View my profile

2020-04-29

Incompetence or Malevolence?

Frank Bruni prompted a line of my thinking today in a piece entitled, "They Didn’t Drink the Bleach, but They’re Still Drinking the Kool-Aid" to describe the modern Republican leadership. He notes the repeated failure of GOP leaders to rein Trump in. He highlights Trump's incompetence and notes that it "meant one thing pre-pandemic and means quite another now. The same goes for Republican lawmakers’ enabling of the president."

Mr. Bruni applies the rules of “normal” political behavior to our current situation, basing it on finding common ground even between fierce opponents. He is to be commended for his optimism. We all hope to find that day when opponents can cooperate to fashion policies that benefit the greatest number. We do not live there now. 

We live in the age of mortal enemies. Not that they are challenging each other to a duel, but if some people die because of their actions that’s the price we pay. For example, the meat-packing industry is forcing employees to return to work despite massive outbreaks of COVID-19. They are forced to return because that's what the owners want and in part because of a presidential order. The result is an explosion of cases with thousands of workers infected and more that a score dead—so far. It seems that Republican leaders consider this collateral damage for the sake of pork chops. 

These decisions are in line with far-right economic thinking that exalts the investment class over workers. This is particularly true among Republicans who subscribe to the teachings of the economist James Buchanan. The best shorthand description of his thinking is to take Ayn Rand and make her darker and harsher. The devaluation of human life did not begin with Trump, but it seems to be reaching its apogee. 

For Trump, Graham, McConnell, and the other bluest Republican lights, there are only two kinds of people: the peers and the help. Guess which group most of us belong? Some of the help are clearly expendable, but that’s the price of doing business. Nasty, deadly business. 

2020-04-25

Invent Nothing, Adapt Everything (again)

A few years ago, I wrote a blog for my company about our response to the Ebola crisis in West Africa. That crisis hit hard and fast in some of the poorest countries in the world. We in the global public health area responded as best we could with the resources we had at hand. What we discovered, and I noted in my blog then, was we needed to use what was currently available. 

I came up with a rubric to help people understand our approach: Invent nothing, adapt everything. The idea was that we could not bring anything new into the arena, we had to use what was already there. That was a decision forced upon us the material circumstances in West Africa. In our current crisis over COVID-19, we face a different issue. 

The United States leads the world with the greatest number of confirmed infections of SARS-CoV-2, the virus that causes COVID-19 disease. WHO conservatively reported 830,053 US cases on April 24. We also lead in the number of deaths, again by WHO's conservative report42,311. These are sobering numbers in any country, but one with the economic and medical resources of ours it moves into a realm beyond tragedy. Frankly, it is irresponsible that our response has not been more effective. 

We do not lack the scientific, manufacturing, or financial wherewithal to address the needs for personal protective equipment, testing for both diagnosis and serological evidence, and fielding trained personnel for contact tracing. These issues have been well documented elsewhere. 

What we lack is coordination and consistency. Some would call that leadership. The failures of our federal government to address the crisis are now obvious, and we should not look to them for remedies soon. We must act at a different level. 

Governors are the executives who have been struggling with the outbreaks in their states. They have relied on their own state departments of public health to understand the issues and address the needs. Sadly, their responses have not been coordinated or consistent. They often bid against each other for badly needed supplies and equipment. They have no mechanism for shifting personnel between states to address growing outbreaks. They are uncoordinated and inconsistent in their responses. This must end. 

Here are my naive ideas on a response. There are probably better ones, but these can be adopted today. They only require a few people to get the ball rolling. 

The National Governors Association offers guidance and some links to potential resources, but it has not embraced the administrative function to coordinate resources. Granted, this should be a federal responsibility, but we cannot depend on them. The NGA needs to establish an emergency operations center and work with each state to understand their needs and present them to other states and the private sector for fulfillment. Nothing need be invented. Use eBay. 

Every state has a chapter of the Medical Reserve Corps. It's supposed to be administered by the US Health and Human Services Department, but let's assume that they are not helping. Each state can connect through the NGA with information on volunteers with skills suitable for deployment to meet COVID-19 demands in hotspots. Every state has the data and can contribute it to a common information resource, so the governors can see what is available. Use Google Sheets.

Absent leadership, our states must step forward to address the pandemic. It is not going to end soon. We face months of uncertainty, fear, illness, and death. To address these challenges, we need coordination and a common resource for information. The tools have been invented. Adapt and use them. 

2020-04-19

Dealing with (Imminent) Death

I'm not heroic. I've never pulled a baby out of a burning building. I've never faced down a gunman. But that does not mean that I've not consciously put my life at risk. (Apologies to the double negative-hating crowd.)

There are two places where I've consciously taken on deadly risk. The first in Afghanistan during the civil war that continues to threaten its people. I took four trips there for work from 2014 to 2017. The second involved three trips to Liberia from 2015 to 2018, the first two during the Ebola outbreak. In neither case was I more than threatened by exposure to danger. I was never attacked by human or viral agents. I never heard a shot fired or saw injury or death directly. Hence, I'm not a hero.

But I did take on risk that I could not understand in advance. I did plan to go to these places, stayed there for weeks, and returned home more sober about death. The purpose here is what I learned in dealing with deadly risk. These lessons may be useful for others.

First, prepare. Before leaving home, I needed to do and understand a few things. I was briefed by people who understood a bit of what I would face. I had to get immunizations, take along some useful things, and prepare for the worst. That last part was the hardest because I had to do practical things like find my will and document all my digital passwords––just in case I did not return. I also needed to think of kidnapping and how I could prove I was alive to my family. The proof of life test involves asking a question that only I would know the answer. Usually it's something intimate and shared with a loved one, never documented, and concisely answered. I thought of it as the last words I might send.

Next, pay attention. In both countries, getting there involved many flights in cramped quarters. (People in global development do work in "exotic" places, but the commute is hard.) For both countries, every trip I arrived without sleep for a couple of days, muscles cramped by inactivity, and entered a confusing place. In Liberia, all international air travel arrives and leaves in the dead of night––from 2:00 to 3:00 am. (It's how the airlines avoid high landing fees.) In Afghanistan, all civilian air travel arrives after dawn and leaves before dusk to thwart surface to air rocket launchers. My point is that upon arrival I had to do some things that normally require some attention. In these cases, as a tired and confused arrival, I had to make extraordinary effort to pay attention.

In Afghanistan, once I found the security detail that was picking me up, I received the first of three briefings. These involved what I should do if I felt or was physically threatened, particularly by kidnapping. There were devices involved and procedures to follow. (I'm being purposely vague here.) The first of these briefings was in the car on the way to my hotel. The second at the hotel to point out their security protocols. And the third at the office, usually after a short (blessed) nap. The briefings focused on what I needed to do, what I needed to know, and how to react depending on where I was. Finally, I was asked to sign a statement that I had received these briefings. (Insurance companies are everywhere.)

In Liberia, the situation was less well organized but no less thorough. The first step upon getting off the plane is washing your hands––in the dark. Not at a sink and not with soap. Putting them under a slowly flowing tap on the bottom of a keg filled with bleachy water. Bleach so strong that you could smell it from a distance. Oh yes, I should mention that someone watches you so you have to do it properly and for long enough to be disinfected. (Later, I discovered this was the practice before entering every public building in the country.) Once your hands are clean but wet (no towels), you had your temperature taken by a health care worker before you got to enter the terminal building. You did not get in if you were running a fever.

In both places, getting through passport control and customs was far more onerous than any place else, although they were looking for different kinds of threats. In Afghanistan the worry was violence and in Liberia one of infection. They really wanted to know why you were there. They wanted to see your yellow fever card and they read it carefully. (It lists all the immunizations you have had.) They wanted your fingerprints and they checked if you had ever been there before.

In Afghanistan, I was never alone when traveling. When traveling by car there was a driver and a security guard. For longer trips, such as airport runs, the car was armored. (I should not have been, but was surprised at how heavy the door was to open and close.) In Liberia, the same driver and security guard pair were there on airport runs because the airport was a 90-minute drive from the capital through rural areas with active marauding bands on the highways. Remember, dead of night. I never saw a weapon, but suspect that they were at the ready.

All this sounds a little scary, and it was––at first. Then it became routine. Danger was normalized. Oh, it was present in the armed Afghan guards and security check points. It was obvious in the hand washing and never shaking hands in Liberia. But those were features and functions that done dozens of times faded into the background. They became rote.

But danger and death were there. Perhaps only a shadow of conscious thought but present always. That's the third part of the lesson. Never forget that death is hovering nearby. You might be practicing those safety steps unconsciously, but you needed to readily take them out of your back pocked in an instant.

So, why this exploration in my non-heroic status? I wonder about that myself. Perhaps, I'm trying to help the four people who read this blog understand their situations through mine. Perhaps, I'm processing earlier dangers so I can handle the current COVID-19 one. Whatever the reason, one thing I had to grapple with was my mortality. We all will die. But we cannot know when or how.

These episodes allowed me to think about death in practical and pragmatic ways. They turned out to help me understand our current predicament in my own terms. They made me recognize that others would feel my loss. Every trip involved saying goodbye to my family. Taking a final hug and kiss and making it last for a lifetime. We now face terrors that we cannot feel or see at first. Every physical contact is now dangerous, but each emotional one is vital.

Every moment we share is precious. Value them.

2020-04-18

Of Exponents and Atlas Shrugged

There's a dangerous notion afoot that we should fully reopen the economy right now. Moreover, some are advocating just letting the virus have full run. They assert that the survivors will have herd immunity and America will return to the greatness of rugged individualism.

Someone needs to put down his copy of Atlas Shrugged.

He needs to start reading about epidemics and economics. He needs to learn about exponentiation. Yes, that's a word. It's the how fast this outbreak growsat an exponential rate. That means that when you graph the actual number of US cases day-by-day it looks like this:
Source: CDC
Source: Merriam-Webster
You can see that from the first reported case on January 22nd, the numbers remained very small until late March. Then they exploded. As of April 16 the total number of reported cases is 661,712 with 33,049 deaths. Those are only the confirmed cases, not all cases. Because of the failure of our federal government to organize reliable testing at scale, we cannot currently confirm even suspected cases. Most cases go undetected because they are asymptomatic. Meaning that the person has no:

  • Fever
  • Cough
  • Shortness of breath or difficulty breathing
  • Chills
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of taste or smell

These infected individuals can spread the virus without knowing they have it. They can remain asymptomatic and infectious for up to 2 weeks. Because our testing rate is not close to what we need just to understand the spread of the virus, many people are spreading it unknowingly. It's a case where ignorance can kill.

On Friday, our president called for the residents of Michigan, Minnesota, and Virginia to "LIBERATE" themselves from the lockdown. (Yes, he did all caps.) Just to add some spice, he called on Virginians to  “LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!” Okay, take a breath and then let's consider the political reasoning behind this call.

Clearly, the president wants a popular uprising to resist the Democratic governors of these three states, including a strong implication to use "2nd Amendment" remedies. He did not call on the residents of California, New Jersey, or New York to take similar action because he has no hope of winning their electoral votes come November. Nor did he focus on the locked-down states of Ohio or Mississippi or Texas because they have GOP governors. He chose Michigan, Minnesota, and Virginia so he can thump his chest in the hopes to rile supporters in those states by picking fights with their opposition party governors.

If the Atlas Shrugged-clutching crowd decides to march in the streets or hold rallies, the number of infected people will not slow down and will continue to climb. It will be a tragedy of greater illness and death to come. If the protesters decide to show up armed, then the chances of an immediate tragedy escalate by exponentiation.

2020-04-17

The Wrong Decisions at the Worst Moment

The Trump Administration is mulling over when and how to resume "normal" economic activity. If past is prologue, they will manage to make the wrong decision at the worst moment. Here's how:

The president seems to focus on a single point of fact at a time. Like he fixated on the stock market for a time. Probably right now the fact capturing his attention is that more than 22 million Americans have filed for unemployment benefits within the past month. To say that is unprecedented understates its novelty. No society has seen an event like that. It's not the stock market crashing in 1929. It's not the oil price shocks of the 1970s. This is a body blow to the economy. We have been pushed off the cliff.

Statista.com from the IMF
There's no fixing this in the short term. There's no "V" shaped curve for economic activity. Those predictions are predicated on the notion that we will have an effective treatment within a year and a vaccine for all 7 billion human inhabitants within 18 months.

The outbreak will persist and we have lost those opportunities, if we ever had them. The best we can do is provide continued assistance to those suffering by supporting incomes, probably by shoring up the state unemployment systems with federal dollars. Because all states have to balance their budgets, they are only months away from having to choke off their spending.

We also need to maintain the quarantine and lockdown. Until we know who is infected, who is immune (if anyone is), and where those people are, lifting the restrictions is folly.

Will the president act wisely? I highly doubt it. It runs in the face of the hardy individualist myth of America. His approach will focus on the quarantine. He will try to say that the lockdown orders should be ignored and people return to work and normal life. He may tailor that for places where the curve is flattening, like New York, or where it has yet to ramp up. That's the mistake. Without understanding the epidemic curves–through a massive testing program that does not exist–we will induce another exponential surge in cases. We would see another cycle of growth in infections, followed by hospitalizations, followed by deaths.

We are going to see those humps anyway, but by acting blindly they will be more severe and therefore more deadly.


2020-04-12

What Joe Left Out

Joe Biden, the presumed nominee for president from the Democratic Party, offered his thoughts on how to safely reopen America. His vehicle was an OpEd in the New York Times. He talked about testing, both for diagnosing COVID-19 and serological testing to determine who may have some immunity. That type of information will allow careful reopening of parts of our economy. 

Mr. Biden's ideas work as a thoughtful approach to the factors involved in returning our economy from its currently moribund state. He did not state a timeframe, but clearly months would be involved in the type of programmatic approach he outlines. It's that timeframe that prompts me to point out what he did not specifically mention–income support. 

Ramping up testing of the kinds he outlines will take months itself. Moreover, testing alone is not enough. These tests have to be part of a programmatic approach that is societal in scale. He mentions that, but does not give the complexity and logistical elements their due. The implication is that all that  effort and development takes time for a nation of almost 330 million people. 

In that meantime, what can people do who are waiting to return to serving patrons in restaurants, teach children in classrooms, or do any of the myriad jobs that are closed now. Those jobs will remain on the shelf until those workers can safely return to work. And they should be closed because the alternative is illness and death not seen for a century or more. 

What will those who cannot work do? They need more than the one-time payment in current law. They need continued income support to keep feeding their families and paying for a place to live. Everyone has bills to pay. Without income support, these families will continue to suffer. So will the rest of us. 

Come on, Joe, finish the circle. Add income support to your plan. 

2020-04-11

Can the Economy Become Normal Again?

The COVID-19 outbreak is a global phenomenon. It's even potentially in outer space with the launch of a Soyuz mission to the International Space Station last Thursday. That ferry delivered two Russians and an American to the ISS from countries still struggling with the virus. So, there is no place where humans reside that is safe.

Our president is considering re-opening shuttered businesses because bankers and corporate leaders are lobbying for a return to normal. Perhaps by the end of April. That is understandable since my state now officially has 500k unemployed people, 10% of the workforce. The actual percentage is certainly higher since many undocumented and other workers do not or cannot apply for such benefits. Nationally, more than 16 million claims have been filed in three weeks. Again, your mileage may vary since not all workers are allowed to file claims.

Clearly, the people who do the work of America are suffering. For all who cannot or should not go to their jobs, they have to fall back on personal savings or the unemployment system. At this moment, state unemployment websites are crashing daily because they are overwhelmed by the number of hits as so many people need to file a claim.

Well, help is on the way–sort of. The federal government is going to pay individuals who make less than $75,000 per year $1,200 in the next few weeks. You either have to be in the IRS system or get registered for payment. (What could go wrong there?) That's one payment that is a bit above the official poverty rate (which has its own issues of being too low to sustain a healthy life). One payment. One.

Clearly, even the Trump Administration believes that the stimulus payment will not be enough to help businesses and their employees survive. Hence the talk of reopening things earlier than public health experts say is prudent. We have a collision of interests between the needs of health and the demands of the economy. People need money, but returning to work puts more people at risk of illness and death. And more people will die if we return to work without qualifications. How can we do it?

First, stop thinking that it's a giant on/off switch. It's like a panel of switches that do more than turn things on or off. We need to calibrate between issues of public and economic health and for a very long time. Ridding the world of COVID-19 will take, best case, 18-24 months. That's because we won't have a vaccine sooner than that and it will have to be universally administered to be globally effective. It took 30 years to eliminate smallpox from the earth. No less a logistical and managerial effort will be required of COVID-19.

This will be different, you say. Everyone is at risk rather than just people in poor and remote countries. Perhaps, but we have an infinite capability to rationalize risk. Once America has achieved vaccine-induced immunity, will we continue to fight the virus as strongly in the rest of the world? But I digress.

What about the economy? Can we turn it back on? We might be able to but only carefully. It involves understanding who has and who has had the disease. That's tricky since we don't know if surviving the disease confers lasting immunity in every case. Even if it does, we then need to test everyone everywhere and many of those more than once. Repeated testing is needed because if you don't show the antibodies that indicate immunity does not mean you are not sick or infectious. The body takes a few days to produce those, so everyone without them is still a possible source of infection. All of this assumes that the detection of antibodies is a solid indication of immunity. And that immunity will last.

So, without massive testing of a test that does not exist for an immunity that is unproved, we should not turn the massive Everything-ON switch for the economy. We need a series of stimulus bills to keep the economy on life support while we work on testing, treatment, and a vaccine.

2020-04-07

Consequences and Truth

As children, we are taught sometimes hard lessons about actions and consequences. If our parents are wise, they structure these encounters to encourage a sense of responsibility in their children. A broken cup, causing a sibling to cry, or worse, present opportunities for growth---even when a parent is beyond their tolerance to consciously deliver such lessons. That is because actions have consequences and consequences are the responsibility of the actor. An exhausted and frenzied parent may not deliver a measured response, but they often do deliver the consequences to the offending child. Most of us grow up to understand that we are responsible for our actions.

Nations also learn such lessons. Sometime they are delivered in national myths. In a series of apocryphal stories about George Washington, the pastor Mason Locke Weems tried to establish moral lessons for the budding United States. His fable about young George who cut down his father's cherry tree was not just a lesson about telling the truth, it was a lesson in responsibility. George confessed his crime because his character, at least in fable, compelled him to do so. He accepted any punishment his father was to deliver. Instead, he received a different life lesson. His father was ecstatic that his son was compelled to take responsibility. He cried "in transports" of joy, "Such an act of heroism in my son, is more worth than a thousand trees, though blossomed with silver, and their fruits of purest gold."

One may groan at the ridiculous case of the Cherry Tree crime and lack of punishment. Few, if any, parents would be able to muster such a response to a grave transgression. Yet, the myth has stuck in our national imagination. It persists, too often in jest, but it lives with us today. Why?

Why did we ascribe to Abraham Lincoln the moniker "Honest Abe" and celebrate such a complex man with a single term---honest. Lincoln was skilled in the fine arts of cutting political deals and using the patronage system to get what he wanted. His guile was in full force as he cut backroom deals with lame duck Democrats to get support in the House for the 13th Amendment abolishing slavery. Yet, the myth of Honest Abe lives on.

Perhaps the reason is that we value both character and consequence in its purest form: responsibility. My mother once told me that she thought more highly of a man who admitted mistakes out loud. It was a not so subtle jab at my father, but the observation formed an enduring memory and a life-long practice of painfully admitting mistakes. At least more than once. But I digress.

We value leaders who can tell us the truth, even when they don't reflect reality. Franklin Roosevelt told us that "the only thing we have to fear is fear itself". He uttered those words at his first inaugural when the heart of the American economy had stopped beating. In reality, there was plenty to fear: unemployment, loss of farms, eviction from homes, and ever-present hunger. Roosevelt was speaking to a truth in our hearts. We were all afraid. He was saying that was understood, but that we would deal with it.

Today, such leadership is lacking. Not just the divorce from facts by the chief executive. Not just the constant, voluminous, and repetitious lying. Not even the denial of reality. It's the evasion of responsibility.

Americans should consider evasion of responsibility as the lowest a person can go. There is nothing more odious. Unfortunately, it's an open question if enough of us do.