The Case For Covid Elimination?

Bacchus wrote:

And let the others die and thus decrease the surplus population

laine lowe wrote:

Sounds like victim blaming. You're not doing enough to be in good health therefore you deserve to get COVID-19 and potentially die.

Perhaps that is one way of reading my posts, but that's absolutely not what I'm saying. There are people at high risk of a bad outcome, so of course we should do what we can to protect those people. What I am saying is that taking whatever steps you can to be healthier will reduce your chances of a bad outcome, and it has been a failure of public health officials to communicate this fact.

Having said that, we are not all equal in our capacity to take steps to improve our health as individuals. That is where the issue of public health and social determinants of health come into play. Why hasn't there been an attempt to educate the public about the social determinants of health? Things like poverty, bad housing, and envrionmental pollution (particularly air pollution) have long been problems. I would think that now would be the best time to start talking about these things and to demand serious action on each front. I don't see that on the public policy agenda at all, and I don't see any public health officials talking about that as they tell us to wait for a vaccine that may never come.

Pondering wrote:

Aristotleded24 wrote:

Having said that, we are not all equal in our capacity to take steps to improve our health as individuals. That is where the issue of public health and social determinants of health come into play. Why hasn't there been an attempt to educate the public about the social determinants of health? Things like poverty, bad housing, and envrionmental pollution (particularly air pollution) have long been problems. I would think that now would be the best time to start talking about these things and to demand serious action on each front. I don't see that on the public policy agenda at all, and I don't see any public health officials talking about that as they tell us to wait for a vaccine that may never come.

I don't know where you have been because people have been discussing the impact of poverty and living conditions on vulernability to Covid.

I'm specifically talking about the Chief Medical Officers of Health and that they have said very little about overall public health of big picture changes that can be made. If you can find a definitve quote from one of them that proves me wrong, I would be glad to hear it.

To give a local example, our Chief Medical Officer of Health, Dr. Brent Roussin, has said absolutely nothing about any health issue facing this province. Long before the pandemic, Winnipeg has been grappling with a meth problem that has fueled a spike in violent crime. Community groups have called for a safe injection site, but Roussin has not backed them up on that. There are other issues besides covid that have caused untold misery and death in this province that haven't received attention and still aren't. I would absolutely love it if on his next press conference, Roussin said, "diabetes is a major health problem in Manitoba. It is also a huge risk factor for a bad outcome for covid, so that highlights the urgency of this matter. Here is an action plan we need to follow to address the problem of diabetes in Manitoba."

Pondering wrote:

As to emphasizing general good health there is danger in that because it gives people a false sense of security.

My overall point is that if you can improve someone's health, that is a good thing, and that it is especially important now because it will reduce the risk of a bad covid outcome. I thought that would be a self-evident point. I'm astounded that I'm actually debating this point with people, or having to explain this basic thing over and over. Why wait for a vaccine? Why not take steps to improve health as individuals and as a society right now? I would think this would be an urgent time for so doing.

Pondering wrote:

Some people are dying because of an overactive immune response.

This raises the question of whether having an autoimunne disorder increases the likelikood of a bad outcome. Perhaps now is a good time to start serious research into the issue of autoimmune disorders, and see if we can find ways to cure them instead of managing the symptoms.

Overactive immune systems are not just a problem with corona, by the way. That was one factor that apparently cost many lives during the H1N1 pandemic. Perhaps if we understood what triggers an overactive immune response, and can find ways to address that, we'll not only prevent corona deaths now but also flu deaths later on?

Can testing on this scale end the pandemic quickly?

Quote:

An extra 1 million tests a day will allow us to ramp up contact-tracing operations and slow down the virus, but they will not change the texture of daily life in the pandemic, especially if there is another resurgence of the virus in the winter. For that, Mina’s moonshot is required. It will require much more than the $200 million the federal government has invested in testing technology so far, and it will require the full might of the federal government, with its unique ability to coerce manufacturing capacity. But its costs are not astronomical. If every paper test costs $1, as Mina hopes, and every American takes a test once a week, then his plan will cost about $1.5 billion a month. Congress has already authorized at least $7 billion to fix testing that the Trump administration had declined, for months, to spend. And even if Mina’s plan cost $300 million each day, the annual expense would amount to a fraction—about 3 percent—of the more than $3 trillion Congress has already spent dealing with the economic fallout of the pandemic. Yet the plan wouldn’t merely mitigate the harm of the pandemic. It could end it. To escape the pandemic in this way, the U.S. must make hundreds of millions of contagiousness tests—tests that are not perfect, but just good enough.

Mass-producing a cheap thing fast is, as it happens, something the United States is very good at, and something this country has done before. During the Second World War, the U.S. realized that the most effective way of shipping goods to Europe was not to use the fastest ship, but to use cheap “Liberty ships,” which were easy to mass-produce. The Allies “created this model of a ship that was kind of cheap, not as fast as they could make it, and not as good as they could make it,” Mark Wilson, a historian at the University of North Carolina at Charlotte, told us. “They were building cheap—one might say disposable—ships. They weren’t very good. But they just wanted to out-volume their opponents.”

We must out-volume the virus, and what will matter is not the strength of any one individual ship, but the strength of the system it is part of. When the FDA regulates tests, though, it looks at the sensitivity and specificity of a single test—how well the test identifies illness in an individual—not at how the test is part of a testing regimen meant to protect society. For this reason, Mina proposes that the FDA make room for the CDC or the NIH to oversee the use of contagiousness tests. “I think the CDC could potentially create a certification process really simply. They are the public-health agency, and could say, ‘We will evaluate different manufacturers. None of these will be fully regulated by law, but here are the ones you should or should not choose.’”

Paper tests do have downsides. Testing tens of millions of people each day would be an unprecedented biotechnical intervention in the country, and it might have unpredictable, nasty side effects. Mina’s plan is “being pushed without really thinking through the operational consequences,” Nuzzo said on a recent press call. Brett Giroir, the federal testing czar, has worried that a deluge of positive paper tests could lead asymptomatic people to swamp the rest of the medical system. “You do not beat the virus by shotgun testing everybody, all the time,” he said on the same call. Paper tests are based on an inference about human behavior. For example, if people knew that every paper test would catch only seven or eight infections out of every 10 (compared with PCR, which would catch all 10), would they keep taking them? Would the country’s testing system split in two, delivering PCR tests for the rich and cheap paper tests for the poor? Each way of testing for the virus is not only a technology or a medical device. Each is its own hypothesis about public health, human behavior, and market forces.

So here is what May 2021 could look like: Vaccines are rolling out. You haven’t gotten your dose yet, but you are no longer social distancing. When your daughter walks into her classroom, she briefly removes her mask and spits into a plastic bag; so do all the other children and the teacher. The bag is then driven across three states and delivered to the nearest Ginkgo processing facility. When you arrive at work, you spit into a plastic cup, then step outside to drink coffee. In 15 minutes, you get a text: You passed your daily screen and may proceed into the office. You still wear your mask at your desk, and you try to avoid common areas, but local infection levels are down in the single digits. That night, you and your family meet your parents at a restaurant, and before you proceed inside, you all take another contagiousness test. It’s normal, now, to see the little cups of saliva and saline solution, each holding a strip of color-changing paper, sitting on tables near the entrance of every public place. And before you fall asleep, you get a text message from the school district. Nobody in your daughter’s class tested positive this morning—instruction can happen in person tomorrow.

There is no technical obstacle to that vision. There is only a dearth of political will. “The lack of testing is a motivation problem,” Stuelpnagel said. “It’s going to take a lot of effort, but it should take a lot of effort, and we should be willing to take that effort.” Mina is frustrated that the answer is so close, and so doable, but not yet something the government is considering. “Let’s make the all-star team of people in this field, pay them whatever they need to be paid, put billions of dollars in, and get a working test in a month that could be truly scalable. Take it out of the free-market, capitalistic world and say: ‘This is a national emergency’—which,” he said, “it is.”

Is it really possible to scale up this kind of testing while the disease curve is on the upswing? Conversely, if the disease is on a downswing, is it possible to scale up testing then so that the case count drops quickly, and then should cases rise you would have the testing infrastructure necessary to stop the virus in its tracks?