Tag Archives: Decisions

The Ideal COVID-19 Team

Every crisis movie has them, the elite team of experts that tackle the crisis often with widely differing views (e.g. Sum of All Fears). If our firm was asked to assemble a team that would make recommendations for the duration of the crisis, this is what that team would look like:

  • Two U.S.-trained virologists/epidemiologists who had actual on the ground experience battling a virus (i.e. Ebola, SARS, HIV veterans).
  • Two Foreign-trained virologists/epidemiologists who also had actual on the ground experience battling a virus. The foreign training, preferably from the BRICS countries, would be able to suggest lower cost solutions.
  • Two applied probability experts that have experience with large data sets, validation, and attention to detail over naming conventions and the meaning of variables. The best I have seen are Census Bureau employees for their attention to detail. For instance, they double program every model.
  • Two market analysis experts that have at least a decade of experience in pricing markets with high volatility and low information (e.g. oil, gold, FX, VIX).
  • Two macro economists, preferably one from an Austrian economics background and one from a Keynesian background. Maybe a supply side economist as well for good measure.
  • Three emergency room medical doctors, all without ties or payments from pharmaceutical companies. Preferably, at least one with significant experience in doctors without borders or who has seen emergency disease care under constraints up close.
  • Three pharmacists, all foreign trained and with foreign experience. It is impossible to trust US pharmacists to not have ties to US drug companies or find ones aware of foreign low cost solutions. The best would be Canadian pharmacists so they have some knowledge of US drugs.
  • Three complexity scientists with experience and publications studying tail probabilities. Preferably, these experts would help interview and select the probability gurus. One may specialize in urban issues (e.g. like the Santa Fe Institute). One may simply be used to check/question the work of others before they present (designated skeptic).
  • Three labor leaders, preferably in essential worker industries such as food preparation, trucking and public transportation.
  • Two supply chain experts preferably sourced from business.
  • Two organizational psychologists, preferably one who has studied mass media effects.
  • One administrative law and constitutional lawyer.

Why such a large team (27 in all)? Germany assembled a team of just 10 experts spanning medicine and economics.

First, large teams have low decisiveness and high deliberative capacity. The founding fathers recognized this in giving so much power to the largest body of congress. In any crisis, the self-inflicted wounds may be the easiest to avoid; these are avoided by deliberation. For instance, rather than rushing to build of models to determine impact when many of the required fundamental variables were unknown, deliberation over first steps and mitigation were a far better use of time. The complexity scientists, such as Nassim Taleb, and foreign scientists have put little faith in the models and rather suggested PPE, social distancing, and lockdowns long enough to gather data. The US experts seem to have a fetish for models.

Second, large teams are unlikely to make bold predictions that get printed when the underlying is an unknown. For instance, SARS in 2003 was suspected of spreading via aerosol transmission, but many government agencies including the WHO came out early in the COVID crisis and said that airborne transmission was not occurring. After an outcry from doctors, most walked back this assertion, though the CDC is still battling internally over this issue. These types of statements do not help create an informed public and harm the vulnerable who then may take excessive risk.

Third, large teams are unlikely to cede to the demands of one group. If Governor Cuomo had had a large team it is unlikely they would have simply adopted the hospital’s urging to take seniors back out of the hospitals while infected. One group’s emergency can be more rationalized by a larger team. Giving hard NOs is easier when no one group is dominating the team (i.e. medical doctors and epidemiologists dominate US advising teams).

Fourth, large teams have the expertise needed amongst themselves. As a result, they can use the knowledge they gain from the long-term/repeat deliberations to assess each other’s biases. Furthermore, having the necessary expertise within the group reduces the number of calls to outside experts for reports because the team is large enough to break down issues and summarize the data themselves. This prevents the citation game of unaccountable experts or experts not in the room to defend the assertion. Working groups can each contain medical and non-medical expertise. Thus, the team is able to trust or expect balance in the work produced by sub-committees. Likewise, they know that any work produced must be defended, which tempers claims and arguments.

What would be their decision making apparatus?

While large teams may not be as decisive, their recommendation procedures can be adjusted. For instance, early in the COVID crisis many in the public were simply searching for any possible mitigation techniques. So any mitigation techniques used for any other virus, for the worst-case scenario, or simple emergency preparation techniques would have informed people of actions that even if marginally useful would have cut the R0 for the virus. Getting people informed and in mitigation mode early was the basis for success in Germany vs. Spain. Preferably in this mode, the deliberations of the team would be public, transcribed, and include citations. Thus, publishing all ideas signed by one scientist on the team could be a decision mode for quick information dissemination.

Longer reports with advice to governors, mayors, etc. could be deliberated behind closed doors. Dissents could be signed and published as well.

Recommendations to the president, administrative agencies, and businesses, especially if they directed an administrative agency to act or sought to impair business, would be deliberated publicly by the team, transcribed, and well cited.

Risk assessments and areas of risk could be compiled by each group of experts or by interdisciplinary teams. With all compiled and agreed risks from each group being published. Again, awareness of risks, however, unlikely allows mitigation. Slow moving disasters often are avoided (e.g. Y2K bug).

That sounds like a lot of transparency and information to wade through?

Yes, and information is key; credibility is key; openness is key. Public health crises have always had elements of fear and distrust. It is hard enough for the public to evaluate the opinions that would be produced without the added questions and concerns over quid pro quo and additional agendas. Notice that politicians, the military, drug companies, diplomats, and hospital managers are not on the committee.

A team like this that owes no allegiance to any prior team/agency/party would certainly have performed better than the shouting matches between the CDC/NIH and White House economists that have “decided” most policy to date in the USA. For instance the Swiss team advising their politicians was able to quickly ban hydroxychloroquine (HCQ) based on a paper published in May 2020 and then re-instate its use three weeks later when that paper was withdrawn for data errors. Perhaps the usefulness of HCQ is not yet known; perhaps it is only useful in early stages or with other drugs/supplements. The problem is that other countries are trying these options, experimenting with crowd transmission, and collecting data. The US “team” is really just three separate Federal organizations (CDC, NIH and Economic advisors) with their own interests to defend and no reason to give ground. As a result, Fauci seems to only accept double blind pharmaceutical-funded studies (no other organizations can afford double blind nor is it realistic in an emergency) and the White House, on the other hand, will accept anything as the cure. Thus, the failure of the current team stems in part from an unwillingness to even acknowledge the other side’s experts or develop some baseline reasoning. It is complete break down from where I am standing.