(04-19-2020, 07:52 AM)Genuine Realist Wrote: The Speaker of the House and the presumptive Democratic Presidential nominee both denounced travel bans as xenophobic in early February, in response to Presidential action. We can only imagine what they would have said to the notion of locking down the nation or even NYC, which was strongly opposed by the Democratic mayor of Chicago when it did happen. Etc. You can choose the villains you like. To me, there is no point.
Major US health agencies were influenced by the wHO, which bought into the Chinese line through the end of January. I've posted somewhat neutral recounts of the actual dawning of awareness elsewhere. But you can believe whatever history is most convenient for you. That's what mostpeople do.
You talk about this as if the only choices facing our leaders were 1) shutdown and 2) travel ban, but completely ignore the many public health measures that would have could have made a difference had they been pursued earlier and would have made a shutdown unnecessary (as was the case in Taiwan and South Korea).
I don't understand the defense of the travel ban. The travel ban was clearly ineffective; the proof is in the pudding. You talk about the travel ban as if it would have been helpful on its own and the only reason it didn't get implemented was opposition to Trump. But of course, the travel ban was implemented and it was implemented as designed by the administration without congress or the courts intervening. To my knowledge, despite some people complaining about it, there were no lawsuits, no district courts that held it up, and compared to a lot of Trump administration actions, opposition was fairly muted. Yeah, it was opposed, mostly because epidemiologists believed that it would be ineffective, because there was already community transmission in the US when it was implemented. And it turns out that the opponents were right; it didn't work by itself! At the point that the travel restrictions were implemented, there were already 300,000 people who had come from China in the previous month. I'd be more sympathetic to Trump's position if he had tried to pursue a complete travel early and been prevented from doing so by the opposition. Then we might ask what the counterfactual would have been like had he not been prevented from implementing the restrictions. But Trump looks at the restrictions as necessary and sufficient to prevent a pandemic, and they were clearly not sufficient on their own. Whether they were even necessary is also under debate. Maybe a travel ban, implemented along with aggressive contact tracing and other public health interventions early would have worked, and then maybe we could be holding the debate as to how much the travel restrictions helped, and some people are arguing the travel ban was a linchpin in success and others arguing that the travel ban was unnecessary and it was the other measures that were critical in stopping the pandemic, and maybe some people arguing that everything was unnecessary and the threat of the virus was overblown from the beginning. That's a debate I wish we were having. But the travel ban was tried, and it failed spectacularly. At this point, support for the travel ban falls along the lines of "we had to do something; the travel ban was something; therefore we had to do the travel ban".
There is also a long set of measures that could be implemented in between only a travel ban and a complete nationwide shelter in place system. So here goes.
Obviously, the first thing would have been to expand testing earlier. The seminal moment to the problematic response was the delay in identifying community transmission in the US. The biggest problem we had in our response was believing for far longer than was the case that only people traveling from China or their close contacts could have COVID-19. The travel restrictions were announced on January 31. The first case of community transmission in the US was announced on February 26 (long after the CDC had reversed itself on person-to-person transmission)! That's basically an entire month where we had community transmission in the US without knowing it. Moreover that patient's doctors wanted to test her for COVID-19 a week before; the CDC kept denying the request, because the patient didn't meet the criteria, because she had not traveled to China or been in close contact with someone who had. Now, anyone with a brain could see the problem here. If the criteria for testing requires travel to China or close contact with someone who has, you will never test anyone who got the virus due to community transmission, so you will never know that community transmission is occurring.
Identifying community transmission two weeks earlier would have made a demonstrable difference in the trajectory of the outbreak in the US. It would have accelerated the widespread roll out of testing, and would have changed the criteria for testing, enabling much more testing of community members without direct ties to China. It would have allowed local health authorities to test and track while the numbers were still small and testing and tracking was still possible. It would have allowed local governments and health authorities to implement more limited social distancing measures (like canceling large gatherings) earlier slowing its spread. Instead, the virus was allowed to fester in the community, so that by the time we realized there was widespread community spread, a lot of the more limited measures we could have pursued back then, which might be effective for a small outbreak, are no longer effective.
Also, it would have helped if government leaders from up and down local to federal levels were speaking in one voice. I am sympathetic to your argument that a very early shutdown would have been near impossible to implement. But it would have been easier to implement earlier if, instead of minimizing the extent of the pandemic, the administration was telling the American people directly why the relatively few number of cases were a big deal. Also, we would have tested and diagnosed more people, so the extent of the spread would have been obvious to more state and local officials and they would have implemented measures earlier. I have in the past criticized Bill DeBlasio (especially) and Andrew Cuomo for their pissing match which delayed shutting down New York. If that had been implemented even a few days earlier, the outbreak in New York would have been much milder. Even a one day delay in implementing measures makes a very big difference (compare the Bay Area to Southern California, and California to New York).
Here's one illustration of that:
![[Image: 1*4kOJv8hmd5VFPcBL1mywsw.png]](https://miro.medium.com/max/2000/1*4kOJv8hmd5VFPcBL1mywsw.png)
A one day delay in implementing social distancing measures results in a 40% increase in your final case count. That is, unfortunately, the problem with exponential growth. So here is where federal leadership would have been helpful. I praised the administration's guidelines for opening up the country. Imagine if there had been a similar document for how to implement social distancing that offered guidance to states and local communities as to which measures carried the highest "bang for the buck" (slowed transmission the most for a given disruption to daily life) and when to implement increasingly severe restrictions. You might have still seen severe restrictions placed in some parts of the country, but in others restrictions of large gatherings without shelter in place might have been enough.
So to sum up, the travel ban was ineffective on its own, and the administration could have implemented a lot of measures short of a shutdown that would have had a meaningful effect on the pandemic. At the very least, the administration could have avoided undermining local efforts. Maybe a shutdown would have happened anyways because less intrusive measures would eventually have proven not effective enough, but the actions of the administration made the shutdowns inevitable.
BC
