Mike’s back… with advice for what the next Administration can do to fight COVID and prevent this disaster from ever happening again. The secret? Realistic modeling, Big Data Analytics, a top-notch medical logistics system, and a focus on the social determinants of health. Oh, and Yankee Candle reviews (?!) Suggested drink pairing: Lepanto OV, neat in a Glencairn glass. But hey, you made it to the end of 2020, drink whatever the hell you want.
He’s Back…
It’s true, Meaningless Useketeers; I have finally returned. Not for lack of trying. No fewer than four times did I sit in front of this laptop and try to start an article, only to find the news cycles just getting crazier and crazier. Half the time my columns would degenerate into a bitter jeremiad. (One aborted article was done entirely in the style of a Sumerian lamentation.) Around the time POTUS got COVID and couldn’t care less, I threw up my hands in despair and decided to take a break until after the election. I had more pressing matters to focus on, anyway.
It is a running joke that my column is entitled “the lighter side of Health IT,” yet consists almost entirely of me prophesying doom and gloom. I try, when possible, to insert humor into my doomsaying, but this wasn’t possible in the case of the COVID pandemic. My worst-case scenarios were exceeded. The Trump Administration: threw away the pandemic playbook; discredited experts; refused to invoke the Defense Production Act for ventilators and PPE; encouraged resistance to state health orders, leading to a plot to kidnap Michigan governor Gretchen Whitmer; held super-spreader rallies at Sturgis and Tulsa; itself became riddled with COVID; and finally gave up. Even worse, a significant percentage of the population still thinks the disease is a hoax, or that the vaccine is a hoax, or that Bill Gates and the Deep State are using the vaccine to chip and track people, or some other Q-Anon dumbassery. What could I have possibly written? An incoherent string of curse words? Meanwhile, nearly 280,000 Americans are dead from COVID-19.
Thankfully, there is light at the end of this tunnel. Multiple vaccines are in Phase 2 and 3 testing. The incoming Biden Administration is making the pandemic priority number one. In true Meaningless Use fashion, I am here to offer spicy hot takes on what President Biden can do to fix this mess.
On January 20, 2021, at noon, the crashing second wave of COVID will be Joe Biden and Kamala Harris’ problem. What can they learn from the worldwide successes and failures in battling COVID?
Have You Herd What Happened in Sweden?
Sweden famously avoided lockdowns in an attempt to build “herd immunity” against COVID. It didn’t work. COVID mortality and infection rates are among the highest in Europe and containment isn’t working. Sweden’s top immunologist says herd immunity is “a mystery” and:
“It’s obvious that it does slow down transmission, but it’s been difficult to understand how large that effect is and how it should be weighed against other factors that speed up transmission,” Tegnell said. That “balance may have been different than I and many others believed.”
Now I know that sounds like a lot of words to admit culpability, but trust me: It sounds a lot better in the original Swedish:
Yet there one lesson we can take away from Sweden’s failure to contain COVID. Immunity does not limit spread as much as models indicate they should. We need to keep this in mind because the rate of spread is about to increase for three reasons.
First, people are fatigued and cutting corners regarding social distancing. The next time you mask up and go to the store, check: how many people are strictly staying six feet apart, or using one-way aisles properly? If even one person brushes past someone else at a pinch point, the effects of social distancing are blunted. If that person is being slack about wearing a mask, the effects are negated. Just one person who cuts corners is like an ember which can reignite a flame. With COVID fatigue affecting the population writ large, there are a lot of potential flashpoints, especially after holiday super-spreader events.
Second, thanks to a recent Supreme Court ruling, there will be no limits on religious gatherings. There will be people who insist on meeting to worship and that is going to seriously impact the epidemiological models. The Biden Administration will have to take this into account – a population that is weary of social distancing rigorously combined with a constitutional right to gather in enclosed spaces means that we are going to look to Sweden’s growth curves as models for our own. It sucks, but it is the bitter truth, so the Biden Administration will have to accept it and work with it.
Third, the Biden Administration will be leading a country with a significant population of anti-vaxxers. It’s amazing how social media echo chambers, fueled by foreign influence campaigns, have led to bizarre conspiracy theories. These theories are a chimera of Bill Gates, George Soros, 5G, adrenochrome-eating (((GLOBALIST ELITES))), and God knows what other nonsense. As a result, a significant portion of the population will not accept a Coronavirus vaccine. This dips us well below the threshold we need for the type of herd immunity that vaccines require. Hell, we can’t get there anymore with a measles vaccine. As the Swedes found out, the COVID-19 threshold is even harder to establish, but thanks to the Infowars crowd, we know we won’t get there.
Bottom Line: Americans are tired, lonely, anxious, and getting lazy about social distancing and masking. Some of us are itching to go to church and there is no law that can prevent that. Still more continue to believe this is a hoax or that the vaccine should be avoided. We cannot rein in the spread. Whether or not we want it, our growth curves will be like Sweden’s. The Biden playbook needs to reflect this reality.
You Can’t Hold a Candle to Big Data: Hidden Signs to Track and Trend
The Biden Administration will need to deploy its best data scientists to track this pandemic. We will also need skillful data science to track and prevent future pandemics before they start.
An brilliant scientist, Kate Petrova, noticed an interesting trend: COVID-19 cases correlated strongly with negative review of scented Yankee Candles. Unscented candle reviews remained constant. The correlation makes sense: COVID can be weakly symptomatic, but one common symptom is a loss of smell.
As humorous as this may sound, it’s often this sort of unexpected correlation that leads to an epidemic being spotted to begin with. When doctors discovered unexpectedly high clusters of Kaposi’s Sarcoma and pneumocystis pneumonia in gay men in the 80’s, that statistical blip led to the discovery of HIV/AIDS. Identifying and crowdsourcing unexpected correlations will be key to tracking and containing future pandemics.
Bottom Line: The Biden Administration needs to apply a holistic approach to tracking everything, in a cabinet-wide monitoring and trend analysis campaign.
Vaccines and Distribution
So far, Operation Warp Speed has been a success. This is for two reasons:
First, Coronaviruses are a known category of viruses; many instances of the common cold are Coronaviruses, as is SARS. In addition, Coronaviruses mutate more slowly than retroviruses like the flu, making it easier to formulate the vaccine to last between seasons.
Second, vaccine manufacturers worked at risk by gearing up the manufacturing in parallel with the research. Normally, since vaccine trials may or may not be effective, Big Pharma won’t set up their manufacturing, supply and distribution chain until they know the vaccine is effective. In this case, the fact that Coronavirus is a known quantity allowed the vaccine manufacturers to go out on a limb and gear up for something they were fairly sure would be ready for mass production. However, they didn’t have to go at risk. This is exactly what the Defense Production Act is there for; assuring that vendors will be paid so they can focus on mass production. If only it had been used for ventilators and PPE.
Once the vaccine is ready for market, we need a coherent plan to distribute and administer the vaccine. During the first presidential debate, President Trump stated that the military would be responsible for this. As with so many things our Trump says, this is not true as stated. The military does have a role to play, primarily logistical, but will not be the endpoint of the vaccine program.
My advice to the Biden Administration is to expand the logistical role the military plays. The Defense Medical Logistics Standard Support (DMLSS) is the gold standard for medical materiel storage and distribution. Don’t let the fact that it is approximately six hundred years old and runs on whale oil and child sacrifice fool you. It is very good at what it does, so much so that Veterans Affairs has settled on it as a successor to its medical asset tracking system. More importantly, DMLSS has strong assemblage management capabilities. Assemblage is a fancy term for saying that perishable or volatile components must be kept stable until the time for use. Many vaccines (and medicines) must be kept within a certain temperature range, yet the United States military needs this materiel no matter where it deploys. This includes harsh environments like desert or arctic climates. (You know, like G.I. Joe.)
With most COVID vaccines requiring extreme refrigeration (in an age of unprecedented climate change), the DMLSS assemblage management capability will be key to making sure that we can get vaccines from sea to shining sea.
Now, the matter of the antivaxxers. The only way to combat this is to lead by example. Presidents Clinton, Bush and Obama have all volunteered to take the vaccine publicly to reduce doubt. I don’t know if doing so will send a message to most conspiratorial depths of the Q-Anon hellscape, but every effort counts.
Bottom line: In response to COVID, and as standard operating procedure for the pandemic playbook, the Biden Administration and successors must aggressively use of the DPA to produce and DMLSS to assist in assemblage of vaccines is key. Lead by example and make sure the leaders take the vaccine publicly on camera.
In it for the Long Haul; Chronic Effects and Social Determinants
You may have heard of “Long Haul COVID,” where COVID leaves lingering vascular and neurological effects. Other effects include lingering erectile dysfunction. (Maybe this will help encourage masks and social distancing.) Some theorize this is the result of lingering lung inflammation which affects oxygen levels and other system issues. At its core, COVID is a vascular disease, affecting blood clotting and non-lung tissues. There is some practical advice that COVID convalescents can follow, but more research needs to be done into combatting the systemic inflammation. The Biden Administration should devote resources to fighting the symptoms of COVID long haulers.
This is important because COVID long haulers suffer from ongoing health and productivity issues will affect our society as a whole. This is not the first time this has happened. The Russian flu of the late 1880’s and the Spanish flu of 1918 had long haul effects that shaped demographics and society for generations to come. (Interestingly enough, a Fed study concluded that the 1918 Spanish Flu led to increased support for the rise of the Nazis in Germany.)
The social determinants of health will be drastically altered by COVID for many reasons. First, the hit to the economy has caused a staggering amount of job loss. Lockdowns, social distancing, and the closure of social spaces such as bars, restaurants and gyms are affecting psychological and emotional health and raising stress levels. Certainly, the fact that we all know someone who has had COVID, and many of us have known someone who has died from it, affects psychological health. The closure of gyms and the increasingly sedentary nature of lockdown lifestyle affects long term health and wellness.
In this sense, our move to Value-Based Care could not come sooner. Accountable Care Organizations focus on social determinants of health, and boy, there will be some changes to these determinants.
Bottom Line: The Biden Administration needs to account for the economic damage to our society affecting social determinants of health. At the same time, they need to combat long-haul COVID symptoms, because these symptoms affect productivity that feed into aforementioned social determinants. Politically, it’s nearly impossible to get passed, but the logical solution is to tack a public works program onto the Affordable Care Act. This combines the need to provide long-term care, with the need to improve the social determinants of health.
An Inaugural Voyage
So here we are. 2020 has been an absolute dumpster fire. Yet there is light at the end of the tunnel. It will take a lot of work to get there. I do not envy the Biden Administration at all. Depsite the promise that we can, with work get to a better place, we are still in for a majorly tough winter as the hospitals are at capacity and that will only get worse over the short term. Yet as a member of the Federal Health IT community, I am excited to see a coherent Federal response to the worst public health disaster of my (hopefully long) lifetime. What we do today, and tomorrow, and the day after that, will echo throughout history. Our actions in this crisis will be remembered by future generations.
I may have missed my chance to write a Mesopotamian lamentation, but I’m still closing out this flaming garbage heap of a year and honoring the nearly 280,000 dead Americans, with a proper funerary dirge. Sending this craptastic year off to the shades of the underworld, is Carpenter Brut’s latest single Fab Tool. By far it depicts 2020 the way it was meant to be depicted: post-apocalyptically. Think Pacific Rim meets Fist of the North Star via Fury Road. Vocals by David Eugene Edwards. Staggering visuals by the incomparable Dehn Sora.
Have a safe, socially distanced holiday. I’ll see you next year. We have work to do.
