It’s the Inequality, Stupid: Why Test, Trace, Isolate Won’t Stop Covid-19 in America

Asian teens dancing memes on disease safety precautions are amazing

Everything is changing, and in the face of that, America is failing. Over 90,000 souls have paid for our failing. Millions more are living in terror for their livelihoods and their families. But Covid-19 isn’t a technology problem, or a science question, or a supply chain issue, or even a question of doctoring. This challenge is public health, and that is something we’ve been failing at for a damn long time. Not completely, but for most people the American health system is a nightmare, and interacting with it is among Americans’ greatest fears. Without addressing that fact, anything else we do can’t succeed, not in the models of countries like South Korea, Germany, or the overlooked best of all pandemic responses, Vietnam. (Not only did they aggressively treat, trace, and quarantine every case, but they did wonderful and memeworthy public communication from the start)

 

…Versus pasty uncool white people protesting their right to sicken other people before they die themselves.

California Governor Gavin Newsom, who reacted quicker than any other governor to shut down the state of California, saved innumerable lives. Now he is opening many shops for curbside pick up, and relaxing other measures. “This is a very positive sign,” he said, “and it is happening for only one reason: The data says it can happen.”

But with testing capacity still lacking in the state, (fewer than 1 in 20 Californians being tested) the data says no such thing, and it’s even worse in most of the country. We are not ready to open. The history of fighting epidemics from Ebola to AIDS to antibiotic resistant TB is very clear. To stop an epidemic: catch every case with testing, trace every contact, and make sure the ill and their contacts can and do isolate safely, and be treated promptly if they fall ill. That last part is key, and each of these epidemics have borne  out that treatment is important to both preventing transmission, and creating a unified populous for fighting the epidemic. Without all of those elements, the only thing stopping Covid-19 burning through the world is staying home, staying distant from everyone else – the isolated life we’ve been living so far in this pandemic.

Sars-CoV-2 is an infectious respiratory virus with a as-of-yet unknown but presumed small infectious dose. One person missed, one popular guy or woman about town doing essential work can start the whole cycle again within days without ever so much a cough or a headache. One party full of invincible young people or one pre-symptomatic nurse can begin another train of transmission that can eventually sicken or kill thousands.

The decisions that determine the course of an epidemic, all epidemics, are personal decisions. They happen millions of times every day in all kinds of contexts around the world. They happen when a kid stays in, or sneaks out a window. They happen when a community of faith cannot bear to be apart and tries to find ways to cope. They happen when people are balancing the need for health and comfort against the proclamations of some local official who is now a soi-disant disease expert. They happen when a doctor with unexamined bigotry passes over caring for a black patient in favor of a white one, or a rich man over a poor woman. They walk the balancing line between top-down power, community consciousness, and the choices each person makes about who they care about and how they enact that caring. On this score, in this pandemic, America has one terrible failing that rises above all of its others: its unwillingness to provide treatment to the sick.

This nonsense.

There are a lot of bad and desperate ideas in America right now: immunity get-out-of-jail-free cards, Bluetooth contact tracing apps, incoherent partial re-openings, and going wild and pretending it’s all going to go away if we just can get a haircut.

The idea of certifying immunity status would be terrible. If you wanted something like that to work, it would have to convey no immediate benefit to the person being certified immune, and certainly not convey the benefit of being free and able to earn a living for yourself and your family. It is the ultimate moral hazard arising out of an immoral and unjust system.

How would you punish people for defrauding this system? Incarceration and fines would only drive more disease. And people faking immunity is the best case problem a health system would face. The worst is people intentionally getting the disease in order to be allowed back into society, and spreading the virus, even knowingly, because they are desperate. What will you do to the people using this system to get ahead in life? Covid-19 parties are inevitable, because people are people, but what happens when they become a condition for public life? Not only will it drive the poor to risk death while the rich sit away safer in their homes, it means that the level of disease will persist in semi-permanently trapping everyone who doesn’t want Covid-19 and can afford to never go out.

Bluetooth apps do not contract trace. Tracing is an intimate process, a long empathetic conversation with a person who understands your community and seeks to understand and hear you. You have to trust a contact tracer, you have to feel like the people who you name and place in their system will be cared for, protected, and treated, should the worst come to pass.

Bluetooth can’t tell if there’s a wall between you. It can’t tell how windy it was between you and that other person, or if you were stuck in traffic next to them for a half hour. An app can’t tell that you left your phone at home that one time. It cannot tell you of someone who went to the emergency room suddenly, phone lost and forgotten, only to be admitted for a week. It cannot tell you about someone who died alone at home, without ever being tested at all. It can tell you about neighbors you never see or speak to, but it can’t tell you it’s them, so you sit, wondering who it was, wondering if it was real, and what to do now.

Tracing a disease through a community is a human conversation. These are things only humans can do. This is a human job, and a job for those who are trusted by their communities, that speak the language, that know about the things that happen in the neighborhood.

Contact tracers don’t just question people. They mostly are there to listen, and to listen carefully, to safeguard people’s secrets and hopes as well as their shame and their double lives. They need to not just speak the language of those affected by the disease, they need to speak the culture. In the largely Spanish-speaking immigrant neighborhood where I am sheltering-in-place, I take many walks. And in those walks, I have seen hundreds of informational flyers, but almost none in Spanish – more failing.

We know that we need more testing and contact tracing, and we know we need people to quarantine to slow this disease, but before all that, we need to treat the people who are most at risk as human beings. In the long term, everyone’s fate depends on that.

If you want people to stay home and be safe, it has to be financially and logistically possible. People who are doing the right thing have to be supported and cared for. If you want people to seek medical care, it must be available and not cost more than the patient can reasonably pay – which means nothing for the poorest people.

Using police powers to enforce public health is also fool’s game. Any use of police powers must be rare and only for the most unusual situations — no one should be able to look at those situations and say “That could be me there.” The racist enforcement we’re seeing now defeats the goals of public health and endangers everyone, not only spreading the disease to the victims of these arrests, but preventing the populations they come out of from cooperating with public health investigations. Incarceration or fines only threaten to spread disease as wells as deepen poverty and resentment. Diseases, all diseases, feed on poverty and resentment.

Even with some as yet un-obtained insight into immunity status, we won’t know for years how long immunity lasts, or how strong it will be from person to person. We still need to understand how the virus is likely to evolve, and how it affects its victims long term, before we can say much about what the elusive goal of “herd immunity” would really mean.

The simple fact is: a million tests a day, a hundred million, won’t make a difference if the people most likely to get the virus don’t want to be tested because they can’t afford to test positive.

The unspoken problem with engaging with a testing regime is why do it when you can’t get treatment, or afford it if you could get it? Why go to the doctor when that risks destroying your family’s future? We want to test, trace the contacts of every case, and isolate everyone infected, and thus reopen the economy, but without the treatment piece, this idea fails the most basic part of epidemiology: universal participation.

The way we get out is not immunity passports or herd immunity, it’s not test test test, it’s a whole system of health that cares for the whole population. The things that have worked the world over, from Germany to Vietnam, always begin and end with universal access to healthcare. Not just testing, tracing, isolating, but the most important part of public health: treatment. But doing that requires a public health system with the public as the beneficiary, not a small percentage of those who can afford it with ease.

If you want people to work together to get out of this, the people coming forward need to know that themselves and their people will be tested and treated with dignity and mercy. They need to know that going to the hospital with Covid-19 doesn’t mean going bankrupt, giving up on dreams of educating their children, taking care of their parents, or facing deportation. They need to know that they will be treated on the basis of their illness, not their skin color, class, sex, or any other distinction the virus doesn’t respect. Biology doesn’t care about social distinctions. The virus doesn’t either — it is a simple machine that responds to the environment it finds itself in. It’s we who create more susceptible bodies through stress, ill health, co-morbidities untreated in a failed healthcare system. But the virus is not prejudiced, it only seems so in statistics. It will kill rich men in good health, and spare prisoners.

Not everyone is going to be prosocial, but when incentives are right, and peoples’ needs are met, overwhelmingly people do the right thing. There’s always exceptions, and those exceptions become news, but rarely are those the people who tip the balance. People well cared for and informed, educated and competent, will act for the best of their communities and loved ones. This in turn creates the kind of healthy communities that break the chains of transmission. If we concentrate on building healthcare capacity and supporting communities, many of the antisocial people will disappear into them, looked after by their own people. There will always be exceptions, but no one can tell you what to do like Grandma can, especially if Grandma can also see to it you get healthy food, a good education, and most importantly right now, medicine when you’re sick.

America’s health disparities, and the likelihood that Covid-19 could follow other coronavirus immunity patterns could mean that we’re doing this again every couple of years, even as other places in the world begin to recover. Our inability to treat, based on our desire to make medical treatment profitable, will doom us to cycles of disease until most susceptible Americans have died, and others who remain are maimed by the potential long term consequences of this disease.

Even with a vaccine, access in our current system, as well as the poison of antivaxxers, could doom the effort to control the disease. If we chose to do nothing to help or treat the victims of Covid-19, our commitment to denying healthcare to all could potentially keep chains of transmission alive for decades. With universal access to care and aid for isolation, we could break that chain in the next few months. But as we have currently constructed what it means to be American, that would be impossible. The choice this country faces is whether to change as a country, or possibly cease to be out of our commitment to inequality.


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon. Photo thanks to Becker1999, and more thanks to Ryan Singel


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34 replies
  1. Rob says:

    The sad thing is profiting from covid was wired in before it even got to the USA as Trump obeyed the health lobby and refused to buy testing from outside the states. The delay in getting reliable testing in place in large enough numbers condemned thousands to die but at least the health industry wallows in cash either way.

    • Rapier says:

      Numerous stories about China and Hong Kong portray their use of tracing apps as an important element in their huge reduction of new infections. The app didn’t do that on its own however. It was the vast army of Party cadres actively using the info to directly intervene in the lives of those ID’d as near contact with infected persons that was thing that made it work.

      Obviously that isn’t going to happen here. Still with widespread use of the apps some useful info would be available to individuals but that isn’t going to happen here either. I doubt half of American will use them. Throw in that a quarter of the population consciously now wants to spread the virus.

      • P J Evans says:

        Apps won’t work when people don’t have smartphones, as I don’t. I stay home as much as I can, and wear a mask when I have to go out – but not everyone does, even in a city where everyone is supposed to do so.

    • Quinn Norton says:

      Yep, and he doesn’t even factor in when people tell the network they’re positive because they have an allergy attack or for the lulz

    • Rayne says:

      Tracing apps have little utility at the stage in the pandemic when the virus has not been consistently tracked. They can work to a degree in communities and countries where contagion has been mitigated to the point of complete containment — like South Korea or New Zealand.

      Say one confirmed case shows up at the hospital in a county where no other known active cases existed. Where had that person been? And who had been in the same place in the previous 5-10 days? It’s at that point when tracing app can work based on a narrow retroactive time frame, regardless of whether potential vectors of transmission were fomite or aerosol or other.

      It’d be nice if an actual epidemiologist was asked about this issue instead of techbros.

        • Rayne says:

          You realize the authors of that study are both in Stanford U’s Department of Management Science and Engineering, right? That they aren’t actually epidemiologists but researchers who study cost effectiveness of practice with regard to public health policy?

          • jerryy says:

            Yup,

            They show that it is a question of will. Do we have the will to push to the point needed to push the means to get the end …

            Tuberculosis, hepatitis, measles, polio, hiv, various sexually transmitted diseases, and more. Show up in a doctor’s office with symptoms of any of these (except for maybe measles depending on where you live) and you will be subjected to contact tracing, possibly being quarantined, and all courtesy of your local health department.

            All of these could have been ended if we had had the will. Covid-19 is no different in that regard. Contact tracing has its limits under the best of circumstances and cost effectiveness is part and parcel integral to public health policy. It is not a question of in-person interviews, perhaps in conjunction with technological aids to hopefully reduce missed cases, but it is how much will there is to push to what end.

    • John Langston says:

      I think it’s doubtful contact tracing will have a big benefit until the number of cases are at manageable number. If we can can quarantine the infected and give them free healthcare, it might work. Of course we’ll need universal testing.

  2. aram says:

    Great article but I think there are a few reasons to be slightly more optimistic. Bluetooth contact tracing has limitations but could supplement a traditional contact tracing effort. An ideal version would convince exposed people to call into a traditional contact tracing effort, or to get tested, and if positive, again to use the traditional system. It may well be that there will be too many false positives/negatives for them to be useful but I think it’s hard to know this for sure until we’ve tried it, including trying to tune these apps based on our experience with them in carefully studied pilot programs.

    It’s true that people need help isolating. But Massachusetts’ program offers significant social services for people who are asked to voluntarily isolate. I don’t know if other places do too but it is possible to do this.

  3. Yogarhythms says:

    Qn,
    Excellent reporting. Tearfully true indictment at this moment 17MAY2020 healthcare in USA. Contact tracing as you so elegantly describe is compassionate.
    President Trump’s devoid of compassion.

  4. Raven Eye says:

    And for information, we get this combination of an incompetent local TV reporter and a guy with a big hat who is all about his “rights” (about which he is pretty clueless) and never once mentions “responsibility”.

    https://kobi5.com/news/local-news/faith-and-freedom-rally-in-downtown-medford-draws-out-hundreds-of-people-128741/

    Yeah — this is a small market, and the TV reporters are pretty green…But to just swallow the swill from the organizers…

    • P J Evans says:

      I wonder if they ever had any kind of civics or government classes, where they should have learned about all this.

      • Raven Eye says:

        You do wonder.

        Mr. Immune is a lost cause — he’s lived in the bubble for too long. He probably thinks that social responsibility is some kind of left-wing Commie idea to take away his rights and that he’s taking the responsibility to make sure that doesn’t happen, no matter who gets hurt (or infected) in the process.

        As for the reporter, there’s no excuse. I had to take a semester of press law to get my BA. Either she slept through it, or her program never even offered it.

    • rwdjung says:

      Speaking of “faith and freedom,” here are some thoughts on the matter— along with responsibility and focus in the paramount needs of “the neighbor”—Martin Luther wrote from Wittenberg in 1527 when the bubonic plague had struck the town.

      Note: I posted elsewhere on the matter. Hope it’s all right to post again. I think it’s worth repeating.

      “Others . . . are much too rash and reckless, tempting god and disregarding everything which might counteract death and the plague. They disdain the use of medicines; they do not avoid places and persons infected by the plague, but lightheartedly make sport of it and wish to prove how independent they are. . . . This is not trusting god but tempting him. God has created medicines and provided us with intelligence to guard and take good care of the body so that we can live in good health.

      “If one makes no use of intelligence or medicine when he could do so without detriment to his neighbor, such a person injures his body and must beware lest he become a suicide in god’s eyes. . . .

      “It is even more shameful for a person to pay no heed to his own body and to fail to protect it against the plague the best he is able, and then to infect and poison others who might have remained alive if he had taken care of his body as he should have. He is thus responsible before god for his neighbor’s death and is a murderer many times over.

      “Indeed, such people behave as though a house were burning in the city and nobody were trying to put the fire out. Instead they give leeway to the flames so that the whole city is consumed, saying that if god so willed, he could save the city without water to quench the fire.

      “No, my dear friends, that is no good. Use medicine; take potions which can help you; fumigate house, yard, and street; shun persons and places wherever your neighbor does not need your presence or has recovered, and act like a man who wants to help put out the burning city. What else is the epidemic but a fire which instead of consuming wood and straw devours life and body?

      “You ought to think this way: ‘Very well, by god’s decree the enemy has sent us poison and deadly offal. Therefore I shall ask god mercifully to protect us. Then I shall fumigate, help purify the air, administer medicine, and take it. I shall avoid places and persons where my presence is not needed in order not to become contaminated and thus perchance infect and pollute others, and so cause their death as a result of my negligence.’

      “If the people in a city were to show themselves bold in their faith when a neighbor’s need so demands, and cautious when no emergency exists, and if everyone would help ward off contagion as best he can, then the death toll would indeed be moderate.

      “But if some are too panicky and desert their neighbors in their plight, and if some are so foolish as not to take precautions but aggravate the contagion, then the devil has a heyday and many will die. On both counts this is a grievous offense to god and to man—here it is tempting god; there it is bringing man into despair.”

      Martin Luther, Luther’s Works, Vol. 43: Devotional Writings II, ed. Jaroslav Jan Pelikan, Hilton C. Oswald, and Helmut T. Lehmann, vol. 43 (Philadelphia: Fortress Press, 1999), 131–134. (Light editing: God–>god for sound theological and not militant atheist polemical reasons.)

  5. observiter says:

    You mention at the beginning that the over 90,000 deaths is from “our” failing and that public health is something “we’ve” been failing at for a long time. I would disagree about the “we” part, or at least suggest the issue is larger than this article.

    But saying that, I would like to make two related observations.

    Our role model of the moment, Mr. T, is going around saying there’s nothing there with the virus and it’s now time to party. So how come Mr. T’s partner, Ms. Melania, who has always there alongside him, is no where to be seen. And where are his buddy sons and daughter? Where is his son-in-law?

    Secondly, we’re talking about a virus. There’s been a debate for years to decide if a virus meets the definition of a living thing or not.

  6. Terry Salad says:

    Seeing an “open up Illinois” rally this weekend was incredibly dispiriting. While the rally only attracted between 1000 and maybe 1500, hardly anyone was wearing a mask. The idea that “your fear ends where my liberty begins” is too ridiculous for words. We Americans suck. We are too fat and lazy to lockdown with any effectiveness. Wearing a mask is now seen by many as “cowering in fear.” The virus has spread nationwide. Contact tracing will be halfassed and essentially useless. Americans was to go to Applebees and not wear a mask. They want herd immunity, and are fully willing to accept the death of well over a million people — as long as it is old folks and the poor.

    • P J Evans says:

      There are people who believe that “shelter in place” is the same as “house arrest”, that people under that order can’t go out for any reason, and that it will last forever.

    • vvv says:

      The local news interviews showed people who are, pardon the expression, truly deplorable. It would be of great benefit to me and perhaps others if someone could identify the businesses that the claimed owners are clamoring about, so that I can avoid and reco others avoid them forever.

      I still don’t and won’t buy Oberweiss anything, or Chik-Fil-ay or trump, or go to a Hobby Lobby, even as I currently refuse to engage Rethuglicans.

      I also shall not be going to WI or MI or MS or IA except on business, and certainly will not spend any discretionary money there.

      Business owners in my suburb are keeping quiet, but the mayor has been bitching about re-opening, and so I shall be working against him, also.

  7. madwand says:

    https://asiatimes.com/2020/05/why-east-beat-west-on-covid-19/

    This is part one of a two part article on differences between eastern and western nations articulating differences in leadership, policy, health systems, cultural habits, attitudes toward governance and of course the stats are thrown in, mortality, percentages etc.

    Conclusion is that east has done better than west easily, which if you go to the charts at JHU or Worldometer will tell you without much investigation.

    Hegseth at Fox this morning was talking about a constitutional right to open at a gym in NJ where a bunch of people, many without masks, including Hegseth, were demonstrating. While we all recognize this as stupidity, these people have decided their “constitutional rights as related by Hegseth,” are more important than protecting the rights of the vulnerable and innocent. Since this is viewed by the political right as their interests as defined by power, this is IOKIYAR. Guys with guns are showing up in state houses, also IOKIYAR. It is not a stretch to believe that polling places, especially in battle ground states, will be occupied by guys with guns in November, that will be IOKIYAR. One can see where the extension of this is going. Terrible things happen when people collaborate with terrible perpetrators.

    • Rayne says:

      These manipulated selfish gits who whine about their constitutional rights forget the entire Constitution was written to this end:

      We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

      Their claims of their individual rights at the expense of others’ health do not form a more perfect Union, do not contribute to equitable Justice, upset domestic Tranquility, undermine our common defense against illness and hurt the general Welfare.

      No one made sick by these selfish monsters’ rejection of the public’s collective rights is blessed with Liberty, nor are those of us denied our representation by their terroristic intimidation of law enforcement and legislators.

      They also forget this country wouldn’t have succeeded had all the colonists acted like them, failing to take up common defense including quarantine against sickness like yellow fever. Ignorant pigs, the lot of them, and most of them likely soft minded having adopted this selfishness after repeated exposure to propaganda from Fox and whatever fascistic forces promulgate this crap in social media.

      • vicks says:

        It’s like a bad horror movie, seniors scared shit-less of their own spawn.
        In all seriousness,
        This is their own community they are stomping on, this isn’t nameless faceless people they are will to let die, this is a reckless disregard for their own family members, friends, neighbors, and co-workers.

        • Rayne says:

          Oh, it’s uglier than that. These selfish cretins are white people under 60 years of age. They’ve been assured by the media’s attention on the racial disparity in COVID-19 deaths that they won’t be seriously affected.

          Except we don’t know jack about this virus yet. We don’t know whether persons who may have had mild to asymptomatic cases may have latent long-term effects. We’re hearing reports of people with mild cases who are losing toes and fingers — what other damage is hidden in their bodies where small blood vessels were shut off by unusual clotting, which they only survived this time because they have a better diet than someone living in an urban food desert? What effects did this virus have on immunity to other viruses?

          The karmic debt will demand payment from these arrogant, careless morons.

    • Quake says:

      Lumping China, Japan, Korea, Malaysia, India, Pakistan, Tajikistan, etc., etc., into one homogeneous category of “Eastern nations” is a kind of unconscious racism (you probably don’t agree, and I’m sure you didn’t mean it that way, but still…).

      • madwand says:

        No I didn’t mean it racially, I am especially happy to see Vietnam as zero as the article states. After ten years of unnecessary war in the 60s and 70s and a mostly destroyed nation, they’ve come a long way. South Korea and Japan also. But still……….they’re doing a lot better than the west.

  8. Tom Marney says:

    “Not everyone is going to be prosocial, but when incentives are right, and peoples’ needs are met, overwhelmingly people do the right thing. There’s always exceptions, and those exceptions become news, but rarely are those the people who tip the balance. People well cared for and informed, educated and competent, will act for the best of their communities and loved ones. This in turn creates the kind of healthy communities that break the chains of transmission. If we concentrate on building healthcare capacity and supporting communities, many of the antisocial people will disappear into them, looked after by their own people. There will always be exceptions, but no one can tell you what to do like Grandma can, especially if Grandma can also see to it you get healthy food, a good education, and most importantly right now, medicine when you’re sick.”

    Sounds rather analogous to the process by which society used to subsume authoritarian personality traits rather than deliberately cultivating them for political deployment against all that’s good and right as is done now. Crazy uncles have always been with us, but for them to comprise the majority of one party is new, and rare AFAIK. At some future point, we’ll need to figure out how to Make Conservatism Nontoxic Again, most likely by reanimating intrafamily giving a damn and other traditional methods.

    • vvv says:

      While I like the idea of what you wrote, I gotta say I think it’s simplistic. The intra-family dynamic of the family trump was apparently a racist, anti-semitic (I read triple-K affiliated, altho’ that’s been disputed), authoritarian, thieving, etc., ethos, with too much ill-gained money (even as the amount is exaggerated) – and too little conscience (if any).

      Hopefully enough of them will be “subsumed” into prison such that the others are unable to care for their progenitors and progeny, being too busy fighting incarceration themselves.

      I truly feel sorry for the minor children.

      • Tom Marney says:

        Oh, I’m not talking about Trump at all. I’m talking about his supporters. Tens of millions of them.

        I have a theory: About thirty percent of the population, any population, are authoritarians, most of which gravitate to the right. The American political system is heavily biased toward two parties, each of which strives to attain a majority, which in the long run means that each usually gets about fifty percent of the vote. Through most of the twentieth century, the authoritarians were split between the two parties. The racists with their disdain for the misdeeds of Lincoln went to the Democrats, while the more conventional wingnuts with their revulsion toward FDR went to the Republicans. Since the civil rights movement and Nixon and his party’s southern strategy, both contingents of authoritarians have moved into one party. Thirty percent of the electorate split between two parties can be subsumed by each party’s majority, but thirty percent of the electorate in a fifty percent party is a dominant majority. That, per my theory, is why the Republican Party is the way it is, and I have no idea what to do about it.

        The big problem with my theory is that while authoritarians exist in similar proportion in every society, it’s unusual for them to be as off the rails as they are here. So there must be something else at work in other places that’s not at work here, such as… the type of socialization lauded in this piece.

  9. John Langston says:

    I contacted my state volunteer medical corps about two weeks before the lock down. I thought I’d let readers know about this service in case they’d like to participate. I’m a retired logistician and wanted to be involved in the planning, budgeting and acquisition phases. I was notified recently that they might consider me to be contact tracer, so perhaps I will get into the game.

    Anyway I’ll just go through my laundry list.

    1) How will the US convert a private health care system to meet a public healthcare need?
    2) Why did we fail at virus testing and allowed the virus to penetrate our country? Why weren’t our borders protected? Why did so many countries succeed and we failed so miserably?
    3) When Sec Azar was asked before Congress about purchasing vaccines, it was clear that he had no plan for distribution. It almost appeared he saw it as a profit opportunity for Pharma.
    4) The testing deficit meant we had to close most of the country’s economy since we didn’t know where the hotspots were, even though some places might’ve still been able to quarantine the infected yet maintain the general economy.
    5) We’re opening the economy and still don’t know where the hotspots are. (reverse of above)
    6) Insufficient PPP for essential workers. Many without sick leave, health insurance (see #1), life insurance, child care. (“Warriors” without guns or VA system?)
    7) No federal plan for healthcare or restarting the economy. Little relevant information, standards, metrics or public service announcements.

  10. Tarkeel says:

    Very good points Quinn, and I agree with just about everything you say, but there is one point I would like to add.

    While the lack of treatment options is a real concern in the US, I’m even more concerned about the lack of paid sick leave. Most of the infected won’t need any form of treatment, but they will need to be quarantined, which brings us to paid sick leave. As long as people feel (often rightly so) that they will be punished for staying at home when sick, they will find ways to make it to work even when they shouldn’t. If people who are symptomatic sick are incentivized to work, how can you effectively quarantine the asymptomatic whom have been in confirmed contact with the infected?

    Just after Norway announced that anyone arriving from infectious hotspots would be quarantined, our national “social security” was very quick to announce that as long as you were quarantined on medical orders, they would treat you as sick; i.e. full pay for the entire quarantine period. This was probably one of the most important measures taken to limit infections here.

    This order hard to be modified later on to exempt those that voluntarily took actions to be placed in quarantine after many people went shopping in Sweden.

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