Guru Madhavan’s op-ed at the Wall Street Journal is essentially a hymn to engineering:

Much of the conversation will come back to engineering, which historically has advanced public health far more than medical care has. Sanitation, water supply, electrification, refrigeration, highways, transportation safety, body scanning and mass production are a few examples. It’s easy to overlook how these technologies improve health outcomes, so consider one that’s an obvious part of many Americans’ lives today: the bandwidth necessary for telework.

I think he overstates his case somewhat but there’s resonance between his point and one I’ve been trying to make around here.

He mentions Margaret Hutchinson or, in the name by which I know of her, Margaret Hutchinson Rousseau. Alexander Fleming, a physician, discovered penicillin but Ms. Rousseau designed the first commercial penicillin production plant and she was a chemical engineer. We remember Fleming and have largely forgotten Ms. Rousseau and it’s just not because of her gender.

Other fields have figure prominently in the advances in public health as well. Louis Pasteur wasn’t a physician. He was a chemist but his work probably did as much as anyone’s to make the modern world and, especially, modern medicine possible. And he was fought by the medical establishment every step of the way as was his disciple, Joseph Lister, who was a surgeon.

My point here is not to dismiss physicians but to point out that they aren’t the only experts. Engineers, chemists, epidemiologists, statisticians, computer scientists, public policy experts and, yes, even politicians have their own expertise and all will be necessary if we are to deal with the challenges with which SARS-CoV-2 presents us.

He concludes:

Separated, specialized approaches to remake our health, economy and civics will guarantee the next breakdown. Let’s engage engineers and adapt industry practices for federally organized logistics to pave the way out of this pandemic. This is an essential service.

New York Times columnist Thomas Friedman has returned to make specious analogies to China again. This time he want to institute a “more democratic version” of the contract tracing China has done:

In sum, if we are going to save the most lives while getting the most people back to work to prevent an epidemic of unemployment, depression and despair, it is going to require a federally coordinated, democratic version of the China strategy.

Let’s take that at face value. The “China strategy” was to shut down Wuhan’s public transportation, suspend train service to the city, and close the roads going into it. Short of declaring martial law, that is beyond the president’s power and the president can’t order the mayor of New York or the governor of New York State to do it.

But I have a deeper question. How do you go about tracing a person you happened to be sitting in the same car with on the subway? Let alone doing so democratically? I don’t believe there’s any way to do it other than coercively.

However, I’m skeptical about taking anything the Chinese authorities have told us at face value. More to the point what did the South Koreans do? There is a description in this New Yorker article.

Leaving aside that privacy considerations would render the approach the South Koreans took untenable, graph theory would suggest that scale is important. You’d expect the complexity to be on the order of the square of the number of people involved. In other words what is just barely practical in South Korea would be completely unworkable in the United States even if we discarded everything we’ve considered sacred in privacy rights.

I guess my point here is that rather than looking for a Chinese solution or a South Korean solution, the preferred strategy in the U. S. should be one that makes some sense here rather than urging us to remake our society so it’s more Chinese or South Korean.

Illinois Gov. J. B. Pritzker has announced his plan for reopening Illinois, reported at TriState.com. Dividing Illinois into eleven health regions:

The five phases of reopening for each health region are as follows:

Phase 1 – Rapid Spread: The rate of infection among those tested and the number of patients admitted to the hospital is high or rapidly increasing. Strict stay at home and social distancing guidelines are put in place and only essential businesses remain open. Every region has experienced this phase once already and could return to it if mitigation efforts are unsuccessful.

Phase 2 – Flattening: The rate of infection among those tested and the number of patients admitted to the hospital beds and ICU beds increases at an ever slower rate, moving toward a flat and even a downward trajectory. Non-essential retail stores reopen for curb-side pickup and delivery. Illinoisans are directed to wear a face covering when outside the home, and can begin enjoying additional outdoor activities like golf, boating and fishing while practicing social distancing. To varying degrees, every region is experiencing flattening as of early May.

Phase 3 – Recovery: The rate of infection among those tested, the number of patients admitted to the hospital, and the number of patients needing ICU beds is stable or declining. Manufacturing, offices, retail, barbershops and salons can reopen to the public with capacity and other limits and safety precautions. All gatherings limited to 10 or fewer people are allowed. Face coverings and social distancing are the norm.

Phase 4 – Revitalization: The rate of infection among those tested and the number of patients admitted to the hospital continues to decline. All gatherings of up to 50 people are allowed, restaurants and bars reopen, travel resumes, child care and schools reopen under guidance from the IDPH. Face coverings and social distancing are the norm.

Phase 5 – Illinois Restored: With a vaccine or highly effective treatment widely available or the elimination of any new cases over a sustained period, the economy fully reopens with safety precautions continuing. Conventions, festivals and large events are permitted, and all businesses, schools, and places of recreation can open with new safety guidance and procedures in place reflecting the lessons learned during the COVID-19 pandemic.

The Chicago metropolitan area includes five of those regions.

I suppose that Gov. Pritzker is to be commended for announcing such a plan but I found it disappointing, a plan that could well have been announced on the day that he issued his “stay at home” directive back in March. It is appallingly lacking in target metrics. Fully reopening Illinois in Phase 6 requires “a vaccine or highly effective treatment widely available”, things that may never materialize.

Illinois met the criteria for Phase 3 more than a week ago. We remain in a Phase 1 shutdown.

To my eye the plan appears to be one for not reopening Illinois.

It may come as a surprise to those under the age of 60 but for most of the state’s history Illinoisans lived perfectly ordinary, healthy lives without vaccines or treatments for common illnesses, some of which could, indeed, kill you. Risks were considered a normal part of life.

The way you deal with risks is to identify the highest risks and implement measures for mitigating them, implementing less strenuous measures for lower level risks. Waiting until there are no risks is not a plan.

The editors of the Wall Street Journal rush to the defense of Sweden’s national reaction to COVID-19:

The American left has misunderstood Sweden for years, holding up its significantly liberalized economy as a socialist utopia. Now the misapprehension has moved in the opposite direction, as progressives fret over the country’s supposed economy-over-life approach to Covid-19.

While its neighbors and the rest of Europe imposed strict lockdowns, Stockholm has taken a relatively permissive approach. It has focused on testing and building up health-care capacity while relying on voluntary social distancing, which Swedes have embraced.

The country isn’t a free-for-all. Restaurants and bars remain open, though only for table service. Younger students are still attending school, but universities have moved to remote learning. Gatherings with more than 50 people are banned, along with visits to elderly-care homes. Even with relatively lax rules, travel in the country dropped some 90% over Easter weekend.

Officials say the country’s strategy—which is similar to the United Kingdom’s before it reversed abruptly in March—is to contain the virus enough to not overwhelm its health system. Anders Tegnell, Sweden’s chief epidemiologist, said the country isn’t actively trying to achieve broad immunity. But he predicted late last month that “we could reach herd immunity in Stockholm within a matter of weeks.” Some British public-health officials reportedly leaned toward less restrictive measures before the country’s leaders imposed a harsh lockdown.

I don’t have a dog in this hunt. To be honest to the extent that I’m interested in the strategies being used in other countries at all I’m more interested in Portugal’s than Sweden’s. Portugal, sitting right next door to countries that have mortality rates an order of magnitude higher than theirs, shut down about the same time as we did here in Illinois and they’re beginning to open up again. The largest difference is that the Portuguese paid more attention to nursing homes and hospitals than we have.

I think that longing for a national strategy for the U. S. only makes sense if you’re sitting in New York or Washington, DC. Our circumstances vary too much among different parts of the country. I do wish that the Trump Administration were acting to limit travel on the interstates to trucks hauling freight and that there was a national program of epidemiological testing.

In a report that will be no surprise to anyone familiar with either the organization or the situation, the Economic Policy Institute has published a report that finds that the program is basically a stalking horse for low wages:

H-1B is a temporary nonimmigrant work visa that allows U.S. employers to hire college-educated migrant workers as well as fashion models from abroad; nearly 500,000 migrant workers are employed in the United States in H-1B status.1 The H-1B is an important—but deeply flawed—vehicle for attracting skilled workers to the United States. The H-1B visa is in desperate need of reform for a number of reasons that we have explained in other writings,2 but the fundamental flaw of the H-1B program is that it permits U.S. employers to legally underpay H-1B workers relative to U.S. workers in similar occupations in the same region. This report explains how this occurs by describing the H-1B prevailing wage rule and analyzing the available data on the wage levels that employers promise to pay their H-1B employees.

The key findings of the report are:

• DOL lets H-1B employers undercut local wages.
• A small number of employers dominate the program.
• Outsourcing firms make heavy use of the H-1B program.
• Major U.S. firms use the H-1B program to pay low wages.

This is a serious political issue but not a partisan one. All of those have been true under both Democratic and Republican administrations and is as true of companies run by Republicans as those run by Democrats.

Reuters reports that the Chinese authorities are being told by their own intelligence services that they need to be prepared for a global backlash over SARS-CoV-2 greater than any that has been experienced in 30 years and which could conceivably lead to war:

BEIJING (Reuters) – An internal Chinese report warns that Beijing faces a rising wave of hostility in the wake of the coronavirus outbreak that could tip relations with the United States into confrontation, people familiar with the paper told Reuters.

The report, presented early last month by the Ministry of State Security to top Beijing leaders including President Xi Jinping, concluded that global anti-China sentiment is at its highest since the 1989 Tiananmen Square crackdown, the sources said.

As a result, Beijing faces a wave of anti-China sentiment led by the United States in the aftermath of the pandemic and needs to be prepared in a worst-case scenario for armed confrontation between the two global powers, according to people familiar with the report’s content, who declined to be identified given the sensitivity of the matter.

The report was drawn up by the China Institutes of Contemporary International Relations (CICIR), a think tank affiliated with the Ministry of State Security, China’s top intelligence body.

Not only do I not support war with China, I think we should do what we reasonably can to avoid it. However, I also think that the events of the last half year have demonstrated that as long as the Chinese Communist Party runs China, it is simply too risky to have China as a trading partner even indirectly which means we should discourage our other trading partners from trading with China as well.

I don’t know that I have mentioned my own status during the “stay at home” directive. My wife and I have been “sheltering in place” since March 16 (before the statewide directive was issued). During that period we have been quite rigorous about using masks when shopping for groceries or other necessaries. Under normal conditions I am a daily shopper. I have limited my shopping expeditions to once every three or four days. I only shop at my beloved Happy Foods to the greatest degree possible. It’s small but the people who shop there are careful and courteous and most have been wearing face masks for weeks.

I’m walking so much, getting so much exercise, and eating so healthfully I’m probably healthier than at any time in the last 40 years.

I’m skeptical that anything that is being done is more than theater but theater is important, too. I’m in full compliance with the directives because I believe it’s important to set a good example for others and contrariwise I wouldn’t want to encourage anybody to do anything that might harm themselves.

It frustrates me to see so many people who clearly don’t give a damn, especially city employees who should know better. Why are they toying with my life and health and prolonging the risks to my livelihood?

I am going on my eighth week of “sheltering in place”; the state has officially had a “stay at home” directive in place since March 22; on Friday a facemask directive was added to that. Based on the statistics provided by the Illinois Department of Health, there are no actual signs of the number of new cases diagnosed daily peaking. The number of new cases diagnosed yesterday was greater than a week before which was greater than the week before that which was greater than the week before that. The number of cases or new cases is not doubling every six days but they weren’t doubling every six days a month ago, either.

Some of that stands to reason. The number of cases diagnosed is positively correlated with the number of tests conducted. More tests—more cases. I see no signs that the number of ICU beds or ventilators in use are being stressed. In Chicago the increases in the use of both are due to more use for non-COVID-19 cases, at least some of which I attribute to the shooting spree going on in a few South Side neighborhoods.

Politically, it’s easier for the governor to double down on his present policy that it would be to acknowledge defeat. Keep the state shut down long enough and there will surely be some improvement. Any improvement, whether produced by the measures in place or not, will allow the governor to declare victory. Or else the state will run out of money.

In a pitch for more, faster antigen testing, Scott Gottlieb presents a status report on the campaign against SARS-CoV-2 in an op-ed at the Wall Street Journal which I will take the liberty of quoting in full:

The Covid-19 epidemic continues to expand in some 20 states. The number of new cases in New York City is slowing, but the picture is different elsewhere in the nation. America has hovered around 30,000 new daily infections and 2,000 deaths for almost a month. Yet the number of days it takes for infections to double has improved, from less than a week in hot spots to almost a month nationally. This represents progress.

But everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill. Mitigation hasn’t failed; social distancing and other measures have slowed the spread. But the halt hasn’t brought the number of new cases and deaths down as much as expected or stopped the epidemic from expanding.

Officials face intense pressure to reopen, and the reality is stark: Continuing spread at something near current levels may become the cruel “new normal.” Hospitals and public-health systems will have to contend with persistent disease and death.

Higher rates of spread may be limited to some areas; a majority of states have more than 250 new cases of Covid-19 every day. But as states begin to open up their economies and Americans return to traveling, the disease will continue to expand. We need to prepare to deal with such a grim future, which will require a persistent posture of prevention and treatment.

That means doubling down on screening and isolating sick people to slow the spread as much as possible, which will save lives and prevent health-care systems from being overwhelmed. That means channeling resources into places where outbreaks are prone to happen: nursing homes and shop floors, and among disadvantaged communities that lack access to testing and can’t practice social distancing easily.

Technology and a well-equipped and competent medical and public-health workforce will be essential. This includes better drugs. On Friday the Food and Drug Administration authorized the use of remdesivir by Gilead Sciences. This drug is the first antiviral medicine that blocks SARS-CoV-2 replication. It isn’t a cure, but it will help patients at highest risk of bad outcomes, especially when deployed early in the course of the disease. More treatments are likely to follow, including antibody drugs that bind and block the virus. These should be available this fall if progress continues apace.

A number of vaccines, meanwhile, are on track to clear early FDA safety trials by fall, and tens of millions of doses could be ready to use in studies that test for efficacy. These doses can be used in large trials that will establish whether the vaccine is safe and effective for mass inoculation, trials that can be conducted in cities suffering from outbreaks.

But the public also needs better diagnostic tests to make screening for Covid-19 inexpensive and routine. This is where medical progress has been slow. Testing so far has relied on detecting the nucleic acids of the virus’s genetic material. These platforms are reliable and were initially easy to expand. The U.S. medical system is now screening more than 1.5 million people a week. But these platforms can only run so many tests each day, and issues like transporting samples are precluding quick turnarounds.

What’s needed now is the equivalent of the rapid flu and strep tests available in a doctor’s office. These tests look for antigens that the pathogen produces, which betray its presence in blood and saliva. Antigen tests are less precise than polymerase chain reaction (PCR) tests, but they enable fast and widespread testing. The government needs to rush development of these technologies and work with manufacturers to increase capacity.

More-precise platforms like PCR will still have an important role. They’ll be used by big commercial labs that can run them at the scale needed to improve cost and efficiency. They’ll also serve as a reference standard and be used for mass screening by pooling many patients’ samples—say, in a workplace—and testing them all at once to see if anyone in the group is infected.

If the virus continues to spread, the economy won’t snap back. Many Americans will be scared to go out, and with good reason. Summer may provide some reprieve, but the virus could return aggressively in the fall. Activity can resume in parts of the country where risk is low, but there is still much disease and death in the days to come.

Dealing with this new reality will require screening to identify new cases and isolate infections. That will depend on better testing technologies that aren’t yet available—but can be achieved. The sooner the better for the health of Americans and the economy.

I think there needs to be more introspection about why the measures put into place since March have failed to live up to their advance publicity as illustrated in this sentence:

But everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill.

Even in the limited successes I see a lot of post hoc propter hoc reasoning being advanced. Is the slow decline in the number of new cases being reported in the NYC metropolitan area because of the measures that have been put in place, because of other changes, or because the disease is running its course?