A Solution Only an Economist Could Love

In an op-ed in the New York Times economist Laurence Kotlikoff and epidemiologist Michael Mina propose what they characterize as a “cheap, simple way to control the coronavirus”:

Simple at-home tests for the coronavirus, some that involve spitting into a small tube of solution, could be the key to expanding testing and impeding the spread of the pandemic. The Food and Drug Administration should encourage their development and then fast track approval.

One variety, paper-strip tests, are inexpensive and easy enough to make that Americans could test themselves every day. You’ would simply spit into a tube of saline solution and insert a small piece of paper embedded with a strip of protein. If you are infected with enough of the virus, the strip will change color within 15 minutes.

Your next step would be to self-quarantine, notify your doctor and confirm the result with a standard swab test — the polymerase chain reaction nasal swab. Confirmation would give public health officials key information on the virus’s spread and confirm that you should remain in quarantine until your daily test turned negative.

Perhaps we should acquaint the learned gentlemen with Von Moltke’s famous dictum: “No plan of operations extends with any certainty beyond the first contact with the main hostile force”. We can’t even get people to obey laws against drunk driving or illegal drug use. We can’t get people to wear facemasks or observe social distancing voluntarily. The key word in “cost effective” is “effective” and such a plan requires 100% compliance to be effective.

Accepting their estimate of $1/day the cost of such a plan would cost $120 billion per year. That’s $120 billion that wouldn’t be spent on education, highways, or other health care and in the absence of 100% compliance it would be useless.

I could come up with plans to improve compliance but every single one would be so costly whether in money or time as to be impractical.

That’s why I have been perseverating on the need for rigorous epidemiological testing. Regular mandatory testing of a sample of people rather than testing everybody every day. We should apply resources where they are needed rather than dreaming about 100% compliance.

1 comment

Record-Breaking?

The Fourth of July weekend tends to be one of the most violent of the year in Chicago. In 2019 7 were killed and 69 wounded over the Fourth of July Weekend. So far this weekend one has been killed and three wounded. In 2017 the tally was 15 killed, 89 wounded. Does anyone are to bet that this weekend will break 2017’s record?

2 comments

Exceeding Their Powers

In a similar vein I question the authority of the states to regulate travel from other states. I’m not even going to both to find a link but several of the states, notably New York, are imposing restrictions on travel which I believe are beyond their authority. The reason? Section I, Article 8, Clause 3 of the U. S. Constitution: the Commerce Clause. That and numerous subsequent court decisions confirm that the federal government has sole authority to regulate travel between the states and there is no exigent circumstances exception to that.

Once someone had traveled from one state to another, I agree that the state governments have the authority to place individuals under involuntary quarantine but I don’t believe that they have the authority to require people undergo voluntary quarantine as a condition for entering the state. To obtain that power they should appeal to the Congress. I doubt they would get it but the Congress might start limiting domestic travel itself. That should be popular.

2 comments

Not Kings

One of the major news items hereabouts is a recent state court decision. The Chicago Tribune reports:

A southern Illinois judge on Thursday declared void Gov. J.B. Pritzker’s orders aimed at slowing the spread of the new coronavirus, saying state law doesn’t allow governors to extend disaster proclamations beyond 30 days or restrict the activities of residents and businesses by executive order.

Pritzker first declared a statewide disaster because of COVID-19 on March 9 and has issued extensions every 30 days. Those proclamations have been the legal basis for the governor’s stay-at-home order and restrictions in each phase of his “Restore Illinois” reopening plan.

The immediate implications of Clay County Circuit Judge Michael McHaney’s order, which stemmed from a lawsuit filed by state Rep. Darren Bailey, were not clear.

The state is in the fourth phase of Pritzker’s reopening plan, which includes a number of restrictions, such as a limit on crowd sizes and stricter regulations on businesses.

“That’s gone as we stand here right now,” said Bailey’s attorney, Thomas DeVore.

The Illinois attorney general’s office, which is expected to appeal, had no immediate comment.

The mystery in this is that the governor hasn’t appealed to the state legislature to amend the law that grants him 30 day emergency authority. I’ve cited it here before and it could hardly be clearer. There’s really no ambiguity. 30 days and that’s it.

But the Illinois legislature, both houses of which have Democratic majorities, would undoubtedly grant the governor just about any powers he request to deal with COVID-19. Why they haven’t acted is a mystery to me.

3 comments

Does It Or Doesn’t It?

The Henry Ford Health System is an organization of six hospitals, nine emergency rooms, 40 general medical centers, and seven specialized medical facilities. It is a major provider of health care in the Detroit Metro area. The Detroit News reports on a study in the system that is sure to cause some controversy:

A Henry Ford Health System study shows the controversial anti-malaria drug hydroxychloroquine helps lower the death rate of COVID-19 patients, the Detroit-based health system said Thursday.

Officials with the Michigan health system said the study found the drug “significantly” decreased the death rate of patients involved in the analysis.

The study analyzed 2,541 patients hospitalized among the system’s six hospitals between March 10 and May 2 and found 13% of those treated with hydroxychloroquine died while 26% of those who did not receive the drug died.

Among all patients in the study, there was an overall in-hospital mortality rate of 18%, and many who died had underlying conditions that put them at greater risk, according to Henry Ford Health System. Globally, the mortality rate for hospitalized patients is between 10% and 30%, and it’s 58% among those in the intensive care unit or on a ventilator.

“As doctors and scientists, we look to the data for insight,” said Steven Kalkanis, CEO of the Henry Ford Medical Group. “And the data here is clear that there was a benefit to using the drug as a treatment for sick, hospitalized patients.”

Could the difference between this finding and those of other studies that found no benefit be the race of those being treated? Or could it be due to the timing of receiving the drug?

Patients with a median age of 64 were among those analyzed, with 51% men and 56% African American. Roughly 82% of the patients began receiving hydroxychloroquine within 24 hours and 91% within 48 hours, a factor Dr. Marcus Zervos identified as a potential key to the medication’s success.

As noted above this finding is sure to provoke comment, given the other studies finding the opposite and the politicization of the drug.

5 comments

Happy Birthday, Olivia!

I missed this. Yesterday was Olivia DeHavilland’s 104th birthday. Happy Birthday, Olivia!

0 comments

What Credibility?

In an op-ed in the Wall Street Journal physician Joseph A. Ladapo admonishes politicians and “medical experts” that the politicization of the response to COVID-19 impairs their credibility:

Political leaders and health officials have often invoked “science” to justify decisions manifestly guided by their personal preferences. That costs them credibility. Restoring public confidence will require acknowledging their role in politicizing the pandemic, yielding to accommodations and sensible alternatives in the areas of greatest controversy, and focusing on the widely supported goal of not overwhelming hospitals, rather than less meaningful metrics such as increases in Covid-19 cases.

Recommending to politicians that they not politicize is like telling fish not to swim or birds not to fly. And credibility? For anyone who really cared there isn’t a single politician holding on to a shred of credibility in the entire country. What does credibility matter when you have a “safe seat”?

He advises:

If political leaders and health experts want to restore their credibility and the public’s confidence, they need to begin by acknowledging that politics rather than science has influenced important public-health decisions and by making accommodations for dissenting perspectives. Alternatives to masks, for instance, include physical distancing and using face shields while indoors.

And while there is more to learn about immunity, there has not been a single confirmed case of reinfection among the 10 million cases of Covid-19 world-wide, according to a May report in the Journal of the American Medical Association. Until the data say otherwise, people who have recovered from Covid-19 should be exempt from restrictions.

The most important step political leaders and health officials can take is to base their decisions on hospital capacity, rather than case counts, which inevitably will continue to increase among low-risk young people. Policing of social distance and restrictions on personal, educational and business activities are fueling culture wars. Focusing on the goal of not overwhelming hospitals is sensible and less vulnerable to politicization—so long as the data are publicly available for independent analysis. Hospitals often run near capacity to maximize profits, so the promises made during shutdowns to increase capacity need to be fulfilled—or capacity will become a political weapon.

Since citizens are already opting out of high-risk activities they want to avoid, let them enter bars, enjoy the beach, exercise at the gym, and learn in school if they choose. The government should intervene with mandates and closures only if regional hospital capacity requires it, while being transparent about bed availability, illness severity of hospitalized patients, and efforts to increase treatment capacity, including the supply of promising medications such as remdesivir and dexamethasone.

Here in Illinois only 10% of ICU beds are presently occupied by patients with COVID-19. In Chicago I suspect that more ICU beds are occupied by gunshot victims than people with COVID-19.

8 comments

The Inevitable

Both the editors of the Washington Post and the Wall Street Journal are outraged by Beijing’s overnight end of its “one country two systems” policy with respect to Hong Kong. From the WaPo:

HONG KONG as it has been known — a bastion of free speech and rule of law, an autonomous, glittering capital of capitalism — has been smothered. Overnight, China has imposed a new national security law of six chapters and 66 articles that will criminalize dissent and install a system of secret police, putting the territory under the same authoritarian boot as the mainland. President Trump has been signaling for a long time that he would not stand up for human rights and democracy in Hong Kong. Perhaps not surprisingly, China acted with brusque indifference to protests from the West.

The law was passed in secret by the Standing Committee of the National People’s Congress in Beijing and signed by President Xi Jinping before people in Hong Kong had even seen the text.

and the WSJ:

China’s decision to impose its national-security law on Hong Kong is a seismic event that goes well beyond the sad fate of its 7.5 million people. The illegal takeover shows that Beijing’s Communist rulers are willing to violate their international commitments with impunity as they spread their authoritarian model.

We say this with regret because we were among those who hoped, amid China’s reform era that began in the 1980s, that the Middle Kingdom could be drawn into a world of peaceful global norms. Hong Kong, a showcase of the prosperity that economic freedom and the rule of law can produce, was a lesson for Beijing to learn from.

What astonishes me is that they could possibly imagine it might have been otherwise. As I have been saying for decades, China is irredentist. The CCP maintains its hold on power through force and repression. There is no international accord to which China is a signatory that it has not violated.

5 comments

They’ve All Failed

I agree with the caption on the editors’ of the Washington Post’s latest editorial: “Americans sacrificed to flatten the curve. Their leaders have let them down.” I have reservations about just about everything else in the editorial. I’m afraid that Captain Bezos’s obsession with killing the Great Orange Whale is clouding the editors’ critical faculties. I’m going to try my best not to fisk the editorial and instead just concentrate on a few highlights.

First, the elephant in the room. There is one action that could have saved the lives of hundreds of thousands of people and that action could only have been taken by one person: Chinese President Xi. If China had suspended travel in or out of the country early enough in their COVID-19 outbreak, it might have saved the lives of the Italians, Spaniards, Americans, Brazilians, and others who’ve died of the disease. If he hadn’t suppressed the information that the disease was being contracted via “community spread” as soon as they knew it, at the very least it would have given other countries more time to prepare for what was to come. Those lives are on his head and let’s not lose track of that in political infighting.

Now onwards to our domestic problems. There are things that President Trump was negligent in not doing:

  1. He should have suspended all international travel when he suspended travel by Chinese travelers to the U. S.
  2. He should have been much tougher with the FDA and CDC. After they’d had two weeks to futz around, producing a test should have been opened to the private sector.
  3. He should have used his authority under the Defense Production Act for masks, ventilators, and tests.
  4. He should have directed the CDC to come up with a nationwide epidemiological testing plan and put it into action. That should have happened a month ago.

All of those could have been done without a declaration of martial law under legal authority the president already has. Whether presidents should have that authority is a question for another post.

Back to the editorial. I think this is mistaken:

Experts have identified the best strategy: test, to find out who is sick; trace, to find out who may be sick; and isolate those who are suffering. Personal habits must accompany this: wearing face masks, hand washing, physical distancing and avoiding crowds in enclosed spaces.

The strategy worked in nations that pursued it with conviction, such as South Korea and Germany.

What the actual experts on the front lines have been doing is testing to confirm those who are sick and treating them. That’s no national epidemiological plan. Some states have began their own epidemiological testing plans but that’s inadequate.

Additionally, a better diction would be “The strategy worked in strongly cohesive countries with high levels of compliance but, unfortunately, the U. S. is not such a country.” Furthermore, are we actually sure that South Korea has faced the same strain of the virus we have? I do not trust anything coming out of China these days but the Chinese have claimed that the strain they’re seeing now is not the same one they were facing back in January.

The “Test—Trace—Isolate” strategy is not the only one. I’m skeptical that contact tracing would be practicable under our circumstances. How about Portugal’s strategy of isolating the most vulnerable from the very outset? It appears to have been quite successful: their mortality rate is lower than any of their neighbors.

Finally, nowhere do the editors mention the gross negligence on the part of state and local officials that have led to the loss of so many jobs and the deaths of so many of those in “nursing homes”. There is plenty of blame to spread around.

It also should be mentioned that regardless of all of the breastbeating the mortality rates per million population in California, Texas, and Florida remain tiny fractions of those in the Washington-Boston corridor.

7 comments

Some Sort of Record

Eight members of the Toledo City Council have not been arrested for accepting bribes. ABC Toledo reports:

TOLEDO (WTVG) – Four members of the Toledo City Council have been accused of accepting bribes while in office, according to court documents obtained by 13abc on Tuesday. At least three of those council members have been placed into federal custody. 13abc crews were on the scene as council members Larry Sykes and Yvonne Harper were placed into custody. Federal documents also implicate council members Gary Johnson and Tyrone Riley.

According to a criminal complaint filed with the U.S. District Court, Councilman Sykes faces complaints of “Reciept of Bribe by Agent of Organization Receiving Federal Funds” and “Hobbs Act Extortion Under Color of Official Right.” In the affidavit filed along with the complaint, council members Harper, Riley, and Jonson are also named as subjects.

I wonder if Chicago would fare as well.

2 comments