I sat here last night experiencing ennui, feeling sadness that I can't magically fix the US Covid19 strategy debate. The "to lockdown more, or to not" binary is frustrating to me in that people just don't see how wrong the framing is. It's a sucker's choice - choosing either "the economy" or "saving lives" loses you both, versus the strategy of suppression which is the only real solution.

To my perspective, my default "assume everyone comprehends the situation mostly like I do" view, it just looks like people A) are giving up, and/or B) would rather fight the outgroup than save the world. It doesn't seem like it should be that hard to see how the relevant bits of reality work here! But I'm sure that unaware self-sabotage is just so much more likely than conscious death cult-ing, so people must not see it - and my, what a frightening world to live in for anyone who believes they are trapped inside that Sophie's Choice. What is preventing clear sight?

  • Suppression is the only answer - with or without a vaccine. False equality #1: "vaccine == suppression".
  • Lockdowns are not and were never a way to solve the crisis by themselves. False equality #2: "lockdowns == a strategy".
  • They were only ever a tool to help us with suppression, not to make the virus go away. False equality #3: "suppression == containment".
  • And pointing out the damage of the other side of the health/freedom polarity is both correct and also not-even-(well formed enough to be)-wrong. False equality #4: "heath & wealth == zero sum".
  • I think it's mainly the ingroup/outgroup effect of that argument that has two wrong answers fighting each other instead of learning from the world. False equality #5: "other countries' strategies == irrelevant to US".

All of those add up to what I think is the linchpin of wrongness: that "suppression == impossible". Whether it's "people would never comply here" or "there's no solution until a vaccine arrives" or "we already flattened the curve, so now it's time to open", all of those falsehoods derive from the lack of knowledge-and-or-belief that suppression (not containment nor mitigation) is possible.

When I say suppression, I mean "test, trace, and (supported) isolate" - TTSI, the strategy used on Ebola, on SARS v1, on so many other diseases for decades of modern epidemiology. It's still correct! All of the lockdowns [are, should be, should be communicated as being] are merely one piece of a broader strategy. They help us get to suppression, and the Harvard TTSI plan (link to my extracted quotations) shows us how!

I'll simplify it even more than they did:

  • Green zone is containment - easier TTSI to keep prevalence negligible
  • Yellow zone is suppression - harder TTSI to keep spread declining
  • Red zone is mitigation - big-hammer lockdown to get back to manageable

Yellow is basically the "dance" of the popular Hammer and Dance piece (though that piece left out "isolate" in its chart #15), even though it seems to be missing from most people's awareness of what the "next normal" might be. You can't red your way to green, and you don't want to oscillate in and out of red either. But as you can see in this map, most of the country is in the yellow zone!

from https://www.pandemictesting.org/maps as of May 12th

The TTSI strategy applies even when you can't trace every case. It's all about keeping the effective transmission rate below 1.0. The more effort we put into testing, tracing contacts, and isolating infected people to minimize transmission, the more we can open up regular economic activity AND the more lives and health we preserve! It's a win-win solution, and we should all be united in pursuing it.

The faster we can all collectively agree to head in this direction, the better off we'll be. The longer we allow e.g. contact tracing to be politicized and ingroup-v-outgroup'ed, the more we lose jobs and lives. Let's start trying now, without wasting more months. Please help us spread the word.

Questions/comments here