My avian flu blog days

Circa 2004 or so, it seemed to me that America was grossly underprepared for a possible pandemic.  I started reading up on the topic, and I produced a very basic, simple Mercatus policy paper on avian flu.  For obvious reasons, much of it is out of date and some of the recommendations have been adopted, but here is the first part of the Executive Summary:

1. The single most important thing we can do for a pandemic—whether avian flu or not—is to have well-prepared local health care systems. We should prepare for pandemics in ways that are politically sustainable and remain useful even if an avian flu pandemic does not occur.

2. Prepare social norms and emergency procedures which would limit or delay the spread of a pandemic. Regular hand washing, and other beneficial public customs, may save more lives than a Tamiflu stockpile.

3. Decentralize our supplies of anti-virals and treat timely distribution as more important than simply creating a stockpile.

4. Institute prizes for effective vaccines and relax liability laws for vaccine makers. Our government has been discouraging what it should be encouraging.

5. Respect intellectual property by buying the relevant drugs and vaccines at fair prices. Confiscating property rights would reduce the incentive for innovation the next time around.

6. Make economic preparations to ensure the continuity of food and power supplies. The relevant “choke points” may include the check clearing system and the use of mass transit to deliver food supply workers to their jobs.

7. Realize that the federal government will be largely powerless in the worst stages of a pandemic and make appropriate local plans.

8. Encourage the formation of prediction markets in an avian flu pandemic. This will give us a better idea of the probability of widespread human-to-human transmission.

9. Provide incentives for Asian countries to improve their surveillance. Tie foreign aid to the receipt of useful information about the progress of avian flu.

10. Reform the World Health Organization and give it greater autonomy from its government funders.

And also from later on:

4. We should not expect to choke off a pandemic in its country of origin. Once a pandemic has started abroad, we should shut schools and many public places immediately.

5. We should not obsess over avian flu at the expense of other medical issues. The next pandemic or public health crisis could come from any number of sources. By focusing on local preparedness and decentralized responses, this plan is robust to surprise and will also prove useful for responding to terrorism or natural catastrophes.

Still relevant today.  For a while I also wrote an avian flu blog with Silviu Dochia, archived here.

Comments

Also I would add "eat better" (TC's food blog!) Since your immune system is activated to fight viruses if so.

Bonus trivia: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Today (Sunday 3/8/20) is the first day that total new CHN Covid-19 cases have not increased. So Monday should be green for worldwide stock markets

From the yr 2006 archived site that TC links to: "President Bush is expected to approve soon a national pandemic influenza response plan that identifies more than 300 specific tasks for federal agencies, including determining which frontline workers should be the first vaccinated and expanding Internet capacity to handle what would probably be a flood of people working from their home computers." and "UK plans mass grave - Mass burials are being considered by the Home Office as part of contingency plans for a possible avian flu pandemic" . LOL your government at work; they keep the federal employees alive first (recall the nuclear bunker for politicians plan in the USA).

The only suggestion that really made sense to me, to stop pandemics, was TC's bullet point about PATENTS, which most of you will miss. But what is a 'fair price'? T. Aquinas scholars needed to opine.

Or realize that all public policy is a balancing act.

"Under 28 U.S.C. § 1498 (“Section 1498”), the federal government has the power to use or manufacture any patented product, and must provide only “reasonable” compensation to the patent holder. The government could therefore elect to either contract with another manufacturer to produce a cheap generic version of expensive patented drugs. Or it could use the threat of Section 1498 to negotiate a license from the brand-name manufacturer to use their drugs at a steep discount.

This is sensible policy: intellectual property—like all property rights—is meaningful only by virtue of government enforcement. Government provides the patents, the courts, and the laws to protect drugmakers’ intellectual property. In exchange for this valuable enforcement of intellectual property rights, the government gets to insist on its own right to carve out exemptions from patents for public use, while providing fair compensation to the patent owner.

Another way to think of Section 1498 is as eminent domain for drugs. As Hannah Brennan, Amy Kapczynski, Christine Monahan, and Zain Rizvi explained in a 2016 law review article, the government must have the power to acquire property for public use with fair compensation in order to combat what’s known as the “holdout problem.”

That's all very well and good in theory except it ignores that patent rights in practice are valued at something like less than 5% of their true market value (pioneer patents not troll patents). Compare to Fee Simple Absolute and real estate: if the state offered you less than 5% of market value to pave over your house for a freeway, you'd complain and likely win in court (pace Kelo v. City of New London, 545 U.S. 469 (2005), though I think even there the owners of the taken property got more than 5% of market value). Same doesn't happen in IP. One reason nobody outside a geek, insanely desperate person or hobbyist does inventions anymore (or ever actually, looking at history)

But with vaccines for pandemics, we are in a situation where the best outcomes will have to involve governments anyway. What we would want is fast production and trying to achieve herd immunity, but looking at COVID-19, there's no way in hell I'd pay for the market price for a vaccine for me and my family: Nobody is in the most dangerous groups. What my family would do, though, is increase the risk of infection everywhere around us. Therefore, the national good is for me to get vaccinated, and that'd not happen unless it was free, or close to free, to me. What is best for the pharma company is not to get rid of the pandemic at all, as there's no way they should lower the price that low for me. Therefore, a government stepping in and railroading over a pharma trying to maximize their revenue is the natural outcome.

The immune system can also overdo its response resulting in deaths. The coronavirus and the 1918 flu have been known to trigger cytokine storms as explained here:

https://www.nationalgeographic.com/science/2020/02/here-is-what-coronavirus-does-to-the-body/

Your link says 1.8K new confirmed cases today.

The history of derangement against Republican presidents is long running it seems.

Number 6 seems more than a bit of a stretch, as we will see and then apparently forget about again. A pandemic is exceedingly unlikely to disrupt food or power supplies. The idea of using mass transit to transport workers was silly even when talking about avian flu.

The prediction markets shows how fads come and go in a humorous way, and is especially amusing when dealing with a new disease.

More TDS from TC. So boringly expected. The overreaction from NeverTrumper libtards is worse than COVID.

Good News From Science - Regular drinkers of hard liquor are better protected from COVID 19.

Also, get your rest. Eat well. Take extra vitamin C. Hydrate. Daily tablespoon of cod liver oil. Keep your filthy hands away from your eyes, face, mouth, nose. Wash Your Hands. Stay home if you are ill.

Avoid crowds. Don't spit into the wind. Don't step on Superman's cape. Don't pull the mask off that old Lone Ranger. And, don't mess around with Trump.

The Guardian - "A range of drastic new measures, including emergency legislation allowing people to switch jobs and volunteer to work in the NHS or care homes, are being drawn up by ministers in an attempt to tackle the coronavirus crisis.

The measures – which also include plans for courts to use telephone and video links to avoid people having to attend in person – are likely to be included in a special Covid-19 emergency bill, as the government prepares to move to the next phase – delay – of its response to the spread of the virus."

Sounds eminently practical, though one has to wonder - does the UK have a local or a centralized health care system?

It has local health authorities - but public health is a national system.
Contingency plans for pandemics are driven nationally, which means a more coordinated response than (for example) in the US.

I'll be curious to see how many people volunteer to work at the hospital during a pandemic.

One assumes more than zero from a pool of people familiar with the work involved at a hospital. Such as that required for caring for diabetics, where such volunteers could free up other trained personnel - or fill in for the sick ones over a period of several weeks. The health care system is going to be under extended stress - any pool of labor that can be used in the next month or two are likely to be very important.

This is what preparedness is about in the end - what can be done to handle a situation as it develops.

People just recovered from Coronavirus are probably immune, and also familiar with the treatment process. Their numbers grow as the pandemic procedes. With some basic training they can become very valuable.

The prediction markets probably did not see the public health benefits of changing customs using surveillance capitalism. Do not touch your face dot com. Remove the spaces, and replace dot with a full stop, and feel good about yourself contributing to some company's bottom line while keeping your face untouched in these troubling times.

How about having reliable and battle hardened protocols for health care facilities that are triggered early, a soon as it is apparent there is a virus in the wild and likely to show up. Two reasons; the workers in these places are a critical resource, and if they become disease vectors it seems to turn a bad situation into a catastrophe.

I'm getting the impression that there is an institutional lethargy at play. Is it by design? It seems there is a profound desire to control the flow of information, to control the development of tests, to control the responses. Is this the same mentality that thought that the middle east wars could be run from a room in the White House, thinking that a pandemic could be handled from a room in Atlanta? I tend to look at these things as working as designed; the politicians are fed the information that the experts believe. I would love to hear the inner conversations, how much of it is about controlling the release of information to avoid panic, and how much of it is about hard measures that deal with what can be done in a timely way to assist those on the front line? I suspect the higher you go up the chain the more you hear of the first.

Over the next week the numbers are going to skyrocket, not from new infections but from test results.

A month long school shutdown probably would be a great idea right now.

What would be much better is having people not visit facilities with a large population of elderly. As can be seen in this response from a AskMe question about keeping children home from school -

We have elderly parents and relatives we visit on weekends.

I would suspend these visits rather than your children's schooling.

I share your concern. There is a reason that Trump appointed a sycophant with no expertise in this area to lead to lead the effort, rather than accomplished and knowledgeable public health expert who would demand independence and the latitude to make candid public statements (e.g. Scott Gottlieb, who effectively led the FDA for a couple years of this administration).

Also from the Guardian - "The American Conservative Union also reported on Saturday that an attendee of its annual conservative political action conference last month has been diagnosed with Covid-19.

The organiser said the affected person had “no interaction” with Trump or Pence and did not attend events in the conference’s main hall, held in Fort Washington, Maryland, just outside the District of Columbia.

Asked about the development later on Saturday, Trump told reporters in Florida he was not concerned and planned to continue to hold political rallies."

Who says Darwinians are rare in a Republican administration?

I am waiting for some conservative preacher to announce that CPAC is being punished by God for its sinfullness

Did southern Germany temporarily shut down its machine shops?

Prior is full political trolling 24/7 on every Corona thread.

The current shortage of protective masks, which are either made in China or made with Chinese components, or the fact medicines’ supply chains are bottlenecked on Chinese precursors, means a complete supply-chain analysis needs to be made and domestic supplies subsidized. Resilience in pandemics is as much part of national security as ensuring our 5G networks do not have Chinese backdoors or kill switches, or that our weapons do not include Chinese-made components.

Trump wasted his political capital on 5G instead of COVID. His poll numbers are dropping like the stock market.

Unless the U.S. healthcare system is extremely poorly supplied (an idea almost reflexively rejected by many commentors), the shortage is coming. A shortage that undoubtedly would have been lessened by more domestic suppliers and by having larger stockpiles.

Panic buying is a simple human reaction, which has also led to the creation of a shortage of something not actually required yet in large amounts.

This WAPO article is fascinating - Then something worse happened: I was taken back immediately, ahead of everyone on the gurneys, in the wheelchairs, on the floor and even those who appeared passed out in the chairs. No insurance papers were needed. “Mr. Dawsey, please come this way.”

After I was whooshed into a private, Manhattan-studio-size room at MedStar Washington Hospital Center, nurses in heavy-duty hazmat-like suits and masks suddenly surrounded me, inserting an intravenous needle, checking my heart and pulse, examining my organs and writing measurements on charts. New masks were changed. One doctor stood at least 10 feet away from me, his back against the wall, as he talked to me.

Read through the entire thing - there is abslutely no way that any healthcare system in the world can maintain that level of intensity for weeks. Also note that the person who had been in contact with him (likely during that initial five days, though the article is not clear), but not showing any symptoms, was not treated as if she could also be spreading the virus outside of the area where the suspected case was isolated.

And not having a straightfoward testing framework, starting before admittance (note that the urgent care place also seems to have taken no particular precautions with a suspected case of corona virus) mans that the wasted resources are immense.

The U.S. is going to have a lot of problems if this article is representative of how corona virus is handled. Other places are already much more advanced at trying to limit the spread, with the NHS seeming to have actually heeded a number of TC's suggestions, meaning they can easily implement a reasonable pandemic response.

One thing TC pretty well overlooked was the importance of mass testing in the early days of an outbreak. Information drives good public health measures.
Drive in testing centres (for example) are an innovation seen in both ROK and the UK.

The UK's response has been notably better than that of the U.S., even though both countries have two political figures in current charge of the executive who have been noted for decades for their self serving lies and self-aggrandizement.

Meaning it is not primarily the leader at the top that matters, but the healthcare system itself. And to this point, the American system is turning out to be about as exceptional as one would expect.

The NHS has set up isolation areas for A&E rooms in the last couple of weeks, so as to avoid what this article actually describes in the U.S. The sad thing is that some people would likely consider the massive waste on display in that article to be a sign of a superior American system.

www.washingtonpost.com/health/when-an-emergency-room-suspected-i-had-coronavirus-things-got-serious-fast/2020/03/07/b7a75e18-60a1-11ea-8baf-519cedb6ccd9_story.html

Isn't testing cited as THE reason why the US healthcare costs so much? Countries with socialized medical care seem to contain their costs better than the broken system we have.

This discussion is exclusively concerned with testing for the presence of COVID19. Such testing is the first critical step in attempting to slow the spread of the disease, by allowing those infected to remain (self) isolated for a half month,

“ Once a pandemic has started abroad, we should shut schools and many public places immediately.”
I think this is misguided. Certainly you need to be ahead of the curve, but there is a limit to how long society will tolerate lockdowns - which of course impose other significant costs.
Without widespread testing (as in the US), it is very difficult to say how soon is too soon (the UK will make an interesting case study).

The UK will be interesting, as some schools (not school systems) have already shut down.

And mobilizing millions of volunteers already in the system seems like admirable preparation for a major surge in covid19 cases (the Guardian is a much more global source of news than any American source in my experience, at least since the end of the Cold War)

Another secret Tyler blog? What others are there?

It's not secret. In fact, it was front-and-center in the early days of MR.

One has to admire your creativity. Other users simply used a number series to get around name banning, but you keep exploring all sorts of boring variations on your silly obsession.

As for health systems becoming overwhelmed (and remember this is the prosperous part of Italy):

https://www.bbc.co.uk/news/live/world-europe-51789355
>>The health care system in the Italian region of Lombardy is on the brink of collapse, the head of its crisis response unit has said.

"We're now being forced to set up intensive care treatment in corridors, in operating theatres, in recovery rooms. We've emptied entire hospital sections to make space for seriously sick people," Antonio Pesenti told the Corriere della Sera newspaper.

"One of the best health systems in the world, in Lombardy, is a step away from collapse," he said....<<

Italy and China seem to have it the worst. Something about eating good noodles and rice.

One hearsay theory I have heard which can be partially verified with a web search is that many Italian firms offering exclusive hand made goods employ Chinese staff working in Italy as short term migrants. Hence Italy was host to a number of Chinese unknowingly bringing Coronavirus with them from home.

Tons of places employ Chinese this way. Are they also experiencing outbreaks?

It seems that a lot of these supply problems come down to the fact that people are not incentivized to maintain stockpiles or surge capacity because of laws and social norms against “price gouging” which effectively prevent them from making a profit during emergencies that would compensate for the costs of keeping surge capacity during times of non-emergencies. Hopefully public views towards surge pricing will change (maybe more people will be used to it from paying it on Uber?) and that will alleviate these supply problems.

It also seems like the best strategy is to improve flu surveillance in all countries. However with the amount of blame and travel restrictions being thrown around, I wouldn’t be surprised if the next country that discovers a potentially pandemic disease pushes it under the rug until it shows up in a different country and that second country gets the blame.

Nonsense, surge pricing is gouging, profiting off of human misery and common crisis.

The cost of stockpiling a bazillion N95 masks is incidental. They are not stockpiled because our entire system is designed around not stockpiling anything, for the obvious reason that those extra pennies are sunk costs most of the time.

Current and future epidemics are distinguished from past ones by the ready availability of test kits for diagnosis (and I expect this to improve with practice and further technological progress). This should make containment by isolation more practical, especially if quick mass testing is available for people with possible contact displaying no symptoms.

Many of the UK measures I see discussed here are so far proposals for future action, and have not yet been rolled out. One exception, which I believe is in play, is drive through Coronavirus testing.

The isolation set up for A&E is also finished

Educate people on sunk costs and their irrelevancy.

If you paid for a cruise or trip, and now you are uncertain:

Ask yourself: Would I purchase that ticket today?

Ask yourself: How many people on this airplane decided not to stay at home with their cold or flu because they had already paid for the ticket.

Pass the hand sanitizer, and, for god's sake, if you are going to sneeze, don't sneeze in your hands and hold that handrail as you walk out in front of me.

Of course, airlines and cruise companies could change their refund or rescheduling fees.

It's both the consumer and the producer who are part of the game.

Unless you are sick with a cold + of Asian decent. The ones I know are staying the hell home so as not to get stoned to death by mobs.

fwiw United airlines yesterday announced a relaxed refund policy.

How does that fix the problem? Stop eating bats? OK, no more bats for light snacks. Will move to chicken wings.

Alex thinks to compare COVID-19 with century-old "Spanish flu" (highly contagious, all agree, on a planet with a human population of under two billion), Tyler is pleased to compare COVID-19 with avian flu of more recent vintage (for a global human pop. of c. 7 billion, compared to today's c. 8 billion). Neither has addressed how the global human pop. size contributes to epidemiology, but they seem not to be alone among internet information peddlers. (For that matter, neither has any reproach to offer the international commercial airline industry, the chief vector for launching this global pandemic from all appearances.)

COVID-19, from the WHO and CDC(P) accounts, looks to be nothing else than SARS II, a fresh new plague of viral pneumonia. (The SARS I mortality rate turned out to be c. 9.6% by the time that outbreak had tapered off or ended.)

I invite both Tyler and Alex to next compare COVID-19 properly with SARS. (Fruitful comparisons of COVID-19 with MERS might also be made.)

A per-mile tax on air travel would be a sensible way to fund emergency supply stockpiles, monitoring staff and other standby measures in preparation for next time around.

And a per diem tax on cruise ships.

We wish it looked like SARS: If it did, controlling its spread would be orders of magnitude easier. We have plenty of examples of contagion that comes from asymptomatic individuals.

When it comes to final effects, we'd happily trade for a disease that killed a lot more people that contract it, but always lead to very visible symptoms, and was only contagious while symptomatic. SARS could look like a picnic when we compare total deaths and hospitalization, just at end of the year.

It is instructive to watch Libertarians when they get a little bit scared, and are confronted with large-scale problems. Suddenly there's calls for top-down directives, emergency legislation, and filing the gaps where the infallible market failed.

Sure, there's a touch of blame-the-regulators in the wording, but the overall message is clear: GOVERNMENT SAVE US!

Don’t be silly. We want good government, and good governance. We just happen to believe the best governments are smaller, leaner.

nah. the vast majority of liberts i meet irl and the web are far more scorched earth and dogmatic.

so whats your explanation for why the free market doesnt have us prepared for reasonably predictable calamaties?

There is some strange psychology going on. For the most part people recommend very moderate actions: hands washing, avoiding large groups, staying home if you have a fever, or are especially vulnerable.

And yet. There is this huge push back against "panic."

That itself looks suspicious, right?

If you can't wash your hands and go on about your business, maybe you are panicking?

(To be fair, maybe the criticism is directed more at people who cry for tests. They would absolutely be nice, and I hope they'll be available next week, but in the meantime there are simple and reasonable things to calmly do.)

Yeah this comment aged particularly poorly.

1/4 of Italy is now in quarantine.

Huh? You think critics of "panic" are talking about quarantine in badly hit areas?

That is even stranger if true.

Happy thoughts for the day from the CDC website:

...."It’s likely that at some point, widespread transmission of COVID-19 in the United States will occur.

Widespread transmission of COVID-19 would translate into large numbers of people needing medical care at the same time. Schools, childcare centers, and workplaces, may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and sectors of the transportation industry may also be affected. Healthcare providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions would be the most important response strategy."

But, don't worry, Dr. Don has told us otherwise.

Did you ever consider that Dr. Don may be having his hotel developer hat on when he makes his pronouncements that this will be over in April?

Point 1 has to be trolling, right? "The single most important thing is to be prepared in useful ways."

Gee, it's great that someone is thinking of these things....

That sounds like sarcasm already, Tom. Getting old.

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