Opening Up From Coronavirus. The Case Of Georgia.

It’s said that one of the strengths of our federal system is that the individual states can serve as independent laboratories for new ideas which will be tested out and compared with results in other states. It’s reported that 3 states, Georgia, Oklahoma and Alaska, plan very shortly to allow more aggressive commercial opening. Efforts to dissuade Georgia governor Brian Kemp, including from the President himself, have not so far changed his mind.

Slowly but surely the evidence is coming in that Covid19 is for the great majority of those it infects an inconsequential or very mild problem. In addition, antibody testing is showing that it is far more widespread in the population than we had supposed. To be sure, what turns out to be a relatively small minority of those infected develop severe illness. As of now management has been mostly just supportive. However in the daily medical reports I read online information is coming in from doctors and researchers almost by the hour on the illness’s specific pathophysiology, that is, how it affects the body to do its damage, key points that will likely gradually produce more helpful treatment, above and beyond drugs that attack the virus itself.

Our social distancing efforts have apparently slowed down the contagion enough to give the medical community a breather, primarily in the population-dense urban areas where the illness was intense. But it does not rid us of the virus or change the nature of the illness. Dr. Fauci, in last night’s Task Force report, expressed his certainty that the virus, even though slowed, would be back in the winter. In fact, it seems clear that the strategy of simply slowing the virus’s spread actually ensures persistence of the virus, and eventual continued illness in the vulnerable, by preventing development of even more general immunity in the population.

In considering how to proceed at this point we must balance the recommendations of the public health officials against the effects of major increasing unemployment, which if sustained too long may have a cascading effect due to business failure resulting in more unemployment. This is essentially what happened after the stock market crash in 1929. The bad effects of sustained high unemployment are well documented and are myriad. These include increases in depression, with substantial increased death from suicide, drug and alcohol addiction and poor physical health. Crime and social unrest increase. Social services can help for a while but, as the demand for governmental social service increases, available funds from taxation sources decreases.

So, suppose, as Governor Kemp and his two other colleagues have decided, we take a more liberal attitude with our commercial restrictions and intensify efforts to protect the vulnerable who we now are fairly well able to identify. Could this cause a more generalized immunity which might starve out the virus. If we continue with the present more cautious restrictions the virus will presumably linger on, and, as Dr. Fauci has described, return intermittently, and continue to strike the vulnerable. In thinking about this scenario there is the concern that the virus could mutate and recur as does the influenza virus, but as in the SARS pandemic of 2003, the virus of which was a close cousin to our present problem (and which incidentally also started in China), there was no recurrence. This does not appear to be the tendency of coronaviruses.

In Sweden they are taking the less restrictive approach and it seems to be working out. If Governor Kemp sticks to his guns, as Mr. Trump is fond of saying, we’ll see what happens.

Coronavirus Management and Herd Immunity

Little by little the picture of this epidemic is becoming clearer and is gradually confirming what seemed likely from previous small clues. The disease seems very mild in the large majority of cases and because in most instances it is undetectable without testing, it is far more widespread than we had supposed. To be sure it can be lethal, rarely in young otherwise healthy people, but primarily in those susceptible to any illness. In fact, there is controversy over how to determine the cause of death in those who appear to die from a previous serious condition but have virus present on testing. Thus, considering the previously undetected large pool of those infected, the infection appears to have a mortality rate closer to the range of epidemic illnesses like the flu which we normally take in stride.

 

There are a couple of major differences however. First is its tendency to cause, in those more seriously affected, an extensive lung inflammation requiring intensive treatment. Second it is a novel virus with no previous community exposure and is highly contagious so that in some areas the medical system is greatly stressed. Moreover, a strong suspicion is emerging that the lung involvement is more a severe immunologic reaction to the virus rather than the infection per se leading to some new ideas about treatment.

 

Our country's response to the problem was to try to reduce the viral infectivity by limiting the opportunity for transmission, social distancing. This reduces the rate of illness but doesn't affect the virus survival so that there is fear that if social distancing is withdrawn a more severe epidemic will reemerge.

 

Development of a vaccine appears to be too far off to be useful at present. We are hopeful for effective treatments, but this remains uncertain. Another theoretical way to address the problem remains. We assume that the large majority of those minimally symptomatic have at least temporary immunity to reinfection and if the number of such individuals is large enough that viral spread will be limited. But allowing the infection simply to run its course to develop this so-called herd immunity is unacceptable because of the higher morbidity and mortality in some susceptible individuals.

 

One epidemiology expert from Yale University, Dr David Katz, has proposed that there could have been another alternative to the one we have taken of shutting down all but essential activity. In his scenario we could have directed all our resources to prevention of exposure to those susceptible to serious illness, but otherwise allow the contagion to proceed, thus allowing for widespread public immunity. He notes that, considering what has already been done it is too late to consider his approach. However, he presented his idea in the New York Times in late March. Much has happened since then. The curve has been flattened. We are now attempting to return from the economic abyss that has destroyed the livelihood of so many in our country. We have increasing civil controversy over what degree of restriction of our freedoms is reasonable and necessary. As we move into this phase I think Dr Katz's ideas should be considered as a way to proceed. I was interested to see that at his recent news conference Governor Cuomo  had a similar thought.

 

 

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The Plan To Get The Country Back To Work

I like the administration's plan to get the country back to work.

It has induced the obligatory chorus of anti-Trump rhetoric - he's pushing things too soon, he's putting the stock market before people's lives, etc. But wait a minute. This is not the President's plan. It has been devised and has been put forth by the medical people, Dr Fauci, Dr. Brix and their team. At the daily briefings they are advocating and explaining it. Oh, sure, you say, but Dr. Fauci is being coerced into doing it! I don't think so. I watch these briefings every day and almost always Dr Fauci is there to present the medical aspects. The only time I've seen this guy, with his unfailingly pleasant personality, come close to getting angry was his reaction when one of the news people asked him if he was acting voluntarily. So, yes, the plan is "following the science" as we so often hear demanded.

Mr. Trump is anxious to get through this national nightmare and back to our normal state as soon as it is safely possible, as we all should be. Many of us, such as myself, are reasonably well positioned to get through a few months and wait for things to return, but a for great many others the economic impact of what's going on is disastrous, so let's give them some consideration. I watched a Ken Burns documentary of the '30s tonight with pictures of the massive depression bread lines. Let's not even contemplate going in that direction. Our problem is not a matter of economics versus lives, it's a serious balancing of everyone's life.

Sure, congress is eagerly, and I think also appropriately, providing trillions of dollars in economic aid, but let's all remember that this is funny money. They're putting it on the tab, not a solution that can go on forever and which someone's going to expect to have paid somewhere down the line.

But what I like best about the plan is its devolution of decision-making to the individual states. This is a big country with a large amount of geographic diversity, so it makes perfect sense that, within some basic guidelines, localities should decide for themselves how to proceed.

That's also in line with the most basic founding idea of our country. The tenth amendment in our constitution's Bill of Rights makes it clear that the federal government activity is supposed to be limited to doing only those tasks specifically delegated to it by the constitution and that the fundamental political power in our country is supposed to reside in the people and the state and local governments which they choose. Throughout our country's history there has been a tension between advocates for central as opposed to local control but starting with FDR and the great depression the balance has swung greatly toward the central federal government. This crisis may be a turning point in the other direction. The various governors, with federal backup, will now have to make difficult, innovative decisions on their own, and who knows, they may get to like it. But most of the states themselves have considerable variation between urban, suburban and rural areas and the governors must take heed of local needs. As a consequence, we are now beginning to see public debate in the social websites on what should be done, as well as citizen pleas and protests to state and local government regarding seemingly irrational regulation. Every cloud has a silver lining, and to my mind, if anything good can be said to come out of this situation, it would be this development.

I watched Governor Cuomo's press conference on C-Span today and thought he was taking on the responsibility very well. He commented on this very issue of the states taking charge and gave a good and well-balanced discussion of the problems involved in managing the situation in New York. He emphasized the destructive effect of bringing political division to this issue and I couldn't agree more.

 

 

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The New York Times, The President, And Coronavirus

A friend of mine forwarded to me a recent article from the New York Times detailing at great length all the warning signs about the coronavirus threat that Mr. Trump supposedly ignored or minimized, resulting in inaction that led to our present crisis. Let's set the record straight.

 

News about this strange virus in Wuhan began emerging in December and early January. While news of the virus was building up what was preoccupying the complete attention of congress, and inevitably to some extent the President? An impeachment trial which was carried on from January 16 to February 6, an exercise which Speaker Pelosi, and everyone else, understood to be pointless given the makeup of the Senate.

Despite this, was the President distracted enough to ignore the virus as his enemies contend? Well, on January 31, while the trial was ongoing, he imposed a ban on all flights from China, a dramatic decision at the time, which was criticized as being unnecessary  by the World Health Organization, and which Joe Biden, and for that matter Bernie Sanders, labeled as hysterical and xenophobic.  Shortly thereafter came the same condemnation from the clairvoyant New York Times and the Washington Post as well as all the anti-Trump TV networks.

By this time in late January Mr. Trump had already formed and met regularly with a Task Force to evaluate and advise about the matter, which included as members Dr. Fauci and later Dr. Brix as well as his other health and economic advisors.

 

What were they advising? Well on February 17 Dr. Fauci, in an interview with USA Today, stated that the risk of coronavirus in the U.S. was miniscule and that we should worry more about influenza. He advised that we definitely should not be avoiding Chinese restaurants because of excessive concern. I saw him being interviewed only yesterday on the Jesse Watters show, and when asked about his statements, he explained that this was based on the erroneous information he had about the transmissibility of the virus. Really Dr. Fauci? On February 17, more than 2 weeks after the Chinese flight ban. Don't get me wrong. I admire Dr. Fauci's expertise and integrity as much as anyone else, but I point this out to demonstrate how difficult potential events were to predict, even for an epidemiology expert.

But Dr. Fauci wasn't the only one. On February 24, Nancy Pelosi made a publicity tour of the San Francisco Chinatown, particularly to calm the concerns of the local business owners. During the event she said that there was no reason for tourists or locals to be staying away from the area out of fear over coronavirus concerns and even implied that to do so was racist.

The President went on to ban all travel from Europe on March 12 and then announced the federal guidelines on social distancing shutting down the country on March 16. Showboat Jim Acosta looked in the retrospectoscope and asked in one of the press conferences how many less people would have died if he had put the guidelines in place 2 weeks earlier. That would have been when there was a total of 5 deaths in the country, and incidentally 573 deaths from influenza.

 

The decision to close schools, non-essential businesses, concerts, sports events, social gatherings, church services was courageous and painful. As we all understand, millions lost their jobs, most especially the little guys, the waitresses, hair stylists and assembly line workers that the political allies of the New York Times claim to represent. How many 40 somethings who put their savings in hock and went into debt to open a new business have seen everything disappear in a flash. And the trillions that congress has appropriated does not come from some mysterious government money tree.

Yes, the President was happy with the economic surge that came on with his administration. Could there be any President who would not be? But give him some credit for his concern for our country's welfare and his reluctance to put our citizens through this trial. I say thank heavens he's where he is. Would Joe Biden have had the energy and managerial ability to oversee all the medical, economic, logistical, foreign policy and political aspects of this crisis?

 

I'm a pretty even-tempered guy but this New York Times article makes me angry. For 3 years the President's enemies have subjected him to every harassment they can conceive of. Fair enough, that's politics although pretty darn intense. But the ongoing attempt to undermine his every word and action during this national crisis, which affects every race and gender, Democrat and Republican, is not right. It even leaves me with the feeling that some critics would like to see things go bad just to turn people against him and defeat him in the coming election. I hope not. But then didn't so-called comedian Bill Maher say that he hoped we would have a depression so we could get rid of Trump.

 

Well Bill. Here's your depression. How do you like it?

 

 

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The Strange Case Of The Coronavirus Around The World

Something very strange is going on with the coronavirus epidemiology picture. I watch Drs. Fauci and Birx every day and, although they certainly have great expertise and integrity, I'm starting to think that their almost exclusive emphasis on mitigation is missing something. It's not that I necessarily think their recommendations are wrong, although it must be admitted that they are causing great economic havoc and suffering. They appear to be necessary, less to save lives than to prevent an overwhelming of the health care system. But it looks to me like there's got to be more to the story of this epidemic.

 

What started me thinking was my happening to come upon the article by Victor Davis Hanson that I posted recently. Written in late March, it deals the question of the great disparity in the effects of the virus between California, as well as other west coast states, and New York, which has 40% of the country's cases. VDH points out that by any measure, California should be the largest hot spot in the country. The good doctors Fauci and Birx attribute the good results in California to their efforts at mitigation, but I don't believe it. Governor Newsome in California announced a state lockdown on March 23. Governor Cuomo in New York started theirs on March 20 and by March 23 NYC was a "ghost town" with the remarkable photos of empty streets.

 

Then I happened to see a post by one of my more liberal friends where it was pointed out that New Zealand had only a single death (at this point it is up to 4) implying a deficiency in the U.S. efforts. The commenter attributed New Zealand's good fortune to aggressive mitigation efforts and widespread testing. But when I checked it out it wasn't true. New Zealand in fact was rather late to the game, starting aggressive mitigation on March 25, and with limited viral testing early on due to a deficiency of testing kits. Drive through testing started on 3/21, is limited to those with symptoms and with considerable variability in different parts of the country.

I talked to my cousin who lives in Sydney Australia last night, and their situation, on a larger scale, is similar to New Zealand. Out of a population of 24 million they have at this point 53 coronavirus deaths, many of them coming from a single infected cruise ship,  even though they did not start mitigation efforts until March 25 and testing was delayed due to lack of test kits and limited to those only with respiratory  symptoms accompanied by fever.

 

China is much closer to these countries than to the U.S. Both have large  Chinese populations, especially Australia, with a tremendous amount of travel between the countries, especially between 12/19 and 2/20 for the Chinese New Year. One would expect a high infection and death rate.

So I thought to look at other East Asian countries, closer still to China. Japan is interesting. It's a country with 126 million population of particularly high density. In the densest areas of Tokyo population is 22 thousand/sq km while the densest areas of NYC is 28 thousand/sq km. Although the Japanese people were being cautious and wearing masks, etc. fairly early on, and schools were closed in late February, Prime Minister Abe was concerned about the economy and did not impose general mitigation measures until April 7, long after it started in the U.S. Viral testing is now being ramped up, but until very recently was very limited, being done only for vulnerable persons.

 

Other East Asian countries are similar. Taiwan did take the illness seriously, started screening of travelers and follow up of contacts, but did not ban flights from China until about the same time as the U.S. did. Their screening was pretty much just extensive temperature taking, rather than actual viral testing, leaving the large loads of asymptomatic carriers undetected. In Hong Kong, Singapore, South Korea the situation has been the same, even allowing entertainment venues like bars and mahjong parlors to continue operation until the past few days. And how can you account for the fact that millions of Chinese left Wuhan before it was shut down, before China reported the virus, many of them one would presume were showing no signs of any illness.

So then, what is the death toll in these countries. In Japan 93, Taiwan 6, S. Korea 211, Singapore 8, and Hong Kong, which is contiguous with mainland China with a population of 7.5 million and one of the highest population densities in the world, 5.

 

So, to my mind the reason for these gross incongruities in the impact of this virus in different geographic areas is mysterious. From what I could find, a difference in the carrying out of public health measures is not a satisfactory explanation. Somebody help me!

 

 

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