[Magdalen] Thoughts about the future (resend)

[Kate Conant]

Jim,

I was glad to read such a well-thought-out take on the current situation.
I have some thoughts (as an otherly-educated person!)  that I, for now,
will keep to myself.  I wish DJT would do the same.  There seems to be so
much that is yet unknown about COVID-19.

Kate


"What does the Lord require of you, but to do justice, love mercy, and walk
humbly with your God?"
Micah 6:8


On Sun, Apr 26, 2020 at 7:29 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>