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A little over a year ago, I started a collaboration with David Denkenberger essentially trying to answer the question of what can we do to prepare for pandemics, focusing on things that are Important, Tractable, and Neglected. The resulting paper, entitled "Review of Potential High-Leverage and Inexpensive Mitigations for Reducing Risk in Epidemics and Pandemics" has now been accepted for publication. The publication process is unfortunately very slow*, but in addition to talking about a number of the things we should have been doing before COVID-19 hit**, there are a few that we are perhaps not too late to address.

I thought it was worth considering a few of the still-relevant needs and activities that seem like potentially high-leverage avenues for investigation. Given that a few of the things seem still neglected, but are potentially addressable for the current pandemic are, I wanted to highlight them.

1) Enable people to stay isolated effectively.

People are currently being told to stay in quarantine if they were exposed. Unfortunately, staying home may become more difficult if people in isolation need supplies and have no income to allow them to purchase things, or if they cannot get certain things - many medicines must be picked up in person, and in some places, supplies cannot be easily ordered online. Furthermore, if delivery services are interrupted, (which is likely given the heightened risk of exposure for delivery workers, see below,) this will become more difficult. Contingency plans to help deal with the challenges would be helpful, and systems to enable volunteers to assist could also be a useful avenue of research.

2) Triage and manage medical care remotely.

Much medical care does not require hospitals or emergency rooms, but they are utilized anyways - that's where the doctors are. If medical facilities become overwhelmed, many of these need to be replaced by alternatives - self-administered diagnostics, systems to enable phlebotomy and similar testing without needing to go to hospitals, and similar. EMTs may need to be trained to do pre-hospital triage rather than bring lightly injured patients, or people at high risk of serious infection, to hospitals. Similarly, to the extent that people can self-treat, videos and instructions for doing so may be valuable.

3) Manage critical services through disruptions.

Many people doing preparation for large scale disruptions have pointed out that it seems unlikely that their homes would lose access to electricity or clean water. The reason this is true is that these critical services will have a high priority. It is unclear, however, how much redundancy and backup exists for key personnel in this type of facility. If all of the senior engineers who can accomplish a critical function are simultaneously absent, they cannot be replaced easily during a crisis - and they are somewhat likely to all be exposed and become sick around the same time.

4) Ensure transport systems remain functional.

If international shipping is slowed or stopped, or trucking or other transport were disrupted - either due to quarantines, or because of a lack of personnel, the US food supply systems would be reduced to a fairly short supply of goods. Similarly, if Amazon, UPS, or other delivery companies can no longer deliver goods, many systems that rely on the ability to reorder components. This is a critical need, and it is unclear how the system would cope with a large scale unavailability of drivers.

To conclude, I'll mention that I'm hopeful that the discussion can start to shift towards preparation for contingencies before it becomes obvious that they are needed. Hopefully, this is something people can still lead and be proactive, rather than reactive.

*) The paper was submitted to the International Journal of Emergency Management in June, got desk rejected without review in October, and was submitted again in November to the Journal of Global Health Reports. It's now accepted - slightly too late for it to be timely for COVID-19 preparation, but hopefully in time to suggest some new ideas about response.

**) Most of the paper was pointing to a number of no-longer-neglected but more clearly important issues, such as the likelihood of shortages of supplies like masks, and talking about how companies should look at how they can enable remote work in advance to allow self-isolation. Still, there are quite a few points in the paper that aren't yet being discussed that still seem valuable.





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Depending on how the situation develops, I think our suggestions about homemade versions of masks, gloves, etc. could also be useful. Hopefully we do not get to the point of loss of critical industries and needing backup plans.

Same as in the post above here.

Thanks for the article. I had an idea related to your category number 2 Triage and manage medical care remotely which I also posted to another forum article as a comment [Please delete this comment in either of the articles if it is unnecessary in two places] :

If it were possible to make a home test kit for COVID, I think that would be helpful. By home test kit I mean an arrangement where people could order these tests by phone or from Internet and they would be mailed to them. Then the person would proceed to take a test sample according to the instructions in the kit and mail it back to the laboratory. The laboratory would test the sample and give the person the results via phone or web.

This kind of arrangement would allow people suspecting that they might have COVID to self-quarantine until they have a certainty (or near certainty since no test is perfect) whether they have the disease or not. Thus, it would lead to less people being exposed to potential early-stage COVID carriers and hinder the disease from spreading. Importantly, it would also protect the health care workers as they would have to come to contact with so many potential COVID carriers.

There is a lot of discussion in the literature about setting up local testing centers, and a significant drawback is that even staffed with nurses and trained volunteers, there are real quality control and process issues. Given that, I can't imagine that home testing wouldn't have far larger problems. For example, if samples weren't gathered and handled exactly correctly, I'd expect the false negative rates could be incredibly high, and people who would otherwise self-isolate or get tested correctly would assume they could go out.

If you haven't already, please upload a version to the open science framework as a preprint: https://osf.io/preprints

I have uploaded it to preprints.org, linked above, pending the final layout and publication. (With an open source license in both cases.)

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