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What the US Health Care System Should Do For Covid

What COVID19 has woefully exposed is the inability of the decentralized, nonuniversal health care system of the United States to manage appropriately a deadly pandemic. There has been: inadequate availability of personal protective equipment (PPE) from the start; marginal availability to date of critical equipment such as ventilators; inadequate testing for virus; inadequate case identification, isolation and contact tracing; insufficient public health personnel to carry-out contact tracing; wild-west use of erroneous antibody testing; 50 states randomly opening up their economies with varying strategies, often based on gut instincts of medically-naive governors; 50 states bidding up, also against the federal government, the prices paid for PPEs and other essential equipment (eg:ventilators).

Beyond the tempest of fragmentation of health care, because of the consideration by some politicians in charge of the zero sum game of controlling infection vs opening of the economy, the public has been grossly misinformed by competing voices, science on one side, one political party on the other. This compounded by absurd recommendations of medications and other harmful interventions.

As it exists at present, the US health care system appears unable to respond rationally and effectively to COVID19. The obvious eventual solution is to create what all other developed nations have, which is a universal health care system, which should also include a robust public health component. Subject identification and contact tracing appears beyond what can be done now. Had we adopted a Sweden-type model, of keeping the economy open during the course of the disease (still ongoing and getting worse) we would not likely be seeing the disaster that is unfolding: in intial early high peak, plateau, and progressive increased peak, with no end in sight. Forget a second wave, it may well be we have just a progressively increasing single wave. Since none of these appropriate health care measures seem possible in the rabble-like disorder of multiple states, and politics fighting science; the only thing that would have made sense is to adopt a Sweden-type model, where the economy has remained open, but careful disease control measures undertaken. Keeping the economy open would likely have avoided the need that some politicians have felt necessary to misrepresent and downplay the importance of the public wearing masks, or social distancing.

This is what should have been done, and can still be done in the ongoing slow-moving train wreck of the COVID19 management. The economy open; social distancing in all settings; requirement of wearing masks, and the masks should be N95 masks for everyone, to both prevent the passage of infection to others, which the current US mask program aims to achieve, but also to avoid infection of the individual wearing the mask; reasonable hand-washing. Interestingly even from the very start, the medical experts did not advocate the public wearing of masks, but from the perhaps short-sighted rationale of preserving these for health care workers, but even till the present time, the masks advocated are only partially effective, even including bandanas across the lower face. This remains short-sighted, everyone should be wearing N95 type masks to prevent not only passage of infection to others, but also to prevent the wearer from getting infection. Social distancing is most crucial in indoor settings, and it is crucial to avoid spending too much time in spaces occupied by (many) others.

The one problem of the Sweden-model is that it does require a public to be thoughtful and altruistic. Perhaps it is only a transient phenomenon in the present age, but the american public appears too selfish and anti-intellectual to be able to act in such a way to protect the health of others, which somehow is also garbed in a misinterpretation of the 1st Amendment. Hopefully things will change, the answers are simple and obvious, the Sweden model success depends on a public-spirited population.

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