Although I am sorely tempted I will not fisk the latest New York Times editorial, calling for an “all-in” effort (read: nationalized) to rescue the city from the consequences of its own folly. I’ll limit myself to remarks on this sentence:

Public health experts say wide-scale testing has saved lives in countries like South Korea and Germany, which have seen far fewer deaths from Covid-19 than the United States.

That’s an example of something called “lying with statistics”. While true when looked at from 50,000 feet, that doesn’t tell the whole story.

A quarter of all cases and fully half of the deaths due to COVID-19 in the entire United States are in New York State. 70% of New York State’s cases and deaths are in the counties of the New York City metropolitan area. Do the math. Moreover, the adjacent areas of New Jersey and Connecticut, essentially bedroom communities of New York City, add even more to the NYC cases and deaths.

To place that in perspective the number of cases and deaths, adjusted for population, in Illinois is 10% of New York State’s while California’s is 3%. In other words when you exclude the New York Metropolitan Area from your figures for the United States, the U. S.’s cases and deaths due to COVID-19, adjusted for population, are actually better than Germany’s and approaching South Korea’s.

The inescapable conclusion is that there is a serious COVID-19 outbreak in the NYC MSA, coping with it will require federal resources, and extraordinary measures will be required. In a sense that’s good news. The logistics of dealing with New York’s problem are manageable; extending it to the entire United States is impractical.

I won’t even hazard a guess as to why New York has this problem. There is no shortage of prospective reasons. Population density, reliance on subways, more extensive contacts with Europe, inadequate health care resources for a city of that size, the list goes on. I will only point out that the way you determine if there’s enough light in a reading room is if you have enough light to read by.

Here’s my modest proposal for dealing with the outbreak. First, close the NYC MSA, by force if necessary. No one goes in or out except to deliver necessary supplies or assistance. Second, focus national testing efforts and PPE deliveries on the NYC MSA. Test everybody, again by force if necessary. That alone is a daunting task. There are 20 million people in the NYC MSA. The entire U. S. has conducted about 3.5 million SARS-CoV-2 tests to date.

Third, shut down all public transport within the NYC MSA. That will slow the spread of the disease. Fourth, no one would be allowed out of the cordon sanitaire unless, after a two week mandatory quarantine, they test negative for the disease.

Finally, the quarantine will not be lifted until everyone within it has recovered from the disease, died, or a vaccine for it has been discovered.

The plan may cost trillions. It should be treated as a loan to the people of the NYC MSA. A surtax should be levied on residents of the NYC MSA so that the loan may be repaid over a period of 10 yearS. That should also serve to mitigate future risks.

I fully recognize that this plan is a non-starter. It has serious logistical, moral, legal, and civil rights issues. But that’s what an “all-in” plan would look like.

It’s always gratifying to see others thinking along the same lines as I have been. In this case shrink Vatsal G. Thakkar muses in this Wall Street Journal op-ed about the role Vitamin D might play in explaining disparities:

Black Americans are dying of Covid-19 at a higher rate than whites. Socioeconomic factors such as gaps in access to health care no doubt play a role. But another possible factor has been largely overlooked: vitamin D deficiency that weakens the immune system.

Researchers last week released the first data supporting this link. They found that the nations with the highest mortality rates—Italy, Spain and France—also had the lowest average vitamin D levels among countries affected by the pandemic.

Vitamin D is produced by a reaction in the skin to the ultraviolet rays in sunlight. Many Americans are low in vitamin D, but those with darker skin are at a particular disadvantage because melanin inhibits the vitamin’s production. As an Indian-American, my skin type is Fitzpatrick IV, or “moderate brown.” Compared with my white friends, I need double or triple the sun exposure to synthesize the same amount of vitamin D, so I supplement with 5,000 international units of vitamin D3 daily, which maintains my level in the normal range. Most African-Americans are Fitzpatrick type V or VI, so they would need even more.

This requires further study, but earlier research is suggestive. In 2018 a longitudinal study by researchers at Massachusetts General Hospital looked at whether vitamin D supplementation had any health benefits, specifically in regard to heart disease and cancer. The overall conclusion was that it didn’t, for most people. Yet buried in the results was one that should have made headlines: Vitamin D supplementation in African-Americans reduced cancer risk 23%. How? Cancer cells develop regularly in most animals, including humans, as the result of toxic injuries or glitches in DNA replication, but a healthy immune system destroys them. There is evidence that low vitamin D levels make the immune system go blind.

The need to treat different people differently may not be fair but it’s real. A major dietary source of Vitamin D supplementation is in milk and other dairy products and blacks tend to avoid those because so many are lactose intolerant (75-95%). As Dr. Thakkar points out, it’s worth investigating.

The editors of the Washington Post remind us that the poorest countries will need help in dealing with COVID-19:

GOVERNMENTS OF the world’s 20 largest economies — the Group of 20 — agreed Wednesday to a debt-service moratorium worth as much as $20 billion for the world’s 76 poorest nations, through the end of the year. The relief applies to government-to-government loans and may be renewed for an additional 12 months. The G-20 called on private lenders to grant similar forbearance; the Institute of International Finance, representing bank lenders to developing-nation governments, has spoken favorably about the idea (but not formally agreed). The International Monetary Fund (IMF) already offered some debt relief and pledged to deploy at least $1 trillion in lending power.

All of the above are steps in the right direction, if likely only the beginning of what it will take to prevent the coronavirus crisis from undoing the past two decades of progress in the world’s less developed countries, during which global poverty rates fell by more than 50 percent. Even as the United States, China, Europe and Japan are themselves reeling from public health and economic calamities, it is a moral imperative to help the developing countries and their people. It is also a matter of self-interest: We need healthy customers in emerging markets; the virus itself cannot be contained if developing countries must spend scarce resources on debt service rather than public health.

If we are really concerned about poor countries, the very best thing we could do for them is to get American consumers back on their feet. Whatever the role of other countries as markets for U. S. goods, it’s dwarfed by the role that U. S. consumers play in the economies of those countries.

We might also consider that American companies’ disentangling their supply chains from China and relocating them in not just one but multiple other countries would be of enormous economic benefit to the rest of the world.

It may also bear mentioning that about 150 countries, most of them poor, are paying debt service to China.

Yesterday President Trump released his plan for “reopening America”. You can read the entire plan here. It won’t take more than 5-10 minutes.

I’m clearly not the target audience for the plan. I would prefer more specific metrics—IMO that’s the only way you can actually measure progress, along with action items for himself, government agencies, states, private corporations, etc. along with metrics for those. But specifics would expose the president to attack so they’re avoided and the sort of detail I’m talking about would bore the pants off most people.

I have found it grimly amusing that nearly the same people who were outraged that Trump would claim the authority to reopen the country are now complaining that he’s dumping everything on the states. Welcome to federalism. Presumably, someone informed the president that he doesn’t actually have the authority to lift governors’ “stay at home” directives. Clearly, whatever shortages there may be in tests, protective equipment, hand sanitizer, and toilet paper, there is no shortage of outrage.

I think we’re going to see a lot more reports like this:

BOSTON — The Centers for Disease Control and Prevention is now “actively looking into” results from universal COVID-19 testing at Pine Street Inn homeless shelter.

The broad-scale testing took place at the shelter in Boston’s South End a week and a half ago because of a small cluster of cases there.

Of the 397 people tested, 146 people tested positive. Not a single one had any symptoms.

“It was like a double knockout punch. The number of positives was shocking, but the fact that 100 percent of the positives had no symptoms was equally shocking,” said Dr. Jim O’Connell, president of Boston Health Care for the Homeless Program, which provides medical care at the city’s shelters.

particularly over time. The article goes on to discuss the implications of those results for testing in Boston’s homeless shelters but I think there’s a lot more to it than that. The assumptions behind much of present policy include that, for example, it’s possible to avoid exposure to SARS-CoV-2. What if it’s sufficiently widespread that you can’t?

Another possible issue is that whatever test they’re using is giving lots of false positives. As I’ve pointed out before a test that produces lots of false positives and lots of false positives is pretty dubious. I wouldn’t want to use its results as a guide for policy.

I found this article at STAT by Sharon Begley interesting:

A widely followed model for projecting Covid-19 deaths in the U.S. is producing results that have been bouncing up and down like an unpredictable fever, and now epidemiologists are criticizing it as flawed and misleading for both the public and policy makers. In particular, they warn against relying on it as the basis for government decision-making, including on “re-opening America.”

“It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to projecting Covid-19 deaths, epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health told reporters this week, referring to projections by the Institute for Health Metrics and Evaluation at the University of Washington.

and

The chief reason the IHME projections worry some experts, Etzioni said, is that “the fact that they overshot” — initially projecting up to 240,000 U.S. deaths, compared with fewer than 70,000 now — “will be used to suggest that the government response prevented an even greater catastrophe, when in fact the predictions were shaky in the first place.”

That could produce misplaced confidence in the effectiveness of the social distancing policies, which in turn could produce complacency about what might be needed to keep the epidemic from blowing up again.

If you’re not already aware of it you may find this informative:

There are two tried-and-true ways to model an epidemic. The most established, dating back a century, calculates how many people are susceptible to a virus (in the case of the new coronavirus, everyone), how many become exposed, how many of those become infected, and how many recover and therefore have immunity (at least for a while). Such “SEIR” models then use what researchers know about a virus’s behavior, such as how easily it spreads and how long it takes for symptoms of infection to appear, to calculate how long it takes for people to move from susceptible to infected to recovered (or dead).

“The fundamental concept of infectious disease epidemiology is that infections spread when there are two things: infected people and susceptible people,” Lipsitch said.

Newer, “agent-based models” are like the video game SimCity, but with a rampaging pathogen: using computing power unimagined even a decade ago, they simulate the interactions of millions of individuals as they work, play, travel, and otherwise go about their lives. Both of these approaches have often nailed projections of, for instance, U.S. cases of seasonal flu.

The IHME model doesn’t use either approach.

If I were made of money and had nothing but time, I would try feeding every shred of information we have on people who’ve contracted and people who’ve died of COVID-19 on a day by day basis into a neural net. What you’d get from the exercise would probably not be actionable but it would be interesting if it were better able to predict incidence and outcomes than the “tried and true” approaches.

I suspect that none of the models are actually much use as a guide to policy-makers because they depend so greatly on their assumptions. A reality of model creation is that what a model produces for you depends on what you put into it, particularly on the model’s assumptions. For example:

how many people are susceptible to a virus (in the case of the new coronavirus, everyone)

is something we don’t necessarily know is true or false. It’s an assumption. It may be that some previous pathogen is enough like SARS-CoV-2 that those who contracted that previous pathogen and survived have some level of immunity to the virus we’re facing now.

Additionally, “susceptibility” has more than one component. The component referred to above is those who have immunity because they’ve already had the disease and that’s given them some level of immunity over some period of time. That, too, is an assumption. It may be true or false.

Some people are immune to some pathogens by virtue of hereditary or congenital immunity. For example, some are immune to HIV. There are some forms of cancer which strike people who have certain genes. We simply don’t know enough to claim with any confidence that everybody is susceptible to SARS-CoV-2. We don’t know that everybody is susceptible to the flu.

I have been running across a bumper crop of conspiracy theories about SARS-CoV-2. Pat Lang, whose opinion I generally regard highly, is convinced that the virus did not just originate in China but is a Chinese plot. Maybe he’s right or maybe he’s just lost in the “wilderness of mirrors”.

This article at Forbes, mostly devoted to the gamesmanship of Gilead’s announcements, expresses a different notion but a conspiracy theory all the same:

Bizarrely, China has just suspended one trial of the drug Remdesivir in Jin Yin-tan hospital in the outbreak capital of Wuhan and terminated another in Bin Cao Beijing, and the government report says, “The epidemic of COVID-19 has been controlled well at present, no eligible patients can be recruited.”

It is possible the Chinese government are worried Remdesivir is too effective and have moved to shut down the trials over fears the US drug could corner the global market. However, further tests are underway on the US west coast, including hundreds of hospitals and care homes.

Studies are currently being conducted at universities like University of Alabama at Birmingham School of Medicine – Infectious Disease, University of California, San Diego Health Jacobs Medical Center, and University of California Los Angeles Medical Center – Westwood Clinic.

Worldwide testing has begun in France, including studies in Paris, Nantes and Lille, there is testing underway in Oslo, Norway, and also in The Democratic Republic of the Congo in Africa.

I suspect that Remdesivir’s being covered on the news this morning won’t hurt Gilead’s share value, either.

My view is that sometimes a cigar is just a cigar, as Freud observed about images in dreams. Maybe China is ending its trials of the drug because they have just run out of patients. That seems incredible to me but maybe it’s true. The truth will emerge in time.

However great our sense of urgency, the real world is not a movie and not everything will be revealed in 110 minutes.

Despite our daily briefing from mayor, governor, and president and the focus of our major media outlets notwithstanding, the most important questions in the world are not about the United States and SARS-CoV-2 but about India and the virus.

India has not tested very many people at this point—about 1% as many relative to its population as the United States which many people contend is too few. It has been claimed with some reason that were India to test 10 times as many people it would identify 10 times as many cases of COVID-19.

Neither South Korea nor Japan nor Germany nor the United States is the model for the many poor, populous countries in the world. India is. If India cannot control COVID-19, it will be a global disaster however the U. S. fares.

India has some handicaps. Not only is it poor, populous, and its cities densely populated it has terrible air quality and diabetes is believed to be quite common among its population. It has a fraction of the physicians, hospital beds, and ventilators relative to its population as the U. S. and the countries of Europe do. But it has advantages, too. Its health care system can be of higher quality than in many other poor, populous countries. It is the world’s largest producer of hydroxychloroquine. The entire country has been on lockdown for weeks. And it is hoped, at least, that India’s climate will stymie the virus, especially during the summer.

The history of SARS-CoV-2 will be written in India. If the worst case scenario is realized, millions will die there. And in Nigeria, Indonesia, Bangladesh, Malaysia, and other poor, populous countries.

At Politico John F. Harris muses over a “backlash” that may emerge over the “stay at home” directives. Much of the piece consists of chortling about supposed discomfiture of Rand Paul in contracting the virus but he then turns to more substantive observations:

Now that Paul has recovered—he says he felt fine and symptom-free the whole time—it is a good time to ask: Are we sure that the pandemic joke will ultimately be on him?

What if the opposite is true? Far from rendering Paul’s brand of politics irrelevant, it seems possible, even probable, that the wake of the coronavirus will be a powerful boost to the animating spirt of libertarianism: Leave me alone.

Among the questions looming over American politics is about the nature of what promise to be multiple backlashes over different dimensions of the coronavirus crisis. Most obvious is what price Trump pays for his administration’s tardiness in responding to the contagion in its early stages. Less obvious is what price supporters of activist government pay for the most astounding and disruptive intervention in the everyday life of the nation since World War II.

The imminent libertarian surge is not a sure thing but it more than a hunch. In informal conversations, one hears the sentiment even from people I know to be fundamentally progressive and inclined to defer to whatever health officials say is responsible and necessary to mitigate the worst effects of coronavirus. It is possible both to support the shutdown and powerfully resent it — the draconian nature of the response, and the widespread perception that to voice skepticism of any aspect of its necessity is outside respectable bounds.

The absolutist nature of the country’s shutdown and the economic rescue package have democratic consent—enacted by a bipartisan roster of governors and overwhelming votes in Congress—but it was the kind of consent achieved by warning would-be dissenters, Are you serious? There is no choice!

Many people concluded that for now there is nothing to do but suck it up. It won’t be surprising if some of those people eventually have an intense desire to spit out.

If so, this would be entirely consistent with the history of crises, both recent ones and more distant. Very often, after some cataclysmic external event, politics responds in ways that scramble normal divisions and create the impression—as in that recent 96-0 vote—that familiar ideological dynamics have been suspended.

Almost always, this is an illusion. Ideology hasn’t been suspended. It has been forcibly suppressed—in ways that inevitably will come roaring back, sometimes in highly toxic ways.

He then turns to a comparison I think is completely specious:

The most vivid example in American history likely was around World War II. As the world was aflame, but the United States not yet engaged in hostilities, the country was bitterly and intensely divided over the all-consuming question of that era: intervention or isolation. Then came Pearl Harbor, and the debate ended in an instant. Isolationism looked to be a defunct ideological force. Except it wasn’t really. The movement’s essential spirit—fear of corrupt and scheming interests beyond American borders—found new and malicious expression in McCarthyism in the late 1940s and early 1950s.

That’s basically nonsense or else he’s using an eccentric definition of “isolationism” to mean, presumably, “beliefs held by people I don’t like”. The attack on Pearl Harbor killed isolationism as a political force in the U. S. There was more than one kind of isolationism (basically Jacksonian and Jeffersonian) and all varieties have largely been silenced as a consequence of the attack. The U. S. could no longer shut itself off from the rest of the world and there was a fear that the Atlantic and Pacific could no longer protect the U. S. mainland. That and the American Civil War are the sources of our present trigger-happiness. We do not want to fight a war within our borders and have decided that the best way to prevent that is to ensure that wars that start elsewhere end elsewhere as well.

It is not isolationist to think that when a foreign power has infiltrated not just your government but many other of your institutions as well that something should be done about it. But Joe McCarthy was no libertarian and conflating him with libertarians as this article does is not constructive.

IMO the longer, the stricter, and the more hypocritical “shelter in place” directives are, the greater the chafing against them will become. The scene yesterday in Lansing, Michigan was a mild preview of what is to come.

What do I mean by “hypocritical”? Chicago Mayor Lori Lightfoot was called out, embarrassingly, on having her hair done. She blurted out a feeble explanation of being the “face of Chicago” which I guess was better than “Suck it up, peasants” but everybody knew that’s what she meant. Police officers not following “social distancing” guidelines or facemask directives are other examples. You can’t make one set of rules for politicians and public employees and another for everybody else.

Arbitrary determinations of what are or are not essential businesses are problematic as well. Here lawn services are on the list of “essential businesses”. ‘Splain me, Lucy. Are clothing stores that sell candy bars at their sales counters essential while those that do not aren’t?

I continue to hear claims about “bending the curve” but still see that as mostly wishful thinking. Consider this graph from the Illinois Department of Public Health:

Each succeeding bar of that columnar bar chart is taller by a few than the preceding. That is not “bending the curve” and the state has had a “stay at home” directive in place for nearly a month now.

If “stay at home” directives remain in place long enough, they will inevitably disrupt the food supply chain and elected officials will have much, much more to worry about than not overloading the health care system.