“Covid-19 is here to stay. The world is working out how to live with it”

"There’s a spectrum of possible post-coronavirus futures, no straight line from here, to there. The new “normal” depends on several unknowns....The virus will keep churning through the population, keep “trying to find humans to do what it does,” infectious disease epidemiologist Michael Osterholm said in a recent interview, until we achieve 60 to 70 per cent herd immunity.” [ Sharon Kirkey, “After the COVID-19 crisis ends, what does our ‘new normal’ look like?”, The National Post, May 2020]

Previous chapters

Chapters 1.1, 1.2 and 1.3 catalogued the impacts of the pandemic on individuals/families, the health care system, the economic fallout and the social fallout. The following thumbnail sketches are images of page one from each of these previous articles. My objective with these initial chapters was to chronicle Donald Rumsfeld’s ‘Known Knowns’ (things we know that we know - the facts) of each crisis. 

Chapter 2 - “Every cloud has a silver lining” 

This chapter steps outside the negativity of the earlier chapters and scans the media articles for possible ‘silver linings’. Although George Orwell said “Never use a metaphor, simile, or other figure of speech which you are used to seeing in print”, I have broken rank and used this cliche as the title of this chapter because It’s used to provide reassurance to those going through a tough time, to tell them that something good will come of even the worst situation – even if you can’t see it at the time.” [“11 English Clichés and What They Mean: Useful Fun for English Learners”, Oxford Royale Academy]

This chapter describes each ‘silver lining’ in Rumsfeld’s heuristic of the known unknowns - things that we now know we don’t know. For example, the first ‘silver lining’ I identified is the potential for the messenger RNA (mRNA) technique used by Moderna to develop their vaccine, to be used to develop vaccines for other diseases like cancer, sickle-cell disease, and maybe even HIV. We ‘know’ the technology but the unknowns include will governments and Big Pharma go after these disease - i.e. one of several ‘unknowns’.

I focussed my search on aspects/things that are occurring or will/could occur that have larger socio-economic-political effects. Although mildly interesting, things like ‘Drive-in movie theaters made a comeback’ or ‘Crayola unveiled new inclusive skin-tone crayons giving kids the chance to “accurately color themselves into the world”, didn’t make the cut. The following eight ‘silver linings’ are my subjective application of the cliche.

Chapter 2 - “Every cloud has a silver lining” 

Abstract

This chapter begins (obviously) with the old proverb “Every cloud has a silver lining” ... I have identified 8 ‘silver linings’ that are future-oriented - i.e. we know they are happening but their full impacts will be some time in the future: 

• 2.1 Applications of messenger RNA (mRNA) technique for “cheap gene fixes for cancer, sickle-cell disease, and maybe even HIV.” 
• 2.2 The Remdesivir ‘trick’ - “better antivirals could buy us time to develop vaccines against potential future outbreaks.”
• 2.3 Covid-19 Has Nearly Wiped Out the Flu - How Do We Keep It From Coming Back?
• 2.4 Reducing reliance on foreign suppliers/supply chains of medical equipment, supplies and medicines
• 2.5 Face masks have become commonplace in spite of deniers, Patrick Henry wannabes, Doubting Thomases and Trump
• 2.6 Temporary respite from the “epidemic of dirty air” 
• 2.7 Moving work into “socially distant mode” - remote work/telework/working from home
• 2.8 “Say his name George Floyd” - galvanized protests nationwide that catapulted systemic racism onto the political agenda
• 2.9 Closing comments 
• End Notes

The point of identifying ‘silver linings’ is to offset, in some small way, the overwhelmingly negative impacts of the coronavirus pandemic. Scientists, epidemiologists and historians recount the horrors of the 1918-19 Spanish Flu Pandemic as one of the most catastrophic events in human history. The Covid-19 Pandemic of 2020-21 will probably be added as an equivalent catastrophe - a bookend, if you will, to the Spanish Flu Pandemic.

2.1 Applications of messenger RNA (mRNA) technique for “cheap gene fixes for cancer, sickle-cell disease, and maybe even HIV.” 

•  “For there to be any vaccines, let alone a plethora of them, less than a year after the first cases of covid-19 were reported is an unprecedented achievement.” [240]

When it was realized that the Covid-19 pandemic was not going to be vanquished by masking, social distancing requirements and lockdowns, the promise of a yet to be developed/discovered vaccine was collectively embraced as the solution. It suddenly seemed like every medical research facility and company in the world was invested in the search for a vaccine - press reports identified more than 100 academic and commercial entities in the race to develop a vaccine.

The following descriptions are extracts from Jonathan Gardner, Ned Pagliarulo and Ben Fidler’s article “ The first coronavirus vaccines have arrived. Here’s where the rest stand.”. [241]

Moderna - “The vaccine went from a computer design in January to human study in just three months, making Moderna the first U.S. company to reach that point... A Phase 3 study began on July 27 and, four months later, delivered strongly positive results that indicated the vaccine was 94% effective in preventing COVID-19. ... The company formally asked the Food and Drug Administration for emergency approval on Nov. 30 and a panel of agency advisers endorsed the vaccine on Dec. 17. Just one day later, the FDA granted authorization for the shot, marking a milestone for both the U.S. public health response to the pandemic and for the decade-old biotech.”

BioNTech, Pfizer - “Across the Atlantic, in Mainz, Germany, BioNTech started work on an mRNA vaccine for the coronavirus early on and agreed to partner with Pfizer in mid-March, joining forces with the larger drugmaker ... with the two companies winning clearance from the U.K. drugs regulator for their shot just eight months later, followed quickly by authorization in Canada on Dec. 9 and an emergency clearance from the FDA on Dec. 11 ... affirming earlier positive results and demonstrating a better-than-expected 95% efficacy in preventing COVID-19.”

Univ. of Oxford, AstraZeneca - “A team there was already working on a vaccine for the virus that causes MERS, a close cousin of SARS-CoV-2. The Oxford researchers quickly adapted their work and, by April, had started a large Phase 1 trial of their new vaccine in the U.K. ... But the program hit several setbacks, beginning in early September when AstraZeneca and Oxford halted testing worldwide after one participant in the U.K. study fell sick with an unexplained neurological illness. ... Despite the confusion, the U.K. drugs regulator authorized the shot about a month later, clearing the two full dose regimen given to the majority of participants in the U.K.- and Brazil-based studies. ... AstraZeneca and Oxford’s vaccine is viewed as important for global immunization efforts as it can be more easily distributed and stored. AstraZeneca has also committed to sell doses more cheaply than others, and expects to produce a greater number of doses.”

Johnson & Johnson - “J&J was first among larger drugmakers to pursue a coronavirus vaccine ... The pharma sped up its plans, however, securing help from the U.S. government through Operation Warp Speed took more time. An initial study began in late July and two months later, on Sept. 23, J&J kicked off a global Phase 3 study. ... In late January 2021, data from that study showed a single dose of J&J’s vaccine was 66% effective in preventing moderate or severe COVID-19.

Although they don’t get the coverage or recognition in North American media, we should recognize China and Russia’s vaccines because they are being marketed to the rest of the world :

Sinopharm, Beijing Institute - “While the Western world has focused on leading candidates from large multinational drugmakers, China’s state-owned Sinopharm has advanced two inactivated vaccines through late-stage trials and to approvals in the UAE and Bahrain. ... Early-stage studies began in April for both of Sinopharm’s candidates, data from which were published in JAMA in August and The Lancet in October, respectively. In each case, vaccination via two injections was generally well tolerated and triggered immune system responses against coronavirus proteins. ... The UAE granted emergency authorization for the Beijing Institute shot in mid-September, followed by a full approval in December. A short announcement from the UAE health ministry indicated an interim analysis of Sinopharm’s trial found vaccination was 86% effective ... The vaccine is also approved in Bahrain, Egypt, Jordan, Pakistan and Hungary.”

Gamaleya Research Institute (Sputnik V) - Russia approved Gamaleya’s vaccine on Aug. 11, less than two months after the first studies in humans began and, critically, before large-scale trials had proved whether it could protect against COVID-19. ... On Dec. 14, Gamaleya released detailed data from that study, which gave 22,714 volunteers either the shot or a placebo. ... Because three times as many trial participants received the vaccine as did placebo, Gamaleya calculated efficacy against COVID-19 as more than 91%. ... More than a dozen countries have authorized GRI’s shot, and vaccinations have begun in Belarus, according to the state-owned Russian Direct Investment Fund.”

The ‘silver lining’ is the application of messenger RNA to more than just Covid vaccines

The Moderna and BioNTech, Pfizer use of messenger RNA (mRNA) is heralded by the scientific community for its potential beyond Covid-19 immunization. As Diana Kwon notes in her article:

• “The concept of using mRNA to produce useful proteins to fight disease has been around for decades. But until now, no vaccines using this technology have made it this far in clinical trials. The success of the SARS-CoV-2 vaccines “is really good for the RNA field, because until very recently, there were just a handful of people who really believed in mRNA vaccines,” Pardi tells The Scientist. “We now have the chance to really prove [their usefulness] in an actual outbreak situation.” [242]

This ‘silver lining’ is a hope about the future with the amazing potential to enable the development of vaccines for diseases that have afflicted humanity since they were discovered:

•  If this potential is realized, the discovery of the use of mRNA in the construction of vaccines will provide society with a variety of vaccines to fight more diseases in our increasingly vulnerable planet.

• “Beyond potentially ending the pandemic, the vaccine breakthrough is showing how messenger RNA may offer a new approach to building drugs. In the near future, researchers believe, shots that deliver temporary instructions into cells could lead to vaccines against herpes and malaria, better flu vaccines, and, if the covid-19 germ keeps mutating, updated coronavirus vaccinations, too.
• But researchers also see a future well beyond vaccines. They think the technology will permit cheap gene fixes for cancer, sickle-cell disease, and maybe even HIV.” [ 243]

What do we know that we don’t know

Known unknown: The use of messenger RNA (mRNA) has the potential application to other diseases. “In the near future, researchers believe, shots that deliver temporary instructions into cells could lead to vaccines against herpes and malaria, better flu vaccines, and, if the covid-19 germ keeps mutating, updated coronavirus vaccinations, too. ...the technology will permit cheap gene fixes for cancer, sickle-cell disease, and maybe even HIV.” [ 244] The unknown is whether this methodology will be used address cancer, sickle-cell disease, and HIV. 

2.2 The Remdesivir ‘trick’ - “better antivirals could buy us time to develop vaccines against potential future outbreaks.”

Remdesivir was not a new therapeutic treatment. It was developed by Gilead Sciences in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) in the search for therapeutic agents for treating RNA-based viruses that maintained global pandemic potential, such Ebola virus (EBOV) and the Coronaviridae family viruses exemplified by Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). [245]

But the drug, once discovered by the former President, became another self-proclaimed cure (along side hydroxychloroquine, azithromycin, ritonavir, ruxolitinib, and camostat) in the campaign to downplay the seriousness of the coronavirus pandemic: 

Remdesivir is probably best known for former President Trump’s claim in March, 2020, “At a news conference Thursday, President Donald Trump said the malaria drug chloroquine and the experimental antiviral drug remdesivir are being tested as possible COVID-19 therapies and could slow the epidemic.” [246] 

“With the overwhelming influx of compassionate use requests, on March 23, 2020, Gilead Sciences suspended compassionate use access to remdesivir for all cases save children and pregnant women, shifting their focus to support mounting clinical trials and establish a system of expanded access, wherein hospitals or physicians can request emergency use of remdesivir for multiple patients at one time.” [247]

Dr. Fauci came to the rescue in April 2020, when he said that the interim results of the studies of Remdesivir on coronavirus patients “show that time to recovery (i.e., being well enough for hospital discharge or to return to normal activity level) was 31% faster for patients who received remdesivir than for those who received placebo.” [248]

Then in July, 2020, former President Trump claimed that the US had bought the world’s entire supply of remdesivir. And when former President Trump contracted the coronavirus in October, doctors at Walter Reed Medical Center, administered an IV infusion of the antiviral drug remdesivir.[249]

To add fuel to the debate over Remdesivir ‘s use in the fight against the coronavirus, “The World Health Organization recommended against using Gilead Sciences Inc.’s remdesivir to treat hospitalized Covid-19 patients less than a month after U.S. regulators granted the drug a speedy approval.” [250]

The Adaptive COVID-19 Treatment Trial was complete in October 2020 and concluded the antiviral treatment was beneficial, consistent with the preliminary findings. Patients who received remdesivir were quicker to recover, which was defined as being medically stable enough to be discharged from the hospital. The median recovery time was 10 days with remdesivir compared to 15 days for the placebo group. [251]

 Remdesivir is one of the few proven therapeutic medications for treating Covid-19 patients. Remdesivir is the only treatment of its kind currently approved in the US for the coronavirus. 

“The trick is that remdesivir does not go after the virus directly”

“The trick is that remdesivir does not go after the virus directly. Instead, it targets the system the virus uses to replicate itself, hijacking it like you would your office’s copy machine as part of a company-wide prank. Remdesivir is an “analog,” designed to mimic the appearance of one of the RNA letters, adenosine. It looks so similar that the polymerase can unknowingly pick it up instead of the real adenosine and insert it into the strand of viral genome that’s being constructed, like bringing home the wrong twin from summer camp. Once in place, the analog acts as a cap, preventing any additional pieces from being strung on. This leaves the strand short of the full genome. The virus can’t go on to replicate or infect other cells.” [252] . This means scientists can use the same trick to develop new and improved antivirals. Antiviral drugs are medications used for treating viral infections. Remdesivir is an antiviral drug. 

“Having better antivirals could buy us time to develop vaccines against potential future outbreaks.”

Remdesiviris not a vaccine, it is a therapeutic medication for treating Covid-19 patients- reducing the severity and duration of some of the symptoms. Kenneth Johnson, professor of molecular biosciences at the University of Texas at Austin maintains “This is not the last unique coronavirus that’s going to come after us. Having better antivirals could buy us time to develop vaccines against potential future outbreaks.”

What do we know that we don’t know

Known unknown: “Covid-19 is the third coronavirus to make the leap from animals to humans in less than 20 years” Many experts/scientists claim more ‘spillovers’ will occur and we will have new zoonotic diseases/epidemics/pandemics to deal with. We don’t know which of the 827,000 viruses in the animal world that have the potential to infect humans will attack next but one will, according to the ‘virus hunters’. Professor Johnson’s point is “So even if this pandemic is brought under control soon, it still makes sense to continue developing weapons against coronaviruses. We might need other drugs that are like remdesivir, but different enough that they can then go after the mutated forms,”[ 253] The unknown is what is the next zoonotic disease that will strike humans and when is it likely to occur?

Government interventions with pharmaceutical companies proved the drugs could be developed in a timely manner. “The global pharmaceutical industry is no longer innovating. Research shows that 78 percent of patents approved by the U.S. Food and Drug Administration correspond to medications already on the market, while those disease areas not considered growth markets are ignored. From 2000 to 2011, only 4 percent of newly-approved products globally were designed to treat neglected diseases that affect lower- and middle-income countries.... Large pharma companies spend more on share buybacks to boost share prices (and stock options — the main way that executives get paid) than on research and development. ... The solution? Apply the same mission-oriented approach used in national defense to health care. The military has historically used public funds to solve problems by interacting dynamically with the private sector, albeit with government direction, with the goal of benefiting the taxpayer.” [ 254] The unknown is whether the Biden Administration will adopt this solution and push for more antiviral drugs?

2.3 Covid-19 Has Nearly Wiped Out the Flu - How Do We Keep It From Coming Back?

• ““It’s absolutely remarkable,” Binnicker, the Mayo Clinic’s director of clinical virology, told me. “I fully expected there to be a typical influenza season this year.”

In the early Fall of 2020, health care physicians and public health experts were warning of the coming wave of Covid-19 infections colliding with the annual flu season and potentially overwhelming the system - the ‘Twindemic’. As we know now, normal influenza infections, hospitalizations and deaths failed to materialize.

• ““Our hospitals are absolutely [at] capacity in Ontario, and we’re not coping well already with the current second wave,” he said. “Just imagine if you then put our usual hospitalization volumes related to pneumonia and the flu on top of that. Our system would’ve collapsed weeks ago.” [ 255]

Contemporary Annual Flu Season - 12,000 – 61,000 deaths annually

The typical patterns of the annual influenza pandemic are between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010. [256].

In the 2019-2020 flu season, 38 million people were ill, 18 million people went to a health care provider, 400,000 were hospitalized, and 22,000 died with influenza. [257]

The occupational health and safety website -ohsonline.com - reported:

• “This year, flu-related medical visits have dropped by about 50 percent, with influenza-like-illnesses (ILI) accounting for just over 1 percent of all medical visits – in a typical year, ILI visits account for about 2.6 percent of all medical visits.” [258]

Looking at the flu season from a testing lab’s perspective, Katherine Wu found that the number of samples tested dropped to a “a mere 0.2 percent. This time last year, close to 100 times as many flu cases had been identified from nearly the same number of tests.”.

• “Since early fall, about 800,000 laboratory samples have been tested in the United States for the flu and reported to the CDC, and only 1,500 or so have come up positive—a mere 0.2 percent. This time last year, close to 100 times as many flu cases had been identified from nearly the same number of tests.” [259]

In Canada, there have been just 17 positive cases of influenza compared to 711 at this point in last year’s flu season.” Many health experts feared that a fall wave of COVID-19 would not only be worse than the first wave in the spring, but that it would come just as seasonal flu infections started to spread, making it impossible for hospitals to keep up.” [260 ]

“This is an extremely puzzling phenomenon. We’re in a historic, unbelievable situation,”

The speculation among health care experts is that this reduction in influenza is probably due to:

• “Scientists don’t know, precisely, which Covid-19 public health steps are contributing most to the drop in flu cases. But they have suspicions. “It is the lack of travel, the school closures, and the distancing and masking that are making the biggest difference,” says Helen Chu, a physician and epidemiologist at the University of Washington who studies the flu.” [261]

• “Researchers don’t think the steep declines are due to more people getting flu vaccines this year. “The vaccination is helping, but there’s absolutely no way that increased vaccination on its own is responsible for this,” Stephen Kissler, an epidemiologist at Harvard says. Yes, flu vaccine uptake is up (around 15.5 million more doses), but it’s not enough to explain what happened to the flu. (The flu is also more commonly spread from contaminated surfaces. So routine surface cleanings may be hygiene theater when it comes to Covid-19, but it could be helping out when it comes to the flu.)” [262]
• “The broad spread of SARS-CoV-2, the virus that causes Covid-19, in countries like the U.S. may play a role in blocking the flu by lifting people’s immunity against other viruses. One study in the spring of 2020 in New York City found that people testing positive for SARS-CoV-2 were far less likely to be carrying other common viruses such as influenza viruses. Still, research into that hypothesis is just beginning.” [263]

This reduction in influenza wasn’t the only respiratory virus that saw a decline:

• “Other respiratory viruses have fallen away as well, among them respiratory syncytial virus, parainfluenza viruses, even other coronaviruses that cause common colds—nearly all of the usual suspects behind the fevers, coughs, and sniffles that typically rear their head this time of year. On the virological scoreboard, the only pathogen that’s truly had a good year is the new coronavirus, SARS-CoV-2.” [264]

What do we know that we don’t know

Known unknown: “If flu can be nearly wiped out this season, why not every season?”“Seasonal influenza will continue to impact countries every year and influenza viruses with pandemic potential will continue to emerge,” said a WHO spokesman in an email.... To keep the flu from returning stronger than ever, doctors said people would have to stick to some of the habits they have learned during Covid-19, including frequent hand-sanitizing and mask-wearing. The best protection, though, is a flu shot, said Dr. Naito in Tokyo. “I believe we need both masks and vaccines, but medically speaking, vaccines are more effective than masks,” he said. ... The unknown is will people be willing to continue wearing face masks, increase annual vaccinations, etc.?

Anti-vaxxers and vaccine hesitancy are an on-going resistance and aversion to aiding in elimination of influenza. ”The world once considered it unavoidable that hundreds of thousands of people would die each year of the flu, Dr. Mizutani said, but “we need to ask ourselves whether we are going to continue to allow it in the future.” [265 ]Deciding not to accept the annual flu infections, hospitalizations and deaths as inevitable does not mean it can be prevented. The additional unknown is the impact of the traditional anti-vaxxer movement and vaccine hesitancy.

2.4 Reducing reliance on foreign suppliers/supply chains of medical equipment, supplies and medicines

This story began in 2005, when the Department of Health and Human Services convened a national summit on pandemic influenza preparedness. It was followed by statewide summits that discussed the weaknesses in the nation’s ability to respond to large-scale emergency situations, whether disease outbreaks, naturally occurring disasters, or acts of terrorism. During any such event, local hospitals and emergency departments will be on the front lines. The National Academy of Sciences, in their 2007 report “Hospital-Based Emergency Care - At the Breaking Point” noted:

• “The result is that few hospital and EMS professionals have had even minimal disaster preparedness training; even fewer have access to personal protective equipment; hospitals, many already stretched to the limit, lack the ability to absorb any significant surge in casualties; and supplies of critical hospital equipment, such as decontamination showers, negative pressure rooms, ventilators, and intensive care unit beds, are wholly inadequate. A system struggling to meet the day-to-day needs of the public will not have the capacity to deal with a sustained surge of patients.” [ 266]

Scroll ahead ten years to 2017, when Shannon Muchmore, repeats the National Academy of Sciences’ criticism in her caustic article “What does it mean for a hospital to be ready for disaster?”:

““Experts say most hospitals are not currently fully prepared for any disaster... The issues healthcare organizations need to consider when preparing for a disaster are myriad. They include supply chain integrity, information sharing, protecting and preserving patient records, shelter-in-place plans, essential equipment, evacuation plans, patient surge and managing mass fatalities.” [267]

The chickens came home to roost in the Covid-19 pandemic of 2020

The chickens came home to roost in 2020, when, “during a 3-week period in late February to early March, the number of U.S. COVID-19 cases increased more than 1,000-fold...” 

First it was Ventilators - Because Covid-19 attacked the respiratory system, severe cases of acute respiratory distress syndrome (ARDS) require mechanical ventilators to help the patient breathe. Covid-19 patients who need ventilators are typically on the machines for around 10 days which means the normal inventory of ventilators gets tied up quickly and additional ventilators must be acquired/purchased to meet patient demand. The New York Times brought this massive failure in hospital supply chain integrity to light:

• “American and European manufacturers say they can’t speed up production enough to meet soaring demand, at least not anytime soon.” [268]

Then it was Personal protective equipment - At the same time, the emergency department/ICU physicians, nurses, technicians and orderlies were scrambling to protect themselves with inadequate and insufficient personal protective equipment - masks, face shields, gowns and gloves (PPE). NBC News conducted a survey of 250 health care providers on the front lines of the coronavirus pandemic:

• “Many reported being forced to ration or reuse supplies, including surgical and N95 masks, for fear of running out. Many also said they were facing shortages of basic sanitary supplies, including hand sanitizer and disinfectant wipes.” [269]

“We weren’t really thinking about” Nasopharyngeal swabs - Then the health care system discovered they didn’t have enough nasopharyngeal swabs...

• ““We weren’t really thinking about, ‘Wow, what’s our swab supply?’ because we haven’t really faced anything that depleted our swabs before,” said Dr. Josh Adler, the chief clinical officer of U.C.S.F. Health. .... “You can’t go to your local store and get Q-tips,” he said.” [270]

The ventilator and PPE vendors (most of whom were off-shore) were auctioning their supplies to the highest bidders

The shortage of ventilators and PPE was exploited by the manufacturers and resellers of to charge exorbitant prices through informal auctions that forced state governors and city CEOs (and Canadian provincial Premiers and city CAOs) to compete with each other for limited stocks and inventories. The shortages in the equipment lockers in hospitals was exacerbated by shortages in the medial equipment supply chains in both America and Canada. Foreign suppliers dominated what quickly became an international market with countries competing with each other for these limited inventories. As with any natural disaster that results in scarce emergency products and equipment, these stakeholders -i.e. the manufacturers and re-sellers of scarce ventilators and PPE - benefitted both immediately and in the longer term repatriation of their supply chains from the Covid-19 pandemic.

The solution: repatriation of medical supply chains

Governor Cuomo of New York State was one of the first to voice concerns about the the risks associated with America’s overdependence on foreign manufacturing of medical equipment and supplies - he called it a “real cruel twist of fate” that China is now the main manufacturer of ventilators and other equipment that states are desperately trying to acquire”. PBS, the Associated Press and the Global Reporting Centre reported on the deadly consequences of the fragmented worldwide medical supply chain:

“Medical supply chains that span oceans and continents are the fragile lifelines between raw materials and manufacturers overseas, and health care workers on COVID-19 front lines in the U.S. As link after link broke, the system fell apart. 

From the very moment the pandemic reached America’s shores, the country was unprepared. Hospitals, nursing homes and other health care facilities didn’t have the masks and equipment needed to protect their workers. Some got sick and spread the virus. Some died.”

“Harvard Medical School professor Dr. Andrew T. Chan and colleagues found health care workers who didn’t have adequate PPE had a 30% greater chance of infection than colleagues with enough supplies. Black, Hispanic and Asian staffers had the highest risk of catching COVID-19, they found.” [271]

As many non-medical companies learned during the pandemic, dependence on other countries as a source of cheap products and supplies can create a strategic vulnerability in terms of factory and border closures, transportation disruption, shifting demand, and price increases. Some companies that bought into globalization, are reconsidering those decisions. Supply chains for medical equipment and supplies were found similarly vulnerable. 

• “The US imports almost half its personal protective medical equipment, including masks, goggles and gloves, from China, according to figures compiled by Chad Bown at the Peterson Institute for International Economics.
•  In February, as concerns increased about the effect of prolonged coronavirus-related closures of critical facilities in China, Mr Navarro told the Financial Times that the outbreak was a “wake-up call” for the US to reduce its reliance on pharma and medical supply imports from China and the rest of the world.” [ 272]

Using the Defense Production Act (DPA) to repatriate/reshore medical equipment and supplies

The Defense Production Act gives the President of the U.S. the power to direct companies to prioritize orders from the federal government and “to jump ahead of a vendor’s other clients.”

“The Defense Department has routinely used the law since 1950 to prioritize the fulfillment of its contracts, including for the president’s plane, Air Force One, and armored vehicles. The Pentagon estimates that it uses DPA authority to place roughly three hundred thousand orders per year for a variety of military-related equipment. The Federal Emergency Management Agency (FEMA) also uses the law to respond to disasters, bumping its orders for items such as food and bottled water to the front of the line. The DPA was also used to supply natural gas to California during the 2000–2001 energy crisis.” [273]

The Trump Administration used the DPA to require General Motors to produce ventilators, 3M to produce face masks and to increase the domestic production capacity of essential health products. Although it generated considerable controversy, Trump also ordered restrictions on the export of “critically needed” personal protective equipment (PPE). Bloomberg reported a case of this restrictions of exports when Trump attacked 3M Co. over supplies of protective face masks which caused 3M to challenge the President’s criticisms:

• “The company pushed back against what it described as a White House request to stop exporting the products from the U.S. While 3M said it has worked to increase the number of masks imported from its overseas factories, including approval to ship 10 million respirators from China, part of its U.S. production is needed in Canada and Latin America.
• There would be “significant humanitarian implications of ceasing respirator supplies to healthcare workers” in neighboring countries, 3M said in the statement. The company has ramped up production to 100 million masks a month, about 35 million of which are produced in the U.S.” [274] 

The newly elected Biden Administration is also planning to use the DPA to solve the supply chain problems of medical equipment and supplies: 

• “Biden signed an executive order directing his administration to identify shortfalls in the supply of materials needed for the pandemic response and use the DPA to address them, if necessary. Biden’s COVID-19 response coordinator, Jeff Zients, said the administration has identified twelve supply gaps, including in masks, gloves, and testing swabs. The order also tasks the administration with ensuring adequate supplies for future pandemics, including by improving supply chains and expanding the Strategic National Stockpile. ...That likely means boosting the supply of equipment such as low-dead-space syringes, which can be used to extract more vaccine doses per vial.” [275]

What do we know that we don’t know

Known unknown: Repatriation/reshoring supply chain of medical equipment and supplies would be beneficial for the economy and increase security/supply of medical equipment needed in pandemics. The painful experiences during the covid-19 pandemic have created a desire on the part of politicians, health care authorities and health care workers themselves to have secure supply chains that can meet their needs during pandemics. ‘Secure’ is interpreted to mean domestic/local/national. The notion of product substitution/replacement strategies has long been an approach to regional economic development. President Biden has said he will use DPA for Repatriation/reshoring manufacturing of pharmaceuticals, medical equipment and supplies . The unknown is what percentage of the medical equipment and supplies needed will be repatriated and over what time frame? 

Altering supply chain could take “years” and incur “significant costs.”...“While Phrma, the trade body representing US drug manufacturers, agreed with the need to explore ways to “encourage even greater domestic development and manufacturing of medicines”, it added that altering just one element of a supply chain could take “years” and incur “significant costs”. [276] The unknown is if this fish is too big to pull into the boat?

2.5 Face masks have become commonplace in spite of deniers, Patrick Henry wannabes, Doubting Thomases and Trump

Resistance to wearing a face mask pre-dates Covid

In spite of the evidence that wearing face masks reduces the transmission of the flu virus and SARS, there has been little public uptake prior to the Covid-19 pandemic globally. Several Australian studies documented the value of face masks in reducing the risks for influenza-like infections, yet less than 50% of the participants in their study wore face masks regularly.

• “Outside the hospital environment, the effectiveness of facemasks in containing the spread of airborne diseases in the general population has been diminished largely due to improper use and lack of user compliance. An Australian study showed that among the three methods used to handle an influenza pandemic – vaccination, isolation and mask-wearing – willingness to comply with mask-wearing was the lowest. 
• Another Australian study found that while adherence to mask-wearing significantly reduced the risk for influenza-like infections, less than 50% of the participants in their study wore facemasks regularly. In a study conducted in Singapore during the SARS outbreak, only 4% of the respondents had worn a facemask in the preceding three days. 
• This highlights a need to uncover the determinants of mask-wearing, in order to identify the issues and overcome the barriers associated with mask-wearing compliance.” [277]

Resistance is futile

Although their research was focussed on Asia and Australia, Shin Wei Sim, et al, in their review of the literature, found studies that revealed the following characteristics regarding the use of face masks: [278]

• Age: In Australia, a telephone survey by Taylor et al found that younger people (aged 16–34 years) were less willing to wear facemasks;
• Marital status: In the same study by Tang et al, a higher level of compliance with mask-wearing was also found among people who were married;
• Educational level: Our literature review revealed that higher education was positively associated with mask-wearing behaviour. In a survey conducted among traditional market workers and shoppers in Taiwan, participants with a senior high school education or higher were found to be more likely to wear facemasks;
• Gender: In several studies, it was observed that women were more likely to don facemasks than men. During the SARS outbreak in Hong Kong, women were reported to be more likely to wear facemasks to prevent SARS.

The WHO and CDC initially ‘dissed’ face masks

In spite of the public health mantra “Wash your hands, wear a mask, keep 6 ft social distance”, the WHO and CDC dismissed the use of face masks. This dismissal of face masks was justified because the WHO and CDC “that the limited supply of surgical masks and N95 respirators should be saved for health care workers”.

• “Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization now recommend cloth masks for the general public, but earlier in the pandemic, both organizations recommended just the opposite. These shifting guidelines may have sowed confusion among the public about the utility of masks. The legitimate concern that the limited supply of surgical masks and N95 respirators should be saved for health care workers should not have prevented more nuanced messaging about the benefits of masking. “We should have told people to wear cloth masks right off the bat,” he said.
• Another factor “is that culturally, the U.S. wasn’t really prepared to wear masks,” unlike some countries in Asia where the practice is more common, said Chin-Hong. Even now, some Americans are choosing to ignore CDC guidance and local mandates on masks, a hesitation that Chin-Hong says is “foolhardy.” [279]

In April, the CDC recommended that masks be worn when physical distancing isn’t an option; the WHO followed with their own acknowledgements. This messaging by two of the world’s leading scientific organizations on infectious disease was followed by negative political pronouncements that dissed the wearing of face masks and confused the public more. 

Made face masks a test of political affiliation

Face masks had become the visible declaration of which side one is on in a culture war between the ‘responsible’ citizens and Patrick Henry’s ‘ ‘give me liberty or give me death’ stakeholders. Trump’s continued refusal to wear a face mask is perhaps the most symbolic rejection of health over the economy that continued to buoy the spirits of protestors. His refusal to wear a face mask is a bit ironic given that the mask has become the badge of morally conscious citizens who believe “you should be responsible and protect people close to you from the micro-particles of your breath”. 

“...there is still a partisan divide. A Pew Research Center study in August found a 16-point gap between Democrats and Republicans on wearing masks in public settings.

The divide is evident in Republican-controlled states across a wide swath of the Great Plains and the northern Rockies, many of which were late to adopt mask mandates, or where they don’t exist at all. South Dakota, which now has the highest daily Covid death rate in the world, still has no mask rule and many local governments have refrained from stepping in. From the Dakotas to Idaho, Utah and Iowa, rising cases and resistance against masks has led to heated confrontations and political fights. In many places, local health departments have hesitated to impose and enforce mask mandates in the face of heated public opposition.” [280]

Protests against masks and physical/social distancing - “Give me liberty or give me Covid-19”

The 1st wave of the coronavirus pandemic ‘missed’ the states of North Dakota (308 cases, 8 deaths), South Dakota 730 cases, 6 deaths), Nebraska (814 cases, 17 deaths), Iowa (1,587 cases, 41 deaths), Arkansas (1,400 cases, 29 deaths) Utah (2,303 cases, 18 deaths) and Wyoming (270 cases, 0 deaths) as of CNN’s reporting April 13, 2020. Compared to New York State with its 6,000 new virus cases per day and a death toll that stands at 16,162 on April 24th, it is easy to understand why residents of these mid-western states felt the public health measures were an unnecessary intrusion of the state governments. There was no pandemic, just a few more flu-like cases affecting some old folks.

USA TODAY did a brief survey of residents in eight states without specific lockdown orders to get a sense of how people are confronting the growing coronavirus outbreak:

“But let’s be honest, what country do we live in?” says Joens. “It’s the USA, which is freedom, freedom to choose. When we get notes from the government saying do this or do that, it feels like that’s not what this country is built on. People should be smart, and you live with your choices.”

• “In every case, there was a clear understanding of the lethal nature of COVID-19...But many also were uneasy with state-ordered health directives, arguing that residents should make smart decisions for themselves. And some blamed the media for overplaying a pandemic that is expected to threaten lives across the globe for much of 2020.” [ 281]

The Washington Post reminded us that “This has played out before: helmets for motorcyclists, seat belts in cars, smoking bans in restaurants. All of those measures provoked battles over personal liberty.” [282]

• ““Making individual decisions is the American way,” Parsell, a 29-year-old lineman for a power company, said as he picked up his lunch at a barbecue joint at a rural crossroads south of Jacksonville. “I’ll social distance from you if you want, but I don’t want the government telling me I have to wear a mask.” 
• “Now it’s masks and the coronavirus, with face coverings emerging as an emblem for what cleaves the nation. A flurry of recent studies supports wearing cloth face coverings as a means to limit transmission of the novel coronavirus, which causes the illness covid-19. To many people, masks represent adherence to civic duty and a willingness to make individual sacrifices for the greater good of public health. To others, masks symbolize government overreach and a violation of personal liberty.”

“But among extreme right-wing voters there’s still a perception that they’re [face masks] a sign of weakness or a symbol of being duped.” [283]

The fruitless struggle to convince ‘deniers’ with the evidence that face masks work

Health experts now say the evidence is clear that masks can help prevent the spread of COVID-19 and that the more people wearing masks, reduces community spread.

“To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease. 

•  ... Another study looked at the effects of US state-government mandates for mask use in April and May. Researchers estimated that those reduced the growth of COVID-19 cases by up to 2 percentage points per day. They cautiously suggest that mandates might have averted as many as 450,000 cases, after controlling for other mitigation measures, such as physical distancing.
• “You don’t have to do much math to say this is obviously a good idea,” says Jeremy Howard, a research scientist at the University of San Francisco in California...” [284]
• “The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high.” [285]

Pew Research Center survey showed increase in population wearing masks

The Pew Research Center’s survey in July/August 2020, found 85% of the population surveyed saying they regularly wore masks in stores:

• “As the coronavirus pandemic continues, a growing share of Americans say they are regularly wearing a mask or face covering in stores and other businesses. More than eight-in-ten U.S. adults (85%) say they have done so all or most of the time over the past month, according to a Pew Research Center survey conducted Aug. 3 to 16. When asked the same question in early June, 65% of Americans said they had been regularly wearing masks.
• In the new survey, 82% of adults under age 30 say they regularly wear a mask – up 20 percentage points since June, when 62% said they did so. The youngest adults are now nearly on par with those ages 65 and older, 88% of whom say they have usually worn masks to stores over the past month as of mid-August, up from 74% in the spring. [ 286]

One mask is difficult, now it’s “Double masking” to protect against coronavirus variants 

Public health officials are doubling down on face masks as variants that have increased transmissibility continue to spread across the U.S. Since the variants, like B.1.1.7, are more adept at transmission, getting the public to increase their efforts to protect themselves becomes even more critical and double masks are vital.

• “According to a recent study [Jin Pan, et al, “Inward and outward effectiveness of cloth masks, a surgical mask, and a face shield”, medRxiv , 2020] double-masking can produce 70-90 percent efficacy when it comes to filtering particles that can cause Covid-19, as opposed to around 50 percent efficacy from just wearing a surgical mask or non-medical cloth mask alone.” [287]

The Centers for Disease Control and Prevention endorsed double masking or fitting a single mask more closely on the face. The Wall Street Journal has reported more doctors supporting double masking:

• “As new, more-contagious coronavirus variants circulate, doctors say it’s important to improve the effectiveness of your mask practices—such as by “double masking” to wear two at once. Numerous studies have found that masks help protect the wearers as well as those around them from the virus that causes Covid-19.” [ 288]

“Taking your mask off too early is like playing Russian roulette, depending on who you are hanging out with and what activities you are doing”

Dr. Mark Kortepeter, a physician and biodefense expert, makes the case for continued use of face masks in spite of the ongoing vaccination efforts [289]:

• Reason 1: It may take months or longer to get vaccinated.
• Reason 2: You won’t know who has or hasn’t been vaccinated. Some of the vaccines may require one or more boosters to provide maximum protection, meaning you have to get another shot after a certain period of time. But you won’t know where anyone else is in their vaccination schedule, and therefore how well protected they are. Therefore, you will still need to protect yourself when around others.
• Reason 3: We don’t know the vaccines’ effectiveness. We also don’t know what protection from the vaccines will look like. Ideally, the vaccines would provide complete protection from illness and block the person from any risk of transmitting virus; however, the vaccines could also provide a range of protection from illness or only partially reduce the chance of shedding virus in our secretions. Therefore, it pays to remain cautious until we know.
• Reason 4: We don’t know the duration of vaccine protection. Because the vaccines are rolling out so quickly, we will not have any data on long-term protection. It can take months to years to fully understand the long-term effectiveness of the vaccines. Even if you have a good response to the vaccine, only time can tell whether boosters beyond the initial vaccination schedule will be needed to maintain protection.
• Reason 5: People can be re-infected. We now know it is possible for some people to become re-infected. The proven re-infections that have been reported thus far appear related to exposure to a different strain of virus. As the country opens up and people travel more–within the US and beyond–opportunities for exposure to different viral strains increases. We don’t know how long the vaccines in development will remain effective as the virus continues to evolve over time.

What do we know that we don’t know

Known unknown: Using a well-fitting cloth mask over a surgical or disposable mask can decrease exposure to particulates by 85% to 90% . The original argument for wearing a face mask was to protect ‘other’ from your breath, cough, sneeze. Now the experts are saying double masking is a mean of protecting yourself...“Importantly, wearing a double mask will be effective against these new variant strains. As mentioned, the new variants will still be transmitted by contaminated droplets and aerosolization. The manner of transmission, compounded with the heightened infection rates of the new strains, indicates that another protective layer in the form of a mask can protect you more than only one would. Additionally, wearing a double mask can protect you from someone that is asymptomatic, and it can also protect others from you if you are asymptomatic. As Dr. Fauci has said, the way to beat the virus is to eliminate the virus. Double masking can help achieve that.” [290] The unknown is we don’t know what the up-take of double masking will be. “Sometimes, it takes a pandemic to change behavior. Across East Asia, mask wearing really took off in the aftermath of the SARS outbreak in 2003. The U.S. was largely spared from SARS. But in Hong Kong, where more than 280 people died, there was widespread panic. All of that led to many countries developing practices around how to tamp down on potential disease outbreaks early, with measures like social distancing, travel bans, and masks. Almost two decades later, this advanced planning gave the region an edge when it came to Covid-19. Many people already had a mask or two at home and had become used to wearing one. In countries like Taiwan, those who did not wear a mask were occasionally even publicly shamed on social media for failing to take proper precautions.” [ 291]

The health experts are ‘hinting’ that we will have to wear face masks into 2022. “So, when can we remove the masks? The real signal for when it is safe to reduce mask wearing will come from reductions in viral spread in our communities. Even without vaccines, this has been the key all along. If we see a consistent decline in cases and deaths, that will signal that we are headed in the right direction. Once we reach levels of minimal spread, such that our public health responders can jump on any new cases and stop the spread of infection, that is the time for the general public to take the masks off.” [292] The unknown is when, if ever, we can put our face masks in the drawer, saved for the next pandemic. Don’t forget the annual flu season.

Face masks are an alternative to lockdowns - “What you want is 100 percent of people to wear masks, but you’ll settle for 80 percent,” said Rutherford. In one simulation, researchers predicted that 80 percent of the population wearing masks would do more to reduce COVID-19 spread than a strict lockdown. [293] The unknown is will the powers at be recognize face masks as an alternative to the next lockdown?

2.6 Temporary respite from the “epidemic of dirty air” 

• “It’s what we call an unexpected, natural experiment,” McLinden said. “It’s not really something you can duplicate in a lab.” [294]

The Stay-at-home/lockdown orders had the unintended, but not unexpected, benefit of temporarily reducing PM2.5 particles and nitrogen dioxide because the restrictions “kept people at home instead of on the roads” and shut down businesses, plants and buildings. 

• “In the U.S., the stay-at-home orders began in March. The drop in NO2 has been most pronounced in cities and along major transportation corridors. The declines are sure to be only temporary. To get healthier air for the longer term, means shifting to clean energy and transportation, “not ordering people to stay at home at drastic economic cost.” But the cleaner pandemic skies do show how fast we can bring down pollution when we reduce our burning of fossil fuels. [295]
• “...In cities like Toronto and Montreal, the nitrogen dioxide levels fell more than 30 per cent, which McLinden said is mainly because there were fewer cars on the roads, and factories either closed or cut production. In Edmonton and Calgary, the drop was closer to 40 per cent, he said.” [ 296]

Predictable but not the reason for the lockdowns

This improvement in air quality was no surprise to the NASA people - “We all knew the lockdowns were going to have an impact on air quality,” said lead author Christoph Keller with Universities Space Research Association (USRA) at NASA’s Goddard Space Flight Center in Greenbelt, Maryland.

• “In some ways I was surprised by how much it dropped,” said Keller. “Many countries have already done a very good job in lowering their nitrogen dioxide concentrations over the last decades due to clean air regulations, but what our results clearly show is that there is still asignificant human behavior-driven contribution.”
• Wuhan, China was the first municipality reporting an outbreak of COVID-19. It was also the first to show reduced nitrogen dioxide emissions—60% lower than simulated values expected. A 60% decrease in Milan and a 45% decrease in New York followed shortly, as their local restrictions went into effect. “ [297]

We have forgotten or simply inured to the harmful effects of air pollution

This temporary reprieve also reminded the media and the public of the health hazards of air pollution. The WHO has said that air pollution is responsible for 7,000,000 deaths annually worldwide. The National Geographic article notes “air pollution still kills more than 100,000 Americans every year.”

In the United States, decades of regulation have led to air quality that is far better than in most of the world. In New York City, for example, PM2.5 levels actually fell 30 percent from 2009 to 2017, which has presumably saved many lives during the current pandemic. Nevertheless, air pollution still kills more than 100,000 Americans every year. [298]

• “... So basically the reduction in NO? gave us 10 percent in terms of life saved than the loss we had due to COVID.”[299]
•  “ ... It could reduce the spread of disease. A high level of air pollution exacerbates viral uptake because it inflames and lowers immunity.” [300]

The American Lung Association published a pre-Covid warning in 2017 that is a frightening reminder (for those of us who are old enough to remember the scares smog scares in the 70s) of the adverse effects of air pollution on human health:

“ 1. Premature death: Science shows that both short-term and long-term exposure to unhealthy air can shorten your life and lead to premature death. Medical experts have known about this risk for decades —remember our blog about the great smog event depicted in “The Crown”?

  2. Asthma attacks: Breathing ozone and particle pollution can lead to increased asthma attacks, which can result in visits to the emergency room and hospital admissions, not to mention missed work and school.

  3. Cardiovascular disease: Air pollution can increase the risk of both heart attacks and stroke.

  4. Lung cancer: In 2013, the World Health Organization determined that particle pollution can cause lung cancer, which is the leading cause of cancer-related death in the U.S.

  5. Developmental damage: Exposure to air pollution can slow and stunt lung development in growing children, harming their health now and reducing their lung function as adults.

  6. Susceptibility to infections: Air pollution increases the risk of lung infections, especially in children.

  7. Worsened COPD symptoms: Exposure to air pollution can make it even harder for people with chronic obstructive pulmonary disease (COPD) to breathe. Severe symptoms can lead to hospitalization and even death.

  8. Lung tissue swelling and irritation: Even people with healthy lungs are susceptible to irritation and swelling. For those living with chronic lung diseases, such as asthma and COPD, these effects can be especially harmful.

  9. Low infant birth weight: Some studies show exposure to air pollution may increase the risk of low infant birth weight and infant mortality.

  10. Wheezing, coughing and shortness of breath: Like many of the other conditions in this list, these can be caused by both long-term exposure and short-term exposure to high levels of air pollutants.” [ 301]

“Possibly making people more vulnerable to COVID-19”

“Every year, around 4.5 million premature deaths are linked to air pollution from fossil fuel burning. In 2018, it has been reported that the global cost of air pollution reached US$8 billion per day, which is roughly 3.3% of the world’s GDP. And according to the WHO , 91% of the global population live in areas that exceed the WHO air quality standard.

• What’s worse, evidence suggests that air pollution damages the body’s ability to resist respiratory viruses, possibly making people more vulnerable to COVID-19, and air pollution is a risk factor for many chronic diseases that make COVID-19 more severe. Another study discovered that air pollution could potentially increase COVID-19 mortality.” [302]

Researchers from Harvard University’s T.H. Chan School of Public Health, in a recent study, found that air pollution makes Covid-19 more lethal. They analyzed PM2.5 levels and Covid-19 deaths from about 3,000 U.S. counties and found that “Counties that averaged just one microgram per cubic meter more PM2.5 in the air had a COVID-19 death rate that was 15 percent higher.” “If you’re getting COVID, and you have been breathing polluted air, it’s really putting gasoline on a fire,” said Francesca Dominici, a Harvard biostatistics professor and the study’s senior author. [303]

•  “The flip side is that even temporarily cleaner air can help “flatten the curve” of the pandemic, easing the burden on health care systems by reducing the number of people who experience severe COVID-19 symptoms, said Christopher Carlsten, head of respiratory medicine at the University of British Columbia’s School of Population and Public Health, in Vancouver. Cleaner pandemic skies should also reduce other pressures on hospitals struggling with COVID-19 cases, Carlsten said. In addition to the cumulative effects of breathing dirty air for years, a large body of evidence shows that short-term changes in air quality have an immediate impact on heart attacks, strokes, and emergency room visits. All increase when pollution spikes.
• Authorities in British Columbia had that hope in mind when they issued restrictions on the fires farmers typically light at the start of spring to clear old growth from fields. One region in British Columbia even banned campfires. Wood smoke is thick with PM2.5 particles.” [304]

 “An increase of only 1 ug/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate”

• “The results were statistically significant and robust to secondary and sensitivity analyses. Conclusions: A small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate.” [305]
• “Reducing economic activity to levels equivalent to a lockdown state may be impractical, yet maintaining “business as usual” clearly exacerbates global pollutant emissions and ambient exposure levels... finding means to curb air pollutant emissions remains important, and here we provide empirical evidence at a global scale for a coupling between vehicle transport reduction and declining ambient NO2 concentrations.” [ 306]

Face masks also reduce deaths due to air pollution

The irony is that wearing masks will also reduce deaths due to normal air pollution. The images of smog in cities in China, Singapore, etc. show the populations wearing masks normally. But we have no similar images of European or North American populations wearing mask to prevent illnesses or deaths from air pollution.

• “... we have 60,000 premature deaths in Italy because of air pollution. And people are very much afraid of COVID, but they don’t consider or fear air pollution. So that remains a big reason for showing this number and repeating these numbers, because most people don’t realize it. I’m still puzzled why that’s the case. I’m still puzzled why now everybody’s wearing a mask, but with very bad air pollution, you would see people running around in Milan, running without a mask with nothing, in a day with very bad air pollution...” [307]

The World Health Organization issued its own warnings about the risks of polluted air:

• “While there’s a push to reduce levels of urban air pollution by encouraging people to use sustainable forms of transportation such as walking and cycling, many are concerned about how much pollution they’ll be exposed to while travelling these ways. Although a review that looked at 39 studies on air pollution found that car commuters were exposed to more air pollution than other commuters, when you consider that a person breathes more air during physical exercise, cyclists and pedestrians actually inhale higher doses of pollutants than vehicle drivers.
• Wearing face masks has become an increasingly common way that people are trying to reduce their exposure to air pollution while walking or cycling. [308 ]

What do we know that we don’t know

Known unknown: The Stay-at-home/lockdown orders that shuttered the U.S. and Canadian economies in March and April 2020 reduced air pollution almost immediately. As the NASA environmental scientists said “We all knew the lockdowns were going to have an impact on air quality,” The enormous price, however, was significantly reducing economic activity/output, killing thousands of job overnight, tripling unemployment, increasing loneliness, reducing social support because of restrictions on gatherings, depression, anxiety, and financial concerns. But it did demonstrate how quickly air quality could be improved and how noticeable the improvement was. The unknown is will the economic recovery plans simply restart the industries that cause air pollution or will ‘Build Back Better’ support/subsidize ‘green’ industries in sufficient numbers to sustain this improvement in air quality?

Renewed awareness of the “epidemic of dirty air”. The National Academy of Sciences, in their report on air pollution called it an epidemic of dirty air - “Long thought to primarily harm the lungs and cardiovascular system, air pollution is now catching the attention of neuroscientists and toxicologists.” [309] “The BBC in their lengthy article in their Future series reported “Emerging studies show that air pollution is linked to impaired judgement, mental health problems, poorer performance in school and most worryingly perhaps, higher levels of crime. These findings are all the more alarming, given that more than half of the world’s population now live in urban environments – and more of us are travelling in congested areas than ever before. Staggeringly, the World Health Organization says nine out of 10 of us frequently breathe in dangerous levels of polluted air.” [310]  The unknown is will governments do anything to improve air quality as society moves to the ‘nu/next normal’?

2.7 Moving work into “socially distant mode” - remote work/telework/working from home

“We all know that work will never be the same, even if we don’t yet know all the ways in which it will be different,”.

The BBC used the term ‘remote work’ to include all arrangements that defied the traidional office as they maintained that “the pandemic has normalised remote work ... “We all know that work will never be the same, even if we don’t yet know all the ways in which it will be different,”.[311] . 

The Future Forum research of 4,700 knowledge workers found the majority never want to go back to ‘9-to-5, office-centric work’. 

“Nearly 42 percent of the U.S. workforce is working from home, according to a survey of managers conducted by job recruitment firm Upwork. While only 12.3 percent of the US workforce teleworked before the pandemic, roughly 27 percent is still expected to work remotely by December 2021, according to the survey.” [312]

• “COVID-19 may permanently change the way many of us work. At present, shifting as many people as possible to home-based telework is a necessary response to a terrible crisis. In the post-pandemic world, it may stay with us as a popular practice that, if done well, can improve job satisfaction, raise productivity, reduce emissions, and spread work to more remote regions.” [313]

“The pandemic has normalised remote work”

The lockdown exemption universally given to businesses/organizations that could perform their work from home, although intended to reduce the transmission of covid-19, had the unintended consequences for the world of work.

Businesses and organizations that could carry on by having their managers and employees work-from-home increased/accelerated the trend of electronic/virtual organization of ‘work’ and eliminated the need for/cost of office space, commuting and employee safety. from the virus. “The research indicates that three-quarters of businesses now have more than 76% of their employees working from home compared to just under 25% at the close of 2019... one-third (38%) of U.S. companies observed productivity gains during remote work and a staggering 84% anticipate broader and more permanent WFH adoption beyond the pandemic.” [314]

Since the World Health Organization declared Covid-19 a pandemic in February, the pandemic has normalised remote work. What will that might mean. “Today, we’re starting by looking at the issue of work: how the pandemic has normalised remote work, and what that might mean. Will we go to the office again – and, if so, how often? What impact will a ‘hybrid’ way of working have on how we communicate, connect and create? Will work-from-home be the great leveller in terms of gender equality and diversity? And what will work mean if our offices are virtual and we lose those day-to-day social interactions?” ... Our Future Forum research of 4,700 knowledge workers found the majority never want to go back to the old way of working. Only 12% want to return to full-time office work, and 72% want a hybrid remote-office model moving forward. [315]

25% of Canadian business are ‘likely’ or ‘very likely’ to offer their employees the option to work remotely

According to Statistics Canada, businesses that expect their employees to continue working from home include the information and cultural industries sector (47 per cent) and the professional, scientific and technical services sector (44.5 per cent).

• "The survey results also found that 25 per cent of Canadian business are ‘likely’ or ‘very likely’ to offer their employees the option to work remotely following the pandemic, while 14 per cent reported that they will make it a requirement.
• Previous data from Statistics Canada reported that 40 per cent of Canada’s workers found themselves working from home as pandemic lockdowns were enforced. That compares to less than 10 per cent in 2018 who had the option to work a day or two a week from home.” [316]

“We are looking at a prolonged period of hybrid working – from home and office in different proportions.”

From an employer’s perspective, remote work had the obvious benefit of enabling those who could, continue their operations during the work-at-home/lockdown orders during March/April/May 2020 when governors and premiers shuttered their economies. This induced/forced excursion into these trials brought home the benefits of weathering pandemics and natural disasters (floods, hurricanes, wildfires, etc.) that disrupt the ability of employees to commute to office locations. Under the ongoing public health requirements to protect employees from the coronavirus, remote work can reduce the risks to employees and reduces the costs of protecting employees from transmission of the virus. Depending on the remote work model/hybrid, it can result in decreased real estate and occupancy costs (including heating, lighting, electricity, office supplies, furniture, equipment, coffee and janitorial services). Remote work also increased ability to attract employees without having them to move to the city where the employer was headquartered. Although a number of preliminary studies point to increased productivity, the verdict is still out as some manager struggle with how to manage employees who are not within eyesight daily in an office.

From the employee’s perspective, remote work reduced, and potentially eliminated, the onerous tasks of daily ‘beating the traffic’ in a daily commute - depending on the remote work model used including hybrid models of one day a week to five days a week at home and “third places” such as coffee shops and coworking spaces. The environmental benefits of less commuting is reflected in their lower carbon footprint. Remote work allows for flexible working hours and family management. 

• “In a report published by the Royal Society for Public Health in the UK, it found that 55% of people felt more stressed as a result of their commute. Snacking habits also increased and with less free time available, the report also found that workers were leading less active and healthy lifestyles.
• In a 2014 study by PGi, a leading provider of software services, it found that 80% of remote workers reported higher morale, 82% said it helped lower their stress levels, and 69% reported lower absenteeism.” [ 317]

Over time, however, face-to-face interaction is required to facilitate collaboration, build relationships, etc. Remote work requires high quality broadband connection in the home. As the American Community Survey data revealed “Nearly 10% of working-age adults do not have a home broadband connection ... or are too slow where they live.” [318]

Not all work can be done remotely 

But these generalizations about the desirably/interest in remote work from home should be qualified by the type of work/sectors/occupations that are apropos: 

• “Evaluating the economic impact of \social distancing” measures taken to arrest the spread of COVID-19 raises a fundamental question about the modern economy: how many jobs can be performed at home? We classify the feasibility of working at home for all occupations and merge this classification with occupational employment counts. We found that 37 percent of jobs in the United States can be performed entirely at home, with significant variation across cities and industries. [ 319]
• Computer and Mathematical Occupations 
• Education, Training, and Library Occupations 
• Legal Occupations
• Business and Financial Operations Occupations 
• Management Occupations 
• Arts, Design, Entertainment, Sports, and Media Occupations 
• Office and Administrative Support Occupations 
• Architecture and Engineering Occupations 
• Life, Physical, and Social Science Occupations

Indranil Roy: Executive Director, Human Capital practice, of Deloitte Consulting observed that organizations can make the transition to remote work on a corporate scale if they meet the following 4 criteria:

• “One, the workplace is distributed across home, office and satellite offices. Employees can choose to work remotely or face-to-face based on their nature of work and teams’ preferences. Two, the teams are virtual ready. Managers know how to manage, coach, collaborate, evaluate performance and motivate their team remotely. Three, the technology enables multiple modes of working. Data is saved on cloud; access and security are tailored for different working modes; and applications allow seamless virtual collaborations. Four, the culture prioritises trust and belonging. Interpersonal bonds are formed with intent and care.” [320] . 

Notwithstanding the learning curves involved in transitioning to remote work, this new organizational paradigm away from the ‘9-to-5, office-centric work’ model is another Grey Rhino that is highly probable/high impact.

What do we know that we don’t know

Known Unknown Studies and reports indicate as many as 84% of Businesses (that can) will likely increase remote work capacity beyond pandemic... compared to just under 25% at the close of 2019.. But “The United States is ready, but not ready enough: Despite some concerns, the United States is well poised for business continuity, with robust digital platforms and digital payment infrastructure. But with businesses asking employees to work from home, surges in digital traffic have stressed the internet infrastructure..” [321] The unknown is what percentage of the firms that can work remotely decide to make it permanent. 

Significant shifts to remote work in any given city core will have adverse knock-on effects...“The decline in daily commuters as well as business travel has a knock-on effect on those whose jobs support and serve these workers and offices. A full one-in-four workers are in the transportation, food service, cleaning and maintenance, retail and personal care industries. These jobs, often concentrated in cities and lower paid, are disappearing or are at risk of disappearing in the near term.” In England, a ‘lunch is on us’ campaign was launch last summer “ to offer lunch vouchers to incentivise workers’ return to office . “The firm Offices is calling this campaign “Lunch is on us” and states it is very similar to the “Eat Out to Help Out” scheme that was announced by Rishi Sunak, Chancellor of the Exchequer and is due to run throughout the whole of August. The scheme was used more than 10.5 million times in its first week, which Mr Sunak described as “amazing”.[322] The unknown is the full scope and magnitude of these knock-on effects of remote work and emerging counter strategies?

Remote work will have some knock-on effect on coastal superstar cities as remote workers migrate out of city cores. “As a general rule of human civilization, we’ve lived where we work. More than 90 percent of Americans drive to work, and their average commute is about 27 minutes. This tether between home and office is the basis of urban economics. But remote work weakens it; in many cases, it severs the link entirely, replacing spatial proximity with cloud-based connectivity. What knock-on changes will this new industrial revolution bring? ... According to U-Haul’s annual review, California lost more people to out-migration than any other state in 2020, and the five largest states in the Northeast—New York, Pennsylvania, New Jersey, Massachusetts, and Maryland—joined California in the top 10 losers. Rents have fallen fastest in “pricey coastal cities,” including San Francisco, Seattle, Los Angeles, Boston, and New York City, according to Apartment List.” [323] The unknown is the extent of such out-migration and how will communities near-by exploit this trend?

2.8 “Say his name George Floyd” - galvanized protests nationwide that catapulted systemic racism onto the political agenda

•   “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.” - Dr. Martin Luther King, Jr.

As I sifted through the stories and articles about potential ‘silver linings’, George Floyd’s death and the protests it launched for racial justice kept rising to the surface in spite of the fact that these protests were unrelated to the Covid-19 pandemic - other than they occurred during the summer of the pandemic and drew a large portion of their protestors from the ranks of people thrown out of work because of the lockdowns and closures of business due to physical/social distancing requirements. I asked myself “would these protests have been as powerful in instigating these budding changes for racial justice if there was no pandemic?” Probably not. In the end, I decided including it as a ‘silver lining’ would honour his death and recognize the need for a renewed effort for racial justice, even in the ‘Great White North’.

“... the most [public protest] since the aftermath of the assassination of Martin Luther King Jr in 1968”

 The death of George Floyd under the “knees” of the police, on May 25th, triggered angry protests that began in Minneapolis and quickly spreading to New York City, Atlanta and Washington, D.C. 

• “Fires burned near the White House, stores were looted in New York City and Southern California, and a tanker truck drove into marchers in Minneapolis as the United States struggled to contain chaotic protests over race and policing. National Guard troops were deployed in 15 states and Washington, D.C. in an attempt to quell a sixth night of violence on Sunday. The unrest began with peaceful protests ...
• ... the most since the aftermath of the assassination of Martin Luther King Jr in 1968” [324]

Protests spread internationally to Amsterdam, London, Berlin, Paris,Barcelona, Toronto...

By May 31st, protests had spread internationally to Amsterdam, London, Berlin, Paris,Barcelona, Toronto, many of which turned violent as protestors clashed with police. These demonstrations all carried the same messages of solidarity with the family, friends and black community of Minneapolis - “Black Lives Matter”, “no justice, no peace”, “Injustice anywhere is a threat to justice everywhere,” and “Being black is not a crime”. [325]

The protests continued well into the summer with nightly marches

The protests continued well into the summer with nightly marches with only sporadic violence and looting by outsiders and gangs.

• “Before Floyd’s killing, the highest estimate for any American protest -- the 2017 Women’s March -- was 4.6 million. Polls indicate that, as of mid-June, as many as 21 million adults had attended a Black Lives Matter or police brutality protest. They continue today, more than 10 weeks after a Minneapolis policeman knelt on Floyd’s neck till the life left his body.” [326]

“ 74% of Americans felt that the killing of Mr Floyd was part of a broader problem in the treatment of African Americans by police”

The Washington Post catalogued the deaths of a dozen black Americans since 2014. [Nicole Dungca, et al, “A dozen high-profile fatal encounters that have galvanized protests nationwide” The Washington Post, May 2020] Yet these previous protests of police killings of black people did not incite the outrage that the killing of George Floyd did. 

“History changes when you have an unexpected convergence of forces,” argued Mr Roberts. ”You have a situation where the entire country is on lockdown, and more people are inside watching TV... more people are being forced to pay attention - they’re less able to look away, less distracted.” A poll for ABC suggested that 74% of Americans felt that the killing of Mr Floyd was part of a broader problem in the treatment of African Americans by police.

This was a sharp rise from a similar poll in 2014, following deaths of Michael Brown and Eric Garner - where 43% of Americans felt that those incidents reflected a broader problem, ABC reported.” [327]

Canada was not immune to protests and accusations of racism

Anti-racism protests were held across Canada, some in solidarity with the U.S. demonstrations and others to highlight similar concerns in Canada. 

• “Protests against police brutality spread from the United States to Canada over the weekend, sparked in part by last week’s death of a young Black woman in Toronto, as critics argue that systemic racism festers just as deeply here. Thousands of people took to Toronto’s streets on Saturday, while similar events took place in Montreal, Vancouver and other Canadian cities this weekend, and more are planned.” [328] 

An Angus Reid survey, in 2020, found 73% of those polled said police in Canada interact inappropriately with non-white people at least some of the time.

• “...nearly two-in-five Canadians say there is a “serious problem” with the way police interact with Black, Indigenous and other non-white people across the country, while more than one-quarter (27%) say it is a serious problem in their own community. Further, nearly two-thirds (63%) agree that systemic racism is a serious problem for the RCMP, and three-quarters (73%) say police in Canada interact inappropriately with non-white people at least some of the time.” [329]

Calls for government and Corporate America to finally do something about “entrenched racism in our legal, social, and political systems”

The months of protests in cities in North America and Europe repeated the calls for justice in policing, racial equality, and support for “Black Lives Matter.” Their voices, heard on television and in newspapers, reverberated through the halls of government and permeated Corporate America.

• “.A majority of Americans have accepted the diagnosis of Black Lives Matter activists, even if they have yet to embrace their more radical remedies, such as defunding the police. For the moment, the surge in public support for Black Lives Matter appears to be an expression of approval for the movement’s most basic demand: that the police stop killing Black people. This request is so reasonable that only those committed to white supremacy regard it as outrageous. Large majorities of Americans support reforms such as requiring the use of body cameras, banning choke holds, mandating a national police-misconduct database, and curtailing qualified immunity, which shields officers from liability for violating people’s constitutional rights.” [330]

Calls for Defunding Police

One of the most extreme outcomes of these protests has been the call to ‘defund the police’. The premise of defunding police is (a) a proposal to decrease police budgets and power while (b) using those savings to fund alternative community safety models such as anti-homelessness, healthcare, education, drug rehabilitation, affordable housing, etc. The Minneapolis City Council rocketed to national attention with they voted to divert nearly $8 million from the proposed policing budget to other city services:

“The shift in funds — about 4.5 percent of the proposed $179 million police budget — was not nearly the sweeping change that activists and some lawmakers had demanded in the wake of the police killing of George Floyd in May. Still, Jeremiah Ellison, a city councilman who had favored more aggressive efforts to defund the police, called it an “incredible investment.” [331]

Forbes Magazine identified cities to date that have “cut funding from police department budgets or decreased officer numbers with several more in the process amid a national reckoning over systemic racism and police brutality”: [332]

• Austin, Texas voted unanimously to cut $150 million (roughly one third) from the police budget, reinvesting much of that sum in social programs, including food access, violence prevention and abortion access;
• New York slashed $1 billion from its 2021 budget totaling $88.9 billion (reallocating $354 million to mental health, homelessness and education services);
• Los Angeles approved a $150 million budget cut from its $1.86 billion proposed budget;

”They don’t want to necessarily eliminate police departments...”

Once the initial excitement/zeal/buzz of the BLM protests died down, calmer voices surfaced mitigating the rhetoric of the term ‘defunding police’ -”they don’t want to necessarily eliminate police departments or take away all of their money. Rather, they assert that now is the time to address systemic racism and policing problems in America”. [333]

The overriding characteristic of these efforts to ‘defund police’ is a willingness, on the part of the proponents, to admit “they are not certain what policing will look like once they are finished, and they caution plans will take a long time to carry out.”

Donations flooded in to support anti-racism efforts - Sometimes donations are a proxy for not doing anything else

• From bail funds to college fees, crowdfunding is helping raise millions to support Black Lives Matter (BLM), Higher Heights, Color of Change and other anti-racism/racial justice groups : [334]
• “This is a watershed moment for all black-led organizing groups,” said Kailee Scales, managing director of the Black Lives Matter Global Network, who did reveal that one of her group’s online petitions alone had raised $5 million... Another person familiar with the group’s fund-raising said that it had raised $10 million just on Blackout Tuesday”
• “At the forefront of the giving wave were bail funds, as millions of Americans spontaneously gave money to ensure that any protesters who were arrested in clashes with the police got out of jail quickly. Leaders of two national networks said bail funds had received a combined $90 million over two weeks”
• “Crowdsourced memorial funds for the families of Mr. Floyd, Ahmaud Arbery, who was gunned down this year in Georgia, and Breonna Taylor, who was killed by the police inside her home in Louisville, Ky., have amassed more than $23 million. The Floyd memorial broke GoFundMe’s record for most contributions, with nearly 500,000 contributors.”

Corporate America took some notice 

The World Economic Forum published the following sampler of anti-racism initiatives: [335]

• “Evan Spiegel, CEO of Snap – the Snapchat social network owner – has done this in a novel way, announcing to his employees that he is “heartbroken and enraged” by racism in America, and calling for a more progressive tax system which would see the corporations pay more.
• Many other companies have pledged their support for Black Lives Matter and other campaigns against racial injustice; Nike’s social media videos urging “For Once, Just Don’t Do It” attracted millions of views and communicated a timely message of solidarity.
• Nike has pledged $40 million over four years to support Black community initiatives, as well as stepping up measures to attract a more diverse workforce. And there have been large donations from Silicon Valley giants, including Amazon, Airbnb, Uber, YouTube and Facebook.
• Uber Eats lets customers identify and support Black-owned restaurants on its app. And Twitter co-founder and CEO Jack Dorsey made Juneteenth a company holiday; the 19 June date commemorates the end of slavery in the United States. 

But Corporate America has an “obligation to go beyond tweets and quotes”

The Harvard Business Review took the bull by the horns and declared that “Corporate America and the Business Roundtable have an obligation to go beyond tweets and quotes by committing to an agenda that will advance racial equity in meaningful ways.” Here are the 10 things they need to do: [336] 

1. Commit to anti-racism personnel policies and racial-equity training.

2. Commit to pay equity

3. Commit to giving employees a voice.

4. Commit to supporting full participation in democracy.

5. Commit to lobbying for good.

6. Commit to paying a living wage.

7. Commit to paid parental and sick leave.

8. Commit to full health care coverage for all employees and support national health care.

9. Commit to an employee emergency relief fund or low-cost loan program.

10. Commit to democratize employment applications.

The author qualified this list by noting “These commitments won’t eliminate structural racism, quell protests, or stop continued violence against the Black community, but they are changes within the power of every company that will make a profound difference.”

The George Floyd Justice in Policing Act was approved 220-212 in the House

The legislation was first approved last summer but stalled in the Senate. This version would ban chokeholds, eliminate “qualified immunity” for law enforcement and create national standards for policing.

• “But the debate over legislation has turned into a political liability for Democrats as Republicans seized on calls by some activists and progressives to “defund the police” to argue that Democrats were intent on slashing police force budgets. This bill doesn’t do that.” [ 337]

The question now is what will happen when the Senate debates the bill.

What do we know that we don’t know

Known unknown: Racial justice has been placed on the national agenda and in the board rooms of corporate america. “In the wake of the killing of George Floyd in Minneapolis, many major corporations are tweeting out statements of concern and support for the Black community. That’s a start, but what is needed at this moment is action. We cannot pretend that most major corporations in America — and their shareholders — have not benefited from the structural racism, intentional inequality, and indifference to suffering that is behind the current protests.” [ 338] The unknown is the degree to which Corporate America goes “beyond tweets and quotes” and implements one or more of these 10 commitments.

The George Floyd Justice in Policing Act has been passed by the House. “Broadly, the George Floyd Justice in Policing Act of 2021 tries to do four things at the federal level: make the prosecution of police misconduct easier, expand federal oversight into local police units, limit bias among officers, and change policing tactics. The bill works to encourage state and local governments to adopt its federal reforms through penalties — those that don’t make changes, or that refuse to comply with the bill’s data submission requirements, would lose access to federal policing funding, and in some cases, that funding would be redistributed to those departments that do cooperate.” [339] The unknown is will it be passed by the Senate, and in what form?

Racial justice groups have received a phenomenal boost in donations. “Much of this funding will likely support Black-led groups engaged in criminal justice reform and fighting for education equality. Wealthy donors in the first half of the year gave nearly US$6 billion in donations of $1 million or more, but people of at various income and wealth levels are also increasingly supporting racial equity causes and organizations.” [340]. The unknown is how they will manage to keep racial justice on the national agenda. Once some form of the George Floyd Justice in Policing Act is passed and the Biden Administration embeds racial justice across Federal agencies, policies, and programs, they will likely move on to their next pressing agenda items - i.e. immigration reform, build the economy back, tackle the climate emergency, etc.

2. 9 Closing comments on ‘silver linings’ 

Finding ‘silver linings’ to the coronavirus pandemic has been more difficult and time consuming (over two months) than I initially assumed. Although the searching had its challenges, the process of selecting potential ‘silver lining’ forced me to think hard about what constitutes ‘something good’ and what it entails. These eight are the results of my struggles.

Each of these 'silver linings' can be expected to have a positive effect on the lives of stakeholders if Corporate America and governments follow through and bring them to fruition. Most of these 'silver linings' have to do with curing diseases and preventing illnesses and death. I have identified them using Rumsfeld's heuristic - these are 'Known Unknowns, things we know but about which there are still some unknowns. They are not 'Grey Rhinos' - big, obvious things coming at us which threaten to trample us unless we do something about them. There is no other name for them except 'silver linings'. If the reader has any 'silver linings' of the pandemic or edits or challenges, I would be interested in seeing them. Just hit the 'comment' button and fill it in.

Cheers

Robb Ogilvie 

End Notes for Chapter 2 

2.1 Applications of messenger RNA (mRNA) technique for “cheap gene fixes for cancer, sickle-cell disease, and maybe even HIV.” 

[240] “Vaccinating the world -The great task”, The Economist, Jan 2021

[241] Jonathan Gardner, Ned Pagliarulo, Ben Fidler, “The first coronavirus vaccines have arrived. Here’s where the rest stand.”, biopharmadive.com, Feb 2021

[242] Diana Kwon, “The Promise of mRNA Vaccines”, The Scientist, Nov 2020

[243] Antonio Regalado, “The next act for messenger RNA could be bigger than covid vaccines”, MIT Technology Review, Feb 2021

[244] Antonio Regalado, “The next act for messenger RNA could be bigger than covid vaccines”, op. cit.

2.2 The Remdesivir ‘trick’ - “better antivirals could buy us time to develop vaccines against potential future outbreaks.”

[245] Richard T. Eastman, et al, “Remdesivir: A Review of Its Discovery and Development Leading to Emergency Use Authorization for Treatment of COVID-19”, American Chemical Society, May 2020

[246] Elizabeth Weise and Ken Alltucker, “ US coronavirus cases top 11,000, Trump touts two potential ‘exciting’ treatments”, USA TODAY, March 2020

[247] Richard T. Eastman, et al, “Remdesivir: A Review of Its Discovery and Development Leading to Emergency Use Authorization for Treatment of COVID-19”, op. cit.

[248] Sue Hughes, “Remdesivir now ‘standard of care’ for COVID-19, Fauci says”, mdedge.com/hematology-oncology, April 2020

[249] Aria Bendix, “Doctors say giving Trump the antiviral drug remdesivir is a sign his infection may be serious — even though the timeline is still unclear”, businessinsider.com, Oct 2020

[250] [Anna Edney, “WHO advises doctors against using Gilead’s remdesivir for treating Covid-19 “, Bloomberg, Nov 2020].

[251] “Final report confirms remdesivir benefits for COVID-19”, National Institutes of Health, Oct 2020

[252] Andrew Joseph, “As the coronavirus spreads, a drug that once raised the world’s hopes is given a second shot”, statnews.com, March 2020

[253] Marc Airhart, ”, Remdesivir ‘trick’ could lead to better antiviral treatments”, FUTURITY, Feb 2021

[254] Mariana Mazzucato, “Opinion: Big Pharma is hurting drug innovation”, The Washington Post, Oct 2018

2.3 Covid-19 Has Nearly Wiped Out the Flu - How Do We Keep It From Coming Back?

[255] Jaren Kerr, “Flu almost non-existent this year as coronavirus cases rise across Canada”, The Globe and Mail, Dec 2020

[256] “Disease Burden of Influenza”, CDC, https://www.cdc.gov/flu/about/burden/index.html

[257] “Estimated Influenza Illnesses, Medical visits, and Hospitalizations Averted by Vaccination in the United States — 2019–2020 Influenza Season”, CDC, https://www.cdc.gov/flu/about/burden-averted/2019-2020.htm

[258] Dr. Dina Nader , “Did We Miss Flu Season? What a Mild 2020-2021 Flu Season Means for Employers”, ohsonline.com

[259] Katherine J. Wu, “The Pandemic Broke the Flu”, The Atlantic, Feb 2021

[260] “Flu cases in Canada ‘exceptionally low’ so far, public health says”, CBC News, Nov 2020

[261] Brian Resnick, “We wiped out the flu this year. Could we do it again?”, VOX, Feb 2021

[262] Ditto

[263] Miho Inada, “Covid-19 Has Nearly Wiped Out the Flu—How Do We Keep It From Coming Back?”, The Wall Street Journal, Jan 2021

[264] Katherine J. Wu, “The Pandemic Broke the Flu”, op. cit.

[265] Miho Inada, “Covid-19 Has Nearly Wiped Out the Flu—How Do We Keep It From Coming Back?”, op. cit.

2.4 Reducing reliance on foreign suppliers/supply chains of medical equipment, supplies and medicines

[266] “Hospital-Based Emergency Care - At the Breaking Point”, National Academy of Sciences, 2007

[267] Shannon Muchmore, “What does it mean for a hospital to be ready for disaster?”, Healthcare DIVE, Sept 2017

[268] Sarah Kliff, et al, “There Aren’t Enough Ventilators to Cope With the Coronavirus”, The New York Times, March 2020

[269] Hannah Rappleye, et al, “‘This system is doomed’: Doctors, nurses sound off in NBC News coronavirus survey”, NBC News, March 2020

[270] Katie Thomas, “The Latest Obstacle to Getting Tested? A Shortage of Swabs and Face Masks”, The New York Times m March 2020

[271] Martha Mendoza and Juliet Linderman, “U.S. Medical Supply Chains Failed, and COVID Deaths Followed”, pbs.org, Oct 2020

[272] Aime Williams, “US lawmakers push to reclaim medical supply chains from China”, Financial Times, April 2020

[273] Anshu Siripurapu, “What Is the Defense Production Act?”, Council on foreign Relations, Jan 2021

[274] Jordan Fabian and Rick Clough, “Trump Attacks 3M Over Mask Production, Drawing Company Pushback”, Bloomberg, April 2020

[275] Anshu Siripurapu, “What Is the Defense Production Act?”, op. cit.

[276] Aime Williams, “US lawmakers push to reclaim medical supply chains from China”, op. cit.

2.5 Face masks have become commonplace in spite of deniers, Patrick Henry wannabes, Doubting Thomases and Trump

[277] Shin Wei Sim, et al, “The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model”, Singapore Medical Journal, March 2014

[278] Ditto

[279] Nina Bai, “Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus”, University of California San Francisco, June 2020

[280] Kathleen McLaughlin, “Mask defiance remains strong in Big Sky Country, even as the pandemic rages”, statnews.com, November 2020

[281] Marco della Cava, “‘This will blow over’: In states without stay-at-home orders, Americans celebrate freedom as death toll climbs”, USA Today, April 2020

[282] Lori Rozsa,, et al, “The battle over masks in a pandemic: An all-American story”, The Washington Post, June 2020

[283] Donald G. McNeil Jr., “The Long Darkness Before Dawn”, The New York Times, Nov 2020

[284] Lynne Peeples, “Face masks: what the data say”, Nature, Oct 2020

[285] Jeremy Howard, et al, “An evidence review of face masks against COVID-19”, National Academy of Sciences, Jan 2021

[286] Stephanie Kramer, “More Americans say they are regularly wearing masks in stores and other businesses”, Pew Research Center, Aug 2020

[287] Sage Anderson, “New CDC Research Says Double-Masking Could Be Effective Against Covid-19”, Rolling Stone, Feb 2021

[288] Sumanthi Reddy, “Double Face Masks? N95? Protect Yourself Against New Covid-19 Variants With These Mask Upgrades”, The Wall Street Journal, Feb 2021

[289] Mark Kortepeter, “Why You’ll Still Need To Wear A Mask Even After Covid-19 Vaccines Arrive”, Forbes, Oct 2020

[290] “Expert: You should wear two masks to avoid COVID-19”, Michigan State University, Futurity, Feb 2021

[291] Christina Farr, “Will masks become the ‘new normal’ even after the pandemic has passed? Some Americans say so”, CNBC, Oct 2020

[292] Mark Kortepeter, “Why You’ll Still Need To Wear A Mask Even After Covid-19 Vaccines Arrive”, op. cit.

[293] Nina Bai, “Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus”, University of California San Francisco, June 2020

2.6 Temporary respite from the “epidemic of dirty air” reminded us of hazards of air pollution

[294] Mia Rabson ·, “COVID-19 economic slowdown has cut air pollution in Canadian cities”, CBC News, May 2020

[295] Beth Gardiner , “Pollution made COVID-19 worse. Now, lockdowns are clearing the air.”, National Geographic, April 2020

[296] Mia Rabson ·, “COVID-19 economic slowdown has cut air pollution in Canadian cities”, CBC News, May 2020

[297] “NASA Model Reveals How Much COVID-related Pollution Levels Deviated from the Norm”, NASA, Nov 2020

[298] Beth Gardiner , “Pollution made COVID-19 worse. Now, lockdowns are clearing the air.”, National Geographic, April 2020

[299] Valentina Bosetti,, et al. “Air Quality Impacts of the COVID-19 Pandemic: A View from Two Epicenters, with Valentina Bosetti”, Resources Magazine, Aug 2020

[300] Jonathan Watts and Niko Kommenda, “The Pandemic Has Led to a Huge, Global Drop in Air Pollution”, WIRED, March 2020

[301] “The Terrible 10: Air Pollution’s Top 10 Health Risks”, American Lung Association, April 2017

[302] Minwoo Son, “It’s time to say goodbye to air pollution”, greenpeace.org, June 2020

[303] Beth Gardiner , “Pollution made COVID-19 worse. Now, lockdowns are clearing the air.”, National Geographic, April 2020

[304] Mia Rabson ·, “COVID-19 economic slowdown has cut air pollution in Canadian cities”, CBC News, May 2020

[305] Xiao Wu, et al, “Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study”, T.H. Chan School of Public Health, Oct 2020

[306] Zander S. Venter,et al, “COVID-19 lockdowns cause global air pollution declines”, National Academy of Sciences, Aug 2020

[307] Valentina Bosetti,, et al. “Air Quality Impacts of the COVID-19 Pandemic: A View from Two Epicenters, with Valentina Bosetti”, op. cit.

[308] Ian Colbeck, “Can pollution face masks really protect us from exposure to toxic particles?”, THE CONVERSATION, Feb 2020

[309] Lynne Peeples ,” How air pollution threatens brain health”, The National Academy of Sciences, june 2020

[310] Melissa Hogenboom, “How air pollution is doing more than killing us”, BBC Future, April 2019

2.7 Moving work into “socially distant mode” - remote work/telework/working from home

[311] “Coronavirus: How the world of work may change forever”, BBC, Oct. 2020

[312] Sylvan Lane, “ Businesses see transformed landscape even after vaccines”, The Hill, Dec 2020

[313] Katherine Guyot and Isabel V. Sawhill, “Telecommuting will likely continue long after the pandemic”, BROOKINGS, April 2020

[314] “New Research Indicates 84% of Businesses Will Likely Increase Work-from-home Capacity Beyond Pandemic Despite Security Concerns”, Pulse Secure, May 2020

[315] “Coronavirus: How the world of work may change forever”, op. cit.

[316] Brooklyn Neustaeter, “More Canadians will be working from home post-pandemic, StatCan data suggests”, CTV News, July 2020

[317] Andrea Loubier, “Benefits Of Telecommuting For The Future Of Work”, Forbes, July 2017

[318] Tracy Hadden Loh, Lara Fishbane, “Covid-19 Makes the Benefits of telework obvious”, BROOKINGS Institute, March 2020

[319] Jonathan Dingel, Brent Neiman, “How Many Jobs Can be Done at Home?”, University of Chicago, Booth School of Business, June 2020

[320] “Coronavirus: How the world of work may change forever”, BBC, Oct. 2020

[321] Bhaskar Chakravorti and Ravi Shankar Chaturvedi, “Which Countries Were (And Weren’t) Ready for Remote Work?”, Harvard Business Review, April 2020

[322] Darius McQuaid, “Campaign launched for businesses to offer lunch vouchers to incentivise workers’ return to office”, HR Strategy News. Aug 2020

[323] Derek Thompson, “Superstar Cities Are in Trouble”, The Atlantic, Feb 2021

2.8 “Say his name George Floyd” - galvanized protests nationwide that catapulted systemic racism onto the political agenda

[324] Brendan O’Brien, Carlos Barria, “Fires burn near White House in violent U.S. protests”, Reuters News, May 2020

[325] William Booth and Loveday Morris, “ Protests over death of George Floyd, police killings spread to London, Berlin, Toronto”, The Washington Post, May 2020

[326] Eliott C. McLaughlin, “How George Floyd’s death ignited a racial reckoning that shows no signs of slowing down”, CNN, Aug 2020

[327] Helier Cheung, “George Floyd death: Why US protests are so powerful this time”, BBC News, June 2020

[328] Alastair Sharp, “ Canada protests police violence, racism in shadow of U.S. tumult”, National Observer, June 2020

[329] “Defend or Defund? One-in-four support cutting local police budgets; most back social spending over hiring more cops”, Angus Reid Institute, Oct 2020

[330] Adam Serwer, “The New Reconstruction”, The Atlantic, Oct 2020

[331] Jenny Gross and John Eligon. “ Minneapolis City Council Votes to Remove $8 Million From Police Budget”, The New York Times, Dec 2020

[332] Jemima McEvoy, “At Least 13 Cities Are Defunding Their Police Departments”, Forbes, Aug 2020

[333] Jack Kelly, “The Movement To Defund Or Disband Police: Here’s What You Need To Know Now”, Forbes, June 2020

[334] Shane Goldmacher, “Racial Justice Groups Flooded With Millions in Donations in Wake of Floyd Death”, The New York Times, June 2020

[335] Adwoa Bagalini, “After the George Floyd protests, what next for racial justice in the US?”, World Economic Forum, June 2020

[336] Mark R. Kramer, “The 10 Commitments Companies Must Make to Advance Racial Justice” The Harvard Business Review, June 2020

[337] Will Weissert and Padmananda Rama, “With Biden’s backing, Democrats revive bill to overhaul policing”, The Globe and Mail, March 2021

[338] Mark R. Kramer, “The 10 Commitments Companies Must Make to Advance Racial Justice” The Harvard Business Review, op. cit.

[339] Sean Collins, “The House has passed the George Floyd Justice in Policing Act”, VOX, March 2021

[340] “Racial justice giving is booming: 4 trends”, THE CONVERSATION, Oct 2020

[341] Jennifer Jee-Lyn García and Mienah Zulfacar Sharif, “Black Lives Matter: A Commentary on Racism and Public Health”, American Journal of Public Health, Aug 2015

[342] Keeanga-Yamahtta Taylor, “ The Black Plague - Public officials lament the way that the coronavirus is engulfing black communities. The question is, what are they prepared to do about it?”, The New Yorker, April 2020

Created by R.J. (Robb) Ogilvie, Managing Partner, Ogilvie, Ogilvie & Company - March, 2021

Researcher, policy wonk, facilitator, author and curator of information about ‘wicked’ policy issues