Wait - why is Jason talking about COVID-19? And why are these written like FaceBook posts? There’s a longer explanation here but the short version is that my day job for the past 15+ years has been developing models of human health effects and medical response for chemical injuries and biological illnesses, including pandemics. I’ve been making these posts on FaceBook and I was asked to put them in a more shareable manner. I’m linking to the posts on the explanation page. These are the original, unedited posts. I’ll continue until I run out of things to say.
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I sent out a tweet earlier this week that got a little popular. It said:
When we're doing mass casualty response planning, we often include models where the postal service delivers countermeasures and even vaccines. They're the only system that visits every house in America, every day. They're a logistical miracle. Anyway, that seems relevant.
I followed that tweet with:
BTW, these plans were often met with resistance. Not because the USPS couldn't handle it, and not because the science couldn't package meds in an accessible way. It was mainly because people were afraid someone would take 60 courses of cipro on day one for "extra protection."
That one was structured a little bit more like a joke - there are a lot of reasons that folks might resist the idea of shipping medications to folks who are at risk. For one thing, we’re talking about controlled substances that require prescriptions. They may have specific administration requirements or side effects. During normal times, they require guidance, the availability of a doctor to answer questions, etc. And, yes...there is a fear that some folks might swallow the wrong number of pills for the wrong reason, especially considering misinformation and a general sense of fear across a population.
But on the plus side - what’s a more effective model than the postal service to distribute drugs or a vaccine to potentially hundreds of millions of people, many of which will probably be contagious? Vaccines carry an efficacy, which measures the likelihood of it actually working. A great vaccine can carry an efficacy of 95% or higher! Which means approximately 95 people out of a hundred will be protected from the disease. But there’s a catch! That efficacy isn’t guaranteed at the moment you get the vaccine. Sometimes it takes a little bit of time - sometimes it takes booster shots. Some vaccines will only be 40 or 50% efficacious at first and even that won’t be from the minute the needle breaks your skin. The point is, for a highly contagious disease, it’s risky to line people up for vaccines. So now you gotta set up some drive through infrastructure, maybe schedule times for folks to come in, procedures that greatly slow down the actual distribution of a vaccine. An autoinjector or nasally-administered vaccine distributed to each household through the postal service, though, that would be a big idea.
These ideas often remain nothing but big ideas.
When you sit around a table with a bunch of folks and think through these problems, you realize that there are great solutions that seem simple but probably won’t fly unless things get really bad. I remember talking through a potential scenario ten years ago, or so - the scenario had lots of casualties, not enough doctors - and I said, “We can recruit veterinarians; if you can intubate a dog you can intubate a person.” That received a ton of push back. But I do wonder, if we have massive overflow hospitals in the Fall, if anyone would care that a veterinarian was intubating a kid. They probably wouldn’t.
If things get really bad, will the government start turning hotels into hospitals? Will Uber’s infrastructure be piggybacked for picking up patients? Will the postal service deliver a vaccine to your house a few days after it’s approved?
A lot of folks would say no to these..in the planning phase. I have always said, and will now say again, “Depends on how bad it gets.”
Honestly, if our strategy is going to be, “Wait for a vaccine,” it really could get bad enough.
Anyway - short post today. Just a check in; some rambling thoughts. Truth is, I am SO BUSY right now at work. I’m also getting married this month, which adds to the busy-ness! It’s going to be a very small, immediate family only wedding (with onlookers allowed from behind the fence). Masks and social distancing mandatory. Everything outside. There’s no dancing, no reception. Bathroom cleaning rules. Single serve everything. So much signage. Plenty of hand sanitizer. But also...it’s going to be kind of great and necessary. There are some days in this COVID-driven world that feel completely mundane and hopeless. Everyone needs something. And I’m lucky that my something is a tremendous partner.
And a great editor. My future wife edits this site.
Anyway, stay safe. Wear a mask. Make good decisions. Find some hope. I’m sure my next post will be about how to throw a wedding in the time of COVID-19. I’m not in a Full On Doom mode right now. I’ll save that for October.
Finally, as a little plug, I will be on my friend Saul Colt’s Facebook Live show on Wednesday at 11AM. You can even call in with questions. So check it out - it’ll absolutely be mostly about COVID, even tough there are a lot of other things I could talk about.
These are my opinions and thoughts and analyses - I am not representing any government agency or my company. More disclaimers on the main page.