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The CDC Triumph

In 2005, Republican President George W. Bush read a book on the 1918 flu pandemic. The potential devastation from a recurrence of that world-shaking catastrophe struck the president powerfully; he immediately insisted that his cabinet begin work on a pandemic response plan. The 9/11 trade towers attack sensitized Bush and his cabinet to the potential disruption of improbable but highly impactful events. Eventually, this would lead to a CDC triumph.

The CDC Triumph
The CDC triumph: the pandemic playbook

The CDC pandemic play book

Bush’s cabinet produced a nearly 400-page playbook detailing evaluation of dangers, limiting disease spread with travel bans and closures, marshaling critical supplies, managing adequate health care facilities, implementing social controls and practices, tracing contacts, the discovery, production and distribution of treatments and vaccines, best practices for avoiding panic and promoting compliance to healthcare measures. The playbook was tested and refined on Ebola, SARS, H1N1 and other infectious outbursts. The 2017 revision of this playbook still exists on a Center for Disease Control website.

Pandemic preparedness

The 2019 Global Health Security Index, a report produced by an international group of institutions, including Johns Hopkins Center for Health Security and The Economist magazine, ranked the U.S. number one among 195 nations in pandemic preparedness, largely on the basis of the playbook.

The week before the November 2020 general election, ten months later, the U.S. has almost 230,000 dead, roughly 70,000 more deaths than Brazil, the next hardest hit country. Brazil ranked 22 on the Global Health Security List. The United Kingdom, ranked 2 on the Global Health list has almost 50,000 dead. Columbia, ranked 65, has only 30,000 dead.

Preparedness results

The U.S. was the most prepared and it has had the worst results. The U.K. was second most prepared and their results are not good. Columbia gets a low B on preparedness and protects their people better. Angola is in the bottom segment of the list and has only 275 dead, far fewer than our own Washington State.

Looks like preparedness is overrated.

Think twice, grasshopper. That hop to a conclusion sailed clear off the dock. Preparation without execution is a wandering ghost: free floating intent with no consequence.

What in blazes is that supposed to mean?

Preparation without execution is null

Preparation does not matter if it is ignored. Read the CDC playbook. The plans were ignored and neglected. Protective gear was supposed to be stockpiled. Congress refused to allocate funds and the stockpiles were under supplied. The play book calls for extensive testing and includes guidelines on developing and deploying tests. The U.S. flubbed this badly at the beginning. The official test didn’t work, which was an unfortunate but recoverable misstep. But the U.S. did not follow its own plans to correct and recover. Over and over, the playbook was ignored. Testing is still below the plans in the playbook. I could go on. You can check it for yourself. The official 2019 playbook is here. The full implementation is here.

The playbook was ignored. Would the plans would have worked if they were followed?

The CDC playbook is not dead

Astoundingly, the plans developed by the CDC under Presidents Bush and Obama were followed and used. Just not by the U.S. I looked at two countries that have dodged the covid-19 bullet: Taiwan and New Zealand. Both have documents with nearly the same name as the U.S. playbook. Taiwan has its Pandemic Influenza Strategic Plan. New Zealand has its New Zealand Pandemic Influenza Plan.

The plans of the three countries are long detailed documents and I confess that I have not read them in their entirety, but I have read enough to convince myself that all three are the same plan, close enough that I would be surprised if there was not a lot of cribbing. I’ll be a U.S. chauvinist: I think New Zealand and Taiwan did most of the copying, but I don’t know that. The difference is that both Taiwan and New Zealand followed their plans, the U.S. did not.

The day after I wrote the above paragraph, I stumbled on this, a video report from the New York Times that makes the same point far better than I.

The CDC playbook test

Two countries that executed the playbook and one that wrote the book but did not execute the plan is as close to a gold standard test of a strategy as you can get.

Results

Now let’s see the results. Taiwan, population 23 million, 554 cases, 7 deaths, no new covid-19 cases in the last 200 days. New Zealand, population 5 million, 1950 cases, 25 deaths. U.S., population 328 million, 8,990,196 cases, 229,141 deaths on the Johns Hopkins COVID-19 Dashboard.

Compare apples to apples

That comes out to 24 cases/million for Taiwan, 390 cases/million for New Zealand, and 27,400 cases/million for the U.S.

If the U.S. had kept covid-19 in check like Taiwan, we would have under 8,000 cases. At New Zealand’s rate, 125,000, instead of close to 9 million. If we compare deaths, 100 at Taiwan’s death rate, 1600 at New Zealand’s death rate, instead of 230, 000 deaths in the U.S.

Covid-19 hoax

If we had followed our own playbook for a pandemic, we could have expected a few thousand deaths. Less than the estimated 22,000 flu deaths we had in 2019. Like Y2K, covid-19 would have been declared a hoax, not as bad as the flu.

The CDC triumph

There is a silver lining to this: the U.S. CDC playbook won. We didn’t use it, but it won. The scientists who wrote the playbook are still here. They have the same abilities they had under Presidents Bush and Obama. They are here for us to call on.

All we have to do is elect a government that will use our treasures to save us.

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The Radicalization of America: Whatcom County

I read an article in the New York Times this evening “The Radicalization of a Small American Town.” Brian Groh, the author of the Times article, describes a microcosm of the radicalization of America, a small town in Indiana that has been devastated by the economy of the 21st century, wracked with pain and death of opioid addiction, crippled by the response to the covid-19 epidemic, and violently political.

Radicalization of America
Sunrise in Whatcom County

Instead of the friendliness, lack of pretension, and sense of decency Groh remembers from his youth, he recounts the story of a former neighbor who was recently threatened when he expressed a political opinion.

Groh laments the change.

Opioid crisis and the radicalization of America

It’s a good story, but I wonder if many of his neighbors would agree with his view. I looked at opioid death statistics in Indiana where statewide deaths per thousand are above the national average. The county in the article has one of the lowest rates in the state. We in Whatcom County are fortunate: although opioid and other drug deaths are still far too prevalent, some statistics show a slight decline in the opioid death rate in Whatcom County between 2002 and 2018.

We have a problem, but not a raging crisis. Thank heavens. Covid-19 is bad enough.

Rural Indiana

I’ve visited Mr. Groh’s rural Indiana. I’ve never lived there, but it felt like home as I listened to conversations among farmers at the tractor dealership where I was installing software. Both my Dutch and German ancestors spent a few decades in the Midwest before they made their final jump west to the edge of the Pacific Ocean. In rural Indiana, I felt like I could have been in Lynden or Ferndale.

What’s changed?

Groh’s experience does not match my experience in Whatcom County. I agree that the rural America I see today is not the place I saw when I was growing up. But the question is what changed? Did Whatcom County change? Or did I?

Well. I changed. I know that. I went off to college and graduate school.

What I learned

There, calculus taught me that differentiation and integration are mathematically two aspects of the same operation. In chemistry and physics, I learned that science can measure and predict the changes around us with greater precision than muddled impressions of undisciplined observation, but it continually refines and deepens understanding rather than lays down immutable laws.

At the age of nineteen, a mathematical logic class forced me to plumb the mysteries of the proof of Gödel’s theorem, which asserts that no matter how much you know, there will always be things you can’t fully understand. By twenty-one, I had learned to read classical Chinese and was forced to notice that the Athens-Jerusalem axis of western civilization has not been the only foundation for successful societies.

Then I realized that a humble farm boy had best quit straining the seams of his underpants. I came back home to work that out, but I was no longer the kid I was growing up and already I saw Whatcom County through changed eyes. But I also realized that my eyes had become exotic. I fret over Gödel’s theorem. My neighbors don’t.

Fifty years later

Fifty years later, I’m still working on that project. I see that my neighbors and relatives have many virtues. They are tough, self-confident, often happy. Some are prosperous, some think the prosperity they deserve has been withheld by forces they should control but can’t. Some are accomplished, many are stylish. A significant number are convinced that they have right on their side. I’m still the lout with manure on my boots that I was fifty years ago.

My experience is in the software business, which is like most businesses, as far as I can tell. You don’t last long in the software if you can’t spot who is likely to get the work done and who is likely to screw things up. I learned to stay away from loudmouths who succeed by refusing to pay their help, stiff their creditors, shift blame, and counter reason with bluster. They may succeed for a while, but eventually business caves in around them and everyone loses. That’s about as far as my politics go.

Doubling down

I also know it is easier to double down on a bad choice than it is to switch to a better choice. Switching to a choice that you once rejected is a humiliating struggle. I’ve been wrong often enough to know the sick feeling and bad taste that fouls my gorge when I recognize a misjudgment. I’ve faced it often enough; I don’t wish it on anyone.

When a bad choice is not all bad, the struggle is more painful. If a segment of the population prospered for three years while others struggled, the segment that thrived will not readily give up their gains. They will be proud of their sagacity. Those who look up to prosperity often throw their lot in with the prosperous even though they have reaped few benefits. Humans are not good at balancing long and short-term gains.

2020 vs 1960

In pandemic 2020, everyone is overstressed and close to anger. Add an atmosphere that promotes strife and tension over calm, and you have a community inclined toward violence.

But is the Whatcom County community fundamentally different from the same place sixty years ago? I say no. It was not ideal then and it is not ideal now. McCarthyism was still a topic sixty years ago. Racism was casually accepted among my parents and grandparents. Abusing native Americans acceptable behavior. The Ku Klux Klan flourished for a while in Whatcom County. Dig into the local newspaper archives and you soon run into language and propositions that might make you flinch.

Given today’s conditions, I think the county of my youth would have been inclined toward violence, perhaps more so than today. Although gun enthusiasts are vocal and prominent today, guns and ammunition were more easily available fifty years ago. Most country people had weapons for dealing with varmints and were ready to use them. More so than I see today.

Racism was more overt, mistreating the tribes was usual.

But serious violence never erupted. That’s important. Today, folks rant about antifa and the far right. As a kid, I overheard talk about threats from Bolsheviks, Wobblies, Fascists, Communists, and so forth, but it all turned out to be nervous fretting.

Is Whatcom County radicalized?

I don’t think so. No more today than fifty years ago. What I do see today, like fifty years ago, is a huge and quiet majority of concerned good people who want to live their lives in peace with their neighbors.

That hasn’t changed at all.

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Farm Inspired Software Remote Agile Scrum

Lessons for managing teams working at home

A jagged line of hills…

I’m usually an early riser, a habit that started when I was growing up on a farm where the day’s work started when the cows woke up. In early fall, I’m awake when the crests of the foothills begin to show as a faint silhouette on the horizon. One morning this week, looking out on the same jagged line between dark and light in the eastern sky that I have seen thousands of times and hope to see a thousand times more, I realized that habits I learned in the old farmhouse inspired the remote agile scrum I used to manage remote software development teams working from dispersed offices and homes.

Sixty years ago, working from home was common. My uncle Arn and several of the neighbors on Waschke Road worked out, which meant they had jobs off the farm, not that they exercised their muscles regularly. Avoiding exertion was more in vogue then.

Most ran their own farms, more or less independently. Farm cash came mainly from dairying. Milk checks were small in those days, very small if your bacteria counts were high and you were forced to ship milk to the ice cream, cheese, and powdered milk factories instead of the Seattle Grade A fresh milk market. Many of the jobs on the farm, like harvesting hay, thrashing grain, and filling silos were too big for a single family to handle by themselves and there was no money for hiring help. The answer was to work together.

Working together

You don’t see folks working together much now the way the used to. Today, folks who want to accomplish something big and complex hire a contractor. The contractor has an organization and a network of suppliers and subcontractors. Strike an agreement and the contractor gets the work done.

Even when someone acts as their own contractor, the process is based on money moving from person to person. If you don’t have ready money but you want the job done immediately, no problem. There’s an entire financial industry– banks, mortgage companies, credit cards, payday loans, and pawn shops– eager to supply you with whatever money you need. If that fails, there is always GoFundMe. But at the time and in the place where I grew up, those resources were rare and money was hard to come by.

No Gantt charts, critical paths, or milestones

In those days, work was often done without money. Hands showed up on the day they were needed. No Gantt charts, critical path analysis, or milestones, not even a crude schedule on the back of an envelope. Maybe a phone call or two, but mostly the word got around and the hands appeared. The crew knew exactly what to do. No boss ever ordered anyone around. I never saw a To Do List on the farm and yet all the work was finished. Never a word about job descriptions, pay grades, or equal pay for equal work. Then, it seemed effortless. Now, it seems more like magic or a miracle.

When I think back on what working together was like, I realize that it was a subtle and delicate process that took a demanding level of skill to execute. Human nature is, in my observation, constant. Offer too much, and you are taken advantage of, offer not enough and you freeze in isolation. The variables are subtle and elusive. What is egregious flattery today is mild social lubrication tomorrow. My parents knew their work group with greater precision than I knew the software development team I led.

Farm management and visiting

My parents always shipped Grade A milk, but money was still tight. For them, maintaining social ties among their work group was a way of life. Nearly every afternoon and many evenings after milking, a neighbor or relative stopped at our house or mom and dad visited someone at their house.

I used to think sharing a cup of coffee was recreation. My parents enjoyed visiting; sitting down for “coffee-and” was a few minutes of rest in a long and strenuous day that started at sunrise and ended long after sunset, but I realize now that they had no choice: the circuit of visits, cups of coffee, and plates of cookies and sandwiches were the essential cooperative fabric of farm life. Cooperative work was designed and planned in those sessions, sometimes in wordless agreement, only occasionally with explicit dates, times, and assignments.

Mutual obligation

The neighbors worked from home on their own farms, paid their own bills, and nursed their own wounds, but to cut, rake, bale, and load hay into the mows; bind and thrash grain; and fill silos with chopped grass and corn, they had to work together. Without their neighbors, very small farmers and pensioners like John Schaefer, Luther Johnson, Howard Fretz, and Art Coss as allies, my parents could not keep the farm running. My parents helped them and they helped my parents. They formed an alliance, a team, that could be counted on for the big jobs. I saw no accounting of quid pro quo, no balancing of the books, only a simple recognition of mutual obligation.

While managing software development, I used mutual obligation without explicit quid pro quo to keep remote teams working together, although I did not know where I learned the technique, certainly not from the books of self help and management strategies I read. But the remote agile scrum I used to run were based on mutual obligation.

The daily standup

I always insisted on a daily “stand up.” Although I seldom enforced the rule, a daily stand up meeting is a meeting in which no one is allowed to sit down, because when no one gets comfortable, meetings automatically stay short. In the agile programming paradigm, these meetings are intended to answer several specific questions: what is everyone doing today, what is blocking progress, and what help do you need? The questions do not have to be answered in the standup. It’s often more efficient to deal with them in smaller side conversations.

That’s how it works in theory. Practice is somewhat different. Dissembling, I won’t call it lying, is endemic to standups. Everyone says they are bounding forward and wildly successful; no one ever freely admits they are stymied. Management-speak encourages dissembling: the word “problem” must always be replaced with “challenge.” Hah. Progress comes in small steps littered with mistakes that no one wants or needs to hear about.

Mutual obligations on software teams

So why insist on daily standups? Because remote teams have to work together, just like the small farmers when I was a kid, and they can’t work together if they don’t understand each other and their work. Communication and cooperation may look spontaneous, but they seldom occur without cultivation. My parents visited, I ran standup meetings to ensure that every member of the work group understood the role they and their neighbors played in the web of mutual obligation that makes up a team.

Little of that communication occurred in standup meetings themselves; most happened in the side conversations that the daily standup started and continued through the day and night. Since software teams are often globally distributed and the workweek varies from place to place, any hour of my day or night could be in the middle of some member of the team’s workday. Consequently, the work of the team never stopped. Someone was moving the project ahead every hour of every day.

I considered a big part of my job was to make sure the team members kept talking after the daily standup ended. In those days, I had administrative assistants. One of their tasks was to keep a contact sheet up to date and distributed to every member of the extended team. My assistants knew I liked to see new contact sheets distributed within minutes of changes in phone extensions, chat room parameters, anything that was necessary for team members to keep in touch. Those contact sheets were as essential as my parents’ knowledge of who was farming in the sections surrounding the farm.

I kept a mental list of conversations that I would verify were taking place, dropping in on discussions, making phone calls, and trying not to be a pest while urging the team on.

The daily standup was the hub and mutual connections were the rim of the wheel

As I am ending this post, the sun is not yet up. No horizon is showing; soft white fog blankets the farm. The fence our son hired a contractor to put up last month is only fifty yards away and invisible in the mist, yet I am confident that the fields are still there. Some days are like this both on the farm and in software projects. You’re sure everything is okay, but you can’t see what’s ahead. A good day for visiting and reinforcing the ties that make the wheel of progress roll.