More Covid-19 speculations and a note on the American response

If you absorb no other Covid-19 news today, read this summary of a panel of public health officials three days ago. It gives us no pleasure, other than the pointless frisson of self-regard, to point out that many of our speculations of February 29 are looking more likely to become true.

The next two weeks will see a surge of testing in the United States, and then a surge in cases. This site keeps track in damned close to real time, for those of you following along from home. We expect that the media frenzy and inevitable finger pointing will go to at least “11”. So you might not want to jump back in to the stock market until we get through that.

The debate about the poor availability of testing in the United States will rage for a long time, because it feeds our competing national political narratives. Read this actually excellent account in the New York Times for an early first draft of history. Did we blow it — and we definitely have blown it — because of too much big government, or too little? Your reading of the history is a Rorschach test for your political alignment. Did we fail because our federalist system relies too much on state and local governments and we have a president who is poorly suited to driving the federal agencies toward a common goal? Or did we fail because the permanent professional government is inherently confused, indecisive, and excessively lawyered up? One can read that article both ways, which is, by the way, a rare enough thing in the New York Times.

We propose a third way of looking at the testing problem and the American response thus far. In the approval of new medical tools (drugs, laboratory tests, and medical devices), our system — including direct federal and state regulators and our civil liability regime — massively prefers safety (avoiding sins of commission, if you will) to the introduction of new technology that might save lives. We don’t put a feather on the “safety” side of the scales, we weigh it down with an anvil, and are thereby far more willing to commit the sin of omission (doing nothing) than commit the sin of approving a technology that is dangerous or ineffective.

Voters, politicians, government officials, and the press overwhelmingly favor the “safety paramount” approach of the United States. Unfortunately, the highly deliberative manner of the American approach becomes dangerous in a rapidly spreading pandemic. Much as the media and citizens wish it were otherwise, we cannot change our system, or even our bureaucratic impulses, suddenly. Even if lives depend on it.

Then there is the question of federalism. By design, even in matters of public health, the foundation of our government’s response is, first, state and local, however much the poorly educated or cynical in the media and among voters expect it to be federal. In a pandemic, that is probably more a bug than a feature, insofar as we are not able to marshal a simultaneous national policy and enforce it immediately. (It is far from obvious, however, that a polyglot multicultural continental nation can respond under any circumstances with the efficiency and compliance of, say, South Korea or Singapore, but that is an argument beyond the point of the post.)

Our system and culture, however, is not without its advantages. At the governmental level, we can see the policy mistakes in one state or city and avoid them in jurisdictions that are following along a few days behind. You might say that is worse than a perfect national policy, but it is better than a flawed national policy. The people who want the federal government to make all policy in these situations almost always assume that it will execute better than any other state. That is an extremely fraught assumption.

We have, however, cultural advantages. The independence of our private sector is a huge asset, even in the current crisis. In many countries, businesses do not make a move on a matter of public interest without consulting with the government, or waiting for government direction. In the United States, with our liability regime and history of initiative — something for both left and right! — some businesses move very quickly, and that builds tremendous public relations and liability pressure on the others to follow in a hurry. In the current experience, large American businesses (the “corporations”, for those of you looking for a label) have been running ahead of almost all levels of government in useful communications and effective policies to contain spreading, and are saving lives in so doing.

The approval of a vaccine may challenge us again. The usual “safety paramount” approach is to run a huge double-blind trial, in which half the people who enroll get the drug, and the other half get a placebo. That traditional process takes a long time, and people poorly educated in medical ethics may put pressure on the players (the manufacturers, investigators, and the FDA) to skip the placebo arm, or short-cut the trial. That may make sense, balancing the risks of the situation, but the manufacturers will want protection from liability if it turns out the rushed vaccine harms some people in addition to protecting millions. That will be a beautiful political moment.

Take care, and do everything possible to flatten the curve.