"Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate."
Michael O. Leavitt, U.S. Secretary of Health and Human Services, 2007
Learn it. Internalize it. We are about to learn what it means in a big way.
I was there for it when he said it. And if a conservative Utahn (Mike Leavitt) and a liberal blogger could share a table then, it can be done now. From a 6 foot distance, for less than 10 minutes, preferably virtually.
Peter Wehner/Atlantic:
The Trump Presidency Is Over
It has taken a good deal longer than it should have, but Americans have now seen the con man behind the curtain.
It took until the second half of Trump’s first term, but the crisis has arrived in the form of the coronavirus pandemic, and it’s hard to name a president who has been as overwhelmed by a crisis as the coronavirus has overwhelmed Donald Trump….
The nation is recognizing this, treating him as a bystander “as school superintendents, sports commissioners, college presidents, governors and business owners across the country take it upon themselves to shut down much of American life without clear guidance from the president,” in the words of Peter Baker and Maggie Haberman of The New York Times.
Donald Trump is shrinking before our eyes.
Gregory Mankiw:
Thoughts on the Pandemic
Several reporters have emailed me, asking my thoughts about the current economic situation in light of the ongoing pandemic. Here they are, in abbreviated form:
- A recession is likely and perhaps optimal (not in the sense of desirable but in the sense of the best we can do under the circumstances).
- Mitigating the health crisis is the first priority. Give Dr. Fauci anything he asks for.
- Fiscal policymakers should focus not on aggregate demand but on social insurance. Financial planners tell people to have six months of living expenses in an emergency fund. Sadly, many people do not. Considering the difficulty of identifying the truly needy and the problems inherent in trying to do so, sending every American a $1000 check asap would be a good start. A payroll tax cut makes little sense in this circumstance, because it does nothing for those who can't work.
- There are times to worry about the growing government debt. This is not one of them.
- Externalities abound. Helping people over their current economic difficulties may keep more people at home, reducing the spread of the virus. In other words, there are efficiency as well as equity arguments for social insurance.
- Monetary policy should focus on maintaining liquidity. The Fed's role in setting interest rates is less important than its role as the lender of last resort. If the Fed thinks that its hands are excessively tied in this regard by Dodd-Frank rules, Congress should untie them quickly.
- President Trump should shut-the-hell-up. He should defer to those who know what they are talking about. Sadly, this is unlikely to occur.
Scott Gottlieb:
THREAD: Very significant approval. Will substantially increase patient testing capacity by end of next week by tens of thousands a day across all labs, commercial and academic. Will take time for labs to stand up these platforms; should roll out next week.
New Coronavirus Test 10 Times Faster Is FDA Approved
By end of next week, we should be scaling up, even more in 2 weeks, but the clinicians say we can’t do it as of this writing.
Kaitlyn Tiffany/Atlantic:
The Dos and Don’ts of ‘Social Distancing’
Experts weigh in on whether you should cancel your dates, dinner parties, and gym sessions.
But what exactly does “social distancing” look like for a woman trying to go about her life while staying healthy and helping keep the people around her healthy? Even detailed instructions are difficult to sift for actionable advice. If I have a fourth date tonight, do I go? If I’m invited to a wedding in two weeks in another state, is it too late to cancel? If we’re on lockdown, and I live alone, can I walk to my friend’s apartment when I feel sad? If I end up officially quarantined, can I walk around the park at night for some fresh air?
The CDC guidelines acknowledge factors like the size of a community, its population density, its access to health care, and caveats that social-distancing measures can “be scaled up or down depending on the evolving local situation.” There are conflicting messages coming from media and people’s peers: On Reddit, young people are signing a “self-quarantine manifesto” while, at a press conference, the mayor of New York City is telling people to continue visiting bars and restaurants as normal, to protect the local economy.
So I took my personal questions to a series of public-health experts. “I think it’s a hard time because many of the recommendations we’re making are about increasing the distance between people, but of course, being close to people is what makes life a pleasure,” Carolyn Cannuscio, the director of research at the Center for Public Health Initiatives at the University of Pennsylvania said in a phone call. “So this is going to be a very difficult time. No question.”
ProPublica:
Should I Quarantine Because of Coronavirus? It Depends on Who You Ask.
Agencies, local authorities and national governments do not agree on who should be quarantined or what that should actually look like. Here’s what we do know.
Interviews with people across six states who have been exposed to the coronavirus show that even when agencies like the CDC or local health departments have a clear standard on paper, they often fail to carry out their own policies. People say agencies are giving wildly different advice to those in similar circumstances. This may be appropriate, considering the varying situations in different geographic areas; some have given up on tracking down people for quarantine and begun canceling public events. But the failure to clearly explain what to do and why has led to confusion and mistrust.
Many proactive, civic-minded citizens appear to be taking matters into their own hands, deciding on their own to stay at home, frustrated, scared and anxious, while they wait on health officials to return their calls.
The lack of clear instruction, exacerbated by a paucity of tests, comes at a critical juncture, as the number of reported cases in the United States has risen above 1,000 — a considerable increase over a week ago, yet still not so many that it’s too late for the country to curb the spread of the disease, according to public health experts.
Check with the sites above (CDC, King County, NY) and cross check. Use best practice if they differ. The experts will be on the same page soon enough.
Technology Review:
These are 6 of the main differences between flu and coronavirus
Here are six differences between coronavirus and the flu:
— Coronavirus appears to spread more slowly than the flu. This is probably the biggest difference between the two. The flu has a shorter incubation period (the time it takes for an infected person to show symptoms) and a shorter serial interval (or the time between successive cases). Coronavirus’s serial interval is around five to six days, while flu’s gap between cases is more like three days, the WHO says. So flu still spreads more quickly.
— Shedding: Viral shedding is what happens when a virus has infected a host, has reproduced, and is now being released into the environment. It is what makes a patient infectious. Some people start shedding the coronavirus within two days of contracting it, and before they show symptoms, although this probably isn’t the main way it is spreading, the WHO says. (However, one non-peer-reviewed article this week also suggests that coronavirus patients are shedding huge amounts of the virus in these early stages, when they have either no symptoms or just mild ones.) The flu virus typically sheds in the first two days after symptoms start, and this can last for up to a week. But a study in the Lancet this week, which looked at patients in China, showed that survivors were still shedding the coronavirus for around 20 days (or until death). One was still shedding at 37 days, while the shortest time detected was eight days. This suggests coronavirus patients remain contagious for much longer than those with flu.
— Secondary infections. As if contracting coronavirus wasn’t bad enough, it leads to about two more secondary infections on average. The flu can sometimes cause a secondary infection, usually pneumonia, but it’s rare for a flu patient to get two infections after the flu. The WHO warned that context is key (someone who contracts coronavirus might already have been fighting another condition, for example).
If we do nothing:
Liz Specht/StatNews (no paywall for coronavirus stories):
What does the coronavirus mean for the U.S. health care system? Some simple math offers alarming answers
As of March 8, about 500 cases of Covid-19 had been diagnosed in the U.S. Given the substantial underdiagnosis at present due to limitations in testing for the coronavirus, let’s say there are 2,000 current cases, a conservative starting bet.
We can expect a doubling of cases every six days, according to several epidemiological studies. Confirmed cases may appear to rise faster (or slower) in the short term as diagnostic capabilities are ramped up (or not), but this is how fast we can expect actual new cases to rise in the absence of substantial mitigation measures.
That means we are looking at about 1 million U.S. cases by the end of April; 2 million by May 7; 4 million by May 13; and so on.
Yascha Mounk/Atlantic:
The Extraordinary Decisions Facing Italian Doctors
There are now simply too many patients for each one of them to receive adequate care.
The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”
The authors, who are medical doctors, then deduce a set of concrete recommendations for how to manage these impossible choices, including this: “It may become necessary to establish an age limit for access to intensive care.”
Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, would be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”
In addition to age, doctors and nurses are also advised to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.”
Take this seriously. Do what you need to do. Shut it down.
And late Friday:
