We knew better by April 23, 2020

A few days ago I tried to do a summary of what we now think we know about Covid-19 and our responses to it.  With two years of fiasco, it was necessarily incomplete.  One point I made several times is that this is a novel virus and therefore uncertainty and absence of knowledge is inherent.  Some decisions were, and had to be, made when little was known.  On the other hand, we accumulated a lot of information very quickly and we had good grounds for making reasonable decisions, or revising earlier bad decisions by as early as June 2020.  

I was trying establish a break line of criticism.  Bad decisions with unknown conditions is an almost certain outcome.  All we can ask for is that decisions are made with the best available information and that we revise earlier bad decisions.

I just came across this piece, What I have come to believe by Arnold Kling from way back on April 23, 2020.  He pushes back the date line from June to late April. 

Kling is a bright guy.  He is not a public health expert nor an epidemiologist but he is certainly accustomed to working with and using data to reach conclusions.  

He made eleven assessments at that time, four months after Covid-19's emergence in China and three months after it first appeared in the US.  Nine months before a viable vaccine was available.  Simply from the best information then available.  He notes then about his conclusions:

Those beliefs may or may not be correct. But I have tried to arrive at them by reading with an open mind. I do have strong political opinions, but I hope that I have not let those opinions drive what I believe about the virus.

He did pretty well.  Far better than the CDC or FDA.  By my understanding of the current data, nine of his assessments in April 2020 were correct.  Had the CDC and FDA been similarly competent in assessing data, the past two years would have played out dramatically differently and better.  A truncated version of Kling's list follows with new numbering and my notes in bold.

1. Ventilators do not produce good outcomes.  True.  That they did not produce good outcomes is now well established.

 

2.  Treatment is proving to be very difficult.  True.  This was one of the singular failures of our response to Covid-19.  We never got around to a disciplined search for treatments and we allowed politics to interfere.  

3. I am not counting on finding a vaccine soon. False.  He had good reasons to be skeptical, as did we all.  Those skepticisms were confounded.  Yes, there is a massive drop-off in effectiveness in the vaccines within nine months and yes, there are plenty of negative side effects which are only now coming into clear sight.  But the vaccines were effective and did save many lives amongst those in our most vulnerable populations.  

4. Testing does not work well.  True.  Badly planned, badly executed, ill-considered, and widely misunderstood.  We still need dramatically better testing tools and protocols.

5. It is worse than the flu. True.  Worse than ordinary flu and less bad than Spanish Flu is a pretty broad range.  Those who discounted the virus at the beginning were wrong.  

6. The differences in severity by age group are staggering.  True.  It is now known that based on age segregation, Covid-19 is a lot worse than flu for those above 70.  Probably only marginally worse for those 0-60.  

7. Close contact in enclosed spaces is a much more important transmission mechanism than doorknob effects.  True.  Physical trace contact transmission is not a significant transmission vector.  

8. Social distancing works less well than one would hope. True.  There is still debate about whether it works at all or whether it does make a minor difference.  So far, it has been clear that case load increases are virtually entirely driven by seasonality and new variants.  Social distancing has no effective impact.

9. To successfully drive down the infection rate close to zero, you need more drastic measures than what we have undertaken in the U.S. and Europe. True.  Zero Covid strategies have been a consistent failure worldwide and achieved at a high cost.  The Australia and New Zealand experiences support that with rigor and high cost, delays can be achieved in endemic status but the consensus seems now that Zero Covid is not an achievable strategy and Covid-19 will become endemic everywhere.  

10. A fresh-air lifestyle is good for you. True.  One thing that has become clear from Covid-19 is that the degree to which excess deaths occur is highly correlated with the general fitness and health of the population.  High sedentary rates, high obesity, low general health conditions are all highly correlated with excess deaths.  Want to be less vulnerable?  Exercise, be outside, get your weight under control.

11. Masks are good for society. Still Disputed.  I think it is false when you look at the population level.  Masked or unmasked adjacent territories death rates are driven by seasonality and variants.  There is no evidence of variance in death rates due to variance in masking policies.