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The Terrifying Lessons of a Pandemic Simulation (newyorker.com)
115 points by scentoni on June 1, 2018 | hide | past | favorite | 57 comments


There is an interesting amount on behind-the-scenes IT going on for just this sort of disaster, and others, in the government sector.

We don't hear about any of it, so we assume nothing is being done. But the reason it's kept secret is so that people don't start freaking out at scary tabloid headlines.

For example, there is a thing called "the black web" (different sectors have different names for it). Many U.S. government agencies have websites ready to launch in the event of a catastrophic calamity like a pandemic or a radiation leak that affects millions.

Source: Two people I worked with who worked on one of the projects.


its a good practice. This week, our town had a algae based toxin problem with their water. They sent out emergency alerts via text, email, the school district callouts, etc. I got texts forwarded from 8 friends/family.

Everyone referred you to the city's home page. The site buckled under the load, and was completely unresponsive for hours. If it was a more urgent emergency, the lack of information could have led to people being harmed.

I was hoping they would switch to a less dynamic site for alert pages, perhaps use a CDN or edge proxy like cloudflare, etc. But no, it appears demand just died off, and they are still doing the same thing. They just put out info on where you can go to national guard filling stations to fill up water bottles, and their home made .net based website is back to taking 10 seconds to render the home page.


On 9/11 I heard some very strange news on my bedroom clock radio. "Americans falling from the sky...". Tried various websites... all down. Only way I could get news was slashdot.org and they had switched to a very light weight text only format.


Oh hey, good to see someone else from my neck of the woods! The whole thing was overblown IMO, but it would have been nice to know a week ago when the test results came through and we hadn't been drinking the tap water all week. Normally it's fantastic.

The best part was the emergency phone alert they pushed out several hours late that didn't even have any information about what the emergency was, which resulted in 911 being flooded. Some jokes were made about the new hire from Hawaii...


We had a water problem and I didnt know about it until days later.

No local TV and not reading the paper + no facebook= living somewhere else?

I knew all about HN, but no clue that we couldnt use water.


This is where Twitter excels. It's the best way I have found to get local breaking news. Don't bother following any media outlets either, it's counterintuitive but their feeds are mostly marketing garbage with extra click tracking/redirects and excessive dupes. Pick a few local journos whose articles or reporting you like and follow them instead. Those, plus random friends and other local people will give you all the news you need almost instantly. I don't even turn the TV on when something big happens any more, I just check Twitter.


That assumes you live somewhere that has local journos to speak of. I only live about 40 miles outside of a major US city. But there's no real local news source. I'd only find out about an emergency because of a auto-call from the local emergency services or because it was such big news that it was covered in the Boston Globe.


This is where another HN front page item (neighbourly.google.com)[1] might help soon, nextdoor.com might help right now, and facebook with some local contacts probably would have sufficed.

I can't stand Facebook, but it was better than nothing during the Northern California wildfires this last year, so I logged in and used it. The groups created by residents to track info were wonderful at first, but quickly descended into somewhat low utility after a day or tow as people regurgitated old information and misinformation every few hours, each time one level removed from the source and thus a bit harder for people to confirm or deny.

My wide uses nextdoor.com, and I've long thought I should take a look, but never gotten around to it. It would be interesting to see if Google can leverage their brand name to get enough people to sign up such that you could easily switch between multiple levels of locality, and also allow local news to leverage that in a way that preserves local reporting. If I could easily toggle between neighborhood, school district, city, state and region to find relevant information, and discussions, I would be pleasantly surprised.

1: https://news.ycombinator.com/item?id=17209127


Serverless FTW!


There are actually servers running your "serverless" crap, you know. And they are AWS servers, because that's the whole point: To get people locked back into AWS as a provider.


Interesting how you read lambda in my comment


Hah! Hey, well, you're right... It seems I'm also not immune to AWS propaganda. Regardless, my original point stands: Serverless doesn't mean infinitely-scalable. There are machines somewhere running those containers, and if your traffic spike was sufficient to be notable on a global scale, there are going to be limits like with any other technology. Outsourcing the containers and everything underneath doesn't automatically give your application more capacity to scale. Just to use the example of Lambda, at some point, you will hit a capacity whereafter AWS will be spinning up EC2 instances to accommodate their containers that run your functions, and those take some minutes to spin up. Now, all that being said, I don't pretend to have any special insight into the way AWS builds their reserve infrastructure, though I'd be very interested to have that insight. Just through a layer of abstraction and barring any special preparation of reserve capacity, serverless won't automatically give you more capacity to scale than running your own containers or EC2 instances or bare metal somewhere.


I used to live a mile from a nuclear power plant. Every time they sent their emergency process flyers around town many people freaked out. They should have been happy that there was a plan to deal with emergencies (which could deal with other things as well)


-I would expect the authorities to prepare for such an eventuality; however, I can also understand the need to keep this low-key - way too many would take the fact that the government prepared for such an event would mean either that they feared one was imminent or more sinister still - planned one.

Much better to just keep quiet about it.


Which interestingly means that although we all agree we should pretty much panic and react accordingly in the event of such an emergency, it's best for people not to anticipate such panic until absolutely necessary. And this implies we ought to trust others to come up with contingency plan for us, since we ourselves shouldn't think about it for now.


The opening paragraphs of this article really remind me of the film Contagion, which IIRC tried to portray a pandemic hitting the current world as realistically as possible.

https://en.wikipedia.org/wiki/Contagion_(film)


It's even more accurate than I thought when I saw it. I assumed the the visualization of the virus was stupid movie crap, then I worked in bioinformatics and realized it was https://pymol.org/2 . One of my friends worked for the state health department, and she said that the level that R0 was explained was spot on as well.


I'm an infectious disease epidemiologist - their explanation of R0 (which is occasionally a silly concept but that's another story) is one of the better ones, and the one I use in my classes.


Reminds me of this game, Plague Inc [1], where you can simulate a plague that starts silently until the symptoms become too strong and starts a race between the deadly decease and the governments looking for a cure together and closing borders to prevent it from spreading.

[1] https://www.ndemiccreations.com/en/22-plague-inc


One of my most frustrating memories was Madagascar shutting their borders down at the first sign of disease in any other country. The bane of my teenage existence.


That was originally Pandemic 2, which Plague Inc cloned.

http://knowyourmeme.com/memes/shut-down-everyting


We were 1 homeless person away from Ebola in the US, the ambulance in Dallas picked up a homeless guy along with the guy who had Ebola. The homeless guy wandered away from the hospital. While Ebola isn't always transmitted by close contact, if it had been I bet there would have been thousands of people within a few days with it. How many doctors or hospitals even recognize Ebola when a random person walks in the door?


Ebola transmission is almost always from patient to a close caregiver. While the latter often are family members in Western Africa, someone bleeding from all orifices will get to an ER much faster in the US. Some transmissions from the index case would certainly be possible, although even standard hospital practice goes a long way towards inhibiting it.

I doubt a diagnosis would take more than a day, especially if the patient recently traveled or the hospital is near a major hub. Medical professionals are as obsessed with such diseases as we are.

Once the threat is known, I have no doubt that any decent medical system would contain it within a few days at the most. Ebola isn't the Sci-Fi threat you might think, requiring Biohazard suits etc. Basic precautions work well, finding possible contacts will be much easier, and the tendency of Americans not to attend mass events helps tremendously: Cars instead of public transport, Netflix instead of crowded bars, small families in suburban houses instead of large families in shared apartments, Wall-Mart instead of markets, etc


"...someone bleeding from all orifices will get to an ER much faster in the US. Some transmissions from the index case would certainly be possible, although even standard hospital practice goes a long way towards inhibiting it."

We now know this is not the default presentation of Ebola. In most patients, it's a serious febrile disease, not "Leaking blood from everywhere". The diagnostic process is much harder than you're giving credit for.

"I doubt a diagnosis would take more than a day, especially if the patient recently traveled or the hospital is near a major hub. Medical professionals are as obsessed with such diseases as we are."

The number of times travel histories are skipped or missed is staggering.

That being said, I worked in a group that was modeling both Ebola in West Africa and Ebola in the U.S., and the conclusion, even with some pretty serious scenarios, was that Ebola in U.S. would be pretty swiftly contained.


I'm under the impression that the relatively successful containment in the Democratic Republic of Congo (compared to the West African outbreak) is an illustration of the impact a prepared, functional public health system has on Ebola. Nigeria too.

I wouldn't be stunned by a delay in response due to "it can't happen here" chauvinism, but once enough people were taking it seriously I would expect the US public health system to be up to the challenge. Hopefully there would be little or no delay in treating it seriously, I'm just pointing to that as a likely contributor to the size of a potential outbreak.


Indeed. It's important to note that the DRC has an order of magnitude more doctors per capita than Liberia does. The border between Guinea, Liberia and Sierra Leone is pretty much disease containment hard mode.


All somewhat true, but there are a few key areas where America does attend mass events that can help spread diseases quickly. The top three examples in my mind are the trifecta of public schools, large office complexes, and churches (esp mega-churches).

These all feed and overlap each other. Something can spread through the public school system's children quickly into parents, who take it into large shared office building environments (think typical complex of skyscrapers full of tenant companies sharing hallways, elevators, sidewalks, lunch spots, etc), and once a week completely different insersectional sets of these adults and children then gather up in a large church and disperse into the trifecta.

Hospitals themselves are another factor. Those with family ties end up randomly visiting hospitals a few times a year on average for their eldery relatives' or childrens' sakes, where they pick up a ton of chances at diseases.


During a serious outbreak of something more transmissible than endemic disease like the flu (and all the various viruses that give us colds), people would freak out and attendance to all those things would plummet.


Hospitals are cesspools for infections of all kinds. They are best avoided unless your life is in imminent danger.


At that time, with Ebola raging in Africa, I think that there was a lot of awareness around containing it and hospitals in the USA were definitely on the lookout for it.


I was on several CDC conference calls and yes, there was a lot of awareness about it in local hospitals.


From this article, it seems like the simulation was acted out by people who were formerly in leadership/advisory positions in the US government.

How likely is it that current leaders heed their advice when an outbreak happens? Wouldn't it be more useful to have the people currently in power preparing for this?

Honestly asking - I have no idea about the modus operandi of Washington bureaucracy.


People who currently have these jobs are generally too busy to spend all day wargaming through a simulated pandemic. You’d be lucky to sit them down long enough to play the board game Pandemic. What probably ends up happening is that this gets turned into a written report that some staffer has on hand to pull out and brief the key decision makers on. As the article points out, the learnings from these exercises sometimes get turned into actionable policy, e.g. Bush implementing continuity-of-government plans.

The most similar thing I know about personally is military contingency plans. My dad was a Marine Corps officer and, among other things, worked on contingency plans in the late 1960’s. There are standing contingency plans for almost every conceivable military operation the US might perform, ranging from amphibious landings on the fjords of Norway to capturing any given small Caribbean island. The plans don’t always get followed, though. My dad spent a lot of time developing a contingency plan to capture the island of Grenada, and he spent the rest of his life bitterly insisting that his plan was far better than how that operation actually turned out!


That's actually really cool. What was his plan like compared to the actual operation? Also, what kind of methodologies would one use to plan something like this?


He passed away some years ago so I'm just going off my recollections here.

His main complaint was that the actual operation used an unnecessarily large cross-service force (largely for political reasons; the Air Force and Army didn't want to miss out on the chance to get involved) when his plan required less than a division of Marines with accompanying air support.

The contingency plans themselves are highly classified, and none of the plans nor the associated maps and whatnot are allowed to leave a specifically secured facility, making this one of the few times in his military career that my dad couldn't just take home his paperwork at the end of the day. In the case of the Grenada plan, there was already an existing plan that is reevaluated and updated with new intelligence, doctrine, etc. on a periodic basis.

One detail of the plan my dad mentioned investigating was a standing tank (i.e. a large barrel for storing liquids) in the middle of a field on the island. The old plan entailed securing the tank and using it as temporary fuel storage, but my dad was suspicious. It turns out the tank was in the middle of a sugar cane field. It was a molasses tank. Probably not safe or feasible for fuel storage.

Even writing this out, I find this story a little hard to believe, but that's the level of detail the military, at least, puts into their contingency plans.


I think some of those plans may be for planning's sake (not a bad idea) and less of a case of "might actually need later".... others are somewhere in between.


We had a plan for war with the British empire. Once it was made public the Canadians got a bit upset as it was basically a detailed plan for preemptively invading them.

https://en.m.wikipedia.org/wiki/War_Plan_Red?wprov=sfla1


At the risk of making a political statement here (sorry dang!), the current administration in Washington seems to be highly resistant to outside advice.


It is safe to say that the current administration in Washington is incapable of making any intelligent decision based on facts. The current President is too much of an intellectual light weight; lacking the understanding and ability to grasp complex and nuanced issues he would have to have to handle a pan-epidemic. He also does not have the talent around him to help or make any decision that would be correct and wise during a pan-epidemic.


I'm not even sure ability is the issue when it comes to grasping things.

I think it is simply he chooses not to understand in favor of gut instinct and even what he last read / saw on TV.

Like you said I don't want to go down the rabbit hole, but I think there's a difference between trying an unable and simply choosing not to try understand a thing (for whatever reason that is).


> I'm not even sure ability is the issue when it comes to grasping things.

I am pretty sure it is lack of ability. Some of the reported interactions between him and other world leaders is pretty alarming. For example, Merkel of Germany had to tell him 11 times that he could not negotiate trade deals between the United States and Germany because Germany is part of the EU. (http://www.businessinsider.com/trump-trade-merkel-germany-eu...)

He uses his gut instinct all the time because that is all he has.


> lacking the understanding and ability to grasp complex and nuanced issues he would have to have to handle a pan-epidemic.

I mean, the guy can't even read.


”...Rear Admiral Tim Ziemer, had been removed from his position as the head of global health security on the White House’s National Security Council after the Trump Administration cut funds for fighting pandemics.”


I can't imagine the potentially catastrophically random decisions made by the current Trump administration when it would come to something as serious as a pandemic....


> Even within the artificial confines of the simulation, there was a lack of leadership. Everyone agreed that the President had the final word on everything in general, but nobody seemed to be responsible for America’s outbreak response specifically. The table returned endlessly to questions about who would brief Congress; who would be capable of authorizing an emergency deployment of military tents as civilian isolation units; who would call state governors to try to ensure a coördinated national response; and who, even, would attend all the funerals.


>Some of the day’s dilemmas revealed vulnerabilities that are hardwired into the American system. Some private hospitals, for instance, turned away Clade X patients in order to protect their shareholders. (By the end of the simulation, American health care had been forcibly nationalized.)

GL HF with that. What really would have happened is that the government does what it always does: throw money at the problem. Every hospital gets x dollars to prepare or gets x dollars per confirmed diagnosis. Change like that never happens during a crisis, always after.


History does not back up that statement. During the Civil War, WWI and WWII certain parts of the economy were nationalized. It would be safe to expect that in a sever pan-epidemic that the health care system would be nationalized.


I was thinking of the 2008 financial crises. Rather than nationalize banks there was a bailout. In 911 there was no nationalization of airports or airlines just more money to set up security theatre. I suppose it could be argued that the DHS personnel are a nationalized rent a cop operation but that sems like its something new not something appropriated


Airport security was nationalized after 9/11.

During the 2008 financial crises, the government did not nationalize the banks but it did "nationalize" how some of the banks did fail. Banks that could/would survive, were told to absorb banks that could not/would not survive with money that the government provided and dictated how much it would be paid back. Technically, not nationalization but pretty close.


Last I checked, there was a major dispute between the hospitals that took Ebola patients and the government as to how much X needed to be.


This sort of reminds me a of a story Danny Hillis has told about Shell Oil and how they were the only major oil company that handled the 1980s oil glut [1] at all well, because the executives had played through a simulation of it. He talked about this in the 2000 game developer's conference keynote [2] (from about 12:30 - 15:26). I've transcribed that bit below:

I think sensible business people are also playful business people. And I think that any great development project, or any great engineering project, you can feel it, you can walk into the room and see people playing around, and you can see if they're acting seriously.

There was actually an interesting case, I don't think they would think of this as a game, but it was literally a game development story: Shell Oil.

Shell Oil -- in the 1980's, there was a time when the price of oil took a big dive, now Shell Oil it turns out was the only company that handled that situation well, and here's why:

Before then, oil was going up, up, up, and in order to be a good oil company you basically had to drill wells as fast as possible, increase production capacity as fast as possible, and pretty much all the oil companies were doing that. The strategic planners at Shell Oil realized that the price of oil might start going down, and that was bad news that no one in the oil industry wanted to do, nobody really wanted to believe it. So they thought about how to get these Shell Oil executives to actually pay attention to it, and they realized the only way they would actually pay attention to this idea was in the context of play.

So what they did is they basically built a simulation game of the oil industry, and they had the Shell Oil executives sit there in the game and put in their assumptions and play it out sort of like SimCity or something like that, of what oil prices would do, according to their assumptions. So they all played little roles, like one of them was an oil sheik, and another one was OPEC, another their competitive refineries, things like that, and they played out the consequences of various games. And one of the things that happened is in every one of their scenarios, the price of oil would crash. And everyone started laughing and they thought this was really silly, because of course everybody knew this wouldn't happen. But after they played this game a while, they started realizing that there were patterns that would happen. They were able to learn in the safety of a game what they really couldn't ever think in the danger of a real spreadsheet they were running the business with.

And in fact, that's what play lets people do. It lets them learn in safe situations things that are actually going to be useful in life. And in fact, in that particular example, Shell Oil realized from their playing that it was actually plausible that the price of oil would collapse, they took some steps to scale back some of their refineries and things like that, and they were the only major oil company that was actually in good shape when that happened.

[1] https://en.wikipedia.org/wiki/1980s_oil_glut

[2] http://www.gdcvault.com/play/1014862/2000-GDC-Keynote-Dr-Dan... (requires Flash. The whole talk is pretty good, and immediately preceding this bit is are funny anecdotes about Richard Feynman and Marvin Minsky)


The best pandemic simulation was Corrputed Blood Incident[1].

[1] https://en.wikipedia.org/wiki/Corrupted_Blood_incident


How did it end? Did they run out of cubes, player cards, or have 8 outbreaks?


Those wily blue cubes, getting out of control.... usually, it's the black disease cubes that outbreak.

https://en.wikipedia.org/wiki/Pandemic_(board_game)


>Rear Admiral Tim Ziemer, had been removed from his position as the head of global health security on the White House’s National Security Council after the Trump Administration cut funds for fighting pandemics.

The present administration isn't interested in preserving the status quo in the event of a pandemic. They are interested in preserving the whiteness of America. An epidemic that they can shape the response and resources around to cull the immigrant, native and slave-descended population would serve their supremacist vision.

4,600 are dead in Puerto Rico due to their negligence. [1]

4,600 is a conservative estimate.

1. https://www.nejm.org/doi/full/10.1056/NEJMsa1803972



What was the lesson?




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