I honestly don’t know what to make of this Washington Post editorial:

From a public health standpoint, the disruption caused by social distancing is worth it; the sacrifices are temporary and far less painful than thousands of deaths, overrun hospitals and a runaway virus.

But this is every bit as much about human behavior as about public health. It is absolutely essential in the months ahead that political leaders retain people’s trust — not an easy task even in normal times. If the restrictions are draconian, they could boomerang. People may panic or be tempted to disobey. That would in turn threaten further spread of the virus. Political leaders must allow a society to breathe, not only fresh air in parks and playgrounds, but also to go about life as normally as possible, to have access to groceries, banks, pharmacies and other essential services. It is important that leaders retain credibility so that the next time they ask for emergency action, they are heeded.

The word “lockdown” suggests jail. The concept is hardly what the United States needs at this juncture. We need careful, clear public health decisions to guide us back to normal as soon as possible.

Are they really quibbling about the terminology that is being used? Shouldn’t our first concern be ends and means? They seem to agree with the objective and the means of accomplishing it but don’t like the wording.

Let’s do a little thought experiment. Who is more likely to be held accountable as the number of cases in his state rises, the governor who declares a state of emergency and issues a “shelter in place” directive, calling it a “lockdown” or a governor who urges people exercise “social distancing” but stops there? IMO politics is front and center in all of these decisions.

I also wanted to draw your attention to this post at RealClearScience by Nevan Krogan. When time is of the essence there’s probably no better way to identify a treatment for a newly emerging disease than by mining the existing data to find one and that’s what Dr. Krogan and his team are doing:

Facing this crisis, we assembled a team here at the Quantitative Biosciences Institute (QBI) at the University of California, San Francisco, to discover how the virus attacks cells. But instead of trying to create a new drug based on this information, we are first looking to see if there are any drugs available today that can disrupt these pathways and fight the coronavirus.

The team of 22 labs, that we named the QCRG, is working at breakneck speed – literally around the clock and in shifts – seven days a week. I imagine this is what it felt like to be in wartime efforts like the Enigma code-breaking group during World War II, and our team is similarly hoping to disarm our enemy by understanding its inner workings.

and

By March 2, we had a partial list of the human proteins that the coronavirus needs to thrive. These were the first clues we could use. A team member sent a message to our group, “First iteration, just 3 baits … next 5 baits coming.” The fight was on.

Once we had this list of molecular targets the virus needs to survive, members of the team raced to identify known compounds that might bind to these targets and prevent the virus from using them to replicate. If a compound can prevent the virus from copying itself in a person’s body, the infection stops. But you can’t simply interfere with cellular processes at will without potentially causing harm to the body. Our team needed to be sure the compounds we identified would be safe and nontoxic for people.

The traditional way to do this would involve years of pre-clinical studies and clinical trials costing millions of dollars. But there is a fast and basically free way around this: looking to the 20,000 FDA-approved drugs that have already been safety-tested. Maybe there is a drug in this large list that can fight the coronavirus.

Our chemists used a massive database to match the approved drugs and proteins they interact with to the proteins on our list. They found 10 candidate drugs last week. For example, one of the hits was a cancer drug called JQ1. While we cannot predict how this drug might affect the virus, it has a good chance of doing something. Through testing, we will know if that something helps patients.

Facing the threat of global border shutdowns, we immediately shipped boxes of these 10 drugs to three of the few labs in the world working with live coronavirus samples: two at the Pasteur Institute in Paris and Mount Sinai in New York. By March 13, the drugs were being tested in cells to see if they prevent the virus from reproducing.

Our team will soon learn from our collaborators at Mt. Sinai and the Pasteur Institute whether any of these first 10 drugs work against SARS-CoV-2 infections. Meanwhile, the team has continued fishing with viral baits, finding hundreds of additional human proteins that the coronavirus co-opts. We will be publishing the results in the online repository BioRxiv soon.

The good news is that so far, our team has found 50 existing drugs that bind the human proteins we’ve identified. This large number makes me hopeful that we’ll be able to find a drug to treat COVID-19. If we find an approved drug that even slows down the virus’s progression, doctors should be able to start getting it to patients quickly and save lives.

The great advantage to this approach is that all of their candidate drugs have already received FDA approval for other uses. The risks of using any of these drugs for off-label use are already known to some degree.

Epidemiology is, indeed, a science but it’s not the only science and, given COVID-19’s lengthy recovery time (as I’ve pointed out practically nobody who was sick with it three weeks ago has recovered) mining the existing data to identify effective treatments is a pretty darned good strategy.

This post is more an airing of a grievance than it is a serious policy proposal. As I’ve mentioned before here in Illinois the governor has issued a “shelter in place” directive and aired all “non-essential” businesses that are unable to conduct their businesses from their homes to close their doors.

In my opinion this is theater rather than serious policy. There are several reasons for that belief. First, the governor and whatever experts he has relied on are categorically unable to distinguish between what is essential from what isn’t but, second, businesses that are essential but also carry on trade in something that’s non-essential are continuing to carry on with that trade.

Distinguishing between what is essential and what isn’t depends on personal habits, preferences, and the time horizon. In the short term you don’t need to get your teeth cleaned or checked but in the long term you do. For a vegetarian neither a butcher shop nor a grocery meat counter are essential; for most people they are.

That’s the reason that soviets are inferior to markets for determining what goods should be produced and at what price they should be sold. That is as true during an emergency as it is at any other time.

But additionally closing brick and mortar stores that sell clothing or craft materials or anything else while allowing ecommerce sites to sell the same products to be delivered by UPS or FedEx grants them an undeserved and unearned competitive advantage.

Consequently, my modest proposal is that, if we’re serious about “shelter in place”, Amazon.com should be closed.

As of today nearly 318,000 cases of COVID-19 have been diagnosed with nearly 14,000 deaths. China’s reports of both new cases and deaths remain unmatched anywhere else in the world. Germany continues to be anomalous as do Italy and South Korea in opposite directions. I cannot distinguish between differences in what these countries are doing in response to the COVID-19 virus and how they’re reporting their results.

I wanted to draw your attention to a couple of articles. The first is a video from Pro Publica from which I’ve sampled the following infographic:

It illustrates nine different scenarios of how the COVID-19 outbreak may unfold with differing assumptions about the speed with which different percentages of the population become infected. IMO there are two significant revelations in these scenarios. The first is that different parts of the country face different risks. The West Coast and New York City are at increased risk not just because they have a lot of cases but also because the resources available there aren’t great enough to handle the load.

The second revelation is that in order for the course of action that’s being taken here and in other places to make any sense you must assume one of the worst case scenarios. More specifically, the only way in which the “shelter in place” directive Gov. Pritzker has ordered in Illinois makes sense is if a) he is panicking; b) he is making his decisions based on information about a state other than Illinois; or c) he thinks one of the worst case scenarios (the three in the lower right quadrant of the grid) is likely.

The second article is this analysis of the available data, originally posted at Medium but now posted at Zero Hedge along with a refutation of the article. You actually need to click through to read the refutation but it’s well worth the effort. If nothing else the entire discussion is significant evidence that the entire outbreak has been heavily politicized.

Finally, lighten up! Here’s a song parody about our present circumstances which I found through, of all people, Janis Ian.

Illinois Gov. Pritzker has issued an order for all Illinoisans to remain home beginning tomorrow, March 21, and continuing until Tuesday April 7. We may go grocery shopping, purchase gas, go to the pharmacy, or to see our physicians. We may engage in outdoor activity like walking, jogging, or hiking so long as we maintain a six foot distance from others. We may also care for family members or other people in another household.

That’s much what my wife and I have been doing all week.

I will admit that I have reservations about the order but I plan to comply with it. I don’t really believe that anything will have changed between now and April 7 other than that a lot more people will be sick and the health care system more overtaxed. I also don’t think that the decision-makers understand the implications of supply chains. “Essential workers” not only means people who work in grocery stores but people who drive the trucks the supply the grocery stores, the workers in the warehouses from which the trucks obtain the supplies, the people who clean or maintain the warehouses, and the office workers who enter the data and file the paper work that keeps it all going.

There’s an article in the Financial Times on a subject that has been noticed—Germany death rate from COVID-19 is much lower than that of other European countries:

According to data from Johns Hopkins University, there were 13,979 coronavirus infections in Germany on Thursday afternoon, more than in any other country except China, Italy, Iran and Spain.

At the same time, Germany had only registered 42 deaths. Neighbouring France, by contrast, reported 9,058 infections and 243 deaths. Spain had 17,395 infections and 803 deaths. The US, the UK, Italy and even South Korea all show case fatality rates significantly higher than Germany. 

The apparent anomaly has sparked debate in Germany and beyond, though experts warn against drawing sweeping conclusions. They argue that the country’s low fatality rate most likely reflects the fact that the outbreak is still at a relatively early stage, and that the age profile of those affected has so far been younger than that in other countries. Younger patients without previous ailments have a much better chance of surviving Covid-19 than elderly patients. 

Another factor that may help explain the variance is the unusually high number of tests being carried out in Germany. According to Lothar Wieler, the president of the Robert Koch Institute, German laboratories are now conducting about 160,000 coronavirus tests every week — more than some European countries have carried out in total since the crisis started. Even South Korea, which is conducting 15,000 tests a day and has been held up by virologists as an example to follow, appears to be testing less than Germany. 

“This is about capacity. The capacity in Germany is very, very significant. We can conduct more than 160,000 tests per week, and that can be increased further,” Prof Wieler told journalists this week. Test capabilities would be boosted not least in part by switching laboratories that specialise in animal health towards coronavirus checks. There was no sign that test kits were running low, Prof Wieler added. 

In the short term at least, mass testing feeds through into a lower fatality rate because it allows authorities to detect cases of Covid-19 even in patients who suffer few or no symptoms, and who have a much better chance of survival. It also means that Germany is likely to have a lower number of undetected cases than countries where testing is less prevalent. Indeed, one notable feature of the coronavirus outbreak in Germany so far is the high number of relatively young patients: according to data from the Robert Koch Institute, more than 80 per cent of all people infected with the coronavirus are younger than 60. 

But

However, Prof Kräusslich cautioned that the picture in Germany was likely to change in the weeks and months ahead: “We are still at a relatively early stage in the outbreak in Germany. The overwhelming share of patients became infected only in the last week or two, and we will probably see more severe cases in the future as well as a change in the fatality rate.” 

Presently, the recovery rate in Germany is declining while the death rate is increasing. That support’s the Herr Doktor’s observation. That’s my greatest concern about this outbreak whether in Germany of the United States. Recovery is quite prolonged.

As of today there are more than 260,000 diagnosed cases of COVID-19 and nearly 12,000 deaths. Nearly half of all the reported deaths have been in Italy. By comparison the number of death compared to the number of diagnosed cases in South Korea is much, much lower.

I wanted to take a quick look at something I touched on earlier—South Korea’s “bending the curve”. Consider this graph of diagnosed active cases there (diagnosed cases less deaths and recoveries):

As you can see the total number of active cases has peaked and the number is declining slowly. The number of active cases is just about what it was two weeks ago, having declined from a peak of about 7,000 to about 6,500. The reasons for the decline are primarily fewer new cases and some recoveries. It should be apparent that’s not much of a decline. It could easily be overwhelmed by a correction in the data or by a second wave of new cases. We’ll need to wait and see. What I think should be noted is that most of the people who were sick three weeks ago in South Korea are still sick.

If it is our good fortune to follow the path taken by South Korea, at the rate at which new cases are being diagnosed here the peak is not yet in sight and the time at which we have reached the point at which South Korea is now is unlikely to have been reached before June.

Here in the United States “shelter in place” orders are going out on both coasts and in some places in between. The six counties around San Francisco (San Mateo, Marin, Contra Costa, Alameda, Santa Clara) are included in that. Santa Cruz is under lockdown. San Miguel County in Colorado has imposed a shelter in place order. That is being debated in New York City. The Oak Park suburb of Chicago has imposed a shelter in place order. It is being considered for the state of Illinois.

I think that such measures are mistaken—both overly broad and too late.

In her regular Wall Street Journal column Kimberley Strassel makes my case for me:

The coronavirus has “laid this bare: America was less prepared for a pandemic than countries with a universal health system,” declared Vox. The pandemic has “inflicted new stress on a system already too unequal to function,” wrote Sarah Jones in New York magazine, lecturing on the need to “devolve power from wealthy interests.” “The coronavirus crisis exposes the stupidity of Trump’s healthcare policies,” railed Los Angeles Times columnist Michael Hiltzik. A Morning Consult poll suggests this opportunistic sloganeering is resonating, with 41% of the public more likely to support universal health-care proposals amid this pandemic.

Yet these claims are fantasy. Here’s the lesson of the virus so far: Relying solely on government bureaucracy is insane. To the extent America is weathering this moment, it is in enormous part thanks to the strength, ingenuity and flexibility of our thriving, competitive capitalist players.

Government will save us? How’s that working out for Italy? Even Mr. Biden made this point during the Sunday debate, reminding Mr. Sanders that “you have a single-payer system in Italy. It doesn’t work there.” Italy had 62 cases on Feb. 22; nearly a month later, that number is 41,000. It has recorded more deaths (3,400 plus) than any nation on the planet. Crucial miscommunication in early days between the central government and hospitals resulted in a system that is now overwhelmed and rationing treatment.

The U.S. is working hard to avoid its own worst-case scenario, and the federal and state governments are playing crucial roles in coordinating resources, imposing public-health measures, and keeping the public informed. But the single biggest mistake so far came from the government. The feds maintained exclusive control over early test development—and blew it. The Centers for Disease Control and Prevention’s failure delayed an effective U.S. response, and the private sector is now riding to the rescue.

The “crooks” at drug company Roche had started on their own high-volume test in January, and were finally able to get approval from the Food and Drug Administration. Google is up with a website advising people on symptoms; retailers like Walmart and CVS are converting parking lots for drive-through tests; private labs are standing by to process them.

As for other “moneyed interests,” no fewer than 30 Big Pharma and small biotech firms are racing for treatments and vaccines. Moderna turned around a vaccine batch in just 42 days. Gilead Sciences is already in Phase 3 trials for its remdesivir treatment for Covid-19. Straight off President Trump’s announcement of FDA approval for antimalarial drugs to treat the disease, Bayer announced it would donate three million chloroquine tablets.

Meanwhile, the loathsome “multimillionaires” at Comcast, Verizon and Sprint are guaranteeing to keep Americans online for the next two months, regardless of who can pay. Adobe and Google are making remote-learning tools available to schools, universities and parents. U-Haul is offering free self-storage to college kids. Fannie Mae and Freddie Mac are suspending foreclosures. The list of corporations voluntarily offering sick leave, pay for contractors and vendors, work-at-home flexibility, and donations to affected communities is enormous—and inspiring, especially given the general financial distress.

I’ll try to return to this in my status report but the reality is that at this point no country (other than reports from China of which I remain skeptical) has actually “bent the curve” appreciably. South Korea may have but it’s not bending particularly rapidly and it may succumb to additional waves of the virus. We just don’t know. What we do now is that it isn’t just us. The United Kingdom, France, Germany, Italy, and Spain all are seeing cases and deaths skyrocketing, just as we are.

In an op-ed at the Wall Street Journal Arthus Herman urges the United States to become the “medicine chest of the world”, analogous to FDR’s “arsenal of democracy”:

y invoking the Defense Production Act, the administration can clear away bureaucratic impediments to an effective pandemic response. Just as FDR’s administration temporarily set aside antitrust standards so companies could band together to produce everything from aircraft parts to tanks and synthetic fuels, the Trump administration can encourage companies to pool their patents and intellectual property to increase production of key drugs and technologies.

Bringing together companies like Walgreens, Walmart and Google to streamline the Covid-19 testing process was a good first step toward making America safer and more secure against the growing pandemic. But there is much more the U.S. can do to mobilize its health-industrial and manufacturing base. It’s absurd that Italy must rely on China for emergency supplies of ventilators when America is home to major ventilator manufacturers like Vyaire, ResMed and Allied Healthcare Products. The Trump administration should work out a timeline with these medical-device makers to produce all the ventilators the world needs right here in the U.S. The same is true for respirators, swabs and other types of protective gear crucial to preventing a global health-care catastrophe.

Washington should also clear the way for the American pharmaceutical industry to develop and deploy therapies for Covid-19 until antiviral drugs, and ultimately a vaccine, are in place. Regeneron Pharmaceuticals of Tarrytown, N.Y., which developed a drug last year to combat Ebola, announced Tuesday it has made progress in the hunt for a Covid-19 treatment. Swift action by the Food and Drug Administration has already streamlined the approval process so that what might normally take two to three years will now happen in a matter of weeks.

The government’s first missions must be to keep Americans safe and to secure the U.S. economy as the mainspring of the global order. A Washington-led mobilization of the health-industrial and manufacturing base can also boost economic growth, just as the mobilization of the defense-industrial base did during World War II. “We won because we smothered the enemy in an avalanche of production, the like of which he had never seen, nor dreamed possible,” said Lt. Gen. William “Big Bill” Knudsen of the American war effort. Knudsen had been president of General Motors before Roosevelt asked him to direct the War Department’s production and procurement efforts.

I think that’s a much taller order than he may realize and, indeed, he may be trying to close the barn door after the horses have already bolted. In 1940 the U. S. did not import munitions. Indeed, the Congress enacted the Export Control Act to limit U. S. exports to other countries, particularly Japan.

The situation is nearly the opposite with respect to pharmaceuticals. Consider world exports here and world imports here. We import far more than we export and in all likelihood the primary impediment to our importing more are federal law and regulations.

And that only considers exports by dollar value not tonnage. I can’t prove it but I suspect that you will find U. S. exports dominated by relatively few high value pharmaceutical exports. If you’re looking for a “medicine chest of the world” that would probably be India which exports far more pharmaceuticals than it imports.

Could U. S. companies, which include most of the largest biomedical companies in the world, beef up domestic production to encourage exports? Probably but that would take more than relaxing a few regulations. It would require a major overhaul in management attitudes in those countries. And don’t expect German, French, Israeli, Chinese, and Indian pharmaceutical companies to stand still while that’s going on.

This isn’t the 1940s. We have competition from every major economy in the world.