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Healthcare executives debated these topics at the Healthcare In Politics salon
Last week, Vator and HP hosted their latest salon, called Healthcare in Politics, where we held multiple panels of experts, policy makers and lawmakers who were be on hand to discuss topics related to healthcare policy and decision making.
One topic that came up multiple times was about the shut downs that a number of states went through earlier this year: how effective or ineffective they were, and what we should be doing going forward.
It came up a bit during the first panel, moderated by Archana Dubey, Global Medical Director at HP and Bambi Francisco Roizen, Founder & CEO at Vator, in which Donald Luskin, Chief Investment Officer at TrendMacro, recited stats that he said showed that states that did shut downs didn't have outcomes any better than those that stayed open.
"My contribution to helping with policies is to try to show you some evidence of the policies that we, and everyone else in the world, have tried so far have been an utter failure. And we had I'm sure the best of intentions going in but you know what they say about the path to hell," he said.
The data Luskin used was from the University of Maryland's Transportation Institute, which took Google cell phone tracing mobility numbers and put them into an overall social distancing index in order to see whether people actually complied with shut downs or not.
"Idaho was the least locked down, District of Columbia was the most locked down," Luskin noted, but they had inverse responses to the pandemic.
"Now I know this is gonna be very, very hard for you to believe because from first principles if you have an infectious disease, I admit it makes all the sense in the world to try to isolate people from each other in order to prevent them from spreading it. But it turns out to not be that way. And, by the way, we all have a big investment in having done this and it would be very embarrassing if we caused the depression for nothing but that is what the backward looking empirical evidence tells you," he said.
"DC was the most locked down, as I said before, but was well above median result in fatalities, that's not the direction you want. Idaho, which was the least, did better. We can look at the 15 least locked down states, all the three did better than median in terms of controlling fatality; the 15 most locked down, all but three were worse than median."
When looking at the data from the period of opening up, from around mid-April to early August, you get exactly the same result.
"With almost as good coefficiency of determination, you get this very unpleasant report card that it costs lives to lock down," said Luskin, noting that the research has been reproduced, and also took into account potential explanations, such as population density.
"We've looked at this at the county level, the city level, the zip code level, the congressional district level, you get the same result. It doesn't matter the average age of the population, it doesn't matter the racial composition, it doesn't matter the weather, it doesn't matter the number of people as a share of population in nursing homes. The only thing that has any explanatory value at all, that we've found, is intensity from state to state of rapid transit utilization, which I guess goes some way in explaining the terrible experience that New Jersey, New York and Connecticut had. So, I hate to be a nihilist but I'm here to tell you that what we thought would work, didn't work. We caused the depression for nothing, we probably made it worse."
Dubey responded that the prevalence of rapid transit did probably make a difference, as well as the fact that people in New York City often live in apartments, to which Luskin countered that other cities around the world, namely Tokyo and Hong Kong, also have rapid transit and did much better in terms of their COVID response.
"For those of you who've had the experience of testing all three of those systems, you know how different they are. You know that the systems in Tokyo and in Hong Kong are sparkling clean, people wear masks if they even have a sniffle, and it could not be more different than that petri dish on wheels called the New York City subway system," he said.
"Unfortunately, we didn't lock down the New York City subway system, we locked down the schools in the parks but it wasn't until the worst of the lockdowns were over that they even shut down the New York City subways at night to clean the damn things. At least after all these years they finally cleaned them. Too late, too many people died."
The topic of shut downs, and how to open up, came up more in the second panel, which was centered around that specific topic. Dubey posed a question to Phil Kerpen, President at American Commitment, asking him about reopening schools and how the federal government is handling that.
His response: we should be opening them up because, so far, there have been virtually no problems in any places that have already done so.
"The remarkable story of this particular virus with schools has been the lack of problems really anywhere, no matter what type of opening you have, with one possible exception in the entire world in Israel, although they opened up a lot of other things at the same time, including weddings and large events, so it's difficult to isolate the impact of schools there," he said.
Basically every European country had no significant increase in community spread and no major issues in the school populations and then we had this debate in this country. ‘Well, are we like Europe or are we in a different situation because of a relatively higher prevalence?’ And we have the answer to that now, which is we're not different."
For example, Cherokee County in Georgia, which had 15 percent positivity in the greater community, has had only 14 cases out of 42,000 students who went back to school.
"We're starting to see these stories now almost everywhere. Schools opened and, ‘Oh, we’re so surprised, there was no issue,’ well, the question is why are we still surprised when you see the same thing over and over and over again? We should not be surprised anymore, this should be expected, and it should be much easier for us to go ahead and open schools almost regardless of what the context is of community prevalence," said Kerpen.
Despite that, he admitted that you can't just reopen, since parents and teachers are still afraid, and those fears need to be addressed.
"Part of that is education and sharing information and sharing the experience of these other places. If you can also say ‘look, we've got this instant test, you're going to be able to find out, you're going to be certain that everyone who was in that school has been tested that this week or whatever the frequency of the testing is,’ that goes a long way towards reassuring people in places that have been hesitant, that have been have been skittish to go back. That may get them over that initial status quo bias of, ‘I'm scared to do it.’ Once they get back, and they see there aren’t problems, it becomes much easier but overcoming that initial hump, that status quo bias, is where the instant testing can be very, very helpful."Kerpin also worried that false positive could actually wind up hurting the reopening effort.
"Our kids and our schools are as important as our professional athletes. I'd like to see something like the NFL protocol where you use the instant test as an initial screen but then you use lab testing to confirm the positives before you consider them a confirmed positive, that the instant test would be considered a suspected positive but you would have that additional step, just to make sure you're not dealing with false positives. I think it can be very, very helpful," he said.
"On the issue of should we open up or not, let me put it differently: should we lock down again? Absolutely not, it would be insane," he said, noting his belief is that if we had done a nationwide shut down at the beginning of the pandemic, as many people now thing we should have, it would not have worked, for a variety of reasons.
"There have been a lot of people looking back to the March call to have a lockdown which was spread unevenly across the country in timing and scope. They said, ‘why didn't we have a national response, shut everything out at the same time, stop all travel, no more flights?’ Sounds good. I think if we had done that we probably could have survived easily for a week, we have enough stock of stuff, essential foods, medicines and all that, and maybe it could have stretched two weeks, but after that everything starts to break. The supply chain breaks, bad things begin to happen," Davidson said.
Part of the problem, he noted, is that, at the time there were no masks, no PPE and no contact tracing, plus all of our institutions failed. Therefore, a shutdown wouldn't have done much good.
"We had a really good plan under the Bush administration for if a big pandemic happened. Where is that plan? Nobody took it out of their shelf and used it. We had all this stockpile of PPE that FEMA was supposed to run. And I think a lot of it was used up when we had the Swine Flu come back again, the H1N1, in 2009. Nobody replenished it, nobody maintained it. There are people whose only job is to make sure that stock is there and happy and ready, and they failed at their only job. So, with his profound institutional failure across the country, the lack of proper data and what would have happened is we would have tried it and we would have failed to have the real impact of it we should have had," he said.
"What's worse, when we did the the quasi lockdown to flatten the curve for hospitals, we changed the goalposts. Hospitals are fine but California is still in a semi lockdown. The supply chains would have busted. So, my point is, I am personally cautious. I believe in masks, I think everybody should, but a lot of these hypothetical ways to solve the problem looking back on it wouldn't have worked, or would have caused even deeper problems downstream."
Francisco then asked Emily Barson, Executive Director, United States of Care, what policies her organization is pushing to try to help kids get back to school. She responded by defending the initial response, saying, "We only had basic information, our knowledge has continued to evolve, both about who would be most impacted but also the impact of some of these prevention measures."
"Flattening the curve requires taking drastic action and, as was shared, it's questionable whether we fully utilized that time during the initial shutdowns to build the infrastructure needed. I would agree that it needs to be both mindful of where people are and their comfort level. People are expecting their leaders to have comprehensive plans, to be monitoring and preparing for what happens in different scenarios in their school district, and hopefully preventing the need to open and then have to reclose. That public sentiment and public comfort and confidence in their government and in their leadership to fulfill that is low right now," she said.
People are rightfully concerned about the mental health impacts of distance learning and whether they're getting the education they need, Barson noted, but also not necessarily feeling confident that there's protocols and a plan in place.
"Part of that is the need for the federal government to provide resources for both the physical infrastructure, for keeping the kids and the staff and the teachers safe; we can't pretend that the only people in school buildings are between five and 18 years old. The fact that many of the teachers have expressed concern also goes to the lack of clarity and a plan that can instill confidence in their staff and in their communities, that the schools are doing everything they can. To some extent, a lot of that response will require a level of federal support in order to have that infrastructure in place, and I don't know that people or cities will feel comfortable until they can have that competence."
(Image source: womeninoptometry.com)
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