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  • Authorities and Amateurs

    March 24th, 2020
    covid-19  [html]
    People are writing a lot about the coronavirus, and I've seen a lot of pushback on how pieces often haven't been written by people with epidemiology or public health credentials. For example, Flatten the Curve of Armchair Epidemiology, Listen To Actual Experts On Coronavirus, and comments like this one. The argument that we should be listening to experts and not random people would make a lot of sense if the "armchair" folks didn't keep being right.

    Let's look at the articles they're criticizing for having non-expert authors:

    With two weeks of perspective, however, these articles were exactly right. They clearly laid out the case for decisive action, and if we had followed their prescriptions more closely we would be in much better shape right now.

    This goes beyond a few articles, however. All the aspects of this crisis that have involved planning more than a couple weeks out have been very poorly handled:

    • People weren't told to stock up on food so that they'd be able to reduce trips outdoors, and so that they'd have food in case they were quarantined for 2+ weeks. Stores weren't told to prepare for a rush. A government that was on top of things could have started advocating this in early February in an "if you can afford to" way. This would have spread people's buying over a longer period and avoided the empty shelves we see now. Instead, once restaurants were closing and people realized that they could be quarantined at any time, everyone simultaneously tried to buy weeks worth of ingredients and we had widespread shortages of basic goods starting in mid March.

    • Hospitals weren't told (or allowed?) to ration personal protective equipment such as masks until they had shortages. The CDC didn't publish guidelines for sanitization and reuse, and start telling people to conserve. In weeks of handling initial cases, hospitals burned through amounts that would have lasted months with careful rationing.

    • The federal government, state governments, or even hospitals could have placed emergency ventilator production orders in February, but didn't. Because we don't allow price gouging, ventilator companies can't ramp up production speculatively figuring that if there is really an epidemic then they'll make their money back. By mid March it was obvious that we were far short of where we needed to be and the companies started ramping up but we lost about a month of production increase.

    • Masks were sitting on shelves across the country, and the government could have requisitioned them for emergency medical use, or even just gone and bought them. Instead the Surgeon General tweeted a request that people not buy them.

    • Testing has been completely messed up, though it's hard to tell how much was bad luck vs reasonable rationing of scarce tests. But we should have been quarantining people who seemed to have it based on symptoms, instead of saying "well, since we can't test you we have to assume you don't have it, so you're welcome to continue living your life".

    • We could have planned and built out COVID-specific facilities to reduce the risk of others getting sick and make more efficient use of ventilators and personal protective equipment. We're just starting to do this now, much too late.

    • The passengers of the Grand Princess were offered testing but told that if they tested positive they would be required to undergo quarantine. Of 858 passengers, 568 declined testing and were released without even advice to self-isolate.

    • The CDC is still (3/24) not recommending the general public avoid contact with others unless you're sick, they're sick, or you know covid-19 is spreading in your community. They're only recommending people stay home if they're sick.

    And I understand: this is moving very quickly, and authorities aren't used to needing to respond so rapidly. But there was a meme going around:

    Neil Diamond: touching hands
    CDC: no don't touch hands
    Neil Diamond: reaching out
    CDC: please avoid that
    Neil Diamond: TOUCHING YOU-
    CDC: everyone is Boston is doomed
     —@actioncookbook (2/27)

    This joke and its many copycats feature the CDC we wish we had. A CDC that would have been pushing social distancing a month ago, when it would have helped so much more.

    Google Trends: "social distancing"

    If we had listened to the warnings and prepared better we would have the experts we need, with the influence to get policies changed, and we wouldn't need the advice of the armchair epidemiologists. But that's not the world we've found ourselves in, and the amateurs have been doing critical work filling in for them in pushing policy.

    A policy of "listen to random experts" is better than a policy of "listen to random amateurs". But rejecting the arguments of amateurs who were making clear arguments, solely on the grounds of their non-expert status, was harmful here.

    Comment via: facebook, lesswrong

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