New Coronavirus threat

[Todjaeger]

The biggest public health challenge in the United States is that these policies are largely implemented at the state and local level; so we can’t blame everything on the White House. The federal government has financial resources and can help set the tone, but it is ultimately up to these state governments to decide what makes sense for them. This is precisely where many of the problems with America’s Covid-19 response emerge – and that is because of how public health has become a partisan issue.

I wanted to clear something up here. At present, public health policy regarding the COVID-19 response is largely being decided on and set at the state level, however that is not how it has to be, since the Federal gov't has the authority to establish national policies. My take on this is that the states and local gov't has been making policy to fill the vacuum left by a lack of national policy. A lack of national policy would be IMO a failure on the part of the Executive branch, which would lead back to the White House.

 

[ASSAIL]

I wanted to clear something up here. At present, public health policy regarding the COVID-19 response is largely being decided on and set at the state level, however that is not how it has to be, since the Federal gov't has the authority to establish national policies. My take on this is that the states and local gov't has been making policy to fill the vacuum left by a lack of national policy. A lack of national policy would be IMO a failure on the part of the Executive branch, which would lead back to the White House.

I agree with OPSSG that the fractured response to COVID in the US can be blamed on the Public Health organisation.
This overarching organisation is detailed here https://www.nhpf.org/library/background-papers/BP77_GovPublicHealth_08-18-2010.pdf
For those without time to read the whole I offer a few fundamental quotes:
“Legally and traditionally states are the primary authority for Public Health”
“Federal funds are mainly awarded to specific projects” but make up about half of state funding.
“Federal policies influence but do not dictate state and local health practices”
“The broad flexibility states have in defining the public health role has led to highly varied and fragmented government health infrastructure”
“State governments play a pivotal role in planning for public health emergencies”
“States are to coordinate their efforts with the CDC”
“States regulate all public health authorities”

There has been much comment by both sides of politics during this pandemic and it has been the sole topic used against the incumbent however, from the above you can see that the executive is pretty limited in responding to the issue despite the commentary.
Moral leadership however is a different question.

 

[John Fedup]

...or put another way, the states could be considered as players on the healthcare team that might not understand the game plan but a good coach can correct that. When great sports team organizations lose the big game, whose job is usually at risk?

 

[ASSAIL]

...or put another way, the states could be considered as players on the healthcare team that might not understand the game plan but a good coach can correct that. When great sports team organizations lose the big game, whose job is usually at risk?

To expand your sport analogy, unfortunately all the states are on two opposing teams!

 

[Todjaeger]

I agree with OPSSG that the fractured response to COVID in the US can be blamed on the Public Health organisation.
This overarching organisation is detailed here https://www.nhpf.org/library/background-papers/BP77_GovPublicHealth_08-18-2010.pdf
For those without time to read the whole I offer a few fundamental quotes:
“Legally and traditionally states are the primary authority for Public Health”
“Federal funds are mainly awarded to specific projects” but make up about half of state funding.
“Federal policies influence but do not dictate state and local health practices”
“The broad flexibility states have in defining the public health role has led to highly varied and fragmented government health infrastructure”
“State governments play a pivotal role in planning for public health emergencies”
“States are to coordinate their efforts with the CDC”
“States regulate all public health authorities”

There has been much comment by both sides of politics during this pandemic and it has been the sole topic used against the incumbent however, from the above you can see that the executive is pretty limited in responding to the issue despite the commentary.
Moral leadership however is a different question.

There are a few issues I have with the paper linked which I suspect has left people with an incorrect understanding of who can do/does what regarding US public health.

Firstly, the paper is specifically about state/local public health departments, or their responsible agencies that have a public health role (as many places an agency or department might have multiple roles which might or might not touch on public health). The important bit about this though is that the paper does not address either the powers or role of the Federal gov't in public health.

Secondly, and this I suspects relates to the first, is that the paper itself is a bit dated, having been put out in August, 2010 which was not long after the PPACA or ACA (more commonly known as Obamacare) passed into law, but several years prior to major provisions of the law coming into effect. It was also just after end of the 2009 'swine flu' outbreak yet before a number of the lessons learned could be determined, and several years before another bad US flu season/epidemic in 2012-2013 where yet more lessons were learned. IIRC examples would be FEMA's Emergency Management Institute (EMI) courses IS-520 and IS-522 which were both updated following lessons learned. These courses deal with continuity operations for pandemic influenzas and pandemics respectively.

Thirdly, the organization that released the paper was located on K Street in DC, which is primarily known as a centre for lobbying. Not sure if the group was involved as a lobbying organization as the National Health Policy Forum closed down 1 April, 2016 but it is the sort of thing which would have made me inclined to double check assertions made about the role the Federal depart. HHS and it's subsidiaries like the NIH, CDC, FDA, PHS, etc. could play.

One of the key factors that I suspect people might not be aware of is the relationship between between the various public health organizations in the US, as well as the more or less general responsibilities of the organizations, as well as some of the Federal non-public health agencies that have roles and responsibilities in national emergencies and disaster response.

If people are interested, I can provide some specific examples which come to mind as being both problematic and Federal in nature.

 

[OPSSG]

United States COVID-19 cases — 9,277,955

https://twitter.com/i/web/status/1323441893418717184

According to the COVID Tracking Project, the United States has 9,277,955 confirmed COVID-19 cases at a nation wide level (and at a state level, it depends on the Governor). As of 2 Nov 2020, the states with the highest number of COVID-19 cases is either California or Texas.

Texas	936,816
California	936,144
Florida	807,412
New York	509,735
Illinois	423,527
Georgia	361,982
North Carolina	276,692
Tennessee	261,426
Arizona	247,473
New Jersey	239,629
Wisconsin	228,862
Ohio	219,000
Pennsylvania	214,416
Michigan	197,406
Alabama	193,985
Missouri	188,325
Louisiana	183,341
Virginia	182,392

Whoever wins the 2020 Presidential elections, they will inherit this mess. States who fail to follow the science and mask up with soon be hitting the leader boards.

https://twitter.com/i/web/status/1323340343866204162

The Governor of NY, for example is doing a decent job, in particular, see: New York “Micro-Cluster” Strategy October 21, 2020 Executive Summary.

 

[Sandhi Yudha]

Covid: Bolsonaro hails suspension of Chinese vaccine trial

The head of the institute conducting the trials says there was a death but not caused by the vaccine.

www.bbc.com

Thats why i do not trust the vaccins, specially not the chinese one of Sinovac.

The development of a vaccin takes normally 5-15 years....and now they rush the development in less than 1 year!?

 

[tonnyc]

Covid: Bolsonaro hails suspension of Chinese vaccine trial

The head of the institute conducting the trials says there was a death but not caused by the vaccine.

www.bbc.com

Thats why i do not trust the vaccins, specially not the chinese one of Sinovac.

The development of a vaccin takes normally 5-15 years....and now they rush the development in less than 1 year!?

They kinda have to rush, no? Which country wants to take the slow and steady path needing 5-15 years when the pandemy is happening now? You rush something, even if it's not perfect, and once the pandemy is under control, use the time you have bought to perfect it.

Now, the Brazilian case is likely not related to Coronovac (that's the vaccine tested on that person). But even if it is, I will take the vaccine. Even vaccines with decades of refinement can not achieve a perfect record. The polio vaccines occasionally will cause polio. The smallpox vaccine had killed children via allergic reactions. So on. But the ratio is very small. Far more are saved, even though no one can guarantee zero adverse reaction. Same thing with the vaccines for the coronavirus. A vaccine that passes all the tests will be a lot safer for me than going without a vaccine and if one in a hundred thousand gets severe allergic reactions, that's way better than the mortality rate for COVID-19.

If you don't trust Coronovac there will be other vaccines. But all of them will be rushed.

 

[ngatimozart]

They kinda have to rush, no? Which country wants to take the slow and steady path needing 5-15 years when the pandemy is happening now? You rush something, even if it's not perfect, and once the pandemy is under control, use the time you have bought to perfect it.

Now, the Brazilian case is likely not related to Coronovac (that's the vaccine tested on that person). But even if it is, I will take the vaccine. Even vaccines with decades of refinement can not achieve a perfect record. The polio vaccines occasionally will cause polio. The smallpox vaccine had killed children via allergic reactions. So on. But the ratio is very small. Far more are saved, even though no one can guarantee zero adverse reaction. Same thing with the vaccines for the coronavirus. A vaccine that passes all the tests will be a lot safer for me than going without a vaccine and if one in a hundred thousand gets severe allergic reactions, that's way better than the mortality rate for COVID-19.

If you don't trust Coronovac there will be other vaccines. But all of them will be rushed.

You pays your money; you takes your chances. Like the article says, COVID-19 is highly political in Brazil with a President who is a Trump clone. It's one death that's reported as being unrelated to the Sinovac vaccine and the article states that neither Indonesia nor Turkey where the vaccine is also being trialled have called a temporary halt to the trials.

 

[cdxbow]

I agree with OPSSG that the fractured response to COVID in the US can be blamed on the Public Health organisation.
This overarching organisation is detailed here https://www.nhpf.org/library/background-papers/BP77_GovPublicHealth_08-18-2010.pdf
For those without time to read the whole I offer a few fundamental quotes:
“Legally and traditionally states are the primary authority for Public Health”
“Federal funds are mainly awarded to specific projects” but make up about half of state funding.
“Federal policies influence but do not dictate state and local health practices”
“The broad flexibility states have in defining the public health role has led to highly varied and fragmented government health infrastructure”
“State governments play a pivotal role in planning for public health emergencies”
“States are to coordinate their efforts with the CDC”
“States regulate all public health authorities”

There has been much comment by both sides of politics during this pandemic and it has been the sole topic used against the incumbent however, from the above you can see that the executive is pretty limited in responding to the issue despite the commentary.
Moral leadership however is a different question.

The most important thing in managing a pandemic is clear, coherent, consistent messaging of science based measures from the top. None of that has been present in the US response. While the Fed/states arrangements makes it complicated in the US, descending into outright Fed/state warfare made it much worse. Then there is the promotion of crack cures, raising false hope, refusing to wear a mask and encouraging dangerous behaviours in others. The US response was the worst it could be. It will become a case study in how not to respond to a crisis.

 

[kato]

While the Fed/states arrangements makes it complicated in the US, descending into outright Fed/state warfare made it much worse.

There hasn't really been that much fractionalization through federalism in the US, just the usual inter-party banter that permeates politics over there.

Over here we had a state government tell a local district to shut down one of their emergency hospitals in April because "emergency hospitals are not part of the state pandemic strategy" and basically that they want "that building turned back into its original school function by the end of the month when the state reopens schools".

 

[John Fedup]

This article points out the apparent difference in approach to vaccine development by Russia compared to the West (military versus academic/commercial). The 48th CRI could have some other motives besides vaccines. Interestingly, no mention of the other significant player that has both approaches, China.

Russia’s COVID-19 vaccine, the military input and what it may mean for the future use of biological weapons

Rod Thornton and Marina Miron On 20 July this year, the Russian Deputy Minister of Defence, Ruslan Tsalikov, announced that his military had developed a COVID-19 (SARS-CoV-2 coronavirus) vaccine. I…

defenceindepth.co

 

[swerve]

Clearly, free and open societies haven’t been doing well against COVID with a few notable exceptions. Poor leadership is partly to blame along with populations with a significant number of Darwin Award contenders.

In addition to poor leadership, the US also has this stupidity to deal with, not sure how difficult $hit-canning a federal court judge is? Mind you I am not a fan of holy rollers so maybe this is gene pool improvement.
Two Colorado churches win lawsuit against state's Covid-19 mask and crowd limit requirements
Two Colorado churches win lawsuit against state's Covid-19 mask and crowd limit requirements

Germany, Denmark, Norway, Finland, Austria, Japan, Australia & New Zealand haven't done well?

Russia & Iran have done terribly. They've both tried to hide it, especially Russia, but the Russian statistics agency hasn't been so compromised that it lies about the total number of deaths. Or at least, it hadn't been up to the end of July. The death rate's been much higher than expected since Coronavirus struck. The number of excess deaths up to July 31st had been almost six times as many as the number of officially declared COVID-19 deaths. Various people have commented on massive rises in the numbers of deaths attributed to various previously known ailments, such as pneumonia. Oddly, all these illnesses share symptoms with COVID-19.

 

[OPSSG]

https://twitter.com/i/web/status/1327076193124851713

The ship's captain announces 5 people have tested positive for #COVID19 on SeaDream 1, the first cruise ship to embark on a voyage in the Caribbean. Not that cruises can’t ever be conducted — especially in travel bubbles between low case count cities. Rather, it is a bad idea for the American cruise ship industry to reopen at this time as CORVID-19 spread in America is not contained or even managed.

- 0 to 1 million cases: 96 days
- 1M to 2M cases: 44 days
- 8M to 9M cases: 14 days
- 9M to 10M cases: 10 days

Trump’s #election2022 transition temper tantrum is deadly, with #COVID19 spreading rapidly. Biden & Ron Klain needs to unite the America behind a new pandemic strategy.

https://twitter.com/i/web/status/1326987401391190036

The coronavirus numbers are so bad, after all the Trump election rallies, that Biden’s advisor is proposing a 6 week shutdown to prevent the hospitals from being overwhelmed again. Cities that had previously opened schools are preparing to shut them down while, insanely, not shutting down restaurants or gyms. Meanwhile, all across America, medium-size indoor social gatherings are spreading the coronavirus like crazy—medium-size social gatherings just like the ones countless Americans are just about to travel far and wide to attend for Thanksgiving and Christmas.

 

[ASSAIL]

https://twitter.com/i/web/status/1327076193124851713

The ship's captain announces 5 people have tested positive for #COVID19 on SeaDream 1, the first cruise ship to embark on a voyage in the Caribbean. Not that cruises can’t ever be conducted — especially in travel bubbles between low case count cities. Rather, it is a bad idea for the American cruise ship industry to reopen at this time as CORVID-19 spread in America is not contained or even managed.

- 0 to 1 million cases: 96 days
- 1M to 2M cases: 44 days
- 8M to 9M cases: 14 days
- 9M to 10M cases: 10 days

Trump’s #election2022 transition temper tantrum is deadly, with #COVID19 spreading rapidly. Biden & Ron Klain needs to unite the America behind a new pandemic strategy.

https://twitter.com/i/web/status/1326987401391190036

The coronavirus numbers are so bad, after all the Trump election rallies, that Biden’s advisor is proposing a 6 week shutdown to prevent the hospitals from being overwhelmed again. Cities that had previously opened schools are preparing to shut them down while, insanely, not shutting down restaurants or gyms. Meanwhile, all across America, medium-size indoor social gatherings are spreading the coronavirus like crazy—medium-size social gatherings just like the ones countless Americans are just about to travel far and wide to attend for Thanksgiving and Christmas.

I love the hypocracy of some.
Cases are really bad after the rally super spreader events but the nation wide wave of jubilant demonstrators/celebrations after Biden’s win can’t possibly spread COVID, really.

 

[OPSSG]

Keeping in mind that a Biden/Harris proposed shutdown is very unpopular in red states, but they are committed to controlling the rate of spread.

I love the hypocracy of some.
...the nation wide wave of jubilant demonstrators/celebrations after Biden’s win can’t possibly spread COVID, really.

https://twitter.com/i/web/status/1327089827054034950

Agreed. The BLM demonstrations and Biden win celebrations are all bad in a pandemic — would be happy to point out hypocrisy on Biden’s side too.

All 3 Twitter posts below are from Trump supporters.

https://twitter.com/i/web/status/1326577900775157762

It is not just gatherings, demonstration or celebrations but also a lack of mask wearing culture in the US — both Democrats and Republicans are guilty. In many other countries like Korea, Japan and Singapore, there is 99.9% compliance with mask wearing in public.

Trump/Pence rallies have a very, very, very low mask wearing rate (less than 35%) — because of Trump’s example. Trump’s campaign organisers do not care about the pandemic, and there is no attempt to enforce mask wearing — that is very irresponsible for a sitting President.

https://twitter.com/i/web/status/1325815926600593412

Biden/Harris on the other hand encourages mask wearing, and mail-in votes to reduce the risk in a pandemic — the Biden/Harris leadership and transition team are concerned about the spread of CORVID, and I suspect that there is a 70 to 90% rate for mask wearing, for Biden organised venues. In this picture below of a Harris event, there is even social distancing — which is used to infer lack of support for Biden/Harris and suggest fraud.

https://twitter.com/i/web/status/1324569323420164096

 

[Maximuswarrior]

The bitter truth is that COVID-19 is here to stay. It won't disappear even if the entire world received mass vaccinations which presumably would have the desired effect as intended. Of course we all know this won't be the case. The vaccines are being manufactured in a rush without long-term testing. Frankly we don't even know what effects the many vaccines are going to have on the world populace. Many people are falsely pinning their hopes on a vaccine miracle. This is wishful thinking. This pandemic will be a long trial and error experiment. Surely the scientists and pharmaceutical industries are learning a lot, but it is still in its infancy. The harsh reality is that nature is having its course.

The bad news is that humans were never prepared against a catastrophic pandemic on this scale. Worse, we haven't unified or made an attempt to take the pandemic seriously. Some people believe it is a hoax or a conspiracy to control the masses. Others believe it is an experiment fabricated in a lab. With this kind of attitude there won't be any short-term success in controlling the pandemic. The worst thing is that we are unwilling to learn hard lessons from this catastrophe. The numbers don't lie. Infections are skyrocketing. Not to even mention the number of deceased. Even during a pandemic powerful nations are involved in chestthumping. It is a terrible nightmare.

 

[John Fedup]

To date the 1918 flu epidemic was and still is the worst pandemic in the last 200 years or more and if modern transportation existed back then, it may have been much worse.
SARS was a wake up call and some nations took note, notable exception my own country which had an significant outbreak and despite some great efforts by some, quickly forgot about the dangers.

COVID-19 will result in better responses in the future mainly because the economic consequences have been horrendous.

 

[hauritz]

Hard to compare different eras. There was never a vaccine developed for the Spanish flu. It pretty much just ran its course. In the end it was thought that around a third of the world's population might have contracted it. The death rate for the Spanish flu might have been greater than 2.5% but back then treatment for the sick mostly involved just keeping the patient comfortable. Depending on the source somewhere between 17 million and 100 million died from it.

By way of comparison there have so far been around 55 million confirmed cases with around 1.3 million deaths. That is less than one tenth of a percent of the world population. Of course there are almost certainly more cases than have been reported. Probably more deaths as well.

Had Covid 19 struck in 1918 it may well have been deadlier than the Spanish Flu.

 

[Todjaeger]

Hard to compare different eras. There was never a vaccine developed for the Spanish flu. It pretty much just ran its course. In the end it was thought that around a third of the world's population might have contracted it. The death rate for the Spanish flu might have been greater than 2.5% but back then treatment for the sick mostly involved just keeping the patient comfortable. Depending on the source somewhere between 17 million and 100 million died from it.

By way of comparison there have so far been around 55 million confirmed cases with around 1.3 million deaths. That is less than one tenth of a percent of the world population. Of course there are almost certainly more cases than have been reported. Probably more deaths as well.

Had Covid 19 struck in 1918 it may well have been deadlier than the Spanish Flu.

Actually a flu vaccine was developed which found to be effective vs. the 1918 pandemic influenza strain. The 2009 H1N1 flu which caused a number of problems had a vaccine developed to help protect against H1N1 influenzas, and testing has since determined that the 1918 influenza strain was also a type of H1N1, and that the 2009 H1N1 vaccine would help provide protection.

This of course is no help to those infected in 1918, but it does illustrate that not only do diseases morph or mutate, but they also come back around. Something similar happening with SARS-CoV-2 is quite possible.