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So I was one of those people that leaned into the uncertainty surrounding the coronavirus to decide it must have missed us somehow. Late Feb/Early March, still no explosion of cases in the US. Did we really even want to test and create panic 1/n https://thehealthcareblog.com/blog/2020/04/11/the-covid-pandemic-who-dunnit/
Then Italy happened. And the first hand accounts from the hospital went out. Quite a wake-up call. Days later, I was sending multiple emails to my school district asking to close the schools. Weird thing: Initial response was still 2/n
worried more about impact of school lunches, and closure impacting parents that didn't have childcare. Understandable considerations of course, but not quite the concerns of folks with knowledge of a pandemic heading for us 3/n
& this wasn't political! I live in a hyperliberal part of a liberal town, so the ? was why we were all so conditioned to dismiss this. Why was the local Dept. of Health, even after Italy, after local +ve cases in the community still not in alarm mode? 4/n
The WHO & CDC seemed the natural early warning system. Why didn't I remember missives from these folks? Where was the urgency from them to test/restrict travel/screen more? So I started to look (a week ago) at what the WHO had been saying. Easy to find 5/n
Almost every daily press conference from January to now was online. Also online via tweet is a timeline of what the experts at the WHO thought as the pandemic unfolded. Over and over I found a desire to reassure. 6/n
By the time the WHO let the world know China informed them of a new cluster of pneumonia's January 5th, a number of texts by worried local Chinese physicians had already gone viral. 7/n https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30382-2/fulltext
It was a Shanghai lab that released the viral sequence to open access data repositories 6 days after letting central chinese officials know. Only then did the Chinese National Health Commission announce it was releasing the information to the WHO. The WHO framing: 8/n
In China, as an ever-increasing number of patients swarmed local hospitals no public mitigation measures were evident. A lunar year banquet scheduled in Wuhan proceeded as planned January 18th, and 40,000 families gathered to share home-cooked food 9/n
According to a New York times study of cellphone data from China, 175,000 people left Wuhan on January 1st alone. It was not until January 20th that the lead physician in China in charge of the virus response confirmed that human to human transmission was possible. 10/n
Scrambling to contain a situation spiraling out of control, China imposed a lockdown of Hubei (60 mill ppl) on Jan 23rd. The unprecedented actions taken by China should have been a signal to the WHO and the rest of the world that everything was most definitely not ok. 11/n
The WHO convened soon after to decide what to do, and after a day of meetings decided to meet in a week. That next meeting was 1.30. At the end of that meeting they decided to declare a "Public Health Emergency of International Concern" But observe the framing again: 12/n
Even after Italy's and Iran's disaster was apparent, and the WHO finally declared March 11th this was a pandemic, this was the advice given to the world 13/n
Again, 1 may say who cares about the WHO, the US should have known better. But senior members of the US bureaucracy were parroting this line as well. Here is the very smart (I'm being sincere) Dr. Fauci when asked if the US should be worried after Wuhan shut down. 14/n
Understanding the problems with WHO requires understanding the rot that lies at the core. The WHO is a far cry from super-sleuth virus hunters, and its been systemically inadequate for some time. 2 excellent articles https://www.thenewatlantis.com/publications/the-politics-of-the-who
https://www.thenewatlantis.com/publications/the-ebola-gamble 15/n
https://www.thenewatlantis.com/publications/the-ebola-gamble 15/n
Examining the SARS outbreak, and the Ebola outbreak response is illustrative
SARS: The WHO comes to know only after the virus has escaped to Vietnam, after an Italian doctor Carlo Urbani is suspicious of an American traveler. Dr. Urbani died later of the virus. 16/n
SARS: The WHO comes to know only after the virus has escaped to Vietnam, after an Italian doctor Carlo Urbani is suspicious of an American traveler. Dr. Urbani died later of the virus. 16/n
Politics, as usual, play a role: The WHO even refused to publicly report Taiwan’s cases of SARS until public pressure prompted numbers to be published under the label of “Taiwan, province of China”. 17/n
But public health concerns apparently motivate the WHO to champion the cause of a sovereign Palestinian State! 18/n
The Ebola missteps are more severe. Despite the fact Ebola has a 40% case fatality rate, the WHO continued to maintain the “evidence was insufficient” to recommend more than a surgical mask for protection of health care workers. https://apps.who.int/iris/bitstream/handle/10665/137410/WHO_EVD_Guidance_PPE_14.1_eng.pdf;jsessionid=2EE1B7AB67BC11185F686C759E18F155?sequence=1 19/n
The CDC follows the consensus EBM approach. Plain old surgical mask ok. But this is what head of the CDC Tom Frieden was wearing at the time when visiting an Ebola Doctors without Borders site. 20/n
It took two health care workers in Dallas contracting Ebola from a patient for the CDC to change its recommendations in October 2014. 21/n
The WHO/CDC also took a similar stance with another controversial topic—quarantines for health care workers returning from treating patients with Ebola. No quarantines unless symptomatic they said. 22/n
When a NY physician returned from treating Ebola patients , was in the community, and tested positive days later, governors moved to mandate quarantines. They were opposed by the CDC, & the Obama admin.. 23/n
The argument made was that Ebola could only be transmitted by the symptomatic, and so it was anti-science to consider mandatory quarantines. Not mentioned is when one crosses the threshold from asymptomatic and not infectious to symptomatic and infectious. 24/n
The default position to reassure the world fits with a mission to preserve the economies of source countries by not restricting the flow of international trade, and avoiding stigma. 25/n
That thinking pervades politicians with good reason. Their constituents have rent to pay after all. So they need data for well respected sources to tell them to take drastic actions. There is just no way I see NY mayors/governors, let alone Presidents acting w/o med consensus
The videos of Trump's reassurance have been seen by many , but caring for commerce is a bipartisan endeavor! Here is Governor Cuomo. There are easy to find links of reassurance even as late as March of him saying similar things.
NYC health commisioner : "Go about your daily lives"
Heres the NYC mayor 3.2 . "Very little threat here"
NYC mayor 3.2 . "We cannot just shut down because of undue fear"
These are politicians. Without public health consensus, they picked the path of least resistance. We all needed better information of the scale of the outbreak. Hubei is 60million people, 80,000 cases, 3000 dead. No outbreaks in the rest of China. 31/n
The strands of information were there in retrospect. Why did China move so aggressively, the cruise ship that suggested this was much more infectious than the Chinese data would suggest. Some saw it : @ScottGottliebMD @ChristosArgyrop Even Steve Bannon! 32/n
We r going to need to do way better the next time. It may be the institutions will always move too slow. If we are to avoid the next pandemic, it will be because we listen to those at the coalface and ignore the empty suits from Geneva and their even emptier proclamations.
We are all Indebted to first responders for everything they are doing and to those who have paid a heavy price. Sincerely believe things would be so much worse if not for people in the trenches stepping up to do the right thing. Fin
