[Magdalen] Thoughts about the future (resend)

[James Handsfield]

Resending because what I sent had no explanation.

I had a great Zoom conversation with family yesterday evening, consisting of my brother who is an infectious disease doc and epidemiologist, his wife who is a retired public health administrator, my niece and her family (husband and two boys, one adult and one close).  The conversation turned, at one point, to the ramifications and timing of this COVID19 pandemic.  Today, I put some of my thoughts in writing which follows.  The short version is that the recovery from this pandemic is going to take YEARS, and the recovery, when done, won’t look anything like the normal of two months ago.

I realize that some of the thoughts I had are pretty far out there, but I think they point in the right direction.

There is no good model. Some are useful.

 

This is a truism among mathematicians, computer scientists, statisticians, and all kinds of people who crunch numbers for a living.  

 

A model is in essence a mathematical equation that related several factors to an outcome in some logical way.  A typical formula looks like:

 

Y = (Sum(Mx2) +  E

where Y is the outcome,  åMX2 is the sum of the counts for each factor, and E is the unknowable error factor due to randomness or other unmeasured factors.  It’s been a long time and I’m too lazy to look it up to get it exact.

 

It predicts, with a certain amount of confidence what an outcome will be given the factors and the frequencies of those factors.  Clear as mud?  But it covers the ground.

 

Of course, one a model is developed, then collection of data must follow for each of the factors on the right side of the equation to relate to the frequency of a given outcome.  With the COVID19 pandemic, this is usually cases or deaths from cases.  The factors are as many items as necessary, i.e. age, sex, ethnicity, economic status, ZIP code, symptoms, testing, etc.  For each factor, there needs to be sufficient frequency of occurrence to have confidence in the model.  The model can be no better than the worst data.  If there are missing data in the model (i.e. testing type or frequency), then the model loses its usefulness.

 

In the current pandemic we have no idea what the prevalence of COVID19 might be for a couple of reasons.  First, the pandemic is still very active with new cases and deaths daily.  So at best, any model is a moving target.  But also, we have no baseline by way of serological testing to know what the overall frequency of symptomatic cases is relative to the number of infections.  Add the incubation time for the virus to replicate enough to cause symptoms, and there’s a huge amount of unknown.

 

My assessment is that NONE of the models being shown by any source can be trusted to produce accurate predictions, and if the models are not trustworthy, the processes of “reopening” become an exercise in SWAG*

 

No one knows what’s really going to happen over the next months to several years.  Not even Dr. Fauci.

 

 

 

 

*Scientific Wild Assed Guess

 

Without a good model, what’s going to happen.

 

Well, referring to the SWAG above, here’s mine based on what we know.

 

1.     The virus will continue to infect people who come in contact with it.  We can reduce that number by maintaining social distance, a lot of hand washing and using hand sanitizer, keeping your hands and fingers away from your face, and protect others by wearing a face mask when you must go out shopping or into any enclosed area.  In some cases one should wear a mask even going out to exercise, but that presents a lower risk.

 

2.     IF SARS-CoV-2 (the name of the virus itself) wanes in the summer months, it will almost certainly be back as temperatures drop in autumn and winter.  Businesses that have reopened may well have to close again, and the economic cycle we’re experiencing will spiral further out of control.  My best guess is that we are moving into depression like conditions.


3.     The World Health Organization published a notice on April 25, 2020 (only 8 months until Christmas!) that there is currently no evidence that recovering from COVID19 provided immunity against reinfection.  There’s also no evidence that it does not.  But if that turns out to be true, the job of making a vaccine become much more difficult.  Speaking of vaccines, even in the best case, it will be one to one and a half years before a vaccine can be developed, tested, and approved.  Then it needs to be manufactured.  In order to achieve herd immunity, the ultimate public health goal, approximately 60% of the population needs to be vaccinated.  That’s about 228 Million people.  That’s ten time the number of people getting flu vaccine every year.

We have no idea how long it will take to manufacture that much, or, once available, how long it will take to vaccinate that many people.  More data that are missing from the models.

 

4.     I think we’re looking at YEARS to return to any semblance of what we think of as normal, and even that won’t look anything like the normal of two months ago.

 

 

What else?

 

1.     I think this pandemic will have other consequences that will be long term, some of them good.  Because those who have lost jobs because of the virus also lost health care coverage, the door is open to expanding coverage to some level of universal healthcare, and I think it will be done faster than anyone imagined.  In addition we will see much expanded services like unemployment insurance, WIC, and SNAP.  


2.     Voting by mail will become the standard.  All ballots will be mailed to registered voters and they will have the option to mail back the completed ballot or there will be drop off points.  Voter registration will become automatic with getting or renewing one’s drivers license.  Same day registration will become available nationwide. 


3.     Medical equipment and drug manufacture will come under much tighter control of the federal government, including at least a temporary time when emergency equipment and medications will be nationalized to build and then maintain the stockpiles that will support care during future epidemics and pandemics. There will be a much stronger relationship between CDC, FDA, the US Public Health Service and the nation’s national security agencies.  Oversight from Congress will strengthen.  While the administration of the President will provide administrative services, accountability will either be placed in another, independent agency, or such an agency may be part of the Legislative Branch.


4.     Medical practice will change to mostly telemedicine and mobile services.  Instead of going to a doctor’s office, the visit will be by computer communication, and if laboratory tests are ordered, the patient will be directed to mobile collection site or, for more serious cases, the mobile collection can go to the patient.  If a patient needs emergency service, the ER will be mostly robotic.  Robotics will be developed for more and more surgical procedures.


5.     Fashions industries will start making and selling garments that have protective properties.  The face mask will become a necessary fashion accessory.  Impervious gloves disguised as fashion will become common.


6.     Finally, I think out financial system(s) will change radically.  I’m not at all sure what it will look like, but I suspect that it will become much more socialistic, but still a liberal democracy;  capital will still be important as will private business and services operating under a system of much fairer economic balance among ethnicities, economic classes, and taxes.  In order to pay for these changes, taxation will fall heavily on the wealthy and less on those who can afford less.  Property taxes may become the norm for state income rather than income or sales taxes (sales taxes are regressive on the poor).


7.     IF the current occupant manages to be reelected, then all bets are off.  I fear we would soon find ourselves in a right wing dictatorship with Trump as the puppet leader.







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Education is its own reward, both for the individual and for society.

Jim Handsfield
jhandsfield at att.net <mailto:jhandsfield at att.net>