China isn’t the only one that will be facing court cases. So will governors as Lindsay Wiley explains in an op-ed at the Washington Post:

If individuals or businesses affected by long-term interventions to combat the pandemic choose to sue, the courts would not be limited to an all-or-nothing approach. Judicial orders could require authorities to demonstrate that they are implementing public health surveillance measures to determine which areas are affected by significant community transmission and will, in due course, implement widespread testing and surveillance to tailor the timing, geographic scope and severity of public health restrictions so as to maximize benefits while minimizing harms.

It will be a full employment program for plaintiff’s attorneys. Even in an emergency elected and appointed officials are constrained by law and takings are takings.

I didn’t want to let too much time go by without remarking on Tom Friedman’s New York Times column in which he outlines a plan for restarting the U. S. economy after the COVID-19 hiatus:

One of the best ideas I have come across was offered by Dr. David L. Katz, the founding director of Yale University’s C.D.C.-funded Yale-Griffin Prevention Research Center and an expert in public health and preventive medicine.

Katz wrote an Op-Ed in The Times on Friday that caught my eye. He argued that we have three goals right now: saving as many lives as we can, making sure that our medical system does not get overwhelmed — but also making sure that in the process of achieving the first two goals we don’t destroy our economy, and as a result of that, even more lives.

For all these reasons, he argued, we need to pivot from the “horizontal interdiction” strategy we’re now deploying — restricting the movement and commerce of the entire population, without consideration of varying risks for severe infection — to a more “surgical’’ or “vertical interdiction’’ strategy.

A surgical-vertical approach would focus on protecting and sequestering those among us most likely to be killed or suffer long-term damage by exposure to coronavirus infection — that is, the elderly, people with chronic diseases and the immunologically compromised — while basically treating the rest of society the way we have always dealt with familiar threats like the flu. That means we would tell them to be respectful of others when coughing or sneezing, wash their hands regularly and if they feel sick to stay home and get over it — or to seek medical attention if they are not recuperating as expected.

Because, as with the flu, the vast majority will get over it in days, a small number will require hospitalization and a very small percentage of the most vulnerable will, tragically, die. (That said, coronavirus is more dangerous than the typical flu we are familiar with.) As Katz argued, governors and mayors, by choosing the horizontal approach of basically sending everyone home for an unspecified period, might have actually increased the dangers of infection for those most vulnerable.

“As we lay off workers, and colleges close their dorms and send all their students home,’’ Katz noted, “young people of indeterminate infectious status are being sent home to huddle with their families nationwide. And because we lack widespread testing, they may be carrying the virus and transmitting it to their 50-something parents, and 70- or 80-something grandparents.’’

“O.K.,’’ I said, calling Katz by phone at his home in Connecticut after reading his article, “but we are where we are now. Most states and cities have basically committed to some period of horizontal social distancing and sheltering in place. So, can we make lemonade out of this lemon — and not destroy our economy?’’

I don’t see why not, he answered. “Now that we have shut down almost everything, we still have the option of pivoting to a more targeted approach. We may even be able to leverage the current effort at horizontal, population-wide, interdiction to our advantage as we pivot to vertical, risk-based, interdiction.’’

How? “Use a two-week isolation strategy,’’ Katz answered. Tell everyone to basically stay home for two weeks, rather than indefinitely. (This includes all the reckless college students packing the beaches of Florida.) If you are infected with the coronavirus it will usually present within a two-week incubation period.

“Those who have symptomatic infection should then self-isolate — with or without testing, which is exactly what we do with the flu,’’ Katz said. “Those who don’t, if in the low-risk population, should be allowed to return to work or school, after the two weeks end.”

Effectively, we’d ‘reboot’ our society in two or perhaps more weeks from now. “The rejuvenating effect on spirits, and the economy, of knowing where there’s light at the end of this tunnel would be hard to overstate. Risk will not be zero, but the risk of some bad outcome for any of us on any given day is never zero.’’

There are several issues with this, the most serious being that I don’t believe the virus works that way. My understanding is that the best intelligence we have is something like 68% of those infected show symptoms within a week, 95% within two weeks, 99% within three, etc. Said another way his plan is unlikely to have the desired effects.

I do agree that a “one size fits all” approach will probably maximize the economic harm without accomplishing the presumed objective. Here in Illinois the governor has shut down the entire state (population: 12.74 million) for 1,200 active cases (12 deaths). One of the casualties of this experience is likely to be the end of the notion of a risk-free life. Nowadays things that my grandparents took for granted are practically unheard of. “Ordinary childhood diseases” used to kill thousands every year.

I’ve been thinking about this for some time but James Kraska has put it into words at War on the Rocks. The hugest liability suit (or group of suits) in the history of the world is now inevitable and China will be the defendant. After explaining the nature of the deliberate misconduct he goes on to explain the liability:

While China’s intentional conduct is wrongful, is it unlawful? If so, do other states have a legal remedy? Under Article 1 of the International Law Commission’s 2001 Responsibility of States for Internationally Wrongful Acts, states are responsible for their internationally wrongful acts. This commission’s restatement of the law of state responsibility was developed with the input of states to reflect a fundamental principle of international customary law, which binds all nations. “Wrongful acts” are those that are “attributable to the state” and that “constitute a breach of an international obligation” (Article 2). Conduct is attributable to the state when it is an act of state through the executive, legislative, or judicial functions of the central government (Article 4). While China’s failures began at the local level, they quickly spread throughout China’s government, all the way up to Xi Jinping, the general secretary of the Chinese Communist Party. He is now being pilloried by Chinese netizens for his failures of action and inaction. The most prominent critic, Chinese tycoon Ren Zhiqiang, lambasted Xi for his mishandling of the coronavirus, calling him a “power hungry clown.” Ren soon disappeared.

Responsibility flows from local Wuhan authorities to Xi himself, which are all organs of the state of China, and whose conduct is therefore attributable to China. An “organ of the state” includes any person or entities that are acting in accordance with national law. Even if China were to disavow conduct by local authorities or state media as not necessarily directly attributable to the national government, such actions nevertheless are accorded that status if and to the extent the state acknowledged and adopted the conduct as its own, as was done by the officials in Beijing (Article 11).

Wrongful acts are those that constitute a breach of an international obligation (Article 11). A breach is an act that is “not in conformity with what is required of it by that obligation … .” China’s failure to expeditiously and transparently share information with WHO in accordance with the International Health Regulations constitutes an early and subsequently extended breach of its legal obligations (Article 14). Consequently, China bears legal responsibility for its internationally wrongful acts (Article 28). The consequences include full reparations for the injury caused by the wrongful acts. China did not intentionally create a global pandemic, but its malfeasance is certainly the cause of it. An epidemiological model at the University of Southampton found that had China acted responsibly just one, two, or three weeks more quickly, the number affected by the virus would have been cut by 66 percent, 86 percent, and 95 percent, respectively. By its failure to adhere to its legal commitments to the International Health Regulations, the Chinese Communist Party has let loose a global contagion, with mounting material consequences.

President Xi will probably also be named personally and I would be greatly surprised if cases haven’t already been filed in U. S. courts. The U. S. federal government could shield China from such litigation but it’s hard for me to see why. As the article suggests the value of these litigations will likely be in the trillions.

The very least that should happen is that China should be expelled from the World Trade Organization.

I am increasingly convinced that South Korea is successfully “bending the curve” on COVID-19, i.e. constraining the number of active cases to a fairly manageable level. Let’s do a little analysis, shall we? You can follow along at Worldometer.info if you care to.

On March 11, nearly two weeks ago, SK’s active cases peaked at 7,362. As of yesterday the number had declined to 5,884 (a difference of 1,478) through a combination of deaths (44) and recoveries (1,434). The number of deaths per day has not declined since about March 2. That has proceeded with an average of five per day since then.

At that pace it will take SK about 44 days before the number of active cases has dropped to zero. 220 more people will have died. That will be May 6.

Here in the United States we do not appear to be particularly close to being where SK is now or realistically even where SK was on March 2. Said another way unless something changes markedly it will be June before the COVID-19 outbreak here can be truly said to be under control. I don’t think the lockdowns, “shelter in place” directives, or other draconian measures that have been taken will hold until then.

In his regular Wall Street Journal column Andy Kessler advises against a stimulus package with “a price in every box”:

Politicians need to do something, right? Yes, but it should be short-term and temporary. President Trump has a “big bold plan.” White House adviser Peter Navarro wants an $800 billion payroll-tax cut. Senate Republicans want to send $1,200 checks to a huge share of Americans. Treasury Secretary Steven Mnuchin is negotiating with congressional leaders a bailout of as much as $2 trillion. Rep. Ro Khanna, Mr. Sanders’s campaign co-chairman, ups the ante with checks of up to $6,000 for those making less than $65,000. Candy-coated popcorn, peanuts and a prize.

Mr. Mnuchin has smartly authorized the Fed, via Section 13(3) of the Federal Reserve Act, to lend directly to solvent companies, creating a trillion-dollar backstop for the commercial-paper market and money-market funds. A “lender of last resort” is needed. Airlines need capital, so lend to them at a Bagehotian penalty rate, against future ticket sales or even planes as collateral. The penalty rate is to make sure those that don’t need it don’t clog the system. The same program could shore up hotels and other still-solvent large businesses. And with support from the Fed, banks can do the same for small businesses. If the economy has a three-month hole because of quarantines and lockdowns, the Fed can provide a bridge loan across that void.

Those without jobs also need direct assistance, like debit cards for food handed out by local authorities. No one should go hungry as the economy evaporates for 90 days. Food aid could also be provided internationally—maybe using those mothballed cruise ships.

But one big puzzle is deciding the best way to help workers, many of whom are out of jobs, or are running short on tips and trips if they’re waiters or Uber drivers. We have a social safety net, and each state must temporarily but immediately lower bureaucratic barriers to collecting unemployment insurance—which obviously should include waiving the requirement that applicants seek work. Temporary sick leave is critical, as is helping small businesses continue to pay wages.

What I want to comment on is his assertion that”government giveaways as stimulus don’t work”. I agree with him that as presently constructed they don’t work as well as they did 80 years ago. I believe that John Maynard Keynes would say the same thing. When you combine the Ricardo’s theory of comparative advantage, a fiat currency, Keynesian stimulus, and deciding that the United States’s advantage are in providing health care services, finance, and personal consumption expenditures. Under those circumstances the multiplier goes down to zero and you’re merely transferring consumption from the future to the present. That’s fine until it becomes the future but the future is now.

As we are seeing right now in order to make something politically palatable you need to put prizes in a lot of boxes. That’s politics not economics.

I have just noticed that I missed the anniversary of my starting this blog last week. As of March 15 I had been been posting here for 16 years. Time flies.

In an op-ed in the Wall Street Journal Scott Gottlieb offers his take on the proper national course of action in dealing with COVID-19. Many of these have been mentioned in comments here. Here’s his plan in outline form:

• Containment where that still makes sense.
• Mitigation tactics for places, e.g. New York, Seattle, where the virus is in all likelihood already widespread.
• Widespread testing for epidemiological purposes rather than diagnostic ones. That would require a national testing plan rather than placing the decision of whether to test or not in the hands of individual physicians.
• Serological surveillance which would mean identifying those who have already recovered from the virus whether they have been symptomatic or not.
• Effective therapeutic strategies. IMO this is the highest priority. Regardless of how many tests are administered unless cases are cleared more rapidly the healthcare system will inevitably be overwhelmed.
• Regulatory reform. That should not be a one-time process or undertaken as-needed. It should be ongoing, incremental, and iterative.

He also recommends ramping up the production of “promising” drugs in anticipation of demonstration of their effectiveness. How one would quantify “promising” is unclear to me and, frankly, I’m skeptical. Each decision to increase production of one drugs means something else is decreased or at least de-emphasized.

I would also mention that we need to optimize processes beyond regulatory ones. We need to change how healthcare is delivered in this country and how it is measured. I would also take preventive measures but I’ve been posting about that for the last fifteen years.

I honestly don’t know what to make of this Washington Post editorial:

From a public health standpoint, the disruption caused by social distancing is worth it; the sacrifices are temporary and far less painful than thousands of deaths, overrun hospitals and a runaway virus.

But this is every bit as much about human behavior as about public health. It is absolutely essential in the months ahead that political leaders retain people’s trust — not an easy task even in normal times. If the restrictions are draconian, they could boomerang. People may panic or be tempted to disobey. That would in turn threaten further spread of the virus. Political leaders must allow a society to breathe, not only fresh air in parks and playgrounds, but also to go about life as normally as possible, to have access to groceries, banks, pharmacies and other essential services. It is important that leaders retain credibility so that the next time they ask for emergency action, they are heeded.

The word “lockdown” suggests jail. The concept is hardly what the United States needs at this juncture. We need careful, clear public health decisions to guide us back to normal as soon as possible.

Are they really quibbling about the terminology that is being used? Shouldn’t our first concern be ends and means? They seem to agree with the objective and the means of accomplishing it but don’t like the wording.

Let’s do a little thought experiment. Who is more likely to be held accountable as the number of cases in his state rises, the governor who declares a state of emergency and issues a “shelter in place” directive, calling it a “lockdown” or a governor who urges people exercise “social distancing” but stops there? IMO politics is front and center in all of these decisions.

I also wanted to draw your attention to this post at RealClearScience by Nevan Krogan. When time is of the essence there’s probably no better way to identify a treatment for a newly emerging disease than by mining the existing data to find one and that’s what Dr. Krogan and his team are doing:

Facing this crisis, we assembled a team here at the Quantitative Biosciences Institute (QBI) at the University of California, San Francisco, to discover how the virus attacks cells. But instead of trying to create a new drug based on this information, we are first looking to see if there are any drugs available today that can disrupt these pathways and fight the coronavirus.

The team of 22 labs, that we named the QCRG, is working at breakneck speed – literally around the clock and in shifts – seven days a week. I imagine this is what it felt like to be in wartime efforts like the Enigma code-breaking group during World War II, and our team is similarly hoping to disarm our enemy by understanding its inner workings.

and

By March 2, we had a partial list of the human proteins that the coronavirus needs to thrive. These were the first clues we could use. A team member sent a message to our group, “First iteration, just 3 baits … next 5 baits coming.” The fight was on.

Once we had this list of molecular targets the virus needs to survive, members of the team raced to identify known compounds that might bind to these targets and prevent the virus from using them to replicate. If a compound can prevent the virus from copying itself in a person’s body, the infection stops. But you can’t simply interfere with cellular processes at will without potentially causing harm to the body. Our team needed to be sure the compounds we identified would be safe and nontoxic for people.

The traditional way to do this would involve years of pre-clinical studies and clinical trials costing millions of dollars. But there is a fast and basically free way around this: looking to the 20,000 FDA-approved drugs that have already been safety-tested. Maybe there is a drug in this large list that can fight the coronavirus.

Our chemists used a massive database to match the approved drugs and proteins they interact with to the proteins on our list. They found 10 candidate drugs last week. For example, one of the hits was a cancer drug called JQ1. While we cannot predict how this drug might affect the virus, it has a good chance of doing something. Through testing, we will know if that something helps patients.

Facing the threat of global border shutdowns, we immediately shipped boxes of these 10 drugs to three of the few labs in the world working with live coronavirus samples: two at the Pasteur Institute in Paris and Mount Sinai in New York. By March 13, the drugs were being tested in cells to see if they prevent the virus from reproducing.

Our team will soon learn from our collaborators at Mt. Sinai and the Pasteur Institute whether any of these first 10 drugs work against SARS-CoV-2 infections. Meanwhile, the team has continued fishing with viral baits, finding hundreds of additional human proteins that the coronavirus co-opts. We will be publishing the results in the online repository BioRxiv soon.

The good news is that so far, our team has found 50 existing drugs that bind the human proteins we’ve identified. This large number makes me hopeful that we’ll be able to find a drug to treat COVID-19. If we find an approved drug that even slows down the virus’s progression, doctors should be able to start getting it to patients quickly and save lives.

The great advantage to this approach is that all of their candidate drugs have already received FDA approval for other uses. The risks of using any of these drugs for off-label use are already known to some degree.

Epidemiology is, indeed, a science but it’s not the only science and, given COVID-19’s lengthy recovery time (as I’ve pointed out practically nobody who was sick with it three weeks ago has recovered) mining the existing data to identify effective treatments is a pretty darned good strategy.