For those wondering about what’s wrong with the World Health Organization, this Wall Street Journal op-ed from Lanhee J. Chen should explain the issues:

The World Health Organization isn’t just “China centric,” as President Trump called it on Tuesday. It is also broken and compromised. The WHO fell short in its dithering reaction to the 2014 Ebola outbreak in West Africa, which claimed more than 11,000 lives. Now its response to the coronavirus pandemic shows it is willing to put politics ahead of public health. The way the WHO has consistently acted to placate China’s leaders makes clear the need for fundamental reform.

The U.S. is the biggest financial contributor to the WHO—more than $400 million in 2019, when China sent only $44 million, according to the U.S. State Department. Mr. Trump suggested that the U.S. might hold its funding while his administration takes a “good look” at what the country is getting for its money. He and Congress should go further.

While Washington pays, Beijing works behind the scenes to influence WHO leaders. The current director-general, Tedros Adhanom Ghebreyesus, was backed strongly by the Chinese government during his campaign for the job. Mr. Tedros was a controversial pick, dogged by allegations of having covered up cholera outbreaks in his native Ethiopia, where he served as health minister (2005-12) and foreign minister (2012-16). During those years, China invested in Ethiopia and lent it billions of dollars. Shortly after winning his WHO election, Mr. Tedros traveled to Beijing and lauded the country’s health-care system: “We can all learn something from China.”

Under Mr. Tedros’s leadership, the WHO has accepted China’s falsehoods about the coronavirus and helped launder them into respectable-looking public-health assessments.

On Jan. 14, before an official WHO delegation had even visited China, the group parroted Beijing’s claim that there was “no clear evidence of human-to-human transmission.” Two weeks later, after China had reported more than 4,500 cases of the virus and over 70 people in other countries were sick with it, Mr. Tedros visited China and heaped praise on its leaders for their “transparency.”

Recall that China waited six weeks after patients first saw symptoms in Wuhan to institute a lockdown there. During this time Chinese authorities censored and punished physicians who tried to sound the alarm, repeatedly denied that the virus could be transmitted between humans, and held a public banquet in Wuhan for tens of thousands of families. In the meantime, more than five million people left or fled Wuhan, according to the city’s mayor. This included the patient with the first confirmed case of the virus in America.

The WHO finally declared a public-health emergency on Jan. 30, after nearly 10,000 cases of the virus had been confirmed. China’s reported figures rose in early February to more than 17,000 infections and 361 deaths, yet Mr. Tedros rebuked Mr. Trump for restricting travel from China and urged other countries not to follow suit. He called the virus’s spread outside China “minimal and slow.” It took until March 11 for the WHO to declare a pandemic. By that point the official world-wide case count was 118,000 people in 114 countries.

China’s influence is also apparent in the WHO’s exclusion of Taiwan. The WHO didn’t even bother replying to Taiwanese inquiries in December about whether the coronavirus could, contrary to Beijing’s claims, be transmitted between humans.

Last month a Hong Kong TV reporter asked Bruce Aylward, who leads the WHO-China Joint Mission on Coronavirus, if the organization would reconsider its refusal to allow Taiwan to join. Dr. Aylward, on a remote video connection, sits silent and expressionless for nearly 10 seconds before the reporter prompts him again: “Hello?”

“I’m sorry,” he finally says, “I couldn’t hear—I can’t hear your question, Yvonne.”

“Let me repeat the question,” she says.

“No, that’s OK. Let’s move to another one then.”

When she presses him on Taiwan, he terminates the connection. The reporter calls back and tries a different tack: “I just want to see if you can comment a bit on how Taiwan has done so far in terms of containing the virus.”

His reply: “Well, we’ve already talked about China, and, you know, when you look across all the different areas of China, they’ve actually all done quite a good job.”

The exchange demonstrates how the WHO prioritizes politics over public health. It has internalized Beijing’s view of Taiwan and seeks to praise China’s leaders at every turn. And at no point during the crisis has the WHO substantively investigated the Chinese regime’s claims about the virus or been transparent about the thinking behind its decisions.

As the biggest financial contributor to the WHO, the U.S. has the leverage to push for radical reform. Congress should condition all future funding on the WHO’s explaining in detail how it reaches its public-health decisions and rigorously and independently investigating the extent of disease outbreaks.

The U.S. should work aggressively to change the culture and leadership of the WHO. The Trump administration took a good first step in January by creating a special envoy at the State Department focused on countering China’s attempts to control international organizations. The WHO’s next director-general must not be a rubber stamp for Beijing.

If the WHO not only does not decrease risk but actually increases it and if it does not reduce the transactional costs of dealing with international health problems, it does not perform any function to which we should subscribe. Time for it to go.

It is darned hard to make reasonable inferences based on the data we’re getting and, especially, based on the media reports. Keep in mind that most of the people in the national media live in the New York City metro area, the Washington, DC metro area, or Los Angeles.

Roughly one third of all confirmed cases of COVID-19 in the United States are in the New York metro area. We’re not sure why that is. Population density, temperature, the number of people returning from China during January and February, and the behavior of the people, e.g. crowding into subway cars, probably all play roles.

More than one third of all confirmed cases of COVID-19 in California have been in the Los Angeles metro area. The reasons for that are even less clear than for New York. The only two that seem to apply are the number of people coming from China during January and February and behavior.

Composed as it is of parts of Maryland, Virginia, and the district itself, Washington, DC is harder to ferret out. To my eye there actually haven’t been a lot of cases in the DC metro area.

Compare New York and LA with some other places. There have been more confirmed cases in the Bronx than there have been in the ten states with the lowest number of cases put together (Minnesota, West Virginia, Nebraska, Kentucky, Hawaii, Alaska, Oregon, Montana, Kansas, North Dakota). Those states are all over the map but quite a few of them have things in common. The Upper Midwestern states in that list plus a few others are relatively homogeneous, socially cohesive, known for maintaining “social distancing” even under ordinary circumstances, and tend to have low population densities. Hawaii has a warm climate going for it.

Shoehorning a policy crafted for New York City into the rest of the country does not sound like a formula for success to me, especially when you can’t even shoehorn it into New York City. The subway is still running, albeit with a much lower ridership.

Now maybe all that will change. Maybe it won’t.

I have a little difficulty separating the political fulmination from the facts in our handling of the COVID-19 outbreak here in the United States. Let me give an example of what I mean.

As of this writing no country other than China has succeeded in “bending the curve”, at least not in the way that the curves are usually drawn, and I don’t believe the reports coming from China at all. Not South Korea, not Taiwan, not Singapore, not Japan and certainly not Germany. Not Sweden. The strategies taken by these countries are not in lockstep. They vary.

What South Korea apparently has succeeded in doing is to maintain the present growth in the number of cases. Unless a vaccine or effective treatment is right on the horizon, that’s no solution. It’s just kicking the can down the road.

I think I shocked a colleague of mine when I suggested that not only will the number of new cases not peak in April, it might not peak until June or July.

You might find this post by Ian Klaus at CityLab about the prospective effects of the COVID-19 pandemic on cities interesting. Think it will result in sweeping policy changes? Think again:

Historical analogies are a dangerous and difficult game, and the combination of a public health crisis with an economic downturn cautions that they should be deployed carefully. The coronavirus stands to deliver big surprises and innovations in policy, politics and space. But even as an imperfect guide, history suggests one should not wait on a dramatic post-pandemic revolution in urban space. Why?

There are a number of explanations for the force of historical inertia in urban spaces. The creative classes and politics that give shape to the built environment require expertise, organization and trusting relationships, all of which take time to build. The bureaucratic institutions that ultimately manage these spaces are, by intention, rarely revolutionary in nature. Even new technology, as the historian David Edgerton has illustrated, rarely ushers in immediate change. And finally, there is the intersection of urban areas and the wider economy. Whether cities are shaped to attract investors or businesses or are shaped as much by them, capitalism has shown itself capable of both adapting to and shaping new forms of space.

For those hoping that we might at this moment be shocked into some historic urban transformation, the story of continuity will not be welcome news.

Another factor that he does not mention. All sorts of organizations, whether private corporations, NGOs, not-for-profits, or government departments are already fully mobilized to shape public policy in directions they favor. They will not let a little thing like a pandemic dissuade them. They’ve been doing that for decades now and their inertia is tremendous.

Most mornings on our morning walk Kara and I pass a neighbor’s house with a panel truck parked in the driveway. The panel truck is emblazoned with messages indicating they are in the industrial cleaning business. In Illinois at least such businesses are considered “essential” and, consequently, they’re still hard at work.

This morning when we passed the truck I asked the neighbor a question. From a discreet distance, of course. How’s business? I found his response interesting.

He said that he’s both losing and gaining business. He does do biological decontamination. Small customers aren’t doing what they had done before; big ones are doing more. His greatest uncertainty is whether his customers will actually pay him.

I suspect a lot of companies (including my employer) are wondering the same thing.

Nearly everyone expects COVID-19 to produce a worldwide recession, possibly a worldwide depression. Just as a reminder there is no generally accepted definition of a depression. The National Bureau of Economic Research, the official scorekeeper for economic contractions and expansions, does not call out depressions. One proposed definition is an economic contraction of two or more years in duration that results in a 10% or greater decline in GDP.

There’s exactly one factor that will determine whether there is a COVID-19 recession or a COVID-19 depression and it’s how quickly the U. S. consumer springs back into action. One of the things that managing the aftermath of COVID-19 means is managing the direction in which the U. S. consumer springs. I will go so far as to predict that, if the U. S. consumer does not recover at all or does so phlegmatically, there will be a global depression.

At RealClearPolitics Charles Lipson has his own plan for managing the aftermath of COVID-19:

The WHO is probably beyond repair. China won’t give up its authority there, and the U.S. shouldn’t give China more weight by withdrawing. But it should cut back sharply on funding, and so should other advanced democracies. Together, they should form a parallel organization, a NATO/Health entity that includes not only America, Canada, the U.K. and EU but also Israel, Ireland, Japan, South Korea, Australia, and Taiwan. All are established democracies with developed, high-tech economies and sophisticated medical research and public health systems. Their data can be trusted, and they are transparent enough to share it. They need an easy, institutionalized way to cooperate, outside the politicized, corrupted WHO.

The next big change will be to repatriate production of vital medicines and equipment to the United States. Since the U.S. refused to share some masks and other equipment with Canada and other close allies, you can also expect those countries to seek more self-sufficiency, or at least bigger stockpiles of medicines and devices made abroad.

Self-sufficiency has always been important to military planners. For a century, they have focused on heavy industries, essential for building tanks and planes. Over the past two decades, as modern warfare changed, they realized that several other economic sectors are equally important to national security and require their own indigenous research and production capabilities. That is obviously true of super-computing, artificial intelligence, chip fabrication, and cybersecurity. What was less clear, until now, is that medicine and health equipment also fall into that “essential” category.

This pandemic has shown that the United States not only needs sophisticated research in biotechnology and bioengineering, it needs more manufacturing capability. It cannot depend on the People’s Republic of China, simply because it is the low-cost supplier.

Another change, likely to come soon, is authorizing the Food and Drug Administration to find out where our medicines and supplies are produced. We need to know. The FDA and White House can then decide which medicines, precursor ingredients, and medical devices ought to be made solely (or mainly) in the United States. That production will be brought back with subsidies and restrictions, such as “Buy American” provisions for government purchases.

International corporations will act on their own to reevaluate where they produce key products and component parts. They will reevaluate any supply chains that pass through China on their way to sales in the U.S. and Europe. They will also face political pressure, not just from Washington but from London, Brussels, Berlin, and elsewhere. If President Trump is going to tell 3M not to sell masks to Canada during an emergency, then Ottawa will have to decide whether to manufacture those locally, build a stockpile of essential supplies, or perhaps strike a bilateral deal not to restrict supplies in emergencies.

He goes on to focus on the EU in which I have no particular interest.

If there is an ounce of justice one of the outcomes of the outbreak will be that, as long as China is governed by the Chinese Communist Party, the country will be ostracized from the community of nations up to and including a blockade. That won’t happen. As an alternative what we might do is revive the idea, articulated more than 15 years ago, of a League of Democracies. It isn’t just the WHO that is beyond saving. The entire United Nations is past redemption. World government is impossible in the absence of a consensus among nations and that simply does not exist. That majority Muslim countries do not subscribe to the Universal Declaration of Human Rights while nearly every country that does not have a Muslim majority does points to a fundamental problem with even the most rudimentary of world governments. The corruption of the World Health Organization by China and the membership on the United Nations Human Rights Council of some of the countries most abusive of human rights are further indications.

NATO is a mutual defense pact. It shouldn’t be expanded to include functions beyond that for the simple reason that it’s hard enough to get its present membership to shoulder their responsibilities for mutual defense. We do, however, need a forum beyond NATO and beyond the impossible United Nations for group action and a League of Democracies, unburdened by the “attack on one” clause of the NATO charter, would be one possible such forum.

Something else that we absolutely must do is to ensure that companies and countries understand that they will not be indemnified against the consequences of the risks that they take. IMO doing business with China is just too risky as long as the CCP is in charge.

I’m still trying to understand Megan McArdle’s argument in her latest Washington Post column. Is she really arguing that insurance companies should not be required to pay claims under business interruption policies because they can’t afford to do so?

After all, while the businesses that are currently shuttered didn’t do anything wrong, neither did their insurers. The government has shut them down to protect us all against a deadly virus. Since everyone is getting the benefit, everyone should pay for it: through borrowing now and taxes later.

Think of it as Americans belonging to one of the largest mutual insurers in the world: the United States of America, Ltd. It’s a scandal that small businesses are having some trouble getting their claims addressed. But it would still be a mistake for them to try recover losses from lesser firms. Instead, we should all focus on making sure that our mega-insurer covers all valid claims in the most efficient and timely manner.

However, “everyone” did not collect the premiums—insurance companies did. In some cases they’ve been collecting these premiums for most of the last century.

I read her argument somewhat differently. The companies’ actuaries did not factor in the risk of the state governments shutting down their insured businesses. It was no act of God and the federal government shuttered nothing. The expensive lesson the insurance companies are learning is that they should never have offered business interruption insurance. They are incapable of assessing the risks presented by a globalized economy. You don’t offer insurance on uninsurable risks.

If they had assessed and priced the risks properly, would companies have been able to afford supply chains that extended into China at all?

In my view we definitely should not indemnify these private companies, the insurance companies, against the consequences of their own folly. If that means the end of insurance, so be it. They are not benevolent societies.
They are for-profit businesses and we should not ability their ability to make a profit.

I was greatly frustrated by this column by Justin Fox at Bloomberg, trying to draw inadequate analogies between New York City and (among others) San Francisco:

As a Manhattan resident, I’ll be the first to admit that New York City in general and Manhattan in particular are not optimally designed for social distancing. People here tend to get around not in their own automobiles but on foot or by bus, subway, taxi or ride-share. We buy our groceries mostly not in giant wide-aisled supermarkets but in cramped little stores. We live cheek-by-jowl in apartment buildings, with elevators usually too small to accommodate the 6-foot rule. Most of us don’t have our own outdoor spaces, meaning that walking the dog or just getting some fresh air requires venturing out in public. And surely Manhattan is the only place in the U.S. where having your own washing machine is such a luxury that even lots of people in the top 10% of income distribution don’t (not because they can’t afford it but because their buildings ban them for fear of overtaxing ancient plumbing).

I am skeptical of the argument, though, that density equals danger in this age of Covid-19. For one thing, a bunch of East Asian cities even more densely populated than New York have successfully withstood the initial onslaught of the disease, indicating that well-conceived and well-executed public-health measures can more than counteract the disadvantages posed by millions of people living on top of one another. For another, New York City’s density is so anomalous in the U.S. context that I doubt its trials tell us much of anything about which other areas of the country are best equipped to fight off a pandemic.

What if population density is a factor but it isn’t the only factor? Consider this:

Those are median high and low temperatures for the three cities for February, March, and April. Need I pull out statistics that demonstrate that Los Angeles and Honolulu are both warmer than that? What if the key factors are population density and temperature? Or humidity?

I see all sorts of people wrapping themselves in the mantle of science and making sweeping generalizations. The reality is that we don’t know enough about the virus that produces COVID-19 to make such generalizations.

I don’t know that temperature or humidity have anything to do with the contagion at all. And I don’t think anybody else does, either, but it’s sure a tempting possibility.

What if none of the measures taken anywhere have “lowered the curve”? What if any curve-lowering is due to factors other than testing, isolation, or any other policy measures and all of the claims are simply post hoc propter hoc reasoning?

In an op-ed at Bloomberg infectious disease authorities Arturo Casadevall and Liise-anne Pirofski try to explain why it’s hard to predict who will live and who will die after contracting COVID-19:

Among individuals in the same risk group — the same age, say — differences in infection outcome can result from five different variables outside their control.

The first of these is microbial dosage or inoculum, the number of viral particles that cause infection. Small numbers of viral particles are more likely to be contained effectively by the body’s defenses. Then, infection may cause no symptoms or only mild disease. In contrast, a large number of particles can lead to increased viral growth, overwhelming the immune system and causing more severe disease.

Genetics may also influence susceptibility to severe infection. Viruses often gain access to host cells via surface proteins, which vary in presence and nature from person to person. Someone with no such surface proteins may be resistant to infection. In the case of HIV, for example, some people lack the receptors needed for viral infection and are not susceptible to the virus.

A third variable that influences infection outcome is the route by which a virus enters the body. It’s possible that virus inhaled in the form of aerosolized droplets triggers different immune defenses than does virus acquired by touching contaminated surfaces and then touching one’s face. The nose and the lung differ in local defenses, so the route of infection could significantly affect the outcome.

The fourth variable is the strength of the coronavirus itself. Viruses differ in virulence — their capacity to damage host tissues or immunity — even when they are all the same species. This is why flu seasons vary in severity from year to year. The varieties of a virus such as coronavirus differ depending on small genetic characteristics and how these affect the interaction with human hosts. As the coronavirus spreads from person to person, it may undergo unique changes in its genetic structure that enhance or attenuate its capacity to do harm. Strains that are more virulent could lead to more severe disease.

Finally, people’s immune status — especially their history of prior infectious diseases — crucially determines how they respond to a new infection. The immune system remembers previous encounters with microbes, and that affects how it fights and responds to new ones. In the case of dengue, infection with one type of the virus can make the individual more susceptible to infection with a different type of the same virus. In other situations, a recent infection with a virus can affect susceptibility to an unrelated new infection. For example, having had the flu before coronavirus infection could change the course of Covid-19 disease in unpredictable ways. When a person’s immune system has no memory of an infectious agent, it may be unable to rapidly respond, and this may allow the invader to escape detection, giving it more time to cause damage.

And then there’s the interactions among these factors.

It’s not entirely clear to me why that explanation is actually better than attributing it Providence or fate. They’re about equally predictive.