Unusually confused piece for the Economist, which says govts should not rely on contact tracing apps as silver bullet, as the apps can have incomplete participation, leading to mistaken/dangerous conclusions, plus they give more power to the tech giants. However, it concludes with
"In this case, though, Google’s and Apple’s cautious approach is sensible. In a pandemic, experimenting with novel public-health responses such as mass surveillance should be done carefully...."
Agreed. It’s like when you get an essay prompt in high school English that asks a binary question but you want to be a contrarian so you don’t take either side of the issue and end up presenting some garbled middle ground.
The management of this pandemic, both here in the UK and in the US, has been appallingly poor. We're months in and we still don't really know all the symptoms or the various R values or the mortality rates. It's actually insane how badly we've done.
This will be downvoted but- in the US, on a national level, "poor management" is a deliberate choice.
The chaos that stems from absence of leadership suits the Chaos Monkey President. Like all grifter/carnival barkers, he despises his customers (marks), whose only option in the absence of information, support, structure, is YOLO, and who will therefore ultimately suffer the most, while continuing to turn to him for his cynical false messaging and identification of an Other to blame for any misfortune.
Those who are not under his spell are beaten into apathy by the sheer unrelenting awfulness and the absence of an alternative national strategy other than "vote in November."
Even states/regions (like mine, NY) where there is less insulation for incompetent or malignant leadership than at the national level and that are finally proceeding rationally and relatively transparently nevertheless failed to act quickly enough at the start, and continue to be presented with grotesque and criminal obstacles by the national government.
It is an appalling state of insanity that we are in, that's for sure.
The US health system is not well positioned for command-and-control from a centralized source. This has various advantages and disadvantages, but is a severe hindrance in a pandemic.
There wasn't even a unified diagnosis code for COVID until April 1, and that required a herculean effort and a shirking of normal coding update processes. There were various guidances for coding, but identifying diagnosis in structured data for fast analysis was a difficult ask. (I know this to be true, I've done it across the health records of millions of patients.)
I'm sure some fault lies in the administration, but my belief is that our health system is systemically unable to properly deal with widespread pandemic, especially from a newly discovered illness.
That's one of those trade-offs that have to be considered when looking at how health care in the US should be handled in the future.
As long as the US has free movement of people across state borders, it needs a nationwide response to infections disease.
Historically, the US had the ability to coordinate a nationwide response to pandemics. Starting in 1947 the National Malaria Eradication Program was one very successful example of this process which succeeded in eradicating malaria in the United States by 1951. https://en.wikipedia.org/wiki/National_Malaria_Eradication_P...
Similar efforts for widespread vaccinations etc have also worked just fine. This pandemic is exactly what the CDC was designed to handle, it’s simply been horrifically mishandled.
PS: The blame goes beyond this administration, but great leadership early on could have made a massive difference.
Are you referring to ICD-10 code U07.01? I thought the US had to wait for the WHO to add the code, so I'm not clear on how our health system was worse than other countries in that respect.
Yes, U07.1. I was not aware of the WHO aspect (only that it had to be accelerated.) Prior to April 1 there were several CDC guidances for covid that unfortunately were complicated by existing code re-use.
Thanks for reply. No disagreement about the US health system from a command and control perspective.
There actually isn't even a US health system, in the sense of other countries having a (public) health system. The US has a ton of private health systems, plus some large public ones for the elderly, poor, and veterans who are unable to buy into a private system. It is a mess.
Issues with this mishmash of public and private systems aside, the primary failing I would argue is political- as a coordinated response to a pandemic involves education, housing, supply chain- lots of systems that have nothing directly to do with health.
I would be curious if points you raise from a health system perspective were to some extent covered in the pandemic playbook that had been created and was handed over to the new political leadership following the election- then abandoned by them, as is well documented. If they were, it points even more strongly to political failure, as an aggressive political approach, building on prior planning work, could have greased so many administrative wheels- instead of, as is clearly happening now, simply and shamelessly lining the pockets of political allies.
> These acts, in turn, have sparked calls for administration opponents to be more civil.
> Intrepid Internet sleuths have discovered similar resistance and calls for civility during the Nazi
> American Christian religious leaders urging Jews to "appeal to the German sense of justice and German national conscience" rather than "baiting Hitler and trying to fight back," and Jews would be better served if they showed "good-will" towards the Nazis rather than "hate."
I don't necessarily agree with the idea(s)/opinion(s) presented in the article, or the comparisons, but I do appreciate discourse that attempts to put forward an idea/opinion tactfully & thoughtfully. I think everyone is better served to understand/hear/read/listen to other points of view.
That being said, if your article had opened with lines such as:
> Chaos Monkey President
> Like all grifter/carnival barkers
I don't know that it would have gotten the point across as well as it did. However, given how upvoted the comment I replied to appears to be, perhaps I am in the minority.
No disagreement on your points; we have a "leader" who has precisely 0 desire to lead, and 100% desire to seen as a leader, to inflate his ego. To do so requires fawning attention, deflecting blame, and avoiding hard decisions.
However, even in states that are taking strong stances, they're all at least slightly different, and I still have a sense that they're all sort of biding time until some "adults" come along and provide leadership from the top, because that's how it's always worked in the past.
Objectively speaking, we are at a juncture in time where People need to think and act from the perspective of allegiance to economic opportunity rather than arbitrary geographies (called nations). This kind of thinking leads to non violent approach of forming groups of people on a given geography rather than a violent approach that is bred by nations and patriotism. It’s time to consider moving out of US may be. Smaller countries are better managed. They are poised to act fast and the higher degree of homogeneity (in thinking) helps with policies, laws etc. making the govt actually able to do things for its citizens rather than form factions along party lines and paralyze the system. The chaos monkey is just a symptom not the root problem. And so long as the root problem remains unaddressed there will be more monkeys and I would say worse than this one. He has set the bar for what presidents can do which mean other politicians with see it as it’s ok to use tactics like his over time this becomes the norm and only to be one broken by even worse monkeys in their efforts to “stray from the normal”. As a result the normal just keeps degrading.
In the end we get the govt and politicians we deserve. The system that has morphed in the US for its citizens is quite worse. The masses are so busy they are merely citizens Trying to meet ends with their busy lives and can’t perform active citizenry which is critical for democracy. Between school,children and work there is very little personal time let alone be an active citizen. The youth is somewhat detached from the reality of the corrosive system of govt working from them because they mostly don’t feel the direct consequences of an inept govt system as their needs are somewhat less than middle aged masses. The older folk are just pissed at what they see and become one issue voters. So the people who actually have the time to vote are voting for very specific issues. This breeds politicians that cater to these voters and what you get is a political body that caters to and operates on extreme positions of left and right rather a more centrist or moderate approach. All in all there are too many structural issues from years of “corrosion“.
As with most changes in history the catalyst for big change is usually natural disasters and wars. Technology advances to play a role too. Covid is one of those power shifting natural disasters. The shift will be gradual an not a sudden as spectacular as a building being demolished. The citizens are like frogs being boiled alive. Most don’t realize what’s happening right under given the slow degradation with small flares here and there thst grab their attention but not big enough to muster any energy to drive change.
Thank you. Agree COVID is a catalyst for global change, probably only the first of many more to come. I expect climate to continue to present more systemic challenges in the coming years and decades. And I don't expect the collective "us" whatever that collective is to get "it" right in response to COVID.
I am still an advocate and supporter of rule of law rather than rule of man, and recognize that many of the issues Chaos Monkey is finding have to do with scale and the legal and administrative equivalent of technical debt. I like solving for scale and debt problems and while we are in a real shitstorm now, we also have millions of us triage agents working to bring back rationality and accountability. Our day to plan and rebuild will come.
all indications are that the data are quite contradictory, we neither understand nor are able to properly describe who gets infected and why exactly those and not others.
I cringe at all these "simulations" in various journals and newspapers, where you can drag a slider of 5 people infecting 6 more etc. and then seeing the outcome - completely useless for decision making
it's really not how it works at all, the world is a far more varied mosaic the signals far more noisy and hugely affected by local variations
The fact that we're not testing enough to really understand the case fatality rate is definitely a governmental failure in the ability to (even attempt to!) ramp up and implement rigorous testing.
However, I think the transmissibility and other such information is just a HARD problem with how quickly this has come on, with different factors in every single locality where it's happening.
That may have been the case previously, but is not my understanding of the current state. At least in California, Tests are readily available and anyone who wants one can have one.
So, first of all, my wife works directly with patients in a hospital in Santa Clara, and she just got tested for the first time yesterday.
You're correct that anyone who wants a test can get one (or, if you're wrong, I'm wrong, too). But that's a very different thing from the kind of frequent, high-volume testing we'd need to actually understand what's going on with COVID-19. There's a serious selection bias at play here when the only people who are ACTUALLY getting tested are those who suspect they might have been exposed or are showing symptoms.
Just because the data isn't there doesn't mean they have done a good job though (IMO they mostly haven't at all).
You can still act without data, you just don't know exactly what effect it will have because even without data some actions just seem quite likely to have a positive outcome.
There's a great clip of Dr Michael J Ryan, Executive Director at WHO who that's relevant that's worth watching:
Social distancing, lockdowns, masks, these all intuitively help the situation, and if and when it is reaslised that they don't, then you can withdraw the rules or advice. However, it's impossible to regain the benefits of things you didn't do if you start to do them much later.
You are right, there was contradictory data, but what governments should have, and should still be doing, is acting where there is uncertainty, not waiting for certainty before acting, and the fact that many aren't, or are doing it to such a limited degree, is the problem.
Ironically many of the UK's woes are due to rigidly following WHO advice. For example, when multiple countries in Europe and the US were recommending or mandating face coverings, the UK rigidly stuck to the WHO line that there's "no evidence" that face coverings are effective. They reluctantly changed course last week, but it's too late now, the public is now set in their way.
The same goes for border controls. The UK is only now thinking about instituting a 14 day quarantine for arrivals as it had been sticking rigidly to the WHO advice from February that measures at the border are "unnecessary".
This kind of mentality pervades the British government. Rules must be followed at any cost. Many people voted for Brexit simply because they preferred having blue coloured passports instead of red ones. There's some EU guideline that passports should be red and this was blown up by the media into a kind of rallying cry. UK could have just disobeyed the guideline but they stuck rigidly to it even when it was irrational to do so.
Yeah, the WHO is't completely right, I bever said they were, but it doesn't have to be either/or.
You can do "test test test" as the WHO said, at the same time as enforcing face masks, which they have not. The UK government has done neither of those things yet.
I don't think this is about following the rules, the WHO provide advice and perhaps guidelines here. I think this is perhaps a fear of doing the wrong thing, combined with a desire to seem like they're in control. If you hold back 14 day quarantine "until the time is right", then get up in front of people and say "the right time is tea time next Thursday" it makes you seem like you know what you are doing.
> They reluctantly changed course last week, but it's too late now, the public is now set in their way.
I'm just south of Manchester. Almost no-one in my area is wearing a mask, and since Monday when the new catch phrase was announced social distancing seems to have gone out the window.
>all indications are that the data are quite contradictory, we neither understand nor are able to properly describe who gets infected and why exactly those and not others.
This is really a secondary issue. You don't really need crazy amounts of "data" to respond effectively to a pandemic. We know full well how to deal with viral outbreaks in general, and when looking at other countries that have the exact same amount of information as everyone else has the differences could not be more stark.
Hong Kong and New York City are quite comparable on most metrics, and look at the different results even though the former neighbours the outbreak.
I wish we could finally bury this data-ism, as if it wasn't possible to make sound decisions under uncertainty. You need zero data to provide protective gear, enact hygiene measures, distance, and just follow general safety measures. Instead of experts talking about r-values you need the civic population to folow basic rules and the supply chains to be able to manufacture the necessary equipment.
29 comments
[ 5.9 ms ] story [ 77.1 ms ] threadUnusually confused piece for the Economist, which says govts should not rely on contact tracing apps as silver bullet, as the apps can have incomplete participation, leading to mistaken/dangerous conclusions, plus they give more power to the tech giants. However, it concludes with
"In this case, though, Google’s and Apple’s cautious approach is sensible. In a pandemic, experimenting with novel public-health responses such as mass surveillance should be done carefully...."
The chaos that stems from absence of leadership suits the Chaos Monkey President. Like all grifter/carnival barkers, he despises his customers (marks), whose only option in the absence of information, support, structure, is YOLO, and who will therefore ultimately suffer the most, while continuing to turn to him for his cynical false messaging and identification of an Other to blame for any misfortune.
Those who are not under his spell are beaten into apathy by the sheer unrelenting awfulness and the absence of an alternative national strategy other than "vote in November."
Even states/regions (like mine, NY) where there is less insulation for incompetent or malignant leadership than at the national level and that are finally proceeding rationally and relatively transparently nevertheless failed to act quickly enough at the start, and continue to be presented with grotesque and criminal obstacles by the national government.
It is an appalling state of insanity that we are in, that's for sure.
There wasn't even a unified diagnosis code for COVID until April 1, and that required a herculean effort and a shirking of normal coding update processes. There were various guidances for coding, but identifying diagnosis in structured data for fast analysis was a difficult ask. (I know this to be true, I've done it across the health records of millions of patients.)
I'm sure some fault lies in the administration, but my belief is that our health system is systemically unable to properly deal with widespread pandemic, especially from a newly discovered illness.
That's one of those trade-offs that have to be considered when looking at how health care in the US should be handled in the future.
Historically, the US had the ability to coordinate a nationwide response to pandemics. Starting in 1947 the National Malaria Eradication Program was one very successful example of this process which succeeded in eradicating malaria in the United States by 1951. https://en.wikipedia.org/wiki/National_Malaria_Eradication_P...
Similar efforts for widespread vaccinations etc have also worked just fine. This pandemic is exactly what the CDC was designed to handle, it’s simply been horrifically mishandled.
PS: The blame goes beyond this administration, but great leadership early on could have made a massive difference.
https://www.who.int/classifications/icd/icd10updates/en/
There actually isn't even a US health system, in the sense of other countries having a (public) health system. The US has a ton of private health systems, plus some large public ones for the elderly, poor, and veterans who are unable to buy into a private system. It is a mess.
Issues with this mishmash of public and private systems aside, the primary failing I would argue is political- as a coordinated response to a pandemic involves education, housing, supply chain- lots of systems that have nothing directly to do with health.
I would be curious if points you raise from a health system perspective were to some extent covered in the pandemic playbook that had been created and was handed over to the new political leadership following the election- then abandoned by them, as is well documented. If they were, it points even more strongly to political failure, as an aggressive political approach, building on prior planning work, could have greased so many administrative wheels- instead of, as is clearly happening now, simply and shamelessly lining the pockets of political allies.
Cheers.
> Intrepid Internet sleuths have discovered similar resistance and calls for civility during the Nazi
> American Christian religious leaders urging Jews to "appeal to the German sense of justice and German national conscience" rather than "baiting Hitler and trying to fight back," and Jews would be better served if they showed "good-will" towards the Nazis rather than "hate."
I don't necessarily agree with the idea(s)/opinion(s) presented in the article, or the comparisons, but I do appreciate discourse that attempts to put forward an idea/opinion tactfully & thoughtfully. I think everyone is better served to understand/hear/read/listen to other points of view.
That being said, if your article had opened with lines such as:
> Chaos Monkey President
> Like all grifter/carnival barkers
I don't know that it would have gotten the point across as well as it did. However, given how upvoted the comment I replied to appears to be, perhaps I am in the minority.
Cheers.
However, even in states that are taking strong stances, they're all at least slightly different, and I still have a sense that they're all sort of biding time until some "adults" come along and provide leadership from the top, because that's how it's always worked in the past.
Objectively speaking, we are at a juncture in time where People need to think and act from the perspective of allegiance to economic opportunity rather than arbitrary geographies (called nations). This kind of thinking leads to non violent approach of forming groups of people on a given geography rather than a violent approach that is bred by nations and patriotism. It’s time to consider moving out of US may be. Smaller countries are better managed. They are poised to act fast and the higher degree of homogeneity (in thinking) helps with policies, laws etc. making the govt actually able to do things for its citizens rather than form factions along party lines and paralyze the system. The chaos monkey is just a symptom not the root problem. And so long as the root problem remains unaddressed there will be more monkeys and I would say worse than this one. He has set the bar for what presidents can do which mean other politicians with see it as it’s ok to use tactics like his over time this becomes the norm and only to be one broken by even worse monkeys in their efforts to “stray from the normal”. As a result the normal just keeps degrading.
In the end we get the govt and politicians we deserve. The system that has morphed in the US for its citizens is quite worse. The masses are so busy they are merely citizens Trying to meet ends with their busy lives and can’t perform active citizenry which is critical for democracy. Between school,children and work there is very little personal time let alone be an active citizen. The youth is somewhat detached from the reality of the corrosive system of govt working from them because they mostly don’t feel the direct consequences of an inept govt system as their needs are somewhat less than middle aged masses. The older folk are just pissed at what they see and become one issue voters. So the people who actually have the time to vote are voting for very specific issues. This breeds politicians that cater to these voters and what you get is a political body that caters to and operates on extreme positions of left and right rather a more centrist or moderate approach. All in all there are too many structural issues from years of “corrosion“.
As with most changes in history the catalyst for big change is usually natural disasters and wars. Technology advances to play a role too. Covid is one of those power shifting natural disasters. The shift will be gradual an not a sudden as spectacular as a building being demolished. The citizens are like frogs being boiled alive. Most don’t realize what’s happening right under given the slow degradation with small flares here and there thst grab their attention but not big enough to muster any energy to drive change.
I am still an advocate and supporter of rule of law rather than rule of man, and recognize that many of the issues Chaos Monkey is finding have to do with scale and the legal and administrative equivalent of technical debt. I like solving for scale and debt problems and while we are in a real shitstorm now, we also have millions of us triage agents working to bring back rationality and accountability. Our day to plan and rebuild will come.
Cheers.
all indications are that the data are quite contradictory, we neither understand nor are able to properly describe who gets infected and why exactly those and not others.
I cringe at all these "simulations" in various journals and newspapers, where you can drag a slider of 5 people infecting 6 more etc. and then seeing the outcome - completely useless for decision making
it's really not how it works at all, the world is a far more varied mosaic the signals far more noisy and hugely affected by local variations
However, I think the transmissibility and other such information is just a HARD problem with how quickly this has come on, with different factors in every single locality where it's happening.
You're correct that anyone who wants a test can get one (or, if you're wrong, I'm wrong, too). But that's a very different thing from the kind of frequent, high-volume testing we'd need to actually understand what's going on with COVID-19. There's a serious selection bias at play here when the only people who are ACTUALLY getting tested are those who suspect they might have been exposed or are showing symptoms.
You can still act without data, you just don't know exactly what effect it will have because even without data some actions just seem quite likely to have a positive outcome.
There's a great clip of Dr Michael J Ryan, Executive Director at WHO who that's relevant that's worth watching:
https://twitter.com/Prof_S_Taylor/status/1238598239902994433
Social distancing, lockdowns, masks, these all intuitively help the situation, and if and when it is reaslised that they don't, then you can withdraw the rules or advice. However, it's impossible to regain the benefits of things you didn't do if you start to do them much later.
You are right, there was contradictory data, but what governments should have, and should still be doing, is acting where there is uncertainty, not waiting for certainty before acting, and the fact that many aren't, or are doing it to such a limited degree, is the problem.
The same goes for border controls. The UK is only now thinking about instituting a 14 day quarantine for arrivals as it had been sticking rigidly to the WHO advice from February that measures at the border are "unnecessary".
This kind of mentality pervades the British government. Rules must be followed at any cost. Many people voted for Brexit simply because they preferred having blue coloured passports instead of red ones. There's some EU guideline that passports should be red and this was blown up by the media into a kind of rallying cry. UK could have just disobeyed the guideline but they stuck rigidly to it even when it was irrational to do so.
You can do "test test test" as the WHO said, at the same time as enforcing face masks, which they have not. The UK government has done neither of those things yet.
I don't think this is about following the rules, the WHO provide advice and perhaps guidelines here. I think this is perhaps a fear of doing the wrong thing, combined with a desire to seem like they're in control. If you hold back 14 day quarantine "until the time is right", then get up in front of people and say "the right time is tea time next Thursday" it makes you seem like you know what you are doing.
> They reluctantly changed course last week, but it's too late now, the public is now set in their way.
I'm just south of Manchester. Almost no-one in my area is wearing a mask, and since Monday when the new catch phrase was announced social distancing seems to have gone out the window.
This is really a secondary issue. You don't really need crazy amounts of "data" to respond effectively to a pandemic. We know full well how to deal with viral outbreaks in general, and when looking at other countries that have the exact same amount of information as everyone else has the differences could not be more stark.
Hong Kong and New York City are quite comparable on most metrics, and look at the different results even though the former neighbours the outbreak.
I wish we could finally bury this data-ism, as if it wasn't possible to make sound decisions under uncertainty. You need zero data to provide protective gear, enact hygiene measures, distance, and just follow general safety measures. Instead of experts talking about r-values you need the civic population to folow basic rules and the supply chains to be able to manufacture the necessary equipment.