On Coronavirus

There’s a lot of armchair quarterbacking and political critiquing the coronavirus response. A lot of it seems pretty knee-jerk, which, as always, is difficult to respond to in real-time because there’s so much going in, it’s near impossible to talk to someone who has fucked up facts. There’s a lot of details that take a little to assemble, and even if you could, where do you start, and how do you paint a complete picture?

This essay was triggered by the assertion, “Trump is handling Coronavirus just as well, probably better, as Obama handled H1N1. Those that say otherwise are being partisan in assigning blame, and they’re just out to get Trump because they don’t like him because they’re foolish liberals who don’t really understand the facts.”

Comparison to SARS

SARS was a briefly lived excitement in 2003 during George W Bush’s regime. Although there was a small spike of cases in China, and it did make it to the US (for 27 cases), it didn’t live up to the media attention and was stamped out.

If you hear people talking about Obama’s response to SARS, they’re mixing things up; they mean H1N1 Influenza.

Comparison to H1N1

The H1N1 influenza struck in April 2009 in Mexico and the US. Timeline:

  • 15 April, 2009: A US flu case got the CDC’s attention.
  • 21 April, 2009 (T+6 days): CDC was working on a vaccine.
  • 22 April, 2009 (T+7 days): CDC Emergency Operations Center activated.
  • 24 April, 2009 (T+9 days): CDC published the sequenced genome of H1N1
  • 26 April, 2009 (T+11 days): The US government declared a Public Health Emergency and began doling out supplies from the national stockpile.
  • 1 May, 2009 (T+17 days): Tests collected by the CDC revealed the virus was an aggregation of several others strains, including an avian flu, human flu, and a variety of US and international swine flus.
  • 11 June, 2009 (T+58 days): President Obama declared a National Emergency.
  • 10 April, 2010 (T+1 year): CDC estimates H1N1 about 61M US infections, with 12K deaths over the past year.

Things that stand out:

  • H1N1 was taken seriously from the beginning.
  • Vaccine work was started within a week.
  • The government was responding in 11 days.
  • Though H1N1 was a new, exciting hybrid, it was still a flu—something we’re used to dealing with and for which we regularly make vaccines.

The 11 day response (the public health emergency) is dismissed by Trumpists, who ignore it and only look at the national emergency declared in June. I think that’s disingenuous.

When there’s a storm coming, we get storm warnings and watches before the storm arrives. If we’re being responsible citizens, that means we prepare for the emergency by making sure we’ve got everything we need (which for many apparently means running to Wegmans and clearing them out of TP, frozen food and meat).

The public health emergency was that storm warning. Stuff started getting put into place for the coming blow, which arrived in early June, prompting the national emergency. And when the national emergency was announced, a lot of shit was already in place to cope with it.

The national emergency was when the storm actually started making trouble. Separating them was appropriate: sometimes, the forecast is wrong. It turns out to be just a little rain, or just 27 cases of SARS.

Obama didn’t wait until the snow was piling up, then panic. But on the other hand, he didn’t declare the national emergency until it really seemed necessary. That’s a balanced approach, and it seems reasonable to me.

Coronavirus in the US

The exact timeline of Coronavirus in the US is conjecture, and has changed as we’ve learned that different strains arrived at different times, some earlier than we originally thought. Some infections and deaths, especially for one variant strain running around the west coast, weren’t identified as coronavirus until weeks after-the-fact.

Here’s the present timeline we have:

  • December 31: China reports a new illness.
  • 11 January, 2020: first China death.
  • 21 January, 2020: first currently-known US case. We’ll call this T.
  • 31 January, 2020 (T+10 days): US blocks foreigners who have been in China recently, and declares a public health emergency.
  • 5 February, 2020: The Diamond Princess cruise ship docked with quarantines.
  • 19 February, 2020: The Diamond Princess disgorged.
  • 23 February, 2020: Italy caught fire (not literally–that’s Australia, a few months earlier).
  • 24 February, 2020: Iran caught fire.
  • 28 February, 2020: The rest of Europe started smoldering.
  • 29 February, 2020 (T+39 days): First currently-known US death
  • 3 March, 2020 (T+42 days): US finally starts ramping up mass testing
  • Early March, 2020: New York City was smouldering.
  • 13 March, 2020 (T+52 days): Trump declared a National Emergency, and allocated $50 billion to fight Coronavirus.
  • Mid-March, 2020: New York City caught fire. Or at least, we noticed it was on fire.
  • 26 May, 2020: 99K deaths

Now let’s look at similarities and differences in detail:

Public Health Emergency. Under H1N1, this triggered distribution of supplies to prepare for the coming pandemic. But in January 2020, the reserve had still not been restocked properly. Obama had 5 years to restock it. Trump had 3 years to restock it. Neither did, but Trump was the one caught with his pants down.1

But I will fault Trump for not doing more at this juncture. It would have been prudent to prioritize orders for medical goods. Instead he poo-pooed the virus as insignificant. That incurred problems later.

Testing. Coronavirus isn’t the flu, and it’s my impression we didn’t have tests ready for coronaviruses, or at least not nearly enough; they had to be built. This is very different from the H1N1, for which (as a flu) we already had tests and a supply chain to replenish them. I can’t fault Trump for it being a different virus. Responding would have taken longer, no matter what.

Again, though, if Trump had taken the threat seriously then supply chains would have been set up starting in early February. He didn’t, and they weren’t, which incurred problems later.

National Emergency. From fears to fire was about 8 weeks; Trump took about a week less than Obama. Both were working off conflated data: how much were new infections, and how much was improving testing?

Let’s compare from time T:

Time H1N1 Coronavirus
T+17 days 141 cases/1 death 11 cases/0 deaths
T+24 days 1,639 cases/2 deaths 15 cases/0 deaths
T+31 days 4,714 cases/4 deaths 35 cases/0 deaths
T+38 days 6,552 cases/9 deaths 66 cases/0 deaths
T+45 days 8,975 cases/15 deaths 332 cases/17 deaths
T+52 days 13,217 cases/27 deaths 2,204 cases/49 deaths; emergency
T+58 days Emergency 8,736 cases/149 deaths
T+59 days 17,855 cases/44 deaths 13,133 cases/195 deaths

Infections initially jumped for H1N1, but with few deaths, which climbed slowly and steadily. For Coronavirus, infections steadily climbed, and it was deaths that started with a jump.

Both emergencies were declared at similar death counts; coronavirus at a much lower case count, but with deaths on a much steeper rise. Deaths matter more than cases; we all get colds and nobody cares. So on the data 2, both responses seem reasonable.

There was one big difference: we were ground zero for H1N1 (thus working off expectations of other influenzas and updating as data arrived). Coronavirus’s potency had already been demonstrated in China, Italy, and Iran.

So I’m not calling either side for the timing of their response. They were different scenarios, different data, creating different responses, as much similar as different.

As far as the $50 billion Trump allocated for fighting the virus? Better than nothing, but way too late. By this time, supplies should have been in the warehouse or in delivery. That’s the one thing I’ll really ding Trump for. And I do acknowledge, Obama benefited from the national stockpile, which wasn’t his doing (it was gradually stocked under both Clinton and Bush), and he failed to replenish it—just as Trump did. Both fucked up the opportunity to be proactive.

Considering My Changing Thoughts

In the beginning. To be fair, when schools shutdown in March, I thought it was bullshit. This was just a flu-like variant; we’d get sick, get better, build herd immunity. At the time, it seemed this was Cuomo panicking, but in the aftermath it seems he did the right thing, at least in the beginning:

  • Coronavirus is highly infective. It spreads easily.
  • It kills a lot of people. We’ll be crossing 100K US deaths today, in 3 months. It’s way more virulent than the flu, H1N1, or SARS.
  • It’s got exponential growth. And if we’re all sick at the same time, an overwhelmed health care system means bonus deaths.
  • At the time, there was a shortage of medical supplies like gloves, disinfectant, and ventilators.
  • We didn’t have a lot of testing, so we didn’t know the scale.
  • Downstate was already a shitshow. Cuomo wanted to contain the existing shitshow, and avoid additional fiascos up here.

In light of this, Cuomo’s initial response seems reasonable. The shutdown gave us a chance to slow down infections, and stock up on supplies to handle existing cases before being more overwhelmed.

Still, we might have avoided or shortened shutdowns, if Trump & Co had taken it seriously from the get-go and ordered supplies so they were available when needed.

Here, now. But at this point, I’m frustrated with Cuomo’s delays.

By end of April, we understood the efficacy of masks in reducing spread, there was plenty of capacity in hospitals, and the medical supply chain was catching up. And while the data wasn’t great, we had enough testing to see what areas of upstate were controlled, where there were fires, and what the trends were.

Parts of upstate could—should—have entered their first phase of reopening at the start of May, which would have yielded data about efficacy of mediation efforts and risks. Instead, we fucked the dog for 2 more weeks and then had to pussy-foot around because we didn’t know how the first phase would effect infections. Cuomo fucked our economy an extra couple of weeks in the name of health safety.

Elsewhere. But that’s New York. Elsewhere, I see states (often “red” states) where folks think, “It’s all bullshit, let’s go back to business as usual.” So they’re opening up, no masks, no precautions. They’re taking health risks to gain economic safety.

That’s fucking reckless. The high infectivity and exponential growth means things can spiral out of control really fast. Here’s a thought game I’ve sometimes seen to demonstrate:

Exponential growth. You win a lottery, and have a choice: do you take (a) $1,000/day for the next month, or (b) 1₵ today, 2₵ tomorow, and just keep doubling for the next month. Which is better?

So, cents, or thousands of dollars? At first glance, that’s what it seems like. I mean, a week into this thing, it’s $7,000 vs $1.27. Obvious right? Two weeks, $14,000 or $163.83.

On day 17, (a) gives you $1,000, (b) gives you $655.36. But day 18, (b) makes beats (a) and makes up for day 17. Day 19, (b) makes up for days 16 and some of 15. By day 21, (b) still lags, but only by $29: $21,000 vs 20,971.51.

Day 22, you get another $1,000 or you double your money. And again, and again, all the way to the end of the month. The cents take a while to get going, but once they do, oh baby: $10,737,418.23 beats $30,000 by 300 times.

That’s exponential growth. That’s why coronavirus can spiral out of control really quickly if we’re not careful. It’s why returning to “business as usual” is playing with fire, why I think many states are cavalier—no, I should just say reckless—in the way they are opening up.

Opinions

Going forward. At the end of it, it is opinion. And my opinion is New York is being too timid, at least about upstate. Other states are being reckless.

There’s a middle ground somewhere, a place of sanity and balance, and neither side is hitting it.

Major sporting events, festivals and concerts? We need to break awhile; these would be reckless. We should start small, test the water.

Small offices, restaurants (limited and/or outdoor seating), campgrounds, small retail—these should have been open weeks ago, with precautions about masks and social distancing in place, to start finding where the tipping point is. Yet it does require caution, because we want to find the tipping point, not go careening over it.

Trump is dangerously anecdotal and non-scientific. He’s repeatedly told us the virus would just go away on its own—tell that to the 100K dead. He’s reactive but not proactive, and he responds more to public opinion than he listens to experts. He trusts his instincts, even when he knows very little about a topic; he is a stunning example of the Dunning-Kruger effect.

For example, he saw a positive report on Faux News, blindly believed it. The original tests had dodgy methodology, and further testing has shown no efficacy, only dangerous side effects. But to Trump (like most), anecdotes outweigh data. So he touted hydroxychloroquine as a solution, causing a run on the drug so folks who need it—lupus patients—can’t get it. Meanwhile, he’s gotten himself on the drug (probably by browbeating his physician), and I find myself wondering if the side effects—addled thinking, among others—might be behind his suggestion of a cure by injecting or ingesting cleaning fluids3.

On a more intuitive level: He is cunning and charismatic, and he knows how to deflect blame and pin it on someone else. He fails to recognize the seriousness of matters, yet convinces others he’s got everything under control. He somehow makes people think he’s knowledgeable and intelligent.

I’ve worked with people like this in the tech world, and I’ve learn to spot them. They’re incompetent, yet can regurgitate what they hear, mixing in buzzwords and lingo—and somehow, often work themselves into positions of power. Once there, they jam shit up or fuck shit up, always managing to dodge the blame.

I do not trust is intent or his judgement. To the degree coronavirus has been handled reasonably, it’s people around him who have kept him from making it worse, not him making great decisions.

But he is occasionally right, and he’s not against saying the unpopular thing. 4 On March 23, he twitted, “We cannot let the cure be worse than the problem itself.” 5 He’s right. But he went on, “At the end of the 15 day period, we will make a decision as to which way we want to go!” Setting a deadline, a goal to meet, rather than leaving it open to new data and facts: typical Trump. Disregard for the seriousness of the pandemic: typical Trump. Treating the pandemic like it’s a competing business whose delivery date we better beat or we’ll lose out, that’s Trump. But unless the metric is coffins delivered to cemeteries, this isn’t a race in which we should participate.

Pray others continue to mitigate his damage. It’s going to be a trainwreck if he ever comes unbridled.

Bibliography

  • http://www.cdc.gov/h1n1flu/updates/050109.htm
  • http://www.cdc.gov/h1n1flu/updates/050809.htm
  • http://www.cdc.gov/h1n1flu/updates/051509.htm
  • http://www.cdc.gov/h1n1flu/updates/052209.htm
  • http://www.cdc.gov/h1n1flu/updates/052909.htm
  • http://www.cdc.gov/h1n1flu/updates/060509.htm
  • http://www.cdc.gov/h1n1flu/updates/061209.htm
  • http://en.wikipedia.org/wiki/Timeline_of_the_COVID-19_pandemic_in_February_2020
  • http://en.wikipedia.org/wiki/Timeline_of_the_COVID-19_pandemic_in_March_2020
  • Various CNN reports from January and early February 2020.
  • http://www.nytimes.com/article/coronavirus-timeline.html

        
        
                
                
        
        

  1. Err, maybe that‘s a colloquialism I should stay away from for Trump, given it wouldn’t seem outrageous to literally find Trump with his pants down.  ↩

  2. I recognize it's to some degree comparing apples to oranges.  ↩

  3. I‘ve seen the video; if you believe his later assertion he was joking, then please write me about a fantastic deal I’ve got a bridge over the Potomac river just outside Phoenix.  ↩

  4. It doesn't make up for his blunders and incompetence.  ↩

  5. Decapitalized for your reading pleasure.  ↩