The editors of the Wall Street Journal react to the shaking down of the federal government that high-spending states want:

The question to ask is why taxpayers in Appleton and Sarasota should rescue politicians and unions in Albany and Springfield?

“You know the state governments are broke, to use a very blunt term. You know the state governments are now responsible for the reopening and the governors are going to do the reopening, and they have no funds to do it,” New York Gov. Andrew Cuomo said Tuesday after making his case to President Trump for more federal cash.

The Governor blames the pandemic and recession, but states like New York were already in trouble from their own mismanagement. Mr. Cuomo warned for months about a $6 billion state deficit thanks to runaway Medicaid costs and taxpayers leaving his high-tax state. He signed a $177 billion business-as-usual budget on April 3 that allows him to borrow $11 billion if spending exceeds revenues. The coronavirus was already a clear and present danger.

Or take Illinois, where Gov. J.B. Pritzker in February proposed a $40.8 billion budget that included $9 billion for public pensions. Mr. Pritzker raised taxes in 2019 and wants to make the state’s current flat tax progressive if voters approve a constitutional change this fall. Yet he and the unions who own the state house have blocked pension or spending reforms.

They’ve long bet on a federal bailout, and they see Covid-19 as their main chance. Illinois Senate President Don Harmon last week sent a plea for a $41.6 billion federal bailout to his state’s Democratic Congressional caucus. He wants $15 billion in no-strings-attached cash; $6 billion for the state’s unemployment trust fund; $10 billion for pensions; and $9.6 billion in unrestricted aid for cities including Chicago and its unreformed pensions. Oh, and he also want the federal government to pick up 65% of the state’s Medicaid costs though Congress’s second relief bill already increased the rate to 56% from half.

Mr. Pritzker is now projecting a $7 billion deficit, which the state could staunch by furloughing nonessential employees or adjusting employee benefits to the level of private workers. Illinois’s unfunded pension liability increased 60% between 2010 and last year to $137 billion even as the stock market more than doubled. Public retirees in the state still get annual compounded pension cost-of-living raises of 3%.

I believe that the editors are mistaken in their claim that Illinois can solve its problems by “adjusting employee benefits to the level of private workers”. The state’s constitution prohibits public pensions from being reduced. Not only would they need to amend the state’s constitution, the courts would need to find that doing so did not violate Article I, Section 10 of the U. S. Constitution. I do not believe that Congress has the power to allow states to declare bankruptcy even if it should care to amend the federal bankruptcy code to allow states to declare bankruptcy for just that reason.

But notice another appearance of that word: mismanagement. These states’ elected officials didn’t mismanage their states’ affairs. They engaged in a corrupt program to defraud the citizens of those states and now they want to extend that to all of the people in the country.

I object strongly to the characterization in this New York Sun editorial of Illinois as “poorly managed” or “mismanaged”:

The Constitution grants Congress the power to establish uniform laws for bankruptcies throughout the country. Yet the bankruptcy code lacks a chapter extending such protection to states, which might be why some of them have become so profligate. That combined with the coronavirus has put some of them on the brink of collapse.

This erupted in the news when the President of the Illinois senate, Don Harmon, wrote a letter to the Illinois delegation in the U.S. Congress asking a bailout of more than $40 billion for the state. Chicago Tribune blew its stack in a memorable editorial. What was so galling about it, at least to us, is that Mr. Harmon sought a $10 billion bailout directly to the Land of Lincoln’s long-underfunded pension system.

That had nothing to do with the pandemic, of course; it was about years of mismanagement of Illinois’ budget. New York and California have also dug themselves into shockingly deep holes. For any state in such circumstances to suggest that its obligations ought be paid by taxpayers in other states boggles the mind. Particularly when many states pensions are far more generous than those of private employers.

Either characterization conveys the impression that mistakes were made or that Illinois’s elected officials did not know what they were doing or miscalculated somehow.

Nothing could be farther from the truth. Illinois’s elected officials, chief among them Illinois House Speaker Mike Madigan who has held that post for most of the last 40 years, have worked with supreme skill to buy votes, remain in office, and enrich themselves personally through manipulations of the tax code. They didn’t just mistakenly forget to put the check for the state’s contributions to the public employees’ pension funds in the mail. They deliberately neglected to pay it, diverting the money to increase state-paid benefits in various ways. It was a corrupt strategy not inadvertence.

As the total number of cases of COVID-19 diagnosed worldwide continues to creep towards 3 million, little has changed over the last few days. Only South Korea, Taiwan, and Japan seem to have avoided major outbreaks of the disease. Singapore seems to be seeing a resurgence in the number of cases.

The curve may be bending in Italy. The peak in the number of new cases took place on March 21 and that seems to be holding although new cases continue to be accumulating. I can’t distinguish whether the measures the Italians have put in place are succeeding or the epidemic is just running its course there.

Here in the U. S. the health care system hasn’t been overwhelmed but I see few signs that we’re “bending the curve”, either. The New York metropolitan area still has about a third of all cases of COVID-19 diagnosed in the U. S. and about half of the deaths. There are some reports that pressures on ICUs in that area are decreasing. The situation seems to be worsening in the Washington, DC area.

The number of cases per million population in Florida, Texas, and California are 10% their number in New York State. Maybe those states are being protected by heat or sunshine. Population density would appear to be a more significant factor. Minnesota has a rather low prevalence and morbidity and the state is not known for heat or sunshine.

I wanted to share the information above from the Illinois Department of Public Health. Illinois has been under a statewide “stay at home” directive for almost six weeks now. I would think that if there were any “curve-bending” going on we would see evidence of it by now. There’s more info at the IDPH site. Based on what they show there is still substantial available capacity in every sector of the state. The City of Chicago itself is tightest, as you might expect. That Chicago is in the middle of a shooting spree that began the week after the governor announced the “stay at home” directive might have something to do with that.

I suppose one might make the argument that the fact that Illinois’s ICUs are not stretched to capacity is proof positive that the “stay at home” directive is having the desired effect. As I’ve said before that strikes me as a “tiger repellent” argument. It also does not disaggregate the effects of the “stay at home” directive with any changes in treatment protocols that may have taken place over the same period. Are treating physicians still as likely to put people presenting with the symptoms of COVID-19 on ventilators as they were six weeks ago? I have no idea.

According to NPR the National Institutes of Health is raining on the HCQ parade:

A panel of experts convened by the National Institute of Allergy and Infectious Diseases recommends against doctors using a combination of hydroxychloroquine and azithromycin for the treatment of COVID-19 patients because of potential toxicities.

“The combination of hydroxychloroquine and azithromycin was associated with QTc prolongation in patients with COVID-19,” the panel said.

QTc prolongation increases the risk of sudden cardiac death.

The recommendation against their combined use would seem to fly in the face of comments made by President Trump suggesting the combination might be helpful. On March 21, for example, the president described them in a tweet as having a “real chance to be one of the biggest game changers in the history of medicine.”

There are also some other treatments they recommend against:

But occasionally, there are recommendations explicitly against certain therapies. For example, the panel recommended against using Lopinavir/ritonavir or other HIV protease inhibitors because of negative clinical trial data. It also recommended against using interferon because it seemed to make patients with SARS and MERS worse. Those diseases are caused by a coronavirus related to the one causing COVID-19.

“It’s all based on the data,” said panel member Dr. Susan Swindells, a professor in the department of internal medicine at the University of Nebraska College of Medine. “We just plowed through everything that was, and apart from supportive care, there wasn’t anything that was working terribly well.”

The panel also concluded that there was insufficient evidence to recommend any kind of treatment either to prevent infection with the coronavirus or to prevent the progression of symptoms in those who are already infectious. That recommendation could change based on clinical trials presently underway.

I don’t have any ox to get gored in this discussion but I wonder how the NIH explains the experience in South Korea? Or are they just discounting it completely?

Just to pass along a little gossip I heard according to one doc I’ve spoken with South Korea’s strategy for handling their COVID-19 outbreak made it impossible for other countries to follow its lead, at least in the near term which was when it would have been necessary. The country had already sucked up all of the necessary supplies. Just gossip, as I say.

Santa Clara County, California has reported a death due to COVID-19 that took place weeks before what had previously been presumed to be the first death due to the disease here in the U. S.:

Santa Clara County, CA – The County of Santa Clara Medical Examiner-Coroner has identified three individuals who died with COVID-19 in Santa Clara County before the COVID-19 associated death on March 9, 2020, originally thought to be the first death associated with COVID-19 in the county.

The Medical Examiner-Coroner performed autopsies on two individuals who died at home on February 6, 2020 and February 17, 2020. Samples from the two individuals were sent to the Centers for Disease Control and Prevention. Today, the Medical Examiner-Coroner received confirmation from the CDC that tissue samples from both cases are positive for SARS-CoV-2 (the virus that causes COVID-19).

Additionally, the Medical Examiner-Coroner has also confirmed that an individual who died in the county on March 6 died of COVID-19.

February 6 is three weeks earlier than what had thought to be the first death due to SARS-CoV-2. That is additional confirmation of the point I have been making for some time. Without China’s being much more forthcoming weeks earlier than they actually were any prospect for avoiding an outbreak of COVID-19 here in the states depends on assumptions unrealistic in the extreme.

I think that “unrealistic assumptions” will be the story of the handling of this pandemic from end to end, not limited to the United States. The word I’m getting now is that India, which issued a countywide “stay at home” directive several weeks ago, is about to surrender and just let the disease run its course.

So, what next? I would think that the experience of Florida, which initiated “stay at home” directives much later than in other jurisdictions and the incidence and mortality due to COVID-19 are an order of magnitude lower than in New York, suggests that whatever is happening in the U. S., it cannot be attributed to “stay at home” directives alone.

I found this op-ed at USA Today from virologists Konstantin Chumakov and Robert Gallo pretty interesting. In addition to searching for a specific vaccine for SARS-CoV-2, why not deploy a vaccine that’s been in our arsenal for a long time and, coincidentally, has already been approved by the FDA?

Ultimate control over COVID-19 will be possible only after a large part of the world population becomes immune. This can happen either after a large fraction of the world population gets infected or by prophylactic vaccination. Efforts are underway to accelerate the development of safe and effective vaccines. However, vaccines can be used for mass immunization only if they prove to be safe and effective by thorough clinical evaluation. Given the time this requires, vaccines specific to COVID-19 are likely to remain unavailable for mass immunization during the current pandemic.

In the meantime, we propose an approach to mitigate the SARS-CoV-2 pandemic through the use of existing attenuated live viral vaccines. In particular, oral polio vaccine has been documented to induce protection against a number of viral and bacterial infections. OPV, developed by Albert Sabin, consists of attenuated (weakened) poliovirus and has been used with great success in worldwide efforts to eradicate poliomyelitis.

In addition to protecting against polio by inducing antibodies that kill the virus, OPV activates other protective mechanisms, including an innate immune system, thus making people resistant to infections caused by other viruses and bacteria. For example, in large scale multicenter clinical trials conducted in the 1970s during outbreaks of seasonal influenza, OPV protected more people from influenza than most flu vaccines do. Furthermore, observational studies in many countries suggested that the hospitalization rate and the overall mortality among children immunized with OPV were consistently lower compared with unimmunized children, even in the absence of poliovirus in communities.

Related studies revealed that similar nonspecific protection can be induced by immunizing people with measles vaccine, tuberculosis vaccine (BCG) and some other live attenuated vaccines. These observations suggest that the nonspecific protective effects are a result of boosting innate immunity that is our body’s front-line defense against infectious agents. This protection would last for a period of several weeks or months preventing or reducing the severity of disease in immunized individuals and slowing down the spread of COVID-19.

An idea so crazy it might just work. It’s at least worth experimenting with on a limited trial basis.

Brian Doherty has published a good post at Reason, the thesis of which is that posing the debate between “Openers” and “Closers” as one between “idiot death-worshippers” and “unnecessarily frightened tyrants” is counter-productive:

Beyond its devastating effect on the health of hundreds of thousands and the livelihood of millions, the COVID-19 crisis is a harshly vivid example of Americans’ inability to understand, fruitfully communicate with, or show a hint of respect for those seen to be on other side of an ideological line.

Americans are divided about the best way to proceed from here, three months since the first case was diagnosed in the U.S. The division is more vivid and harsh on social networks than in the polls, where a vast majority of Americans still think strong lockdowns are the best idea moving forward. Such Americans think the economy needs to stay shut down by law until a vaccine or some effective treatment is developed that ensures no more, or a very tiny number of, people will be seriously harmed or killed by COVID-19.

On the other hand, some Americans think, on balance, the country’s overall quality of life demands we start letting people and businesses make their own decisions about whether it is safe to go out in public or conduct business openly, especially given access to simple prophylactic measures such as gloves and masks.

Read the whole thing. It isn’t terribly long.

I’d like to offer some scattershot reactions. My first reaction is that dehumanizing your opponents isn’t supposed to be productive. It’s some combination of kneejerk reaction and battlespace preparation. It makes it easier simply to dismiss them rather than treating their concerns as legitimate.

A second reaction comes from one of my oldest blogging correspondents, Wretchard of The Belmont Club: “The cost of politicizing the disease is it locks people into positions. In fact dealing with an epidemic is an exercise in adaptation.” We don’t know “the facts” and may never know them completely but a famous response of the economist John Maynard Keynes’s seems appropriate: “When my information changes, I alter my conclusions. What do you do, sir?” When altering your conclusions in response to new revelations is seen as some sort of moral failing, we have a basic problem.

Finally, I think the political incentives are presently completely disregulated. IMO the “stay at home” directives will remain in place until they become impossible to maintain or serious recall and/or impeachment proceedings begin. Then they will be lifted in an excessive rush.

I’ve got to admit that the logic of Illinois’s public officials’ policies and public statements eludes me. The Chicago Tribune reports:

Gov. J.B. Pritzker on Tuesday said models are now predicting the new coronavirus won’t peak in Illinois until mid-May, weeks later than previously projected.

During an interview on The Washington Post Live, Pritzker noted that Illinois was the second state to issue a stay-at-home order and that because people have been abiding by it, “for the most part,” the anticipated peak of the outbreak in mid-to-late April has changed.

Meanwhile, Chicago Mayor Lori Lightfoot said on a conference call with reporters that she expects Pritzker’s stay-at-home order could extend into June.

State officials reported 1,551 new known COVID-19 cases on Tuesday, as the total number of known infections reached 33,059. There were also 119 additional deaths reported, bringing the toll since the start of the outbreak to 1,468.

I simply don’t understand. Is the policy succeeding, failing, or will it continue whether it succeeds or fails?

The number of new cases and new deaths in Illinois continue to increase. To the extent that there is any trend, it is up. It looks to me as though the actual changes are smaller than irregularities in reporting. They are not declining.