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Another COVID Casualty
Experts in epidemiology are starting to remind me of Gen. George McClellan—he could promise you a brilliant battle plan but only if he had perfect data about the numbers, location and intentions of the enemy. So in the meantime, you wait, hunkered down, stripped of the initiative.
Like with climate scientists, the virus modelers offer either mild, easily handled transient changes or large-scale disaster depending on the assumptions (offerings) we feed the models.
The economists who told us to ignore borders, the ever-changing expert guidance on human sexuality, an absurdly ideological professoriate, grossly unprofessional professional journalists … our faith in expertise is dying. Now after a decade of scandals in fraudulent research publications, the virus is attacking another species of our faith in experts. Epidemiologists are people who look into microscopes, do lab stuff, and are really good at math — so how can they be so ineffectual in this crisis? The Marcus Welby, MD, paradigm may be gone but we really want to have faith in all parts of the medical professions.
The model of society beloved by the likes of Woodrow Wilson, Benito Mussolini, and Barack Obama, in which the masses are relieved of the burden of judgment and decision-making through mandatory reliance on enlightened technocrats, is fading fast. It is not clear what will replace it.
Published in General
I am skeptical of people who keep trying to sell us on the idea that this could have been contained (whatever that means; what percentage of a population can get something and it still be “contained”?) absent being a city-state (Singapore and kinda sorta Hong Kong), an island (Taiwan), or effectively an island (South Korea). A highly contagious disease that is transmitted human to human and over the air is in some sense uncontainable. It seems that people are trying to sell the idea that any hardship could be avoid if only we listen to the them sooner (and – not coincidentally – all of the time). People see a low death rate in countries with high testing and can’t think through the fact that the low death rate is an artifact of the testing adding marginal cases to the denominator rather than an improvement in the actual results. Flattening the curve is probable good but whether you are doing so can’t actually be calculated in real time. The bottom line is that if you have the symptoms of either the flu or coronavirus you should isolate and receive treatment for the symptoms.
Contrary to all that, it seems that most of the epidemiological triumphs involve tracking down a source (a polluted well for cholera, a feted swamp for malaria, a parasite infested pig for trichinosis) or a fluid vector other than droplets in the air (HIV and Ebola). The only lesson that can be learned from tracing coronavirus to its source here is one that will stop future pandemics rather than the current one: namely, don’t eat bats.
I accept that there are big unknowns and that the Chinese hurt the world because they were more interested in keeping the bug secret until they couldn’t. It is disappointing the the CDC/FDA were so grossly unprepared and slow to provide test kits. Because we could not test (including broad sampling on those with no symptoms to test the ‘herd immunity’ hypothesis and accurately asses the rare of lethality) our elected leaders were all forced to operate under worst-case assumptions, a one-dimensional analysis.
That was the Chamber of Commerce crowd and we just gave them a $2T bailout.
Two big problems in attempting ‘control’ in any meaningful sense of the word is that you have one highly important and unobserved variable – asymptomatic but contagious virus carriers – and a 10 – 14 day delay in finding out whether and how any action you take affects the outcome. It’s a nightmare scenario for anyone with a background in control theory, and pretty much guarantees going with hard intervention, and then backing off if possible, since you may not get another chance if you undershoot.
I can’t condemn the profession, yet. I suspect that few cranks teamed up with a media that loves a frenzy to drive the narrative. The cranks like publicity and media like the cranks. Perhaps the good epidemiologists were yelling sane things and nobody heard them.
We can all agree that the CDC failed. Like every big government entity they obsessed with the previous crisis. The FDA seemed to have SARS-1 on the mind and a casual attitude about seasonal flu.
Problem – the current test cannot pick up people who are asymptomatic. It would be great if it was, but it is not that sensitive, at least not yet. If that has changed, awesome, but it was not the case last week. Once the patient is showing symptoms, it can reliably state they have COVID-19 and not the flu, which is why hospitals are running testing only for symptomatic patients.
The problem is that the CDC has let their mission shift. First and foremost, they should be on epidemic watch. After that, perhaps study chronic diseases like heart disease for high level patterns, but studying social problems like obesity and drug use are not their job. Trying to shoehorn in political agendas like gun control is pure poison, and needs to be stopped. Secretary Azar needs to make sure the CDC stays on mission, or people need to be fired.
The point of an expert advisor is that he has studied the field more than the leader, and he needs to be trustworthy. This is an area close to my heart, as my background is public health. When you bring in politics to expert advisors, competence vanishes. The expert needs to be professional, and give advice even if he didn’t vote for the leader. Stick to what you are good at, and you will be remembered for your crucial advice.
Part of the problem is that epidemics are all one off events. Much like peace time generals, we don’t actually know who knows what they are doing until the war/epidemic finally arrives.
If the COVID-19 virus doesn’t kill us, the stimulus package probably will.
We– We’re caring about that again? I hadn’t been told.
Ultron not get to inject everyone with aluminum filled vaccine? Ultron sad. Maybe hang out with Hulk and go smash things while observing social distance.
From what I read the stimulus package will get those who weren’t already killed by the Trump tax cuts and Net Neutrality.
What I hope emerges from this is skepticism of nonlinear mathematical models that lead us to extreme positions. This applies, by the way, to climate modeling as much as contagion modeling.
The modelers cannot help you in decision making where it counts. The best common analogy I can think of is your local school district. The weather models suggest the possibility of a serious winter storm tomorrow. The school district has to decide tonight (to give the parents time to prepare) whether or not schools are open or closed tomorrow.
Weather models are pretty good, as complex models go, but winter storms are particularly hard to get exactly right. Just a fraction of a degree off, and huge snow becomes sleet and rain. If the schools are closed and no big storm happens, the decision looks stupid. And if the schools are open but the big storm hits, the decision looks stupid and children are at risk. Does this tell you why your local school district cancels classes when there is any chance of bad weather? The risks are asymmetrical.
As are the risks for decision makers in the face of this disease. Some models forecasted dire outcomes if nothing is done. The federal government (in the role of the school district) is almost certainly going to decide in terms of avoiding the worst possible outcome. Keep people alive, even if they don’t have a job. All in the service of a model which is unverified (and probably unverifiable).
I am glad I am not the local decision maker for school closing with uncertain weather models. I am VERY GLAD I am not the President deciding national responses to a virus with extremely uncertain virus models.
It can be done and has been done. After the disastrous Western African Ebola outbreak a system was adopted to rapidly respond to outbreaks and it has worked again and again in Africa to snuff out outbreaks early. That history is told in a book.
Containing COVID-19 was made impossible because the outbreak in Wuhan was covered up by the dastardly, evil Chicom government. Infected people traveled all over the world before anyone in authority realized what had happened. Now all the epidemiologists can do is estimate how bad it’s going to be if we don’t follow social distancing, quarantines, etc.
Agreed. But Ebola was much easier to isolate because there is no long lead time or large percentages of asymptomatic carriers. Even if we had much earlier warning, the testing capability was not there and no politician anywhere was ever going to order costly shutdowns unless and until the disease began to manifest.
Add to that the fact that Ebola does not spread over the air. It requires physical contact at the very least.