Lyman Stone 石來民  🦬 🦬 🦬

It's important to understand that the US had PLENTY of "state capacity" to make a serious response to COVID. Numerous Federal and state agencies knew what needed to happen, had the capacity to do it, but were stopped by politics and fears of politics.

I talked to one state agency official who *said to me*, and I'm almost quoting here "Look, yes, centralized quarantine would save lives, bail out struggling hotels, and we have the personnel and finances to do it. I just don't think we'd survive the political fallout."

It was wild being on a call where a *health official* just explicitly said to me they weren't gonna save lives because can you imagine how it would look

I've also seen several health officials be like "oh boo hoo I'm getting death threats" your job is to protect the public from lethal and actively-spreading diseases and you can't handle the hate mail!?!?

My belief is some of this is driven by the specific way CDC advises about handling epidemics. CDC's manuals correctly tell people that epidemics are social phenomena and so a public health leader's main contributions are related to public presence and information.

But the way the CDC has modelled that for many decades has been basically "try not to worry people too much." Even when they publish "worst case" forecasts like the Ebola-One-Million one, they still are always telling people "don't panic."

When in fact what should be done is telling people, "Here is the correct way to deploy that sense of impending doom you are feeling: do these things."

Furthermore, our public health officials have so deeply drunk of the idea that public health is a politically situated phenomena and they are non-neutral actors that they've forgotten that often their job is to leap screaming onto a grenade on behalf of society.

But more generally, this gets to an issue I harp on a lot. What we lack is not state capacity. What we lack is moral spine.