Despite our daily briefing from mayor, governor, and president and the focus of our major media outlets notwithstanding, the most important questions in the world are not about the United States and SARS-CoV-2 but about India and the virus.

India has not tested very many people at this point—about 1% as many relative to its population as the United States which many people contend is too few. It has been claimed with some reason that were India to test 10 times as many people it would identify 10 times as many cases of COVID-19.

Neither South Korea nor Japan nor Germany nor the United States is the model for the many poor, populous countries in the world. India is. If India cannot control COVID-19, it will be a global disaster however the U. S. fares.

India has some handicaps. Not only is it poor, populous, and its cities densely populated it has terrible air quality and diabetes is believed to be quite common among its population. It has a fraction of the physicians, hospital beds, and ventilators relative to its population as the U. S. and the countries of Europe do. But it has advantages, too. Its health care system can be of higher quality than in many other poor, populous countries. It is the world’s largest producer of hydroxychloroquine. The entire country has been on lockdown for weeks. And it is hoped, at least, that India’s climate will stymie the virus, especially during the summer.

The history of SARS-CoV-2 will be written in India. If the worst case scenario is realized, millions will die there. And in Nigeria, Indonesia, Bangladesh, Malaysia, and other poor, populous countries.

At Politico John F. Harris muses over a “backlash” that may emerge over the “stay at home” directives. Much of the piece consists of chortling about supposed discomfiture of Rand Paul in contracting the virus but he then turns to more substantive observations:

Now that Paul has recovered—he says he felt fine and symptom-free the whole time—it is a good time to ask: Are we sure that the pandemic joke will ultimately be on him?

What if the opposite is true? Far from rendering Paul’s brand of politics irrelevant, it seems possible, even probable, that the wake of the coronavirus will be a powerful boost to the animating spirt of libertarianism: Leave me alone.

Among the questions looming over American politics is about the nature of what promise to be multiple backlashes over different dimensions of the coronavirus crisis. Most obvious is what price Trump pays for his administration’s tardiness in responding to the contagion in its early stages. Less obvious is what price supporters of activist government pay for the most astounding and disruptive intervention in the everyday life of the nation since World War II.

The imminent libertarian surge is not a sure thing but it more than a hunch. In informal conversations, one hears the sentiment even from people I know to be fundamentally progressive and inclined to defer to whatever health officials say is responsible and necessary to mitigate the worst effects of coronavirus. It is possible both to support the shutdown and powerfully resent it — the draconian nature of the response, and the widespread perception that to voice skepticism of any aspect of its necessity is outside respectable bounds.

The absolutist nature of the country’s shutdown and the economic rescue package have democratic consent—enacted by a bipartisan roster of governors and overwhelming votes in Congress—but it was the kind of consent achieved by warning would-be dissenters, Are you serious? There is no choice!

Many people concluded that for now there is nothing to do but suck it up. It won’t be surprising if some of those people eventually have an intense desire to spit out.

If so, this would be entirely consistent with the history of crises, both recent ones and more distant. Very often, after some cataclysmic external event, politics responds in ways that scramble normal divisions and create the impression—as in that recent 96-0 vote—that familiar ideological dynamics have been suspended.

Almost always, this is an illusion. Ideology hasn’t been suspended. It has been forcibly suppressed—in ways that inevitably will come roaring back, sometimes in highly toxic ways.

He then turns to a comparison I think is completely specious:

The most vivid example in American history likely was around World War II. As the world was aflame, but the United States not yet engaged in hostilities, the country was bitterly and intensely divided over the all-consuming question of that era: intervention or isolation. Then came Pearl Harbor, and the debate ended in an instant. Isolationism looked to be a defunct ideological force. Except it wasn’t really. The movement’s essential spirit—fear of corrupt and scheming interests beyond American borders—found new and malicious expression in McCarthyism in the late 1940s and early 1950s.

That’s basically nonsense or else he’s using an eccentric definition of “isolationism” to mean, presumably, “beliefs held by people I don’t like”. The attack on Pearl Harbor killed isolationism as a political force in the U. S. There was more than one kind of isolationism (basically Jacksonian and Jeffersonian) and all varieties have largely been silenced as a consequence of the attack. The U. S. could no longer shut itself off from the rest of the world and there was a fear that the Atlantic and Pacific could no longer protect the U. S. mainland. That and the American Civil War are the sources of our present trigger-happiness. We do not want to fight a war within our borders and have decided that the best way to prevent that is to ensure that wars that start elsewhere end elsewhere as well.

It is not isolationist to think that when a foreign power has infiltrated not just your government but many other of your institutions as well that something should be done about it. But Joe McCarthy was no libertarian and conflating him with libertarians as this article does is not constructive.

IMO the longer, the stricter, and the more hypocritical “shelter in place” directives are, the greater the chafing against them will become. The scene yesterday in Lansing, Michigan was a mild preview of what is to come.

What do I mean by “hypocritical”? Chicago Mayor Lori Lightfoot was called out, embarrassingly, on having her hair done. She blurted out a feeble explanation of being the “face of Chicago” which I guess was better than “Suck it up, peasants” but everybody knew that’s what she meant. Police officers not following “social distancing” guidelines or facemask directives are other examples. You can’t make one set of rules for politicians and public employees and another for everybody else.

Arbitrary determinations of what are or are not essential businesses are problematic as well. Here lawn services are on the list of “essential businesses”. ‘Splain me, Lucy. Are clothing stores that sell candy bars at their sales counters essential while those that do not aren’t?

I continue to hear claims about “bending the curve” but still see that as mostly wishful thinking. Consider this graph from the Illinois Department of Public Health:

Each succeeding bar of that columnar bar chart is taller by a few than the preceding. That is not “bending the curve” and the state has had a “stay at home” directive in place for nearly a month now.

If “stay at home” directives remain in place long enough, they will inevitably disrupt the food supply chain and elected officials will have much, much more to worry about than not overloading the health care system.

Repent at leisure. Forbes reports that there is, surprise!, a provision in the CARES “stimulus” act that we might want to be corrected:

While wealthy Americans are not eligible for the comparatively measly $1,200 stimulus checks that are now being disbursed to many Americans, they are on pace to do even better. 43,000 taxpayers, who earn more than $1 million annually, are each set to receive a $1.7 million windfall, on average, thanks to a provision buried in the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

You may or may not be surprised that some of the language conveniently inserted into the $2.2 trillion-dollar Coronavirus Aid, Relief, and Economic Security Act (CARES) skews heavily in favor of the wealthy. The provision doling out literally millions of dollars is aimed at a limitation that was created in 2017 when Republicans overhauled the tax code. It “temporarily suspends a limitation on how much owners of businesses formed as “pass-through” entities can deduct against their non-business income, such as capital gains, to reduce their tax liability,” according to The Washington Post.

and

“For those earning $1 million annually, a tax break buried in the recent coronavirus relief legislation is so generous that its total cost is more than total new funding for all hospitals in America and more than the total provided to all state and local governments,” said Doggett. “Someone wrongly seized on this health emergency to reward ultrarich beneficiaries, likely including the Trump family, with a tax loophole not available to middle class families. This net operating loss loophole is a loser that should be repealed.”

Policy is hard and it’s a lot easier to enact flawed legislation in a panic than it will be to amend that legislation once enacted into law.

IMO there are serious constitutional questions about the legality of the CARES act, e.g. the pesky Origination Clause in the Constitution. That there was an emergency and how could you possibly expect our legislators to know what was in the law for which they voted are not good excuses.

At Newsweek Jason Lemon reports that a group of “international policy experts and politicians” have penned an open letter criticizing China’s response to the COVID-19 pandemic:

A group of international policy experts and politicians strongly criticized China’s government in an open letter about its coverup and mishandling of the coronavirus pandemic, referring to the botched response as a “Chernobyl moment.”

The letter was published Tuesday on the website of Canada’s Macdonald-Laurier Institute, a national public policy think tank based in Ottawa. It was signed by more than 100 policy experts, lawmakers and academics who hail largely from North America, Europe and Oceania.

“While the exact source and spread of the virus are not clear yet the question of origin is highly important, for the people of China and for all humankind: only by understanding how this global disaster could emerge we can prevent it from happening again,” the letter argued.

It went on to say that the origins of the global pandemic “are in a cover-up by CCP [Chinese Communist Party] authorities in Wuhan, Hubei province.”

To my eye there were few if any Americans among the signatories but they did appear to be notable neoconservatives. I do not believe this will be the last such declaration. It may well turn out that SARS-CoV-2 will be the least of China’s problems. As one commentator noted, the CCP has taken an axe to their own business model.

It’s not exactly a roadmap but it’s a start. California Gov. Gavin Newsom outlined six criteria for reopening the Golden State:

California’s six indicators for modifying the stay-at-home order are:

• The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed;
• The ability to prevent infection in people who are at risk for more severe COVID-19;
• The ability of the hospital and health systems to handle surges;
• The ability to develop therapeutics to meet the demand;
• The ability for businesses, schools, and child care facilities to support physical distancing; and
• The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary.

Since I have been calling for just such criteria to be promulgated, I found this an encouraging first step. I was disappointed, however, because none of the criteria were quantified. Without that you cannot determine whether progress is being made. That’s the sort of commitment that I think is needed rather than simple aspirational goals. Does anyone actually disagree with any of them? The devil is in the details.

If you’re following the scholarship relating to the present pandemic at all closely, you should find this paper from Science very illuminating. Be aware that it’s pretty technical. In the paper they explore the effects of seasonality (the tendency of a virus to return on a seasonal basis) and susceptibility (which includes but is not limited to acquired immunity) on prevalence. Here’s a snippet from the conclusion:

In summary, the total incidence of COVID-19 illness over the next five years will depend critically upon whether or not it enters into regular circulation after the initial pandemic wave, which in turn depends primarily upon the duration of immunity that SARS-CoV-2 infection imparts. The intensity and timing of pandemic and post-pandemic outbreaks will depend on the time of year when widespread SARS-CoV-2 infection becomes established and, to a lesser degree, upon the magnitude of seasonal variation in transmissibility and the level of cross-immunity that exists between the betacoronaviruses. Social distancing strategies could reduce the extent to which SARS-CoV-2 infections strain health care systems. Highly-effective distancing could reduce SARS-CoV-2 incidence enough to make a strategy based on contact tracing and quarantine feasible, as in South Korea and Singapore. Less effective one-time distancing efforts may result in a prolonged single-peak epidemic, with the extent of strain on the healthcare system and the required duration of distancing depending on the effectiveness. Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available. The authors are aware that prolonged distancing, even if intermittent, is likely to have profoundly negative economic, social, and educational consequences.

or, as others have put it more succinctly, we need to ensure that the cure is not worse than the disease.

There is an enormous number of things we simply don’t know. In the past I have suggested that the closest analogy we have to SARS-CoV-2 is the seasonal flu and that’s the assumption on which this paper is predicated but we just don’t know. The paper is silent, as it should be, on whether “highly-effective distancing) or contact tracing are practical in the United States. I incline towards believing that neither can be due to our physical and population size, the structure of our society, and our low degree of social cohesion.

I strongly believe that investigations of this sort should inform policy which is not to say that experts should be making the policies. Relying on science and putting policy decisions in the hands of scientists are not identical. Indeed, effective policy cannot be left to the experts.

Abbott has updated its information on its rapid COVID-19 test:

• Through Saturday, April 11, we have shipped 566,000 of our rapid ID NOW tests to all 50 states, Washington DC, Puerto Rico and the Pacific Islands. The majority of these tests have been sent to outbreak hotspots and we’ve asked that customers prioritize frontline health care workers and first responders.
• We’re currently manufacturing 50,000 tests per day, plan to increase ID NOW manufacturing capacity to 2 million tests a month by June and are working to expand beyond that.
• We have shipped more than 1 million tests to customers across the U.S. We’re also shipping these tests to customers throughout the world.
• There are approximately 200 m2000 instruments in hospital, academic center and reference labs throughout the U.S.

I’m having a bit of trouble reconciling the numbers I’m seeing not just here but in other things I’ve read. In particular I had previously read that there were 18,000 ID Now devices installed in the U. S. There’s a big difference between 200 and 18,000. Is there more than one model? I researched that and couldn’t identify one. Is there a predecessor model with a larger user base? Capability and compatibility may be issues.

Whatever the case scaling up to 2 million tests per month by June sounds like a lot but isn’t particularly hopeful if your objective is testing everyone in the U. S. let alone everyone in the world and the thought of scaling up other, less automated testing approaches is even more discouraging.

That doesn’t even start to address the issue of false negatives and positives which originally led me to stumble across Abbott’s update. I’ve read that the number of false negatives is 30% which is being interpreted as multiple tests per individual are needed.

In his latest Wall Street Journal column Walter Russell Mead articulates the case that China is still misleading not just the rest of the world but its own people on SARS-CoV-2:

As the world struggles to contain the coronavirus outbreak without triggering a new Great Depression, China is withholding vital information that would save lives and significantly alleviate the economic catastrophe that now threatens to immiserate hundreds of millions of people around the world.

This isn’t the old coverup, when Communist Party bumbling and deceit allowed a local outbreak to turn into the worst global disaster in decades. The new coverup is even more brazen. China continues to falsify vital information about the epidemic on a massive scale.

The evidence comes from many sources. In a classified report to the White House, the U.S. intelligence community has concluded that China underreports both deaths and the total number of cases. The Economist magazine compared China’s reported statistics with those from other countries and found that numbers changed dramatically in response to political events, such as the firing and replacement of local officials. Using conservative figures and assumptions, a report by Derek Scissors of the American Enterprise Institute estimates 2.9 million total cases in China, rather than the total of about 82,000 Beijing reports. If Mr. Scissors is right, the number of cases that China has concealed is greater than the total number of cases reported in the rest of the world.

These data matter. Without accurate information about the number and location of cases, including asymptomatic cases from China, it is much harder for the rest of the world to understand basic facts about the disease and its spread. And the absence of accurate information from China makes it much more difficult to know when it is safe to lift lockdowns.

The near-total shutdown and gradual restarting of a complex modern economy is something that has never been done before. No one could reasonably expect Beijing or any other government to get everything or even most things right on a first effort, but access to real information about what is happening in China could save many other countries from making costly mistakes. Just as in December and January China’s official culture of secrecy unleashed a terror on the world, so now that same culture weighs down the world’s efforts to cope.

and then gets to the meat of the piece:

What worries Beijing most is public opinion at home. The two sources of the Chinese Communist Party’s legitimacy—its technocratic skill and its ability to increase China’s prestige abroad—are challenged both by the epidemic and the government’s flailing response to it.

After seven decades in power, the party still depends on a governance system that combines arbitrary rule, brutal repression, eye-popping corruption and massive levels of deception, fraud and abuse. The coronavirus outbreak, concealed as long as possible from the higher-ups by the usual self-dealing cliques of local officials, cruelly exposed the gap between the imposing image Beijing seeks to project and the gritty, unsavory realities of one-party rule.

To divert public attention, China’s rulers reverted to their standard playbook: concealing information, squelching discussion of the disaster, and whipping up nationalist sentiment. The trouble is that the steps Beijing saw as necessary to shore up its power at home have dramatically worsened China’s economic prospects and its international reputation.

China, which became a major world power by using and sometimes abusing free-trade rules and global supply chains, has now taken an ax to the roots of its own business model. If the cost of doing business in China includes increased exposure to ruinous shocks like the pandemic, “Made in China” doesn’t pay. And if Beijing can lie so vociferously and implausibly about the pandemic, can private investors or foreign governments ever rely on its promises?

Let’s see. A regime that by its very construction cannot be trusted and whose actions impose risks on the rest of the world whose costs run into the trillions of dollars and hundreds of thousands of lives. Those are risks greater than any prospective benefit, at least to the rest of the world.

Res ipsa loquitur as Cicero put it. The thing speaks for itself. There is really only one reasonable response. As long as the Chinese Communist Party rules China, China must be ostracized.

Fasten your seatbelts, we’re in for a bumpy ride.

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.