Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for May, 2020

Strategy in the Age of COVID-19: Just Assume You Are Wrong

“I” before “E” except after “C” and when sounding like “A” as in neighbor or weigh, and on weekends and holidays and throughout May, and you’ll always be wrong no matter what you say!!” –Brian Regan

Not surprisingly this came to mind as Beth and I were talking about the best, or right, or acceptable way to start to resume life outside of our houses. How to return to the office, go to the grocery store, visit a family member or a friend. Fantastically superistically smart people who spend their entire lives thinking about this kind of stuff haven’t been able to find even the tiniest kernel of agreement, and yet we poor intellectual peasants are out here picking at their intellectual crumbs as we try to do the right thing. Go out/stay in? Hug the grandchild or wave? Mask/no mask? You get the idea.

The issue of testing is a great example of the conundrum faced by both the intelligentsia and the hoi polloi. It’s not even as easy as test or don’t test. Nah, that’d be altogether too easy. You gotta decide which test. Do you have the virus now? 4, 5, maybe 6 tests to choose from, all of which are substandard when it comes to accuracy in a normal world. Which one do you choose? How many times must you be tested? How long between? Have you ever had the virus? Meh, same issues. All but the most recently pseudo-approved tests in both categories take days to return a result. Does it really matter, that result, after it’s been a couple or a few days? Is it better to choose a slightly less accurate test in order to get the result within minutes, or wait for a slightly more accurate result arriving soon come? Now decide if you should venture out based on your decision.

See? No matter what you do you’re wrong.

We have all lost sight, at least a super majority of our government officials and many of our non-governmental experts have lost sight, of what “flatten the curve” was meant to do. It all made so much more sense, and the resulting overshoot on stuff like saving PPE for the tip of the spear workers was more tolerable, when we had a clear mandate that could be graphed accurately: prevent the surge of infected individuals from flowing over the level at which our acute care facilities would run out of space and materials necessary to provide the highest levels of care. Easy. Easy to be right. There were no extrapolations necessary to see if you were succeeding; you used real data. The line below which you succeeded was a known number: ICU beds + respirators. Nowhere in the U.S. have we seen the tragedies of Lombardy where doctors had to decide who made it into the ICU and who did not. We saw the curve, we understood the curve, and we successfully flattened the curve.

So what’s been lost? It’s a little more difficult to understand the concept of the AREA under the curve. How many people either get sick with the virus or die from the virus. Very few of our experts showed the far right side of their graphs. Fewer still gave any explanation regarding the dirty little secret of “flattening the curve”: all you are doing is pushing out the infections and resultant deaths from the virus. Pushing them out further in time. Flattening the curve simply means that you are not having EXCESS deaths caused by insufficient acute care availability in an overwhelmed  system. Without either a vaccine to prevent infection or a medication that treats the virus such that people don’t die, the same absolute number of people will eventually become infected, same number of people will become sick, and the same number of people will die.

Let me say that again so that it is clear: flattening the curve saves only those excess lives lost to insufficient hospital resources during a surge. Over time it does not save lives unless a vaccine and/or treatment arises.

Once again, no matter what you do, just like “I” before “E”, if you persist in flattening the curve edicts you are wrong unless you have a hard arrival date for a vaccine or a treatment/cure. You see, lockdown policies such as those in place in much of the world now are not entirely benign when it comes to health. Or death. Lockdown policies that mandate isolation, especially those that make it difficult to take care of what would otherwise be well-controlled chronic medical problems, actually cause EXCESS deaths. How many? The cold reality is that not a single model is capable to telling us that. Or at least telling us with enough degree of certainty and accuracy that we could titrate the “flattening” policies in such a way that the EXCESS deaths caused by the lockdown are more tolerable to a society than the excess deaths caused by system overload. No flattening of the curve? Excess deaths from system overload. Extend the curve? Excess deaths caused by solitude, reduced access to typical medical care, and the well-known health effects of an economic recession or depression.

Are the experts saving lives by insisting on these draconian lockdown policies across the country? Sure. Today. They are saving the lives of those who would not survive a viral infection should they become infected today. Are these lives that will ultimately be saved from being ended by the virus entirely? As of today the answer is a resounding “No” despite the earnest pleas and declarations from the various governmental pulpits. Absent a vaccine or a treatment/cure the math is as inescapable as math can be: the area under the curve, flattened or not, remains the same if you look far enough to the right. Deaths from the virus will be equal over time.

The REAL curve, the one we’ve yet to see and the one we are unlikely to see from those same pulpits, is one that adds the deaths from the virus to the excess deaths caused by the lockdown policies. Preventable deaths from untreated or inadequately treated cardiac disease or cancer for example.  That curve will show that no matter what you do, at home or behind the desk where you sign the lockdown edict, you will be wrong. That’s what makes this all so discouraging for me. What makes it all so dark. You can’t be right. Like “I” before “, be it May or just any old today, no matter what you do you’ll be wrong. Literally the only thing that changes that is a vaccine or a cure, two highly elusive solutions, the  achievement of which historically takes years, not months. Only then does the curve flatten to zero. Only then can we say that lives in the absolute have been saved.

There is only one thing left now, and that is a vaccine or a cure. Whatever light remains in the shadow of the virus, it exists here. Will it be months as we’ve been told? Will this virus fall to a vaccine in months where prior scourges took years to defeat (HIV), while we still await victory over others (Ebola)?  We must all pray that in this one single instance the people who are leading us are not wrong. For if they are wrong, if the area under the curve is the same no matter what shape the curve takes, it will upon the souls of our Government, our elected and appointed leaders, that each excess lockdown death will weigh.

“I” before “E” as directed by “G” means that the weight of being right falls on them, not on you or me.

Sunday musings…5/17/2020

Sunday musings…

1) Lockdown 1. One of my annual meetings, some 15,000 typically in attendance. Cancelled weeks ago. Somehow they managed to transition the whole shebang to a virtual setup. How’d it go? No idea. After 8+ weeks of nothing but online Zoom-type “meetings” I just couldn’t make myself log on to yet another one no matter how many friends were watching.

Sasha took me for a walk instead.

2) Lockdown 2. “[F]acts and data are independent of your credentials.” Aaron Ginn

Some of the most educational (and educated) pieces on the corona virus have been published by a few of my ophthalmology colleagues. You read that right; the so-called “eye dentists” have done excellent work both fishing out interesting ideas for treatment and testing and assimilating available information to form some sort of coherent whole.

You may remember that the first doctor to sound the alarm in China was an ophthalmologist.

The point? There are all kinds of degreed and pedigreed experts who have been belittling and lambasting very smart people outside of their little professional circles for having the audacity to opine on facts that are available to anyone to parse. The possession of a degree or an appointment does not confer upon you an exclusive right to set policy, or advise those who set policy, in your area of study. It certainly doesn’t inoculate you from having your conclusions questioned by other smart folks who may see something different in the data.

Data are what they are. Ideas sprout from data. It is those ideas that should be addressed, not who it may be who proposes them. Lofty credentials do not entitle one to an exclusive on the ideas.

3) Leadership. Have you been watching the  epic 10-part series on the 6th NBA championship won by the Michael Jordan/Scottie Pippin Bulls? It’s fascinating for dozens of reasons, none the least of which is the insight we have gained into the leadership style of Jordan. MJ comes across in episodes 7 and 8 as, there’s really no way around this, kind of a jerk. He bullies, berates and belittles his teammates, pushing and pulling them to heights most of them were wholly unaware that they might reach. No one, it seems, was immune from his attacks, though they took on terrifically different forms when applied to different teammates.

We’ve seen this type of leadership before in otherwise lauded and revered leaders. Steve Jobs comes instantly to mind. Jobs was infamous for how badly he treated subordinates at all levels. His impatience with underlings who failed to deliver was matched only by the vigor and venom with which he made his displeasure known. Now you could surely say that Jordan spent his career in a perpetual zero sum setting; winning was the only acceptable outcome and there would only ever be one winner. Jobs, it should be noted treated every market his company entered as if it, too, was a zero sum game. It wasn’t enough to simply succeed, to be profitable. Nope. The goal was to win so completely that the competition left the game.

Was Jobs an asshole? During his career was Jordan? I have to admit that I simply don’t know enough about the rest of Job’s life, how he treated people who were not in his chain of command, to opine of his overall asshole quotient (though it is rather common knowledge that he was quite unkind to his daughter from his first marriage). Jordan, too, was private enough that one can’t really say what his non-winner life was like. Did he treat Bulls staffers (other than the GM) better than his teammates? The guy who parked his cars, did the laundry in the locker room, mopped the gym floor? If he did does that lower his asshole quotient? There are some who say that it was the naming of Bill Cartwright as co-captain that catalysed the dynasty. Does a toxic leader need a consoler to be effective?

One thing you can say about MJ and his leadership style is that there was no subterfuge involved.

4) Unlocked. We finally cracked. Just a tiny bit, but crack we did. Not being able to force myself to log on to a national meeting with my peers was the first little leak in the dyke. A couple of videos of the grandchildren we usually see several times a week and hadn’t for 6 or 7 days, the announcement that our closest friends here in town were moving. Yet another series of announcements that our “new normal” was going to be around for 18-24 months. It all just became too much. One tiny bit of good news–it turns out that asthma is not the high risk problem after extensive research–and we took stock of what it would mean to live for another year or two without a vaccine. In the end one must accept that up to 50% of our nation will contract the virus (though medical technology will inevitably reduce the % of people who die because of that).

Without putting others at risk the question one must now ask is what part of your life, which of your loved ones can you accept the risk of seeing because not seeing them is more a case of not dying rather than living?

All around us similar cracks are opening up for similar reasons. Mind you, this is not “we love to go out to dinner” so we’re putting ourselves out there to visit our favorite restaurants. No, as much as I pine for Veal Picatta served with a side of smiling snark on “Tina Tuesday” at one of our locals, this is much more personal. As close to need as can be. This is about seeing our children and their spouses, even if it’s 6 feet away, instead of viewing them on FaceTime. It’s a running, jumping hug from my Man Cub and a kiss on the cheek from his sister the Pipsqueak. A very special bottle of wine, 22 years in the waiting, shared across a ludicrously huge table for only four people, but around a real table pouring from the same bottle with cherished friends. No hugs or handshake there, but THERE.

There is an energy that exists in love extended and received in person, even if in person means 6 feet apart, maybe even a mask or face shield. That energy is real, and at some point being walled off from that energy is to be walled off from what it means to be alive. In no way am I telling anyone what it means for them to feel alive. It would be unforgivably presumptuous to tell anyone that they cannot live behind an impenetrable curtain of seclusion, or which of their people they can accept as so essential to living that being with them may be the source of acquiring the virus.

We may escape an interminable pandemic. A vaccine may be on the way along with all of the other blessings we each receive. Until then we must accept that we each have a responsibility to protect our fellow travelers from whatever risk we might personally represent. For ourselves we will all eventually need to come to terms with what it means for us to be living, and who it is we need to have along with us as we do.

“The Last Word” Credit: Men’s Journal

Anyone who knows me well knows that one of my very favorite drinks is called “The Last Word”. It’s also a huge source of frustration because so few bars, however hifalutin and pretentious, can make a decent one. But this is not an essay on drinking. Far from it. “The Last Word” is the running series on the last page of each issue of Men’s Journal in which an older male celebrity is asked to answer a series of questions about life. There’s nothing particularly unique or imaginative about either the endeavor or the questions asked. Still, it makes me think, and I thought it might be a fun thing for us to think about together.

Herewith, the most frequently asked questions. I’ll offer up my own answers in a follow-up post. Perhaps you might answer either here in the comments, on Facebook, or somewhere else I might find you.


Who were your heroes growing up?

What is the best advice you ever received and from whom?

Who had the biggest influence on you when you were younger?

Was there a life-changing book you read? Movie you saw? Adventure you had?

What is the trait you most admire in other people? Least admire?

How should one handle getting older (if you are, indeed, older)?

How should one handle criticism?

If you could select the guests for your dream dinner party, attendees living or dead, who would you invite?

Do you have any advice you’d like to have given to your younger self?

How do you want to be remembered?


There’s a whole lotta ground you could cover there. Pick a few or pick ’em all. No rules here, just an opportunity to take a little stock, draw a few lines in the sand, look both forward and back. Write it down somewhere I might see it. Or not. Incorrigible naval-gazing bloviators like yours truly might turn each question into a an essay of its own, filling pages in the process. The poets among us will tell epic tales using fewer word than a Haiku.

That’s all part of the fun, eh?





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