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Covid-19: what has been learned so far?


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I do not necessarily mean public policy in Canada as it's hard to see any consistent approach or strategy in the hectic, ad hoc, often delayed sometimes near panic level knee-jerk measures. But in the big picture some patterns are beginning to emerge. Before mass vaccination was introduced, and while the early data is encouraging we will need to see its effect on the infection in the longer perspective, two quite different effective approaches were developed.

Both required active monitoring of the situation, sound and quick assessment and prompt and effective reaction when needed.

The essence of the first strategy is strong management with the objective to suppress the infection to the minimum or eliminate altogether. It involved prompt closing of all borders, strict unconditional quarantine on entry, active and comprehensive monitoring and prompt action if and when cases are discovered including short but comprehensive quarantine to suppress the spread of detected cases into the community.

Examples: Australia, New Zealand, Taiwan, some countries in Europe. Covid-19 casualty count in Taiwan (population approx. 25 million) is 11 (not thousand).

This strategy can be effective in relatively isolated nations with strong and effective public health care and government in all levels. However it may not be as effective where there's significant exchange and integration with the outside world.

The second strategy is based on public confidence, open and accurate information and targeted intervention. Its priorities:

1. Reliance on public understanding and participation in preventing the spread (for example social distancing, 1.5 meter economy). Voluntary compliance, accurate and proactive information and dialogue with the public.

2. Targeted intervention to secure places of potential risk (workplaces, long-term residences, etc).

3. Sufficient health care capacity with effective treatment of severe cases.

Example: Northern Europe. In Sweden the message to the public has been consistent from the first days of the epidemics with the emphasis on voluntary compliance. Compared to what the word means here, Sweden so far has not had a lockdown, for example restaurants, malls and gyms did not close. While Sweden was not as successful in targeted intervention with high numbers of long term residence casualties, the current cost of Covid-19 per capita is on the same level with Quebec.

Variants of this approach were implemented in other countries of Northern Europe: Finland, Norway. To the best of my knowledge, restaurants and schools remained open. Casualty per capita is significantly lower than Ontario's: Finland 3-4 times, Norway 4-5 times.

Conclusions: restrictive lockdowns is not the only way to deal with the pandemics. Intelligent and effective measures combined with clear communication and voluntary participation of the public can produce same or even better results without the cost and downside. Outdated and inefficient bureaucracy in administration of critical matters can be a high cost to the society in more than one way.

 

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Better border control and very restricted travelling are lessons learned. Lack of border control and travel ban at the beginning of Pandemic was very costly in both human lives and economic terms. 25000 Canadians died so far and over 400 billion deficit just for last fiscal year and many businesses closed for good. Borders must be closed so that variants of different types mutating in third world countries do not enter Canada and kill even more Canadians and more lockdowns.

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2 hours ago, CITIZEN_2015 said:

Better border control and very restricted travelling are lessons learned.

Not learned you meant? There was SARS-1 in 2002 and MERS in 2006 both with one of the highest casualties in the developed world. This is the third in a row and the question in order is, can they be learned, ever and at all?

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Posted (edited)

And another truth that we are learning even as of now as the world is reopening and getting back to some normalcy is that an entrenched, self-absorbed bureaucracy will be the last one to act if/when needed, and also among the last to relax the restrictions when they are not justified or no longer needed. It's only bureaucratic 2 x 2: proactive, sound response is impossible in the system (SARS, MERS, Covid over two decades); while keeping restrictions as long as possible for no reason other than cover in the case of negative developments makes a lot of sense (not to the society though but who cares about that). Things improve - thanks the quarantine. Things go down - the quarantine was too lax or too short (5 months and counting). No can't lose and that was the whole point. Doing it without quarantines or with smart and effective quarantines? Yes possible but so difficult! We found a better way, see?

In this country we're forgetting the very basics of democracy: no democratic authority can be granted without 1) accountability and 2) responsibility. Without these two, it will be a bureaucracy for itself and to itself. Now learned in direct experience. No surprises.

Edited by myata
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As is becoming apparent, the infection comes in waves. Between the waves a focus on correct, current and honest information of the population is essential to maintain its trust and engagement. Intervention can be specific, targeted and limited, including where necessary, enforcement. This approach ensures that the population is informed and on board with minimal disruptions of normal life.

In the background there's real work in continuous and accurate monitoring of the situation. It doesn't involve incessant preaching and contradictory orders. It does require competence and efficiency though.

If and when the infection rate is accelerating, the public needs to be made aware of the potential risks, and some measures highlighting it like limits on gatherings and open times can be imposed. Because it has been on board with open and honest communication, voluntary compliance would go a long way. Everything else can be addressed with targeted intervention.

And in the background there's real work in preparation of the healthcare resources and facilities, treatments, supplies and so on. It needn't involve wrenching hands and heartfelt appeals. It does require competence, professionalism and efficiency.

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Here is what has been learned so far- all these fearful efforts to confine ourselves from each other does not help confine the spread very much, but hurts also. These methods arguably hurt as much, or more, than they help.

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Another thing learned is how inflexible and stupid we are. Our system, our “leadership” lends itself well to producing incompetence at the helm.

Any dingbat can run the province when all is well. Doug Ford proves this. But when all is not so well...

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Posted (edited)
1 hour ago, OftenWrong said:

Here is what has been learned so far- all these fearful efforts to confine ourselves from each other does not help confine the spread very much, but hurts also. These methods arguably hurt as much, or more, than they help.

I had anecdotal and possibly not statistically significant (disclaimer) conversations with acquaintances in some parts of Europe where people have developed more relaxed attitude to the problem. Restaurants are open, there are events and parties, and international travel to where its open is more common. No I'm not advocating it blindly. Yes many had the infection and yes, there is a cost, however as can be verified factually that it is not dramatically higher than here. We need to understand that this is a complex issue that needs not panic-driven strategy but intelligent and realistic strategy. Just as shown in a number of places which managed to deal with it without both panic and restrictive lockdowns.

Edited by myata
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The questions to discuss:

1. Have communications been open, accurate, clear, transparent and honest? Is information provided to the public accurate, clear and complete?

2. Have effective measures of targeted management been developed and implemented in the environments and places of higher risk?

3. Has public healthcare system been adapted to the needs of epidemics management to operate effectively and efficiently if and when needed?

All of these are in direct competence of the governments and authorities. And until it can be shown and proven that all possible steps and improvements have been implemented it is both dishonest and ineffective to ask for and even require sacrifices from general public. Until and unless it's done and demonstrated it will have the appearance of avoidance and relegation of clear and direct responsibility. The responsibility was not to appeal and mandate; it was to manage affairs effectively and achieve the results which the society needs and for which it pays the bureaucracy.

It has grown very adept in mixing the two up though. Even we, the public can easily forget that it's supposed to be working for us, not directing and managing us.

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1. No, imo as I have posted here since the shitstorm began, there are doctors and other medical professionals with a markedly different opinion on this response. They were ignored at first, and now effectively silenced. In BC they’ve made it illegal, I think.

Even when I voiced my opinion on here, to try and show a more reasonable compassionate view, I was vilified for it. One member even called me a nazi.

Well, look who the nazis really are now. ;) 

2. No. See old-age homes. See schools and recreation for children. If anything, these measures hurt children far more than adults. One would almost think our health authorititties are really trying to harm children. Not protect the elderly, and then use their mortality count against us. Against freedom.

3. Health system is strapped due to years of cuts, cutting hospital beds to make room for fancy lounges and suites for the administrative class that moved in there, starting about 25 years ago. I have a memory, I remember...

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I went to the big city one day a while ago. There is no quarantine. Yet we pay the price anyway, by imposing the rules on businesses, and paying people to stay home so they can drink and smoke and meet friends in parks. There is no quarantine by half measures, yet we pay as if there was one.

These adults see to it they get their relief somehow, but the psychological harm is greater the younger in age you go. This harms kids more than any other group.

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On 5/21/2021 at 3:42 PM, myata said:

This is not just guessing: early signs of UK cases going up despite high level of vaccination. I so hope that after 18 months of the pandemics and 18 years after SARS it's not going to be all eggs in one basket, and "oh so new!!" discoveries all over. Can we hope though?

It shows the difference between full covid measures and no measures. Yes the measures help but very little bit. For all that effort and cost, and societal harms the benefit of public health measures is only a tiny amount. 

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Posted (edited)

Effective management and panic management is not the same thing, just "management". There are effective policies and panic, knee-jerk policies. They are not the same, "just policy". Finland has similar geography, population density, lifestyles, and the cost due to covid is less than half of Ontario's (per capita) and a small fraction of Quebec's. And yes, even without months long lockdowns.

Effective policy would include:

  • Current, accurate, detailed and comprehensive monitoring of the situation.
  • Clear, open, honest and active communications with the population, maintaining both trust and engagement, with a focus on voluntary participation and compliance.
  • Effective targeted intervention in the areas and environments of increased or increasing epidemiological risk.
  • Effective management, adjustment and improvement of the epidemiological capacity in the public health care in all relevant areas, including capacity, resources, connection to research for effective treatments and other.

 

That's 4 (at least) and what would be our score on this scale? "Policy" isn't just a word, a good policy is an intelligent and effective action and a good or excellent result. Just one question: what if vaccinations work less than perfectly? Would it be back to square one, all the way to 2020?

Edited by myata
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We have to admit that in this country very little (speaking mildly) has been learned by the bureaucracy in this time (not to mention almost two decades since SARS). When in response to ICU shortages access to grocery stores reduced to 10% of capacity, what does it do? Does it protect anybody, or sends people waiting longer, in a limited space outside stores? What is it helping to control and how?

Is still about effective control of epidemic, or already into punishing the population for the epidemics?

Who said publicly, "travel from the hotspot, not a problem!" twenty years after SARS? Who let it into the communities, thoughtlessly and carelessly?

The response is to ICU shortages, but whose job it was to monitor the situation carefully and accurately, with actual, accurate and current data not just finger in the sky "models" and detect early signs of spread before it hit ICUs?

Who was responsible to design and implement effective targeted measures to limit the spread in high risk areas and stop it in the early stages if and when early signs are detected?

And who was paid generous and sometimes next to outrageous wages, bonuses and benefits by the taxpayer to manage hospital capacity effectively and efficiently so that the beds and treatments are there when needed?

What, no one was responsible for that, someone else's job and not in the job description? The job was not to manage effectively and produce results but to write policies and issue orders? And so it's up to you Joe and Jane now, to waste hours in the line to a grocery store to fight the pandemic?

In the times like this we are getting to see, feel and know the true worth of what we have build to manage our common affairs. And it does not look good by any reasonable measure.

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Interesting observations can be made from the case statistics (Ontario, but may be relevant to other provinces as well, switch to all time view): https://covid-19.ontario.ca/data.

The first "stay at home order" was declared from Dec.26. The graph shows that the counts actually started climbing from early November (over 1,000) to the lockdown (2,500) with first significant drop in new cases by the 20s of January, 2021 (2500, 18.01), almost a month later. Back to under 1,000 by Feb.15. Note the the total duration of the wave: approx. 3.5 months.

Now the next wave: March 7, over 1,000, lockdown April 8 (one has to switch to last 90 days and look at the actual numbers of cases, the shape of the curve is misleading), May 2 is still showing close to 4 thousand new cases (3732). By the way, add 3.5 months, what do we get? In my calculation, mid June. Surely, a coincidence.

Does it make sense though? If lockdowns are effective, say by cutting 50% transmissions, one would see first drop in cases 8 - 10 days after the lockdown is imposed, the incubation period. There is no escaping the math, if the number of new cases is halved on the first day, there has to be a 50% drop in detected cases within 10 days. Instead the drop isn't seen in a month. In the second wave to get a 30% drop in the counts as of April 8 (3,000) one has to wait till May 17th, way over a month.

Is someone being clever here? By knowing an approximate duration of the wave it's not so hard to "correlate" lockdowns with the case dynamics in the waves by imposing them close to the expected peak then waiting for cases to drop to claim successful causation (forget the fallacies for now). Otherwise, why wait a month (third wave) or almost two (second) before implementing the response? Why real cases wouldn't react to the lockdowns as they should?

And this is of course, if there was a reason to expect that they were doing something. Luckily we have the example of Ontario where Toronto area, the main hotspot stayed in lockdown since late December. There was no indication that restaurants and stores were ever a significant source. Closing provincial borders, no more than a publicity stunt. What does it leave? Right, schools. For a long time pretty much everybody with the notable exception of experts felt what schools could be a significant source unless properly secured. And all this time experts and bureaucrats preached that schools were safe instead of securing them. Then, had to close them anyways. Same with ICUs. Clever tricks and heartfelt appeals instead and in place of: effective monitoring; effective and honest communications; effective targeted interventions; and effective management of care facilities.

There's one lesson here for us, the populace: if we expect and are thankful for what is given or drops from above including clever manipulations and obvious bs that's what we're going to get. And not a shred more. This is only natural and logical, no surprises.

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I hope the Gov learned to quit trusting the chinese. This story about the lab out west and the firing of 2 Chinese scientists, could be real ugly. 

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Posted (edited)

The ink on the previous post was still wet when another wonderful coincidence came to my attention: Covid cases dropped by 70%. CMO seriously struggled to stay modest: "Tam said the "considerable decline in infection rates" is linked to vaccine uptake rates "increasing in leaps and bounds" in combination with strict public health measures in most provinces."

Remember the story (was it Indiana Jones?) of an inventive explorer who saved himself from certain death in the hands of bloodthirsty tribe by making the Sun turn away from them (aka employ the previous knowledge of a predicted solar eclipse) It worked for him (in the story) so why not. Really, if a Covid wave takes approximately three months, with, without or with pretty much any policy, why not use it to take well deserved credit?

And so, was it the wrath of Sun gods, or a predicted natural event? One or the other for sure. It isn't even too hard to tell which one, but let everybody make that conclusion for themselves. Sorry have to get that drum, time for the Covid dance.

P.S. we will see about the link to leaps and bounds comes the fall. I hope there's no surprises for us but will keep an eye on it and will make sure to follow up. Just like with predicted 18,000 cases by expert models, travel from Wuhan, army run retirement homes and other great achievements so far.

Edited by myata
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