How Do We Defeat Covid-19?

 Like everyone else, I was very pleased and impressed to see Joe and hold yesterday’s ZOOM with the new task force that has assembled to deal with Covid-19. The group appears to include the medical and scientific experts that together can really develop and implement the proper and long-overdue plan.

There was, however, one member of the group whose presence was somewhat interesting precisely because he’s a physician who doesn’t happen to have any real experience or expertise in infectious disease. I’m referring to Atul Gawande, who holds a professorship at the Harvard School of Public Health, but in fact has spent most of his career writing some very interesting books about medicine and how we deliver medical care.

Back in 2012, Gawande spent a week or so hanging around the kitchen of a Cheesecake Factory restaurant and then wrote an article about how and why medical care could be improved and made cheaper if hospitals purchased equipment and managed their operations with the same degree of diligence which The Cheesecake Factory used to turn out all those lovely meals.

A couple of years later the Cheesecake Factory filed for bankruptcy, and it looks like the chain is about to go under again. I didn’t notice Dr. Gawande ever updated his idea that hospitals might learn better business practices from how these restaurants cook and serve their meals, nor did he say anything on his Twitter when Consumer Reports said the Cheesecake Factory serves the unhealthiest meals of any national restaurant chain.

I guess Atul Gawande has been added to the Covid-19 task force because someone needs to write an authoritative account of how this country did and didn’t deal with what may ultimately turn out to be the worst pandemic of all time. And if this is what Atul or anyone else is thinking of doing, let me give you a little tip.

The truth is that we don’t need a vaccine. We don’t even need a federal task force, as important as such a strategy appears to be. All we need (as if this is possible which it probably isn’t) is a culture which doesn’t regard public authority with a combination of fear, loathing and mis-trust. The idea that government should not be telling us what to do didn’t just start with Reagan in 1980 or Goldwater back in 1964.  We are the only industrialized country, perhaps because our industrial growth was so successful, that doesn’t take the role or responsibility of government seriously at all.

The one time that most of the country felt that a great crisis could only be solved with government intervention was when Roosevelt got elected in 1932. Despite Hoover’s claim that the economy was rolling along, industrial production was below 5% of capacity, local banks were all closed, and in parts of the country people were facing famine, the worst threat of all.

By 1936, however, the economy had recovered to the point that the GOP refused to endorse the New Deal in its political platform, setting itself up as a party that opposed every government program until the government started spending money to arm the country and its allies for World War II. The first Social Security check was issued in 1940. The last legal challenge to the Social Security Administration ended in 1949.

Countries like the Czech Republic, Ireland and Denmark have successfully controlled the virus because their populations have responded positively to lockdowns and other management program to maintain public health. These countries have also mounted energetic and sustained surveillance campaigns to make sure that social distancing rules and regulations are being observed.  

I live in a state, Massachusetts, which has tried, albeit with limited success, to impose comprehensive social distancing rules. But lately, Covid-19 cases have started ticking back up, and average daily death rates while low, are also moving back up.

This may sound rather draconian and hard to take, but I would have no problem finding some way to enforce a mandate against not just public, but large private gatherings as well. And both the flu vaccine and an eventual Covid-19 vaccine should also be required, personal choice be damned.

And if Atul Gawande wants to write another article about how we can learn better public health management practices from the private sector, he can go right ahead.