'Mind-Numbing' Pandemic Toll Could Have Been Averted: Op-Ed

The following is an op-ed by Framingham District 6 School Committee member Geoffrey Epstein. The views here do not necessarily reflect those of Framingham Patch.

With the COVID-19 pandemic reaching epic proportions, the U.S. is navigating an historic health crisis. The death toll is well above 400,000 and rising by thousands every day. In addition, over 2 million COVID-19 survivors are suffering chronic, long term effects, and their numbers are also growing by the thousands every day. Plus, the total cost of the COVID-19 pandemic, including lost economic output, is projected to be $16 trillion.

The sheer magnitude of the pandemic impact is truly mind-numbing.

The additional threat right now is that, with widespread infections, the virus is replicating rapidly, and the number of mutations is rising accordingly. Already, there are more infectious UK and Brazil variants, and a South African variant which may lower vaccine efficacy. While the rollout of the vaccine is an obvious priority, it remains critically important to improve the current U.S. border quarantine defense against dangerous incoming mutations and to lower the transmission rate.

At present, U.S. COVID-19 border quarantine leaks like a sieve. The UK and Brazil variants have already gotten past our defense, and it is just a matter of time before the South African variant flies in.

There is plenty of guidance on how to deploy an effective border quarantine defense against COVID-19. One can simply look at countries in the vicinity of China, where the virus first emerged: Taiwan, South Korea, Laos, Vietnam, Thailand, Singapore, Australia and New Zealand, amongst others.

Here are some of their COVID-19 numbers, along with the U.S. for comparison:

U.S.: 25.6 million cases, 428,000 deaths, 298 million tests, population 332 million
Taiwan: 889 cases, 7 deaths, 144,600 tests, population 23.8 million
New Zealand: 2,283 cases, 25 deaths, 1.4 million tests, population 5 million
Australia: 28,766 cases, 909 deaths, 12.7 million tests, population 25.5 million

Obviously, the U.S. is the largest in population, but allowing for that, if the U.S. COVID-19 defense were as good as Taiwan’s, it would have about 97 deaths. A "New Zealand" defense would cut the U.S. death toll to 1,689 deaths. An "Australian" defense would cut the U.S. death toll to 11,940.

These are huge differences.

These countries have also employed a multi-layered defense. Here are the major elements,
including border quarantine:

1. Quick action, based on truth and science
2. Teamwork, involving all levels of government, properly resourced, with good logistics
3. Managed border quarantine for all incoming people
4. Testing and contact tracing which constantly engages the public, is digitally enabled and focuses on containment and suppression
5. 100 percent effort on masks, social distancing and gathering limits

It is obvious to anyone looking that there have been huge U.S. failures on all these measures.

Of special immediate relevance to the U.S. is the "masking, social distancing, gathering limits, testing and contact tracing," part of the defense. Each of the successful countries has experienced virus outbreaks due to leaks in border quarantine but has employed those tools to suppress them. They don’t just mitigate outbreaks. They crush them to zero.

These successful countries are always focused on the transmission factor, called R. If one infected person infects just one other, R is 1. If one infected person infects two others, R is 2, and so on. COVID-19 started out with an R of 2 and let loose in a population, without any counter measures, doubles the number of infected people every five days. Six doublings in a month. So, if you start with one infected person, you have 64 a month later, 4,096 in two months and so on. It rapidly gets out of hand if it gets a head start. You can suppress an outbreak if you can get R to less than 1. If you can get R to ½, the outbreak will die off as fast as it grew. The whole point of masking etc. is to get R to much less than 1. The recent mutations of COVID-19 have pushed R to 3.5 or more. Without countermeasures, one infected person leads to 1,800 infected people in a month, 3.4 million in 2 months, 140 million in 2.5 months. That is a huge threat to the U.S. One of the known, present COVID-19 mutants could burn through the U.S. population before the vaccine has been sufficiently deployed.

Let's go back and run through the list of five COVID-19 defenses to complete the story.

The Australian experience is especially useful here, as it is well publicized and has exposed what works and what does not. Australia also has the most in common with the U.S. in terms of its origins, its democratic government structure, its culture, its attitudes and views of the world.

First, Australia is not suffering from the other pandemic which has infected the U.S. The pandemic of untruth, myth and conspiracy theories. There is the usual small echelon of outlier Aussies, but nothing like the U.S. where about 30% of the population appears to believe things which are not true. U.S. leadership during 2020 made this worse, especially regarding critical pandemic information. In contrast, sound scientific and medical advice in Australia has been, freely and publicly, given and received. Dangerous advice like use of hydroxychloroquine as a COVID-19 cure has never been blessed by Aussie government leadership, and the Aussie community has responded well to sound, scientifically based advice from the government. This has made a great difference in achieving an effective pandemic response.

Second, from the outset, on March 13, 2020, an Australian National Cabinet was formed to coordinate the COVID-19 response, with federal, state and territory leadership at the table. There was no partisan divide. There was always some griping about interstate border closures, but federal money flowed for resources needed for the pandemic response, and to a "job keeper" program that greatly mitigated the financial effects of job loss. Everyone was on the same page. And of course, no Aussie lost their health care, vital in a pandemic, because Aussie health care is universal and not tied to jobs or income. That also helped keep the community better engaged in a team effort.

Third, it was found early on that self-managed border quarantine simply does not work. That leaks like a sieve. What does work is managed quarantine. Each incoming person goes to a hotel for 14 days with quarantine security managed by local police and the military. Negative COVID-19 tests 72 hours before flight departure are not good enough, as Australians have discovered. And Australian border quarantine was the first line of defense to detect arrival of the UK variant and enable its containment. The cost per incoming person is about $2,000 and with 7 million visitors to the U.S. in 2020, that amounts to $14 billion annually. That is a low cost for the U.S. cost with a huge benefit. Plus, a large part of that money would be pumped into the hotel and food service industries and would help keep them afloat in tough times. That is a win-win.

Fourth, the next line of defense after border quarantine is contact tracing and testing, which works well for small scale outbreaks which result from border quarantine leaks, to track the path of the escaped virus, contain it and reduce it to zero cases. That worked well in the Australian context, using genomic sequencing and extensive use of QR codes to manage information digitally and communicate risk locations to the public using local media. There was never any comparable effort in the U.S., and, with such widespread infections in the U.S., this is now useless as a containment/suppression tool.

Fifth, wearing masks, social distancing and limiting gatherings, are arguably the least expensive, most effective, highest payback actions available to everyone. Australians don’t take to masks like ducks to water, but when country called, they masked up. It was the right way to protect your "mates," not some liberty infringement. It is hard to fathom the damage done in the U.S. by the politicization of these actions and their repeated, flagrant denigration by former President Donald Trump and cohorts. Campaign rallies, White House formal events and everyday operations, from the Oval Office on, were all transmission accelerators and served to completely undermine the national effort to use this simple and effective tool, crucial to containing the pandemic spread. The mind reels at the impact this has had on the scale of U.S. deaths, financial damage and survivor distress. This remains the single most devastating and tragic deception visited on the American people. If everyone in the U.S. simply masked up, social distanced and said no to gatherings, the infection rate would plummet, and huge improvements would be seen in a month or two, saving tens of thousands of lives and a ton of money.

Geoffrey Epstein is the District 6 School Committee member and an Australian who has lived in the U.S. since 1975, and a U.S. citizen since 1988. He is a theoretical physicist by training and an engineer by trade.