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Comment by jefftk | Hacker News Reader

The article is presenting this as some sort of scandal, that we spent a lot of money to urgently build things that we didn't end up needing. This way of thinking about things is why we are generally not well prepared for unlikely disasters: most work you put in will not be needed.

Instead we should see this as really positive: we were working to make sure that if stay-at-home (which has cost far more than $600M) didn't work we would have space to treat people, and then we kept the infections low enough that we didn't need to use it.

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I think the article takes a very balanced stance. It is pointed out multiple times the that people are glad the hospitals are mostly unused, that they now exist if there is a surge, and that the excess bed capacity is very helpful during a crisis like this. The real criticism is nothing like you've paraphrased.

> They praised the Army Corps for quickly providing thousands of extra beds, but experts said there wasn't enough planning to make sure these field hospitals could be put to use once they were finished.

>The Army Corps limited the competition in awarding the projects to speed the process, which usually takes six to nine months, according to agency documents. Officials noted they were able to complete the contract award for the Stony Brook project in a "little more than three days."

>The two Long Island field hospitals were completed in late April. They never opened to the public and didn't treat any patients.

>The plan was for the Javits Center to take patients from overwhelmed hospitals in the city. But in practice it wasn't that easy. Some hospitals complained that the intake process was too complicated. And they sent few patients to Javits — even as they resorted to treating patients in the hallways.

Seemingly like all of the US coronavirus reactions we dragged our feet at multiple points, had no reliable central coordination, and large sums of money was made against the backdrop of human suffering.

the Detroit area "field hospitals" (convention centers) had very strict restrictions on who could be admitted- you had to be sick, but not too sick. In practice only a handful of patients were eligible and admitted before they closed. I am starting to suspect that the whole exercise amounted to a giveaway to the convention center owners who previously were forced to shut down.

And yet the Denver Convention Center laid off the vast majority of their staff shortly after converting to one of these field hospitals.

>I think the article takes a very balanced stance.

Not really. It just does the usual cowardly trick of complaining about something by selectively citing cherry-picked experts. Rather than this quote salad I'd very much prefer honest, direct criticism where the outlet or the authors make it clear what is their stance and why.

That is the responsible thing to do. It wouldn't present opinion as news (as is the case with this article) and it would give a better opportunity for people to respond to criticism.

I prefer outlets that do their very best to attempt to remain impartial and present a "just the facts and all the facts please" view, even if we all know it's not 100% achievable.

I agree with you, this article is not that. If you listen to any economist, healthcare provider, or logistics expert, they will all tell you that this was the prudent choice given the worst-case tail scenario, and that this resource is one that has continuing value for some time.

But this article takes all that information and manages to paint that information in a negative light. It is "an opinion of the author" piece that even manages to express the opposite opinion FROM the expert opinions it reports.

Nothing personal, but I found it a bit ironic that your own criticism of the parent amounted to simply asserting "Not really" without addressing any specific points. You didn't say which experts you would have chosen, and why, and how you know that the author of the article has purposefully attempted to cherry pick specific people. Its one thing to simply dismiss someones work, its quite another to provide constructive criticism with actionable material.

Speaking only of the headline, it should be a banner ad for successful preparation and containment; it should not hint at overkill or wasted money, which it does (unless there actually was money wasted on overkill that the article wishes to expose). Even on a psychological basis, it made the populous feel more secure that the authorities were doing their best to cope. And economically speaking, it's standard economic theory that injecting money into the slowing economy will have a near term beneficial effect beyond just the direct recipients of the money.

That's just the headline, and the people who write the articles famously don't write the headlines, but still, the headline is a bad headline.

The opening is: "As hospitals were overrun by coronavirus patients in other parts of the world, the Army Corps of Engineers mobilized in the U.S., hiring private contractors to build emergency field hospitals around the country. The endeavor cost more than $660 million, according to an NPR analysis of federal spending records. But nearly four months into the pandemic, most of these facilities haven't treated a single patient."

The motivating event is that we're starting to decommission these facilities, but the author instead chooses to emphasize how much they cost and how few patients were treated.

It's also a bit cynical to say "nearly four months into the pandemic", as if there have been four months where the hospitals could have been seeing patients in the US but didn't.

Also, in the big picture this cost is trivial. 660m is less than $2 per person. Compare that to the 3T bailout or so (numbers change so quickly I can't keep up), which is around $10,000 per person.

Its not cynical, if the entire point is to flatten the curve below maximum capacity. Flattening significantly below capacity (or increasing capacity and not using it) only extends the required time in lockdown (based on some admittedly questionably assumptions, but assumptions currently being relied on).

And no matter how much you trivialize costs, it's always better to spend on resources that will be used that ones that won't. Like funding the ERs that are currently dealing with the double whammy of covid patients and seeing only 40-50% of normal patient numbers (and therefore 40-50% of normal income).

Plus we really don't want to flatten the curve to the point where people start losing aquired immunity before we've reached levels for herd immunity. Then it's no longer a curve, but a never-ending line. At least until a successful vaccine is developed.

No, it's not always better spending resources! That sounds like maybe it's a good idea for us to break a few windows.

Better to replace windows already broken than to hoard spare windows in a convention center, then just throw them away.

Funny I wrote a longer response that I trimmed down to just my broken windows fallacy jab where I talked about how building, stocking, and manning field hospitals that remain underutilized is wasting resources, akin to hoarding spare windows.

Well then thanks for teeing-up my response :)

I definitely over-thought it at first, too.

Did we read the same article? It praised the actions of building the hospitals, while stating what you said in that it shows we weren't as prepared as we should be for a pandemic.

>we kept the infections low enough that we didn't need to use it.

The article specifically said the hospitals were needed despite being unused. The problem was existing hospitals didn't have policies in place to use them, so instead doctors were treating patients in overrun hallways while these beds lay empty.

The cost of these field hospitals is negligible and I am not upset about them. But I am upset that the healthcare system seems to have been nowhere near capacity. Which means we are paying the full cost of the lockdown while not getting the full return in term of herd immunity, which we will pay later on with more lockdowns probably starting in fall. In other words we overreacted and flattened the curve too much.

> In other words we flattened the curve too much.

For the first go-around, with minimal available data, that seems like the much better way to err - it would've been very, very difficult to fix a mistake in the other direction. We've got more data now, and can do a better job of toeing the line with upcoming waves.

It's not like we can't unflatten the curve if we really want to.

That is a reasonable objection. But now that we have this data, there doesn't seem to be any appetite to bump up the curve, i.e. it's not about flattening the curve anymore, it is targetting zero infection until an hypothetical vaccine. Very different objective, no debate about it. And no herd immunity.

There's plenty of appetite for opening back up, which'll almost certainly bump up the curve. No one's saying outright "let's have more infections!", but it'll be the end result of the reopening policies.

Even hard-hit NY is looking to do it fairly soon; most of our regions just need more tests and contract tracers hired. https://www.governor.ny.gov/programs/new-york-forward

I am not sure that it is the policy. In the US or Europe, all governments have warned that they would back down from opening up if they see a rise in new cases.

Sure, they're going to have to ride the rollercoaster up and down for a while. I suspect we'll absolutely see further lockdowns; the question is going to be how long we can go before declaring one.

More data is good for determining how far we can let things grow before locking down, but it's confounded a bit by social factors like people getting tired of the bumpy ride and not following them as well after a while.

Moreover, the point of the shutdown was to keep the virus from spreading, and yet the number of cases is still rising in most places in spite of it. As states are talking about reopening, it's just going to rise faster. The article notes that the field hospitals aren't being taken down, in case we need them. Since the spread seems likely to accelerate soon, it seems to early to say "we didn't use these field hospitals."

Yes, I had the same thought. I was actually surprised and happy that we managed to pull that off.

All my life I have had this weird thought: If someday aliens will come down and tell us to move some random huge mountain 10 miles to the left, in one month (it doesn't have to look the same). If we can't do it they will wipe us out. I wonder if we would be able to pull together and somehow do it. And then my mind thinks through all the crazy iterations of ways to start trying. I keep thinking that we will globally waste 2 weeks planning it.

I guess not everyone is threatened by death in Covid, but it does seem amazing some of the things we have been able to pull together during this.

Easy one. We all come together to agree that the mountain will be mapped 10 miles to the left relative to its current position. Everything else will also be shifted slightly to account for that.

An earth-destroying asteroid is the more realistic form of this. We could get anywhere from days to years of notice it was going to hit (if years, it would just be a probable hit) and have to put together our Armageddon/Deep Impact mission to divert it. There are plenty of papers published on what we could do and the idea has had millions of dollars in funding, but it would need billions. We're screwed if the notice period is days, but we'd have a good chance to build something in months.

TBH given the failures of the last months, I wouldn't be surprised if we are completely unable to execute, even if we get a couple of years. A pity.

If people are really upset about this, they should take a look at the US Defense/Military budget.

We prepared for a worst case scenario for a developing situation we knew very little about, and ended up not needing it. This should be viewed as a good thing.

Which is a giant jobs program and subsidizes international trade. Look at how much of it is pork.

Right. This obsession with government is austerity is part of why we're in this mess to begin with: A more robust response in January and February would have saved tens of thousands of lives and could have greatly reduced the scale of any lockdown measures. It would have meant spending tens of billions of $$$ towards testing and tracing infrastructure which in the age of trillion-dollar bailouts seems like a bargain.

I agree but unfortunately that response didn’t happen. We gotta learn a lesson here

Your analysis misses an important point, which is opportunity cost. Every action has costs and putting resources toward one area means taking them away from another.

Hindsight is 20/20. Could you or anyone have said this a few months ago?

EDIT: let me make it clear what I'm saying/implying. Saying stuff about opportunity cost means that you think that this wasn't necessary. Given the fears of overrunning hospitals, I can't see anyone being able to justify not doing this except in hindsight.

No, I’m not saying that it wasn’t necessary. Simply that a more intelligent analysis would have factored in various costs and benefits, as well as the likelihood of actual events vs. perceived ones. Every action has unintended consequences, but this simple fact seems to have been total forgotten with the response to the coronavirus.

Fair. :) I feel like I'm seeing this with the "lock down until vaccine/forever" viewpoint as one of the most recent examples.

Hedging is NPV + risk management, right?

Policy makers should adopt some of the modeling tricks from Wall St. and Silicon Valley. Manage risk. Assess sure things and long shots, feed in the parameters, then allocate resources appropriately.

We need better financial instruments, novel forms of insurance, put a price on resilience, to counterbalance the drive towards lean efficiency. So that key suppliers can maintain capacity without assuming all of the risk, for instance.

Perhaps I missed it, but I don't see anywhere in this article where it implies this is a scandal in any way. There's no axiological statement here, just a pretty decent overview of the facts. I agree with you that not having a need for these field hospitals is a good thing (obviously) and I don't see the article implying otherwise.

Right? Moreover they were lamenting that CN was building prefab hospitals in 10 days .. and we were unable to do that and that would leave us with a bed shortage...

The question is - was the egregious price the contractors charged a good price? I have the right to care about that as a tax payer

What I don't understand is that this disease becoming globally endemic is pretty much a forgone conclusion. With that in mind, when did the goal posts move from flattening the curve to keeping things shutdown indefinitely with no clear criteria for slowly returning to normal and allowing an economic recovery to happen.

With flattening the curve I suspect we'd want to keep the field hospitals due to the lag time in knowing the actual infection and hospitalization rates.

Authoritarian politicians are drunk on power they've only dreamed of before. They won't give it up easily.

I fear particularly for a subset of countries for whom this could easily be an opportunity for highly punative destruction of rights that has been forming in the background already. South Africa for example.

It's not even a subset of countries. It's all countries, the US included. We're being conditioned to roll over on rights that we've fought hard for over 244 years.

Indeed. But in SA this could result in the government stealing your property. Literally.

I don't know where you're from, but here in WA we do have clear criteria. What changed is that we realized that we aren't capable of testing people. Everyone expected tests to be easy to create and widely available well before now.

Ditto nukes

I watched most of the Coronavirus Task Force briefings. Several times Trump suggested Dr. Birx was telling him that these things would not be needed. And she confirmed that she felt they weren't going to be necessary. So it appears the scientists/experts knew it wasn't necessary from a medical standpoint. One could argue whether or not it was politically/emotionally necessary.

Edit: you can see from several posts here that building these things really did bring a lot of emotional comfort to people, which is an important part of dealing with a crisis. People really underestimate psychology in an emergency.

"So it appears the scientists/experts knew..."

The primary theme of this pandemic is that we don't know almost anything about what is happening or what is going to happen. The list of wrong predictions can and has filled thousands of column inches and hours of briefings.

We expanded our healthcare capacity because of Italy and the humanitarian crisis that was occurring there. It had nothing to do with emotion. If it made people feel nice then I suppose that was a minor unintended benefit.

I agree with your sentiment and I would go one level deeper down the rabbit hole. A lot of what we've been led to believe were blatant lies. Just look at the way people are talking about reopening. There's all this talk of vaccines and testing. Those aren't going to be real solutions. A vaccine is a year away. Closing everything for a year+ would be the end of civilization. As far as testing... think about the scale of testing we would need. You'd have to basically isolate everyone, test them, and then keep the infected isolated. And you'd have to do that over a very short period of time, like a few days. We're not delivering 300+ million tests in a few days. It's not happening. Testing is useful. It's not going to be some panacea of perfection, or even particularly "good." The hard truth is we're going to eat a lot of deaths from this. And none of the experts can possibly know what is the exact right recipe to minimize deaths, either from covid or economic disaster. Any state/country/whatever that gets better results will have done so totally by luck and their solution might not have worked elsewhere for a myriad of reasons. It's all false confidence.

Just look at Remdesivir, or however it's spelled. The news corps are pushing that as a possible treatment. Except guess what? It doesn't seem to reduce your chances of dying. Worth noting, pharma companies are major advertisers for news networks. It's all been bullshit.

South Korea, Taiwan, China, Vietnam, and other countries all used Test, Trace, and Isolate to contain the virus with few cases and deaths.

You don’t actually need 300 million tests if you can stay on top of the virus, so I don’t think this is blatant lies like you’re talking about - in theory we’ve just spent 6 weeks locked down to reduce the number of active virus cases and now could transition to the test/trace/isolate approach we should have taken in February like the successful countries did.

That said I agree the opening seems to be coming too fast and no one I have seen is presenting a model where test/trace/isolate succeeds in the USA - due to political polarization there is no national plan for it. China took 87 days to lift the lockdown on Wuhan and we are going much faster than they did, while having had a much less strict lockdown in the first place.

It’s true that Redemisivir has not been scientifically proven to save lives yet, just to reduce the length of hospital stays (which means hospitals will have more capacity since each individual case stays in the hospital for a shorter time), but scientists think it may be able to reduce death rates if given earlier in the course of infection - clinical trials are still ongoing to see if this is true.

You mentioned feeling like the country is reopening too fast. Can you talk about how many deaths you expect from the virus vs deaths caused by economic distress related issues if we stay closed? I feel like talking about one without the other is missing half the story. The media has framed everything to only talk about virus related death but it's not the only cause of death.

IMO, that’s a false choice.

Economic distress could be solved by improvements to the rescue package (The USA is currently able to borrow money at about 1% interest rate over 20-year terms, which is a negative interest rate when accounting for future inflation). Individual workers are already eligible for $600/week of unemployment bonus through July 25 as long as their business doesn’t re-open, for many of them their economic situation is actually better if we waited two months to reopen as they get paid more than they would working their job.

Unfortunately some businesses like restaurants are being poorly served by the PPP and treasury department regulations that don’t allow them to pay enough out of PPP to pay rent in higher-rent locations.

That could be changed, but the Federal government is counting and planning on economic pain to force states to reopen too fast instead, without tests or other measures in place that could reasonably be expected to cap or reduce new virus cases. It’s a very short-sighted plan.

That seems to be the case, seems that's also why Cuomo wanted 30k ventilators, only got 2k and a lot of those went into storage unused.

As a leader you really have to take a deep breath and not let emotions get the better of you.

Over-preparedness and knee-jerk reactions can hurt you.

I'm glad we didn't fulfill the request for 30k ventilators and take away from other states/countries that needed it.

Trump suggests all sorts of things, often directly contradictory, or contradicted shortly thereafter by his own experts. I'm not sure why you'd put any stock in those suggestions at this point.

The expert in question was about 4 feet away from him and confirmed what he said immediately, and repeatedly.

That's because the experts who blatantly contradict the boss are quickly moved to a much greater distance.

Trump claims experts were right.

Trump acknowledges he defied the experts and potentially wasted a bunch of money.

What, exactly, are you imagining is the scandal here? That Trump is lying, he didn't defy the experts, and the potential wasting of money was the fault of experts and not Trump? Is that the scandal you're imagining?

I mean, this is hard to productively discuss without the actual quote and/or video in question.

Trump has demonstrably had live disagreements with his experts at these things (hydroxychloroquine, disinfectants, etc.). https://theintercept.com/2020/03/20/trump-disagrees-top-immu...

I suspect most of us have had the experience of biting your tongue while your boss is chatting with a client, too.

If $1tn had been spent on extra capacity, would that have been really positive?

Was the extra capacity good value? Was there any corruption?

During these highly emotional times I think it's more important than ever to stay rational, and question our governments.

Seems like we were able to build them quickly enough that we prematurely built them.

Wasting tax payer money that could've been invested in things like increasing PPE production for existing hospitals.

The core of the issue is that we couldn't ramp up testing fast enough, leaving us completely blind and then we relied on models that believed the infection was moving far more aggressively than it was.

When you're dealing with exponential growth and high uncertainty, anything you do is likely to either look like a large underreaction or large overreaction in retrospect.

I think there was/is near-infinite money available for Covid-related projects, and spending was more limited by identifying them or bureaucracy or political will. I don't think we would have taken the $660mm and spent in on PPE without this hospital construction; instead, our national debt would just be that much lower.

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