Thursday, June 10, 2021

Smarter Covid Reviews

 Last week Joe Biden announced that he had asked his secret service to explore the possibility that Covid originated in the Wuhan lab in China. It seems to me that this is a rather pointless exercise, and there are at least five alternative studies that Biden could sponsor that might have more value.

 

The study is one more example of how the world is in the process of fracturing into two competing blocks, manifested as a second cold war. The driver for Biden to become sucked in is mainly political. The Republicans have few credible policy arguments, and they can only win with jingoism. So Fox News carries continuous coverage of the Mexican border and also drums up fear of China, reminding us how “tough on China” Donald Trump was. The tangible benefits of this toughness are hard to discern and the global consequences are dire, but Biden feels he has to dampen the political threat. Publicly implying that China is so incompetent as to release a deadly virus into the world and so devious as to cover it up serves his purpose well.

 

Why is the study pointless? It is political theatre. It is also unlikely to decide the issue at hand, so long after the fact and with few useful trails of evidence. But the many reason for its pointlessness is that essentially it does not matter. It is possible that Covid originated in the Wuhan lab. It is also possible that it transferred from animals, likely involving the Wuhan wet market. Both possible origins offer lessons to minimise the risk of future pandemics, and no doubt China is busy quietly applying those lessons and other countries can too. But whichever cause was to blame, Covid is here and knowing the origin won’t make dealing with it any easier. It would make sense to assume that both causes could have been to blame rather than wasting time, money and diplomatic capital trying to establish which. But that would not be such good domestic politics.

 

So what about the five alternative studies? I would start with a critical review of the US health institutions during the period between December 2019 and February 2020. One quote that has remained with me from my reading during the pandemic was from an epidemiologist who claimed that almost all viruses are circulating for many weeks or months before symptoms appear en masse. This makes sense to me and was obviously the case with Covid, since the virus managed to travel from Wuhan to Italy and New York somehow and then quietly disperse among unsuspecting populations.

 

During this period the US seems to have been asleep at the wheel. To be fair, it was not just the US, but US is the place with the largest budgets and the claims of pre-eminence. Surely some of this resource should have been trying to understand Covid, putting early measures in place while preparing a menu of tougher measures, and briefing politicians. It is too easy to blame Trump. If he wouldn’t listen, others could have been briefed instead. It was usually possible to work around Trump on important issues. It is too easy to blame the WHO as well, or the Chinese.

 

Michael Lewis, he of Moneyball and The Big Short fame, studies the root causes of this inaction in his latest book. I intend to read this book soon, but the reviews and preview material are already clear. The CDC is one of many US agencies that has become bloated and politicised. The leader is a political appointee, so liable to be short-term, under-qualified and in hoc to those with impure motives. The permanent staff become thinned out, disillusioned and risk averse. Bad news does not receive the airtime it needs. Meanwhile by all sorts of role overlaps with other institutions magnify confusion and inactivity. There is the NIH, the Health and Human Services agency, the WHO and many state bodies. It is no wonder that policy in practice is set by political imperatives and the lobbyists for Big Pharma.

 

Such bureaucratic muddle tends to spread over time. Whoever coined the phrase “never waste a good crisis” knew this well. Biden has a rare chance to improve some key institutions. Will he take it? No, of course not, he will bash China instead.

 

A second useful study would review how the guidance changed in light of new information about how the virus spread. Here it has become clear that an early mistake took far too long to correct, indeed parts of the US establishment still stubbornly defend out-dated findings.

 

A limited early study concluded that the primary means of spread was either close contact or from surfaces. Remember how we all feared touching doorknobs early in the pandemic? Slowly we started reading that an alternative means of spread was via aerosols lingering in the air, but the formal advice did not seem to react quickly enough to this new information.

 

A key data point was the early super spreader event involving a choir in Washington State, where one person managed to infect as many as fifty others with fatal consequences for some. As a choir singer, friends of mine made me aware of this event, and it has spooked us all ever since, leading us to be very cautious about singing, for good reasons. It never made sense that this event could have involved spreading via surfaces or very close contact, and surely it was a strong pointer towards aerosols, which linger longer and further after the strenuous exhaling involved in singing. But much guidance continued to emphasise surfaces over airborne spread, to the extent that many officials doubted the efficacy of masks for too long, giving ammunition to the deniers and conspiracy theorists. How experts incorporated new data in a timely fashion, domestically and internationally, would surely make a valuable study.

 

A third study might try to learn from a positive bi-product of Covid. The rapid development of vaccines is a triumph for science, one where the US should share credit and one that even casts Trump in a very good light. One interesting consequence has been that suddenly vaccine development has accelerated in other fields, such as finding an effective vaccine against malaria or dengue fever.

 

My study question is how it took the Covid crisis to spur innovation in areas that cried out for solutions for decades. What were the mechanisms in place? Where were the incentives? And what changes could be made that could accelerate innovation without the kick-starter of Covid? Humanity could have benefited generations ago from a malaria vaccine, and science could probably have developed one if the right incentives had been in place. If malaria were prevalent in the rich world, I suspect it would have been supressed a long time ago, in the same way that if it were men who suffered menopause, mitigating treatments would be a lot better by now. This are is ripe for international study. I am sure Bill Gates would have some useful ideas.

 

My fourth study is about efficient state disbursement of benefits. Another wonderful side effect of Covid has been to open up the political possibility of direct payments to those who need them. The Biden child support initiative might become his most enduring legacy.

 

But, admittedly acting in haste, Congress probably wasted a lot of money too and misfired with other money. There are stories about small business grants being swallowed by large businesses and those with strong relationships with banks (and therefore good sources of alternative support). No doubt many schemes are open to fraud, or simply too slow to be useful. It is great to offer a total of $3200 in cash, but the eligible member of my family has not seen a cent of his yet. If, as we can hope, that direct transfers will play a bigger role in public policy going forward, then it is important to learn practical lessons from early attempts.

 

There are many candidates for my fifth review. Perhaps somebody could work out how to help Americans understand the concept of probability (rather worrying given how many seem to enjoy gambling). It would be good to avoid debate about whether six feet is a better safe distance than five, or why somebody had a vaccine and still caught the virus. A specific review about how to keep schools open during pandemics would be useful, given what a low priority most states seemed to place on that. Something about state versus federal roles might help too.

 

I expect Biden will call for none of these potentially useful reviews. To be fair, the Republicans would probably try to spike most of them, like they spiked the insurrection review. But I do wish he would not drag himself down to their level with petty, pointless barbs at China. 

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