
How did the U.S. end up with nurses wearing garbage bags? - dankohn1
https://www.newyorker.com/news/letter-from-trumps-washington/the-coronavirus-and-how-the-united-states-ended-up-with-nurses-wearing-garbage-bags
======
GeekyBear
Just in time manufacturing is a recipe for disaster when you allow a single
nation to do the lion's share of everyone's manufacturing, and that nation is
the first to shut down.

A decentralized manufacturing system with distribution through regional
warehouses was more resilient, if less cost effective.

Some states, California and New York among them, did create their own local
stockpiles of ventilators and PPE after the bird and swine flu scares, but did
away with them in the fiscal crunch after the financial meltdown.

[https://www.msn.com/en-us/news/us/california-once-had-
mobile...](https://www.msn.com/en-us/news/us/california-once-had-mobile-
hospitals-and-a-ventilator-stockpile-but-it-dismantled-them/ar-BB11O8Gs)

[https://www.propublica.org/article/how-new-york-city-
emergen...](https://www.propublica.org/article/how-new-york-city-emergency-
ventilator-stockpile-ended-up-on-the-auction-block)

~~~
jl6
Remember that our generals will always fight the last battle. We will be well
prepared for the next pandemic. But the next big thing probably won’t be a
pandemic.

~~~
marvin
It's not just about fighting the last war, though. It's also about having
competent leadership that's able to adapt to a new reality, quickly discover
which of their current heuristics are wrong, and then reason from first
principles about what needs to be done for a good outcome in the current
situation.

There has been a spectacular difference in various nations' performance during
this crisis. As a Scandinavian I'm a bit skewed in my judgement, but I'm
especially in awe at Denmark and Norway's actions, given their lack of recent
history with infectious disease:

Quickly discover from external evidence what the new reality is, that it's
much worse than anything seen during the lifetimes of current leaders, that it
requires extreme measures normally only deployed during times of war, and then
use science-based leadership and a broad array of expertise to choose what
measures to apply. Then apply them with vigor and competently deal with the
fallout.

This is not trivial - crucially, it requires that the central leadership
avoids dogmatic and heuristic reasoning adapted to conditions that no longer
apply. Because even if you have such top leadership, there will be leaders on
the second tier of this hierarchy that are not used to reasoning on a war
footing. They will act or give advice that's normally sound, but
counterproductive in the new and extreme reality. Top leadership needs to
catch onto this fast, and strike down or disregard advice that's not
applicable to the crisis at hand.

You can see these phenomena in a plethora of fields. Scientists grasping for
N=100,000 double-blind randomized peer-reviewed studies for a novel
phenomenon, rather than make the best educated guess from reasoning and
available evidence. National leadership trying to solve a health-induced
economic crisis by printing money and nothing else. Politicians infighting and
posturing by old routine, as if the enemy army isn't already banging down the
gates. Reasoning by analogy, let's do the same as we do in a bad flu season.
Blame the other party, has always worked before.

Or a subtle insidious variant that's currently responsible for Sweden's
problems: let the experts handle it, and dictate public policy without regard
for what happens _outside_ of their field of expertise. Turns out an expert in
a narrow field with an IQ of 120 and a track record of success is a very
dangerous leader. They often aren't aware of their blind spots.

~~~
geomark
Yes, competent leadership. Doing things in the way you described. I have a
real conundrum, however, when I compare countries that are held up as good
examples and the place where I live, Thailand, which is largely ignored in all
the multi-country charts.

You see, as of today we have 2,473 confirmed cases and 33 deaths in Thailand.
Denmark, on the other had 5,819 confirmed cases and 247 deaths as of a couple
of days ago. I am sure the data is noisy and that testing here is not nearly
widespread enough. But the bodies are not piling up and we don't really have
the kind of censorship here that would keep it hidden if there were a lot of
deaths from Covid-19. And most importantly, the words "competent government
leadership" and "Thailand" should never be uttered in the same sentence.

So I guess leaders have done some things right by listening to the right
experts (a form of competence I suppose). Or maybe it's the weather (popular
theory that seems to have been dismissed). Or cultural habits have saved
Thailand. Because I look to more _advanced_ countries, especially in
Scandinavia, and don't understand why they are doing so much worse than where
I live.

~~~
marvin
Are you sure that the proportions (confirmed cases) / (actual cases) and
(confirmed deaths) / (actual deaths) are the same in these countries? That's
my biggest concern whenever I see dramatically (i.e. 2x or more) different
death rates between countries.

Climate, general health, age distribution and other unknown factors certainly
play into it, and could easily affect the rate of deaths by such a factor. But
I smell a rat when I hear that Norway get 5% positives and NYC gets 25% when
they test. Also, Italy makes it clear that even with a relatively consistent
approach to hunting down the corpses, a big factor can get lost in the noise.
Way above 2x.

So it's not trivial to compare this between countries, but it seems feasible
to (by critical judgement) at least distinguish between a wildly incompetent
and a good response.

~~~
geomark
Not sure, of course, because testing is insufficient and the data is noisy.
But it seems pretty clear that there are not a lot of dead bodies piling up.
That would be all over social media even if it wasn't reported by local MSM.
All of the reported deaths here had serious comorbidities. Are Thais really
that much healthier on average? I wouldn't think so, but I'm not sure.
Climate? If hot humid weather is the answer then we are safe because we are
into hot season now and the weather is miserably hot and humid.

------
TomMckenny
There is a difficult follow up to this. When the dust settles months from now
and some 40% of the country becomes convinced none of these problems ever
happened, how shall we prevent this or other fiascos next time?

~~~
z9e
There's already movements being made in Japan and other countries to move
manufacturing out of China, I'm hopeful policies will come out of this that
get rid of the just-in-time supply chain for critical things like PPE for
Dr's.

------
Balgair
"The news agency found that _not a single shipment of medical-grade N95 masks
arrived at U.S. ports during the month of March_... Federal agencies waited
until mid-March to begin placing bulk orders for the urgently needed
supplies... The first large U.S. government order ... was not placed until
March 21st—the same day that Ries got his first phone call about the Kushner
effort. The order... did not even require the supplies to be delivered until
the end of April" (emphasis mine, edited for length)

Though the article goes into more detail to the question that the title asks,
I thought this part was pertinent.

How did we end up with nurses in garbage PPE? The same way they still are in
them. The problems that existed a month ago still exist today and are likely
to continue to exist.

------
sherr
There's a tremendous amount of bureaucratic infighting and cluelessness in
many countries just now (I'm in the UK). There have been debates for many
years about streamlining the chain of command and responsibility in the USA;
just think about the post-9/11 debates. I understand that the federal
structure makes some things hard but it would seem to me that a proper central
authority to manage a crisis like this would be very useful - but isn't this
what FEMA is for? After the dust settles, some heads need to be bashed
together.

~~~
shas3
The incompetence of CDC and FDA is staggering.

It is not hard to imagine an alternative reality where the CDC-FDA testing
fiasco did not occur, there was some test-and-trace early in the epidemic, and
the cost and extent of the shut-downs were lesser and far fewer deaths
occurred.

It is a bit dismaying to say this: but CDC and FDA have a lot of blood on
their hands.

~~~
rabidrat
Who installed the CDC leadership and gutted their budget? It's easy to foist
the blame on some faceless TLA govt org without digging just one level deeper
to figure out how the gross incompetence was able to manifest.

~~~
shas3
You'd be right, if CDC's Covid-19 response isn't a repeat of their initial
incompetence during Ebola, SARS, etc.
[https://thehealthcareblog.com/blog/2020/04/11/the-covid-
pand...](https://thehealthcareblog.com/blog/2020/04/11/the-covid-pandemic-who-
dunnit/)

"To be fair, what’s on display here is a broader institutional malady. The US
version of the WHO, the CDC, took a similar stance with another controversial
topic—quarantines for health care workers returning from treating patients
with Ebola. Four states—New York, New Jersey, Florida, and Illinois—instituted
policies to quarantine anyone who had contact with someone infected with the
Ebola virus while in west Africa, including medical personnel who cared for
patients. No less than the Obama administration, backed by the CDC, attempted
to squash these policies, arguing that this would serve as a disincentive for
US health workers to travel to Africa to combat the disease at a time this
help was sorely needed."

------
darkerside
There's a terrific debate to be had about the role of the federal government
in a national emergency. Is it the air support for state led initiatives, or
should it be more of a quarterback coordinating action across all state lines?

~~~
eli
A pandemic that affects all states and all countries in the world and requires
almost unprecedented collective action to solve? How can forcing states to
figure it out themselves possibly be beneficial? Why is the Governor of NY
negotiating directly with Chinese suppliers? Why are states bidding against
each for the same scarce equipment, enriching only the middlemen who have
suddenly and suspiciously inserted themselves in the process?

~~~
toasterlovin
FWIW, states like New York and California have larger populations and
economies than most European countries. That, I think, is an argument in favor
of being more hands off and letting the governors figure out what’s right in
their state. They’ll have a much better understanding of what their local
problems and capabilities are.

~~~
Symbiote
The EU organised a joint purchase.

I'm not sure how much single-country purchasing has also happened.

[https://ec.europa.eu/commission/presscorner/detail/en/ip_20_...](https://ec.europa.eu/commission/presscorner/detail/en/ip_20_523)

~~~
paganel
That article was from March 24th, more recently (and as things got even more
serious) bigger EU countries like Germany have started going solo, like
documented in this recent article [1]. The article is in German (which I don't
know) but I'm going to post a translation provided by some other guy from whom
I've taken the link:

> During the Corona crisis, Chancellor Angela Merkel, in talks with China's
> President Xi, created the conditions for Germany to gain direct access to a
> state-owned Chinese manufacturer of protective clothing. This is stated in a
> paper with which the Federal Ministry of Health informed the Bundestag about
> the procurement of protective clothing.

> The paper for the Bundestag states that after a discussion between Merkel
> and Xi and subsequent talks between the Chinese Ministry of Commerce and the
> Federal Ministry of Health, "direct access to a state producer (Moheco)
> could be established" at the beginning of April. Moheco promised a "higher
> level of quality and delivery reliability". In addition, an "air bridge"
> between China and Germany will be established with unused Lufthansa
> passenger planes to transport the masks.

As a non-German EU citizen I find this type of tactics very, very wrong and
fundamentally detrimental to the future of the Union.

[1] [https://www.sueddeutsche.de/politik/schutzausruestung-
merkel...](https://www.sueddeutsche.de/politik/schutzausruestung-merkels-
direkter-draht-nach-china-1.4871798)

------
stock_toaster
Kakistocracy at its finest, that's how.

------
CryptoPunk
There would have been more substantial stockpiles of all essentials and safety
equipment if price 'gouging' wasn't illegal.

When you restrict prices to below a arbitrary level of any good, you get
shortages during those periods when the price should be above that level.

------
de_watcher
If it looks stupid but it works, it ain't stupid.

~~~
richbradshaw
[https://www.businessinsider.com/kious-kelly-hospital-
nurse-d...](https://www.businessinsider.com/kious-kelly-hospital-nurse-dies-
trash-bags-2020-3?r=US&IR=T)

[https://www.businessinsider.com/coronavirus-uk-nurses-
forced...](https://www.businessinsider.com/coronavirus-uk-nurses-forced-to-
wear-bin-bags-test-positive-2020-4?r=US&IR=T)

so, doesn't really work no, but is a desperate measure which is at best better
than nothing.

------
101404
"Interdependence" was a nice theory, but it seems to have it's limitations.

------
notyourday
That's easy. Hospital administrators were more interested in selling Tylenol
pills available $5.00 retail for $500.00.

------
fctorial
Do they even work?

------
matttproud
The United States: your global leader in self-afflicted wounds.

~~~
dang
Please don't post unsubstantive and/or flamebait comments to HN.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

