There is a difference between knitting a sweater over a week’s time and knitting 1,000 sweaters over a week’s time. Lots of the commentary I’ve read lately fails to recognize that. It’s not just 1,000 times more complicated. It’s many, many times a 1,000 times more complicated.

For Iceland to test 8% of its population of 365,000 people is a major undertaking. For the United States to test 8% of its 330 million population isn’t 1,000 times more complicated. It’s a million times more complicated. The logistical, manpower, communications, and material components are all incredibly vast. That’s sufficiently complex that it may not even be a worthwhile goal at all.

We need to be smarter than that.

That is the question asked by this very interesting article at STAT by Sharon Begley:

The question is whether ICU physicians are moving patients to mechanical ventilators too quickly. “Almost the entire decision tree is driven by oxygen saturation levels,” said the emergency medicine physician, who asked not to be named so as not to appear to be criticizing colleagues.

That’s not unreasonable. In patients who are on ventilators due to non-Covid-19 pneumonia or acute respiratory distress, a blood oxygen level in the 80s can mean impending death, with no room to give noninvasive breathing support more time to work. Physicians are using their experience with ventilators in those situations to guide their care for Covid-19 patients. The problem, critical care physician Cameron Kyle-Sidell told Medscape this week, is that because U.S. physicians had never seen Covid-19 before February, they are basing clinical decisions on conditions that may not be good guides.

“It’s hard to switch tracks when the train is going a million miles an hour,” said Kyle-Sidell, who works at a New York City hospital. “This may be an entirely new disease,” making ventilator protocols developed for other conditions less than ideal.

Read the whole thing. Remember, these decisions are being made in good faith and on the fly. They aren’t scientific in the sense that they’ve been rigorously tested. They’re being made based on experience, convention, the standard of care, and guesswork.

I found lots of interesting observations in the article including that people with COVID-19 look more like people with altitude sickeness than they do like people with pneumonia. I can’t testify as to the veracity of any of this but it is interesting.

For those wondering about what’s wrong with the World Health Organization, this Wall Street Journal op-ed from Lanhee J. Chen should explain the issues:

The World Health Organization isn’t just “China centric,” as President Trump called it on Tuesday. It is also broken and compromised. The WHO fell short in its dithering reaction to the 2014 Ebola outbreak in West Africa, which claimed more than 11,000 lives. Now its response to the coronavirus pandemic shows it is willing to put politics ahead of public health. The way the WHO has consistently acted to placate China’s leaders makes clear the need for fundamental reform.

The U.S. is the biggest financial contributor to the WHO—more than $400 million in 2019, when China sent only $44 million, according to the U.S. State Department. Mr. Trump suggested that the U.S. might hold its funding while his administration takes a “good look” at what the country is getting for its money. He and Congress should go further.

While Washington pays, Beijing works behind the scenes to influence WHO leaders. The current director-general, Tedros Adhanom Ghebreyesus, was backed strongly by the Chinese government during his campaign for the job. Mr. Tedros was a controversial pick, dogged by allegations of having covered up cholera outbreaks in his native Ethiopia, where he served as health minister (2005-12) and foreign minister (2012-16). During those years, China invested in Ethiopia and lent it billions of dollars. Shortly after winning his WHO election, Mr. Tedros traveled to Beijing and lauded the country’s health-care system: “We can all learn something from China.”

Under Mr. Tedros’s leadership, the WHO has accepted China’s falsehoods about the coronavirus and helped launder them into respectable-looking public-health assessments.

On Jan. 14, before an official WHO delegation had even visited China, the group parroted Beijing’s claim that there was “no clear evidence of human-to-human transmission.” Two weeks later, after China had reported more than 4,500 cases of the virus and over 70 people in other countries were sick with it, Mr. Tedros visited China and heaped praise on its leaders for their “transparency.”

Recall that China waited six weeks after patients first saw symptoms in Wuhan to institute a lockdown there. During this time Chinese authorities censored and punished physicians who tried to sound the alarm, repeatedly denied that the virus could be transmitted between humans, and held a public banquet in Wuhan for tens of thousands of families. In the meantime, more than five million people left or fled Wuhan, according to the city’s mayor. This included the patient with the first confirmed case of the virus in America.

The WHO finally declared a public-health emergency on Jan. 30, after nearly 10,000 cases of the virus had been confirmed. China’s reported figures rose in early February to more than 17,000 infections and 361 deaths, yet Mr. Tedros rebuked Mr. Trump for restricting travel from China and urged other countries not to follow suit. He called the virus’s spread outside China “minimal and slow.” It took until March 11 for the WHO to declare a pandemic. By that point the official world-wide case count was 118,000 people in 114 countries.

China’s influence is also apparent in the WHO’s exclusion of Taiwan. The WHO didn’t even bother replying to Taiwanese inquiries in December about whether the coronavirus could, contrary to Beijing’s claims, be transmitted between humans.

Last month a Hong Kong TV reporter asked Bruce Aylward, who leads the WHO-China Joint Mission on Coronavirus, if the organization would reconsider its refusal to allow Taiwan to join. Dr. Aylward, on a remote video connection, sits silent and expressionless for nearly 10 seconds before the reporter prompts him again: “Hello?”

“I’m sorry,” he finally says, “I couldn’t hear—I can’t hear your question, Yvonne.”

“Let me repeat the question,” she says.

“No, that’s OK. Let’s move to another one then.”

When she presses him on Taiwan, he terminates the connection. The reporter calls back and tries a different tack: “I just want to see if you can comment a bit on how Taiwan has done so far in terms of containing the virus.”

His reply: “Well, we’ve already talked about China, and, you know, when you look across all the different areas of China, they’ve actually all done quite a good job.”

The exchange demonstrates how the WHO prioritizes politics over public health. It has internalized Beijing’s view of Taiwan and seeks to praise China’s leaders at every turn. And at no point during the crisis has the WHO substantively investigated the Chinese regime’s claims about the virus or been transparent about the thinking behind its decisions.

As the biggest financial contributor to the WHO, the U.S. has the leverage to push for radical reform. Congress should condition all future funding on the WHO’s explaining in detail how it reaches its public-health decisions and rigorously and independently investigating the extent of disease outbreaks.

The U.S. should work aggressively to change the culture and leadership of the WHO. The Trump administration took a good first step in January by creating a special envoy at the State Department focused on countering China’s attempts to control international organizations. The WHO’s next director-general must not be a rubber stamp for Beijing.

If the WHO not only does not decrease risk but actually increases it and if it does not reduce the transactional costs of dealing with international health problems, it does not perform any function to which we should subscribe. Time for it to go.

It is darned hard to make reasonable inferences based on the data we’re getting and, especially, based on the media reports. Keep in mind that most of the people in the national media live in the New York City metro area, the Washington, DC metro area, or Los Angeles.

Roughly one third of all confirmed cases of COVID-19 in the United States are in the New York metro area. We’re not sure why that is. Population density, temperature, the number of people returning from China during January and February, and the behavior of the people, e.g. crowding into subway cars, probably all play roles.

More than one third of all confirmed cases of COVID-19 in California have been in the Los Angeles metro area. The reasons for that are even less clear than for New York. The only two that seem to apply are the number of people coming from China during January and February and behavior.

Composed as it is of parts of Maryland, Virginia, and the district itself, Washington, DC is harder to ferret out. To my eye there actually haven’t been a lot of cases in the DC metro area.

Compare New York and LA with some other places. There have been more confirmed cases in the Bronx than there have been in the ten states with the lowest number of cases put together (Minnesota, West Virginia, Nebraska, Kentucky, Hawaii, Alaska, Oregon, Montana, Kansas, North Dakota). Those states are all over the map but quite a few of them have things in common. The Upper Midwestern states in that list plus a few others are relatively homogeneous, socially cohesive, known for maintaining “social distancing” even under ordinary circumstances, and tend to have low population densities. Hawaii has a warm climate going for it.

Shoehorning a policy crafted for New York City into the rest of the country does not sound like a formula for success to me, especially when you can’t even shoehorn it into New York City. The subway is still running, albeit with a much lower ridership.

Now maybe all that will change. Maybe it won’t.

I have a little difficulty separating the political fulmination from the facts in our handling of the COVID-19 outbreak here in the United States. Let me give an example of what I mean.

As of this writing no country other than China has succeeded in “bending the curve”, at least not in the way that the curves are usually drawn, and I don’t believe the reports coming from China at all. Not South Korea, not Taiwan, not Singapore, not Japan and certainly not Germany. Not Sweden. The strategies taken by these countries are not in lockstep. They vary.

What South Korea apparently has succeeded in doing is to maintain the present growth in the number of cases. Unless a vaccine or effective treatment is right on the horizon, that’s no solution. It’s just kicking the can down the road.

I think I shocked a colleague of mine when I suggested that not only will the number of new cases not peak in April, it might not peak until June or July.

You might find this post by Ian Klaus at CityLab about the prospective effects of the COVID-19 pandemic on cities interesting. Think it will result in sweeping policy changes? Think again:

Historical analogies are a dangerous and difficult game, and the combination of a public health crisis with an economic downturn cautions that they should be deployed carefully. The coronavirus stands to deliver big surprises and innovations in policy, politics and space. But even as an imperfect guide, history suggests one should not wait on a dramatic post-pandemic revolution in urban space. Why?

There are a number of explanations for the force of historical inertia in urban spaces. The creative classes and politics that give shape to the built environment require expertise, organization and trusting relationships, all of which take time to build. The bureaucratic institutions that ultimately manage these spaces are, by intention, rarely revolutionary in nature. Even new technology, as the historian David Edgerton has illustrated, rarely ushers in immediate change. And finally, there is the intersection of urban areas and the wider economy. Whether cities are shaped to attract investors or businesses or are shaped as much by them, capitalism has shown itself capable of both adapting to and shaping new forms of space.

For those hoping that we might at this moment be shocked into some historic urban transformation, the story of continuity will not be welcome news.

Another factor that he does not mention. All sorts of organizations, whether private corporations, NGOs, not-for-profits, or government departments are already fully mobilized to shape public policy in directions they favor. They will not let a little thing like a pandemic dissuade them. They’ve been doing that for decades now and their inertia is tremendous.

Most mornings on our morning walk Kara and I pass a neighbor’s house with a panel truck parked in the driveway. The panel truck is emblazoned with messages indicating they are in the industrial cleaning business. In Illinois at least such businesses are considered “essential” and, consequently, they’re still hard at work.

This morning when we passed the truck I asked the neighbor a question. From a discreet distance, of course. How’s business? I found his response interesting.

He said that he’s both losing and gaining business. He does do biological decontamination. Small customers aren’t doing what they had done before; big ones are doing more. His greatest uncertainty is whether his customers will actually pay him.

I suspect a lot of companies (including my employer) are wondering the same thing.

Nearly everyone expects COVID-19 to produce a worldwide recession, possibly a worldwide depression. Just as a reminder there is no generally accepted definition of a depression. The National Bureau of Economic Research, the official scorekeeper for economic contractions and expansions, does not call out depressions. One proposed definition is an economic contraction of two or more years in duration that results in a 10% or greater decline in GDP.

There’s exactly one factor that will determine whether there is a COVID-19 recession or a COVID-19 depression and it’s how quickly the U. S. consumer springs back into action. One of the things that managing the aftermath of COVID-19 means is managing the direction in which the U. S. consumer springs. I will go so far as to predict that, if the U. S. consumer does not recover at all or does so phlegmatically, there will be a global depression.

At RealClearPolitics Charles Lipson has his own plan for managing the aftermath of COVID-19:

The WHO is probably beyond repair. China won’t give up its authority there, and the U.S. shouldn’t give China more weight by withdrawing. But it should cut back sharply on funding, and so should other advanced democracies. Together, they should form a parallel organization, a NATO/Health entity that includes not only America, Canada, the U.K. and EU but also Israel, Ireland, Japan, South Korea, Australia, and Taiwan. All are established democracies with developed, high-tech economies and sophisticated medical research and public health systems. Their data can be trusted, and they are transparent enough to share it. They need an easy, institutionalized way to cooperate, outside the politicized, corrupted WHO.

The next big change will be to repatriate production of vital medicines and equipment to the United States. Since the U.S. refused to share some masks and other equipment with Canada and other close allies, you can also expect those countries to seek more self-sufficiency, or at least bigger stockpiles of medicines and devices made abroad.

Self-sufficiency has always been important to military planners. For a century, they have focused on heavy industries, essential for building tanks and planes. Over the past two decades, as modern warfare changed, they realized that several other economic sectors are equally important to national security and require their own indigenous research and production capabilities. That is obviously true of super-computing, artificial intelligence, chip fabrication, and cybersecurity. What was less clear, until now, is that medicine and health equipment also fall into that “essential” category.

This pandemic has shown that the United States not only needs sophisticated research in biotechnology and bioengineering, it needs more manufacturing capability. It cannot depend on the People’s Republic of China, simply because it is the low-cost supplier.

Another change, likely to come soon, is authorizing the Food and Drug Administration to find out where our medicines and supplies are produced. We need to know. The FDA and White House can then decide which medicines, precursor ingredients, and medical devices ought to be made solely (or mainly) in the United States. That production will be brought back with subsidies and restrictions, such as “Buy American” provisions for government purchases.

International corporations will act on their own to reevaluate where they produce key products and component parts. They will reevaluate any supply chains that pass through China on their way to sales in the U.S. and Europe. They will also face political pressure, not just from Washington but from London, Brussels, Berlin, and elsewhere. If President Trump is going to tell 3M not to sell masks to Canada during an emergency, then Ottawa will have to decide whether to manufacture those locally, build a stockpile of essential supplies, or perhaps strike a bilateral deal not to restrict supplies in emergencies.

He goes on to focus on the EU in which I have no particular interest.

If there is an ounce of justice one of the outcomes of the outbreak will be that, as long as China is governed by the Chinese Communist Party, the country will be ostracized from the community of nations up to and including a blockade. That won’t happen. As an alternative what we might do is revive the idea, articulated more than 15 years ago, of a League of Democracies. It isn’t just the WHO that is beyond saving. The entire United Nations is past redemption. World government is impossible in the absence of a consensus among nations and that simply does not exist. That majority Muslim countries do not subscribe to the Universal Declaration of Human Rights while nearly every country that does not have a Muslim majority does points to a fundamental problem with even the most rudimentary of world governments. The corruption of the World Health Organization by China and the membership on the United Nations Human Rights Council of some of the countries most abusive of human rights are further indications.

NATO is a mutual defense pact. It shouldn’t be expanded to include functions beyond that for the simple reason that it’s hard enough to get its present membership to shoulder their responsibilities for mutual defense. We do, however, need a forum beyond NATO and beyond the impossible United Nations for group action and a League of Democracies, unburdened by the “attack on one” clause of the NATO charter, would be one possible such forum.

Something else that we absolutely must do is to ensure that companies and countries understand that they will not be indemnified against the consequences of the risks that they take. IMO doing business with China is just too risky as long as the CCP is in charge.