By Ian Allen
Reading Vice President Mike Pence’s optimistic Coronavirus op-ed in The Wall Street Journal, “There Will Be No Second Wave,” reminded me of President Bush’s Mission Accomplished banner in 2003. At that time, I was in the Marines, stationed in Virginia, angry that I missed out on the wars. I say missed out. In 2003, the war in Afghanistan was two years old, and the war in Iraq had just begun. My commander at the time – twenty years older than me – noted the Mission Accomplished message and said plaintively, “Don’t you worry, these wars are a hell of a long way from over.”
The following year, in 2004, was the first time I lost a friend in the wars. The last time was 2016. In between, twelve years of loss. A long way from over, indeed.
War has been used as a metaphor for COVID-19 often and can be taken a few ways. At best it’s a great national effort where we all rally together, sacrifice together and leverage our deep and diverse talents to a great cause. On the other end, it’s a never-ending drain where we kill and die and some companies get rich while we never accomplish much of anything. Then there are the other metaphorical wars like the one on drugs; militarizing and divisive with severe second- and third-order effects. It could also be the Cold War, where we put a man on the moon. Or, Iraq, where three years after the Mission Accomplished speech the country was coming apart at the seams.
The First Wave Hasn’t Yet Peaked
Today it feels a bit like the US is coming apart at the seams. Perhaps that’s one of few broad agreements now; the kind of national mood where an op-ed titled “There will be no Second Wave” would feel depressingly Panglossian if it weren’t so badly missing the point: we’ve lost 120,000 lives, bled untold jobs and businesses, added several trillions of dollars to the national debt, and cases are still rising. Texas, for example, just reversed the state’s reopening plan and California rolled back reopening in seven counties. We’ve still not seen the peak in cases, deaths, jobs lost, businesses closed, and homes foreclosed. Moreover, “There Will Be No Second Wave” gazes hopefully right over the class and racial disparities hammered home by COVID-19. Nothing to see here, it says, look to the future where things will be better!
Maybe. But is there a plan? To say only that we’re testing more (a point disputed by the President in Tulsa) and have delivered a bunch of gowns and masks (a point disputed by the WSJ) is to litigate the past. I’d feel better if the op-ed was: We’ll be Prepared if There’s a Second Wave. But what does prepared look like? And what is the federal government doing to plan for it?
Hope is not a Course of Action
Whatever President Bush’s faults and mistakes before and after the Mission Accomplished speech, he can’t be accused of looking the other way and hoping for the best. If ever there was a need for the federal government to lead and coordinate, it’s now. True, COVID-19 will ultimately be beaten locally, but federal coordination is essential. I’m reminded of another war metaphor: Sun Tzu’s warning that “strategy without tactics is the slow road to victory, tactics without strategy is the noise before defeat.” Yes, the soldiers have to win the firefights, but the generals have to have a plan. Or, failing the generals, at least the colonels. There are many dedicated career professionals in government who are up to the task, they need only be empowered.
Granted, the challenges are myriad; some are simple but hard, some complicated and hard. In the former category are sclerotic state health departments that have generally been starved over the past several years and lack the infrastructure to manage complex fast-moving problems. In the latter category is a for-profit health care system that isn’t designed for pandemics. I’m not criticizing for-profit or advocating government-run healthcare, I’m just noting the fact that pandemics are a weakness for for-profit systems. Consider some math: Massachusetts General Hospital – arguably one of the highest-quality and best-resourced hospitals in the world – expects to lose $400m per month due to COVID-19. This seems to indicate that a second wave could be devastatingly hard to absorb. If that’s the case for MGH, how will other systems manage?
This is compounded by the fact that hospitals are their own ecosystems inside wildly disparate and hyper-local public health care systems (New York, for example, has 57 separate public health jurisdictions, more than 200 public and private hospitals, and large nonprofit clinics that serve tens of thousands of people every year). This makes coordinating resources, case management, and shortening the time between a COVID-19 diagnosis and quarantine – an essential metric in containing the spread – extremely difficult.
Further, those losses in revenue are driven by a precipitous decline in elective procedures and diagnostics. It’s an unknowable number, but it seems safe to say that the number of life-years lost to delayed diagnostics and forgone case management could be staggering. Even vaccinations are way down. Imagine also that many heretofore undiagnosed diseases will cluster in the fall and early 2021 when people return for long-delayed checkups, placing further strain on the system.
So, that’s the bad news. Let’s work on some good news.
Test, Trace, Treat, and Leverage Technology
First, we know what we need to do: test, trace, treat. We also have enormous and largely untapped capability to support this effort: the high-powered computers we all carry around in our pockets, and the computational capacity of any number of cloud service providers. A bit harder (but not complicated) is the desperate need for data scientists at the state and local level, who have the ability to interpret data sets and express their meaning to key health policy decision-makers. We have all the tools we need to provide integrated infrastructure and analysis for every disparate health care system in the country.
I should pause to explain a few things here. I’m the co-founder and CEO of a data analytics company but have many long-standing complaints about tech, “big data,” and their scary cousin, the threat of a surveillance state. My cofounder is a career government technologist with the same concerns. During the “move fast and break things” phase of tech that gave rise to the likes of Facebook and Twitter, my co-founder and I were working in the government on (oftentimes life-and-death) problems that were little served by Silicon Valley innovations like infinite scroll and step trackers.
However, what we’ve seen since March as part of the COVID-19 Technology Task Force is much different. The selfless, humble, and tireless efforts of tech companies both large and small has been awe-inspiring. From companies providing free data to Amazon providing free cloud services for analyzing COVID-19 spread to the Google/Apple Bluetooth exposure notification app. Tech innovations and support will be how we coordinate and empower the public health professionals across jurisdictions; ranging from remote medicine to contact tracing to disease surveillance. If properly leveraged and coordinated, this could save untold lives and livelihoods.
Again, I don’t say this as a techno-utopian. As I said, I’m very much the opposite. It’s also evident that tech companies have work to do to make up the trust gap after years of misusing data and speech. And there are still companies who have fallen short in their ethical obligations about data use in recent weeks. It is incumbent on tech companies to lay out their policies around data use and collection to ensure that insights and products don’t bring harm to the most vulnerable people and communities, or make them yet more invisible. We saw one such example early in the pandemic with smart thermometers (which told us that cases would trend down); a conclusion drawn from a small and specific demographic of people who want and can afford internet-connected thermometers. More, all of us in tech have an obligation to communicate openly and clearly about how we use, secure, and manage data; we must be clear about how we leverage data for dispassionate science-based insights while bearing in mind the frequent politicization and manipulation of data. We must also work closely with academia and government to ensure that our tools are deeply informed by science, open to public oversight, and respectful always of the people we seek to serve on the other end of all this technology.
How Business Can Help
It could be true that there will be no second wave in our war on COVID-19. If so, it’ll be very nearly the shortest war – metaphorical or literal – in American history. More likely, we’re in for a longer struggle. And many of our challenges – such as coordinating between health jurisdictions, contact tracing, and disease surveillance – are problems with which tech is well-positioned to help and to date is vastly underutilized.
If there is good news in June of 2020, it’s this: at this moment there is a refocus on people, on our experience, on everyone’s value. Right now there is broad support previously unseen for generations to question all things, from how we use technology to the political, social, and legal frameworks that lift people up or repress them. It’s a remarkable moment in a thousand ways, and it’s disappointing that the Vice President does not seem to recognize it. No matter. Business, then, should step up. They should explain themselves not only to shareholders but also to the many who are impacted by their products and decisions. If they do, we have the capability to start making things better right now.