Optimism Ain’t What It Used To Be

In her Washington Post column Megan McArdle presents the reasons she’s optimistic about the U. S. response to COVID-19:

Our first advantage lies in our health-care system. Yes, you read that right. The United States has gaps in its coverage that other countries don’t have — and I have repeatedly urged Congress and the president to close those gaps for the duration of this emergency. We also don’t have universal mandatory paid sick leave, which means that some workers will be tempted to work while sick.

But, in fact, these aren’t the gaps we most need to worry about; the government can (and should) pass emergency measures to provide paid sick leave, and to pay for coronavirus treatment as well as testing — as well, of course, as working with laboratories and regulators to ramp up our testing capability. That’s an easy problem compared to what Italy is dealing with now: more critical patients than they have ICU beds. Ventilators and trained critical-care staff can’t be mobilized as fast as government funds.

Fortunately, the United States already has a lot of ICU beds relative to its population. Our hospitals love to develop their expensive, intensive capabilities, and we’ve no central regulator who can stop them. Normally, this may be an expensive waste of resources, but right now, it could save a lot of lives.

The United States also has private-lab capacity waiting to be mobilized. And that’s vital, at a time when the Centers for Disease Control and Prevention and the Food and Drug Administration have been tripping over their own feet, as former FDA commissioner Scott Gottlieb pointed out on Twitter Thursday morning. We are lucky to have a robust private market which can, in cooperation with regulators, scale up to help us identify and isolate carriers, rather than a potential single point of failure.

Finally, Americans have a penchant for self-isolation. This starts at with our individual physical space; we just prefer to stand further from each other than people in many other countries. We don’t like to kiss or hug anyone except close friends and family. Our harassment laws make us leery of touching co-workers.

I wonder if she understands how presumably unintentionally funny that is. Let me restate it. Compared with other countries we’re already behaving as though there were a crisis and we’ve been behaving as though we were self-quarantining for years.

Once again, I don’t think we know enough to ascertain whether we have advantages over other countries in coping with COVID-19, disadvantages, or both. I think our greatest advantage is that we have numerically more medical researchers than anywhere else in the world and, as Samuel Johnson put it, “Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully”.

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About Me

I am presently working from home. My employer sent out an email night before last authorizing anyone who so desired to work from home so that’s what I’m doing. I’m way over 60 so I guess I’m among the most vulnerable group. I’m in very good health, generally. There’s nothing wrong with me that hasn’t been wrong for 20 years or more. I have a strong immune system—I rarely get sick.

I’m not particularly nervous. What will be will be. But I am washing my hands a lot more and am now curtailing travel.

One thing I wanted to pass along is that employers in India, at least in the big cities, are taking precautions similar to those being taken by employers here. I suspect that in due course we’ll learn that India has had quite a few cases of COVID-19 but as of now they haven’t reported many. Maybe it’s the heat.

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Chicago: Closed Until Further Notice

Chicago, like other major cities is taking steps which are undoubtedly bolting the barn door after the horses have fled. ABC 7 Chicago reports:

Governor Pritzker has laid out new guidelines when it comes to events with crowds. He is not ordering schools to close, but some are closing and even beginning spring break early.

Joined by Mayor Lori Lightfoot, Pritzker announced that all events of 1,000 people or more are mandated to be canceled. Officials are also asking event organizers to cancel or postpone gatherings that would be 250 people or more together.

The crowd restrictions are in effect until May 1 and the governor made clear the sacrifices are urgent.

“I am not going to hesitate to take the most aggressive measures possible to protect the people of our state,” Pritzker said. “We need to reduce social contact in order to try and control the spread of the virus and prevent our medical infrastructure from dealing with too many cases at one time. We all have responsibilities to the most vulnerable among us and that means making sacrifices in the immediate term.”

Chicago Mayor Lori Lightfoot said the city will also enforce the ban against events exceeding 1,000 individuals.

“We have to continue practicing social distancing and if you do not feel well, for God’s sake stay home,” Mayor Lightfoot said.

Lightfoot said they changes are not intended to make people scared and the focus is on stopping the spread of COVID-19 for the general public’s safety.

The elderly and people with underlying conditions are believed to be the most vulnerable, but several schools have already closed their doors as a precaution.

Illinois presently has 32 confirmed cases of COVID-19. That’s of a population of nearly 13 million people. Increased testing will undoubtedly confirm many more cases than that but it won’t tell us how long we have had cases of COVID-19 here. It might have been for weeks, months, or years. If you test for it, you’ll find more of it than if you don’t.

The hope, as suggested above, is that the serious cases requiring hospitalization can be trafficked through the system at a rate that the system can accommodate.

I don’t think the reality of the situation has really sunk in with people yet. Just to provide one example, what does Chicago Public Schools do? If they remain open, they’re Petrie dishes. If they close, many of the kids have nowhere else to go and in some cases school provides their only meal of the day. If CPS closes it will mean a loss of federal funding and I doubt that they’re even aware of the procedures for handling that.

The situation is becoming surreal. As I type this I heard a TV spot for an event that will now not take place. Chicago’s Civic Theater, home to Chicago Lyric Opera, has a capacity of more than 3,000 people. Lyric sent out a blast email to subscribers last night that, essentially, said nothing. At the very least I strongly suspect they will need to cancel the balance of their 2020-2021 season.

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The Italian Experience

I don’t have enough time to do all of the cutting and pasting for this so I’ll just send you the links. Take a look at the graphs of COVID-19 cases and deaths for Italy alone at Worldometers. Also, check out both the linear and logarithmic versions of the graphs. The logarithmic graph tells you the trend.

Two observations. First, there’s a dogleg in the graph of cases. That is an artifact. It means they suddenly either changed the criteria or started keeping track of new cases in another way.

But more importantly, the trend is up. The Italians are going to see many, many more cases in the days and weeks to come. Maybe it will eventually start to trend down but right now it isn’t.

You could also take a look at the data for the U. S. Our experience is going to be a lot like the Italians’.

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What To Do And What Not To Do

As might have been expected the editors of the Wall Street Journal approve of some measures that have been proposed for dealing with the COVID-19 outbreak and some they do not. They approve of

  • Target the real hardship. The analogies here are unemployment insurance or disaster relief./li>
  • Make the relief immediate.

while the measures of which they disapprove are:

  • A big new infrastructure spending bill. Their point is what good does a highway built in 2022 do for the economy in 2020?
  • Don’t subsidize bureaucracies.
  • Refrain from imposing new mandates on businesses.
  • Be cautious about creating new entitlements in the guise of providing emergency assistance.

The one thing we should expect from the Congress is that they will not let a good crisis go to waste.

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Mitigating the Effects of a Severe Outbreak on the Poor

In a Wall Street Journal op-ed Michael R. Strain and Scott Gottlieb make what appear to me to be some pretty solid suggestions about some of the measures the federal government should take in the face of the incipient COVID-19 pandemic. The op-ed also contains some observations on the potential impact of a severe outbreak on the poor you might not have considered:

Congress should make direct cash payments—mailed checks or direct deposits—to low-income households in places with severe outbreaks. Hourly wage workers should not feel compelled to show up to work sick because they need to pay bills. Congress can help these Americans recover and keep other people healthy by financing their time away from work.

In states experiencing severe outbreaks, Congress should waive the requirement that people receiving unemployment insurance payments look for work. Better that such unemployed workers receive financial assistance for rent, mortgages and groceries than to risk spreading the virus by applying and interviewing for jobs. Congress should also waive work requirements in the food-stamp program.

Children in low-income families will miss subsidized meals if schools are closed. Federal subsidies to those households should be increased to account for lost breakfasts and lunches. This might help relieve some of the pressure on low-income parents, who might otherwise feel the need to go to work even if ill.

The mechanics of some of these plans aren’t entirely clear to me. For example, I’m not sure how the proposed legislation could be limited to “places with severe outbreaks”.

What is clear to me is that with some big cities closing their schools, there is no time to waste.

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I’m Puzzled

I’m a bit puzzled by the media reaction to the oil price war. Yes, it could be hard on U. S. shale oil producers. But it’s also clear it is resulting in immediate prize cuts in gas at the pump and, historically at least, low gas prices are associated with a booming economy not recession. Take a look at the statistics. The Great Recession was preceded by a sharp increase in gas prices.

A price war between Russia and Saudi Arabia could, at least in the short term, be the economic stimulus that a lot of people are calling for. Enjoy it will you can. My wife just paid 10-20% less for gas than we have been recently.

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First: Don’t Panic

The editors of the Washington Post have advice for how we should deal with COVID-19:

Avoid large crowds. Workplaces should turn as much as possible to video conferencing. Avoid big meetings and food-sharing. If you can work from home, do so.

All nonessential large social gatherings should be reconsidered and if possible postponed. Sports games might proceed without fans, but concerts may have to be delayed. Political campaigns can proceed without rallies. A St. Patrick’s Day parade is a bad idea. Cruise ships are turning out to be virus incubators — don’t take a spring break cruise. Air travel poses risks of exposure to large numbers of people: If you don’t have to fly, don’t. If you’re sick, stay home so as not to expose others. If you’re an employer, keep paying your workers who do the right thing and stay home when they’re sick.

Voting is vital to the health of our democracy, but it can be organized to minimize the risks of infection. Schools are a difficult question. They could prove to be transmission grounds. But closing schools means cutting off meals for needy students and straining life for parents — including nurses, doctors and other health-care workers. If schools are kept open, rigorous migitation measures must be enforced.

Personal hygiene won’t solve everything, but is important. In addition to hand-washing, avoid face-touching, and follow good cough and sneeze etiquette. The elderly are particularly vulnerable, according to the early studies of the virus, so extraordinary efforts should be taken to protect them from possible infection.

I think the first thing we should do is not panic. I see lots of signs that people are, hoarding being among them. Even in the worst case scenario, COVID-19 will not be the zombie apocalypse. If it marks the end of civilization, it’s only because people have chosen to abandon civilization.

It would help if the media weren’t trying to whip people into a frenzy while other institutions attempt to minimize the problem. Yes, there is a problem and, if what I think is most likely to happen which is following a very large number of infections with consequently, about 1-2% of those becoming infected dying, the virus will become endemic in the population which in turn could change our behavior forever. Some industries may not survive a change in behavior but that just tells us they were fragile to begin with.

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There Are Some Things We Are Better Off Not Knowing

At Outside the Beltway James Joyner comes out in favor of mandatory retirement ages for elected and appointed officials or at the very least periodic evaluation:

We are increasingly a gerontocracy. Maybe it’s time to get past the joking about cognitive decline and actually start doing something about the real dangers of critical decisions being made by people who are likely suffering from it. It would not be at all unreasonable to require people who want to be in those positions to be evaluated regularly and have the results part of the public record.

Bringing back mandatory retirement, while politically unfeasible, may be advisable. Many US states require judges to retire when they reach 70, for example. And while the Age Discrimination in Employment Act makes mandatory retirement illegal, it makes exceptions for Bona Fide Occupational Qualification (usually, public safety—law enforcement officers, pilots, etc.) and for “Bona Fide Executives” or those in a “High Policymaking Position” over 65.

Certainly, the President of the United States is both a bona fide executive and a high policymaking position.

Such a move would require a constitutional amendment and would be hugely controversial. Periodic evaluations are a move that sounds a lot better than it would be in practice. I’m skeptical that it could be done without being political.

What would you evaluate? Physical ability? That would probably have ruled FDR out. Memory? There are lots of completely competent people with lousy memories and individuals with serious mental or psychological problems with excellent memories (they’re called “savants”). Neurocognitive tests of the sort used by physicians tend to rely heavily on the judgment of the physician applying them. They may seem objective in nature but they aren’t. When the stakes are low that’s one thing but administering such tests to a president is something entirely different. How would we determine that the physician is applying his or her professional assessment rather than his or her prejudice or agenda?

Intelligence? There is a close correlation between the old pre-reform SAT scores and IQ. Bill Clinton’s combined SAT scores have been widely reported as 1032. That would suggest an IQ of around 110 which is about what I would expect but lots of people find that shocking. I think he would have rated extremely high on any assessment of social-emotional ability which actually matters a lot more than IQ. My own combined SAT scores correlate pretty well with my measured IQ, thank you for asking.

Psychological? I suspect that a lot of our presidents have been sociopaths or at least have had sociopathic tendencies. As many as 20% of highly successful people have been estimated to be sociopaths and presidents frequently have traits that are associated with sociopathy (craving validation and recognition from others, self-centered, high levels of entitlement, etc.).

While I wouldn’t be opposed to a maximum age for elective and appointed officials of 65, I would oppose periodic assessments. We already have them. They’re called “elections”. We also have a provision for an extraordinary evaluation of the president’s mental fitness. It’s called “the 25th amendment”.

Otherwise I think there are some things we are better off not knowing.

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What Are They Shopping For?

I wasn’t shocked but I was amused by the signs I saw displayed prominently in Costco yesterday listing the products they were putting on allocation (limiting shoppers’ purchases). They included:

Rice
Sugar
Water
Sanitary wipes
Lysol

I can understand the sanitary wipes and Lysol and maybe even rice but sugar and water? That sounds more like they’re shopping for the zombie apocalypse than for a two week quarantine.

There was lots of toilet paper and it wasn’t on allocation BTW.

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