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As the legendary football coach Bill Parcells once said, “You are what your record says you are.”
“All science is modeling. In all science you are abstracting from nature. The question is: is it a useful abstraction.” Useful, to Bob Glass, meant: Does it help solve a problem?
And if … well, it wasn’t long before she’d have an epidemic on her hands. “I knew I had to stay ahead of it,” said Charity. “Because ninety percent of the battle is in the first few days. But in the beginning it’s always quiet, and you are quietly making decisions, and you’re a nut job.”
Charity never would know which of the measures she took had controlled the disease; she knew only that all of them together had. To her, all that really mattered was that the disease had been contained.
Charity could see that the CDC’s strategy was politically shrewd. People were far less likely to blame a health officer for what she didn’t do than what she did. Sins of commission got you fired. Sins of omission you could get away with, but they left people dead.
The federal government had a well-earned reputation for moving slowly. Rajeev marveled at just how fast it could move—when the president was pissed.
“When you go into the details of the cases, you see it’s not bad people,” he said. “It’s bad systems. When the systems depend on human vigilance, they will fail.”
“You can keep mistakes from happening if you can identify the almost mistakes. This kind of changes how I view everything.”
The gist of it was that people don’t learn what is imposed upon them but rather what they freely seek, out of desire or need. For people to learn, they need to want to learn.
“I couldn’t design a system better for transmitting disease than our school system,” he said after his visit.
It had taken Lisa, Richard, and Carter some time to see that they were in a war of competing narratives, and that whoever had the best narrative would win.
“The ICU is like a funnel,” said Richard. “It concentrates all of the badness.” But that badness only told you so much; you needed to see the goodness, too. The infection fatality rate had not just a numerator (deaths) but also a denominator (infections). If you didn’t know how many people had survived infection, you couldn’t say how deadly the virus actually was.
A case fatality rate of 1 percent implied a terrifying pandemic. It also implied that, at the critical decision-making moment, only one person in the entire city of one hundred thousand people would have died. Might not even have died yet, but was merely lying in some ICU bed, about to die. It would take extraordinary leadership to look at that situation and say, “Shut it all down.” The decision would necessarily be unpopular, and difficult to explain to the public. But that’s what a leader would need to do.
“Experience is making the same mistake over and over again, only with greater confidence,”
Managing a pandemic was like driving a weird car that only accelerated, or braked, fifteen seconds after you hit the pedal. “Or think of looking at a star,” he said. “It’s the same thing. The light you see is from years ago. When you are looking at a disease, the disease you are seeing is from last week.”
“It always starts with one case and an eerie silence,”
Joe thought that scientists should be encouraged to look at stuff without having any idea of what they were looking for. “There’s a time and a place for a hypothesis,” said Joe, “and there’s a time and a place to let it go.” He also thought that people who looked at stuff without any preconception of what they might find were the ones who saw the things that no one had seen before.
“It’s often individuals who pick up the baton, and they’re not even doing it as part of their day job description,”
“Scattered throughout those organizations there are these people, but they aren’t organized, trying to compensate for the deficiencies in the system.”
He hated in particular the way some people were able to use their own inefficiency to create a seeming need for more funding; and other people, people with a gift for making do with less, were, as a result, given even less.
You cannot wait for the smoke to clear: once you can see things clearly it is already too late. You can’t outrun an epidemic: by the time you start to run it is already upon you. Identify what is important and drop everything that is not. Figure out the equivalent of an escape fire.
The Mann Gulch fire captured the difficulty people had imagining exponential growth, even when their lives depended on it. “We are reactive and tend to only intervene when things are getting bad,” wrote Carter. “And what we underestimate is the speed that what’s bad moves.”
He thought that they should be approached the way an ICU doctor treated a patient clinging to life. Play forward whatever you are thinking about doing, or not doing, and ask yourself: Which decision, if you are wrong, will cause you the greatest regret?
“You let the falsehood continue until slowly the falsehood takes over. By the time you’re done, you are no longer just filling blank spots. You have this burden of maintaining optics. It’s all optics.”
