[Magdalen] Thoughts about the future (resend)

[Ann Markle]

Interesting (very well-educated) speculations, Jim.  I would add (with
admitted personal interest, because I think I had it in January) antibody
testing, so we can get some better idea of the ratio between total
infections and serious (hospitalization, death) implications.  I also agree
that the new normal won't look anything like the old normal.  As someone
who enjoyed meals out with friends several times per month, I wonder what
the food service industry is going to look like.  Yoga studios, where the
bigger classes have us not much more than 12-18 inches apart on our mats?
Gyms?  Maybe private dinner parties will resurge.  Buffalo is a huge
restaurant town.  I do think universal (single payer?) health insurance
coverage will become easier to enact.  Will we learn anything about our
human impact on the environment, and will the changes have some beneficial
effect (as this dramatic full stop has done)?

One of my favorite preoccupations is listening to these speculations from
people who have reason to know something (as I do not).  Me, I mostly think
about church, liturgy, the Eucharist.  Interesting diocesan clergy
discussion on how we will administer communion when church can resume. Our
sexton (and others) may also be busy between services, wiping down pews and
altar rail.

Ann

The Rev. Ann Markle
Buffalo, NY
ann.markle at aya.yale.edu


On Sun, Apr 26, 2020 at 7:28 PM James Handsfield <jhandsfield at att.net>
wrote:

> 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.
>
>
>
>
>
>
>
> -------------------------------------
> Education is its own reward, both for the individual and for society.
>
> Jim Handsfield
> jhandsfield at att.net <mailto:jhandsfield at att.net>