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.