The next pandemic : What have we learned ?

[mistermack]

I know this one is far from over, but I'm curious to see what people would do differently with the next one, what lessons we have learned from this one.

Here are my own suggestions. 

1) Move Heaven and Earth to nip it in the bud. We COULD have done it this time, with more drastic isolation procedures. Right at the start, we had a weakly transmissable virus, with low numbers of cases. A couple of weeks of truly drastic action would have wiped the virus out. In the UK, even with the virus established, with a lockdown, we reduced it from 5,000 cases per day to 398, between april and july 2020. But then they eased off, and now we have 50,000 a day with a much more transmissable variant. 

2) Reaction times to new outbreaks need to be close to instant. Time after time, complacency has meant that the virus got going, and almost impossible to control, because a couple of weeks went by before decisions were taken.

3) We have to contemplate the unthinkable. Closing down international travel, unless the two countries are clear of the pandemic. 

4) Forget human rights. Force people to isolate, locking them in if necessary, until they are truly clear of the pandemic agent. 

The point is that if these type of actions were taken at the very start, the oubreak would only last a couple of months at the very worst, and only a few thousand people would actually be affected. Surely a bitter pill at the start would be the best for everybody.

After all, the next pandemic might be far worse than this one, and this one could get much worse yet.

The fact is that this outbreak would be over in two weeks, if everybody locked down. It won't happen, but it could have at the start.

[studiot]

4 minutes ago, mistermack said:

2) Reaction times to new outbreaks need to be close to instant. Time after time, complacency has meant that the virus got going, and almost impossible to control, because a couple of weeks went by before decisions were taken.

But the decisions also have to be right when they are taken.

The UK track record here is not so good.

And not only decisions but also the right examples set.

IMHO, when he stood up yesterday to announce the new restrictions to come into effect next Tuesday, Boris should have also said,

"However I am wearing a mask right now as are the two non speakers with me, there is no need to wait a week for the regulations to become law, everyone could choose to do it right now".

 

[Peterkin]

The biggest problem I saw at the beginning -- actually, make that three problems:

-indecision - Most government were standing there with their pants down, going, "What? What?" After SARS, Ebola and West Nile, the central health agencies of Canada and the US (and I have to assume, most other countries) developed a plan of action, a set of protocols to follow, recommendations for health care personnel and facilities and a list of supplies. https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2019-45/issue-6-june-6-2019/article-3-canadian-pandemic-influenza-preparedness-public-health-strategy.html

It wasn't followed closely enough, soon enough or consistently. Governments don't like to budget money for what might not happen under their administration - so they end up spending ten times as much when it does. And when something bad does happen on their watch, they worry first about their popularity, second about the economy... and by then, people are dying, so they scramble around, doing damage control. 

- poor communication - The news of the early outbreak was kept secret by China, and when it got out of China, was kept a close secret by top security agencies... They usually say, as in the alien invasion movies: "to prevent panic." Wouldn't you rather prevent a million deaths? 

Government and health authority need to communicate better; governments need to listen better; governments need to be a lot more forthcoming with the people.

And the news media need to take responsibility for giving out correct information, coherent instruction and sound advice. If that means fact-checking government handouts and politicians' pronouncements, do that. If it means suppressing some high-profile idiot's remarks, do that.   (CBC got its act reasonably together by about the end of March, which wasn't too bad, but they couldn't help themselves reporting all the fringe crap as if it had the same value as the doctors' opinion.)

- discord - The worst example we saw, of course, was Trump v. Fauci and then Trump v. sanity, but other 'representatives of the people' also made major gaffes and bad decisions, working at cross purposes with the health advisory boards established by their very same governing bodies.

Governments and health officials need to get on the same page - with the latter in the lead, and the former following their advice, so the top doctor and the top administrator send the same message, act on the same principles and have the same objectives.

(Also, shutting vaccine laboratories because they're not profitable enough is criminally idiotic. But that's just our Conservatives.... probably.)

Edited December 9, 2021 by Peterkin

[CharonY]

A couple of thoughts regarding OP:

1) No-COVID policies seem to work, looking at New Zealand or China, for a time at least. In order to stamp out alone (i.e. without waiting for vaccine) international coordinated efforts would be necessary, which could be trick, which relates to point 3. Fundamentally we always needs some movement to keep the supply chain moving. It would be necessary to prioritize essential functions (e.g. deploying regular tests) and lock down non-essential functions. A bit issue is the time delay from rise of new disease, the first verification of the nature of the disease and the development of a clinical assay. Until that is done, spread could already be underway. Europe was warned eventually of SARS-COV-2 but until they clinically verified cases, it was already spreading for a while. 

2) I don't disagree, a bit issue is that many governments were afraid to do the wrong thing and basically did nothing for an extended time period. Countries that had better outcomes had a task force for infectious diseases in place and gave them tools and funds to actually do something. In others, leadership (speak: politicians) coordinated efforts and often diluted down recommendations by health specialists. Some countries did that and could avoid lockdowns by employing aggressive contact tracing policies. However, most Western countries ultimately failed to do so. They lacked resources and basically after a few contact points the system broke down.

3) It would require a total shutdown of travel for basically every country, not only those with reported outbreaks. This is related to the fact that we have an incomplete view of spread, especially in the early phases of a pandemic. If only affected countries are banned, then still ongoing traffic from other countries can still go on. We again observed that with this pandemic, where e.g. most travel-related cases in the US came from Europe. We also see it with the rapid spread of omicron. By the time it was identified, it already traveled around the world. And this is already with tools in place. I.e. an entirely new outbreak could have spread further and wider already. This makes it a bit difficult to assess whether travel bans for extended periods are really effective. That being said, banning non-essential travel in conjunction with mandatory isolation, contact tracing and testing seems to work well to stop further travel-related spread.

4) While it could be effective, it is obviously not feasible in a democracy. That being said, there is quite a lot of ground to cover between human rights abuse and compelling folks to take certain measures, including fines and other sanctions.

42 minutes ago, Peterkin said:

- poor communication - The news of the early outbreak was kept secret by China, and when it got out of China, was kept a close secret by top security agencies... They usually say, as in the alien invasion movies: "to prevent panic." Wouldn't you rather prevent a million deaths? 

Even before China locked down there was tons of information in press. I have no idea how that would be considered keeping it secret. Rather there was complacency in the public as e.g. SARS only caused relatively few deaths and folks assumed it would follow a similar trajectory. A couple of realizations happened later, such as the ability to spread in pre-symptomatic folks, which was a game-changer for epidemiologists but the urgency following that was barely heard by the public. OTOH if scientists were more panicky from the get-go, folks might have dismissed it, too, so a bit of a lose-lose situation.

 

42 minutes ago, Peterkin said:

Government and health authority need to communicate better; governments need to listen better; governments need to be a lot more forthcoming with the people.

The issue that my colleagues in the health authorities have is that if they are free to communicate the political leaders often water down their messages so that their response seem more effective than they are. If they are allowed to speak freely, they have repeatedly e.g. sent the message of overflowing ICUs, overworked staff and other critical issues. These then promptly get ignored by the local government, who try to spin it positively somehow or at some point even muzzle health officials. In other words, a health task force must be freed from political shackles to be effective. We have seen worldwide how politicking has critically affected health responses (probably nowhere as obvious as in Brazil or the USA).

 

42 minutes ago, Peterkin said:

And the news media need to take responsibility for giving out correct information, coherent instruction and sound advice. If that means fact-checking government handouts and politicians' pronouncements, do that. If it means suppressing some high-profile idiot's remarks, do that.   (CBC got its act reasonably together by about the end of March, which wasn't too bad, but they couldn't help themselves reporting all the fringe crap as if it had the same value as the doctors' opinion.)

But then much of the stupid spreads from social media. Even among our students taking infectious disease classes we have quite a few who are misinformed because of some stupid video they saw on youtube. This form of propaganda has proved to be deadly.

 

One of the things that has not been mentioned yet is better monitoring: we need to get a better view of new diseases and their spread. Clinical tests will only provide information after the fact. If you have one positive, you likely already have more that you did not see. We have developed or revived a number of tools (e.g. wastewater monitoring, metagenomics) but to maintain such programs costs money and effort. Usually they are shut down after a few years at most.

In addition, there is the question whether our current surveillance system (based on reporting to health authorities) is really sufficient. As mentioned before, there was some warning time in the early phases of the pandemic, yet most countries struggled to identify and report outbreaks in time. While China has deservedly received criticism for its failure to report and/or suppress evidence of a new disease, I am not entirely certain whether the reporting structures in other places would be enough to capture and report COVID-19 faster.

Preparedness. We need persons and mechanisms in place to implement pandemic measures but also maintain the ability to do so over years. If a committee is formed to select persons once the pandemic hits it is arguably too late. Countries that have done well had implemented such a task force based on SARS and have kept those groups going until this one hit. And for the most part it paid off. 

Long-term vision. There must be a long-term commitment to these plans. No one can say where the next disease will come from nor when. If we always plan to the next fiscal period or election, we risk being caught unawares again and again.

Communication has been mentioned before, but there are a few things that I want to add to which I have no real answers. A big issue is that the public wants simple messages (mask on or mask off) and feel that they understand what is going on, but do not really want to deal with the details. I.e. why mask policies change. The issue is therefore that if new findings come up or the situation changes, folks get discontent because the initial message clashes with the new ones, even if it makes perfect sense from a medical perspective. For example many struggle with the term "fully vaccinated" as most assume total immunity against infections and never have to deal with the virus again. Explaining the intricacies of boosters and waning of immune responses and so on, helps to some degree (I think we reached the majority of a given audience, especially when we can address their questions directly), but then there is always a group that uses their lack of understanding as evidence of something... sinister perhaps? I am therefore not entirely sure where the balance of dumbing down and still being accurate should be.

[Peterkin]

9 minutes ago, CharonY said:

But then much of the stupid spreads from social media. Even among our students taking infectious disease classes we have quite a few who are misinformed because of some stupid video they saw on youtube. This form of propaganda has proved to be deadly.

That's the single most important reason I think mainstream news has to re-establish its reliability, re-earn the trust of the public. Commercial broadcasting networks have been so preoccupied with sponsorship and ratings that they let hard news, solid, competent journalism slide, in favour of spectacle and sensation and partisan agendas, and cringed from saying anything unpopular or that some powerful lobby would find objectionable. People lost confidence in the 6 o'clock news and turned to the internet. We all did - but some of us are more intelligently selective of our sources than others are prejudicially selective of theirs.

But when the worst bilge is spewing out of the highest office in the land, there isn't much news media can do. And when the internet sources are manipulated by agencies from the dark side, you can't trust anybody.    

[swansont]

4 hours ago, mistermack said:

4) Forget human rights. Force people to isolate, locking them in if necessary, until they are truly clear of the pandemic agent. 

I don't think this a matter of "forgetting" human rights. Governments have to be empowered to enforce isolation or even just mask mandates, and then have the fortitude to carry out the required actions, childish public reactions be damned. 

 

edit: this requires that they listen to the scientists, even when this means updating the response in light of new information.

[TheVat]

There is always a tension inherent between democracy and government mandates.  I think it was someone like Edmund Burke who pointed out that you have to, in order for government to impose a top-down rational scheme for a public good, assume that some people are somewhat "childish" and will not voluntarily act in their own best interest or that of the community.  Philosophers like David Hume and Burke pushed back against that.  Unfortunately, Burke et al did not anticipate the sort of turbocharged mind-control and propagandistic powers of the Net, and lived in a much simpler time where events happened at a much more local level. 

Pandemics are the classic large-scale event that our normal local perceptions and moral sentiments (to use a Burkean phrase) really are not equal to, and so history shows over and over that you have to go Draconian (a word that itself derives from a famous solution to an epidemic, IIRC) and somewhat violate the usual social and political norms if you really want to save lives.  

My guess is that societies that have a cultural foundation built more on conformity will have an advantage in fighting pandemics, because public health mandates will be received with far less distress and ideological debate.  I find it ironic that the social movement in the US that most resists public health measures, and howls the loudest about their freedom, seems also to be the group that is most plagued with unthinking conformity. 

 

[CharonY]

In my earlier post I also forgot to add a biggie:

- worldwide collaboration: Some countries cannot enact measures because of their limited resources. It is critical that richer countries help out as otherwise we would create reservoirs of a given infectious disease. Stamping it out is in all our interest. Related to that, vaccines and treatments must be made affordable to everyone. Again, if only the rich countries defend themselves and let the disease rage elsewhere we have little chance to stop a pandemic. In fact, if anything this pandemic has demonstrated that an egoistic approach is ultimately harmful to us all (I would very much to have at least that as a take-home message, but I have little confidence that it will be one).

[beecee]

6 hours ago, mistermack said:

4) Forget human rights. Force people to isolate, locking them in if necessary, until they are truly clear of the pandemic agent. 

 

1 hour ago, swansont said:

I don't think this a matter of "forgetting" human rights. Governments have to be empowered to enforce isolation or even just mask mandates, and then have the fortitude to carry out the required actions, childish public reactions be damned.

I enforce those two statements in the strongest terms possible. As a great representitive of the Vulcan's put it..."the needs of the many, outweigh the needs of the few...or the one"

[swansont]

4 hours ago, TheVat said:

There is always a tension inherent between democracy and government mandates.  I think it was someone like Edmund Burke who pointed out that you have to, in order for government to impose a top-down rational scheme for a public good, assume that some people are somewhat "childish" and will not voluntarily act in their own best interest or that of the community.  Philosophers like David Hume and Burke pushed back against that.  Unfortunately, Burke et al did not anticipate the sort of turbocharged mind-control and propagandistic powers of the Net, and lived in a much simpler time where events happened at a much more local level. 

Pandemics are the classic large-scale event that our normal local perceptions and moral sentiments (to use a Burkean phrase) really are not equal to, and so history shows over and over that you have to go Draconian (a word that itself derives from a famous solution to an epidemic, IIRC) and somewhat violate the usual social and political norms if you really want to save lives.  

My guess is that societies that have a cultural foundation built more on conformity will have an advantage in fighting pandemics, because public health mandates will be received with far less distress and ideological debate.  I find it ironic that the social movement in the US that most resists public health measures, and howls the loudest about their freedom, seems also to be the group that is most plagued with unthinking conformity. 

 

The US used to mandate draft registration (still does) and military service if your number came up. Seems to me putting yourself in harm’s way in service of your country would get more pushback than efforts to protect you, but this is where we are, I guess.

[CharonY]

As Swansont mentioned, there already mechanisms in place that restrict certain liberties (e.g. freedom of movement) in place. It is just that the local and/or federal governments are unwilling to implement them.

[Phi for All]

On 12/9/2021 at 10:44 AM, swansont said:

I don't think this a matter of "forgetting" human rights. Governments have to be empowered to enforce isolation or even just mask mandates, and then have the fortitude to carry out the required actions, childish public reactions be damned.

I agree completely. This isn't about individual rights, and I think those who think protecting our population from viruses and disease is a choice they get to make individually are being obtuse. Some things need to be agreed on by everyone participating or the system won't work at all. I see little difference between "You can't make me wear a mask!" and "You can't stop me from urinating in the streets!", other than current enforcement.

[CharonY]

1 hour ago, Phi for All said:

I agree completely. This isn't about individual rights, and I think those who think protecting our population from viruses and disease is a choice they get to make individually are being obtuse. Some things need to be agreed on by everyone participating or the system won't work at all. I see little difference between "You can't make me wear a mask!" and "You can't stop me from urinating in the streets!", other than current enforcement.

Or don't drink and drive. Too many still frame public health as personal risk mitigation and do not consider their impact on others.

[CharonY]

To summarize (and re-iterate) some general thoughts on this topic:

- Surveillance and reporting has to be improved. We need a more pro-active and less reactive approach. This takes money, ongoing commitment and the development of and maintenance of expertise. Some measures, such as travel restrictions are really only helpful if surveillance can keep up. Otherwise measures will happen too late.

- Health response and messaging must not be political. It has to follow the best available science. It should be communicated to the public (repeatedly, it seems) that recommendations are bound to change. However, more information sessions should be provided within smaller groups to explain some of the intricacies of the recommendations. More often than not, folks that are properly briefed have a better chance of reaching others in their sphere of influence who are misinformed.

- Responses have to the funds for emergency measures, including beefing up ICUs, create isolation wards, beefing up staff etc. This is connected to the general health system which should be tested and improved for these situations. 

- If disaster hits, make it clear to the public that sacrifices are necessary to ensure safety. Engage and discuss reasons with the public as needed.

- Create centralized response systems, which allows coordination on a national, ideally international level.

- Assess weaknesses in supply chains and develop strategies to keep it moving if things have to be shut down.

- Don't treat infectious diseases which have high potential of spread as a local challenge. Once a pandemic becomes likely, nations have to coordinate. This includes development and distribution of vaccines as well as expertise to localize and isolate infections.

- We have to take the threat seriously before it happens. Successful containment responses (such as SARS) were often ridiculed as overblown. Folks have to learn that there is no such thing. Either it is successful, then it looks overblown, or it isn't, which leads to what we have now.

[StringJunky]

28 minutes ago, CharonY said:

To summarize (and re-iterate) some general thoughts on this topic:

- Surveillance and reporting has to be improved.

I've decided to do my bit and become a surveillance datapoint by  lateral  flow testing twice a week under NHS guidance. I report the results online. I've had two AZ's and just had a Pfizer booster. Harking to an earlier point of yours, I'm disappointed emphasis is not moving towards less vaccinated countries... rather short-sighted and collectively selfish. 

Edited December 12, 2021 by StringJunky

[CharonY]

2 hours ago, StringJunky said:

I've decided to do my bit and become a surveillance datapoint by  lateral  flow testing twice a week under NHS guidance. I report the results online. I've had two AZ's and just had a Pfizer booster. Harking to an earlier point of yours, I'm disappointed emphasis is not moving towards less vaccinated countries... rather short-sighted and collectively selfish. 

Despite some struggles, there are some aspects where UK has deployed good ideas, especially in the surveillance area. Large-scale sequencing of patient samples as well as efforts to detect otherwise unidentified infections are some of the examples, which provides us with much better data than elsewhere. Also thanks for putting in the effort. We had a meeting with folks working on that end with the NHS and they were telling us that folks sometimes do not keep it up because the reporting system (especially in the beginning) was quite annoying to handle.

 

[StringJunky]

36 minutes ago, CharonY said:

Despite some struggles, there are some aspects where UK has deployed good ideas, especially in the surveillance area. Large-scale sequencing of patient samples as well as efforts to detect otherwise unidentified infections are some of the examples, which provides us with much better data than elsewhere. Also thanks for putting in the effort. We had a meeting with folks working on that end with the NHS and they were telling us that folks sometimes do not keep it up because the reporting system (especially in the beginning) was quite annoying to handle.

 

It's a bit of a rigmarole in the beginning on PC, but I bet it's worse doing it on the mobile. I'm not surprised at the teething issues because this is the first time 99+% of those alive now  have been in a global medical emergency.  The real world logistics for delivering treatment and containment at this scale have yet to be learned, I think.  I will say that I might be less willing to do this in a country with a decentralized private health system, like the US. I still value my medical privacy, and don't think I would be so trusting that it won't be exploited for profit in some way. I hold the concept of the NHS in pretty high esteem, even with the problems it has.

Edited December 13, 2021 by StringJunky

[koti]

I think we’ve learned 3 main things,

1. We simply can’t manage to deal with a global pandemic through existing mechanisms.
2. There is a significant amount of complete morons inhabiting our planet and without throwing democracy out the window there is no way of dealing with the pandemic.

3. Too late for education, we have to bribe or tax the sceptics and send the morons to islands.

I’ve had my Moderna booster shot 2 weeks ago after prior 2 doses of Pfizer. I’ve had Covid exactly a year ago with a fairly moderate course, a bacterial infection in Nigeria years back was far more taxing for me. I’m not even scared any more, just waiting for next week when we can vaccinate our almost 6 year old.

Edited December 13, 2021 by koti

[CharonY]

5 minutes ago, koti said:

2. There is a significant amount of complete morons inhabiting out planet and without throwing democracy out the window there is no way of dealing with the pandemic.

Except of course sometimes the morons are those in power and if they are allowed to throw democracy out of the window they can effectively neuter health responses. 

13 minutes ago, StringJunky said:

I will say that I might be less willing to do this in a country with a decentralized private health system, like the US. I still value my medical privacy, and don't think I would be so trusting that it won't be exploited for profit in some way.

That is a fair point and I think that again goes toward the idea of centralized efforts rather than local or even business-led efforts.

 

[StringJunky]

6 minutes ago, CharonY said:

Except of course sometimes the morons are those in power and if they are allowed to throw democracy out of the window they can effectively neuter health responses. 

That is a fair point and I think that again goes toward the idea of centralized efforts rather than local or even business-led efforts.

 

Does a decentralized health system hamper NIH's ability to collate timely live data compared to what the NHS has available?

[koti]

23 minutes ago, CharonY said:

Except of course sometimes the morons are those in power and if they are allowed to throw democracy out of the window they can effectively neuter health responses.

 

I think power has largely shifted from polititians to social media influencers, at least in the pandemic/vaccine context. In my opinion this should be the primary objective in dealing with the pandemic crisis.

Edited December 13, 2021 by koti

[Ken Fabian]

Whilst nations that can afford it work hard at vaccination of their own populations they appear reluctant to support global vaccination efforts in a big way - not at the scales necessary. New variants are one of the consequences of that parochialism.

And whilst developers of vaccines deserve and require a financial return I don't think we can afford ordinary patent rights having precedence over maximising production and distribution; government involvement and support for those R&D efforts has been substantial but could be structured differently to assure the developers recoup or are subsidised for costs without making independent manufacture under license expensive and difficult. Cynically, it seems to be in the interests of Big Pharma to widely distribute such vaccines even with minimal profit - more people who survive Covid will be more ongoing customers for their other drugs - which can be a lot more profitable.

[CharonY]

1 hour ago, koti said:

I think power has largely shifted from polititians to social media influencers, at least in the pandemic/vaccine context. In my opinion this should be the primary objective in dealing with the pandemic crisis.

Well, there is quite some truth to it, though the issue is that the politicians themselves are in many parts of the world propagating the issue. Moreover, there is political efforts to actively diminishing public health measures, as we have seen in the US for example.

 

1 hour ago, Ken Fabian said:

Cynically, it seems to be in the interests of Big Pharma to widely distribute such vaccines even with minimal profit - more people who survive Covid will be more ongoing customers for their other drugs - which can be a lot more profitable.

Well, they obviously do not see it that way. Many corporations are rather short-sighted when it comes to profits. Or perhaps they actually did the calculation and the current strategy is turning up a bigger profit. Who knows, but clearly public health is not at the forefront of these considerations.

1 hour ago, StringJunky said:

Does a decentralized health system hamper NIH's ability to collate timely live data compared to what the NHS has available?

I think in the US the CDC is collecting data. The issue here is that each state has a different ways to count and report (and there is some evidence of suppression) so whatever ends up at the CDC can be hard to compare. This ranges from seemingly simple issues as dates, for example. Different dates could be used for regional reports, such as when the patient sample was taken, or when it was actually tested or when it was reported. Then we have different testing rules. In some areas everyone can get tested, others only test symptomatic folks. Some collect vaccination status of patients, others don't. I am not actually sure whether the NHS has similar challenges (did not think to ask that, though there are different data streams. I.e. for example the data set for clinical tests and the one for surveillance with volunteers. I do not think that they can be cross-referenced as participants and patients are anonymized. Canada has similar challenges with the different provincial health systems. 

[StringJunky]

1 hour ago, CharonY said:

Well, there is quite some truth to it, though the issue is that the politicians themselves are in many parts of the world propagating the issue. Moreover, there is political efforts to actively diminishing public health measures, as we have seen in the US for example.

 

Well, they obviously do not see it that way. Many corporations are rather short-sighted when it comes to profits. Or perhaps they actually did the calculation and the current strategy is turning up a bigger profit. Who knows, but clearly public health is not at the forefront of these considerations.

I think in the US the CDC is collecting data. The issue here is that each state has a different ways to count and report (and there is some evidence of suppression) so whatever ends up at the CDC can be hard to compare. This ranges from seemingly simple issues as dates, for example. Different dates could be used for regional reports, such as when the patient sample was taken, or when it was actually tested or when it was reported. Then we have different testing rules. In some areas everyone can get tested, others only test symptomatic folks. Some collect vaccination status of patients, others don't. I am not actually sure whether the NHS has similar challenges (did not think to ask that, though there are different data streams. I.e. for example the data set for clinical tests and the one for surveillance with volunteers. I do not think that they can be cross-referenced as participants and patients are anonymized. Canada has similar challenges with the different provincial health systems. 

Right, ok. 

[zapatos]

On 12/9/2021 at 7:20 AM, mistermack said:

4) Forget human rights. Force people to isolate, locking them in if necessary, until they are truly clear of the pandemic agent. 

 

Looks like I might be in the minority in this thread but I couldn't disagree with this one strongly enough. I'd rather get COVID and join the (ugh) Republican Party than be part of forgetting human rights and locking people up.