Cartoon – Plain Truth or Sugar Coated?
Category Archives: Truth
Most consumers nervous about returning to care settings
https://mailchi.mp/aa7806a422dd/the-weekly-gist-may-8-2020?e=d1e747d2d8
As non-essential businesses begin to reopen, there’s no guarantee that merely opening the doors will make customers return. A recent Morning Consult poll provides an assessment of the impact of COVID-19 on consumer confidence: fewer than one in five US adults are currently comfortable doing (formerly) everyday activities like eating at a restaurant or going to a shopping mall.
The graphic below provides similar data for healthcare. Consumers’ willingness to visit healthcare providers in person for non-COVID care is only slightly better, at 21 percent. Which providers might see patients return most quickly?
Consumers say they are about twice as likely to visit their primary care doctor’s office than other healthcare facilities, including hospitals, specialists, and walk-in clinics. And when it comes to scheduling a routine in-office visit, nearly half say they will wait two to six months, with almost one in ten not comfortable going to a doctor’s office in person for a year or more.
Healthcare facilities face an uphill battle in bringing back patients—many of whom have ongoing chronic diseases that necessitate care now. Reaching patients through telemedicine and providing concrete messages about how they can safely see their doctor will be critical to staving off a tide of disease exacerbations that will mount as fear delays much-needed care.
Cartoon – Modern Reporting
The White House said it was following health experts’ advice. Then we learned it isn’t approving a key CDC document.
Several hours later, we got another example of the White House resisting what those health experts are advising.
The Associated Press reported around midnight that the White House had shelved planned guidelines from the Centers for Disease Control and Prevention. The document, which was due nearly a week ago, was aimed at providing local authorities with step-by-step guidance on how to reopen:
The 17-page report by a Centers for Disease Control and Prevention team, titled “Guidance for Implementing the Opening Up America Again Framework,” was researched and written to help faith leaders, business owners, educators and state and local officials as they begin to reopen.It was supposed to be published last Friday, but agency scientists were told the guidance “would never see the light of day,” according to a CDC official. The official was not authorized to talk to reporters and spoke to The Associated Press on the condition of anonymity.
A coronavirus task force official told The Washington Post that the document has not been completely shelved but was in the process of being revised because it was “overly specific.” The official also indicated that it was felt the document was too broad, as “guidance in rural Tennessee shouldn’t be the same guidance for urban New York City.”
The denial, though, reinforces that the White House is reluctant to submit to the CDC’s more detailed prescriptions for reopening the economy. And it’s difficult to divorce the delay in this document’s publication from Trump’s anxiety to reopen the economy — and the tension that has created with past guidelines.
The administration in mid-April issued phased advice on when areas should start to reopen places such as restaurants and other nonessential businesses. But many states have moved forward with certain elements of reopening without actually satisfying those guidelines. Most notably, they have begun to reopen without meeting the Phase One guideline that they should see a decrease in confirmed coronavirus cases over a 14-day period.
As The Post’s Philip Bump reported, some states that have pushed forward with reopening have also seen an increase in cases — which would prevent them from satisfying the requirement for moving into Phase Two. That requirement is that the decline should continue for another 14 days after Phase One begins.
Issuing a detailed document would seemingly complicate further reopenings, because it would again restrict what states and local authorities are supposed to do.
The Washington Post’s Lena H. Sun and Josh Dawsey previewed what the document was set to look like last week. And they also obtained a draft of the document. The new guidelines were to go beyond the initial ones in prescribing specific actions that could be taken in each phase of the reopening. Advocates for reopening have worried that strict guidance could make it difficult for businesses, churches, child-care centers and other facilities to actually function.
Trump, who has long signaled a desire to begin reopening that economy sooner rather than later, has doubled down on that rhetoric in recent days. Despite a steady national death rate that approached previous highs on Tuesday and Wednesday, and even though cases continue to increase outside the major U.S. hotbed of New York City, Trump on Tuesday signaled that we are entering the “next stage” of reopening the economy.
“Thanks to the profound commitment of our citizens, we’ve flattened the curve, and countless American lives have been saved,” Trump said. “Our country is now in the next stage of the battle: a very safe phased and gradual reopening. So, reopening of our country — who would have ever thought we were going to be saying that? A reopening. Reopening.”
Trump has been resistant to the advice of the health officials around him, from the early days of the outbreak when he continuously downplayed the severity of the situation. On several occasions, this tension has boiled over.
We’re also hearing from those officials less and less. The CDC long ago ceased holding briefings on the coronavirus outbreak, and the White House coronavirus task force briefings, which often featured health experts Anthony S. Fauci and Deborah Birx, have now been halted in favor of less-frequent and less-coronavirus-focused briefings from McEnany. Fauci has also been prevented from testifying to the Democratic-controlled House, although he is still slated to testify in the GOP-controlled Senate and has continued doing some interviews. The cumulative effect is that these health experts aren’t on the record as much as the effort to reopen the economy begins in earnest.
In the place of those public comments, the CDC guidelines were to provide firm and detailed advice from those officials for the new stage. But for reasons that seem pretty conspicuous, we still don’t have them.
COVID-19 and the End of Individualism
The pandemic has shown that it is not existential dangers, but rather everyday economic activities, that reveal the collective, connected character of modern life. Just as a spider’s web crumples when a few strands are broken, so the coronavirus has highlighted the risks arising from our economic interdependence.
Cartoon – False Hope
Whistleblower alleges Trump administration ignored coronavirus warnings
Rick Bright, the former director of the U.S. Biomedical Advanced Research and Development Authority (BARDA), filed a whistleblower complaint Tuesday alleging that the Department of Health and Human Services failed to take early action to mitigate the threat of the novel coronavirus.
Flashback: Bright said last month he believes he was ousted after clashing with HHS leadership over his attempts to limit the use of hydroxychloroquine to treat the coronavirus.
- President Trump has repeatedly touted the use of hydroxychloroquine for the virus. In late April, the FDA cautioned doctors on the potentially life-threatening side effects of treating COVID-19 patients with the antimalarial drug.
What’s new: In his complaint, Bright claims he was excluded from an HHS meeting on the coronavirus in late January after he “pressed for urgent access to funding, personnel, and clinical specimens, including viruses” to develop treatments for the coronavirus should it spread outside of Asia.
- Bright alleges it “became increasingly clear” in late January that “HHS leadership was doing nothing to prepare for the imminent mask shortage.”
- Bright claims he “resisted efforts to fall into line with the Administration’s directive to promote the broad use of chloroquine and hydroxychloroquine and to award lucrative contracts for these and other drugs even though they lacked scientific merit and had not received prior scientific vetting.”
- He adds that “even as HHS leadership began to acknowledge the imminent shortages in critical medical supplies, they failed to recognize the magnitude of the problem, and they failed to take the necessary urgent action.”
The White House declined to comment. HHS did not immediately respond to a request for comment.
https://www.documentcloud.org/documents/6882494-NEW-R-Bright-OSC-Complaint-Redacted.html
Cartoon – Want to Hear Basis Leadership
‘Sadness’ and Disbelief From a World Missing American Leadership
The coronavirus pandemic is shaking bedrock assumptions about U.S. exceptionalism. This is perhaps the first global crisis in more than a century where no one is even looking for Washington to lead.
As images of America’s overwhelmed hospital wards and snaking jobless lines have flickered across the world, people on the European side of the Atlantic are looking at the richest and most powerful nation in the world with disbelief.
“When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said Henrik Enderlein, president of the Berlin-based Hertie School, a university focused on public policy. “We are all stunned. Look at the jobless lines. Twenty-two million,” he added.
“I feel a desperate sadness,” said Timothy Garton Ash, a professor of European history at Oxford University and a lifelong and ardent Atlanticist.
The pandemic sweeping the globe has done more than take lives and livelihoods from New Delhi to New York. It is shaking fundamental assumptions about American exceptionalism — the special role the United States played for decades after World War II as the reach of its values and power made it a global leader and example to the world.
Today it is leading in a different way: More than 840,000 Americans have been diagnosed with Covid-19 and at least 46,784 have died from it, more than anywhere else in the world.
As the calamity unfolds, President Trump and state governors are not only arguing over what to do, but also over who has the authority to do it. Mr. Trump has fomented protests against the safety measures urged by scientific advisers, misrepresented facts about the virus and the government response nearly daily, and this week used the virus to cut off the issuing of green cards to people seeking to emigrate to the United States.
“America has not done badly, it has done exceptionally badly,” said Dominique Moïsi, a political scientist and senior adviser at the Paris-based Institut Montaigne.
The pandemic has exposed the strengths and weaknesses of just about every society, Mr. Moïsi noted. It has demonstrated the strength of, and suppression of information by, an authoritarian Chinese state as it imposed a lockdown in the city of Wuhan. It has shown the value of Germany’s deep well of public trust and collective spirit, even as it has underscored the country’s reluctance to step up forcefully and lead Europe.
And in the United States, it has exposed two great weaknesses that, in the eyes of many Europeans, have compounded one another: the erratic leadership of Mr. Trump, who has devalued expertise and often refused to follow the advice of his scientific advisers, and the absence of a robust public health care system and social safety net.
“America prepared for the wrong kind of war,” Mr. Moïsi said. “It prepared for a new 9/11, but instead a virus came.”
“It raises the question: Has America become the wrong kind of power with the wrong kind of priorities?” he asked.
Ever since Mr. Trump moved into the White House and turned America First into his administration’s guiding mantra, Europeans have had to get used to the president’s casual willingness to risk decades-old alliances and rip up international agreements. Early on, he called NATO “obsolete” and withdrew U.S. support from the Paris climate agreement and the Iran nuclear deal.
But this is perhaps the first global crisis in more than a century where no one is even looking to the United States for leadership.
In Berlin, Germany’s foreign minister, Heiko Maas, has said as much.
China took “very authoritarian measures, while in the U.S., the virus was played down for a long time,” Mr. Maas recently told Der Spiegel magazine.
“These are two extremes, neither of which can be a model for Europe,” Mr. Maas said.
America once told a story of hope, and not just to Americans. West Germans like Mr. Maas, who grew up on the front line of the Cold War, knew that story by heart, and like many others in the world, believed it.
But nearly three decades later, America’s story is in trouble.
The country that helped defeat fascism in Europe 75 years ago next month, and defended democracy on the continent in the decades that followed, is doing a worse job of protecting its own citizens than many autocracies and democracies.
There is a special irony: Germany and South Korea, both products of enlightened postwar American leadership, have become potent examples of best practices in the coronavirus crisis.
But critics now see America failing not only to lead the world’s response, but letting down its own people as well.
“There is not only no global leadership, there is no national and no federal leadership in the United States,” said Ricardo Hausmann, director of the Growth Lab at Harvard’s Center for International Development. “In some sense this is the failure of leadership of the U.S. in the U.S.”
Of course, some countries in Europe have also been overwhelmed by the virus, with the number of dead from Covid-19 much higher as a percentage of the population in Italy, Spain and France than in the United States. But they were struck sooner and had less time to prepare and react.
The contrast between how the United States and Germany responded to the virus is particularly striking.
While Chancellor Angela Merkel has been criticized for not taking a forceful enough leadership role in Europe, Germany is being praised for a near-textbook response to the pandemic, at least by Western standards. That is thanks to a robust public health care system, but also a strategy of mass testing and trusted and effective political leadership.
Ms. Merkel has done what Mr. Trump has not. She has been clear and honest about the risks with voters and swift in her response. She has rallied all 16 state governors behind her. A trained physicist, she has followed scientific advice and learned from best practice elsewhere.
Not long ago, Ms. Merkel was considered a spent force, having announced that this would be her last term. Now her approval ratings are at 80 percent.
“She has the mind of a scientist and the heart of a pastor’s daughter,” Mr. Garton Ash said.
Mr. Trump, in a hurry to restart the economy in an election year, has appointed a panel of business executives to chart a course out of the lockdown.
Ms. Merkel, like everyone, would like to find a way out, too, but this week she warned Germans to remain cautious. She is listening to the advice of a multidisciplinary panel of 26 academics from Germany’s national academy of science. The panel includes not just medical experts and economists but also behavioral psychologists, education experts, sociologists, philosophers and constitutional experts.
“You need a holistic approach to this crisis,” said Gerald Haug, the academy’s president, who chairs the German panel. “Our politicians get that.”
A climatologist, Mr. Haug used to do research at Columbia University in New York.
The United States has some of the world’s best and brightest minds in science, he said. “The difference is, they’re not being listened to.”
“It’s a tragedy,” he added.
Some cautioned that the final history of how countries fare after the pandemic is still a long way from being written.
A pandemic is a very specific kind of stress test for political systems, said Mr. Garton Ash, the history professor. The military balance of power has not shifted at all. The United States remains the world’s largest economy. And it was entirely unclear what global region would be best equipped to kick-start growth after a deep recession.
“All of our economies are going to face a terrible test,” he said. “No one knows who will come out stronger at the end.”
Benjamin Haddad, a French researcher at the Atlantic Council, wrote that while the pandemic was testing U.S. leadership, it is “too soon to tell” if it would do long-term damage.
“It is possible that the United States will resort to unexpected resources, and at the same time find a form of national unity in its foreign policy regarding the strategic rivalry with China, which it has been lacking until now,” Mr. Haddad wrote.
There is another wild card in the short term, Mr. Moïsi pointed out. The United States has an election in November. That, and the aftermath of the deepest economic crisis since the 1930s, might also affect the course of history.
The Great Depression gave rise to America’s New Deal. Maybe the coronavirus will lead the United States to embrace a stronger public safety net and develop a national consensus for more accessible health care, Mr. Moïsi suggested.
“Europe’s social democratic systems are not only more human, they leave us better prepared and fit to deal with a crisis like this than the more brutal capitalistic system in the United States,” Mr. Moïsi said.
The current crisis, some fear, could act like an accelerator of history, speeding up a decline in influence of both the United States and Europe.
“Sometime in 2021 we come out of this crisis and we will be in 2030,” said Mr. Moïsi. “There will be more Asia in the world and less West.”
Mr. Garton Ash said that the United States should take an urgent warning from a long line of empires that rose and fell.
“To a historian it’s nothing new, that’s what happens,” said Mr. Garton Ash. “It’s a very familiar story in world history that after a certain amount of time a power declines.”
“You accumulate problems, and because you’re such a strong player, you can carry these dysfunctionalities for a long time,” he said. “Until something happens and you can’t anymore.”
The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 Crisis
https://khn.org/news/the-inside-story-of-how-the-bay-area-got-ahead-of-the-covid-19-crisis/
Sunday was supposed to be a rare day off for Dr. Tomás Aragón after weeks of working around-the-clock.
Instead, the San Francisco public health officer was jolted awake by an urgent 7:39 a.m. text message from his boss.
“Can you set up a call with San Mateo and Santa Clara health officers this a.m., so we can discuss us all getting on the same page this week with aggressive actions, thanks,” said the message from Dr. Grant Colfax, director of San Francisco’s Department of Public Health.
“Will do, getting up now,” Aragón responded.
It was March 15, two days before St. Patrick’s Day, a heavy partying holiday and nightmare scenario for public health officials.
The novel coronavirus was spreading stealthily across the San Francisco Bay Area and public health officials were alarmed by the explosion of deaths in Italy and elsewhere around the globe. Silicon Valley would be next, case counts indicated.
Until then, they had primarily focused on banning mass gatherings. But they knew more had to be done — and wanted to present a united front.
Within a few hours of the text, Bay Area public health leaders jumped on a series of calls to debate options, including the most dramatic — a lockdown order that would shutter businesses, isolate families and force millions of residents to stay home.
They decided they had no choice. And they were able to move swiftly because they had a secret weapon: a decades-long alliance seeded in the early days of the AIDS epidemic that shields them from political blowback when they need to make difficult decisions.
Together, they would issue the nation’s first stay-at-home order, likely saving thousands of lives and charting the course for much of the country. Three days later, Gov. Gavin Newsom followed with his own order for California. New York came next, as have dozens of states since.
“This was one exhausting and difficult day for all of us,” Aragón later wrote in his journal. “We all wish we did not have to do this.”
Now, officials nationwide are weighing how to lift isolation orders as the rate of COVID-19 transmission slows — and protests against the orders mount. The Bay Area is again poised to lead, but with a warning: All of this could be for naught if it isn’t done right.
The coalition of county public health officers didn’t set out to lock down the Bay Area that fateful Sunday morning in mid-March. But as they discussed the exponential increase in Santa Clara County cases, where the hospitals were becoming overwhelmed by infected patients falling ever sicker, what they needed to do “started to crystalize,” said Dr. Sara Cody, the county’s public health officer.
“It felt huge to me,” she recalled, “because I knew how disruptive it would be.”
Elsewhere in the region, diagnosed cases were sparse. But decades of experience had shown the health officers that while they represent different jurisdictions, they are one region when it comes to infectious diseases. “We knew that it would be a matter of time before that was our experience,” said Dr. Matt Willis, Marin County’s public health officer, who contracted COVID-19 days later.
Cody told her colleagues that Italy was under siege, and her county was just two weeks away from a similar fate. If she could have locked down sooner, she told them, she would have.
“That was compelling,” said Dr. Lisa Hernandez, the public health officer for the city of Berkeley, which had not yet recorded any cases of community transmission. “We knew there was going to be St. Patrick’s Day parades and celebrations, so the timing was critical.”
Dr. Scott Morrow, California’s longest-serving public health officer, who heads operations in San Mateo County, said he also felt the urgency. “We thought, ‘Yes, the clock is ticking,’” he recalled.
County health officers in California have immense power to act independently in the interest of public health, including the authority to issue legally binding directives. They don’t need permission from the governor or mayors or county supervisors to act.
Even for this group, though, with all its collective strength, telling millions of Californians to shelter in place seemed risky at first. But the health officers involved had grown to trust one another, even if they don’t always see eye to eye.
For instance, they currently disagree on whether to require residents to wear face coverings. Some counties, including San Francisco and Marin, are requiring them in public, while others, like Santa Clara, are not.
On the first Sunday morning call, Aragón floated the idea of developing a coordinated recommendation that Bay Area residents stay at home. By the next confab, Cody, Santa Clara County’s health official, made the case that for social distancing to work, it had to be an order.
“Sara Cody was the courageous leader!” Aragón later wrote in his journal.
So forceful a move can be unpopular, but evidence shows it can also be the most effective, in the absence of treatment or a vaccine. “Here’s the rub on these methods — they only work if you do it really early,” said Dr. Howard Markel, a medical historian at the University of Michigan and an expert on the 1918 flu pandemic.
“When you do a quarantine, you stop the commerce, you stop the flow of money,” he said. “But on the other side of that are those whose lives are saved.”
This isn’t the group’s first pandemic. The alliance, formally called the Association of Bay Area Health Officials, was born in 1985 in the early days of the AIDS epidemic.
Dr. David Werdegar, who became health officer for San Francisco that year, was analyzing AIDS data for surrounding counties and asked their health officers to join him for dinner at Jack’s, an old bordello-turned-political hangout in the city that has since shuttered.
Most of the infectious disease research was happening in San Francisco at the time, but HIV was spreading, and one city couldn’t fight it alone.
“It was important that we share all the information we had,” said Werdegar, now in his 80s and retired.
Dr. Robert Melton, a former Monterey County health officer, said that working for nearly two decades with Bay Area public health giants taught him tremendous lessons. “Camaraderie is important in maintaining the energy to be able to focus on the common good, through good and bad,” he said.
That close-knit relationship among the 13 health officers — representing counties stretching across a large swath of Northern California from Napa to Monterey — continues to this day. Collectively, their public health actions touch about 8.5 million people.
They meet monthly and communicate regularly on Slack, a messaging app. Their diverse backgrounds and expertise, especially in an era of funding cuts, provide a deep well of public health knowledge from which to draw. Together, the group has joined forces to combat youth vaping, air pollution and measles outbreaks.
And they have also tackled various influenza scares, which is why they had an emergency response blueprint at the ready when cases of what would later be called COVID-19 first cropped up in Wuhan, China.
“We spent a couple years as a region thinking about pandemic planning, and that really helped us come a long way thinking about these policies for COVID-19,” said Dr. Erica Pan, the interim health officer for Alameda County.
So when they jumped on the call that Sunday, they were already in mid-conversation about how to respond. They brought their lawyers and, working into the predawn hours, translated their lockdown plan into legalese, one that would be enforceable with fines and misdemeanor charges.
They would make prime-time announcements across the region the next day, alongside elected officials. “This is not the moment for half-measures,” said San Jose Mayor Sam Liccardo. “History won’t forgive us for waiting an hour more.”
At first, the stay-at-home order applied just to the “Big Seven” counties surrounding the San Francisco Bay, whose officers peeled off from the larger group to issue it first. They shared their model ordinance with the others, who quickly followed.
Dr. Gail Newel, an OB-GYN and Santa Cruz County’s health officer, is not an infectious disease expert. She has relied heavily on the group’s expertise throughout her career, and especially now.
“It’s this incredible bank of knowledge and wisdom and experience that’s freely shared among the members,” she said. “And the whole Bay Area benefits by that shared knowledge bank.”
Roughly one month after they made the unprecedented decision to close the local economy, the risk seems to have paid off. It will be years before researchers have fully analyzed its impact, but officials across the Bay Area are cautiously optimistic. Others haven’t been so lucky.
Though there are important differences between the two regions, New York City, which issued a stay-at-home order four days after the Bay Area, saw its hospitals completely overwhelmed and had recorded more than 14,600 deaths as of Monday.
By comparison, the counties represented by the alliance have documented more than 215 deaths and hospitals haven’t been overtaken by a surge. In fact, hospitals brought online specifically to accommodate an overflow of patients are sitting largely empty.
Even within California, communities that waited to issue lockdown orders have emerged as COVID-19 hot spots, including Los Angeles, where Mayor Eric Garcetti followed suit three days after the Bay Area.
Internally, some of the Bay Area health officials have wondered if they made the right call. But “anytime I have any doubt, I just read another news report from New York or Detroit or New Orleans,” said Dr. Chris Farnitano, Contra Costa County’s health officer.
And the close-knit band is already undertaking its next task: reopening the economy without causing another spike in cases.
Before the orders are lifted, the officials say there must be rapid, widespread testing across the population. They want to hire disease investigators by the hundreds, if not the thousands, to trace the virus and quarantine those who have been infected. And until there is a vaccine, they may ask people to wear masks in public and continue social distancing, even in bars, restaurants and schools when they reopen.
“I was concerned that we might get a lot of resistance and it might get interpreted as alarmist and overreach,” said Marin County’s Willis. “Time has shown that it was really a vital step to take when we took it.”
HENRY KOTULA 
CAMBRIDGE – Aristotle was right. Humans have never been atomized individuals, but rather social beings whose every decision affects other people. And now the COVID-19 pandemic is driving home this fundamental point: each of us is morally responsible for the infection risks we pose to others through our own behavior.
In fact, this pandemic is just one of many collective-action problems facing humankind, including climate change, catastrophic biodiversity loss, antimicrobial resistance, nuclear tensions fueled by escalating geopolitical uncertainty, and even potential threats such as a collision with an asteroid.
As the pandemic has demonstrated, however, it is not these existential dangers, but rather everyday economic activities, that reveal the collective, connected character of modern life beneath the individualist façade of rights and contracts.
Those of us in white-collar jobs who are able to work from home and swap sourdough tips are more dependent than we perhaps realized on previously invisible essential workers, such as hospital cleaners and medics, supermarket staff, parcel couriers, and telecoms technicians who maintain our connectivity.
Similarly, manufacturers of new essentials such as face masks and chemical reagents depend on imports from the other side of the world. And many people who are ill, self-isolating, or suddenly unemployed depend on the kindness of neighbors, friends, and strangers to get by.
The sudden stop to economic activity underscores a truth about the modern, interconnected economy: what affects some parts substantially affects the whole. This web of linkages is therefore a vulnerability when disrupted. But it is also a strength, because it shows once again how the division of labor makes everyone better off, exactly as Adam Smith pointed out over two centuries ago.
Today’s transformative digital technologies are dramatically increasing such social spillovers, and not only because they underpin sophisticated logistics networks and just-in-time supply chains. The very nature of the digital economy means that each of our individual choices will affect many other people.
Consider the question of data, which has become even more salient today because of the policy debate about whether digital contact-tracing apps can help the economy to emerge from lockdown faster.
This approach will be effective only if a high enough proportion of the population uses the same app and shares the data it gathers. And, as the Ada Lovelace Institute points out in a thoughtful report, that will depend on whether people regard the app as trustworthy and are sure that using it will help them. No app will be effective if people are unwilling to provide “their” data to governments rolling out the system. If I decide to withhold information about my movements and contacts, this would adversely affect everyone.
Yet, while much information certainly should remain private, data about individuals is only rarely “personal,” in the sense that it is only about them. Indeed, very little data with useful information content concerns a single individual; it is the context – whether population data, location, or the activities of others – that gives it value.
Most commentators recognize that privacy and trust must be balanced with the need to fill the huge gaps in our knowledge about COVID-19. But the balance is tipping toward the latter. In the current circumstances, the collective goal outweighs individual preferences.
But the current emergency is only an acute symptom of increasing interdependence. Underlying it is the steady shift from an economy in which the classical assumptions of diminishing or constant returns to scale hold true to one in which there are increasing returns to scale almost everywhere.
In the conventional framework, adding a unit of input (capital and labor) produces a smaller or (at best) the same increment to output. For an economy based on agriculture and manufacturing, this was a reasonable assumption.
But much of today’s economy is characterized by increasing returns, with bigger firms doing ever better. The network effects that drive the growth of digital platforms are one example of this. And because most sectors of the economy have high upfront costs, bigger producers face lower unit costs.
One important source of increasing returns is the extensive experience-based know-how needed in high-value activities such as software design, architecture, and advanced manufacturing. Such returns not only favor incumbents, but also mean that choices by individual producers and consumers have spillover effects on others.
The pervasiveness of increasing returns to scale, and spillovers more generally, has been surprisingly slow to influence policy choices, even though economists have been focusing on the phenomenon for many years now. The COVID-19 pandemic may make it harder to ignore.
Just as a spider’s web crumples when a few strands are broken, so the pandemic has highlighted the risks arising from our economic interdependence. And now California and Georgia, Germany and Italy, and China and the United States need each other to recover and rebuild. No one should waste time yearning for an unsustainable fantasy.