coronavirus

The Occam’s Razor of Pandemic Response

(This is from a Twitter thread that grew into an essay. I’m pretty active in that domain so if interested feel free to follow here.)

From a covid19 response perspective, there’s been a lot of conversations about why some places did better than others and who is ultimately responsible for poor outcomes for populations facing the pandemic. Specific to initial pandemic readiness, I think things are actually simpler than we’re making it. There’s a bit of Occam’s Razor involved.

I’m not the first to suggest it but the notion that comparative pandemic response breaks down along the lines of Southeast Asia vs others is a pretty clear way to look at the problem. Adding variables doesn’t get us closer to the truth. It just adds noise. And so the actual solution to future pandemic outbreaks keeps getting paved over with other things.

It’s nearly impossible not to watch the daily Covid19 pressers and not imagine some sort of panacea that didn’t involve the current administration. Or even one that just made us feel a little better. A good contrast is clear in New York.

Governor Cuomo has an approval rating nearing 90% because he’s standing up and delivering the message his constituents want to hear. As a result they feel like things will eventually get better. It doesn’t change the reality that they weren’t ready either though. And like the rest of America, thousands of people will die who otherwise may not have. The contrast between Trump and Cuomo doesn’t account for where we are materially.

Like New York, Italy and Spain are in full outbreak mode with more absolute deaths than the U.S. with only 20% of our population. There is no Trump administration there. And they have universal healthcare. In fact, it’s safe to say the entire West was caught asleep at the switch with many different sorts of leaders with many different sorts of healthcare systems.

The variable for readiness isn’t Trump or universal healthcare, though both of those things matter tremendously going forward. And none of the politically energetic arguments can account for the difference in readiness between the West and the East. Nearly every effective response, South Korea, Taiwan, Singapore, China (if you can believe any version of their numbers) have all come from the same region. And it brings  a simple conclusion.

Southeastern Asia has more experience dealing with pandemic than we do. And so they’re better at it. We can talk about state capacity and authoritarian rule vs liberal but the simple reality is we in the West are pandemic rookies.

I live in Southern California. We have both a high Asian American population, high levels of Asian temporary residence workforce and a high volume of Asian tourism. I’ve been watching people from Asia walking around in crowded places in America with masks on for fifteen years. I’ve never seen anyone from anywhere else do the same. And frankly I always viewed the practice as unnecessary and alarmist…like nearly every western leader and much of MSM with Covid19. Because pandemic response was not a part of our contemporary culture.

SARS hit in China within a year of the 9/11 attacks in the U.S. There have been multiple Chinese outbreaks since that have stressed their system. None were severe enough to have the impact Covid19 has had. But they were all severe enough to drive action and build the muscle of pandemic response. In the same time period America has built up counter terrorism capacity in to the same extent. I was a part of it.

Remember the Boston Marathon Bombing in 2013? Boston locked down the entire city cheerfully until a joint task force of intelligence community, federal law enforcement and local police caught the bombers in days.

Not weeks. Days.

The American counter-terrorism muscle was and is that strong. Because we’ve spent the last 19 years exercising it. Southeast Asia has spent at least some effort getting better at pandemic response.

It’s telling that no one really cared when President Trump eliminated the pandemic response directorate within the National Security Council. We do now of course. And it looks like a terrible decision. I didn’t even remember it happened though. And I pay more attention than 99% of most Americans.

After we go through recession, have 30% unemployment and lose our personal liberty for three months in America, I suspect we’ll improve our response. This is some part of our identity. We are the “sleeping giant” after all.

It’s little consolation to those of us living through it now I know. The proactive response was a uniform failure in the West. Our energy is best spent on insisting the reactive response is effective and holding our leaders accountable for that.

Thoughts on COVID-19

I’ve been a part of enough things in my life that eventually became news stories to see a pattern. Whatever is reported is either an exaggeration, a partial truth or an outright misrepresentation of what actually took place.

Rarely is a dispassionate account of the truth rendered.

As a result, I’m skeptical of many things I read. I understand the forces that are at work in the media. The money, the ratings and the ultimate goal of eyeballs and clicks get in the way of the effective distribution of important information. It’s not a conspiracy. It’s a misalignment of incentives. The result is that we should remain healthy skeptics when consuming information.

For many, the appeal of President Trump has been his willingness to challenge what experts, the media or anyone, frankly, is saying. The uncomfortable truth for many of us is that so much of what circulates in our modern information stream is not entirely true or skewed by spin. And so if one decides to “call bullshit” on everything, one has a very good chance at being right quite often.

President Trump has made it a standing policy to call bullshit on everything that doesn’t come from him or that doesn’t align with administration policy. Based on the patterns I just described, he’s often right.

The risk has never been accuracy with this approach. The risk is a loss of confidence in the institutions we need to take action when something eventually isn’t bullshit.

The global COVID19 outbreak is not bullshit. It is real. And it is shutting the world down in front of our eyes. The claims that this is just the flu are not real. Even it it were, doubling a flu outbreak and increasing the mortality rate would still overwhelm our current care infrastructure. Pointing out that it’s just the old and sick that will die isn’t helpful either. We will not simply sit back and let everyone of us who isn’t completely young and healthy die. Along the way, we will shut down daily life and the modern global economy to avoid that end.

Does anyone honestly believe that China is prone to overreact to save some lives? The state that brought you a famine that starved millions to death and a Cultural Revolution that exterminated an entire class of intellectuals shut down the country to keep the virus from spreading. We should take notice. This is not a drill.

There is good news though. Because for once, we actually have some control over our fates.

In a world where we seem powerless against the march of never-ending wars, environmental catastrophe and the erosion of social cohesion, this pandemic gives us an opportunity. This virus needs us to live. We have domain over its host.

For once, we are in control. And we can be heroes.

There are things that spread viruses faster. We know what they are. We have already stopped doing many of them. There are things that impede progress of spread. We should do them. Limiting public gatherings, taking sick days, social distancing, self-quarantining and washing hands are all things that slow the spread of the virus.

Those are the things we can do as individuals. But there’s more. This is an opportunity to address some things.

It’s probably time to have legislation that ensures that the people who serve our food get paid sick leave. Think about that. The people handing you your food all feel like they have to work through being sick. Coronavirus or not, I’d rather that end. Trader Joe’s changed their policy on this immediately. Heroes.

It’s probably time to figure out how more roles can work remote. It’s probably time to figure out how employers handle parents that have to stay home to care for kids whose schools are closed. It’s probably time to identify a national response plan for any epidemic. What buildings get used for overflow. What labs can be used for emergency testing. What funding can be immediately released.

I thought this was all already in place. It’s not.

Today the New York Times reported that we had testing capacity in Seattle weeks ago. The lab there wasn’t allowed to test because of a standing CDC policy. Two dozen people in Washington state are dead. It’s easy to Monday morning quarterback and lay blame. But it’s also easy to stand up and say that for the next six months, all policies prohibiting testing are waved.

One great question this pandemic may bring us closer to answering is this:

How do we pandemic proof our globally integrated economy?

The real risk that we have is that we can’t save lives right now without tanking the economy. What would need to be true in order for that not to be the case?

The United States of America has been at war nearly my entire adult life. Aside from the days and weeks after 9/11, nothing the war has had to offer has impacted Americans the way the COVID-19 outbreak already has. Understanding the risk and what to do going forward should be a national policy issue second to nothing.

The goal is simple. Short Term: Take positive action to slow the spread of the virus to a rate that allows our medical response to keep pace with it. If we don’t, medical facilities will get overwhelmed, people won’t get treatment and our ability to respond to other everyday medical issues will be limited. Longer Term: Drive institutional change that makes us more resilient to future outbreaks.

I’ve worked in risk my entire professional life. The regrets I have from taking actions against things that didn’t materialized into catastrophe are zero. The regrets I have from not taking action when it could have mattered are substantial. Moreover, I have no idea what catastrophes were avoided by small actions early on in the problem. I’ll never know. And I don’t regret that either.

In the world of the material, beyond politics and media swirl, when we work to solve these sorts of existential issues, no one claims we’re overreacting. The word panic doesn’t even wander into the room. Instead, the tone is one of a requirement to be stewards of the resources we’ve been trusted with to carry out the responsibilities we have to those that count on us.

No one calls bullshit. Because it’s not bullshit.

We have a window here. But it’s going to close. If it does, the outcomes won’t be disaster movie extinction. It will be thousands of lives lost, the loss of effectiveness of our current medical care infrastructure and eventually the catastrophic shut down of the domestic and global economy.

That’s one potential outcome. The other is a coordinated and committed effort to doing what we can, while we can to avoid it. So, before you hit share on the witty, people all need to calm down meme, ask yourself this.

What’s the cost of being wrong about that?

The math on this one is clear. And we’re on the clock. This is our chance to be heroes.