As someone who has watched the CDC try to do the right thing, but repeatedly miss the mark, usually by releasing guidance or making decisions that are at least a couple of steps behind what is happening on the ground, it finally occurred to me what has been going on.
COVID, and especially its shock troops Group Omincron, has gotten inside the CDC’s (and most all other organized public health systems’) OODA loop.
And what is an OODA loop? From Wikipedia:
“The OODA loop is the cycle observe–orient–decide–act, developed by military strategist and United States Air Force Colonel John Boyd. Boyd applied the concept to the combat operations process, often at the operational level during military campaigns. It is now also often applied to understand commercial operations and learning processes. The approach explains how agility can overcome raw power in dealing with human opponents. It is especially applicable to cyber security and cyberwarfare.[1]”
The first “O” is observe: Here we have our first problem, although probably not as big as what follows. We are attempting to observe what is going on with a fast moving, fast changing virus, and at least in the US, we don’t really have an efficient, consistent process for even this most elementary step. Putting aside the initial need to recognize something different is happening (witness the process in Wuhan and then again most recently in South Africa), even once recognized, the US does not have a consistent and high quality reporting system. We know of coroners who refuse to put COVID on death certificates, states (looking at YOU, Florida), who attempt to suppress and obfuscate incoming data, and we know that access to testing, which could be a great early warning system for catching hidden trends, is spotty at best and abysmal at worst.
Regardless, information does come in - some of it from systems that are much more consistent and sophisticated than ours (Thank-you, Israel), and that should really help. But then we come up against the second “O” - Orient. That doesn’t just mean “which way is north”, but rather a much more complex set of cognitive and behavioral actions. Again, to quote the wiki:
“As stated by Boyd and shown in the "Orient" box, there is much filtering of the information through our culture, genetics, ability to analyze and synthesize, and previous experience. The OODA loop was designed to describe a single decision maker; the situation is usually much more complex than shown, as most business and technical decisions have a team of people observing and orienting, each bringing their own cultural traditions, genetics, experience and other information. It is here that decisions often get stuck, which does not lead to winning,”
And it is here that a combination of factors, including innate bureaucratic inertia, the multi-layered process of getting information to the people who need it, the culture of an organization that is used to slowly sifting through lots of data and an non-emergent, “academic” pace, and of course the politics of power and who gets to make decisions, along with the anxiety about the consequences of getting too far out in front “of the science” and “the people”, causes a further slow-down.
As Col. Boyd stated:
“In order to win, we should operate at a faster tempo or rhythm than our adversaries—or, better yet, get inside [the] adversary's Observation-Orientation-Decision-Action time cycle or loop ... Such activity will make us appear ambiguous (unpredictable) thereby generate confusion and disorder among our adversaries—since our adversaries will be unable to generate mental images or pictures that agree with the menacing, as well as faster transient rhythm or patterns, they are competing against.”
Now, some of this is not relevant to a non-thinking virus - and that is actually a good thing. We don’t have to worry about the virus knowing our plans or knowing what we are thinking. We aren’t trying to develop “confusion and disorder among our adversaries” - but rather we are trying to avoid the confusion and disorder sown by the virus, and instead react faster than the nature constrained OODA loop of the virus.
As a thought experiment - imagine for a moment that at the time of the initial Wuhan outbreak, we had, within days, completed our two “Os” and Decided (the “D” in OODA) to universally ACT (the A in OODA) with a massive testing blitz along with reasonable travel restrictions (not unlike what Hawaii did, with it’s “test to fly” rule). And to further the thought experiment beyond what would have really been possible but to push home the point - we had a vaccine that was 90% effective and we got it out to 90% of the population within 30 days of the initial Wuhan outbreak (end of January, 2020).
From the perspective of a barely alive and certainly not thinking organism, that level of response would have shut it down before it had a large enough pool of hosts upon which to randomly mutate and find better and better strains to infect humans.
But of course that is all water (and viruses and variants) under the bridge at this point. COVID is out there, wreaking havoc among our human population and repeatedly demonstrating that it can, through random mutation and natural selection, find better and better ways to infect us. And all the while it is doing this, the CDC is analyzing data from two waves ago and making recommendations based on a reality that no longer exists. It is Orienting, Deciding, and Acting on a world that isn’t there anymore. The current isolation and quarantine rules are just one example of that, but the one that I, has a healthcare provider have been dealing with for the past couple of months was the decision out of Medicare to REQUIRE long term care facilities to open up visiting for patients to just about anybody and everybody at any time - just as the Delta wave was getting underway. A decision that reflected the reality of June and July, that came out in the fall, just as case rates were once again rising.
So - what is the solution? For that I think we have to look at two famous WWII generals, Eisenhower and Patton. Eisenhower is quoted as saying (and he most certainly wasn’t the first to say this),
“IN PREPARING FOR BATTLE I HAVE ALWAYS FOUND THAT PLANS ARE USELESS, BUT PLANNING IS INDISPENSABLE.”
A corollary to this quote is “no battle plan survives first contact with the enemy.”
What these two quotes embody is the reality that you have to PLAN and plan well for the future, but that plans are merely the jumping off place for what happens when the reality of the ground situation is exposed. I should also note that plans and planning are really of two types here. Getting back to our pandemic, the first level of planning is what the Obama administration tried to give to the trump administration - a generic approach to a generic biological threat - an unknown, undefined pandemic, with large-scale, systems responses to address the threat. A more immediate “plan” involves the tactics of what to do once you know the nature of the threat - what we should have executed once we knew the nature of COVID.
And why Patton? It relates back to both planning AND the OODA loop. For all of his personal faults and stone-age (i.e., facist) politics, Patton understood the importance of not only preparation (observation and orientation) but rapid response. History.net does a great job of telling the real story of Patton and his famous 90 degree turn and debunking the lovely Hollywood scene wherein Patton promises a 90-degree turn of his army within 48 hours, based on planning from the night before, but it does a great job of going into great depth about the amount of “O & O” that went into Patton (D)eciding that there was a reasonable likelihood of an attack on the US forces that became the Battle of the Bulge. With that, he created several contingency plans, all of which could be executed on short notice. When the battle situation became clearer, the decision was made, and the plans were executed post-haste.
So why the digression off to generals and WWII? Because in the two examples we see what the CDC is not so good at - having a general and well-coordinated strategic approach to a pandemic, AND a set of contingency plans that can be executed on good but imperfect knowledge (one of my personal gripes about the CDC and its leadership is that they think like internists (we need more data, we need more tests, we need more of this, we need more of that), and less like ED physicians or surgeons (“shit is happening, and the best info we have right now is that this is what is going on and so let’s start taking care of business and adjust as we need to”).
Of course, complicating this whole process is that fact that we have between 30% and 40% of the country ready to knee-jerk oppose anything our Democratic administration and its functionaries propose, thus essentially establishing a “resistance” (which they, without irony, embrace) against our attempts to control, contain and eradicate COVID. But that again, is part of the O & O that leaders need to take into consideration as they Decide and Act.
A final note - I think at this point, this is all grist for a future mill. Omicron is out, the wave is on, and at this point those of us who can protect ourselves are pretty much on our own, until such time Omicron has burned through the easy, dry timber (the unvaccinated, unboosted) and starts bumping into larger pockets of immune protected (either by surviving Omicron or having three (or four) shots).
But all this will happen again.
And next time it could be a whole lot worse.
Like Black Death worse.
