The number of diagnosed cases of COVID-19 worldwide has topped 3 million; the number of deaths due to the disease is over 212,000. Here in the U. S. more than 1 million cases have been diagnose and nearly 57,000 deaths are attributed to the disease.

Most of the U. S. remains under “stay at home” directives although they are being lifted or will soon be lifted in some states. Other states are extending those directives.

Although there are some signs in some places (New York) of “bending the curve”, it remains hard to assess the relative importance of varying causes in identifying why that might be. Post hoc propter hoc seems to dominate thinking.

IMO the “Holy Grail” of the struggle against COVID-19, a vaccine, will remain elusive for the foreseeable future. Although lots of things are being tried on an experimental basis, supportive care remains the primary treatment modality. There are some signs that strategies for supportive care are improving, illustrated by a leveling off of the use of ventilators.

The big news here in Chicago is described in this report from WGN TV:

CHICAGO – A video going viral on social media reportedly shows people attending a crowded house party in Chicago early Sunday in violation of the state’s stay-at-home order.

Posted live to Facebook by Tink Purcell, the video appears to show people partying and listening to music while standing shoulder-to-shoulder inside a home in the early hours of Sunday morning.

While some people in the video are wearing masks, most are not, and everyone in it is breaking social distancing recommendations issued by the state to prevent the spread of COVID-19.

The Chicago Police Department could not confirm the exact location of the party, but many residents told WGN it possibly took place on the West Side. On Sunday afternoon, CPD issued the following statement:

We are aware of a video circulating on social media depicting a large house party inside of an alleged Chicago residence. While we cannot authenticate the nature or location of the gathering, we want to remind everyone of the social distancing requirements in place. CPD will disperse crowds in violation of social distancing requirements, and if necessary, issue citations or as a last resort, enforce via arrest.

I don’t think that what’s going to happen if the “stay at home” directives stay in place long enough is that people will become depressed. I think that people will stop complying with the “stay at home” directives. We’ve already been under such a directive for about six weeks. The rules have always been too arbitrary. Lawn services are an “essential business”? Non-emergent city tree-trimming is essential? Non-compliance by city workers is widespread if not universal. Mayor Lightfoot, clean up your own house.

I have reservations about Scott Gottlieb’s WSJ op-ed, urging a massive effort and a massive rollout of a SARS-CoV-2 vaccine in the U. S.:

The first nation to develop a vaccine for Covid-19 could have an economic advantage as well as a tremendous public-health achievement. Doses will be limited initially as suppliers ramp up, and a country will focus on inoculating most of its own population first. Even with extraordinary international collaboration among multiple companies, it could be years before a vaccine is produced at a scale sufficient to help the entire world. The first country to the finish line will be first to restore its economy and global influence. America risks being second.

China is making rapid progress, with three vaccines entering advanced development. Chinese officials say they could have a vaccine available for widespread use next year. The Europeans are also making progress. While friendly nations will try to share a successful product—to a point—the U.S. can’t rely on vaccines from China or even Europe being available in America quickly. So it’s important to take steps to speed up progress in the U.S., and to prepare to manufacture such a vaccine on a global scale. A more prepared U.S. could inoculate Americans quickly and share the product with others, particularly low-income nations that can’t develop their own vaccines and need protection.

More than 70 companies and research teams are working on a vaccine, but fewer than 20 have the experience and manufacturing scale to pull a product through development. Only five or six operate primarily in the U.S., which means foreign governments might try to make a claim on a vaccine before America can. Each company is taking a slightly different approach, spreading bets and increasing the chance for success. (I serve on the board of one of them, Pfizer Inc. )

To win the race to a vaccine, America needs to engineer a development and regulatory process that is unprecedented in scope and urgency. Testing six or more candidate vaccines at once during a pandemic has never been tried anywhere. But it can be done.

First, the Food and Drug Administration should work with companies to conduct early safety testing while the vaccines are evaluated in laboratory and animal models to assess the full strength of their immunity. This parallel development process will save time and reveal more about the vaccines sooner. Regulators can also allow manufacturers to share common platforms for conducting the necessary studies. The FDA has developed good measures for potency using laboratory tests and animal models for the virus. These platforms should be adopted across industry, which will let regulators get clear answers more quickly.

Next, this effort will require novel approaches to clinical testing that allow us to build a large safety database and get an earlier answer on whether a product is working in people. Given that this vaccine will be deployed for mass inoculation of entire populations, a vaccine will need to be tested in tens of thousands of patients before it is approved for general use. An unsafe product could cause significant harm. The urgency to develop a vaccine quickly is eclipsed only by the need to make sure it is very safe.

Large Covid-19 outbreaks in American cities this fall may be inevitable. Against this grim backdrop, one approach to testing a vaccine is a “stepped wedge cluster.” Under this kind of clinical trial, a vaccine would be administered in the setting of an outbreak. The point is to provide some potential benefit while building a large and rigorous data set to evaluate its safety and effectiveness. This could be done as soon as a vaccine has cleared early safety trials.

The idea is to take a large number of doses and hold a trial in an outbreak city by serially vaccinating big groups of people—perhaps 25,000 at a time—with each cohort spaced two weeks apart, until 100,000 people have been inoculated over about six weeks. To see if the vaccine works, researchers compare the four groups and assess if timing of inoculation had a discernible impact on someone’s likelihood of contracting Covid-19.

The next massive challenge is making enough vaccines. Congress has set aside more than $3.5 billion for this purpose as part of the Cares Act. This allows the government to secure doses in advance of a product’s approval, which is essential for rolling out a vaccine the minute it’s approved. The money will be used to support investments in large-scale manufacturing. Johnson & Johnson recently announced a major collaboration with the Health and Human Services Department’s Biomedical Advanced Research and Development Authority to secure an early supply of vaccines. The government should also give grants to manufacturers with the most promising vaccines to rush the construction of large factories and other facilities.

I think there are some steps missing from his plan. For a massive trial in an “outbreak city”, don’t you need to know the prevalence? We don’t know that and if we stay on our present path we won’t know in three months or six months or a year, either. Otherwise how do you know what you’re measuring?

Or this:

China is making rapid progress, with three vaccines entering advanced development. Chinese officials say they could have a vaccine available for widespread use next year.

At this point how much would you trust a Chinese vaccine? How much would you trust their claims for it? How much would you trust whether what they’re producing is actually the same thing that they tested? Fool me once… I think the only thing we can do at this point is to ignore China.

My final misgiving was stated pretty well by G. K. Chesterton: anything not worth doing is not worth doing well. How confident should we be that, regardless of how great the prospective rewards, an effective vaccine can actually be developed? How do you scale up the production of something that cannot be produced?

We don’t know, for example, if having recovered from the virus conveys resistance. I would be a lot more comfortable if an effective vaccine for any coronavirus had been developed in the past.

I found this op-ed at the Wall Street Journal by T. J. Rogers interesting and timely:

Do quick shutdowns work to fight the spread of Covid-19? Joe Malchow, Yinon Weiss and I wanted to find out. We set out to quantify how many deaths were caused by delayed shutdown orders on a state-by-state basis.

To normalize for an unambiguous comparison of deaths between states at the midpoint of an epidemic, we counted deaths per million population for a fixed 21-day period, measured from when the death rate first hit 1 per million—e.g.,‒three deaths in Iowa or 19 in New York state. A state’s “days to shutdown” was the time after a state crossed the 1 per million threshold until it ordered businesses shut down.

We ran a simple one-variable correlation of deaths per million and days to shutdown, which ranged from minus-10 days (some states shut down before any sign of Covid-19) to 35 days for South Dakota, one of seven states with limited or no shutdown. The correlation coefficient was 5.5%—so low that the engineers I used to employ would have summarized it as “no correlation” and moved on to find the real cause of the problem. (The trendline sloped downward—states that delayed more tended to have lower death rates—but that’s also a meaningless result due to the low correlation coefficient.)

No conclusions can be drawn about the states that sheltered quickly, because their death rates ran the full gamut, from 20 per million in Oregon to 360 in New York. This wide variation means that other variables—like population density or subway use—were more important. Our correlation coefficient for per-capita death rates vs. the population density was 44%. That suggests New York City might have benefited from its shutdown—but blindly copying New York’s policies in places with low Covid-19 death rates, such as my native Wisconsin, doesn’t make sense.

I’ve highlighted the portion of the op-ed I think is most significant. The balance of the op-ed deals with Sweden and to my eye it contains a certain amount of handwaving so I have not quoted it. The fact remains that Sweden’s outcome has been worse than other, demographically, culturally, and geographically similar countries that adopted other strategies. That seems to me as close to a real world experiment as we’re likely to come.

It seems to me there are multiple questions worthy of consideration from a public policy standpoint. The first is whether putting “stay at home” directives in place early are effective? But that isn’t identical with the second question: how risky would it be to lift them? The final question is what should we be doing?

If you don’t like the op-ed, propose your own evaluation methodology. I’d be interested in seeing what you come up with.

I see that college law prof and Bloomberg columnist Stephen L. Carter has come around to a position I’ve articulated here. The companies who’ve been shut down by state and local governments have a case:

Why is everybody scoffing at the anti-shutdown lawsuits? It seems to me that they may have more of a point than critics seem to realize.

Consider the claims by shuttered businesses that continue to suffer losses — and in many cases face extinction — as shelter-in-place orders drag on. In their lawsuits, they essentially argue that by destroying their economic viability, the state governments have violated the Takings Clause of the Fifth Amendment to the U.S. Constitution, which requires just compensation when private property is taken for public use. The suits may not prevail; but they raise questions we should not ignore.

It’s true that the courts usually reject claims for compensation when the government restricts or even destroys private property to prevent the spread of disease. Cases involving the destruction of plants and animals are common. But almost always, the plants and animals are infected — or reasonably believed to be at high risk. In 1928, for example, the U.S. Supreme Court denied compensation after a state ordered the cutting down of ornamental cedars infected with a disease that would have caused enormous damage had it spread to a nearby apple orchard.

Ironically, the case was grounded in the need to protect the value of the state’s orchards, in which “many millions of dollars are invested” and “which furnish employment for a large portion of the population.” In other words, the justification for the destruction of the trees was the protection of the state’s economy.

Similarly, there will be times when no compensation is due even though properties are demolished entirely. In 1909, for example, the Supreme Court ruled that no compensation was due after the U.S. military commander in Cuba during the Spanish-American War ordered the destruction of several buildings to prevent the spread of yellow fever. There, however, the buildings were believed to be harboring germs; and the justices rested the outcome explicitly on the exigencies of wartime emergency.

Sounds pretty strong — but as it turned out, the claim of war did not bar all suits. In 1946, in a case called United States v. Causby, the justices ruled that the government had to pay damages for depreciation in the value of a farm adjacent to an airstrip for military planes. That the damage occurred during a national emergency made no difference. Nor did it matter that the farm was still useable; the compensation was due to loss in property value caused by low-flying planes.

Modern cases of this type rest heavily on the degree of economic harm. If the harm is small, the plaintiff loses. In 2009, for example, a federal appellate court rejected the claim of a Maine hospital forced by state law to serve indigent patients. The cost of the care was hundreds of thousands of dollars, but the judges pointed out that this amounted to only one half of one percent of the hospital’s gross revenues.

But this line of cases consistently notes that the outcome might be different if the economic harm is significant. In the coronavirus shutdowns, the harm is enormous. Many small businesses as well as some huge retailers are expected to fail.

The Takings Clause hasn’t always been held to apply to the states. It is only since 1978 that the Takings Clause of the Fifth Amendment

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

in Penn Central v. New York City. The significant precedents that would rule against the plaintiffs are much, much older and rendered moot by Penn Central.

Whether they have merit or not, the inevitable lawsuits are going to tie up state and local governments for years.

All of which could have been avoided by a more prudent and thoughtful Congress. It’s easy to legislate to spend money. Legislating to do so prudently actually requires thought, consideration, and understanding.

I want to take note of a recent post from Nate Silver. In the post Nate does a pretty fair job of assessing the present state of America’s struggle with COVID-19. It is blessedly free from political posturing. Here’s his one sentence assessment:

While the situation in many states is improving, in nearly half of all states in the U.S., there are as many COVID-19 cases as ever, and in some cases, even more.

but he has a reasonable humility about the limitations of the approach he’s using in his analysis:

As I’ve written before, the number of new confirmed cases can be a deceptive indicator of how much the coronavirus is spreading unless you also account for how many tests are conducted. But the stubborn persistence of the novel coronavirus in many parts of the country isn’t just an artifact of rising testing volume.

I think it’s it’s a weak indicator even if you account for the number of tests conducted and that will be the case as long as who is tested is basically self-selecting. That’s the reason I’m skeptical of his announcement of victory in New York:

Last week, I wrote about how New York has successfully bent the coronavirus curve after an extended period of social distancing. The evidence this week is even stronger. As of Wednesday, just 27.6 percent of newly reported COVID-19 tests in New York City were positive, still a fairly high rate — but substantially down from a peak of 59.4 percent on March 29. Other states are also seeing a decline in new cases — Louisiana, in particular, has seen a highly encouraging turnaround.

It may be a sign of victory or it may be a sign that lots of panicky New Yorkers with coughs who don’t have COVID-19 are having themselves tested and the tests are available to them. Until we have a better handle on how many people have contracted the virus but don’t show the symptoms of COVID-19 there’s really no way of telling. You’ve got to have some idea of what both the numerator and the denominator are.

I also want a better explanation of what’s happening in Illinois. Illinois was the second state in which the governor issued a statewide “stay at home” directive but at least to my eye it shows few if any signs of having “bent the curve”. I, for example, have basically been at home since the middle of March. I think the rational explanations are limited and contribute evidence to the notion that what we’re seeing, not just in Illinois but everywhere, is just the disease running its course rather than any measures that have been taken being effective in slowing its spread.

At any rate, read Nate’s post. It’s interesting and well-informed.

Will there be panic-buying and hoarding of nicotine gum and nicotine patches?

In an op-ed in the Wall Street Journal Andrew Biggs reacts to Illinois’s request for a federal bailout of its public pension funds:

Given Illinois’s record of poor pension stewardship, Congress should reject any bailout on the merits. And yet the alternative might be worse. I have spent the past three years as a member of the federal Financial Oversight and Management Board for Puerto Rico, wrestling with the island’s 2016 insolvency, which included the exhaustion of its main public pension funds. A governmental bankruptcy is an ugly process from which no quick or clean resolution can be expected. Illinois’s unfunded pension liabilities substantially exceed its bonded debt, meaning that even a complete debt default wouldn’t put its finances back on track. A statewide economic contraction could also become a regional threat.

So Congress may want to offer assistance, but it should come with strict conditions: Any state looking for a pension handout must either live by the stricter accounting rules federal law imposes on private pension plans or freeze its pension and shift all employees to defined-contribution retirement plans.

Private-sector plans must assume more-conservative investment returns than public-sector plans and address unfunded liabilities more rapidly. As a result, private pensions today have set aside more than twice as much funding per dollar of promised future benefits than have state and local pensions. If adopted decades ago, stricter funding rules could have saved pensions such as Illinois’s. But today those states are in a bind: Many can barely make their contributions using the lenient public-sector funding rules, much less the stricter rules for private plans.

The alternative is what the Puerto Rico Oversight Board insisted on: Freeze the old pension to prevent any new benefit accruals while shifting all employees to 401(k)-like retirement accounts. Freezing a pension doesn’t make its unfunded liabilities go away. But it caps existing liabilities while shifting employees to plans in which the government’s funding obligation is clearly defined and can’t be evaded using actuarial or accounting tricks.

Illinois politicians will claim their state constitution prevents pension changes. But it was a misguided 1970 amendment to that constitution that made public pensions in Illinois a contract for life. By contrast, federal laws governing private pensions prohibit cuts to benefits that have already been accrued but allow employers flexibility to alter the rate at which future benefits are earned. Any assistance should be premised on constitutional or legal changes to align state pension rules with federal law.

I don’t think that Mr. Biggs understand the situation completely. Doing what he proposes is, in fact, against Illinois’s constitution. It is not merely a “claim”. It is settled law. It would require amending the state’s constitution.

At the minimum that would require a 3/5s vote of the state’s legislature. Is there any motivation that would impel 60% of sitting representatives to commit political seppuku? Certainly not statesmanship or public-spiritedness. If those were present in our legislators we wouldn’t be in the mess we’re in.

I also find the willingness of people to blame the voters for Illinois’s predicament distressing. The columnist John Kass has characterized Illinois’s politics as “the Combine”: the Illinois Democratic Party and the Illinois Republican Party, like two criminal gangs, have entered into an informal and corrupt pact to divide power in the state. The voters don’t have a choice between one candidate who will do the right thing and another who won’t. They have the choice between two candidates who are largely in agreement on maintaining the corrupt status quo.

The City of Chicago is a case in point. In our recent mayoral election we did not have the choice between a big-spending Democrat and a minarchist Republican. No Republican ran. As has been the case for decades here two Democrats who largely agreed on the issues squared off against each other, both of them functionaries in the corrupt political machine. In the primaries I, along with a plurality of black voters, had voted for an outsider. He came in third.

Back in 2014 I crossed party lines to vote for Republican Bruce Rauner for governor. I felt it was the only chance we had for reform. He won but, unfortunately, either he didn’t understand the political situation well enough or merely did not have the guile necessary to do what needed to be done. He was stymied by an intransigent Democratic supermajority in both houses of the legislature.