In earlier posts, I described a form of government that I referred to as by data and urgency. In that concept, the key value is gathering data, in particular of the behavior of humans actually living now. To get the best data, the government should impose as little control as possible, and it can do this by limiting the number of enforceable rules at any time. For example, an old rule would need to be retired to make room for a new rule. Consequently, the only rules in force at any time would have to be the most urgent ones. This has other implications such as the abolition of prison terms since it would make no sense to imprison someone for a violation of a rule that is no longer enforced, and besides we want to gather data of the person interacting with the public.
This type of government is very different from enlightenment-style democracies or even predecessor autocratic rule. Unlike democracies, this government has the the power to immediately enact very authoritarian rules without regard to individual liberties. Unlike autocracies, the rules are limited to only those that address the most urgent of issues, to be retired as soon as the urgency passes: either the problem is gone or the population accepts the problem as the new normal. Again, to work properly, the government needs to find a new calm where people may be allowed maximum liberty in order to collect the best information for future crises.
The above is a background of my thoughts about the current crisis we face with a new virus that is more contagious and more lethal than similar viruses. There is a growing concern that this is going to infect a major portion of the entire planet’s population with a major portion of those infected ending up dying from the disease.
Many of the current public policy actions are assuming the worst case scenarios extrapolating from the early data about this virus. This extrapolation of the contagion rate, incubation period, recovery period, and fatality rate predicts rapid large-scale impact in the coming few months.
So far the emphasis has been on containment using quarantines and travel restrictions with the goal of allowing the currently infected to not infect others and for the virus to work its way out within the currently infected. Quarantines are definitely a restriction of a person’s liberty and the origin of this virus in China permitted very strict enforcement so that there was very high level potential for this approach to succeed.
When the initial attempts at containment failed, it became clear that there really is no plan B. Instead, we started talking about multiple hot spots, each spot being new areas to impose the same quarantine measures that already were shown to be ineffective.
Quarantines make the most sense when they are limited to isolated individuals. Quarantines become progressively less effective as they are applied to families, neighborhoods, or towns. It appears that China has extended this to whole metropolitan areas or regions.
The shocking thing to me is that there does not appear to be a distinctly different plan for when containment fails. If any such plan would be possible, we would see it in China. As the virus spreads to other countries, it is clear no one else has a plan either.
The next phase in public response is a modification of quarantine that is less well enforced. This plan is to educate people about how to avoid infection and to educate the ill about how to avoid infecting others. When the symptoms are unmistakable, there may be a quarantine but it is much more voluntary than the earlier phase.
The purpose of this phase is to slow the inevitable spread of the disease with the hope that the number of new cases closely matches the number of recovered cases so as to not overwhelm the medical system.
At least in my mind, this phase can not last forever. It is almost certain that eventually the infected population will exceed the medical capacity. Even if by some miracle we are able to limit the spread to a sustainable level, the medical capacity will decline. Medical providers themselves will become infected and may die. In addition, the disruption of supply chain will lead to shortages in medicines, life-sustaining equipment, disinfectants, and protective equipment.
From what I can tell, the governments are relying on this phase of cooperative preventive measures to buy time to invent and distribute new medicines to help reduce the complications and to find some vaccine that could be distributed at large enough scale to end the crisis.
This window of opportunity is very short, certainly less than a year, and probably just a couple months. That is a very short time to develop, test, approve, and mass produce a medicine for the sick. It is even shorter in comparison with the similar times needed to produce a vaccine for currently healthy people.
I was especially concerned about the enthusiasm raised for a new experimental alternative to the traditional approach of making vaccines. This approach involved laboratory production of messenger RNA that when injected will cause the healthy body cells to produce virus proteins that can then trigger the desired immune response.
My concern is that it is the body’s normal cells making the viral proteins. This may in fact trigger the desired immunity to the actual virus. I fear the body would recognize this not as a virus but as defective cell behavior. It could lead to autoimmune response that will show up much later leading to large scale problems such a organ failures or chronic debilitating diseases that at the very least will lead to a lower quality of life long after the virus crisis is over. Alternatively, it could shut down the body’s normal defenses against misbehaving cells and thus lead to a future increase in cancers that the body otherwise would have stopped or managed on its own.
The messenger RNA approach for vaccination could be the breakthrough we need because it offers the promise of developing a new vaccine within the period of a current epidemic. This may be the opportunity to test it. If it works and nothing bad happens, we may have higher confidence for future epidemics. On the other hand, if it fails, we may end up with an even worse scenario a few years from now when our medical system is overwhelmed with a new pandemic of incurable autoimmune or cancer diseases.
From the perspective of the approach I outlined at the top, this appears to be very risky. It is not even clear we will find the vaccine in time to stop the pandemic from overwhelming our medical systems.
There could be a different plan. I may be missing it, but I don’t see any nation working on this plan.
From the perspective of data and urgency, the alternative plan is to extrapolate what we know now. We have neither a vaccine nor a cure other than allowing the body to cure itself. We are gradually getting better statistics about the infection rate, complication rate, and death rate. The numbers are converging to numbers that are very concerning. Large numbers of people will soon be infected. And a disturbingly high proportion of those will end up dying.
A government by data and urgency would accept this reality as is and immediately act on plans to manage this eventuality. This does not rule out any parallel efforts to develop some vaccine or cure. However, the actions to manage the eventuality with the assumption there will be neither a vaccine nor a cure is our best hope of keeping the entire economy working at a level where to make such vaccines or cures can actually be administered in a significant way.
As we are seeing currently in China, the current approaches are leading to shutting down of supply chains and of production. This data about the economic flows of goods is as available as is the data about the human impact of the disease itself.
Given the recent sell-off in the stock markets, it appears that the market is recognizing this threat. My concern, and probably the market’s concern as well, is that it doesn’t appear that any government has prepared in advance to tackle this economic threat. All the planning was based on containment with quarantines.
We should by now be seeing evidence of some new plan for when it is obvious containment failed. That plan would focus on maintaining the economy, keeping supply lines running and production flowing when it is known that many productive people will be infectious and prone to being unproductive at least temporarily in the near future.
In particular, it is imperative that we keep the medical systems working at high capacity an in fact increase that capacity. This demands that we keep supply lines running with adequate supplies as well as sufficient protections for the health care workers to not get sick themselves.
Among the necessary protections for health care workers is to make sure they get the rest and nutrition they require. One of the findings about optimal body immune system is the importance of regular sleep and good sleep of at least 7 hours. This requires that they have enough relief of stress to actually obtain that sleep. We can’t expect the health care workers to work all their waking hours and expect them to last the duration of what is needed for the pandemic to complete.
It should be clear that we need to keep economic supply chains working. We need to continue to produce food, as well as medicines and medical supplies. We also need to keep our infrastructure working with reliable power, water, waste-removal, computing and communications. To do this, we need infectious people to work and for healthy people to work along their side. Quarantines are no longer workable, but obviously we would take efforts to minimize the infectious people spreading the virus and to minimize the healthy people from catching the virus. Minimize involves taking precautions but it implies acceptance that the infectious rate will be non-zero and probably significant.
More importantly, we need to augment the medical practitioners.
First of all, we need to protect the most qualified professionals in the area of treating and controlling the spread of infectious diseases. We need to exploit modern computing and communication technologies to multiply their knowledge to treat more people.
This might be done with a new force of workers who will do the actual work of handling individual patients. A government by data and urgency would by now have invoked a process of conscripting able bodied and available people to begin showing up for training camps to learn how to take instructions from medical professionals and then administer at least the basic medical procedures using a technological link to the professional using remotely controlled or transmitting devices. To offset their limited training and experience, they would work in teams of 2-3 per patient and they would work narrow shifts of perhaps just 4 hours per day. The point is that we will need a lot of them.
In addition, this training will begin to differentiate levels of aptitude. While they all will be working as soon as practicable, some will have opportunities to get advanced training to earn more full nursing or doctoring credentials. In fact, this is essential because we will need to supplement the existing credentialed practitioners and probably replace the ones lost to the disease.
We also need to recognize that there remains the usual medical needs of non-infected people. We still have people needing treatments for traumas, other types of infections, as well as cancers, heart diseases, and other chronic ailments. We cannot afford to reassign them to treat the pandemic. Instead, we need to supplement the infectious-disease specialists through the advanced training of the conscripted workforce.
When will we see this level of preparation? It needs to be occurring now given what we clearly can expect in a couple months.
A government by data and urgency would be doing this right now. This is an illustration of what an urgency is. It also illustrates the notion of punctuating the liberties. People will be drafted into a medical workforce prepared to take on the coming challenges of managing a major pandemic. There may be a comparable imperative on people to keep the supply lines and the infrastructure operating. People will need to cover for hours lost to those who fall ill or die. We will need an augmenting workforce to take over the more routine and readily supervised tasks.
In many ways, this pandemic is equal to a war. This enemy’s intentions are contrary to the health and well-being of all of humanity. This enemy is not human, and it is not possible to negotiate with. We have to put our full energies into fighting this as if this were an existential war. In the past, our species survived by mobilization to face the enemy (natural or otherwise) with the risks to individuals. Only in temporary calamities like storms or fires would we survive by sheltering and waiting it out. Longer lasting threats requires engaging directly with that threat.