§ Complex in that (i) what is important varies by individual vs population considerations, and by culture (ii) in coordinating action at various levels and among regional and political entities and (iii) we cannot precisely predict resolution or know that the pandemic will be the only crisis we face—another disease may become an epidemic, and other crises may arise.

§ Rationality, multiple dimensions of covid-19, and multiple crises and issues

What is a pandemic and related definitions?

Tentative definitions to be researched:

A pandemic is a relatively rapid and widespread outbreak of a disease with significant morbidity and mortality rates and may also be socially, economically, and politically disruptive. Threat of further spreading may be known or incompletely known.

Rapidity—one season to a year.

Widespread—three of five continents, generally with multiple areas in each.

Significant rates—a significant proportion relative to the general background risk.

History

Pandemic of 1918, three waves.

Reasons to declare a pandemic

Primarily to stop the spread and to enable treatment of affected individuals. Includes development of antiviral or antibiotic agents.

Mobilize individual, local, national, and global resources—economic and restrictive measures. And to encourage development of the same.

What is a covid death, and why the question is important?

According to What counts as a COVID-19 death? | The Herald-News (theherald-news.com), if a person has covid at the time of death, it counts as a covid death, even if the person died of other causes (A). On the other hand, those who would minimize covid, insist that covid be the only cause listed in the death certificate—this would clearly result in underestimation. But what is the alternative to the overestimation, given that a true assignment of causes, when there are hundreds of thousands of cases, would be monumentally difficult. Thus, (A) is a nominal estimate.

From the individual point of view, from a family’s point of view, a death is a death.

But from the population point of view, ought we to be counting deaths? A reasonable alternative is to count fractions of lives lost. Death of a ninety-year old is a smaller fraction of lost life than death of a twenty-year old. To get the loss due to covid, there would be a further ‘fractional cause factor’. Clearly, this would be monumental to do case by case. But a population level correction may be relatively easy to estimate.

Why is the question of what is a covid death important?

§ We want realistic, not sensationalist information.

§ It is a basis of rational comparison with other causes of death, e.g. auto accidents, cancers, the flu… and all of this ought to be similarly subject to rational measure.

Reporting in the media and by authorities

Media reporting affects people’s awareness, a good thing, and anxiety, not good if it is due to sensationalist and selective reporting.

We would like (even though profit makes it unlikely)

§ Information on numbers of people, rather than celebrities and so on.

§ Certainly, reporting on the individual health damage due to covid is important.

§ Per capita data preferred to raw numbers. Comparison among regions is relevant but ought not to be sensationalized.

§ Periodic update of cases, harmful effects, death, perhaps in charts, all on a per capita basis, would be preferred to the media wall of daily covid articles.

§ Comparisons with other causes of death are relevant. Relative risk is a reasonable source of risk awareness.

§ Informational reporting on PPE, protocols, testing, and treatment.

§ Information exchange with links to authoritative sources of the latest information. Progressive and updated articles, rather than a random medley.

§ Clear release of guidelines and rationale by regional authorities. The latest guidelines ought not to be submerged in a sea of historical guidelines and news releases.

1.3.2 Values and restrictions

§ Ultimate vs immediate; we ought not to lose sight of the ultimate

§ While there are cultural values, when looking at individual values (and cultural values are often a façade for imposing an individual’s values, or charismatic values), can we impose our values on anyone—and ‘can’ is relevant for if we impose them then they are not individual, and can we choose except those who cannot choose for themselves and for whom we are responsible?

§ In lockdown, stay at home, shutting of all but essential services, some people suffer more than others. The youth suffer (i) economically, relative to older people with retirement etc (ii) more importantly, we are telling them to turn off their lives—and I, as an older and at risk person, have empathy with the youth and refuse to demand that my remaining life is more important than theirs (I, a risk taker, am not claiming to represent the silent generation, older people, boomers, or Gen X, millennials, or Gen Z).

§ Nuclear reactor and forest fire suppression analogies

§ What is a proper balance between social and other measures to prevent spread of the disease and the cost of the measures. Note that the costs on both sides are human and economic. This contrasts to a common view that one side is human and the other merely economics.

§ What are the measures? What is a rational approach to their application and later relaxation? Without rational incremental application and relaxation, there is a tendency to overcommitment and too fast or too slow implementation and relaxation and lack of public trust and cooperation. What is a good approach to worldwide monitoring for disease and early action? What are the early actions? Why the development and implementation of an program must have input from (i) public health, (ii) systems engineering, (iii) economic (delivery of essentials, access to income and resources, stability), (iv) political, (v) public education and information, (vi) the public.

§ What a covid death is—discussion above.

1.3.3 Statistics

§ Theory and practice

§ Cases, morbidity, and deaths per capita more important that totals

§ Cases etc per demographic unit, hot spots, as important as per political unit

1.3.4 Economics

§ Macro, and need for stability

§ Economics, survival, and security

§ Economics as driver of politics

1.3.5 Medicine, medical science, and technology

§ Disease

o Bacteriology

o Virology

§ Science

§ Genetic engineering

§ Vaccines

· Theory

· Development

· Testing

· Certification (the FDA in the US)

§ Other diseases for comparative base

o Pandemic

§ What it is, latency of corona virus, research into vaccines and medicines, how long do viruses last on surfaces, ways of transmission—Protocol for corona virus protection (begin with what is known about flu and pneumonia protection). Documents—symptoms for cold, allergies, strep, flu, and covid-19.docx.

§ PPE—personal protective equipment

o Development, testing

o Pharmaceuticals research, manufacturing companies

o Effectiveness

§ Individual

§ Population

o Cost, distribution

§ Prevention—above

§ Treatment

§ Hospitals, field hospitals—rapid setup

§ Medicines

§ Maintenance and life support

§ Development, testing, and distribution

1.3.6 Politics

§ Truth

§ Abuse of politics and limiting abuse

o De-politicizing strategies (see information, below)

§ Getting compliance

§ Setting policy and / or involving the population

1.3.7 Information

§ Traditional media

§ Social media

§ Data, analysis, availability, and distribution

Holism

§ Politics – economics…

1.3.8 Epidemiology

§ General epidemiology

§ “The science of a pandemic and its revisions”

§ …

§ Statistics

§ Countries

1.3.9 Civilization and society

§ Sociology

§ Social values and compliance

o Independence vs community

§ Population

o Population growth and viral spread

1.3.10 Economics, politics, vaccines, development, and distribution

Economics and time

Restrictions that curtail economics and living assume that the disease is time limited. It is therefore important that we distinguish restrictions according to cost.

§ No cost

o Masks, hygiene, social distancing

§ Some cost

o Cleaning surfaces, which seems to have minimal benefit re covid, but has offsetting benefits re other diseases

§ Cost

o Lockdown, stay at home (may be vaccine limited)