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Comment by threatofrain | Hacker News Reader

In the end, California and Texas are projected to not exceed ICU capacity, but the most serious outbreak first happened on the east coast and I think that made all the difference for NY, NJ, MI, etc.

It means that states on the east coast would have needed far more acute preparation than states on the west coast. The fact that there could be such a difference in timing implies that this should be handled at the federal level -- or all major cities must prepare to be ground zero, which sounds very inefficient.

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How is that inefficient? If anything preparing major cities to be ground zero for crisis makes sense. Major cities have way more people from way more places, so it makes sense they would be the ones hardest hit by famine/disease/terrorism/etc.

I think the comment is positing that each major city making it's own preparations is inefficient and ineffective. What if the pathogen escapes that city and is now floating around the country?

We got lucky. Covid19, while deadly, is not as deadly as it could be. If we'd run into Spanish Flu, we'd be in a world of hurt right now. The more deadly pathogens out there are just not to be met with half measures. If you're talking Spanish Flu, you don't want to be putting Dallas on lockdown, and still have who knows how many people on the road to Norman, or Tyler, or Nacogdoches. All because they left before the city of Dallas was able to close the city. The city of Dallas would not even have the ability to know where those people are, or where they are headed, or what planes they are on, or what cars they are in. There really are no other options here, if you want to ensure maximum survival, you must have the coordination be at the federal level.

Again, with something like covid19, it probably doesn't make much difference. Sloppiness is not going to kill 10 or 20 percent of your population in the case of covid19. So we can tolerate the kind of Keystone Kops thing we've got going on right now. But if something comes along like Spanish Flu? I'm sorry, but we shouldn't be pussy footing around with a bug like that.

It's states not cities.

and as I understood it the spanish flu was rough but mostly it was so deadly because there were no antibiotics to treat secondary infections. And don't forget about lack of respirators.

Even at the state level, it doesn't work.

If you take the original example, how would the state of Texas know where the kids who drove to Norman, OK are? They would need to, at a minimum, ask the state of Oklahoma. You scale that up and it's obvious that there has to be some mechanism for public health and law enforcement to act across state lines. That mechanism is obviously best implemented at the Federal level.

The government of Alabama can't be diddling about trying to find out who to call in Minnesota when they realize one of their residents left Birmingham just before a lockdown headed for Minnesota. Even worse, if the person was in a car, they'd have to check with every possible state, along every possible route to Minnesota. That's incredibly inefficient. We need Federal control of that stuff.

“ all major cities must prepare to be ground zero” is the more efficient route because they are in the best position to determine what they can do and what nuances exist for their particular place.

You want a strong team of experts (epidemic experts, medial, logistical) at the federal level advising everyone what they should be doing (and perhaps making some federal funding available) and then the city and state responsible for implementing.

Otherwise you get a bureaucratic mess beholden to particular politics (eg WHO). The current version of the CDC is a good plan structurally, just poorly implemented.

> all major cities must prepare to be ground zero, which sounds very inefficient

All major homes preparing to be ground zero, independently, is how you get toilet paper and hand sanitizer hoarding.

Which is fine, as long as they don't all stock up one week before the pandemic arrives in their area. If they prepare in the next couple of months for a pandemic in a couple years, it'll all be ok.

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