I continue to be unclear on what the rules for presidential accountability are these days. For example, I don’t see how you can give Obama credit for “saving the economy” without also pointing that the unemployment rate was higher under Obama than it was under Bush and that Obama officials were saying that the growth rate under Obama was as good as it will get.

This morning I saw some chortling on right-leaning sites blaming the lack of respirators on Obama’s failure to re-supply the federal stockpile. Guess what? Neither did Trump.

The politics of COVID-19 are interesting. Trump will undoubtedly be credited with saving the country by his supporters and blamed for letting it get as bad as it will and, concurrently, tanking the economy by his opponents.

In general I the only things I either credit or blame presidents for are related to foreign policy and the military where they have the most authority and I blame the Congress for just about everything else. Like politicians just about everywhere I think the members of Congress know what needs to be done. They just don’t know how they can keep their jobs if they do it and, well, there are priorities.

I honestly do not see how you can blame Trump for not closing international travel down and more tightly in late January without also observing that he was being impeached by the House then and the criticism he received for doing as much as he did. I also don’t see how you can deride Trump as a fascist and then complain that he isn’t acting more like a fascist.

My own view is that most of the complaints being lodged today are Monday morning quarterbacking and partisan in nature and that the reality is that for anything material to have been done to avoid where we will undoubtedly be going we would have needed to close down international travel tighter than a drum in December of even November and that would have required prescience.

Let’s talk about now. I think that President Trump should be using the Defense Production Act more lavishly than he is and should urge the Congress to take urgent steps during the crisis other than spend money, like suspending interstate air travel and, indeed, anything but necessary travel between states. Trucks, yes. Buses and passenger cars, mostly no.

I also wish President Trump were speaking to calm people’s fears but I’m afraid that just isn’t his style. Maybe he can rise to the occasion.

When I rise tomorrow morning I expect the number of diagnosed cases of COVID-19 worldwide will have exceeded 1 million. That’s a large number but still a tiny fraction of the total human population—about .013%. I expect the number in the United States to start closing in on 250,000—about .076%. The case fatality rate is around 2%. In some states like New York it’s a bit more. Here it’s almost exactly 2%.

I don’t think that anybody, except possibly the head of the World Health Organization, actually believes the numbers the Chinese have reported. I’ve seen estimates everything from twice as large to forty times as large, both for cases and deaths.

Italy continues to be the best example of a bad example. It’s number of deaths per million population is the highest in the world—218, more than an order of magnitude higher than ours or just about anybody else’s except Spain. I presume that the Italian response will be studied for years to come.

South Korea remains the brightest hope. On the positive side it’s barely possible they’ve reached an inflection point—the number of deaths seems to be declining. On the negative side new cases continue to be reported and the number of new cases is inching up to exceed the number of new recoveries.

There has been a report of another prospective treatment: HC + Z-Pak + Zinc. I suspect that some brave physicians will continue to experiment with new treatments until a provably effective treatment is found.

From what I’ve observed in my walks today unless eliminating the spread within crowds is enough to “bend the curve” any hope of doing so is a fantasy. Cops idle their prowl cars a foot from one another and talk through the windows to each other. Lawn crews and other workmen continue as though nothing out of the ordinary were going on, not observing “social distancing”. People stand within a few feet of their neighbors, shooting the breeze. I sometimes actually need to challenge people for them to give me enough space.

Bill Gates has some thoughts about getting ahead of COVID-19, expressed in this Washington Post op-ed:

Through my work with the Gates Foundation, I’ve spoken with experts and leaders in Washington and across the country. It’s become clear to me that we must take three steps.

First, we need a consistent nationwide approach to shutting down. Despite urging from public health experts, some states and counties haven’t shut down completely. In some states, beaches are still open; in others, restaurants still serve sit-down meals.

This is a recipe for disaster. Because people can travel freely across state lines, so can the virus. The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere. Until the case numbers start to go down across America — which could take 10 weeks or more — no one can continue business as usual or relax the shutdown. Any confusion about this point will only extend the economic pain, raise the odds that the virus will return, and cause more deaths.

Second, the federal government needs to step up on testing. Far more tests should be made available. We should also aggregate the results so we can quickly identify potential volunteers for clinical trials and know with confidence when it’s time to return to normal. There are good examples to follow: New York state recently expanded its capacity to up to more than 20,000 tests per day.

There’s also been some progress on more efficient testing methods, such as the self-swab developed by the Seattle Coronavirus Assessment Network, which allows patients to take a sample themselves without possibly exposing a health worker. I hope this and other innovations in testing are scaled up across the country soon.

Even so, demand for tests will probably exceed the supply for some time, and right now, there’s little rhyme or reason to who gets the few that are available. As a result, we don’t have a good handle on how many cases there are or where the virus is likely headed next, and it will be hard to know if it rebounds later. And because of the backlog of samples, it can take seven days for results to arrive when we need them within 24 hours.

This is why the country needs clear priorities for who is tested. First on the list should be people in essential roles such as health-care workers and first responders, followed by highly symptomatic people who are most at risk of becoming seriously ill and those who are likely to have been exposed.

The same goes for masks and ventilators. Forcing 50 governors to compete for lifesaving equipment — and hospitals to pay exorbitant prices for it — only makes matters worse.

Finally, we need a data-based approach to developing treatments and a vaccine. Scientists are working full speed on both; in the meantime, leaders can help by not stoking rumors or panic buying. Long before the drug hydroxychloroquine was approved as an emergency treatment for covid-19, people started hoarding it, making it hard to find for lupus patients who need it to survive.

We should stick with the process that works: Run rapid trials involving various candidates and inform the public when the results are in. Once we have a safe and effective treatment, we’ll need to ensure that the first doses go to the people who need them most.

He also talks about producing a vaccine in quantity. I tend to believe that an effective vaccine will be much more elusive than he seems to.

Those all appear to be sensible suggestions, based on certain assumptions. The question I would ask is for the avoidance strategy of the “stay at home” directives to be effective how complete a compliance is necessary? If your answer is “100%”, we should be implementing another strategy as quickly as possible. We can’t get 100% compliance with anything. If something below 100% compliance would be sufficient, what will be necessary to achieve that level? Just as an example here in Chicago, the number of shootings was actually greater during the week following Gov. Pritzker’s statewide “stay at home” directive than it had been the prior week. Criminals are notoriously observant of rules. Additionally, something between 5% and 10% of the U. S. population is composed of people who are here illegally. The one thing they have in common is that they’re not predisposed to follow the rules if the rules stand in the way of what they want to do.

I’m sad that he doesn’t mention emphasize finding effective treatments in his op-ed. Unless you assume zero new cases, the very slow rate of recovery from serious cases of COVID-19 tells us that “bending the curve” is a much lengthier process than would otherwise be the case. We need effective treatments urgently. Supportive care is not enough.

I see that the editors of the New York Times are now worried about something I’ve warned about since the “stay at home” directives first began to be issued:

Unfortunately, the federal $2 trillion coronavirus stimulus package does little to mitigate retailers’ woes, despite their executives’ pleas for relief, though the Federal Reserve is working to ensure that larger companies have continued access to credit markets. The aid plan gives tax relief for prior property improvements, and it establishes a $350 billion fund for small-business loans that could help those firms maintain payroll and rent, but little else.

Though the cracks in bricks-and-mortar retail began forming years ago, the widening coronavirus outbreak stands to hasten physical retail’s decline and strengthen the monopoly hold of Amazon and other online giants. Such a consolidation of power among just a few retailers threatens to leave consumers with higher prices and less choice.

During the pandemic, reliable delivery of essentials like milk, eggs, toilet paper and cleaning supplies has been a lifeline for those who are reluctant or unable to venture outside their homes — Amazon-branded trucks have remained a familiar sight in residential neighborhoods. The competitive advantages of Amazon’s meticulously constructed worldwide logistics network, built to shuttle nearly every imaginable item to customers in as little as an hour, are especially evident in this crisis.

While many other traditional retailers are struggling with falling demand, Amazon has pledged to hire 100,000 temporary workers to keep up with it. Several other retail giants, including Walmart and Target, have kept pace with coronavirus quarantine demands by keeping physical stores open and leaning on their own delivery networks for grocery shipments and other necessary items. Walmart plans to hire 150,000 new workers.

and

Even in less frantic times, Amazon has been criticized for its workplace culture and its heavy-handed tactics with sellers. Last year, The Wall Street Journal contended that Amazon may be losing control of its own marketplace, allowing dangerous counterfeits to appear on its virtual shelves that would never pass muster at traditional retailers. Both Walmart and Amazon have quashed unionization efforts.

Amazon and Walmart have offered critical delivery services during this crisis, but regulators and elected officials should not lose sight of the dangers of monopoly power falling into the hands of the fortunate few that survive the coronavirus fallout.

My beloved Happy Foods continues to offer home delivery. It always has but that has increased substantially during Illinois’s “stay at home” directive. Indeed, the panic-buying of a week or so ago has gone a long way to redressing the damage that the city did to it over the last couple of years. Both Jewel and Mariano’s both now offer home delivery. At least in Chicago people don’t need Amazon to get “milk, eggs, toilet paper and cleaning supplies” without walking into a store. Is it different in other places?

Amazon’s real competitive advantage resides in its ability to sell and deliver clothing and everything else that people buy. My first suggestion was that Amazon be prohibited from selling anything other than essentials during the crisis.

My second suggestion was that it, along with Google and Facebook, be made so busy with the “war effort” that they wouldn’t have the resources to expand their monopolies. That’s what happened during World War II. IBM became IBM because it didn’t participate in the war effort and its much larger competitors were too busy manufacturing machine guns to introduce new products. My last suggestion was that, once the crisis is over, the Federal Trade Commission start working overtime in breaking up monopolies.

I have reservations about the rest of the this Wall Street Journal editorial but I find their conclusion a pretty good summary of where we stand:

April is going to be a brutal month for America, and the next two weeks especially. But as the bad news arrives, it’s important to understand that the worst-case-scenarios that many in the media trumpet are far from a certain fate.

Right now, this minute, the death toll from COVID-19 of those who have contracted the disease is less than 2%. Here in Illinois it’s 1.44%. IMO it’s a pretty good assumption that, as the number of people who’ve been tested and the velocity of testing both increase, that percentage will actually decline since right now the sickest are being tested. A little back-of-the-envelope calculation tells you that a couple of hundred thousand people may well die. That’s awful—a multiple of those who die every year from the seasonal flu. But it’s not the Black Death. It isn’t even the Spanish Flu.

We need to do a lot more testing, especially epidemiological testing and serological testing. Let’s abandon any thoughts of putting the measures the Chinese did into place. According to the reports I’ve heard everybody has received a QR code for their phones that identifies them and tells what the results of their latest COVID-19 test was. They’re only allowed out if they’re negative for COVID-19 (that’s from the wife of a colleague whose family is in Shanghai).

But I’m also skeptical of China’s reports. There are those who are not bat-**** who say that China’s total cases and death toll may be an order of magnitude or more than they’ve acknowledged. I have more faith in South Korea than that.

The editors of the Washington Post have their own ideas about what should be done next:

There is no room for a patchwork response. Without restrictions in place, what’s happening in New York City today will be in Miami, Detroit or Chicago tomorrow. A few irresponsible politicians can undermine recovery for everyone. The only way to break the chains of coronavirus transmission is for the entire country to engage in physical distancing until the pandemic abates or an effective vaccine or therapy is ready. A piecemeal approach invites a raging, rolling pandemic.

While I agree that the federal government should restrict interstate travel temporarily (that is within its power), otherwise I think that a patchwork response is exactly what we need. Centrally controlling the production of a new test for COVID-19 is precisely what put us behind the 8-ball where we find ourselves. Why repeat or continue that mistake? What is necessary for New York City is probably not needed in Marfa, Texas.

The federal government should focus its efforts on the areas of its legitimate authority. It will have enough to do there. Governors and local officials need to step up to the plate, too. Under our system of government the states are where the action is. Simply because COVID-19 can infect anybody and everybody will not change that.

I both agree and disagree with the editors of the New York Times in their prescription for “reopening” America. For example, I agree that contrasting the need to preserve life with the need to keep the economy afloat is a false dichotomy:

This is a false choice. While policymakers must sometimes make trade-offs between life and money, this is not such a moment. The American economy needs to be shut down in order to preserve both human life and long-term prosperity. During the 1918 influenza pandemic, communities that quickly imposed stringent measures not only saved lives but experienced stronger economic rebounds, according to a new study. The message is clear: Coronavirus is a danger to life and prosperity; a strong public health response is the needed corrective.

but I disagree with their strategy. Keeping the economy shut down too long will kill people much more surely than COVID-19 will. The economy of 2020 is not the economy of 1920. Farming is not as important to the economy as a whole as it was then. There has been enormous consolidation—there are fewer companies per million population than there were then. Banks and the whole financial sector comprises a much large portion of the economy.

Offhand I’d say that a one month shutdown will lead to 10% of companies declaring bankruptcy and a three month shutdown will lead to 30% of companies declaring bankrtuptcy with longer shutdowns doing even more damage. After a year-long shutdown there would be little economy to reopen. I can think of no surer method of returning to the economy of 1918 than than acting as if it were still 1918.

It increasingly appears necessary that for the next eight weeks, and possibly for longer, all nonessential businesses should be closed, domestic travel restricted and the “shelter-in-place” measures being employed by some parts of the country extended to the rest. Such a shutdown will be enormously expensive in the short term, likely requiring fresh rounds of federal aid on top of the $2.2 trillion Congress approved on Friday. But scientists say that based on what they’ve learned from Europe and Asia, that’s the only way to get the virus, which is spreading like wildfire across the country, under control.

Quite to the contrary the too-slowly increasing testing should be exploited to allow us to selectively end the mass shutdowns in favor of much more targeted shutdowns. People who are provably, testably non-infected should go back to work with all due haste. It may be that very densely-populated areas like New York City and San Francisco should remain locked down for a protracted period. I agree with them, however, that foreign and domestic travel should be restricted, including American citizens. IMO one of the biggest mistakes in the early days of the pandemic was not quarantining everybody returning from international travel.

I agree with them that we will need to do a lot of testing on an ongoing basis. I disagree that the method for doing so should be by beefing up public health:

To build such capacity, the federal government will have to invest in the nation’s undervalued and deeply strained public health system: more funding will be crucial, but it will not be enough. State and federal leaders should work together, now, to create a public works corps to assist epidemiologists with contact tracing, to erect thousands of drive-through testing sites, and to do the work of infection control in nursing homes and homeless shelters. Some states are already doing this on their own, but others will need federal funding — perhaps in the form of block grants.

That is simply not how our government operates in the 21st century. What could happen is that the federal and state governments could let contracts to private organizations, for profit and non-profit. Such a process is guaranteed to be far too time-consuming, will only let contracts to preferred organizations, and will, ultimately, be a license to steal. How could they possibly know there are no “shovel-ready projects”? Much more needs to be done by local governments and the private sector. In many (but not all) cases the best role for the federal and state governments will be to get the heck out of the way. People, both as individuals and in the form of companies are eager to do what they can to aid in this “war effort” just as they were during World War II. Unfortunately, just as then, too, some are eager to profit from it. Dealing with that is a legitimate activity for the state and federal governments.

I’m not opposed to this:

Public health authorities also should oversee the creation of temperature checkpoints outside of factories and office buildings, and in other close-packed or high-traffic places — and those measures should be increased anytime disease detectives find the hint of a brewing outbreak. This will take a combination of state-level mandates and aggressive public advertising campaigns. People hate being told what to do, never more so than when it comes to their own bodies; clear and consistent messages will help mitigate the predictable pushback.

This is nonsense:

Some scientists are working to rectify that problem — to create the apps and websites that such a crisis demands. But those efforts will only be useful if they are brought to scale quickly. That, too, will take federal oversight and financial support.

Have they not learned their lesson yet? The federal governments is incapable of creating or overseeing the creation of solid, functional web sites and apps in a short time frame. Do you know who can do that? Google, Amazon, Facebook and a handful of other companies. They should be shamed into producing these sites and apps as their part in the “war effort”. To do otherwise will push their development into a future after the need is over, to be developed by a qualified vendor, i.e. one with political connections.

USA Today reports that the Food and Drug Administration has approved Abbott’s 5-minute COVID-19 test:

CHICAGO – A five-minute, point-of-care coronavirus test could be coming to urgent care clinics next week, and experts say it could be “game-changing.”

The U.S. Food and Drug Administration issued Emergency Use Authorization to Illinois-based medical device maker Abbott Labs on Friday for a coronavirus test that delivers positive results in as little as five minutes and negative results in 13 minutes, the company said.

The company expects the tests to be available next week and expects to ramp up manufacturing to deliver 50,000 tests per day.

“I am pleased that the FDA authorized Abbott’s point-of-care test yesterday. This is big news and will help get more of these tests out in the field rapidly,” FDA Commissioner Steve Hahn said in a statement. “We know how important it is to get point-of-care tests out in the field quickly. These tests that can give results quickly can be a game changer in diagnosing COVID-19.”

Scott Gottlieb, former FDA commissioner, echoed Hahn’s comments on Twitter, calling the development a “game changer.” Gottlieb also said it’s “very likely” that we’ll see additional approvals of point-of-care diagnostics behind this one, extending testing to doctor offices across the U.S.

Physically the tests are small cartridges that are used by Abbott’s ID NOW benchtop instrument. There are presently 18,000 of these units installed around the country. I suspect we can expect Abbott to start producing more of them.

Also, USA Today reports that the limitations the FDA had imposed on Battelle’s using its facemask sterilization process have been lifted:

COLUMBUS, Ohio – After a day of pressure from Ohio Gov. Mike DeWine, the U.S. Food and Drug Administration late Sunday rewrote rules to allow full application of a potentially game-changing Battelle technology to sterilize protective masks worn by those treating coronavirus victims.

The agency ruled that upgrading its emergency use authorization from partial to full “is appropriate to protect the public health or safety.”

DeWine said Sunday night that he and Lt. Gov. Jon Husted “just had a very productive call” with the Food and Drug Administration. “I anticipate a positive announcement soon. We must do all we can to protect our front-line workers.”

Husted tweeted: “This Ohio-driven solution has the potential to save lives now and in the future across the United States.”

I suspect these are just two of many new tests and processes that will be deployed in the coming days. 50,000 tests a week and 80,000 masks sterilized per day are fractions of the need but these are steps in the right direction. They won’t be the last.

Update

And yet another small step. The Hill reports that the FDA has issued an emergency use authorization for the use of hydroxychloroquine (HC) and chloroquine in treating COVID-19:

The Food and Drug Administration (FDA) on Sunday issued an emergency-use authorization for a pair of anti-malaria drugs as health officials work to combat the rapid spread of the novel coronavirus.

The Department of Health and Human Services (HHS) said in a statement that the authorization would allow 30 million doses of hydroxychloroquine sulfate and 1 million doses of chloroquine phosphate to be donated to the Strategic National Stockpile. The doses of hydroxychloroquine sulfate were donated by Sandoz, while the chloroquine phosphate was developed by Bayer Pharmaceuticals.

Hopefully, this move will motivate more physicians to start giving these drugs to their patients with COVID-19, possibly in combination with azithromycin, as was used in South Korea.

Use of HC will probably cause some problems, too. The drug is presently used to treat other diseases including rheumatoid arthritis and shortages will probably develop rapidly. We need to produce all of the pharmaceuticals domestically and some emergency grants for doing just that should be approved by the Congress.

At Genetic Literacy Project Ricki Lewis argues that we need to be cautious about COVID-19 treatments:

At ClinicalTrials.gov since last week, new registered studies have gone beyond China, with many from Italy and Spain, but also Egypt, Jordan, the UK, Canada, France, Germany, Denmark, Romania, Israel, and the US. In addition to more repurposing candidates are a sprinkling of studies on the social manifestations and consequences of the pandemic, such as “social media effect on knowledge dissemination.”

[…]

Pharmaceuticals aren’t like noodles, flung against a wall to see what sticks.

But even though the “RCT” – a randomized controlled clinical trial – is widely recognized as the gold standard, many researchers, Dr. Fauci said, are uneasy at the prospect of giving a placebo in a study, even if it is an existing treatment. Is doing so a betrayal of their oath to “do no harm?”

Fortunately, a novel clinical trial strategy, called an adaptive design, may help speed the drug approval process. Dr. Kalil describes it in his Viewpoint. It allows a clinical trial to test more than one treatment. That’s what the National Institutes of Health is doing in a trial of Remdesivir, which has been much talked about and is already through phase 2 to treat HIV/AIDS. It is an intravenous infusion.

In the end I think that Dr. Lewis fails in her argument. It amounts to “it isn’t good science”. So stipulated. Neither is issuing “stay at home” directives in the largest states in the country. When pharmaceuticals have been approved by the Food and Drug Administration for treating other conditions including conditions that are not “100% fatal”, and there is some clinical evidence and copious field experience albeit not in the U. S. it seems to me that resorting to something that isn’t pristine science is the lesser evil.