In a piece in the New York Times Ezra Klein laments the U. S.’s response to COVID-19:
We began this pandemic by asking the wrong questions, and thus we got the wrong answers. Rewind to October 2019. The Johns Hopkins Center for Health Security and the Nuclear Threat Initiative release the Global Health Security Index. It ranks 195 countries on their pandemic preparedness. Each country is judged on prevention policy, on detection capabilities, on response infrastructure, on health system capacity, on international cooperation and on underlying risk. The news is reassuring, at least if you live in the United States: We’re No. 1!
Then, only months later, we get an actual, once-in-a-century pandemic. The United States fails the test. We have more infections, more deaths, more pain and suffering and division and grief. Our performance doesn’t just fall short of rich countries like Germany and Denmark. It falls short of far poorer countries, too. The Global Health Security Index was measuring the wrong things. The researchers later noted that tucked inside the report was a finding about the United States that would prove more predictive of our response: “It had the lowest possible score on public confidence in the government.â€
I hope I’ve made it clear that I think that “policy”, at least as Ezra uses the term, has had relatively little to do the prevalence or virulence of COVID-19. I think other factors including genetics, climate, and obesity had considerably more effect.
Ezra closes with this:
Let’s flesh that out a bit with this:
Here are my suggestions for preparing for future pandemics which I strongly suspect will occur with increasing frequency and rapidity until we start thinking more clearly:
- Elected officials should stop lying to the people.
- Politicians should stop making promises they do not have the ability or even the intention of keeping.
- Elected officials should model in their own behavior the behaviors they expect to see in the people.
- Elected officials should not become wealthy in government service or shortly thereafter by selling their ability as facilitators with their erstwhile colleagues.
- Negative political advertising should be eschewed.
- We should stop preaching hatred of each other.
- We need to return to our traditional optimistic view of the United States and its future.
- We need to stop importing immigrants from countries in which trust is lower than it is here.
And, yes, I recognize that would mean an end to politics as we know it.
“The researchers later noted that tucked inside the report was a finding about the United States that would prove more predictive of our response: “It had the lowest possible score on public confidence in the government.†”
Shorter Klein: Shut the fuck up and do as you’re told.
The dot points, especially the first 4, are pipedreams and indicate that the proper response to Klein is shut the fuck up, and grow up.
As I’ve said before I think that Americans don’t trust their government because they’re perceptive. Our government is not trustworthy (particularly here in Illinois).
Absolute power corrupts. Big, fat bureaucratically-run government corrupts absolutely. When people fight this type of government, the corrupt government fights back. Thus, people see government as more of an enemy than an ally, which is where we stand today with governments around the world – especially here in the U.S. Bottom line is, who trusts their enemy?
Jan, the tragedy of government in the United States today is that the folks in the trenches genuinely think they’re overworked, understaffed, and underpaid because they stay so busy. But most of the activity isn’t actually mission-oriented. It’s organizational in nature.
Most civil servants are good people who are doing their best but the entire system is so messed up people doing their jobs to the best of their ability just isn’t enough.
There is a kind of entropy law for governments: things only get worse.
Eventually, the government collapses because of invasion, revolution, or plain system failure. Then, after a while, which could be centuries, something arises. Think Bronze Age/Iron Age transition. That’ where we are.
Dave, I’m construing “organizational†work to be busy work. The greater the bureaucracy the more boxes to check, nuisance rules to follow, and paperwork to thumb through. Somehow, bulky piles of paper seems to create an illusion of productivity and authenticity. However, the real work, and wisdom attached to it, is often done with straight line simplicity and a large dose of common sense.
Pretty none of what you suggest will do much to help in future pandemic management. Good general rant but not specific to pandemics. What might help are a few of the following.
1) Acknowledge that future pandemics are likely and maintain a pandemic response team who would include keeping surveillance in areas likely to produce future pandemics. This would include making sure the CDC head has real public health experience.
2) Maintain supplies. Dont let them go bad or not restock to save money. Maintain facilities that can go into mass vaccine production.
3) Better surveillance testing.
4) More upfront investment in therapeutics and vaccines. De-emphasize looking at existing drugs as it is unlikely they will work and will mostly create controversy.
5) On the political front elect leaders that will prioritize the pandemic and not their own re-election.
6) Find some way to get people to accept vaccines. There has always been an anti vaccine movement in the US. It got worse with this pandemic. If everyone got vaccinated this would have been over.
7) Accept that no matter what you do people will find reasons to not do wha they should. Plug on anyway.
Steve
steve:
I suspect that every single one of your suggestions is a good way to spend money without having a great deal of material effect on real pandemics. How do you know what supplies will be required? Early on in this pandemic there was an emphasis on disinfectants. Not so much now. How do you invest upfront in a therapeutic for a disease about which you know nothing? I should add that a more robust domestic industrial sector would greatly shorten the lead times necessary for materials.
We have already invested more upfront in therapeutics and vaccines than every other country in the world put together. That is a consequence of our enormous over-investment in the healthcare sector. How high is “up”?
The underlying issue in rejection of vaccines is trust. I should have added that we should elect leaders whose leadership is more trustworthy. More governors, fewer senators. Without greater trust I doubt any of the measures you suggest will mean a damned thing.
Since we’re not going to eliminate immigration, we need to partner with immigrant communities to inform them of the science, safety and importance of vaccines, and make the vaccines readily and consistently available to them. Don’t be the messenger… enlist trusted immigrant ambassador/messengers to meet with and inform community members in a safe space. And lastly, make the service free. In our church we have done this successfully and more than 90% of the eligible immigrant adults are fully vaccinated… a higher percent than the white community.
I think your suggestions are good, Susan G.
I don’t want to eliminate immigration, I want to control immigration. There are also three things that need to be recognized:
1. Trust once lost is very difficult to regain`
2. When people’s lifetime experience tells them not to trust gaining trust is that much more difficult
3. The only way to gain trust is performance.
“Our government is not trustworthy”
Perhaps the nexus of the horrid performance of politicians and public health officials and the arrogance of school boards, exposed for all to see by the pandemic, will serve to alter people’s sheep-like faith in government.
But, perhaps then I would be the one sucking on a pipe in some opium den.
“More governors, fewer senators.”
Amen. Executives, not professional talkers. Steve’s suggestions sound like something a senator, or one of those large corporate task forces, would come up with.
We dont have a clue about how to get people to trust govt. It just wont work in our current political state. The issue is not so much a lack of trust in government as lack of trust in the other tribe’s government. Conservatives had complete faith and trust in Trump. None in Biden. Liberals the other way around. Whichever party is out of power will undercut vaccination efforts and stuff, though the right will always be worse. We are just going to have to live with the 20%-30% who believe conspiracy theory and grifters (see jan).
The best we can do is provide a more rapid response to those who will accept help. So we do know a lot fo what we need to spend on. Maintaining adequate stocks of PPE would not really be that expensive not would having a stockpile of ventilators. We could engage in long range training so that more people cross train in critical care. There had already been arrangements made for some facilities to be built and mothballed to make vaccines but IIRC they were not finished. Lets have a couple more of those. We are talking a few billions here vs shutting down economies which costs trillions.
Yes, our overall spending on health care is high. Pretty much irrelevant if the topic is future pandemics. Another topic. If your plan is that since we already spend too much on health care we will suddenly manifest enough staff, supplies, facilities etc to manage a pandemic that pours thousands of new, very difficult pts into our system then you are conceding failure.
Steve
“Just how did Joe Biden’s withdrawal from Afghanistan turn into a rout and a Taliban victory? A new report from the US Army, provided to the Washington Post, details some of the long train of failures that resulted in the loss of more than a dozen troops and the disgraceful abandonment of thousands of Americans behind Taliban lines — not to mention tens of thousands of allies. It all starts with a president and State Department that refused to listen to the Pentagon.”
Thousands? Biden, Psaki and Kirby have been telling us hundreds, if not a mere few dozens.
Someone was saying something about an untrustworthy government?
At the base of everything.
Acknowledge that political science takes precedence over epidemiology and virology. We can imagine / wish otherwise but working with things as they are is the first step.
I have a few suggestions about the media which could help in the next pandemic.
1. Follow and enforce an actual code of ethics.
2. Don’t confuse objective journalism with advocacy journalism; and journalism most essential function in society is objective journalism
3. Journalists tend to cover every topic from their lens of their speciality; it’s a disservice to have political journalists do most of the coverage of the pandemic since everything is covered towards its political implications first.
I agree with that and, indeed, that’s where Ezra’s article comes down.
What do you mean by your first point? Congressional code of ethics, journalistic code of ethics, civil servant’s code of ethics, all three? We can’t even define what a journalist is. The NYT, WaPo, etc. want to define journalism as something they do. The courts have not agreed with them.
Congress will never willingly put a meaningful code of ethics for its members with teeth in place. And a civil servant code of ethics is part of the civil service reform I harp on.
I think there are some obvious lessons-learned:
1. Have a national stockpile that is fully equipped and up-to-date. This is what incentivized the initial noble lie that damaged government credibility right out of the gate. There is no solid reason to have mask shortages 2 years after the start of the pandemic – in the future, the government should be able to provide masks and other basic PPE and essential gear at the beginning – that means appropriate stockpiling.
2. Have a standing task force for pandemic response that does regular training and best practices. Biden’s covid task force has been a mixed bag with most of the covid messaging passed off to Fauci and Wollensky, which was clearly a mistake. Instead, the head of the task force should work directly for the President and be in clear charge. The task force should clearly weigh political, social, and economic factors with public health, and transparently provide the reasoning and justification for recommendations. The military figured out this organizational structure a long time ago and it works – there is no reason for the ad hoc way it’s been handled with this pandemic.
3. There is a whole lot of necessary federal and state-level reforms. A shortlist:
– Better defining the scope and extent of emergency powers
– Fixing problems in the federal code. One example is OSHA and respirators. Employers – even in places like nursing homes – do not mandate N95 masks because doing so triggers a huge OSHA regulatory burden.
– Improve the rules and procedures for getting vaccines and medicines out earlier. The FDA also needs to stop treating all testing as a medical diagnostic tool. There need to be rules to quickly approve testing for other purposes, like epidemiological and home testing.
– Improve the planning for pandemic crisis response. Lots of lessons learned here, everything from logistics to the problems of local capacity.
– Reorganize the credentialing and regulations of the medical profession so that the US can produce more doctors and medical professionals.
– Create and expand on systems that allow for coordination between federal, state, and local government. The Trump administration, for example, hired Palantir to make a vaccine distribution and tracking system in a couple of months because one didn’t exist – that is something we should already have in place.
– Consider federal more and better subsidies for state and local health departments. There was a massive effort done after 9/11 that did help with Covid, but much of the money and increased capabilities was wasted or put into things that didn’t help. I’m normally a subsidiarity guy, but I think federal assistance in pandemic preparedness for state and local health departments is warranted and wise.
– Improved data collection and dissemination. We’re two years into the pandemic and third-party organizations are, in several cases, still collecting, analyzing, and disseminating data better than the CDC.
That’s off the top of my head, I’m sure I could come up with more.
My meaning was a code of ethics for journalists.
I don’t think its the governments place to impose (First Amendment); but most media, especially the ones with influence, are big organizations and they should follow the same rules that apply every other big organization (like having and enforcing conflicts of interest rules for all employees — that standards of business conduct training every employee must take every year).
Here’s an example; the most scandalous part of Jeff Zucker’s resignation from CNN wasn’t him having an affair with his subordinate. It was the fact it came out Allison Gollust was Andrew Cuomo’s former media director; and both Zucker / Gollust was giving Gov Cuomo communications advice during the early COVID emergency, and repeatedly put Gov Cuomo on Chris Cuomo’s show. Apparently the whole thing was an “open secret” and everyone acknowledged it violated all sorts of conflict of interest rules. The only reason it came public was Chris Cuomo’s lawyers were trying to use it to extort a settlement for being fired on an unrelated matter.
At this point; t wouldn’t shock me if there was an element of blackmail between Zucker and Cuomo’s; and for that matter Zucker and Trump. How much did that coverage (adulation of Cuomo during the early pandemic in defiance of reality) wrap the pandemic response of this country?
On a bigger point about trust. This isn’t the 1970’s; it isn’t just trust in “Government” that’s tanked. Its trust in everything; media, religious organizations, higher education, police, labor unions, big business, “big science”, even the military.
Sure there is. When we are dependent on offshore production and offshore production is cut off, there will be problems. Keep in mind that these are consumables. The notion that we’re going to stock enough for 330 million people for several years is pretty unrealistic.
The question is why haven’t we reshored that production? There are any number of factor including that you can’t expect capital investment if investors can’t expect a return and managers assume the supply chains will go back to normal quickly. And, of course, politics.
NIH and CDC spokesmen lying or telling half-truths may be justified in the short term but has the long term effect of undermining trust in those agencies.
I support that but it’s an extremely complex issue that goes well beyond Medicare funding more residencies. Example: 28% of physicians and 8% of nurses are presently foreign-trained. In pandemic conditions when foreign travel has been limited it shuts that spigot off at least temporarily.
Having a national stockpile of PPE and equipment that is continuously restocked as supplies are used – unlike what happened under the Obama Administration. Address our inadequate supply chains, where the U.S. manufactures their own PPE, meds etc., without having to depend on opposing but cheaper countries like China.
Abolish the TNI (Trusted News Initiative), which initiated a collaboration between big tech and news organizations that constructed a blanket of censorship, defining anything or anyone disagreeing with the government narrative as “misinformation.â€
Push back on medical associations and boards censoring physicians from independently treating their patients with FDA approved, repurposed drugs. If nothing else the Right To Try Act should be allowed to intervene giving patients, their doctors and pharmacies more options to use in their medical care, other than vaccines.
Officials or task force members, making medical policy decisions, should not have any association, membership on boards, or monetary interests dealing with pharmaceutical companies or the like. The current conflict of interest among major players in this pandemic is unwise and unacceptable.
Realistic as compared to what?
I don’t really care how it’s done – stockpiling a huge number or restoring or some combination or something completely different, but the lack of access to PPE and critical supplies is something that should be addressed before the next pandemic so there aren’t shortages.
That’s why it has to be done before the next pandemic. More medical professionals before a pandemic mean more surge capacity, but it also helps when there isn’t a pandemic.
Curious,
There probably is a code already, but the problem is ethics takes a back seat to economics and the journalism profession is in decline. And I think with the diversity of media, the problem solves itself eventually.
More important, IMO, is restricting the business models social media company’s use.
Jan,
Trump had three years and GoP Congress to resupply that national stockpile and he didn’t. This wasn’t some oversight that was unique to the Obama administration.
The cost of that many N95 masks would be about $1 trillion. A back of the envelope estimate of storage space would be roughly 9 square miles. We’d probably want to disperse that. According to the manufacturers they require climate-controlled storage. That means the storage facilities, heating and A/C, the handling equipment and the personnel to staff them. Let’s say another $100 billion.
Being able to produce them domestically end-to-end is obviously a lot more practical at least to my eye.
An analogy would be the relationship between the strategic petroleum reserve and oil production.
The reserve is approximately 30 days worth of national imports. Combined with private stockpiles, the country has 120 days worth of imports in stockpiles.
It fits with the idea of what an emergency is. Once an crisis is past a couple of months; that should be enough time to adjust production as necessary for the circumstances. If one cannot adjust a couple of months into an emergency; there are much bigger problems then a lack of stockpiles.
Most state governors had something like a seventy-five percent approval rating during the initial stages of the pandemic, and state government is far more relevant to people’s personal experience with pandemic response. I’m not sure general distrust for government is the right metric, it seems to me that people will rally to support government in a time of crisis for a period of time before reverting to normal politics. Maybe governors lose support because of their failings or for things that were outside of their control, but I suspect that governors inevitably (like Illinois’ governor) fall back on partisan attacks as one of their learned tools of the trade. Some evidence in the rating of governors here:
https://morningconsult.com/2021/11/18/phil-scott-approval-vermont-polling-senate-race/
Republican governors of blue states appear to have the highest ratings.
In November Pritzker had a 50% approval rating/40% disapproval. That’s still in positive territory.
Pritzker had a 75% approval / 43% disapproval rating at one point during the pandemic.
https://napequity.org/wp-content/uploads/NAPE_governor-approval-ratings_edits_5.21.20_vfinal-002.pdf
I think it’s called “wearing out your welcome”.
N 95 masks go for about $2 each. We used to get them for about $.75 each pre pandemic but lets go with $2. If you have a 5 day supply you can rotate them and wear for a long time so lets say 5 per person. $10. 330 million people. $3.3 billion. That ignores ongoing production so realistically probably $2 billion. YMMV. Ones at link are cheaper. 3M so they are pretty good. Just called and asked nurse to measure size of box for linked model. Assuming she correctly understood and measured correctly (severely blonde) it is 10x6x6. Lets assume we lie them flat we get 60 square inches or about 0.5 sq feet. 1 acre is about 45,000 sq feet so about 100,000 boxes in an acre. 1 acre = 2 million N 95s. 1.5 billion/2 million = 1000 acres but this is if they lie flat. Lets say we stack 20 deep and then we need 50 acres. (Acre is 1/640 of a square mile.) So about 1/10 of a square mile. All very rounded.
Masks last 5-10 years I think so can spread that cost out. Warehousing not that expensive. About $1 million per acre per the internet.
Multiply everything by 20 if you want to give everyone 100 masks.
What did I screw up?
https://www.northernsafety.com/Product/8210/3M-8210-N95-Standard-Size-Disposable-Respirator-Masks-20-Box
Just to add on to the comment by PD in nearly every survey people doing trust Congress but they trust their own congressperson.
Steve
My mistake was that I assumed single use.
A box of 1,000 occupies about 2′ X 2′ X 1′.
Speaking of single use.
Has the FDA given formal approval to the use of masks/respirators as a medical device for the use of preventing disease. Traditionally, mask quality / standards were defined by the OHSA, at the beginning of the pandemic the FDA gave EUA approval, but I don’t recall a formal approval.
It would be interesting what conditions/indications the FDA would put. Would FDA require surgical masks and above, KN95, N95, or N100? Would they require fitting? Would FDA approve masks for multiple use?
And the more important question: why haven’t they done that already?
Conflicting regulation of masks is an example of the needed regulatory reform I was talking about. I hadn’t heard of the FDA approving masks as medical devices.
It’s actually NIOSH. Not sure why FDA would need to be involved.
Steve
Because the FDA is the regulator of all medical devices. Does the FDA regulate medical gloves? Powered respirators?
The other one was until the pandemic; N95’s were more known for their use in the workplace then as a tool to limit the spread of germs.
I actually found this an interesting question, so I looked it up. Masks were actually exempt from FDA regulation based on an agreement between the FDA and NIOSH in 2018. But the agreement certainly makes it clear it wasn’t meant to cover its use in the pandemic.
https://www.govinfo.gov/content/pkg/FR-2018-05-17/pdf/2018-10563.pdf
“The Food and Drug Administration (FDA or Agency) is publishing this final order to exempt certain surgical apparel from premarket notification requirements, subject to conditions and limitations. FDA is limiting the exemption to single-use, disposable respiratory protective devices (RPD) used in a healthcare setting and worn by healthcare personnel during procedures to protect both the patient and the healthcare personnel from the transfer of microorganisms, body fluids, and particulate material. These devices, commonly referred to as N95 filtering facepiece respirators (FFRs) and surgical N95 respirators…”
The Medical Device Regulation Act of 1976 rather clearly gives the Food and Drug Administration authority over a device to be used for the prevention of disease. NIOSH would have authority over the use of similar devices when used in workplaces for other purposes.