Friday, May 08, 2020

Guidelines


Parque Eduardo VII, Lisbon, on Thursday afternoon, empty

We near the end of Portugal's first week in a State of Calamity. Portugal leaves its State of Emergency, and takes the first steps to re-open. There are some interesting aspects of this new State: the land border with Spain remains closed until next week, but beach restrictions are being lifted with group limits raised to ten.

Along with other small shops (two hundred square meters or less), SEF is processing visas again. They called us and rescheduled my residency interview, which was on Wednesday. So I got my temporary residency approval, but I was only given a letter from the SEF office. The shop that prints cards and passports is still closed (except for emergencies), so I can only leave Portugal to return to the US; I cannot travel in the Shengen without the card. Even if I could, I don't think I'd want to go anywhere right now.

In fact, instead of suspending immigration and causing a big kerfuffle, as in the US, the government in Portugal is safeguarding all foreigners awaiting residency – as my interview on March 26th was cancelled, that included me. This is not amnesty. Portugal is simply providing legal standing for housing and employment, and access to the national health care system. Thus, no one feels the need to call lawyers or fly somewhere while courts and airlines are shut; everyone can stay safe, stay put, and stay sane.

On the big COVID-19 tables, Portugal drops out of the top twenty countries for confirmed cases, having been passed this week by Ecuador, Saudi Arabia, and most recently, Mexico – Pakistan and Chile are also gaining fast, with oddball Sweden catching Portugal a little more slowly (though Sweden has nearly tripled Portugal in deaths). The UK is moving up the charts, as is Russia – the UK passed Italy for second place in terms of deaths and Russia is now up to fifth place in terms of cases. The US, Russia, and Brazil are the only countries to add more than ten thousand new cases in a single day, in the past three days (think Trump, Putin, and Bolsonaro).

It's also been two weeks since Georgia began it's re-opening process, and the numbers are diverging as might be expected. As a reminder, Georgia and Portugal have the same population size, reported their first confirmed cases on the same day, and tracked to nearly identical stats by early and mid-April. But during the first week of May, Georgia has averaged about seven hundred sixty (759) new daily confirmed cases while Portugal has averaged just under three hundred (292). Since April 24th, Georgia's count has increased by over nine thousand (9,084), while Portugal's has increased by less than four thousand (3,918). Full graphs from March 2nd, with seven-day rolling averages below:



The procedures we use to appraise the re-openings, and the precautions applied to it, make all the difference. But the White House has basically abandoned any kind of national plan, with CDC officials being told, "the guidelines would never see the light of day." How are US leaders responding to top-level management issues: what resources do we have? what capacities do we need to build? what metrics do we look out for? what data do we rely on? The one big data trove that almost everyone has trusted during the pandemic is the Coronavirus Resource Center at John Hopkins, and the one of the epidemiologists there, Caitlin Rivers, testified to the House on Wednesday:
There are four criteria that states should meet in order to safely re-open ...
The first is to see the number of new cases decline for at least two weeks, and some states have met that criteria. But there are three other criteria and we suggest they should all be met ...
To my knowledge, there are no states that meet all four of those criteria. 
She is also the co-author of a Road-map to Re-opening process, as well as the more comprehensive Guidance for Governors (being used by the National Governors Association). For example to reign-in the fragmentation, she proposes a national forecasting capacity like the the National Weather Service. So while there is no national plan, there are plans; it's simply up to the governors to follow them. Here is a kind of compendium of national summaries – states that are re-opening and whether or not they should, generally based on the un-issued White House-CDC guidelines:

Hard to erase the image of Trump, when asked what metrics he's using to re-open the country, reply by pointing to his brain. That was just before Easter, almost sixty thousand in the US have died since. At the same time, it is important to acknowledge that we have to think about the data and the models in the right way. Governments fight fear and fallacy with calm and clarity.

This is why it's so disturbing to see what's happening with the national guidelines. The President and the White House aren't just nullifying the recommendations, they are intentionally subverting them. Why else is there a shockingly violent and angry backlash in the US against social distancing? or against wearing, or even selling face masks?

It is pretty clear that the situation is not being centrally organized, as if the lack of guidance means more good ol' American freedom. This matters because there is no way to prevent an infection spreading in one state from affecting another. Like states competing to procure PPE and testing supplies, some are setting their own guidance, and seem to be burying the data so that they can follow their political allegiances. Arizona Governor Doug Ducey, for example, has indicated that he is re-opening by following new instructions provided by the White House, though no one has been given any further information regarding that advice. Also, as it no longer seems necessary, Gov Ducey apparently asked the teams at the state's universities to suspend their statistical modeling.

cases: 3,950,454 global • 1,295,058 USA • 27,268 Portugal
deaths: 271,799 global • 77,058 USA • 1,114 Portugal

This MSNBC video piece examines how guidelines are being applied, loopholed, or ignored. It also spotlights the White House's hypocrisy, when officials there say that a national testing program is unnecessary, while staffers are tested daily (but even then, are not required to wear face masks).


This article from PBS Newshour gives an account of the CDC guidelines, how they were reviewed, passed back and forth, and finally buried.
But hours later on April 30, CDC’s Chief of Staff McGowan told CDC staff that neither the guidance documents nor the decision trees “would ever see the light of day,” according to three officials who declined to be named because they were not authorized to speak to reporters. 
The next day, May 1, the emails showed, a staffer at CDC was told “we would not even be allowed to post the decision trees. We had the team (exhausted as they are) stand down.”

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