One can think of government as playing two roles in the virus crisis. One role is to exercise control, meaning giving orders. The other role is providing information, including reliable data and analysis. My criticism of government can be summarized by saying that it has been too eager to use control, while in the area of information it has been derelict and incompetent.
Here is what I would do if I were in charge of the CDC.
1. I would have one unit focused on providing consistent, accurate information about deaths. Deaths would be reported by date of death. Deaths would be reported in categories: deaths with no relationship to the virus; deaths of people with the virus but caused primarily by pre-existing conditions; deaths that were caused by a combination of pre-existing conditions and the virus; deaths that were caused primarily by the virus. The CDC reporting unit would give clear guidance to health care workers on how to do this classification. Trends would be reported by age and by institutional status (nursing homes, prisons) as well as by geographic area.
2. I would have another unit charged with determining the prevalence of the virus. As you know, there are two types of tests, one for whether someone currently has the virus and another for someone has the antibodies to the virus. For each of the two types of test, the testing unit would use the testing procedures with the highest reliability, including re-testing people if that reduces classification errors. It would use stratified random sampling.
3. I would abandon all models that work with a single spread rate or a single infection fatality rate. Instead, I would work with the Avalon Hill metaphor and have a unit evaluate hypotheses relative to that metaphor. Some of these hypotheses can be tested using healthy volunteers willing to expose themselves to possible infection. Others can best be evaluated by studying cases of infection events and deaths. The idea is to better predict what happens in an encounter between an infected person and a person at risk of becoming infected.
This unit of the CDC would focus on how both the probability of infection and the severity of disease are affected by the following factors:
4. Characteristics of the person at risk for becoming infected. age; and pre-existing conditions, including obesity. (This cannot be tested experimentally, but the cases that we have seen could be evaluated more closely.)
5. Extent of symptoms of the infected person.
6. Type of contact between the infected person and the person at risk.
7. Duration of contact between the infected person and the person at risk.
8. Distance between the infected person and the person at risk.
9. Masks. Neither person uses a mask; only the person at risk uses a mask; only the infected person uses a mask. Both use masks.
10. Whether contact takes place indoors or outdoors.
My first choice would be for government to provide information on these factors and let individuals and businesses make decisions based on this information. My second choice would be for government to obtain this information and issue orders to citizens based on this information. The current state of affairs is that government issues orders without this information. As I see it, exercising control without information is the least desirable role for government.
“The current state of affairs is that government issues orders without this information.”
That’s because the people that want government to issue orders use the standard that, unless evidence can conclusively prove that the government orders are unnecessary or harmful, then the orders should stand. Under that standard, of course, we will end up with a lot of orders that precede information.
Yes, no orders. End lockdowns.
Apparent, but not really mentioned by the “experts” is that spittle/breath exchanging activities will be limited for quite some time. This is important information for re-opening many public venue businesses and schools/universities. Professional sports may be able to make adaptations with testing and isolation of players, but college and k-12 sports are a different problem. Similarly with group singing, cheerleading, even projecting oration will have to be adjusted to impede “droplet” exchange.
Such information, provided as reasoned limitations, could open up a lot of innovation among those most familiar with the activities so that they can have the best chance for restarting. The idea so many pontificate over, that sports will begin as before, is really not helpful. Empty stands are obvious, but contact sports require contact. Even baseball has close, explosive release of breath, contact to tag out runners.
Pro sports could easily afford to test every player, every day.
I wonder what would have happened if very early on, the word had come down from on high, “If you are over 65 or obese or have respiratory problems, stay at home until we tell you to come out. All others can go about your business as long as you wear something that covers your mouth and nose.”
Things would probably be a lot better now if people had accepted that, but as the old call and response goes, “What are the chances? Slim and none.”
Even worse than than their epidemiological incompetence have been the WHO and CDC’s consistently misguided efforts to control medical praxis without information. John Hinderaker (I hope I got that right and apologize for previously incorrectly attributing Powerline stories) in a piece entitled “How treatable is Covid-19?” Links to this two treatment protocols developed by separate groups of front-line doctors. https://www.powerlineblog.com/archives/2020/05/how-treatable-is-covid-19.php
He cites one group’s paper on how top down control has cost lives:
“The systematic failure of critical care systems to adopt corticosteroid therapy resulted from the published recommendations against corticosteroids use by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the American Thoracic Society (ATS) amongst others. A very recent publication by the Society of Critical Care Medicine and authored one of the members of our group (UM), identified the errors made by these organizations in their analyses of corticosteroid studies based on the findings of the SARS and H1N1 pandemics. Their erroneous recommendation to avoid corticosteroids in the treatment of COVID-19 has led to the development of myriad organ failures which have overwhelmed critical care systems across the world.”
He concludes by observing:
“It seems to be increasingly clear that both the World Health Organization and the Centers for Disease Control have been worse than useless in the present epidemic. Happily, front-line doctors are learning from experience what treatments can be helpful. As they continue to share information, it is reasonable to expect that fatalities associated with the Wuhan virus will decline.”
If the information required to issue low-noise orders existed, then all we’d need is some sort of aggregator/summarizer.
This information does not exist, at least not in a form that can be readily aggregated.
We call making up the difference “leadership”. There’s an an entire … priesthood devoted to nothing else. We grant status in exchange for subsuming the risk of prediction.
Look to how generals were managed in WWII. They were frequently relieved. They were not discarded, but somebody else got a turn on the slide. So we’re back to Game 1 and Game 2….
Why should the government bother collecting the information if it is not going to be used in government decision making? Let individuals collect their own data and the private sector will provide data services for those who might benefit from them. Collectivists imagine that fighting a plague might require collective action, but individual freedom is much more important, or, as they say, let the devil take the hindmost.
I don’t think doctors find it so simple to categorize patients that way. Right now there are enough deaths caused by the virus to cause a noticeable increase in total deaths relative to previous years (and it’s relatively safe to attribute that aggregate increase to the virus), but categorizing individual deaths is trickier.
I agree. I think excess deaths should be reported against two contexts: 1) same time period in previous years, 2) time periods that included excess deaths caused past recent flu (e.g. H1N1 and the winter of 2018).
Numbers without context or bad context (e.g. vs 9/11 deaths or Vietnam war deaths) are propaganda and should be called out as such.
Timothy Taylor has a post on an interview Paul Romer gave to the New Yorker at his blog pulling out a comment on specialization and resiliency. But another question provoked a very important observation on public confidence
“Fear and uncertainty are just like the acid that kills investment, and investment is what it takes to restart. So, until we can reduce the uncertainty and address the fear, credibly address the fear, you can’t just use happy talk to try to make the fear go away. Unless you’ve got a credible, understandable way to make the fear go away, we will not get the recovery we need.”
Have recently learned that the annual ‘flu deaths’ are just model driven nonsense. Almost no one knows anyone who knows anyone who has died of flu (unlike corona, where most of us have friends of friends who’ve died by now)