COVID-19: What’s next?

This is a short video I created for Twitter, without intro as Twitter videos have to be short. I’ll make a longer one and a few short ones after this one. There is much more to this topic.

The person talking about dialing up and dialing down any measures taken to halt the spread of COVID-19 and who believes that this should be done on a relatively small scale (and not mandatory but in the form of a recommendation) is Lindsay Wiley, by the way. (Who was very patient with me when I kept asking strange questions, I should add. A little bit too patient perhaps… She’s much more a legal scholar than an epidemiologist, I realised later when I looked into her. That may explain a lot.)

 

 

I can see what she means and why it might be needed – we’ve just seen Hokkaido dial measures up again after the infection numbers went up – but if you do this country-wide or island-wide as in the case of Hokkaido, it’s a very different story than if you do it regionally.

Regionally, though, has been the approach in the US so far as far as I can tell. I don’t know whether that has led to any problems with people travelling from a location with no or limited restrictions to a location with strict measures. County borders, state borders, city borders.

People have been protesting against various measures – unfortunately partly inspired by the hogwash spread by two doctors in California who would lose their licences if it were up to me – but these protests make bigger headlines than the news about Americans who have been defying their governor who eased or lifted a lockdown.

(And if you keep people in a lockdown too long, their physical health will start to decline because their lives have become so much more static, particularly for people who live in small apartments. That might make them more susceptible to COVID-19. When does that effect start to kick in and make a real difference? After two months? Three?)

What I don’t know is how it would work out longer-term if you were to dial up and dial down measures regionally or locally.

Would it cause chaos, such as when someone has a job interview or a project planned for which he or she needs to be in Chicago and then all of a sudden, the recommendation changes?

If it is not mandatory, then how effective would such measures be? Effective enough, presumably, as this is the approach that’s most strongly endorsed by expert panels in pre-pandemic plans/studies, so I understand.

If such measures are not mandatory and you have a job interview, then not many people are involved and the situation can be resolved.

But for anything involving more people – say, a large company – it may be tricky. If the company does not follow the recommendations, it may be sued by its staff. If the company does follow the recommendations, it may be sued by its clients.

Imagine having to construct a hotel for a famous real estate mogul and not showing up because the recommendation for the location in question has changed (been dialed up). Or having to install new computers and networks for a bank or a call center.

(There is also the question of how you would keep people informed. I think it could be part of the weather predictions, just like UV radiation and pollen counts are. If you travel, you usually check the weather at your destination before you travel or on the way.)

If, on the other hand, you limit people to traveling within their own city or county or state, you cause fewer problems for people who normally never travel beyond those geographical borders.

But how would you ensure that people would do that? If it costs them their job if they follow the recommendation or if their job is ten miles away but in a different county, how likely are they to follow that recommendation?

Then you might have spreading from the borders of your geographical area, inward, if the neighboring counties have a higher rate of infection. Do you use travel permits?

Do you test everyone within a certain distance of such a geographical border to identify new cases and quickly isolate them?

From a purely epidemiological point of view, it probably all makes perfect sense.

Does it also make sense from a practical point of view? That’s less easy to figure out. What does small-scale dialing up and down of measures mean for Joe and Jamie Public when they get up in the morning and prepare to take their kids to school? I can’t get a clear response to that question.

Besides, there also is a strong cultural angle to this. In some countries, citizens will be more likely to follow recommendations than in others, I’ve noticed. Socioeconomic aspects – level of inequality – as I’ve mentioned, play a role as well.

I have to conclude that the experts don’t have all the answers yet either. The experience is new for almost all of us, with the exception of people in parts of Asia that have gone through MERS and through SARS aka SARS-CoV-1.

The previous whopper of a pandemic we had occurred a century ago, after all (Spanish flu). Even the Hong Kong flu that hit around 1968 happened too long ago to be able to translate that experience into the way we are living now. In those days, most women in my home country stayed at home all the time anyway because they were home makers, for example.

But that’s for the here and now and short term. How about the longer term?

Continue reading