
Miscalculation at every level left U.S. unequipped to fight coronavirus - Reedx
https://www.wsj.com/articles/miscalculation-at-every-level-left-u-s-unequipped-to-fight-coronavirus-11588170921
======
vikramkr
I still remember how when the pandemic was breaking out, I and my colleagues
in the lab were not taking this seriously because we were so confident we'd be
able to get it under control. All we had to do was test rigorously, and, like
c'mon. It's just qPCR. I remember overconfidently asserting that, like, the
USA _invented_ PCR - we know how to do it. laugh out loud. Hell, I had a plate
in the machine as I was speaking! Colleagues agreed. After all, it only got so
bad in china because they were covering it up, right? We just gotta run more
tests, trace, and isolate. The stuff we were working on the lab was hard
fundamental questions - the science needed to stop the pandemic was some PCR
and quarantining people. And, the CDC was developing our own diagnostic
instead of using the WHO's, but that makes sense, they're the CDC. What were
the odds that they'd screw up so badly that the FDA would describe conditions
as so bad they'd be reason enough to shut down the lab if they weren't the
CDC? What were the odds that our friends in testing labs would find themselves
describing the CDC as having "simply failed at molecular biology" [0]?

Of course, I use the past tense when describing our feelings about our
research since we're certainly not working on it now. It's all nonessential.
We're not allowed to go to the lab now unless you really need to water the
plants or feed the mice. Just to keep a sustaining gene pool of our model
organisms alive, so we can breed back what we need when we get back.

We really learned a lesson in humility. Part of miscalculating is having the
wrong set of assumptions to derive calculations from. I don't think we were
the only people who should have known better that were arrogant and
overconfident.

We're hearing from some local labs that they have enough reagents to run
tests, they have the right primers, they have what they need. But they can't
get the cotton swabs they shove all the way up your nose and the little
plastic collection things they need to administer the test. Cotton swabs. And
little plastic vials.

We're talking about developing a vaccine, a cure, privacy-respecting contact
tracing, fighting a once in a generation pandemic, keeping the hospital system
from being overwhelmed. And we don't have the cheap disposable plastic and
cotton things we need to run a test.

Truly a lesson in humility.

[0][https://www.nature.com/articles/d41586-020-01068-3](https://www.nature.com/articles/d41586-020-01068-3)

~~~
throwaway894345
Adding to the list of CDC failures was their utter failure to procure masks.
You know, those things that would be absolutely vital for just about any
epidemic or pandemic (never mind the respiratory variety that we knew would be
the most likely). It’s not like preparing for an epidemic is the raisin d’etre
for the CDC or anything. I’m normally not this snarky, but I too thought the
CDC was the one functioning agency but it turns out that it’s closer to the
opposite. And not only that, but their utter incompetence killed tens of
thousands.

~~~
Consultant32452
The CDC, US Surgeon General, and WHO have all claimed with a straight face
that masks don't protect you from getting the virus. I guess that's why they
didn't see any value in stockpiling them. /s

~~~
ashtonkem
I too assume that surgeons wear those masks for funsies.

Of course the “masks don’t work” was pure, transparent, bullshit from the very
beginning. It didn’t even pass the smell test. Now if the argument was “please
save masks for healthcare workers first, they’re higher risk” that would be
_fine_. But “they don’t work”? Fuck off.

Edit: I’m referring to the CDC here, not you personally, dear HN commenter.

~~~
WrtCdEvrydy
If you tell people to save masks for healthcare workers... then the hoarding
would have been worse.

At least by telling people masks don't work... peer pressure would keep them
from buying them?

~~~
ashtonkem
It doesn’t look like anyone bought it, masks still sold out quickly and health
care providers are still reusing N95 masks. And in exchange the CDC spent a
large amount of their credibility; a real lose lose.

~~~
hsitz
I'm curious, was the official word always that even N95 masks didn't protect
the wearer? Or just that "masks" in general (i.e., lesser masks) would not
protect wearers?

~~~
DanBC
N95 masks are used as part of a package of PPE. That includes eye shields,
gloves, and gowns. There's a complex protocol to put them on, and to take them
off.

Without the rest of the kit, and without careful adherence to correct donning
and doffing, there are at best marginal benefits to mask wearing.

There's some concern that those marginal benefits are eliminated if people
wearing masks go on to engage in risky behaviours. These behaviours include
increased touching of their face (often without immediate handwashing
afterwards), reductions in distance between people, increase in frequency of
leaving the home, etc etc.

~~~
ashtonkem
Nonsense.

PPE is designed to mitigate a completely different level and type of risk. PPE
is designed for medical professionals who by the very nature of their job must
spend hours in physical contact with known sick patients. The protocols must
be strict because failure means guaranteed infection.

I on the other hand have no obligation to physically touch random strangers,
thank god, and don’t have to go interact with known sick people. Instead I’m
trying to provide some protection for myself, and trying to work in aggregate
to reduce the risk that asymptomatic carriers spread the disease while doing
essential activities. “Marginal benefits” in this context is also known as
“reducing R0”, which is absolutely a public health goal.

Now all of that is a good argument for saving N95 masks for medical workers
and relying on surgical or cloth masks for the general public, especially in
the light of PPE shortages. But that is an entirely different argument from
“masks don’t work”.

~~~
DanBC
> I on the other hand have no obligation to physically touch random strangers,
> thank god, and don’t have to go interact with known sick people.

What's the point of wearing the mask then?

~~~
ashtonkem
Gotta go get groceries at some point, and that means breathing in the air
someone else exhaled.

~~~
DanBC
Where's your evidence that the virus is present in the air that people exhale?

~~~
ashtonkem
We know it’s a highly infectious respiratory disease with asymptomatic
transmission, this isn’t rocket science.

~~~
DanBC
You've just destroyed your own argument.

If you're wearing a mask to protect against droplets then maybe you'd get
marginal benefits. But if your concern is virus carried in the water vapour
that people exhale, then an N95 isn't nearly enough to protect you.

~~~
7786655
Even if the mask is 10% effective that's still better than nothing.

~~~
DanBC
Not if it's causing people to decrease social distancing or to touch their
face.

------
colmvp
I live in Canada and our response between January - mid March was in line with
the U.S. where the government said things like "the risk to Canadians was low"
and "asymptomatic people are not main drivers of epidemics." That laissez-
faire attitude perpetuated the belief that we didn't need to screen people at
airports, or force people coming in from hot zones to self-isolate for 14
days.

Meanwhile, a country like Vietnam which doesn't have the same technological or
financial resources as North America managed to quell the spread through mass
quarantines and aggressive contact tracing done as early as February. They
literally fenced off a village that had one known infection.

Taiwan acted quickly and decisively throughout the key time periods of the
crisis. Things like stockpiling and producing more PPE in January, making
quarantine taxi's ferry potential infected to their homes instead of allowing
them to take public transit, using technology to aid with contact tracing,
mandatory use of masks in public spaces, thermal screenings at airports and
stations...

Looking back, I think we both woefully under-estimated the potential for
asymptomatic/pre-symptomatic individuals to spread the virus. As a society we
looked at the low numbers and scoffed at the idea of doing proactive
preventative measures... until it all hit the fan and we had to hard stop.

~~~
Ididntdothis
i think there is a lot of superiority feeling in Western countries over Asia
and then in Western countries against each other. For example when things
started happening in Italy the Germans thought that it's an Italian problem.

As far as the US goes it was pretty clear that the administration didn't want
to deal with this at all at home. So they were constantly behind the curve and
did things only when basically forced.

~~~
davidw
> For example when things started happening in Italy

As someone who lived in Italy and now lives in the US, this was driving me
absolutely crazy. They have a great health care system, and are a transparent
democracy. When things started to happen rapidly there, it was very, very
clear that the same situation would play out in the US, and yet there were
still a lot of "just a flu" people.

~~~
ardy42
> When things started to happen rapidly there, it was very, very clear that
> the same situation would play out in the US...

When it was still restricted to China, I was able to reassure myself into
complacency with memories of the original SARS. China contained that, so maybe
they will contain this one, too?

As soon as it hit Italy hard, that story didn't work anymore, and it was clear
it was only a matter of time before it spread _everywhere_.

------
fermienrico
I am not great at markets, startups, business ventures, etc. But I feel like
these things are broken:

* Governments and only governments can and should prepare for national emergencies, because saying Hospitals don't have enough PPE for pandemics is like saying your local farm doesn't have enough stockpile of rice to server the public during a famine/war. Private institutions have no incentives to serve the greater good of the country.

* Manufacturing is an industry every nation should invest in. If labor is expensive, the government should subsidize it so that the essential skills to manufacture and the infrastructure to do so remains functional even though market forces tells consumers otherwise. "Made in Switzerland" marketing can only do so much when the T-shirt costs CHF 120 vs. CHF 11.99 on Amazon which is probably made in Bangladesh. I am not saying govt should subsidize T-shirt manf, just trying to make a point.

* Dismantle short-term capitalism that exists in the stock market. Public companies should disclose their financials on a yearly basis or even every other year. Capitalism needs to be refactored to orient itself for long-term gains. Also making it illegal to not act in the interest of share holders is an insane law - CEOs should have the ability to put moral, environmental and other concerns in front of their priority list and not just creating value for the shareholders. This whole system is messed up.

* Executives sold off their country's soul to China, made a bank, cut corners, fucked consumers and went to the bank laughing. They paid off senators and govt officials, created a greater divide in the income distribution around the world. Limit executive pay for public and private firms.

* Reliance on China needs to change, diversify manufacturing supply chain. Just making sanitizer in US doesn't help if 90% of the ingredients are shipped from China.

~~~
dnautics
> Private institutions have no incentives to serve the greater good of the
> country.

What are the incentives for government to serve the greater good of the
country, specifically, why should government be uniquely qualified to decide
what is good for everyone. As the old joke goes, "democracy is the belief that
the people know what they want, and they deserve to get it, good and hard".
But nobody in the world really lives in a democracy, it's even worse! There's
indirection. To believe that governments are qualified to serve the "greater
good" is to believe that people are qualified to select people who are good at
judging the greater good. And that's not even counting the next layer of
indirection. You're really hoping people are qualified to select people
(politicians) that select people (unelected bureaucrats) that know what the
greater good is.

There are many, many cases, when private enterprise (often, but not
exclusively, for-profits operating in a nonprofit/goodwill capacity) has been
the most effective responder in national emergencies, for example Walmart
immediately providing tons of supplies in the wake of Hurricane Katrina.

There is a wide window of human activity between a selfish money grubbing
capitalist firm, and the government.

~~~
pbourke
> What are the incentives for government to serve the greater good of the
> country

"We the People of the United States, in Order to form a more perfect Union,
establish Justice, insure domestic Tranquility, provide for the common
defence, ___> promote the general Welfare<_ __, and secure the Blessings of
Liberty to ourselves and our Posterity, do ordain and establish this
Constitution for the United States of America. "

> why should government be uniquely qualified to decide what is good for
> everyone

The government is uniquely qualified to be the actor of last or only resort in
a number of situations.

> There are many, many cases, when private enterprise (often, but not
> exclusively, for-profits operating in a nonprofit/goodwill capacity) has
> been the most effective responder in national emergencies, for example
> Walmart immediately providing tons of supplies in the wake of Hurricane
> Katrina.

Indeed we all remember when Walmart's convoy of soldiers arrived at the
Superdome to finally open a supply line to the thousands that sheltered there.
Or when Walmart's sailors airlifted or floated out 33,000 citizens stranded in
floodwaters.

~~~
dnautics
"We the People of the United States, in Order to form a more perfect Union,
establish Justice, insure domestic Tranquility, provide for the common
defence, promote the general Welfare, and secure the Blessings of Liberty to
ourselves and our Posterity, do ordain and establish this Constitution for the
United States of America."

Man! If every organization held true to its founding ideals. _do no evil_ , or
heck, March of Dimes. You know, that document you cite also has a list of ten
amendments, of which I know zero have been held to over 200 years. That's
right, even the US has violated the 3rd amendment by quartering soldiers in
warzones, for example Afghanistan, and even WWII (the amendment does not
specify homes of citizens).

Do you think the US follows this clause of the constitution? Did you even know
it was there? "In Suits at common law, where the value in controversy shall
exceed twenty dollars, the right of trial by jury shall be preserved, and no
fact tried by a jury, shall be otherwise re-examined in any Court of the
United States, than according to the rules of the common law."

Forgive me if your assertion that the least binding part of a legal document
that has brooked all sorts of breaches to its principles holds very little
confidence.

> why should government be uniquely qualified to decide what is good for
> everyone. > The government is uniquely qualified to be the actor of last or
> only resort in a number of situations.

You're begging the question.

~~~
pbourke
You asked “What are the incentives for government to serve the greater good of
the country“ and I gave you an answer: it’s the reason why governments were
created. Are they perfect? No. Can they be entirely replaced by the private
sector? No.

~~~
dnautics
If you really believe that governments were created "for the greater good of
their people", I strongly suggest you review the entirety of human history.

I'm not religious, but the hebrew bible has a really fascinating parable (1
samuel 16) about the israelites wanting "a king" (and importantly, describing
there motivations for such) and god begrudgingly granting their wish with a
warning for what was to come.

Governments serving their people is a very modern and very imperfect concept.
I would argue we're not there yet.

------
hanniabu
I think calling it a miscalculation is beyond extremely generous.

~~~
avs733
It's the wall street journal. They want to blame government...not a lack of
leadership by the party they best align with.

The pervasive use of passive voice is a dead giveaway.

~~~
eli
This is unfair. The WSJ editorial page is bananas but the reporters are top
notch.

~~~
avs733
the reporters have great access and great information. The tone and
perspective though are what they are.

------
neonate
[https://archive.md/qrkt3](https://archive.md/qrkt3)

------
dirtyid
Everyone should read: The ‘Red Dawn’ Emails: 8 Key Exchanges on the Faltering
Response to the Coronavirus

[https://www.nytimes.com/2020/04/11/us/politics/coronavirus-r...](https://www.nytimes.com/2020/04/11/us/politics/coronavirus-
red-dawn-emails-trump.html)

Full emails here:
[https://int.nyt.com/data/documenthelper/6879-2020-covid-19-r...](https://int.nyt.com/data/documenthelper/6879-2020-covid-19-red-
dawn-rising/66f590d5cd41e11bea0f/optimized/full.pdf)

It seems like experts at least at an exceedingly clear grasp of the situation,
with fair accurate predictions based on available data on the time. It doesn't
seem like there was much "miscalculation" by subject matter experts, but
bureaucratic incompetence on many levels that still persist.

~~~
0xddd
Why is this downvoted? I'm about a quarter through and have found this totally
intriguing. Their concerns in late January seem spot on. I'm glad it got
shared.

------
11thEarlOfMar
What are the disaster vectors that the government should plan and equip for?
What scale should be prepared for each?

~~~
jakeogh
[https://www.washingtonexaminer.com/washington-secrets/new-
wa...](https://www.washingtonexaminer.com/washington-secrets/new-warning-
covid-19-nothing-compared-to-emp-295-million-dead)

------
chihuahua
It amazes me that the entire strategy of the U.S. government is "Everybody
stay inside and wait until this goes away". Two months into this, that still
seems to be all there is.

"And what if it doesn't go away by itself?" "Then we stay inside for another
month!"

~~~
vikramkr
We're not waiting for it to go away by itself. We're keeping the rate of
spread below the threshold where we overwhelm our hospital capacity. This buys
us time to scale testing and develop things like contact tracing, drugs, and
vaccines that will be our weapons in the next stage of this fight.

~~~
jimbob45
How is this getting downvoted?

This is the strategy. We're not gonna wait out the vaccine but we certainly
won't have overwhelmed hospitals like Italy.

~~~
jdminhbg
It seems to be the strategy in the sense smashing a window with a hammer is a
strategy to kill a fly. Hospitals are so empty that workers are being
furloughed, say nothing about the unused field hospitals and naval ships. The
Lombardy scenario does not appear to be on the table.

Edit: I should add that I didn’t downvote.

~~~
nomel
Many positions at a hospital aren't related to treating someone with
coronavirus. For example, elective and non-time-sensitive surgical departments
should have nothing to do right now.

~~~
jdminhbg
The ICUs aren’t even close to full, and indefinite delays of non-emergency
care also has real consequences.

~~~
nomel
There are only about 7,300 ICU beds in California [1]. If we're at 20%, that's
only about two doublings before people start being rejected for care. In
March, we were seeing a doubling every few days, with ICU requirements
following [2].

I'm not disagreeing that we need to let people be infected if we want to
achieve herd immunity, but I think it's a tough choice in deciding which
portion of the population you put out to partially die, since letting everyone
out at once will result in some high R0 value again, and a vaccine may be on
the way. These politicians are in a lose-lose situation here. Anything they do
will result in someone being harmed.

[1] [https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-
guida...](https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
management-patients.html)

[2] [https://www.mercurynews.com/2020/03/28/coronavirus-gov-
newso...](https://www.mercurynews.com/2020/03/28/coronavirus-gov-newsom-says-
number-of-patients-in-icus-doubled-overnight/)

------
RickJWagner
Of the sources I read for coronavirus news is a daily chart posted on
RealClearPolitics.

Per today's chart, the US has the most confirmed cases, the most tests taken,
and one of the lowest deaths per million.

It's tough to judge which countries are doing well and which aren't, even
given stark contrasts in policy. I don't think it's possible to harshly
condemn (or praise) anyone at this point.

------
jakeogh
The US beat every single expert pre-peak total deaths prediction; by a lot.
There are supply chain issues to fix, and the few spots that could not deal
with the case load need to be fixed, but by any scientific measure against the
predictions, we did excellent.

[https://www.imperial.ac.uk/media/imperial-
college/medicine/s...](https://www.imperial.ac.uk/media/imperial-
college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-
modelling-16-03-2020.pdf)

p16: "In the most effective mitigation strategy examined, which leads to a
single, relatively short epidemic (case isolation, household quarantine and
social distancing of the elderly), the surge limits for both general ward and
ICU beds would be exceeded by at least 8-fold under the more optimistic
scenario for critical care requirements that we examined. In addition, even if
all patients were able to be treated, we predict there would still be in the
order of 250,000 deaths in GB, and 1.1-1.2 million in the US."

EDIT to rrss's comment:

First, note that ~60k is how many people died and tested positive AND were
coded as COVID-19. It's not necessairly how many people died because of a
COVID-19 infection. We will not know the real #'s until all-cause death is
examined. There appears to be a significant drop in "normal" pneumonia deaths
for example. It also ignores the error bars on the testing
false/positive/negative rates.

Second, I'll restate: The US beat every single explicitly enumerated via a
integer expert pre-peak total deaths prediction; by a lot.

If the authors had given a table for the US, we could see what their model
predicted, but they did not, and _you_ assuming that the US is a linear
relation to GB may or may not be accurate.

~~~
rrss
You are misrepresenting the conclusions of that report. The report clearing
distinguishes between "mitigation" and "suppression" in the second paragraph.

> However, the resulting mitigated epidemic would still likely result in
> hundreds of thousands of deaths and health systems (most notably intensive
> care units) being overwhelmed many times over. For countries able to achieve
> it, this leaves suppression as the preferred policy option.

The aggressive social distancing implemented in the U.S. falls under
"suppression," and therefore is not considered in the predictions you quoted:

> suppression will minimally require a combination of social distancing of the
> entire population

Two paragraphs after the bit you quoted:

> We therefore conclude that epidemic suppression is the only viable strategy
> at the current time. The social and economic effects of the measures which
> are needed to achieve this policy goal will be profound. Many countries have
> adopted such measures already, but even those countries at an earlier stage
> of their epidemic (such as the UK) will need to do so imminently.

The report predicted 5,600-48,000 deaths in Great Britain if all four
interventions discussed were put in place. The UK has had ~26,000 deaths.

This prediction for GB (suppression) is 80-98% lower than the prediction you
quoted (mitigation). A naive application of these ratios to the US suggests
that the predicted number of deaths with all interventions would be something
like 24,000 - 220,200. The U.S. is currently at ~60,000 deaths.

So, erm, no - the United States has not "beat every single expert pre-peak
total deaths prediction; by a lot."

~~~
orwin
No, GB's excess mortality compared to last year is already greater than 35
thousand death, and that's not taking into account the 4-day lag between the
actual death and the report (unlike "covid19" hospital death. GB is not
testing home sudden death (that are often caused by cardiac arythmia that
might be induced even in very mild covid19 cases), so only excess mortality
data is reliable:

[https://www.euromomo.eu/graphs-and-maps/#z-scores-by-
country](https://www.euromomo.eu/graphs-and-maps/#z-scores-by-country)

[edit] That said, your argument still stand and in fact is even better with
this data

