March 24, 2020 - Five Imperatives Redux, Pt 1 -- Numbered Jokes, Prioritizing the Economy -

Two parter, part I:

Remember the day I woke up with the Big Picture of the five competing imperatives? It’s down my page a ways, now, and it begins, “Okay, people, I get it!”

To save you the hunt, though, and to save time, I’ll just list the five here, because I want to start referring to them by number:

1) We need herd immunity
2) We need to flatten the curve
3) We need to protect the vulnerable
4) We need to keep the (national, local, global) economy going
5) We don’t have the tools we need to assess ….

(Just a pause here to savor my father’s all-time favorite, about the old couple who have been together so long that they have numbered all their jokes. They enjoy sitting around companionably, lobbing them back and forth. One says, “43” and they both laugh. Ha! Good old 43! And then the other says, “71!” and they both laugh. And this goes on until he says, “19!” and she doesn’t laugh. And he says, “Hey, 19! You LOVE 19! Why didn’t you laugh!?” And she says, “It was just… the way you told it.”)

SO! I’ve started to realize that when I see people (governments, businesses, etc.) doing things I don’t understand, they are prioritizing one of the imperatives over another. (The last one, 5, already needs a substantial edit, but later.)

I’ve started to imagine we could just yell them at each other.

A: What are you DOING?
B: I’m doing 4!
A: STOP IT! You should be doing 2!
C: Doesn’t matter if we don’t do 1, we’ll just have to do 2 AGAIN!
D: I think we are heartless slobs unless we make 3 our top priority!
B: There is NO WAY to do 3 and 2!

I mean, it could be fun, while away an afternoon, right?

I do not have the right answer to the puzzle, because these are competing imperatives. I will now shoot down some solutions other people have made, while offering none of my own, which is something I begged my direct reports not to do, back in the day. Because, as somebody posted yesterday: You might as well pronounce the “l” in “salmon.” Nothing matters any more. (I don’t know why I liked that. Tastes in black humor vary enormously.)

SO, I have heard tell that “we” are thinking of turning the Convention Center into a homeless shelter during this crisis, to keep people safe (3 – take care of the vulnerable) and to keep them from circulating (2 – flatten the curve), but …. that’s basically a giant cruise ship, right? Some people are going to be sick already, and it is a lovely gesture to provide them with shelter, but if you lock healthy people in with them, then you expose those healthy people, which (if the healthy people get the disease and get over it and don’t die) leads to 1) more immune members of the herd, YAY!, but since 5) at this point, we can’t tell who is immune (no serological test) we can’t tell who those immune members are.

(NOTE: I read a thing yesterday in a Harvard publication that there’s a serological test in the works at the Icahn School of Medicine at Mt. Sinai, and they are trying to scale it up, but honestly, I may have that wrong, and in any case, SHHHH, do not tell you-know-who about this, because it will be all “crisis already closed thanks to my own natural genius, re-elect ME” if you know what I mean, and we mustn’t forget that this disease kills people, while others get mild or asymptomatic cases, so we really still need to worry about 2.)

I have heard from many sides that if we don’t prioritize 4 – keep the economy going! then none of the rest matters because whoever the survivors may be, they will all emerge from this crisis into your basic cliché post-apocalyptic landscape with small but fierce warring bands setting upon each other …. Okay, I’m exaggerating, but you get my drift, and I suspect you have heard variants of this too, that locking down to achieve 2 will actually have “worse” effects in terms of 4. I guess my air quotes there give me away, in terms of my bias towards 2 right now.

I bring up the whole 4 vs 2 conflict because in the same Harvard article, a smart guy said, well, one way to get both 1 – herd immunity and 2 – flatten the curve, is to do a stop-start over the next many months. We lock down until the health care system isn’t overwhelmed with cases (until, that is, we have some beds and ventilators and healthy HCPs to spare). Then we let everybody loose to run around until the next lockdown. Then we lock down again to give the health care system a chance to catch up. Then we let everybody loose to run around again…..
(You are right! He didn’t use my numbers. He didn’t say “1.” But pretty soon everybody is going to be using them, mark my words. And I have faithfully done my best to capture the gist of his stop-start idea.)

Anyway, after reading the article, I mentioned the “stop-start” idea to my nearest economist, who is completely on board with 1 through 5, but something about the stop-start IDEA, and the way that the economy deals with uncertainty, how uncertainty is THE biggest killer of the market, made him react “But stop-start would be curtains for 4!” (He didn’t say 4, or curtains. I’m oversimplifying.)

(I want to stop here and say the smart guy in the Harvard article was absolutely clear that all the solutions were bad. He said so. On the other hand, I felt good that he (one Marc Lipsitch by name, article here) was on the case, thinking everything through and looking for better solutions. That’s what we need. He was very big on 5, Dr. Lipsitch. I am too. He had a 6 and a 7, I think, and he saw their advantages and profound disadvantages.)

Back to today. This is what competing imperatives ARE. If you meet one, you strain another. (end part 1)