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By Douglas Moran

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About this blog: Real power doesn't reside with those who make the final decision, but with those who decide what qualifies as the viable choices. I stumbled across this insight as a teenager (in the 1960s). As a grad student, I belonged to an org...  (More)

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Is Palo Alto prepared for a Coronavirus outbreak?

Uploaded: Jan 30, 2020
No. I can confidently say this based upon earlier outbreaks -- they have repeatedly demonstrated that various failures by decision-makers and others are part of human psychology, social organization, and politics. There is irrational optimism that leads to ignoring the lessons of history, the severity of the current situation and reasonable projections of the near-term future. Emergencies are perforce infrequent events, and preparations tend to deteriorate in the interim, both physical materials and plans/procedures.

With all the travelers to the San Francisco Bay area, especially from Asia, I was surprised it wasn't one of the first places in the US to diagnose an infected person. I am encouraged that the US is responding faster than during earlier outbreaks, such as during ^SARS^ (2001-2003), ^MERS^ (2012-2013), and Ebola (2014-2016). I am also somewhat scared by what this quicker response implies about the danger of Coronavirus. While SFO is one of the ^20 airports screening for Coronavirus^, neither San Jose (SJC) or Oakland (OAK) are on the list.

Much of what is currently known about the Coronavirus is likely false, that is, it is partially true but is treated as entirely true. The portions that are wrong may lead to people being unnecessarily exposed to the disease and to people who are infected not getting timely treatment. My intent here is to encourage a healthy skepticism of the official pronouncements by presenting situations from previous outbreaks. This may also help you infer non-malicious motives when officials (inevitably) get caught in a falsehood. Also, I anticipate that there will be inquiries to the City government about what it can do now and what additionally it should be preparing for.

----You can't handle the truth!----

A consistent concern of the officials during an emergency or disaster is of public panic, and this shapes their narrative. However, research starting the 1950s has found the contrary and has been prominently publicized. So why does this belief persist? My speculation is that officials are using different criteria for "panic": That the public isn't following their directions even though that derives from the public having lost faith and confidence in officials. For example, officials, fearing panic, release false information of the category "Who are you going to believe? Me or your own lying eyes." For the public, it is rational to not follow instructions predicated on falsities, whereas officials interpret this as "panic".

----Officials have false certainty: They believe they know things that they should know/realize they don't know----

In disease outbreak after outbreak, I have seen officials repeatedly make statements that start with a disclaimer about how little is currently known about the disease, and then announce measures that fail to accommodate the uncertainties. It's as if they are clueless to the patterns of discovery during similar outbreaks.

Example: During the early days of the AIDS epidemic, the public was repeatedly told that HIV could not be transmitted by X only to be followed up by "Whoops. It is transmitted by X ." Sometimes both occurring at the same conference. Yes, this is the way that science works: hyping claims/confidence in results in order to get published and more funding, followed by "refinements" (corrections). But it is definitely not the way that public policy is supposed to work -- policy decisions involve risk-management and tradeoffs, including the knowns versus the unknowns.

Similarly during and after the ^2014-2016 Ebola epidemic in Guinea and nearby countries^. The list of ways that the virus could be transmitted expanded greatly. Initially, the virus was said to be very short-lived outside a living host, transmitting through "bodily fluids" such as blood, sweat, mucus, saliva ... Later it was discovered to be able to survive for days on many surfaces in a hospital environment, including stainless steel and protective suits (Tyvek).(foot#1)

----Lying with statistics----

Seeking to reassure the public (preventing "panic"? see above), officials produce statistics that distort reality by various means. For example, when the first case of Ebola in the US was diagnosed, a statistic was produced claiming that you had an absurdly minuscule chance of getting Ebola while in public. Turned out, the calculation was based on there being a single infectious person in Dallas ((CORRECTION: originally "New Orleans"), but treating that whole population of the US as having equal chance of getting the disease, that right, a person sitting on a Dallas bus next to an infectious person was portrayed as at the same risk as someone living in Fort Yukon Alaska (^map^).

----Absurd claims----

Another example of "reassurance" from the Ebola epidemic: We were told that you couldn't catch it from someone you were sitting next to in a plane. No explanation of why this might be true. Anyone who has traveled in "cattle-class" knows that skin-to-skin contact is often unavoidable, as is avoiding touching things that someone else has just touched. And you can get stuck next to someone who is sneezing and coughing because there is no empty seat to move to. For the common flu, the "effective range" of coughs and sneezes is about 6 feet.

Add in the estimate that 20% of contagious people were asymptomatic. Screening passengers for symptoms before boarding was a useful measure, but was no guarantee with a disease that could progress from asymptomatic to highly contagious during the time the plane was in the air, such as a flight from West Africa to the US or across the US.

----Optimism gets promoted----

Research on organizational behavior repeatedly finds that optimistic people are much more likely to be promoted than those with more realistic viewpoints. Managers like good news and those that bring it. Those who point out potential or developing problems often get dismissed with "Bring me solutions, not problems!" Cautionary tales have the expert rendering a decidedly negative assessment on a proposal that gets progressively softened as it passes up through the levels of management until it crosses over the threshold into being a positive assessment that gets transformed into an enthusiastic endorsement.

Top management may think the organization is well-prepared for an outbreak when the reverse is true. For example, well into the Ebola epidemic, a nurse who had been working with infected people in Africa flew into Newark airport. Officials wanted to play it safe by temporarily isolating/quarantining her, but there was no facility -- they had to quickly cobble together one. This at one of the US's top-20 international airports over 10 years after SARS. Unbelievable.

When a person with Ebola symptoms showed up at a Dallas hospital, he was misdiagnosed and sent home. While the intake nurse had entered into his online record that he had just arrived from West Africa, the doctor had failed to notice the comment. Reportedly, instructions/advice issued by the CDC hadn't taken this common and well-known error into account. Attaching bracelets with key information to the patients themselves was already an established practice in many -- not all -- medical facilities.

When the patient was subsequently put in treatment, two of the nurses became infected, despite being trained in the use of the bio-isolation suits. Turned out that getting safely out of the suit was very difficult and the training had missed some minor but crucial techniques. With only one active case in the US, wouldn't the CDC have sent someone with extensive experience with the suits to observe and mentor those nurses, both to help them and to see where the instructions might need to be improved? Uhh, no -- the CDC didn't.

----Scaling up has surprises----

The experience with the Ebola patient in Dallas drove home the extensive resources needed. My recollection is that when a detailed calculation was made, the estimate was that the whole of the US could provide that level of care to roughly 20 patients at a time. The US was lucky that we didn't have to test that limit. When one reads accounts of the 1918 Flu Pandemic and sees the pictures of hospital wards chock-full of patients it is very sobering.

----The predictable limitations of bureaucracies----

Bureaucracies were created to address the problems in haphazard and inefficient administration. They are intended to provide consistent treatment of known problems and to develop new procedures when previously unknown problems are discovered. There is a 2x2 matrix where the first of these is called the "known-knowns", and the second is called the "known-unknowns". The third of matrix item is the "unknown-knowns", that is, information that is known but is inaccessible, rendering it effectively unknown. For example, a web page that doesn't show up in web search. Bureaucracies tend to be good at organizing information to minimize such occurrences.

That leaves the "unknown-unknowns", that is, what you don't know (realize) that you don't know. Bureaucracies tend to handle this category very badly, typically by forcing them into known categories.

In a major disease outbreak, we need a bureaucracy to handle the scale of the problem and the scaling up. But being designed for stability and consistency inhibits its ability to rapidly evolve and to be flexible enough to handle the uncertainties from the unknowns. That's right, we need a tall, thin, short, fat man.

In response to the SARS outbreak, the 2007 emergency preparedness exercise for our area had a scenario starting with numerous concert-goers becoming infected with a highly communicable disease and then infecting others on their way home and more the next day. One part of the exercise what to distribute medication, prioritizing those most at risk. The planners from the medical community treated this like a flu shot clinic, with people lining up to receive their dose. They didn't recognize that those lines could increase the spread of the disease, by placing infectious people among the as-yet uninfected. A better scheme was pointed out by then-Chief of Police (Lynne Johnson): Curbside distribution with cars serving as isolation pods. Aside: Palo Alto didn't participate because, despite months of lead time, it was unable to be ready. This small part of the scenario was tested in a later exercise.

----Psychology: A current victim takes precedence over preventing future victims----

In the early days of the AIDS crisis in San Francisco, it was recognized that the bathhouses were a major factor in the spread of the disease. Yet closing them was fiercely resisted and the delay cost untold lives. The psychology, sociology and politics of this battle was complex and controversial, but if you are interested in the problems of quarantines, this could be an interesting variant. It is also off-topic here (to large and complex an issue).

During the Ebola epidemic, most of the medical personnel returning to the US quarantined themselves. However, there were some exceptions, most notably the nurse mentioned above. She rejected the need for quarantine and resisted it. The dominant narrative of the media was that since she had sacrificed to work in the Ebola zone, she should not be subjected to the inconvenience of the quarantine. One reporter went so far as to break the quarantine by going up to her and shaking her hand. The media's "logic" seemed to be that since there wasn't proof that she was infected, she wouldn't become infectious in the future. In effect, the media was rejecting the tradeoff that protecting the lives of the whole country from Ebola was worth the temporary inconvenience of a single individual.

A similar situation occurred after the ^Pulse Nightclub shooting in Orlando FL in 2016^. Because of the unconscionable delays by the police, some of the wounded bleed to death and the killer was given time to go back and kill others. Consequently, the local blood banks were able to provide the needed supply. Not knowing this, many people laudably rushed to donate. When gay men were rejected under the current rules, there were protests that this represented discrimination and slander. However, the CDC's period review of the donation eligibility rules had occurred very recently (months?) and had decided that although the technology for screening the blood itself had advanced considerably, it wasn't yet reliable enough to justify lifting the ban on sexually active gay men. Despite this, numerous advocates and prominent politicians -- including at least one currently seeking the Democratic Presidential nomination -- called for the ban to be immediately lifted (unnamed because I couldn't quickly find the supporting news articles).

Such is the state of our current political environment that powerful decision-makers would prioritize ^virtual signaling^ over protecting the nation's blood supply. This does not bode well.

----Summary and Disclaimer----

I am in no position to make predictions about the Coronavirus nor the current state of preparedness -- national and local -- for such a disease. My contribution here is intended to alert you to some of the relevant lessons from history so that you can be a better consumer of information about this disease. It can also provide some background for residents interested in participating in the City's emergency preparation programs and activities, but I have no contact information -- it may not yet exist.

----My other blogs on coronavirus (COVID-19)----
"Coronavirus (COVID-19): Underappreciated Unknowns & inexplicable failures", 2020-02-28.
"Preparing for COVID-19: An epidemic is not a hurricane. Panic buying harmful", 2020-03-03.
"COVID-19: Critiquing News Releases: What's missing + teachable opportunities", 2020-03-19.

1. ^Ebola Virus Lives for Days on Steel, Plastic^, MD Magazine, 2015-05-04. Reporting results from the US Centers for Disease Control and Prevention (CDC).

An ^abbreviated index by topic and chronologically^ is available.

----Boilerplate on Commenting----
The ^Guidelines^ for comments on this blog are different from those on Town Square Forums. I am attempting to foster more civility and substantive comments by deleting violations of the guidelines.

I am particularly strict about misrepresenting what others have said (me or other commenters). If I judge your comment as likely to provoke a response of "That is not what was said", do not be surprised to have it deleted. My primary goal is to avoid unnecessary and undesirable back-and-forth, but such misrepresentations also indicate that the author is unwilling/unable to participate in a meaningful, respectful conversation on the topic. A slur is not an argument. Neither are other forms of vilification of other participants.

If you behave like a ^Troll^, do not waste your time protesting when you get treated like one.
What is it worth to you?


Posted by Resident, a resident of Another Palo Alto neighborhood,
on Jan 30, 2020 at 3:34 am

Banning Lunar New Year events is not going to make any difference.

Anyone who has traveled to mainland China, or lives with someone who has, in the past 6 weeks, should self quarantine themselves as much as possible.

[[Blogger: the mention of banning Lunar New Years refers to the article "Rapid spread of coronavirus prompts local organizers to cancel Chinese New Year events" (Web Link

Posted by Resident, a resident of Midtown,
on Jan 30, 2020 at 8:25 am

I won't lie, it's way too much to read but it's interesting how you chalk it up to virtue signaling.
I think today, in response to the election of DJT, there's been a backlash of radical virtue signaling that has reached extreme proportions and is used to justify anything, and yes it's downright dangerous what the power of groupthink and peer pressure in this regard can cause.
It's like we've regressed to medieval times where the witch hunting, crusading morality of the collective sharply delineates "right" vs "wrong" even if it flies in the face of logic and a more nuanced reality. Save the climate and fight "racism" or thou shalt burn in the fires of hell!

Posted by If we were serious, a resident of Duveneck/St. Francis,
on Jan 30, 2020 at 11:01 am

If we were serious is a registered user.

If we were really serious about this not spreading to the US, we would not allow anyone who had been in China within the last two weeks to enter and medically screen anyone who had been in China in the last month.

Posted by resident, a resident of Downtown North,
on Jan 30, 2020 at 2:08 pm

Doctors say that California residents are far more likely to die from the flu than from this virus. [[Blogger: deleted. Standard troll attributing anything to racism.]]

Posted by Scotty, a resident of Green Acres,
on Jan 30, 2020 at 3:00 pm

Scotty is a registered user.

Resident--Paranoia, definitely. Selling fear, absolutely. Racism, not so much. Perhaps more of a resentment against eating domesticated animals.

Posted by Douglas Moran, a Palo Alto Online blogger,
on Jan 30, 2020 at 3:26 pm

Douglas Moran is a registered user.

> "Doctors say that California residents are far more likely to die from the flu than from this virus."

Why would you give any credibility to such doctors? They don't have the data to make such a claim because there isn't any where near statistically significant data to make a projection (except possibly in China which is covering up what it knows).
For example:
- how long before you are infected until you become infectious?
- how long before you are infected until you show symptoms? Current working guess seems to be about 20 days.
- what are the methods of transmission? Based on similar viruses, the current asssumption is it is airborn.
- fatality rate, total and for various age groups and medical conditions and ...

Update: 2019-01-30 4:09 PM

An article presenting this claim: Why we panic about coronavirus, but not the flu.

Notice the flaws in the logic:
Flu cases - reporting is fairly reliable
Coronavirus - cases that have been identified and admitted.

Flu season started early in the US, so stats cover a much longer time period.
Coronovirus - identification and spread just starting.

A more accurate title would have been
"For someone in the US who as died since Aug 2019, the flu is a much more likely cause than Coronavirus"
But then, who would have read the article?

Posted by Douglas Moran, a Palo Alto Online blogger,
on Jan 30, 2020 at 3:35 pm

Douglas Moran is a registered user.

> "If we were really serious about this not spreading to the US, we would not allow anyone who had been in China within the last two weeks to enter..."

This presents an interesting risk-assessment problem. Because of the Chinese government coverup, we don't know the extent or distribution of the disease within China. Does the US err on the side of caution and accept the (unknown) costs of such a travel ban or take lesser measures until more is known?
And what is the criteria for other countries that are finding cases?

Posted by Michael O., a resident of Stanford,
on Jan 30, 2020 at 4:48 pm

"Yes, this is the way that science works: hyping claims/confidence in results in order to get published and more funding, followed by "refinements" (corrections)."

Straw man argument if I ever read one, and you erase those from replies to your blog. And absurd, as it is clearly not how science works. I'm really not sure why you undermine yourself by making irrelevant and insupportable arguments. You have a lot to say. (And yes, if you delete this I will write (again) to the publisher to complain)

Posted by Douglas Moran, a Palo Alto Online blogger,
on Jan 30, 2020 at 5:26 pm

Douglas Moran is a registered user.

RE: Michael O

1. You stripped my statement of the context (the 2 lead-in sentences).

2. Are you aware of the "replication crisis" that started in Psychology and has spread to many fields?
- p-hacking.
- sample sets far too small to justify the claims.
- results that can't be reproduced by the scientist using the same equipment.
- claims of "the only" or "cannot" based upon statistics of inadequate sample sets, that is, you are unlikely to encounter a one-in-a-million event when looking at only 100. This was the context for the quoted sentence.
- over-simplication of experiments to fit the budget, without the reported results acknowledging the variables excluded.
- ...

Medical research has long been plagued by trumpeted results based on a tiny number of subjects.
The work on the replication crisis in Psychology is finding that major, long-standing results of the field cannot be reproduced or that there was significant fraud in the reporting (eg, the Stanford Prison Experiment).

Posted by Michael O. , a resident of Stanford,
on Jan 30, 2020 at 6:36 pm

I accept your reply, but it's not really what you said. You said it is how science is done. If you are aware of any scientists who hype claims in order to get publications and funding, please name them. If you have problems with how sample size misestimates the true effect of an experiment, say that. The “replication crisis" is not a crisis at all -- that's a hyped up medial narrative! -- but is instead a realization that more studies need replication before we, the public and the science community, Accor their results. What you did is make a blanket dismissal of all science, and it comes across as cynical. You can use actual data rather than innuendo and accusations to make your points. That said, wash you hands often and don't bother with a mask.

Posted by Michael O. , a resident of Stanford,
on Jan 30, 2020 at 6:37 pm

Sorry for the typos. Wrote on a phone!

Posted by Curmudgeon, a resident of Downtown North,
on Jan 30, 2020 at 9:40 pm

Let it come. We're as ready as we'll ever be.

Posted by Douglas Moran, a Palo Alto Online blogger,
on Jan 31, 2020 at 12:17 am

Douglas Moran is a registered user.

> "Sorry for the typos. Wrote on a phone!"

Commenters: If you need corrections for readability, post a comment and I can make fixes. Once I make the fixes, I will delete the comment requesting them. You can also send me an email using the link next to my photo. Warning: the email headers may reveal your identity whereas using a comment preserves anonymity.

For some reason, the copy of comments I receive has a larger character set than what appears on the web page -- for example, the mdash -- and I silently make the corrections. I also correct various unambiguous misspellings when I spot them and have time.

Posted by swuzy, a resident of Charleston Meadows,
on Jan 31, 2020 at 11:25 am

swuzy is a registered user.

It is a much bigger problem than the common flu.
The US death rate from flu and pneumonia is about 0.14%.  About 30 to 40 million get the flu annually in the US, so about 42,000 to 56,000 flu deaths.
The median R rate of flu is about  1.3 (one person infects 1.3), the estimated R rate of Wuhan flu is 2.6 (one person infects 2.6).
There are vaccines for the flu and pneumonia; there are none for Wuhan flu.
The death rate from the Wuhan flu is about 2.3%.  If 30 to 50 million get it, the deaths can run 690,000 to 1,150,000.

Posted by Former PA resident, a resident of Mountain View,
on Feb 1, 2020 at 6:20 pm

Separate subtopics:

1. "I am encouraged that the US is responding faster than during earlier outbreaks. . .I am also somewhat scared by what this quicker response implies about the danger of Coronavirus."

To be a bit of a devil's advocate here: couldn't that just be evidence that those officials you cite are, after all, learning from experience with new outbreaks? Maybe combined with steadily increasing international communication bandwidths over the years mentioned?

2. 1st posted comment here makes the same mischaracterization of organizers' decisions to cancel local Lunar-New-Year events as some comments did on the Embarcadero papers' story you linked -- comments seemingly ignoring the story's content. It was the groups' own leadership that canceled those events, and with evident support from local Chinese communities. Not some imposed "ban."

3. Michael O.'s reaction on realities of how "science works" astounds me. Maybe *some* science emerges innocent of any spin from human nature, but I started learning about the cynical realities even in grad school. As a casual example, has Michael O. never once heard the (perhaps weekly) mainstream-media interviews with newsmaking scientists, who strain the limits of optimism in forecasting benefits for the average person, instead of admitting such payoffs to be highly speculative and at best far in the future? Was 1989's "cold fusion breakthrough" a straw-man case? I remember when "Interferon" became hyped everywhere (national-magazine cover stories) as a likely cure for "cancer" (itself often characterized in popular media as if it were a single disease, rather than a diverse class of disorders sharing certain properties).

Posted by Douglas Moran, a Palo Alto Online blogger,
on Feb 1, 2020 at 7:59 pm

Douglas Moran is a registered user.

> "1. ... officials you cite are, after all, learning from experience with new outbreaks?..."

My skepticism is based on limited improvements in response to the previous decades of outbreaks, I can't see anything that would overridden the inertia we saw over those decades. Recognize that the badly botched Ebola response was only a few years ago (2015).

Adding to the list in the blog were multiple episodes of concern of pandemic flu (similar to 1918) -- Bird Flu, H1N1, ...

Add to that analogous events, such as the much delayed acknowledgement of the PBB (chemical) contamination of dairy foods in Michigan in the late 1970s (I remember because I was there), and the similar delays in responding to Mad Cow disease (Bovine spongiform encephalopathy) in Britain in the 1980s -- as a consequence of my living there during part of this period, I am banned from donating blood (no non-lethal way to detect who is infected).

Similarly for hurricanes. I was in one of the hardest hit areas of 1972's Hurricane Agnes -- a disaster that caused the creation of the federal flood insurance program. Despite there having been two 100-year floods and one 500-year flood in the previous 30 years, officials were taken by surprise. The high school I had gone to had been built on a mound that kept it a few feet above flood waters, whereas the one downstream was in a low area next to a dike and flood waters reached almost to the ceiling of the chemical lab and supply room on the second floor.

Locally: Cell phone
During the day-power outage 2010 (plane crashed into transmission lines), cell phone service shutdown in 4-6 hours as the backup batteries (and generators?) were exhausted. Despite only Palo Alto being affected, the operators of the cell towers were unprepared/unwilling to remedy this. I wrote a proposal to the City to remedy this and have made periodic attempts to try to get it attention. This failure was my primary reason for dropping out of the emergency preparedness activity after more than 15 years of involvement.
Note: In a disaster, telephone service -- which for many people know is exclusively cellular -- can greatly improve the response and resilence: "If you can communicate, you can adapt." (slogan)

Posted by Former PA resident, a resident of Mountain View,
on Feb 2, 2020 at 10:46 am

Topic of shallow cell-telephony reliability is a little off your main theme, yet related, including its lessons about attitudes.

I grew up learning about phone systems from various angles. Vast US investment in "copper-wire infrastructure" since late 1800s* (with large firms enjoying "natural-monopoly" status 'til the 1980s) included gov't financial incentives to build local telephone equipment for reliability in various disasters. Part of this was that telco wiring and facilities were independent of electrical utilities except at powering points that charged the local telco central office's wet-cell battery array, which could support local calls even in extended power outages. In principle, mobile generators could extend the service indefinitely.

For cell phones (common since the 1990s), carriers focused on features and convenience, not deep reliability. As you know, in an extended power outage, the distributed cell base stations have at most a few hours' battery life (never mind your phone's own battery, that's not the real limitation). Generators are largely irrelevant since the numerous small stations each draw from local power lines. Despite preparedness advice constantly warning about this, many people don't consider reliability when giving up their unfashionable landlines (which aren't even costly, for very basic service).

Other individuals who scarcely know where they're going lately without watching a hand-held screen will be in worse trouble in power outages. Internet services depend on many things in different places all working, not just wireless communications.

*Also an unsung enabler of 20th-cent. US industrialization. As a student I met peers from other countries, who remarked not only how bad phone communications were back home, but what a difference it made for economic opportunity. In countries that had not built (or couldn't afford) all that wired connectivity, not only was it harder for individuals to stay in touch, but also, small businesses could be stymied for lack of timely access to suppliers or whatever. The World Bank might make grants or loans for economic development in the "3rd world" and yet economic activity in the target country faced obstacles just from lack of infrastructure taken for granted in prosperous nations.

Posted by Douglas Moran, a Palo Alto Online blogger,
on Feb 6, 2020 at 12:50 am

Douglas Moran is a registered user.

I have restricted commenting to registered users because there has been too much SPAM (advertising related to HIV/AIDS and related products).
14 total; last 7 comments; 9 of the last 10.

Some people have signed up for notification of new comments and I don't want to get interrupted by SPAM comments.

Posted by Curmudgeon, a resident of Downtown North,
on Feb 14, 2020 at 7:33 pm

Curmudgeon is a registered user.

" [snip] the operators of the cell towers were unprepared/unwilling to remedy this [outage due to depowered cell nodes]. I wrote a proposal to the City to remedy this and have made periodic attempts to try to get it attention."

Not sure what cell service has to do with CV, but I'll follow your lead. Can you post a link to your proposal and the response to it?

Also, this seems like an opportunity for Tesla's battery backup technology. Are you reading this, Mr. Musk?

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