What I won’t forgive

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1. Flying blind. I have been complaining about two major unknowns.

(a) We don’t know the true prevalence of the virus. Random-sample testing could have addressed this.

(b) We don’t know the spread mechanisms. For example, we know that the virus can remain on a doorknob for a long time. But we don’t know how likely it is that one will become infected via a doorknob. We need the experiment.

I blame the CDC for continuing to fly blind.

2. Absence of masks. As Americans, we look at masks from a “what will it do for me?” perspective. Maybe if I wear a mask and I’mm around infected people who don’t wear masks, I won’t improve my chances much. But Asians look at it from more of a social perspective. If I wear a mask an I am unknowingly infected, it seems likely that I greatly reduce my chance of infecting other people. So if everybody wears a mask, my thinking is that we can mingle in public and hold the spread rate down. Not to zero, but enough so that we don’t need to cripple the economy with lockdowns.

When I see countries that are a lot closer to China with lower case loads and deaths, and I see lots of masks in use, that makes me think that masks might be sufficient. At least in some parts of the country.

Where is the CDC on this? On the one hand, they tell us that masks won’t work. On the other hand, they tell us that masks are precious and they must be reserved for front-line health care providers.

We should have had a gigantic strategic mask reserve before this crisis started. No, I never thought of that before. But it should have occurred to the CDC. As the saying goes, You Had One Job.

3. On macroeconomic policy, using the same measures that were used in the 2008 financial crisis. This ignores (a) the fact that those tools did not work very well then and (b) this is a different crisis. In particular, this is mostly a liquidity crisis in the nonfinancial sector. We could do without fiscal “stimulus.” We could do without the Fed expanding its balance sheet. We could help people get by with short-term loans. These would enable individuals and small businesses pay rent, utilities, and meet other financial obligations. And perhaps we could let people get back to work if we used the scarves and masks strategy.

I blame economists for falling back on the 2008 playbook.

46 thoughts on “What I won’t forgive”

  1. In fact, as I understand it, it did occur to the CDC and we do have a mask reserve, but both the Obama and Trump administrations failed to restock it after drawing it down in 2009, and so it was far too small for the present situation. Source is https://www.liebertpub.com/doi/10.1089/hs.2016.0129

    linked from this generally terrible but somewhat informative NYT editorial:
    https://www.nytimes.com/2020/03/25/opinion/coronavirus-face-mask.html?action=click&module=Opinion&pgtype=Homepage

    • China has a COMPARATIVE ADVANTAGE in producing masks versus domestic producers.

      And unused inventory is economically inefficient!

      Granted, I don’t find these things persuasive, but the free traders shoved it down our throats for years.

      • asdf: I disagree. Milton Friedman even mentioned in one of his books that if you want to make a national security argument regarding free trade, it’s often better just to stockpile the item that the foreign producer makes. So he addressed this exact issue decades ago.

        As an analogy, no one is claiming that we should wait for a war start before procuring all of our tanks.

        • In theory we should have stockpiles of necessary goods.

          But what is necessary? And how does one demonstrate necessity in a politically acceptable way during non-crisis.

          And what is an adequate stockpile?

          In a climate in which questioning offshoring is seen as being some kind of ignorant backwards racist troglodyte, nearly all those questions are going to be answered in favor of lower stockpiles and more offshoring.

          I’m sure there were people that made arguments for a bigger mask stockpile, and for a domestic mask industry in case that stockpile ran out. In fact you can see such arguments with timestamps from years ago for all sorts of medical equipment. But they obviously lost those arguments to people who said they were overly cautious and inefficient.

          • What is the ‘necessary’ amount of autarchy? How do you make the case for that during a non-crisis? Has the same political problem. Stockpiling however would be less wasteful.

      • asdf, both the U.S. and China have a comparative advantage when it comes to medical supplies. Canada has a significant disadvantage and many of the daily updates at the Federal and Provincial level have been on the issue of procurement. The Ontario Premiere has been focused mainly on local manufacturers retooling for needed supplies.

        The American challenge now is Fortifying the Health System in areas with uncontrolled community transmission (NY, NJ, CA, WA?). Flatten the Curve did not happen so every day you need to

        1. Isolate the Illness
        2. Fortify the Health System

        and you should plan on about 4 weeks of doubling system supplies until you know whether your measures to Isolate the Illness are working (good feedback takes 4 weeks and 8 weeks to stop new cases).

        America is doing well with Test equipment, PPE, and Ventilators. I’m pretty sure the manufacturing capabilities exist. Isolating the Illness has not even started in earnest yet.

  2. The obsession with surgical or N95 masks diminishes the importance of any mask for limiting spread. We should be mass producing the cheaper surgical masks even if not quite up to full clinical standards and urge it on all citizens, even make it mandatory in critical cities like New York.

    • Mask production is indeed ramping up, similar to the way testing is ramping up. Unfortunately, it is too little, too late, not “two weeks behind” but two months or two years.

      The United States should have had a stockpile of 10 Billion masks, with an idled, decentralized and redundant, strategic reserve of a domestic, turn-key capacity to produce and distribute at least a billion more per week, for the duration of the crisis, which of course implicates whatever upstream supply chain production and stockpiles would be necessary to accomplish that.

      Actually, viruses go whereever people can go, so such stockpiles should exist everywhere in the world, and having had them was probably as good a measure of “state capacity” as any, in which case Singapore and Taiwan come out looking like absolute champions, the envy of the world.

      But for the US especially, not having either the supply or the capacity to quickly make a bunch for ourselves is particularly embarrassing and humiliating. To the extent government officials passively tolerated or even helped spread bad information about the effectiveness or importance of everyone covering their faces, it is downright scandalous.

      • Hospitals themselves could do the stockpiling necessary for a certain level of preparedness (speaking of decentralization; they’d need to have the incentive to do so of course). This would free up the supply of masks to general consumers. Many individuals and businesses may start keeping a bunch of masks from now on; I expect the new steady state demand (and ultimately supply) of masks will be significantly higher going forward.

        • Banks could voluntarily stockpile extra capital for emergencies too and … oh.

          Part of the problem is there is always an incentive to gamble with going uninsured.

          Another problem is that no one knows ahead of time just how much the state will chip in.

  3. I disagree on your third point. I don’t see what’s wrong, for example, with the Fed’s response to this round of financial system stress. I think that liquidity provision against good collateral in a way that is in the end profitable is what the central bank is supposed to do. This is what they did in 2008+ and this is what they are doing now. This is the central bank’s job. It’s even more so the central bank’s job when the regulators have imposed supplemental leverage restrictions on banks. I’ve never understood why there is any problems with central bank balance sheet expansion, unless that expansion takes significant credit risk that isn’t guaranteed by the Treasury. Is the problem here credit risk or what’s the issue?

  4. I agree with your broad points about the unforgivability of “flying blind” and mask policy. Agreeing with those examples of failure, I would add the paucity of testing kits as a third point.

    Laying blame at the CDC’s door, though, seems too simplistic; it looks like blaming Eichmann for the holocaust — certainly he (and the CDC) deserve blame, but the failures are more deeply rooted and implicate higher authorities as well as reflect pernicious public sentiments.

    A final thought on masks: The CDC policy might be appropriate in context. *Given* there is only a small number of available masks, perhaps conserving supply for medical professionals is the right recommendation. If this reflects CDC thinking, then we should see a reversal of the recommendation once production ramps up.

  5. I blame economists for falling back on the 2008 playbook.
    —
    I been fighting that tendency for ten years. Why not plan the recessions openly, why plan them in the secret halls of government. We can say:
    “OK, these Ford class carriers were a boondoigle, a blunder, let’s write the, off in the next scheduled recession”.

    There is nothing wrong with government having the occasional blunder, the big error is always the cover up which generates another blunder.

  6. I’m mad because nobody is hiring the hundreds of thousands of health workers that will be needed to trace contacts after the lockdown ends, so what is the point really?

    • Re: the 0.01% death rate estimate,

      The article is certainly right that we badly need a good estimate of true infection rates. But the authors’ attempt to argue that death rates may be extremely low is just plain wrong.

      Sure, the numbers will look very optimistic if you take only the registered number of COVID-19 deaths and divide it with an estimate of the true infection rate that’s orders of magnitude higher than the number of tested (let alone positive) people.

      The latter may well be correct (even if these authors are going overboard), but the trouble is, the true number of COVID-19 deaths is also certain to be much higher than the number of identified cases — possibly orders of magnitude higher.

      This seems evident from what’s been happening in Italy. Greg Cochran just had a blog post about it today:
      https://westhunt.wordpress.com/2020/03/25/just-another-flu-in-bergamo/

      The raw mortality rate — simply counting the number of people who have died in a given area over the last week or month, of all causes — is going through the roof in places badly affected by this epidemic, far above numbers seen at any time in modern era. This is a simple observation that doesn’t depend on any assumptions, calculations, or estimates.

      And it immediately refutes any attempt to argue that the real death rate of COVID-19 may in fact be very low. A disease with a 0.01% (or even 0.06%) mortality simply cannot produce an enormous spike in overall death rates of the sort we’re seeing in the worst-affected Italian towns.

      • I don’t know what to make of this argument but some people are saying that a lot of the Italy deaths are a combination of flu and coronavirus, that neither would have produced the death by itself. One point in favor is that Italy has a very low rate of flu vaccination among the elderly.

        Thus, one way to reduce second or third waves of COVID-19 is for everyone to get a flu shot.

      • I don’t think the major source of bias is so much unrecorded deaths as the fact that it’s only been 3-4 weeks since the epidemic even started in most places, and it takes almost 3 weeks for the average person to die from the virus, so current mortality rates are 2-3 weeks behind the overall prevalence estimates. That’s the big reason why just dividing fatalities by estimated infections leads to a gross underestimate.

    • The linked article does say that one reason for East Asian mask wearing if to avoid infecting other people. It just says that there are also other reasons.

      • thanks for the link. Here is the issue. We don’t know who is sick and who is well. That’s why we are going through lockdowns. But everybody masking would be cheaper than mass lockdowns and probably more effective.

        • No Arnold, you are not thinking through the problem. I’m watching the Weinstein/Heying podcast now and I’m paused at where they are discussing masks. They are wrong, “Gross Negligence” is the term they are using and it ironically applies to their misinterpretation. This is the different between the hard sciences and the applied sciences. So far they are getting a big “F” in my Wartime General score. I hope it improves. I really like the biological discussion though.

          I’m not supporting widespread lockdowns. But I understand the “14-day reset” in any area where uncontrolled community transmission is occurring. Because of the incubation period (1-14d), the symptomatic period (<=8d), the testing lag, and the incredible time consuming effort required for Contact Tracing, the decisions being made by epidemiologists make sense. My engineering mind sees ample opportunity to improve the way things are currently being done to minimize the scope of the lockdowns but their approach is correct given the facts on the ground. I've been jumping ahead to optimizing their processes when I should have been more vocal about supporting their decisions right now. I hope my suggestions get heard or thought up by someone else with true voice and reach.

          This is a link I wish I had for you previously. My apologies for not being more proactive. British Columbia’s Dr. Bonnie Henry on Asymptomatic Transmission (Wed Mar 25).

          Even if you don’t know who is sick, very conscious hand washing is the most effective tool in your arsenal. The “super spreaders”, like the medical professionals at the B.C. Dental Conference, or the Edmonton Curling Bonspiel, only have to have a cough and make the mistake of coughing into their hand (the natural response that has to be untaught) and then immediately touching a shared object like a serving utensil. Half of the 70 or so doctors at the bonspiel got COVID-19. Only one person of the thousands that attended the international mining conference in Toronto got it. The bonspiel was Community Transmission but it was not chained, the public health Contact Tracing seems to have worked.

  9. The biggest blunder of the virus battle was Obamacare telling everyone to go to emergency room. Been telling us that for ten years, just go to clinic and they fix us for free.

    The emergency room is where it has been spreading, that and nursing homes. We lost home triage just when we needed it, home knowledge of treating flu systems. Activating that knowledge, in one single directive, would have worked, cut it by two I am sure. Nationalized medicine devalues home triage, we need that fixed. Absent home triage we have congestion, always, at the clinic and emergency room.

    • The pros I have read predicted all along the bottleneck problem, mostly picking the emergency room at the likely spot. They have been right over ten years.
      This is a clear pattern of PSST, there is a pattern that must be sustained to move the patient through the process. It can congest up quite easily, and hospital management is all about sustainable patterns in the specialized wards, a test book case of the theory.

  10. Arnold, with all due respect, you personally believe that you are flying blind but you are obsessed with the broken gauges and refuse to look up and work the problem.

    This is total war for America which means the only way to win is with the might of the American Economic Machine focused on two objectives:

    1. Stop the Spread
    2. Fortify the Health System

  11. If you squint and believe you can look at the 1200$ check as a short term loan since government debt is supposed to be payed with future taxes

  12. You are better than that Arnold on number two. Budgets are finite and everybody would scream bloody murder if you wasted it on low probability low impact events. Why did you not stockpile a year worth of masks? Your employer? Your state? Etc. Even if you wanted to argue the Feds should waste money on storing and maintaining billions of masks for hundreds of years including rapid logistical channels to fight yesterday’s war for the once a century flu pandemic, that would still be FEMA and not the CDC.

    The real question is where is FEMA, not CDC, in this “crisis”

    • FEMA is doing a ton actually, especially with regards to their main mission which is to help state and local jurisdictions respond to crisis and to answer their requests for assistance. They also did a lot to model and encourage those jurisdictions to develop plans to deal with such events, usually using “pandemic influenza” terms.

      Here’s the problem. The perfect plan typed up nice and neat and put in binders on the wall is pretty much worthless if whatever material requirements weren’t ever resources and people aren’t already intimately familiar with it and regularly trained and certified to execute it well when the time comes.

      Binders better be in brains, not bookshelves.

      Having a stockpile of masks is great. Having a stockpile of state capacity and organizational capital in the heads of government employees is even better.

      • “Having a stockpile of state capacity and organizational capital in the heads of government employees is even better.”

        We have huge stockpiles of state capacity and organizational capital in the heads of government employees at all levels (and people who circulate in and out of government). Unfortunately almost all of this stockpile is for the pursuit of largely socially destructive “virtue”-signalling and assertions of control by our loony elites (note how the national security and law enforcement apparatus jumped into action and ground away for two years in pursuit of a fairy tale about how Trump “stole” the election). None of that stockpile is doing us much good now.

  15. Much of the stimulus package seems to boost the unemployment insurance system, which seems to be doing what is needed: replacing the incomes of those who lost work through no fault of their own, because of a difficult to foresee event.

    • TBH I’m expecting much of that to go unclaimed as most (all?) require you to actually be unemployed, i.e. “looking for work” .. rather hard to do in a quarantine. So basically you can fraudulently claim you attempted to find three jobs that week OR you can starve … great set of incentives there. It shouldn’t have went to unemployment but block grants and welfare to individuals.

      • I would be very surprised if that requirement wasn’t waived (officially or “wink, wink” unofficially) until the emergency is officially declared over.

        • I’m pretty positive it was unofficially which annoys me. These folks have large staffs, how hard is it to write appropriate edicts. The problem with doing so unofficially is it will discourage some filers who are aware and don’t want to commit fraud plus it will increase anxiety in people in others who know they are committing fraud and will worry until the statute of limitations is up.

  16. So my family got sick just before the lockdowns got going, and my wife had been to a conference in Dulles right before. They got sick first and me later, and while they seem on the mend I’ve been struggling with illness for two weeks. Terrible cough. As they have slowly recovered I’ve stayed sick and not recovering in any stable way, in fact I feel downright awful. We have isolated the whole time but I’ve had to make a grocery trip or two in that time.

    I haven’t wanted to go to a doctor for fear of being exposed to germs at the doctors, and I didn’t have a bad fever which I was told was a likely Covid symptom, but I’ve had a mild fever occasionally. Also, I haven’t really felt bad in my lungs, even though my sinuses and throat feel terrible.

    When I found out about a drive thru testing center in MD that would not just do Covid but test for all other respiratory diseases I decided to give it a shot.

    They test you for flu first. Will only give you Covid test if you have symptoms, come back negative for other things, and have pre-existing conditions (I have all pre-existing conditions). I was told I got one of their last three tests.

    They told me it was going to take 8 DAYS to get results back. If I actually have it, seems like that information will be too late to act on.

    Most of the staff was covered in PPE and masks and was wiping everything down, but one assistant didn’t want to wear her mask. I don’t know if she put it on when dealing with patients but she had it off while walking around the parking lot and doing much of her work.

    The nose swab is rather invasive and unpleasant. Ended up coughing up a lot, blowing mucus and blood out my nose immediately afterwards.

    They gave me a Z-pack which they claim they are also using on Covid in addition to the usual respiratory infections.

    • Maryland has performed a stunningly small number of tests, given its size, population (6 million), proximity to DC, and many top notch universities and medical centers.

      It’s fewer than any other state except Delaware, to include Wyoming, Alaska, and even West Virginia.

      The latest in Maryland is only 517 tests compared to Massachusetts at nearly 20,000 and New York at over 100,000.

      https://covidtracking.com/data/#MD

    • asdf, I missed your comment from this morning.

      MESSAGE TO ARNOLD: can you expand the number of comments in the sidebar from 5 to a larger number?

      ASDF: call friends or family and ask them to deliver groceries to your doorstep. As long as they practice good hand hygiene they will be fine. In Canada, the public health officials emphasize that neighbours should practice safe hand hygiene when they are “inside” an infected person’s home. This is not ebola. Common sense goes a long way and you have an abundance of it. Stay calm, stay safe. I hope your friends and/or neighbours remember to be Kind.

      I listened to a good interview Nobody was coughing with one of the first people infected with COVID-19 in Seattle. She also described it as being like the worst flu she ever experienced and absolutely floored both her and her husband. She also said they experienced a high fever day after day. I think this is the normal course which is why the original East Asian screenings focused so much on fever using passive temperature sensors.

      She also said that her husband is asthmatic so they were worried. Her and her husband along with all of their close friends that were infected recovered just fine. She also said that her cough persisted for days/weeks afterwards.

      My amateur guess is that all of their symptoms were limited to the Upper Respiratory system. It is my understanding that when it gets into the Lower Respiratory system (bronchitis and pneumonia) it is quite severe compared to influenza. One of my close family was hospitalized for pneumonia and she experienced significant chest pain. I think it’s hard not to panic when you experience trouble breathing (as most asthmatics know) and acute chest pains. I’m guessing this accounts for the 20% that rush to the hospital even though they’ve seen the horror show on television in places like Italy. I’m guessing that COVID-19 LRTI always results in hospitalization and COVID-19 URTI scares the heck out of people and makes them wonder if they should seek help.

      The advice of Alberta’s Dr. Deena Hinshaw the other day when they changed their protocol to Symptom Onset Plus Ten Days was that you should continue to Self-Isolate if you are still experiencing symptoms after ten days. I think this is one of those grey areas that we will learn more about as time goes on. I hope you have been keeping a journal to track your family’s illness.

      I think I mentioned Pulse Oximeter’s to you before. I got a AAA battery operated Go2 by Nonin about a decade ago, just out of curiosity. If I was having trouble breathing one of these would give me peace of mind about needing hospitalization. Last Black Friday, I bought a Garmin Vivosmart 4. All of the newest Vivosmart line include a Pulse Oximeter, that I had to enable through a firmware update, that can be enabled to track automatically overnight while you sleep but there is also a manual mode. Anyway, my apologies if I’m making bad assumptions about the usefulness of any of the information I’m sharing.

      • MESSAGE TO ARNOLD: can you expand the number of comments in the sidebar from 5 to a larger number?

        I second that. The blog is getting a lot more comments recently. Now if it’s only getting more influence …

    • Oh, I thought of another “tip” that may or may not be useful to you asdf. I use a Phone/Web app named OurGroceries that has a simple list sharing mechanism. It also has an excellent Amazon Alexa interface so you can add items handsfree. I think many people use the physical hints as they walk up and down the grocery store aisles to remember what they need. It is hard to switch to a pre-planned list when you’ve used the Aisle-Memory-Jog technique all of your life. Mind you, I think what is on the shelves determines what we buy but maybe that will change soon.

  17. A possibly worthwhile innovation for an entrepreneur: figure out how to make masks (and gloves) with much longer shelf lives to reduce the cost of stockpiling those things, could make a killing in the aftermath of this.

  19. The CDC, unfortunately, believed they had many jobs rather than just the one. Prior to the pandemic, their priorities were vaping and gun control. After all, in a works where pandemics don’t happen anymore, how can they stay relevant?

    • Don’t worry, the WHO stills lists tobacco as a pandemic so the CDC in good company.

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