What things shouldn’t we be wasting this crisis on?

Not sure Winston ever said that, but it sounds like the kind of thing he might have said. Quote investigator doesn’t tell me sadly. Grateful for any others’ researches in comments below.

The subject of this post has been a theme of some conversations I’ve had with some people in Canberra. What things should we have been doing before the crisis that the crisis concentrates the mind sufficiently to try to do now? And what things should we have been thinking of, but weren’t till the crisis arrived?

Though lots of things need to be done quickly and needn’t have some long-term game plan attached, it’s worth thinking about what long-term benefits might come. Doubling the dole, I’m hoping will make it more likely that when the payment is ‘normalised’ it goes back to a more humane level than it was at. There will be little need for the government to be stingy with it when it’s trying to engineer a recovery in six or more months time.

The Commonwealth being the government with the big tax base and a central bank sitting behind it should be offering broad underwriting of State schemes of tax relief. It might hopefully use that to bring about some rationalisation of state and federal taxes at the end of the process – and closer cooperation between states and the feds – for instance allowing the Commonwealth to collect tax for the states to simplify administration for businesses.

Then there’s regulation.

For instance, there’s a venture to develop a coronavirus vaccine at UQ (which as Paul Frijters can attest is notorious for its unethical experiments on innocent – but slightly racist – bus drivers). Others will know the details better than me but I’ve always been struck by the way in which safety and efficacy seem to be far entangled with each other in regulatory approval of pharmaceuticals than they need to be. I’d expect there are large and now urgently needed and easily understood gains to be made in that regard.

An example of the kind of thing I’m talking about is the taking of Hydroxychloroquine. We have decades of experience of this as an anti-malarial drug. In fact, while we were getting the experience, so were the mosquitoes and they’re pretty much over it by now. There are only a few places where the drug actually works against malaria. But we’ve got lots of experience with it so we can prescribe it and supervise the safety of using it.

If it’s promising there should be field trials of it right now. We can run a randomised controlled trial inside a hospital giving the drug to one large group of medical professionals and a placebo to another large group. We’d learn lots and fast. There are lots of other sensible experiments that could be run.

In such circumstances, with proper communication, there should not be strong resistance to any of this – as it will enhance and be seen to enhance saftey. There’s the additional issue of the extent to which one should trade off the safety of some treatment – in this case a vaccine or other treatments of COVID-19 – with the lives that are lost from delay in releasing/adopting it. These decisions are made now. And it’s easy to say that the medical regulators are risk-averse. Generally speaking, they should be. But right now it doesn’t take a genius to work out whose risk they’re minimising. Their own, that’s who.

Regulators have careers and over an appreciable period of time, their skin in the game gradually comes to dominate that of others. Decisions get made for them, and not the people for whose benefit they’re regulating. To get round this, I’d identify a class of medically trained people (specialists, doctors and nurses) and informed people from the community from whom I’d choose at random a board of decision-makers. I’d go with any decision for which there was a strong majority of say 2/3rds or more – or perhaps a weaker majority subject to an appeal to another similar body in the event of any strong dissent. Anyway, I’m just sketching things here.

In any event, it seems to me that now might be a time when governments might be prepared to actually try to think about regulating safety from the wider perspective of maximising the lives saved and minimising suffering.

If medical staff become overwhelmed, or even just seriously stretched, there’s a need to consider how one trains people to help them out. There are lots of things nurses do that could be done by people quickly trained to do those things – taking temperatures, giving injections. They might also be trained to administer complex machines in fairly routine ways whilst being trained in detecting things that need escalation. Often these things simply go by the board for lack of staff resourcing now.

Those nurses who were up to it could also have expanded duties. There’s been skirmishing between nurses and doctors for decades with functions kept off nurses for no better reason than to protect the doctors union and prop up demand for their services. As I understand it, some mild progress has been made over the last decade or so, but I expect plenty more could be done.

I’d like to take the high ground here. Currently, the rules get haggled over, but there’s not much regard for independent or evidence-based decisions. There could be better and worse ways of operationalising this. As an illustration, I’d suggest this:  For the duration of the crisis some independent arrangement would be put in place to oversee improvisation at the hospital level. That is, as the need arose, doctors, nurses and hospital administrators could work out any arrangement they considered was appropriate in the circumstances. (One might want a board of the kind I sketched out above).

Leglisation would be passed protecting all participants from any negligence claims arising from any changes to the demarcations in the division of medical labour where those changes were agreed in a way that complied with the method that had been agreed upon the accepted way of making them. These changes and how they were made would be registered in some national database to ensure transparency and the ability of different institutions to learn from one another. Efforts should be made to measure the safety of the resulting system.

Something similar should happen regarding the division of labour in nursing homes, not just of the medical staff, but also of other staff. Changes should only be made if there is competent monitoring of outcomes and an independent body judges that it is in the interests of the patients all things considered.

Another area in which progress has always been much slower than people expected – like regulation review – has been teleworking. Since the telephone people have predicted a surge in work from home, but it’s amazing how slowly it’s happened. The same is true of distance education – and the replacement of universities by MOOCs.

If I seem fairly vague about what the answers are here – that’s because I am. But these are areas in which we need to discover more answers than we have. I doubt they can be solved using top-down approaches so we should be funding experiments. Since we don’t have any choice but to ramp up these activities very aggressively, we should be making funding available for a lot of human-centred design activity to try to figure out how we can make these systems more human, improve feedback over them, and community building over them. As with the more streamlined regulation discussed above, having some national clearinghouse of successful and less successful experience in an attempt to seed a national knowledge commons on these things could be helpful. Governments could also negotiate with the providers of software as a service in ways that could improve the power of such a knowledge commons as I sketched out here.

Anyway … In those areas I’ve identified there must be lots of other good ideas. Any ideas? And what other areas should we be looking at?

 

 

 

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6 Responses to What things shouldn’t we be wasting this crisis on?

  1. Kien Choong says:

    If this crisis leads us as a community (including as individuals and the government) to instil good hygiene (e.g., washing hands regularly) and other measures, we might even save lives by reducing flu infection rates (including the common cold).

    I suggest the following measures (just examples):

    (a) make it compulsory for all public places to have accessible hand-washing facilities, including the lobbies of 5 star hotels. It should be much much easier (and common) for people to wash their hands without going to a toilet.

    (b) prohibit people from going to work if they feel unwell, and prohibit employers from cutting pay if people work from home for a few days (even if they are less productive) because they feel unwell.

    (c) prohibit people from boarding planes if they feel unwell, and require incoming travellers to declare go into self-quarantine (say for 7 days) if one of their fellow passengers report feeling unwell.

    (d) require international visitors to download an app that tracks their movements for (say) 21 days, and have legislation requiring the data to be destroyed after (say) 3 months.

    We should also anticipate that the world will experience a Covid-19 type virus mutation every 15 years or so. Governments, central banks, institutions, businesses, NGOs should assume that such mutations will happen regularly.

  2. JJ says:

    Totally agree about citizen and creative knowledge commons involvement and about trying to respond to strategic changes (it’s not as if we haven’t been warned about pandemic risk). However our problems in Government run very very deep indeed. We will need to maximise change at a political level to cement cultural changes – otherwise the old patterns will remain. For example…..

    The political effects of social media have driven change in Government behaviour to paradoxically but logically avoid engagement by bureaucrats with social media (and Government to become ever more top down and consultant driven).

    It appears to me as an ex-bureaucrat that the discussions about covid risk on Twitter are of a very high level and generally transparent (providing you follow the right people of course). The opposite is true in Government. Governments currently reflexively employ the same large consultants.

    I’ve just discovered the Commonwealth Government’s health analytics contract (just expanded) is with a firm that has as a principal, the same person who was a principal for consultants who undertook modelling in the department I was. Our excellent in-house statisticians said the modelling was flawed and could not be fixed. We could only informally say it because the Secretary had engaged the ‘modellers’. The ‘modelling’ went on. Then the next Secretary engaged the same firm, with what appeared to be similar issues. (The current modelling may be of high quality – we just don’t know as it’s secret).

    No idea how you drive and cement changes unfortunately.

  3. Kien says:

    This may be off-topic (apologies), but here’s an idea for putting the economy on hibernation so it can be “woken up” with as little damage as possible:

    (a) pay everyone a basic income during hibernation;
    (b) subject to (c), suspend all pre-existing contractual obligations during hibernation including:
    (i) interest on loans, dividends (which are discretionary anyway), rent;
    (ii) wages;
    (iii) performance obligations (unless deemed “essential”) including by employees, contractors, business;
    (c) allow firms and individuals to form new contractual obligations that apply only for so long as hibernation continues;
    (d) once the hibernation is lifted, pre-existing contractual obligations will resume and contractual obligations made during hibernation will be subsumed into the pre-existing contractual obligations or extinguished altogether;
    (e) taxes don’t apply to any income earned or goods/services consumed during hibernation.

    Under the hibernation arrangements, workers will have job security; once hibernation is lifted, employees can resume their work. The same applies (as far as feasible) to firms. Qantas would not have to pay rent/interest on its planes during the hibernation period. Restaurants don’t have to pay rent or wages to staff. Banks don’t have to pay staff during the hibernation period. Owners of capital will not have any income, labour has no income, everyone just relies on the universal basic income.

    It’s as if hibernation is a period that “never happened”; when courts adjudicate disputes post-hibernation, they are to ignore anything that happens during hibernation.

    Is this feasible??

  4. Andrew Farran says:

    Hi Nicholas
    Your lengthy article discussed various approaches to finding medical remedies against the virus, but you did touch on jurisdictional issues between the Commonwealth and the States in that regard and pandemics generally.
    The following item of mine outlines some of the jurisdictional issues Involved.

    https://johnmenadue.com/andrew-farran-a-new-constitutional-health-power-for-the-commonwealth/

  5. Chris Borthwick says:

    Some obvious changes that are happening now that give some guidance for the future are
    a) homelessness; rough sleepers have been cleaned off the streets and put into hotels.
    b) prisons; they’re getting around to releasing anybody who’s in on a trivial charge or a short sentence.
    What we really need right now today is for researchers to be sicced on to these changes so that when we go back we have a clear perspective on the arguments for continuing them.
    On a slightly different tack, can I recruit anybody in the project of pressing the government to release asylum seekers from the detention centres now that we bloody well need the centres for coronavirus patients?

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