Tag: public health

Follow the Parents

Published on by D. G. HartLeave a comment

Sometimes I wonder if journalists who cover the virus actually believe the narrative that leads to panic (which means they are as gullible as the fear-driven Trump voters) or are cynically reporting in a way to generate clicks and listens. A few weeks ago, Scott Simon, the master of journalistic empathy, revealed that journalists may actually prefer strong parents to reporters who question authority.

NPR’s Scott Simon talks with Dr. Curtis Chan, Deputy Health Officer for San Mateo County, CA about the county’s decision NOT to issue a stay-at-home order, as neighboring counties have.

SCOTT SIMON, HOST: Nearly 3,000 Americans are dying each day now from COVID-19. Hospital beds are full. ICU units are overwhelmed. Mayors and governors are saying stay home. Five counties near San Francisco and the city of Berkeley are in shutdown, but not San Mateo County. We’re joined now by Dr. Curtis Chan, who is deputy health officer for San Mateo County. Dr. Chan, thanks so much for being with us.

CURTIS CHAN: Nice to be here.

SIMON: Why has San Mateo decided to do something different?

CHAN: San Mateo County is following the federal guidelines and state guidelines, including the ones that were just released explaining that we should be staying at home once ICU capacity is below 15%. And we intend to follow that. You know, we also looked at our data. And we said, who is not staying home? Who’s causing the most transmissions? And we wanted to have targeted interventions for those people who are not staying at home and those people who are causing transmissions.

SIMON: Well, what does the data show?

CHAN: As for the specific cases going up, what we’ve seen in the last four weeks, it’s primarily amongst young adults between 20 to 30 years old. And those were the rates of highest rise. And we’re already in the very restrictive purple tier in California. And we didn’t think that immediately having health officer orders was going to be the strategy that would change behaviors immediately.

SIMON: Well, why not? I mean, why not issue the order and use that as, if nothing else, dramatic emphasis to make your point?

CHAN: Yeah. I think it’s an approach of harm reduction and thinking about people’s mental state. We’ve seen from the CDC reports that young people are the ones who are experiencing a tremendous amount of anxiety and stress and depression. And many of them are accustomed to social gatherings. And they’ve been continuing to social gather despite our health officer orders previously.

SIMON: You know, you’re stating some very good scientific facts, but I still don’t understand what makes you then shy away from some kind of stay-at-home order. I mean, I say this as a father. Help me translate it. It strikes me that in some ways you’re saying, look; if you tell people you must stay at home, this young group, this young demographic we’re trying to reach will do just the opposite.

CHAN: Well, the first thing is that it’s not enforceable. If we could actually enforce this and it was statewide or across the region or the country, I would think it’s a great idea. But I think, you know, it’s going to be counterproductive because it’s going to drive behaviors underground. And we think that there would be resentment that they can’t socially gather, let’s say, outside. But we don’t have the enforcement to prevent people from gathering inside, and there could be, you know, 10 young people or eight young people. So we think it’s a tremendously good idea. And those are our public health recommendations. But we didn’t have that as a legal order that suggests that it’s going to be enforced by law enforcement officials.

The reporter’s tell: “you’re stating some very good scientific facts, but I still don’t understand what makes you then shy away from some kind of stay-at-home order. I mean, I say this as a father.”

The Public Health official’s honesty: “the first thing is that it’s not enforceable. If we could actually enforce this and it was statewide or across the region or the country, I would think it’s a great idea. But I think, you know, it’s going to be counterproductive because it’s going to drive behaviors underground.”

Imagine that. Balancing science, human nature, and possibility.

Public Health is Harder than Long Division

Published on by D. G. Hart1 Comment

James Scott’s book, Seeing Like a State (1998) came up in this fascinating discussion of public policy, health systems, government, expertise, and legitimate political authority. The following is from a review of Scott’s book in The New Republic, May 18, 1998 (“More is Less”, by Cass R. Sunstein). This is precisely what state governors and their advisors are doing during the COVID-19 pandemic:

German psychologist named Dietrich Dorner has done some fascinating experiments designed to see whether people can engage in successful social engineering. The experiments are run by a computer. Participants are asked to solve problems faced by the inhabitants of some region of the world: poverty, poor medical care, inadequate fertilization of crops, sick cattle, insufficient water, excessive hunting and fishing. Through the magic of the computer, many policy initiatives are available (improved care of cattle, childhood immunization, drilling more wells), and participants can choose among them. Once initiatives are chosen, the computer projects, over short periods of time and then over decades, what is likely to happen in the region.

In these experiments, success is entirely possible. Some initiatives will actually make for effective and enduring improvements. But most of the participants—even the most educated and the most professional ones—produce calamities. They do so because they do not see the complex, system-wide effects of particular interventions. Thus they may recognize the importance of increasing the number of cattle, but once they do that, they create a serious risk of overgrazing, and they fail to anticipate that problem. They may understand the value of drilling mote wells to provide water, but they do not foresee the energy effects and the environmental effects of the drilling, which endanger the food supply. It is the rare participant who can see a number of steps down the road, who can understand the multiple effects of one-shot interventions into the system.

These computer experiments have countless real-world analogues. As everyone now knows, an unanticipated problem with mandatory airbags is that they result in the deaths of some children who would otherwise live. Less familiarly, new antiterrorist measures in airports increase the cost of air travel, thus leading people to drive instead, and driving is more dangerous than traveling by air, so more stringent antiterrorist measures
may end up killing people. If government wants to make sure that nuclear power is entirely safe, it should impose tough controls on nuclear power, but those controls will increase the price of nuclear energy, which may well increase the use of fossil fuels, which may well create the more serious environmental problems. . . .

On Scott’s view, the failed plans and the thin simplifications ignore information that turns out to be crucial. To be sure, an all-seeing computer, capable of handling all relevant information and envisioning the diverse consequences of different courses of action, may facilitate tyranny. But it need not blunder. This is the real lesson of Dorner’s experiments, for which Scott has provided a wealth of real-world counterparts. And this is not
the end of the story. Dorner also demonstrated the possibility of successful planning by those who are attuned to long-range effects. Scott’s analysis would have been improved if he had compared success with failure, and given a clearer sense of the preconditions for success.

Still, Scott’s advice is far from useless. It can be applied to contexts far afield from those that concern him here. His case studies help explain, say, why national regulation tends to work better when it consists of altered incentives rather than flat commands. Some of the most successful initiatives in American regulatory law have consisted of efforts to increase the price of high-polluting activities; and some of the least successful have been rigid mandates that ignore the collateral effects of regulatory controls. Scott’s enthusiasm for metis also suggests that certain governmental institutions will do best if they act incrementally, creating large-scale change not at once, but in a series of lesser steps. We might think here not only of common law, but also of constitutional law. Many judicial problems derive from a belief that judges can intervene successfully in large-scale systems (consider the struggles with school desegregation in the 1960s and 1970s), and many judicial successes have come from proceeding incrementally (consider the far more incremental and cautious attack on sex discrimination in the same period).

And Scott also offers larger implications. A society that is legible to the state is susceptible to tyranny, if it lacks the means to resist that state; and an essential part of the task of a free social order is to ensure space for institutions of resistance. Moreover, a state that attempts to improve the human condition should engage not in plans but in experiments, secure in the knowledge that people will adapt to those experiments in unanticipated ways. Scott offers no plans or rules here, and a closer analysis of the circumstances that distinguish success from failure would have produced greater illumination. But he has written a remarkably interesting book on social engineering, and be cannot be much faulted for failing to offer a sure-fire plan for the well-motivated, metis-friendly social engineer.