What if public health disease mitigation does not work or does not work well?

We have social distancing, physical distancing, six foot spacing, face masks, schools closed and more.

But what if these public health measures do not work or do not work well?

Many public health measures seem “intuitively obvious” but that does not mean they work in the real world, with real people.

A journal paper, co-authored by 4 epidemiologists, asked this question in 2006 – and claims many of the public health measures we are using today did not work well, or did not work at all, or have no evidence to support their use.

Who would write such a journal article? One of the co-authors is David Henderson, the doctor credited with eradicating smallpox from planet Earth.

The threat of an influenza pandemic has alarmed countries around the globe and given rise to an intense interest in disease mitigation measures. This article reviews what is known about the effectiveness and practical feasibility of a range of actions that might be taken in attempts to lessen the number of cases and deaths resulting from an influenza pandemic. The article also discusses potential adverse second- and third-order effects of mitigation actions that decision makers must take into account. Finally, the article summarizes the authors’ judgments of the likely effectiveness and likely adverse consequences of the range of disease mitigation measures and suggests priorities and practical actions to be taken.

Inglesby, T. V., Nuzzo, J.B., O’Toole, T., Henderson, D.A. (2006). “Disease Mitigation Measures in Control of Pandemic Influenza”. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Vol 4, No. 4.

https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.556.2672&rep=rep1&type=pdf

Among some of their observations:

  • School closures are only useful for the first few weeks of an epidemic
  • Isolation of sick people is effective (if provided support to do so)
  • “Forced isolation and quarantine are ineffective and impractical”, according to WHO
  • Large scale quarantine has not been used effectively in the control of any diseases in the past 50 years.
  • Travel restrictions have never worked to reduce the spread of a disease
  • Personal distancing or social distancing – seems intuitive but there is no data to support that it actually works
  • Hand washing – seems intuitive but there is no data to support that hand washing reduces the spread of the disease in the community
  • Mouth coverings – seems intuitive but there is no data to support that covering one’s mouth reduces the spread of the disease in the community.
  • Concluded that only N95 masks, when used properly, work. 

All pandemics eventually end, typically due to herd immunity or vaccines or sometimes the virus mutates to a lesser form.

States and countries that did well for a few months seem to later do badly eventually. And places that did badly, seem to do well eventually.

Most studies leave out the time dimension. I read a study saying that face masks work in the general community. It examined a selection of counties and states last spring and correlated face mask with new cases. That study neglected the time dimension: If we compare China in February to the U.S. in February, the U.S. was doing great! But wait a few months… Similarly, Hawaii is a state that supposedly did everything right – early lock downs, travel restrictions, quarantines, face masks, social distancing, the destruction of their tourism-based economy – they had everything and it seemed to be working. Until it wasn’t working. This month Hawaii had the highest R-0 of any state, for example.

Undoubtedly the views of the authors have changed since 2006 but the above is what they published in 2006, adding to the confusing messaging surrounding public health.

Update

A contemporary paper did not find support for lock downs and mandated measures in Germany.

Conclusions: The decline of infections in early March 2020 can be attributed to relatively small interventions and voluntary behavioural changes. Additional effects of later interventions cannot be detected clearly. Liberalizations of measures did not induce a re-increase of infections. Thus, the effectiveness of most German interventions remains questionable. Moreover, assessing of interventions is impeded by the estimation of true infection dates and the influence of test volume.

The Institute of Disease Modeling found that my state was receding in March prior to the Governor’s lock down order. I also saw this in the data. Her order was issued on March 23d, which was also the peak day for hospitalizations, which decreased the next day 🙂 However, hospitalizations are a lagging indicator and would not have been influenced by the shut down for another week or two – suggesting the decline was underway before the lock down order.

Another paper found many public health measures had no effect on mortality (but may have improved outcomes for patient recovery).

Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. 

Remember, I am an idiot with no expertise in any of this. Any comments related to anything in health topics are for entertainment purposes only.