In a pitch for more, faster antigen testing, Scott Gottlieb presents a status report on the campaign against SARS-CoV-2 in an op-ed at the Wall Street Journal which I will take the liberty of quoting in full:

The Covid-19 epidemic continues to expand in some 20 states. The number of new cases in New York City is slowing, but the picture is different elsewhere in the nation. America has hovered around 30,000 new daily infections and 2,000 deaths for almost a month. Yet the number of days it takes for infections to double has improved, from less than a week in hot spots to almost a month nationally. This represents progress.

But everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill. Mitigation hasn’t failed; social distancing and other measures have slowed the spread. But the halt hasn’t brought the number of new cases and deaths down as much as expected or stopped the epidemic from expanding.

Officials face intense pressure to reopen, and the reality is stark: Continuing spread at something near current levels may become the cruel “new normal.” Hospitals and public-health systems will have to contend with persistent disease and death.

Higher rates of spread may be limited to some areas; a majority of states have more than 250 new cases of Covid-19 every day. But as states begin to open up their economies and Americans return to traveling, the disease will continue to expand. We need to prepare to deal with such a grim future, which will require a persistent posture of prevention and treatment.

That means doubling down on screening and isolating sick people to slow the spread as much as possible, which will save lives and prevent health-care systems from being overwhelmed. That means channeling resources into places where outbreaks are prone to happen: nursing homes and shop floors, and among disadvantaged communities that lack access to testing and can’t practice social distancing easily.

Technology and a well-equipped and competent medical and public-health workforce will be essential. This includes better drugs. On Friday the Food and Drug Administration authorized the use of remdesivir by Gilead Sciences. This drug is the first antiviral medicine that blocks SARS-CoV-2 replication. It isn’t a cure, but it will help patients at highest risk of bad outcomes, especially when deployed early in the course of the disease. More treatments are likely to follow, including antibody drugs that bind and block the virus. These should be available this fall if progress continues apace.

A number of vaccines, meanwhile, are on track to clear early FDA safety trials by fall, and tens of millions of doses could be ready to use in studies that test for efficacy. These doses can be used in large trials that will establish whether the vaccine is safe and effective for mass inoculation, trials that can be conducted in cities suffering from outbreaks.

But the public also needs better diagnostic tests to make screening for Covid-19 inexpensive and routine. This is where medical progress has been slow. Testing so far has relied on detecting the nucleic acids of the virus’s genetic material. These platforms are reliable and were initially easy to expand. The U.S. medical system is now screening more than 1.5 million people a week. But these platforms can only run so many tests each day, and issues like transporting samples are precluding quick turnarounds.

What’s needed now is the equivalent of the rapid flu and strep tests available in a doctor’s office. These tests look for antigens that the pathogen produces, which betray its presence in blood and saliva. Antigen tests are less precise than polymerase chain reaction (PCR) tests, but they enable fast and widespread testing. The government needs to rush development of these technologies and work with manufacturers to increase capacity.

More-precise platforms like PCR will still have an important role. They’ll be used by big commercial labs that can run them at the scale needed to improve cost and efficiency. They’ll also serve as a reference standard and be used for mass screening by pooling many patients’ samples—say, in a workplace—and testing them all at once to see if anyone in the group is infected.

If the virus continues to spread, the economy won’t snap back. Many Americans will be scared to go out, and with good reason. Summer may provide some reprieve, but the virus could return aggressively in the fall. Activity can resume in parts of the country where risk is low, but there is still much disease and death in the days to come.

Dealing with this new reality will require screening to identify new cases and isolate infections. That will depend on better testing technologies that aren’t yet available—but can be achieved. The sooner the better for the health of Americans and the economy.

I think there needs to be more introspection about why the measures put into place since March have failed to live up to their advance publicity as illustrated in this sentence:

But everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill.

Even in the limited successes I see a lot of post hoc propter hoc reasoning being advanced. Is the slow decline in the number of new cases being reported in the NYC metropolitan area because of the measures that have been put in place, because of other changes, or because the disease is running its course?

I found Alabama representative Bradley Byrne’s Wall Street Journal op-ed sadly amusing:

For nearly two months, my staff and I have been fielding calls from the people of southwest Alabama—small-business owners, bankers, seniors and many others. The government’s response to coronavirus is affecting their livelihoods, and their congressman may be the only voice they have in Washington. But when the lights are turned off in the committee rooms and on the floor of the House, who’s watching out for them? Who’s holding Washington accountable?

More important than the flawed message Congress’s absence sends to the American people—that their representatives value personal protection over their constituents’ interests—is the reality. When nobody is around, it is easier to make backroom deals, and Speaker Nancy Pelosi is taking advantage. She has consolidated the power of the institution in her person. Without lawmakers there to speak up for their districts and influence the legislative process, Mrs. Pelosi has made herself the sole voice and negotiator for the House, as it passes massive funding and regulatory bills.

Allow me to elucidate. When Rep. Byrne began his tenure in the House, Paul Ryan was House Speaker. Ryan was an unusually weak Speaker. The awesome power of the Speaker of the House he’s describing is the norm; Ryan was the exception. Speaker Pelosi is doing the same things she was doing during the last period during which she held the Speaker’s gavel.

Welcome to the House of Representatives, Mr. Byrne.

The Associated Press is reporting that a Department of Homeland Security report has asserted that the Chinese authorities deliberately downplayed how contagious and severe SARS-CoV-2 was in early to mid-January so that they could hoard the supplies needed to deal with the disease:

WASHINGTON (AP) — U.S. officials believe China covered up the extent of the coronavirus outbreak — and how contagious the disease is — to stock up on medical supplies needed to respond to it, intelligence documents show.

Chinese leaders “intentionally concealed the severity” of the pandemic from the world in early January, according to a four-page Department of Homeland Security intelligence report dated May 1 and obtained by The Associated Press. The revelation comes as the Trump administration has intensified its criticism of China, with Secretary of State Mike Pompeo saying Sunday that that country was responsible for the spread of disease and must be held accountable.

and

Not classified but marked “for official use only,” the DHS analysis states that, while downplaying the severity of the coronavirus, China increased imports and decreased exports of medical supplies. It attempted to cover up doing so by “denying there were export restrictions and obfuscating and delaying provision of its trade data,” the analysis states.

The report also says China held off informing the World Health Organization that the coronavirus “was a contagion” for much of January so it could order medical supplies from abroad — and that its imports of face masks and surgical gowns and gloves increased sharply.

Those conclusions are based on the 95% probability that China’s changes in imports and export behavior were not within normal range, according to the report.

On the one hand I think we need to reserve judgment a bit. A report of a report of a conclusion based on indirect evidence and motive is not exactly a “smoking gun”. On the other I think that the Chinese authorities are guilty of capital crimes at enormous scale and need to be held accountable for their malfeasance.

I think the only practical way to accomplish that is through ostracization and enlisting the support of other countries to do the same. We just need to rally the support of the other major economies. Perhaps the Trump Administration can rise to the occasion but persuasion and rallying the reluctant to their cause has not exactly been among their strong suits.

Yesterday I looked my high school up on Wikipedia for the very first time. I don’t think I learned much that I didn’t already believe (other than that Sacagewea’s son graduated from my high school). I did learn that the son of a family friend who was a few years ahead of me was now a professor of business ethics at Harvard.

We are all the products of the sum of our experiences plus our genetics plus a bit of chance and innate temperament. Attending my high school was certainly a formative experience for me. I attended on full scholarship—my dad would have accepted nothing else. He was skeptical about my siblings’ or my attending anything but a public high school. Both he and my mom had graduated from public high schools, after all. All of my siblings attended the local public high school and they received good high school educations.

My high school is routinely rated one of the top 20 high schools in the country. Most of the others are well-known eastern prep schools. Entrance was based on competitive examination. Going from eighth grade to my high school was a bit like attending a good, small college immediately. Most of my high school teachers had post-graduate degrees, generally doctorates. Some had more than one. My junior and senior year English teacher had doctorates in theology and comparative literature. My Russian teacher for four years had doctorates in Russian and Italian. By the time I graduated I had the equivalent of two years’ worth of college English, two years’ worth of college Russian, two years’ worth of college Latin, a year’s worth of college math.

I was actually disappointed when I went to college. Not only was the highly-ranked college I attended tremendously easier and less rigorous than my high school but I missed the high quality of my peers. It’s not that my college peers weren’t smart. It was more that not all of them were exceptional.

This morning on my walk with Kara (about 3 miles) I saw several Chicago police officers, standing together, not observing social distancing and not wearing facemasks despite the statewide directives. Although I was sorely tempted I did not take their pictures and did not remonstrate them.

If public employees are not going to observe the rules, how can they expect others to do so?

It had not occurred to me until hearing this collaboration that there was a remarkable continuity from the folk rock groups of the 60s like the Byrds and Buffalo Springfield, swamp rock groups like Credence Clearwater Revival, and pop rock groups like the Dooby Brothers.

The City of Chicago is dependent for revenue on service revenue (water and sewer charges, airline fees—$3.82 billion), local taxes (mostly sales tax—$1.83 billion), property taxes ($1.45 billion), non-tax revenue (fees and fines—$1.12 billion), and grants from the federal and Illinois state governments. All of these sources have largely dried up during the “stay at home” directive. When people can’t pay their rents, landlords aren’t likely to pay their taxes, either.

Can Chicago borrow? Its credit rating is already circling the drain and that will only drive it lower.

Chicago is still spending. It has budgeted $65 million for its emergency response and it continues to pay many city workers and the pensions of retired city employees. What happens when it runs out of money?

Even though outbreaks of COVID-19 in the Global South have been mild relative to those in Europe and the United States, the repercussions of the tactics used in coping with the pandemic in the developed world will have severe consequences in poorer countries, as this article by Daniel Moss at Bloomberg points out:

The Covid-19 pandemic is exposing deep flaws in the economic model that both encourages and exploits migrant labor. Too many rich countries are dependent on low-cost workers, and too many poor communities are over-reliant on the money sent home for food, shelter and education.

Remittances to low and middle income countries will drop by a fifth this year to $445 billion, according to a recent World Bank report. That’s the worst slide in decades and a sharp turnaround from last year’s increase to a record $554 billion, which exceeded foreign direct investment in these destinations. The lender forecasts a slide of 22% in South Asia, where funds are largely bound for India and Pakistan. The Philippines, which gets 10% of its gross domestic product from such payments, could see a decline of 13%.

The situation for the migrant workers themselves is pretty awful:

The pandemic is producing a triple-whammy for migrants: They can’t work, they can’t go home (with airlines grounded) and they stand a greater risk of infection by staying put in their densely packed urban quarters. The bulk of Singapore’s recent surge in cases comes from dormitories built for 200,000-plus foreign laborers. In the Middle East, long a source of remittances for many parts of Asia, living conditions have been criticized as substandard.

A 10% decline in GDP YoY is serious and a 20% decline is desperate in countries where people struggle simply to survive.

The situation with migrant workers in the U. S. is complicated, like everything else here. Millions of legal agricultural workers, deemed “essential”, continue to work, generally without social distancing or any forms of protective gear, frequently living together in close quarters. When H-1B workers are laid off, if they are not hired by another eligible company within 60 days, they lose their legal status.

The millions of migrant workers here illegally are now largely without work or pay and ineligible for social services. I expect many of them to return to their countries of origin, in some cases taking SARS-CoV-2 with them.

I don’t think that Illinois legislator Dan McConchie has the right end of the stick in his criticism of governors exceeding their powers this op-ed in the Wall Street Journal:

As governors across the country destroy their states’ economies in the name of public health, there is shockingly little oversight of their actions.

In my state of Illinois, Gov. J.B. Pritzker has locked down the state, closing swaths of commerce and limiting the movement of citizens in response to Covid-19. These actions have been challenged in court by my colleague, state Rep. Darren Bailey, and a judge initially agreed to a temporary restraining order on the governor’s emergency measure, but only as they apply to Mr. Bailey. The rest of the state remains under lockdown by the governor’s orders, which continue without oversight.

Normally, the three coequal branches of government impose checks and balances to ensure accountability. Power is divided to allow recourse if one branch grows too intrusive or authoritarian. And while many people have sued governors in recent weeks to demand judicial redress, the judicial branch is reactive in nature, usually declining to disrupt legally plausible actions during a crisis. The legislative branch is a far better source of timely restraint.

His problem is not with the governor but with the legislature and the judiciary. In Illinois the governor’s emergency powers are defined and restrained by 20 ILCS 3305/7:

Sec. 7. Emergency Powers of the Governor. In the event of a disaster, as defined in Section 4, the Governor may, by proclamation declare that a disaster exists. Upon such proclamation, the Governor shall have and may exercise for a period not to exceed 30 days the following emergency powers; provided, however, that the lapse of the emergency powers shall not, as regards any act or acts occurring or committed within the 30-day period, deprive any person, firm, corporation, political subdivision, or body politic of any right or rights to compensation or reimbursement which he, she, it, or they may have under the provisions of this Act…

I agree that the governor must conform with the provisions of the law but the issue doesn’t end there. The judiciary needs to articulate the law and the legislature needs to be willing to amend the law or to ensure that it is enforced. I see a mutual longing for despotism among all three branches.

I see it as largely a partisan issue. If Republican Bruce Rauner were still governor, he’d’ve already been shut down by the legislature.

However, I agree with this:

Here in Illinois, some of Gov. Pritzker’s limits on commerce can hardly be defended as “based in science.” Even under his latest Executive Order released Thursday, I can visit Target to buy furniture, Walmart to buy clothing or my grocery store to buy flowers. But I can’t go inside a furniture store, a clothing store or a florist, even though those stores could easily adopt the same safety measures required of the retail outlets permitted to stay open.

Oh, they’re based in science all right. Political science and sociology. Keeping Target and Walmart opened prevents people from rebelling against the lockdown and enabling those stores to continue business as usual is easier to administer than forcing them to close non-essential departments. They’re open for the same reasons that non-emergent city services continue.

Government at all levels is providing enormous subsidies to big businesses while putting small businesses out of business. Half of all Americans work for small businesses. Don’t be surprised if, when the lockdowns end, there’s nothing for people working for those businesses to return to.