Thread by @conways_law

With the exception of @Laurie_Garrett and a few other public-health experts, I find the public conversation about how to respond to the COVID-19 pandemic deeply dismaying. Where is the systems thinking?

1/19

I mean something specific by this. Systems thinking requires one to reason about two levels of aggregation, both at the same time, and in a connected way: (1)the individuals and their connections within a system, and (2)the aggregate system itself.

2/19

Here is an example: reasoning about a murmuration of starlings (the blob) and how this arises from the way each individual bird relates to its neighbors.

There is a deep connection to public health.
npr.org/sections/13.7/…

3/19

Every day in the news we see totals of COVID-19 cases and deaths (aggregates). Then we hear: “Testing, testing, testing” (of individuals). What’s the connection? It seems to be assumed but how one leads to the other is never explained.

4/19

What does a test do? With respect to the entity being looked for, one test gives you:
1. A Yes or No, in the context of
2. The individual being tested, and
3. The moment of the test.

What good is that, outside of a test plan?

5/19

Test plan? What’s that? How many times has a public figure described one to you? How many different types are there? What are their different purposes?

6/19

We are told that you have to have big numbers of tests (on individuals) in order to “open up the economy” (an aggregate). How will the first cause the second? A lot of talk. Very little connection.

7/19

What hurts is that, without making the connections we won’t get it right. That’s because it’s complicated.

And if the leadership doesn’t understand, they will communicate confusion, which will sow distrust. That is certainly happening.

8/19

I’ve seen at least three goals discussed publicly. They are not the same, and they require different strategies that must be conducted concurrently, possibly necessitating tradeoffs among them in real time.

9/19

Goal one:
Minimize the total individual health impact of the pandemic. That’s a composite that requires a balance of keeping healthcare resource utilization below saturation by “flattening the curve”, minimizing total deaths, and detecting and rapidly suppressing outbreaks

10/19

This is not a simple optimization because of the spatial and temporal diversity of the patterns of growth of the infection. Density and duration of exposure affect different groupings differently. The pandemic is moving from the coasts to the interior differently.

11/19

Implementing goal one requires what is usually discussed in public: a combination of rapid and ubiquitous testing and contact tracing combined with means of isolating people who are infectious.

Some countries applied this strategy successfully. Are we even going to try?

12/19

Goal two:
Minimize the total human non-health impact of the pandemic. This requires keeping people fed, housed, and safe. This can be done separately from supporting businesses, because the Government can directly subsidize people without their having to be employed.

13/19

After some time this might not be socially desirable, but that is a separate issue.

14/19

Goal three:
Maximize the rate of growth, and the final level, of recovery of the aggregate economy. This is again a composite goal and so will require tradeoffs. This goal is coupled to goals one and two in that, as three succeeds, one and two will recede.

15/19

We are learning that implementation of the law is affecting small and large businesses differently. This is another tradeoff to be addressed.

16/19

We need goal three in order to generate taxes to pay for goals one and two. It will involve business-related financial policies, not necessary for either of goals one or two.

There is deep official confusion about this.

17/19

In terms of public health, goal three has different objectives. Creating a growing economy means safely growing coherent cohorts of infection-free people who can conduct business together. This is not the same public-health policy as goal one.

18/19

The public needs clarity that is now coming from almost nowhere.

Shouldn’t we be drawing lessons from the massive public obfuscation, in some cases encouraged by the President, to which we are subjected? What are these lessons?

19/19

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