off once they took their seats.

A Cleveland Clinic doctor with masks just walked up to a number of unmasked members of the audience on Trump’s side of the room and asked them to put on masks. She told me they refused to take one and wear them. https://t.co/rNUFjLfUEf

— Tyler Pager (@tylerpager) September 30, 2020

But before we discuss the new developments in the epidemiology of the Virus, and the implications for Contact Tracing, let’s revisit where we are with this Hoax, in comparative terms:

Current COVID Reality:

Obviously the U.S. is worst in the world in number of deaths and cases, but we have the 3^rd largest population in the world, so a per-person comparison is fairer. We started off as the world leader in Pandemic expertise, having suppressed three prior diseases before they BECAME Pandemics. As of Oct. 2^nd we were 8^th worst in Deaths per Million, an improvement from a couple of months ago because Brazil, Chile, Peru, and Ecuador had rocketed past us. The U.S. stands 4^th worst in cases per million^[1]. While those total numbers matter, of more immediate concern is the recent trend in deaths per million [graph at right], where we and South America are far worse than countries with “First World” Leadership. Our Leadership performance, compared to a competently managed countries, translates into at least 130,510 unnecessary deaths compared to Canda, or 175,262 unnecessary deaths compared to Germany. [table below] More tellingly, as the former world leader in Pandemic Response, up to 99% of our deaths could have been avoided, as they were by several countries even closer “downwind” of China, but who learned the correct lessons from their prior exposures to Chinese-born viruses.

New Lessons Learned:

An excellent Atlantic article points out two things that really matter in dealing with COVID-19: a) we need to focus on super-spreader events, and b) we are doing contact tracing the wrong way (when we’re doing it at all, given our lack of testing). The NBA and the NFL are showing a form of Best Practice when it comes to COVID; they are testing like crazy, isolating, and wearing masks (and fining the heck out of people who don’t follow the rules).  Sports leagues have also proven we CAN suppress the virus, given resources and motivation.

What recent evidence teaches us is that COVID-19 spreads most in “clusters”, rather than linearly – like traditional flus. Some excerpts from that Atlantic article:

“To fight a super-spreading disease effectively, policy makers need to figure out why super-spreading happens, and they need to understand how it affects everything, including our contact-tracing methods and our testing regimes.”

Also, we should be doing BACKWARD contact tracing, finding who caused the current infections, more than we should do forward contract tracing (finding people who have been in contact with the current case), if our resources are too limited to trace everyone (and they are so limited right now).^[2]

“…if we can use retrospective contact tracing to find the person who infected our patient, and then trace the forward contacts of the infecting person, we are generally going to find a lot more cases compared with forward-tracing contacts of the infected patient, ”

To understand the science behind this, I encourage you to read that article, which I will not repeat here. However, the bottom line implications are clear:

1. South Korea’s aggressive and successful response to that outbreak—with a massive testing, tracing, and isolating regime— lead to 99% less deaths than in the U.S.

2. Japan shared some of the same problems that faced the U.S., but by focussing its efforts on super-spreader events, it held its deaths down to 2% of the U.S. level. Japan also did not initially have the capacity to do widespread testing. Nor could it impose a full lockdown or strict stay-at-home orders; it would not have been legal. However Japan understood as early as February, the risks of super-spreader events and thus created a strategy focusing mostly on cluster-busting, which tries to prevent one cluster from igniting another. That strategy included undertaking aggressive backward contact tracing to uncover clusters. Japan also focused on ventilation, counseling its population to avoid places where the three C’s come together – Crowds in Closed spaces in Close contact – in recognition of airborne aerosol transmission, as well as presymptomatic and asymptomatic transmission.

As with dozens of other countries who have suppressed the Virus without a vaccine, Japan created an effective strategy and was led effectively to contain the damage.  There is also a cultural ethic at work there, of the Interdependent Self, which is less prevalent here – but that’s another article.

What Next?

Well, Republicans may finally be willing to spend serious money on a relief package now: Pelosi anticipates reaching economic relief deal with Mnuchin, saying Trump diagnosis ‘changes the dynamic’

It’s been obvious to medical scientists that Trump’s campaign rallies are both spreading the virus and setting the wrong example. From Herman Cain’s death following the Tulsa rally, to Secret Service agents and campaign staffers getting sick, to the entire White House, Trump’s focus on “optics” has cost lives. As a useful CNN article pointed out:

The West Wing had wanted to “portray confidence and make the public believe there was absolutely nothing to worry about,” the official, who spoke before the President’s diagnosis, said, revealing the image-conscious reason for the opposition to masks for the first time.

“We lost so much time,” a former administration official said, looking back. “The whole thing was mind-blowing. This could have been so different.”

I hope it’s clear now that was exactly the wrong move and the wrong motivation in dealing with a Pandemic – not wanting to look bad, as opposed to setting the proper public health example by looking wonky with a mask, like Biden. The saying goes “Reality Bites”, but let us hope it also teaches, so we don’t lose more lives needlessly.  While we’re at it, there’s this Climate Crisis people seem to want to ignore…

FOOTNOTES:

[1]
Among countries with 10+ million population; 5th worst if you count Israel with 9.2 million people.

[2]
Backwards contact tracing was how we found Typhoid Mary, and what was used in AIDS and other STD’s.