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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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For The Birds

It’s the day after Christmas and I am asking myself why I am so dumbfoundingly optimistic.

It is no longer illegal to negligently kill migratory birds. The Migratory Bird Treaty Act prohibits killing migratory birds without a license. Up until recently, the law was interpreted to mean that birds killed as a result of oil spills, destroying their habitat, or otherwise interfering, resulted in federal prosecution and fines.

No more. You can still be prosecuted if you intentionally kill a migratory bird without a license, but not if the bird happens to be killed in the pursuit of some other goal. For example, an eagle killed by a wind turbine used to be subject to a $15,000 fine, oil spills that killed thousands of shore birds resulted in massive fines, projects that destroyed nesting grounds were subject to fines and injunctions without some mitigation such as providing an alternative nesting environment. Today none of that applies if you are operating a wind turbine, shipping oil, or paving nesting grounds into parking lots but your goal is making money rather than killing birds. (Detail here.)

This saddens me because seeing eagles turning circles over Ferndale, snow and Canada geese in the fields of the Nooksack valley and flats, and ducks in almost any body of water in Whatcom County all remind me that the world we have all been given is magnificent.

I’m not squeamish about killing birds. My dad encouraged my cousins and me to shoot English sparrows and starlings when I was a kid. He was not sympathetic toward invasive species, although we immigrant Germans and Dutchmen were invasive tribes ourselves.

Duck and goose hunting were all part of the grand tradition when I was in junior high (middle school.) In the fall, a bloodthirsty knot of boys would gather before first period and talk about who shot what that morning out at Tennant Lake and the innumerable ponds that surround Ferndale. I wished I were among the guys who were out wading in the cold and wet while hunting game birds, but my dad wanted me helping with milking, not messing with exciting and dangerous weapons.

He hunted himself when he was young. The few times I saw him fire a gun, he hit his target accurately. He was not sentimental about animals, but he was always on the watch for signs of wildlife around the farm and I suspect that, all things equal, he was on the side of the ducks, geese, and pheasants.

Think about the law for a minute. Who kills birds intentionally? These days, almost entirely sport hunters. I have nothing against hunting. It’s no longer my choice for recreation, but sport hunters guard our wildlife more carefully than a lot of sentimental enthusiasts who only think about wildlife occasionally. Hunters cull herds and keep them healthy, unlike massive collateral damage from industrial ventures that destroy habitats and wipe out entire species. The law now only limits folks who care about birds and gives free reign to industries who destroy species pursuing profits.

There’s a pond close to our house in Ferndale. Albert, The Border Collie, and I walk around the pond every morning and evening. I don’t know the history of the pond, but I suspect that it didn’t exist in my junior high school days. It has the look of a bulldozer sculpture, built for runoff control rather than a naturally occurring resting place for migrating geese and ducks. Nevertheless, I am happy to see the number of birds, raccoons, possums, deer, rabbits, and squirrels that Albert and I encounter on our walks.

The pond would have been in Allen Gardiner’s backyard. I haven’t seen or heard from Allen since high school, but I owe him a debt. One day in the Frank Alexander Junior High library, he pointed me toward a shelf of books by Robert Heinlein, the science fiction author, and started me on a science fiction binge in the seventh or eighth grade that I haven’t quite shaken yet. I wouldn’t be who I am today without Allen’s prompting. Not that I’m anything special, but I just wouldn’t be who I am.

Getting back to the pond. A few days ago, night and morning, I counted twenty-three geese, maybe two dozen mallards, three drake mergansers and I’ll bet three female mergansers were lurking and diving, a blue heron perched in a tree, and a seagull bobbing on the water. The following afternoon, I saw maybe a dozen mallards, one merganser drake, and Albert spotted a squirrel. (He keeps an exact tally of squirrels.) The heron and geese were gone.

I haven’t seen as many geese as last year this fall; I miss those noisy honkers and prolific poopers. I am not about to say that the changes in migratory bird regulation has had immediate effect, but this temporary paucity reminds me of what I will miss as wildlife disappears.

Until the community takes a stand, wildlife of all forms will become rarer and harder to experience. When there is money to be made, there is always someone willing to grab a buck and trash what other people care about. Practically, sometimes a small sacrifice may be justified, but a balance must be struck. When something dies, money can’t buy it back or fix it. Lose too much and we all have nothing.

We once cared. Raptors were rare in the skies over Waschke Road when I was growing up, but after DDT and other pesticides were regulated, the hawks and eagles returned.

So. I am optimistic. If we once cared, we can care again.