CDC coronavirus testing decision likely to haunt nation for months to come | Hacker News Reader

CDC coronavirus testing decision likely to haunt nation for months to come

khn.org

277 pointsbookofjoe313 comments

Getting the test was difficult enough here in California. A bigger problem that isn't being discussed is the delay to get the results. I had a test 10-days ago and still do not have results. Obviously, still self-isolating.

The local health county department have taken over issuing the results. Yesterday, after multiple calls they told me to call the hospital as they don't have an answer. Was able to contact someone today at the hospital - they told me to call the local health department again.

The city keeps issuing updates/running daily conferences with new data (more than likely 1-2 weeks old).

If the US had enough tests at the start - we would probably still be seeing similar data points in the news as the backend infrastructure of issuing results is in no way able to handle the amount of cases as is.

Heard a report of a test getting "lost".

https://thebatesstudent.com/2020/03/23/jack-allard-16-is-in-...

What a nightmare for him and his family. Hope he pulls through.

Well in 4 days you don't need to know any more.

I'm planning to still self-isolate beyond that for now. The median duration of viral shedding is 20 days according to the research out of Wuhan. The longest observed duration of viral shedding in survivors was 37 days.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Vital shedding does not necessarily mean you are contagious with the virus.

I'd like to know more information about this. Some sources really do refer to viral shedding as a source of contagion, others refer to it as simply reducing viral load (getting well).

The damage will be much longer lasting than this.

The Chinese bought the US precious weeks to prepare while it locked down vast numbers of its own population.

The disaster could have been prevented through a vigorous testing/quarrantine program in Washington and California.

At every step of the way the US either bungled testing, or actively discouraged testing. It's been nothing but lies and mistakes from the start.

Like most American catastrophes, this one will only be slowly understood many years after the fact. There will be Congressional investigations and fact finding rituals.

In the end it will come down to three things:

1. Pandemic preparedness was not taken seriously by the incoming administration.

2. Testing was screwed up from the start and never found its footing.

3. The administration actively discouraged testing through both political pressure (e.g. W. Virginia "doing a tremendous job") and rationing of tests.

I don't understand this mentality when other Western Nations are going through the exact same thing.

Did the administration cause every other countries problems with containing the virus too?

Similar mistakes were made by seemingly every country that hadn’t dealt with a SARS virus before. This might be partially explained by the leadership position the US has traditionally enjoyed on the world stage.

Based on the current growth of cases, it looks like the situation in the US will be way worse than other western nations. Even when you adjust for population size.

Is this true? I thought the hot spots in the US locked down earlier (in terms of case counts/deaths) than other countries. But I haven't looked into it very much.

It only feels like the US locked down earlier because we were under the false impression that we got the virus later than Europe.

Indeed we probably got the virus at the same time as European countries but had no idea because we didn’t test....that’s why we have more cases than any other nation except Italy and China (and soon will have more than Italy).

The US has been far behind other Western countries in testing: https://www.nytimes.com/interactive/2020/03/17/us/coronaviru...

The per-capita chart is most notable. Other Western countries' responses haven't been stellar either, but the US's is particularly flawed.

For more up to date data see https://covidtracking.com/us-daily/

The FDA had test kits which were flawed. It got caught with its pants down in public. The rest is damage control.

https://www.worldometers.info/coronavirus/

US is 21st in per capita deaths (and falling... that is, it was 18th a couple days ago.)

Spin all you want about testing and the like.

But, the fact remains that the US's medical system is doing a better job than the other western countries.

Its striking that Italy, Spain, Netherlands, Switzerland, France, Belgium, UK, Sweden, Denmark, and Austria have more per capita covid deaths than the US. (Looks like Germany is about to be added to that list.)

I do not see how any rational and objective analysis could characterize the US's response as 'particularly flawed'.

There is no sense in comparing per-capita deaths this early in the pandemic, especially when the spread of the virus in the US trails a few weeks behind that in Europe. Talk to me in a few months. Furthermore, per-capita figures are meaningless when comparing areas of substantially different population size and density (e.g. Austria, Switzerland) to the US. _I_ do not see how a "rational and objective analysis" like yours can ignore these basic mitigating factors when making such comparisons.

The US was weeks behind Italy in the initial spread of the virus. If the Chinese example wasn't enough to learn, at least what was happening in Italy should have been.

At least for me and many other people, I suppose, when I saw what happened to Italy is when I saw what was going to happen here. It has been painful. It is like watching a train wreck happening in slow motion, and you are in front of the train.

Whatever happened to American exceptionalism?

>Did the administration cause every other countries problems with containing the virus too

The American people did not elect and pay other countries to take care of them, they did for their government. The administration dismantled the pandemic team from the highest levels and along with their media cronies, actively minimized it for several weeks[1][2] and made it political, which is costing lives now. The other countries did not do that to Americans.

[1] https://www.youtube.com/watch?v=ifKbwDf51bA&feature=youtu.be...

[2] https://www.nytimes.com/2020/03/15/opinion/trump-coronavirus...

When you use the word “administration” are you thinking about a few hundred elected and directly appointed officials or the hundreds of thousands of government employees? Because it seems like the employees bungled the job.

Not for nothing, but we are 3 years into an administration that has done everything it could to push out career employees with lifetimes of expertise.

There have been failures from the top to the bottom. But let’s not pretend that there hasn’t been a systematic, intentional degradation of these agencies that has only served to exacerbate those failures.

I voted for the guy specifically because the agencies were rotten and the civil service needs deep reform. I’m very disappointed that the law has not need changed to so that more government employees can be immediately fired.

No, but it offers a stark comparison of the actions taken by "leader" of the "free world" vs countries like South Korea and Taiwan who managed to control the outbreak.

The United States is supposed to be the most prepared country to deal with a pandemic like this, yet the administration failed at its duty to protect its citizens and economy, even with ample warning from the world's best medical experts and intelligence agencies.

If America is struggling to contain this, how are impoverished countries supposed to?

> The United States is supposed to be the most prepared country to deal with a pandemic like this

Based on what? For years - long before the current administration - health experts in the US have been talking about how unprepared the US is for a pandemic. So where did you get this idea?

Yes the western countries failed spectacularly. Even tho they had Asian counties as examples. There are no excuses

Don't forget the mask shaming that was perpetuated in the US.

You’ll still get looks for wearing a mask. It’s ridiculous.

Often I am the only one wearing a mask in the whole grocery store. Munich, 1300 infections. One infected for couple city blocks.

Have you considered that people are looking at you not because they want to shame you, but because they're trying to determine if you're sick and they should be extra careful around you, e.g. don't touch anything you've touched, etc?

If the guidance so far has been to only wear a mask if you're sick, it seems reasonable to assume that someone wearing a mask is more likely to be sick than average.

Most of these people are passersby on the street who would have no opportunity to touch something I've touched.

I heard from someone who wore a mask recently who was flat-out told, "You're overreacting." It's not just caution, there is some kind of social insistence that the masks are not necessary and even to be discouraged, which I even sense in myself when I'm out and about without a mask and see others wearing them. It's natural for whatever reason, but we should be cognizant that it's just better than if people don't have protection enough to fight that tendency.

I think it has to do with their (incorrect) assessment of the situation. Rather than reevaluate their assessment (as that would increase their anxiety), they rationalize your assessment as overreaction.

Yet another example of the bullying culture of the US.

It is not an airborne infection.

Only in the sense that "airborne" is a scientific medical term meaning larger than 0.5 µm. When most people hear "airborne" they think it means "in the air", which the virus certainly is. The use of this terminology in the strict scientific sense when speaking to general audiences is borderline irresponsible.

People have implicit or explicit reactions to things. Not trying to down play your experience here (your experience is still valid), but they probably are not intentionally thinking or making a face. It's probably because this is new to them and not something they usually experience, so they do a double take and end up with a stare. I've done this will people wearing gloves recently, even though after 2 seconds of thinking about it I know there's rationale behind it.

Try not to presume people are so quick to judge, rather that people are just feeling whatever they feel instinctively, and it is what it is. They probably don't even know why they feel what they do, it's just bad intuition not ignorance.

I think it's because of cognitive dissonance. The combination of "I don't have a mask" and "masks are helpful" is painful.

Well, I am in the Midwest and there is hardly anything going on here, so yeah, wearing a mask would be kind of out of place. Anyways, I basically stay away from people anyhow.

Our hospitals here are all losing money waiting for a crowd that may never arrive. Kids are silly miserable. We're losing our way of life and our nation to mass hysteria and we need to be strong instead.

If there really is "hardly anything going on here", that's the perfect time for a lockdown in your locality. The whole cause of this mess was an understated and late reaction to the signs that there was a problem.

There is no clear way to be strong. If we quarantine, which we've started to do, but could continue, people may starve. If we don't, an equal or greater number of people may die from the disease. It's wrong to say that having a lockdown isn't strength, though, since it is something you can't do without strong resources backing your nation.

> Our hospitals here are all losing money waiting for a crowd that may never arrive.

Wow! You are in a better situation than most of the rest of the world. What is there to complain about?

> Kids are silly miserable.

Oh. That's awful. We should definitely let people die to prevent that.

I suspect it will be shown that disposable $0.50 N95 masks are largely effective and that the US population was deliberately misled about their effectiveness because the country has no way to provide such masks not only to the general public but to healthcare workers.

Agree, but it's not so cut and dry. https://slatestarcodex.com/2020/03/23/face-masks-much-more-t...

edit: speaking of cut and dry..men should be clean-shaven to ensure snug fit.

Interesting preface.

In the UK we were told that masks were simply not effective, there was no need for them, they would not hinder the spread of infection.

Similarly with closing schools: "the gov has this special plan that uses herd immunity, you idiot, so we don't need to close schools" [actually it's always "Boris has a plan", I can't understand why -- if it's the PM's plan then it's probably entirely ignorant of all the facts ...].

Anyway, yeah, the argument wasn't that

>"[we] disagree on whether surgical masks alone help prevent the wearer from becoming infected" [from your link]

it was "masks of any kind are ineffective".

And we bloody well know that just the effectiveness of masks in preventing spread from infected patients makes them worthwhile. It's simply maths that 1 infected who spreads to 1 more is more than 1 infected spreading to zero more.

I wonder if there was a lie of omission by the health professionals: "N95 Masks won't help the spread [because the general public will touch their face without washing their hands after removing the mask, thus masking the mask a moot point]" ~ the brackets representing the "lie of omission" part. I honestly don't know, just wondering out loud...

That, and I think disposable nitrile type gloves are way underplayed as well. They're easy to remove inside-out, limiting exposure when disposing. I remove one to get into the car (clean hand on handle), get inside, hold empty glove in other gloved hand, and pull second glove over first glove to contain it. Probably saw this on ER or some show years ago.

If you're going to be that fatalist, you may as well say "there is no preventing COVID-19" because everyone will touch their face without washing their hands.

No, assume people can follow instructions and disseminate the truth, not a revised version of the truth, or you risk credibility as clearly has been damaged on the CDC's part. There are dire consequences when a public health authority has no authority anymore due to lying.

The US government is only partially to blame here.

Goldman Sachs apparently donated over 100k N95 masks to New York last week.

As a personal critic, I did see some of this coming in my own finances and did divest. I should have done more to be outspoken about this risk, but I am daily surprised by how unprepared we were and how few people are speaking out in ways that matter.

Kudos to Cuomo.

EDIT: I do think the article is correct in the analysis that this _should_ be months of impact. This is likely from just considering the health impact, and not the correlated factors that 1. the stock market was damn high (inflated by stock by-backs) 2. there is currently a mess being made in federal reserve intervention in the pre-crash quantative easing measures, and the current precedents with 'unlimited liquidity' promised. 3. a lot of people are going to lose their jobs 4. a lot of people will lose their healthcare 5. soon to be bailed out corporations (ie Boeing) have flat rejected equity stake in the company, saying that they will seek private funding before they take a bail-out of that kind

An interesting observation on (1), if companies had taken Trump tax breaks and invested in their businesses or kept that cash, they would likely have reduced their bail-out burden substantially. Boeing voluntarily committed to 2bn$ in dividends before the crash. They have not revoked that as of yet.

I’m curious... did GS already have those masks for some reason or did they purchase and then donate them? I thought the masks were is short supply so I’m surprised if a non-health care org was able to purchase 100k masks recently.

I will do some reading, but it is my thinking that they had stockpiled them, pre-crash. Will update.

to be explicit, GS has no other purpose to stockpile other than they anticipated... better than hospitals.

EDIT: There are a few stories saying the stockpiled pre-crash. Though some claim they had them since the swine-flu epidemic in 2009. Given the read I had on how the markets might respond, and how much information there was screaming that China's economy had stopped (for example I couldn't get circuit boards etc)... I would bet a lot of money they called this a few weeks before.

[1] https://www.cbs58.com/news/donations-of-respirator-masks-and... [2] https://www.fnlondon.com/articles/goldman-gives-face-masks-t... [3] https://www.wsj.com/articles/financial-institutions-share-st...

It seems doubtful GS anticipated this better than hospitals... more likley they had a budget that allowed them to prepare for a wider range of events.

There was a story yesterday about Facebook having 720,000 masks stockpiled. They'd bought them in case west coast fires were an ongoing issue.

These problems are not due to an "administration". The rot of American institutions is deep. The competence and coherence of the entire American civil service and civil life has fallen precipitously in the last 20 years, and, in part because of their irrational fixation on this administration, people still cannot wrap theirs head around the fact that problem is in personnel and structure.

The CDC botched the development & rollout of a pretty simple PCR assay. The CDC happily participated in the 'don't test, don't tell' cover-up of the real # of stateside cases. The CDC and FDA were in territorial pissing matches with one another around test regulation. The FDA has hindered the effective deployment of tests and therapies at every turn. The entire journalistic chattering class was lecturing the American public no more than 2 weeks ago about how over-reacting to the virus or calling it the wrong name was more dangerous than the virus itself. The American economy spent the last 3 decades moving every single manufacturing facility and shred of know-how that could make PPE, ventilators, and pharmaceutical precursors overseas to save a few pennies, and wasn't stopped by the government. And we've now learned Congress was given an accurate assessment of the pandemic threat months ago and chose to... sell their private stocks.

This crisis is not going to result in happy little vision-less "to-do list" for future bureaucrats to improve upon, it is deepening the American people's awareness that the entire bureaucracy & elite class have been shown wanting and must be replaced in their entirety by massive reform of the federal civil service.

This so much. The system is absolutely corrupt and broken to the core. Poor leadership exacerbates the problem but it is not the fault of poor leadership. We've merely been coping with the horrible brokenness of our system for decades.

I see this logic a lot and I don’t understand it. The current administration dismantled the departments we needed, left whole organizations leaderless, and prompted the brain drain of nearly 1500 scientists from the federal government.

... yet your argument is that they are blameless in the poor performance that followed because of historical factors?

> yet your argument is that they are blameless in the poor performance that followed because of historical factors?

No, they're not blameless, they did all of those things. What is more worrying is a structure wherein actions as sweeping and dangerous as these are possible.

I see posts like this quite a bit, seemingly as a defense of the administration which is known for pushing deep cuts in various institutions, bungling messaging and/or outright lying about the state of affairs, among a litany of other issues which are exceedingly well documented.

If we were to treat the US as a business (as the President would want, apparently), poor leadership is the reason why we're going bankrupt both economically and socially. His actions are akin to cutting the QA department across your various software teams because 'their duties are redundant and can just be done by the developers instead', then encountering a crippling bug that could've been fixed by having QA at inception.

this is a ridiculous statement, you constantly refer to "him", i can only persume you are referring to our current president. You do know that the U.S. has been increasing debt since way before his tenure, right?

It largely the fault of the current leadership as well as the political party in power. In last 20 years they have destroyed institutions when in power and stopped the other political party to revive them when they were not in power. All the government lockdowns and blocks when Obama/Democratic party wanted to spend money on healthcare are there to see. Though Democrats are not blameless nor is the American public for allowing this to happen.

Spending money on healthcare wouldn't have helped. You could treble the capacity of the healthcare system and it wouldn't make that much of a difference. No system is ready for 1-3% of the population suddenly requiring weeks of time in a hospital bed.

The countries that are coping with this aren't doing so by putting everyone in great, well funded hospitals. They are avoiding people getting sick through combination of border control, cheap & quick medical testing and infectious disease specialists in key positions.

Spending money on healthcare would have helped. Actually would help now currently in the us doctors and nurses are complaining about lack of protective wear. In reality it is available but hospitals are not buying and providing them to it staff as they are expensive. Had US been investing on healthcare hospitals would not be worried about running out of funds and not protectings its doctors and nurses.

There may be structural problems, but the current administration contributed significantly the poor response to this epidemic. Had they kept existing infrastructure and people in place, things could have gone significantly better.

https://www.reuters.com/article/us-health-coronavirus-china-...

https://blog.ucsusa.org/anita-desikan/trump-administration-h...

Yeah, for me the inflection point was NOAA and hurricane Dorian. Only so many people can put their careers on the line before something breaks in an organization.

There's a lot to be said about WH-level leaders with the authority to corral and force action down the chain. It's bad enough that the CDC and FDA screwed up, but there was no urgency from the top-down that solutions had to be rolled out in a timely matter or alternatives had to be explored even in parallel. You see the difference now, when there's a sense of urgency, and we are willing to break rules, engage lots of different groups to work on efforts in parallel, etc. None of that happens without urgency from the top.

And the lateral side. Even right now, Congress is bickering about a relief bill, stuffing it with unrelated pork while people die.

There is plenty of blame (and some praise, too) to go around.

Rather, the previous administration was just more successful bringing the full weight of the media machine on turning down news of the previous H1N1 pandemic which had 2 orders of magnitudes more cases and deaths so far. https://www.businessinsider.com/coronavirus-compared-to-sars...

This current pandemic just happened to have happened outside the US so it couldn't keep the lid on the news.

According to your source

> The coronavirus outbreak is more severe than the 2009 outbreak of H1N1, or swine flu. That illness infected between 700 million and 1.4 billion people worldwide but only had a mortality rate of 0.02%.

1.4 billion worldwide, not just in the United States.

The mortality rate is much worse for coronavirus and it hasn't been around since 2009 so we've yet to see how many cases and deaths occur.

Just an FYI: the mortality rate of swine flu is based on estimate of total people infected (around 60 million cdc estimate) while the mortality rate of covid is from confirmed cases as we don't have estimates of total infection with some speculating that it's 10x of confirmed cases

We know from the cruise ships that mortality is in the 0.1% - 1% ballpark. With a broken down healthcare system it may go a bit beyond 1%, but not a lot. Data from Italy shows many people who get a ventilator die anyway, so running out of them wont make the figure jump.

I agree with what you've said here. I'm curious if you have thoughts as to an underlying cause, or causes, that you would be willing to share.

You are being kind. From my perspective, the ineptitude and mismanagement easily goes back 50 years, not 20.

It's sad to see so many people blinded by the hatred aimed at Trump to be completely blind to how it is we got here. A simple example from data that came out today: Governor Cuomo refused to buy 16,000 ventilators in 2015, when he was told they would be needed for an event such as what we are experiencing. Remember this is when Bill Gates was already on TED talking about the next pandemic. And so, today, Cuomo tries to blame their lack of preparedness on the federal government.

The other item you mentioned that is also right on point, is the brutal erosion of our ability to manufacture almost anything at scale. And then you have people, reporters and politicians yelling and screaming about the Trump administration not materializing masks, bed, ventilators and entire hospitals instantly out of thin air.

I mean, we barely make our own molds for plastic injection molding in the US and we are indignant because we can't spin-up industrial scale manufacturing capacity in days? It takes MONTHS, no, YEARS, to integrate some of these supply chains and produce quality product at scale.

Segments of our society, "leadership" and media are acting as if a combination of Superman and Captain Picard are going to swing into action, instantly materialize millions of products we don't have the industrial base to produce and fly around the planet at ludicrous speed in reverse to turn back time.

Well, that's not reality. Reality is we can't make shit in the US any more and it takes a tremendous amount of time to spin up production lines from nothing, particularly if we are talking about life saving devices.

Everyone needs to calm down, stop pointing fingers and find ways to contribute. As the saying goes, "United we Stand". Time to show what that really means or face failure, as the rest of that phrase predicts.

Most of my life I've been told that government is horrible, and that the most terrifying thing to hear is "I'm from the government, and I'm here to help." When an entire generation hears the demonization of civil service (though not military service), then it's no wonder that we end up with a government that can't serve us.

Why isn’t there any political will to completely overhaul civil service hiring, pay, qualifications, “tenure”, and so forth?

This will likely get downvoted, but it seems to be the most accurate explanation.

American culture is not able to understand the common good anymore. And it cannot understand the brutality of politics, nor the need to participate in it. This is the age of children of cages, forgotten in a week for the official opposition to complain about civility on Twitter. Meanwhile other Western countries burn tires and flip over cars for a thousand times less. In non Western countries, people stand up to bullets in order to complain about the government. But this country made mean people on Twitter the main issue in the election cycle, above Healthcare, War and Concentration camps.

The American public has grown soft, largely by design.

I'm going to give a very cynical response to this, but I believe all of these factors are relevant. I'm also going to be going against the grain of the political leaning of this forum. I hope that we can discuss the points where we agree and avoid getting stuck at the first point of disagreement.

Factors:

1. Typically, people who wish to be in power are not the people who really want to use power for some greater good. Police make great examples because their abuses of power are often made visible, but this issue goes all the way up to the top. To give an example from right this moment, that I'm sure withstands bipartisan scrutiny, just look at how much political posturing and hot air has stalled the Covid-19 stimulus that is currently being negotiated. [1]The last proposal from the dems included identity politics and various climate provisions. Whether you agree with the policies or not doesn't really matter in this case, what sense does it make to fight for these policies right now in this bill?

2. Our political system centralizes all decision-making power into two parties. Each party has massive influence and control, even to the point of 'rigging' their own internal election processes. As such, the average American has substantially less ability to influencer outcomes at the upper tiers of government as they often think they do. This is the reason there was such distrust of parties by the founding fathers. The solution to this is to either have unlimited parties (requires a different voting system, of which there are several viable options) or to have no parties at all. Then there is a need to institute concepts like a public veto/vote for when things go haywire (think Brexit, but ideally without the intentional political incompetence).

3. Removing those in power is a scary affair. If your government decides to do heinous (or criminally stupid) things and there's no 'political will' at the top to change course, the people must intervene. How much peaceful recourse is there? There are finite 'legal' moves to be made, and they all take time. Once you run out of those options or time, the only remaining choices are 'illegal' and thus risky to individuals - and therefore require large groups of people to organize.

This is a problem understood by our founders, evident in their writings. It's also been commonly addressed since the 1800s in sayings like: [2]"There are four boxes to be used in the defense of liberty: soap, ballot, jury, and ammo. Please use in that order."

4. Both parties in the United States, despite their protestations to the contrary, have proven to have corruption up to their highest levels. [3]Both Democrats and Republicans dumped stock running up to the current crisis - after they were briefed about the risks. There's also intense 'fighting' over entirely manufactured issues. [4]One example I use often is "assault weapons," which are used to commit murder less than half as often as people's fists. It's hard to even imagine how much progress could be made if the same political energy were expended on more impactful social issues. (Targeting poverty which leads to desperation and organized crime might be a good start).

[1]https://www.wsj.com/articles/the-pelosi-schumer-contagion-11...

[2]https://en.wikipedia.org/wiki/Four_boxes_of_liberty

[3]https://www.politico.com/news/2020/03/21/coronavirus-trading...

[4]https://ucr.fbi.gov/crime-in-the-u.s/2017/crime-in-the-u.s.-...

I would argue Congress’ power is weak compared to the career civil servants who decide whether policy should actually be implemented or not. Popular politics serves as a complete distraction while unelected bureaucrats make most of the decisions behind the scenes.

> I'm also going to be going against the grain of the political leaning of this forum. I hope that we can discuss the points where we agree and avoid getting stuck at the first point of disagreement.

I agree 100% with the points you made. These are important points to understand, each with its own set of tentacles and consequences. It is also true that HN (and other fora frequented by a younger generation) tends to lean heavily towards an ideological framework that, from my perspective, tends to be the result of the intense indoctrination our educational institutions have been shoveling for decades.

> 1. Typically, people who wish to be in power are not the people who really want to use power for some greater good.

This is universally true anywhere in the world. Politics is not a profession where altruism reigns. Even with Trump, this is only my opinion, I believe he decided to run because Obama put him down and diminished him in a very public way during that famous WH dinner. Once in the race, and particularly once he won, he clearly decided to do a good job. He has a record for being the only politician who has, so far, delivered on everything he promised during the campaign. Is he altruistic? Well, no, I don't think so. He is as self serving as anyone else, but at least he is (was?) getting important things done.

> does it make to fight for these policies right now in this bill?

I was absolutely baffled by the strategic blunder. Is Pelosi so powerful that nobody dared go against her? What they did is nothing more than sheer madness, not to mention the disgusting stench of using a national emergency of this magnitude to strong-arm the other side into adding irrelevant items to an economic rescue plan.

> 2. Our political system centralizes all decision-making power into two parties.

I've been saying for a long time that our system of government is obsolete. It had a good run, but this makes no sense. A simple example pulled out of the current environment is the gate-keeping of medical decisions by a bunch of 70 year old lawyers in the Senate and a hodge-podge of people in the House. To me it would make sense to decentralize this power and, effectively, have "Vice Presidents" and teams who are not political parties to manage important areas of our country. In other words, you would have a VP of Health and an executive team under him/her. The fact that someone like Trump or Pelosi have power over medical/healthcare policy and actions is a failure of the system.

> soap, ballot, jury, and ammo

The second option should be the most powerful one. However, as we have seen both in the US and elsewhere, the masses are easily manipulated, which can lead to bad decisions. My canonical example of this is the whole Bernie business. In a rational society he would have been laughed out of the political stage decades ago. Yet, here he is. I am not sure how to counter irrationality other than to somehow push hard to change our system of education for greater balance and critical thinking, a task that would not deliver results for a decade or two.

This is an odd conclusion to draw. You're saying that people call the government incompetent, and now they're demonstrating incompetence, and you're convinced that the causality flows from the former to the latter?

As an external observer, I think it's not so much about whether the current US government is incompetent or not, although of course that does play some role. The key point is that a large fraction of USians have a purely ideological belief that government cannot ever be good.

As a consequence, too large a fraction of the population and of political leadership don't even try to make government institutions better, and are instead actively standing in the way of people who do try. Instead, they end up dismantling institutions or making them worse when they fail to dismantle them. (Note that this is the semi-official policy of one of your major parties. They call it "starve the beast".)

And yes, this is genuinely different from other countries. Over here, while trust in institutions is often lower than it would ideally be, the vast majority consensus at least of political and media leadership is that government can and should be good. As a consequence there's a significant number of people over here genuinely trying to make better government happen, to at least some success.

It's really no surprise that US government is so dysfunctional, and it's entirely self-inflicted by bad culture.

> As an external observer, I think it's not so much about whether the current US government is incompetent or not, although of course that does play some role. The key point is that a large fraction of USians have a purely ideological belief that government cannot ever be good.

I'd be wary of outgroup homogeneity bias here. I'm a fairly big-government guy; there are plenty of things the market is sorely ill-equipped to handle where active, competent govt can do tons of good.

But unlike most people on the big-govt side of the discussion, I don't think that it's blasphemy to question why the US govt is so especially incompetent in certain areas (infra construction is a glaring example, etc). Waving it away as "they don't have enough funding to do good things" is undetermined, the kind of answer that people reach for because it seems obvious, not because it's correct (or rather, complete).

While I've decided that big govt is, in many cases, worth the inefficiency, it's still worth asking _why_ it's inefficient and whether we can improve this. I also don't begrudge some very smart friends of mine who've decided that its inefficiency means that decentralizing power is a better path forward. I can guarantee you that all the people I've talked to who feel that way have given it far more thought than the simple-minded stereotypes the GP comment engages in.

The role of the federal government is to be our insurer and to eat risk. Unlike state governments, there is no balanced budget requirement. Blaming Cuomo -- ie all 50 individual states, with not only currently varying populations, but populations and incomes and risks that vary over time -- for not independently staffing up and buying equipment to be prepared against all eventualities is silly.

Second, Trump diddled for 8-12 weeks to start manufacturing things. People are screaming because the Chinese government confirmed by Dec 31 that they had cases of the virus. That means the NSA had almost certainly been hearing about it for a couple weeks. Given the worlds' experience with SARS and MERS, that was the time to get serious.

What was possible with this warning? Taiwan, for example, used this time to create 32 new production lines [1] for masks.

Later, there were classified briefings that Republicans like Senator Burr were privately warning businesses about. While lying to the public and using the warning period not to get serious about dealing with the pandemic but to save money.

We had 8-12 weeks of warning, and Trump either took no serious action or deliberately delayed decisive action to start figuring out supply lines of respirators or ventilators. We had, to use your phrase, "MONTHS" -- actually a quarter of a year -- and Trump squandered them.

He invoked the Defense Production Act YESTERDAY for god's sake. The time to do that was when it became clear containment had failed. Ie sometime around mid-January.

ps -- we make plenty of stuff in the US. in reality, the US is the second largest manufacturer in the world after China. That's not to say that manufacturing isn't declining in the united states, but to pretend the enormous set of US manufacturers doesn't exist is not grounded in facts.

See also BLS 51-4111 -- 72k employed in the US in tool & die manufacturing.

[1] https://focustaiwan.tw/society/202003230016

All correct. Also, Snowflakes think the country can run all shut down, but not if you want food on your table. We have to get back going, take our hits, and survive. The alternative is worse.

People want a simple, tidy villain and hero story. As though everything would suddenly be solved if only their hero of choice vanquished the villain. Unfortunately, as you point out, the real problem is institutional decay.

A recent article summed this up pretty well:

"Such a mobilization failure is never an individual's fault. Rather, it reveals a hollow state. In the alphabet soup of federal agencies, there is no one with the information and authority to act on the consequences of an exponential curve...

In the middle of the 20th century, a cadre of credentialed experts was created to replace citizens. This was a mistake. The selection mechanism for entry into this cadre selects against bravery and original thinking. Experts should be consulted, but what use is an expert unwilling to consult on a grand vision? The American system of the 2020s through the city, county, state, and up to the federal level has been staffed with people who know how to speak and make themselves appear blameless, but not how to act."

https://americanmind.org/features/the-coronacrisis-and-our-f...

"The CDC and FDA were in territorial pissing matches with one another around test regulation."

This is normal. In every org at every level.

It's leadership's job to knock heads, to span boundaries and turf and inertia, to make everyone play nicely together.

"Buck stops here" and all that.

Yes, it's not just the current heel in the top job, but there were a lot of unforced errors owing to his team's problems.

Trump's a germaphobe, & a deregulator, & big on border security.

But he left the pandemic office in the White House go unfilled, & his CDC eliminated an in-China monitoring position, & he proposed additional cuts.

After initially considering people like FDA critic & aggressive deregulator Balaji Srinivasan as FDA Chair, that was ignored as a priority – & FDA delays in approving alternate, distributed diagnostics added weeks or months of delay to testing capabilities. Even now FDA inspection delays have medical supplies from reliable, longtime suppliers held from delivery. The steps the FDA has finally taken are waivers they could have granted by administrative fiat months ago. And key discoveries of community-spread in the US required researchers to disregard CDC guidance. (The agency designed to sound the alarm had instead removed the batteries from the smoke detector!)

And while countries with a sense of seriousness about foreign disease threats have closely monitored visitors by origin-of-travel, recent countries visited, and fever-monitoring from early-on, even when Italy was in full outbreak there were no health-screenings or fever-monitoring on US arrivals from there. Trump responded late, with crude bans by entire country-of-origin, even when those countries have no greater prevalence-of-community-spread than the US itself.

So yes, the rot is deep and crosses multiple administrations. But the current Administration is also especially inept, even in areas like disease, deregulation, and borders where they've touted their vigilance.

Of the two US political parties, one has an explicitly stated mission to defund, neuter, and shrink public institutions[1]. I don’t think it’s a stretch to blame an institutional crisis on those who want to take credit for the “savings” they’ve achieved by crippling those same institutions.

[1] https://en.m.wikipedia.org/wiki/Starve_the_beast

CCP deserves no credit for buying time. Any other government would have tried to stop the virus instead of trying to cover it up while it spreads far and wide.

> The Chinese bought the US precious weeks to prepare while it locked down vast numbers of its own population.

This could all have been stopped if the CPC had acted earlier, not covered it up, not lied about human to human transmission, not advised that travel restriction and testing were unnecessary.

> Dec. 27: Wuhan health officials are told that a new coronavirus is causing the illness.

> Jan. 1: Wuhan Public Security Bureau brings in for questioning eight doctors who had posted information about the illness on WeChat.

An official at the Hubei Provincial Health Commission orders labs, which had already determined that the novel virus was similar to SARS, to stop testing samples and to destroy existing samples.

> Jan. 14: WHO announces Chinese authorities have seen "no clear evidence of human-to-human transmission of the novel coronavirus."

> The bottom line: China is now trying to create a narrative that it's an example of how to handle this crisis when in fact its early actions led to the virus spreading around the globe.

https://www.axios.com/timeline-the-early-days-of-chinas-coro...

That's true but its impacts could have been significantly reduced here if the US government hadn't covered it up either, or if Trump didn't dismiss it as a hoax.

Trump did the same damn thing as China. And they all did it for the same damn selfish reason. Money and power.

The west has deteriorated, that much is clear, and a big reason why clearly incapable populists, benefiting from information warfare, have taken many positions in western government.

What did the US cover up? Yes Trump is incompetent, but that's pretty different than spreading known lies about it (like stating there was no human-human transmission), or hiding cases from the international community.

> and a big reason why clearly incapable populists

No, the reason is that in the west we're more resistive to storm troopers locking us into buildings and arresting people for being in public. An authoritarian nation that regularly suppresses free speech is obviously going to have an easier time dealing with this type of problem, but that's not something to admire.

> And this is their new hoax. But you know, we did something that’s been pretty amazing. We’re 15 people [cases of coronavirus infection] in this massive country. And because of the fact that we went early, we went early, we could have had a lot more than that.

> So a number that nobody heard of that I heard of recently and I was shocked to hear it, 35,000 people on average die each year from the flu. Did anyone know that? 35,000. That’s a lot of people. It could go to 100,000, it could be 27,000, they say usually a minimum of 27, it goes up to 100,000 people a year who die, and so far we have lost nobody to coronavirus in the United States. Nobody. And it doesn’t mean we won’t, and we are totally prepared, it doesn’t mean we won’t. But think of it. You hear 35 and 40,000 people, and we’ve lost nobody, and you wonder, the press is in hysteria mode.

- POTUS

> No, the reason is that in the west we're more resistive to storm troopers locking us into buildings and arresting people for being in public. An authoritarian nation that regularly suppresses free speech is obviously going to have an easier time dealing with this type of problem, but that's not something to admire.

I think you've taken my paragraph out of context. I was talking about the deterioration of the west as a world leader and power - not the corona virus outbreak here.

> The disaster could have been prevented

As in: 100% prevented?

> The administration

and this is where you lost me..

I don't know why you are so obsessed with testing? In the US, if you have a medical problem, you go to the doctor. The doctor may order tests. If you are not sick, or the doctor doesn't think you need certain tests, they don't order the tests.

It was never possible to ramp up test kits for 350M people and it's not going to help anyways. You test negative one day, then...what? You can still catch the virus! It's a false sense of security.

Japan is handling the crisis the best of any nation so far--calmly, without idiots posting on web forums about their non-expertise and not giving in to who can yell the loudest.

>> "without idiots posting on web forums about their non-expertise and not giving in to who can yell the loudest."

What are your credentials?

PhD Mathematics/Computer Science

So nothing that qualifies you to speak as an expert on matters of medicine. I refer you back to your own words:

>> "without idiots posting on web forums about their non-expertise and not giving in to who can yell the loudest."

I don't think you need credentials to learn enough about a topic to discuss it intelligently, but I do think people should be consistent in application of their own standards.

Where was the media in this? Lots of scare stories about potential pandemics back to January, in the US media, but I dont recall much if any "the CDC is fucking up / not testing" coverage.

Of course that kind of thing was probably being said in the froth of the fringe and conspiracy theorists, but thats all "fake news" and unmentionable now.

Because in the initial days, the CDC had a valid point. The W.H.O/Chinese test wasn't that reliable (at the time) and it wasn't unreasonable for the US to make their own. It wasn't until week after week went by, with the CDC straight up lying to the FDA/HHS, that the real failure became apparent.

The second the CDC realized it wasn't up to the job, it should have begged the FDA to allow labs/companies to make their own tests. Instead they lied for weeks, wasting the most critical time in the US's portion of the pandemic getting nothing done. It wasn't until UC Davis broke the law and tested a patient and the governor of California dared the FDA to do anything about it, that Trump put Pence in charge and things started to move forward and responsibility for testing was moved away from the CDC.

I don't know if Dr. Redfeild of the CDC made these calls, but either way, he should have been replaced immediately, because he'll make the history books for the amount of lives this will cost.

> Because in the initial days, the CDC had a valid point. The W.H.O/Chinese test wasn't that reliable (at the time) and it wasn't unreasonable for the US to make their own. It wasn't until week after week went by, with the CDC straight up lying to the FDA/HHS, that the real failure became apparent.

The initial test was developed in Germany, and was ready by 17 January. This test proved able to isolate the virus from other coronaviruses, and thus received the recommendation of the WHO. CDC published its protocol on 28 January, a test that was less efficient and reliable than the German test. In the mean time, WHO had recommended countries use the German protocol.

> Because in the initial days, the CDC had a valid point. The W.H.O/Chinese test wasn't that reliable (at the time) and it wasn't unreasonable for the US to make their own.

How would this be an excuse not to start using the WHO tests while the CDC was developing theirs? Even if the test was hot garbage (as you imply), surely something is better than nothing.

The CDC test was mostly pretty good. My impression from This Week In Virology was that some aspects were too clever which is why it took so long to come out but the parts of it that involved the detection of SARS-Covid-2 worked just fine. The problem was that there were some bad reagents in the part of the test that looked for other respiratory illnesses so the third part of the test that wasn't directly concerned with the Coronavirus didn't work. And it would be illegal to run a test that didn't conform to protocol - simply skipping the relatively useless part of the test that didn't work.

The CDC deserves some blame for taking 3 weeks to produce a gold-plated test that had a part that didn't work but I think we ought to blame the FDA more for preventing any of the qualified labs from doing any tests until the CDC finished taking its sweet time to make a test and then that test didn't work to FDA standards. There are tons of competent hospitals, universities, and companies that could have made a test to WHO standards in under a week and gotten us testing early.

Well, the FDA managed to prevent most testing but Dr. Helen Chu was willing to break the law and alerted us to the Seattle outbreak. She saved countless lives and I hope she doesn't go to jail for it.

I don't remember the exact start date when people started noticing we had severely fucked this up, but it's been a common refrain in the media for the last month at least. If you're still asking "where was the media" NOW then you need to seriously reevaluate what media you're paying attention to, because the ones you're looking at are doing you a big disservice.

Here's one from a month ago: https://www.latimes.com/world-nation/story/2020-02-28/corona...

Ten days before that, people were becoming aware of asymptomatic carriers which should've triggered a huge testing effort to try to prevent community spread: https://www.latimes.com/science/story/2020-02-18/report-show...

Less awareness of it in late January: https://www.latimes.com/california/story/2020-01-26/coronavi...

Feb 1st in Business Insider: https://www.businessinsider.com/tests-for-coronavirus-us-mig...

Feb 12th in the NYTimes: https://www.nytimes.com/2020/02/12/health/coronavirus-test-k...

Feb 12th in LiveScience: https://www.livescience.com/coronavirus-testing-kits-flawed....

Feb 12th from Physicians Weekly: https://www.physiciansweekly.com/some-u-s-states-launch/

Feb 13th on FoxNews: https://www.foxnews.com/health/some-coronavirus-testing-kits...

The media has been all over this, news stories just don't have the penetrating power they used to. Plus, Trump admin officials kept saying the tests were fixed and would be shipped shortly even though it was patently false, so I don't think people thought much of it.

https://www.bloomberg.com/news/articles/2020-03-06/trump-aid...

I didnt start digging until 2/19; when my daughter went to a clinic for something that "wasn't flu or strep"; and there was no answer about "is there a test for the new wulan virus?"

I think the Media the-boy-who-cried-wolf itself. There are scares all the time and people grew (rightly) indifferent. Imagine a responsible media that's not out looking for click grabbing headlines all of a sudden mentioning a would-be pandemic...

Can you mention a few scares that you mention that happen "all the time" ?

World War 3 supposedly started in January by some accounts, but is nearly forgotten now. What's some mystery flu in China got on that as far as headlines go?

Sure, we can answer this with a bit of hindsight, but it's amazing how quickly we forget even wildly incorrect predictions.

Can you expand on thst WW3 reference - it's not a story that made the rounds here.

I think they are referring to the killing of Qasem Soleimani and the subsequent retaliation [1].

[1]: https://en.wikinews.org/wiki/United_States_military_kills_Qa...

Indeed, there were a lot of people going on about WW III, a draft, etc. It's a bit harder to find good examples now that the hype has faded and the results get buried on Google, but here are a few samples -

https://townhall.com/tipsheet/cortneyobrien/2020/01/03/some-...

https://www.washingtonpost.com/national-security/2020/01/04/...

https://www.washingtonpost.com/opinions/2020/01/07/youth-nee...

Can you show some predictions of World War 3 imminently happening by news sources? Say CNN.

Look down thread, I linked to a few WaPo articles.

I was on Google news in January and you'd have thought that WW III was already started.

You're right. A fair, unbiased media is key for western government as we know it.

There is so much misinformation everywhere, and it has been exacerbated by the internet.

It's not hard to see why many distrust the media these days. And that's extremely problematic.

On 1/24/20 the WHO said there’s no human to human transmission of covid-19

https://twitter.com/WHO/status/1217043229427761152?s=20

They are to blame as much as anyone else

WHO isn't faultless, but that's a fairly misrepresentative version of what that Tweet actually says..

"WHO said there's no human to human transmission" vs.

> Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China.

Agreed. They surely share in the blame but then again, it's not as if China is our ally who we can count on to give accurate and timely information. They (and others) would love nothing more than to see the US crumble and burn. So I understand some of the WHO (and CDC) skepticism in the early days. Not that I'm defending their later actions (or lack thereof).

It was 1/23/20. Wuhan was under lockdown but there was no clear evidence of human to human transfer? Cmon

That tweet was from ten days before the lockdown, based on evidence gathered prior to that. The first death from the disease was 3 days prior to the WHO tweet and Chinese researchers had only identified the specific virus 6 days prior:

https://www.nytimes.com/2020/01/08/health/china-pneumonia-ou...

That very same day the WHO was recommending handwashing / avoiding close contact with anyone with flu-like symptoms / and avoiding wet markets and close contact with animals (since the largest known source of infection was the market in Wuhan):

https://twitter.com/WHO/status/1216754859292184577

It's hard to lay any blame on the WHO for not taking the virus seriously enough in the first days of the outbreak when major politicians were still dismissing it two months later.

Your source for that is China itself?

WHO deserves a ton of blame. For one, they refused to call it a pandemic and actually pressured experts who disagreed to take back what they said and then called it a Pandemic the very next day. https://twitter.com/RizaHawkeye8/status/1241415090097684480

Um, I've not been watching the WHO that closely, but didn't they state clearly their definition of a pandemic, and say [not a direct quote] "it's not yet a pandemic but might well become one", and then when it did pass their definition they called it a pandemic.

Seems reasonable, forthright, and scientific.

What did you want instead? Every epidemic to be called a pandemic?

It was obvious to many experts (see tweet for one example) that it was a pandemic. These experts were frustrated that WHO was not recognizing it as one.

My opinion is that WHO should have called it pandemic much earlier and raised the alarm much earlier.

They said there is no evidence of it, that's completely different from what you wrote.

> Lots of scare stories about potential pandemics back to January, in the US media

We live in an environment where the signal to noise ratio has been deliberately polluted by politicians to the point where actual signal is being lost. Everything that disagrees with the ruling regime, calls out incompetence, or is even slightly embarrassing, is "fake news". We've entered a scary time, indeed.

I don't know if your wording was intentional, but your comment gives the impression that you think this was "scare stories", when clearly, in retrospect, they were warnings. We should have listened. Some did. Leadership clearly did not.

The pandemic is getting worse and we're ramping up the finger-pointing. Instead, we should be listening to experts, mounting effective response, and holding leaders accountable. We continue to fail on that last point and shoot messengers.

As I recall, a lot of the media was saying we should be more worried about the Flu than this. That was the prevalent mantra from Jan-Feb.

An exponential curve looks like nothing when the numbers are really low. By mid-February even in media it wasn't a curious case in China anymore, though.

We didn’t know there was a huge testing problem until we had a huge amount of people who needed tests.

CDC and FDA having strict rules on who could test is vastly more important than the CDC botching its own tests, imo. The Seattle Flu Study had proof of community spread in January from their own testing, and the CDC and FDA told them to stop testing because it was against the law (per a NYT article.)

The problem is a global lack of preparation for a pandemic of this nature, despite multiple warning shots in the last couple of decades. The problem is incompetent, complacent government, and the political processes which enable it, and lately, even reward it.

Blaming the CDC seems pointless. There are any number of institutions which could have done better. The thing is you don't want to be relying on everything going right in a crisis.

> The problem is incompetent, complacent government, and the political processes which enable it, and lately, even reward it.

Whilst I entirely agree with this statement, I actually doubt that any political party that stood on a platform of pandemic-preparedness, and the budgetary spending required for such, would have been voted into Government anyway.

We, the people, have been voting for that which we believe to advantage us as individuals based on the political rhetoric / media spin we're turning in to.

We, the people, get the Governments we deserve.

In one of Hillary Clinton's books she talks about how she would have dramatically scaled up US preparedness for pandemics. I don't believe she explicitly ran on it for her platform though. (Which makes sense as it's not something ordinary people think about.)

The trouble with the concept of something like the CDC is that it needs to remain very sharp and poised for events that only happen once every few decades. That means that there is plenty of time between major events for the employees to lose focus on the primary mission.

Complacency will always exist in places that are complacent.

There's a reason empires fall and superpowers crumble. Most of the time it isn't one decisive battle or event. It is slow, ever growing rot and corrosion, forever pushing forward while most don't even notice because they're comfortable.

This whole line of analysis has confused me. The CDC tests, while flawed, were never very numerous, right? Is the contention that if these early tests had worked, they actually would have been sufficient to protect the entire nation?

It's seemed to me the problem has more been that we haven't stockpiled supplies over the past few years like South Korea did.

> Is the contention that if these early tests had worked, they actually would have been sufficient to protect the entire nation?

The contention in the article is that there were multiple, compounding layers of fuck-ups.

An analogy I used over a “Zoom & Bourbon” meetup last night was that the COVID handling by the US federal government is very similar to aircraft crashes: it’s never just one failure, but a series that cascade (and you invariably “get behind the aircraft” due to being overwhelmed) and lead you to the crash site.

We’re almost to the crash site, just a few more weeks to go. Please make every attempt to stay safe and healthy.

Are you by any chance describing the Swiss cheese model?

https://en.wikipedia.org/wiki/Swiss_cheese_model

Yes! It’s overused, but very useful when communicating the idea.

I agree.

The US response to Covid19 is nothing like the Swiss cheese model.

The Swiss cheese model is a perfect storm of unlikely failures that leads to a negative outcome, a failure that slips through multiple safety nets and checks. A real “Swiss cheese failure” reads like a bizarre set of coincidences within a highly rational system of disaster prevention controls, with a unique outcome that never gets repeated again - like some plane accidents where every level of check/balance has had a miss.

Other countries have not failed (Taiwan, Singapore, Vietnam, South Korea, Japan, China) which shows that rational actions could prevent this.

Many other countries have failed (Italy, Spain, US, Iran, etc) which shows this isn’t a Swiss cheese model.

> Meanwhile, the FDA did not allow anyone other than the CDC to test for coronavirus.

true

> there were multiple, compounding layers of fuck-ups.

also true

All of it is completely true. And the issue is that both of these were blatantly obvious to anyone paying attention to the situation. The CDC was struggling to develop the test, and the FDA regulates who can create tests under normal circumstances. The larger question is why the heck didn't the administration seeing what was going, on step in, and say this is an emergency situation, allow private testing! That's your role as head of the executive branch. Observe the individual government agencies and plan and coordinate a response. It would take 5 mins to call the FDA and say "due to this emergency situation, change your rules to allow private testing".

Why did the admin just sit there this whole time? Everyone saw the CDC couldn't scale up in time. Everyone knew the FDA regulation only allowed the CDC to create a test. Why do nothing for weeks watching this train wreck?

In any emergency or sudden crisis situation, shit happens - things don't go to plan. The point of leadership is to analyze what's going on and take decisive action to rectify it. Not just stand there. Put in place a damn contingency plan.

If you have a livesite issue and one of your main services to diagnose goes down, You look to see how long it will take to get it back up - and if it's not fast enough you find a mitigation. You don't just stand there and say "Well, we'll just sit and wait however long it takes to get fixed while letting this thing spiral out of control. And do essentially nothing else to solve this."

> FDA regulation only allowed the CDC to create a test

wondering why this regulation exists and are there any guidelines for extreme situations.

I imagine it’s the same guidelines for most centralized regulations.

People who believe that central control is good. Which is a much larger discussion.

I can tell you that in normal times the FDA does prevent a good amount of injuries and deaths simply by being a chilling force for medical device manufacturers. It's not a matter of religious fervor to sometimes prevent the marketing of something because it can potentially be harmful.

Well, you get somebody out here going "Hey, we've got great tests for this, the best." and a bunch of people who are about to drink aquarium chemicals take the test, get a negative result because the test doesn't work, and now you've got a bunch of morons running around infecting everyone else.

The testing shortage is a grand fuck-up, to be sure. But it's not as bad as waiting to tell everyone to stop congregating and start washing their hands more.

> it's not as bad as waiting to tell everyone to stop congregating and start washing their hands more

People should have already been doing this themselves from basic common sense. You shouldn't need the government to tell you to take obvious precautions.

Well, in extreme situations the best thing to do isn't to fire the pandemic response team three years prior cause "never gonna happen".

Those regulations (and most bureaucracy to be honest) is to provide guidance and constraint during normal times - these are extreme times and it's perfectly rationale to restrict burdensome regulations that hurt the public good right now.

> Everyone saw the CDC couldn't scale up in time. Everyone knew the FDA regulation...

No way that is possibly true. People realised they didn't have tests. A bunch of people of a liberterian bent or systems thinkers would have picked the FDA as the problem very quickly. But for most people diagnosing and rectifying that sort of snarl in a complex bureaucratic process would have taken about as long as it did. This happened at blinding speed for a bureaucracy fixing up its own problems.

There were compounding failures that required a government body to put their hand up and say "I have too much power" or "lets take a risk on letting some non-government actors take key roles". It wasn't going to work unless the executive happened by amazing luck of have an infectious disease specialist in a key role (maybe president or VP) who was already sweating at night about asymptomatic infections.

The problem is the legislative framework where first response in a crisis was to centralise the response on a single point of failure. It barely matters who the actors were, superhuman effort by one or two people can't reliably overcome a bad system. This should never have been a situation where the CDC making a mistake delayed the crisis response by months and nobody but the CDC/FDA had the power to fix that.

> No way that is possibly true. People realised they didn't have tests. A bunch of people of a liberterian bent or systems thinkers would have picked the FDA as the problem very quickly.

You didn't need a "libertarian bent" or special"systems thinking" to figure that out. The CDC was testing at most 50 people a day IIRC. Can 50 tests across an entire country get you detailed info? No. You need labs to run tests, CDC has limited lab space for testing. South Korea was capable of doing thousands of tests per day. No rational person though 50 was sufficient. They simply sat and waited for the CDC doing nothing.

Who has labs? Universities, sure start there? Who does the testing for the population in general? Quest & LabCorp, have them run the test.

> It wasn't going to work unless the executive happened by amazing luck of have an infectious disease specialist in a key role

It doesn't require having "amazing luck" to see what was happening. Everyone on the internet looking at it did. Like the task force they killed? This is utter incompetence by the executive branch. In January, how do you see 700 million people on some form of lock down in China and not immediately spin up a task force to evaluate risks to the US? It's astounding levels of negligence.

The administration let the country down enormously. And a lot of people are going to suffer because of it.

> The administration let the country down enormously.

Is this a failing of current democratic system. Are there no check and balances for this sort of let down by the administration. How can we design a system that has nothing to check it if its making mistakes. Is that the job of the opposition or does opposition lack intelligence to find out in time.

I think so, I've emigrated up to Canada and comparing the parliamentary government up here to the system in the US has been interesting. Canada has had some majorly extreme parties over the years (including the PPC[1]) but there is room in the system for these parties to grow outside of the centrist parties. Currently in Canada the dominant party is the Liberal party it's a rather centrist but socially liberal party that's about equivalent of America's corporate Democrat types like Clinton and Pelosi - but in recent elections a more left leaning party has gained some ground and is challenging them from the outside.

There is a lot of party loyalty in Canada, but since the political field isn't purely divided between Liberal and Conservative there's significantly more freedom when it comes to elections, the election system is still first past the post but most voters can vote their conscience rather than strategically.

I think the failure of the democratic system is reducing elections to a binary vote, and I think that that reduction is impossible to avoid with direct election of the executive branch instead of being driven by the composition of the congress - additionally America's system is very vulnerable to having a minority party executive and while minority governments in parliamentary systems is a thing, it tends to be less damaging by still ensuring/requiring that a minority government is able to form a coalition government initially.

1. https://en.wikipedia.org/wiki/People%27s_Party_of_Canada

Good systems would obviously be desirable, but this is basic executive competence. A US response to a potential pandemic brewing in China should have been a top White House priority since early January. When there are coordination problems, it's the responsibility of the person at the top to sort it out. They didn't even try and fail to fix the problem, they identified an entirely different concern: the threat to the stock market, which is where the response concentrated.

The Trump administration has responded quite slowly compared to the Obama administration's response to H1N1. The CDC commenced emergency operations a week after the first H1N1 case was detected, and advised school closings less than a week after that [0]. It seems likely that Trump's unfavorable comparison of the Obama H1N1 response to his COVID-19 response will come back to haunt him [1]. We'd be extremely lucky to get away with only 12,000 US deaths, this time.

[0] https://www.cdc.gov/flu/pandemic-resources/2009-pandemic-tim...

[1] https://www.countable.us/articles/42948-tale-2-pandemics-gov...

I'm curious about why this is being downvoted.

You're comparing the Trump and Obama administrations handling of different diseases and it looks like you are making a partisan point.

This is the early phase of a crisis. Now is the time to call on leaders to do things; not to politic about whether something could have happened a bit earlier or not. Trump is still going to be held responsible for the administration's performance; but now isn't the time.

Nobody is going to bother going back to compare this to the Obama Administration's H1N1 response. The H1N1 response is not a useful guide for how to deal with the piles of dead bodies that are about to start appearing outside hospitals.

Interesting perspective. Thanks.

You're underestimating how much more leeway the executive branch gets when given emergency power. In recent history alone state of emergencies have been used to: bypass Congressional war declaration powers in the form of at least one "war", ban entire countries from entering the United States with the recent travel ban, and bypass Congressional power of the purse with the border wall. Not to mention emergency powers were used to suspend habeus corpus for almost two years until Congress could meet during the Civil War and pass a bill making it official, in direct defiance of a circuit court ruling written by a Supreme court judge.

The act of declaring a national emergency is enough to give the President substantial powers that can be used immediately in the form of executive orders. Judges would be very hesitant to approve any injunctions in a real crisis.

Which of those things do you think would help in this particular instance? Respond to a lack of tests by suspending habeus corpus? And Trump did exercise his powers to issue a travel ban; that was a good move that bought the US a week or so. Not enough to make up for the lack of tests. A comparable action to those you've listed would be to suspend the FDA and/or the CDC for a few months. That is the sort of decisive, broad-brush move that the executive can pull quickly. It probably would have made the situation even worse.

Technically speaking, if you wrote a timeline down and then passed it back to someone important back in January or early February someone could have easily done something. But there is a real fog of war where up until around the 6th of February the message would have been "everything is OK" and then the scale of the disaster would only have become apparent on about the 10th. Then about two weeks later testing starts to ramp up. A debacle, but a predictable one given that everything was being run in serial.

If the response was going to succeed, it should have been 5 different Biomed companies hear about COVID and start making tests independently, then the CDC ratifies one on the 6th Feb. It turns out to fail, so they move to the next supplier and the rollout proceeds on the 10th. The companies have their own logistics teams that have started making preparations for testing supplies and distribution before hand. Maybe a company president knows Trump as a golfing buddy and rings him up asking for a fast track approval. Maybe a New York Mayor screams loudly enough that a test gets approved even earlier. Greasy, ugly, political and much more effective than what actually happened.

The moment the decision was taken that the CDC was going to develop the first response test kit was the moment that the system failed. Everything that happened after that is mostly uncontrolled good or bad luck.

I think Leslie Groves or Admiral Rickover would have figured it out with a few phone calls.

The CDC produced 160,000 tests that were defective. Meanwhile, the FDA did not allow anyone other than the CDC to test for coronavirus. That is the reason why the US was weeks behind on testing.

I don't doubt you, but I'd love it if you posted links to sources for the defective tests and the fact that the FDA didn't allow anyone but the CDC to test.

https://www.newyorker.com/news/news-desk/what-went-wrong-wit...

https://www.gq.com/story/inside-americas-coronavirus-testing...

It's exponentially easier to respond to an outbreak the earlier you act, but our early response was hamstrung by the CDC and FDA (and complete apathy from the white house). We could have slowed or halted this in the early stages with better testing. At the least it would have confirmed how much community spread there already was and hopefully prodded the gov, states, and businesses into action sooner. Time matters. I wonder how many people the FDA killed by blocking local tests?

This lacklustre response is still going on, the federal government simply isn’t taking this seriously.

Trump saying things will open up in just a few weeks and it’s important to restart the economy will cost thousands of lives by encouraging states not to lock down. Full lock down is now the only way out, and as it has spread, that will take months. Testing needs to massively ramp up too.

2000 people died in one day today globally from this, deaths have doubled in about five days and are growing exponentially.

Suggesting a resumption of normal work and not calling for more laggardly states to get their acts in order has been immensely irresponsible. Additionally he's reaffirmed the benefits of Plaquenil/Chloroquinine and already one self-medicator has died from improvising a supply[1].

Don't expect the federal government to start acting intelligently anytime soon.

1. https://www.nbcnews.com/health/health-news/man-dies-after-in...

Yes, its infuriating but hardly surprising. This is what happens when you don't have a responsible adult in charge during a crisis. The economy does matter, but the longer we wait, the longer we'll have to endure a crippling lockdown. So far some governors have filled in for the missing executive function of this country. Unfortunately that's localized and states simply cannot apply the same level of resources or coordination that the federal government can.

All we can hope for from the federal government is that they keep the checkbook open. It would be nice if they would stop dispensing such terrible misinformation but I don't really think that's realistic.

They're not. Trump authorized disaster counseling in Washington but has so far not done anything else. Inslee asked him to authorize the full gamut of disaster relief services including food distribution and unemployment benefits almost a week ago. You'd think if Trump were taking this seriously he would actually authorize federal disaster relief. I fear this is going to be a repeat of Katrina but in Washington instead of Louisiana.

The Senate and House have also failed to provide any relief bills that do anything but prop up the economy. Specifically they aren't authorizing the purchase of any medical equipment or supplies to support people through this emergency, but they're perfectly happy to make sure major corporations have enough money to wait out the period while we're all dying.

Michael Lewis wrote a whole book about potential scenarios like this which could arise from lack of capable executive leadership.

https://en.wikipedia.org/wiki/The_Fifth_Risk

There is a very real, if hidden, cost to economic suppression, especially in the United States where social safety nets are few and far between.

There's a line in the Big Short: "Whenever unemployment drops 1%, 40,000 people die". Surprisingly; this is more or less true, not movie drama. Its obviously difficult to draw causation between these two things, but there is causation. People have reduced access to healthcare. They have anxiety and depression from staying inside and being unable to socialize. They aren't working out as much. They can't take care of their family.

Let me present you this: People need N95 masks. Thank goodness, 3M is now churning out millions of them. But, wait... 3M is a company, but its staffed with people. So, those people need to go back to work, right? Those people need to drive to work, so they need gas stations, maybe even car maintenance. They need food, so supermarkets and restaurants need to stay open. Apply the same to people working in pharma factories, or our heroic healthcare workers, or many other industries.

The United States does not have a system that can stop. Some countries are built to be more resilient to stopping, and can do so over short periods of time. The United States is not one of them. If we don't get the economy started again, soon, people will die because we stopped the economy. Its a catch-22. There is no right way out, except to, hopefully, be more prepared and cautious the next time this comes around. But that doesn't help us today.

> Let me present you this: People need N95 masks. Thank goodness, 3M is now churning out millions of them. But, wait... 3M is a company, but its staffed with people. So, those people need to go back to work, right? Those people need to drive to work, so they need gas stations

Please find me a state in this country where gas stations and supermarkets have been closed, or a PPE factory that has been shuttered. Everyone knows that there are important things that can't be turned off. It hasn't been turned off, anywhere. That isn't what people are arguing about. Trump wants people to go sit in movie theaters or fly somewhere and stay in one of his hotels.

> especially in the United States where social safety nets are few and far between.

These things can change. The UK has suddenly grown a safety net that covers 80% of income for people who aren't working due to the coronavirus. We've also taken the railway network into public ownership overnight. Both of which would have been unthinkable 3 months ago.

It's also possible to keep essential businesses open while shutting everything else. Most things are shutdown here, and... for the most part it doesn't make a lot of difference. I can still get food and petrol. I don't really need anything else.

There absolutely are compromises to be made, which are not being made in the US and should be (distinguishing essential from non-essential, sending everyone else home to work at home if they can, locking down all social activity). No country is resilient to stopping, and no state is unique in this or an island.

The numbers above went up to 2.4k dead in 24 hours since I posted.

We are gong to enter a global recession or even depression because of the worldwide response, and I agree people are going to die from the economic impact, but the alternative is much worse.

Listen to Cuomo on this, please.

South Korea started developing tests for the virus early in the year and had the capability of testing on a wide scale when the virus broke out there. This combined with aggressive tracking and management is what gave SK the edge in controlling the disease.

If the CDC had been at all organized they could have been in the same position as SK with respect to testing. If you can test and target the infected you don't need a stockpile of supplies.

South Korea didn't do well just because they had supplies. They were able to test mind boggling number of people nearly from day one, which meant they could do contact tracing as fast as humanly possible and stop new cess as they were spread. And yes, the initial CDC test production we were promised would have been on par with South Korea's initial response. We had a chance to slow this down and the CDC blew it, then lied about it for weeks.

The problem is that the CDC didn't use the tests WHO had developed, and stonewalled states and private labs from developing their own testing, while they fucked around developing their own tests.

OK, fine, if the CDC wants their own tests, whatever. The WHO tests were not the be-all end-all of testing. There was clearly room for improvement on test speed for example. I have seen this called out as something that specifically needed to be improved with the WHO tests, they are not "10 minute" type tests.

But leaving us with no testing for two months is unacceptable. Preventing anyone else from taking a turn at the brass ring is also unacceptable. That's the problem with the CDC's "testing decision" here. If they wanted to develop their own test, they could work on it in parallel while deploying the tests that we had.

IMO this was likely a top-down decision to try and "keep our numbers low" as it were. The President has been obsessed with not spooking the stock market with scary numbers going up, and the "fix" for that is not to do any testing at all. So he stalled the CDC from deploying testing and sent them off on a wild goose chase.

Small correction: It wasn't the CDC preventing other tests from being used -- that's not their job. It was the FDA.

Anyone with a table top PCR machine could have been running tests. CDC/FDA were actively preventing folks from doing their own tests.

Yup they shut down the folks in washington after they started getting positive results!!

We need to look forward here. It's way too early for a retrospective.

And let's have some humility here. No matter what such a retrospective shows, it's pretty hard to learn any real lessons from this kind of thing. We will almost certainly just overfit our institutions to fight the next coronavirus; I doubt we will better at handling crises in general.

It's still possible that the US will have a reasonable outcome. Let's do what we can to make that happen and make use of our advantages. More cars and less public transport may make physical distancing more effective.

One of the issues is that the initial CDC test was overly complicated.

>On Wednesday, under pressure from health experts and public officials, the CDC and the FDA told labs they no longer had to worry about the portion of the test intended “for the universal detection of SARS-like coronaviruses.” After three weeks of struggle, they could now use the test purely to check for the presence of COVID-19.

https://www.propublica.org/article/cdc-coronavirus-covid-19-...

Months? This is going to haunt the US for decades.

I'm also surprised that there isn't more talk about the sensitivity of the standard nasopharyngeal swab + RT-PCR. When the FDA approved it, they showed it's extremely accurate... if you use swabs saturated with the virus at various concentrations. Then I read about the poor (70-80%) sensitivity in the real-world, which isn't suprising considering you (1) have variably expert technique in positioning swabs into uncomfortable body spaces, and (2) apply it to people at various stages of the disease with low viral shedding initially and also at end stages. Apparently you can swab two different areas and may raise your sensitivity 10% to 85%.

So if you are "negative" with say a 80% sensitivity, that leaves a lot of room for actually infected people to think they are in the clear. There's a reason why screening tests need to be highly accurate. I'm all in favor of at least recognizing the positives and quarantining them, but with a high R0 disease, the false negatives could be a problem.

If the reproduction rate is 10, and you catch 70% of cases, then the effective reproduction rate will be closer to 3. Since even the highest estimates of the basic reproduction number are only about 4, a test that's 75% accurate means an effective reproduction rate closer to 1.

Are you aware of the difference between 4^x and 1^x?

Since you are being snarky:

Are you aware that the sensitivity quoted was mostly in symptomatic and hospitalized patients and not those in the very earliest stages who could also be shedding less virus?

Are you aware that each false negative can infect N others, some of whom might have also been previously tested, and also be greenlit to deal with high-risk populations like nursing homes?

Are you aware that your 4^x vs 1^x comparison assumes that in that chain everyone is tested, which is not even close to the case now.

My favorite game.

Are you aware that the test can be improved by training medical personnel on sampling technique?

Are you aware that tests will, as a general rule, improve?

Are you aware that the majority of people understand the difference between 70% and 100% accurate?

Are you aware that public policy was affected by poor data on the spread?

Are you aware that it's far easier to successfully test [nearly] everyone in the chain when the number of cases is small, like it would have been when this test was initially available?

The _only_ way this can be contained is through massive lockdowns. If tests were performed _as soon as possible_, then there's a good chance we could have done a good job containing it through contact tracing. Even if that weren't the case, it would have given our medical system several extra weeks to prepare for the case load. It would have given our politicians better data to enact policies.

So after you try to belittle me about not understanding 4^x vs 1^x, you are now talking about future efforts, hopes how an entire medical community can be retrained, etc. Let's stay focused on the real world and not some hypothetical past where we were like South Korea. None of your comments apply to a 1^x spread in the current system since we aren't testing many people, and in hot spots, we aren't testing hardly anyone outside those in hospitals.

Here's where we agree. We agree that the only way this can be contained is massive lockdowns, and I believe this particularly true in the face of unreliable and unavailable testing. I also think it has to be coordinated across the country to prevent constant reseeding. We agree that testing everyone would've been good, particularly in the containment phase, but that ship has sailed.

My original point is that under the current system where we are occasionally testing the public at large, and also using swab RT-PCR just after suspected infected contact (way before symptoms like Pence, etc), the variable sensitivity is troubling.

It's like talking to a brick wall. Medical technology is approximately monotonically increasing, so it's absurd to think the test we cobble together in the first month won't be improved upon. The CDC FUCKED UP. I expect careers to be finished. I want a criminal investigation, just in case of corruption, and I hope some people lose their license.

But even in the current environment, testing is important. It guides public policy, and it helps doctors triage patients in serious condition. It still helps to limit the spread, and will do so even more when testing overtakes the infection rate (aided by lockdowns). If testing improves, then it could cut weeks off a global lockdown, because the long tail will die that much faster.

Not everyone is a neckbeard with a programming job who can live in a basement for two weeks without a single human contact, so anything that helps extinguish this disease helps. Now if you'll excuse me, I should go shave.

> It's like talking to a brick wall.

Yes, it certainly is. Did I ever say we shouldn't test? Did I ever argue testing couldn't be improved? Suggest you argue points that were actually put forth instead of using straw men arguments. Re-read the last line of my original post. I'm all in favor of trying to find positive cases.

Brick. Wall.

>Re-read the last line of my original post.

Still wrong. Reread the second to last line of your original post.

>There's a reason why screening tests need to be highly accurate.

They don't. That's the point. It doesn't need to be 99.9% accurate unless the disease is so aggressive that you're all dead anyway.

There's the contention. The goal is exponential decay, and the only scalable method is to reduce the reproduction rate. Even if you don't drop below 1, a smaller exponential still grows exponentially slower.

Screening tests need to be highly accurate OR you need to be fully aware and manage the fallout from false negatives, which is the point I'm making. First, screening tests have costs, that's why many diseases don't have screening tests. It's what's drummed into us in medical school. Sometimes the medical community backs away from a screening test like has been done in many areas with prostate exams. The cost/benefit isn't worth it. One cost in the COVID case is use of PPE, health care worker time, and test availability hence why CA is backing away from broad testing to triage tests to in-hospital use. Another cost is the possible grouping of symptomatic patients together as they wait for tests. Sure, if rollout can be perfect this isn't a problem, but medicine is about what happens in the real world where delivery is not perfect. By the way, NYC and CA medical community is saying the cost/benefit isn't good enough for broad COVID screening at this time. I'm sure you know better because you know the math of disease spread and are completely unable to grok other reasons why'd they do that.

Second and less talked about, there are consequences of a false negative population which is NOT handled appropriately -- like not letting people know if they test negative they STILL should stay away from high-risk population or take precautions like you still could be infected. That directive has been circulated a little but most people I've seen don't know that. The news reporters don't ask Pence about serial tests. They seem satisfied he had one negative test.

Once again, and I don't know how many times I have to say this, I'm not against widespread testing of the current RT-PCR swab, particularly if we had lots of tests, didn't have PPE shortages in the area, and guidance was given to all those receiving results. Your contention that accuracy doesn't matter is incorrect. It matters because false negatives matter and it's great to do testing to decrease the spread, which is pretty obvious, but you absolutely need additional management depending on accuracy. Like not setting the standard of working with high-risk patients as a single negative test. They need to be tested serially and hopefully get a more accurate test for nursing home workers in future. Like not assuming Pence isn't spreading disease because of a single negative test. He could be one of the many asymptomatic infected. This has been my point for this entire thread. I'll leave you to argue something different.

Admittedly, America dropped the ball, tripped over it, and broke it's nose.

However, lets not forget that the WHO was also wildly irreaponsible by not declaring this a pandemic sooner.

How have they been "wildly irresponsible"? Placing a label on the whole crisis is a rather symbolic act. Important was and is to spread the available knowledge, tests, and know-how.

Symbolic acts such as the labeling in question are how many laypersons interpret. and react to the severity of a crisis.

But saying that there was no proof for human to human transmission [0] in mid January when china was already going ramping up containement efforts was negligent imo. They were the only international observers on the ground and it's hard for the rest of the world to prepare itself when they tell you that you basically don't have to.

They shouldn't have just relayed whatever early study came out that was most likely trying to play down what was happening there. And if you add up their mysterious 'typos' and their other efforts to please/appease the Chinese government, the WHO comes out of this with little credibility left

[0] https://twitter.com/WHO/status/1217043229427761152?s=20

I've embedded the tweet in wikipedia's timeline of events (I've trimmed the events).

https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%932...

31 December

On 31 December 2019, China contacts the WHO and informs them of "cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan"[37]

2 January

On 2 January, 41 admitted hospital patients in Wuhan, China, were confirmed to have contracted (laboratory-confirmed) the 2019-nCoV (Novel coronavirus); 27 (66%) patients had direct exposure to Huanan Seafood Wholesale Market.

6 January

On Monday, 6 January, the Wuhan health authorities announced they continued seeking the cause but had so far ruled out influenza, avian influenza, adenovirus, and coronaviruses SARS and MERS as the respiratory pathogen that had infected 59 people as of 5 January.[52]

9 January

The WHO confirmed that the novel coronavirus had been isolated from one person who had been hospitalised.

11–12 January

In China, more than 700 close contacts of the 41 confirmed cases, including more than 400 healthcare workers, had been monitored, with no new cases reported in China since 5 January.[36][50][63][71] The WHO published initial guidance on travel advice, testing in the laboratory and medical investigation.

14 January

World Health Organization (WHO) @WHO Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China.

14 January

On 14 January, two of the 41 confirmed cases in Wuhan were reported to include a married couple, raising the possibility of human-to-human transmission.[74][75]

On 14 January, Maria Van Kerkhove, acting head of WHO's emerging diseases unit said that there had been limited human-to-human transmission of the coronavirus, mainly small clusters in families, adding that "it is very clear right now that we have no sustained human-to-human transmission"

18 January

The Wuhan City government held an annual banquet in the Baibuting community celebrating the Chinese New Year with forty thousand families in attendance despite the officials' knowledge of the spread of the Wuhan coronavirus. They shared meals, plates and ate together.

20 January

On 20 January, after two medical staff were infected in Guangdong, China announced that the virus was human-to-human transmissible.

To the degree that the WHO was wildly irresponsible - and I'm not I'm ready to apply the "wildly" part, it was publishing the terrifying 3.4% CFR when there was no basis for caluculating a denominator at that time.

Even though they've been called out on that by one of the world's foremost experts in the area of research reliability [0], and even though every subsequent study [1] [2] [3] [4] has shown the CFR to be far lower, the extreme measures based on this being a once-in-a-century coronavirus are not only still in place, but being expanded as if that number is still reality.

0: https://www.reddit.com/r/PrepareInsteadOfPanic/comments/fl08...

1: https://www.cebm.net/global-covid-19-case-fatality-rates/

2: https://www.nature.com/articles/s41591-020-0822-7

3: https://sci-hub.tw/https://doi.org/10.1136/bmj.m1113

4: https://www.sciencedirect.com/science/article/pii/S092485792...

People keep repeating this idea that there's no basis for guessing the denominator of the CFR. This is silly.

The denominator of CFR is the number of people positively identified as having the disease. This isn't something that needs guessing.

The problem is that the general population doesn't understand that you can't project from a CFR at one instant in time to the actual fatality rate in the population.

But there's no need to criticize epidemiological terms of art just because people don't understand them and/or misuse them.

You are responding to arguments that nobody (at least that I've seen) are making.

This has nothing to do with terms of art. The WHO used the CFR at a moment when every expert was pointing out that the vast majority of cases were unknown and unreported. If the WHO wanted to publish a specific report, outlining their methodology, and including the (not very useful) CFR, that'd have been fine, and in keeping with what we might expect from the practices of a world-class public health organization.

But they didn't. They held a press conference, intended for the general public, during which the director read a prepared statement that said, "Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected," with no further clarification of what those numbers mean or what it means to compare them in this fashion.

> The problem is that the general population doesn't understand that you can't project from a CFR at one instant in time to the actual fatality rate in the population.

I don't think this is the problem. I think that the problem is that the WHO chose to use this number without explaining it, and used it in a comparison that makes no sense.

> But there's no need to criticize epidemiological terms of art just because people don't understand them and/or misuse them.

Just to be clear: you are criticizing John Ioannidis for his lack of understanding of the terms of art of epidemiology because he thinks that the WHO press conference was misleading? Do I have that right? How exactly do you suggest he frame his argument so as not to run afoul of this rule?

Do you make the same argument of all of the experts around the world pointing to "the denominator problem"?

Sure, there's a sizable denominator problem. That people misunderstand what CFR is is a problem, too.

If we want to know how lethal the virus is, we need sampling of who actually has contracted it, which is tough in the early stages of a pandemic.

> If we want to know how lethal the virus is, we need sampling of who actually has contracted it, which is tough in the early stages of a pandemic.

But several studies have done the best job possible, given different pieces of the dataset, to arrive at a more accurate IFR (see the links in the above content).

I haven't seen anybody, in any published paper, defend the 3.4% as a likely indicator of the actual fatality rate.

So why are we still crafting policy as if this virus is between 10 and 100 times more deadly than it actually appears to be, according to the best data available today?

Because it becomes 10x or so more deadly when proper care is not available, as is happening in areas where too many people have it at once. Letting this run wild would cripple hospitals. Many NYC area hospitals are already out of ventilators and that situation is just ramping up.

> Because it becomes 10x or so more deadly when proper care is not available

Source?

> Many NYC area hospitals are already out of ventilators

I don't think that's true. The governor predicted it last week, but it hasn't happened yet, right?

I can't find evidence of this happening in any hospital, much less many hospitals.

When they tried testing in NYC they got sick people to stand in line with people who just think they might be sick, which causes the not sick people to be sick.

Yep, there's something that just screams "wake up and use your head" about that. It happened in Australia as well. Have people just lost their ability to think?

I wonder how many people got sick while panic buying toilet paper.

AFAICT "panic buying toilet paper" is mostly constructed bullcrap arising from the facts that:

* Essentially everyone needs toilet paper * Places don't stock that much so it sells out quickly when people pull forward their next week or two of purchases * toilet paper is extremely bulky so it makes for good pictures of loaded people (even when they just have one jumbo multipack) and empty aisles

In most of the pictures I've seen claiming to show "panic buying toilet paper" showed each party with similar or less toilet paper than I purchase at ordinary times (e.g. the big costco pack) for almost everyone in the frame.

Worse, the net effect of circulating these sorts of things shames people for taking the actions they need to take to avoid continually going out.

The smart countries are using drive-through testing.

In NYC more than half of the population doesn't own a car.

I guess taking an Uber isn't the best idea.

Maybe the driver would give you a bad rating if they have to drop you off a drive through test facility.

In practice, you can walk through too -- or have a friend swap you at home (at-least that's being contemplated some places).

Simplifies testing: just take everyone who stood in line more than two hours and give them a slip of paper that says "Positive".

:-/

From the New York Times:

"Peter Hotez, an eminent vaccine scientist at Baylor College of Medicine, told me that he and his colleagues have a candidate vaccine for the coronavirus but still haven’t been able to line up sufficient funding for clinical trials."[1]

This scientist was involved with developing a SARS vaccine. It never went to full clinical testing because the disease disappeared before the vaccine was ready. Hotez is also politically unpopular in some areas because he publicly takes on the anti-vaxers over measles vaccination.

VCs: now there's an opportunity.

[1] http://archive.is/skGAe#selection-1219.0-1219.231

The CDC is still instructing healthcare providers NOT to test UNLESS a person has either come into contact with a known COVID-19 carrier OR recently traveled abroad. Otherwise, the guideline is "do not test."

I am married to a healthcare provider. Nevermind clinical judgement, context, or an abundance of available tests. If you don't meet the above guidelines, my spouse is being firmly instructed by the clinical practice manager to follow the CDC guideline: do not test.

Someone needs to update your clinical practice manager with the info from 2 weeks ago:

https://emergency.cdc.gov/han/2020/han00429.asp

Thanks for that, I'll be sure to pass along.

To add insult to injury all those CDC-developed test kits nobody was using because they were faulty actually were perfectly usable the whole time.

https://www.businessinsider.com/cdc-coronavirus-testing-erro...

We're witnessing the fall of the Roman Empire. CDC just implements the will of healthcare bosses who want to take the most of it before this card house falls apart. In the corporate world this is called the phase of creative destruction.

Does anyone know actual facts about testing in the US?

Yes, the CDC's tests were flawed, but ...

1) Other countries don't have a problem testing millions of people, so why doesn't the US use the same tests they do?

2) 3.5 weeks ago the Trump admin promised 1 million tests that week with many more to follow soon thereafter. After all this time they still haven't materialized, so what happened to the million tests?

3) Is there any reliable data on tests given by day, by city or state in the US today?

4) Is there some kind of struggle among different people or agencies in the US government, some wanting more testing and others trying to suppress testing?

Literally no country has tested 1 million people, let alone millions.

> no country has tested 1 million people

Well, the country prepared for epidemics just didn't have to test one million people, but still kept it under control:

https://www.nbcnews.com/news/world/how-south-korea-flattened...

They were indeed able to use their tests more efficiently than any other country, and to really do a lot of tests compared to any other country:

https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=00...

348,582 tests up to now.

Yes, they appear to have done a phenomenal job. Hopefully the rest of the world can learn from some of the things they've done.

that's the important thing, take what worked, learn from it, and don't make the same mistakes again.

Wouldn't it also help that South Korea is 1/7th the size of Texas so it's a little easier to test everyone? It also helped one company mass produced tests

It's about priorities.

The US spends 15 times more money for military than South Korea but is still not able to comparably protect itself from a single epidemics. Instead, the U.S. citizens get what I've cited in another message here: "It will magically go away."

I wouldn't be so angry if that attitude haven't been contagious -- a lot of leaders of the U.S. NATO partners simply "followed the leader" and continued to sell similar story to their own countries.

Now the whole world is where it is.

The US benefits from economies of scale. We just choose not to implement public health infrastructure.

South Korea has twice the population of Texas (51.7M vs 19M). Alaska is twice as big as Texas, is it harder to test everyone in Alaska than Texas?

The context matters:

https://www.factcheck.org/2020/03/trumps-statements-about-th...

"Feb. 26: “And again, when you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.” — Trump at a press conference."

"Feb. 27: “It’s going to disappear. One day — it’s like a miracle — it will disappear.” — Trump at a White House meeting with African American leaders."

"Feb. 29: “And I’ve gotten to know these professionals. They’re incredible. And everything is under control. I mean, they’re very, very cool. They’ve done it, and they’ve done it well. Everything is really under control.” — Trump in a speech at the CPAC conference outside Washington, D.C."

Let's face the truth: that was the main problem.

FDA, CDC, etc., are a massive bureaucratic flywheel, and pay little attention to whoever is in the Whitehouse.

I'm not sure I'm a fan of Trump's messaging, but I'm under no illusion that it made any difference at all in this.

SK reformed their pandemic response in 2014-2015, the rest of most developed countries left their old plans in place.

I am amazed that anyone expected the CDC, FDA, or other Fed, state, local public health bureaucracies to spring into action doing the best right thing.

They are government bureaucracies that historically bumble around, waste resources, act slowly, are led by career bureaucrats, and so on. Just like other large bureaucratic organizations, expecting them to work in times of crisis is unrealistic.

The CDC and FDA had a plan in place -- developed long before Trump took over, they executed that plan. Unsurprisingly, the plan under produced and came in behind schedule, like many government programs. It is unrealistic to think anything else would have happened.

We have all witnessed government agencies big and small completely drop the ball when it counts. This time is no different.

Wait are you really blaming Trump because he made stupid comments?

I'm surely don't believe that he is some exception, i.e. that he was the only one being stupid. As I see it, the presidents (and the prime ministers) represent the sentiment of the system, the power structures and the voters.

The system he and his equivalents across the world represent is based on the premises that it's totally expected to plan spending 1.5 trillion for a single plane, but that preparing for the next epidemics is something not worth doing. To quote why there are already not more resources allocated in, for example, being prepared to produce more vaccines or contain the epidemics before it spreads:

https://www.newyorker.com/news/news-desk/how-long-will-it-ta...

"there may never be a market for a vaccine at the end of the development process, because the epidemic is contained, or never comes to pass. Then, traditionally, if there is an epidemic, it may take hold in a developing country where the costs of research and development cannot be recouped. “The resources and expertise sit in biotech and pharma, and they’ve got their business model,” Grant said. “They’re not charities. They can’t do this stuff for free.”"

The brokenness of the system that results in all that: the 1.5 trillion plane and maintaining the force and the technology to destruct the whole world on a minute notice, but at the same time not being ready to invest in health preparedness because

"it may take hold in a developing country where the costs of research and development cannot be recouped"

is way beyond stupid. The system which intentionally does nothing to prevent the demise of the world, just because some people expect to profit every time the danger occurs. The same people obviously profit every time a 1.5 trillion dollar plane is being made.

Also as I understand US sets the tone for Europe:

https://www.theregister.co.uk/2011/03/03/eurofighter_nao_ana...

A big part of the world does the same stupidities.

> Other countries don't have a problem testing millions of people, so why doesn't the US use the same tests they do?

Many (most?) countries do have a problem testing people. It's not just the US. I imagine the whole world is competing on some scare resources now and most countries are simply unable to produce millions of these tests (and even masks apparently) in a short time.

The problem is not lack of raw resources, the problem is lack of manufacturing capacity. We had a 2 month lead-up time to get that capacity in place, and we didn't lift a finger.

The US leadership has been deniers of science, and of reality, for quite a long time. Decades.

I know that HN tries to shy away from politics, but this shows that politics has a way of intruding into even the most technical of areas. Large parts of the US seem to be willing to vote for folks who are not reality-based, and it is a problem for making progress.

A lot of the other comments even right now are also deflecting from the topic being discussed - "what good does it do?". It shows how much HN doesn't even want to criticize this particular issue about the government. It's a root cause analysis and anyone who's been on call knows that if you want to avoid repeating this issue again, you have to keep notes/metrics/data while still working on fixing the issue.

This is going to drive future pandemic prevention and response. We better get this right. The death rate and demographic impact of this virus means humanity is not going to be wiped out. The next one could be more severe.

According to this[1] about ~350k tests have been administered as of today.

[1] https://covidtracking.com/us-daily/

Probably because there is a shortage of tests, so they want to save the tests for people who are most likely to have contracted the virus.

Can you design a test for this virus that scales out to over a million people in two months? If so, you should start working on that.

My spouse was being fed outdated information. Latest testing guideline is here:

https://emergency.cdc.gov/han/2020/han00429.asp

How many deaths per capita for US versus other industrialized countries?

Deaths per capita will be most important at the end of the pandemic. Right now you're better off looking at case-fatality-rate, day over day rate of new cases, and the current number of cases.

Right now the US is at 52K cases and ~650 deaths. That is ~1% fatal, but that can decrease by more testing or increase because it takes time to die. Currently 0.01% of the US has tested positive and 0.0002% of the US has died. The worry is that those numbers double every 2-3 days and will cause an unprecedented spike in the number of hospitalizations.

You can try predicting the number of deaths by looking at a semilog plot: https://www.ft.com/coronavirus-latest

US is 18th in deaths per capita.

(And falling.)

In a thread criticizing the US, it is odd that this simple fact isn't mentioned. Or, alternatively, the importance of the fact is minimized.

(Even more odd that the US per capita death from covid is less than U.K., Netherlands, France, Sweden, Denmark and many other countries whose health-care systems are routinely praised on this site.)

Because the virus is spreading exponentially, the rankings for per-capita cases/deaths are going to be highly dependent on how long the outbreak has been going on in that area. Is the US's health care system worse than Palestine, Honduras, Cuba, and Pakistan?

I see you're using https://www.worldometers.info/coronavirus/ for your rankings. The per-capita rankings are very sensitive to small populations. I think these 9 should be considered outliers:

San Marino (basically Italy): 21 deaths; Andorra: 3; Cayman Islands: 1; Luxembourg: 9; Iceland: 2; Channel Islands: 1; Curaçao: 1; Norway (half the pop of Sweden, but the cut-off has to be somewhere): 14; Slovenia: 6.

That leaves 10 places which I agree are currently doing worse in deaths per-capita: Italy, Spain, Iran, France, Netherlands, Switzerland, Belgium, UK, Denmark, Sweden; and 5 places doing roughly the same: Portugal, Austria, Germany, Ecuador, Greece.

However, the number of deaths per-capita is doubling every 3 days in the US. If we do 3 days worse then other countries, we'll pass Denmark and Sweden. A week worse and we'll pass the UK. 10 days and we'll pass France, Netherlands, Switzerland, and Belgium.

>The per-capita rankings are very sensitive to small populations. I think these 9 should be considered outliers:

I agree.

Time will tell about the final rankings.

But, the US health-care system is far more robust and creative than many of these other systems.

Health-care COST is a legitimate debate. But, at the end of the day, when it comes to care, you are generally far better off in a US hospital than one of the others.

In any case, we shall see...

There are two ways to react to this:

* React to protect people, this is what Europe is doing.

* React to protect large businesses, this is what the US is doing by trying to prop up the market, lie to the citizens about the dangers, actively block testing.

The CDC screwing up wouldn't have been so bad without the FDA. I'm just going to quote Scott Alexander here[1] (supporting links in original):

"No problem so bad overregulation can’t make it worse:

So far the government has bungled its coronavirus response pretty egregiously.

Most hospitals have the equipment in house to detect coronavirus. But the FDA banned them from using it. They said all coronavirus tests needed FDA approval, and refused to approve anything except the official test made by the CDC.

Unfortunately, the official CDC test was defective. The test itself worked, but one component in the test kit was broken. Most hospitals had their own supply of this component and could have substituted it in, but the way the FDA approved the CDC test banned them from doing this.

The CDC tried as hard as it could to fix their broken tests quickly, but they weren’t able to do it fast enough to satisfy demand. In order to ration the scarce tests, they mandated that hospitals only test people who had recently been to China, or been in close contact with someone who had.

This was a disaster. For example, here’s a story from a person who traveled to Japan, where the coronavirus is active. He came back to the US, started developing symptoms, and went to a hospital. The hospital said since he hadn’t been to China, they couldn’t test him, and sent him home (he voluntarily quarantined after discharge, so thanks).

But even worse, the policy ruled out by fiat ever being able to detect when the epidemic spread to the US. So in mid-February, when a patient with no history of travel to China came to a hospital in California with coronavirus symptoms, the doctors had to ask the CDC for special permission to test. The CDC dithered for four days before granting the permission, during which nobody put any work into containing the disease. Finally the test came back positive – after some health workers had already been infected.

There were many points where this could have been avoided. A better CDC could have made tests that worked from the beginning, or ramped up production of working tests faster, or come up with smarter criteria for rationing tests. But it would have been even better to have a system where things don’t have to go perfectly, and where a few mistakes don’t choke up the entire response to an epidemic for weeks. If we hadn’t let our culture reach the point where governments ban things by default and review at leisure, and where individual iniative is frowned upon in favor of waiting for official permission to do the right thing, we could have recovered from all of these mistakes. Hospitals would have used their existing tests which they already have more than enough of, doctors would have had permission to test suspicious cases at their discretion, and we would have had a chance to catch infections early before they could spread. If the government didn’t already regulate adrenaline, buspirone, insulin, and genetic testing to the point of near-unavailability, maybe people would have thought it was weirder, or raised more of a fuss, when they started doing it for coronavirus tests.

If you don’t trust me, trust former FDA director Scott Gottleib, who explains the situation here in an unusually candid communication from an ex-government official talking about his former agency. His Twitter feed is a great source of information in general.

And here’s a more careful analysis of some of the laws around diagnostic testing and how they contributed to the current crisis. And by more careful, I mean it ends with “Bottom line: the FDA is going to kill us all”."

[1] https://slatestarcodex.com/2020/03/02/coronavirus-links-spec...

This article does not mention the WHO offered tests to the US before the CDC decided it should make its own[1]. This alone should have been enough to bring impeachment charges against public officials, for criminal neglect.

If the WHO had proven these in China, and you have no other alternative, it make sense to do both 1. buy tests you know are in active use and 2. make your own tests if needed.

Someone at the CDC must have been asleep or was ignored. China was shut down for weeks, the port of LA didnt have 25% of its normal volume in February and the WHO was shipping tests to over 60 countries _at the end of February_.

EDIT#1: I also emailed Dr Fauci a full week before about the short sightedness of allowing cruise ships to continue operating and while he was claiming "if you are healthy, they are fine". His office returned my mail a few days ago with a blanket "Dr Fauci is busy, and appreciates your comments" email.

EDIT#2: There is a more nuanced version of this discussion in the comments below. It is technically not correct to say the "WHO offered the US tests", the more technical distinction would be the "WHO supported leading research from Berlin, and the CDC did not. This decision lead to a delay in tests that did not have a higher number of false positives... (etc). The US generally has resources to produce these tests, and would not rely on the WHO." Either way, a test existed and the US could have chosen to take a more conservative stance by adopting the research and producing its own simulatneously. The Chinese economy was shutdown.

[1] https://www.politico.com/news/2020/03/06/coronavirus-testing...

To clarify. The WHO did not offer the US tests. The Politico article just says that the US was not on the list of countries it offered tests. It never offers the US tests, because it has national labs that can make their own tests. The WHO only gives tests to countries who do not have a national infrastructure of their own to build tests.

But the WHO did recommend the Berlin tests, as it had no false positives, and was quickly able to isolate the virus from other coronaviruses, something the initial CDC test was not able to.

https://www.politifact.com/factchecks/2020/mar/16/joe-biden/...

Just as additional information for anyone interested, this is the paper about the development of the test distributed by the WHO:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988269/

This was published on January 23, and it contains all the information you need to establish this kind of test in your own lab. And while I'm not an expert in this area, the controls done to ensure avoiding false positives based on other viruses seem pretty thorough to me. And this validation is the part that I would suspect to be one of the more time-consuming and important aspects.

What’s your point? The WHO lost all credibility.

As late as January 14, 2020 the WHO tweeted that there is NO evidence of human to human transmission of covid-19

https://twitter.com/WHO/status/1217043229427761152?s=20

"Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China," - WHO.

Sounds like these were preliminary results, which would have been well rectified by February. Wuhan was under quarantine Jan 23.

There is a substantial difference in being wrong a month or so after a new virus is discovered, and being wrong after a country has been shutdown for nearly a month.

EDIT: Updated for correct date Jan 23, not Jan 29, of Wuhan shutdown.

Wuhan was under quarantine on Jan 23rd.

Precisely. I don't understand why the WHO would put out such information with reckless disregard of current events.

I'm guessing based on the other reply that you corrected the date. But how does WHO repeating a statement from Chinese authorities (attributed in the tweet) have anything to do with the WHO's credibility?

Nothing. "The WHO has lost all credibility" is a line that was parroted in every troll comment in February and early March; I guess this one hasn't yet gotten the memo, or maybe it's a bystander that's bought into it.

It's amusing how some people are reacting on a one-month or even two-month delay. I still see people saying that there's a new disease being covered up in Wuhan, or that we need to shut down travel from China, as if they were in a coma from mid-January all the way to late March. The actual situation changes faster than people's narratives of it.

Both the WHO and the CDC have (deservedly) lost trust with the public.

I don't see any evidence in media or conversations that anything of the sort is true. If anyone has looked inept in the eyes of the public its potentially the federal administration in the USA. But what blame does WHO shoulder?

WHO appears to have been fairly well in front of this pandemic as soon as the evidence began to support it. The White House was in full denial/hoax mode until the end of February.

There is huge difference between "no evidence of human to human transmission" and "evidence of no human to human transmission". The former means, we don't know yet. You can blame them for not knowing. But admitting that was right. And when they knew, they told everyone. At least in this instance, they haven't lost any credibility. On the contrary, it shows integrity to admit your limits of knowledge.

They knew it all by Jan 23rd

Perhaps the most responsible thing to do is to buy the existing tests, start immediately making your own, and then offer the tests to others the moment supply exceeds demand.

You get to save people first, and save face later.

Can we stop threatening criminal negligence charge for every single mistakes people make?

It's not going to improve performance in the next pandemic if people are afraid of doing their job or engages in ass covering.

Accepting any kind of help in a crisis seems reasonable.

Uhm, yes, skin in the game?

Things generally don't improve because people get better. Things generally improve because bad people/groups/corporations/ideas fail.

Way more people should be fired / tried / impeached. Need I remind you that nobody went to jail over 2008? It does make the system more healthy. If you're responsible for the health of some country you better be scared, because the consequences are dire, and your decisions are of utmost importance. I want that person to be on constant lookout for problems, bordering on desperation.

Things generally don't improve because people get better. Things generally improve because bad people/groups/corporations/ideas fail.

Things improve when we endeavor to make things better and test our ideas and willingness to learn from mistakes, especially so if we prioritize pandemic preparation.

Punishing people for their mistakes lead to people hiding their mistakes, not trying their damn hardest not to make a mistake, especially since mistakes are probably inevitable in a complex and evolving situation like a potential pandemic.

I think people who mismanage situations should be fired. We fire our POTUS roughly every 8 years. My mgmt has made decisions during the pandemic that have endangered me and my coworkers. I think they should be fired as well.

That's effectively the complete opposite of how to actually eliminate errors. The way engineers do it involves depersonalizing it to get away from blame games, assessing all contributing causes, doing proper risk modeling and working to improve the systems so that they rely on human frailty as little as possible.

Skin in the game is an easy concept we're all familiar with, but it generally leads to adverse behavior like gaming the numbers instead of fixing the problems.

See, e.g. http://www.hazardcontrol.com/factsheets/principles/core-prin...

---

"Herein, the term “unsafe condition” is retained, but the term “unsafe act” is rejected as historically leading to error or incomplete cause analysis.

Rather, inappropriate human actions or inactions of persons that contribute to accidents (resulting from error or human nature associated with the common relevant human factor capabilities and limitations of men and women) are called “unsafe actions,” defined as unsafe system use methods and procedures, without any initial implication of fault or blame."

I think you're mainly describing the optimal culture for the organization or workplace, but either collectively or perhaps even just the leaders, they must recognize the importance of their decisions and the possibility to cause deaths. That's why research like what you mention is important, it shows how organizations and leaders with "skin in the game" can achieve success.

I don't think the concept is easy for people to understand at all. It's just darwinism really, but people think it's about punishment. Note that darwinism doesn't just reject bad ideas, it has a rather high and variable false positive rate. I.e. it's unfair, for example Ramanujan died prematurely despite being a genius and a gift to his species. But it is overall also quite effective.

If you can game the numbers there's no real skin in the game. And people do! Just sell volatility ("everything will always be fine") regardless of the conditions, it will work wonders, until you blow up. The difference is that if you blow up your own money you cannot continue the game, whereas if you blow other people's money - you can.

You seem to believe that "skin in the game" guarantees the survival of the fittest leaders. This is only true assuming that the selection criteria are good ones and ones that cannot be cheated.

As long as anyone is capable of gaming their numbers, it floods out honest people in favor of cheaters. It's very powerful at selecting for whatever your metrics are. When you have the wrong metrics or ones that can be cheated, it's very powerful in an extremely bad way.

In addition, the general public and the media are absolutely not good at this, or we would have far better leaders than we do.

Engineers create systems where individual vigilance is less disastrous, or where vigilance is augmented. The real world and tech world still does rely on brute-force responsibility sometimes, to cover the gaps in a plan where the details were left out.

Exactly, the complexity of the "real world" far exceeds that of what a typical engineer deals with. This requires more darwinian, rather than cerebral, processes, simply because human brains are too small to understand all consequences.

Nothing about safety modeling requires that we understand every risk in the model. I don't understand how you think that, e.g., aviation safety modeling doesn't have to deal with the real world or with real people who do stupid things. It's true that we're probably less able to control all the risk factors in some cases, though, but nothing prevents us from understanding them or doing what we can to make better systems for future pandemics. E.G. we could come up with a better plan for testing and perhaps better ways to share (or leak?) data on new diseases.

The fact is that the public are terrible bosses. We look for people to blame, we're inattentive and have no idea, generally, how to evaluate things on actual metrics. We have no idea which metrics are being gamed and the people who do are actively gaming the metrics and flooding us with cherry-picked information as well as disinformation, though the former is probably more dangerous and more widespread.

The average person in the public will be satisfied as long as we blame some random politician instead of looking for structural reform. E.G. maybe we should adopt Japan's culture of using masks in public when sick, require employers to guarantee minimum standards of sick leave, and change various hospital/ER waiting room practices.

> Need I remind you that nobody went to jail over 2008?

First, this is simply false.

Second, can you name anyone who should have gone to jail and state the law they broke?

Congress had eliminated a lot of regulations that could have prevented or tempered the meltdown. There were not really laws to break. And the population happily kept electing said people.

The electorate had skin in the game. And they did not learn.

Skin in the game is not that effective.

"packed churches for easter" is pretty much round2 for haunting for months to come.

This is like a massive IQ test for the country, we failed.

These "leaders" didn't self-anoint, they were put there and sustained.

When China announced they had a mystery virus, travel from China should have been stopped.

When China locked down their country, travel from China should have been stopped.

When community spread was detected in Washington state, the U.S. should have been locked down.

Testing wasn't the problem.

All of those things are true, but that doesn't change the fact that testing is the problem.

That's a very good illustration of the danger of demagoguery. If someone not already in the habit of looking for any reason to keep foreigners out proposed it, maybe it would have been taken more seriously.

> When community spread was detected in Washington state ... Testing wasn't the problem.

If you detect community spread without testing you are too late anyway.

Not for the rest of the country

You are two weeks behind with testing. There is no rest of the country anymore.

People are blaming trump and while I'm no fan, the cdc is an embarrassment. How many decades did they have to prepare for disease control?

Didn't the Trump administration slash CDC funding?

This claims so:

https://www.businessinsider.com.au/trump-cuts-programs-respo...

And here we have him saying "I'm a businessperson. I don't like having thousands of people around when you don't need them," Trump said. "When we need them, we can get them back very quickly."

https://markets.businessinsider.com/news/stocks/trump-defend...

Not exactly. Again, 1 screen, but folks are seeing 2 different movies.

https://www.factcheck.org/2020/03/dems-misconstrue-trump-bud...

Your link — which you’ve posted twice — doesn’t address the points being made.

It’s a fact that the pandemic response team was cut, and it’s a fact that the White House budget proposal included cuts to the CDC.

1: https://www.snopes.com/fact-check/trump-fire-pandemic-team/

You should read the factcheck.org link more carefully, as it details/addresses these points, and also indicates congress indeed funded (they control the purse, after all) the CDC, despite Trump's proposal.

I hate to be the “we should use metagenomics” guy but we should use metagenomics:

https://en.wikipedia.org/wiki/Metagenomics

Thanks for being that guy because now I just learned about something awesome I’d not heard of.

I just don't see what good is going to come out of worrying about this right now while the world is on fire. Everybody needs to be thinking about how to help in the coming weeks, anything else is a waste of time and mental energy.

There will be plenty of time to analyze what went wrong with the initial response when things calm down. This is just raising the level of angst unnecessarily in my opinion.

If you want to come out of a lock-down without also causing the number of cases to spike again, we'll need to implement a widespread test-and-trace protocol similar to South Korea's. This requires _lots and lots_ of testing.

If you want to come out of lock-down, you really need a different test... you need a serological antibody test to tell if you've been exposed to the novel coronavirus (and thus have immunity from re-infection [0]). The current test can only tell you if you have an active infection. But before we can really open things up again, we'll need to know who is still at risk, and that requires the antibody test. There has been good progress in getting these tests to work, but it's not quite ready for prime-time.

And it will still be quite a while before we have a vaccine which is the ultimate goal.

[0] (assuming you can't be re-infected)

I mean, you're not wrong, if we can test for anti-bodies we can get a better handle on this whole thing in 3 months, especially given the reportedly high occurrence of mild or asymptomatic individuals. That'll give a sense of where we are in total. But no way are we waiting for herd immunity before the restrictions start to loosen.

We very much still need to be able to test for people that currently have it - we're kind of starting from zero every time people come out of lock-down, so we need to test for outbreaks before they happen.

It also requires population participation in testing and that requires making the tests accessible including providing them for free or cheap[1] and without judgement[2].

1. This is currently not the case, Payers have widely agreed not to charge co-pays for tests, but deductibles may still apply and the uninsured will pay the full cost.

2. Hey Trump Administration - you know how you've eroded all the trust and faith of the immigrant community? Yea, that's not so great suddenly (I mean it wasn't great before, but now it'll effect you!). Even legal immigrants have expressed concerns over the census, the chances they'll go to a testing site where there will be LEOs (police certainly, maybe national guard) are slim to none.

It's not entirely clear that some politicians aren't contemplating ending the lockdown and accepting the casualties.

It seems crazy when you run the numbers.

This comment is heavily biased towards a US-centric worldview. Different parts of the world are burning, or burning out, at different rates... so it’s not so much about “worrying about this right now” but “what lessons can one part of the globe learn from another that is a few days/weeks/months ahead”

The article is by a U.S. institute about a problem that only affects the U.S. There's nothing for the rest of the world to learn...they already did it right by using the WHO test.

Several countries are in similar situations. For example Iceland‘s recent order for more tests got scaled back to 2,000 from 5,000. But unlike the US their acting like the situation is worse than it appears to be to try and limit spread.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

Most of the EU countries only test the very sick or dead. Americans tend tu spend too much time on arguing each other, it's too late to get it under control like that anyway.

In any post mortem, it's dreadfully important to capture information while everything is fresh. People writing articles like this now are capturing valuable information that will inform any thorough post-mortem performed later.

The absolutely most useful post-mortems I've dealt with were ones where information wasn't gathered immediately. An outage that occurs on a Friday night is an example of one that will be low fidelity and less actionable. By Monday morning, everyone involved forgets many important details and the proper order of events necessary to get an accurate picture of what happened.

The good is that next week when same issue will be about to happen, people able to push back will be in better position to push back and there will be more pressure on them to push back.

What happened once will happen again.

Why not when you have time to spare?

I personally am trying to spread good information, and push back on misinformation as my part to help, but I feel I am seriously losing that battle at present.

Part of fixing “world on fire” is fixing your mistakes. And honestly, just because the US is on fire (due to lack of effective planning and mitigation), doesn’t mean Japan or other first world countries are on fire.

I'm also trying my best to push back on misinformation, but not feeling like I'm having much positive effect. It feels like there's just a flood of it.

January 14, 2020- There is no human to human transmission of covid-19

https://twitter.com/WHO/status/1217043229427761152?s=20

WHO officials and their Chinese counterparts should be on trial.

Reply on news.ycombinator.com