What Could Go Wrong?

Starting January 5, 2023, all travelers from China, Hong Kong, and Macau must have proof of a negative PCR COVID test to enter the US, even if they pass through other international airports. It won’t shield the US from Chinese COVID, but it will slow the spread dramatically. The US is also instituting Voluntary Genomic testing at the seven largest US airports. This should minimize COVID entry into the US and to identify new variants as early as possible.

The US is introducing wastewater collection on international flights to monitor COVID levels. Wastewater COVID-19 counts rise two to three weeks before population testing does. Depending upon how it is deployed it could detect mutations coming from unexpected countries. This layered defense can trigger the CDC to mobilize more government resources.

The plan is not to screw up like 2019.

COVID was already spreading rapidly in China before demonstrations against lockdowns began. President Xi Jinping lifted his Zero COVID policy before its failure would be known. He purchased sufficient Paxlovid for the members of the Chinese Communist Party, the military leadership, and regional administrators. The Chinese people will have to make do with Sinovac and Sinopharm vaccines and other locally made inferior vaccines and treatments. The virus will pass through a billion Chinese, plus untold numbers of ferrets, hamsters, and other susceptible mammals. There will be new mutations.

We learned some lessons in the pandemic playbook since 2020.

The 2020 travel ban was a sieve. It blocked flights directly from China to the United States, but failed to account for intermediate stops. It did not apply to US citizens or flights from European countries.

The 2023 travel ban applies to individuals from their point of origin through any intermediate airports. There is in-depth testing, including genomic sequencing, Italy, with similar defenses, has already announced that half of its tests show Omicron without new mutations.

In 2020, the turf wars in Washington, DC, between Health and Human Services, the Center for Disease Control, and the Food and Drug Administration delayed testing and information sharing including dealbreaker: the CDC COVID-19 test was defective. The CDC refused to let states and universities develop their own testing and refused the World Health Organization test that was available on January 16. The US lost eight weeks at the crucial start of the pandemic.

In 2023, federal agencies are assimilating data on the fly and issuing Emergency Use Authorizations promptly for pandemic-related products. The cumbersome editorial process of major journals is now surrounded by a sea of pre-publication papers in online platforms like PLOS, accelerating the spread of scientific thinking at light speed.

In January 2020, Dr. Helen Y Chu at the University of Washington wanted to repurpose thousands of nasal flu swabs to test for COVID-19 to determine where it was and how fast it was spreading. Federal and state officials objected on regulatory grounds. She started the COVID testing, and it showed extensive COVID-19 spreading under the radar. She only stopped when the regulators threatened to shut her lab permanently.

In 2023, we understand the need for an early warning system, and we have ongoing nationwide monitoring.

In 2020, nursing homes learned the painful lesson of not isolating.

In 2023, nursing homes have isolation policy manuals content right next to fire alarms training.

We have an adequate first line of defense against new Chinese mutations, and we will have to see how it evolves, especially messaging from public health agencies. The other good news is that it may bring down president Xi Jinping. His three-legged chair rests on economic progress, improved healthcare, and an iron fist for surveillance and punishment. As we speak, the first two legs of the stool are wobbling, and it couldn’t happen to a nicer guy.

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