I want to draw your attention to this interesting article at the New York Times by epidemiologist Marc Lipsitch, considering who is likely to contract SARS-CoV-2:

The ideal scenario — once infected, a person is completely immune for life — is correct for a number of infections. The Danish physician Peter Panum famously figured this out for measles when he visited the Faroe Islands (between Scotland and Iceland) during an outbreak in 1846 and found that residents over 65 who had been alive during a previous outbreak in 1781 were protected. This striking observation helped launch the fields of immunology and epidemiology — and ever since, as in many other disciplines, the scientific community has learned that often things are more complicated.

One example of “more complicated” is immunity to coronaviruses, a large group of viruses that sometimes jump from animal hosts to humans: SARS-CoV-2 is the third major coronavirus epidemic to affect humans in recent times, after the SARS outbreak of 2002-3 and the MERS outbreak that started in 2012.

Much of our understanding of coronavirus immunity comes not from SARS or MERS, which have infected comparatively small numbers of people, but from the coronaviruses that spread every year causing respiratory infections ranging from a common cold to pneumonia. In two separate studies, researchers infected human volunteers with a seasonal coronavirus and about a year later inoculated them with the same or a similar virus to observe whether they had acquired immunity.

In the first study, researchers selected 18 volunteers who developed colds after they were inoculated — or “challenged,” as the term goes — with one strain of coronavirus in 1977 or 1978. Six of the subjects were re-challenged a year later with the same strain, and none was infected, presumably thanks to protection acquired with their immune response to the first infection. The other 12 volunteers were exposed to a slightly different strain of coronavirus a year later, and their protection to that was only partial.

It is presently hoped that some people have acquired at least temporary immunity to the virus. Or that some people are resistant to the infection because they have contracted a similar disease in the past.

There is also a certain amount of information emerging that some people are more predisposed to becoming infected or if infected seriously ill, not just by virtue of pre-existing health conditions or behavior but by their genetic makeup. To some extent such research is taboo in our society not only because it violates notions of “fairness” but because it has been abused in the past. That’s an unfortunate but understandable prejudice. The greater our knowledge about this virus, the greater may be our ability to fight it.

Read the whole thing.

As of this writing we are closing in on 2 million diagnosed cases of COVID-19 worldwide (1,773,112 precisely) with more than 100,000 deaths attributed to the disease (108,471). The U. S. leads the world in number of cases diagnosed, number of deaths, and number of tests administered albeit not in number of cases per million population (San Marino), number of deaths per million population (also San Marino), or number of tests administered per million population (Iceland). Nearly all Americans live in states which have issued “stay at home” directives.

To my knowledge no one has taken any position on what level of compliance with such orders would be necessary for them to have any effect. It’s obvious to me at least that there is some level of non-compliance below 100% which renders such order moot. We’re not going to achieve a compliance rate of 100% on anything.

At this point I am convinced that South Korea, practically alone among countries, has actually managed to “bend the curve”. They have kept their new cases per day to from 25-55 for almost a week now. They have tested nearly 1% of their population, starting in late January, shortly after the first cases began to appear. Their response to the virus has been a combination of aggressive testing, follow-up, and tracing of all positives. IMO and, I believe, in the opinion of just about everyone with an open mind, it’s too late for that strategy in the U. S.

I should add that the differences between South Korea and the U. S. are stark. By comparison it’s small, compact, with generally high social coherence, and conformity with rules. South Korea is already exporting test kits albeit not in numbers sufficient to make a dent in U. S. requirements.

I see few signs of our bending the curve at this point and I think that the predictions I’ve heard of deaths per day peaking today are wishful thinking. In Nate Silver’s piece on ABC’s This Week I thought he was drawing conclusions far too sweeping based on too small changes over too short a timeframe. Reporting errors or delays could account for everything he’s seeing.

We don’t have enough tests or protective equipment yet. I wish President Trump were making more aggressive use of the Defense Production Act.

In the U. S. there are presently competing notions about how to proceed, largely drawn along party lines. I think that both extreme positions (test everybody and stay locked down until the threat passes vs. go back about your business as normal) are nuts. What I would prefer would be a highly organized systematic nationwide sample of tests used to inform lifting or tightening of “stay at home” directives and to optimize the still limited availability of resources. I would characterize such a plan as epidemiological testing. It should be accompanied by serological testing, with much the same objectives.

I am indifferent as to whether such a plan would come from the federal government, from the states working in cooperation, or from the private sector as long as it happens.

We should be paying more attention to the responses of other countries, not just South Korea but, importantly, South Africa. South Africa has put one of the strictest “stay at home” policies outside China in place along with aggressive testing, has a largely sub-Saharan black population, and has a pretty temperate climate, making a transition from its summer to its autumn. Running experiments are difficult in the real world but you can obtain helpful information from the experience of other countries if you’re willing to make a realistic assessment of the differences among countries.

I don’t think we’re receiving any information from China that’s worth considering and I don’t really think that we can learn much from the experience of ethnically homogeneous city-states or their equivalents but I wish that Americans including American scientists and physicians who should know better were not so dismissive of information gleaned from South Korea or any number of other countries with populations over 50 million.

I agree with Joe Biden’s plan for reopening America, published here in the New York Times:

Here’s what our national strategy should look like.

First, we have to get the number of new cases of the disease down significantly. That means social distancing has to continue and the people on the front lines have to get the supplies and equipment they need. President Trump needs to use his full powers under the Defense Production Act to fight the disease with every tool at our disposal. He needs to get the federal response organized and stop making excuses. For more Americans to go back to their jobs, the president needs to do better at his job.

Second, there needs to be widespread, easily available and prompt testing — and a contact tracing strategy that protects privacy. A recent report from Mr. Trump’s Department of Health and Human Services made clear that we are far from achieving this goal.

We should be running multiple times the number of diagnostic tests we’re performing right now. And we should be ready to scale up a second form of testing: rapid serology tests to tell who has already been infected with the coronavirus and has antibodies. This isn’t rocket science; it’s about investment and execution. We are now several months into this crisis, and still this administration has not squarely faced up to the “original sin” in its failed response — the failure to test.

Third, we have to make sure that our hospitals and health care system are ready for flare-ups of the disease that may occur when economic activity expands again. Reopening the right way will still not be completely safe. Public health officials will need to conduct effective disease surveillance. Hospitals need to have the staff and equipment necessary to handle any local outbreaks, and we need an improved federal system to get help to these places as needed.

Make no mistake: An effective plan to beat the virus is the ultimate answer to how we get our economy back on track. So we should stop thinking of the health and economic responses as separate. They are not.

Once we have taken these steps, we can begin to reopen more businesses and put more people back to work.

The devil, of course, will be in the details. I think that testing every American for SARS-CoV-2 not just once but multiple times, something Mr. Biden has also supported, would not produce results relative to its costs.

I think the Trump Administration has been far too slow in taking some of the measures at its disposal to speed this process along.

But treating this as a distinctive failure on Trump’s part is a step too far. It’s a failure of Trump’s but not just a failure of Trump’s. This isn’t a partisan issue. The U. S. failure to take the prospect of a pandemic seriously has taken place over the last four administrations at least. While it’s true that the Trump Administration did not restock the national stockpiles of ventilators, respirators, and so on, neither did the Obama Administration in which Mr. Biden served as vice president. Neither did the Bush Administration or the Clinton Administration.

And the one thing that needs to be acknowledged more than anything else is that a global pandemic has always been a risk of a globalized economy. Now it’s not just a risk but an issue.

It’s reasonable to ask how much time, money, and attention should be devote to low probability high impact events but it’s also reasonable to ask what that we have done instead would you be willing to do without to prepare for those low probability high impact events? You can argue about the advisability of spending money but that time and attention are not infinitely expandable resources is a fact which we need to acknowledge. Should we, for example, not have educated children, built roads, or treated the sick so that we could devote more resources of time and attention to preparing for a pandemic?

For a “way out of this pandemic”, the Washington Post turns to Danielle Allen, a political theorist, as one does when dealing with a health crisis. Dr. Allen proposes creating a Pandemic Testing Board analogous to the World War II War Production Board:

What would it do?

First, it would carry out a Pandemic Testing Supply Initiative.

That means the board would have authority to identify supply-chain elements necessary for manufacturing, procuring, scaling and deploying any items related to testing. It would have the power to procure these materials via contracting with producers and servicers, and the power to mandate production or services, akin to authorities in the Defense Production Act. Contracting firms would be required to follow all existing labor laws, including maintaining collective bargaining agreements.

At the same time, there would also need to be a Pandemic Testing Deployment Initiative. To deploy testing at scale, there would need to be sufficient personnel to test individuals outside of hospitals and doctors’ offices. So the Pandemic Testing Board would:

• Craft recommendations for states to use the National Guard to deploy testing in conjunction with business, labor, nonprofits and academia.
• If necessary, be authorized to create a Pandemic Response Corps, made up of tested civilians, to assist.
• Make recommendations on tracking the spread of the virus.
• Before disbanding, craft recommendations on long-term preparedness.

This entire idea is gobsmackingly half-baked but it’s about what you would expect from someone without practical experience of anything other than cracking a poli sci text. The effect of such a board would be to create an all-powerful soviet whose mandate would never end because the problem it was created to address would never be solved. As I’ve described it before, it would be the world’s largest, most expensive, most futile game of Whac-A-Mole.

Fortunately, we don’t need to do that. What we do need to do is create a plan for sampling the population and start using the tens of thousands of testing devices already installed in hospitals around the country, mobilizing such industrial support as is necessary to create more test kits. Let’s not buy the materials to do that from China, hmm?

The editors of the Washington Post want to know why the death rate due to COVID-19 among American blacks is so much higher than for whites:

THE NOVEL coronavirus, as far as we know, does not discriminate along racial lines. But America does — and the data so far show that black people are dying at a disproportionate rate. The first thing to do about it? Get more of that data, and fast.

The numbers trickling in from cities, counties and states in recent weeks are alarming: Chicago’s population is about 30 percent black, but so are nearly 70 percent of those in the city killed by the virus. Milwaukee County looks worse: Black people make up 26 percent of the population, and a whopping 73 percent of covid-related deaths. In Michigan, it’s 14 and 41; in Louisiana, it’s 32 and 70. Maryland has a 30 percent black population and reported Thursday that black residents account for 40 percent of the state’s deaths.

They are convinced that the only possible explanation is racism. It’s the only explanation of which they will admit. The same is true of the explanations proffered by our governor and mayor.

I think they are probably over-simplifying. If the racial disparity in death rates were solely due to racism, wouldn’t you expect that there would be a similar disparity in deaths due to seasonal flu or pneumonia? There aren’t. Blacks are at a slight disadvantage with respect to those diseases as well but it’s not remotely as stark. COVID-19 is different.

I would suggest that there are multiple factors involved including:

• Racism, historic and present
• Behavior including social behavior and dietary preferences
• Maybe even genetic predisposition

Here in Chicago we are concluding the deadliest week in recent Chicago history. More young black men have shot and killed each other than we are accustomed to and that despite “stay at home” directives or maybe even because of them. A quarter of the total homicides for the entire year. Attributing that to racism is just too pat. It’s more complicated, a soup of gangs, boredom, drug use, and social dysfunction from which racism is inextricably entwined.

The graph above, sampled from the site of the Illinois Department of Public Health and annotated by me, depicts the number of COVID-19 cases on a daily basis from March 10, the day after Gov. Pritzker declared a state of emergency, to the present. Gov. Priztker says we’re “bending the curve”. If we are, I don’t see it. The good news, I guess, is that the number of diagnosed cases isn’t doubling every six days, suggesting the outcome won’t follow the worst case scenarios.

What I think is happening is that despite the “stay at home” directives, banning public gatherings, closing the beaches, etc., the disease is running its course.

I continue to believe that the only public health measure that might have been effective would have been to ban all foreign travel starting in late December. Under the circumstances that would have required prescience.

It’s possible that the spread of the contagion within the U. S. might have been contained had we suspended domestic air travel and started epidemiological testing in late January. That would have required considerable political courage.

In the years, decades to come, the events of the last six months will undoubtedly be studied, rehashed, and second guessed millions of times. As I see it anyone trying to come to a complete understanding of COVID-19 and its spread needs to answer some questions:

1. In the absence of full disclosure and complete cooperation from the Chinese authorities starting in December 2019, could we reasonably expect anything effective to have been done?
2. Why was Italy so affected by the contagion?
3. Why has the spread of the disease been so limited in Germany?
4. Why is New York City so stricken? It accounts for a third of all of the cases in the United States. As a side note, why are the subways still running in NYC?
5. Why are the prevalence and morbidity of the disease so different from state to state?
6. Why do people of sub-Saharan African descent in the United States comprise such a large percentage of the cases of COVID-19 and an even larger percentage of the deaths due to the disease?

I think the answers to those questions will be a sort of litmus test.

I found the proposal for improving the CARES Act, supported here by the editors of the New York Times prudent:

Senator Josh Hawley, Republican of Missouri, has proposed an American version. Under his plan, the government would pay up to 80 percent of payroll costs for each employee up to the median wage — which the Social Security Administration pegged at $32,828 in 2018.

Mr. Hawley’s whatever-it-takes plan recognizes the immensity of this crisis.

“It’s like, ‘Wow, we’re going down, down, down, down, down.’ Nobody can see the bottom,” he told The Washington Post. “I personally don’t care to find out where the bottom might be!”

Crucially, the money would be distributed by a much larger arm of the government, the Internal Revenue Service. (The program is technically designed as a payroll tax rebate.)

The plan also would provide a bonus for rehiring workers laid off since the crisis began.

And the same aid would be available to larger employers affected by the crisis, too.

It does have a fatal problem, hwoever: it was proposed by a Republican which will probably render it DOA in today’s House while Rep. Jayapal’s considerably less prudent proposal will likely sail through.

A key problem, one shared by elected representatives, is that people just don’t appreciate the immensity of the task or its logistical requirements. Issuing checks probably isn’t the best approach, either. About 7% of U. S. households are “unbanked” while another 15% only have a tangential relationship with a bank.

There are plenty of people with the required logistical mindset, both in the private sector and public sector, and there’s an urgent need to make someone of that stamp responsible for coordinating the country’s response to the present crisis, either a general, someone in supply chain management for a large company, e.g. Apple or Amazon, or someone presently working for a big 3PL (third party logistics company, e.g. UPS).

I suspect we’ll see many, many more course corrections to the policies we’ve been putting in place over the last few months over time.

Against my better judgment I am presently listening to President Trump’s briefing on the status of the “war on coronavirus”. I just wanted to comment on one thing. President Trump just said that the United States had administered tests for the virus than more people than any other country. That is true but it is quite misleading. We have administered nearly 2.5 million tests but we are a very large country.

On a tests per million population basis not only have we not administered the most tests, we aren’t even in the top 40. Who is?

Nearly all of those in the top twenty per 1M population are relatively small islands and city-states. After that are Norway, Switzerland, Slovenia, Germany, and Austria. Then other highly cohesive ethnic states including places very hard-hit by COVID-19 including Spain and Italy.

I see little correlation between raw number of tests administered and anything useful. I think we’d be better off being smarter than that but it’s hard to drum up support for that in a country like ours.

Here’s an expert opinion from the National Academy of Sciences on the prospective effects of various conditions of temperature and humidity on the “novel coronavirus”. From the conclusion:

Some limited data support a potential waning of cases in warmer and more humid seasons, yet none are without major limitations. Given that countries currently in “summer” climates, such as Australia and Iran, are experiencing rapid virus spread, a decrease in cases with increases in humidity and temperature elsewhere should not be assumed. Given the lack of immunity to SARS-CoV-2 across the world, if there is an effect of temperature and humidity on transmission, it may not be as apparent as with other respiratory viruses for which there is at least some pre-existing partial immunity. It is useful to note that pandemic influenza strains have not exhibited the typical seasonal pattern of endemic/epidemic strains. There have been 10 influenza pandemics in the last 250-plus years—two started in the northern hemisphere winter, three in the spring, two in the summer and three in the fall. All had a peak second wave approximately six months after emergence of the virus in the human population, regardless of when initial introduction occurred.

Additional studies as the SARS-CoV-2 pandemic unfolds could shed more light on the effects of climate on transmission.

In summary, though experimental studies show a relationship between higher temperatures and humidity levels, and reduced survival of SARS-CoV-2 in the laboratory, there are many other factors besides environmental temperature, humidity, and survival of the virus outside the host, that influence and determine transmission rates among humans in the “real world”.

Cheery, no?

Is this a fair summary?

1. We shouldn’t bet the farm on the summer baking the virus out.
2. It is likely, nearly certain, that SARS-CoV-2 will return in the late summer or early fall.

To that I would add that New York City may have provided a nearly optimal environment for the virus: it was the right temperature, the right humidity, and a lots of travel back and forth with China in the weeks of active spread there.

Said another way, I don’t think we should be too quick to attribute successes against SARS-CoV-2 to the actions that have been taken. We don’t know enough, it’s more complicated than that, and the situation is very fluid.