Yesterday we received a delivery of five pounds of fish. I don’t recall whether I’ve mentioned it before but there are a few luxuries my wife and I allow ourselves. Other than the dogs, of course. We have a subscription to Chicago Lyric Opera and we belong to Sitka Salmon. Sitka Salmon is a sort of co-op of Alaska fishermen who for ten months of the year send their catch directly to consumers in the lower 48. The fish are caught by independent fishermen operating small boats (rather than factory ships), processed and flash frozen and packaged right on board, shipped to us, and delivered by local deliverymen. At this point we have a couple of months of good fish dinners in our freezer. This month we received Pacific Cod.

As long as we have electricity, cooking oil, and a bag of rice, we won’t go hungry, at least not for a couple of months.

I do not envy the lot of journalists trying to write about very nearly any of the aspects of the situation that presently confronts us in the outbreak of COVID-19. Imagine you’re a copy writer for a major newspaper, assigned to write an article on how to shorten the time to produce a vaccine against the virus that causes it, SARS-CoV-2. Or imagine you’re a J-school graduate with no practical experience of anything including actual reporting. But I repeat myself.

It’s the biggest news story of the decade and we can say almost nothing about it with confidence. It’s a virus. People are dying of it. We don’t really know how to prevent it or treat it or how contagious it is or whether any of the measures that have been put in place to mitigate the risks are actually working. And yet we’re being deluged with millions of words, most of which are meaningless noise.

This post began in life as remarks about an NYT article on how the time to produce a vaccine against SARS-CoV-2. We don’t even know if an effective vaccine can be produced. How can you write an article on such a subject when you know nothing about medicine, public health, politics, chemical engineering, or business? You can write anything you care to as long as you ignore biology, politics, economics, and industrial practice. That’s the alternative that was chosen.

I am filing this post under three categories: COVID-19, journalism, and O tempora o mores, my category for laments about the sorry state of just about anything.

The Associated Press reports that the “field hospitals” that were set up in New York City largely went unused:

NEW YORK (AP) — Gleaming new tent hospitals sit empty on two suburban New York college campuses, never having treated a single coronavirus patient. Convention centers that were turned into temporary hospitals in other cities went mostly unused. And a Navy hospital ship that offered help in Manhattan is soon to depart.

When virus infections slowed down or fell short of worst-case predictions, the globe was left dotted with dozens of barely used or unused field hospitals. Some public officials say that’s a good problem to have — despite spending potentially billions of dollars to erect the care centers — because it’s a sign the deadly disease was not nearly as cataclysmic as it might have been.

When is it preparedness and when is it panic? The argument articulated above (“it’s a good problem to have…”) suggests that no cost is associated with allocating resources for facilities that are never used but that isn’t true.

I found this interview in Die Welt of two pathologists, one a specialist in lung pathology, very interesting. I’ll try to provide a few translations. They say that infection is via nose and throat and suggest that ventilator support may actually be causing the deaths of at least some of the patients receiving it.

Jonigk: Blood clotting occurs in the lung [capillaries], which are in the walls of the lung alveoli that serve to absorb oxygen and remove CO2. The damage causes protein to escape from the blood into the alveoli. Oxygen must somehow be transported from the air we breathe into the capillary network. That’s how we breathe. Anything that lengthens that route ensures that the patient can no longer supply himself with sufficient oxygen. It’s like playing soccer when you’ve skinned your knee: First a brown-red crust of protein and blood develops. We have a similar situation in the air bubbles. And breathing through them is massively difficult. The patient has a feeling of breathlessness, too little oxygen gets into the organism. It is more likely to be secondary to an inflammatory reaction. A downward spiral begins, which ends in a so-called shock lung. The lung and with it the patient fight for their lives.

In response to a question about which pre-existing conditions predispose a patient to worse outcomes:

Older people with previous damage to the lungs. Patients who are dependent on medication that diminishes the immune system. And smokers, for example. Or people who live in an area with high particulate matter pollution and therefore already have pre-damaged lungs. So they are already not well before that. If an acute infection such as SARS-CoV-2 is then added, this can be enough to put the already sick patient’s life in danger.

which makes me wonder if it’s not population density per se but air quality. That could be very bad news for India, for example, whose cities have some of the worst air quality in the world.

Classic pneumonia is a bacterial infection with purulent sputum. The pus is yellow because it is made up of fatty granulocytes. Their task is to fight the enemy, the pathogen, in the body. But SARS-CoV-2 is a virus. It attacks cells directly and reprograms them. After an initial unspecific reaction, the response to this infection consists of specific T-lymphocytes, a subtype of white blood cells. These can recognize and attack virus-infected cells. We now have a large number of lymphocytes in the basic structure of the lung, which collect in the walls of the alveoli and develop their inflammatory activity there.

I found these remarks about the dysregulation of clotting interesting:

Up to 25 percent of intensive care patients have disorders of liver and kidney functions. In addition, blood coagulation often appears to be permanently disturbed. Small, local blood clots form at many sites because the inflammatory cells beat around to destroy the virus-infected cells, which include vascular cells. No matter where this occurs, it always has considerable consequences for the organ — strokes occur and sometimes extremities have to be amputated. In many organs, the occlusion of a blood vessel can be compensated. But if you have many occlusions, the blood does not flow properly, organ damage occurs, inflammatory cells do not get where they actually want to go, and the heart is also put under strain.

There’s also a lengthy suggestion that the sudden deaths on the part of young people are being caused by over-exertion, as in working out. They also point to the peculiar demographic issues in Germany as I have and have this observation:

It’s not enough to say, “This patient had something.” Rather, the previous illnesses must be systematically uncovered in relation to the population.

About Italy:

As far as we know, in Italy a corona test was carried out on every person who died and everyone who was found to have the virus was considered to have died of corona. In the case of pre-existing conditions, a distinction must also be made between diseases that generally shorten life expectancy and diseases that specifically increase the risk of corona infection and possible complications. This is somewhat muddled in the public discussion.

which would increase the reported number of deaths due to SARS-CoV-2, wouldn’t it? I’ll try to find a version that isn’t firewalled and is translated in full for you.

The editors of the Wall Street Journal take note of Germany’s experiment in reopening the economy while simultaneously avoiding an increase in the introduction of new cases of COVID-19:

German officials are concerned that the disease’s reproduction rate, or R0, has drifted upward since smaller shops were allowed to reopen April 20. The Robert Koch Institute, the government’s disease-control agency, estimated Monday that the rate is 1. That means each infected person on average spreads the virus to one other person. A rate above one signifies exponential growth in infections.

That matters because Berlin is conducting an experiment in whether it’s possible to reopen an economy in a way that controls R0. Chancellor Angela Merkel, who holds a doctorate in chemistry, became an internet sensation this month for a press conference in which she soberly lectured Germans on why they must suppress the rate, and why R0 would be the benchmark for the government’s reopening policies. Two days before the lockdown started easing, RKI estimated the rate was 0.8.

That approach and Germany’s aggressive test-and-trace program earlier in the outbreak were presented as a triumph of science-based policy in contrast to a certain U.S. President. Yet it’s plagued by problems. One, as the RKI acknowledges in its daily briefings, is that no one can know in real time what the reproduction rate is. RKI’s figure is only an estimate. Any leader who picks R0 as a policy target will be flying half-blind.

I don’t think the editors appreciate just how fundamentally COVID-19 is challenging the foundations of German social thinking. Germany is striving to remain German, a futile struggle in my opinion. The ethnic German population is more at risk from the virus because it’s older. A high toll among older ethnic Germans will leave a much higher proportion of ethnic Turks and Arabs who are not only not ethnically German, they’re not culturally German, either.

Additionally, Germany is highly dependent on process and near 100% conformance with the processes in place for its prosperity and its entire way of life. The VW scandal has already revealed the holes in that. How could the scandal take place at all? Why didn’t the processes in place prevent it from happening? It’s being portrayed as just a few bad apples but, given the nature of German society, IMO it’s more likely that the processes in place are actually an elaborate fraud.

Now they’re relying on process and conformance with the process in a society much less socially cohesive and, yes, less German that it has been at any time in the postwar period and, consequently, less conformant. Will they succeed? Or will they just have excellent metrics for why they failed?

And again at Bloomberg Clive Crook warns that the economic contraction that just about everybody is expecting is not likely to be the V-shaped recession that had been hoped for:

It was clear from the start that the coronavirus slump was a strange kind of recession. Some economists even thought “recession” was the wrong word. The setback would be brief and severe, many believed, a deliberately induced shock to the supply side of the economy. But within a few months and before much lasting damage was done, governments could lift the restrictions and switch their economies on again. Output would quickly surge back. The path through the emergency would be V-shaped — not U-shaped, much less L-shaped.

This is no longer plausible. Some countries have begun easing restrictions and letting some of their businesses start up again. Others are getting ready to. But they’re moving cautiously. They’ve found that even very strict controls have only slowed new infections, not stopped them. If they ease too much, there might be new waves, maybe worse than the first, and they’ll have to put lockdowns back in place. Governments are being advised that some restrictions might be needed indefinitely, until a vaccine is available and widely deployed.

As I’ve pointed out before, especially but not exclusively in the case of small companies, the “stay at home” directives have been deathblows. For them there will be no recovery and a large business recovery isn’t much like a small business recovery. They won’t hire new workers to take up the slack.

The greatest likelihood is that any recovery will be long and painful. If you’re in your 50s or older, your plans for your old age may be permanently disrupted. Nothing you were depending on will be worth as much as you were expecting.

There is potential for economic growth, mostly in primary production and re-onshoring some supply chains. The biggest help that will be needed for that are regulatory relief and assistance in meeting the environmental standards we’ll want to keep in place.

We’ll need to re-engineer SSRI, too. More people will be more dependent on it than had been expected. Don’t be surprised if this year’s Trustee’s Report is delayed and, when it finally arrives, has some unhappy surprises.

And what about the COVID-19 profiteers? I’m thinking particularly of large retailers with robust online presences whose sales have actually increased? And whose workers have been kept on the job despite the risks as “essential”? Or companies much of whose profitable business has been in web services? But I repeat myself.

At Bloomberg Karl W. Smith proposes something I think is a pretty darned good idea:

The coronavirus has U.S. businesses grappling with enormous uncertainty, making them cautious about new investment. At the same time, without increases in private investment and capital spending, the overall economy won’t be able to make the structural changes required to prosper in a post-pandemic environment.

What’s needed are policies that both spur investment now and put the economy in a better position for long-term growth. One idea that should be part of the debate is to allow the permanent full expensing of all capital investments.

If you think of this change as a relatively minor detail, consider the big picture: The Federal Reserve currently has limited ability to use interest rates to stimulate investment. In a crisis such as this, typically the Fed would lower short-term interest rates to reduce the cost of borrowing. That would then set off a virtuous cycle: Capital expenditures would increase employment, which would increase spending, allowing more businesses to expand, and so on. That option isn’t available because short-term interest rates are already at zero.

If you’re not willing to abolish the business income tax entirely, current year expensing of capital expenditures is the next best thing. The corporate income tax is an inefficient tax. It actually falls on workers and consumers. Remember that the next time you hear political posturing about corporations “paying their fair share”.

Nearly all major developed countries allow current year expensing. We are absurdly behind the times.

I would like to see something a little more targeted than what Mr. Smith proposes but it’s close enough for government work as the saying goes. I think that we’re likely to see more capital investment within the U. S. to the extent there is capital investment at all.

In their Wall Street Journal op-ed on the risks of over-reliance on international pharmaceutical manufacturers, Scott W. Atlas and H.R. McMaster conclude:

A secure drug supply chain couldn’t have made up for the Chinese Communist Party’s decision to conceal the threat of Covid-19. But it is essential for mobilizing resources to mitigate the crisis. And the stakes are high, even in normal times. More than 15 million American seniors, or 1 in 3, take five or more medications daily. As the U.S. population ages, society will become even more dependent on drugs indispensable to treating the biggest killers—heart disease, cancer and stroke. Preventing an interruption of the supply of vital medications that save lives and treat diseases, whether during pandemics or in routine care, is a matter of national security.

If you’re not aware of the mechanics of 21st century pharmaceutical production, they provide a reasonable primer:

While U.S. pharmaceutical companies may preserve redundancy in their sources for patented drugs, the generic drug business, which accounts for more than 90% of all U.S. prescriptions, prioritizes low cost over supply-chain resiliency. Most generics, including antibiotics, are imported from India—and India imports some 70% of its active ingredients from China. America needs to understand and diversify sources of supply, as well as maintain a strategic reserve of antibiotics and the key drugs for the most prevalent serious diseases.

Beyond scale and complexity, details on drug manufacturing are opaque and complex. The Food and Drug Administration requires country-of-origin markings, but the U.S. Court of Appeals for the Federal Circuit ruled in February that processing ingredients into tablets in the U.S. is enough to constitute “manufacturing.” A drug made into tablets in the U.S. with active ingredients from India may list only the U.S. as “principal place of business” for FDA purposes. Labeling should be straightforward, but not at the sacrifice of security.

There is no robust system of international civil law. If you’re injured by a prescription drug, you can sue the company under whose brand it was made. Or, if you’re killed by an adulterated drug, your heirs can sue. If the drug was manufactured in India using Chinese ingredients, that company has no or next to no legal recourse.

The use of ingredients manufactured overseas isn’t limited to generics, BTW, and is isn’t limited to pharmaceuticals. Just about every food additive to change a food’s color, texture, or nutritional content is made in China. Consider that the next time you eat a Twinkie (or any other processed food).

Illinois Gov. J. B. Pritzker is outraged at the judge’s ruling that found that his emergency powers had lapsed at the beginning of April as noted in this report from WIFR:

CHICAGO, Ill. (WBBM) — Governor J.B. Pritzker has filed an appeal of a downstate judge’s ruling exempting a Republican state lawmaker​ from the governor’s extended stay-at-home order.

State Rep. Darren Bailey (R-Xenia) claimed in a lawsuit filed last week that Pritzker has exceeded his authority and is violating the civil rights of the state’s residents by extending the stay-at-home order for an additional 30 days, through May 30.

Clay County Circuit Court Judge Michael McHaney on Monday granted representative Bailey a temporary restraining order, barring the governor from enforcing the stay-at-home order on the lawmaker, meaning Bailey won’t have to comply with the extension once it begins on Friday.

The judge said the governor’s extension, “shredded the constitution.” Representative Bailey agrees, calling the extension an overreach of Pritzker’s power as governor. While Bailey is the only person exempted from the stay-at-home order, the judge’s ruling opens the door for others in Illinois to join his lawsuit, or file their own.

Pritzker isn’t wasting any time appealing the ruling. Illinois Attorney General Kwame Raoul filed a notice of appeal with the Illinois Appellate Court on Monday night, asking the court to reverse McHaney’s ruling, and dissolve the temporary restraining order.

The governor has said Bailey’s lawsuit puts people in Illinois at risk, and he has vowed to “fight this legal battle to the furthest extent possible.”

and from Crain’s Chicago Business:

A judge from far southern Illinois on Monday threw a legal bombshell into Gov. J.B. Pritzker’s continuing response to the COVID-19 pandemic, ruling the governor exceeded his authority in issuing a statewide stay-at-home order.

Pritzker immediately blasted the judge’s ruling, sought in a case brought by state Rep. Darren Bailey, R-Xenia, saying it violates “decades of precedent” and “puts people in danger.”

IMO Gov. Pritzker is directing his ire in the wrong direction. He should be blaming Illinois do-nothing, corrupt, incompetent legislature. All of us including Gov. Pritzker must adhere to the law, emergency or not. That the legislature has not amended the law to extend the governor’s emergency powers is neither the plaintiff’s nor the judge’s fault.