Tag Archives: public health

Neglected political issues I: Life expectancy

May 29, 2023 – 10:31 am

A number of decades ago, I attended an Arlo Guthrie concert. A presidential primary campaign cycle was heating up — probably 1980, but I’m not sure. Guthrie, in his wise-fool persona, claimed to be anxious about the state of the nation because “All these people on TV, they’re telling me we need leadership and we’re just not getting it.” Then he described how on some recent evening, just before going to bed, he had brushed his teeth and then looked in the mirror and asked himself: “Arlo, did you need leadership today?”

That line was funny — and continues to be funny years later — because it captures the disconnect between political rhetoric and our actual lives. Guthrie’s joke is on us, and how easily manipulated we are. In the heat of a campaign, it’s easy to become either excited or enraged over some “issue” that (when you boil it down) really has no effect on either yourself or anyone you know or care about, and may be little more than a phrase or an image.

And so, during his campaign launch Wednesday, Ron DeSantis talked about the “the woke mind virus”, “woke ideology”, and “critical race theory”. The Republican he hopes to catch up to, Donald Trump, spends most of his speeches talking about his persecution by the Deep State. He offers to replace President Biden’s “weakness” with his own “strength”. Kevin McCarthy and Republicans in Congress have been focused on America’s “spending problem”, an issue whose lack of substance I examined a few weeks ago.

Any of those “issues” might take the place of Guthrie’s “leadership”. I can imagine myself staring into my own bathroom mirror and asking, “Doug, did you need protection from the woke mind virus today?”

Meanwhile, President Biden has been spending his time trying to avoid crashing into the debt ceiling, a looming disaster that is real enough, but is also entirely manufactured. Rather than solve our problems, politicians have created a new one to wrestle with.

Isn’t it wonderful that the external world isn’t presenting any challenges that require our collective action?

Well, except for climate change. Biden seems to know about that problem, but it was all he could do this week to avoid rolling back the anti-climate-change parts of the Inflation Reduction Act. Despite governing a state that will soon start vanishing under rising oceans, DeSantis seemed oblivious, saying “I’ve always rejected the politicization of the weather.” Trump still occasionally refers to climate change as a hoax.

Biden and other Democrats occasionally talk about gun violence, domestic terrorism, and the threats to American democracy. But there is little pending legislation of any consequence on any of those issues, other than efforts at the state level to roll back gun restrictions, increase gerrymandering, and take control of its elections away from one of our largest cities.

And then there are the problems that neither party is talking about. In the coming months I plan to call attention to a few, starting with: declining life expectancy in the United States. It would be bad enough if our political system were simply oblivious to the problem. But in fact political action is causing a lot of it.

Talk about a matter of life and death.

Declining life expectancy. In the United States, like most of the world, life expectancy had gone up and up for centuries, until the last few years. Here’s a graph of US life expectancy from 1860 to 2020.

Except for brief glitches during the Civil War and the World War I/Spanish flu era, life expectancy at birth goes inexorably upward, almost exactly doubling from 39.41 in 1860 to 78.94 in 2015. Not even World War II could bring it down (probably because the health advantages of ending the Depression overcame the casualties of war). Until recently, Americans had come to think of increasing lifespans as an inevitable dividend of scientific progress. Of course our generation would live longer than our parents’ generation, and our children would live longer yet.

Different sources produce slightly different numbers, but just about everybody sees a leveling-off in the mid-2010s, followed by a sharp drop in the last few years to levels not seen since 1996. Nearly three decades of progress have vanished.

Now, there’s an obvious reason for this: the Covid pandemic, which has killed 1.1 million Americans since it started in 2020 (and is not done, even if we’ve stopped paying attention to it). Largely because of mismanagement by the Trump administration and misinformation from the larger MAGA movement (which encouraged lax attitudes, snake-oil cures, and vaccine resistance), we took a bigger hit than most comparable countries. The US has had 3,480 Covid deaths per million people, while Canada has had 1,364, Norway 986, and Australia 801. Even some of the countries hit earlier and harder than the US have fared better in the long run: Italy has had 3,159 deaths per million and Spain 2,595. One likely reason: 86% of Spaniards and 81% of Italians have been vaccinated, compared to 69% of Americans.

But OK then: If Covid is the problem, it should go away as Covid recedes. And that’s happening in the rest of the world. But not here.

The headline from this graph is that life expectancy in comparable countries bounced back in 2021, almost regaining its 2019 level, while life expectancy in the US dropped further. But there’s also a long-term story here: In 1980, US life expectancy was lower than the comparable-country average by less than a year. By 2021, though, the gap had grown to more than six years. Even pre-Covid, there was a 3.8 year gap.

Where did that come from?

Bad habits or bad government? The simple explanations for our long-term life expectancy gap focus on our bad habits: We’re too fat, we’re out of shape, we take drugs, and we kill ourselves and each other at a high rate. It’s easy to tell the life-expectancy story as a crisis of individual moral gumption: If Americans would just eat better, get off the couch, get clean from drug abuse, and deal with our depression and anger problems, we’d live longer.

And all that is true as far as it goes. But if you look at those “moral” problems, each one has a political component.

Guns. Most obviously, our high suicide and murder rates are related to our gun policies. People get depressed and angry in other countries too. But depressed or angry Americans are more likely to have ready access to guns. In 2020, researchers at Stanford published a study on the relationship between guns and suicides:

The researchers found that people who owned handguns had rates of suicide that were nearly four times higher than people living in the same neighborhood who did not own handguns. The elevated risk was driven by higher rates of suicide by firearm. Handgun owners did not have higher rates of suicide by other methods or higher rates of death generally.

The researchers themselves wrote:

Suicide attempts are often impulsive acts, driven by transient life crises. Most attempts are not fatal, and most people who attempt suicide do not go on to die in a future suicide. Whether a suicide attempt is fatal depends heavily on the lethality of the method used — and firearms are extremely lethal. These facts focus attention on firearm access as a risk factor for suicide especially in the United States, which has a higher prevalence of civilian-owned firearms than any other country and one of the highest rates of suicide by firearm.

In general, gun deaths are higher in states with more guns.

Food policy. Obesity is a major factor in Americans’ poor health, and is the one most likely to be seen as a moral issue. (“Just stop stuffing your face, fatso.”) But while we can all imagine ways that we could improve our discipline regarding diet and exercise, it’s also true that it’s hard to live a healthy lifestyle in the United States.

Nationally, our food policy tilts towards putting high-fructose corn syrup in just about everything. Our giant factory farms make meat and dairy cheaper here than in many other countries, but also less healthy. Particularly in our poorer neighborhoods, fast food is easier to find than fresh vegetables. The food industry spends billions every year trying to persuade us to eat fat- and sugar-laden foods.

Compared to cities in other countries, American cities encourage travel by car and discourage walking.

In short, there are reasons we’re fat. And not all of them are lack of willpower.

The place this really becomes clear is when you look at children. Even if you think obese adults lack willpower, do you really hold children responsible for their food-and-exercise choices?

Healthcare. Some politicians like to claim that American healthcare is “the best in the world”. And that may be true if you’re rich or have excellent health insurance, live near a top medical center, and need the kind of major medical interventions American medicine specializes in.

But overall, our public health is terrible compared to other rich countries, all of whom spend less per capita on healthcare than we do. For example,

Among 11 developed countries, the United States has the highest maternal mortality rate, a relative undersupply of maternity care providers, and is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period, a recent report from The Commonwealth Fund concluded. Compared with any other wealthy nation, the United States also spends the highest percentage of its gross domestic product on health care.

Maternal deaths have been increasing in the United States since 2000, and although 700 pregnancy-related deaths occur each year, two-thirds of these deaths are considered to be preventable.

The statistical term for preventable deaths is “amenable mortality”. In 2019 — pre-Covid, in other words — amenable mortality in the US was responsible for 177 deaths for every 100K people, compared to a 38-country average of 126. Japan and Switzerland had 83, and Canada 116.

The difference is our reliance on the private sector. In the US health-insurance business, the way to make money is to insure only healthy people. Much of the administrative effort in our health-insurance companies is devoted to shifting costs onto someone else, rather than improving health overall.

And of course, the private health-insurance industry has no interest in the poor at all. If poor and lower-working-class Americans aren’t on Medicaid, they’re probably uninsured. Uninsured people fear our expensive healthcare system, and are likely to hope problems go away on their own rather than get them checked out. Those decisions end up killing a lot of people.

One conservative policy designed to limit healthcare spending is to give people more “skin in the game“. In other words, to increase copayments so that people (especially the poor) have more incentive to ignore problems and hope they go away on their own.

Red states and blue states. The policies I’ve been talking about — limiting gun access, subsidizing healthy food choices (or penalizing unhealthy ones), promoting public health, lowering medical copayments, pushing for walkable cities, and making it easier to get health insurance — are classic liberal policies that conservatives ridicule as examples of the “nanny state”. Blue states are more likely to take these actions than red states.

And guess what? Blue states have higher life expectancy than red states. Paul Krugman tweeted the following chart comparing Biden’s margin over Trump in 2020 to each state’s change in life expectancy over the previous 30 years:

He comments:

Life expectancy is hugely unequal across U.S. regions, with major coastal cities not looking much worse than Europe but the South and the eastern heartland doing far worse.

But wasn’t it always thus? No. Geographic health disparities have surged in recent decades. According to the U.S. mortality database, as recently as 1990, Ohio had slightly higher life expectancy than New York. Since then, New York’s life expectancy has risen rapidly, nearly converging with that of other rich countries, while Ohio’s has hardly risen at all and is now four years less than New York’s.

Summing up. Life expectancy ought to be a major political issue. Americans aren’t living as long as citizens of other rich countries, but that isn’t due to some unforeseeable act of God. We’re doing it to ourselves through our political choices.

By weeklysift | Posted in Articles | Comments (23)

Back to School

July 13, 2020 – 9:10 am

When schools began closing in March, everyone said it was just for a few weeks. The logic was simple: The virus’ incubation time was two weeks or so; if we all just stayed home through one incubation cycle, everyone already infected would show symptoms, they’d go into quarantine, and the rest of us could get back to our normal lives. When things didn’t go that way, schools were closed for a little longer, and then for the rest of the year. Still, few imagined that it wouldn’t be safe to go back in the fall.

Now it’s mid-July, time (or maybe past time) to start making commitments for the 2020-2021 school year. The virus’ widely anticipated summer lull never arrived. And although the world’s well-governed countries have been getting their epidemics under control, the United States has not been well governed for some while. The experts at the CDC established sensible standards for restarting normal life in stages, but our president pushed the states to ignore them, encouraging lawsuits and even armed protests against governors who tried to follow them. As a result, Covid-19 is still spreading like wildfire in all but a handful of states.

So what do we do with schools in the fall? Several fundamental facts about schools, children, and the virus point in different directions.

  • As a group, compared to the general population, children are less vulnerable to the most serious consequences of Covid-19. The odds that your child will die from catching it at school may not be zero, but they are very low. At the same time, the long-term consequences of a “mild” case are still not well understood.
  • Leaving schools closed also has risks and costs, especially for children whose home life is stressed in some way. Some children live in homes with large indoor and outdoor play spaces, robust internet connections, and extensive book collections; their parents may also work at home and may be well equipped to supervise online learning. Some other children not only lack those advantages, but live in dangerous or abusive homes; before Covid, school was the safest part of their day.
  • Traditional classrooms share a feature that has made meat-processing plants and prisons such fertile ground for Covid-19 to spread: “prolonged close proximity to other[s]”. Worse, strict protocols of masking and social distancing will be hard to enforce in schools; violating them provides an easy way for difficult students to disrupt the classroom.
  • Schools link households that would otherwise have little contact. With schools open, the community becomes a denser network that is easier for the virus to traverse. (For some reason, elementary schools have not been implicated in major outbreaks, but schools for older children have.)
  • Children are not the only ones in the classroom. Many teachers are near retirement age, or have other Covid-19 risk factors. Is it age discrimination, or a violation of the Americans With Disabilities Act, to require teachers in high-risk categories to either endanger themselves or quit? Will teachers unions agree to open schools under conditions that are unsafe for many of their members?

And we are once again going through the familiar pattern: The CDC has established guidelines for opening schools safely, but the president and his education secretary are pushing communities not to follow them, to the point of threatening their federal funding. [1]

we’re very much going to put pressure on governors and everybody else to open the schools, to get them open. And it’s very important. It’s very important for our country. It’s very important for the well-being of the student and the parents. So we’re going to be putting a lot of pressure on: Open your schools in the fall.

The CDC’s advice includes closing schools for extended periods if there is “substantial community transmission” of the virus, and making major adjustments (no field trips, desks six feet apart, students wear masks, staggered scheduling, …) when there is “minimal to moderate community transmission”. The President has pronounced those measures “impractical“, but has offered no alternative plan beyond just opening the school doors and letting the epidemic run its course.

Worse, he has turned school reopening into a test of loyalty. If you’re on his side, you support his alternate reality, where the virus surge is just an artifact of overtesting, 99% of cases are “totally harmless“, and there’s no reason not to fully open all parts of the economy, including the schools — unless, of course, you’re a Democrat trying to hurt his re-election chances.

Corrupt Joe Biden and the Democrats don’t want to open schools in the Fall for political reasons, not for health reasons! They think it will help them in November. Wrong, the people get it! [2]

New York City. A number of school districts have already announced their own plans for the fall. New York City, for example, intends to have students physically present only two or three days a week, cutting the number present on any given day in half. The school-system chancellor said:

We know that we cannot maintain proper physical distancing and have 100% of our students in school buildings five days a week. It’s just geographically, physically not possible. Health and safety requires us to have fewer students in the building at the same time.

This is not nearly good enough for the Trump administration, which wants five full days a week. NYT columnist Michelle Goldberg offers a liberal parent’s view: She agrees, up to a point.

I want schools to open full-time at least as much as Trump does. On Wednesday, New York City announced its plan to send kids back to school part time, and it is a calamity. To accommodate C.D.C. guidelines calling for six feet of distance between desks, students will be able to go to school only one to three days a week. It is not yet clear if schools will be able to ensure that siblings will attend on the same days. Working parents could end up needing full-time child care indefinitely, and there are, as yet, no plans to provide it publicly. …

So far, the results of so-called “remote learning” — a term I dislike, since it presumes that learning is happening — have been terrible for students, especially disadvantaged ones. The fallout for many parents’ financial prospects and mental health is catastrophic. And part-time schooling is likely to significantly amplify educational inequalities that are already enormous. As those who can afford it hire private teachers and tutors, we are rapidly heading toward a system of neo-governesses in which basic schooling becomes a luxury good unattainable for many people outside the 1 percent.

But she also recognizes that Trump’s politicization of the argument has made any rational discussion of reopening plans much harder:

Trump’s interference means that now no departure from the current C.D.C. guidelines will be seen as credible outside of MAGAland. “The recklessness has made people distrust anything that they say because they have downplayed the virus from the beginning,” said [American Federation of Teachers President Randi] Weingarten. … This is a president with negative credibility. The more Trump demands that schools open, the more people who’ve paid close attention to him will fear they all must remain closed.

Florida. As if to prove the point that we should do the opposite of whatever Trump urges, there’s Florida. New York was once the worst-hit state in the nation, but has been doing comparatively well lately. Florida is one of the states currently experiencing the worst outbreaks, but Education Commissioner Richard Corcora is insisting on a full reopening of the state’s schools.

Under the emergency order, all public schools will be required to reopen in August for at least five days a week and to provide the full array of services required by law, including in-person instruction and services for students with special needs.

Governor Ron DeSantis, who got the state into its current mess by following Trump’s advice on early reopening of businesses and bars, compares schools to big box stores.

I’m confident if you can do Home Depot, if you can do Walmart, if you can do these things, we absolutely can do the schools.

This silly pronouncement has received the widespread disrespect it so richly deserves. California Congressman Ted Lieu’s response was one of many:

Did I somehow miss the true Home Depot experience? I didn’t realize Home Depot packed 35 people together in a room for 6 hours a day.

Similarly silly was this Trump tweet:

In Germany, Denmark, Norway, Sweden and many other countries, SCHOOLS ARE OPEN WITH NO PROBLEMS. The Dems think it would be bad for them politically if U.S. schools open before the November Election, but is important for the children & families. May cut off funding if not open!

Yes, let’s compare Florida and Denmark. Florida has a little less than four times the population of Denmark. But in Covid-19’s entire history, Denmark has had 13,000 cases. Florida found 15,000 new cases yesterday. Denmark had 159 new cases in the last week; Florida over 69,000. Safely opening schools in Denmark is a completely different problem than opening them in Florida.

It is absolutely insane for Florida schools to be planning to open five days a week. If this hadn’t become a Trump-loyalty issue, no one would support doing it.

What at least one teacher thinks. If there’s one blog you ought to be reading right now that you’re probably not, I’d say it’s Teacher Life, written by Mrs. Teacher Life. Start with “Nobody Asked Me: A Teacher’s Opinion on School Reopening“, where you’ll find this kind of insight:

Let’s discuss hand washing. If an average class size of kindergartners is 25, then it would take 8.3 minutes for them each to wash their hands for 20 seconds- not too bad you might think. That’s doable- let’s reopen! Unfortunately that does not account for transition time between students at the sink, the student who plays in the bubbles, or splashes another student, or cuts in line, or has to be provided moral support to flush the toilet, because they are scared. It doesn’t account for the fact that only a few students will be allowed in the bathroom at a time and the teacher must monitor whose turn it is to enter and exit the bathroom, and control the hallway behavior, and send the student who just coughed to the “quarantine room” that doesn’t exist BECAUSE THERE ARE NO EXTRA ROOMS. Where are the students in hallway waiting? In line? All together? Six feet apart? No wait, three feet is okay now. Either way, 25 children standing three feet apart is a line over 75 feet long. Who is monitoring this line? Keeping them quiet, reminding them to keep their hands to themselves?

When you take a classroom-level view, you start to see a strange disconnect: Getting schools open is somehow both a top priority and barely an afterthought. On the one hand, it’s absolutely essential, because the economy can’t get back to normal (and the President can’t get re-elected) until parents can go back to work without leaving unsupervised children at home. But on the other hand, if it were actually that important, you’d think some roomful of geniuses would have been convened long ago to work out

  • exactly what conditions need to hold in our communities for it to be safe to reopen schools
  • how we’re going to achieve those conditions (i.e., do we really need to re-open the bars?)
  • how schools are going to function when they do reopen
  • what additional resources they need to function that way.

So, for example, what about that quarantine room Mrs. Teacher Life doesn’t have? Or the bigger classrooms that allow socially distanced desks? Or the extra assistants who supervise those 75-foot lines at the bathroom? Or new desks to replace the tables where children can no longer sit together? Or the extra crayons and scissors and whatnot, now that it’s unsafe for kids to share? Who is going to sub for all the teachers who are quarantined, or who ordinarily would come to work even when they feel sick, but shouldn’t do that now?

If we do find a sub- what germs are they bringing in? Where have they been? If they test positive do all schools they have been subbing at have to quarantine?

If school reopening were really a priority, there would be a plan and there would be money to implement that plan. There isn’t. That’s got to tell you something.

[1] For what it’s worth: I would not take these threats seriously. Trump does not understand how the government works, so he often makes threats he has no idea how to carry out. In this case, attempts to redirect funding approved by Congress would be blocked by the courts, at least until the next presidential term begins in January. If we can vote Trump out, those cuts will never happen.

What he and Education Secretary Betsy DeVos seem to be hinting at is turning federal aid into a voucher that students can use for private schools in areas where public schools are not physically open. (This is what DeVos wanted to do even before the pandemic.) But neither DeVos nor the White House press secretary have been able to explain what legal authority would allow them to do this.

And I know it’s petty, but comparisons between DeVos and Harry Potter’s Delores Umbridge never get old.

[2] I think Trump is the one who doesn’t get it here, probably because he doesn’t understand people who live for others. Parents will accept risks to themselves — going to an unsafe job, for example — if the family needs it. But they have a far lower tolerance for risks to their children. Statistics don’t help here. Once you’ve told parents that their child could die, they’re not going to pay much attention to the exact probabilities.

By weeklysift | Posted in Articles | Also tagged | Comments (3)

Back to Square One

June 29, 2020 – 10:53 am

This week the number of new Covid-19 infections spiked up to even higher levels than before the shutdown. Other governments have avoided this scenario, but ours has no plan for dealing with it.

What if we have a crisis? In one of the less-noticed parts of John Bolton’s new book, Chief of Staff John Kelly complains that he is frustrated to the point of quitting. “What if we have a real crisis like 9/11,” Kelly asks Bolton, “with the way he makes decisions?”

As Bolton — like so many other former Trump insiders before him — demonstrates with numerous examples, “the way he makes decisions” is to start from a place of complete ignorance. (Prior to his ill-fated Helsinki meeting with Putin, he asked aides whether Finland was part of Russia. He also seemed not to know that the United Kingdom has nuclear weapons.) Then he ignores the briefings that come from the intelligence community or other government experts, and doesn’t ask for any studies or position papers from people the government employs to do research like that. Instead, he spends hours each day talking to friends on the phone and listening to the pundits on Fox News. If he hears something he likes, maybe that becomes government policy immediately, or maybe it turns into a line he uses at rallies. If the rally-goers cheer, then that’s what the world’s greatest superpower will do.

If you think there ought to be a more rigorous process than that, you must be part of the Deep State.

This is how we got the border wall project. No one who studies border security for a living ever concluded that a wall between the US and Mexico was the most efficient way to accomplish some desirable goal. But Trump’s 2016 campaign advisers decided he needed a “mnemonic device” to get him to focus on immigration. Any realistic plan to deal with unwanted border-crossings is full of the kind of legal, diplomatic, environmental, and other details Trump hates, but “Build a Wall” was simple enough to hold in his head, and the crowds loved it — especially when he added the fantasy that Mexico would pay for it.

Those cheering crowds are why some adviser’s mnemonic device is turning into a physical wall that takes years to build, costs billions of dollars, and doesn’t solve any identifiable problems. We just lucked out that Trump wasn’t still holding rallies when the inject-yourself-with-bleach idea got into his head.

Own-goal crises. The reason Bolton and Kelly were having a what-if conversation rather than recalling an actual disaster is that until that point the United States had been having an extraordinary run of good luck. You may remember these last three-plus years as a high-wire state of constant national anxiety, but in fact the real world was unusually tame. Barack Obama had handed Trump a country in pretty good shape, particularly compared to the one Obama had received from George W. Bush. All the major economic trends were in the right direction, Obama’s light-footprint strategy to defeat the ISIS caliphate was working, and so on. Obama did leave behind a number of worrisome long-term challenges, like climate change, the ascension of China, nuclear proliferation, the decades-long decline of America’s middle class, and so on. But no one really expected Trump to make progress on any of that, and on any given day all those problems have been pretty easy to ignore.

Instead, what made the pre-Covid Trump years feel so tense were the crises Trump created himself: He ratcheted up his “fire and fury” rhetoric against North Korea to the point that war seemed inevitable, and then arranged a marvelous reality-show resolution when he “fell in love” with Kim Jong Un, a performance so compelling that Trump wanted a Nobel Peace Prize for it. Of course, nothing was actually accomplished by the whole up-and-down cycle (other than some great propaganda for the Kim regime), but didn’t it look grand on TV?

The low points in his approval rating were similarly self-inflicted: when he described the neo-Nazis marching in Charlottesville as “fine people” or sided with Putin against the US intelligence agencies or couldn’t let go of a spat with a military widow. His China trade war spooked the markets and slowed the economy, but that was also something he brought on himself, so he could create good news whenever he wanted by tweeting about “progress” in the negotiations or delaying some tariff he had threatened to impose unilaterally.

Since those were all holes he dug himself, he could just stop digging, divert the public’s attention elsewhere, and wait for it all to blow over. Easy-peasy.

And then there was the ever-rising budget deficit, which would have been framed as an existential crisis for Obama, but became acceptable once a Republican was in the White House.

Before Covid, Trump only had to face two truly external problems: impeachment and his complete botch of the federal response to the Puerto Rican hurricane. Impeachment was never a big worry for two reasons: First, no matter how guilty he was, the Republican Senate was never going to convict him. (In the end, they decided that the House’s evidence wasn’t good enough to remove a president chosen by 46% of the people, and that if there was better evidence, they didn’t want to see it.) And second, the underlying offense (the extortion of Ukraine) didn’t really matter to Trump’s base. As for the Puerto Rican hurricane, well, that mainly affected Spanish-speaking people of color that the Trump base also didn’t care about. (Yeah, thousands of them are dead, but it’s not like they were ever “real Americans”, right?)

The virus is real. But Covid is different. There’s a real virus out there killing people. It can’t be intimidated by tweets or derogatory nicknames like “Wuhan virus” or “kung flu”. Even though it has been killing people of color at a rate disproportionate to their numbers, it kills white people too. And now it’s even spreading in red states (Texas) or purple states (Florida) that Trump needs to carry if he wants to be re-elected.

Trump has no plan to defeat the virus, but that’s par for the course. He doesn’t have a plan to deal with any of America’s problems. For example, he’s still promising a “FAR BETTER AND MUCH LESS EXPENSIVE ALTERNATIVE” to ObamaCare, and to “ALWAYS PROTECT PEOPLE WITH PRE-EXISTING CONDITIONS, ALWAYS, ALWAYS,ALWAYS!!!” But in the five years since he came down the escalator, he has not produced so much as a back-of-the-envelope sketch of a program to deliver on such promises. I’m sure the words in those capitalized phrases sound good to him and his fans, but as soon as the sound waves fade out the air is empty again.

Like his bromance with the North Korean dictator, Trump’s coronavirus briefings also made good TV for a while, but eventually they became embarrassing and he got bored with them. So he applied his usual crisis-control tactic: He congratulated himself for defeating the virus, which is “dying out“; flattered or browbeat Republican governors to reopen their states too early; stopped talking about the whole crisis, even as additional thousands of Americans continued to die each week; tried to divert our attention elsewhere; and waited for it all to blow over.

But here’s the thing: Reality doesn’t blow over. Covid-19 isn’t a PR flap or a misstep he can back away from, it’s a pandemic. For a short time, he may be able to get large segments of the public to “ignore that pile of dead bodies over in the corner” (as Bill Gates put it), but people keep dying even when everyone’s looking the other way, and eventually we start to notice again.

Comparisons. Covid-19 started out in China in December, and from there spread around the world, taking different courses in different countries. Some small countries with good leadership and a strong public spirit — New Zealand, Iceland, and South Korea pop to mind — reacted quickly, got the epidemic under control, and continue to hold it in check through a combination of testing, contact tracing, quarantine, and public cooperation in preventive measures like mask-wearing, hand-washing, and social distancing.

A number of EU countries, beginning with Italy, had really bad outbreaks, but then shut down just about all activities other than food distribution and medical care, using their national wealth and strong social-welfare systems to keep individual and family budgets above water. After a month or two of extreme sacrifice, the number of new infections began to collapse, to the point that they can now make use of the tactics that the fast-reacting countries used.

And then there’s the United States, where Covid-19 became the kind of crisis Kelly had been worrying about. Here’s how our daily reported new infections compared with the EU and South Korea as of Saturday.

South Korea’s infections stayed down. The EU’s went up and came down. But in the United States infections went up, started to creep down a little, and then shot back up.

What did we do wrong? A lot of things. Thursday The New York Times presented an illuminating series of graphics describing about how the virus spread in the US.

At every crucial moment, American officials were weeks or months behind the reality of the outbreak. Those delays likely cost tens of thousands of lives.

A short list of early failings:

  • The CDC’s initial set of test kits were faulty, and tests were not imported to fill the gap, resulting in what the NYT described as “the lost month“. This was both a CDC failure and a White House failure, because it’s the role of the White House to keep tabs on the workings of the government and intervene when something important is falling through the cracks in the system.
  • As a result, the initial spread of the virus was grossly underestimated. The NYT article suggests that in mid-February, when the US had 15 known cases (that Trump said “within a couple of days is going to be down to close to zero“) there were actually around 2,000 cases spread across ten major cities.
  • Unlike other countries, the US did not use its lead time to build its stockpile of masks and gowns for medical personnel, as detailed by HHS whistleblower Dr. Rick Bright.
  • The federal government did not prepare the public for the sacrifices that would eventually be asked of it. Instead, officials from President Trump on down consistently reassured the public that the virus was “totally under control” and “the risk is low”.
  • Trump began politicizing the virus response early, charging on March 9 that “The Fake News Media and their partner, the Democrat Party, is doing everything within its semi-considerable power (it used to be greater!) to inflame the CoronaVirus situation, far beyond what the facts would warrant.”

By mid-March, states began to respond, with Republican Governor Mike DeWine shutting down schools in Ohio, Democrat Andrew Cuomo closing businesses in New York, and local health officials in six San Francisco Bay counties issuing a shelter-in-place order. A national campaign to “flatten the curve” began. Even Trump got on board for a month or so, rewriting history to claim: “I’ve always known this is a real, this is a pandemic. I’ve felt it was a pandemic long before it was called a pandemic.”

Undermining the national will. The number of new cases reached an initial peak of 33,000-a-day in early-to-mid April and then began to slope downward. But unlike Europe, the United States lacked the national will to finish the job.

That failure came from the top. As soon as it was clear a peak had been reached, Trump began pressuring states to relax restrictions and reopen their economies without waiting to achieve the milestones listed in his administration’s own guidelines.

Trump encouraged armed demonstrators to intimidate state governments. When protesters with rifles came to the Michigan statehouse carrying signs saying “Tyrants get the rope”, Trump tweeted “LIBERATE MICHIGAN!”. He also encouraged “liberators” in Virginia and Minnesota. Without once calling for the protesters to disarm, he tweeted:

The Governor of Michigan should give a little, and put out the fire. These are very good people, but they are angry. They want their lives back again, safely! See them, talk to them, make a deal.

Michigan more-or-less held firm, but Republican governors in red states knew they could not survive a Trump tweet storm and could benefit from White House photo ops. Georgia, Florida, Texas, and Arizona began to open their economies without achieving the statistical milestones laid out by the CDC. When the Republican members of Wisconsin’s Supreme Court invalidated the Governor Ever’s stay-at-home order and plunged the state’s gradual-reopening plan into chaos, Trump was jubilant.

The Great State of Wisconsin, home to Tom Tiffany’s big Congressional Victory on Tuesday, was just given another win. Its Democrat Governor was forced by the courts to let the State Open. The people want to get on with their lives. The place is bustling!

Meanwhile, he was campaigning against wearing masks, which nearly all public health officials recommend when people are unable to maintain social distance. He mocked Joe Biden for wearing a mask in public, and for “cowering in the basement” rather than holding face-to-face events. Trump refused to wear a mask while touring a mask factory in Arizona, even as “Live and Let Die” played on the sound system.

Long after it had become clear that the reopenings were premature and cases were spiking, Trump pushed to hold dangerous large-crowd events in Tulsa and Phoenix. (Fortunately for the nation, the crowd in Tulsa was not nearly so large as he had expected.) In Tulsa, he discounted the rising case numbers, arguing (falsely) that they just reflect increased testing, and offering a 10-year-old with “sniffles” as an example of a case. He said he had asked his administration to “slow down the testing”, and later contradicted aides who tried to downplay that suggestion as a joke. “I don’t kid,” he told reporters.

This anti-social leadership has had its effect: Around the country outraged people, many sporting MAGA hats or Trump shirts, are refusing to abide by rules that mandate mask-wearing or social distancing. Michelle Goldberg summarizes:

This is what American exceptionalism looks like under Donald Trump. It’s not just that the United States has the highest number of coronavirus cases and deaths of any country in the world. Republican political dysfunction has made a coherent campaign to fight the pandemic impossible.

The viral resurgence. New infections have been rising sharply in precisely the southern and western states that have reopened quickly, refuting the theory (which Trump had long promoted) that the pandemic would fade in warm weather. Nationally, cases had flattened out at less than 20,000 per day in late May and early June. But they have been above 38,000 each of the last five days.

On the state level, the best measure for comparison is the 7-day-weighted-average of new cases per day per 100K people. Here are the most seriously affected states:

Arizona 44

Florida 30

South Carolina 25

Mississippi 23

Arkansas 20

Louisiana 20

Nevada 19

Texas 19

California also has an large number of cases, due partially to its size. Its daily-new-case-per-100K number is 12. New York, which was the center of the epidemic in April, is down to 3.

And as for Trump’s attempt to discount those numbers, 10-year-olds with “sniffles” don’t show up in the ICU. Hospitals are reportedly close to capacity in Arizona, Florida, and Texas, and perhaps other states getting less national attention.

The Washington Post assesses what went wrong in Arizona:

At critical junctures, blunders by top officials undermined faith in the data purportedly driving decision-making, according to experts monitoring Arizona’s response. And when forbearance was most required, as the state began to reopen despite continued community transmission, an abrupt and uniform approach — without transparent benchmarks or latitude for stricken areas to hold back — led large parts of the public to believe the pandemic was over.

And now, Arizona is facing more per capita cases than recorded by any country in Europe or even by hard-hit Brazil. Among states with at least 20 people hospitalized for covid-19, the disease caused by the coronavirus, no state has seen its rate of hospitalizations increase more rapidly since Memorial Day.

And Republican governors or not, Texas, Florida, and Arizona have all had to retreat on their reopening timetables.

Deaths haven’t turned back up yet, but they will. The one saving grace is that nationally, deaths are still declining. For weeks I’ve been commenting on the mystery of how the death rate could continue downward while the new-case rate flattened and then turned upward.

Med school Professor Florian Krammer points to the same three explanations I’ve given: more testing has raised the new-case rate (or more accurately, made it better match the actual spread of the infection); better care is keeping people alive; but most of all, that the age-distribution of the infected population is shifting to younger people who are more likely to survive.

But he then goes one step further: Something similar happened in Iran in May. The new-case curve had been dropping, but started going up again around May 1.

But deaths did not go up. People explained to me, that now mostly young people are getting infected so nothing bad would happen.

Deaths started going up May 25.

What happened? First, it takes time to die of COVID-19. Second, cases probably really built up in younger people. But they diffuse into older populations. And then the deaths rose.

Each state has its own version of the pandemic, and death rates might already have started upward in some of them, like Arkansas and Texas. (The curves are jittery enough that it’s hard to be sure.) But nationwide, the new-case curve started rising around June 10. That would suggest deaths will begin rising about July 4.

Similar ideas (with a similar timeline) show up on the COVID Tracking Project Blog.

New daily positive cases only began to exceed the plateau of the previous two weeks around June 18-19, which means that an increase in deaths as a result of the rise in new cases would not be expected to show up until July.

So where are we? In some ways, we’re back where we were in April, and in some ways we’re worse off. Except in the northeast, whatever we gained through the sacrifices of the shutdown has been frittered away by bad leadership.

So now John Kelly knows: What happens if we have a real crisis “with the way he makes decisions”? This.

What is needed at this point is another wave of restrictions, and every state that thinks it is about to reopen its bars or arenas needs to think again. The American people can’t be trusted in bars; that is now a proven fact, at least until we have a vaccine. But a second wave of stay-at-home orders is hard to feature given that most of the country has nothing to show for the first wave.

We also need the kind of public spirit we had in the early days of “flatten the curve”: We need to encourage each other to wear masks, avoid crowds, keep our distance, and in general use common sense. Unfortunately, this is very unlikely to happen now that flouting common sense is necessary to establish your identity as a Trump conservative.

As best I can tell, this hasn’t happened in any other country (except maybe Brazil, which is also in very bad shape). Things got bad in Italy and Spain, but taking stupid risks never became a political identity.

And that reminds me of another famous question, this one raised by Trump himself in the 2016 campaign. “What the hell do you have to lose?”

Now we know.

By weeklysift | Posted in Articles | Also tagged | Comments (10)

Trump Has No Endgame

May 18, 2020 – 10:14 am

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.

By weeklysift | Posted in Articles | Also tagged , | Comments (41)

Things We’re Finding Out about the Pandemic

May 4, 2020 – 10:07 am

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.

By weeklysift | Posted in Articles | Comments (11)

Trump Is Still Eating Souls

April 27, 2020 – 11:56 am

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.

By weeklysift | Posted in Articles | Also tagged | Comments (9)

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

April 27, 2020 – 10:44 am

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.

Why?

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.

By weeklysift | Posted in Articles | Also tagged , | Comments (18)

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

April 20, 2020 – 9:18 am

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:

SYMPTOMS

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

AND

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

CASES

Downward trajectory of documented cases within a 14-day period

OR

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

HOSPITALS

Treat all patients without crisis care

AND

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.

TESTING & CONTACT TRACING

  • 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)

HEALTHCARE SYSTEM CAPACITY

  • 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

PLANS

  • 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.”

By weeklysift | Posted in Articles | Comments (8)

My Coronavirus Test

April 6, 2020 – 10:42 am

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.

By weeklysift | Posted in Articles | Comments (34)

The Speech a Great President Would Give Now

April 6, 2020 – 8:51 am

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.

By weeklysift | Posted in Articles | Also tagged , | Comments (23)