It's a bit strange to see a suggestion like that accompanied by the disclaimer that it shouldn't be taken. What scenario would you suggest that is not accompanied by such a disclaimer? In other words, say we put you in charge of public policy tomorrow without the option to abdicate, what would you suggest we do, assuming it would actually be done as you advise?
Build a time machine and invest more in the CDC and the NIH back in 1985?
Seriously though I can't think of a more reasonable strategy than that carried out by the US, Sweden, and China (each represents a different experiment).
China's extreme level of population restriction and high level of testing seems to have greatly reduced transmission and impact (I don't know how to interpret China's published numbers, and I don't really trust them that much). This is probably necessary in any area where population density is high enough that rapid transmission can occur. However, my guess is that it also led to a large number immune-naive people and I don't think that any current vaccine will be useful for more than a year, so I think they're at constant risk of explosive disease growth that they can only address through strict policies.
For countries with fairly small number of dense cities, like Sweden, I think what they did was excellent. They stated their prior beliefs and more or less stuck to them and, in my interpretation, they did not suffer any more than other countries, when population density is considered.
Finally, the US. The US did fairly well even though there is a large noncompliant population for a number of reasons. First, we've invested heavily in disease management infrastructure (research, hospitals, strong public health) which meant that we could deal with (to some extent) the massive surge of patients going to hospitals who then infected others nosocomically, and have industries that developed vaccines and other treatments quickly. Second, we actually have a well organized public health system that is relatively powered to implement unpopular but reasonable policies. But, I worry that our court system moves too slowly (for example I would really like to see the supreme court making an extraordinary decision that the US has full rights to mandate vaccines for its entire population) and we have a large number of people who seem to actively fight reasonable public health measures.
So in short, the best approach is to have a large amount of resources (public health researchers, medical folks) combined with excellent realtime knowledge about spread, a largely compliant population which is willing to suspend civil liberties in emergency situations, and political leaders who are willing to risk their long-term careers by providing cover for the researchers.
Finally, thank goodness that the US had the foresight to make and fund the NIH and CDC for so long, providing us with an excellent foundation with which to respond to diseases like this. I am in awe of the folks who pushed for the creation of a new field (molecular biology) in the 30s and 40s which led to the elucidation of the genetic code and development of structural biology, which ultimately provides the foundation for much of our understanding of viruses.
Fair enough, thank you. I like to keep things grounded in reality, theoretical considerations are fine for after the fact analysis but in a fluid situation decisions need to be made. They'll never be perfect but not deciding is abdication and that isn't really an option.
Where I live the health care system has been weakened to the point that we can't really deal with such levels of calamity in a responsible manner any more, the result of years of neo-liberal cost cutting and attempts to create a market situation around health care. The end result is a terribly fragile mix of high density populations, extreme mobility and very little cushion to absorb mistakes. It remains to be seen if either one of the three scenarios you sketched will work for us in the longer term, so far it's not looking all that good but it also could have been far worse.
