There are actually all sorts of interesting aspects of the COVID-19 outbreak, now spreading all over the world. The first, of course, is that it’s spreading all over the world. Countries in sub-Saharan Africa and South America are now beginning to report cases—South Africa 62, Senegal 26, Brazil 234, Colombia 57, for example. That COVID-19 can spread in countries with tropical climates (like Singapore) by community spread casts a pall on the theory that the outbreak will abate with the advent of warmer weather.

Something else that puzzles me is how few recoveries are being reported. To the best of my ability to determine no country has reported that a majority of cases has recovered. Either they’re failing to report recoveries, recovery is very slow, or people are just failing to recover. Maybe there’s some other explanation but I find that interesting.

The daily number of deaths from the virus in South Korea, never particularly large, was only three yesterday. It was seven on March 2. That difference is too small a number from which to draw conclusions.

According to the Wall Street Journal Singapore, Taiwan, and Hong Kong are experiencing another wave of new infections:

Singapore, Taiwan and Hong Kong are witnessing fresh waves of coronavirus infections, as the growing number of cases around the world test their successful early defenses against the disease.

Singapore reported 23 new cases late Tuesday, its highest daily count since the epidemic started. Taiwan recorded a single-day high of 10 cases of infection, bringing its total to 77. Hong Kong added five new cases—a day after it recorded nine—the most since Feb 9.

These are being attributed to people bringing the infection back with them not just from China but from other countries. That suggests that countries that do a lot of international trade are at particular risk. Or maybe those “recovered” are still able to spread the infection. Or maybe the number of the infected is being drastically underestimated. We just don’t know what we don’t know.

Here’s the telling quote:

“The trouble with this virus is that it is very unpredictable. We do not know who will be at the center of a super-spreading event,” said Paul Anantharajah Tambyah, the president of the Asia-Pacific Society of Clinical Microbiology and Infection. “We are not safe in any place until everyone all over the world is safe.”

I found a lot of interesting snippets of information in this Washington Post article by Peter Whoriskey and Neena Satija. For example:

The United States’ struggles, in Landt’s view, stemmed from the fact the country took too long to use private companies to develop the tests. The coronavirus pandemic was too big and moving too fast for the CDC to develop its own tests in time, he said.

Landt, a German biomed entrepeneur quoted in the piece, thinks that the CDC’s desire to control the process has actually impaired our ability to produce effective tests quickly enough. That’s supported by this:

It has been long-standing practice for CDC scientists in emergencies to develop the first diagnostic tests, in part because the CDC has access to samples of the virus before others, officials said. Later, private companies that win FDA authorization can scale up efforts to meet demand.

You might find this darkly amusing:

Shortly after publication of the virus’s genome in early January, German researchers announced they had designed a diagnostic test. Then, within days, scientists at the CDC said they’d developed one, too, and even used it detect the first U.S. case.

Or this:

In fact, the U.S. efforts to distribute a working test stalled until Feb. 28, when federal officials revised the CDC test and began loosening up FDA rules that had limited who could develop coronavirus diagnostic tests.

And I found this particularly interesting:

On March 7, FDA Commissioner Stephen M. Hahn stressed the importance of quality, noting that diagnostic tests in some other countries have been flawed. He did not specify which countries he meant, but China’s test may have produced lots of false positives, according to a recent publication by Chinese researchers.

A test which produces lots of false positives and lots of false negatives, as I presume was the problem with the CDC’s first test, is worse than useless.

To get the whole story you’ll need to read the whole thing.

I’ve already expressed my opinion that Donald Trump will undoubtedly be blamed whatever happens with the COVID-19 outbreak so my next comments should in no way be construed as a defense of Trump but anyone who blames Trump for the lack of tests is living in a dream world. The CDC has been in charge of the process, it’s a bureaucracy, and ordering a bureaucracy to do anything is like commanding the waves of the sea to recede. You can order individual researchers or teams of researchers to work hard or faster or cut corners but not a bureaucracy. That’s like holding a deep philosphical discussion with a dog.

All large organizations are either bureaucracies or autocracies or, frequently, both. We know of no other way of organizing them. That’s why all large organizations, public or private, are frequently so ineffectual. The problem is the whole system. That’s the complaint of Trump’s supporters. That’s what “drain the swamp” means.

The difference between my view and theirs is that I don’t believe that anyone who doesn’t understand the swamp can drain it other than by an Alexandrian cutting of the knot and that has implications as bad or worse than an impeding bureaucracy and I don’t think that Trump is the guy to do it.

I have realized that my assumptions about this “novel coronavirus”, COVID-19, seem to be quite different than those most people, especially most policy-makers, are proceeding on. I’m assuming something that approximates a worst-case scenario, that the contagiousness and virulence of the disease don’t abate when the weather becomes warmer, that it doesn’t just vanish, and that no effective vaccine is ever developed for it. I also assume that none of the information that has been published by the Chinese authorities about the disease is reliable, although one regular commenter here has produced reasonable evidence that the disease has, in fact, abated in China at least temporarily.

Here’s my question. Does it make a difference? Should different policies be followed depending on the assumptions and what are the implications of following the wrong course?

For several weeks I have been saying that additive manufacturing should be used to fill some of the supply chain gaps that we may be seeing in things like masks, respirators, and other consumables used in treating COVID-19. Here’s an article very much to that point on how a valve used in respirators and need to be changed out for each patient can be manufactured to order by a 3D printer:

Many have been asking what the implications of the current Covid-19 pandemic are going to be on additive manufacturing as an industry. The relationship between coronavirus and 3D printing is not entirely clear, mostly because we are very far from understanding what the long, medium and even short terms implications of the pandemic are going to be on global supply chains.

Additive manufacturing may be able to play a role in helping to support industrial supply chains that are affected by limitations on traditional production and imports. One thing is for sure though: 3D printing can have an immediate beneficial effect when the supply chain is completely broken. That was, fortunately, the case when a Northern Italian hospital needed a replacement valve for a reanimation device and the supplier had run out with no way to get more in a short time.

By now complete designs, ready to be produced on a 3D printer, should be appearing on the Internet. If intellectual property laws are interfering with that, we need to change our intellectual property laws so they’re working for us rather than against us.

If regulations prevent that, maybe we need much more agile regulatory apparatus.

I wonder when I’m going to be laid off from work. It’s not that I’m not working (I worked on both Saturday and Sunday, for example) but when you’re physically present in the office it at least looks as though you were working. I’m expensive and, regardless of how valuable I am or how much I bill, the temptation to get rid of me is always great.

The news from Chicago is that not only have the schools been shuttered and public events of more than 500 people banned but bars and restaurants are now open only for carry-out and delivery.

Tomorrow is St. Patricks Day. In Chicago at any rate St. Paddy’s Day is to bars what Valentine’s Day is to florists and candy companies. Closing bars on two days before March 17 is serious medicine here.

For us this has little impact. We haven’t dined in a restaurant for months but for many people it’s a way of life. I cook everything from scratch and between what we’ve got in our freezer and in our pantry we could probably go for months without venturing out of the house. A lack of fresh vegetables would be tedious (not to mention unhealthful) but we could endure. That’s not the case for a lot of people who rely on prepared foods.

Update

Every morning Kara and I walk 2-3 miles (3-4 on weekends). This morning on our walk we saw about ten people (five in a single lawn crew—they weren’t practicing “social distancing”) and even fewer cars were on the road. On a normal day there would have been dozens of cars and two to three times as many people out and about.

In an op-ed in the Washington Post Jared Diamond and Nathan Wolfe explain why China is particularly conducive to producing new illnesses:

The jump of SARS to humans occurred in wild animal markets in China. Throughout China, there are many such markets, where wild animals that have been killed or captured are sold, dead or alive, for food and other purposes. SARS came from marketed civets, small carnivores that in turn had contracted SARS from bats.

Wild animal markets exist in other countries besides China. But Chinese markets are especially efficient for launching epidemics because China has the world’s largest human population and is increasingly connected by cars, planes and high-speed trains.

These facts about the animal origins of emerging human diseases, and about the ideal transmission opportunities offered by Chinese wild animal markets, have been familiar to public health workers for many years. When SARS emerged from the markets in 2004, that should have been a wake-up call to China to permanently close the markets. But they remained open.

When a novel coronavirus surfaced in the city of Wuhan in December 2019, public health officials quickly suspected that it came from a wild animal market there. That hasn’t been proved yet, but everything points to wild animals and their trade as the source.

The Chinese government reacted initially by playing down the outbreak’s significance. But then Beijing reacted forcefully, establishing systems to limit transmission on a scale the world has never seen before. The policy appears to have helped dramatically. China also sought to prevent the emergence of more zoonoses by finally closing the wild animal markets and putting a permanent end to the trade in wild animals for food.

That’s the good news. But there’s also bad news. The government has not banned the other major route of human/wild-animal contact in China: the trade in live animals for the purposes of traditional medicine. This trade encompasses many animal species and is patronized by enormous numbers of people. For instance, the scales of small ant-eating mammals called pangolins are used by the ton in traditional Chinese medicine, because they are thought to combat fevers, skin infections and venereal diseases.

For Western observers, the solution seems obvious. How could the all-powerful Chinese government, capable of locking down millions of people within days, not prohibit the wild animal trade completely? But wild animal products represent more than a mere delicacy for many Chinese — using them is a fundamental cultural practice. But the global threat from coronaviruses is too great. China and other governments around the world must act quickly and decisively to end the wild animal trade.

We have fundamental cultural practices, too, and one of them is a reluctance to tolerate other countries’ practices spreading diseases to our population.

We can’t influence the behavior of the Chinese government. That is beyond our ability. We can, however, change our own behavior and one way we can do that is to place everyone who comes to the United States from abroad in quarantine to ensure they’re not bringing an unwanted guest along with them. We can, in effect, quarantine ourselves. We would also need to secure our borders, a political hot button issue.

Or we can accept the risk of the disease that kills tens or hundreds of millions becoming our least desired import.

President Trump’s performance as president will now inevitably be judged by the outcome of the COVID-19 outbreak in the United States, both on our people and on the economy. Some people will die—we don’t know how many—and he will be blamed for that. Even worse from his standpoint he won’t get much credit if we weather the outbreak quickly whether that’s because of the changing weather or something else and the economy “comes roaring back”. Politics isn’t fair.

During his presidency Donald Trump has done little to cultivate confidence outside his supporters. He lives in a reality of his own, manifest in his many exaggerations, misstatements, or flat out lies. I won’t bother to document or catalogue them. There are thousands of examples. That alternative reality is a barrier to trust. Although it’s a factor in the ceiling of his support, partisanship isn’t its only cause. The casual relationship of what he says with the verifiable truth is a big factor. But again politics isn’t fair.

The coverage of the COVID-19 pandemic is replete with fantasies, frequently peddled as realities. There are realities. As of today at least 160,000 people worldwide have contracted COVID-19 and at least 6,000 people have died, both of which mostly in China. Those are realities. Here in the United States as of this writing those numbers are 3,324 people diagnosed with the disease of whom 63 have died. That’s 10 cases for each million population, a number that’s rising every day. Those are facts, too.

This morning on the talking heads programs Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), asserted that the federal government is doing everything it can and everything it should to address the pandemic. That is an opinion. You would not have to search very hard to find people, both informed and un-, who hold the opposite view. That, too, is an opinion.

It is my opinion that the graph at the top of this post, which is making the rounds these days, is a fantasy or, at the very best, grossly oversimplified. My objections to the eye-catching infographic are many, the primary one being that we simply do not know whether any governmental or personal measure or group of measures would have the illustrated effect. The graphic is intended to convey the message that we can minimize the total number of deaths due to COVID-19 by constraining the rate at which new cases are diagnosed below the dashed line labelled “Health-care system capacity”. We do not know that any set of measures put in place now, on February 21, or on January 21, when the first case of COVID-19 was diagnosed in the United States, would have that effect. We just do not know.

My confidence would be higher if we had banned all foreign travel to the United States and closed our borders on December 21, 2019 but those measures would have required prescience and would undoubtedly have been condemned as a drastic overreaction. Our European cousins are condemning the recent announcement of a ban on European travel. You can imagine what their reaction would have been had that step been taken a month or two months ago. However, as soon as “community spread” began taking place, it may already have been too late to produce that outcome. Again, we just don’t know.

My second objection to that graphic is that the dashed line is depicted as flat (slope of zero). If we are prudent we should be increasing the slope of that line with all due haste. It is my understanding that is already happening by bringing trained individuals who have left the workforce for one reason or another back or by training new individuals as well as other creative ways of increasing the total size of the resource. But that doesn’t make as compelling an infographic.