How Perfectionism Has Made the Pandemic Worse

The Covid-19 pandemic has dominated the news in 2020. I’ve noticed one regularity in how the US (and many other countries) have handled the pandemic: perfectionism has been getting in the way of a quick and powerful response. Every little bit would have helped reduce the reproduction ratio of the coronavirus, but only things that were big bits were allowed. Let me list some instances of this perfectionism:

  • Early on, not yet having clear evidence of the benefits of masks was described to the public in a way that made it sound as if masks wouldn’t help much.

  • Highly accurate tests whose results take many days to arrive are next to useless. But the US government was very slow to approve tests of lower accuracy that could have made a big difference because they gave results within minutes.

  • Many decision-makers acted as if each person needed a test, when tests of samples pooled from many people could be very useful in showing where individual tests were needed and where they weren’t.

  • In what could have been a big mistake, the government was saying it would only allow a vaccine that was at least 50% effective, when even a 30% effective vaccine could have put a lot of downward pressure on the reproduction ratio of the virus—meaning that in conjunction with continued social distancing it could have brought the epidemic under control. Fortunately, the key vaccines seem to be coming in with effectiveness closer to 95%, making what could have been a big mistake moot.

  • Despite evidence that having had Covid-19 confers decent immunity, there is little push to conserve currently scarce vaccine doses by strongly discouraging those who have had Covid-19 from getting vaccinated until supplies of the vaccine are more abundant. I think using scarce vaccine doses on those who have already had the disease is motivated by the idea that the immunity of those who have had the disease is probably imperfect, which no doubt is true, because nothing is ever perfect. But Tom Frieden writes in “How to Handle the Covid-19 Vaccine Breakthrough the Right Way”: “very encouraging are the results of three new studies appearing to show that infection with the virus creates a high level of immunity to Covid-19. In the first study, examining a large outbreak on a fishing ship, none of the three people with antibodies got sick, while nearly everyone else got infected. In the second, of an outbreak at a summer camp, none of the 16 people with prior antibodies got sick or tested positive, while nearly everyone else did. More recently, a preliminary report from a study of infected health-care workers found that immunity appears strong and seems to last at least six months.”

  • Because the vaccine protocol used two doses, the vaccine-rollout plan while vaccine doses are scarce is to vaccinate half as many people with two doses rather than twice as many people with one dose, which the vaccine trials suggest has a high enough level of efficacy that vaccinating twice as many people with one dose would lower the vaccines reproduction ratio much more.

  • Finally, in something that shocks me, the article at the top, “Highly Touted Monoclonal Antibody Therapies Sit Unused in Hospitals” by Sarah Toy, Joseph Walker and Melanie Evans suggests that there is a reluctance to use monoclonal antibodies because there is not yet evidence that goes far beyond what was needed to get government approval. Monoclonal antibodies work by the same principles as vaccines; the big differences are (a) vaccines get your body to make antibodies, monoclonal antibody treatment directly injects antibodies, (b) the monoclonal antibodies are chosen to be especially high-quality antibodies, while your body might or might not make a lot of high-quality antibodies after you are vaccinated, and (c) you have to vaccinate everyone, but the monoclonal antibody treatment can be given to people after they start to show some symptoms and so can be prioritized better. You can bet that I would ask for monoclonal antibody treatment if I got Covid-19.

Some of the caution about evidence, accuracy, efficacy and side-effects would make sense if we were facing a lesser disease. But when people are dying all around, getting the job done is what counts, even if you get the job done by imperfect means. The way the reproduction ratio works, combining a set of several very imperfects means that pushed the reproduction ratio below the critical value of 1 could crush the spread of the coronavirus.

For a while, the Union’s top general in the Civil War was a perfectionist: George McClellan. George McClellan kept looking for the perfect opportunity to engage the forces of the Confederacy in battle. He accomplished little. Ulysses Grant and William Tecumseh Sherman got the job done by their willingness to use imperfect methods.