[Genuine Realist]

I'm going to start posting various ideas under this heading, meaning a blending of Blue (SIP, insistence on social distancing) and Red (emphasis on reopening society ASAP) - not the most subtle metaphor in the world. I'm going to avoid politicization as best I can, though I am going to post a long pendant, maybe with an edit, about the inevitable, unavoidable Trump. 

This first one is on the reddish side of Purple, just suggesting an irreducible minimum of the effect of social distancing practices. When the full impact of Covid-19 began to be appreciated fully, in early March, I accepted the epidemiological models without too much quibbling, mostly because they made sense and there was no real opposition. But the models as I understand it treat the all-too-human public as mathematical objects - you have so many people in a given population, with an R nought of such and such, interacting in various quantifiable ways. (Correct me if I am wrong). At the outset, because the model begins from a zero state and the public is generally supportive, the model works well to reduce the most pessimistic estimates of the spread of the disease to more satisfactory levels.

BUT . . . .  as the weeks pass, and it has now been ten weeks . .  . the purity of the mathematical model becomes more and more suspect. To be specific, it ignores sociological and cultural factors. (Again, correct me if I am wrong.) People aren't ciphers. They have ideas, reactions, values - and has time goes by, these come more and more to the fore. Four weeks of enforced idleness is acceptable - it may even be kinda fun. Ten weeks, and no end in sight, and a real question whether you're ever going to be able to resume your work, and life, and different attitudes set in.

All of which is a long-winded way of suggesting that there may be social constraints to the type of regimen a pure epidemiological approach would impose. Maybe there is some irreducible minimum, beyond which society can't go, because the returns diminish to a point that the degree of social force necessary to achieve them isn't worth it. We can pretty much insist every one stay home for a short period of time. But if we have to start putting hairdressers in jail to enforce limits that continue to extend, we may decide as a people that the candle isn't worth the game.

This is a pluralistic, extremely energized nation, the social energy of which over the last century has transformed the world. Pushback against ANY social order as drastic as social distancing is and was, is inevitable. The grumbling that accompanies it at first transforms gradually into passive, then active, resistance, accompanied by cynicism and conspiratism.  Health professionals, focused on the epidemiological curve, may continue to insist on drastic measures to continue to flatten the curve. But as a matter of sociological reality, is this even possible? Without far more legal force than anyone wants to expend or which would even work? (Recall Prohibition.)

My own thought, purely intuitive, is that it isn't - that in the words of the song, we've gone about as far as we can go with enforced distancing. That's not to say that a sensible regulatory environment doesn't work - masks in enclosed spaces, maintain six feet distance to the extent possible, etc. But the fact is that the virus is certain to be with us for some years, in cycles, and we can't continue with these regimens. (A shutdown of the severity we are enduring is not going to be repeated, no matter what party is in power. For my two cents, we should reopen entirely, with the regulatory environment, I mentioned, and look for the people as a whole to find the stasis, the angle of repose, that makes the best sense out of the competing Blue and Red values. It won't be perfect - but I think it is inevitable, and we might as well get on with it.

In any case, the suggestion is that as a sociological matter - not medical - we may well have hit an irreducible minimum. It's possible we can't do any better with enforced social distancing than we have done.

[Genuine Realist]

I'm going to start posting various ideas under this heading, meaning a blending of Blue (SIP, insistence on social distancing) and Red (emphasis on reopening society ASAP) - not the most subtle metaphor in the world. I'm going to avoid politicization as best I can, though I am going to post a long pendant, maybe with an edit, about the inevitable, unavoidable Trump. 

This first one is on the reddish side of Purple, just suggesting an irreducible minimum of the effect of social distancing practices. When the full impact of Covid-19 began to be appreciated fully, in early March, I accepted the epidemiological models without too much quibbling, mostly because they made sense and there was no real opposition. But the models as I understand it treat the all-too-human public as mathematical objects - you have so many people in a given population, with an R nought of such and such, interacting in various quantifiable ways. (Correct me if I am wrong). At the outset, because the model begins from a zero state and the public is generally supportive, the model works well to reduce the most pessimistic estimates of the spread of the disease to more satisfactory levels.

BUT . . . .  as the weeks pass, and it has now been ten weeks . .  . the purity of the mathematical model becomes more and more suspect. To be specific, it ignores sociological and cultural factors. (Again, correct me if I am wrong.) People aren't ciphers. They have ideas, reactions, values - and has time goes by, these come more and more to the fore. Four weeks of enforced idleness is acceptable - it may even be kinda fun. Ten weeks, and no end in sight, and a real question whether you're ever going to be able to resume your work, and life, and different attitudes set in.

All of which is a long-winded way of suggesting that there may be social constraints to the type of regimen a pure epidemiological approach would impose. Maybe there is some irreducible minimum, beyond which society can't go, because the returns diminish to a point that the degree of social force necessary to achieve them isn't worth it. We can pretty much insist every one stay home for a short period of time. But if we have to start putting hairdressers in jail to enforce limits that continue to extend, we may decide as a people that the candle isn't worth the game.

This is a pluralistic, extremely energized nation, the social energy of which over the last century has transformed the world. Pushback against ANY social order as drastic as social distancing is and was, is inevitable. The grumbling that accompanies it at first transforms gradually into passive, then active, resistance, accompanied by cynicism and conspiratism.  Health professionals, focused on the epidemiological curve, may continue to insist on drastic measures to continue to flatten the curve. But as a matter of sociological reality, is this even possible? Without far more legal force than anyone wants to expend or which would even work? (Recall Prohibition.)

My own thought, purely intuitive, is that it isn't - that in the words of the song, we've gone about as far as we can go with enforced distancing. That's not to say that a sensible regulatory environment doesn't work - masks in enclosed spaces, maintain six feet distance to the extent possible, etc. But the fact is that the virus is certain to be with us for some years, in cycles, and we can't continue with these regimens. (A shutdown of the severity we are enduring is not going to be repeated, no matter what party is in power. For my two cents, we should reopen entirely, with the regulatory environment, I mentioned, and look for the people as a whole to find the stasis, the angle of repose, that makes the best sense out of the competing Blue and Red values. It won't be perfect - but I think it is inevitable, and we might as well get on with it.

In any case, the suggestion is that as a sociological matter - not medical - we may well have hit an irreducible minimum. It's possible we can't do any better with enforced social distancing than we have done.

[Mick]

For my two cents, we should reopen entirely, with the regulatory environment, I mentioned, and look for the people as a whole to find the stasis, the angle of repose, that makes the best sense out of the competing Blue and Red values. It won't be perfect - but I think it is inevitable, and we might as well get on with it.

In any case, the suggestion is that as a sociological matter - not medical - we may well have hit an irreducible minimum. It's possible we can't do any better with enforced social distancing than we have done.

I think the Blues should support this policy, given the predictable reduction in Red voters when this policy comes to pass... ;). I make zee small joke.

[Mick]

For my two cents, we should reopen entirely, with the regulatory environment, I mentioned, and look for the people as a whole to find the stasis, the angle of repose, that makes the best sense out of the competing Blue and Red values. It won't be perfect - but I think it is inevitable, and we might as well get on with it.

In any case, the suggestion is that as a sociological matter - not medical - we may well have hit an irreducible minimum. It's possible we can't do any better with enforced social distancing than we have done.

I think the Blues should support this policy, given the predictable reduction in Red voters when this policy comes to pass... ;). I make zee small joke.

[Genuine Realist]

For my two cents, we should reopen entirely, with the regulatory environment, I mentioned, and look for the people as a whole to find the stasis, the angle of repose, that makes the best sense out of the competing Blue and Red values. It won't be perfect - but I think it is inevitable, and we might as well get on with it.

In any case, the suggestion is that as a sociological matter - not medical - we may well have hit an irreducible minimum. It's possible we can't do any better with enforced social distancing than we have done.

I think the Blues should support this policy, given the predictable reduction in Red voters when this policy comes to pass... ;).  I make zee small joke.

Irish realism.

[Genuine Realist]

For my two cents, we should reopen entirely, with the regulatory environment, I mentioned, and look for the people as a whole to find the stasis, the angle of repose, that makes the best sense out of the competing Blue and Red values. It won't be perfect - but I think it is inevitable, and we might as well get on with it.

In any case, the suggestion is that as a sociological matter - not medical - we may well have hit an irreducible minimum. It's possible we can't do any better with enforced social distancing than we have done.

I think the Blues should support this policy, given the predictable reduction in Red voters when this policy comes to pass... ;).  I make zee small joke.

Irish realism.

[oldalum]

For my two cents, we should reopen entirely, with the regulatory environment . . .

Maybe I am misinterpreting what this means, but I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation to a higher but stable rate of infections. It may be that people like me will effectively continue to do mostly SiP indefinitely until a vaccine is available. I also don't know what to think about the people who refuse to take any precautions to keep themselves or others from being infected: are they really very few and unimportant? Will they achieve herd immunity among themselves while inflicting collateral damage on others along the way?

[oldalum]

For my two cents, we should reopen entirely, with the regulatory environment . . .

Maybe I am misinterpreting what this means, but I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation to a higher but stable rate of infections. It may be that people like me will effectively continue to do mostly SiP indefinitely until a vaccine is available. I also don't know what to think about the people who refuse to take any precautions to keep themselves or others from being infected: are they really very few and unimportant? Will they achieve herd immunity among themselves while inflicting collateral damage on others along the way?

[Genuine Realist]

For my two cents, we should reopen entirely, with the regulatory environment . . .

I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation. But it is unclear what will happen if it doesn't!

I'm far more optimistic than you. I think the vast majority of the public, who really don't want to get sick, are going to take the same practical steps in place now to avoid infecting themselves. I think you are going to see cloth masks be nearly universal, not because the government tells people to do so, but because sensible people want to avoid infection. 

That's the story of Georgia and Florida, I believe. Some really dumb pundits in the MSM - I mean REALLY dumb - assumed because the States were opening up everyone would rush back to stadiums sitting knee to knee, and passing beer round. But of course they didn't. Georgian or Californian, nobody wants to end up under a ventilator. So there has been a spike - maybe, hard to tell with testing so much more available - but nothing like the predicted disaster.

There's a moral there.

[Genuine Realist]

For my two cents, we should reopen entirely, with the regulatory environment . . .

I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation. But it is unclear what will happen if it doesn't!

I'm far more optimistic than you. I think the vast majority of the public, who really don't want to get sick, are going to take the same practical steps in place now to avoid infecting themselves. I think you are going to see cloth masks be nearly universal, not because the government tells people to do so, but because sensible people want to avoid infection. 

That's the story of Georgia and Florida, I believe. Some really dumb pundits in the MSM - I mean REALLY dumb - assumed because the States were opening up everyone would rush back to stadiums sitting knee to knee, and passing beer round. But of course they didn't. Georgian or Californian, nobody wants to end up under a ventilator. So there has been a spike - maybe, hard to tell with testing so much more available - but nothing like the predicted disaster.

There's a moral there.

[2006alum]

FWIW, most people I know who hear "The Color Purple" think the Pulitzer Prize winning epistolary slave novel by Alice Walker.

[2006alum]

FWIW, most people I know who hear "The Color Purple" think the Pulitzer Prize winning epistolary slave novel by Alice Walker.

[Genuine Realist]

FWIW, most people I know who hear "The Color Purple" think the Pulitzer Prize winning epistolary slave novel by Alice Walker.

Yup. Shameless plagiarist me. You might also think of the Spielberg movie,  which featured both Whoopie Goldberg and Opah Winfrey.

But the metaphor applies, and I am going to use it.

[Genuine Realist]

FWIW, most people I know who hear "The Color Purple" think the Pulitzer Prize winning epistolary slave novel by Alice Walker.

Yup. Shameless plagiarist me. You might also think of the Spielberg movie,  which featured both Whoopie Goldberg and Opah Winfrey.

But the metaphor applies, and I am going to use it.

[akiddoc]

For my two cents, we should reopen entirely, with the regulatory environment . . .

I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation. But it is unclear what will happen if it doesn't!

I'm far more optimistic than you. I think the vast majority of the public, who really don't want to get sick, are going to take the same practical steps in place now to avoid infecting themselves. I think you are going to see cloth masks be nearly universal, not because the government tells people to do so, but because sensible people want to avoid infection. 



That's the story of Georgia and Florida, I believe. Some really dumb pundits in the MSM - I mean REALLY dumb - assumed because the States were opening up everyone would rush back to stadiums sitting knee to knee, and passing beer round. But of course they didn't. Georgian or Californian, nobody wants to end up under a ventilator. So there has been a spike - maybe, hard to tell with testing so much more available - but nothing like the predicted disaster.



There's a moral there.

There are still government restrictions on businesses in Florida and and Georgia. Those states are also trying to trace all of their positive tests. Going completely hands off hasn't happened anywhere and it shouldn't. This virus is going to be around for a long time, possibly for millennia. It will definitely be a major issue for several years. We'll have to manage it with new social norms that allow human commerce and other activities to proceed. Governments will have to push those norms along. If large numbers in the manufacturing sector get sick, major economic and social disruptions will ensue. Look at the meat processing industry as an example.

https://www.aarp.org/politics-society/go...tions.html

If infecting 2-3% of the population killed 100,000, just letting it ride could cause a much larger calamity. 10-20% of the population gets infected with influenza every year even with some baseline immunity in the population. This virus is at least as infectious and no one seems to have any immunity (children might have some immunity due to frequent infections with other coronaviruses, but no one is sure yet).

[akiddoc]

For my two cents, we should reopen entirely, with the regulatory environment . . .

I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation. But it is unclear what will happen if it doesn't!

I'm far more optimistic than you. I think the vast majority of the public, who really don't want to get sick, are going to take the same practical steps in place now to avoid infecting themselves. I think you are going to see cloth masks be nearly universal, not because the government tells people to do so, but because sensible people want to avoid infection. 



That's the story of Georgia and Florida, I believe. Some really dumb pundits in the MSM - I mean REALLY dumb - assumed because the States were opening up everyone would rush back to stadiums sitting knee to knee, and passing beer round. But of course they didn't. Georgian or Californian, nobody wants to end up under a ventilator. So there has been a spike - maybe, hard to tell with testing so much more available - but nothing like the predicted disaster.



There's a moral there.

There are still government restrictions on businesses in Florida and and Georgia. Those states are also trying to trace all of their positive tests. Going completely hands off hasn't happened anywhere and it shouldn't. This virus is going to be around for a long time, possibly for millennia. It will definitely be a major issue for several years. We'll have to manage it with new social norms that allow human commerce and other activities to proceed. Governments will have to push those norms along. If large numbers in the manufacturing sector get sick, major economic and social disruptions will ensue. Look at the meat processing industry as an example.

https://www.aarp.org/politics-society/go...tions.html

If infecting 2-3% of the population killed 100,000, just letting it ride could cause a much larger calamity. 10-20% of the population gets infected with influenza every year even with some baseline immunity in the population. This virus is at least as infectious and no one seems to have any immunity (children might have some immunity due to frequent infections with other coronaviruses, but no one is sure yet).

[Genuine Realist]

For my two cents, we should reopen entirely, with the regulatory environment . . .

I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation. But it is unclear what will happen if it doesn't!

I'm far more optimistic than you. I think the vast majority of the public, who really don't want to get sick, are going to take the same practical steps in place now to avoid infecting themselves. I think you are going to see cloth masks be nearly universal, not because the government tells people to do so, but because sensible people want to avoid infection. 



That's the story of Georgia and Florida, I believe. Some really dumb pundits in the MSM - I mean REALLY dumb - assumed because the States were opening up everyone would rush back to stadiums sitting knee to knee, and passing beer round. But of course they didn't. Georgian or Californian, nobody wants to end up under a ventilator. So there has been a spike - maybe, hard to tell with testing so much more available - but nothing like the predicted disaster.



There's a moral there.

There are still government restrictions on businesses in Florida and and Georgia. Those states are also trying to trace all of their positive tests. Going completely hands off hasn't happened anywhere and it shouldn't. This virus is going to be around for a long time, possibly for millennia. It will definitely be a major issue for several years. We'll have to manage it with new social norms that allow human commerce and other activities to proceed. Governments will have to push those norms along. If large numbers in the manufacturing sector get sick, major economic and social disruptions will ensue. Look at the meat processing industry as an example.

https://www.aarp.org/politics-society/go...tions.html

If infecting 2-3% of the population killed 100,000, just letting it ride could cause a much larger calamity. 10-20% of the population gets infected with influenza every year even with some baseline immunity in the population. This virus is at least as infectious and no one seems to have any immunity (children might have some immunity due to frequent infections with other coronaviruses, but no one is sure yet).

Not only is there a role for government, but continued government intervention is essential. What I am doing is channeling Herbert Packer's old book 'The Limits of the Criminal Sanction', and wondering whether we have reached the limit of effectiveness of the draconian SIP practiced for the last 10 weeks. One idea might be to relax completely regulations for businesses with a small number of customers (e.g, hair salons, barbers, Democratic prayer meetings) and impose them for businesses above a certain level of foot traffic (Walmart, Target, most supermarkets). Those are easy for large merchants to implement and set a good example for smaller establishments, without killing them with regs. There has been a lot of public education in the last few months - not all that much good example is necessary.

But I would back off the total shut down at this point.

[Genuine Realist]

For my two cents, we should reopen entirely, with the regulatory environment . . .

I fear this would come at the expense of the health care system and especially health care workers, by reigniting exponential growth in infections in many areas, overwhelming local health care systems. The New York City experience should not be repeated anywhere. There are areas that are already at full capacity right now. I'd be more with you if we had adequate numbers of trained personnel and hospital resources, and more-than-adequate PPE for them, but I don't think we do in many places. I think mass indoor gatherings, and probably mass outdoor gatherings (shoulder to shoulder) without masks should continue to be prohibited until we see what happens with resumption of other economic activity. At a minimum if enough people don't participate in an activity in accordance with regulations, the activity should be prohibited. But in general I think you're right in that we don't really know what level of effectiveness will be achieved with the regulatory environment and the range of measures people will voluntarily take; it may be turn out to be a generally acceptable accommodation. But it is unclear what will happen if it doesn't!

I'm far more optimistic than you. I think the vast majority of the public, who really don't want to get sick, are going to take the same practical steps in place now to avoid infecting themselves. I think you are going to see cloth masks be nearly universal, not because the government tells people to do so, but because sensible people want to avoid infection. 



That's the story of Georgia and Florida, I believe. Some really dumb pundits in the MSM - I mean REALLY dumb - assumed because the States were opening up everyone would rush back to stadiums sitting knee to knee, and passing beer round. But of course they didn't. Georgian or Californian, nobody wants to end up under a ventilator. So there has been a spike - maybe, hard to tell with testing so much more available - but nothing like the predicted disaster.



There's a moral there.

There are still government restrictions on businesses in Florida and and Georgia. Those states are also trying to trace all of their positive tests. Going completely hands off hasn't happened anywhere and it shouldn't. This virus is going to be around for a long time, possibly for millennia. It will definitely be a major issue for several years. We'll have to manage it with new social norms that allow human commerce and other activities to proceed. Governments will have to push those norms along. If large numbers in the manufacturing sector get sick, major economic and social disruptions will ensue. Look at the meat processing industry as an example.

https://www.aarp.org/politics-society/go...tions.html

If infecting 2-3% of the population killed 100,000, just letting it ride could cause a much larger calamity. 10-20% of the population gets infected with influenza every year even with some baseline immunity in the population. This virus is at least as infectious and no one seems to have any immunity (children might have some immunity due to frequent infections with other coronaviruses, but no one is sure yet).

Not only is there a role for government, but continued government intervention is essential. What I am doing is channeling Herbert Packer's old book 'The Limits of the Criminal Sanction', and wondering whether we have reached the limit of effectiveness of the draconian SIP practiced for the last 10 weeks. One idea might be to relax completely regulations for businesses with a small number of customers (e.g, hair salons, barbers, Democratic prayer meetings) and impose them for businesses above a certain level of foot traffic (Walmart, Target, most supermarkets). Those are easy for large merchants to implement and set a good example for smaller establishments, without killing them with regs. There has been a lot of public education in the last few months - not all that much good example is necessary.

But I would back off the total shut down at this point.

[BostonCard]

But I would back off the total shut down at this point.

As of May 20, every state that had imposed a lockdown or shelter in place order began lifting restrictions.  So what we are really talking about is whether the pace should be faster or slower.

https://www.cnn.com/interactive/2020/us/...irus-trnd/

In favor of moving faster, cases and deaths have continued to decline despite states opening up.  There also doesn't seem to be much correlation between the pace of "déconfinement" (to use the French term) and declines in cases.  It has gone down sharply in states hardest hit (New York), and is going down slowly or is flat in most other states.

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  Also, while cases are going down overall, most of that decline is driven by New York and other hard hit states; the states opening up are mostly flat.  I would prefer that if we are basically going to accept a steady state, that it was at a lower level.

But ultimately I agree with you, it will be behavior and not restrictions that drive the spread of the infection, and at this point our collective behavior seems adequate to keep the virus at a steady state.

BC

[BostonCard]

But I would back off the total shut down at this point.

As of May 20, every state that had imposed a lockdown or shelter in place order began lifting restrictions.  So what we are really talking about is whether the pace should be faster or slower.

https://www.cnn.com/interactive/2020/us/...irus-trnd/

In favor of moving faster, cases and deaths have continued to decline despite states opening up.  There also doesn't seem to be much correlation between the pace of "déconfinement" (to use the French term) and declines in cases.  It has gone down sharply in states hardest hit (New York), and is going down slowly or is flat in most other states.

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  Also, while cases are going down overall, most of that decline is driven by New York and other hard hit states; the states opening up are mostly flat.  I would prefer that if we are basically going to accept a steady state, that it was at a lower level.

But ultimately I agree with you, it will be behavior and not restrictions that drive the spread of the infection, and at this point our collective behavior seems adequate to keep the virus at a steady state.

BC

[Genuine Realist]

But I would back off the total shut down at this point.

As of May 20, every state that had imposed a lockdown or shelter in place order began lifting restrictions.  So what we are really talking about is whether the pace should be faster or slower.

https://www.cnn.com/interactive/2020/us/...irus-trnd/

In favor of moving faster, cases and deaths have continued to decline despite states opening up.  There also doesn't seem to be much correlation between the pace of "déconfinement" (to use the French term) and declines in cases.  It has gone down sharply in states hardest hit (New York), and is going down slowly or is flat in most other states.

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  Also, while cases are going down overall, most of that decline is driven by New York and other hard hit states; the states opening up are mostly flat.  I would prefer that if we are basically going to accept a steady state, that it was at a lower level.

But ultimately I agree with you, it will be behavior and not restrictions that drive the spread of the infection, and at this point our collective behavior seems adequate to keep the virus at a steady state.

BC

The bottom line to me is that this thing is going to be with us for quite a while, absent a miracle vaccine. Society is going to be transformed in all sorts of ways. So we might as well get the process going.

[Genuine Realist]

But I would back off the total shut down at this point.

As of May 20, every state that had imposed a lockdown or shelter in place order began lifting restrictions.  So what we are really talking about is whether the pace should be faster or slower.

https://www.cnn.com/interactive/2020/us/...irus-trnd/

In favor of moving faster, cases and deaths have continued to decline despite states opening up.  There also doesn't seem to be much correlation between the pace of "déconfinement" (to use the French term) and declines in cases.  It has gone down sharply in states hardest hit (New York), and is going down slowly or is flat in most other states.

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  Also, while cases are going down overall, most of that decline is driven by New York and other hard hit states; the states opening up are mostly flat.  I would prefer that if we are basically going to accept a steady state, that it was at a lower level.

But ultimately I agree with you, it will be behavior and not restrictions that drive the spread of the infection, and at this point our collective behavior seems adequate to keep the virus at a steady state.

BC

The bottom line to me is that this thing is going to be with us for quite a while, absent a miracle vaccine. Society is going to be transformed in all sorts of ways. So we might as well get the process going.

[chrisk]

The US government is betting hundreds of billions of dollars on quick development, manufacture, implementation of a vaccine. The Salk vaccine had a significant impact on behavior (albeit the size and nature of the dip in activity was not as great). It is reasonable to expect that a vaccine would dramatically change behavior.

The reopening of universities this fall will be an experiment of grand magnitude. With universities opening up over a 2 month period with students coming in from far and wide and with very different strategies regarding in-person classes and dormitory living, there will be a lot of data to evaluate. The challenge will be to tease out the best practices amid the random variation.

One strategy to watch is the UCSD self-serve testing strategy at very high levels with quick turnaround. They have already been testing it on a limited basis but are gradually ramping it up to try to make it fully operational by the time the fall term begins.

[chrisk]

The US government is betting hundreds of billions of dollars on quick development, manufacture, implementation of a vaccine. The Salk vaccine had a significant impact on behavior (albeit the size and nature of the dip in activity was not as great). It is reasonable to expect that a vaccine would dramatically change behavior.

The reopening of universities this fall will be an experiment of grand magnitude. With universities opening up over a 2 month period with students coming in from far and wide and with very different strategies regarding in-person classes and dormitory living, there will be a lot of data to evaluate. The challenge will be to tease out the best practices amid the random variation.

One strategy to watch is the UCSD self-serve testing strategy at very high levels with quick turnaround. They have already been testing it on a limited basis but are gradually ramping it up to try to make it fully operational by the time the fall term begins.

[oldalum]

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  

That's the rationale cited by the SCC public health officer, who wants 3 weeks between changes. Makes sense to me: if you do phase 2 and 3 at the same time, and things go to pot, you'd have to rescind both 2 and 3 and go back to phase 1 or even SiP. Then when things stabilize, you'd have to do the stepped re-opening anyway.

[oldalum]

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  

That's the rationale cited by the SCC public health officer, who wants 3 weeks between changes. Makes sense to me: if you do phase 2 and 3 at the same time, and things go to pot, you'd have to rescind both 2 and 3 and go back to phase 1 or even SiP. Then when things stabilize, you'd have to do the stepped re-opening anyway.

[Genuine Realist]

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  

That's the rationale cited by the SCC public health officer, who wants 3 weeks between changes. Makes sense to me: if you do phase 2 and 3 at the same time, and things go to pot, you'd have to rescind both 2 and 3 and go back to phase 1 or even SiP. Then when things stabilize, you'd have to do the stepped re-opening anyway.

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. There is also the fact that data is obtainable from other locales that have moved faster. SCC does not exist in a vacuum.

[Genuine Realist]

In favor of moving more slowly is the fact that there is a delay between any action and its effect on cases and deaths so if there is a spike in cases, you won't know which measure caused it.  

That's the rationale cited by the SCC public health officer, who wants 3 weeks between changes. Makes sense to me: if you do phase 2 and 3 at the same time, and things go to pot, you'd have to rescind both 2 and 3 and go back to phase 1 or even SiP. Then when things stabilize, you'd have to do the stepped re-opening anyway.

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. There is also the fact that data is obtainable from other locales that have moved faster. SCC does not exist in a vacuum.

[oldalum]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

[oldalum]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

[Farm93]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

Elected officials do have this power.  Governor Newsom could easily have issued an order releasing the full state at the same time.   Could have easily noted that citizens from a restrictive county could easily go to a nearby county causing economic damage to the business while doing little to mitigate the spread of the virus.

Newsom did not do this primarily because of LA county, but he could have issued a statewide declaration.

The government needs to pay for these trackers, it probably should be the federal government since many citizens outside of CA can live and work in different states.  Still, got to hire and train trackers ASAP with the goal of keeping all of them active until at least March 2021.

FWIW - CA only appears slow because of the go for broke approach utilized in most of the USA.  Many G7 health officials have openly expressed their concern that the USA is opening up while having so many new cases and so few tracing resources.

[Farm93]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

Elected officials do have this power.  Governor Newsom could easily have issued an order releasing the full state at the same time.   Could have easily noted that citizens from a restrictive county could easily go to a nearby county causing economic damage to the business while doing little to mitigate the spread of the virus.

Newsom did not do this primarily because of LA county, but he could have issued a statewide declaration.

The government needs to pay for these trackers, it probably should be the federal government since many citizens outside of CA can live and work in different states.  Still, got to hire and train trackers ASAP with the goal of keeping all of them active until at least March 2021.

FWIW - CA only appears slow because of the go for broke approach utilized in most of the USA.  Many G7 health officials have openly expressed their concern that the USA is opening up while having so many new cases and so few tracing resources.

[Goose]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

Elected officials do have this power.  Governor Newsom could easily have issued an order releasing the full state at the same time.

He could have lifted his own order across the entire state. He did not do so however. I believe any County Health Department can issue their own, more stringent orders at any time, as the 7 Bay Area counties did initially. Such orders can open part of the county but not other parts.  

The government needs to pay for these trackers, it probably should be the federal government since many citizens outside of CA can live and work in different states.

I don't agree. That argument applies to everything, including local police. If it wasn't obvious before, it should be clear by now that relying on the Federal Government for epidemic control has big down sides.

Still, got to hire and train trackers ASAP with the goal of keeping all of them active until at least March 2021.

Agree we need to hire and train trackers ASAP. The goal has to be keeping them active and available forever, not 2021. Korea, Taiwan, etc. have demonstrated how it has to work. Many of these people can have other jobs, like policemen, firemen, etc. but they must be "on call" when the next epidemic starts. You can't just wave a magic wand and have such a capability show up. When you need it, you need it RTFN.

[Goose]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

Elected officials do have this power.  Governor Newsom could easily have issued an order releasing the full state at the same time.

He could have lifted his own order across the entire state. He did not do so however. I believe any County Health Department can issue their own, more stringent orders at any time, as the 7 Bay Area counties did initially. Such orders can open part of the county but not other parts.  

The government needs to pay for these trackers, it probably should be the federal government since many citizens outside of CA can live and work in different states.

I don't agree. That argument applies to everything, including local police. If it wasn't obvious before, it should be clear by now that relying on the Federal Government for epidemic control has big down sides.

Still, got to hire and train trackers ASAP with the goal of keeping all of them active until at least March 2021.

Agree we need to hire and train trackers ASAP. The goal has to be keeping them active and available forever, not 2021. Korea, Taiwan, etc. have demonstrated how it has to work. Many of these people can have other jobs, like policemen, firemen, etc. but they must be "on call" when the next epidemic starts. You can't just wave a magic wand and have such a capability show up. When you need it, you need it RTFN.

[Genuine Realist]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

Elected officials do have this power.  Governor Newsom could easily have issued an order releasing the full state at the same time.

He could have lifted his own order across the entire state. He did not do so however. However, I believe any County Health Department can issue their own, more stringent orders at any time, as the 7 Bay Area counties did initially. Such orders can open part of the county but not other parts.  

The government needs to pay for these trackers, it probably should be the federal government since many citizens outside of CA can live and work in different states.

I don't agree. That argument applies to everything, including local police. If it wasn't obvious before, it should be clear by now that relying on the Federal Government for epidemic control has big down sides.

Still, got to hire and train trackers ASAP with the goal of keeping all of them active until at least March 2021.

Agree we need to hire and train trackers ASAP. The goal has to be keeping them active and available forever, not 2021. Korea, Taiwan, etc. have demonstrated how it has to work. Many of these people can have other jobs, like policemen, firemen, etc. but they must be "on call" when the next epidemic starts. You can't just wave a magic wand and have such a capability show up. When you need it, you need it RTFN.

Boy, that's harder than it seems. We have never had this need before. We might never have it again for a few centuries.

There's a famous story abut a guard posted by a small flower bed in one of the Czar's palaces in St. Petersburg. Every day the guard would change, 24 hours, different watches, the works. But no one knew why, what was so important with this flowerbed that it was watched so intensely. This went on through most of the 19th Century. Finally, someone took the time to find out WHY the flowerbed was being guarded. It took research into a hundred years of palace orders, to find out that Catherine the Great had placed the guard there when there were some new and rare geraniums she wanted protected. The geraniums were long gone, as was Catherine, but the order had never been rescinded. And so a totally useless guard was kept for over a century.

Maybe you could include it in National Guard protocols, or police affiliates, or some such, so you have a useful cadre of volunteers at the ready. It  would also fit neatly into the rubric of national service, in which I believe. But a dedicated unit? Might turn into another flower guard thing.

[Genuine Realist]

This would make more sense if the severe lockdown had not been overextended (in my opinion) causing much more stress than necessary. 

The sticking point in SCC has been testing, which has been at about a quarter of the level daily that is apparently thought necessary to detect whether a phase of reopening is causing too rapid a rise in cases. Whether that's true, and if so whether it should be overridden by the economic urgency, is unclear to me. Also there should be some differentiation within counties: at a minimum the north part of SCC should have been able to reopen already. I do think, as a structural matter, that that public health officers should not have sole power to make these decisions at this point in the pandemic. Better to have elected officials balance the trade-offs.

Elected officials do have this power.  Governor Newsom could easily have issued an order releasing the full state at the same time.

He could have lifted his own order across the entire state. He did not do so however. However, I believe any County Health Department can issue their own, more stringent orders at any time, as the 7 Bay Area counties did initially. Such orders can open part of the county but not other parts.  

The government needs to pay for these trackers, it probably should be the federal government since many citizens outside of CA can live and work in different states.

I don't agree. That argument applies to everything, including local police. If it wasn't obvious before, it should be clear by now that relying on the Federal Government for epidemic control has big down sides.

Still, got to hire and train trackers ASAP with the goal of keeping all of them active until at least March 2021.

Agree we need to hire and train trackers ASAP. The goal has to be keeping them active and available forever, not 2021. Korea, Taiwan, etc. have demonstrated how it has to work. Many of these people can have other jobs, like policemen, firemen, etc. but they must be "on call" when the next epidemic starts. You can't just wave a magic wand and have such a capability show up. When you need it, you need it RTFN.

Boy, that's harder than it seems. We have never had this need before. We might never have it again for a few centuries.

There's a famous story abut a guard posted by a small flower bed in one of the Czar's palaces in St. Petersburg. Every day the guard would change, 24 hours, different watches, the works. But no one knew why, what was so important with this flowerbed that it was watched so intensely. This went on through most of the 19th Century. Finally, someone took the time to find out WHY the flowerbed was being guarded. It took research into a hundred years of palace orders, to find out that Catherine the Great had placed the guard there when there were some new and rare geraniums she wanted protected. The geraniums were long gone, as was Catherine, but the order had never been rescinded. And so a totally useless guard was kept for over a century.

Maybe you could include it in National Guard protocols, or police affiliates, or some such, so you have a useful cadre of volunteers at the ready. It  would also fit neatly into the rubric of national service, in which I believe. But a dedicated unit? Might turn into another flower guard thing.

[Goose]

Boy, that's harder than it seems. We have never had this need before.

Actually, yes, we have needed it before and had it before. The States and counties had permanent staff whose job it was to identify, trace, and track TB. There were also hospitals owned by both the states and Federal government to house people with TB. Lots of these facilities were closed in the late 60's/early 70's Even today there are "residual" TB testing and tracing responsibilities at the county level. This isn't a "new" thing.

We might never have it again for a few centuries.

True. One could say that the last time a "novel" disease really affected the US was the 1918 pandemic. So, maybe once in a hundred years could be a guess at the frequency. However, travel across the entire world has become so much faster and so much more common that the probability of a major novel disease being transferred from one part of the world to everywhere else is much greater. The damage such a disease can cause is also much greater, as the much larger urban population relies on "essential services". We can't all SIP and survive. In addition, the economic consequences are severe.

The US was fortunate that neither SARS or MERS really took hold here. In nations where it did, they learned the lesson and kept their tracking, tracing, and containment strategies in place. Australia has a pretty good capability as well because of all the epidemics in New Guinea. In the past 20 years, we have seen SARS, MERS, H1N1, ZIKA virus and EBOLA pop up. We basically dodged them or they weren't bad enough to hurt us much. COVID-19 was that bad.

<snip>
Maybe you could include it in National Guard protocols, or police affiliates, or some such, so you have a useful cadre of volunteers at the ready. It  would also fit neatly into the rubric of national service, in which I believe. But a dedicated unit? Might turn into another flower guard thing.

I doubt it. It is very probable we will see another serious viral threat in the next 10 years, given that we saw 6 in the last 20 years. We didn't need a great tracing capability 5 of the 6 times, but when we did, boy howdy did we. Having volunteers or part timers as the core of our response won't cut it. They have to be ready to go on day 0 or we have no hope of containment. We can argue about what the "right" staffing level may be. Right now, Santa Clara County is looking at about 1000 people. Maybe in the future having 250 full time, 250 trained but working elsewhere as county employees, and 500 not yet trained but available from other departments/organizations might work. The state is looking at 10,000. We probably don't need that many on the job all the time, but we do need a "surge" capability with training plans to ramp up very quickly if required. We can't let this happen to us again without making a good effort to prevent it.

[Goose]

Boy, that's harder than it seems. We have never had this need before.

Actually, yes, we have needed it before and had it before. The States and counties had permanent staff whose job it was to identify, trace, and track TB. There were also hospitals owned by both the states and Federal government to house people with TB. Lots of these facilities were closed in the late 60's/early 70's Even today there are "residual" TB testing and tracing responsibilities at the county level. This isn't a "new" thing.

We might never have it again for a few centuries.

True. One could say that the last time a "novel" disease really affected the US was the 1918 pandemic. So, maybe once in a hundred years could be a guess at the frequency. However, travel across the entire world has become so much faster and so much more common that the probability of a major novel disease being transferred from one part of the world to everywhere else is much greater. The damage such a disease can cause is also much greater, as the much larger urban population relies on "essential services". We can't all SIP and survive. In addition, the economic consequences are severe.

The US was fortunate that neither SARS or MERS really took hold here. In nations where it did, they learned the lesson and kept their tracking, tracing, and containment strategies in place. Australia has a pretty good capability as well because of all the epidemics in New Guinea. In the past 20 years, we have seen SARS, MERS, H1N1, ZIKA virus and EBOLA pop up. We basically dodged them or they weren't bad enough to hurt us much. COVID-19 was that bad.

<snip>
Maybe you could include it in National Guard protocols, or police affiliates, or some such, so you have a useful cadre of volunteers at the ready. It  would also fit neatly into the rubric of national service, in which I believe. But a dedicated unit? Might turn into another flower guard thing.

I doubt it. It is very probable we will see another serious viral threat in the next 10 years, given that we saw 6 in the last 20 years. We didn't need a great tracing capability 5 of the 6 times, but when we did, boy howdy did we. Having volunteers or part timers as the core of our response won't cut it. They have to be ready to go on day 0 or we have no hope of containment. We can argue about what the "right" staffing level may be. Right now, Santa Clara County is looking at about 1000 people. Maybe in the future having 250 full time, 250 trained but working elsewhere as county employees, and 500 not yet trained but available from other departments/organizations might work. The state is looking at 10,000. We probably don't need that many on the job all the time, but we do need a "surge" capability with training plans to ramp up very quickly if required. We can't let this happen to us again without making a good effort to prevent it.

[BostonCard]

https://www.economist.com/united-states/...handcuffed

Some answers here...

Public health is chronically under-funded. In 2018 America spent less than $300 per person on it, compared with over $10,000 on all health care, according to the Trust for America’s Health (TFAH), a not-for-profit group. In the decade to 2017, jobs in public health fell by 50,000.

Mr Trump has proposed cutting the CDC’s budget each year by between 10% and 20%, but Congress has protected the agency. The CDC’s budget has been flat since 2016, and this year emergency-spending bills will provide an extra $6bn over the next five years. However, the two main programmes for helping state and local health-care systems prepare for emergencies, Public Health Emergency Preparedness and the Hospital Preparedness Programme, have been cut by over 50% in real terms since 2003. This has forced states to scale back emergency preparation and left the CDC bearing more of that burden.

BC

[BostonCard]

https://www.economist.com/united-states/...handcuffed

Some answers here...

Public health is chronically under-funded. In 2018 America spent less than $300 per person on it, compared with over $10,000 on all health care, according to the Trust for America’s Health (TFAH), a not-for-profit group. In the decade to 2017, jobs in public health fell by 50,000.

Mr Trump has proposed cutting the CDC’s budget each year by between 10% and 20%, but Congress has protected the agency. The CDC’s budget has been flat since 2016, and this year emergency-spending bills will provide an extra $6bn over the next five years. However, the two main programmes for helping state and local health-care systems prepare for emergencies, Public Health Emergency Preparedness and the Hospital Preparedness Programme, have been cut by over 50% in real terms since 2003. This has forced states to scale back emergency preparation and left the CDC bearing more of that burden.

BC