After a Bad Press Conference

by Glenn on May 5, 2020

On Friday, I watched a press conference about the COVID-19 crisis with Oregon Governor Kate Brown. What I understand the governor to have said is that beginning May 15, there are counties within the state where she will relax stay-at-home restrictions, but that will depend on the ability of state officials to test for the disease and track it. One might have wished for more clarity around which counties, but I understand she is dealing with an enormous time lag—we see now the effects of the decisions she made back in March and realize that the consequences of decisions she makes now won’t be known for quite a while. It’s a tough job because it’s a complicated issue.

As a church leader, I respect her authority in these matters and I am grateful that because of her quick and authoritative actions, so far Oregon appears to have avoided a major outbreak. For three days in a row, now, the total cases in Oregon have continued to go up (2,635 on Saturday, 2,680 on Sunday, and 2,759 on Monday) but the death count has remained the same—109. That’s good news. I know that she is weighing health and economic costs and I pray for wisdom for her and all of us.

What was troubling about this press conference was one of the other speakers. I’m still thinking about it, so I decided I would write about it. Dr. Dean Sidelinger, Oregon’s state health officer, spoke after the governor. If the point of a press conference is to answer questions, his contribution was an absolute failure. He raised multiple questions for me.

QUESTION NO. 1—What We Know For Certain

After acknowledging the sacrifices that Oregonians have made, Dr. Sidelinger announced [7:58],

“But the actions we took have prevented 70,000 infections here in the state, and 1,500 hospitalizations and we need to be proud of Oregonians coming together to achieve that.”

Question: How can we know how many infections and hospitalizations were prevented? I have no doubt that the governor’s action has prevented infections, but how can we truly know how many? I don’t mind a number so much as the certainty of this number. Dr. Sidelinger could have used qualifiers like “estimated” or “predicted.” But here it’s as though he has access to an alternate reality where the governor doesn’t put stay-at-home orders in place and he sees exactly how many people would have gotten sick. I don’t think I would have objected if he had said something like, “We believe the actions we took prevented as many as 70,000 infections” or “If we had not taken swift action, our models told us we could have seen 70,000 infections.” Otherwise he was confident about something he could not and should not have been confident about. He presented conjecture as fact.

The best science is based on observation. While I know there are scientific approaches to estimating things that cannot be observed, I wish Dr. Sidelinger would have acknowledged his hypotheticals and models as estimates. Otherwise he was claiming a kind of omniscience, which goes beyond the reach of science and human knowledge.

QUESTION NO. 2—On Testing “Symptoms of COVID-19”

Dr. Sidelinger explained [10:29] that “testing is key to our strategy and testing has gradually been increasing throughout the state.” Noting an increase in the capacity for testing he said,

“We . . . are now recommending to providers that if they see someone in front of them with mild symptoms of COVID-19, that they test that individual so we can identify if they have the disease or not.”

When I heard this the first time, I was very critical. When he said the “symptoms of COVID-19” it sounded to me like there were very specific symptoms related exclusively to this disease at which point I thought Why do you need to test someone for COVID-19 who has COVID-19? In other words, it came across as “someone with a mild case of COVID-19.” On re-listening, I am definitely less bothered. I’m sure he meant “that if they see someone in front of them with even mild symptoms that could be caused by COVID-19 …”, but I still believe the language was unnecessarily imprecise.

Question: Wouldn’t it be better to refer to symptoms that “could be caused by” or “could indicate COVID-19” or “COVID-19-like symptoms”? My issue is that most people who are being tested for COVID-19 are learning that they don’t have COVID-19. In an email I received yesterday, the following statistic was included:

“Of 7,053,366 coronavirus tests conducted in the United States (237,019 conducted since yesterday), 16.4 percent have come back positive.”

If we are, in fact, testing people who mostly don’t have COVID-19, why even mention that disease with those symptoms? When Dr. Sidelinger went on to list the symptoms of COVID-19, many of them sounded like the flu. Are there certain symptoms that are more concerning than others? The loss of taste and smell, for example, or lung-related issues? My understanding is that COVID-19 comes on pretty fast and that you are not aware of lung trouble until it’s often too late. Otherwise, it’s very confusing to hear about “symptoms of COVID-19” that aren’t actually symptoms of COVID-19.

QUESTION NO. 3—On Unexplained Testing Issues

Apparently, there are problems with testing but these weren’t explained very well. Dr. Sidelinger said [11:40], “we’ve worked to ensure . . . that everyone who needs a test can get a test and that we have timely results.” Well, that sounds great because if everyone who needs a test is ensured to get one, then we’re fine, right? But no, it’s “we’ve worked to ensure.” We haven’t actually done that and I’m not sure if or when we will. That’s not clear, though. And in one sentence he says “test capacity continues to increase” while immediately adding “we continue to see supply-chain shortages.” This says to me that we can process more tests than we have tests available. Even when he said those shortages “are easing up” I was left wondering how there can be an increase when there are shortages. This was really confusing. To make matters worse, he added,

“We have multiple different platforms and different machines that labs are using so we hope and we haven’t seen them all go down at once so that we know with this unified front we can move forward more comfortably together.”

Question: What is going on with testing? Are things getting better or not? Is capacity actually increasing or not? How do supply chains factor in? How often are the machines breaking down? How concerned should we be about machines going down? It sounds like they often do, but luckily not all at the same time? What isn’t he telling us? This was alarming and left as a can of worms.

QUESTION NO. 4—Actual Numbers

Dr. Sidelinger talked [12:22] about the number of tests. He said,

“The number of tests performed per week we think is about 15,000 right now is where we need to be, but that’s not the baseline forever and as more people move about and we test more people with mild symptoms that number will need to increase over the coming weeks and we feel that we have the capacity right now to do that and with our capacity with our commercial lab partners and others that we will continue to increase that capacity but we want to do so methodically and that’s why you’ve seen the evolution of our guidance.”

This part of his statement was a mess. It would be helpful to have either a reasonably precise number of tests being performed per week or be told that we can’t know for certain. But when you say you “think” 15,000 tests are being performed, it doesn’t inspire confidence in the listener. We wonder, does he know or not? If not, why not?

And why the emotional word “feel” when talking about the increased need for testing? We either have the capacity for increased testing or not. Feelings have nothing to do with it. We know this or we don’t. Some up-talking after “we feel that we have the capacity right now to do that” didn’t help, either.

Again, Dr. Sideliner refers to people with mild symptoms of COVID-19 but that includes people who don’t have COVID-19. If I understand the statistics, most of the people with mild symptoms of COVID-19 don’t have COVID-19, so maybe it’s more accurate to say “symptoms that could be caused by COVID-19.” It’s probably just a shorthand that might make sense to health professionals, but for me it’s confusing because in reality he is testing people for a disease they do not have.

Question: How many tests are being processed? It seems there are two issues—testing capacity and tests available. It seems like we need two numbers—the number of tests that are available, and the rate at which those tests can be processed. Here it’s all conflated into one goo of unknowing. And it sounds like the goal is to increase testing capacity, but that will require both increased capacity as well as more actual tests.

Beyond this, what is true and what isn’t? How in command of the facts is Dr. Sidelinger? How much actual coordination is going on? What does the Oregon Public Health Division have to do with this crisis? The problem was compounded when Dr. Sidelinger announced, “We’re going to have some of those tests set aside [for health workers and others who are in the line of fire].” I was left wondering, “When will that happen?” None of this was explained.

QUESTION NO. 5—Who and what is in control?

Dr. Sidelinger [14:27] said,

“We know that our infections will go up and we hope to be able to control that.”

Question: Who and what is in control? By saying that infections will go up, isn’t that saying that it’s out of control? Or does he mean there is an acceptable (however one would define that) increase in the number of infections before we will call it “out of control”? When he added, “. . . until we have this disease under control and that we have a virus” I think meant he was saying it’s out of control and at the end, I’m pretty sure he meant, “we have a vaccine.”

Later, during a question-and-answer time from the press [19:37], Dr. Sidelinger was asked about the testing capacity of 15,000 per week. The reporter had a two-part question: “1. What is the current testing capacity per week? and 2. How many tests are actually being conducted per week?”

Dr. Sidelinger answered,

“We currently feel that with the capacity we have we can meet the 15,000 test goal. This is amongst our Oregon state public health laboratory and the health care partners within the state. That doesn’t even count some of the larger commercial labs that we’re able to tap into for surge capacity as needed. This week we’ve done over 2,000 tests on two days and I think that’s due to the increased number of populations or the increased populations that were included in the testing guidance last week and we anticipate that will expand with the guidance that we are releasing today recommending that those with mild symptoms be tested as they seek care. So our daily testing capacity has been over 2,000 has been above a thousand and close to 1,500 every day this week so we’re nearing that 15,000 number right now.”

At this point, Governor Brown added some comments, but it was at this point I decided to leave the press conference. We had a “feel” statement again, which wasn’t that comforting. We still didn’t know how many tests were available to be given right at this moment. I consider this a non-answer, which is not to say that Dr. Sidelinger was being unresponsive, he just failed to answer what I thought was a rather stratightforward question which asked for two numbers. The fact that we received neither number was troubling.

By the way, if 1,500 is the number of tests being performed per day and there were 237,019 tests performed in a day (as per that email from yesterday), our testing represents .63% of the testing going on in The United States. I don’t know if that’s good or not. It’s just over one-half of one percent of all the tests.

*    *    *

In contrast, there was Dr. Danny Jacobs, who is the President of OHSU. He also spoke at this press conference. Here [15:19] are some of his opening remarks:

“COVID-19 has presented medical professionals, health care experts, data scientists, and social scientists with a career-defining challenge. As a society we have experienced few things as devastating as the wide-spread impact of this disease. Some have described it as a once-in-a-century event. There really is no complete rule-book for this disease.”

What a beautiful way to frame this whole thing.

What was so re-assuring about Dr. Jacobs was that he more or less explained why Governor Brown was so non-specific about how we might transition into what he called our “new normal.” Dr. Jacobs came across as a highly educated and knowledgeable man who is working with a team of people to try and deal with an enormously complicated issue. This felt very different from our state health official. Over the weekend I read this statement by Ed Yong in a brilliant article in The Atlantic:

“In a pandemic, the strongest attractor of trust shouldn’t be confidence, but the recognition of one’s limits, the tendency to point at expertise beyond one’s own, and the willingness to work as part of a whole.”

Bottom line: I trust our governor. But that trust is dependent on where she is getting her knowledge. If it’s from Dr. Dean Sideliner, I’m alarmed. If it’s from Dr. Danny Jacobs, I’m encouraged.

Some lessons from this press conference:

1. Be certain only about things of which you can be certain. Models are estimates, not reality.

2. Be precise. Many symptoms of COVID-19 are symptoms of other diseases, too.

3. If there are problems, acknowledge them. Address them if you can. But don’t allude to them and then run past them.

4. Be specific about assignments and numbers. Who is doing what? When you are asked how many, say how many, or say that you don’t know how many or estimate how many and tell us why we can’t know for sure. And when asked for two numbers, give us two numbers (or, again, tell us why we don’t or can’t know).

5. Tell us the goal and define terms. What are you trying to accomplish? If it’s a moving target, that’s fine. In other words, what do “in control” and “out-of-control” mean in the context of this outbreak?

In the midst of my annoyance at this press conference, some things did seem clear:

We need a vaccine or a cure, but that will take time.

Testing is essential for re-opening the economy. We probably need a rate better than 15,000/week.

We’re paying a price to keep the state locked down. If you are fortunate enough to have a job where you can work from home, that’s great, but how long can all of this last?

Some demographics are hurt worse than others. Older people, certain ethnic groups. This is troubling, to say the least.

*    *    *

It’s probably unknowable, but are we more good or lucky in this state? I know the governor acted pretty quickly to authorize stay-in-place orders. We’ve had just over 100 deaths due to the Coronavirus so far, while New York has several hundred a day right now.

About eight months after Nancy and I got married, we experienced our first earthquake. It was the Sierra Madre earthquake, June 28, 1991. We lived in a second-story apartment and the building started swaying back and forth and so we went to stand in the doorway like you’re supposed to. We came through it fine. We didn’t see much damage where we lived. That earthquake produced “only” tens of millions of dollars of damage, as opposed to the Northridge Earthquake a couple of years year—that was billions of dollars of damage. That one didn’t really affect us, either.

But that’s normally how disasters work. Something happens. If we’re in the way, we duck and cover. And when it’s safe, we come out and survey the damage.

This thing we are facing is breaking the rules:

1. It’s not localized anywhere. With natural disasters you’re either in the path of destruction or you’re not. And sometimes when we know it’s coming, we can get to safety. With the Coronavirus, we’re all potentially in the path of destruction. We don’t know when we’re in peril or safe.

2. It’s still happening. With normal disasters, the thing happens and then it’s over with. In the earthquake I described earlier, while there was some damage, we still went to work after the earthquake. But this pandemic is still going on. It feels like it will never end and it seems like the world is in slow motion.

3. With hurricanes and earthquakes, we can see the danger—the risk is obvious and we can see the aftermath. With this, we go outside and it’s strange, we know the world has changed but it looks the same.

4. There are so many questions that can’t be answered:
Why do some people get sick and others don’t?
How long will social restrictions go on?
How do we balance our economic needs and our health concerns?
Is the worst behind us or ahead of us?
We know about lives lost. How many lives have been saved?
And the worst question of all, “Why are there so many unanswered and unanswerable questions?”

We’ve never seen anything like this. And there’s so much we don’t know.

What I do know is that we are called to trust God and obey civil authorities. One only asks that the civil authorities inspire confidence through the things they say.

 

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