Over the past six weeks VUCA, the acronym for volatile, uncertain, complex, and ambiguous, has passed through my mind on countless occasions as I tried to think about how unexpectedly, rapidly, definitely, and devastatingly the world had changed. Almost as frequently, I have mumbled the cliché, “You can’t make this stuff up!” Both were expressions of the weird coexistence of confusion, fascination, curiosity, and fear that I am experiencing, and I know that you are trapped in a similar state or something like it where your mind can wander into the strange dichotomy of misbelief and disturbing reality. It is easy to feel victimized either by the horrible possibilities of a disease that we are told threatens us or by the certainty of the economic losses that are an obvious reality.
In an extension of the dichotomy of the moment, I experience the weird combination of anger at the president and his troop of sycophants, and admiration of all the brave providers and essential workers who make existence marginally tolerable. I quickly developed a list of new leaders to whom I could listen without throwing things at the TV. Initially, I could not read enough to satisfy my need for information. As time has gone by, I have found myself trying to find other things to think about. Through it all, three questions keep coming to mind. How did we get here? When will it end? How will things be different when it is behind us? Natural corollaries to those questions are: Who deserves blame? Who can we trust now to lead us into a new normal? What agency do we have as individuals? What compliance to mandated group behavior can be demanded of us? Where do my personal rights of privacy end in consideration of the rights of others? Over the next several months I know that it will be hard for me to write about anything that does not touch one of these many questions. What follows will take up some, but not all of those questions.
I was delighted yesterday morning when I found a note in my email from Eve Shapiro addressed to me and Don Berwick. Eve is a loyal reader of these notes and a very knowledgeable medical writer who recently co-authored a book on patient and family centered care with Dr. Anthony DiGioia of UPMC, and is close to publishing a remarkable new book on the “joy of practice” which I have had the privilege of previewing.
Hi Gene and Don,
Tom Friedman of the NY Times and Ambassador Dennis Ross are members of our synagogue. Yesterday they gave a Zoom talk that I thought you’d want to hear, especially Tom’s. He talks about the origins that enabled the virus and what is needed now. A lot of straight talk about Trump, as you can imagine, plus lots of other things.
Anyway, here’s the link. Enjoy.
My best, as always…,
Eve
I watched, and she was right. It was very good. I wrote back asking for permission to share it with you and was delighted to get an affirmative answer from the administrator at Kol Shalom with whom she consulted. She wrote:
Thanks for asking!
When we first talked to Tom and Dennis about recording (and then where the recording becomes available), both said it would be fine because there is nothing they would be saying that isn’t already out there in the public domain.
So, yes.
If there is any problem with the link above through the Synagogue Kol Shalom, there is an alternative link through YouTube:
https://www.youtube.com/watch?time_continue=2238&v=6ao3lrUZcvw&feature=emb_logo
I agree that there were no new facts that were not out in the public domain. What I think makes this presentation valuable is not the facts, but the analysis of the facts. I am reminded of the description of conversation before and after Google. Before Google we would talk about what things “were.” We had knowledge deficits that took effort to close. After Google we can easily look things up and know what they are. Acquiring information about the obscure is no longer a problem. Now, enabled by facts that are available to anyone with a computer and an Internet connection, we can shift from talking identification and information, and move into deeper conversations about what things “mean.” Friedman and Ross bring us a wealth of experience that moves the conversation from what we know and don’t know about coronavirus toward what this experience means and the strategies that should flow from that broader interpretation of the moment. It is refreshing to move the conversation from the charts of statistics and maps demonstrating where hotspots currently exist toward a deeper reflection of what this experience tells us about what we have been doing to our world and ourselves toward how we might begin to use our observations of the moment to improve our collective future.
The program begins with an uniquely structured presentation by Friedman that puts the last three months into a much broader perspective than, “There was a virus. We made huge sacrifices to curb its spread. Maybe things will be better soon.” Ambassador Dennis Ross is the second speaker. He has spent over thirty years working on the political problems of the Middle East during five administrations and uses that perspective to reflect on what would have been considered good policy in those administrations. He moves on to emphasize opportunities that still exist for us to help ourselves, by helping the rest of the world. He effectively presents that we should not forget–it is good to remind ourselves that the rest of the world has the same challenges that we have. Both men subtly remind us that viruses do not play by our rules or pay attention to the artificial borders that we have used to partition the world. After presentations by both men, the program finishes with an excellent Q&A through Zoom.
I encourage you to spend the 70 minutes required to watch the program. I have seen it twice now in its entirety and have gone back to bits and pieces of it multiple times. My goal is to be your guide through this conversation, and allow you to sample its wisdom if you don’t have time to watch and listen.
After introductions by Rabbi Gil Steinlauf of Kol Shalom, Friedman is the leadoff hitter. He begins with a “thirty thousand foot view” from the perspective of “Mother Nature.” From that perspective, he asks where this pandemic came from, and asks why we are living in an age of new and aggressive viruses that can create pandemics. Remember, we have already experienced HIV, MERS, SARS, and Ebola. This is not our first dance. His answer moves us from being victims to being ignorant co conspirators. It has the flavor of the answer to one of my favorite questions which is, “What part of the problem am I/are we?”
Friedman states, “We have been abusing the natural world.” He had me with that insight. It is much more helpful than, and far upstream from, “It started in a Wuhan live animal market or escaped from a Chinese viral lab.” He explains that for decades we have practiced unremitting development with deforestation and escalating carbon emissions:
We have been weakening Mother Nature’s immune system. We have been killing the “apex predators” and “iconic species.” Now we are at the mercy of “generalized species” of rats, bats, and other primates who can live in damaged environments, and thrive after we have killed off their natural predators. These species carry 75% of the viruses that have been threatening us. These species have co evolved with the viruses and are immune to them. When we bring them into “wet markets” where they are in contact with domesticated species these viruses jump from wild animals to human beings.
If you say, “Okay what’s new there?” The answer is that Friedman is pointing out that we are more than victims of the “jump.” We set up the environment that enabled the “jump.” Pardon the repetition, but he is pointing out how we got SARS, MERS, and COVID-19. He posits:
We need to get back in harmony with nature. We have not only upset our balance with nature. We have upset our balance with each other.
He adds that we have a president who “injects partisan venom” into our body politic. He continues that we suffer from really bad ideas that circulate around in our society. We are politically vulnerable to the viral spread of bad ideas in ways that have enhanced our vulnerability to this virus.
He finds it interesting to think about the statement that we are “at war with this pathogen.” He says that war is an interesting metaphor, but it is misleading when your enemy is nature. When we are at war with a nation or a terrorist group we are on a turf that we understand and can often control. He says that Mother Nature is a “different kind of foe.” She is just chemistry, biology, and physics. She doesn’t give us a break when we say we have had too much, and:
She always bats last, and she always bats a thousand. Do not mess with Mother Nature!” You can only win the war with Mother Nature by adopting three strategies.
- We must have incredible humility. We are up against the most powerful force on the planet.
- We must be incredibly coordinated in how we respond. Different cities, different states, and different countries must follow similar paths.
- We must be all about chemistry, biology, and physics because Mother Nature is all about chemistry, biology, and physics.
He goes on to say that the two most powerful forces on the planet are Mother Nature and Father Greed, the market. President Trump knows nothing about the natural world or Mother Nature. He was obsessed with the market. While the president was focused on the market, Mother Nature was spreading the virus. She doesn’t work just 9:30 to 4, and she doesn’t take weekends off. He implies that she could care less about the market.
After his creative overview of how we fell victim to Mother Nature’s relentless persistent obsession with chemistry, biology, and physics while we were more worried about the market than our vulnerability to the pathogen that we had given a chance to evolve through many decades of environmental abuse, he turns to our lame responses once we were paying attention to the pandemic. He reviews the brief British dance with “herd immunity.” The next approach he discusses is the radical isolation, testing, and invasive contact follow up adopted by China, South Korea, Singapore, Germany, and Denmark with mixed success. He reminds us that the virus is hard to manage because it is an airborne pathogen that can be passed by asymptomatic carriers, and it is still out there. An alternative approach was taken by Sweden which was similar to what Britain started but did not continue, the pursuit of “herd immunity.” Unfortunately they did not pay attention to nursing facilities. Overall their results are worse than Denmark, but the experiment continues.
He points out that the WHO has raised the question that infection may not produce immunity which is bad news for both the concept of “herd immunity” and creation of a successful vaccine. He is skeptical and thinks the WHO comment was a CYA move in response to recent criticism of its management of the pandemic, but adds that if it turns out that there is no immunity from infection the correct response should be “party on,” because “we can kiss our a–es goodbye.” That comment seemed a little over the top. I will forgive him because it is a statement made for emphasis, but he did fail to offer some hope by not mentioning the alternative strategy of finding an effective treatment, as we have for AIDS, as a viable option.
The last approach he discusses is the “Georgia” approach which is don’t be humble about nature, don’t be coordinated, don’t be scientific. Just say, “We are going back to work.” He worries about the Georgia approach because it doesn’t respect nature, it’s not coordinated, and he reminds us that “when we don’t respect nature she will kill us, or someone we love.” He closed his opening statement by saying that he is available “to ruin” [? Zoom] dinner parties, weddings, and bar mitzvahs.
Dennis Ross began by saying that he too was available for weddings and bar mitzvahs, but quickly moved on to reviewing his experience serving both Republican and Democratic presidents. He asks what those previous presidents from both parties would have done. He believes that all of them would have sought to create a coordinated world wide response with common standards and practices. He observes that the United States is the only country that could successfully call for such a world wide response. He implies that our decision to withdraw from our responsibility to lead dooms the world to the reality of the loss of our most effective tool, the power of a world wide coordinated response.
Ross believes that the presidents for whom he worked would have tried to create a clearing house of how to do things medically and economically. He believes that such a move is not too late, but it remains unlikely because it is “not in the DNA of the current administration.” He points out that there is an “international freefall.” He believes that there is still an urgent need for coordination because there will be a “second wave.” He worries about our vulnerability to a “second wave” coming from the poor countries in the southern hemisphere where there have been few cases so far, but where there are also few resources to fight the pandemic and where there is not much possibility of a coordinated approach without the leadership of America. He proposes immediate action through something like the G 20. He points out that we are not even coordinated within the United States. It’s obvious that the approach in Georgia is very different from the response in California. In summary, his first observation is that with the absence of coordination, we are ultimately backing into a hope for “herd immunity.” At least 60% of Americans will need to be infected before we can experience “herd immunity.” There is no way to avoid the conclusion that given our lack of coordination internally, and with the world, the virus will continue to hurt us.
His second observation is about what we can expect from the Middle East. Iran has adopted an approach that is basically, “Let the people die.” He is concerned that the more distressed they are on the inside by the virus, the more aggressive they will be on the outside. Inside they are stressed by the virus which they have opted not to fight, by our sanctions against them, and by the fact that they are not able to sell much oil, and what they sell gives them less and less resources. As the Iranians export violence through their partner organizations, they force Israel to be more and more vigilant at a time when they need to be internally focused. Because of the collapse of oil prices there are many Middle East countries that would be on the brink of collapse even if there were no potential stresses from a virus. He points out that previous presidents would be asking where we should be coordinating defense against the virus to protect the fragile environment in the Middle East because their problems will quickly affect our own security. His conclusion:
It turns out that “America first,” makes us “America vulnerable.”
He hopes that there will still be something to do if after the election we have an administration with a different world view. From his presentation it is clear that he believes that in the past there have been Republican and Democratic administrations that would have more effectively responded. I think that is important because it suggests that most Republicans are not the problem. The Republican Party has historically been responsible, and has lead many American achievements. The current Republican Party and much of its leadership has been co opted by a demagogue who is incompetent. Without him there may be an opportunity to establish more unity of purpose, and reunite the country in a return to our worldwide responsibilities that have protected us at home for the last 75 years.
Ross finishes his opening comments with a focus on Israel which through a process similar to China and South Korea has had only 200 deaths in 9 million people. They have had more effective testing and contact follow up with quarantine to enhance the benefits of social distances. They are now allowing small businesses to reopen, and are letting people under fifty to return to work. They are internally coordinated even as they are experiencing difficulty establishing a stable government. Even with their political divisions that have produced three recent elections and may eventually cause a fourth election, there is shared agreement that for the next six months unity that enables fighting the virus is the highest priority. I wonder if we could import that attitude.
That covers the first 31 minutes of the presentation. The next forty minutes are a very informative Q&A facilitated by the chat function of Zoom. I urge you to watch the whole program on Zoom and delay watching the last episode of “Homeland” or the sixth season of Bosch. Perhaps it is useful to think of the coronavirus like a series on HBO or Netflix. We may be nearing the end of season one. How many seasons will there be?
The president’s news conference ended yesterday with an interesting question. The entire transcript is available as a publication from the White House. There is much to ponder in the answer to his last question.
THE PRESIDENT: Okay, go ahead. Let’s do — let’s do one more. Please, in the back.
Q If an American President loses more Americans over the course of six weeks than died in the entirety of the Vietnam War, does he deserve to be reelected?
THE PRESIDENT: So, yeah, we’ve lost a lot of people. But if you look at what original projections were — 2.2 million — we’re probably heading to 60,000, 70,000. It’s far too many. One person is too many for this.
And I think we’ve made a lot of really good decisions. The big decision was closing the border or doing the ban — people coming in from China — obviously, other than American citizens, which had to come in. Can’t say, “You can’t come in. You can’t come back to your country.”
I think we’ve made a lot of good decisions. I think that Mike Pence and the task force have done a fantastic job.
I think that everybody working on the ventilators — you see what we’ve done there — have done unbelievable. The press doesn’t talk about ventilators anymore. They just don’t want to talk about them and that’s okay. But the reason they don’t want to talk — that was a subject that nobody would get off of. They don’t want to talk about them.
We’re in the same position on testing. We are lapping the world on testing. And the world is coming to us. As I said, they’re coming to us, saying, “What are you doing? How do you do it?” And we’re helping them.
So, no, I think we’ve done a great job. And one person — I will say this: One person is too many.
Thank you all very much. Thank you. Thank you.
END
I am sure that Tom Friedman and David Ross would join me in saying, “Really?” If the president is right and by the end of “season one” there are “only” 60-70,000 deaths, what can we expect for season 2? I fear that the president and many of our fellow citizens want to think that by June this will all be behind us and we can enjoy a little bit of baseball before we get ready for an exciting NFL season watching Brady and Gronk shine in Tampa while Belichick tries to prove it was him and not Tom that won all those rings.
Friedman and Ross are there for us to watch on YouTube to remind us that Mother Nature plays her own game, and it’s about chemistry, biology, and physics. Remember she always bats last and she always gets a hit. Our challenge is to try to develop some teamwork internally and with the rest of the world. It’s going to be a long game, or to get back to the Netflix metaphor, a show with several seasons. Unlike the audience for a Netflix series, we are part of the mass of extras in the crowd scenes of this show. I fear that season one will end with more than 70,000 lives lost, and that if we continue to follow a man who has more respect for Father Greed than Mother Nature, we are in for a second season for sure.
