What do "analog" and "digital" mean? Analog is approximate, digital is precise. A mercury thermometer, car gas gauge, or bathroom scale are analog -- you estimate numbers from a needle or sliding scale. Digital "readouts" on radios or clocks provide precise numbers.
But precise is not the same as accurate. Have you ever heard someone described as "often wrong but seldom in doubt"? That's digital. After the power outage, the digital clock is still precise -- precisely wrong. The grandmother clock is accurate -- but approximate.
-- Nicholas Johnson (Excerpt from the column "My Grandmother's Clock" in the syndicated column series "Communications Watch," Iowa City Press-Citizen, February 28, 1983)
Now I've stopped. Why? Because for six months now we have been driving, sometimes backwards, on four flat tires, in a ditch alongside a road to nowhere. To continue to watch and report on our odometer mileage, or our average miles per hour -- let alone those digitally precise numbers -- suddenly seems as foolish as it is futile.
I am angry at the politicians whose preeminent focus on reelection and campaign donors' interests have resulted in the avoidable deaths of tens of thousands of Americans. I am disappointed by those Americans who -- while understandably confused by the mixed messages they're receiving -- risk infecting others. And I am dismayed by the total collapse of America's former reputation as an intelligent and compassionate world leader -- while our continued shouts of "We're Number One!," "We're Number One!" are only supported by our world rank in COVID-19 infections and ineffectiveness of our response. What an embarrassment that when Europe opened to travelers from a list of countries, including Algeria, Montenegro, Morocco, Rwanda, Serbia, Tunisia among others, because of the U.S. failure to intelligently control its COVID-19 spread we were, rationally, excluded from the list. Council Agrees to Start Lifting Travel Restrictions for Residents of Some Third Countries," Council of the European Union, June 30, 2020.
Equally embarrassing for Iowans is that our uncontrolled outbreaks of the virus have placed us on New York's list of states whose citizens must be quarantined for 14 days before entering New York -- or face civil penalties up to $10,000. Marina Villeneuve, "New York adds several states, including Iowa, to travel quarantine list, sends monitors to NYC; New York is urging travelers from eight additional states to self-quarantine for 14 days as it awaits a decision on the reopening of indoor dining in New York City," Associated Press, The Gazette, June 30, 2020; J. David Goodman, "N.Y. Will Impose Quarantine on Visitors From States With Big Outbreaks; New Jersey and Connecticut will also require visitors to quarantine for two weeks. The rule reflects a stark shift in the course of the outbreak," New York Times, June 29, 2020. Even using the inadequate numbers (as of June 29, 2020), the United States, with 4% of the world's population now has 25% of the world's positive COVID-19 cases -- 2,558,000 -- more than any other country on Earth, and more than the next two nations combined (Brazil and Russia -- both led by authoritarian dictators). (Source: Johns Hopkins Coronavirus Resource Center.)
So what's wrong with the U.S. numbers?
The Numbers We Don't Have
You might start with the fact that roughly 90 percent of Americans (and 90 percent of Iowans) have never been tested. You could even end with that fact. Why go further? We not only don't know the names of infected Americans (and Iowans) we don't even know the accurate numbers of infected persons. It's like fighting a war in Vietnam or Afghanistan in which your enemy refuses to wear a uniform and is otherwise indistinguishable from the friendly folks. We have not a clue how many Americans (and Iowans) are wandering about infecting others. [The CDC reports there have been 32,300,000 U.S. COVID-19 tests -- but that's tests, not people tested. (Source: CDC, COVID-19, Testing Data in the U.S.) Iowa reports 301,300 individuals tested. (Source: "COVID-19 in Iowa"). In other words, in Iowa and the nation as a whole roughly 90 percent of Americans have never been tested.]
As they say on late night TV, "But wait, there's more." You can add to that, if you must, the fact that about 50 percent (we can only guess at that number as well) of those infected with COVID-19 are either (1) in the incubation period (and therefore not now showing symptoms), (2) will never show symptoms, or (3) are experiencing such mild symptoms that they (and others) are unaware they are infected. All of which is made worse by a president who minimizes the threat, sets the bad example of refusing to wear a mask, urges less testing, and is seemingly incapable of understanding that neither the economy nor his political fortunes will improve so long as COVID-19 infections continue to spread (put aside his lack of both focus on the national interest and empathy for those afflicted).
The Numbers We Do Have
Then there's what may be wrong with the numbers we do have. Consider the "COVID-19 deaths." Which deaths qualify and why? Where does the data come from? How might some deaths be missing from the data? Who collects it?
Epidemiologists believe that what's more accurate than counting "COVID-19 deaths" is counting all deaths and comparing those numbers to prior averages. "Measuring excess deaths is crude, but many epidemiologists believe it is the best way to measure the impact of the virus in real time. It shows how the virus is altering normal patterns of mortality and undermines arguments that it is merely killing vulnerable people who would have died anyway." Josh Katz, Denise Lu and Margot Sanger-Katz, "What Is the Real Coronavirus Death Toll in Each State?" New York Times, June 24, 2020. "In places with large coronavirus outbreaks, researchers have recently found thousands of unexpected deaths beyond those captured in the official tally of COVID-19 fatalities." Kathleen McGrory, "Coronavirus may have caused hundreds of additional deaths in Florida; An analysis conducted for the Times shows a spike in unexpected deaths since late March," Tampa Bay Times, May 20, 2020.For a discussion of those and many other variables see the earlier blog post, "Deaths Data," June 16, 2020.
The numbers for "cases" are not of much use for a variety of reasons; those numbers are a function of the number of tests (among other things). Fewer tests, fewer "cases" -- which is why Trump wants less testing. We know nothing about those who haven't been tested. We're not told the number of infected who have no symptoms. There are problems with the test kits and the tests (and having a $26 million, no-bid contract with an inexperienced supplier). The Gazette reported that roughly 10 percent of the tests with those kits came back "inconclusive." Grace King, "Some Test Iowa results 'inconclusive,' Linn County officials say; 334 people tested in first four days of opening Cedar Rapids site," The Gazette, May 13, 2020. On June 26 The Gazette's Lyz Lenz reported that Test Iowa has left a trail of incompetence, inaccuracy, lack of transparency and "unusable" test results. Lyz Lenz, "'Unusable' coronavirus tests results plague Test Iowa," The Gazette, June 26, 2020.
No one has an incentive to report numbers higher than the reality. Many have an incentive to report numbers lower: partisan officeholders who want to minimize the appearance of disaster and chaos in order to maximize their favorability ratings, nursing home owners who know that reports of cases and deaths in their facilities are bad for business (and possible liability), meatpacking plant owners for whom closures can cost millions of dollars.
The Iowa governor announced that nursing homes need not report cases or deaths unless they had an "outbreak" -- which she defined a three or more cases. The Nebraska governor explained that packing plants did not have to report at all. "Vice President Mike Pence encouraged governors on Monday to adopt the administration’s claim that increased testing helps account for the new coronavirus outbreak reports, even though evidence has shown that the explanation is misleading." "Pence Tells Governors to Repeat Misleading Claim on Outbreaks,"New York Times, June 16, 2020. President Trump told his Tulsa gathering, "Here's the bad part, when you test the, when you do testing to that extent, you're going to find more people, you're going to find more cases. So I said to my people, slow the testing down please!" "Trump: 'I said to my people, 'Slow the testing down, please!'" Yahoo News Video, June 21, 2020.
Would anyone deliberately change numbers for political advantage? Consider Florida.
Rebekah Jones worked for the State of Florida, gathering the state's COVID-19 data and presenting it in "dashboard" form online for the public. (Presumably this was analogous to the State of Iowa's "COVID-19 in Iowa" site.) Her story, as reported by NPR, is that the State wanted to open up more businesses, had a plan for doing so that required certain data levels, and was about to launch it before checking the actual current data. Upon officials discovery they could not justify the opening, under the standards of their own plan, she was ordered to change the numbers. She refused to do so and was fired. Laurel Wamsley, "Fired Florida Data Scientist Launches A Coronavirus Dashboard Of Her Own," NPR, June 17, 2020 (text); Rachel Martin, "Florida Scientist Says She Was Fired For Not Manipulating COVID-19 Data," Morning Edition, NPR, June 29, 2020 (7-minute audio; "NPR's Rachel Martin talks to Rebekah Jones, a scientist who was fired from Florida's health department, who is now publishing a coronavirus dashboard of her own to track the state's COVID-19 cases").
How Did We Get Here?
At least since the global pandemic of bubonic plague that reached Europe in 1347 humans have known the benefits of isolating those infected. During the late 20th and early 21st Centuries the best pandemic-fighting strategies have been explained in everything from fiction to films, from plays to playbooks from scientific, government and military experts. It is not, as we say, "rocket science." Indeed, this year has seen common sense successfully applied by responsible governments around the world: Australia, Canada, Georgia (nation), Germany, Hong Kong, Iceland, New Zealand, Singapore, South Korea, Taiwan, Vietnam -- and most recently Thailand (among others).
We have some of the world's most respected epidemiologists. Our CDC was looked to (and often present) everywhere. We'd had experience with pandemics, we'd written the playbooks on how to fight them, step by step. It's common sense. The steps could be laid out in a 15-minute YouTube video.
So why do we have more infected and dead individuals from this coronavirus than any other nation? How could our federal and state governments -- and the American people -- have been so woefully inadequate in their response to this global pandemic when compared with all of the other 193 UN countries and seven billion people on Earth? We can't blame immigration or China. All the successful countries also had immigration and China. (Thailand is even a favorite vacation spot for the Chinese.) No, the reason we have lost nearly twice as many American lives in three months from COVID-19 as we lost in Vietnam in 19 years is largely because (among other things) (1) the federal and state governments failed to start with the most effective strategies (total test-trace-isolate), and (2) delayed so long in doing even the wrong things.
A pandemic spreads rapidly. It's like weeds in a garden, a cockroach infestation, or erosion in a farm field. Stopped at its inception -- when the first COVID-19 cases were reported -- it can be brought under control and eventual elimination relatively quickly and easily (compared with our chaotic disaster of a response). The inevitable subsequent resurgences can also be more easily handled.
Compare our lackadaisical approach with what happened in Beijing a week or so ago.
Beijing’s new infections emerged two weeks ago . . .. As of June 22, the authorities had taken samples from more than 2.9 million people over the previous 10 days . . .. Wu Zunyou, the head of the Chinese Center for Disease Control, said last week that the outbreak was “under control.” In an interview this week . . . he predicted the number of cases would not exceed 400.(Source: "China says it has tamed an outbreak in Beijing, at least for now" (sub-head within story with main headline: "U.S. Hits Another Record for New Coronavirus Cases"), New York Times, June 27, 2020)
In other words, the Chinese were testing in Beijing -- every day -- about the same number of people as Iowa has tested in four months! And as a result the Chinese virtually eliminated a COVID-19 resurgence from one of the world's largest cities in a couple weeks.
Or, if you'd prefer something a little closer to the size of many Iowa towns, check out one of my first columns on the importance of testing, "How to Eliminate COVID-19," The Gazette, April 4, 2020 (Vo, Italy, tested everyone in the city and eliminated any threat from COVID-19 in about three weeks).
There are many physical and mental health, economic, social, educational and other consequences of our delay. But the most dramatic is the number of predictable, unnecessary, preventable deaths. Joseph Guzman, "Experts: 90 percent of US coronavirus deaths could have been avoided if measures had been taken just two weeks earlier; Two medical experts say issuing social distancing measures just two weeks earlier could have drastically changed the trajectory of coronavirus deaths in the United States," The Hill, April 16, 2020.
The most efficient, speedy and effective way to deal with a COVID-19 (or other viral) global pandemic, knowing they happen from time to time, is to:
(1) prepare for it in advance. ("Preventing disasters is part of the job description of those getting the big bucks to lead corporations and government. ... Leaders’ performance should be judged by not what they propose to prevent 'next time' but by what they failed to do to prevent 'this time.'” Nicholas Johnson, "'Never Again' is Not Enough in Response to School Shootings," USA Today, March 6, 2018)This approach was available to us during January and even February. It is no longer (except for small pockets of infected persons). As of today there are 2.6 million confirmed cases. Some estimate the total number (including the untested) would be 10 to 20 times that number. Dan Mangan, "Coronavirus cases are likely 10 to 20 times higher in US than reported, former FDA chief Gottlieb says," CNBC, April 21, 2020; Joel Achenbach, "Antibody tests support what’s been obvious: Covid-19 is much more lethal than the flu," Washington Post, April 28, 2020.
(2) Once informed of a potential pandemic anywhere (as we were repeatedly during the November 2019 through February 2020 period) be on the lookout for the first cases in the U.S.
(3) Immediately respond (in hours, not days, weeks or -- as in our case -- months) with the test-contact-trace-treat-separate/quarantine/isolate-test-again response with everyone showing symptoms and those with whom they've come in contact.
(4) "Wash, rinse, repeat." In other words, keep after each case as it pops up. The goal is to prevent the exponential explosion of a disease spreading throughout the population. This approach is designed to, ultimately, produce the entire elimination of the coronavirus (as was done globally with smallpox). This is the most cost-effective, economy-protecting, life saving, efficient way to quickly battle COVID-19.
There are, of course, other approaches to COVID-19 none of which have been, so far, successful in eliminating it. Because there is no vaccine, cure or treatment for the disease none of these options are fully satisfactory.
(1) "Herd immunity": A nation just waits until, finally, everyone has been infected -- this appears to be some American politicians' current unspoken favorite by default. This has three drawbacks. It maximizes the number of deaths. It takes a very, very long time. And the scientists don't yet know if it will work. If you are infected, and don't die, does that mean you can never get it again? They don't know. Even if you are immune, does that mean you can't give it to others? They don't know. And, if either are true, how long does your immunity last? They don't know.At this point in time probably the best bet is to do what you and I can to encourage national and state leaders to crank up the enforcement of the epidemiologists' recommendations and their acceptance as national standards -- while complying with them ourselves.
(2) "Hospital capacity": focus on the ability of the healthcare system to handle the infected and dying. So long as the community, or state, has enough hospitals, healthcare workers, beds, intensive care facilities, ventilators, other equipment, and PPE you're OK. The problems with this one are that it is hard to predict the caseload, imposes excessive burdens on healthcare workers, and it does little to nothing by way of reducing the spread of the disease.
(3) "Mitigation": monitor and enforce efforts designed to minimize the rate and extent of spreading the disease, such as closing places where the disease is most likely to spread (e.g., bars, indoor arenas), wearing masks, maintaining six-foot distancing between people, forbidding groups of more than six (or 50). This approach requires acceptance of the ongoing numbers of infected, dying and dead from the coronavirus so long as those numbers are steady, or increasing only slightly ("flattening the curve"). That is mitigation advocates' benchmark for decisions regarding opening or closing businesses and events. Such measures may slow the rate of increase in infected persons, but it neither eliminates the virus nor provides any information about the roughly half of the infected who are without symptoms.
(4) "Mitigation light": the difference between "mitigation" and "mitigation light" is like the difference between those who follow "the ten commandments" and those who consider them "the ten suggestions."
I wish I had better news for you, I really do. But I don't. This is my current take on our current condition and probable future. Meanwhile, I pull such comfort as I can, while keystroking in the living room, from the rhythmic, if approximate, tick-tock, tick-tock from my 120-year-old grandmother's clock in the kitchen.
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