Optimal public health

This contains rush transcripts and may not be in final form. Some non-grammatical forms were edited to conform more with the apparent intent than the exact verbiage, and links and notes have been added. Anyone finding errors or confusing statements is invited to correct them here or raise them in the accompanying "Discuss" page or add updates in notes and / or subsequent sections.

This article consists of a 25-second audio file and two videos on "Vaccination is a civic duty to others" and "Optimal public health". The audio is copyleft 2021 CC0 -- public domain -- to encourage others to redistribute, plagiarize, modify this message in any way to maximize its distribution. Doing so could help protect people you love. Audio extracts from the two videos aired 2021-07-06 and 2020-09-29, respectively on Radio Active Magazine on KKFI, Kansas City Community Radio.

The following is a transcript of the accompanying video of Doug Samuelson^[1] being interviewed 2021-07-03 by Spencer Graves^[2] on "The race between vaccination and mutation. Excerpts from this interview were broadcasted 2021-07-06 as part of Radio Active Magazine^[3] on KKFI, Kansas City Community Radio.

Doug Samuelson  00:00

The news about COVID is not all good. We are in a race between vaccination and mutation. Every new person infected is another opportunity for the virus to mutate to a form that's more contagious, more dangerous and resistant to existing vaccines. Everyone who can safely take the vaccine has a civic responsibility to protect not only themselves but also their family and their neighbors, and people they don't even know by getting vaccinated. I'm Doug Samuelson.

Spencer Graves  00:34

Dr. Doug Samuelson holds a doctorate in Operations Research and is first vice chair of the advisory board of the Health Systems Agency of Northern Virginia.^[4] Can you please elaborate on that, Dr. Samuelson?

Doug Samuelson  00:49

Well, the first thing I should say is that anything I say today represents only my own views, and is not in any way shape or form reflective of the opinion of the Health Systems Agency's Advisory Board of Northern Virginia, for which I have been quietly and steadily trying to do some modeling of whether the next wave is going to overflow our ICUs. Because this is really the the question that we're dealing with now: It's "Do we have waves of disease that will overflow certain facilities and make matters worse," because some people die, either of COVID or of other ailments because they can't get treated?

Spencer Graves  01:39

I was reading in March a report that two thirds of epidemiologists who were surveyed, thought that we had a year or less before the virus mutates to the extent that the majority of first generation vaccines are rendered ineffective, and new or modified vaccines are required.^[5] The mutation rate is proportional to the number of people who get the disease. Am I correct about that?^[6]

Doug Samuelson  02:12

Well, first of all, I don't know. And I don't think anyone else does, how quickly this virus might mutate and to what extent it might get away from current immunization from current vaccines. We also don't know -- vaccines have a way of wearing off. Aside from mutation, they just lose effectiveness over time.

Doug Samuelson  02:36

And given that, in particular, the Pfizer and Moderna are a different technology from what's been done before, we haven't had enough time to see what that does, to see how fast it might wear off. When you've had something out there in the population for six months, you don't know. You have no way of knowing whether it's going to last a year, two years, five years. We can be reasonably confident now that it lasts a few months.^[7]

Doug Samuelson  03:06

But that's all we know. The way I would bet, as somebody involved in public health, is that we're going to need another round of vaccination in about a year. And that's what I would be preparing for.

Spencer Graves  03:18

That's very interesting. So I've done some research, found some stuff, talking about the smallpox eradication program that cost $300 million over 13 years, that was less than a quarter of the Global Burden of Disease.^[8] And everybody benefits from that today. Do you have comments on that?

Doug Samuelson  03:53

Probably the last 20 million of that 300 million was spent tracking down people in rural areas who didn't even know about smallpox, didn't know about vaccination, and convincing them if we vaccinate you, that will help to protect you and a whole bunch of other people you don't know. And it's good for the world.

Doug Samuelson  04:16

We've got to get the reservoir extinguished all over worldwide to beat this disease. Having little pockets of it here and there of people who think, "I'm in an isolated place. I'm not going to be exposed. I don't have to vaccinate," is a good way to provide breeding grounds for the next mutated version, which will then spread. That's why we don't want to stop at 70%.

Spencer Graves  04:43

That's not just an argument for vaccinating smallpox. It's an argument for aggressive promotion of vaccination for the current pandemic and for other things like polio.

Doug Samuelson  04:58

And we want people to get used to the idea that you can't have little pockets and seem relatively safe and leave them alone and be safe. If we're going to eradicate it, we have to eradicate it.

Spencer Graves  05:14

Right.

Doug Samuelson  05:15

The other thing that worries me a lot right now -- we've sort of woken up to COVID is not just bad flu, and we really need to react to it as a public health urgent matter, and we are. What I worry about is that the United States of America has a tendency to focus on the current crisis and throw all its resources at it, and stomp the living daylights out of the current crisis, often in wasteful ways. And ignore everything else.

Doug Samuelson  05:43

I'm worried about right now is that we get blindsided by the next epidemic, because we're so focused on this one.

Spencer Graves  05:51

Yes. I heard you say something the other day in preparation for this conversation about

Doug Samuelson  06:04

Uh-Oh.

Spencer Graves  06:04

whom we should prioritize to get a vaccine?

Doug Samuelson  06:09

Yes. One of the things we have done in this country that I am not happy about is that once we started getting adequate supplies of vaccine, let's go vaccinate all the people we consider most vulnerable. That has been US policy on this.

Doug Samuelson  06:26

It would be more effective, according to some epidemiologists I've talked with, and it just makes intuitive sense if you think about it, to prioritize the people who are most likely to spread it.

Doug Samuelson  06:38

Socially isolate the nursing home, and go down and vaccinate all those people at the beach party in Florida: You probably get more bang for the buck that way.

Spencer Graves  06:48

Right.

Doug Samuelson  06:49

If they'll take the vaccine, which is the other big "if".

Spencer Graves  06:52

Right. So beyond vaccinations, you've said that we need to get better at monitoring public health internationally for other risks to public health.

Doug Samuelson  07:04

Absolutely.

Spencer Graves  07:04

Would you care to elaborate on that?

Doug Samuelson  07:06

Well, most of what I've said about how to manage this as a public health risk reflects the finding of a report by the Scowcroft Institute at Texas A&M in early 2019 -- about a 60 page report, which I am terribly upset with them to say you can't print. You've got to go find it online and read it online, because you can't just get yourself a copy.^[9]

Doug Samuelson  07:39

But what they said in there -- I've read it several times, and I think I got most of it -- was that the International monitoring network that got set up ironically, starting in 2005 by George W. Bush. The Scowcroft Institute was the brainchild of Brent Scowcroft, who had been in George H. W. Bush's cabinet. So there is a big Bush family influence behind that nonpartisan, non-advocacy Institute.

Spencer Graves  08:14

Research Institute.

Doug Samuelson  08:16

It's a Research Institute, yeah. And George W. Bush certainly got on that bandwagon in the middle aughts -- after Katrina, actually.

Doug Samuelson  08:16

The story goes on he went off somewhere to do some reading. Read John Barry's book on The Great Influenza and Laurie Garrett's book on The Coming Plague^[10] and said, "Hey, wait a minute: We've got a problem here, we need to think about and really put a push behind a lot of preventive health measures.

Doug Samuelson  08:41

That's where we got this network of, I think it was, 47 International places, mostly in developing countries, poor places, because what Scowcroft Institute said was, go to the places where public health is poor, and people are more exposed to toxic waste, to wild animals, to all the kinds of things it can jump from. Go there and get it there and stomp on it there.

Doug Samuelson  09:09

And it's good for the world. Because you don't get it popping out of someplace and going other places like Ebola. That was a success story, because we figured out right away where it was breaking out. And it didn't get very far. We sent teams to deal with it there. And we put some measures in place that it wouldn't spread very far.

Doug Samuelson  09:21

This is the way you do it. In 2003 the original SARS broke out in Asia. A few cases were observed in Toronto, and the World Health Organization quarantined Toronto over the vehement objections of Toronto and Canada. "This is overkill. This is way too much. You're killing the economy of our biggest city."

Doug Samuelson  09:37

But it stopped it. SARS never made it into North America in 2003. And that's why.

Doug Samuelson  10:05

When you have effective, somewhat drastic action early, overall you don't have as much economic impact. You just stomp on it quick, and then do a few things to keep it contained.

Doug Samuelson  10:21

A friend of mine, actually, son of one of my best friends, has been living for the last several years in Vietnam and sent out a post not too long ago on Facebook to me and a lot of other people. "This is a country of 98 million people. So far, the Vietnam has had 75 confirmed fatalities from COVID." This is what you can do when you respond effectively.

Doug Samuelson  10:49

And that's not unique. By the way New Zealand had a similar experience. Singapore did. Some of the others, somewhat larger but still relatively small in Asian terms. South Korea and Japan are not small countries.

Doug Samuelson  11:07

But most of the Asian countries had pretty good response. It's not a question of political system. It's a question of a culture and a government where if the government tells you you need to do X, Y, and Z, everybody, you need to do X, Y and Z for the common good, they tend to do it. And the government's have a record of being right about those recommendations, which builds up confidence in, "Yeah, I'm going to go along with the next one. They were right the last time."

Doug Samuelson  11:07

And that's how it works. And that's what Scowcroft Institute said. It ain't rocket science.

Spencer Graves  11:13

Right. Interesting.

Doug Samuelson  11:28

And one of my big disappointments in the Biden administration, which has come in with the avowed intent of undoing all the mistakes of its predecessor, I haven't seen yet the initiative to reestablish that monitoring network. There were 47 of these places. And the Trump administration cut something like 37 of them, cut the funding. And where it was possible to withdraw US resources and support, they did. The rationale the president gave at the time was, I'm a businessman. And in business, it's wasteful to retain excess capacity. You run lean, and if you need something, you go buy it. Which if you're in the construction business, it probably works pretty well. If you're in the emergency response business, that doesn't work very well, because I guess he never noticed that whatever neighborhood he lived, they always had enough fire engines. If something caught fire, they didn't have to worry about how quickly they could go buy a fire engine. I don't think that logic quite seeped in there.

Spencer Graves  12:51

Right. There's a subterranean message here that every new person infected is a new opportunity for the virus to mutate to a form that is more contagious, more deadly and more resistant to the current vaccines.

Doug Samuelson  13:11

Absolutely.

Spencer Graves  13:12

And that's true even if the infected person is asymptomatic?

Doug Samuelson  13:18

Asymptomatic and infectious are two different things. And even if they're neither asymptomatic nor infectious, if they've got enough of a reservoir of that virus, that it can be mutating. It's still an issue. Now, if they're mutating that virus, and they never become infectious, we don't care.

Spencer Graves  13:37

Right. So the Pfizer and Moderna vaccines are rated at, what, 90% effectiveness. That means that if 30% of unvaccinated people get the disease in a certain group or whatever, then 3% of the vaccinated people with the same behaviors will get it. Is that accurate?

Doug Samuelson  13:59

That's a bunch of extrapolations that includes some assumptions I wouldn't make. First of all, you're assuming that if Pfizer and Moderna are 90% effective, they remain 90% effective.

Spencer Graves  14:12

Okay,

Doug Samuelson  14:13

for a long time. We don't know that.

Doug Samuelson  14:13

We also don't know how effective they would be against a new strain. And you can't assume that the people it wasn't effective with will be the only ones significantly affected by a new strain. The model to keep in mind is swarm warfare. We've got this fortress, and the bad guys are trying to penetrate it any way they can. They simply try everything. And if something works, you're going to see more of it.

Spencer Graves  14:15

Right.

Doug Samuelson  14:54

That's the battle we are in against infectious organisms. And for about 80 years there, we lived in this fool's paradise where everything that came along, we were going to be able to develop an effective response and kill it. And the enemy has figured out what we are likely to be able to do and is trying everything else.

Spencer Graves  15:15

Right. And we were talking previously about people who are not getting vaccinated, apparently, for political reasons. And you quoted me a line from a song called "Vincent" by Don McLean.

Doug Samuelson  15:31

[laughing] Yeah, well, it's not just the people not getting vaccinated for political reasons. It's all the people somehow involved in this, who simply can't update their thinking to reflect new information. A recurring line in that song is, "They would not listen. They did not know how. Perhaps they'll listen now." And I'm looking at current US public health and going to the last line, which was, "They would not listen. They're not listening still. Perhaps they never will."^[11]

Doug Samuelson  16:18

A real upbeat note to go on, but that's where I'm afraid we are.

Spencer Graves  16:18

Okay.

Spencer Graves  16:19

I think that's where we need to need to go and we need to end this discussion now with admonishing our listeners to please listen to Dr. Samuelson: If you are not vaccinated, please do to protect others, even if you don't care about yourself. If you are vaccinated, please share, explain this to other people that we all have a civic duty to get vaccinated

Doug Samuelson  16:55

and to observe other public health measures.

Doug Samuelson  16:58

I don't want to end on such a gloomy note. So how about the typical closing line of the sergeant's speech in Hill Street Blues, "Let's be careful out there."

A transcript of the interview 2020-09-29 on "Optimal Public Health" appears next. In it, Spencer Graves^[12] interviews Professor Edward Ellerbeck, Chair of the Department of Preventive Medicine and Public Health at the University of Kansas Medical Center,^[13] and Dr. Doug Samuelson, President and Chief Scientist at Infologix, Incorporated, an R&D and consulting firm in Annandale, Virginia,^[1] for Radio Active Magazine on 90.1 FM, KKFI, Kansas City Community Radio, 2020-09-29. The conversation ran for 36 minutes, but only the first 28 minutes were broadcasted.

Spencer Graves  00:03

Okay, we're getting closer

Bill Clause  00:04

This is Radio Active Magazine,^[14] a KKFI public affairs program of activism, opinion and commentary. The opinions expressed on this program are those speakers alone and are not necessarily the views of KKFI, its staff, volunteers, Board of Directors show hosts, or other guests on the program.

Craig Lubow  00:30

OK. This is Craig Lubow and thank you for joining us here on radio active magazine. You are listening to 90.1 FM, KKFI, Kansas City Community Radio. And now we will go to Spencer Graves.^[12]

Spencer Graves  00:49

Welcome to Radio Active Magazine for September 29. I'm Spencer Graves.

Spencer Graves  01:03

This evening we will discuss "optimal public health" with Professor Edward Ellerbeck, Chair of the Department of Preventive Medicine and Public Health at the University of Kansas Medical Center,^[13] and Dr. Doug Samuelson, President and Chief Scientist at Infologix, Incorporated, an R&D and consulting firm in Annandale, Virginia.^[1] Samuelson is also first vice chair of the advisory board of the Health Systems Agency of Northern Virginia^[15] and author of multiple articles since at least 2008 on preparing for biological crises like the current one.^[16]

Spencer Graves  01:39

How are we doing, Craig? We're doing okay? Good. [Craig, running KKFI's sound board, nods indicating, "Yes."]

Spencer Graves  01:43

So, Professor Ellerbeck, why don't you explain a bit more than my excessively brief bio, and tell our audience what you think are the most important things about the current pandemic, that may not have received adequate attention in the mainstream media so far?

Edward Ellerbeck  02:05

Great, Dr. Graves, thanks so much for having me join you this evening. Really delighted to be here with you virtually.

Edward Ellerbeck  02:12

So this pandemic has gotten a incredible amount of media coverage. But there still are some big gaps in what we've been talking about. I think one of the big gaps that I've seen is that we haven't covered a lot about the results of the testing process and the contact tracing. There's lots of differences between just getting tested and then following up with people after they've gotten tested. And then identifying who their contacts are and getting those individuals in isolation, so we can actually mitigate the pandemic. And a lot of that information really hasn't hit the mainstream about how well we're doing in that process.

Edward Ellerbeck  03:03

I think I actually forgot to introduce myself, though. So I'm Ed Ellerbeck. I'm a general internist at the University of Kansas Health Center. Still see adult patients and also work in the cancer center on cancer prevention and control activities and also in primary care preventive services. We also do a lot of teaching related to public health education here at the Medical Center.

Spencer Graves  03:29

Wonderful. Dr. Samuelson?

Doug Samuelson  03:32

Hi, I'm Doug Samuelson. How's my sound, by the way? We didn't do a sound check.

Spencer Graves  03:35

Wonderful. I think it's wonderful. How's the sound? [Craig Lubow, sound engineer, indicates its OK.] It's fine. Thank you.

Doug Samuelson  03:40

I'm Doug Samuelson. I have a doctorate in operations research, which means that I'm not a medical doctor. But I am a certified high powered, long term experienced number cruncher. And one of the things I've been doing analysis on for many, many years, as my bio indicates, is emergency preparedness, emergency response, some of the things we could do better to be more effective and more responsive to crises.

Doug Samuelson  04:12

I've it's kind of like we Jews just celebrated Yom Kippur. And there are all kinds of credentials a person can get to be a cantor, the singing leader of a Jewish service. But the fact of the matter is, if a person wants to get hired as a cancer, what's going to happen is they'll look through all the credentials. They'll call him in for an interview. "Okay. Let's hear you sing Kol Nidre." If you can't sing it, you're not hired. If you can sing it, you don't need the credentials.

Doug Samuelson  04:48

So I'm a guy who can sing it but doesn't have the credentials as far as public health is concerned. I've been studying this for a long time. I've been tracking a lot of stuff and I think I can convince you that I know what I'm talking about.

Doug Samuelson  05:01

The first thing I'm going to tell you is in case you haven't noticed, the information we have on which to base any kinds of public policy decisions, any kinds of assessment of how we're doing any kinds of guidance about what we ought to be doing, that information is terrible. We simply have no clue.

Doug Samuelson  05:20

And I'll give you one really prominent example. In the middle of August, there was an eight day motorcycle riding conclave in Sturgis. Estimated 450,000 people got together there and rode motorcycles out on the open road and had a grand old time. And every night they were together in bars and restaurants. One night they had a big old concert, where they were crammed shoulder to shoulder. Nope, no distancing, no masks.

Doug Samuelson  05:49

So, question: How many people got sick? How many people got COVID-19? Because of that event, if you go out and scan the net, you will find plenty of answers. You will find some people who say, "Well, we can confirm 700 cases of people who seem to have been infected as a result of going to Sturgis." There is also an article that's got wide circulation from four university professors out on the west coast:^[17] "We're estimating 267,000 infected."^[18]

Doug Samuelson  06:23

Now, do you need a half dozen graduate courses in statistics to know that a number that's somewhere between 700 and 267,000 is not really a very good number, and not one that you can rely on to conclude much about anything? That's where we are.

Spencer Graves  06:44

Wow, that's a major indictment to the current process. So what do we need to do to fix the gaps that you've just described, Professor Samuelson?

Doug Samuelson  06:58

Long term, we might want to pull a few people over from the sports page and the financial pages to the general news section to talk about health, because those are the people who can count with past 10 with their shoes on. The sports pages and the financial pages are the places were the people with any number ability go.

Spencer Graves  07:15

Well, but isn't there something more than just the coverage in the news? I mean, is there not substance that they're not reporting on?  Or the substance is not being collected?

Doug Samuelson  07:28

I don't know how much of a problem we have with too little being reported. I think we have a huge problem with too much misinformation being reported and in some cases, deliberate disinformation, that makes it very hard for not only the average citizen, but actually if somebody like me who's trying to help a public health board, figure out how much trouble we're in. What numbers can I rely on? What can I actually say about whether certain trends are going up or down, whether certain kinds of events are really harmful or not?

Doug Samuelson  08:02

I think I will probably cycle back at some point here to the Scowcroft Institute report, which was cited in the background materials for this. The Scowcroft Institute for Public Policy at Texas A&M University^[19] did a major comprehensive report on public health preparedness in November of 2019.^[9]

Spencer Graves  08:23

I think it was May of 219.

Doug Samuelson  08:25

I think the nuclear threat initiative thing was November, Scowcroft was May of '19. You're right. And what they said was a very heavy emphasis on information shortfalls, shortfalls of cooperation, breakdown of trust among professionals in different places, especially different countries, about what can we believe from what these other folks are saying? That has been a huge contributor and would be -- they said "would be" a huge contributor to a problem if we had a big event. And I think we're seeing that play out.

Spencer Graves  09:09

Dr. Ellerbeck, would you would you care to comment?

Edward Ellerbeck  09:12

I actually agree that we have some serious problems with information, developing reliable information and in the gap of that reliable information. We get lots of rumors and innuendo and misinformation. So we clearly need reliable sources that we can trust.

Edward Ellerbeck  09:35

Do you think the information is not being collected? Or it's being collected, but it's not being released?

Edward Ellerbeck  09:43

I think in the example of Sturgis, I think capturing that information can be difficult.

Edward Ellerbeck  09:51

But an underlying problem is the lack of interactive information systems. So each of our pieces of data lives in its own repository. So every state collects their own data. It's processed within each separate County. And that information isn't necessarily integrated with our electronic health records.

Edward Ellerbeck  10:11

We don't really have a functioning integrated health system, integrated with our public health system.

Spencer Graves  10:20

By the way, for our listeners, the May report that Dr. Samuelson mentioned: a link to that is provided [here and] on the description of this episode of Radio Active Magazine at KKFI.org.^[20] And, Dr. Samuelson, if there's another thing that I've missed, I can add that later.

Doug Samuelson  10:47

Well, the annoying thing about the Scowcroft Institute report^[9] is that you can only read it online. When last I checked, there was no way you could download it or get it in print, anything other than just reading it online. It's like 60 pages long. So this is a bit of an endeavor.

Doug Samuelson  11:08

I summarized some of the major points in an article for the Global Peace Services Newsletter,^[16] which I think we also cited. That was June of 2020. In four pages, five pages, I couldn't do justice to a 60 page report, plus some additional information. But at least I could make the main point, that breakdown of cooperation, the breakdown of collaborative preventive measures, and the breakdown of good, reliable public information was trouble waiting for a place to happen. And I think we found the place.

Spencer Graves  11:45

And by the way, for our listeners, if you go to Radio Active Magazine on KKFI.org, the description of this episode does contain a link to the Dr. Samuelson's June 2020 article that he just mentioned.^[20]

Spencer Graves  12:02

So what do we need to do? What do you suggest we do to fix the problem?

Doug Samuelson  12:13

Well, all of us, we citizens, have to be, I think, more insistant on good information. There's a lot we have to learn about how to recognize what we see on the Internet. What we see in even fairly established news media needs to be questioned. Were there two sources? Were they good sources? Is somebody speculating because he's filling air time, or space, because he doesn't know? If you compare alternative sources for a while, you think about it a bit, you track reliability over time, you kind of get a feel. And you can push back at whatever media you're interacting with. "Come on, tell me more. Tell me why I should believe that."

Doug Samuelson  13:04

There's only so much you can do. We treated, in particular, news media airtime as a public good. You had to have a license to be in there. There were requirements you had to meet. There were all kinds of fairness and reliability tests applied to what you did and called news. That's a public good.

Doug Samuelson  13:39

And then we argue from time to time about the virtues of free markets. We all love free markets, and everybody wants freer markets. But free markets don't work, except within a regulatory structure that assures fairness and prevents a thugocuracy. We have a completely free market, and I'm making a lot of money, and you decide you don't like that, you can hire thugs to take my money. And that means that I have to hire thugs to keep you from doing that. And then we have to worry about whether I hire enough folks that I can go take your money.

Doug Samuelson  14:16

Only within a regulatory framework do the benefits of the free market really accrue. And what you sometimes don't realize is which things are public goods. Public health is a public good. A well functioning integrated health system with reliable transmissible medical records is a public good. And a public information structure that keeps people reliably informed about what's going on and what they might need to do is a public good.

Doug Samuelson  14:49

You wouldn't think about operating a major city down on the Gulf without having a structure somebody can activate, "Here are the alerts going out to the radio stations in the TV." And they're going to broadcast them exactly the way that we send them, because people have to know what's coming and which way they need to flee. That's a public good. We do it for hurricanes. We don't do it for epidemics. We should.

Spencer Graves  15:16

Great.

Edward Ellerbeck  15:17

And Dr. Samuelson, don't you think that reflects some of our chronic underinvestment in public health? And then you also talked about the need for the media to be vigilant and, and, and function as a public good. To the extent that we actually are under investing now in our local media that can actually do the investigative reporting that can help us delineate the truth, that becomes another threat to maintaining our public health.

Doug Samuelson  15:47

Now, that may be getting very close to the kind of call for action we were told not to engage in in this program, since it's a call for action to support KKFI. But, yes,

Spencer Graves  15:57

I'm actually doing a program this Saturday on the Local Journalism Sustainability Act. It's going to be rebroadcasted a week from this Thursday as the Thursday Night Special on KKFI.org.^[21]

Spencer Graves  16:46

So you're saying you think that we ought to be pressing more on the media than on the politicians to make sure that we get the proper information?

Doug Samuelson  17:02

No. I think it was more the question you asked, "What's being neglected?" We're not holding the media enough to account. The politicians are primarily responsible for the failures to respond effectively, for dismantling of preventive and detecting measures that were originally put in place by the George W. Bush administration and expanded under Obama.

Spencer Graves  17:27

Right.

Doug Samuelson  17:27

There are a lot of things we could be doing to monitor better, to alert better, to cooperate better. And those are all political. That's not media. That's political.^[22]

Doug Samuelson  17:37

We could be doing a much better job of contact tracing. We get test results. But we don't tie the test results back to events or push them forward to, "Now who else did these people come in contact with?" With Sturgis, for example, those two professors in California, were relying on a study by one of the cell phone companies. They could tell which cell phones had been in Sturgis during that week and where they then went. This is how we have a number of how many people are capable of transmitting if they were infected.

Doug Samuelson  18:15

In other countries, the cell phone data would be something the government could grab hold of, and follow up contacting all of those people. Where were you? Were you exposed? We want to test you now. Who else have you exposed since you got back?

Doug Samuelson  18:31

We would run into fantastic constitutionality objections from our populace for doing that. But, you know, there are times when the public good has to override individual freedom. That's an absolutely blasphemous thought in the United States of America. But we're facing consequences of not recognizing that there were times when the public good overrides.

Spencer Graves  18:59

Agreed.

Spencer Graves  19:02

So talk to us about the the history of other public health crises from the Black Death of the 14th century to the AIDS crisis of the 1980s. We had some a brief interaction in preparing for this discussion.

Edward Ellerbeck  19:25

So in the show notes that you had --

Edward Ellerbeck  19:28

Sorry, Dr. Samuelson, go ahead.

Doug Samuelson  19:30

You want to take that one?

Edward Ellerbeck  19:32

Well, I can just start that I do more recent history. So in in thinking about some of the responses to this epidemic. I went back to reread And the Band Played On.^[23] I think you have it in your show notes.^[3] And it drew a lot of corollaries to the existing crises, a lot of the inaction by certain government entities, the slow response, the misinformation, disbelief.

Edward Ellerbeck  20:00

It took them three years to close the bathhouses. It took years to actually get the administration to respond and put in financial resources to responding to AIDS.

Edward Ellerbeck  20:12

I do have to admit, the difference here is that we actually have put a lot more federal investment in the response than we actually did during the AIDS crises. But certainly a lot of the miscommunication persisted that we saw then, and the mistrust that we see again.

Doug Samuelson  20:29

Yeah. And I would add in the story about And the Band Played On, you're talking about how long it took to close the bath houses where they closed them. There were some communities where there was a lot more pushback than others.

Doug Samuelson  20:45

There's another little feature of all this. A number cruncher I want to make this point: Most of the models people used to figure out what was going on and where do you need to look and what do you need to trace were these differential equation models. They're called SIR models -- susceptible, infected, recovered or removed -- where that model structure is driven by the activity of the most active spreader. With And the Band Played On, there's this just gripping story of how this young CDC guy gets some of the gay leaders in San Francisco together and says, "I've got a model that seems to fit but it can't be right. There's got to be something wrong with this. According to this model, the most active spreader would be have to be having 1,000 different sex partners per year for a couple of years. And that's not physically possible. What am I doing wrong?"

Doug Samuelson  21:46

After a moment of awkward silence, one of the leaders said your model is correct. Let us explain you what a gay bathhouse is and what happens there. So there was a model that did fit that could explain what was going on with HIV.

Doug Samuelson  22:02

The models we have for COVID do not fit, do not work. And the reason is that the spread mechanism is different. It's not driven by the most active spreader. It's driven by the formation of groups in which they're spread. And those differential equation models don't capture that. I've been working on one that does. And let me tell you, it's quite a challenge. But that's been part of the problem. If you're looking for the super spreader individual, you're missing the mechanism of spread here. It's really "Don't look for the person who's running around, you know, hugging everybody in town. Look for the choir rehearsal."

Spencer Graves  22:43

Okay, so we're discussing optimal public health with Professor Edward Ellerbeck, Chair of the Department of Preventive Medicine and Public Health at the University of Kansas Medical Center. And Dr. Doug Samuelson, President of Infologix, Inc., in Annandale, Virginia, the author of multiple articles, since at least 2008 on preparing for biological crises. Doug, you want to continue with, what you were just saying? Or does Professor Ellerbeck care to respond to that?

Doug Samuelson  23:19

I'll defer to him, I've been, I think, taking more than my share of time here.

Edward Ellerbeck  23:24

No, I actually agree with you. I think that the initial models, talking about random distribution of infected and susceptible individuals, are preposterous. And certainly people do clump. They don't act as random dots moving around. If you actually look at the YouTube video that explains the underlying assumptions behind those models, they just don't fit. I mean, they do give you some sense of how you might be able to mitigate or what worst case scenarios might be.

Edward Ellerbeck  23:55

But it's pretty clear that the congregation or aggregation of susceptible individuals with infected people drives epidemics. And that relates to congregating people in large groups, just like you suggested, and we just don't have good mathematical models to simulate that. I'm glad somebody is working on it, though.

Doug Samuelson  24:16

It's not even just large groups, it's specific structures of large groups. You get a whole bunch of people out at a concert on the beach, and they distance, there's not much of a problem if they distance. You get a bunch of people in a closed room where there's much less circulation of outside air. And let's say they sing.

Doug Samuelson  24:36

Singing turns out to be a wonderful way to transmit it because it travels in small droplets from deep in the lungs. So good singing technique just spreads those kinds of droplets about five feet away.

Edward Ellerbeck  24:52

Our colleagues here at the Medical Center did a nice demo in that in the deep freezer,^[24] where they actually took off their masks and sang and you could actually see it. So as the weather gets colder, I think people are going to understand this transmission dynamics a little bit better: Just follow your breath when you sing or shout.

Spencer Graves  25:09

I've been told we have one minute left. So it's time for concluding remarks by the two of you.

Edward Ellerbeck  25:21

Well, I think the basic control mechanisms are fairly well understood, and they've been covered. Unfortunately, they've been overly politicized and have impeded our response to this. I still am cautiously optimistic that we can make progress. But when we move into the next epidemic, I hope we have just better coordination of our effort and less undermining of scientific messages from our mainstream media and our scientific community.

Spencer Graves  25:52

Dr. Samuelson?

Doug Samuelson  25:54

Well, of the 75 things I'd like to say, the one I think I'd like to emphasize is when you have a plan, you go into crisis, and you have a plan, even if it's not a very good plan, you have a plan and you act by, and then you can tell, everybody can tell what the plan was. Are you following it? Is it working? When you have 12 plans in competition, and nobody knows how it's working, that generally does not work out well.

Doug Samuelson  26:18

That, I think, is kind of where we are now. I think that as soon as somebody says, "We're going to let the public health experts tell us what to do now. Tell us what the balance is between bolstering the economy and trying to contain the virus," let's get on, everybody on one page of the music. It doesn't even have to be the right page. Just one page. You probably get better success.

Spencer Graves  26:42

Yep. Great. So I want to thank our experts, Professor Edward Ellerbeck, Chair of Department of Preventive Medicine and Public Health at the University of Kansas Medical Center and Dr. Doug Samuelson, President of Infologix, Inc., in Annenberg, Virginia, and author of multiple articles over the past a dozen or so years on preparing for biological crises. A few references they suggested are mentioned in the description of this episode of Radio Active Magazine on KKFI.org.^[3]

Spencer Graves  27:13

And if I can steal another few seconds, I'd like to mention two other public affairs shows that I'm personally producing this Saturday, October 3 at noon, central time. I'm organizing a virtual zoom forum on the "Local Journalism Sustainability Act: concerns and opportunities". This forum will be broadcasted on KKFI the following Thursday Night Special, October 8, 7 to 8 pm.^[21]

Spencer Graves  27:53

Also, earlier that Thursday at October 8 at noon, the nationally syndicated show Sprouts will carry a half hour condensation of a discussion of "Electoral integrity in the United States" carried on KKFI on October on August 13.^[25]

Spencer Graves  28:10

I'm Spencer Graves, thanks to Craig Lubow, our engineer this evening.

Doug Samuelson  28:15

Thank you.

Craig Lubow  28:20

Coming up next, we have a couple of spots, and then Counterspin,^[26] followed by "A Taste of Tejano."^[27]

Spencer Graves  28:29

Okay, is there anything else you the two of you would like to say to add to the remarks that I'll post on Wikiversity?

Edward Ellerbeck  28:40

I thought that you got a lot covered. Doug, that was very nice. I like the way you frame the stories and stick with the big pictures. I have a tendency to get down to the specifics far too soon.

Doug Samuelson  28:54

Well, that's kind of what I'm trained to do. As an operations research analyst. I can get into the details too. But you really want to leave the decision maker with an understanding that they believe is comprehensive enough to act on. And I've had a lot of practice trying to do that. That's it. You know, we could probably put together another half hour next week.

Edward Ellerbeck  29:20

Well, any one of those themes, we could have riffed on for, I think, a half hour quite easily.

Doug Samuelson  29:27

Yeah.

Edward Ellerbeck  29:30

Thanks, Spencer, for bringing us together. I don't have anything else.

Doug Samuelson  29:34

I don't think we even got into the question of how do we know whether we have good test kits? And if not, why not? What do we do about it? And that's been one of the issues.

Edward Ellerbeck  29:43

Well, that the uncertainty, the lack of communications about when to get tested, what to do with asymptomatic individuals. You know, the idea that it took us, what, two months before we actually would admit that masks actually worked? Talk about being unprepared or caught for an epidemic with your pants down. I mean, it's kind of hard to believe we didn't have that in our in our back pocket.

Doug Samuelson  30:12

I don't think we knew. I remember back early in the conversations Dr. Fauci saying that hand washing was much more effective and much more important than mask wearing. Mask wearing seemed to be something that is very good if you're infected to keep from spreading it but not all that good if you're not infected to keep from getting it.

Edward Ellerbeck  30:35

But it's precisely that issue, that is of fundamental importance. If we have universal masking, then you keep everybody from creating that aerosol. And that really did not create rocket science research to actually do. I mean, it's very frustrating.

Doug Samuelson  30:54

It was in Seoul in 2015 when the MERS epidemic hit there. So everybody was running around town wear masks. And I was hearing then from people who I thought were pretty knowledgeable, "This is a nice thing to do to keep people conscious of the fact that there's a virus out there and you need to do something, but it's going to have zero effect. It is not helping at all."

Doug Samuelson  31:24

And in fact, if you go back and look carefully at the fatalities from MERS in Seoul, in 2015, there are 184 of them. One of them was the doctor who went to Egypt and to learn about infectious diseases at a conference and brought it back with him. One was an ambulance driver. 182 got it in the emergency room: Somebody'd get sick. The family would go in and sit with them. This was transmitted mostly by mouth to hand to hand to mouth contact, not by aerosol. So those were the people who got it. And the way that they stopped the epidemic -- very, very quietly, they didn't make any noise about this -- but the way they stopped the epidemic was to close the two biggest emergency rooms.

Edward Ellerbeck  32:09

Hmm. Now, the other thing, actually, that I would have gotten into, again, if we got into technical details, is our whole contact tracing system is based on tuberculosis and sexually transmitted diseases.

Edward Ellerbeck  32:23

And frankly, in this communication age where we're supposed to have such fantastic communications, we're worse than ever before.

Edward Ellerbeck  32:33

Yeah, I was kind of impressed with finally the NMWR, we're, what, over six months into this epidemic, and they finally reported some of their data on the success of their contact tracing. Only about half of the people identify any contacts, and of those, we actually contact less than half of them. And the median time to contact them is six days.

Edward Ellerbeck  33:00

So that's a completely broken system. And you know, you actually know as well as I do, you don't answer your phone anymore when it's an unknown number. We have such little trust there. And I just find it amazing that in this information age, we can't actually contact people when we need to.

Edward Ellerbeck  33:19

And frankly, it happens in the medical system, too. When I try to call one of my patients, they think I'm from KU, trying to give them a bill, call them about their bills. And so they don't want to talk to me about their their test results.

Edward Ellerbeck  33:32

So our ability to contact people is really flawed. And in the face of an epidemic, that's seriously problematic.

Edward Ellerbeck  33:39

Now everybody will answer their texts.

Doug Samuelson  33:41

Yeah.

Edward Ellerbeck  33:42

But, you know, all we have to be able to do if we want to make contact tracing work, we would just say we just need the text numbers of them: We're going to text them a link that they may have been exposed. And here it is. It could still all be kept confidential. But whatever.

Doug Samuelson  33:59

Yes.

Edward Ellerbeck  34:01

I'm getting a 50 texts a day from somebody trying to raise money for Donald Trump. I have no idea how they got my cell phone number. Nobody's preventing that. But I could not get a text from somebody who had identified a contact COVID for me, because for some reason, it might create a charge on my account or something. I don't know what it is. But anyway, those are the types of things I think we need to actually do differently to prepare for the next epidemic.

Edward Ellerbeck  34:32

But if we were going to do another half hour I'd want to riff on the communications debacle.

Doug Samuelson  34:41

I would, too. And I would probably get in a little more deeply to the challenges to clinical practice of an organism that spreads differently from what we're used to and just figuring out what is dangerous behavior.

Doug Samuelson  34:59

I don't know, but I've been told -- and I am not volunteering to be in the test group for this experiment -- that standing five feet away from somebody and singing for a few minutes is more likely to transmit it than a French kiss.

Edward Ellerbeck  35:15

Yeah, I don't know, I probably wouldn't want to do this test.

Doug Samuelson  35:17

I'm not volunteering to be in the test group, but that's what I understand from the science of it. And yes, it's counterintuitive.

Edward Ellerbeck  35:25

Yeah. But you know, the trick is we just haven't invested in that type of research. And preparing for a pandemic, that's the type of fundamental research we need to have in place about those types of transmissions. And you know, it's not that hard to create laboratory models of that and test devices.

Doug Samuelson  35:47

Laboratory models and test devices, yes. Test on human subjects. Not so easy. Human Subjects committee might have a few things to say about deliberate exposure.

Edward Ellerbeck  35:58

We actually did it with influenza. We can't do it with Coronavirus. I think the complications are a little bit too severe.

Doug Samuelson  36:05

Right.