Category Archives: Risk Management

Trump and Coronavirus

26 Tuesday May 2020

Posted by in Pandemic, Public Health, Risk Management, Stimulus, Trump Administration

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It’s a bit early to fully evaluate President Trump’s performance in dealing with the coronavirus pandemic, but there are a number of criteria on which I might assign marks. I’ll address some of those below, but in so doing I’m reminded of Jerry Garcia’s quip that he was “shopping around for something no one will like.” That might be how this goes. Of course, many of the sub-topics are worthy of lengthier treatment. The focus here is on the pandemic and not more general aspects of his performance in office, though there is some unavoidable overlap.

General “Readiness”

Many have criticized the Trump Administration for not being “ready” for a pandemic. I assign no grade on that basis because absolutely no one was ready, at least not in the West, so there is no sound premise for judgement. I also view the very general charge that Trump did not provide “leadership” as code for either “I don’t like him”, or “he refused to impose more authoritarian measures”, like a full-scale nationwide lockdown. Such is the over-prescriptive instinct of the Left.

Equally misleading is the allegation that Trump had “disbanded” the White House pandemic response team, and I have addressed that here. First, while the NSC would play a coordinating role, pandemic response is supposed to be the CDC’s job, when it isn’t too busy with diseases of social injustice to get it done. Second, it was John Bolton who executed a reorganization at the NSC. There were two high profile departures from the team in question at the time, and one one was a resignation. Most of the team’s staff remained with the NSC with the same duties as before the reirganization.

Finally, there was the matter of a distracting impeachment on false charges. This effort lasted through the first three years of Trump’s administration, finally culminating in January 2020. Perhaps the Administration would have had more time to focus on what was happening in China without the histrionics from the opposition party. So whatever else I might say below, these factors weigh toward leniency in my appraisal of Trump’s handing of the virus.

Messaging: C

As usual, Trump’s messaging during the pandemic was often boorish and inarticulate. His appearances at coronavirus briefings were no exception, often cringeworthy and sometimes featuring misinterpretations of what his team of experts was saying. He was inconsistent in signaling optimism and pessimism, as were many others such as New York Governor Andrew Cuomo and New York City Mayor Bill De Blasio. It shifted from “the virus is about like the flu” in February to a more sober assessment by mid-March. This was, however, quite consistent with the messaging from Dr. Anthony Fauci over the same time frame, as well as the World Health Organization (WHO). Again, no one really knew what to expect, so it’s understandable. A great deal of that can be ascribed to “the fog of war”.

Delegation and Deference: B

Trump cannot be accused of ignoring expert advice through the episode. He was obviously on-board with Fauci, Dr. Deborah Birx, Dr. Robert Redfield, and other health care advisors on the “15 Days to Slow the Spread” guidelines issued on March 16. His messaging wavered during those 15 days, expressing a desire to fully reopen the nation by Easter, which Vice President Michael Pence later described as “aspirational”. Before the end of March, however, Trump went along with a 30-day extension of the guidelines. Finally, by mid-April, the White House released guidelines for “Opening Up America Again“, which was a collaboration between Trump’s health care experts and the economic team. Trump agreed that the timeline for reopening should be governed by “the data”. There is no question, however, that Trump was chomping at the bit for reopening at several stages of this process. I see value in that positioning, as it conveys an intent to reopen asap and that people should have confidence in progress toward that goal.  

International Travel Bans: A

If anyone wonders why the world was so thoroughly blindsided by the coronavirus, look no further than China’s failure to deliver a proper warning as 2019 drew to a close. Wuhan, China was ground zero; the virus spread to the rest of the world with travelers out of Wuhan and other Chinese cities. The White House announced severe restrictions on flights from China on January 31, including a two-week quarantine for returning U.S. citizens. In retrospect, it wasn’t a minute too soon, yet for that precaution, Trump was attacked as a racist by the Left. In early February, WHO actually said travel bans were unnecessary, among other missteps. Other bans were instituted on entry from Iran and Brazil, as well as entry from Europe in early March, as countries around the globe closed their borders. Trump’s actions on incoming travelers were prescient, so I’ll score this one for Trump. Some of these travel restrictions can and should be eased now, and certainly that is expected in coming months, so we’ll see how well that process is managed.

Deference to States: A-

As a federalist, I was pleased that Trump and his team left most of the specifics on closures and bans on public gatherings up to state and local governments. That allowed more targeted mitigation efforts as dictated by local conditions and, to some extent, public opinion. This is a classic case of “laboratory federalism” whereby the most effective policies can be identified, though as we’ve seen, there’s no guarantee less successful states will emulate them. I grade Trump well on this one.

On reopening, too, Trump has been a consistent advocate of allowing flexility where local conditions permit, though he wrongly claimed he had “total authority” over ending social distancing rules. It’s hard to square that remark with his general stand on the issue of autonomy except as a tactic to strong-arm certain governors on other points.   

CDC/FDA Snafus: D

I applaud the Administration for its emphasis on the salutary effects of deregulation, but Trump went along with some major pieces of “expert advice” that were not only poor from regulatory perspective, but an affront to federalism. One was a directive issued by the CDC to delay “all elective surgeries, non-essential medical, surgical, and dental procedures during the 2019 Novel Coronavirus (COVID-19) outbreak“. (See my post “Suspending Medical Care in the Name of Public Health“.)

This is exactly the kind of “one size fits all” regulatory policy that has proven so costly, sacrificing not just economic activity but lives and care for the sick, creating avoidable illnesses and complications. The idea was to assure that adequate health care resources were available to treat an onslaught of coronavirus patients, but that was unneeded in most jurisdictions. And while the contagion was in it’s early “exponential” phase at the time, a more nuanced approach could have been adopted to allow different geographic areas and facilities more discretion, especially for different kinds of patients, or perhaps something less than a complete suspension of care. In any case, the extensions into May were excessive. I must grade Trump poorly for allowing this to happen, despite what must have been extreme pressure to follow “expert advice” on the point and the others discussed earlier.

That’s not the only point on which I blame Trump for caving to the CDC. In a case of massive regulatory failure, the CDC and FDA put the U.S. well over a month behind on testing when the first signs of the virus appeared here. Not only did they prohibit private labs and universities from getting testing underway, insisting on exclusive use of the CDC’s own tests, they also distributed faulty tests in early February that took over a month to replace. The FDA also enforced barriers to imported N95-type masks during the pandemic. Trump tends to have a visceral understanding of the calcifying dangers of regulation, but he let the so-called “experts” call the shots here. Big mistake, and Trump shares the blame with these agencies.  

Health Resources: B-

Managing the emergency distribution of PPE and ventilators to states did not go as smoothly as might have been hoped. The shortage itself left FEMA with the unenviable task of allocating quantities that could never satisfy all demands. A few states were thought to have especially acute needs, but there was also an obligation to hold stockpiles against potential requests from other states. In fact, a situation of this kind creates an incentive for states to overstate their real needs, and there are indications that such was the case. Trump sparred with a few governors over these allocations. There is certainly blame to be shared, but I won’t grade Trump down for this.

Vaccines and Treatments: C+

 

The push to develop vaccines might not achieve success soon, if ever, but a huge effort is underway. Trump gets some of the credit for that, as well as the investment in capacity now to produce future vaccine candidates in large quantities. As for treatments, he was very excited about the promise of hydroxychloraquine, going so far as to take it himself with zinc, a combination for which no fully randomized trial results have been reported (the recent study appearing in the Lancet on HCQ taken by itself has been called into question). Trump also committed an unfortunate gaffe when the DHS announced the results of a study showing that sunlight kills coronavirus in a matter of minutes, as do bleach and other disinfectants. Trump mused that perhaps sunlight or some form of disinfectant could be used as a treatment for coronavirus patients. He might have been thinking about an old and controversial practice whereby blood is exposed to UV light and then returned to the body. Later, he said he used the term “disinfectant” sarcastically, but he probably meant to say “euphemistically” …. I’m not sure he knows the difference. In any case, his habit of speculating on such matters is often unhelpful, and he loses points for that.

Fiscal Policy: B

The several phases of the economic stimulus program were a collaboration between the Trump Administration and Congress. A reasonably good summary appears here. The major parts were the $2.3 trillion CARES Act in late March and a nearly $500 billion supplemental package in late April. These packages were unprecedented in size. Major provisions were direct cash payments and the Paycheck Protection Program (PPP), which provides loans and grants to small businesses. The execution of both was a bit clunky, especially PPP, which placed a burden on private banks to extend the loans but was sketchy in terms of qualifications. The extension of unemployment compensation left some workers with more benefits than they earned in their former jobs, which could be an impediment to reopening. There were a number of other reasonable measures in these packages and the two smaller bills that preceded them in March. A number of these measures were well-targeted and inventive, such as waiving early withdrawal penalties from IRA and 401(k) balances. The Trump Administration deserves credit for helping to shape these efforts as well as others taken independently by the executive branch. 

Trump’s proposal to suspend payroll taxes did not fly, at least not yet. The idea is to reduce the cost of hiring and increase the return to work, if only temporarily. This is not a particularly appealing idea because so much of the benefits would flow to those who haven’t lost their jobs. It could be improved if targeted at new hires and rehires, however.

Trump’s proposal to grant liability waivers to reopened private businesses is extremely contentious, but one I support. Lockdowns are being eased under the weight of often heavy public and private regulation of conduct. As John Cochrane says in “Get Ready for the Careful Economy“: 

“One worry on regulation is that it will provide a recipe for a wave of lawsuits. That may have been a reason the Administration tried to hold back CDC guidance. A long, expensive, and impractical list of things you must do to reopen is catnip when someone gets sick and wants to blame a business. Show us the records that you wiped down the bathrooms every half hour. A legal system that can sue over talcum powder is not above this.”

Indeed, potential liability might represent a staggering cost to many businesses, one that might not be insurable. Accusations of negligence, true or false, can carry significant legal costs. Customers and employees, not just businesses, must accept some of the burden of risks of doing business. I give Trump good marks for this one, but we’ll see if it goes anywhere.

Some of the proposals for new stimulus legislation from democrats are much worse, including diversity initiatives, massive subsidies for “green” technologies, and bailouts for state and local government for unfunded pension liabilities. None of these has anything to do with the virus. The burden of pension shortfalls in some states should not fall on taxpayers nationwide, but on the states that incurred them. The Trump Administration and congressional Republicans should continue resisting these opportunistic proposals.

The Grade

Without assigning weights to the sub-topics covered above, I’d put the overall grade for Trump and his Administration’s handling of matters during the pandemic at about a B-, thus far. When it comes to politics, it’s often unfair to credit or blame one side for the promulgation of an overall set of policies. Nevertheless, I think it’s fair to say that Trump, could have done much better and could have done much worse. We will learn more with the passage of time, the continued evolution of the virus, the development of treatments or vaccines, and the course of the economy.

 

 

 

 

 

 

 

Coronavirus: Framing the Next Few Weeks #3

05 Sunday Apr 2020

Posted by in Pandemic, Risk Management

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There were a few encouraging signs of change over the past few days in the course of the coronavirus pandemic in the U.S. This is the third of my quaint efforts to provide perspective on the coronavirus pandemic with “tracking” or “framing” posts. The first two were: Coronavirus: Framing the Next Few Weeks, on March 22, and Framing Update on March 28. In both of those posts, I charted confirmed cases of Covid-19 in the U.S. along with optimistic and pessimistic scenarios. I speculated that over the course of a few weeks, social distancing would lead to a reduction in the daily number of new confirmed cases. Unfortunately, it’s not clear whether that curve has started to “bend” rightward, but new confirmed cases on Sunday, April 5 — the number of those testing positive — was down almost 30% from Saturday.

An updated version of the earlier chart appears below, accompanied by a table. The number of confirmed cases (red line) has mounted over the past week, as has the daily increase in confirmed cases, though yesterday’s number was better. The table below the chart shows that the growth rate of confirmed cases (the far right-hand column) has decelerated, but it had leveled off at about 14% over the few days before Sunday. If Sunday’s drop persists it would be encouraging. Unfortunately, even moderate growth rates are destructive when the base of confirmed cases is large. The faster the growth rate declines, the faster the curve will bend.

I did not make any changes to the original “Very Good” and “Pretty Bad” scenarios, deciding that it was better to keep them as a consistent benchmark. As of Sunday, the top of the “Very Good” curve would still be about 2.3x the North Korean experience as of Sunday night, normalized for population. The top of the “Pretty Bad” scenario (which is not visible in this “zoomed-in” version) would be about 1.4x the Italian experience thus far. South Korea’s curve flattened substantially several weeks ago, and now even Italy’s curve is showing a rightward bend. Let’s hope that continues.

The case count obviously depends on the volume of daily testing, which has been increasing rapidly. As I’ve noted before, there has been a backlog of test requests. In addition, every day there is an overhang of “pending” test results. Interestingly, the number of tests stabilized on Saturday and the number of pending test results plunged (see the next chart, which uses data from the Covid Tracking Project). We’ll see if those developments persist. It would represent a milestone because daily case counts will advance as long as tests do, and the effort to work through the backlog has been inflating the speed of the advance in confirmed cases.

Another interesting development coincident with the drop in pending tests has to do with the cumulative percentage of positive test results: it has stabilized after growing for several weeks. This might mean we’ve reached a point at which the most severe incoming cases are fewer, but we’ll have to see if the flattening persists or even declines, which would be wonderful.

I’ve been grappling with potential weaknesses of the data on confirmed cases: first, the U.S. got a late start on testing, so there was the backlog of patients requiring tests just discussed above. That was presumed to have exaggerated the acceleration in the daily totals for new cases. Second, it’s possible that a continuing transition to more rapid test results would exaggerate the daily counts of new cases. Third, It’s possible that testing criteria are being relaxed, which, despite reducing the positive test rate, would increase growth in the “official” confirmed case count. Suspected cases should be tested, of course, but the change in standards is another factor that distorts the shape of the curve.

Any published statistic has its shortcomings. All test results are subject to false positives and negatives. Hospitalizations of patients with a positive coronavirus diagnosis are subject to the measurement issues as well, though they might be driven more by the severity of symptoms and co-morbidities than a positive Covid diagnosis per se. And hospitalizations of Covid patients might be subject to inconsistencies in reporting, and so might ICU admittances. Coronavirus deaths are subject to vagaries: reporting a cause of death is dictated by various criteria when co-morbidities are involved, and those criteria differ from country to country, or perhaps even hospital to hospital and doctor to doctor! In fact, some go so far as to say that all deaths should be tracked for coronavirus plus its co-morbidities and then compared to an average of the past five to ten years to obtain an estimate of “excess deaths”, which could conceivably be negative or positive. Finally, recoveries are even more impacted by inconsistent reporting, especially because many recoveries occur at home.

I’ll be highlighting coronavirus deaths going forward, and I’ll continue to focus mainly on the U.S. and only lightly on other countries. After all, death is obviously the most negative outcome. Again, however, the count of coronavirus deaths does not account for deaths that would have occurred over the same time frame due to co-morbidities or the effect of deaths that would not have occurred absent co-morbidities.

The predictions in the chart below are from the Chris Murray Model, upon which the White House Coronavirus Task Force has focused more recently. This model was developed by Dr. Christopher Murray at the Institute for Health Metrics and Evaluation at the University of Washington. I’ll be using the forecast starting from April 2 as the basis for my “framing” of actual deaths over the next few weeks, keeping it “frozen” at that level as a new benchmark. My apologies for the absence of dates on the horizontal axis, but the origin is at March 14 and there is only a single line up through April 1. That line represents actual cumulative Covid deaths recorded in the U.S. The red line is the mean model prediction. Deaths are expected to ramp up over the next week or so, much as we’ve seen in the confirmed case count, as deaths lag behind diagnoses by anywhere from a few days up to 17 days. This model predicts an ultimate death toll of about 94,000 at the top of the mean curve (not visible on the zoomed-in chart). Above and below that line are upper (blue) and lower (green) bounds, respectively, of a “confidence interval”. It’s unlikely we’ll see cumulative deaths breach either of those bounds. The lower bound would place the ultimate death toll at about 40,000; the upper bound would place it at just under 180,000. At this point, as of Sunday, April 5, actual deaths (black) are slightly below the mean or central tendency, but that’s difficult to see in the current chart.

The ongoing lockdowns in the U.S. and around the world are exceedingly controversial. There is a very real tradeoff between the benefits of extending the length of these lockdowns and the benefits of allowing economic activity to “restart”. But do lockdowns work? Christopher Monkton offers aggregate evidence that they truly do reduce the spread of the virus in “Are Lockdowns Working?” That they would work is intuitive, and decisions to scale them back should be made cautiously for certain “high exposure” activities, and in conjunction with isolating and trace-tracking contacts of all infected individuals, as they have done successfully in countries such as Taiwan and Singapore.

There may be signs that a bend in the U.S. case curve is in the offing, perhaps over the next week or two. That timing would roughly comport with the notion that over the past three weeks, efforts at social distancing and stay-at-home orders have allowed the U.S. to limit the spread of coronavirus through the first major “round” of infections and a much more limited second round. Perhaps these efforts will largely stanch a third and subsequent rounds of infection. Ultimately, if the number of coronavirus deaths is in the neighborhood of the mean value predicted by the Murray Model, about 94,000, that would place the severity of the toll at less than two times the severity of a bad flu season, though limiting the Covid death toll will have been achieved at much higher economic cost.

There are signs elsewhere around the globe that the pandemic may be turning a corner toward more favorable trends. See “Good News About COVID-19” at 80,000hours.org for a good review.

The Bad News Industrial Complex

20 Friday Apr 2018

Posted by in Big Government, Corruption, Risk Management

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Matt Ridley had an interesting piece on his blog last month entitled “Bad News Is Sudden, Good News Is Gradual“. It’s about the timing of news, as stated, and it’s about our bias toward bad news more generally. There is no question that bad news tends to be more dramatic than good news. But with steadily increasingly lifespans, growing prosperity, and world poverty at an all-time low, surely good news must come as much or more frequently than bad. But good news can be inconvenient to certain narratives. It is therefore often ignored, and some other purported disaster is found as a substitute:

“Poverty and hunger are the business Oxfam is in, but has it shouted the global poverty statistics from the rooftops? Hardly. It has switched its focus to inequality. When The Lancet published a study in 2010 showing global maternal mortality falling, advocates for women’s health tried to pressure it into delaying publication ‘fearing that good news would detract from the urgency of their cause’, The New York Times reported. The announcement by Nasa in 2016 that plant life is covering more and more of the planet as a result of carbon dioxide emissions was handled like radioactivity by most environmental reporters.“

Tales of bad outcomes can be alluring, especially if they haven’t happened yet. In fact, bad things might even happen gradually, but dark visions of a world beyond the horizon impart a spooky sense of immediacy, and indeed, urgency. Ridley notes the tendency of people to regard pessimists as “wise”, while optimists are viewed as Pollyannas. And he recognizes that risk aversion plays an important role in this psychology. That brings me to the point I found most interesting in Ridley’s piece: the many vested interests in disasters, and disasters foretold.

Risk management is big business in an affluent society. There is a lot to lose, and a squeamish populace is easily cowed by good scare stories. The risk management and disaster-prevention narrative can be wrapped around any number of unlikely or exaggerated threats, serving the interests of the administrative state and private rent-seekers. One particular tool that has been most useful to this alliance is the precautionary principle. It is invoked to discourage or regulate activities presumed to pose risks to the public or to the environment. But there are three dimensions to the application of the precautionary principle: it provides a rationale for public funding of research into the risk-du-jour, for funding projects designed to mitigate its consequences, and for subsidizing development of alternative technologies that might help avoid or reduce the severity of the risk, often at great expense. The exaggeration of risk serves to legitimize these high costs. Of course, the entire enterprise would be impossible without the machinery of the state, in all its venality. Where money flows, graft is sure to follow.

Well-publicized disaster scenarios are helpful to statists in other ways. Risk, its causes, and its consequences are not distributed evenly across regions and populations. A risk thought to be anthropomorphic in nature implies that wealthier and more productive communities and nations must shoulder the bulk of the global costs of mitigation. Thus, the risk-management ethic requires redistribution. Furthermore, wealthier regions are better situated to insulate themselves locally against many risks. Impoverished areas, on the other hand, must be assisted. Finally, an incredible irony of our preoccupation with disaster scenarios is the simultaneous effort to subsidize those deemed most vulnerable even while executing other policies that harm them.

Media organizations and their newspeople obviously benefit greatly from the subtle sensationalism of creeping disaster. As Ridley noted, the gradualism of progress is no match for a scare story on the nightly news. There is real money at stake here, but the media is driven not only by economic incentives. In fact, the dominant leftist ideology in media organizations means that they are more than happy to spread alarm as part of a crusade for state solutions to presumed risks. There are even well-meaning users of social media who jump at the chance to signal their virtue by reposting memes and reports that are couched not merely in terms of risks, but as dire future realities.

Mitigating social risks is a legitimate function of government. Unfortunately, identifying and exaggerating risks, and suppressing contradictory evidence, is in the personal interest of politicians, bureaucrats, crony capitalists, and many members of the media. Everything seems to demand government intervention. Carbon concentration, global warming and sea level changes are glaring examples of exaggerated risks. As Ridley says,

“The supreme case of unfalsifiable pessimism is climate change. It has the advantage of decades of doom until the jury returns. People who think the science suggests it will not be as bad as all that, or that humanity is likely to mitigate or adapt to it in time, get less airtime and a lot more criticism than people who go beyond the science to exaggerate the potential risks. That lukewarmers have been proved right so far cuts no ice.”

Other examples include the “beepocalypse“, genetic modification, drug use, school shootings, and certain risks to national security. Ridley offers the consequences of Brexit as well. There, I’ve listed enough sacred cows to irritate just about everyone.

In many cases, the real crises have more to do with government activism than the original issue with which they were meant to reckon. Which brings me to a discomfiting vision of my own: having allowed the administrative state to metastasize across almost every social organ and every aspect of our lives, a huge risk to our future well-being is continuing erosion of personal and economic liberties and our ability to prosper as a society. Here’s Ridley’s close:

“Activists sometimes justify the focus on the worst-case scenario as a means of raising consciousness. But while the public may be susceptible to bad news they are not stupid, and boys who cry ‘wolf!’ are eventually ignored. As the journalist John Horgan recently argued in Scientific American: ‘These days, despair is a bigger problem than optimism.'”