Fifty States defying the Global Melting pot
Originally Published by Being Well On Medium
Amid the ongoing Coronavirus pandemic, few people would contend that the continuing global crisis has occupied the political stage. Yet, not only within the United States but also transnationally. The scene of the political showdown took a new turn when the European Union, Germany in particular, announced they are planning to open their borders to international travelers but not for U.S. residents.
The U.S. is amongst a few countries, including Brazil and a few other South American countries, that will face continued travel restrictions. The administration feels U.S. healthcare officials have failed to contain the spread of the COVID-19 virus efficiently.
The new international stance has flamed further partisan debate within the U.S. borders and has placed the media further into attack mode. Citizens question if we are receiving accurate data and information. People and politicians at the top need to be educated before pointing fingers at each other, blaming others for false information, claiming a hoax, and spreading propaganda. A better approach is to the bottom of the problem by giving some insight into common sense.
The common coronavirus disease is a once-in-a-century pandemic. But indeed is not the once-in-a-century evidence fiasco. We are living in a time with a need for quality, unbiased information now more than ever. But unfortunately, looking at both sides of the political aisle, we can hardly grasp the truthful conveyance of information and news around COVID-19 Pandemics.
The meddling of the severe 21st-century pandemic is fierce enough that even some internationally well-recognized epidemiologists are left out or banned from media admittance. We lack reliable data on how many people have been contaminated with the virus or who continue to become infected. Better information is needed to guide monumental significance determinations and efforts and monitor their impact, but even what that quality information and strategy entails is also controversial.
So far, the data dispute centers around methodology. Some argue we have to maximize the COVID-19 testing (PCR, antibody, or antigen), notwithstanding the high associated costs. Even today, the data gathered so far on the number of infected people and how the epidemic is evolving are utterly ambiguous. So far, most countries, including the U.S., experience test capacity limitations. Despite what the media says, no states have reliable data on the prevalence of the virus in an illustrative random specimen of the general population.
Every country has a peculiar set of challenges. The United States does too. Comparing the U.S. to the rest of the world starved of factoring in its particular constitutional stance and short of respecting the sovereign statehood of the constituting states is metaphorically equivalent to comparing apples and oranges.
The United States is one vast territory consisting of fifty individual states; each could be equivalent to a country on the European mainland. Therefore, comparing the U.S. proper- to a country in the European Union (E.U.) is a one-sided comparison. Nonetheless, We can reach the United States to the European Union. Then again, E.U. affiliate countries such as Germany would correspond to one state in this country, like California. To explain what I mean, I would like to refer to a recent article published by New York Times.
The world is building a wall to keep U.S. Citizens Out.
According to the recent piece published by the New York Times, among the list of nations to which Norway and the rest of Europe will soon reopen for travel are three from the region that Trump “flushed down the toilet” by calling them “Shithole Countries.” The latter include Algeria, Morocco, and Rwanda. Even though the European Union opened its door to those countries, the U.S. was still left out. The reason: the United States is nowhere close to meeting Europe’s criteria for reducing the spread of the Coronavirus.
The article points to how successfully a society can fight a pandemic. The objective measure is “national capacity,” at which America ranks near the bottom.
First, how a central government can accept the responsibility of fighting a pandemic starts by defining centralized control echoed by their constitutional setup. E.U. countries work in coordination. However, each country independently regulates who should or should not enter their country and how much control they have over their sovereign territories. The same notion applies to the states in the American system.
The author in the article is collectively associating the U.S., including States that are socioeconomically independently governed, to small countries that are highly centralized. He reflects on the immigration and centralization model state the $ 340 Billion population living in a constitutionally decentralized system. The latter melting pot metaphor is not a typical scenario for the United States, just as it may work in some other countries.
Despite the rhetorical idioms like “We are all in it together,” the reality is that we can all share data and help each other, but you can not forcefully unite communities with glue.
Cultural views and perceptions are among the environmental factors that play a significant role in controlling any crisis, similar to Coronavirus pandemics. It also helps to collect accurate data and lay down precise strategies in smaller communities vs. continentwide enforcement.
The author of the New York Times in his writing broadly compares the U.S. to Rwanda. Not appreciating that the healthcare officials in that country may indeed have success, but they did not follow the centralized approach towards the containment of pandemics- something left-wing politicians do not endorse.
The latter expands from Easing Lockdowns to Scaling Up Community-based Coronavirus Disease 2019 Screening, Testing, and Contact Tracing in Africa, Shared Approaches, Innovations, and Challenges to Minimize Morbidity and Mortality.
The ill-fated about the U.S. system is not necessarily the existence of realistic healthcare solutions. Nevertheless, it is about the pathetic partisan political difficulty that results from the bout between liberal globalists and conservative populists.
Social Distancing is a Personal Responsibility
There is no doubt keeping a reasonable distance reduces the transmission of the COVID-19 virus. Anyone who rejects such a notion lacks common sense. Nonetheless, not every community needs to take extra steps to preserve social distance, as it may not be necessary for areas where the Coronavirus is only sporadic.
Neither social distancing is one hundred percent protective, nor ignoring the required precautions at individual discretion will do us any favors. However, if an individual refuses to act responsibly, then we would give away more autonomy to the government bureaucracy over universal, large-scale collective mandates. The latter can be even extra devastating to people. Therefore if we all practice “the Golden Rule,” probably most, if not all, of the current challenges we are facing today would potentially resolve. That speaks for politicians as well.
Quarantine is a failure; not necessarily a Moral Option
The quarantine enforcement of symptomatic people coupled with the isolation of high-risk individuals to infection, such as those with diabetes and cancer, employs two commonly used epidemic control stratagems. Although “isolation” is seemingly a charming public health measure, quarantine is more controversial.
The mass quarantine can cause considerable social, psychological, and economic costs without discovering many infected patients. Some studies illustrate that the number of infections prevented per infected individual through quarantine is expected to be very feeble, given that isolation is sufficient.
Still, it rises abruptly and at an accelerating pace as the effectiveness of isolation declines. The use of quarantine is most beneficial when there is a significant asymptomatic transmission. It is also efficient if the asymptomatic period is neither very long nor very short.
Given the few but very fragile nature of the quarantine and its even more significant socioeconomic impact, strict isolation is not feasible; besides, if needed, it must be prudently applied in carefully chosen communities and cases.
Selective Stay-at-home Pandemic Orders
The notion of stay home order is complex and requires diligent and proactive efforts to evaluate the norms within the given community. Before it is implemented, it is vital to recognize that We must weigh everyone’s perception of society against the risks associated with pandemics.
The mass media must always be aware of the particular community's perception. Only then, We must tailor the option of stay home to fit their unprecedented interest.
To achieve that, besides taking into account the socioeconomic status, the community should undergo random diagnostic tests by sampling individuals in each community. The extracted data will assist public health scholars in educating the constituents and apply protocols without significantly jeopardizing the local economy.
Preparing for a pandemic forces society to face various difficult hurdles, which transcend the culmination of reduced scientific efficacy. Public health emergencies raise severe ethical issues fundamental to society’s commitment to human rights and social legitimacy. These are particular to small communities and their prevailing local customs. Public health interventions may have adverse outcomes on community financial and civic emancipations.
It is correspondingly true that individual rights are only to be sacrificed when the solution is unquestionably imminent to protect the public’s health. As such, laws must establish the criteria under local government authority, which can exercise temporary emergency controls and provide adequate due process.
We all discern that national media intends to educate people about social distancing, even though preaching in a “collective” language to an incredibly diverse population. Countries like Germany and Sweden are less likely to face challenges with applying “one-size-fits-all” solutions within their respective borders.
Nevertheless, they have less socioeconomically and ethnically diversified populations. They have successfully been able to maintain their decentralized healthcare delivery systems too. Then again, the United States is moreover large, ethnically as well diverse, and constitutionally decentralized to follow the same protocols as some of the other developed nation-states.
All said and done, Governments with the hands of the media and vice versa seem to be making decisions without the utility of reliable data.
So far, the data accumulated on how many people were affected and how the epidemic is evolving are entirely erroneous. Given limited current and seemingly poor testing strategies, some fatalities and apparently, the vast majority of infections due to COVID-19 are being unexploited. We don’t have a definitive resource for estimating the practical values of the infected population and if they are symptomatic, hospitalized, or cured. The inaccurate reporting may be off by multiples of three or 300.
Three months after the epidemic emerged, most countries, including the U.S., can still test specific populations. No countries today have reliable viral prevalence data in a demonstrative random population sample. The latter is due to governments' focus on the national average and statistics rather than local statistics. That is precisely why their efforts follow the identical path.
Notably, the media is failing the status quo by venting through its global approach. This data blunder creates tremendous ambiguity around the prospect of dying from Covid-19. Reported case-fatality measures, like the official 3.4% rate published by the World Health Organization, unnecessarily bring panic.
Patients who have been tested for COVID-19 encompass a significant portion; thus, unduly are the ones with severe symptoms and adverse outcomes. Most health systems face limited testing capability and selection bias, which will make the data even less reliable in the future.
For example, the one circumstance where an entire, closed population was tested was the “Diamond Princess cruise ship” and its quarantine travelers. There, the case mortality rate was 1.0%. Still, this was a primarily elderly population, among whom the death rate from Covid-19 is significantly higher.
Projecting the Diamond Princess fatality percentage onto the age construction of the U.S. populace, the death rate amid people diseased with Covid-19 would be even lower around, 0.125%.
But considering this assessment is based on notably insufficient data, there were only seven mortalities amid the seven hundred affected passengers and crew. The confirmed death rate could stretch from five times lower, i.e., 0.025% to five times higher, meaning 0.625%.
Considering the possibility that passengers who were affected might pass away in the future and that travelers may have different incidences of chronic diseases or comorbid conditions (a risk factor for worse outcomes with COVID-19 infection than the general population), calculating these additional sources of ambiguity, unbiased estimates for the case fatality ratio in the general U.S. population would range from 0.05% to 1%.
Wearing a Face Mask is reasonable given the Risk-Benefit Ratio
Like many other viruses, COVID-19 can penetrate through most conventional face masks or coverings apart from the N-95. Nonetheless, a simple cover, given the social distancing and frequent disinfection, lessens the transmission rate of the infectious organism.
Again- mandating the facemask is also a subject of controversy. One element is to encourage and make it an individual choice to enforce (like business environment policy) selectively. An s across the board, universal enforcement by federal administrations is another option.
The Center for disease control (CDC) advises wearing “cloth face coverings” in public environments and around people who don’t live in the immediate household, mainly when other social distancing measures are hard to sustain. The recommendation is not necessarily done to protect oneself; however, Cloth face coverings may aid in preventing transmission of the COVID-19 virus to others. Yet, this will be most effective when people in public settings widely use them.
Individual Responsibility with COVID-19
When we talk about individual responsibility, our intent is not to legitimize or even overlook the ignorance of those who fail to act sensibly.
“With every free choice, also comes some form of accountability, as no free choice comes at the expense of others. No matter how legit our selection is meant to stand.”
However, We can only enforce such accountability if the majority of the population within a community feels it is necessary to wear a facemask and stay at home. Not every community will see an act as careless, thus holding the perpetrator of such an act accountable. One clear example is while the population in Northern California strictly enforces and supported stay-at-home measures or face mask use, people in Florida protested against wearing facial coverage.
The importance of obligation to self and others has not materialized in some folks and communities. Therefore, the lack of individual responsibility in a few has led governments backed by their society to take collective action even at the state and federal levels.
Some may concede with the idea of the collective deed by administration's intervention as being fair-minded, however as history has taught us all, once the government starts meddling with individual autonomy, it will simply never stop there.
Governments often hold on to that privilege, even though it was meant to be impermanent, as they also enjoy open access for more control. For illustration, due to the 911 attack on the world trade center, the government passed the outstanding Patriot act bill. The bill was enacted to tap into communication lines to fight against domestic and international terrorism. Today, over a decade since the 911 tragedy, the patriot act is still in full effect.
Another example is the surveillance program being implemented to fight Coronavirus pandemics by most regimes, starting with China and many others. The movement is the epitome of massive-scale invasion of privacy by corporations and government entities that will allow them to utilize public data for explanations far alternate than what was intended initially.
A Community-Level Approach to COVID-19 is better than Nationwide or even Statewide.
The current statistics around COVID-19, particularly on the number of reported cases, is unreliable. The recently collected data, at best, is profoundly sketchy and nonrandom. In many regions of the world today, health authorities are still trying to triage the condition with an inadequate number of tests. Their goal in testing is to allocate scarce medical care to the patients who need it the most rather than to formulate a comprehensive dataset intended for epidemiologists and statisticians to analyze.
If we don’t account for testing models, we will make mistakes in judgment. For instance, in a country where the case count is growing because of more diagnostic testing, it might be getting its spread under control. Alternatively, in a nation-state where the reported number of new cases is declining, the circumstances could worsen. The latter discrepancies may be either because its system is too overwhelmed to perform enough testing or only. After all, it’s ramping down on testing for public relations.
Failure to accurately estimate testing tactics can also interpret comparisons between states and countries trivially. According to recent epidemiological studies, which tried to infer the correct number of infected persons from the reported deceased, there is roughly a 20-times variance in case detection rates between the countries.
Considering the spectrum of hurdles associated with accounting for the correct statistics, a community-based approach and truly randomized test sampling is the most optimal way of getting close to the actual numbers.
Unfortunately, we keep hearing in the news vis-à-vis the number of cases in the country instead of the number of cases in another without accounting for the population, distribution, and comorbid conditions. For example, 100,000 cases in 340,000,000, percent wise are different than 100,000 cases among 60,000 population. Or increase random testing may detect additional asymptomatic cases, which may significantly increase the number of positive cases, yet then again may reduce the percentage of fatalities.
Use Random Testing to get an Estimate of True Positives.
More COVID-19 testing will reveal more positive cases. However, the number of confirmed community Covid-19 cases is utilized as a rough analysis of the disease burden. Nevertheless, this estimate depends profoundly on the sampling concentration and the various test criteria used in different domains. A wide range of sources indicates that a significant fraction of cases go undetected. Guesstimates of the valid prevalence of Covid-19 can be made by blind sampling on the community. Plus, efforts to determine the true ubiquity of Covid-19 in circumstantial low-prevalence or disease-free populations can avail from sample pooling strategies. More Coronavirus definite, more asymptomatic positives do not necessarily reflect more fatalities. The percentage will probably drop.
Community Isolation vs. Stay Home
Stay home isolation during the pandemic without correct (or at least near right) estimate of incidence and prevalence of morbidity and mortality of the COVID-19 is counterproductive and frequently costly. And since it is neither feasible to test everyone, randomized community-based testing may be the best alternative. Thus, the result of community-based test estimates and analysis will derive the need for the “selective isolation” or mitigated stay-at-home mandates. Even in the latter scenario, social isolation of that community with limited travel out of the community boundaries may be a better alternative.
As mentioned earlier, again, coronavirus case counts are unimportant except given the transparency of the testing strategy.
There is no reliable study to ascertain the number of asymptotic coronavirus infection cases unless community-based antibody testing is performed parallel to the viral testing.
Realistically, we can only compare European Countries head to head with specific states in the United States proper for COVID-19 Control.
Lately, it has become the everyday media coverage that the United States is the biggest underdog of the developed countries, which is not necessarily accurate. Even if we try to overlook the legitimacy of testing strategy and rely on the numbers we currently see, the United States does not fall within the poor category.
Based on a comparative study of coronavirus fatalities in 183 countries, Belgium (a developed country in the European continent) had the most losses to COVID-19 until July 1, 2020. As of the corresponding date, the virus had disease-ridden over 10.4 million people globally. Moreover, the number of deaths had amounted to over 511,000.
Furthermore, significant differences highlight between countries when combining the number of fatalities against confirmed COVID-19 cases. The United States ranked at 388.93 mortality per one Million.
Once again, although the absolute number of deaths may be expectedly high in the United States, then still, since Belgium's population is much less than the U.S., it places the Belgian mortality rate from COVID-19 at a much higher grouping.
Of course, populations at most considerable risk of complications or mortality from COVID-19 are the elderly, folks with underlying chronic conditions, and immunocompromised people. And while the United States has a relatively average share of older adults, under such circumstances, the U.S. may face a higher COVID-19 disease load than other countries.
Data demonstrate that in the United States, workers and acute hospital bed capacity is lower than in many of the other developed countries. This implies that U.S. healthcare resources will be stretched to more remarkable than those of many other countries. Besides, a recent Commonwealth Fund analysis revealed noteworthy differences among states in terms of capacity to respond.
Despite a smaller supply of acute hospital beds, the U.S. has a lower occupancy rate, indicating the higher capacity to deal with public health emergencies. Furthermore, the U.S. seems to have a relatively higher ability to render radiography (C.T.) scans of suspected COVID-19 patients, as well as a higher quantity of intensive care beds.
So why is the world-building a wall to keep America Out?
The world has exceeded one million COVID-19 cases. The United States is accountable for the largest share, with the Centers for Disease Control and Prevention (C.D.C.) broadcasting that the United States has experienced just under 500,000 cases.
The recent data published recently on Forbes shows- the U.S. administration remained sluggish in responding to the crisis. It was also hesitant to escalate the stringency of its public policies compared to other countries in similar situations. One can’t help but reflect on the lives we might have saved; public health officials responded the way other countries did, like South Korea. Nevertheless, the statistic must be construed with caution. The study used Stringency Index as a reflection of government responsiveness to the pandemic emergency. The latter is a composite measure based on nine response indicators, including school closures, workplace closures, and travel bans rescaled to a value from 0 to 100 (100 = strictest response). The index is a reasonable method to assess government response to the pandemic. However, it does not take into account how effective these policies were executed or carried out. They neither take into account societal and cultural practices that would be protective against the spread of Coronavirus.
Once again, The ongoing coronavirus pandemics is, indeed, the once-in-a-century crisis of its kind. But it is not unbiased or devoid of political discourse. Today we need quality, un-prejudiced information, but we are not getting any. The Coronavirus crisis discussions today have turned up to be pathetically absurd because the subject of COVID-19 has become the playground for the corporate cartel and battlegrounds of political factions. It is sad to see those with no knowledge of epidemiology manipulating the minds of ordinary citizens through aggressive media campaigns while reaching reality is a straightforward strategy away. And yes, the world may be building a wall around us, but most likely not for legitimate whys and wherefores, and the U.S. is not and can’t be a Melting pot, unless and maybe some States Can!