How To Solve The Covid 19 Crisis
A vaccine for COVID 19 is coming from Pfizer that just may be 90% effective 7 days after a second dose but this is only a partial answer to the present crisis and doesn’t address future infections.
Instead of playing the blame game and promulgating caustic rhetoric, we need to ask a very simple question; how can we solve this problem?
. When I began my career as a physician back when Yoda was born, I learned a very important concept. If you want to be successful at anything, listen to a great mentor who is successful in your niche. Better yet, spend lots of time learning your mentor’s skill set. It’s a lot easier than reinventing the wheel.
Actually, this simple formula can be directly applied to the coronavirus pandemic that has killed a quarter million people in the United States.
Let’s take a journey to Taiwan to see if we can find a few “clinical pearls” that can make our lives easier. Let’s be humble and open minded and see if we can learn from a society that isn’t even recognized as a country by China and the UN.
Taiwan or the Republic of China has a population of over 23 million people who live on an island that is 32,000 square miles. New York State has 20 million people living on 53,000 square miles. So both areas have a dense population but that’s where the similarities end.
You see, Taiwan has had 451 cases of COVID 19 and 7 deaths. Since April there have been no additional cases. This must be the magical Land of Oz because this is seemingly an impossible feat.
But this magic is really a scientific skill set that has been honed diligently over the last decade or so. As you may recall, the SARS outbreak back in 2002 was more lethal but less contagious than COVID 19. This coronavirus infection had over a 10% fatality rate and first attacked South China and Taiwan. Like COVID 19, bats seemed to be the reservoir for infection. Taiwan learned from this debacle and vowed to be prepared for the future.
So the phrase by president Kennedy, "Ask not what your country can do for you; ask what you can do for your country," takes on special relevance during this current pandemic.
Clearly the “magic bullet” is not a vaccine. In a recent poll, only 40% of nurses and 60% of physicians will take the vaccine. This saddens me because next to fresh running water, vaccines have saved more lives than just about any other intervention including antibiotics.
Taiwan employed preventive strategies that it learned from the SARS epidemic. This tiny democracy that is denser than NY city stopped the virus in its tracks and here’s how they did it:
1. The population believes in the greater good of its society.
2. There are no lockdowns but wearing a mask is enforced with fines in the neighborhood of 30,000 dollars. Whew!
3. The government refurbished its healthcare system so that early detection of new COVID 19 cases could be readily be achieved. Healthcare officials could see in real time any new cases of the virus because each person had a unique health card number that could be tracked. You were only tracked by medical billing diagnoses and you could still go to grandma’s without “big brother” watching you.
4. Airline travel was monitored and integrated with customs and the healthcare system.
5. Diligent world class, contact tracing was performed as well as quarantines. For each case, nearly 30 close contacts were investigated.
6. Taiwan developed a system to name and shame those who did not wear masks in public spaces or who broke quarantine early. Social media played a big role as well.
7. Frequent national updates were broadcasted by unifying the private sector with government. Citizens received data based upon the science rather than by political parties.
And they accomplished this a magical feat even though 1-2 million Taiwanese work in China!
They say that what appears to be magic is simply advanced science. Taiwan was prepared ahead of time due to SARS and enforced the rules according to the science.
Could we do this in America? We could definitely deploy some of these strategies. Again, success depends upon mirroring the skills of our successful mentors.
Yes, I know that all of us value our liberties but you cannot have liberty without security. In other words, society needs to be reasonably safe before liberties can be exercised fully.
But in order to maintain security and safety, we may have to temporarily give up a few liberties. Quarantines, masks, social distancing and contact tracing encroach upon our personal freedoms but these necessary functions could be implemented and enforced in the United States right now. Given the unemployment situation, fines could be more reasonable.
We can also prepare digitally for the next pandemic by gathering real time data with our airline travel and our healthcare system without using such data as a weapon. Laws can be instituted to minimize this possibility but we must prepare for the future. If a hurricane decimates a city, don’t build the exact same city all over again. Changes need to be made so that we are ready for future infections. As perhaps Einstein said “Doing the same thing over again and expecting different results is the definition of insanity.”
The new vaccine will help to prevent further infections and is certainly a medical triumph but unfortunately our healthcare system still takes the old silo approach. Each doc, insurance company and benefit manager have different computer systems. Nobody is on the same page which leads to a fragmented medical system that can’t adapt and is subject to fraud. Modeling our healthcare system after Taiwan in real time will be a slow process but our future success with pandemics requires that we make many changes to our present system.
So perhaps we should indeed all ask ourselves “What can we do for our country?”
I think the answer is clear. Taiwan has a prescription for success. Each state can model itself after this tiny democracy that hasn’t had a single case of COVID 19 for the last 8 months.