1. Ventilators do not produce good outcomes. My guess is that there are some people walking around today who are happy after having been on a ventilator, but I don’t like the odds. If I were to give an advanced directive for how I want to be treated, it would be “Do not ventilate.” There are other benefits of “flattening the curve,” but I would not promote “making sure we have an adequate supply of ventilators” as a major influence on policy.
In general, treatment is proving to be very difficult. I hope that we will discover a set of protocols and pharmaceuticals that will be effective. For now, the virus seems to have effects on the body that are complex and variable. I can imagine that it will turn out that no one treatment method works for everyone. It could take a very long time to sort this out.
2. I am not counting on finding a vaccine soon. On the one hand, scientists are trying very hard and using a variety of approaches. On the other hand, the track record of not finding vaccines for some other viruses is sobering.
3. Testing does not work well. The problem is that even a low rate of false negatives and false positives can be very misleading, both for the individual and for policy makers. I won’t go through the arithmetic here (I did some in this post). Because of the way that seemingly small rates of false negatives and false positives undermine the efficacy of testing, I doubt that “test, track and trace” is the main way that Asian countries have contained the virus.
4. It is worse than the flu. I never doubted this, and very early on I attacked the point of view that this is just like an ordinary flu. But if you still want to hold onto that view, ask health care workers what they are seeing. Or wait a couple weeks until the number of deaths in the U.S. has doubled again.
5. The differences in severity by age group are staggering. It is catastrophically worse than the flu for patients in nursing homes. It may or may not be worse than the flu for people in their twenties, pending studies of long-term effects.
6. Close contact in enclosed spaces is a much more important transmission mechanism than doorknob effects. I don’t care any more that “the virus can live on surfaces for hours.” Case studies of how people got the disease point to personal contact and/or HVAC (heating and airconditioning).
7. Social distancing works less well than one would hope. That is, while it seems as though you can detect a bit of slowdown in infections in times/places where social distancing increased, the differences are not nearly as dramatic as the age differences or the Asian/Western difference. I am afraid that as a defensive system, social distancing as we practice it leaves too many gaps, especially around nursing homes and sectors that are essential, such as health care and food. People’s impulse to shelter in multi-generational families tends to undermine the benefits of social distancing–the “escape from New York” phenomenon.
To successfully drive down the infection rate close to zero, you need more drastic measures than what we have undertaken in the U.S. and Europe. You cannot let people leave home for “essential” purposes, but instead you have to deliver food rations via the army. You have to keep multi-generational families apart. If you want to quarantine infected people, you have to really do that in separate compounds, not in their homes. Maybe something like that can be enforced in Wuhan or Israel, but I would not want to even try it in this country. And even where it seems to work, the virus could come back.
8. A fresh-air lifestyle is good for you. I am struck by the low death rate among homeless people and in India. Those populations ought to be at high risk, and the only story I can come up with is that they don’t spend as much time as we do indoors with HVAC.
9. Masks are good for society. Places like Taiwan and Hong Kong, which have the sort of density conditions and indoor-living conditions that we have, nonetheless have performed much better. There are other differences in how they cope with the virus, but the contrast between East and West on mask-wearing stands out to me.
Those beliefs may or may not be correct. But I have tried to arrive at them by reading with an open mind. I do have strong political opinions, but I hope that I have not let those opinions drive what I believe about the virus.