The politics of COVID-19: Fact and fiction - Part 4 - Where we are today and what’s to come in less than 80 days
In part 1 we discussed how real-world medicine, as it develops, follows pathways similar to those seen in building a startup business using the Lean Startup approach - a method focusing on learning from and adapting to market response to quickly achieve short term viable results. (See Figure 1)
Figure 1: Data-driven Lean Startup product introduction model
Graph © Tom Cloyd MS MA
It was noted that the COVID-19 virus itself displayed a flexible response early in its incursion into the US population, but the Trump administration’s response to the emerging pandemic did not, as it was not driven by what was actually happening in the early stages of the epidemic.
In part 2 we discussed what Trump knew at various points in time, and how the administration’s designated experts responded to an unknown virus in a manner congruent with the Lean Startup business model. (See Figure 2, below) Following their lead, Trump briefly appeared to recognize the reality of the pandemic, which at this point was causing a major upheaval of US life.
In part 3 we discussed how Dr. Fauci and Trump conceived and executed their pandemic response by attending to real-world data about aspects of the emerging pandemic in the US. Then, their paths went in separate directions, and their conflict with each other became increasingly apparent. In part 4 we bring our account up to date and question what will happen between now and the November election.
Where we are today ^
As of this writing, August 22, 2020, the US has 18 states whose infection rate is still increasing.1 Herd immunity - the point in a pandemic where there are insufficient numbers of individuals vulnerable to infection to keep the pandemic going - remains an elusive goal. We don’t even know with this virus what percentage of individuals have to have invulnerability for herd immunity to emerge, or if it’s even possible to achieve.2
We have no fully approved vaccine with which to produce this unknown number3, nor any assurance that we ever will have such a vaccine, although a huge international effort is in progress to try to produce it.4 The alternatives to a vaccine, which are all we have at present to combat this highly infectious virus, remain strongly aversive.
The first alternative, sustained social isolation, has profound disruptive effects on national economies. However, while the recession-inducing negative effects in the US, among which are losses in employment, productivity, and income, are fairly immediately visible, several sophisticated analyses indicate that the benefits outweigh the costs.5 That said, the immediate costs remain prodigious. The long-term effects of the recession induced by current US social isolation policy appear, however to be far less fearful than one might think.6
Figure 2: Data-driven public health intervention model
Graph © Tom Cloyd MS MA
The second alternative to a vaccine, allowing a natural progression of the disease through the population, in which everyone is infected who can be, except for those isolated for any reason, would kill hundreds of thousands beyond the hundreds of thousands who have already died, without assurance of producing herd immunity.2
New York State’s response to the pandemic was congruent with the Lean Startup model in that it used a phased approach based upon monitoring key indicators as a guidepost to success. If the indicators proved some element of their approach wrong, the governor was willing to adapt. Today, New York has one of the lowest infection rates in the country, as it continues to rely on empirical results.7 Approximately 30 other states are in a similar situation.1
Alternatively, some states decided that individual liberties and the desire to get back pre-pandemic economic and social life should take precedence over real-time, data-driven rethinking of policy and practice. However, COVID-19 is proving that it controls both what works and the timeline for success or failure.
Dr. Fauci’s recommendations, where applied, are working. Alternatively, states such as Florida, Texas, California and Georgia have recently struggled with unsustainable hospital capacities, having chosen to promote political ideology over reality-oriented medical recommendations.
Lean Startup leaders would have abandoned political ideology in such states in favor of facts learned two months earlier.
What do recent events mean for a sitting president facing re-election? ^
The importance of understanding how we go about acquiring new learning and adapting creatively in response to this learning cannot be overstated. Whether guided by learning informally through life-experience or through a methodical Lean Startup approach, adaptive response has life-sustaining results.
The ideologically driven approach generally (see Figure 3, below) is expensive, time-consuming, unable to be measured, and driven by emotions as much as goals. The empirical approach, best used by working in a collaborative team, embraces the questioning of traditional beliefs and assumptions, and focuses on quickly learning from what does and does not work. From the beginning, it recognizes that every step in an initiative can result in a decision to continue the current path, pivot from the path in another direction, or abandon the effort.
Figure 3: Ideology-driven public relations model
Graph © Tom Cloyd MS MA
As we have come to see, using Lean Startup thinking or similar approaches allowed the US to respond to the pandemic in many walks of life, even if different states varied in how quickly they initiated such approaches. Innovation and the willingness to test, disrupt, or change minds is at the heart of why Lean Startup approaches work.
From the perspective of the larger natural world of which we are a part, the pandemic resulted from the success of the COVID-19 virus’s adaptation to the environment which we provided. From the perspective of US federal response to the pandemic - our “product” launch, there was an urgent need to respond to changing events innovatively, if the loss of human lives was to be minimized. Let us not abandon the lessons learned so far, nor stop trying to gain new knowledge as we continue to search for a vaccine response.
What has been learned from December 1st, 2019 to the present time has invaluable lessons for Lean Startup projects. We now see more clearly than ever before the value of tele-learning, tele-meetings, and tele-health in general. We have seen that productivity is possible even when we are asked to rethink standard operating procedures. No one is stating that it has been easy. And the challenge continues, as we now attempt to open our schools this fall. Whatever we are able to achieve will require the continued use of assumption-testing and adaptive responses.
Trump’s narrative has been to suggest that the country is on the road to recovery and that it will be better than before, as we attempt to restore a way of life we long to return to. But evidence to the contrary to the recovery narrative continues to emerge. His is a public relations position that he considers required for a campaign, but the pandemic is effectively countering his script.
Trump’s version of the pandemic and our response to it is in trouble. But any attempt to reduce doubts about its accuracy both contradicts a reality now clearly seen by much of the public and has the effect of reducing the credibility of the very people responsible for testing assumptions upon which our official current response to the pandemic is based. Regrettably, his approach also includes infusing controversial ideas into the dialogue to shift public attention away from any popular focus that doesn’t involve recovery as depicted in his imaginary narrative.
His is consistently a public relations approach that continues to endear him to his base. But the pandemic has no ideological loyalties. It is non-discriminatory, non-political, and a non-economic, systemic equalizer in every way.
As a country we will never be the same, nor should we be. Now the question is whether Donald Trump is right for the next chapter of what the US can become and is becoming? Was he right or were the medical experts right? Is Trump’s narrative indisputable or is Fauci’s? We have less than 75 days to answer that question.
“The herd immunity threshold of real diseases varies. Measles, an especially contagious disease, only slows down after about 95 percent of people become immune. Scientists are still determining the herd immunity threshold of SARS-CoV-2, the coronavirus that produces the deadly disease covid-19. Estimates range from about 40 percent to about 80 percent.” (https://www.washingtonpost.com/graphics/2020/health/coronavirus-herd-immunity-simulation-vaccine/) One major problem is that at least two major studies suggest that herd immunity simply may not be possible. (https://www.cnn.com/2020/07/06/health/spain-coronavirus-antibody-study-lancet-intl/index.html) ^ ^2
https://thevaccinetracker.com/ (This is an extraordinary open source project that presents in a highly accessible manner current-status information on all COVID-19 vaccines under development.) ^
As of August 21, 2020, vaccines have been approved for use in Russia and China. In Russia the approval is for “limited use”, and phase 3 trials have not been completed. In China, the approval is for “early use”, again without completion of phase 3 trials. Such approvals are “unprecedented” and widely viewed as “risky”. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html ^
The benefits of “moderate social distancing scenario (roughly consistent with current US policy)” are substantial, and have been detailed by U. of Chicago economists Greenstone and Nigram (https://bfi.uchicago.edu/key-economic-facts-about-covid-19/#does-social-distancing-matter). About this particular analysis see also https://promarket.org/2020/04/04/covid-economics-social-distancing-and-the-relevant-benefits-of-cost-benefit-analysis/. For an especially interesting summary of the question, do read Steve Banker’s thoughts (https://www.forbes.com/sites/stevebanker/2020/04/08/social-distancing-are-the-costs-of-shutting-down-the-economy-worth-it/ ) ^
In an analysis of quite serious breadth and depth, Morningstar Preston equity analyst Caldwell argues that the long-run effect of recessions in the US have hardly been impressive, and that for multiple reasons the present recession is particularly unlikely to have a lasting effect on the US economy. See https://www.morningstar.com/articles/984843/projecting-coronavirus-long-run-economic-impact for details. ^
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