# A Personal (Interim) COVID-19 Postmortem

I think it's important to clearly and publicly admit when we were wrong. It's even better to diagnose why, and take steps to prevent doing so again. COVID-19 is far from over, but given my early stance on a number of questions regarding COVID-19, this is my attempt at a public personal review to see where I was wrong.

I have been pushing for better forecasting and preparation for pandemics for years, but I wasn't forecasting on the various specific questions about Pandemics on most platforms until at least mid-March, and I failed in several ways.

Mea Culpa
=========

I was late to update about a number of things, and simply wrong in some cases even on the basis of known information. The failures include initially being slow to recognize the extent of the threat, starting out dismissive about masks, being more concerned about hospital-based transmission than ended up being justified, being overconfident in the response of the US government, and in early March, over-confidently getting a key fact wrong about transmission being at least largely via aerosol droplet versus physical contact. I have a number of excuses, of course. Most other experts agreed with my views, my grandfather passed away in January, followed by his wife in early March, I was under a lot of stress, I was very busy with my personal life, I was trying to do a number of other high-priority projects, I was not paying attention to the details, and so on. But predictive accuracy doesn't care about WHY you were wrong, especially since there are always such excuses. And the impact of my poor judgement was also likely misleading to others in the community.

At the same time, I feel the perhaps egotistical need to note where I was correct early, and what I got right - followed by a clearer description of my failures. I started saying there would be PPE shortages due to COVID-19 by January, and was writing about the supply chain issues well before COVID. I submitted [this paper](https://www.joghr.org/article/12530-review-of-potential-high-leverage-and-inexpensive-mitigations-for-reducing-risk-in-epidemics-and-pandemics) November last year with Dave Denkenberger, which was largely finished last summer, and it was accepted in February, which then took 3 months to get published. The delay was in part due to other demands on my time, but in retrospect, if it had been available 3 months earlier, it would have been far, far more impactful.

I also understood the failure mode we ended up seeing, and in [my 2018 paper](https://www.liebertpub.com/doi/full/10.1089/hs.2018.0039), discussing overconfidence in claims that pandemics would be rare, I argued that among the most critical risks was failure to respond to emerging pandemics which could in theory be controlled quickly enough. On the other hand, my failure to realize that this is exactly what was happening is perhaps compounded by the fact that I understood the dynamics, and should have been able to identify what was going on.

Lastly, I maintain I was correct in warning about the poorly thought out and in some cases outright dangerous "preparation" in some quarters of the rationality community proposed in March, such as advocating use of bleach and ozone in closed areas for disinfection. Some people in the community were stockpiling N-95 masks and food and buying up second hand ventilators, and as I said at the time, were at best being selfish and defecting. On the other hand, as I mention below, I was insufficiently clear about the need for better preparation, and [waited far too long to speak](https://www.lesswrong.com/posts/jeyvzALDbjdjjv5RW/pretending-to-be-wise).

Some of My Mistakes, and Related Comments
=========================================

**Slow to recognize the extent of the threat.**
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I said we should [be very concerned](https://twitter.com/davidmanheim/status/1220017992597168129) in January, albeit not very publicly. I took until [early March](https://twitter.com/davidmanheim/status/1236987867630575616) to start suggesting that it was clear that the US would expect to see large numbers of deaths. I was skeptical of valuable efforts early on, and didn't start really publicly sounding the alarm and reacting until even later. I was later than most of this community in recognizing the risks.

**Skeptical about Border Closures**
-----------------------------------

In a conversation that started [Jan 27th](https://twitter.com/RokoMijicUK/status/1221566557320634369), I was asked about shutting down borders to prevent spread. I was dismissive, in large part based on the expert consensus. I'm unsure whether this was a mistake on the object level, since I think that at that early point, the facts were unclear enough, and trade wars really are bad. I also expected response to be better, based on previous cases.

I do not think that border shutdowns were feasible, and historically they have not been. Quarantines at borders were and are logistically impossible. And full border closures for COVID-19 were also not very effective most places until very late in the spread, (Mongolia and Vietnam are the exceptions that disprove the rule.) Even late in the pandemic spread, lots of transmission occurred from places where there had been few or no cases at the time people entered. However, when discussing it, I excused my early claims that it was too economically damaging and would have been ineffective by substituting a different argument about political feasibility - one which I think is correct, but was not my original consideration. This was bad epistemic practice, and I should have been clearer that in retrospect, if they could have been put in place, travel bans would have been a much better idea. I still think my later excuse, that they were politically impossible, holds up - but I had not fully thought through the question until well after my early response.

**Dismissive about masks.**
---------------------------

The research on use of masks was unclear and I don't want to claim it was retrospectively obvious, but as a matter of decision making given uncertain risks, people should have started wearing **_homemade masks_** in public much earlier. We will still need to see how much impact promoting mask wearing in public has had, but at the very least it functioned as a clear and important public signal that COVID was serious, which promotes physical distance and other critical factors.

On the other hand, I said at the time, and still maintain that I was correct in suggesting that buying up P95 and surgical masks in February and March was defecting, since it was already clear that those supplies were needed desperately in hospitals. And Fauci has now [said as much](https://www.thestreet.com/video/dr-fauci-masks-changing-directive-coronavirus) (as a [level-1+2 sage](https://www.lesswrong.com/posts/qDmnyEMtJkE9Wrpau/simulacra-levels-and-their-interactions), in my view.). In retrospect, I think it would have been better, consequentially, to push for cloth masks earlier, but current modeling and our understanding of spread make it clear that mask wearing by itself is only marginally effective. I was instead focused on promoting handwashing, which I think is still undersold in importance, and thought that continued focus on masks would be a net negative. I was wrong, and others here were correct.

**Not clear enough about the importance of preparation.**
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I've long said, following all of the experts, that people should have 2 weeks supply of food and basic supplies. Especially people in California, where earthquakes are far more common than severe pandemics. Further preparation should have been unneeded early on - but in fact, most people don't do this, and the people who were advocating making sure that you were prepared for a worse outcome were correct.

On the other hand, there is an argument I've seen here, and by others in the rationality community elsewhere, that encouraging people to buy critical supplies and hoard early in a crisis sends a price signal to get companies to produce. The argument is that this type of hoarding masks and other PPE will convince manufacturers to make more. I thought, and still think, that this is at least partly misunderstanding the way that price signals and supply chain delays propagate. Anyone who's familiar with MIT System Dynamics' [Beer Game](https://beergame.org/) and the bullwhip effect would tell you that companies that ramped up production in response to demand quickly (rather than projections and an understanding of longer term demand) were being stupid, not prudent, [and companies that tried this in exactly this area were burned in the past for doing so](https://www.npr.org/sections/health-shots/2020/03/05/811387424/face-masks-not-enough-are-made-in-america-to-deal-with-coronavirus). If that isn't clear enough, notice that it took a couple months for the toilet paper and flour "shortages" to be worked out, despite the fact that there was sufficient supply, and there were not actual production supply shortages. Yes, markets are largely efficient, but they aren't magical ways to eliminate production and distribution delays, much less to insulate companies from actual market dynamics - and China and other southeast Asian countries had already stepped up mask production massively by mid-January. Most of the current supply comes from those factories, so the supposed benefits of price signals from buying masks in February seem not to have been actually effective in speeding anything up.

**Oversold Hospital-based transmission.**
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Part of my concern about hoarding of masks and other equipment was that I thought we would once again see a pattern of large transmission events being centered around hospitals. Thankfully, this didn't happen - hospitals have gotten far better at isolation of patients, and they shut down non-essential services early. We did still see many, many cases and deaths in hospital staff, and this was very clearly in large part due to a lack of supply of PPE. Still, it wasn't the critical locus of spread I expected it to be.

**Overconfidence in the response of (certain agencies in) the US government.**
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This was a huge mistake on my part. I have been concerned about the current administration for years, have repeatedly warned that it is destroying government agencies. Despite that, I was (in retrospect very unreasonably) still confident that the CDC was going to handle the situation well. They had handbooks on influenza pandemic preparedness, I had personally discussed pandemic preparedness plans with senior people at CDC just a few years ago, and I was overconfident in the ability to respond. Based on that, in turn, I was confident that the level of concern being voiced by the CDC was a reflection of their planning and ongoing preparation. The CDC has planned for preparation for this exact case for years, and I assumed they would carry out those plans. I was wrong.

It seems, though it is still somewhat unclear, that center directors were told by the director and the head of HHS that they needed not to speak out about the risks, specific recommendations were vetoed, and (easily the worst screw up,) they let the FDA ban private tests, seemingly at the direction of the administration, to hide the extent of the spread. I'm still confused by the level of non-reaction among non-political SES staff and GS-14s. We have seen many people in various agencies come forward with complaints during this administration, but CDC seems to have just dropped the ball on their response. We will likely see in the coming years how much this was due to central directives not to react, versus alack of central directives to react, therefore failing due to passivity. I still want to assume the former, but that's in large part self-justification of my prior views.

I was wrong in trying to defend the CDC's overall response in March. It definitely isn't as clear as I thought at the time that they were, and would be, net positive. I do think that the emergence of Fauci as almost a national hero has been very helpful in getting people to listen to expert recommendations, even if this did come very late. This is a point on the side of getting most people to listen more and attack less. On the other hand, Lesswrong was overall better prepared because of their skepticism, so _at the very least_ I was talking to the wrong crowd to defend them, and more likely should have been quicker to judge their actions as dangerous myself.

The FDA also surprised me with how badly they did, albeit the surprise was less severe because I had lower expectations. I thought they were getting less dangerous to US public health given the previous pushes to reduce regulation by the current administration. Scott Gottlieb was there for two years, and was probably the only Trump nominee I was actually super-happy about. Unfortunately, he left (a fact I wasn't paying attention to,) and it turns out that the incompetence of a sequence of new directors and rapid changes left the FDA even less prepared that they would have been. I would have expected a doctrinaire Republican appointee to seize the opportunity of a crisis to reduce regulation, and instead it seems they did nothing but block critical testing work for months.

I've long considered myself skeptical of government agencies abilities, and lean fairly heavily libertarian in many ways - albeit less than most others at lesswrong. I was still surprised by the level of ongoing, perhaps even malicious incompetence of the current administration. I'm still unclear if this is a Hanlon-dodge, or if they really have broken the US government so badly, so quickly. Other governments managed this far less poorly, so I'm unclear how generalizable the lesson is that governments are bad at everything. But I am glad I left the US.

Being a jerk commenting on a post attacking the CDC
---------------------------------------------------

Given that I'm posting a retrospective, there is a different type of mistake I made that I also need to address. In [a lesswrong thread several months ago](https://www.lesswrong.com/posts/h4vWsBBjASgiQ2pn6/credibility-of-the-cdc-on-sars-cov-2), there were a number of claims made about the CDC's response. I responded that I thought the post was an infohazard, would very plausibly lead to many more people dying, and as such, the posters should have asked for feedback from someone who could vet concerns about this, and that it should be taken down by site administrators. This was stupid, and [I have apologized there](https://www.lesswrong.com/posts/h4vWsBBjASgiQ2pn6/credibility-of-the-cdc-on-sars-cov-2?commentId=2h78FcD2JcLaMSFnc), along with laying out what I hope is a fair analysis of what I know I did wrong, and what I still think I was correct about.

Speculation about Causes
========================

There are lots of things I did wrong.

First, I think I was too close to the situation. I had spent a ton of time [looking at the US's system specifically](https://www.rand.org/pubs/research_reports/RR1576.html), and writing about the closely related -topic of influenza pandemics in my dissertation, then doing work for Open Philanthropy on GCBRs. All of this was during the Obama administration. I left the US a bit after Trump was elected, partly for that reason, and worked on related topics that had less to do with US policy. I'd like to say that's why I didn't update, but to be honest, I think I was just being stupid in accepting my cached thoughts about the risk and best responses, instead of re-evaluating.

I also had too-strong priors and "expert" ideas to be properly fox-like in my predictions, and not quick enough to update about how things were actually going based on the data. Because I was slow to move from the base-rate, I underestimated the severity of COVID-19 for too long. I'm unsure how to fix that, since most of the time it's the right move, and paying attention to every new event is very expensive in terms of mental energy. (Suggestions welcome!)

I also gave too much weight to others' forecasts. Good Judgement's predictions were WAY optimistic about this early on, and I was not forecasting the question, but I was assuming that their aggregate guess was better than that of individuals, especially people who aren't forecasters. This is usually correct, but here it was a mistake. (I now think that superforecasting is materially worse than I hoped it would be at noticing rare events early.) I also followed the herd too much from expert circles, and my twitter feed from infectious disease epidemiology circles was behind even my slow self in recognizing that this was a incipient disaster back in March.

Conclusion
==========

COVID-19 went badly in some places, and went disastrously in others. This was largely predictable, and I failed to notice early enough. (The US is in deep, deep trouble, and this will continue for quite a while longer, with myriad longer term effects on the global economy, and on global stability of other types.) I'm chastened about the poorly calibrated overconfidence of my expert opinion.

I'm also partly unsure what the best next steps are for better-calibration. One key thing I did, several years ago, was explicitly try to rely more on other people's views in the rationality community to guide my decisions, and provide a clear source of feedback. I didn't do this as much as I should have in this case. (On the other hand, it was a large part of why I recognized the mistake as quickly as I did, albeit later than I could have - so it was at least a partial success.)

I'm hoping that this exercise is another way in which thinking through the situation gives me a valuable chance to reflect, and that I can get further feedback. I also hope that it's useful for others to perhaps learn from, but I'm unsure how transferable the lessons of my failures are.