Tidbits of wisdom - Barokong

From my Hoover colleague Niall Ferguson

It is not just that Trump bungled his response to the crisis (though he certainly did). Much more troubling is the realisation that the parts of the federal government that are responsible for handling a crisis like this – supposedly, the genuine experts — bungled it too.
The United States Department of Health and Human Services is a mansion with many houses, but the ones that were charged with pandemic preparedness appear to have failed abjectly: not only the Centers for Disease Control and Prevention, but also the Food and Drug Administration and the Public Health Service, as well as the National Disaster Medical System.

This is not for want of legislation. In 2006 Congress passed a Pandemic and All--Hazards Preparedness Act, in 2013 a Re-authorization Act of the same name, and in June last year a Pandemic and All-Hazards Preparedness and Advanced Innovations Act. In October 2015 the bipartisan Blue Ribbon Study Panel on Biodefense, co-chaired by Joe Lieberman and Tom Ridge, published its first report, calling for better integration of the agencies responsible for biodefence. Last year, it was renamed the Bipartisan Commission on Biodefense ‘to more accurately reflect its work and the urgency of its mission’. On paper, the US was the most pandemic-prepped country in the world.

It’s not just that Trump bungled his response to the crisis; the genuine experts bungled theirs too.
So let’s not pretend that the pandemic illustrates the case for big government. The US already has big government. And this is what it does: agencies, laws, reports, PowerPoint presentations… and then — when the endlessly discussed crisis actually happens — paralysis, followed by panic.
Today, the US has fallen back on the old 20th-century playbook of pandemic pluralism (states do their own thing; in some states a lot of people die), but combining it with the 2009-10 playbook of financial crisis management. The result is insane. A large chunk of the economy has been shut down by government order; meanwhile the national debt explodes, along with the balance sheet of the US Federal Reserve.
Nicholas Bagley, having just offered a course on the history of epidemics at Michigan Law School, wrote this summary of historical experience -- way back on March 4. Plus ├ža change...

...we focused on a different disease each time we met: cholera, Spanish flu, polio, AIDS, SARS, and Ebola.... Every disease provokes its own unique dread and its own complex public reaction, but themes recurred across outbreaks.

  1. Governments are typically unprepared, disorganized, and resistant to taking steps necessary to contain infectious diseases, especially in their early phases.
  2. Local, state, federal, and global governing bodies are apt to point fingers at one another over who’s responsible for taking action. Clear lines of authority are lacking.
  3. Calibrating the right governmental response is devilishly hard. Do too much and you squander public trust (Swine flu), do too little and people die unnecessarily (AIDS).
  4. Public officials are reluctant to publicize infections for fear of devastating the economy.
  5. Doctors rarely have good treatment options. Nursing care is often what’s needed most. Medical professionals of all kinds work themselves to the bone in the face of extraordinary danger.
  6. In the absence of an effective treatment, the public will reach for unscientific remedies.
  7. No matter what the route of transmission or the effectiveness of quarantine, there’s a desire to physically separate infected people.
  8. Victims of the disease are often thought to deserve the affliction, especially when those victims are mainly from marginalized groups.
  9. We plan, to the extent we plan at all, for the last pandemic. We don’t do enough to plan for the next one.
  10. Historical memory is short. When diseases fall from the headlines, the public forgets and preparation falters.
Not every one of those themes was present for every disease; the doughboys who died of the Spanish flu, for example, were not thought to deserve their fate. But the themes were persistent enough over time to establish a pattern. Nicholas' Reading list:

Charles Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866. [I read this one. It's great.]

Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918.

David Oshinsky, Polio: An American Story.

Randy Shilts, And the Band Played On.

Thomas Abraham, Twenty-First Century Plague: The Story of SARS.

David Quammen, Ebola: A Natural and Human History of a Deadly Virus.

Laurie Garrett, Ebola’s Lessons: How the WHO Mishandled the Crisis.

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