Fighting the Bear

I grew up in Boise, Idaho – a small but proper and, at least in my childhood, parochial city (although, like everyplace, it had its radicals and its visionaries, by many of whom I was lucky to be surrounded). As a small but proper city, Boise generally didn’t have bears in its streets, but if one ventured into the hills and mountains surrounding Idaho’s capitol, one was liable to encounter a bear, or at least had to behave as if such an encounter was immanently possible.

Wondering WTF bears have to do with anything? Let’s imagine that you and 49 other friends have gone camping. (It’s colonized land and you are settlers, which is why you go camping in the first place, but set that aside. And actually, you and 55 of your friends have gone camping, but for complex reasons we won’t get into here, you treat six of them like they’re varyingly less-than-human.) Say that you’re very conscious of the risk of bears, so you ring your entire campsite with netting and hang bells from the net-work to alert you to the approach of any potential grizzly. But your tent happens to be among the biggest and most food-packed and bear-appealing of all the 50 (that is, 56) tents, and it sits right next to the makeshift entryway in the protective netting you’ve now set up, and before going to bed, for no good reason, you leave the entryway wide open. No netting, no bells, no nothing. Then you settle down for a long, deep night of sleep. You slumber almost as if you, yourself, were a bear in hibernation.

Then boom, it hits you: You’re awake and there’s a bear in your tent! How had your elaborate bear-protection system failed you? Was it because you left the metaphorical door wide open so the big ursine could come right in? And what do you do now?

You, in this instance, are, of course, Governor Andrew Cuomo of New York, and if you are our fearless Governor, you engage the bear in manly mano-a-mano combat. To be fair to Cuomo, one should really say that the campsite’s superintendent or steward left the entryway open, and that bears are, after all, intelligent, capable, and at times – at least by a human – nearly unstoppable animals.

Still, is hand-to-hand combat with the bear very wise?

Strong Man, or Strongman?

Regular readers will recall that I’ve been highly critical of the Governor’s handling of our current crisis (also of the Mayor’s and most especially of the President’s), and it was with annoyance that I took note of a recent wave of hagiographical puff pieces celebrating the Governor’s leadership, referring to him, for example, as “the Control Freak We Need Right Now” (all of these courtesy of Tech:NYC’s COVID-19 Digest).

I’d argue that what we needed was adequate preparation, foresight, and a coherent program (a la South Korea) of anti-pandemic measures, not machismo and narcissism, and when the Governor goes on MSNBC to speak with his brother – a news anchor – and indulges in some brotherly bickering about childhood whatever in the midst of a global crisis, or names a new bill to protect elders after his own mother, I’m as disgusted as I was when he named the new Tappan Zee Bridge after his own father. It’s why, among other reasons, I backed the highly-imperfect candidacy of Cynthia Nixon, and why I’m at times inclined to label Cuomo the party machine nepotist crypto-Republican par excellence. (I could go on and one, about his backhanded support for the buildout of fracked gas infrastructure in New York State, his perfunctory disbanding of the ethics / anti-corruption panel that was investigating him, his long alliance with the IDC that allowed him to stymie a progressive agenda in New York for years while centralizing power in his person…). But we are here to talk about the COVID-19 pandemic, and, in spite of all my frustrations with Governor Cuomo, I’m deeply thankful that his megalomania is fueling a massive and rapid ramp up in testing. According to his own proclamations, New York State now has the highest rate of per capita testing of any state/territory/country in the world, which is a substantial achievement and a good first step.

He may not have been fully responsible for letting the bear in, though he certainly shouldn’t have been sleeping either, but now that the bear is here, he’s starting to put on a good show.

Where From Here?

Even the toughest Cuomo can only survive so long with a bear in a tent though.

Thankfully, the most coronaviral writer of all, Tomas Pueyo, has another piece out to guide our perplexed executive. Following up on his very-widely-read Coronavirus: Why You Must Act Now, Pueyo makes the case for a suppression rather than a mitigation strategy, and suggests that handled correctly (again, a la South Korea), lockdown measures – to which he refers as “the hammer” – need only last weeks (that is, perhaps a month to a month and a half) and that, thereafter, with the right combination of disease surveillance, testing, contact tracing, case isolation, and precautionary quarantine, we could hope to prevent epidemic explosion of the disease indefinitely while we await what we hope will be the creation of a vaccine; this process, by which we largely return to normal life while all making adjustments in our behavior and being prepared to modulate back up more drastic society-wide measures as the situation demands (that is, if epidemic spread of the disease threatens to resume), Pueyo calls “the dance” – hence the piece’s title, The Hammer and the Dance. The key takeaway / his key claim (bearing in mind that he is, like I am, not an epidemiologist or a health professional) is that mitigation strategies currently being employed in countries including the US and the UK are almost certain to lead to breakdown of healthcare systems, huge numbers of infections, and – in the US alone – tens of millions of deaths – whereas, he argues, suppression strategies like those employed in South Korea, China, and, to some extent, now in France and Spain, can bring the disease’s spread more fully under control, and then allow for measured responses going forward that will prevent catastrophic healthcare system breakdown and, in the US, potentially keep fatality rates in the tens of thousands. His conclusions largely mirror those of the recent Imperial College London study, with one important exception; where that study concluded that even a suppression strategy simply delays the inevitable peak in cases and healthcare system breakdown (while simultaneously inflicting massive social and economic harm on the population at large), Pueyo argues that the South Korea strategy should, again, allow for most daily activities to resume (or continue unabated, as they have in South Korea) without a resumption of epidemic spread so long as less drastic “non-pharmaceutical interventions” are pursued aggressively.

This short piece from Michael Donnelly mirrors my own recent work trying to predict case numbers in NYC, and he’s taken the trouble to do what I was planning to this weekend – namely, to infer, based on the number of COVID-19 hospitalizations in NYC how many total cases we have to date. So far, I’d been trying to predict the number of total cases using a model based on the Wuhan data from JAMA, but that model involved a lot of (questionable) assumptions, and now that the number of hospitalizations has sharply risen in NYC and data on hospitalizations are becoming more readily accessible, Donnelly’s method is preferable – though, for better or worse, his approach and my model yield comparable numbers (that put our current number of total cases in NYC in the vicinity of 100,000 to 200,000).

Here’s another good, short piece from Jason W. Bae – a physician in California – who uses similar methods to predict that there are already more than one million total COVID-19 cases in the US alone.

Finally, in the spirit of being / staying / getting informed, here are the graphs from NYC Health that show the sharp spikes in hospital admissions and ER visits for patients suffering “Influenza-like IIlnes + Pneumonia Syndrome” from early March on. This is the signal that we missed, and the signal that we should have been looking for. Even with that metaphorical door wide open, one of the bells was still ringing, but sound sleepers that we are, we slept right through it.