Monday, April 20, 2020

Tidbits of wisdom

From my Hoover colleague Niall Ferguson
It is not just that Trump bungled his response to the crisis (though he certainly did). Much more troubling is the realisation that the parts of the federal government that are responsible for handling a crisis like this – supposedly, the genuine experts — bungled it too. 
The United States Department of Health and Human Services is a mansion with many houses, but the ones that were charged with pandemic preparedness appear to have failed abjectly: not only the Centers for Disease Control and Prevention, but also the Food and Drug Administration and the Public Health Service, as well as the National Disaster Medical System. 

 This is not for want of legislation. In 2006 Congress passed a Pandemic and All--Hazards Preparedness Act, in 2013 a Re-authorization Act of the same name, and in June last year a Pandemic and All-Hazards Preparedness and Advanced Innovations Act. In October 2015 the bipartisan Blue Ribbon Study Panel on Biodefense, co-chaired by Joe Lieberman and Tom Ridge, published its first report, calling for better integration of the agencies responsible for biodefence. Last year, it was renamed the Bipartisan Commission on Biodefense ‘to more accurately reflect its work and the urgency of its mission’. On paper, the US was the most pandemic-prepped country in the world.

It’s not just that Trump bungled his response to the crisis; the genuine experts bungled theirs too. 
So let’s not pretend that the pandemic illustrates the case for big government. The US already has big government. And this is what it does: agencies, laws, reports, PowerPoint presentations… and then — when the endlessly discussed crisis actually happens — paralysis, followed by panic. 
Today, the US has fallen back on the old 20th-century playbook of pandemic pluralism (states do their own thing; in some states a lot of people die), but combining it with the 2009-10 playbook of financial crisis management. The result is insane. A large chunk of the economy has been shut down by government order; meanwhile the national debt explodes, along with the balance sheet of the US Federal Reserve.
Nicholas Bagley, having just offered a course on the history of epidemics at Michigan Law School, wrote this summary of historical experience -- way back on March 4. Plus ├ža change...
...we focused on a different disease each time we met: cholera, Spanish flu, polio, AIDS, SARS, and Ebola.... Every disease provokes its own unique dread and its own complex public reaction, but themes recurred across outbreaks.
  1. Governments are typically unprepared, disorganized, and resistant to taking steps necessary to contain infectious diseases, especially in their early phases.
  2. Local, state, federal, and global governing bodies are apt to point fingers at one another over who’s responsible for taking action. Clear lines of authority are lacking.
  3. Calibrating the right governmental response is devilishly hard. Do too much and you squander public trust (Swine flu), do too little and people die unnecessarily (AIDS).
  4. Public officials are reluctant to publicize infections for fear of devastating the economy.
  5. Doctors rarely have good treatment options. Nursing care is often what’s needed most. Medical professionals of all kinds work themselves to the bone in the face of extraordinary danger.
  6. In the absence of an effective treatment, the public will reach for unscientific remedies.
  7. No matter what the route of transmission or the effectiveness of quarantine, there’s a desire to physically separate infected people.
  8. Victims of the disease are often thought to deserve the affliction, especially when those victims are mainly from marginalized groups.
  9. We plan, to the extent we plan at all, for the last pandemic. We don’t do enough to plan for the next one.
  10. Historical memory is short. When diseases fall from the headlines, the public forgets and preparation falters.
Not every one of those themes was present for every disease; the doughboys who died of the Spanish flu, for example, were not thought to deserve their fate. But the themes were persistent enough over time to establish a pattern.
Nicholas' Reading list:
Charles Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866. [I read this one. It's great.]
Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918.
David Oshinsky, Polio: An American Story.
Randy Shilts, And the Band Played On.
Thomas Abraham, Twenty-First Century Plague: The Story of SARS.
David Quammen, Ebola: A Natural and Human History of a Deadly Virus.
Laurie Garrett, Ebola’s Lessons: How the WHO Mishandled the Crisis.



14 comments:

  1. Not all governments are incompetent, nor of those that are incompetent are they incompetent to the same degree in the same way. Compare, for example, the response of the City of San Francisco to the response of the City of New York, in the early stages of the epidemic. Consider the example of the State of California's state of preparedness pre Gov Brown to the State's state of preparedness post Gov Brown. You did in an earlier post identify Gov Brown with the withdrawal of state funding of a program of maintaining an inventory of PPE and quick response portable hospital facilities that resulted in the State losing its ability to respond to epidemics. The sense of your remarks was in the vein of "penny wise, pound foolish."

    After this epidemic has passed away, if it ever does, when will the next epidemic arrive on our shores? Who has that crystal ball that will foretell with perfect foresight when that fateful day will arrive and what effects that epidemic will have on the economy and the society when does arrive?

    When there has been a clear and present danger, it has been possible to prepare to meet that danger (cf., the Cold War and associated nuclear arms race). But epidemics by their very nature are episodic--they arrive seemingly out of nowhere, stay awhile, then fade out. Their arrival is uncertain; their damages unknown or unknowable beforehand. We still do not have a clear idea about the exact nature of the SARS-CoV-2 virus or the disease COVID-19. Absent accurate quantitative information, we are left groping in the dark. As yet we still do not know with certainty that the disease will not reinfect individuals who have recovered from COVID-19. In time we might know that.

    Applying hindsight, it is easy to cast blame and level charges that are unanswerable by those charged with misfeasance. One could as easily charge leading economists with not foreseeing the 2007-2008 financial crisis and not taking steps to prevent it. Now that the cause of the economic decline is medical and not financial, economists are blamining public health officials and public agencies charged with disease control and prevention for failing to foresee the epidemic and taking steps to minimize or contain its effects.

    It is easier to lay blame than it is create a plan that avoids the outcomes that give rise to blame. "To err is Human; to forgive is Divine." Being only human, we err often, and rarely forgive.

    That we are all slated to die at some point in time, sooner or later is a given. The time and manner of our going is not, however, given to us to decide, though some do so choose the time and the manner of their passing.

    To say that some of those who have died so far in this epidemic might have been spared with better foresight and better planning and organization on the part of governments and their agencies, is as easy as 'kiss-my-hand', but devilishly hard to prove. And what does it avail us, other than a kind of holier-than-thou burnishing of one's own credentials?

    Better to concentrate on contributing one's real expertise to solve current problems than to expend energy proving that hindsight is, indeed, "20:20."

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  2. Ferguson's last paragraph: "Today, the US has fallen back on the old 20th-century playbook of pandemic pluralism (states do their own thing; in some states a lot of people die), but combining it with the 2009-10 playbook of financial crisis management. The result is insane. A large chunk of the economy has been shut down by government order; meanwhile the national debt explodes, along with the balance sheet of the US Federal Reserve." makes absolutely no sense at all.It may not even be wrong.

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  3. On Nicholas Bagley [though I don't know of any group that is considered deserving of getting the virus] is informative. Yet, some governments do better than others. Why?

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  4. Everything always have to be about Trump -- so anything that passes as wisdom must start with the admonition: "Trump did not do this or bungled that." Political bias aside, perhaps this is all about acknowledging that, as the saying goes: "You can't fire the whole team, so you fire the manager." The trouble with this approach, of course, is that your team still continues to suck, perhaps even more smugly. And in this specific case, the admonition of the aphorism is even more self-defeating. Niall's wisdom, to me, boils down to "We are losing because our players are bringing baseball bats to a hockey game." Trump may not be the best baseball or hockey manager, but he is one of the few managers who has been asking players to bring different equipment to the game.

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  5. Did Trump rely o n the experts? If so, are the experts responsible for the bungling?

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    Replies
    1. The experts relied on China's lies and misinformation, with the WHO providing cover. That's where the blame belongs.

      Regarding halting flights from China, except to repatriate Americans, the experts told President Trump not to, based on the lies from China.

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  6. I respectfully disagree with Niall Ferguson.
    I don't think that Trump bungled with response.
    Trump worked with what "the experts" were giving him.
    Experts with PhDs, from elite schools, just like Niall Ferguson.
    Is Niall Ferguson an expert? How would Niall Ferguson have performed in a situation like this? Because hindsight is 20/20.

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  7. It's even worse than Niall let's on. I did a write up of the dozens of unreadable pandemic plans the government wrote over decades, along with the overlapping and contradictory authorities that were supposed to implement them.

    "Why Two Decades of Pandemic Planning Failed" https://medium.com/@judgeglock/why-two-decades-of-pandemic-planning-failed-a20608d05800?source=post_stats_page---------------------------

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  8. Maybe we need a national guard of medical personal.

    Remember the civilian defense force...maybe we need a civilian medical force.

    The whole focus of this should have been a total lockdown of senior homes...no one in or out...with full national guard tented on site! Instead of LOCKING DOWN the entire country...for little difference! 90% of deaths are above 50 YEars of age!

    Instead we have poorly paid workers commuting on public transfer spreading the disease back and forth!

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  9. Niall Ferguson claims Trump et al."bungled their responses. What they should have done is..." Oops, Ferguson has no suggestions at all. He's carping from the sidelines. One thing Trump *hasn't* done is seize new powers. Is that "bungling?" Perhaps he should not have listened so much to epidemiologists who forgot to include in their models that people have to eat, but then who should be listening to?

    Nicholas Bagley, in his point 2, appears not to have heard of the U.S. Constitution. Authority is clearly delineated. As for the "global governing bodies," they are garbage institutions and have no authority. WHO is a Chinese puppet.

    IMO, lockdown decisions should be 1) Decentralized. Local conditions differ greatly. A policy fit for NYC is not appropriate for upstate NY, never mind Midwestern farm country. 2) Kept within bounds of U.S. and state constitutions. Otherwise these sets of rules are meaningless, to be jettisoned whenever politicians declare a "crisis." 3) Voluntary as much as is possible. Set rules for safer behavior (social distancing, cleanliness, etc.) and let people come up with ways to meet these, rather than try to centrally plan which activities & businesses are "essential" and kill the rest. Let people find innovative solutions, and forget the command & control.

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  10. (1) Where Trump bungled was in trusting the experts, the FDA and CDC people. This doesn't let him off the hook, because he shouldn't have trusted them. He should have forced them to act sooner than they wanted to, because he should see the big picture and know that the bureaucrats don't and have very bad habits and incentives in emergencies(i.e., to move slowly so as not to make mistakes, and to be very wary of smart private operators making profits dishonestly).

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  11. (2) The government design problem is very much like that of putting aside a surplus for a rainy day or for the distant future. States handle this with balanced budget requirements in their constitutions (so at least they have debt capacity for emergencies). We need an agency set up to respond to epidemics. That's exactly the CDC, of course, but the political economy part is that neither the CDC itself nor the elected Presidents wanted the CDC to keep to its mission. Keeping to its mission meant spending lots of money to prepare for rare events that wouldn't come while the current President or CDC leadership was still around. So the CDC spends most of its budget on thigns like people being overweight, or whatever is trendy and shows some boastable output to the public and the President. There's neither glory nor promotion in preparing for an epidemic taht doesn't arrive for 20 years--- ex post, everyone will just say the truth---that all your budget was wasted for the first 15 of those years, psending for an epidemic taht didn't come.
    How do we solve this government design problem? It's tough. Kind of like the central bank inflation problem, but worse because the agency would still have bad incentives even if independent. What we'd need to do is have an independent agency staffed by fanatical epidemic experts who care about nothing else in the world and think every penny spent on cancer, heart disease, etc. is a waste because it should have been spent on Ebola research.

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  12. Ferguson makes a point that's somewhere between mathematically unlikely (at best) and wholly implausible:

    "Between now and then, I fear, a lot of elderly and infirm people will be carried off early, along with many doctors and nurses, who are most exposed to the virus, plus a smallish proportion of plain unlucky younger people.
    The nasty, barely writeable truth is that, as a result, the problem of ageing societies and rising dependency rates will have been solved: people over 70 will go back to being considered ineligible for high office and other positions of responsibility."

    Approximately 2.8 million people die each year in the U.S. (That number is readily available at the CDC website.) That total is obviously skewed toward those who are older and in poor health.

    Just how many COVID-19 deaths is Ferguson predicting? Even at what now appear to be high totals for the U.S. that would assume a big "second wave" - 500,000 to 1 million people - does it really have the fiscal and political impact that he predicts?

    The older people who are dying from COVID-19 are, to be direct, skewed toward those who would otherwise be expected to have lifespans measuring a few more months to a few more years. It's not the otherwise healthy 65 year olds who are dying in big numbers, taking away an expected couple decades of Social Security, Medicare, and (in some cases) state pension spending.

    Or, saying the same things a bit differently:
    (1) The drop in tax revenue - just payroll taxes, before we even consider personal/corporate income taxes and spending - from lower economic activity is plausibly more than any savings associated with COVID-19 deaths among older people.

    (2) Even with a tragic number of COVID-19 deaths in the U.S. (and Western Europe), does the dependency ratio of retirees to workers really look much (if any) different by, say, 2024? I rather doubt it. And, to be clear, I'm saying that's even if we forecast a return to full employment by 2024. I'm saying that the numerator (retirees) simply will still be about the same within 5 years.

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  13. Let's concede all of Niall Ferguson's points above: the U.S. Government botched it and always does.

    But this immediately begs the question: how did both Germany and South Korea get it right? Are they more libertarian than we?

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