Omicron; Problems with expertise
As everyone knows now, we have another CCP Virus variant. So far, not much is known beyond a few things. First, it was discovered in South Africa, possibly from a patient with HIV who had another virus strain for a long time. Second, there is serious concern among scientists and government officials about it and many countries have imposed travel bans from South Africa and other nearby countries. This op-ed here lists some things we do not know but should find out soon, i.e., whether it is vaccine resistant. If you want to sort of dive into the weeds about what various scientists are thinking, this thread by Scott Gottlieb is helpful.
It was only a matter of time before another variant emerged. That is how viruses work and this one is no different. I am not sure how I feel about the travel bans. I understand the impulse and it may help to buy us some time to see how big of a deal this new variant is. On the other hand, it punishes countries that honestly reported what was going on and who need our help. It almost certainly will not stop any variants from getting here and odds are the new one is here already.
One thing we should all be very glad for is that South Africa is a democracy with a free press and an accountable government. Because of that, we found out about the new variant very quickly before it spread far and wide. Had we found out about the original strain that fast, we may have avoided a pandemic altogether. We, of course, did not because the CCP covered it up and lied about it. China is a dictatorship with no free press and no accountable government and that is what those kinds of places do. Just to remind readers again, the reason I call it the CCP Virus is because the CCP is responsible for it becoming a pandemic, regardless of its origins.
One misconception that needs to be cleared up is that the new variant emerging is the result of some countries not getting enough vaccine doses. That is the case in many countries, but not South Africa. They have plenty of doses. The problem is only around 35% of people there are vaccinated. As bad as some people in the US have been, South African is much worse. Their problem is not lack of supply. It is people not getting vaccinated. That is not a uniquely American phenomenon.
We will find out soon enough how easily this new variant transmits, how much more deadly or not it is compared to previous variants and how much vaccine resistance it has, if any. We just have to wait and see and not stress ourselves out. Anyone who reads this blog knows where I stand on the CCP Virus and prevention measures. Nothing in the last few days has changed that and I am doubtful it will. Even if this new variant is vaccine resistant, it will likely only be somewhat, not completely. Just as important, we have antiviral pills from Pfizer that work against all variants, no matter how vaccine resistant they are. The biggest obstacle we have to getting the antiviral pills out there, along with some cheap, instant home tests, is the FDA.
The worst possible thing any of us could do is panic. We have no idea what this new variant will do. It may flame out as other ones have. If anyone reading this has upcoming vacation plans, do not stop them. Do not change anything based on what we have heard during the last few days. We cannot condition ourselves to panic every time we hear about a new variant because we will be hearing about them for the rest of our lives in all likelihood.
Even if the new variant is vaccine resistant, the question then becomes whether it leads to severe cases. If the answer is no and it only or largely just causes mild or asymptomatic cases, we should be popping champaign corks. As an aside, if anyone reading this is 18 or older and fully vaccinated for 6 months or longer, please get your booster if you have not already done so. If you got the J&J vaccine 2 or more months ago, you can get a booster now. I got mine last Thursday. It was just as easy as getting the first two shots.
Expertise is not what you think
Since March of last year, talk about deferring to experts has been at a fever pitch. Experts certainly have their place depending on the issue. The problem is when they stray beyond that. The latter scenario has happened quite a bit during the pandemic.
It is important to understand what expertise is and is not. To give an example, a scientist can tell you how the CCP Virus spreads, what can reduce or prevent its spread and which kinds of effects it might have on someone who is infected. What a scientist cannot tell you is which policies to use in response to it. Those are questions of politics and values.
This is to say that expertise is very narrow. A scientist can tell you about their area of science, but not about economics or law. A lawyer can tell you about their area of law, but not about how to build a bridge. Even those who can ostensibly tell you things may not be able to in light of new challenges. The best credentials in the world are often no match for reality. We saw that repeatedly in Afghanistan. The smartest diplomats and generals in the world were in charge for 20 years and all of them did nothing but one faceplant after another.
It is just as critical to remember that experts have biases that can blind them to things outside their areas. For example, a virologist is only going to be focusing on the CCP Virus and what it can do. They are likely to be very cautious about it in their own lives and extremely risk averse. They will probably recommend that everyone else be like that. But everyone cannot be like that nor should they. Not everyone can afford to be isolated and to put their lives on hold. Not everyone can afford to have no risk tolerance at all.
While nobody has to take a virologist’s advice literally (nor should they), we do not always have the luxury of avoiding the consequences of hyper risk aversion. That is the major problem at the FDA right now. The people in charge of approving medicines all come from the same profession and backgrounds. They all have the same kind of risk tolerance, which is to say they have none at all. That hyper caution causes them to be extremely slow and conservative in granting approval to medicines. In normal times, that may be tolerable (I don’t think it is, but that is for another blog post), but when we have a pandemic killing 1000+ people a day and lifesaving treatment is waiting to be approved, it is a serious problem.
It is also a serious problem when their risk aversion is so great that they cannot even tolerate 1 in 1 million odds. Remember when the FDA paused the J&J vaccine in April? That is because 6 out of more than 6 million people who took the vaccine developed blood clots. Because of that, the vaccine was paused, the number of people taking it plunged and has never recovered. All that for 6, literally 6, people. Now, J&J is seen is bad even though it works amazingly well.
Think of it this way: how many millions of people were going to get the J&J vaccine and did not because the FDA made them think it was bad? How many of those people got the CCP Virus and died or were seriously sickened? I do not know the answer to that, but I promise you that number is much greater than 6. In their zeal to avoid all risks, the FDA has killed and sickened way more people than they thought they were saving. If someone cannot tolerate 1 in 1 million odds, they have no business being in a position of power.
It is not just the case of the FDA where mistaken expertise can cause serious problems. Economists, for example, are almost all in favor of free trade. I am, too, but it comes with tradeoffs that economists can be blind to. Many areas in the Midwest, for example, have not come out better off from it. An economist will look at aggregate numbers and conclude that overall free trade is good because more jobs were created than destroyed and prices are lower. I agree with that. Free trade is good and should be promoted and protectionism is bad. The problem is that there are people who are worse off and many are concentrated in particular areas. That other people have jobs and prices are lower is cold comfort to them. What to do about that is a whole different question, but it is a problem that needs to be addressed somehow and economists do not seem to have an answer for it.
Engineers have biases, too. I am glad the infrastructure bill passed. One thing though that drives me off the wall is people citing the trade association representing civil engineers saying we need to spend more on infrastructure as if that is a reason to do so. It is emphatically not. Civil engineers stand to gain quite a bit from any such spending so naturally they will be advocates for it. They may truly believe what they are saying, but their motives are anything but altruistic.
That is another problem with expertise. Often, the line between expertise and advocacy is very thin. Doctors, for example, love to advocate for rules that put up barriers to entry to the medical profession. They will talk about it like they are advocating for patient safety, but what is undeniably true is that they stand to gain from having fewer competitors. Doctors do know plenty about patient safety, but they also know what is good for their bottom line.
What has been the result of efforts by doctors to reduce competition? We have a big doctor shortage that is depriving many people of needed care. That is especially true for primary care doctors. You can thank the American Medical Association (AMA), one of the worst groups to ever exist, for that. That group more than any other is what stands in the way of so many people having access to doctors and other medical providers. Again, all this is justified on the grounds that only doctors, especially AMA members, know what is best. They and only they are the experts. That is why all foreign doctors must undergo a residency no matter how long they practiced in their home country. That is why nurse practitioners, physician assistants and others are heavily restricted despite having the skills to treat patients. That is why the number of residency slots is limited and medical school comes after college rather than being an undergraduate major. It is all about patient safety, you see. Only members of the AMA can protect us.
If there is any one line that I have disliked hearing the most since the pandemic started, it is “stay in your lane.” I can't stand that line because it is usually argued in bad faith and because staying in one’s lane is not always clear. The bad faith part is easy to explain: people who say that are usually just trying to silence anyone who does not agree with them.
The other part is more complicated. What exactly is staying in your lane? An obvious example is me trying to give advice to a heart surgeon on how to do their job. They should ignore me because I have no clue. I have never done that, just to be clear.
Beyond obvious examples though it becomes harder to determine what is in someone's lane and what is not. The FDA only recently approved boosters after dragging their feet. One reason was the concern that it would deprive other countries of vaccine doses. I agree that we need to help vaccinate the world, but is that the FDA's lane? They are supposed to determine whether a drug is scientifically effective and safe. If it is, their duty is to approve it. Leaving aside the validity of whether approving boosters would deny other countries vaccine doses, that has nothing to do with whether a drug is scientifically effective and safe. The FDA’s job is not to conduct foreign policy. They needed to stay in their lane and did not, causing needless delays.
As I mentioned before, questions of whether we shut everything down to prevent viral spread are political and values based. That is why it is and should be a decision by elected officials. Virologists and other scientists may be in favor of shutting things down, but there are massive tradeoffs at stake that their area of expertise does not account for. A virologist thinks about viruses. They do not think about the economy nor do they think about the toll that isolation takes on people’s mental health. It may be that a shutdown of society is worth the costs, all things considered, but a virologist is not going to take into account those things.
The flip side is an economist may not want to impose any restrictions even when a virus is spreading widely. If that route is pursued during a pandemic, the numbers an economist looks at may seem fine, but many people will get sick and die. Businesses may shut down on their own and an economist may think that is just how the market works and not take into account the immense suffering and need for mitigation measures.
The takeaway is that if you are telling people to stay in their lane, you need to stay in yours, too. An economist should be focusing on economics, but decisions made with respect to the economy should be weighed along with other considerations. Virologists should be listened to when it comes to how viruses work, but not deferred to on anything else. Doctors should be listened to in their areas, but it should always be remembered they are hardly impartial observers. The same is true for any profession. Nobody has the expertise to know every last thing and the more someone acts like they do, the more you should run for your life.
I actually think it would be good for governmental agencies to experiment with people from completely different backgrounds having some say in their operations. One thing I really like about Jay Powell* is that he is not an economist. That lack of an economics background has probably influenced many of the actions he has taken that helped save the world from another financial crisis. I would like to see fewer economists at the Fed and more of them at the FDA and CDC. Conversely, it would be great to see more people at public health agencies who do not have MDs or MPHs and have a risk tolerance similar to a normal person. I doubt that will happen, but one can always dream.
*Biden reappointed Powell to another term as Fed Chair on Monday. Thank god because now I don’t have to jump off my balcony.