Hi Zeynep,

1) I did not see any reference to this, or other similar if exist: https://www.aier.org/wp-content/uploads/2020/05/

I think that any Covid retrospective should begin with asking why we ignored everything written 10+ years prior to this pandemic. There's seemingly no recognition on that failure by every public official, health or otherwise.

2) Your second point is we could have emulated Taiwan. Outside of islands (NZ and Hawaii did similar), with limited access points and better ability to isolate/test entry and exits, this is likely an impossible ask and I dare say not a serious suggestion. To this point, the document above specifically says, paraphrasing, "screening passengers or closing hubs are not recommended".

Do generally appreciate the thoughts, particularly on better mitigation strategies (keep outside open!) and think globally.



Expand full comment
Mar 13, 2022·edited Mar 13, 2022

Some of the biggest mistakes with the pandemic response have been hinted at but they haven't been discussed quite as much or as clearly as they should be.

Big Mistake #1 was that infectious disease experts failed to discover that (most likely) all, fast-spreading, respiratory pandemics are driven by airborne transmission via aerosols, despite having had plenty of time and resources at their disposal to find out about this crucial, elementary, and not-hard-to-determine fact.

Big Mistake #2 was that most of the experts failed to recommended switching to respirators ASAP, even after it was becoming fairly obvious that cloth and surgical masks were ineffective at stopping the variants.

Big Mistake #3 is that respirator use still isn't widely recommended in countries that don't have widespread access to vaccines, even though respirators could be rapidly deployed and be just as (or more) effective than vaccines.

Big Mistake #4 is not holding these experts accountable for their mistakes.

Expand full comment

I read the article yesterday (Friday, Mar 12, 2022) and thought it was very good. We (the country) need to look at the grand picture to see whether we can avoid the pitfalls the next time. Thanks.

Expand full comment

Polite critique of your NYT piece and overall thesis:

Zeynep: “What if the world had reacted as quickly and aggressively in January 2020 as Taiwan did?”

1) The premise that the US (or any other country) could have had better results had they only followed the Taiwan playback ignores that Taiwan is an island roughly the size of Maryland which is far easier to close down. That's the difference of outcome, as the other variables (tests, contact tracing, masks) were all tried in 100 other countries and failed in 100 other countries. To celebrate Taiwan's success would be like telling the rest of the US they should have been more like Hawaii.

2) Contact tracing done early in the pandemic was built around a faulty understanding of how the virus behaves. The old model relied on 6 foot rule, didn’t know it was airborne, didn’t know it could go through HVAC systems and infect patrons across the rooms of restaurants [1], so it's impossible for it to have actually worked by intention. Additionally the PCR test not being able to detect early infection meant that contacts screened were almost certainly cleared before they were truly confirmed virus free. Considering that contact tracing failed for every other non-island country should give pause on its efficacy.

3) Claims the mass testing halted Covid ignore that all of these island nations actually did very little testing. By April 2020 the US (and pretty much all of Europe) had overtaken South Korea and Taiwan in tests/population. [2] Japan didn't even bother with testing or contact tracing (so we praised their "3 C's instead") [3] and gave generous optimism to their cloth mask usage despite the masks not helping their last bad flu season [4]. Meanwhile testing leaders like Denmark wound up having among the highest case rates in the world.

4) Despite being able to put off the inevitability of Covid, all of these island nations eventually realized “zero covid” was impossible as Hong Kong, New Zealand, and South Korea have recently joined Australia in eventually having the virus run rampant through their populations. I’m not clear how we can cite masks, contact tracing, testing, or Japan’s “3 C’s” as effective ways to halt Covid in 2020 when they aren’t working in 2022.

5) Why single out Taiwan or South Korea as an example of “doing it right” when Sweden had a better outcome? The once pariah of Europe enters year 3 of Covid having the second lowest excess deaths in all of Europe, only beaten by Norway (5% more deaths than usual for Sweden 2020-2021 compared to 2.5% for Norway). Sweden is also lower than South Korea (+8.2%) and Israel (+12.3%) and their approach is at least easy to replicate (and carries the least collateral damage) [5]

Zeynep: “Mass testing could have detected people who were infectious before they even knew they were sick and sometimes those who never had symptoms at all.”

MD: Unfortunately we don’t have tests that work like this. The rapid tests are notoriously bad catching infection before you show symptoms. The PCR tests are notoriously good at finding infections you cleared months earlier, giving not “false positive” but more like “shouldn’t have been positives”. Again, the fact that every non-island failed to halt Covid no matter how many tests they rolled out indicates this isn’t a reliable solution.

Zeynep: “South Korea beat back that potentially catastrophic outbreak, and continued to greatly limit its cases. They had fewer than 1,000 deaths in all of 2020. In the United States, that would translate to fewer than 7,000 deaths from Covid in 2020. Instead, estimates place the number of deaths at more than 375,000.”

MD: South Korea actually had roughly 20,000 excess deaths in 2020, so it’s possible their low testing resulted in that undercount. Additionally the demographics of their elderly population are much different than the US (their elderly are much less obese, hypertensive) which is a key difference in potential outcome.

Zeynep: “When vaccines were developed, rich countries hoarded them”

MD: That is true, but what are some examples of countries which had worse outcomes in 2021 than wealthy highly vaccinated countries? The lowest vaccinated countries all appear to be in Africa which has largely evaded Covid.

Zeynep: “Widespread earlier vaccination could have helped limit the possibility for these variants emerging”

MD: What evidence can you provide that widespread vaccination could have prevented variants from emerging especially considering Delta appeared late 2020 before we rolled out vaccines (indicating even “warp speed” isn’t fast enough)? For over 80 years we have been unable to solve the problem of flu vaccines evolving beyond our vaccines – why would we believe now we finally solved that problem despite every highly vaccinated nation having surges beyond anything previous as 2021 ended? That Omicron was selected because of our high vaccination rates seems like a more plausible hypothesis than one where 100% vaccination rates could somehow prevent variants (especially given the issue of animal reservoirs).

[1] https://www.washingtonpost.com/food/2020/12/11/korean-restaurant-coronavirus-airflow-study/

[2] Consider comparing tests per 1,000 people for South Korea, United States, and Taiwan: https://ourworldindata.org/coronavirus/country/south-korea#how-many-tests-are-performed-each-day



[3] https://www.vanityfair.com/news/2020/05/masks-covid-19-infections-would-plummet-new-study-says

[4] https://www.upi.com/Top_News/World-News/2019/02/01/Millions-in-Japan-affected-as-flu-outbreak-grips-country/9191549043797/

[5] See mortality.org, compare average deaths in 2020-2021 to historical 4 year average, note that many countries lag reporting 2021 data (Canada, Australia, etc)

Expand full comment

So good to hear from you, hope you are doing well!

I thought that piece was just excellent, even though I have some skepticism about comparing other countries' successful strategies to ours. I have a friend who is back in the states (Minn-SP) after being 'stuck' in Japan for two years, so spent her pandemic there. She was amazed at the efficiency of their contact tracing, and good for them. But how far back would we have had to go for that to work? We know contact tracing weakens as a tool once you are at the point of community spread, so that means before presence in NYC. Probably before even the Diamond Princess.

So here's my hypothesis: maybe the countries that suffered most to SARS Co-V2 suffered because, as developed, open and mobile societies, they were particularly hospitable to the virus. Restaurants, offices, conventions, travel-hubs: these are a few of SARS's favorite things.

And no, I don't consider Taiwan, S. Korea or Japan to be 'open' countries, certainly not in the way Italy, the US, the UK, or even Brazil are.

Best of all in your article was the indisputable notion that this could have been shut down in Wuhan had they acted correctly. I'm not sure what to do about that. I AM sure what NOT to do, and that's blame random Asian-looking people.

Expand full comment

I'm a paid subscriber - said to say I value Zeynep's writings.

Zeynep, I believe you have been fairly quiet the last few months. Else my email is cheating me.

I also read recent postings as somewhat generic.

I believe you have always had the perspective we need. I'd like to suggest at least one post that I will keep with me. I'll share my personal version as a possible template.

I was 79 in early 2020. My wife was 67. Our early impression of Covid was "Hell no". Not for us.

We purchased paper goods early along with a few other items. No masks yet. We did luck out in March with our China traveler who brought back 1000 KN95s.

Before March I had the good fortune to read a comparison of Covid transmissibility with flu transmissibility. It fairly simply stated, and possibly incorrectly, that it took an average 1500 flu virus particles to infect whereas it only took an average 300 Covid 19 virus particles to infect.

True or not, it said to us that our job whenever we were near people was to not breathe in those 300 particles. Keep our distance. Convene outdoors. No exceptions since individuals are not statistics.

The second good read was regarding the Washington choir that experienced extreme transmission indoors. I was new to droplets versus aerosols but the message didn't need that discrimination. That parable said unequivocally: "Minimize indoor time with strangers. Spend much less time with shouters and singers. Find some masks."

Zeynep, you have tracked the slow, almost non-existent adoption of ventilation.

Once I figured that fresh air was as good as a vaccine, I was all aboard. I was waiting for the CDC to require all schools and similarly constrained institutions to punch holes in their walls.

I was also waiting for the CDC to demand that "essential workers" - medical workers, teachers, bus drivers and subway personnel, etc. get vaccines first. Respect. Often can't survive without it.

So, my thought for a post from you is - very short and sweet:

1. Number one personal rule to obey to avoid catching and carrying.

2. Number two personal rule ...

3. Number three and more as it seems worthwhile


6. Number one social rule such as "Build Corsi-Rosenthal boxes for home, school, church, etc."

7. Work with school boards, churches, workplaces to punch holes and install big exhaust fans.

The above are my thoughts, many of which reflect what you have taught us or reinforced for us.

I request that you bless us with a short and sweet, black and white prescriptive essay.

It would need to go NYT also and pop podcast and TV as well.

Stay well.

Expand full comment

I'm still frustrated by how badly the CDC and FDA did on making testing available early. It was clear very early on from South Korean data that if you had one death that you couldn't trace to an infection path, there were ~100 people wandering around infected, symptomatic or not. The FDA and CDC were hung up on approving the tests as medical diagnostics, rather than as public health tools, and didn't really seem to do the math on being able to accept lower reliability tests for screening and brief isolation as a tool to prevent spread. On top of that, the CDC just completely failed on ramping up test availability, which further led to rationing of the tests that we did have. And then we didn't learn - we essentially failed the next pandemic already when Omicron rolled around just before the holidays in 2021 and the US couldn't supply enough tests for people to test and isolate themselves, so people just went ahead and met together and spread it.

We also could and should have been sequencing at much higher rates to detect variants. The US probably has more RT-PCR and more sequencing capability per capita than the rest of the world, but it's all tied to academic and corporate research labs and there's generally no mechanism to bring it to bear for public health purposes in an emergency. The state of Washington did finally start to do that on its own, and California seemed like it might but didn't as far as I can tell.

When a new pandemic plan gets written, it needs to have a few features:

- Demonstrable ability to ramp up production and distribution of testing capabilities at the scale and speed of South Korea.

- Same as above but for basic PPE that are used for universal precautions. There's a lot of logistics involved to make sure it all gets cycled out of stocks and into use rather than stored and rotting.

- Prepared plans for how to use university research lab capabilities at least for population surveillance, and how medical systems will get samples to them and data back to public health systems quickly.

- Identified production capacity for vaccines that the government can redirect/reconfigure, probably by maintaining production of vaccines for other diseases at levels below capacity limits. This might even be done by using the capacity for vaccines for "orphan" diseases that the private sector has decided aren't economically valuable enough to produce vaccines for.

Expand full comment

I am struck by how futile these “this is how we should prepare for what happens next” pieces are. It is almost all theoretical, not connected to action, and time and again not leading to action. Maybe we should write about things that could lead to action?

Expand full comment

I wish to express my thanks to you for two years of good information provided in high profile forums such as the New York Times and the Atlantic which has had a real chance of reaching decision makers in a timely manner.

Unfortunately, you can bring the horse to water but you can't make it drink. The political situation in the US has made not only for some bad responses but some that were willfully bad with for example Fox pushing what was essentially anti-countermeasure propaganda while their own staff were masked and vaccinated, and plenty similar behavior from de Santis, Abbott and others.

But there were a lot of well-meaning but mistaken responses, such as dismissing the role of airborne transmission while cracking down on outdoor activities, and for those willing to listen and to .make course corrections, the information you and others like you provided was invaluable and I'm sure in some cases lifesaving.

Expand full comment

March of Folly is a great book and so relevant now. The long list of blunders societies arrived at, despite clear and mounting evidence is sobering. Now Covid too.

But one doubt. Even countries that seemed to be smart is beginning to feel rattled, like New Zealand and Taiwan. Are the leaders who messed up royally earlier, like Trump, Modi, Bolsanaro et al, going to use that to paint over their crime?

Expand full comment

I'm confused. Is this an announcement of an intention to write a counterfactual history? Notice that the history has been written but then how to access it?

If the history is yet to be written I hope it will deal with really specific counterfactual? Why were CDC/FDA hostile to massive asymptomatic testing? Why were HCT not used to speed up vaccine development (and why were no updated boosters made available for Delta and Omicron)? Why did DCD not provide information and a methodology for how information should be gathered and used by policy makers for making changing nuanced; data, time, and place sensitive cost effective policies about NPI? Why was the messaging about vaccines almost exclusively about safety (almost 'doth protest too much") for the vaccinated person and not on the benefits to the person ad the people that the vaccinated person would not infect?

Expand full comment

I think this is referring to this article: https://www.nytimes.com/2022/03/11/opinion/covid-health-pandemic.html

Expand full comment

Wecome back!!

Expand full comment

Dear Zeynep,

I wonder whether you are aware of this doctor's report, interesting:


Expand full comment

Nationally, we need to emphasize access to HEALTH CARE (not health insurance).

Expand full comment

Barbara Tuchmann's book is out of date. See https://www.open.ac.uk/research/impact/history/who-started-first-world-war

Expand full comment