At The Hill physician Scott Atlas recites some facts which should be familiar to readers of this blog since, cumulatively, they make up an argument articulated here by a frequent commenter:
Fact 1: The overwhelming majority of people do not have any significant risk of dying from COVID-19.
Fact 2: Protecting older, at-risk people eliminates hospital overcrowding.
Fact 3: Vital population immunity is prevented by total isolation policies, prolonging the problem.
Fact 4: People are dying because other medical care is not getting done due to hypothetical projections.
Fact 5: We have a clearly defined population at risk who can be protected with targeted measures.
I have some more facts.
- We can’t really be sure of any of his facts. It’s just too early to tell and there’s too much we don’t know.
- The incentives point more to governors and mayors keeping their jurisdictions closed than opening them.
- The risks vary from place to place and, as fate would have it, the risks are highest in a place where there are a lot of opinion-makers.
- There’s good money (and power) to be had from panicked people. When the dust of this has settled, ATT, Comcast, Netflix, Amazon, and Walmart will be in stronger shape than ever.
1. We don’t have nearly enough facts for my liking either. But the trend of the test sampling is definitely heading towards the vast majority of people not even being at risk of hospitalization.
2. Protecting the vulnerable should not force everyone else to have to share their prison. Burning the village cropfields to reduce the plague rat population will kill the village deader than the plague will. There are protocols out there to reduce the amount of contact the outside world has with those most at risk. They should be implemented.
3. I think Kung Flu is now so widespread that just going to the grocery store is going to institute herd immunity whether we like it or not. NYC with its refusal to shut down the subways and other mass transit simply telescoped the pandemic in their area and almost caused the collapse of their medical system (which flattening the curve was supposed to do). But then Bill DeBlasio is famous for exhibiting negative intelligence.
4. True. (And to be snarky, the trans community is among those screaming the loudest). And I agree Dave, panic induces people to give up rights and treasure, and those with the deepest pockets and the most deeply entrenched in government are those best able to take advantage of a crisis. I don’t think it was intentional by most of the panic-mongers, but those who are being advantaged by the panic didn’t mind it at all.
5. See the last two sentences of 2.
1. You can always wait for more facts. You will always be correct that way. You will probably also be retired or dead by then, and are certainly useless. We live in a world of experience and judgment. Only pure science is different. But I would note, lack of facts didn’t stop people from implementing hysterical policy with horrible costs. 25 million unemployed can attest to that.
2. Yet another argument against ceding authority to government.
3. Which is why governing by NY and Washington media and opinionmakers is a bizarre stance.
4. You forgot to list government, and their minions.
One of the advantages I have in my work is the benefit of talking to a wide swath of players in both the Wall Street arena and the Main Street arena. Business owners and managers, and bankers, consultants, investment bankers etc. There is a horrible disconnect between Wall and Main Street right now. As big as media and main street and government and main street. Main Street is getting slaughtered, and all the others are still playing their little games. Its criminal. It could definitely result in civil unrest.
Lets just dissect one of his “facts”.
“Fact 1: The overwhelming majority of people do not have any significant risk of dying from COVID-19.
The recent Stanford University antibody study now estimates that the fatality rate if infected is likely 0.1 to 0.2 percent, a risk far lower than previous World Health Organization estimates that were 20 to 30 times higher and that motivated isolation policies.
In New York City, an epicenter of the pandemic with more than one-third of all U.S. deaths, the rate of death for people 18 to 45 years old is 0.01 percent, or 11 per 100,000 in the population. On the other hand, people aged 75 and over have a death rate 80 times that. For people under 18 years old, the rate of death is zero per 100,000.
Of all fatal cases in New York state, two-thirds were in patients over 70 years of age; more than 95 percent were over 50 years of age; and about 90 percent of all fatal cases had an underlying illness. Of 6,570 confirmed COVID-19 deaths fully investigated for underlying conditions to date, 6,520, or 99.2 percent, had an underlying illness. If you do not already have an underlying chronic condition, your chances of dying are small, regardless of age. And young adults and children in normal health have almost no risk of any serious illness from COVID-19.”
The Stanford study (LA one also) has significant problems. No one without an agenda accepts it as fact.
Citing NYC has problems depending upon the study he chooses. The most recent study from the big chain there (Rockwell?) found an 88% death rate for intubated pts. We are running about 60% A little over an hour away from NYC. Are we that much better? Doubt it. I suspect it may be because we never got overwhelmed. Also, being a week or two behind them we benefited from their experience.
“Of 6,570 confirmed COVID-19 deaths fully investigated for underlying conditions to date, 6,520, or 99.2 percent,”
As I said before, in the era of the EMR everyone has underlying conditions. Saw your doctor or NP 5 years ago for knee pain? You have an underlying condition. EMRs are not really set up for providers. If you are lucky they are sometimes helpful. They are really set up for billing. They capture every possible thing wrong with you and keep it forever in the hope that it will let the hospital bill for more.
So I am not seeing facts here, just assertions. Look at #5. We dont know how to do what he says we should do. I suspect that there were some sloppy nursing homes, but I also know that there were some that went very extreme measures and still had big outbreaks. To be clear, part of that is not just the lack of skill to accomplish it but there also isn’t the funding.
Here is the fact. The trade off is between more deaths and a better economy. Another fact. Achieving that balance in trade offs is hard. People keep claiming Sweden is doing it, but it looks like their economy is going to be just about as bad as everyone else’s AND they have twice as many deaths as their neighbors, 50% more than we do.
Steve
One thing that bothers me is the somewhat “defeatist” attitude.
Everyone seems to accept either we have to let this run its course, or we stay in the current posture for an indefinite time.
I don’t think those are the only choices, we see enough examples around the world to say those are not the only choices. I only point out, China, South Korea, Eastern Europe, Australia have all tried different things that succeeded for them.
Germany looks pretty good too, though they are predicting that UE will rocket up to 5.9%. Excluding China, it looks like making good decisions early matters a lot.
https://foreignpolicy.com/2020/04/24/united-states-europe-coronavirus-pandemic-shutdown-unemployment/?utm_source=PostUp&utm_medium=email&utm_campaign=21066&utm_term=Editors%20Picks%20OC&
Steve
“One thing that bothers me is the somewhat “defeatist†attitude.â€
The comfortable home of “experts†and staff. Anyone recall the old drinking song? “No balls at at, no balls at all, yes he had no balls at all. ……..â€.
Men of action are a different breed. They aren’t afraid to be wrong. They speak their mind when it counts, as best they can. They have the confidence of a past inventory of of correct decisions, and the balls to make the next one in the face of uncertainty. They aren’t perfect, and are comfortable with that.
Just look at my investment decision record. It’s extremely good. It’s not perfect. It has one spectacular failure. I can hold my head high.
Look at the media today. They have no record. None. Yet they just give Trump the devil every day. Why (steve) would you pay any attention to these clowns? Seriously, just clowns.
When I take my morning walk each morning I see lawn crews, not maintaining “social distancing”, going about their work. No city worker I encounter is maintaining “social distancing”, wearing a mask, or otherwise doing anything which would tell you they take avoiding the spread of the virus seriously. Each of those people has a family to whom they’re spreading anything they contract and probably don’t take the directives any more seriously than they do.
When I take my afternoon walk, I see groups of 3-5 teenagers who, presumably, do not all live in the same home, walking around the neighborhood without “social distance”.
My attitude isn’t defeatism. It’s just an acknowledgement that Americans simply won’t follow the rules and political leaders are too fond of their jobs to enforce them.
“Yet they just give Trump the devil every day. Why (steve) would you pay any attention to these clowns?”
You know when you listen to someone talk about private equity and they are so wrong it just annoys the hell out of you? That is how I feel when I hear Trump talking about this stuff. He lies. He is wrong. He doesnt sound remotely like he understands wha the is talking about much of the time. If by clowns you mean the reporters I dont know how they can avoid going after him.
I try to get my information from reliable literature sources, our own results and specialists with whom I work. The dreaded experts. I actually read most of the studies I talk about. I try to always note that we shouldn’t jump to big decisions based upon one study, no matter how good it looks at first.
I didnt comment upon the defeatist bit but not sure where that is coming from. We are kind of upbeat about our relative success at avoiding intubations and getting people extubated. We, our network, are already planning on how we will open our hospital to elective cases again. Our state already opened up a few businesses and is planning on opening more as Covid cases decrease. I dont feel defeatist at all.
That said, I still have concerns. I wish someone was really pursuing more PPE. I am at least moderately numerate, so when Trump comes out and throws around numbers saying we have millions more coming I know that his numbers are much lower than what we really should have. And its really not just PPE. Its ventilator filters, circuits, HME filters, gowns, drugs, etc. The people in charge just dont instill confidence.
Anyway, that reminds me. I am contemplating a career in government when I retire in a couple of years. In preparation I am starting a dog breeding business. Want to buy a labradoodle?
Steve
I don’t think it was aimed at you, Dave. Maybe I’m wrong.
I’m so perfect it’s hard to follow. 😈
“You know when you listen to someone talk about private equity and they are so wrong it just annoys the hell out of you? That is how I feel when I hear Trump talking about this stuff. He lies. He is wrong. He doesnt sound remotely like he understands wha the is talking about much of the time. If by clowns you mean the reporters I dont know how they can avoid going after him.â€
I stopped reading here. Absurd. I only have time for serious people.
Trump said he was being sarcastic, almost eludes me. But you can’t miss the anger on his face when he deals with the press. Seems to me in some twist of sarcasm he was playing the buffoon the press love to portray him to be.
If that’s the case he lost it and played into their hand. I don’t know where he can go from here, but I would not repeat that.
No more press conferences. Fireside chats.
The enormous number of nursing home deaths in NY (over 3,500) are due to more than just “sloppiness,â€. Cuomo directed older COViD-19 patients, in late March, to go from hospitals to nursing homes to convalesce. He has backed away from this directive, and is now taking a more authoritarian tone threatening to take away some facilities licenses.
Such a directive was a mistake, joining other ones made by Cuomo like refusing to buy more ventilators in 2015, encouraging not taking this virus seriously until mid March, taking away hospital beds earlier, against the wishes of medical personnel, are but a few. But, Cuomo will only receive mild criticism for these decision transgressions. His R counterpart, however, will be relentlessly grilled, not necessarily for bad judgment calls, but for stupid remarks, like the latest one delivered at yesterday’s presser. Whether it was sarcasm or something flowing from an unfiltered mouth, it was cringe-worthy and totally unacceptable
“I stopped reading here. Absurd. I only have time for serious people.”
You only have time for supporting the cult. You have lost the ability to think for yourself.
“. But, Cuomo will only receive mild criticism for these decision transgressions.”
Cuomo and DeBlasio have both had a lot of well deserved criticism, but after bad early mistakes Cuomo is mostly doing the right things now. It is clear that he actually listens to his briefings and understands them. When he doesn’t know something he says so.
But, like every other governor, he was flying blind a lot of the time when making decisions. There was no ability to test to find out how prevalent the virus was. If he had shut down early like we did in PA or like CA then NYC doesnt have such wide spread disease and we get the constant complaining from the critics that it wasn’t such a big problem after all. Personally, I wish he closed early and took the heat but he made the other choice and deserves the criticism that goes with it. What I dont understand is why you conservatives criticize him. He did exactly (early on) what you wanted. He did nothing. Shouldn’t you be praising him for letting NYC develop immunity by letting so many people die?
“however, will be relentlessly grilled, not necessarily for bad judgment calls, but for stupid remarks,”
Once again, who is the president? Who was in charge of and responsible for the actions of the FDA and CDC? Who could have stepped in and told them if they didnt have a good test in 10 days they had to use the WHO test or fire the people in charge? Which president didnt start working on beefing up production of PPE and the stuff we need until things were well underway? Which president praised China for its transparency and claimed China had things under control? It is not just his words, it is his bad judgment and his bad actions early on that really hurt us. He did hit a turning point in mid March or so where his actions got better. His judgment seemed to get better. Even his words got better, but he has reverted.
He shouldn’t be doing the briefings. His main goal is to make himself look good and use this as a proxy for his campaign rallies by fighting with the press. Let Pence and the response team handle it.
Steve
I’d like to throw this article out there because with the focus now on re-opening it deals with person to person transmission risk and super spreader events. (All events are not equal). Even deals with my persistent packing plant interest.
https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/
The US has about 4% of the world’s population. Yet we have one-third of the world’s reported cases of COVID-19 and one-fourth of its deaths.
We are obviously doing something wrong. Or perhaps our medical establishment is just no damn good. China, taken by surprise, and without the weeks of warning we had, did very much better.
The US is truly FUBAR.
We’re testing more. Diagnosed cases are positively correlated with the number of tests performed as should be obvious. That the number of diagnosed cases in China has nearly ground to a halt is a sign that they’ve stopped testing. Or aren’t reporting their test results accurately. I assume that all Chinese statistics are confabulations at this point.
Since practically all cases are either mild or asymptomatic, testing in the way that we’re doing it, largely self-selecting, is not particularly helpful.
“Men of action are a different breed. They aren’t afraid to be wrong. They speak their mind when it counts, as best they can. They have the confidence of a past inventory of correct decisions, and the balls to make the next one in the face of uncertainty. They aren’t perfect, and are comfortable with that.”
My experience is in the world of military leadership, not finance. I agree to the extent that the ability to make decisions in an environment of uncertainty is a key trait of good leaders. But it’s not the only trait and without other leadership traits the ability to be decisive results in poor, ineffective, and often dangerous leadership. But then in war and warfare the stakes are much higher than finance, and bad leadership and bad decisions carry a much higher price.
Again, I don’t know the world of finance, but my limited view suggests that good leadership is not all that different – it requires expertise, an effective team-based approach and deep knowledge of the systems, players, and what we in the military call the “operating environment” are essential. And, in military affairs, no leader can hold all the knowledge nor can they make effective decisions in isolation. Mattis, Patton, Lee, Rommel, Nelson and some of the other greats understood this and knew how their subordinates would act in the absence of direction in the heat of a crisis. Their ability to train subordinates to understand the “commander’s intent” and operate independently toward that end in the chaos of battle is a big part of what makes them great leaders.
But none of that is Trump whose main expertise is self-promotion and avoiding accountability. Instead of mentoring subordinates to create an effective system of leadership, he plays them against each other, and as the “great man” the are all disposable to him.
Yes, he is a man with “balls” that can make decisions, but it’s not because of some thoughtful ability to evaluate options in an uncertain environment and weigh the tradeoff’s, it all rests on his supreme self-confidence, self-interest and need to be the center of attention. And then there is the complete inability to take any criticism or admit error. And his demand for loyalty.
What would be a fun experiment is to have Trump work for you directly for a while (or have you work directly for him). It would be interesting to see how you would “lead” a person who thinks he is better and smarter than you, believes his intuition is superior to any knowledge or expertise, and doesn’t play or work well with others on a team.
A big difference between business and the military is that the military has a system for being able to impute expertise while business does not. More precisely superior officers don’t need to persuade their juniors.
No, I wouldn’t want to work for Trump. My views of Trump are sort of conflicted. I didn’t vote for him.
The reason I am conflicted is that I’m not comfortable with a president who does the right thing some of the time for the wrong reasons while doing the wrong things a lot of the time for the wrong reasons. How much better is that than a president that always does the wrong thing for the wrong reasons? If Trump were better able to persuade, to bring people around to his point of view, it would help but he isn’t and that has been obvious from the start. As I have said, he’s a counter-puncher. Unfortunately, under the circumstances that is producing a positive feedback loop.
It makes me particularly unhappy because it’s so contradictory to my experience and approach. My approach is to search for points of agreement, to seek common ground, and then to use my obvious understanding of the issues to encourage people who aren’t entirely on board to put their trust in me.
Dave,
Just to be clear, my comment was for Drew and not you.
But I do agree with your issues and characterizations of Pres. Trump.
I guess I am not seeing the “balls” part. He doesnt do anything that might piss off his base, especially the anti-immigrant ones. When he almost made a deal to help the Dreamers he pulled it back when they complained. Sure, he bullies anyone he can safely do so but I dont remember any act of even political courage.
Andy- Dont tell Drew that other people make decisions with higher stakes than finance. It will hurt his world view.
Steve