Tag: COVID-19

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1 AC: What the data tell us

Be wise today so you don’t cry tomorrow.

E A Bucchianari

We’re well into Year 2 AC – After Covid. Clearly, we don’t know all we need to know. Conversely, we are awash in data and probably know more – collectively – than we think we do. In this series of posts, I’ve been presenting my observations, preliminary conclusions they’ve led me to, and what might be better approaches to future pandemics and other disasters, from a community perspective. In this post, I want to focus on the restrictions placed on all of us in response to the pandemic. There is a lot of misinformation out there (particularly if you listen to the media or the rather unprofessional rantings of Rochelle Walensky). While we don’t have “final” data for the pandemic, I think we’re close enough to the end to draw some conclusions about the effectiveness – or not – of the restrictions that we’ve been living with.

Probably front and center in most people’s minds is “Did the lockdowns work?” We paid a high price in terms of our economy, our social fabric and our kids’ lives; we need to know whether we got value for the disruptions. In answering this question, we are faced with several important hurdles:
• Goals. Initially, we were told that lockdowns were necessary to flatten the curve. Then we were told that they were continued to control the pandemic (whatever that means).
• Data. We have case data that is not very good, primarily because we did so little testing early on. The death data seems to be better, but again has some biases because of differing protocols for attribution across jurisdictions, lies misstatements by some public officials, and some question about the accuracy of early data. As noted in my last post, a better early warning system could have helped us have better data early on. For this analysis, I’m going to look at both case and death data, current to 4/5/21.
• Lockdowns and NPIs. If it were simply a matter of looking at lockdowns vs no lockdowns, analysis would be so much simpler! Unfortunately, almost every state has had a mix of non-pharmaceutical interventions (NPIs – mask mandates, social distancing, quarantines and lockdowns) making it difficult to isolate the effects of lockdowns. Further, these have changed over time. There are at least two attempts to develop an index try to reflect this spectrum of NPI responses on a common scale – I’m going to use the one developed by WalletHub, and the values for 2/26/21 (Although I don’t present the data here, I’ve looked at the indices for a few dates. While the absolute values change, the general conclusions are the same.). I have renamed their index “State Openness.”

In the following figure, I’ve plotted both cases and deaths by states (treating both Puerto Rico and the District of Columbia as states). Clearly, there is no relation between “state openness” and the death rate (R2 ~ 0). The data suggests that the states in the red box might want to compare their practices with those in the green boxes – a factor of five fewer deaths! There is a rough correlation (R2 = 0.35) between the case rate and state openness, but it is heavily influenced by outliers, especially the cluster of states in the green box (The gray box represents the Standard Error.). Thus, it appears that the NPIs may reduce the case rate, but have little to do with the death rate. This makes sense because the case rate depends on the public’s actions; NPIs influence those. The death rate is more a reflection of the quality of the health care system; NPIs have little influence there.

I’ve also looked at county data. Ideally, if there were a significant predictor of cases, counties and states could be better prepared to deal with potential “hot spots.” I’ve based my search on the CDC’s 2019 county health rankings data, thinking those data were likely to be the best source for a predictor. I looked at all of the data – but I won’t bore you with a plethora of scatter plots! One predictor that was discovered early on still holds – population density is a good predictor of the number of cases, as is the total population of the county (well, duh!). However, the two counties with the highest incidence of covid-19 are Chattahoochee County, GA, and Crowley County, CO; neither large metro areas. For both about one-third of their residents were infected.

There appeared to be “fuzzy” relationships between median household incomes and the prevalence of both cases and deaths in a county. The number of cases and deaths per 100,000 residents were limited by increasing household incomes. This was true for all residents, as well as when broken done by race. Let me stress this was not a correlation, but rather it appeared that low median household incomes were necessary (but not sufficient) conditions for high case and death rates.

Beyond these , I didn’t find any other data that were correlated with either case or death data.* Perhaps most notably, neither the Covid Community Vulnerability Index nor the Social Vulnerability Index correlated with either cases or deaths. This is particularly unfortunate, because they are intended to indicate potential hot spots. At least at the county level, they don’t.

The county data was further broken down by the type of county. The CDC classifies counties as either large, middle and small metro centers; large fringe centers; micrometro centers or non-core (rural areas). Rather than plot all of the data (a confusing profusion of colors and shapes), I’ve plotted the best fit lines for each county type vs state openness. While there is not a good fit for any of these, the “bunching” of the lines for the case data indicates that the county type did not make much of a difference in terms of cases. However, as the second graph of this pair shows, non-core counties tended to have significantly more deaths than the other county types. I’ve plotted the raw data for the large metro counties (red) and the non-core counties (green) in the lower graph. The data suggests that the health care system in many of the rural counties – but not all – are simply inferior. This may be due to a lack of medical personnel and hospitals, or the distance between those who died and health care centers; i.e., poorer care or poorer delivery. As a matter of interest, all four of the large metro counties with the highest deaths per resident were in NY – Queens, Bronx, and Kings and Richmond Counties. Foard County, TX; Emporia, VA and Jerauld County, SD, were the highest of all counties.

Finally, I’ve looked at state unemployment numbers for February (latest available data). Again, there is a rough (negative; R2 ~ 0.4)) correlation between unemployment and state openness. The most interesting outlier (at least to me) is Vermont (lower left corner) – one of the states with the most restrictions (NPIs) and yet very low unemployment. Perhaps unsurprisingly, California and New York have very high unemployment; but surprisingly (to me) Hawaii has the highest unemployment – probably indicative of restrictions on travel.

So, what’s the data trying to tell us? Lockdowns and the other NPIs have had a modest impact limiting the number of cases but also lead to higher unemployment. The NPIs have no measurable impact on the number of deaths. In that sense, they have done nothing to control the pandemic – lots of pain for little gain. The data on cases and deaths by county type clearly show that there are major disparities in rural health care for virtually every state. Perhaps most unfortunately, the data don’t point to a good predictor of impacts at the county level. The CCVI and SVI were worthy attempts to provide this, but ultimately have not been shown to be useful. It could be useful if health professionals dug more into the relationships between cases and deaths and household incomes; there could be a pony in there!

Clearly, I’m not a health professional. I have tried to present the data in as apolitical way as I can because the messages from the media have been filtered through their political biases. As Ernie Broussard has said, Pain is inevitable, but suffering is optional. If our communities are to avoid unnecessary suffering when the next pandemic hits, we will have to make some hard decisions to take difficult steps to alter our approaches. Let us hope that our leaders will base those decisions on cold facts such instead of the hot passions of the moment, or the emotional push to “just do something.” Let us hope that they are wise, lest the rest of us shed tears.

*The data from the 2019 county health rankings that did not correlate with either cases or deaths were:
Life expectancy (overall and by race);
Age adjusted mortality;
Child and infant mortality;
% of the population experiencing frequent physical and mental stress;
% of the population with diabetes;
Number and prevalence of HIV cases;
Number and prevalence of food insecurity;
Number and prevalence of limited access to health care;
Number and prevalence of drug overdoses resulting in death;
Number and prevalence of deaths due to motorcycles;
% of the population with insufficient sleep;
Number and ratio of primary care physicians to residents;
% of the population who are disconnected youth;
% of the population on free lunch;
Segregation index;
Homicide rate;
Number and prevalence of firearms deaths;
Number and prevalence of homeowners;
Number and prevalence of sever housing cost burden;
Fraction of the population under 18;
Number and fraction of the population over 65 (overall and by race);
Number and prevalence of English as a second language;
Fraction of the population who are female;
Number and fraction of the population living in a rural area;
The individual themes and the overall CCVI;
The SVI.

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1 AC: The counsel of canaries

It’s not that we can predict bubbles – if we could, we would be rich. But we can certainly have a bubble warning system.

Richard Thaler

We have just completed Year 1 AC – After Covid. Clearly, we don’t know all we need to know. Conversely, we are awash in data and probably know more – collectively – than we think we do. In this series of posts, I’m presenting my observations, preliminary conclusions they’ve led me to, and what might be a better approach to future pandemics and other disasters. Of necessity, this will be focused on the US experience; sadly, these observations seem to apply to the rest of the Western world as well.

Early detection is a key to avoiding or at least successfully managing a crisis. Whether it’s the approach of a superstorm or the imminent bursting of an economic bubble, early detection buys time so that we can better respond. One of the most important questions about the pandemic is – why didn’t the US public health bureaucracy respond more rapidly to the crisis. My answer: lack of a canary.

During most of the last century, coal miners took a pair of canaries into coal mines to act as an early warning system for the buildup of toxic gases. If the canaries stopped singing or died, the miners would exit the mine as rapidly as possible (Canaries were chosen because they are easily portable and like all birds are very susceptible to changes in air quality.*).

As late as March, CDC spokespersons (e.g., Dr Fauci) were reassuring Americans that there was no reason to make drastic changes in their lives: “If you are a healthy young person, there is no reason if you want to go on a cruise ship, go on a cruise ship” (March 9, 2020). Throughout the first three months of the pandemic, the CDC seemed to echo the World Health Organization (WHO) in downplaying the severity of the outbreak. In effect, it appears that we were using the WHO as our canary, oblivious to the potential for bureaucratic bungling (or worse) on their part.

Contrast this with Taiwan’s CDC. In December, their monitoring of online sources indicated that there was an unusual outbreak of pneumonia in Wuhan Province, China. They sent an urgent email to both the WHO and the Chinese CDC probing whether there was person-to-person transmission. At the same time, they advised the Taiwanese government to begin screening all passengers entering the country from China. This was accomplished December 31, 2019, one month before President Trump’s Executive Order mandating similar actions. As a result of their vigorous and early action, Taiwan has had only 10 deaths from the virus – 0.00000042 deaths per capita. Contrast this with the US rate of 0.00166 deaths per capita, or 551,005 in total (as of 3/31/21).

According to Dr Deborah Birx in a recent interview, ~100,000 deaths were due to the initial surge. While we will never know how many lives might have been saved if the US had acted sooner, it seems to be inarguable that tens of thousands would not have died. That’s the price we paid for not having a canary.

I am clearly not a health professional, but it seems clear to me that we need a better early warning system for health crises. Taiwan was motivated by the bitter lessons learned from SARS and H1N1; we can only hope that covid-19 serves as the same wakeup call for our public health system. The question then becomes how do we develop one.

There are a few analogues available. The meteorological community, for example, over a long period of time has actively sought to extend the time between warning of a tropical storm and its actual landfall. Their success is largely based on historical patterns incorporated in mathematical models, coupled with sensing data. A key factor to their success so far has been continuity of effort – updating their approaches with data storm by storm. The earthquake community is trying to do the same thing, with increasing success, though relying much more heavily on sensor data. The economic community (as noted in the quote above) continues to expend a great deal of its research effort on looking for canaries that portend economic crises. This is a somewhat more difficult challenge but even here historic patterns of events are providing hints of impending economic disasters.

It does not appear that the health community, at least in the West, has taken the same approach. As I’ve mentioned in previous posts, the health community has developed mathematical models, but they seem to be modeling the spread of contagion rather than focusing on providing early warning (I’ll be thrilled if my observation is proven incorrect!).

Sun Tzu in The Art of War said that the best battle is the one never fought. The best way to avoid a pandemic is to detect contagion as early as possible, and then rapidly take steps to mitigate its effects.** Canaries saved the lives of hundreds of coal miners last century. The thousands of lives lost during the initial surge attest to the fact that we urgently need to develop an effective early warning system for health crises in this century.

* Developing this approach was just one of the accomplishments of John Haldane, a Glaswegian professor and technologist. He also invented the first respirator as well as the decompression chamber for divers.

** The FDA and CDC bureaucracies also bungled the early response. Derek Thompson of The Atlantic has an excellent article detailing this.

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Of Ice Storms, Interdependencies and Impacts on Running a Bar

With apologies to the spirit of Finley Peter Dunne.

We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one destiny, affects all indirectly.

Martin Luther King, Jr.

I originally posted this in 2014, after a rather devastating ice storm hit the southeastern US.  The essential conclusion is that our interdependencies can lead to a cascade of consequences from a disruptive event.  While a community’s web of interdependencies can be a source of strength it also inevitably introduces new vulnerabilities.  We’ve seen this in spades with Covid-19.

This weekend I was sharing a bottle of wine (or so) with my neighbor Dooley, who owns a small pub.  We hadn’t seen each other since before the ice storm which had knocked out power for a couple of weeks, and he asked what I was doing now.  When I told him a little about my work in resilience, and especially when I mentioned interdependencies, he looked at me as if I was some kind of freak and said, “That’s all well and good, but it’s way too [expletive deleted] Ivory Tower for the real world.”  So, with the courage born of three or so glasses of wine, I tried to prove the practical importance of resilience to him.

“You’re a small businessman, right?”  “Yeah.”

“We live in South Carolina, right?”  “Well, duh [Sometimes Dooley is not the most sparkling of conversationalists].”

“Of all the things in this community, what’s probably the most important to your business?”  He looked at me as if I was an idiot and said, “My customers, of course.”

“Okay, but what is the most important thing besides your customers?  What service do you rely on the most to keep your business open?”  “I don’t know, electricity?”  “Bingo.  Electricity – keeps your beer cold, your customers cool, and your business hot.”

“So?”

“What happened to your business when we lost power during the ice storm?”  “I couldn’t open.  In fact, since my rent’s so high, I had trouble making ends meet for a few weeks afterward.  Fortunately, Glen and Shirley [Dooley’s bartender and waitress] were willing to let me be a little late in paying them.  The landlord – that [expletive deleted] – wouldn’t cut me any slack.”  

“And how are you doing now?”  Well, I’m back on my feet; in fact, I’m actually doing better than before the storm – Bill’s Brews and Bratz didn’t make it so I’ve got some new customers.”

“And what happened to Bill’s bartender?”  “I think he left town.  I’d have liked to hire him – he came by looking for work – but the new business wasn’t that good.” 

“See, that’s why interdependencies are so important.  You depend on the electricity being on – if it isn’t, you can’t open.  The folks who work for you rely on you being open for their livelihood; but that means that they also depend on the electric company because you do.  If you bought a generator, you might not depend directly on the power company, but you would depend on a distributor for fuel, which would probably mean that you’d now depend on the power company to power the fuel pumps.  And the electric company depends on its customers to pay their bills, otherwise the company couldn’t pay its employees and suppliers.”

Dooley – always gracious in defeat and articulate to fault – grumbled something like “Humph, rhubarb, rhubarb ratz a fratz.”

I’ve portrayed what I was telling Dooley in the figures below.  In the first, I’ve shown a sort of general picture of a community’s electric utility that experiences a disaster.  There’s an initial loss of capacity, followed by a gradual return of service to its customers.  I’ve also shown a red region, indicating that without power small businesses will begin to fail.  The figure is meant to indicate that some smaller businesses actually fail.  As the outage goes longer, more and more businesses will fail.  You may notice as well that eventually the capacity of the electrical system goes back to what it was before – no more nor less.  That’s because a utility almost never adds new generation in response to a disaster.

In the second, I’ve plotted gross sales for the community’s small businesses.  Sales fall during the service outage, because many of the businesses aren’t open.  And, as indicated in the first figure, some never reopen.  Thus, gross sales plummet. Sales probably won’t fall in proportion to the number of businesses that haven’t reopened, because some of the competitors of the closed businesses in the community will reopen (or stay open if they have a generator) and capture their customers, just as my friend Dooley did.  I’ve plotted small business activity in terms of gross sales because that’s what businesses use to pay their staff.  You may notice that the figure suggests that the workforce is even more vulnerable than small businesses.  The businesses, at least, can lay off one or more of their employees.

In the third figure, I’ve plotted the workforce, expressed as employment.  As you can see, it’s taking a much longer time for this part of the community to recover.  Even after the electricity gets turned back on, it takes a while for entrepreneurs to open new businesses to replace the jobs lost.  I’ve used the different colors to suggest another step in the cascade:  the local government may be able to build up a reserve fund when employment is high (green) through taxes on payroll and other economic activity; may just break even at somewhat lower levels (yellow) of employment; but high unemployment will likely bring with it a higher demand for community services and lower taxes, meaning the government will be running in the red.

As Dooley and I discussed later, each part of the community can do something to reduce the impacts.  Small businesses could buy generators if they need them or buy business interruption insurance for lost revenue.  That shrinks the red region in the first figure. The utility could bury its lines, pulling the black line away from the red region.  Businesses are just as vulnerable, but the likelihood of a loss of electric service is reduced.  Workers could save so they can live without a paycheck if necessary, or gain a diverse enough skill set to be more broadly employable.

We have seen the same kind of cascade of consequences caused by our response to the pandemic.  Our lockdowns and social distancing requirements closed small businesses which didn’t have the financial reserves to survive and recover.  At one point, 20% of our workforce was without jobs.  Local and state governments were – and are – operating in the red because of a lack of revenue (The “stimulus” spending by the federal government has helped tide many (most?) of the displaced workers over, but this isn’t a sustainable solution.).  One of the biggest challenges facing governments at all levels after this election is implementing policies to mitigate this type of disaster.

An ice storm is not a hurricane, or an earthquake, or a terrorist attack.  In fact, ice storms are pretty common in many places across the country.  Resilience is not just about recovering from disasters.  Resilience is really about realizing that change is inevitable, and that our interdependencies – our connections within and outside the community – can amplify the impacts of disruptive events. Community resilience demands that we recognize those possible impacts, and let that recognition point us to a more secure future.

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Covid-19: Disasters Have Direction

You can be sure of succeeding in your attacks if you only attack places which are undefended. You can ensure the safety of your defense if you only hold positions that cannot be attacked.

Sun Tzu

This is an updating of an old post.  The original did not have any specific examples; I think Covid-19 provides a good one.  I’m sure the concept “Disasters Have Direction” is obvious to many of you, but I’ve never seen it articulated.  As I try to show in the discussion of the pandemic, it can be a useful construct as we think about a community’s resilience.

For a few years, FEMA and DHS have championed the idea of an “All Hazards – Maximum of Maxima” approach to planning.  The basic premise is that if a community plans for the worst of the worst, then it will be prepared for whatever may actually happen. This is a deceptively simple tautology that I think deserves a little more analysis than it usually receives, especially in terms of community resilience.

Let’s start by looking at an idealized community.   A community can be thought of as an ecosystem.  There is a “human layer,” made up of individuals and families.  There is an institutional layer, consisting of private businesses and other economic institutions, and all of the other “human-serving” organizations in the community.  Then there is the physical, environmental, layer – containing the built and natural environment.  All of these are held together by the social capital within the community (some may argue whether the physical layer is bound to the community by its social capital, but that’s a subject for another post!).

Of course, this is an ideal community; real communities may have a strong economy but be weak in the human element.  Some have a decaying infrastructure but a flourishing natural environment.  Thus, we can depict a real community as follows.  This real community would be relatively weak in terms of its community institutions, have a somewhat stressed natural environment, but have a robust built environment.

Now let’s assume the community is hit by a pandemic.  There is no immediate physical damage.  Any that occurs most likely happens because the humans who normally maintain things –infrastructure, for example – are not able to do so.  This disaster has attacked individuals and families, and – because they are closely tied to the human layer – the community organizations that meet social needs.  For a pandemic, hospitals, clinics and the public health department would certainly be included.  Since, in this case, there is relatively little capacity in the community institutions (e.g., a rural community), they will be particularly hard hit – most likely overwhelmed. 

But what happens in a natural disaster?  The initial impact on the community is going to be on the physical layer; buildings are going to be blown down, debris will be strewn about, flooding may occur. The other parts of the community will be impacted because of these physical blows.  In our notional real community depicted above, there would be relatively little damage done to the built environment, but the natural environment would experience much greater damage (at least in relative terms) because it is weaker. 

A severe economic downturn attacks the community from another direction.  Businesses lay off workers; some close.  Many individuals and families experience severe economic hardship.  There is no immediate impact on the other parts of the community ecosystem.  Eventually, however, all will be affected.  In our example community, the economic impacts are less severe than for a community with a weak economy, or already burdened individuals and families.

Thus, disasters have a direction, as shown in the next graphic. It must be stressed that the graphic points out the initial point of attack.  If the magnitude of the initial impact is huge, or other parts of the community are weak, then the disaster is likely to ripple throughout the community with cascading impacts.

This simple concept is consistent with the idea that vulnerability to a threat depends on weakness at the point of attack.  This is shown in the next figure.  Threat X indicates a potential health crisis (e.g., a pandemic), while Threat Y is primarily a threat to the community’s economy.  As depicted, Threat X is more likely to lead to disaster than Threat Y because the greater relative strength of the community to withstand an economic downturn.

This simple picture of a community also has meaning in terms of recovery and community resilience.  If community resilience is measured by how fast – and effectively – resources are deployed to achieve community restoration and recovery, then the social capital within the community plays a crucial role.  Suppose Threat X above actually materializes.  The vulnerable part of the community has few available resources.  It is the community’s social capital – its connectedness – that provides the pathways for resources to be shifted within the community.  It is the community’s social capital that determines whether resources from outside the community are effectively brought to bear.  In a very real sense, it is the community’s social capital that determines whether the community actually recovers from disaster.

If we look at Covid-19 through this lens, clearly the pandemic attacked individuals and families, and community health organizations.  Its magnitude varied from community to community, but – initially – dealing with the pandemic exceeded the resources (e.g., PPE, ventilators) available to most communities, i.e., it was a disaster and it had a direction.  Communities had to rely on their connections (bridging and linking social capital) to others in the region and to the state (and, for the biggest cities, to the federal government) to get the resources they needed.  In a later post, I’ll outline a methodology that, if used, could have reduced the impact of the pandemic at the community level.

Our response to the pandemic triggered an economic disaster.  For those of you who remember my old post “Of Ice Storms, Interdependencies and their Impacts on Running a Bar” I pointed out that the number of businesses which could reopen after a disaster depended on how long they were closed.  In some places, the Covid-19 lockdowns lasted for months – and the economic consequences have been devastating.  I intend to update that post as well and expand upon it a little based on the knowledge we’ve gained from the pandemic.

Dan Alesch once said that we recall a disaster by the name of its triggering event, but remember it because of its impacts.  If that’s the case, Covid-19 will join the Dishonor Roll with Katrina, Deep Water Horizon, the Great Recession and so many others.  Each of these disasters were daggers that first pierced specific parts of the community, i.e., they had a direction.  Their impacts were determined by communities’ strengths at the point of attack and the force of the dagger’s thrust.  A community’s social capital determines how rapidly resources can be brought to bear to heal the wounds.  However, those who are not connected – without significant social capital – have to recover on their own:  resources won’t flow where messages don’t go.  In this way, the community’s social capital plays a crucial role in its recovery – and thus is a key component of the community’s resilience.

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Community Recovery in the Time of Covid

Sometimes things fall apart so that better things can fall together.

Marilyn Monroe

Our communities are going through tough times right now. All have seen disease and death damage their social fabrics. Some are experiencing physical devastation due to nature’s wrath and men’s anger. Sadly, we know that more death and destruction is inevitable. Our response to this has led to economic and educational chaos, and stunted lives.

But we also know that eventually these will ebb and end. We will stand on the rubble and realize that our communities must now recover – must now reach toward a New and, hopefully, Better Normal. We know that for some, recovery will require more resources than they have to give. Communities will look to state and federal governments to provide them the resources they lack. But what resources will our communities actually need?

Unfortunately, there’s no single answer. The damage done to many of our communities covers the spectrum from their physical environments to their social fabrics and their economies. Just as the damage experienced by communities will vary so to will the resources needed for recovery. Some communities will reach for any funding that they can, and sort of haphazardly aim to rebuild what was lost. But for those with the greatest damage, “You Can’t Go Home Again.” This time the magnitude of the damage is too great. For them, trying to rebuild the past has no future.

Other, more resilient, communities will recognize that the changes wrought by Covid and our response are so great that they require almost a reinvention. They will make the tough decisions to rebuild their communities to be “Future Fit,” ready to face whatever adversities the future may bring. They will take responsibility for their own recovery and develop plans to reach a New and Better Normal. And through their planning most will recover more rapidly than those who don’t plan.

While those plans will vary in detail, on another level they will have in common a focus on functionality, infrastructure and assets. In terms of functionality, they will likely start with an assessment of the damage to the community’s infrastructures. They will then look at how the existing infrastructure and assets will be used to achieve recovery. While these plans are likely to differ in the terms they use, I think it’s useful to look at their common focus through the lens of the Seven Capitals.

Social. In the US, our social fabric (our social infrastructure, if you will) has been badly frayed, especially in many of our major cities. Rioting, aided by masking and lockdowns, have prevented our social networks from the message-passing that is so vital for recovery of our communities – as I’ve said before, “Resources won‘t flow where messages don’t go.” And I’m not just talking about PPE and medical supplies. Although we don’t talk about it enough, most people depend on their networks of friends, neighbors and acquaintances to find out about job opportunities.

Unfortunately, while academia has established the importance of social capital, the damage to it is being ignored by many politicians. Recovery will require opening the places we gather as quickly as possible, so that we can reestablish our personal networks. That means churches, libraries, schools, parks and recreational venues. That also means getting rid of masks as soon as we can – they facilitate anti-social behavior. And most importantly, getting rid of those barriers that are keeping families apart.

Human. Even before Covid-19 reared its gnarly snout, our educational system had some serious problems. Educational “attainment,” especially in our de facto segregated inner city schools was so bad that it would have had to improve to be abysmal. Look at Baltimore – proficiency in reading and math hovering just slightly over 10%, but with a 70% graduation rate. And DC bordering on the criminal – a whopping 20% proficiency in reading and math among eighth graders, while spending twice the national average per pupil.

But just getting back to that “Normal” is proving challenging. While the “hybrid” model (part in-person, part online) sort-of, kind-of works for middle class kids, inevitably the disadvantaged (esp. in rural areas) will fall behind. We need to get the schools fully open now. But that will not absolve us of fixing the damage the lockdowns have already caused. If you can’t read and can’t do basic math, you can’t get a job to support yourself, let alone your family. One way to approach this is to task the federal Senior Corps with providing educational mentors for those who are struggling. This may also be a business opportunity for some of those out of work.

At the same time we’re taking care of our kids, we need to take a hard look at the skills of our out-of workers. These folks, in general, have developed the life skills to hold down a job. Most of those eventually will find similar work. But many won’t – a lot of jobs are gone, especially those in small businesses. We need to beef up our infrastructure for coaching, redirecting and retraining these once-and-future assets to our society.

Economic. Overall, the US now has a “90%” economy – about 10% of our labor force is out of work. Our goal should be careers, not simply jobs. That means businesses aimed at today’s and tomorrow’s needs, and workers with skills to match. Local government has a small role to play (as I discuss below) but ultimately economic recovery will be accomplished through the actions of innovators and entrepreneurs creating careers, and workers willing to learn new skills.

But that’s not to say that businesses, especially small businesses, don’t need help – many do. Professional and business associations should play a major role. First and foremost, small business owners need coaching as they make the tough decisions about whether and how to relaunch. Damage assessment is a skill that they seldom need, yet it is crucial to these decisions. It may indicate that the customer base isn’t there, or that a new business model is needed. Small business owners also often need help with the paperwork for SBA loans. Most professional associations already are providing guidelines for protecting the health of customers and employees, but they can do more.

Cultural. Anyone who watches the news has to be worried about the cultural chasm that seems to be widening in our country. We’ve always had the elitists who believe that government can solve all of our problems. We’ve always had the anarchists who believe that the only answer to our problems is the complete destruction of society as we know it. In past decades, the sensible middle – those who recognized our problems and worked to implement practical solutions – was strong enough to hold us together in this ideological tug-of-war. I’m not so sure that’s true any more.

If we are to recover our culture, we must first once more define it for ourselves. That means rediscovering our common values – freedom (and its homely twin, responsibility), family, the rule of law, equality of opportunity. That means regaining confidence in our own ability – that of each one of us – to make a difference in our world. That means recapturing our history – America the Aspirational – and our ability to dream. That means looking clearly and critically at our world, not through red- or blue-tinted glasses, but through the lens of our common values. And when we see situations not consistent with those values, once more working for the common good.

Doing all of this requires time and starts with small steps: opening churches, museums, art galleries, recreational venues and, yes, even bars. Rebuilding our culture will require that we reestablish our social networks, especially our ability to repair and extend those networks. The task of community rebuilding and recovery, if done well, will strengthen the sensible middle, and thus strengthen our cultural bonds.

Institutional. It is clear that many (most?) of our communities are going to need rebuilding (if not reinvention). That effort is going to require planning and resources. Since entire communities have been impacted, the whole of these communities needs to be a part of recovery planning, not just government. Further, all must recognize that while there likely will be more federal and state aid, ultimately recovery of the community will depend on how well the community can mobilize its own resources – financial, human and social.

For some communities, some sort of long-term recovery committee will move the community to a New Normal. Ideally, the committee will include all of those who can mobilize resources to get things done. Its most important job will be to “define victory” – determine what a successful recovery is for the community. It will integrate local (not just government!), state and federal resources. A part of this will be finding “patient capital.” It will act as an information hub, letting the public know what businesses are open, and where there are job openings. It will act as an economic gardener, focusing its attention on new and existing businesses looking to grow. Working with both local business and local government, it will flatten some of the regulatory barriers (e.g., licensing/permitting, unnecessary zoning restrictions, environmental reviews) to the birth of new businesses. The committee will also report on progress to the public. After a disaster of this magnitude, recovery will take years not weeks, so keeping the public informed is essential.

Built. Some locations have experienced significant damage to their infrastructures (e.g., from wildfires in the western US and tropical storms in the southeast). We know the drill for recovery – sort of. But if the New Normal is to be better than the old, then we may need to rethink the physical infrastructure, particularly in our bigger cities. I’m not a big fan of Governor Cuomo, but his ideas for making New York City both more livable and “socially distance-able” make sense. But what the events of the last few months have really highlighted are the infrastructure needs of our rural communities. Many of our responses to the pandemic have greatly stressed our – already fragile – rural health care infrastructure. And as I’ve noted above, we need to expand our internet coverage to include everyone, especially those in our rural areas.

This post is much longer than normal (I apologize!) but I could have written even more for each of these. Recovery from the pandemic will be a long slog. We cannot claim to have recovered until we’ve rebuilt all of our infrastructures (the assets of our community capitals) and have them functioning again. While government has a role to play, our communities’ recoveries won’t depend on government’s actions (although failure to recover may). Ultimately the recovery of my community, or your community, will depend on whether you and I – all of us – work together to achieve a New Normal. Our goal must be “Future Fit” communities, ready to face whatever adversities and to seize whatever opportunities the future may present.

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Finding a Better Path

I’ve learned that the safest path is not always the best path and I’ve learned that the voice of fear is not always to be trusted.

Steve Goodier

If COVID-19 returns in the fall, do we really want to go down the same path we’ve been taking? In the US, we have focused on “flattening the curve” – not reducing the total number of deaths directly due to COVID-19, but rather spacing them out so that “indirect” deaths due to insufficient health care system capacity have been minimized. We took this path because our models initially predicted tens of millions of cases – and millions of deaths – that would have overwhelmed our emergency rooms. In taking this approach, all of us were faced with a situation for which we were unprepared – we had never been faced with this kind of crisis. Our stocks of many critical resources had been depleted but never replenished. The “Triple Header” of hurricanes almost three years ago had hinted at what we now know – our EM doctrines are clearly inadequate to handle disasters that go beyond the regional. We acted largely out of caution and a fear of the unknown.

Things will be different the next time. We know that the approach we’ve taken to the pandemic is fraught with unintended consequences – impacting our economy, our social compact and our mental health. We will have much greater testing capability and probably sufficient PPE, and capable supply chains for each, the next time. With luck, we may also have more effective treatments available for those infected.

The problem we face in crafting a new approach is simply that too much conflicting “information” is being fire-hosed at us; it’s damned difficult to find the nuggets of truth in the rushing torrent so that we can plot a better path for the future. I strongly believe we should empanel a national Board of Inquiry for the coronavirus chartered to develop a better approach for nationwide disasters such as this. It is important that we do this for next fall, but also because this crisis may impact our ability to manage severe weather events starting this summer.

Rather than bipartisan, the Board should be non-partisan – focused on policy and planning rather than personalities and politics; lasered in on developing a better approach rather than playing the Blame Game. Such a Board needs a strong chair, versed in both the strategic and operational aspects of dealing with crises; Craig Fugate, Honore Russell or Thad Allen come to mind. The Board should be independent of both the Executive and Legislative Branches, perhaps under the National Academies. The Board should include expertise in economics; health and health care; law; and federal, state and local decision-making.

Such a Board should pursue lines of inquiry such as:

• Situational awareness. Whatever plan we develop, we can be sure that it will have to be modified once case numbers start to rise. Those changes will be informed by the data at hand. I’m sure I’m not the only one who can’t figure out whether we’re severely undercounting or overcounting cases and deaths (My guess is undercounting cases and overcounting deaths, but who knows?). The federal government should provide useful guidance in terms of how to count and report, esp. considering that both the pub;lic and private sectors are likely to be involved.

• Federal, state, community and private sector roles. There seem to be as many opinions about who should lead and how, who should follow, and who should get out of the way as there are politicians and pundits, i.e., way too many. We need simple efficient processes at all levels, minimizing paperwork, and clear on what they are and how to follow them. We really began to have success when we let the private sector get involved. Our processes need to stop stymieing and start encouraging private sector participation.

• Urban areas. Most importantly, we need to understand why urban areas such as NYC were hit so hard. Less than 3% of US counties – all urban and accounting for half of our nation’s GDP – have had 60% of US cases. If NYC was a separate country, its mortality rate would exceed Italy’s! Over one-third of US deaths occurred within a 30 mile radius of NYC. We have to understand what happened in these urban areas to perform better next time.

• Foreign experience. The Board should consider successful responses from other countries. As of today, Taiwan has had only six deaths and less than 450 cases out of a population of 23+M. They learned some hard lessons from SARS – and acted on what they learned; we apparently haven’t.

• Lockdowns. Singapore, South Korea and Sweden all have approached the “Wu Flu” very differently than we have in the US, with arguably better results. One element these have in common is aggressive contact tracking; it seems that we can learn from what they have done. In these countries, the elderly and those potentially at greatest risk were urged to quarantine, but schools weren’t closed; restaurants weren’t closed; retailers weren’t closed. If we look at the responses across our states, lockdowns don’t seem to have had a quantifiable impact on health outcomes; population density does. Conversely, we will likely pay a terrible price later in deaths of those who didn’t go for their cancer treatments, who couldn’t afford to pay for their medications, who didn’t get the proper exercise. This doesn’t begin to address the incalculable impacts on our kids’ educations and future employability, or the millions of children worldwide who the UN estimates are going to die of starvation.

• Next points of attack. We now know that urban centers were the hardest hit in this first round. We need to determine whether this has resulted in “herd immunity.” The potential vulnerability of more rural populations also needs to be addressed.

There are other issues (e.g., border security and immigration) that also should be considered. What we need most now, however, is the wisdom to find those nuggets of truth, the wisdom to use them as signposts toward a better path, and the courage to follow those signs onto that path. Given our highly partisan polity, wisdom, will and courage will all be needed. The GOP and the Dems have both contributed to the problems; the best ideas from both are needed to solve them.

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Once the pale horseman fades away

It’s not how far you fall, but how high you bounce that counts.

Zig Ziglar

As I threatened promised a few weeks ago, over the next few posts I’m going to float some ideas intended to make the New Normal we’re groping for a better place for all of us to live. Each of the things I’m going to propose are going to make at least some of you uncomfortable (Some of the concepts will make all of us uncomfortable!). But these uncomfortable times demand that each of us break out of our bubbles if we’re going to “Build Back Better.”

My focus throughout all of these essays on COVID-19 recovery is on something called “Main Street.” I trust Wall Street will take care of itself, but our Main Streets are going to need help to recover. I use the phrase “Main Street” to evoke a sense of community; a belief in neighbors helping neighbors; a trust in our inherent ability to synthesize a New – and better – Normal from our differing perspectives. And while that may seem overly idealistic, I believe that this is a time for radical pragmatism: real solutions to our real problems that we can all fight for. In this post, I’m going to focus on building a better economy for our communities.

As I’ve pointed out in previous posts, small businesses – the mainstay of our Main Streets – are the ones who have been hardest hit by the pandemic. Last Friday, John Mauldin wrote about an 80% economy in our future – with the lost 20% primarily small businesses. More importantly, the most economically fragile are the ones most likely to lose their jobs and, sadly, the ones least likely to be able catch on somewhere else due to location, education and lack of marketable skills. Many of their jobs – especially in retail and restaurants – are unlikely to come back soon. For decades our “service economy” was lauded; but I do not believe that it can lead us back to something better in its former shape.

There are going to be new job opportunities for those who can stretch to meet them – our entrepreneurs. In the service sector people will be needed to deploy and service the new tools that entrepreneurs are developing for telework and teleschool. Workers will be needed to meet health care needs with new high-tech and low-tech solutions. For example, I foresee a major role for thermal imaging at entrances of any building open to the public – preventing those with fevers from exposing others (and, ideally, at border and customers and immigration checkpoints as well). Initially this will be crudely done by hand-held instruments, requiring workers to “point and shoot” the devices. Workers are being added to support warehousing and delivery of our essentials (and not so essentials) as well.

But I see a greater opportunity for new businesses and jobs in manufacturing. Major companies are already taking a much closer look at their supply chains. Part of our recovery plan should include policies to encourage shortening our supply chains whenever possible, and encouraging our manufacturers to buy American first. But not just shorten but fundamentally change the way we think about our supply chains. For too long, our manufacturers have aimed to make their supply chains as efficient as possible – going for the cheapest source with “Just in Time” delivery. But now we’re seeing “Just-in-time” turning into “Almost never” (e.g., China preventing American factories in China from shipping medical supplies back to the US). The pandemic should teach us that resilience is not the same as efficiency; redundancy (e.g., multiple suppliers) must be built in to avoid loss and for quick recovery (or as we physical scientists say – “Entropy rules!”).

An important part of this rethinking of our supply chains is reducing our dependence on a single source: China, Inc. Our pharmaceutical industry is dependent on Chinese sources of raw materials for about four-fifths of our medicines. China is a primary source of cheap finished medical supplies (e.g., surgical masks). What hasn’t been mentioned enough is that with their Belt and Road initiative, our electronics industry has also become critically dependent on Chinese-controlled sources of precious and rare earth metals. We need to address this in our national recovery strategy – looking at the economics of recovery of critical metals from electronic and other wastes would be an intriguing place to start.

But while entrepreneurial efforts will undoubtedly create new jobs, it is also likely that they won’t be nearly enough for all of the workers displaced by the pandemic. Upgrading our nation’s infrastructure has to play a prime role in putting people back to work. We need to make existing public spaces as pandemic proof as possible. Governor Cuomo’s vision for a New York City that is both more livable and more socially distance-able is a good example. But there are a host of other actions that should be taken to ensure that our infrastructure not only meets present needs but is ready to support our New Normal. For example, rapidly building out and extending the G5 internet throughout the country, especially to rural areas. Hardening existing infrastructure while reimagining how infrastructure can support – perhaps even guide – safer and better living patterns in the future; solving the conundrum of affordable housing; recognizing the value offered by our suburbs in this time of the pandemic. Upgrading our infrastructure will be a tremendous undertaking, with the potential to put all of America back to work. Undoubtedly it will be expensive, costing trillions of dollars, but the return on that investment can be a lasting monument to our resilience.

But just giving people jobs and an income is not enough – the enduring problem that the pandemic has pointed out is that so many of us do not have any savings to tide us over in emergencies, i.e., it’s not so much lack of income, but lack of wealth. We need to find a way to help even the least skilled begin to build a grubstake for emergencies, and to seize opportunities to have a better life. I would suggest that if – as we are being told – we’re in a war, that we harken back to one of the best ideas of the World Wars – bonds, call them Rebuilding America Bonds. If we have to go into debt to repair our economy and reinvigorate our infrastructure, then let’s owe that debt to ourselves, and have that debt aimed at helping the least of us. Give us our income tax refunds in Rebuilding America Bonds. Nudge employers to include Rebuilding America Bonds as part of their pension portfolios. Encourage parents, grandparents, extended family and friends to give Rebuilding America Bonds for birthdays and holidays. Encourage states and communities to float their own version of these bonds to pay for their own infrastructure refurbishment programs, and backstop those programs at the federal level.

For not only our physical infrastructure needs repair; while we say we’re all in this together the words and actions of some are evidence that their “all” is not everyone. We also need to rebuild our trust in each other and our recognition of our common humanity.

Finally, we must – MUST – begin to seriously address the impacts of the pandemic on those just entering or just about to enter the workforce. During the Great Depression, FDR used the WPA and the CCC (enough initialisms there to satisfy even the fussiest of bureaucrats!) as a way to give meaningful work to the jobless. The Civilian Conservation Corps, in particular, gave jobs to about 300,000 youths at a time. Even before the pandemic, about 13% of those 16-25 years of age weren’t in school and didn’t have jobs. Let’s craft programs similar to those implemented 80+ years ago for today’s young people. Have them work at the community level to do needed jobs which will also help them become more employable.

Similarly, we need to think seriously about the minimum wage. While it is kind to consider raising it, it is not wise – here, wisdom is kindness through a telescopic lens, looking at the future impacts of an action. One of those impacts is that raising the minimum wage effectively lowers the boom on young people trying to get the skills necessary for employment. Whatever we decide as a nation to do about the minimum wage, we need to maintain a lower “youth minimum wage” so that there are entry points for even unskilled young people into the workforce. They need to learn the discipline of working at a job; even as they gain the experience and the satisfaction of doing the things to make their jobs a success.

We need to break out of the cocoon of fear fostered by the media – too often minor league politicians-without-portfolios playing “Gotcha Games.” We need to Go Big in our thinking and in our recovery: unleashing our entrepreneurs, rebuilding our infrastructure so that it is both more robust and better sited – and suited – to a changing world; providing our kids with the tools they’re going to need to live – and thrive – in this changing world; supporting the least among us so that they can survive – and lift themselves up – in the world as it changes. This is a different message too often unheard – borne of optimism in our ability to shape a better future for ourselves and our communities.

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Minsky Moments revisited

As Dan Alesch has pointed out, we designate disasters by their triggering events, but we recognize them by their impacts. Thus, we know Katrina and Sandy by the devastation they created; had they exhausted their energies over the Atlantic, their names would be forgotten. In years to come, COVID-19 will cause all of us to shudder, even though we’ve experienced many decades of influenza outbreaks.

But why were these disasters so impactful? And, for all of them, why were there such great disparities in those impacts, even among neighboring countries (Taiwan vs China) and even communities? My answer – Minsky Moments.

A Minsky Moment is a crisis paradoxically born of stability (It takes its name from Hyman Minsky and his financial instability hypothesis). Minsky believed that a long period of stable financial markets led to ever increasing risk tolerance (and often risk-taking) which in turn led to a sudden collapse in the market. His ideas have been used to explain both the crisis in Asian markets in the late 1990’s and the Great Recession that we were slowly climbing out of.

But we see this same behavior occurring over and over again, leading to other kinds of disasters. For example, the hurricanes in Florida in 2004 and 2005 were the first major storms to hit south Florida since Hurricane Andrew in 1992. Individually, each was weaker than Andrew, but collectively their impacts were much greater (For example, Wilma – a Cat 3 hurricane – did almost as much damage as the Cat 5 Andrew even after Ivan and Charley had already done so much.). Over time, people forgot Nature’s devastation – many let their insurance policies lapse; many didn’t properly protect their homes; virtually no effort was made to strengthen buildings built prior to the more stringent building codes put in force after Andrew. People became so risk tolerant that even common sense precautions (such as properly functioning storm shutters) were ignored.

Similarly, even after the devastating effects of this coronavirus in China became apparent (in spite of the Chinese government’s efforts to hide them) in January, the President and many governors and mayors tried to downplay its potential impacts. People were encouraged to “party hearty” – Chinese New Year, Mardi Gras and others. Spring Breakers beached it even into March, and for some, sadly, it was their last Big Wave. We had not had a major epidemic in 100 years; the false alarms of the last two decades (SARS, Ebola, et al.) conditioned us to believe that the party would never end – until it did.

We take action immediately after a disaster and then as its devastation slowly fades from our memories we become more and more tolerant of risk and eventually engage in increasingly risky behavior. Almost invariably, this behavior leads to a Minsky Moment.

Sadly, there can be Minsky Moments in any and every aspect of our lives. Certainly AIDS took so many lives in the 1980s because of the risk tolerance and risky behavior that were the hallmarks of the sexual revolution and drug use in the ’60s and ’70s. We had conquered polio in the ’50s; antibiotics seemed able to cure even STDs; there was no real risk – or so we thought. And yet a virus that apparently had been lying in wait since the ’20s pounced on our risky behavior to become a pandemic that continues today.

The levees of the Sacramento River Valley provide the basis for a potential Minsky Moment in the making. Originally built to provide water for reliable irrigation of farm land, the levee system has led to unrestrained development. This residential and commercial development is occurring in an area that has seen at least six massive floods (When Leland Stanford became Governor of California, he had to use a rowboat to get to his inauguration.). When the levees breach (one estimate indicates a 64% chance in the next third of a century), the drinking water for 25 million people will be contaminated, millions will be left homeless and tens of thousands will die. All because we have forgotten the lessons of the Great Mississippi flood of 1927 (John Barry’s Rising Tide provides an excellent explanation of how bad management and engineering contributed to this event. His The Great Influenza is a worthwhile reference on the Spanish flu pandemic.). Similarly, had we remembered the lessons that Nature tried to teach us with the Long Island Express of 1938 (a massive meat cleaver – compared to Sandy’s butter knife – that carved up the Long Island Sound) much of the devastation of Hurricane Sandy would have been avoided. While some communities had wide beaches and recently constructed berms and dunes that protected them from the worst of the storm, many more of their neighbors went unprotected into that good night. And those still rage over the blight that is strangling their communities.

In too many cases, the impacts caused by extreme events – especially the human suffering – can be attributed to Minsky Moments like these. It is all too human to want to forget the bad things that have happened to us. It is all too human to believe that since no crisis has happened recently, none lies lurking in our future. But to be resilient we must go beyond our human failings – we must ensure that fading memories do not give rise to tolerance of risk, then risky behavior, and then the inevitable Minsky Moment.

Stay well!

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Starting to Bring Back Main Street

The expectations of life depend upon diligence; the mechanic that would perfect his work must first sharpen his tools.

Confucius

The one thing we know for sure about our recovery from the coronavirus pandemic is that things will be different. Like Yeats’ rough beast, we will slowly slouch toward a New Normal. There are things that we can reasonably predict will happen along the way, but for now we do not know what’s at path’s end. In the next few posts I’m going to look at recovery. As the title implies, I see recovery as bringing back the Main Streets in our communities; regaining some stability and control in our lives in more resilient communities.

Recently I stumbled across a definition of resilience as purposeful action to achieve positive change. When I define victory as more resilient communities, what I’m saying is that the goal should be to rebuild communities so that they are better able to make good things happen for their members. “Building back better” shouldn’t only apply to buildings and bridges but to all of the tangibles and intangibles that are a part of our communities. To do this, we will have to reestablish community capital; all kinds of community capital.

Central to rebuilding community capital is rebuilding the capital of individuals, families and neighborhoods. Over the last decade we’ve heard a lot about income inequality, but too little about wealth. It’s estimated that about 39% of Americans have sufficient savings to deal with an $1,000 emergency. When these emergencies inevitably occur, those affected must rely on others to help them make it through: they must have social capital to cope. The question becomes “how do we help them build their capital accounts so that they can better cope with emergencies?”

Because recovery means looking at all types of community capital, I’m breaking this into several parts. In this first part, like the Confucian mechanic, I’m doing my due diligence – sharpening my tools (and wits – both of them) for what’s to come: defining the goal, and trying to see where we’ll be when the fog of our war with the virus clears.

• First, time. We can’t know when this first wave will end, but my best guess – and hope that I’m too pessimistic – is that we’ll be able to really begin on the recovery by the 4th of July. If we accept the rule of thumb that full recovery will take ten times as long as the period of loss, that means five years! There is likely to be a second wave come fall; we should be much better prepared to contain the damage to our communities than we were for this first round.

• Next, the economy. Unfortunately, the recently passed “Stimulus” bill won’t stimulate the economy very much; at best, it will allow many working people to stabilize their living arrangements – mortgages or rents, keeping food on the table. Small businesses and their employees will be the most likely to suffer. A study by the JP Morgan Chase Institute found that the 50% of small businesses had only enough cash to last 27 days. The picture was even grimmer for labor-intensive, low-wage sectors of the economy (restaurants, retail, repair and maintenance, and personal services): the financial buffer of 50% of these businesses was two-three weeks. In my small city, most of the local restaurants have tried to make a go of it via take-out only service. Today’s paper headlined that two of the most popular couldn’t make a go of it. More will follow their lead.

The most fragile businesses were the ones that with the most minority- and woman-ownership. Conversely, capital-intensive, higher-wage sectors (e.g., high tech manufacturing) had over one month of cash buffer. I’m afraid that much of the money allocated for small business loans won’t be accessed – what small business-person will want to take on more debt in a very volatile economic environment? If you’re a restaurant owner, reopening while people are remembering social distancing is risky business.

And, sadly, we’re likely going to see 8-digit unemployment figures. About 20% of restaurant workers already live below the poverty line. About one-third of our workers were barely getting by as part of the gig economy. Undoubtedly the number of cost-burdened and severely cost-burdened renters – and the number of the homeless – will spike.

• Social capital. In a recent column, George Friedman wrote that Canceling social life … cuts against not only the economy but, even more, what it means to be human. Several years ago, a group supported by CARRI* walked through a Whole Community pandemic exercise. One of the things that struck us was the potentially drastic social changes that might occur. Even before the appearance of the virus, we were seeing fewer family networks and, often, almost no contact even between next door neighbors. While many families are soldiering on in this world of social distancing, the bonding and bridging ties that hold our communities together are being further stretched and unraveled; . This is coming at a time of great distrust in our institutions: see the anti-social antics of the Spring Breakers. Once the crisis is over, I foresee something like the social upheaval of the early 1920’s after the Spanish flu pandemic. I also anticipate that both births and divorces will spike! And the elites will segregate themselves further from the rest of us.

• Human capital. The impacts of the crisis on our young people may be the greatest price we will pay, in the long-term. I’ve written before about the problems of youth unemployment; automation and increases in the minimum wage are conspiring to make many of them (esp. young men of color) unemployable. The closing of schools only adds to this. While we are seeing an uptick in online education particularly for colleges and universities, the teachers unions in Pennsylvania and Oregon have used their political power to prevent cyber charter schools from accepting new students. In spite of this, “teleschool” is probably an idea whose time has come.

• Institutional capital. Many of our government institutions have been conspicuous in their incompetence. Closing our borders undoubtedly bought us some time to prepare but – without doubt – we frittered that away in bureaucratic failures. But the rot goes beyond that – our responses to so many of the crises we’ve faced in recent years demonstrates our perverse inability to take action in the absence of a crisis.

Thus, I believe that the national recovery effort will trigger one of the seminal battles in our nation’s history: pitting those who still believe in our federal system of government against those who believe that we must fundamentally change our expand federal power while limiting state and local autonomy. While I want to remain nonpolitical in this essay, our response to COVID-19 indicates that – wherever we are between these two poles – our nation needs to find an approach to crisis management that is faster and more effective.

Once we get through this initial stage of the virus, the real work will begin: rebuilding our economy and reknitting our social fabric. Undoubtedly, some – many? – of the details surrounding my projections of where we’ll be when we begin recovery planning will be proven wrong. However, I strongly believe that the goal is right: building more resilient communities; communities better able to take action to improve our lives. Whether right or wrong, the most important thing is to have a goal in mind for recovery and then to plan and above all ACT to achieve it.

* Jane Kushma, Andy Felts, Susan Kammeraad-Campbell, Charlene Milliken and I.

Pretty heavy stuff! On the lighter side, I recently stumbled across an apocryphal letter from F. Scott Fitzgerald on his approach to social isolation during the Spanish flu pandemic.

The officials have alerted us to ensure we have a month’s worth of necessities. Zelda and I have stocked up on red wine, whiskey, rum, vermouth, absinthe, white wine, sherry, gin, and lord, if we need it, brandy. Please pray for us.

Once the parties start again

We’re now in the third month of dealing with the coronavirus pandemic in the US. In some ways our collective response to this has been effective (e.g., closing the borders), in some ways not (e.g., politicizing the pandemic). We are clearly learning as we go – as we should – and our response efforts are getting better focused. But the pandemic is both causing problems that will last long after we have the pandemic under control, as well as shining new light on existing problems that we haven’t solved.

Taiwan has done exceedingly well in dealing with the pandemic. Even though next door to China, only two deaths have been reported so far (By comparison, Italy’s per capita death rate from the virus is almost 1000 times higher.). Taiwan’s success is due in large part to their taking a hard look at their response to SARS in 2004. They built a crisis plan based on what they learned and have successfully implemented it. Their approach to the crisis has been different from ours and other countries (See here for a nice summary article and to get to a list of the actions they’ve taken.). I hope we in the US will do the same after this crisis passes. In this post, I want to pose some questions that I hope will be considered (starting with gathering appropriate data). I’m focusing on impacts to our communities; there are many others that need to be considered as well.

• What is the “aim point” for our response in the future? The current strategy in the US is aimed at limiting the number of deaths from the virus. Thus, we’re not really trying to prevent the virus from occurring; rather we’re accepting that people will catch the virus but trying to slow down its spread. If we are unsuccessful, then people will needlessly die because we don’t have enough ICU hospital beds, respirators and ventilators to treat the potential spike in cases. If we had a cure OR a vaccine OR more hospital beds and needed equipment, we could potentially employ a different strategy.

• How will those who live in cities and those in rural areas do? I must admit I have often been bemused by our country’s lurch toward urbanization. Cities concentrate risk – you’re more likely to be exposed to the virus if you live in a city (New York City is currently experiencing a death every hour.). Conversely, cities also concentrate resources – there are more hospitals, medical equipment and medicines in cities to deal with the sick. In the Spanish flu epidemics of 1917-19, mortality was less than 1% in urban areas (probably due to partial immunity from previous influenza outbreaks) compared to up to 90% in some rural communities. Right now, we have too few ICUs in rural communities and too many cases in some of our cities. We need to recognize that rural and urban health care needs are different and develop better means to address both. But to do that we need to have a better handle on what those needs are.

• How will the homeless fare? Most of the permanently homeless are in poor physical and mental health. Most of them are men. Drugs, alcohol, and poor environments have compromised their immune systems. They are likely at high risk. I’m fairly certain that our communications with the homeless are – at best – spotty. We need to consider what actions we ought to take to both communicate with and care for this slice of the homeless population.

• How useful were our models of the virus’ spread and mortality? As George Box famously said, “All models are wrong, but some are useful.” Our models for the spread of a pandemic are generally pretty good BUT like all models their accuracy depends on their input parameters. The ones we’re using are based on the Chinese experience, or what they’ve indicated was their experience. We don’t know how well that translates to American demographics or the American health care system.

• Is the approach we’re taking to social distancing the best overall? Taiwan, South Korea have taken a different approach to achieve the same ends as our draconian shutdowns of businesses and schools. While our approach may be best for containment of the virus, we need to know how it impacts other aspects of community life, e.g., businesses, education and other social facets. We are taking action to determine the impacts on small businesses and the economy at large; we need to have the same urgency about the pandemic’s impacts on our kids’ education and our communities’ social fabric.

• Can we track contacts more effectively? Tracking the contacts of those potentially infected is a key part of the strategy followed by Taiwan. This is much harder to do in our country with its patchwork of health departments at community, county, state and national levels. But I’m sick and tired of hearing the phrase “community spread” as a sort of code for “we don’t have a clue how Grandma was infected.” We can do better, but it will require that each of us takes a hard look at the balance between individual privacy and community health security.Along those same lines, we need to begin using Big Data techniques to determine potential future hot spots. There is all sorts of data indicating people flows; we need to start using them for future casting. We undoubtedly will initially stumble – make bad calls – but we can’t do better unless we start doing.

• How should we deal with those crossing our nation’s borders? Our immigration policy – such as it is – is a mess. Was and is, but we need to fix it for the future. Further, many of us Americans (like She Who Must Be Obeyed) have a lot of unsatisfied wanderlust. The government took what appears to be appropriate and relatively effective action to selectively close our borders but it is clear that foreign visitors or returning Americans triggered at least some of the hot spots. While I hate to contemplate it, we need to consider actions such as required medical screening at every border entry for anyone coming into the country.

This is a difficult time for all of us. The approach we’re taking toward the virus in the US is the one most likely to deplete our social capital, at least for a while. As I’ve often said, never underestimate the power of a party – I hope the human love of partying will help us to recapitalize our social infrastructure. But once the parties start again, we need to look back honestly at the crisis past, and be better prepared for the next one – knowing full well that it won’t be like the last one.

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In my next post, I’ll turn from crisis planning to putting together a plan for coming back. Given our approach to the pandemic, what sorts of things ought to be considered in planning for our communities’ recovery?

One more thing. With all of the guidance on hand washing and use of sanitizers, we tend to overlook the obvious: healthy people are going to fare better than those who aren’t, no matter their age. All of us need to find ways to keep fit while we’re isolated. During the week, I’m usually out by 630am walking 3-4 miles. Others are using video exercise or tai chi classes. Whatever you do, please make sure you, your elderly parents and your kids find ways to stay active even while avoiding unnecessary contacts.