In Medias Res

What I’ve got so far:

  1. Everything’s on the table. The likelihood that your preexisting ideology or priorities are an entirely adequate match to what this situation truly requires of us is close to nil. “In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists.” ― Eric Hoffer
  2. That said, your life experience will give you insights. Privilege your experience over your ideology and nominal priorities.
  3. All disasters are local. Concentrate on your meaningfully immediate environment, which in this case will be the local market for medical resources. For most of the US, that will be our MSA. For those outside an MSA (metropolitan or micropolitan) that will be their county; and for some it will be the group of counties that feed into the one hospital in the region.
  4. Deprioritize pandemic news from outside your local area. There are people in the massive NY/NJ/MA outbreak that I worry about, but what happens there will only modestly resemble what happens in the KC MSA, not least because of the difference in population density, which can approach 20x.
  5. Mitigate or avoid your own risk (including the risk you pose to others) by both following the hygiene advice we’ve all heard and minimizing your physical interaction with anyone outside your immediate household. Internalize R₀ = b × k × d, where R₀ is the reproduction number of the virus, b is the probability of infection given contact with an infectious person, k is the contact rate, and d is the infectious duration. While the nominal R₀ of COVID-19 is ~3, your personal R₀ can be driven to < 1 by your own behavior.
  6. The general form of the challenge confronting us is abrupt wide variation in formerly relatively constant phenomena. In Talebian terms, we have migrated from “mediocristan” to “extremistan.” The multiplicative nature of a novel viral pandemic, especially by comparison to the relatively predictable seasonality of influenza viruses, has a thick-tailed (power law) probability structure and complex payoffs (notoriously ranging from large numbers of nearly asymptomatic cases to abruptly life-threatening “cytokine storm” reactions). For detail, see The Fourth Quadrant: A Map of the Limits of Statistics.
  7. So we find ourselves at serious risk of running out of ventilators, ICU beds, and even hospital beds generally, to say nothing of supplies (but see “all disasters are local,” above), raising the prospect of significant second-order mortality among those unable to obtain adequate care for entirely unrelated illnesses and injuries.
  8. In this connection, many prior customs, techniques, tools, and materials are being revealed as highly dysfunctional and, if all goes sufficiently well, will be swept into the dustbin of history. The bad news for me is that my earlier fears about easily-bottlenecked processes have been realized. But we may look forward to significant adaptation, including deregulation of medical services.
  9. Similarly, a large number of purported fixes and remedies will fail. Folk remedies, in particular, seem likely to be disastrous, and this blog’s audience needs no persuasion that attempts at central planning will fail thanks to the Hayekian local knowledge problem. In that connection, and to quote something I wrote a few years back: “John Gilmore famously said that ‘the Net interprets censorship as damage and routes around it.’ The future adaptation of representative democracies will depend on our capability, as individuals, to interpret endemic institutional dysfunctionality as damage and route around it.”
  10. The relatively vulnerable are closer to the center of the network: affluent, living in high-density major cities, well-traveled, extroverted, socially active, with large numbers of regular contacts (even if mostly in a “bubble” as per Murray’s notorious quiz). But some are the alienated and defiant who reject risk avoidance or even risk mitigation tactics (or attempt folk remedies instead), ordinarily associated with …
  11. The relatively invulnerable, who are at or near the edge of the network: impoverished, living in rural or low-density metro areas, untraveled, introverted, socially isolated, rarely in face-to-face contact with others. Many of these people have mental health issues and associated substance abuse problems. But the relatively invulnerable are also the intelligent and conscientious who promptly adopt appropriate risk management strategies.
  12. The post-pandemic preferences of the relatively invulnerable will have massive economic and cultural effects. I expect a reasonably quick partial recovery from the economic shutdown, but full recovery may take several years. Many of the “third places” which have done well over the last few decades will not regain their patronage, and as of early April 2020, we can only guess which ones. Fond hopes of some of my co-religionists aside for a sudden revival, I believe church attendance and involvement will be well down in the aftermath, and will not significantly grow until the next “Awakening,” which per Strauss and Howe should occur at mid-century. Until then, believers will be culturally marginalized and congregations will be smaller—but comprised of relatively fervent, active members.
  13. Geopolitical risks are heightened, especially US-China tensions, and if Xenakis’ “58-year hypothesis” holds, this very year will see an echo of the Cuban Missile Crisis.
  14. The most important output of this process—and it is a process, with inputs, providers, outputs, recipients, etc—will be a collective lessons-learned database, comprised of both tacit and explicit knowledge, and somehow transmitted to future generations.

Supply Chain Management in a Time of Crisis

GE Healthcare, which is ramping up ventilator production, is using 3-D printing both to make parts directly and to make molds for injection molding.  However, the chief engineer for advanced manufacturing at Healthcare says that some of the 3D-printing companies he has been talking to are shut down due to government edicts that deemed their work nonessential.

It sounds like they will get around this barrier…“We have a map of all the companies that have excess capacity, and so we’ll divert whatever print work we need to whatever company has got the ability right now, on top of the equipment we have at GE”…but I expect that there is going to be a lot of this sort of thing. There is no way that local or state officials can understand the supply chain dependencies that exist between a seemingly-minor local business and a major national priority somewhere up a level or two (or more) in the product structure. In some cases, all it might take is a letter from the top-tier manufacturer certifying the importance of the work the supplier is doing, but in many cases I suspect that the only rapid solutions will require Federal involvement.

Madness and Maddow

The Navy hospital ships promised by President Trump to deploy to New York and Los Angeles arrived on-station as ordered a few days ago. MSNBC’s Rachel Maddow, presumed for some obscure-to-me reason to be associated with the provision of news to the public, and most recently famed through peddling Russian conspiracy theories regarding Trump’s election for the past three years, had ridiculed the President’s proposed schedule as “nonsense. ” She, or whatever pronoun she goes by, had loudly and publicly claimed that it would be “weeks” before the hospital ships arrived. Instead, the hospital ships arrived more or less to schedule. A lesser news-person would have the decency to be embarrassed over how transparent a prediction-flop this was. Not this Maddow person, it appears. This is not a good thing, and not for the reason first assumed. PBS’ Yamiche “Rolie-Polie-Olie” Alcindor baldly admitted, and in nicer words, that the name of the game for the national establishment news media is “Get Trump!” and anything goes, fair or foul (mostly foul) will serve that end. Well, really – those of us who have been paying attention, especially for the last decade and a half (or longer) have known very well that the name of the game as far as the establishment national news media is concerned, is to enthusiastically smear Republicans and their conservative supporters (no matter how mild or harmless) the pretext, and to excuse Democrats and their supporters, no matter how vile the offense and actions. Nothing new here, move along. SSDD, as we used to say in my active duty days. (Same sh*t, Different Day.)

Read more

One Million Health Care Workers

As I was driving to work today I heard on Bloomberg that presidential candidate Andrew Cuomo requested a million health care workers to help with the crisis in New York. “A million!” I said to myself in my car.

I looked at the population of New York City and it looks like there are around 8.5 million people there, where most of the problems are. Lets say ten million to make the math easy. So one health care worker per ten patients, assuming every single person in New York City gets sick. Really?

Where would you put them all? Aren’t most of the hotels closed? That would be importing a city the size of San Jose or Austin into New York. Of course it is stupid, so my question is why does Cuomo say something like this?