Lessons Not Learned, Lessons Being Learned, The Ugly Social Reality

Appendix 5

Lessons Not Learned

This whole thing has been an insane apocalyptic shit-show. Everything is different and changing. No way to get ready for it.

Oh Wait! - I call BS on that! Why you ask? See below:

Source: WHO - https://www.who.int/csr/disease/anticipating_epidemics/INFOGRAPHIC_WER_timeline_EN.pdf?ua=1
  • 2003 SARS - a true wtf moment.

  • 2004 H5N1 - oh no - not again

  • 2009 H1N1 - this has to stop happening. Pandemic.

  • 2012 MERS-CoV

  • 2013 Ebola

  • 2014 Zika

The first couple of times - ok - lessons being learned.

But now, especially after MERS-CoV - what’s the excuse? Not being ready...hmm... maybe? - but not acting rapidly - unforgivable.

Lessons Being Learned

Mitigation vs Suppression vs Elimination

Mitigation is being replaced by Suppression (flattening the curve to where relatively few cases) as the pandemic overwhelms healthcare systems. This will require a prolonged ‘lockdown’ response until vaccines or other treatments become available.


The essential elements of an elimination strategy for COVID-19 are likely to include:

  1. Border controls with high-quality quarantine of incoming travellers;

  2. Rapid case detection identified by widespread testing, followed by rapid case isolation, with swift contact tracing and quarantine for contacts;

  3. Intensive hygiene promotion (cough etiquette and hand washing) and provision of hand hygiene facilities in public settings;

  4. Intensive physical distancing, currently implemented as a lockdown (level 4 alert) that includes school and workplace closure, movement and travel restrictions, and stringent measures to reduce contact in public spaces, with potential to relax these measures if elimination is working;

  5. A well-coordinated communication strategy to inform the public about control measures and about what to do if they become unwell, and to reinforce important health promotion messages.

The Ugly Social Reality


The devastating impact of Covid-19 in New York

“Coronavirus has exposed New York’s two societies,” Jumaane Williams, the public advocate who acts as the official watchdog for New Yorkers, told the Guardian. “One society was able to run away to the Hamptons or work from home and have food delivered to their door; the other society was deemed ‘essential workers’ and made to go out to work with no protection.”

Different boroughs, even different neighborhoods within each borough, are experiencing coronavirus almost as though it were two different contagions. In wealthier white areas the residential streets are empty; parking spots that are fought over in normal times now stand vacant following an exodus to out-of-town weekend homes or Airbnbs.

We have almost 100% people of colour in our emergency room.

Sean Petty

In places like the Bronx – which is 84% black, Latino or mixed race – the sidewalks are still bustling with people making their way into work. There is still a rush hour. “We used to call them ‘service workers’,” Williams said. “Now they are ‘essential workers’ and we have left them to fend for themselves.”

The public advocate pointed out that 79% of New York’s frontline workers – nurses, subway staff, sanitation workers, van drivers, grocery cashiers – are African American or Latino. While those city dwellers who have the luxury to do so are in lockdown in their homes, these communities have no choice but to put themselves in harm’s way every day.

If you superimpose a map of where frontline workers live within New York over a map of the 76,876 confirmed cases in the city, the two are virtually identical. In Queens, the most intense concentration of COVID-19 infections are in precisely those neighborhoods with large numbers of essential workers.

One telling detail: at least 41 subway and bus workers have died from coronavirus. A diversity review by the Metropolitan Transportation Authority (MTA) in 2016 found that 55% of its 72,000 employees were black or Latino, and 82% were male – which is also telling as more men than women are dying from the virus.

“We put people out there and said you got to go to work, but we didn’t give them protective gear or additional testing to keep them safe. It was almost as though these groups were expendable to keep the city moving,” Williams said.

This week a tiger tested positive at Bronx Zoo. It generated plenty of headlines, but few media articles made the point that Williams highlighted.

“A tiger tests positive – that’s good to know. If we have enough diagnostic test kits for tigers, shouldn’t we have enough for our own frontline humans?”

Two miles away from Bronx Zoo, back in the ER of the Jacobi medical center, Sean Petty sees the impact of New York’s two societies every day. “We have almost 100% people of color in our emergency room,” Petty said.

Most of the adult COVID patients he cares for are also wrestling with underlying health conditions that make them far more vulnerable to the disease.

“Our patients are coming in with all of the comorbidities associated with poverty and racism – diabetes, asthma, hypertension. We have patients who are sicker and more likely to die because their lives have been conditioned by these chronic illnesses.”

Reliable data has been hard to come by, as both city and state authorities resisted for several weeks releasing official figures on the grounds that the subject of disparities was less important than keeping hospitals afloat. Journalists at the independent not-for-profit news site the City were driven to do their own analysis of NYC department of health data and found that in the Bronx people are dying at twice the rate of New Yorkers as a whole.

On Wednesday, Mayor Bill de Blasio finally caved to pressure and posted preliminary findings that unambiguously underline the racial breakdown of coronavirus’s deadly toll. Black and Latino New Yorkers are dying at double the rate of white and Asian New Yorkers, following precisely the public advocate’s narrative of two societies.