Reviewing WHO’s Draft “Respiratory Pathogens: Pandemic Preparedness Steering” [Pounds Head on Desk]

By Lambert Strether of Corrente.

The World Well being Group (WHO) has simply launched a draft model of “Respiratory pathogens: pandemic preparedness steering” (PDF). Right here is the announcement:

Kerkhove is an infectious illness epidemiologist, and COVID-19 Technical Lead, Rising Ailments and Zoonoses Lead, WHO Well being Emergencies Programme. In fact, if Kerkhove was each a scientist and had the clout, this notorious tweet would now not be up:

However it’s. In order that’s the place we’re with WHO.

That mentioned, WHO exists, has affect, has a $6.72 billion greenback budget, folks nonetheless take heed to them. It even does actual work, when it devises nomenclatures — or coordinates the hassle to eradicate smallpox. So WHO’s deliverables, like this one, have to be examined.

Now, it’s been a very long time since I’ve learn a do cument by a world requirements physique significantly. And I’m not acquainted sufficient with WHO institutionally to assemble a thorough-going critiique. (I’m sure that CDC needs to be burned to the bottom, the rubble plowed below, and the bottom salted; however I’m not so sure with WHO.) Nevertheless, this draft is printed with a name for feedback, so I’ll do what most commenters do: Start by scriibbling notes within the margin. There are my feedback, based mostly on little greater than a cursory studying.

Web page 9: Government Abstract

[1] Extra aspiration. I don’t know translate this into WHO-ese, so I”ll simply say: America below the Biden administration crystallized an method to pandemics that included (a) Vax-only (with restricted therapy choices), (b) “Let ‘er rip”, (c) private threat evaluation, and (d) lively sabotage of non-pharmaceutical interventions. The teachings discovered have been: (1) In america, authorities coverage can slaughter 1,000,000 folks with no riots, and (2) propaganda actually actually works. In order for “key classes of Covied-19”: Isn’t it fairly to suppose so.

[2] That phrase “steering.” It appears to not imply what “steering” means when there’s a regulatory effort in america, the place steering will be both a rule or regulation, or a advice. WHO appears not have even the latter energy. From Bare Capitalism:

For the second, the WHO’s authorized framework – the so-called Worldwide Well being Laws (IHR) – . However that is also about to alter. Because the Politico article reviews, talks are below method to set up a “international pandemic treaty” that may give the WHO extra powers to “strengthen pandemic prevention, preparedness and response.”

(The “international pandemic treaty” has not handed, as of this writing. Extra on WHO’s constitutional and normative powers right here.)

Web page 7: Glossary

[1] The wording all through is aspirational, to not say delusional fanciful. “Making certain,” “offering,” “strengthening,” “proactively constructing,” ” growing” all describe the world was WHO needs it to be, not as it’s. For instance, “Entry to countermeasures”: Anyone who’s skilled the American well being care system can spot the sleight of hand that converts “entry” within the time period to “equitable entry” within the definition. (Additionally, who wrote “guaranteeing synergy”? McKinsey? And what editor let it go?)

Web page 8: Glossary

[1] This occupied with surges is provider-centric. Transmission and an infection inside a inhabitants can surge, however just some fraction of that inhabitants will “demand” providers. However as we see with Covid, even “gentle” instances that don’t require elevated capability — no less than throughout the pandemic — might have critical long-term illl results.

[2] Federalism is, by definition, not collaborative; america, China, and Russia, all nice powers, have their very own variations of federalism. Additional, “public service supply” is usually privatized. Lastly, NGOs typically play signifcant roles. I feel what WHO means to say is “whole-of-state-and-civil-society,” however that’s not what they wrote.

Web page 25: Important Staff

[1] Heaven is aware of I don’t need anybody to get Covid, actually not youngsters or elders. However this can be a laundry record. I’ve highlighted the 2 bullet factors for staff (or, as WHO says, “folks”). It will have been good if WHO had talked about “important staff” — “folks” could possibly be construed to imply the WFH class of emailering laptop computer varieties, and even executives, who’re important no less than in their very own minds — and particularly well being care staff. In response to NBER, “knowledge on 800,000 commercially insured people in Philadelphia recommend that in lockdown important staff have been 55 p.c extra probably than others to get COVID-19.” In response to BMJ, “Healthcare staff [are] 7 instances as prone to have extreme COVID-19 as different staff.” Important staff, and particularly healthcare staff, are, then “significantly weak,” as WHO places within the headline, and but WHO offers no steering that applies particularly to them.

Web page 26: Airborne Transmission

[1] “Transmission by way of fomites, droplet, and aerosols.” First, since aerosols are Covid’s main mode of transmission, aerosols needs to be first. Second, since there’s solely “restricted proof” for transmission by way of fomites and droplets, they need to be positioned in a parenthetical and certified. It seems just like the droplet goons nonetheless maintain sway at WHO, since this wording is all about institutional clout, and never about science in any respect.

That is pretty much as good a time as any to say that the phrase “airborne” doesn’t seem in WHO’s so-called steering in any respect:

Not does the phrase “masks,” actually an odd omission for a doc with the phrase “respiratory” in its title. Does WHO consider that virions are carried to the nostril and lungs by tiny Maxwell’s Demons? Versus being breathed in with the air?

Web page 29: Pandemic Story Arc

[1] The visible presentation — an arc from low, to excessive, and again to low, — suggests {that a} pandemic goes by way of a linear development, starting at “inter-pandemic” and ending at “interpandemic.” Covid doesn’t appear to behave in that manner. As a result of (IMNSHO) immune dysregulation from Covid an infection, we are actually experiencing a “Tripledemic” of RSV, flu, and Covid, such that suppliers are at pandemic ranges of stress. The mannequin implicit within the graphic can not give an account of this phenomenon.

Web page 43: An infection Management

[1] The Hospital An infection Management neighborhood fought each airborne transmission and masking tooth and nail, inside their very own establishments, when advising governments, and in requirements our bodies, and continues to be doing so (see the bogus research from Loeb, et al.). They shouldn’t be answerable for a lemonade stand, not to mention growing nationwide IPC requirements. In fact, TINA, however can we no less than acknowledge their position? Nevertheless obliquely? (See, e.g., Canada’s Dr. John Conley.)

Web page 60: Case Research

[1] The “panorama evaluation and literature overview” appears to consist principally of specialists speaking to themselves. WHO mentions case research. The case research examined for this steering occurred in Germany, Iran, Nigeria, Pakistan, Puerto Rico, Somalia, Vietnam, Uzbekistan, two NGOs (C-TAP and the Pan American Well being Group) and the Caribbean. The place, for good or in poor health, are China and america? The place, should you don’t wish to study Anglosphere debacles, are Japan, South Korea, Taiwan, or Thailand? If the case research are insufficient, as they’re, then the strategies for growing the steering are insufficient, and the steering is insufficient, being based mostly on the specialists WHO is speaking to, versus expertise on the bottom.

Web page 65: Air flow

[1] The one different place the place the phrase “air flow” seems is in An infection Management (p 43). This steering is much more absurd, as a result of it pertains solely to “social welfare, housing, and public works sections. WHO doesn’t even point out air flow within the workdplace! Taking a look at web page 25, we’ve already seen how WHO gave brief shrift to staff, however this actually takes the biscuit.

Web page 69: Panic

[1] Rebecca Solnit, earlier than she turned “Rebecca Solnit,” wrote a beautiful e-book titled A Paradise In-built Hell: The Extraordinary Communities That Come up in Catastrophe: “Panic is uncommon, looting is basically insignificant, persons are not terrified and trampling one another to flee from a catastrophe scene, however in truth are attempting to handle a state of affairs. We might in truth revert to some kind of primordial civility.” Boring normals don’t panic. Elites panic; Solnit reveals that the looting and fires after the San Francisco earthquake solely occurred after the troops arrived.

Web page 70: Triggers

As soon as once more, WHO is being delusional aspirational. I do know that is “steering,” however steering must take some account of the operational capabiity of these guided. In america, for instance:

[1] in my recollection, alerts got here from scientists and information reviews (the “XXXXX”?) not WHO or requirements our bodies;

[2] first instances have been in america weeks earlier than we detected them;

[3] little help was given by CDC to the states, particularly since CDC butchered testing;

[4] all reporting was spotty, instances being particularly unhealthy as a result of no contact tracing was performed;

[5] ranges of immunity in several populations weren’t tracked;

[6] if our present preparations are “routine,” we’d as properly simply throw within the towel.

Conclusion

I’d ship this again for an entire rewrite. At a minimal, there needs to be a science-based concept of transmission for Covid. The choice of case research must also be ample. One way or the other, I don’t suppose that may occur, however a blogger can dream.