Muddled

in a state of bewildered or bewildering disorder or confusion…

Are you feeling muddled? If so, you are not alone. I am feeling extremely muddled. All of the curves you can see on graphs like the one above would serve just as easily to depict my learning curves as to things I think I ought to know but don’t.

In the last several days, I have begun a bunch of stories, none of which have come to fruition because I have been unable to focus my attention sufficiently on just one of them to beat it into submission.

It’s not just stories either.

Yesterday, I devoted a flurry of attention to doing a series of Zoom chats in which I would find someone interesting, invite people to participate and do an online interview. Both of my first two candidates seemed reluctant.

I am not confident that I will get any of these stories properly written, but some of the ideas might be useful or, at least, of interest. Let’s try a lightning round.

Partisan Pandemics

There appear to be two pandemics: a Republican one and a Democratic one. It would be a shame if a good idea was not acted upon because it emerged from the wrong team. It would also be a shame if a bad idea was it acted upon because it came from the right team.

“It was the best of times; it was the worst of times” worked better in A Tale of Two Cities. Let’s not apply it to partisan pandemics.

Ventilators

Governor Cuomo popularized this issue with his heavily accented pronunciation of the word, repeated over and over in his daily briefings. Had he not done so, I doubt many people would even know what they were, how they are used and how complicated the process is.

I have come to wonder if ventilators are worth as much attention as they are getting. Even when there are enough of them, the percentage of outcomes they change does not sound very high.

Shouldn’t allocating resources to ventilators depend on the number of lives saved that would otherwise be lost? If a patient who was going to die goes on a ventilator and dies a few days later, the ventilator did not do much good. If you have to arm twist companies to do something for the common good, what about testing or data gathering?

Triage

It is time to get past conversations about the need to triage. Awful as it is, please get on with doing it as best you can. Triage has existed on battlefields since at least the Civil War, so follow the practices learned in that environment.

My inclination would be to allow the decisions to be made as locally as possible to permit specific mores and religious beliefs to be applied to those who care the most about them. When all of this is over, we might learn something from the ones that worked best.

USS Theodore Roosevelt

How do you manage an epidemic on an aircraft carrier?  None of the things we are told to do would work in that environment. I am sympathetic to Captain Brett Crozier while being mindful that wars are not won by debating societies. When a decision does not go your way, the answer is “yes sir.”

That said, it would not be the first time a wrongheaded decision had been covered up with an attempt at scapegoating. Acting Navy Secretary Modly was quite properly fired (though he was allowed the courtesy of resigning) for bungling the dismissal of the captain, mishandling the subsequent fire storm and giving a dreadful speech to the crew.

Modeling

All of the modeling that purports to display curve bending, the dates on which available resources will be overwhelmed, peak resource usage and return-to-normal dates is subject to bad data. No matter how pretty the charts (and hats off to the chart makers because they are), they are at best directionally accurate.

Like predicting election results from polling, there is a considerable percentage of art to go along with the science. This has surely happened before. Where is a business school study on making good decisions with bad data? Let’s begin using those techniques because the data we have is not going to get better before we need to act on it.

Reopening the Economy

Here is a story sent approvingly by an epidemiologist friend.

How Will We Know When It’s Time to Reopen the Nation?

The four benchmarks suggested are:

  1. Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.
  2. A state needs to be able to test at least everyone who has symptoms.
  3. The state is able to conduct monitoring of confirmed cases and contacts.
  4. There must be a sustained reduction in cases for at least 14 days.

A death caused by economic hardship following the epidemic is no different than a death caused by the epidemic itself, especially to the person who died.

Begin the discussion of when to reopen the economy from these four benchmarks (or others that might be deemed appropriate) and adjust from there.

About a week ago, an attempt to raise the issue caused outrage. Now it is the cover of The Economist.

Africa

The highest concentration of red dots in this picture is in the developed world. Eventually that will be reversed, and Africa will turn red while the other countries return to normal.

Given the level of healthcare in Africa as compared to the levels prevailing in the first world, the outcomes seem likely to be biblical.

I’d begin by listening to Bill and Melinda Gates.

Blaming and Scapegoating

It has already begun and, with the election seven months away, will spread faster than the coronavirus itself.

If anyone cared about solving  problems rather than scoring political points, they would begin with Philip Howard and Common Good. Let’s let him speak for himself, then get behind his work.

The heroic efforts by health care workers and local officials in recent weeks shows what is possible when Americans are unshackled from dense rulebooks.   

America will need similar flexibility for restarting the economy — one-stop shops for permits, waiving work-rule rigidities in schools and public agencies, clear lines of authority for public decisions, and more. Philip Howard describes how an independent Recovery Authority could work in City Journal this week. 

This crisis exposes a core flaw of modern state: it is designed to preempt human responsibility at the point of action. Just follow the rules. That’s why public health officials were forced to wait for precious weeks while the virus spread. That’s also why teachers have lost control of classrooms, and why infrastructure permits can take upwards of a decade.   

Americans can achieve public goals much better if given room to take responsibility. This crisis proves it — both the red tape ineptitude at the start, and the heroic resourcefulness once the rulebooks were tossed. Real people, not rules, make things happen. It’s time for a spring cleaning in Washington.

Elections

Wisconsin held an election today but only because its own Supreme Court and the United States Supreme Court told the democratic governor to do so. He wanted to postpone it for public health reasons, but also perhaps for political advantage. Not to say the republican legislature was immune from that.

It was more than a primary; there were local offices at stake.

Republicans favor in person voting because, historically, Democrats are less likely to show up. For the same reason, Democrats favor early voting, mail in ballots or, perhaps even better, online voting.

The public health concern might have been solved by allowing several days of voting and encouraging different groups to leave home at different times. Last names beginning with the letters A-F Tuesday morning, G-L Tuesday afternoon, M-R Wednesday morning and so forth.

That compromise was not offered. Each side took an all or nothing approach and the judicial votes followed party affiliation.

Depending on when the lockdown is lifted, this situation could prevail throughout the United States in November and, if so, the only hope for continuing faith in the electoral process will be a runaway victory for one side or the other.

If it is close, nobody will accept it.

The Lightning Round

 That’s it for the lightning round. Nine ideas were touched on and only four unfinished drafts remain on my screen. Maybe I will feel less muddled tomorrow.

 

 

8 Responses to “Muddled”

Dianne Warner, April 07, 2020 at 7:48 pm said:

Muddled. Unable to focus. Disrupted and panicked.
A NY hospital surgeon (against hospital policy) has said today in interview, ventilators are killing Covid-19 patients. This is different from pneumonia and ventilators are too aggressive.
Be careful of what we wish for. Oxygen. which is what PM Boris is being treated with, may be best.

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Haven Pell, April 08, 2020 at 11:36 am said:

It is challenging to be asking difficult questions that go against the grain of public opinion. It might be helpful if people would ask themselves, when they express opinions, how certain am I that I am right? Then there is political expediency. “Who cares if this is right as long as it gets me elected.”

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James Walton, April 08, 2020 at 4:39 am said:

1. “If you treat a man like a 5 year old child, he will take the opportunity to behave like one”. That sums up modern government, to my mind.
2. We will probably get thru this mess by using blunt instruments, because subtle ones cant be ‘sold’ to the public. Here in England the debate rages, less lockdown, or more. fewer deaths, or more. And all stemming from one Department in Oxford University….

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Haven Pell, April 08, 2020 at 11:39 am said:

I don’t know what the right answer to that question is, but it is clearly an important, though sometimes unpopular, question. I would ask it of the scientists and economists rather than the politicians, however.

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Temple Grassi, April 08, 2020 at 7:23 am said:

‘muddled’? -I’ll tell the cockeyed world it’s ‘muddled’ -stay the course- do what you’re told ( loved your ‘yes,sir!’ reference) and we should come out of this on the ‘other side’! It’ll be a big party!

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Haven Pell, April 08, 2020 at 11:40 am said:

I am following your advice.

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Chris Ronaldson, April 10, 2020 at 3:58 am said:

Entirely agree that “A death caused by economic hardship following the epidemic is no different than a death caused by the epidemic itself, especially to the person who died.”
I wonder how the overall death rate is affected. Presumably road accidents, which usually kill 35,000 on US roads each year, will come down, but will suicides increase? Domestic violence?

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Haven Pell, April 10, 2020 at 11:07 am said:

Great observation. Why am I not surprised? Anecdotally, my automobile insurer is rebating premiums for the next few months because driving is down. There have been stories about other causes of death associated with both isolation and economic downturn.

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