I agree with the general thrust of the Washington Post’s latest editorial. Reopening the economy will be an enormous task:

Tom Frieden, former director of the Centers for Disease Control and Prevention, has usefully outlined four tasks. First, wide-scale testing must be deployed to know who is sick and who is not. Second, those infected must be isolated from the healthy and susceptible. Third, everyone who had been in contact with the sick must be traced. Fourth, those contacts have to be isolated to prevent further spread. All four have to be accomplished to box in the virus, he says.

Where I differ from them is more in this paragraph:

Unfortunately, there are stubborn, unresolved problems with all four. It will be catastrophic if the next phase unfolds with the kind of chaotic supply shortages and lack of leadership we have seen over the past few months. Diagnostic tests, to see whether people are sick, have been running at about 140,000 a day reported by the states, only a fraction of what is needed for phase two. Serological testing, to see who has recovered with antibodies that might confer immunity from reinfection, has never been done at this scale. Many tests are in the works, but technical and biomedical uncertainty remain, including regarding how long the antibodies last and how strongly they may protect. Former Food and Drug Administration commissioner Scott Gottlieb and former FDA chief of staff Lauren Silvis have suggested that employers ought to take on some of the burden for testing, bringing it into workplaces, making it more routine and widespread.

Rather than the universal testing that they seem to imagine I have been advocating a well-designed, systematic system of sampling. Much depends on what level of certainty and risk you require. If you require 100% certainty and 0% risk, we will never reopen the economy, at least not until a vaccine and treatments are found for SARS-CoV-2 and COVID-19. At some point the food supply chain will break down and we will have much, much more serious problems than hospitals strained beyond their capacity. There will never be a large enough supply of tests and their precursors, enough compliance with directives, or enough people to trace contacts for the entire human population many times over which is what such certainty and risk avoidance would require.

Once you decide you’ve willing to settle for something less than 100% certainty and 0% risk, the matter becomes a political issue rather than a technical one.

Science tells us that we may be able to develop an effective vaccine for SARS-CoV-2. Experience tells us that either we will not or that it is likely to take a long time to do so, longer than we have. Hope tells us that we will.

I think we would be prudent to rely on experience but different people take that to mean different things. I guess that’s why I have been harping so much on the slow pace of recoveries and finding a treatment more effective than supportive care.

I welcome the reports of interstate pacts, like those among California, Washington, and Oregon or among New York, New Jersey, Connecticut, Pennsylvania, Delaware, Rhode Island and Massachusetts mentioned in this article at CNN:

States on the country’s East and West coasts are forming their own regional pacts to work together on how to reopen from the stay-at-home orders each has issued to limit the spread of the novel coronavirus.

The first such group to be announced came Monday on the East Coast. Democratic New York Gov. Andrew Cuomo said his state, New Jersey, Connecticut, Pennsylvania, Delaware, Rhode Island and Massachusetts each plan to name a public health and economic official to a regional working group. The chief of staff of the governor of each state also will be a part of the group, which will begin work immediately to design a reopening plan.
Later on Monday, the West Coast states of California, Washington and Oregon also announced they are joining forces in a plan to begin incremental release of stay-at-home orders. Governors of the three states will collaborate on their approach to getting back to business in “in a safe, strategic, responsible way,” as announced by California Democratic Gov. Gavin Newsom.

I don’t see them as indicating some grave failure of the federal government but rather as indicating that our system is working as designed. States with common interests work together to pursue those interests. Could that pursuit be facilitated by the federal government? Maybe. It could also be impeded by the federal government.

There will be many lessons drawn from our experience with SARS-CoV-2. I would hope that one of them is that redundancy within limits is beneficial and conducive to resilience.

At The Hill Kevin Naughton explains how, paradoxically, adversarial major media outlets may be President Trump’s greatest allies in his re-election bid:

There is no doubt that the country is going to go into a significant recession of undetermined length and casualties will be high.

However, the bar for “success” has been set very low — not just by Trump, but primarily by the media outlets he disdains. Every end-of-the-world report depresses public expectations. Since politics is all about perception, the anti-Trump media have done the president an immeasurable service in their criticism. Trump doesn’t have to do a good job against the coronavirus — he just has to do a barely competent job to exceed expectations.

With new estimates bringing the expected mortality toll down to approximately 60,000 and a collapse of the health care system — even in hard-hit regions — looking to be a much more remote possibility, Trump is set up to declare a victory of sorts. Certainly, there could easily be more flare-ups or a return of the virus in force in the fall, but Trump may well win an expectations game his opponents set up perfectly for him.

Determining responsibility for the spread of the pandemic in the United States is like “Murder on the Orient Express” — everyone did it. Whether it is the Chinese (blamed by 90 percent of Republicans and 67 percent of Democrats) or a World Health Organization whose main competence appears to be toadying to China, Trump has two easy targets on which to focus his considerable bile.

And, while the Trump administration was not ahead of the curve in preparation, neither was the rest of the world. The European Union failed to act, even as an outbreak began sweeping Italy. Japan looked to have successfully avoided a major contagion, only for it to hit in the past week. Outside of South Korea and Taiwan, hardly any developed country has escaped an outbreak.

Trump is helped in the United States by the failures in the New York City region. The states of New York, New Jersey and Connecticut account for approximately half of all confirmed cases (Note: “confirmed cases” is certainly a severe undercount of the total, but assuming that the American states and other developed democratic nations have roughly the same error rate, “confirmed cases” can be used for comparison purposes). The late response by New York politicians, scandalously encouraging people to go out and not disrupt their lives, allow Trump to drop blame for half the epidemic on leaders in a state that did not and will not vote for him.

For every attack levied at Trump, he has a response that may resonate with enough voters to either win the argument or sufficiently muddy the waters.

Moreover, the major media outlets are overwhelmingly located in New York City, Washington, and Los Angeles. That their views are disproportionately based on what’s happening in New York is not entirely surprising under the circumstances.

If the major media outlets had maintained a professional detachment, they would not have assumed the role of foil for Trump they have assumed. However, with the New York Times running front page op-eds and editorials opposing Trump as early as 2016, nearly every crawl on CNN bearing an anti-Trump message, and with the outlets putting their weight behind every foray into impeachment efforts (which began as early as June 2017), that ship sailed long ago.

The editors of the Chicago Tribune point out, correctly, that COVID-19 did not create Illinois’s problems and, although an infusion of cash may allow Illinois’s politicians to kick the can down the road for a little while longer, as Illinois spends money it doesn’t have while concurrently losing revenues, the federal response to COVID-19 can’t save Illinois:

Last year, Gov. J.B. Pritzker’s Office of Management and Budget offered a grim fiscal assessment: “Even with the balanced budget for fiscal year 2020, the underlying structural deficit of the state’s budget has not been addressed. Sizable deficits in the general funds budget are projected for fiscal years 2021 through 2025.” The governor hoped to change the picture by getting voters to approve a constitutional amendment allowing a graduated income tax. But its approval in the November election is hardly guaranteed nor a prescription for fixing state government.

The budget forecast, however, is far worse now than it was just a few weeks ago. The coronavirus pandemic has required a long list of unforeseen expenditures to cope with the public health crisis. At the same time, by closing businesses and forcing most people to stay home, it has crushed economic activity and slashed revenue.

A new report by the University of Illinois System’s Institute of Government and Public Affairs offers a scary preview of how the fiscal landscape will look after this earthquake. In its best-case scenario, revenues would drop by a total $4.3 billion in the 2020 and 2021 calendar years. Worst case? $14.1 billion. The IGPA also anticipates a big jump in outlays for public health, Medicaid and various human services.

As if these consequences weren’t bad enough, the state’s public pension program will suffer as well. At the end of fiscal year 2018, the report notes, the state had only about 40% of the funds needed to cover its long-term obligations. Now, it says, “recession-induced declines in asset values could result in a sharp and sudden increase in unfunded liabilities.”That means more and more revenue will have to be diverted to supporting government retirees instead of providing services to the general population.

Illinois already has the worst bond rating of any state, a product of its endless fiscal mismanagement. After getting a negative rating from S&P Global Ratings, it could see its bonds sink to junk status — making it the first state to earn that badge of shame since the 1930s.

If the federal government had its wits about it, they wouldn’t let this crisis go to waste. They would compel Illinois legislators to do what they will never do under their own steam—amend the state’s constitution to allow the state to rewrite its public employee pension programs, if not for current retirees at least for present public and future public employees in exchange for short term bailout funds.

Sadly, it doesn’t and Illinois politicians will do everything in their power to blame their own bad decisions over the last 40 years on Washington.

There aren’t many domestic ports that can stand up to Portugal’s great port wines but one of them is Mount Pleasant Port from Mount Pleasant Winery in Augusta, Missouri of all places.

You may or may not recall Lord Chesterfield’s famous wisecrack about the custom of giving a case of vintage port to a boy at his birth because by the time the port was ready to drink, the boy would be ready to drink it.

Last night as part of our Easter celebration we opened one of our decades-old bottles of Mount Pleasant vintage port, pictured. This was done with a certain amount of trepidation. Opening a bottle of wine is an irrevocable act—once done it cannot be undone and you can never be completely certain of the results.

In this particular case I was delighted. Although the cork disintegrated almost completely as it was withdrawn from the bottle, the wine had matured and mellowed over the years. It was drier, more nuanced, and overall tremendously improved by its lengthy slumber. A delightful experience. We paired the port with chocolate and strawberries, a classic combination. For those of you who think our lifestyle lavish, I ate 10g of chocolate and one strawberry. You don’t need to eat and drink a lot to eat and drink well.

To your good health!

I want to draw your attention to this interesting article at the New York Times by epidemiologist Marc Lipsitch, considering who is likely to contract SARS-CoV-2:

The ideal scenario — once infected, a person is completely immune for life — is correct for a number of infections. The Danish physician Peter Panum famously figured this out for measles when he visited the Faroe Islands (between Scotland and Iceland) during an outbreak in 1846 and found that residents over 65 who had been alive during a previous outbreak in 1781 were protected. This striking observation helped launch the fields of immunology and epidemiology — and ever since, as in many other disciplines, the scientific community has learned that often things are more complicated.

One example of “more complicated” is immunity to coronaviruses, a large group of viruses that sometimes jump from animal hosts to humans: SARS-CoV-2 is the third major coronavirus epidemic to affect humans in recent times, after the SARS outbreak of 2002-3 and the MERS outbreak that started in 2012.

Much of our understanding of coronavirus immunity comes not from SARS or MERS, which have infected comparatively small numbers of people, but from the coronaviruses that spread every year causing respiratory infections ranging from a common cold to pneumonia. In two separate studies, researchers infected human volunteers with a seasonal coronavirus and about a year later inoculated them with the same or a similar virus to observe whether they had acquired immunity.

In the first study, researchers selected 18 volunteers who developed colds after they were inoculated — or “challenged,” as the term goes — with one strain of coronavirus in 1977 or 1978. Six of the subjects were re-challenged a year later with the same strain, and none was infected, presumably thanks to protection acquired with their immune response to the first infection. The other 12 volunteers were exposed to a slightly different strain of coronavirus a year later, and their protection to that was only partial.

It is presently hoped that some people have acquired at least temporary immunity to the virus. Or that some people are resistant to the infection because they have contracted a similar disease in the past.

There is also a certain amount of information emerging that some people are more predisposed to becoming infected or if infected seriously ill, not just by virtue of pre-existing health conditions or behavior but by their genetic makeup. To some extent such research is taboo in our society not only because it violates notions of “fairness” but because it has been abused in the past. That’s an unfortunate but understandable prejudice. The greater our knowledge about this virus, the greater may be our ability to fight it.

Read the whole thing.

As of this writing we are closing in on 2 million diagnosed cases of COVID-19 worldwide (1,773,112 precisely) with more than 100,000 deaths attributed to the disease (108,471). The U. S. leads the world in number of cases diagnosed, number of deaths, and number of tests administered albeit not in number of cases per million population (San Marino), number of deaths per million population (also San Marino), or number of tests administered per million population (Iceland). Nearly all Americans live in states which have issued “stay at home” directives.

To my knowledge no one has taken any position on what level of compliance with such orders would be necessary for them to have any effect. It’s obvious to me at least that there is some level of non-compliance below 100% which renders such order moot. We’re not going to achieve a compliance rate of 100% on anything.

At this point I am convinced that South Korea, practically alone among countries, has actually managed to “bend the curve”. They have kept their new cases per day to from 25-55 for almost a week now. They have tested nearly 1% of their population, starting in late January, shortly after the first cases began to appear. Their response to the virus has been a combination of aggressive testing, follow-up, and tracing of all positives. IMO and, I believe, in the opinion of just about everyone with an open mind, it’s too late for that strategy in the U. S.

I should add that the differences between South Korea and the U. S. are stark. By comparison it’s small, compact, with generally high social coherence, and conformity with rules. South Korea is already exporting test kits albeit not in numbers sufficient to make a dent in U. S. requirements.

I see few signs of our bending the curve at this point and I think that the predictions I’ve heard of deaths per day peaking today are wishful thinking. In Nate Silver’s piece on ABC’s This Week I thought he was drawing conclusions far too sweeping based on too small changes over too short a timeframe. Reporting errors or delays could account for everything he’s seeing.

We don’t have enough tests or protective equipment yet. I wish President Trump were making more aggressive use of the Defense Production Act.

In the U. S. there are presently competing notions about how to proceed, largely drawn along party lines. I think that both extreme positions (test everybody and stay locked down until the threat passes vs. go back about your business as normal) are nuts. What I would prefer would be a highly organized systematic nationwide sample of tests used to inform lifting or tightening of “stay at home” directives and to optimize the still limited availability of resources. I would characterize such a plan as epidemiological testing. It should be accompanied by serological testing, with much the same objectives.

I am indifferent as to whether such a plan would come from the federal government, from the states working in cooperation, or from the private sector as long as it happens.

We should be paying more attention to the responses of other countries, not just South Korea but, importantly, South Africa. South Africa has put one of the strictest “stay at home” policies outside China in place along with aggressive testing, has a largely sub-Saharan black population, and has a pretty temperate climate, making a transition from its summer to its autumn. Running experiments are difficult in the real world but you can obtain helpful information from the experience of other countries if you’re willing to make a realistic assessment of the differences among countries.

I don’t think we’re receiving any information from China that’s worth considering and I don’t really think that we can learn much from the experience of ethnically homogeneous city-states or their equivalents but I wish that Americans including American scientists and physicians who should know better were not so dismissive of information gleaned from South Korea or any number of other countries with populations over 50 million.

I agree with Joe Biden’s plan for reopening America, published here in the New York Times:

Here’s what our national strategy should look like.

First, we have to get the number of new cases of the disease down significantly. That means social distancing has to continue and the people on the front lines have to get the supplies and equipment they need. President Trump needs to use his full powers under the Defense Production Act to fight the disease with every tool at our disposal. He needs to get the federal response organized and stop making excuses. For more Americans to go back to their jobs, the president needs to do better at his job.

Second, there needs to be widespread, easily available and prompt testing — and a contact tracing strategy that protects privacy. A recent report from Mr. Trump’s Department of Health and Human Services made clear that we are far from achieving this goal.

We should be running multiple times the number of diagnostic tests we’re performing right now. And we should be ready to scale up a second form of testing: rapid serology tests to tell who has already been infected with the coronavirus and has antibodies. This isn’t rocket science; it’s about investment and execution. We are now several months into this crisis, and still this administration has not squarely faced up to the “original sin” in its failed response — the failure to test.

Third, we have to make sure that our hospitals and health care system are ready for flare-ups of the disease that may occur when economic activity expands again. Reopening the right way will still not be completely safe. Public health officials will need to conduct effective disease surveillance. Hospitals need to have the staff and equipment necessary to handle any local outbreaks, and we need an improved federal system to get help to these places as needed.

Make no mistake: An effective plan to beat the virus is the ultimate answer to how we get our economy back on track. So we should stop thinking of the health and economic responses as separate. They are not.

Once we have taken these steps, we can begin to reopen more businesses and put more people back to work.

The devil, of course, will be in the details. I think that testing every American for SARS-CoV-2 not just once but multiple times, something Mr. Biden has also supported, would not produce results relative to its costs.

I think the Trump Administration has been far too slow in taking some of the measures at its disposal to speed this process along.

But treating this as a distinctive failure on Trump’s part is a step too far. It’s a failure of Trump’s but not just a failure of Trump’s. This isn’t a partisan issue. The U. S. failure to take the prospect of a pandemic seriously has taken place over the last four administrations at least. While it’s true that the Trump Administration did not restock the national stockpiles of ventilators, respirators, and so on, neither did the Obama Administration in which Mr. Biden served as vice president. Neither did the Bush Administration or the Clinton Administration.

And the one thing that needs to be acknowledged more than anything else is that a global pandemic has always been a risk of a globalized economy. Now it’s not just a risk but an issue.

It’s reasonable to ask how much time, money, and attention should be devote to low probability high impact events but it’s also reasonable to ask what that we have done instead would you be willing to do without to prepare for those low probability high impact events? You can argue about the advisability of spending money but that time and attention are not infinitely expandable resources is a fact which we need to acknowledge. Should we, for example, not have educated children, built roads, or treated the sick so that we could devote more resources of time and attention to preparing for a pandemic?

For a “way out of this pandemic”, the Washington Post turns to Danielle Allen, a political theorist, as one does when dealing with a health crisis. Dr. Allen proposes creating a Pandemic Testing Board analogous to the World War II War Production Board:

What would it do?

First, it would carry out a Pandemic Testing Supply Initiative.

That means the board would have authority to identify supply-chain elements necessary for manufacturing, procuring, scaling and deploying any items related to testing. It would have the power to procure these materials via contracting with producers and servicers, and the power to mandate production or services, akin to authorities in the Defense Production Act. Contracting firms would be required to follow all existing labor laws, including maintaining collective bargaining agreements.

At the same time, there would also need to be a Pandemic Testing Deployment Initiative. To deploy testing at scale, there would need to be sufficient personnel to test individuals outside of hospitals and doctors’ offices. So the Pandemic Testing Board would:

• Craft recommendations for states to use the National Guard to deploy testing in conjunction with business, labor, nonprofits and academia.
• If necessary, be authorized to create a Pandemic Response Corps, made up of tested civilians, to assist.
• Make recommendations on tracking the spread of the virus.
• Before disbanding, craft recommendations on long-term preparedness.

This entire idea is gobsmackingly half-baked but it’s about what you would expect from someone without practical experience of anything other than cracking a poli sci text. The effect of such a board would be to create an all-powerful soviet whose mandate would never end because the problem it was created to address would never be solved. As I’ve described it before, it would be the world’s largest, most expensive, most futile game of Whac-A-Mole.

Fortunately, we don’t need to do that. What we do need to do is create a plan for sampling the population and start using the tens of thousands of testing devices already installed in hospitals around the country, mobilizing such industrial support as is necessary to create more test kits. Let’s not buy the materials to do that from China, hmm?