Too Much For Too Little?

Nobody ever got fired for buying IBM.

It’s an old catchphrase from the information technology (IT) industry, and likely not as true as it once was, however much that was.

From the late-1960s to the 1980s, as technology morphed from mainframe to mini to micro to mobile computers, IBM went from being the dominant industry player to being a stable but stodgy provider. Cutting edge? Hardly. Cheapest? Certainly not. So, then, buying IBM products and services would be a big career risk for a corporate buying manager? Oddly, no.

By virtue of its early dominance IBM was a respectable, known quantity even to non-techie executives. If your IT project was late to need or over budget or under-performing or all three at once, and you got called upon to explain yourself, it was nice to be able to say you’d bought from IBM rather than from some upstart start-up only the geeks had heard of. You couldn’t be faulted for that.

Not so fast. I first heard this catchphrase in a slightly different form.

You pay too much for too little
but you never get fired for buying IBM.

I like this one better because it highlights the trade-off. No solution is perfect.

I’ve been thinking about this catchphrase this past week or two, as I watch most politicians around the world opt for lockdowns to deal with the COVID-19 pandemic. Having failed miserably to listen to healthcare experts urging us to prepare, we’re now following their advice seemingly without question.

Not so fast. There are dissenting opinions on the right strategy and I’m not talking about the Bad Orange Man. Some epidemiologists and infectious disease experts have argued for more testing or for quarantining the vulnerable rather than the presumed healthy: Here’s one example from Canada, written a few weeks ago.

As I write this, our government has just released our national projections. The number of actual infections is tricky to compare between jurisdictions (due to differences in testing rates, for one, and differences in where places are in their infection journey, for another), so let’s just look at projected deaths: our expected scenario is 11,000 to 22,000 dead (see note 1 below).

Now let’s compare that to the USA:

• Based on population, their projected numbers should be about 10 times higher: 110,000 to 220,000.
• Based on our usual respective flu experience, their numbers could be anywhere from 24 to 40 times higher: 264,000 to 880,000 (see note 2 below)
• Based on actual COVID-19 deaths to date, their numbers could be about 30 times higher (although that’s overstated because they’re about a week ahead of us on the curve): 330,000 – 660,000

So. Anywhere from 110,000 to 880,000 projected deaths in America: a not insignificant range, and a nasty lower number. But the current IHME estimate for the USA is about 60,000 expected deaths in total (as of 09 Apr, see note 3 below), which is only 3 to 5 times ours. Not 10 or 24 or 30 or 40 times.

Although these projections are being used to guide public policy and government spending (see note 4 below), the experts keep telling us we can’t take them as written in stone. But how does this even make sense? How can Canada’s projected deaths be so high compared to the USA’s? Could journalists maybe ask that question when they have public health officials in the room? Sigh.

Let me be clear.

I don’t want anyone to die of COVID-19.

I will keep following public-health advice to limit contact. “Not getting sick” is almost the most civic-minded thing I can do at this point, and as seniors the Big Guy and I have a slightly heightened risk if infected (only slightly, because we’re healthy, but still). But the actions I take to manage my responsibilities and my personal risk might not be a good basis for public policy. Which brings me to my concern.

I don’t think we can do “whatever it takes to save even one life,” as I heard Gov. Cuomo say a few weeks ago that he was going to do. Every life is precious, at every age-and-stage. “Prevent every death at any cost” sounds noble and is an admirable sentiment at the personal level, but it’s not feasible as public policy. It’s not, in fact, what we do in any other sphere, public-health-wise or safety-wise. It ignores the challenge of diminishing returns and the tragic reality of trade-offs.

When Dr. Fauci talked once about his ideal state — every American locked down in their home for several weeks to stop the spread — another public-health-doctor-cum-TV-commentator said, effectively, “Whoa, wait a minute. That would dramatically increase the incidence of domestic violence, and that’s a public health issue too.” That doesn’t even take into account the mental-health damage done by extended unemployment and enforced isolation. No solution is perfect.

Am I surprised that politicians have opted for unprecedented and hugely dislocating and economically damaging lockdowns of a presumptively healthy population? Not really. Apart from that understandable human impulse “to prevent every death at any cost,” at the political level this has seemed like the safe, stodgy solution. When the best-case scenarios are nasty and the the worst-case unthinkable, being seen as doing not much would be risky. If people die in large numbers, how much fault will be laid at your door? How much fault will belong there?

Nobody ever got fired for buying IBM.

Maybe the public-health experts are right: the ones who are calling the shots here, I mean, not the ones who are writing dissenting editorials, nor the ones who have been setting contrarian policy in Sweden, where it’s still too early to tell whether it’s for good or for ill on balance. Maybe Canada will have one-fifth or one-third of the deaths now projected for the USA. Or maybe the USA’s “expected” projections will change again, this time for the higher. God forbid.

But the longer this goes on the confuseder I get, and the more I think of that other catchphrase formulation. The more I worry that we’re paying too much for too little.

Note 1 – Death projections for Canada: There are lots of numbers in the press and that’s hardly surprising: one article says the projected range goes from a high of 44,000 down to a best case of 4,400. As I understand it, that 44,000 is if we do very little and the 4,400 is if we move heaven and earth to shut down all contact. What the Canadian experts (seem to) expect with what we’re doing now is between 11,000 and 22,000.

Note 2 – Flu deaths: The USA has 12,000 to 60,000 flu deaths annually and Canada has ~500 to 1,500 although other government sites cite 3,500 and I know I used to hear 1,500 to 3,000. Why don’t we agree on this number for goodness sake?

Note 3 – IHME projections: The USA death projections (from the Institute for Health Metrics and Evaluation which, regrettably, does not run a model for Canada) were first quoted by Dr. Birx (31 Mar) as being between 100,000 and 240,000. Then they were revised to 93,000 (2 days later), 81,000 (3 days after that), and 60,000 (4 days after that). It’s hard for me to keep up or to understand what it means, although fewer is better, for sure. What’s important, I think, is that the revisions do not seem to be the effect of the lockdown, because these estimates have all assumed physical distancing. That’s even what it says at the top of the IHME site. The experts have been clear that these numbers could/would be much worse if we let up.

Note 4 – Ground Zero – NY State: In his Apr 10 press conference Gov. Cuomo talked about the models he’d seen early on. NY State has about 35,000 hospital beds, and the need at peak was forecast as high as 135,000 and as low as 55,000. No wonder he was worried. A best-case result would have seen them need roughly twice as many beds as they had. What happened? They think they might have hit peak use this past week, using only ~18,500 beds. It looks like they won’t have to use the field hospitals they (prudently) deployed to handle the projected overflow.

Note 5 – Canada’s ICU situation: As of 1 PM on 11 Apr, things are good, although things can change fast.