Thank you for writing this article! As a complete newcomer to pandemic preparedness at large, I found this extremely useful and a great example of work that surfaces and questions often unstated assumptions.
Although I don’t have enough expertise to provide much meaningful feedback, I did want to bring up some thoughts I had regarding your arguments in Reason 2. Your 44 hospitalizations threshold in the numerical examples strikes me as reasonable, but it does also seem to me that the metagenomic sequencing of COVID-19 was related ― if not a critical precondition ― to China confirming its finding of a novel pathogen (source). I recognize that the early detection interventions you are calling into question here may be more of the form of mass/representative sampling programs, but it seems plausible to me that merely having the means to isolate and sequence a pathogen near the site of the outbreak in question could substantially affect time to confirmation.
My prior is that China is likely quite capable in that regard, but other countries may have fewer capabilities. All this to say that investing in more conventional metagenomic sequencing capacity in “sequencing deserts” could still be very cost effective. But note that this is all conjectural; I don’t know anything about the distribution of sequencing capacity, nor even what it takes to identify, isolate and sequence a pathogen.
Thank you for writing this article! As a complete newcomer to pandemic preparedness at large, I found this extremely useful and a great example of work that surfaces and questions often unstated assumptions.
Although I don’t have enough expertise to provide much meaningful feedback, I did want to bring up some thoughts I had regarding your arguments in Reason 2. Your 44 hospitalizations threshold in the numerical examples strikes me as reasonable, but it does also seem to me that the metagenomic sequencing of COVID-19 was related ― if not a critical precondition ― to China confirming its finding of a novel pathogen (source). I recognize that the early detection interventions you are calling into question here may be more of the form of mass/representative sampling programs, but it seems plausible to me that merely having the means to isolate and sequence a pathogen near the site of the outbreak in question could substantially affect time to confirmation.
My prior is that China is likely quite capable in that regard, but other countries may have fewer capabilities. All this to say that investing in more conventional metagenomic sequencing capacity in “sequencing deserts” could still be very cost effective. But note that this is all conjectural; I don’t know anything about the distribution of sequencing capacity, nor even what it takes to identify, isolate and sequence a pathogen.
Thanks again for this brilliant piece!