Tag Archives: public health

Trump Has No Endgame

Stop stressing yourself trying to anticipate the masterstroke in his nefarious plan.

Both in the mainstream media and among my social-media friends, I see people who ought to know better switching back and forth between two divergent and contradictory images of Donald Trump: the Magical Thinker and the Master Planner. Recognizing that the president is a magical thinker makes them despair over how our country will deal with the current crisis. But at the same time they have nightmares about the master planner who will find a cunning way to stay in power.

In everything else, Trump is the Dunning-Kruger poster child. But when the subject changes to the election, or to everything that happens between the election and the inauguration of a new president, they suddenly see him as the genius he claims to be. An evil genius, perhaps — a Lex Luthor or a Victor von Doom — but a genius all the same.

Magical Thinker. When we’re talking about practical governing or attempting to solve the problems of the nation, it seems obvious that Trump indulges in magical thinking: He believes he can make the world be what he wants it to be just by insisting that it already is. What he wants to happen will happen, because he says so: The virus will go away “like a miracle”. It’s no worse than the ordinary flu. Anybody who wants a test gets a test. We lead the world in testing. There is no shortage of PPE for hospital workers. The country is ready to reopen, and when it does, the economy will come zooming back. Everyone should be grateful to him for the great job he’s been doing.

His magical thinking is made even worse by his childlike inability to consider the future. His entire focus is on looking good right now, even if it will hurt him in the long run. During February and early March, for example, his happy talk about the virus seemed to be aimed at keeping the stock market high, because that was the core of his re-election pitch: The market is high, unemployment is low; I promised a great economy and I delivered.

There was never any chance he could keep that scam going until November, but it didn’t seem to matter to him. If the market stayed high today, that gave him a talking point today, and improved his poll numbers today. November was November’s problem.

His daily coronavirus briefings (which he continued until wiser heads made him stop) were full of short-term image-building that could never hold up over time. The hospitals have plenty of masks and ventilators, no matter what they say. And Trump is a genius who has genius ideas nobody else thinks of: Hydroxychloroquine is a miracle drug. Bleach can kill virus inside the body.

It’s obvious now that it was always in Trump’s best interest to do a good job fighting the virus. Imagine if he had sounded the alarm early and started emergency preparations back in January and February (as the disease experts inside the government were pleading for him to do). The death total would be lower by tens of thousands and the economy really might be in a position to reopen. What if the US anti-virus efforts were one of the world’s success stories rather than the cautionary tale of neglect and incompetence it is now?

He could have benefited from the we’re-all-in-this-together wave that has boosted the approval numbers of Democratic and Republican governors alike, even in the states that have the highest death totals. If he had met the crisis head-on and given the American people straight talk combined with the steady reassurance of realistic hope (like Andrew Cuomo did in New York), Covid-19 might have been the tailwind that pushed an otherwise unpopular president across the finish line to re-election.

But that strategy would have required a months-long time horizon, which he doesn’t have. He’d have needed to sacrifice the immediate satisfaction of bragging about how wonderful he is and what a perfect economy he has made. He just couldn’t do it.

He still can’t. With another month or so of lockdown, combined with a well-funded, well-organized national test-and-trace program and some realistic guidelines for gradual reopening, the worst of the crisis might yet be in the rear-view mirror by Election Day. But pushing the states to relax restrictions while the virus is still spreading is the same short-term magical thinking all over again. It feels good right now to tell upbeat stories about restaurants and barber shops reopening, and to imagine schools and baseball stadiums opening soon. But how will that look in the fall, when people start voting?

By November, another few weeks of boredom and struggle in May and June would be long forgotten. But a pandemic that in November is still killing thousands of Americans (but not thousands of Germans or Koreans or Canadians) every week will be hard to wish away.

Master Planner. When it comes to politics, though, many people who otherwise see Trump’s cognitive, intellectual, and psychological shortcomings imagine the existence of a Master Plan that ultimately makes it all work in his favor. If he seems to be charging towards a cliff, that can only mean that he has a parachute, or that a military helicopter is waiting to pluck him out of the air.

I mean, he couldn’t just be stupid or delusional, could he? He couldn’t possibly imagine that the cliff will go away because he wants it to, or that he will sprout wings and fly when he gets there? That would be as crazy as … well, all the other stuff he’s done.

But from this point of view, he’s not blundering his way through the virus fight; he wants the virus to be raging in November so that he can use it to suppress the vote. Or maybe he plans to declare martial law and cancel the election. Even if he loses the election, he must have a plan for that too.

Heather Cox Richardson, who usually strikes me as very level-headed, sees an ominous portent in Trump’s “ObamaGate” maneuvers.

It suggests that the Trump administration really is contemplating legal action against F.B.I. officials who were investigating the attack on the 2016 election. This is unprecedented. More, though, it suggests that the Trump administration does not anticipate a Democratic presidency following this one, since it could expect any precedent it now sets to be used against its own people. That it is willing to weaponize intelligence information from a previous administration suggests it is not concerned that the next administration will weaponize intelligence information against Trump officials. That confidence concerns me.

Gee. Inventing a talking point that helps him today creates a scenario where it all backfires somewhere down the road. Who could imagine Trump doing such a thing?

Apply the model of Trump that we see validated every day in every other part of his administration: He doesn’t “anticipate a Democratic presidency” because he doesn’t anticipate anything. Imagine being a Trump aide and raising the question “What are we going to do if Biden beats you?” Do you think you’d get an answer? Would you expect him to tell you to assemble a team and construct a Biden-beats-me contingency plan? Or would he just take your head off and replace you with somebody who doesn’t ask questions like that?

We need a plan even if he doesn’t have one. Trump never looks ahead, but once he gets into a bad situation he looks around. He isn’t bound by moral scruples or political norms or even the law. All options are on the table.

So I expect him to keep denying his poor prospects for re-election until at least mid-October. In the same way that Hitler in 1945 kept promising “miracle weapons” — like the V-2 rocket or jet fighter planes — that would turn the war around, Trump will always have some reason to project success: a last-minute vaccine announcement, a surprise uptick in the economy (or maybe just forcing the Labor Department to publish fake numbers), war with Iran, or a final ad blitz that will destroy Biden once and for all.

As the election approaches, though, it will eventually dawn on him that he’s really losing. As in the Reagan/Carter race of 1980, the voters who make up their minds at the last minute will ask themselves whether this president deserves another term, and they’ll say no. At that point — and not a second before — he will ask, “How can I stop this?” How can I stop people from voting? How can I discredit the vote count? How can I steal votes in the Electoral College? Can the Senate or the Supreme Court declare me the winner even though I lost? Can I just refuse to leave?

At that point, he’ll thrash like a fish in a net. But whatever he does won’t be well prepared or well planned. A military coup is a bit more complicated than just calling the Pentagon and ordering them to keep you in power. Politicians and bureaucrats and judges who cooperated with you when you seemed invincible may decide they don’t want to go to jail for you now that you’re on your way out. And those bands of overweight yahoos with AR-15s may be willing to get violent on his say-so, but who will they shoot and what will they accomplish? All that would require a plan, and there is no plan.

Democrats should not get complacent going down the stretch, because at the last minute Trump will be ready to try anything. But he won’t suddenly become a master strategist.

He’ll thrash and he’ll bluster and he’ll try crazy things. But like most things he tries, they won’t be well thought out. And like most things he tries, they won’t work.

Things We’re Finding Out about the Pandemic

So far, Covid-19 has been characterized more by what we don’t know than what we do. That has allowed reporters to write either scary or reassuring articles, depending on what they assume about the unknown. This week I went looking for articles that give the unknown its due respect, and explain a lot of the artifacts in the data that might look like trends, but aren’t.

A good place to start is Ed Yong’s “Why the Coronavirus is So Confusing” in The Atlantic.

Terminology: “SARS-CoV-2 is the virus. COVID-19 is the disease that it causes.” It’s like HIV and AIDS. The epidemic — how the disease develops in a community — is yet a third thing.

The fatality rate isn’t a property of the virus. The reason the death rate (or case-fatality rate or CFR) is so hard to pin down is that it only becomes an objective quantity — number of deaths divided by number of cases — in retrospect. The CFR describes how the epidemic unfolded in a particular place; it’s not some inherent property of the virus.

The CFR’s denominator—total cases—depends on how thoroughly a country tests its population. Its numerator—total deaths—depends on the spread of ages within that population, the prevalence of preexisting illnesses, how far people live from hospitals, and how well staffed or well equipped those hospitals are. These factors vary among countries, states, and cities, and the CFR will, too.

We’re not really sure how the virus causes the symptoms of the disease. We know what a human body looks like after Covid-19 has attacked it. We’re not sure how to separate that into (1) damage the virus does, (2) collateral damage the immune system’s response causes, and (3) side effects of treatment.

The disease seems to wreak havoc not only on lungs and airways, but also on hearts, blood vessels, kidneys, guts, and nervous systems. It’s not clear if the virus is directly attacking these organs, if the damage stems from a bodywide overreaction of the immune system, if other organs are suffering from the side effects of treatments, or if they are failing due to prolonged stays on ventilators.

Others viruses might also have more wide-ranging effects than we know, but we just haven’t seen enough cases to notice them.

“Is COVID-19 fundamentally different to other diseases, or is it just that you have a lot of cases at once?” asks Vinay Prasad, a hematologist and an oncologist at Oregon Health and Science University.

Science doesn’t go straight to the right answer. The back-and-forth nature of the early scientific debate (asymptomatic people can’t spread the disease; yes they can) throws a lot of people, but it’s not that unusual.

This is how science actually works. It’s less the parade of decisive blockbuster discoveries that the press often portrays, and more a slow, erratic stumble toward ever less uncertainty. “Our understanding oscillates at first, but converges on an answer,” says Natalie Dean, a statistician at the University of Florida. “That’s the normal scientific process, but it looks jarring to people who aren’t used to it.”

The upshot is that if your whole view of the virus depends on one study by one lab, you should maybe take a wider look.

Uncertainty is a strength, not a weakness. In politics, the guy who is loudest and most sure of himself tends to win the argument. But expertise doesn’t work that way; real experts understand just how far their expertise goes, and recognize past some point, other kinds of expertise become more important.

The idea that there are no experts is overly glib. The issue is that modern expertise tends to be deep, but narrow. Even within epidemiology, someone who studies infectious diseases knows more about epidemics than, say, someone who studies nutrition. But pandemics demand both depth and breadth of expertise. To work out if widespread testing is crucial for controlling the pandemic, listen to public-health experts; to work out if widespread testing is possible, listen to supply-chain experts. To determine if antibody tests can tell people if they’re immune to the coronavirus, listen to immunologists; to determine if such testing is actually a good idea, listen to ethicists, anthropologists, and historians of science. No one knows it all, and those who claim to should not be trusted.

In a pandemic, the strongest attractor of trust shouldn’t be confidence, but the recognition of one’s limits, the tendency to point at expertise beyond one’s own, and the willingness to work as part of a whole.

The flu comparison is even less appropriate than the numbers make it sound. In Scientific American, Dr. Jeremy Samuel Faust concludes that the comparisons we hear about flu deaths vs. Covid-19 deaths are misguided.

When reports about the novel coronavirus SARS-CoV-2 began circulating earlier this year and questions were being raised about how the illness it causes, COVID-19, compared to the flu, it occurred to me that, in four years of emergency medicine residency and over three and a half years as an attending physician, I had almost never seen anyone die of the flu. I could only remember one tragic pediatric case.

He began asking other emergency-medicine doctors, and found that their memories match his. They remember lots of opioid deaths, gun deaths, and traffic-accident deaths — which are supposed to happen in similar numbers — but not flu deaths. Flu death totals, he came to understand, are not counted deaths — deaths of particular people whose doctors write “influenza” on their death certificates — they’re extrapolations based on models. The models assume that many people die of the flu outside of hospitals, and aren’t officially counted.

In the last six flu seasons, the CDC’s reported number of actual confirmed flu deaths—that is, counting flu deaths the way we are currently counting deaths from the coronavirus—has ranged from 3,448 to 15,620, which [is] far lower than the numbers commonly repeated by public officials and even public health experts.

In other words, (and I’m commenting here, not quoting or summarizing Dr. Faust) the flu death totals we usually hear are more comparable to the Covid-19 death totals we’re starting to get from excess-death demographic models — which show much higher numbers than the 65,000+ you commonly see reported. But if we compare counted Covid-19 deaths during the second week of April to counted flu deaths during the worst week of an outbreak “we find that the novel coronavirus killed between 9.5 and 44 times more people than seasonal flu”.

What happened in Belgium? If you study those country-by-country death totals, the one that always stands out is Belgium, which has 677 deaths per million compared the US’s 204 or Italy’s 475. What horrible lesson, you might wonder, should we learn from Belgium’s disastrous handling of the epidemic?

Maybe none.

Belgium’s high numbers have less to do with the spread of the disease and more to do with the way it counts fatalities. Its figures include all the deaths in the country’s more than 1,500 nursing homes, even those untested for the virus. These numbers add up to more than half of the overall figure.

The curve has flattened, but hasn’t turned downward much yet. Check out the Washington Post’s graphs of deaths and new cases per day. The peak in deaths was 2,874 on April 21 (assuming we ignore April 14, when New York City created a blip by reclassifying 3,700  previous deaths). But deaths have been in the neighborhood of 2,000 a day for the last two weeks. Trends are harder to detect due to a Sunday/Monday effect, when deaths are lower for some reason I don’t understand. (Sunday April 26 had “only” 1,087 deaths, but yesterday had 1,558.)

The numbers also depend to a certain extent on how they’re being collected. The WaPo numbers come from Johns Hopkins, and list 2,461 on Wednesday, 2,097 on Thursday, and 1,723 on Friday. But the WHO has a different way of collecting deaths and assigning them to days. They announced that 2,909 people died in the US on Thursday, a new high.

If you look at things Monday-to-Monday, as I do, there is a downward trend. 68K today, 55K last week, 40K and 22K the weeks before. So new deaths per week have gone from 18K to 15K to 13K.

As for where the numbers might be going next, 538 collects the projections of a variety of models about how many deaths we’ll see in the next three weeks. From the 65K deaths already recorded by May 1, some models predict as few as 72K deaths by May 23, others as many as 103K deaths. But if social distancing is abandoned too quickly and a second wave starts, all those projections go out the window.

When (and even whether) a vaccine shows up is anybody’s guess. A good summary here is Stuart Thompson’s article in Thursday’s NYT. If the normal vaccine-development timetable holds, a vaccine is years away, or maybe even decades. (There’s still no HIV vaccine, for example, after more than 30 years of looking for one.) But lots of things are being done to speed up the normal timetable, and maybe they’ll work.

There is a process to finding and producing a vaccine, but not one that can be easily predicted.

Clinical trials almost never succeed. We’ve never released a coronavirus vaccine for humans before. Our record for developing an entirely new vaccine is at least four years — more time than the public or the economy can tolerate social-distancing orders.

But if there was any time to fast-track a vaccine, it is now.

The main way you speed things up is that you do everything at once. Rather than take the most likely vaccine candidate, test it, and then test the next one after the first one fails, 95 different vaccines are being worked on at the same time. Some of them are probably very bad ideas.

What if a promising vaccine actually makes it easier to catch the virus, or makes the disease worse after someone’s infected? That’s been the case for a few H.I.V. drugs and vaccines for dengue fever, because of a process called vaccine-induced enhancement, in which the body reacts unexpectedly and makes the disease more dangerous.

That’s why you don’t just dream up a formula and start injecting it into the general public. Normally, there are three phases of testing, with time in between for analysis. But for Covid-19, you might start one phase before the previous one finishes. You also might start prepping a factory for production before you’re sure a vaccine works.

If you do all that and you get lucky, you might have a vaccine in mass production by August 2021.

The most aggressive timetable has been put forward by a group at Oxford, which is talking about availability in September, 2020. That would be a million doses, not the billions ultimately needed. But a lot has to go right before that happens. Human trials started this week. Right now all we know is that it works in rhesus macaques.

Whatever we’re returning to, it’s not “normal”. Another Atlantic article, Uri Friedman’s “I Have Seen the Future—And It’s Not the Life We Knew“, looks at the early signs of post-lockdown life in countries that are ahead of the US: China, South Korea, Denmark, and a few others. The very resemblance to normal enhances the strangeness of it.

In China, Friedman reports, reactions bifurcate as everyone anticipates the possibility of a second wave or a new plague. Some remain constantly on their guard, while others take a live-now approach: You’d better do whatever you can while you can, because it might all be taken away tomorrow. In general, the Chinese are saving more and spending less, frustrating planners who hope for a quick economic recovery.

Denmark seems to have the opposite problem: When the government reopened daycare centers and schools, many Danes took it as an all-clear signal. “[Just] because the schools open, doesn’t mean you should stop washing your hands,” says a University of Copenhagen professor.

Temperature screening at City Hall in Seoul

The NYT has a similar article:

In Hong Kong, tables at restaurants must be spaced at least five feet apart and customers are given bags to store their face masks during dining.

In China, students face temperature checks before they can enter schools, while cafeteria tables are outfitted with plastic dividers.

In South Korea, baseball games are devoid of fans and players can’t spit on the field.

… Libraries in Hong Kong are reopening, but visitors are allowed to be inside for only an hour at a time.

Hair salons in Sydney, some of which had closed because of the virus or financial pressures, are back in business with abundant supplies of masks and hand sanitizer. At some, magazines are no longer handed out to customers.

… In Sydney, schools are reopening in phases, holding classes one day a week for a quarter of the students from each grade and gradually expanding until the end of June.

We can hope that our opportunities increase over the coming months. But normal? Well, not exactly.

Trump Is Still Eating Souls

I really don’t want to talk about injecting Clorox, but I kind of have to.

To start with: Don’t do it. Disinfectants work by killing living things. You are a living thing. Complete the syllogism.

With that out of the way, the thing to focus on here isn’t that Trump said something monumentally stupid Thursday. He does that; it’s usually not quite this bad, but he says stupid things fairly regularly. On the whole, I think I’d rather have him saying incredibly, ridiculously stupid things rather than run-of-the-stupid-mill things — like that you should take dangerous drugs that haven’t been tested yet — because fewer people are likely to believe him and do harmful things to themselves or others. (Though apparently some did believe him this time too.)

No, the really scary thing about the inject-disinfectant story is what happened next. DHS Undersecretary William Bryan (who had just talked about the effectiveness of sunlight and bleach in killing coronavirus on surfaces — not inside the body) was still standing near the podium, and Dr. Deborah Birx was sitting a few feet away, and neither jumped in to protect public health by telling people not to do what the President just suggested.

Within a minute or two, Bryan was asked a question by a reporter, and he didn’t backtrack to tell people not to inject themselves with bleach. Even later, when a reporter specifically asked “But I — just, can I ask about — the President mentioned the idea of cleaners, like bleach and isopropyl alcohol you mentioned. There’s no scenario that that could be injected into a person, is there? I mean —”, Bryan said “no” in a deflecting way, not calling it out.

No, I’m here to talk about the findings that we had in the study. We won’t do that within that lab and our lab.

In other words: “No, that’s not my department”, not “No, that’s a really bad idea.” Later, on Fox News, Birx did this bit of spin.

When [President Trump] gets new information, he likes to talk that through out loud and really have that dialogue and so that’s what dialogue he was having. I think he just saw the information at the time immediately just before the press conference and he was still digesting that information

Assume that’s true for a second: It’s still political malpractice. Imagine any previous president “digesting information” about a crisis on national TV in real time. Picture George W. Bush — not my favorite president — digesting what his generals are saying about Iraq and spitballing whatever crosses his mind. “Couldn’t we just nuke them? We’re going to wargame that, right?”

I can only assume that both Bryan and Birx have made the same calculation: Protecting public health is less important than protecting the President’s fragile ego. Admitting that Trump said something stupid is a good way to get fired — and then maybe no one in the administration would care about public health.

And so Bryan and Birx have been corrupted by the soul-eating process James Comey described a year ago: First you don’t interrupt when Trump lies about trivial things like his inauguration crowd. Then you give in to peer pressure and flatter him in public.

Next comes Mr. Trump attacking institutions and values you hold dear — things you have always said must be protected and which you criticized past leaders for not supporting strongly enough. …

It bothers you, at least to some extent. But his outrageous conduct convinces you that you simply must stay, to preserve and protect the people and institutions and values you hold dear. Along with Republican members of Congress, you tell yourself you are too important for this nation to lose, especially now. … Of course, to stay, you must be seen as on his team, so you make further compromises. You use his language, praise his leadership, tout his commitment to values.

And then you are lost. He has eaten your soul.

Why the Country Isn’t Rallying Around Trump’s Flag

There is a substantial national consensus and someone needs to speak for it.
Unfortunately, our current President can’t.

The bullhorn speech. The highest presidential approval Gallup ever reported was published on September 24, 2001. Just ten months before, George W. Bush had lost the popular vote to Al Gore, resulting in a bitter dispute over Florida, and a widespread belief among Democrats that his presidency was illegitimate. In the poll published on September 10, Bush’s approval rating had been a lackluster 51%, barely higher than the 48% who had voted for him in November. But now, suddenly, 90% of Americans approved of his job performance.

Bush was the same man he had been two weeks before, but something historic had happened in the meantime: On September 11, the United States suffered a humiliating and horrifying attack. In New York, the twin towers of the World Trade Center fell, killing almost 3,000. In Washington, the Pentagon had been damaged. A fourth hijacked airliner, rumored to have been targeted at the Capitol, had been brought down by a self-sacrificing passenger uprising.

Three days later, Bush stood in the WTC rubble.

The president, who had been in office less than eight months, grabbed a bullhorn and started thanking the fire fighters and other first responders at the scene, telling them that they were in the country’s prayers. Someone in the crowd shouted that he couldn’t hear the president, and Bush replied with the words that made history.

“I can hear you!” he declared. “The rest of the world hears you! And the people – and the people who knocked these buildings down will hear all of us soon.” The crowd reacted with loud, prolonged chants of “USA! USA!”

In this electric moment, Bush captured the mood of the country, delivering just what the American people wanted a combination of gratitude for the rescue workers’ bravery and diligence, defiance toward the terrorists, and resolve to bring the evil doers to justice.

Rally round the flag. Other peaks of presidential approval reflect similar moments of national unity. In 1991 and 1945, the common emotion was pride and relief at the successful conclusion of a war. The first President Bush garnered 89% approval after the surprisingly one-sided victory over Saddam Hussein in the First Gulf War. President Truman reached 87% approval after the surrender of Nazi Germany. Perhaps the moment that most resembled 9/11 was Pearl Harbor, when a similar sense of national determination pushed FDR’s approval up to 84%.

Crisis has a way of uniting Americans around their president. Past mistakes and doubts are put aside. Had W ignored the terrorist threat before 9/11? Had his father’s uncertain policy led Saddam to believe he could get away with invading Kuwait? December 7, 1941 was not just a “date that will live in infamy”, it was also a shocking defeat for the Navy that Roosevelt commanded, and was soon followed by the defeat of American ground forces in the Philippines.

So if you had wanted to disapprove of any of those presidents, you could justify it. But somehow none of that mattered. The nation yearned to be united, and there was only one president to unite around. Lingering disagreements and disappointments would have to be transcended until the current challenge had been met and overcome.

Over time, this pattern has baked itself into the American psyche so deeply that it has a name: the rally-round-the-flag effect.

What about now? Right now, we’re in another national crisis of historic proportions. More than 50,000 Americans have died of Covid-19, almost all of them in the last month. Hundreds of thousands are sick, and nearly every American has felt the impact of stay-at-home orders intended to “flatten the curve” and blunt the upward trajectory of death.

We’re mourning, we’re hurting, we’re frightened, and we’re angry. So why isn’t the rally-round-the-flag effect working for President Trump?

One theory is that the country’s partisan divide has gotten so wide that it’s impossible to cross over and support a leader of the opposite party. But that doesn’t explain why the effect is still working at the state level, for governors of both parties: Democrat Andrew Cuomo of New York, whose televised briefings have made him a national figure, scored an 87% approval rating in late March. And Larry Hogan of Maryland and Ohio’s Mike DeWine are Republican governors with similarly stratospheric ratings: 84% and 83%, respectively.

All those states (especially New York) have been hard-hit by the virus, and you could easily imagine people deciding to blame the governor rather than support him. But that’s not what’s happening. Past disputes are being forgotten. Past oversights are being forgiven. New Yorkers, Marylanders, and Ohioans want to be united, and they only have one governor to unite around. So that’s what they’re doing.

Trump’s problem isn’t us, it’s him. We’re still capable of uniting; he’s just not capable of leading us.

The country tried to unite around Trump. In early April, when he had finally stopped trying to happy-talk the virus into vanishing “like a miracle”, and proclaimed himself a “wartime president”, his disapproval fell below 50% for the first time since early 2017, and his approval rose near 46%, an all-time high.

Democrats were beginning to get seriously depressed about the fall election. In a true rally-round-the-flag moment, it wouldn’t matter that he had been consistently wrong about the seriousness of the virus, or that he had failed to prepare either the government or the public for the battle we are now in. It wouldn’t matter that the economy, which Trump had counted on to be his ticket to a second term, had collapsed. We’d all be in this struggle together, and he’d be leading us.

But that trend fell apart pretty quickly. By this week, Trump’s 538 polling average was back in familiar territory: 52.4% disapproval, 43.4% approval — with the trend line decidedly negative.


How it works. Sometimes we talk about the RRtF effect as if it were a knee-jerk reflex: There’s a crisis, so I’ll support the president. But it’s actually a more complex process than that.

The first thing to notice is that ordinary politics is divisive, while crisis politics is unifying. Ordinarily, our national political conversation is about issues we disagree on: Should abortions be easier or harder to get? Should government do more to help people, or just get out of their way? Do refugees and immigrants continually revitalize our nation, or do they steal opportunities from the native born? Do whites and men have unfair privileges they need to relinquish, or have they yielded too much already?

We’re a two-party system, so we tend to divide into relatively equal sides.

But when a crisis hits, most of us suddenly find ourselves on the same side. When the planes hit the World Trade Center, everybody became a New Yorker. When Nazi Germany surrendered, parties broke out all over America.

Being on the same side, a lot of us find ourselves thinking the same things. After 9/11, a huge majority of Americans were all thinking: “We can’t just let something like this happen to us. We have to find who did it and stop them. We have to make sure nothing like this happens again.”

But at the same time, a crisis makes us feel small in our individuality. It was paralyzing to imagine being in the WTC when the planes hit. What could you have done? And if people on the other side of the world were plotting similar attacks right now, what could you do about it?

That combination of factors creates an opportunity for a leader: When Bush picked up that bullhorn, he spoke for us, and spoke with the strength that we had together rather than the weakness we felt as individuals. (There’s a long conversation to be had about how he misused that strength, but that’s a different topic.) He didn’t say, “Listen to me!” He said “I hear you!” and he promised to channel our unified will into powerful action.

That’s what 90% of America approved of.

The consensus today. If you listen to cable news shows or watch the President’s coronavirus briefings, you might imagine that the virus is an ordinary-politics divisive topic. But it really isn’t. Pretty much everybody is thinking and feeling and wanting the same things.

  • We’re afraid of getting sick and dying, or of passing the virus on to our more vulnerable loved ones and watching them die.
  • We wish we could do something.
  • We’re bored and frustrated with staying at home, but we’re willing to keep doing it if it actually helps.
  • We sympathize with people who have lost relatives or friends without being able to visit them in the hospital or hold their hands.
  • We’re worried about our financial future.
  • We’re rooting for our doctors and scientists to figure out how to beat this thing.
  • We concerned about the long-term effects on our communities. (Will our local shops and bars and restaurants and theaters and stadiums ever reopen? Will they be recognizable when they do?)
  • We miss the lives we used to have.
  • We worry that people will do stupid things to make it all worse.
  • We admire the people who are risking their lives to take care of others, and we feel responsible for the people (grocery workers, meat-plant processors, delivery people) whose jobs require them to take risks on our behalf.

I could go on, but you can probably extend that list yourself.

The arguments we’re having on social media (or that other people are having for us on TV) are mostly artificial. When we talk about reopening businesses, my worry that stupid people will make it all worse may conflict with your desire to get out of the house and your worry that we’ve been wrecking our financial future, but we share all those concerns. Literally everybody wants to restore normal life safely, but none of us know exactly how to do that. We all wish we did.

That consensus creates the opportunity that many governors are using to raise their popularity: They hear us. They’re speaking for us. And they speak with the power we have together rather than the weakness and fragility we feel as individuals.

Why not Trump? The singular virtue that made Trump’s political career is that he has the best-defined personal brand of anyone who has ever run for president. People sometimes say, “You know what he thinks” or “You know where he stands”, but neither of those is actually true. (In reality, he likes nothing better than to get on both sides of an issue and then claim victory no matter how it comes out. Last week I pointed out how he was doing that in regard to reopening the economy, but you can see the same pattern many places. Like China, for example: He’s an anti-China trade warrior, but he also brags about his great relationship with President Xi.)

The real underlying truth is “You know who he is, and he never changes.”

“Who he is” is a divider, not a uniter. The heart of his 2016 campaign was to channel the resentment and anger of rural whites who feel like America has slipped away from them. His whole public persona (and I suspect his personality) is based on resentment. Wherever he goes, he has to define enemies: the Deep State, the fake-news media, Crooked Hillary, Shifty Schiff … it never ends. He recognizes no loyal opposition; those who are against him (or just not for him ardently enough, like Jeff Sessions) are “horrible people”. He couldn’t forgive John McCain, even in death.

Unifying politicians have a way of co-opting their enemies — the way W co-opted the so-called liberal media in the run-up to the Iraq War — but Trump must defeat his. They must visibly surrender and pay tribute to his victory. President Obama found diplomatic roles for George W. Bush to play, as Bush in turn had made use of Bill Clinton. But it’s impossible to imagine Trump asking Obama’s help — despite (or perhaps because of) all the countries where Obama continues to be popular. Obama would have to bend the knee and beg first, and even then Trump would probably refuse (as during the transition, he accepted Mitt Romney’s submission, but refused to offer him a post).

So even trying to speak for the country’s consensus would break Trump’s brand. Who would the enemy be? How could he hold a press conference without demonizing the reporters? How could he be smarter than everyone if he agreed with everyone?

On a deeper level, it would also run counter to his psychology. Look again at Bush’s bullhorn speech. “I hear you,” requires a fluidity of ego that Trump does not have. He is himself, and he is right, and he is better than everybody else. Speaking for the consensus requires putting yourself to the side. Trump will never, ever be able to do that.

Instead, we have the spectacle of his daily briefings, where the reporters are enemies and the doctors are rivals whose loyalty he must constantly assess. The dead are not individuals to mourn and the bereaved are not objects of sympathy or empathy. They are possible sources of blame, and so they must be removed from the spotlight as quickly as possible. There is only one spotlight, and only one person it should illuminate. The opinions that are validated must be his opinions, which he came to first, before anyone else. They can’t be yours or mine or anybody’s but his.

Trump’s Guidelines Aren’t What He Says They Are

Trump’s rhetoric is quite different from what his “Opening Up America Again” plan actually says. The confusion he’s creating doesn’t help fight the virus or boost the economy. (Quite the opposite.) But it will allow him to claim credit for good outcomes while avoiding responsibility for bad ones.

Thursday, the White House released the long-awaited guidelines Opening Up America Again. It was rolled out in a quintessentially Trumpian way, one that will allow him to claim credit for any successes and blame someone else for any failures. This sleight-of-hand is achieved by a simple trick: What the document says is very different from what Trump says about it.

He says it’s a plan by which parts of the country can start relaxing stay-at-home orders almost immediately — even before his previously stated goal of May 1. But if you read the document (and how many MAGA-hatters will bother?) it lists a set of criteria not much different from those put forward by public-health experts all over the world — or by Joe Biden a week ago: a downward trend in cases, a rebuilt stockpile of medical equipment, extensive testing even of those with no symptoms, and exhaustive contact-tracing of those who test positive.

Since no state is anywhere near achieving those criteria, none can use these guidelines to justify opening up anytime in the near future.

You might expect all this open-up/stay-closed confusion to hinder both the economy and the fight against the virus — and you’d be right — but jobs and lives are not the point. The primary goal is to allow Trump to claim vindication no matter what happens.

  • If a state reopens its economy soon and everything works fine, then Trump takes credit for all the jobs gained, because he told them to reopen. Even better, he overruled both Democrats and scientists, who were wrong when he was right. The stable genius wins again!
  • If a state relaxes its lockdown rules, sees a spike in infections and deaths, and has to lock down again, it’s not Trump’s fault that the governor misapplied what was clearly written down in the guidelines. Blame that loser, even if he’s been a loyal Trumpist like Ron DeSantis or Greg Abbott.
  • If a state doesn’t reopen soon, then any economic or psychological distress caused by the continued lockdown is also the governor’s fault, and Trump is the champion of the suffering people trapped in their homes. Liberate Michigan!

It’s a neat trick. Let’s look a little deeper at how it works.

What he says. First off, here’s what Trump is saying:

I think 29 states are in that ballgame, not open enough for opening, but I think they’ll be able to open relatively soon.

Of course “not open enough for opening” is already a big enough loophole to excuse whatever happens. But when asked, he also wouldn’t name any of the 29 states. So no rigorous fact-checking is possible. If you point to, say, South Dakota, which appeared to be in good shape until a sudden explosion of cases this week, he can easily absolve himself with something like: “I didn’t say South Dakota.”

And when is “relatively soon”? Well, on a phone call to the governors, he said:

Some of you are in very, very good shape to open quickly and, if you’d like, according to the guidelines, you could open before the date of May 1.

Once again, though, he didn’t say who “some of you” are. So if any of you open up and it goes badly, you’re not the ones he meant.

And who’s standing in the way of people getting their jobs back, going to the church potluck dinner, or starting the baseball season? Why Democratic governors, of course. Organizations allied with Trump have sponsored anti-lockdown rallies (where some protesters openly carry rifles), and Trump has endorsed them, tweeting “LIBERATE MICHIGAN!“, “LIBERATE MINNESOTA!“, and “LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!“. [1]

In Lansing, gun-toting white male Trumpists raise the patriarchy’s battle cry against women in power: “Lock her up!”

So if you’re facing real hardship during this crisis — or if you’re just bored and resent that you can’t get your hair cut — Trump wants you to know that he’s on your side. If it were up to him, the economy would be booming again. People would be gathering in bars, flying coast-to-coast, and buying standing-room-only tickets for country music festivals. [2]

And the virus? Oh, never mind all that. Trump’s propaganda network is telling his base that the virus is no big deal — pulling false statistics out of their butts, and using the merely 60 thousand deaths predictions of the most optimistic if-we-lock-down models to argue that we don’t need to lock down. [3]

What the guidelines say. In contrast to what Trump himself implies, or the things said explicitly by his mouthpieces at Fox News, the administration’s guidelines take the virus seriously. They set criteria for opening that no state can currently meet, and which probably won’t be achievable for some while.

The guidelines have three phases. To enter Phase 1 (or to progress from one phase to the next), a state has to meet (and then maintain) these criteria:


Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period


Downward trajectory of covid-like syndromic cases reported within a 14-day period


Downward trajectory of documented cases within a 14-day period


Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)


Treat all patients without crisis care


Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

In other words, the virus has to have been in retreat for two weeks, and you have to be prepared for the possibility that loosening restrictions will lead to a new outbreak. But that’s not all. The “Core State Preparedness Responsibilities” section assigns key responsibilities to the states. This is, in essence, a second set of criteria. If you can’t do these things — and no state currently can — you’ve got no business opening up.


  • Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results
  • Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results
  • Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans)


  • Ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need
  • Ability to surge ICU capacity


  • Protect the health and safety of workers in critical industries
  • Protect the health and safety of those living and working in high-risk facilities (e.g., senior care facilities)
  • Protect employees and users of mass transit
  • Advise citizens regarding protocols for social distancing and face coverings
  • Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity

In short, Opening Up America Again says exactly what nearly all the experts (and Biden) have been saying: We need to be doing lots more testing (about triple what we’re doing now, according to one Harvard report), including testing people without symptoms, so that we can figure out who has the virus and spot new outbreaks quickly. Healthcare workers and nursing home workers need antibody testing that is only just now becoming available, and may not be available in the needed quantities for some time. We need to be set up to do extensive contact-tracing, so that we track down everybody who might be infected (again, whether they have symptoms or not).

The healthcare system needs to have slack capacity and rebuilt stockpiles of protective equipment. Key systems like public transportation need to be reconfigured for safe use. Industrial plants (like the meat-packing plant that triggered the South Dakota outbreak) need to be reconfigured to protect workers.

The guidelines also say that public behavior can’t return to normal; you still need to keep away from people when you can and wear masks when you can’t. Keep washing your hands constantly, and self-quarantine if you feel sick.

Businesses that want to reopen need to keep limiting business travel, and shut down or regularly disinfect common areas where workers might otherwise congregate. The guidelines recommend temperature checks at the door for workers and perhaps customers as well.

Does any of that sound like the vision Trump has been putting forward in public? No, of course not. But if states loosen up their stay-at-home orders and something goes wrong, you can bet Trump will point to these Biden-like guidelines as what he really proposed, and completely forget all his contrary statements. “I never told you to do that,” he’ll say. And Fox News and right-wing talk radio will back him up: “None of us ever said to do that.”

And if that butt-covering action requires throwing some Republican governors under the bus — I’m looking at you, Ron DeSantis of Florida — Trump will be more than willing to do it. Whether in business or politics, backing Trump’s play has always been a risky strategy.

The phases. A state needs two weeks of good testing to start Phase 1, then two more weeks to get to Phase 2, then two more to get to Phase 3. So if nothing at all goes wrong, no state can get back to anything resembling normal for six weeks.

In Phase 1, lots of stuff stays closed: schools, day-care centers, camps, bars. Nursing homes and hospitals are locked down against visitors. Gyms, churches, and arenas can open only if “strict physical distancing protocols” are maintained. (Picture a stadium or theater with about 1/10th of the seats occupied and no concession stand.) Out-patient elective surgeries are OK, but not ones that require hospitalization. Businesses should still encourage telework, and redesign their on-site processes for social distancing. As for individuals, you shouldn’t socialize in groups of 10 or more, and keep your distance from people even then. Avoid non-essential travel. Vulnerable people should stay home, and if you live with vulnerable people you need to be able to isolate yourself from them.

In Phase 2, schools can reopen, the limit on social gatherings rises to 50, and you get to travel non-essentially again. Common areas at work should still be closed, and telework continued. Elective surgery with hospitalization is OK. You still can’t visit Mom at the nursing home. Bars can reopen “with diminished standing-room occupancy”, whatever that means. Social distancing protocols for large venues can now be “moderate” rather than “strict”. Vulnerable people should still stay home.

In Phase 3, vulnerable people can come out if they’re careful, and everybody else should minimize time in crowds when not avoiding them altogether. Workplaces can resume “unrestricted staffing”. Bars and gyms can go back to more-or-less normal, but large venues should still maintain “limited” social-distancing practices. You can visit Mom again, if you’re “diligent regarding hygiene” (which Mom always nagged you about anyway).

States are on their own. By listing those “Core State Preparedness Responsibilities”, the Trump administration is denying any responsibility for its failure to create the prerequisites for reopening. Testing, contact tracing, building up PPE stockpiles — those are state responsibilities. So the states shouldn’t count on the federal government to help them get ready to reopen.

But some governors made it clear they are not ready to break out the roadmap, saying they badly need help from Washington in expanding testing.

[New York Governor Andrew] Cuomo, whose state is the most lethal hot spot in the nation and is still seeing over 600 deaths a day, accused the federal government of “passing the buck without passing the bucks.”

“The federal government cannot wipe its hands of this and say, `Oh, the states are responsible for testing.′ We cannot do it. We cannot do it without federal help,” the governor said.

However, Trump will incite citizens to demand — perhaps violently — that their states reopen whether they are ready or not. [4]

Governors out on a limb. In spite of the fact that no state fulfills the prerequisites for Phase 1, several states are announcing some kind of reopening.

Despite Florida hitting a new high for new Covid-19 cases Friday, beaches in Jacksonville, Florida reopened for limited hours. (“This is really a crazy bad idea,” said one resident.) CNN did not see much social distancing. The NY Post reported: “Aerial photos show hundreds of people packing the sand to swim, stroll, surf and fish. Many were without masks.”

Texas Governor Greg Abbott appears to see the trap Trump has laid for him, and so far is doing the same thing Trump is doing: talking in favor of aggressive reopening, but not yet committing himself to anything specific.

Instead of kicking off a full restart, the Texas governor announced that a group of medical and economic experts will guide him through a series of incremental steps aimed at slowly reopening the state’s economy. The group’s aggressive name, the “Strike Force to Open Texas,” belies Abbott’s surprisingly cautious framework. Plans to restart business won’t come until April 27, and Abbott stressed they will be determined by “data and by doctors.”

But unlike Trump, Abbott has no one to pass the buck to. And his base, which belongs more to Trump than to him, is getting restless.

Through the week, as Abbott’s public messaging made it sound less likely that he would announce a grand reopening, he began taking fire from members of his own party who say he’s moved too slowly to reinvigorate the economy and has been overly deferential to public health experts. On Thursday for example, Don Huffines, a former Texas Republican state senator who represented Dallas County, wrote a blistering op-ed for the Austin American-Statesman, excoriated Abbott for his handling of the coronavirus crisis.

Some Republican governors — Mike DeWine in Ohio for one — are standing by their lockdown decisions without waffling. And they are not immune to the Trump-inspired protests, as this Pulitzer-worthy photo from Columbus makes clear.

Attack of the MAGA zombies in Columbus. The woman on the left is a Republican candidate for the Ohio state senate.

But they also must know that Trump will shamelessly throw them under the bus if reopening leads to a new wave of deaths. He has already laid the groundwork to do just that.

[1] If any of this leads to actual violence, of course, that’s not Trump’s fault either. It never is.

Trump advisor Stephen Moore calls these protesters “modern-day Rosa Parks“, because staying home and watching Netflix for a month is exactly like living your whole life under Jim Crow.

And one more thing: None of these demonstrations around the country were more than a few hundred people. Would a similar number of liberals demonstrating for a liberal cause get this much attention? I doubt it.

[2] This vision, of course, is a complete fantasy. The economy can’t recover if we don’t beat the virus.

It’s worth noting that no one has locked down the airlines, but traffic has drastically dropped off anyway, because people very sensibly don’t want to spend hours trapped in a small space with possible carriers of the virus. Iowa has been one of the slower states to respond to the virus, and is not usually considered a hub of liberal hysteria, but The Des Moines Register reports:

Facing a 95% reduction in passenger traffic, Des Moines International Airport officials have closed a terminal, shut down services and delayed projects — including a planned Allegiant Air crew base — to save money during the coronavirus pandemic.

The unprecedented decrease in travelers while Iowans are practicing social distancing follows three years of record-breaking traffic at the state’s largest airport.

Bill Gates makes the point like this:

It’s very tough to say to people, “Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner. We want you to keep spending because there’s maybe a politician who thinks GDP growth is what really counts.”

And Thursday morning I heard CNBC’s Jim Cramer say:

You don’t want to think, “If I go to the movies, I might die.” We’ve got to take dying off the table.

[3] Bill Bennett and Seth Leibsohn write:

The Institute for Health Metrics and Evaluation in Washington state is now projecting 68,841 potential deaths in America. It is also estimating lower ranges than that. The flu season of 2017-2018 took 61,099 American lives. For this we have scared the hell out of the American people, shut down the economy, ended over 17 million jobs, taken trillions of dollars out of the economy, closed places of worship, and massively disrupted civic life as we know it.

But National Review’s Rich Lowry (not usually one of my favorite writers) notes that the lockdown might have had something to do with keeping the death toll down to where it is, and then elaborates:

Consider the perversity of [Bennett and Leibsohn’s] reasoning a different way. If we had shut down the country a month sooner and there had been, say, only 2,000 deaths, then on their terms they’d have an even stronger argument, i.e., “We did all this, and there were only a couple of thousand fatalities?”

In other words, the more effective a lockdown would have been, the more opposed Bennett and Leibsohn would be to it.

[4] Brazil’s President Jair Bolsonaro, who is often likened to Trump, is taking one more step: He’s appearing at anti-lockdown demonstrations that openly call for a return to military rule.

Political observers say the protesters were right-wing Bolsonaro supporters who called for military intervention on behalf of the president because they view the country’s supreme court and legislature as obstacles to his campaign against pandemic lockdown measures, despite the fact that the country has more than 35,000 confirmed cases and over 2,300 deaths as of April 19.

“Now it is the people in power. It’s more than your right — it’s your obligation to fight for your country,” Bolsonaro said, standing on a pickup truck outside the Army headquarters. “We don’t want to negotiate anything. We want action for Brazil.”

My Coronavirus Test

Update: My test came back negative. I don’t have the virus.

Drive-through virus testing at Holy Family Hospital in Haverhill, Mass.

Let me begin this post by saying that, as best I can tell, I’m doing fine. I’ve quarantined myself since Tuesday, but so far my symptoms are somewhere between minor and imaginary. Nonetheless, I got tested Friday, and I should hear results Tuesday or Wednesday.

OK, let’s go back and tell the story from the beginning: My wife has a large number of risk factors, so we are terrified of what would happen should she catch Covid-19. Both of us are in our 60s. She had a lung collapse during surgery several years ago, and it never fully reinflated, so essentially she gets by on one-and-a-half lungs. A different medical problem resulted in half her liver being removed. And she takes a drug that drags on her immune system (though I don’t think it’s that bad; she throws off colds fairly well).

So our household is hyper-vigilant. That gets tricky, because I have a number of conditions that mimic coronavirus symptoms: An allergy causes me to wake up congested every morning and spend my first waking hour coughing and blowing my nose. If I sleep in the wrong position, I’ll have a muscle ache when I do that coughing. As for aches and pains in general, I already mentioned that I’m over 60. In short, most of the early-warning symptoms of Covid-19 are normal for me.

That leaves me focused on the one symptom I don’t ordinarily have, which is fever. Quite the opposite, in fact: My body typically runs cool. A normal morning temperature for me is below 98, and can run as low as 97.4. It tends to rise through the day, but hardly ever hits 98.6.

Anyway, first thing Tuesday, I’m having my morning cough and feeling a little more discomfort in it than usual. I take my temperature and it’s 98.3 — fine for anybody else; not fine for me. And I think “Probably nothing, but …”. And then I think “If you wait until you’re sure, you’ll have waited too long.”

So I call over to my wife, tell her to keep her distance, and explain what’s happening. She grabs some stuff, and goes to occupy a room on the second floor. (While our new apartment is under construction, we’re living on the top floor of a friend’s three-story Victorian. It was bought years ago for a family with five boys, and only two of them are still here.) Except for one trip I’ll describe later on, I’ve been up here by myself ever since. My housemates prepare plates of food and leave them on the steps; I retrieve them like a caged animal. Thank God there’s a bathroom up here.

I expected the temperature thing to resolve itself by Tuesday afternoon, but it didn’t. I kept getting readings that would top out at 99 or 99.1 in the mid-afternoons. (Again, no emergency for anybody else.) Friday afternoon, the digital ear-thermometer I was using went completely wild — I couldn’t get the same reading twice — raising the possibility that the whole episode is an equipment malfunction. By the time I got hold of an old-style mercury thermometer, I was showing more normal temperature patterns, which have continued for the last few days. What to think?

Anyway, Thursday afternoon I emailed my doctor, who did a Zoom-meeting with me Friday morning. She agreed with me that (1) these are pretty sketchy symptoms, and (2) I’m in a situation where I should pay attention to sketchy symptoms. Apparently, though, tests are now plentiful enough to justify getting me one. I suspect that wouldn’t have been true a week before.

There is a drive-through testing site at Holy Family Hospital in Haverhill, Massachusetts, about a 40-minute drive away. (I should add, though, that you can’t just drive up unannounced. They require a physician order.) I went downstairs for the first time in days, was careful to touch nothing until I reached my car, and drove myself to Haverhill.

The picture above is one I took through the windshield. I had to wait in line behind two or maybe three other cars. A young woman swathed in protective garb talked to me through my open window, had me sign a form (with a pen she refused to take back), and stuck a long Q-tip-like thing up each of my nostrils. It was fast, and while I would never do it for fun, it wasn’t that bad. She told me to expect results Tuesday or Wednesday. (Those 15-minute tests you’ve been hearing about apparently aren’t in wide use yet.) Results would go to my doctor, and I shouldn’t call Holy Family. Meanwhile, she said, I should consider myself quarantined for 14 days or until I get a no-infection result.

So now I wait. And in truth, I’m not even sure what I’m rooting for. No infection would be nice, but in some ways the best result of all would be to get away with a minor-symptom case and then have some kind of immunity. On the other hand, I also have heard stories of minor symptoms that suddenly turn bad, so I get anxious every time I start to feel tired. It would be nice to have that over with.

I’ll update this post when my results come in.

The Speech a Great President Would Give Now

If we’re ever going to have great presidents again, we need to hold a space in our imaginations that a great president could occupy.

Ever since Donald Trump made his famous descent down the escalator to announce his candidacy (and assert that Mexicans crossing the border are rapists), we’ve been lowering our standards to his level. Once in a great while he does something so outrageous that his opponents try (and usually fail) to draw a line in the sand. But for the most part we’ve just accepted that he will do the kinds of things he does: ignore obvious facts, insult large swathes of people who have done nothing to deserve it, funnel public money into his own businesses, deny that he said what he said, respond to his critics with schoolyard taunts, and so on. We’ve come to expect him to politicize everything, admit no mistakes, fire anyone who reveals inconvenient truths, and confront everyone who comes into his presence with the choice to flatter him or face his wrath.

At times I’ve been as guilty of this normalization as anyone. Given a choice between letting a lie or injustice go unremarked, and distracting my readers from what I saw as more important issues, I’ve often just shrugged off norm-violations that would have been major scandals in any previous American administration.

Still, every now and then I think it’s worthwhile to ask ourselves: “What would a real leader do in this situation?” Not because I imagine Trump will listen to our answer, slap his forehead, and say, “That’s a good idea!”, but just to maintain our own sense of what is good and right. If we’re ever going to have great presidents again, we need to hold a space in our imaginations that a great president could occupy.

So I have written a speech for a great president to deliver in the midst of the current crisis. There’s no reason Trump couldn’t deliver it, and I hope he does. For obvious reasons, he won’t. I accept that, but I’m still going to put the vision out there.

My fellow Americans:

Every president faces crises and makes decisions that could either save or cost lives. I have already faced my share: military conflicts in various parts of the world; hurricanes in Texas, Florida and Puerto Rico, as well as floods and tornadoes and the full run of other natural disasters. An economic crisis may not take as many lives as war or disease, but it can ruin lives, as people lose their jobs and homes and dreams for the future.

The current crisis, the one brought on by the coronavirus pandemic, is on a scale most presidents never need to confront. Thousands of Americans are dead, and some estimate that the eventual toll could be in the hundreds of thousands, or even millions. Hundreds of thousands of Americans are already sick. Tens of thousands of businesses hang in the balance, and millions of Americans have lost their jobs. Tens of millions are sheltering in their homes.

This is not only the greatest crisis of the four-year term I was elected to in 2016, but most likely it will overshadow the crises of the next four years as well. So whether I serve four years or eight, I believe I have already met the defining challenge of my presidency, the one for which history will judge me.

Public-health experts I trust tell me that we will go through the peak of this crisis in the next month or two. No one can guarantee what will happen after that, but I think it is safe to say that the most important chapters in the story of this pandemic will be written between now and the inauguration in 2021.

It is desperately important that we get this right. The decisions that are made between now and November or January — here in the White House, in Congress, throughout government at every level, and in homes all over this country — could save or cost the lives of countless human beings, and save or cost the livelihoods of countless more. When the stakes are this high, we can’t let politics interfere with doing the right thing.

And yet, how can it not, as we move towards the 2020 election? Already, both my supporters and my critics interpret everything I do in the light of that election. I deserve credit for this, blame for that — no I don’t, yes I do — it goes on and on. But none of those arguments save anyone. They just make it harder for America to move forward in unity.

When this is all over, there will be plenty of time to distribute credit and blame. There are undoubtedly many lessons to learn — both good and bad — from what we have done so far. But trying to do that analysis in the middle of the crisis, and absorbing that discussion into what was already a poisonous partisan environment before Covid-19 emerged, does not serve this country. Partisanship can only decrease the likelihood that we will judge correctly, or learn the lessons that might save us from the next plague.

Right now, there are many things I wish I could do for this country, but they are beyond my powers. I can’t banish the disease by executive order. I can’t decree a vaccine or effective treatment into existence here and now. I can’t speed time up so that we jump past the peak of the crisis and skip all the suffering Americans will have to endure in the coming weeks and months.

But there is one thing I can do: To a large extent, I can take partisan politics out of this struggle, and I’m going to do that right now with this announcement: I will not be a candidate for re-election in November, nor will I endorse any candidate in that election. Instead, I will lead the battle against this disease until my term ends in January.

The election will still happen, and I’m sure the candidates who vie to replace me will debate their views and their plans with all the vigor we expect from a presidential campaign. But I will take no part in it. If any members of my administration want to participate in that election, God bless them, but I will ask them to step away from whatever active roles they might be playing in managing our country’s response to the virus.

I cannot insist that others follow my example. But I can ask political leaders at all levels to do what they can to take partisan politics out of this effort. Most of us tell ourselves that we entered politics to do something important. Let me suggest that nothing you might do in future years from future offices will be quite so important as what you do these next few months. Lives and livelihoods are at stake.

Going forward, there are many choices to make, and I expect to hear much argument about what should happen next. A healthy democracy always has room for disagreement. But let those discussions center on the health and well-being of our citizens, not on the November elections, and especially not on me. My political future is already set: I will finish my term and then return to the private sector to await history’s judgement on my actions. I pray history will be able to say that I rallied a unified nation to take decisive and successful action.

God bless you all, and God bless the United States of America.

How the Economy Restarts

It’s not going to happen soon or fast, but maybe the process begins by June.

Sadly, any serious article about restarting the economy has to begin by brushing aside the misinformation coming from the White House.

Disclaimers. The economy cannot be restarted safely any time soon.

It won’t happen on Easter (as the President was envisioning Tuesday, but has since backed off of). We won’t even reach the peak daily death total by Easter (as he predicted yesterday). If we’re lucky, we might see the daily new-cases totals peak by then, but deaths trail diagnoses by at least a week. (Italy’s new-cases peak was March 21. Deaths might or might not be peaking now.)

Public health experts agree that certain conditions and capabilities need to be in place before it will be safe to relax social distancing practices, open non-essential businesses, or allow people to start congregating. Those conditions and capabilities aren’t in place now and won’t be for at least several weeks, and probably longer. Trump’s notion that the country will be “well on our way to recovery” by June 1 seems wildly optimistic.

The talking point that shutting down the economy to stop the virus is “worse than the problem itself” (which Trump tweeted a week ago yesterday) is nonsense. COVID-19, unchecked, could kill millions of Americans (which Trump finally admitted yesterday: “Think of the number: 2.2 million people, potentially, if we did nothing.”) The idea that the economy might putter along normally while people are dying in those numbers is just absurd. (I think of this as the Masque of the Red Death theory.)

The supporting talking point that “You are going to lose a number of people to the flu [i.e., coronavirus], but you are going to lose more people by putting a country into a massive recession or depression” is likewise nonsense. Not only won’t a depression kill millions of Americans, the effect usually goes the other way: Lower economic activity means fewer overall deaths, mostly because traffic deaths and heart attacks go down.

We find that in areas where the unemployment rate is growing faster, mortality rates decline faster. So during the Great Recession in the U.S., we saw increases in the unemployment rate of about 4-5 percentage points, so that translates to about 50,000 to 60,000 fewer deaths per year

Smithsonian magazine looked further back and found that “The Great Depression had little effect on death rates.”

Prerequisites. OK, now that the decks have been cleared of some widely distributed bad information, we can start talking sensibly about how the economy restarts

Let’s start with the prerequisite conditions. Dr. Thomas Inglesby of Johns Hopkins listed five:

  • The number of new cases starts going down over time.
  • The health system can quickly and reliably test people who may have been exposed to the virus, even if their symptoms are minor or non-existent.
  • Caretakers have a sufficient supply of masks and other protective equipment.
  • Hospitals have sufficient resources: ventilators, ICU beds, etc.
  • Systems are in place to trace the contacts of any new cases.

These five conditions are consistent with what Anthony Fauci and other public-health experts have been saying. Together, they paint a picture of a South-Korea-like containment: The virus hasn’t been eliminated, but the public health system has identified and isolated almost everyone in a region who is infected. As new outbreaks happen, they can be quickly found and traced, so that the newly infected can also be identified and isolated. Moreover, public health workers have the means to protect themselves, so that a new virus outbreak won’t break the system.

It should be obvious that those conditions don’t exist now. Even in New Rochelle and Seattle, early hotspots that took early action, the optimistic story is that the rate of increase in cases is down, not that the number of cases has actually peaked. (The curve is being bent sideways rather than bent down.) Some parts of the country, particularly rural areas, have not seen large numbers of cases yet. But their numbers are increasing and none of them have the virus contained in the way the experts envision. Tests are not as rare as they were a week or two ago, but the number needed has grown to stay ahead of the number provided, so they still are not plentiful. Better and quicker tests have been developed, but are still not widely available.

Perhaps the best evidence that ventilators and masks are scarce is that Trump has stopped denying it and started finding other people to blame for it.

It’s worth pointing out what’s not on this list: a vaccine or a magic anti-viral treatment that changes the whole nature of the struggle. Such advances will happen eventually, but almost certainly not in the next few months, and maybe not for a year or more.

First steps. So it’s not happening tomorrow or next week, but you don’t have to wear rose-colored glasses to imagine a time when the prerequisites have been fulfilled. No matter how bad the pandemic gets, the number of cases has to peak eventually. Tests exist and are being manufactured in ever larger numbers. Ditto for hospital equipment. Infection-tracking systems work in other countries and could work here.

So it’s anybody’s guess how long it will take to get there, but we will get there. And what happens then?

Ezekiel Emmanuel envisions how a restarting process might go. He pictures a nationwide shelter-in-place policy lasting until about June (except in places — are there any? — with so few cases that public-health officials can already track them all), during which he imagines achieving more-or-less the same things Dr. Inglesby described:

State and local health departments then need to deploy thousands of teams to trace contacts of all new Covid-19 cases using cellphone data, social media data, and data from thermometer tests and the like. We also need to get infected people to inform their own contacts. It would be easier to lift the national quarantine if we isolate new cases, find and test all their contacts, and isolate any of them who may be infected.

The national quarantine would give hospitals time to stock up on supplies and equipment, find more beds and room to treat people, get better organized and give clinical staff a respite to recuperate for the next onslaught of Covid-19 care. Without these measures, any Covid-19 resurgence would be far harsher, and economically damaging.

Whether all that happens by June or not is debatable. But even with those capabilities in place, the restart happens gradually. Nobody flips a switch or makes an all-clear announcement.

The first people Emmanuel would send back to work are those who have recovered from the virus and provably have anti-bodies to resist reinfection. And even they would need some rigorous training in safe working procedures: frequent hand-washing, avoiding unnecessary contact with others, etc.

Next, low-risk parts of the population could be allowed to congregate, while higher-risk people continue to shelter in place: Colleges might be allowed to hold in-person summer sessions. Summer school, camp, and daycare for K-12 children could be attempted — with ubiquitous testing to spot any viral resurgence.

If that works — it might not, and then retreats would have to happen — public venues could slowly start returning to almost-normal: Offices, libraries and museums, and bars and restaurants could re-open, but with reduced occupancy limits. (I heard a Starbucks executive interviewed on CNBC. He described the gradual reopening of Starbucks outlets in China: First take-out only, then dine-in with one person per table, then dine-in with at most two people per table.)

This is hardly a let-it-rip vision, and I think that it ultimately relies on some kind of treatment or vaccine developing: The economy isn’t completely closed down, but limps along for a year or so until medical developments rescue it.

Herd immunity. Thomas Friedman has tried to popularize a more ambitious opening envisioned by David Katz, who IMO gives way too much credence to the economic-contraction-will-cost-lives theory. The argument here is to focus on protecting the vulnerable (mainly the elderly), while letting the less-vulnerable behave more-or-less normally.

Even here, though, the same ideas show up: A period of lockdown, during which ubiquitous testing and research give us a much better idea of who has the virus, how it spreads, and who the vulnerable really are. (Some young people are dying too.) There is, I think, too much optimism about how quickly this period could be brought to a close. (Katz proposed two weeks, which is already about to expire without the kind of testing availability his plan needs.)

Once the vulnerable are sequestered — how you keep vulnerable parents away from their virus-exposed children and grandchildren is never specified — the virus spreads more-or-less harmlessly among the rest of the population, resulting in ever more recoveries with corresponding immunity. (We’re not totally positive immunity happens or how long it lasts, but it’s a reasonable theory.) The ultimate result is a general population with enough herd immunity that the virus no longer spreads like wildfire. As time goes by, then, more and more of the vulnerable can return to society.

Science Alert’s Gideon Meyerowitz-Katz dissents on this view: Herd immunity requires something like 90% of the population to be immune, and 20% of COVID-19 infections are serious enough to require hospitalization. So if you picture even the minimal overlap, about 10% of the population winds up being hospitalized. That will break the health-care system, even if it manages to save almost everybody — which it probably won’t.

So again, I think some kind of treatment or vaccine has to appear before the economy gets back to hitting on all cylinders.

Summing up. In every re-opening vision I’ve seen, conditions more-or-less like Dr. Inglesby’s have to be met first, and it’s hard to picture that happening much before June. By then, the $1,200 checks the government is sending out will have been used up long ago, so another trillion or two or three will have to be spent, both to keep people eating and to supply the public-health system with what it needs to get through the crisis.

And there’s not going to be an everybody-come-out-now announcement. Re-opening will happen slowly, and probably in fits and starts. Some things will reopen too quickly, start a new outbreak, and have to close again. Some new habits will have to continue for a long time, and maybe we will never go back to washing (or not washing) our hands the way we used to. Cubicle-farm offices may never reopen with the same density. Business travel may never recover. Working from home may become permanent for many jobs, or working-from-home augmented by rare trips to the home office.

When will we be able to pack into stadiums again? Or elbow-fight for armrest-space in theaters? That will probably have to wait for a vaccine, which is at least a year away.

Interesting (but not necessarily important) Questions and Answers about the Pandemic

You don’t really need to know any of this, but I found it engaging.

The major media is sensitive to the criticism that they’re raising panic, so they garnish their we’re-all-going-to-die coverage with practical information for those of us stuck at home. These public-minded segments answer important practical questions like: What should I do if I get sick? What’s the right way to wash my hands? What disinfectants kill the virus? How should I practice social distancing? And so on.

I’m sure you’ve seen most of those questions discussed more than once, so I’ve just linked to sample articles without rehashing. That kind of stuff isn’t what this post is about.

But you can’t have this many people focusing on a single subject without a few interesting things getting written. The questions below may not have the practical importance as the ones above — some are entirely frivolous — but in my purely idiosyncratic opinion, they’re fascinating.

Why are people hoarding toilet paper? I’ve observed it locally and heard reports from all over the world: Hoarders have been cleaning out stores’ supplies of toilet paper. Numerous Facebook friends posted pictures of empty shelves, while others traded tips about which stores might still have a few rolls.

Most of the other empty shelves in the supermarket have made some kind of sense: There are clear reasons why wipes and hand sanitizers are in demand. And masks; you can argue about how effective they are, but they’re an obvious thing to try. Everybody suddenly wants to disinfect their counters and other surfaces, so it’s been hard to find bleach. (All those over-priced organic no-harsh-chemicals cleaning products are suddenly much less desirable.)

But hoarding toilet paper? Economist Jay Zagorsky points out in The Boston Globe that classical supply-and-demand economics has no justification for it. Other than the hoarding itself, there’s no demand problem: The pandemic doesn’t make us use additional toilet paper. There’s also no supply problem: The US makes 90% of its own toilet paper, and most of what we import comes from Canada and Mexico, where transportation is working just fine.

So why, then? When pragmatic thinking comes up short, it’s tempting to look for psychological explanations. So Time goes Freudian:

What is it about toilet paper—specifically the prospect of an inadequate supply of it—that makes us so anxious? Some of the answer is obvious. Toilet paper has primal—even infantile—associations, connected with what is arguably the body’s least agreeable function in a way we’ve been taught from toddlerhood.

And Niki Edwards from the Queensland University of Technology (evidently they’re hoarding toilet paper “down under” too) echoes:

Toilet paper symbolises control. We use it to “tidy up” and “clean up”. It deals with a bodily function that is somewhat taboo. When people hear about the coronavirus, they are afraid of losing control. And toilet paper feels like a way to maintain control over hygiene and cleanliness.

Other writers (I’ve lost the references) point out that while hoarding toilet paper is an irrational response to the pandemic, it’s not that irrational: Toilet paper is easy to store, it doesn’t go bad, and you will eventually use it up.

But I think Zagorsky ultimately has the best explanation. It’s economic, but comes from behavioral economics rather than classical economics: When people feel endangered, they instinctively want to eliminate the risk rather than mitigate it. So when faced with a risk we can’t eliminate completely, we are tempted to divert our attention to a related risk we can eliminate, even if it’s not the main thing that threatens us. (The economic term for this is zero-risk bias.) So the logic of the toilet-paper hoarder is most likely to go something like this: “Maybe we are all going to die, but at least I won’t run out of toilet paper.”

How does soap kill viruses? Most of us learned about soap long before we learned about science, so soap holds an almost magical significance for us. But now that we’re washing our hands twenty times a day, it’s hard not to wonder if we’re being superstitious: I know Mom said it was important, but … really?

The answer turns out to be: Yeah, really. Simple soap, the stuff that’s older than recorded history, kills all sorts of viruses. The NYT’s Ferris Jabr covers this pretty well. The full article has a lot of fascinating detail, but here’s the gist:

Soap is made of pin-shaped molecules, each of which has a hydrophilic head — it readily bonds with water — and a hydrophobic tail, which shuns water and prefers to link up with oils and fats. … When you wash your hands with soap and water, you surround any microorganisms on your skin with soap molecules. The hydrophobic tails of the free-floating soap molecules attempt to evade water; in the process, they wedge themselves into the lipid envelopes of certain microbes and viruses, prying them apart.

Now that I can’t go to bars, restaurants, and performances, what should I binge-watch on TV? If you’d asked me last fall, I would have picked out March as a particularly good time to be housebound, because I usually spend large chunks of the month couch-potatoing in front of the NCAA basketball tournament. If I have any TV time still available, NBA teams are maneuvering for playoff positions, and hope springs eternal in baseball’s spring-training games.

Well, that plan didn’t work out. But in the streaming era we still have plenty of choices about what to watch.

There are two basic theories here: One says you should use the opportunity social distancing provides to catch up on all the high-quality classics you’ve missed. The other says that life in near-quarantine is stressful enough, so you should chill out by watching stuff as comforting and unchallenging as possible. (In other words, “The Walking Dead” or “The Strain” might not be a good choice right now.)

If you go the high-quality route, I recommend signing up with HBO and watching all five seasons of “The Wire”. Now that “Game of Thrones” is complete, going back to the beginning and seeing how it all hangs together is a worthy project I still haven’t tackled. I’ve also recently gotten the PBS app, through which I’ve streamed “Poldark”, “Sanditon”, “Vienna Blood”, “Modus”, and now “Beecham House”.

But that’s just me. For expert advice, check out The Guardian’s “100 best TV shows of the 21st Century“.

On the other hand, comfort TV (like comfort food) is too personal to find on some expert’s list. I recommend thinking back to some long lost era of your life and recalling what your favorite show was back then. When I ask that question, I drift back to the 80s and remember that I haven’t seen most episodes of “Star Trek: The Next Generation” in at least 30 years.

A third option entirely is to surprise yourself with something you’ve never heard of before. Decider has 10 suggestions, most of which you can find on NetFlix. (I can vouch for “Slings and Arrows”.)

What is “flattening the curve”? And why does it help? The whole point of everything closing and people staying home is to “flatten the curve”. A bunch of sources have images that illustrate curve-flattening. Here’s the one from Wired:

(The Washington Post also has some fabulous graphics that simulate disease spread.)

Left to their own devices, epidemics spread exponentially as long as there are still plenty of new people to infect. And when something bad grows exponentially “everything looks fine until it doesn’t.” The mistake Italy made was to wait until it had a significant number of cases before it started shutting everything down. The right time to shut everything down is when that still seems like a ridiculous over-reaction. (If you do it right, the spike in cases never arrives, and critics conclude that you didn’t know what you were talking about.)

If the number of cases rises too fast, the healthcare system gets swamped, which leads to a whole new set of problems. (It’s bad enough to be sick, but it’s much worse to be sick when nobody has any place to put you.) Social distancing is supposed to slow down the spread, in hopes that the healthcare system might be able to deal with it.

That’s why you eliminate big-arena sports events and other large gatherings — so that one sick guy can’t infect 50 or 100 others. If you can’t stop the virus, make it work harder — it will spread by infecting two people here and three people there, not dozens at a time.

There’s also some hope that if you slow down the virus enough, you can affect not just the distribution of cases, but their total number as well. That’s the lesson of how two cities handled the 1918 Spanish flu.

What the heck did the UK just decide to do? Experts around the world advise that governments shut down places where people meet, encourage social distancing, and hope to flatten the curve. But in United Kingdom, Prime Minister Boris Johnson’s government has a different idea.

On Friday, the UK government’s chief science adviser, Sir Patrick Vallance, said on BBC Radio 4 that one of “the key things we need to do” is to “build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.”

The “herd immunity” notion is easy to make fun of, because it sounds like a let-the-virus-run-wild model. But it’s a little more nuanced than that.

A UK starting assumption is that a high number of the population will inevitably get infected whatever is done – up to 80%. As you can’t stop it, so it is best to manage it. … The [UK’s model] wants infection BUT of particular categories of people. The aim of the UK is to have as many lower risk people infected as possible. Immune people cannot infect others; the more there are the lower the risk of infection. That’s herd immunity. Based on this idea, at the moment the govt wants people to get infected, up until hospitals begin to reach capacity. At that they want to reduce, but not stop infection rate.

I understand this through a thought experiment: Imagine that you had some foolproof way to keep the uninfected-but-vulnerable part of the population safe for a limited time. (Imagine you shot them into orbit or something, but you couldn’t leave them up there forever.) One thing you might try is to have the rest of the population — the Earth-bound part — get sick and recover as fast as possible. Then when the vulnerable people came back, the virus would have a hard time finding them, because they’d be surrounded by people who had developed immunity.

Go back to the Philadelphia/St.Louis graph above. Philadelphia certainly made the wrong choice for its citizens, but if you had managed to hide in a deep mine shaft until November 20 or so, after you came out you’d do much better in Philadelphia.

So the UK government is advising people over 70 (and other vulnerable folks, I suspect) to “self-isolate” while younger and stronger people get sick.

It’s not a completely insane idea, but I’ll be amazed if it works.

How did the Federal Reserve “inject” $1.5 trillion into the economy? And where’s my share? On Thursday, the Fed announced that it was “injecting” $1.5 trillion into the economy. Immediately, progressive social media lit up with comparisons to the cost of Medicare For All or the Green New Deal. Bernie Sanders, for example, tweeted:

When we say it’s time to provide health care to all our people, we’re told we can’t afford it. But if the stock market is in trouble, no problem! The government can just hand out $1.5 trillion to calm bankers on Wall Street.

Vox explains why this is an apples-to-oranges comparison. The Fed didn’t spend the money, it loaned it to banks (at interest, with collateral). The point of the Fed’s move is that loan demand is about to spike: As events get cancelled and people stop traveling and going out, businesses that used to make a profit are going to lose money for a while. The only way they’ll keep going is if they get loans. The Fed’s loans to banks will turn into business loans that hopefully will make the difference between, say, Jet Blue having a disappointing quarter and Jet Blue declaring bankruptcy.

If things work out as expected — the disruption from COVID-19 lasts for a quarter or two, and then the economy more-or-less goes back to normal — all the loans will be repaid and the Fed will get its money back.

That wouldn’t happen if the Fed created money and spent it on healthcare or infrastructure or something else. Whether or not those things would be good ideas, they’re not anything like creating money and loaning it to banks.

It should be fairly obvious that a repo market intervention isn’t like, say, printing $1.5 trillion to pay for an expansion of health care. If the Fed funded Medicare-for-all that way, it would not get $1.5 trillion back plus interest. It would just spend a whole lot of money on doctor’s and nurse’s salaries, MRI equipment, hospital mortgages, etc., and never get it back.

A better comparison might have been the housing crisis of 2008-2009. If the homeowners who couldn’t pay their mortgages were good bets to have future income, and if the houses themselves were worth enough to cover the loans, then it might have made sense to create money to keep those households going until the Great Recession was over. That would have been a similar loan-and-get-repaid scenario. But that kind of retail transaction would require a different kind of institution: something more like the post-office banks Senator Warren has proposed.

What does the COVID-19 virus actually look like? Part of the terror of classic plagues like the Black Death was their invisibility: You barricaded yourself in your home to hide from something you couldn’t see. But with today’s advanced microscopy, we’re not only able to see the virus, but to start designing the antibodies we need to beat it.

Let’s blow that last quadrant up a little more:

Coronavirus Reaches My Town, and other notes

COVID-19 reached my town this weekend. There’s been a case at the regional hospital and some local household is self-quarantining while waiting for test results. We’re still a long way from people dropping dead in the streets — I’ve read Defoe’s A Journal of the Plague Year, so my imagination drifts in that direction — but nearby cases do get my attention. Preparations that seemed speculative a week ago are looking more pragmatic.

The current information, as of this morning, from Live Science:

About 564 people in the U.S. have been confirmed to have the virus. Of those, 22 people have died, with deaths in Washington (18), California (1) and Florida (2). (Globally, more than 111,000 cases have been confirmed, with 3,892 deaths.)

The percentage of US deaths (22/564 = 4%) is higher than you would expect, which probably indicates that we actually have many more cases, but haven’t found them yet. That would be because of the glitches in our testing process.

However, on Saturday (March 7), Dr. Stephen M. Hahn, FDA Commissioner, said that 1,583 people in the U.S. have been tested for COVID-19 through the CDC tests.

For comparison, South Korea is testing 15,000 people per day, and has tested 196,000 to date. The containment efforts of American local health officials have been undercut by the lack of tests. As a result, some people are being quarantined unnecessarily while others are undiagnosed and spreading the virus freely.

Just about everything connected with the virus is uncertain, so any projections should be taken with a grain of salt. I haven’t been able to find much in the way of numerical projections by qualified experts, so I will pass along (with reservations) a link to the calculations of bio-engineer (not epidemiologist) Liz Specht, who is getting quoted by a number of other people. Her main point is that if current trends hold, the US healthcare system will get swamped.

She assumes 2000 US cases on March 6 — acknowledging that the number of confirmed cases is much lower, but increasing it to adjust for the lack of testing. From there she assumes that cases double every six days which is “a typical doubling time across several epidemiological studies“. Obviously, doubling like that can’t go on forever, because the number of cases would eventually exceed the population of the planet. But it could go on for quite a while, as long as the number of infected people remains small relative to the general population.

We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on.

Bad as that sounds, it’s in some ways less alarming than the projection on a slide that was presented at an American Hospital Association webinar on February 26 by Dr. James Lawler of the University of Nebraska Medical Center:

(Business Insider published the slide, but doesn’t appear to have Lawler’s cooperation; the associated article doesn’t fully explain what the slide means. I’ll observe that since Lawler’s doubling time is longer than Spect’s, his epidemic has to continue well into the summer to get 96 million cases. Some people are still hoping for seasonality, noting Singapore’s success containing the virus in a hot climate. But the World Health Organization is skeptical: “It’s a false hope to say, yes, that it will disappear like the flu. We hope it does. That would be a godsend. But we can’t make that assumption. And there is no evidence.”)

Anyway, Spect continues:

The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc). Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. [Lawler’s slide estimates 5%.] … By this estimate, by about May 8th, all open hospital beds in the US will be filled.

A similar calculation has American hospitals running out of masks for its workers to wear while treating COVID-19 patients. That means health-care workers will start getting sick in fairly large numbers, leading to a shortage of them too.

Her point is not that we should all panic, but that we should all pitch in and do whatever we can to slow the spread, in hopes of mitigating the worst possibilities. So: wash your hands, stay out of crowds, cancel unnecessary gatherings, and so on. If you get sick, plan on self-quarantining and riding it out at home if you possibly can.

Now, about that lack of testing. The World Health Organization had a COVID-19 test that it was shipping all over the world — but not to the US — by the end of February. The initial batch of tests made by the CDC were defective, so all over the country, public health officials have been proceeding on guesswork: We can’t be sure who is infected and who isn’t, so our efforts to track and contain the virus have been crippled from the start.

Why the United States declined to use the WHO test, even temporarily as a bridge until the Centers for Disease Control and Prevention could produce its own test, remains a perplexing question … But neither the CDC nor the coronavirus task force chaired by Vice President Mike Pence would say who made the decision to forgo the WHO test and instead begin a protracted process of producing an American test, one that got delayed by manufacturing problems, possible lab contamination and logistical delays.

Reportedly, many more tests will be available soon. But in the meantime, Trump’s solution is to lie about it:

But I think, importantly, anybody, right now and yesterday, that needs a test gets a test. They’re there, they have the tests, and the tests are beautiful. Anybody that needs a test gets a test.

That claim was made Friday, during a tour of the CDC Trump did while wearing his campaign hat “Keep America Great”. Wired reporter Adam Rogers commented:

As a reporter, in general I’m not supposed to say something like this, but: The president’s statements to the press were terrifying. That press availability was a repudiation of good science and good crisis management from inside one of the world’s most respected scientific institutions. It was full of Dear Leader-ish compliments, non-sequitorial defenses of unrelated matters, attacks on an American governor, and—most importantly—misinformation about the virus and the US response. That’s particularly painful coming from inside the CDC, a longtime powerhouse in global public health now reduced to being a backdrop for grubby politics.

The Dear Leader bragged: “I like this stuff. I really get it. People are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.” (If his meeting Monday with pharmaceutical executives was any indication, more likely the doctors were surprised by how incredibly ignorant Trump is.)

He clearly cared much more about his own credit or blame than about Americans facing a potentially deadly disease:

Trump repeatedly sought to judge his administration’s performance by the numbers of how many have been shown to have contracted the virus and comparing it to other nations — and, in doing so, appeared to be making judgments based solely on that scorecard.

He declared he would prefer to keep the thousands of passengers and crew on the cruise ship [Grand Princess] off the California coast aboard the vessel rather than bring them ashore for quarantine, though he acknowledged that Vice President Pence and other top aides were arguing for the ship to be brought to port.

“I like the numbers being where they are,” Trump said. “I don’t need the numbers to double because of one ship that wasn’t our fault.”

Steven Colbert’s Late Show satirized the Grand Princess situation with the song “The Bug Boat“.

Trump’s attempt (amplified by Fox News) to minimize the danger of the virus has real-world consequences. Jelani Cobb tweeted:

Overheard from the person in front of me on line at CPAC last week: “I don’t believe anything the CDC says about this virus. It’s full of deep staters who want to use this to create a recession to bring down the President.”

Meanwhile, Senator Ted Cruz is self-quarantining after coming into contact with a carrier of the virus at CPAC.

Now we get to the economic effects.

You may be wondering why the virus is causing such huge disruptions in the investment markets. No matter how bad the outbreak gets, the worst will probably be over in a few months. In a year (or at most two), COVID-19 should be gone completely, with the vast majority of people fully recovered and ready to be as productive as ever. (The worst epidemic in modern history, the Spanish Flu of 1918-1919, was followed by the Roaring 20s.) So why are stock markets plunging and long-term interest rates at record lows?

The answer is that the virus is a shock to the system, and it’s hard to predict what else might break because of that shock. Say you run an airline. A year from now people are probably going to be flying at the same rates as before and your airline should be as profitable as ever. But what if you don’t get there? Airplanes are expensive and you borrowed a bunch of money to buy yours. That looked like a sound investment decision at the time, because your company had plenty of profits to pay the interest with. But now people afraid of catching COVID-19 have stopped flying, companies have cancelled business trips, and all your profits have gone poof.

But your debt is still there, demanding repayment. And so you may be bankrupt by the time air travel picks up again. Viruses infect people, not airlines. But an airline might die from the secondary effects. Ditto for small businesses that rely on people going out in public, like restaurants and bars. Demand for their services will certainly return to normal in 2021, but they might be out of business by then. And once businesses start closing and companies start going bankrupt, a cascade can start. One company lays off its employees, and then the businesses that serve those employees are in trouble too. One defaults on its debts, and now its creditors face bankruptcy as well. When the dominoes start falling, it’s hard to predict how far the collapse will go.

The Great Recession of 2008 may have started with people defaulting on their mortgages. But things didn’t really break until Lehman Brothers went bankrupt. Eventually, people who had nothing to do with real estate were losing their jobs. The demand-drop and supply-disruption caused by the virus is like the mortgage defaults. We’re waiting to see if this cycle will have its own Lehman Brothers.

Over the weekend, one possible candidate raised its head: Russia and Saudi Arabia have been arguing about how to play the drop in the oil market, with the Saudis wanting oil-exporting countries to cut production and prop up the price, and Russia hoping to use the price drop to drive more expensive producers (like the shale-oil companies in the US) into bankruptcy. This weekend, the Saudis essentially said, “If that’s what you want, Mr. Putin, we’ll give it to you good and hard.” They increased production and drove the world oil price down to $27 a barrel. (It was $63 in January.)

The US stock market opened down about 7%, with the Dow falling over 1800 points.

Such a huge price drop in oil is its own shock to the system, and it’s hard to predict what might shake loose next.