For Want of a Horseshoe Nail

For the want of a nail the shoe was lost,
For the want of a shoe the horse was lost,
For the want of a horse the rider was lost,
For the want of a rider the battle was lost,
For the want of a battle the kingdom was lost,
And all for the want of a horseshoe-nail.

I agree with the point that Joe Nocera makes in his piece at Bloomberg. Donald Trump has been remiss in not increasing the availability of Personal Protective Agreement (PPE) enough:

Hospitals now routinely reuse masks that are supposed to be discarded after one use. Nitrile gloves, which are primarily made in Malaysia, Vietnam and Thailand, have become almost impossible to get. (It didn’t help that Malaysia, where 75% of the gloves are manufactured, was in lockdown recently.) By early next year, needles are going to be scarce, according to supply-chain experts I’ve spoken to.

And that was before the recent spike in Covid-19 cases and hospitalizations. When I asked Marc Schessel what was in short supply now that daily positive cases in the U.S. were regularly topping 100,000, he replied, “Masks, gowns, all of it. It’s going to be a real [expletive] very soon — much worse than Round One.”

Schessel should know. He is the founder and chief executive officer of SCWorx Corp., a company that provides supply-chain management software for the hospital industry. When it first became clear that the PPE supply chain was breaking down, hundreds of hospitals asked him to see if he could source protective equipment. He turned over much of his day-to-day duties at his company to other executives to focus on finding PPE.

Over the last nine months, Schessel has seen it all. Early on, he saw hospitals lose millions of dollars by naively making “down payments” for PPE that was being dangled by fraudsters. He watched deals for millions of masks — deals he thought he had locked down — vanish at the last minute. Warehouses that were supposed to be filled with N95 masks turned out to be empty. He’s seen hedge funds flip shipments of PPE as if they were oil futures, driving up the price as they bought and sold. Sometimes, legitimate PPE orders from abroad got delayed by Food and Drug Administration problems. Most of the PPE he could get his hands on cost three, four or five times their pre-pandemic price. And on and on.

and correcting that problem should be a high priority for the incoming Biden Administration. He proposes

  • Using the Defense Production Act to “take over” PPE sourcing and distribution
  • Getting FEMA to “create new supply chains”
  • Getting the Defense Logistics Agency to distribute PPE
  • Forbid trading by hedge funds (?)
  • Again using the DPA command companies to start manufacturing PPE

Ignoring the legal problems with his plan which are formidable, I think he’s drastically underestimating the scope of the problem. Supply chains work like that little verse at the top of this post and you can’t just wave them into existence. Each step must be present.

Although the U. S. still produces a lot of the world’s cotton, just to pick one example, step by step we have been getting out of the cotton processing business for decades. We no longer have the gins or spinners or looms for making yarn or cloth. Most of the clothing manufacturers have left, too. We no longer make the gins or spinners or looms or sewing machines. We don’t mine the metal or produce the other materials for making them. We don’t have the people with the diverse skills.

That can all be remedied but don’t underestimate the vast amount of industrial subsidies, time, and attention that will be required. What we have learned over the last eight months is that we can’t afford to specialize as much as we have been and, in particular, we can’t specialize in consumption.

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You Can’t Step in the Same River Twice

Walter Russell Mead makes a good point in his most recent Wall Street Journal column—the situation in the Middle East has changed quite a bit in the four years since Barack Obama left office:

Even in the closing weeks of America’s presidential campaign, the grisly murder of French schoolteacher Samuel Paty made an impression. As part of a civics lesson, Mr. Paty showed his class of 13-year-olds the Charlie Hebdo caricatures of the prophet Muhammad. Soon afterward, Mr. Paty was attacked and beheaded in the street. President Emmanuel Macron, whose government has been moving right on law and order as the electoral competition with Marine Le Pen of the National Rally heats up, announced a series of measures aimed at limiting what he called “Islamist separatism.”

The reaction from Muslim religious and political leaders around the world ranged from supportive (the United Arab Emirates and some imams) to perfunctory (Kuwait and Saudi Arabia) to sulfurous, with Malaysian former Prime Minister Mahathir Mohamad helpfully tweeting that Muslims had the right to kill “millions of French people” in retribution for French colonialism.

But the most significant reaction came from Turkish President Recep Tayyip Erdogan, whose country is embroiled in confrontations with France in the Eastern Mediterranean. “Macron needs mental treatment,” Mr. Erdogan said, calling for a Turkish boycott against French products. “What is the problem of this person Macron with Muslims and Islam?”

That a controversy over Islamism should turn into a diplomatic standoff between Turkey and France highlights the dramatic changes in the Middle East and the Mediterranean that the incoming Biden administration will have to address. Since the Democrats were last in office, Saudi Arabia has begun to disengage from the business of supporting radical Islamism, and Turkey and Qatar have picked up the fallen banner. When Europeans these days talk about foreign funding for radical preachers, Turkey is often the source. And when Gulf Arabs like the Emiratis talk about the danger of radical Islamist regimes, they worry more about Turkey even than Iran.

The point here is that the Biden Administration may be confronted with a stark alternative. Either abandon any notion of reopening negotiations with Iran or let long-standing allies hang out to dry so they can start cuddling up to dictators which is much what they’ve been accusing Donald Trump of doing.

Yet more evidence for the point I’ve been making. Erdogan’s Islamist Turkey is not the same country as the secularist Kemalist Turkey that was one of the founding members of NATO. My own view is that while we may have clients in the Middle East we have no allies there in any but a notional sense and are unlikely to get any. He who sups with the devil should use a long spoon.

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Guarded Optimism

The editors of the Washington Post are guardedly optimistic about Pfizer’s announcement I mentioned yesterday:

The companies have a large Phase 3 clinical trial underway with 43,538 volunteers, and the announcement was based only on preliminary results. But should it hold up, the significance is that one of the most promising and new technologies does work at preventing infection. That may well mean that other vaccines will also work, that we can banish from our thoughts the worst-case scenario of “no vaccine,” and that the world will find a way out of a disease that has already taken 1.2 million lives.

but they caution:

Mr. Biden has properly addressed the persistent shortages in diagnostic testing, personal protective equipment and other issues, and on Monday he implored Americans to wear a mask, one of the most vital mitigations. But these are not going to be enough. The nation faces a massive, surging wave of infection into a population dangerously fatigued and complacent. Until the vaccine arrives, the pandemic demands a far more vigorous response. We hope Mr. Biden continues to work on it as he waits to take the reins.

I think they’re getting a bit ahead of themselves and they’re making the same mistake I have cautioned against with respect to Pfizer’s announcement. A few speeches, policy statements, and appointing a blue ribbon panel do not of themselves increase the amount diagnostic testing, PPE, and so on.

I thought for one brief glorious moment that Megan McArdle was actually going to commit journalism in her latest WaPo column. I was disappointed but she does point out some of the limitations in Pfizer’s announcement:

Keep in mind, however, that mass inoculation will be a massive headache. Earlier vaccination programs against childhood illnesses could rely on widespread immunity among adults and focus somewhat narrowly on kids, or adults who hadn’t had the disease. Once we have an effective vaccine, we’d ideally want to inoculate most of the population in short order. That will be particularly challenging with this vaccine, which needs to be stored at minus 94 degrees Fahrenheit. You can’t just pop this one in the fridge.

IMO mass innoculation will be a greater headache than anyone envisions at this point. I question whether your local Walgreens will install the necessary refrigeration capacity for keeping the vaccine or whether they have the follow-up capability that the two phased dose strategy requires.

I don’t want to be a crepe hanger and I recognize the sense of urgency that people feel but I question whether hurrying a completely novel method (mRNA) is prudent. Thhere is no experience with them. Quite literally no one really knows what their longitudinal effects might be—the trial has only gone on for a couple of months. It might take years for unforeseen adverse effects to appear.

There’s one more point I’d like to make. When you start doing back-of-the-envelope calculations about the scale of the plan, keep in mind that COVID-19 is a worldwide phenomenon. We aren’t just talking about innoculating 330 million Americans but 7.5 billion people in the world. In many places the refrigeration requirements of Pfizer’s solution would be as insurmountable a problem as putting it on the moon would be. I’ve also heard a lot of people making blithe assertions of priorities, e.g. healthcare workers and the elderly. I think that in the real world first priority will be given to all “essential workers” which, as we have learned is half of the population. Don’t be surprised if in some countries the military comes first.

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Pfizer’s Announcement

Here’s the full press release from Pfizer today and here’s the meat of the announcement:

After discussion with the FDA, the companies recently elected to drop the 32-case interim analysis and conduct the first interim analysis at a minimum of 62 cases. Upon the conclusion of those discussions, the evaluable case count reached 94 and the DMC performed its first analysis on all cases. The case split between vaccinated individuals and those who received the placebo indicates a vaccine efficacy rate above 90%, at 7 days after the second dose. This means that protection is achieved 28 days after the initiation of the vaccination, which consists of a 2-dose schedule. As the study continues, the final vaccine efficacy percentage may vary. The DMC has not reported any serious safety concerns and recommends that the study continue to collect additional safety and efficacy data as planned. The data will be discussed with regulatory authorities worldwide.

This is important, too:

Based on current projections we expect to produce globally up to 50 million vaccine doses in 2020 and up to 1.3 billion doses in 2021.

That’s all good news. If everything goes as they have planned, that would be 25 million people vaccinated by year’s end (2 doses/individual) and 650 million more in 2021. That would still be a formidable logistical problem. Assuming that the protection is lasting, I wouldn’t expect to get the vaccine before 2023.

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Is Divided Government a Stroke of Good Luck For Biden?

I see that the editors of the Wall Street Journal were struck by the same passage in Joe Biden’s victory speech that I was:

Joe Biden sent an encouraging message Saturday night in declaring “a time to heal” as he claimed victory in the race for the White House. Toppling an incumbent President is no small achievement, and congratulations are in order assuming his votes in the Electoral College hold.

“Let’s give each other a chance” and “put away the harsh rhetoric,” Mr. Biden said. “Stop treating our opponents as our enemies. They are not our enemies. They’re Americans.” After a campaign in which he called the incumbent a racist and blamed him for every Covid-19 death, we’ll give the former Vice President the benefit of the doubt that he means what he says now. And hold him to it.

They go on to make a good point:

So much, by the way, for Mr. Trump’s “authoritarian” takeover. His opponents have spent four years warning that he is a would-be Hitler who would stage an American Reichstag fire (Yale professor Timothy Snyder) or slowly extinguish political freedom (pick a progressive pundit). The 25th Amendment was invoked as a way to remove Mr. Trump from office.

These elites lost faith in American democracy and its institutions when they panicked after Mr. Trump’s victory in 2016. The left and some conservatives spent four years refusing to accept his election as legitimate, and Democrats deployed the FBI in 2016 to subvert his candidacy and then undermine his ability to govern. It was the dirtiest trick in American presidential history. These elites only trust democracy when they dominate it.

If, once all of the dust of the lawsuits has settled and it is determined he was defeated in his re-election bid, should be leave the White House peaceably at the end of his term, quite a few people will owe him an apology which I presume will not be forthcoming.

Here is their peroration:

Mr. Biden will enter the White House after one of the most unusual elections in history. He didn’t change his party as most successful candidates do. Democrats instead elevated Mr. Biden as their last-chance moderate to defeat Bernie Sanders in the primaries and then run a character campaign against Mr. Trump. It proved a smart bet. Rep. James Clyburn, who rallied the moderate black vote behind Mr. Biden in South Carolina, saved the party from a left-wing nominee who would have lost.

Credit Mr. Biden for running a disciplined campaign focused on being the anti-Trump who would crush Covid and unify the country. There’s no reason from the campaign to think he will do any better than Mr. Trump on Covid, except sound more serious. But his message fit the mood of a worried public tired of constant political warfare. His strategy of barely venturing in public, and barely answering questions, limited his potential for mistakes. And the media, united in trying to defeat the President they loathe, gave Mr. Biden a pass.

Mr. Biden’s narrow campaign message—Covid, character and pre-existing conditions on health care—leaves him with a governing dilemma. He has a mandate to end the pandemic and heal partisan divisions. But with the Democratic defeats down ballot, he lacks a mandate for the policies he promised his party’s left. Mr. Trump had more coattails than he did.

In the fine print of the Sanders-Biden unity document, you will find the most radical progressive agenda in decades. But few in the media other than these columns examined it in any depth. Mr. Biden rarely mentioned it. The Americans who voted for him mainly to defeat Mr. Trump do not want a radical economic, political or cultural agenda.

I think the problem is considerably more serious than that. Rarely in U. S. history have the two political parties been so distinct, so discrete, and too many of its members run unopposed other than in the primaries by members of their own party. That leaves neither experience in compromise or a basis for reaching one.

I hope they are correct in their conclusions:

Our sense is that, left to his own instincts, Mr. Biden is not an ideologue like Barack Obama. He is a pragmatic man of the center-left who can work across the aisle. But he will soon be 78 years old, and his vigor is clearly on the wane. He will have to battle younger progressives, inside and outside his Administration, who will be frustrated by the divided government Americans voted for and will want him to cede power sooner rather than later to Kamala Harris.

I don’t think that Barack Obama was as much an ideologue or that Joe Biden as much a pragmatist as they seem to believe. My interpretation of both individuals is quite different. We’ll see. Fingers crossed that Joe Biden lives through his four year term in sufficiently good health not to be replaced.

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The Celebratory Mood

The editors of the Washington Post are in a celebratory mood:

Though the election did not result in the ringing repudiation that Mr. Trump deserved, voters still rejected him, the first time in 28 years that a president has been turned out after a single term. Mr. Biden and his running mate, California Sen. Kamala D. Harris, built a broad coalition of traditional Democratic voters and independents disgusted with Mr. Trump. They won the highest number of votes of any presidential ticket in history and will end with an impressive margin of victory and and strong showings in states in every region of the country.

Did you notice what I did about that second sentence? There was one group conspicuous by their absence from that list of those whose votes elected Joe Biden: Republicans. There aren’t a lot of Republicans in the city of Chicago but I know a few of them. They voted for Biden. In some cases that may be the first time they’ve ever voted for a Democrat and they may never vote for a Democrat again. Would they have voted for Kamala Harris? For whom will they vote in 2024? Does anyone really doubt that George W. Bush, Mitt Romney, and many other Republicans cast their votes for Biden?

Continuing:

Instinctively optimistic, unwilling to write off any of his fellow Americans, not likely to be pushed around by hyper-partisans on either side, Mr. Biden is exceptionally qualified to heal a deeply divided nation.

I wonder what evidence they have that Mr. Biden cannot be pushed around by ideologues? He’s already inched to the left, abandoning positions he’s held for decades, presumably nudged by the Democratic Party’s progressive wing. Back in July he and Bernie Sanders produced a joint statement. How does the contents of that statement differ from being “pushed around”?

I agree with this:

He won on a promise to unify the country and to address major problems that have been neglected or aggravated over the past four years. Voters should expect him to live up to his promises — and Senate Republicans, if they do retain their majority, should accept his open hand in a spirit of decency and cooperation.

Here’s something else for which I would like to see their evidence:

If the voters elected a divided government, they may have been asking for moderation, but they were not voting for stasis.

Quite to the contrary that may be exactly what the voters cast their votes for. How else do you explain that other than Trump Republicans did a lot better than was anticipated and that we may well see the very first time in American history in which a new administration came in to a divided government.

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Alex Trebek, 1940-2020

Alex Trebek, host of the Jeopardy game show for 36 years and practically synonymous with the show, has died. From Variety:

Alex Trebek, the beloved host of gameshow “Jeopardy!” since its 1984 debut in syndication, has died of pancreatic cancer. He was 80.

The official “Jeopardy!” Twitter account announced the news on Sunday morning, writing: “‘Jeopardy!’ is saddened to share that Alex Trebek passed away peacefully at home early this morning, surrounded by family and friends.”

Trebek revealed in March 2019 that he had been diagnosed with Stage Four pancreatic cancer. “I have lived a good life, a full life and I’m nearing the end of that life,” he told USA Today in October. Sony has confirmed that “Jeopardy!” episodes hosted by Trebek will air through Dec. 25, and his last day in the studio was Oct. 29. “Jeopardy!” is not announcing plans for a new host at this time.

How fortunate he was to able to continue to keep doing what he clearly loved doing quite nearly to the very end!

Both my dad and my father-in-law died of pancreatic cancer. It makes me wonder a bit about Mr. Trebek’s medical history.

I’m going to make my prediction now: Mr. Trebek will be replaced as host on Jeopardy by Ken Jennings.

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COVID-19 Status Report, 11/8/2020

Yesterday Kevin Drum published a set of graphs depicting the number of deaths due to COVID-19 in (from left to right, top to bottom) Italy, France, the UK, Sweden, Germany, Canada, Argentina, Mexico, and the United States. Those graphs seem like as good a place as any to begin my status report. What do they show?

The European countries with the exception of Sweden but including Germany along with Canada exhibit a peak in March or April and have recently seen a sharp upswing. Is that upswing beginning in Sweden and the U. S., too? Truthfully, it’s too early to tell.

Let’s dig a little more deeply into some U. S. states (graphs taken from Worldometer).

I see three different patterns: Texas, California or Florida, and Wisconsin. In Texas the number of new cases has risen but the number of new deaths has not risen proportionally to the number of new cases. In California or Florida the number of cases has risen but the number of deaths has continued to decline. In Wisconsin, unlike in most European countries or in Texas, California, or Florida, the number of new cases and the number of new deaths have both increased considerably. Clearly, there’s a serious problem in Wisconsin.

Here’s another pair of graphs to consider, this time from my home state of Illinois:

Illinois’s number of new cases and new deaths is something between Texas and Wisconsin. The number of new cases and new deaths have increased but not as dramatically as in Wisconsin. As you can see even with the increase in new cases the health care system is not presently being overstressed. Might it in the future? Yes. I think that the governor should be emphasizing more convincingly the importance of steps each person can take to slow the increase in the number of cases but not moving towards another lockdown as he appears to be doing.

One more point I’d like to make about Kevin Drum’s graphs. As I have said before I don’t think the U. S. can be understood by comparing us with much more homogeneous countries like France, Germany, or Sweden. We are better understood as two countries occupying the same territory, one something like Germany and the other a lot more like Mexico. When you do a finer-grained analysis of our statistics that is what emerges clearly. Among whites the number of cases per million population and the number of deaths per million population is very similar to Germany’s, even more so if you discount New York and New Jersey where, not to put too fine a point on it but, well, mistakes were made. It was early in the pandemic. By comparison the number of cases and deaths among blacks, Hispanics, and Native Americans is more like those figures in Spain or Brazil. I hasten to emphasize that my conclusion from that is that we need to be devoting considerably more attention to communities with black, Hispanic, or Native American populations. The attention should take the form of both a public awareness campaign and medical assistance.

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Biden’s Victory Speech

Barring some concrete evidence of wrongdoing in the counting of votes sufficient for the courts to step in, Joe Biden will be elected President of the United States by the Electoral College when it convenes next month. Last night he gave a victory speech. If you didn’t listen you can read the whole text here. It wasn’t dazzling oratory but it was an adequate speech. It wasn’t Lincoln, FDR, or John Kennedy. It wasn’t even Harry Truman or Lyndon Johnson, neither known for oratory. But it was an okay speech, a hopeful speech. To my ear this was the most significant passage:

I’ve lost a couple of times myself, but now let’s give each other a chance. It’s time to put away the harsh rhetoric, lower the temperature, see each other again, listen to each other again. And to make progress, we have to stop treating our opponents as our enemies. They are not our enemies. They are Americans. They are Americans.

You will note that paragraph has two parallel sections. The first, “now let’s give each other a chance”, was a plea to Mr. Biden’s political opponents. The second, “we have to stop treating our opponents as our enemies”, was a plea to his supporters. If you listen to the actual speech you will note that it was possibly the least applauded, least cheered passage in the entire speech. I hope I’m wrong but I suspect both passages will be completely ignored by the Congress. It promises to be a difficult four years.

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The Next Pandemic

I’m preparing a status post on COVID-19. There is pretty obviously another surge going on but its contours appear to be quite a bit different from the one in the spring.

There’s also an interesting discussion going on in the comments of this post, having to do with pandemic preparedness. I don’t think that people have really processed what’s been happening for the last nine months. Let me just put it this way. Don’t be surprised if the next pandemic starts while this one is still under way. That’s what happened in the version of globalization that happened in the 16th century and the next phase that started during the 19th century. While I agree with, for example, Bill Gates that we need to be better prepared, I think that whatever your political ideology you will be deeply dissatisfied with some of the measures we’ll need to take. I am greatly skeptical that we can prepare for the next pandemic and pursue a “Green New Deal” simultaneously, just to pick one example.

While I collect my thoughts, what should we be doing if anything to prepare for the next pandemic?

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