THR Blog   /   April 10, 2020

False Positive

How are we to respond when faced with competing uncertainties?

Eric B. Schnurer

( President Gerald Ford receiving a swine flu inoculation from the White House physician, October 14, 1976; David Hume Kennerly, Gerald Ford Presidential Library; Wikimedia Commons.)

“You have swine flu,” my wife said to me over the phone. I just laughed: I knew of swine flu as something of a fluke outbreak I vaguely recalled from thirty years earlier, mostly because we studied it in public policy school as an example of the political price of making prudent governing decisions. How could I possibly have that long-ago virus?

What I didn’t know, back in 2009, was that there indeed was a new swine flu outbreak moving into the United States from Mexico, and I had become its unwitting carrier. I’ve lived outside Philadelphia for decades but had grown up in Northern California and went home for a celebration of my high school’s fiftieth anniversary. I’d decided to stop off along the way in Los Angeles to do some business; the early morning meeting there went so well that, feeling in a good mood, I ambled over to the heart of the Mexican neighborhood in downtown LA for a breakfast burrito, since you really don’t get authentic Mexican back East.

The next morning, as I sat on the runway waiting for my plane to take off for San Francisco, I noticed a strange tickle deep in my throat and an odd feeling of congestion: Too little sleep, too much travel, or the like, I thought, and didn’t pay too much attention to it. By the time I reached my old high school a few hours later, however, I was feeling oddly fatigued. A deepening sense of congestion moved lower into my lungs throughout the evening so that, midway through the gala dinner, I felt the need to take leave of the many friends I hadn’t seen in years and get to bed early.

I barely slept from the pressure in my ears and chest but felt obliged to attend a gathering I’d organized for old classmates, as back in the good old days, out at Stinson Beach. My eyes were burning and I spent most of the day lying on the sand being kidded about how terrible I looked. I had planned to spend the evening at a friend’s house near the airport, but by then I was feeling so depleted—must be a bad cold—that I realized I needed a quiet, comfortable room for a good night’s sleep and so, after a quick meal of Chinese takeout at my friend’s, I checked into a motel across from the airport and fell asleep.

When I awoke the next morning, I immediately recognized there was no way I was making my early flight, fell back to sleep, and eventually called my wife late in the morning to tell her I would be returning on a later arrival because I’d felt so terrible. The previous several days had been a whirlwind of meetings, flights, celebrations, and reunions with old friends, so I hadn’t seen or heard a shred of news. When she asked me to describe my symptoms, I was totally surprised to hear her swine-flu diagnosis. I flipped on the TV and, all of sudden, it began to make sense.

I made my way to the nearest emergency room. I could barely stay upright or awake until I was seen about an hour later. When I claimed to have swine flu, the hospital personnel rolled their eyes—just another panicked news-consumer, they assumed. They almost grudgingly swabbed my throat, but when they re-entered my exam room a half-hour later wearing helmets and hazmat suits, I responded drily, “I guess you believe me.”

Despite that, I was told to go home and self-quarantine. I pointed out that “home” was actually 3,000 miles away; they told me not to get on a plane and infect others. 

Of course, that left me homeless and with a serious illness—but that wasn’t the hospital’s problem. I had to plead with the motel I had slept at the night before to let me stay for another week; after other guests found out and complained to the management when I left my room (wearing a mask) to get some food, I was told I’d be evicted if I ever set foot outside the room again. I had to subsist for the next week on only take-out pizza delivered to my room and left outside my door, as if I were The Man in the Iron Mask. 

I later learned that I was the first swine flu patient diagnosed in Northern California, having accelerated the disease’s travels by flying north from LA to the Bay Area. The friend with whom I’d shared Chinese takeout came down with an even worse case than I had and took months to recover; fortunately, she’s forgiven me (I think). No-one else from the reunion or beach party came down with it, to my knowledge, but slightly more than 100 Californians did—many undoubtedly from my breakfast burrito.

My brush with swine flu gave me a first-hand look at how cruel our health care “system” can be to those who, through a stroke of bad luck, can find themselves without any other proverbial place to go. It showed me how interconnected our own health is to that of others, even those we don’t know. It also gave me a sudden insight into how, despite the current happy-talk about all of us coming together under the (mild) duress of home confinement, people’s instinct for self-preservation can cause them—like the other guests at the motel where I was confined—to act with cruel disregard for others under not-much-less-mild provocation. It is because of such things—the need sometimes for systemic and societal responses, for the ability to look beyond short-term self-interests and lead all of us together to better outcomes than we would achieve acting on our own—that we have, in the best of times, governments and leaders that utilize all we have learned over the centuries from the sciences, social sciences, and even the science of government decision-making, to help make the best decisions for (and by) all of us, together.

Until then, swine flu’s significance to me was, in fact, that it underlay perhaps the most memorable case study in the core curriculum at the Kennedy School of Government when I studied there. In that case, President Gerald Ford’s handling of the 1976 swine flu outbreak served as an example of decision-making under uncertainty; having since served in many positions in government, including as a gubernatorial chief-of-staff, and frequently teaching policymaking at various universities, I can tell you that most government decision-making consists of decision-making under uncertainty. 

In the case of the 1976 outbreak, Ford was faced with two competing uncertainties, one more so than the other: If Ford ordered widespread vaccination to contain the virus’s spread, the vaccine developed for swine flu could be predicted to cause a certain number of bad reactions, including deaths, although the exact morbidity and mortality rates were disputed. On the other hand, if Ford let the virus take its course it could claim many times more victims—or it might be nowhere near as dangerous as scientists conjectured and just fizzle out. The main lesson of the case study was that prudent government decision-makers almost always err on what might be called the side of caution, or, more accurately, the side of false positives—wagering that it’s better to be overprotective of their citizens, and take heat for the resulting downsides, than to try to avoid the short-team heat and risk far worse fallout for far more people (and, incidentally, for themselves politically). 

Ford made the prudent decision to call for vaccination of all Americans—but the swine flu outbreak turned out not to be as virulent as projected, while many died from the vaccines during flu season, right before the election. Ford narrowly lost the presidency weeks later, for various reasons, but anger over his swine flu decision—a bad bet for him but the correct decision for the country—cannot be discounted as among them.

I’ve never met an elected official who wouldn’t make the same call. But then, I’ve never met Donald Trump.

President Trump credits himself—and is equally credited by his supporterswith a keen strategic sense so uncanny that others cannot grasp it, at least until its implications become obvious. Such behavior is consonant with the rhetoric deployed by authoritarian theorists to support the notion that the gut instincts of the true leader are both the synthesis of the inchoate thoughts and desires of the Volk—and thus authentic and pure—and simultaneously superior to the thoughts or reasoning of other beings, especially intellectuals and experts.

President Trump’s response to the challenges of the current pandemic is, then, not purely situational but rather representative of the entire worldview he brings to all issues of governing—a worldview that is strongly embraced by his supporters. It is not simply a matter, as some detractors paint it, of valuing business profits over people. It is, rather, a wholesale rejection of the reality in which the rest of us live, a conviction that simply being positive of one’s own falsehoods will make them true, that experts are, by virtue of their expertise, wrong and that evidence contradicting one’s preferences—in this case pointing to massive morbidity and mortality—is just one big false-positive. No responsible leader, of course, would take such gambles.

In the face of mounting evidence that as many as a quarter-million Americans will die even if 100 percent of us observe social distancing for the virus’s duration—and untold thousands more if we don’t—Trump relented. His supporters, inured to factual argument by now, insist he must have been duped by the continuing Deep State conspiracy, but Trump’s false positivism was too costly even for him. 

Reality eventually prevails; the only question is how costly we make it for ourselves.