July 31, 2020

Dear Interested Readers,

 

Who Is Not Dazed, Confused and Disappointed By COVID-19? It’s a “Wicked Problem.”

 

Once upon a time there were sporting events to attend. In that bygone era, the stands at Fenway Park were always alive with people. It was always a diverse crowd with obviously different interests. Little kids enjoyed getting hot dogs and going to the souvenir shops to see what they could cajole their parents into buying for them. Young people walked around waving at friends and talking on their cell phones. Some old guys could always be seen who were filling in their box scores like diligent students taking a test. There was something for everyone to enjoy even if baseball was not a passion. When I went to Fenway I had three sources of entertainment: the action on the field, the people in the stands, and the scoreboard. 

 

Pre COVID, baseball was a passion for me. Now that the world has changed and there are cardboard cutouts of people in the stands, the sounds from the stadium are rebroadcasts of old crowd noise, and the announcers are watching monitors in studios miles from the field, I miss alot of what I once took for granted and thought would never end. The current facsimile of baseball lacks much of what I loved. I miss the scoreboards, watching the crowd, and also the continuing soap opera of the long season with its many ups and downs. I must admit that minus many of the things I loved that are not possible now, I have not had much interest in watching the recent attempt to salvage a season. Perhaps my disinterest lies in the fact that I can’t go to the park for the full experience. One of the things that television doesn’t quite capture is my ability to watch the scoreboard. The numbers on the “Green Monster” are still changed by hand, but the in-depth information I crave is on the giant screen high over the bleachers. The jumbotron flashes new data with each pitch and each swing of the bat.  Smaller electronic screens are scattered about the park so that anywhere you look there is information coming at you. You have to be there to get the full experience, and “there” is gone for now, and I miss it.  

 

I love the scoreboard because I love all of the statistics associated with baseball. Over the last few decades baseball has moved from batting averages and box scores to a much more sophisticated analysis of the game called “Sabermetrics.” The name is derived from an acronym, SABR, the Society for American Baseball Research, founded in 1971. Chief among the “eggheads” of SABR who enjoy baseball’s history and its constantly evolving metrics is a fellow from Kansas named Bill James. James suggested that the new data sets that were evolving be called Sabermetrics. Sabermetrics has transformed the management of baseball and has added an extra level of pleasure to the game for fans like me who love talking about numbers. 

 

I have often said that Moneyball: The Art of Winning an Unfair Game, one of several incredible books by MIchael Lewis, was the best business book I ever read. In Moneyball, Lewis describes how Billy Beane, the manager of the Oakland Athletics, used Sabermetrics to find real value that other traditional approaches to baseball ignored. As a person who came to business responsibilities late in my career, I had a lot of catching up to do with all those folks who acquired an MBA or MPH as icing on their MD. My fear of failure turned me into an avid consumer of business books. Moneyball is a discussion of what provides value in a very competitive world that is rife with uncertainty, and it presents its wisdom intertwined with a new perspective on the game I love. 

 

Whether I was trying to manage a patient with complex and interrelated medical problems like coronary disease with CHF, moderate renal failure, some COPD, and diabetes, or as a manager who was trying to discover how we might simultaneously reduce the cost of care while increasing compensation, improving our operating margin, improving patient satisfaction, and improving quality and safety, the attempt at developing a strategy always began by gathering all the data I could find to evaluate where things stood in the moment. It is a reality that if you don’t know where you are, it is hard to be sure about where you are going. Data dispels ambiguity. Measurement is the antidote to a self deluding and distorted view of possibilities. I have always believed that management begins with measurement. If you are fooling yourself or don’t know where you are, you are headed for disappointment. Our president and his administration are a prime example of the mess that can be created by ignoring uncomfortable information that measures where you are, and having no interest in using data to create strategies that solve problems. Just because you don’t like what the numbers say doesn’t mean that they are wrong. Denying the numbers because they tell a story that doesn’t fit your expectations, is not a strategy that will bring about what you want unless you have some sort of magic wand. 

 

If Moneyball was my favorite business book, How the Mighty Fall by Jim Collins was a close second. As the 2009 New York Times review of the book pointed out, it was a “dark book” that matched the times. If you have forgotten 2009, we were in the “Great Recession” that followed the collapse of Bear Stearns and Lehman Brothers precipitated by the subprime mortgage fiasco.  The Times review contains a succinct description of the lesson that was the core of the message that Collins offered in his book. Like the laws of gravity, the principles that Collins elaborated in 2009 hold true today:

 

…the stages of decline that he maps out in the book — hubris born of success; undisciplined pursuit of more; denial of risk and peril; grasping for salvation with a quick, big solution; and capitulation to irrelevance or death — offer a kind of instant autopsy for an economy on the stretcher.

 

With the change of a few words that quote could be used as a description of our collective management of the COVID-19 pandemic. Those states that thought they were doing a good job in April, when really they had just been lucky did have something akin to hubris. They did demonstrate “excessive pride or self-confidence.” I offer the governors of Florida, Texas, and Georgia as the poster boys of “excessive pride or self-confidence.” They wanted more, and opened the economies of their states too soon and with disregard for the CDC recommendations and data to “get more” or to stop losing the “more” they already had. They played for a big win while denying the “risk and peril.” As a result of their lack of good judgment and the total disregard for data that was driven by an unrealistic hope for a quick solution they, and unfortunately the rest of us, seem to be heading into even deeper water. That’s what the data says. 

 

So, here’s the “score” from Johns Hopkins at the end of July.  

 

• Worldwide over 17 million cases
• USA 4.5 million cases
• World wide 650,000 deaths
• USA over 150,000 deaths
• Currently, the USA has about 70,000 new cases every day
• Currently, the USA has about 1,000 new deaths every day”

 

That is the “medical side” of the “score.” Since the “hell bent for election” governors seemed to be more concerned about their economies than the medical challenges that their states might face, and to some degree their actions reflect concerns about how Republicans will fare in the fall elections, how is the economy doing now five months into the ambiguities of to mask or not, to distance or not, or to “party” or not? 

 

The answer, as we all know, is: “Not so good.” We have some high level scores with concerns about the economy that should not surprise you.And the list of worries grows:

 

• A second quarter drop in GDP of over nine percent that anualizes to about 33%, the worst ever despite trillions of dollars of extended unemployment benefits, and business support.
• Unemployment of over 20 million Americans with over  1.4 million new claims filed last week, and Congress is deadlocked over new programs for continued support of the economy until a safe recovery is possible.
• The resurgence of business closings as a result of increased numbers of new cases and deaths. 
• Teachers, students, and families don’t know when or how to return to school.

 

My analogy to score keeping in a game breaks down here, because if this were a football game we don’t know which quarter we are playing. Is it the end of the first quarter with three more quarters to go, or are we in the second half?  In a baseball game it could be that the pitcher blew up in the third inning or your bullpen has just given up eight runs in the ninth. In the real world of the COVID-19 pandemic, is it the end of the beginning, or are we late in the game still behind a few runs, but expecting the heart of our lineup coming to bat once we get one more out? Where are we in the pandemic?

 

Just because we are tired of it and want it to end before all of our resources are depleted does not make the end in sight. It could still be the first leg of a very long and increasingly difficult trek. Is relief coming in six months? Would you bet on a vaccine being developed and deployed in the next six months? A few years ago we were worried about Ebola. Will COVID-19 become history before the next pandemic evolves? My bet is that even though we are being fed a steady stream of good news that gives us hope that we will have a vaccine in six months, the timeline to success has many potential detours. If we do have a useful vaccine in six months, and the government and Bill Gates are willing to spend billions for it so that everyone can get it, it will still take many more months to distribute several hundred million doses here, and much longer to get out billions of doses to people around the globe. If it was a baseball game, I would pray for rain. 

 

What is easy to see as one looks back in time is that we have always been playing “catch up” with the virus. We have never had the wisdom or the courage to look into the abyss that it presents to us. Even as it spread silently through our nation, our leaders were telling us that we would surely win, or that there was no real problem to start with. What began as a public health issue was discounted by people who were really not interested in knowing the score if the score suggested that their “success” was hubris, and their desire for “more” might be denied. 

 

A guiding principle and fundamental that was passed on to me by mother, after it was given to her by her mother was, “Gene, always remember, you can’t do wrong and get by.” Years later when I developed some interest in game theory I learned that over multiple transactions honesty always outperforms deception. People can be fooled a few times. A liar scores some impressive early wins, but in the end my grandmother and mother were right even without divine intervention, deception for gain is a loser’s strategy. 

 

What the combination of the pandemic, the secondary economic losses, our impatience with separation and discomfort, and the deception of our leadership has created is what is technically called a “wicked” problem. I have written about the conflicts within healthcare as “wicked” problems, as have many others.  

 

I described some of the history and principles of “wicked problems.” 

 

In 1973 Horst Rittel and Melvin Webber, two U.C., Berkeley professors, published a paper describing Wicked Problems. They said that the traditional scientific approach doesn’t work in solving social problems. Problem solving in the industrial age focused on efficiency, and the challenges our scientists and engineers address are similar. They all focus on “tame” or “benign” problems such as solving a mathematical equation or analyzing the chemical structure of an organic compound. For these, they say, “the mission is clear. It’s clear, in turn, whether or not the problems have been solved.”

 

A wicked problem is one that’s not easy to describe, it has many causes, it’s hard or impossible to “solve.” It occurs in a social context where diverse stakeholders understand it differently.

 

Rittel and Weber articulated some basic principles of “wicked problems” in their 1973 paper.

 

• There is no definitive formulation of a wicked problem.

• Wicked problems have no stopping rule.

• Solutions to wicked problems are not true-or-false, but better or worse.

• There is no immediate and no ultimate test of a solution to a wicked problem.

• Every solution to a wicked problem is a “one-shot operation”; because there is no opportunity to learn by trial and error, every attempt counts significantly.

• Wicked problems do not have an enumerable (or an exhaustively describable) set of potential solutions, nor is there a well-described set of permissible operations that may be incorporated into the plan.

• Every wicked problem is essentially unique.

• Every wicked problem can be considered to be a symptom of another problem.

• The existence of a discrepancy representing a wicked problem can be explained in numerous ways. The choice of explanation determines the nature of the problem’s resolution.

• The social planner has no right to be wrong (i.e., planners are liable for the consequences of the actions they generate).

 

The pandemic with its medical, economic, social, and political components qualifies in my mind as a “wicked problem.” I am certainly not the first person to call the COVID-19 experience a wicked problem.  Dr. Mark Lawrence a European climate scientist knew the score back in April when he wrote and article for the Institute of Advanced Sustainability Science in Potsdam entitled “The “Wicked Problem” of the Covid-19 Pandemic.” He began by saying:

 

The current outbreak of the new coronavirus (SARS-CoV-2) will affect virtually every person on Earth, either directly or indirectly. Many people will die of the infectious disease caused by this coronavirus (Covid-19), and others will lose people close to them. Many more will suffer other extreme hardships – psychological, social and financial – due to the extensive physical distancing measures that are reducing the spread of the virus. While there may be some perceived “silver linings”, such as temporarily reduced air pollution and CO2 emissions, and for some an opportunity to slow down and contemplate their ways of living, in the balance the effects are already tremendously challenging for the world, and are likely to get much worse before the pandemic is over.

 

He continued by addressing three issues:

 

• How does the current coronavirus situation compare to climate change and other great societal challenges?

• Are the extensive physical distancing measures really justified?

• Is there a chance to move “forward to better” rather than “back to normal” (or even worse)?

 

The last bullet point resonates with Joe Biden’s campaign slogan, “Build Back Better” which should be the resolve of us all. According to David Brooks in a column published yesterday entitled “The Future of American Liberalism: What Biden Can Learn From FDR”, Biden should learn from F.D.R’s “moderate” position in the New Deal, that the solutions will be found in the center and not in the extremes.  To “Build Back Better” everyone needs to be a part of the solution, and the solution will cost everyone something. To move in the direction of solving a “wicked problem” we need a pragmatic leader who knows the score and uses failures to make course corrections. 

 

Economic and health calamities are experienced by most people as if they were natural disasters and complete societal breakdowns. People feel intense waves of fear about the future. They want a leader, like F.D.R., who demonstrates optimistic fearlessness.

They want one who, once in office, produces an intense burst of activity that is both new but also offers people security and safety. During the New Deal, Social Security gave seniors secure retirements. The Works Progress Administration gave 8.5 million Americans secure jobs.

Biden’s “Build Back Better” slogan is a perfect encapsulation of this mood of simultaneously longing for the safety of the past while moving to a brighter future.

 

Wicked problems are hard because they have no perfect solution. The New Deal was a pragmatic process that was often messy, and as it solved some problems it created others, but it did carry us along in a positive direction, and its best parts remain alive today. The New Deal is a great demonstration that he best solutions require sacrifice or change from all parties whether the issue is peace in the Middle East, a healthcare system designed to meet the needs of all citizens for a sustainable cost, or developing a better world following the pandemic. Lawrence sums it up:

 

This is another part of what makes the Covid-19 pandemic a wicked problem – there is no solution to it that does not involve extreme losses in some form or another. The question is not whether we can win in this situation itself, but rather only how we choose to weigh the losses against each other in deciding how to approach this crisis. There is, however, a glimmer of hope: while the situation will involve losses for the vast majority of the world’s population at present, there is a small but real possibility that over the course of a longer time, the pain and suffering of going through this situation can be more than compensated by the impulse it gives to develop future societal structures that are better for the world’s population as a whole. Instead of going “back to normal” (or even worse for many people), perhaps we can go “forward to better” after this crisis is over.

That would not at all be easy, especially for the many people worldwide whose entire social and financial existence is being threatened or wiped out by this situation. It would require those who are privileged enough to go through this crisis without substantial existential loss to capitalize on the difficult impulse that the pandemic brings to make extensive changes towards sustainable development.

 

FDR was a leader who was pragmatic and did ask everyone to give something or as Lawrence describes:

 

…require those who are privileged enough to go through this crisis without substantial existential loss to capitalize on the difficult impulse that the pandemic brings to make extensive changes towards sustainable development.

 

Our current leader lacks an interest in the score of anything but his own ratings. He is willing to try to use deception to further his desires and to maintain power. He will not ask for any sort of sacrifice from his base, not even one as small as wearing a mask. In the interim our individual behaviors will make a difference, but the ultimate outcome, whether the future is better or worse, will depend on the reality that “Building Back Better” after a big “wicked problem” like the pandemic will require leadership, wide cooperation, and some sacrifice from everyone. Keeping our eyes on a scoreboard of reliable data will help us move toward the solutions that we so desperately want, and perhaps, will enable us to develop rational approaches to interim issues like when to safely reopen businesses and send children back to school. I am learning to live without baseball as I loved it, and have no expectations for football. I fear that my next trip to Fenway lies far away in an uncertain future that we are struggling to reach.

 

Solitude At A Summertime Sunset

 

There are many wonderful things about where I live, but nothing is better than the sunsets on a summer evening when there are a few clouds to reflect the dying light as a multicolor splash of beauty across the water. My front door faces west, but the action is at the back where the lake is. We have great sunrises as my wife demonstrated in a photo earlier this month, and shared with you in the letter of the 17th. I see most of my sunsets from the vantage of my kayak where I enjoy ending many summer days. 

 

Ironically, it’s not the sun itself, but the interaction between the fading light after the sun goes down with the clouds, and reflected by the glassy surface of the water. Late in the day the waters become still, and the surface of the lake becomes a huge mirror. At that time, the best show is seen by looking north across the east west arc that the sun has just completed. The photo in the header this week was taken from my dock. I almost missed the show, because I was watching a recording of the evening news. The whole room filled with a red glow, and I realized that it was time to put Norah O’Donnell on hold, and go see what would not wait for anyone. 

 

I have been kicking myself because I missed the recent NEOWISE comet. On some evenings there was a dense cloud cover, but there were other times that I forgot to go look for it. Once I meant to catch it after a Zoom meeting, but I forgot. It was my loss. I understand that it may be visible until the end of the month, but the clouds that make for a great sunset also make comet viewing not so good. 

 

I hope that you will have the opportunity to enjoy some summer sunsets. I have got to believe that enjoying a good sunset on a lovely summer evening is something that will take the edge off of the stress of the pandemic and its associated economic turmoil. I have to remind myself that summer is the shortest season. The sense of summer always ends on Labor Day no matter how hot it might be in September. In these days of uncertainty when we do not even know if children will be able to go to school in the fall there is one thing that is certain; there are only seven summer weekends left. Make the most of each one.

 

Be well! Still stay home if you can. When you are out and about, wear your mask and practice social distancing as best you can. Don’t try to outguess the virus.Think about the America you want for yourself and others. Demand leadership that is empathetic, thoughtful, truthful, capable, and inclusive.  Look for opportunities to be a good neighbor. Let me hear from you. I would love to know how you are experiencing these very unusual times!

 

Gene