Tag Archives: public health

How the Economy Restarts

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Coronavirus Reaches My Town, and other notes

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


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

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

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

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

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


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

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

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

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

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

Anyway, Spect continues:

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

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

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


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

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

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

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

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

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

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

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

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

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

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


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


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

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

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


Now we get to the economic effects.

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

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

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

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


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

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

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

The Coronavirus Genie Escapes Its Bottle

The COVID-19 virus broke out of containment this week. A week ago, you could still draw an imaginary boundary around the places affected and hope it stayed inside. Mostly it was in China. Other countries, like the US, had a handful of cases that could be traced to affected areas — foreign travelers and such. Just keep those people in quarantine and maybe everybody else would be safe.

Now, though, “community spread” has started: People have COVID-19 even though they have no traceable connection to China or any other area with a known outbreak. Two Americans have now died, and a cluster of cases in Washington state raises suspicion that the virus has been spreading undetected for weeks. The virus is out there now, and before long you will have to assume that anybody might have it.

That’s bad, but not necessarily apocalyptic. This first-person account in the Washington Post demonstrates that catching COVID-19 isn’t always dire.

My chest feels tight, and I have coughing spells. If I were at home with similar symptoms, I probably would have gone to work as usual. …

During the first few days, the hospital staff hooked me up to an IV, mostly as a precaution, and used it to administer magnesium and potassium, just to make sure I had plenty of vitamins. Other than that, my treatment has consisted of what felt like gallons and gallons of Gatorade — and, when my fever rose just above 100 degrees, some ibuprofen. … After 10 days, I moved out of biocontainment and into the same facility as Jeri. [his wife, who had been exposed but tested negative] … As of my most recent test, on Thursday, I am still testing positive for the virus. But by now, I don’t require much medical care. The nurses check my temperature twice a day and draw my blood, because I’ve agreed to participate in a clinical study to try to find a treatment for coronavirus. If I test negative three days in a row, then I get to leave.

The low impact the virus has on many people is one reason it spreads so widely. For comparison, if you caught Ebola you’d likely get very sick and maybe die before you had a chance to infect many other people. With COVID-19, you might think you can go to work “as usual”.

But even if any particular case of the infection is likely to be mild, it’s a mistake to write the whole thing off, as Rush Limbaugh did when he said “The coronavirus is the common cold, folks.” (Turn that statement around — the common cold is a coronavirus — and it becomes true: There are many types of coronavirus, some of which cause a common cold.)

A 2% fatality rate (the estimate I keep hearing, concentrated among the elderly and those previously in poor health) may not sound scary, but it turns into horrifying numbers when enough people get infected. If all the world’s 7.5 billion people got infected, 2% fatality would lead to 150 million deaths. In the US alone, 7 million deaths. Universal infection is probably not going to happen, but those numbers illuminate what’s at stake.


NPR and Vox have everybody-stay-calm articles about planning for a major outbreak, and what to do if you think you’re infected.


For most Americans, social and economic consequences of the virus are likely to hit harder than the disease itself. You and your loved ones may stay perfectly healthy, or at worst spend a week or so hindered by fever and malaise. But you might still face considerable challenges and disruptions. Japan, for example, has cancelled school for the next month. Various countries have cancelled sporting events, and this summer’s Tokyo Olympics are in doubt. Any plans you have that involve large crowds may have to be changed.

The Dow Jones average dropped 12% last week. That may seem a trifle extreme, until you factor in that growth was already slowing and the world economy is due for a recession soon anyway. The worrisome thing about an economic slowdown now is that there isn’t much ammunition for fighting it: Interest rates are already near record lows, and the US budget deficit was already projected at $1 trillion, thanks to Trump’s tax cut.


Now we start to get into the politics of the contagion. Any infectious disease reminds us of something we tend to forget: We’re all in this together. You may receive marvelous health care, but you’re still only as safe as the janitor who cleans your office or the waitress who brings your french fries. If they live paycheck to paycheck and don’t get paid time off, they’ll be coming in to work when they’re sick. If they can’t afford to get tested or treated, they’ll probably try to ignore their symptoms as long as they can.

When someone has flu-like symptoms, you want them to to seek medical care,” said Sabrina Corlette, a Georgetown University professor and co-director of the Center on Health Insurance Reforms. “If they have one of these junk plans and they know they might be on the hook for more than they can afford to seek that care, a lot of them just won’t, and that is a public health concern.” …

Azcue [who got tested for his symptoms and didn’t have COVID-19] said his experience underscores how the costs of healthcare in the U.S. could interfere with preventing public health crises. “How can they expect normal citizens to contribute to eliminating the potential risk of person-to-person spread if hospitals are waiting to charge us $3,270 for a simple blood test and a nasal swab?” he said.

ObamaCare got rid of junk health insurance for a while, but the Trump administration brought it back. COVID-19 — which is probably not going to be the last or even deadliest plague of this era — reminds us why we need to achieve the goal of universal health care.

That’s one of many ways this administration has made us less safe and more vulnerable to an epidemic. For example, the pandemic response team inside the National Security Council was disbanded when John Bolton reorganized the NSC in May. Its leader left the government and was not replaced.

Trump has tried to cut funding for the Center for Disease Control in each of his budgets, but Congress keeps putting the money back. So things could be worse, but only because Trump didn’t get his way.


Ever since it became clear that the Trump regime didn’t care what was true or not true — either about important things like climate change or trivial things like the attendance at Trump’s inauguration — I’ve been hearing people ask some version of “What’s going to happen when we have an actual crisis?”

If you were in Puerto Rico after Hurricane Maria, you’ve already seen the answer to that question: Thousands of people died while Trump was congratulating himself on how well he was handling things.

So now it looks likely that the US mainland will face a public health emergency. In such situations, rumors run wild and people have a tendency to panic. They both overreact and underreact, doing ridiculous things to try to stay safe while ignoring practices that might actually help. Government has an important role to play, both in organizing treatment and in giving the public reliable information.

Wouldn’t it be great to have a government that could fulfill that role? One that we could trust to tell us what was actually happening and what we should or shouldn’t be doing?

Trump himself is utterly hopeless in that regard. Here’s what he’s said so far about the virus.

Reed Galen writes:

For President Donald Trump, the coronavirus represents a personal threat: to his brand, to the economy he claims to be growing, and to his self-professed understanding of how society works. But unlike most of the people in his administration, the coronavirus does not listen, is not scared of mean tweets and can spread regardless of the information the president chooses to share or to diminish.

Trump’s whole career has been based on bullying and marketing, but neither talent helps him here. He’s good at intimidating or conning people into doing things that work to his advantage (and usually to their disadvantage). But he’s never shown any talent for dealing with the physical world, where things are either real or not, and events happen or don’t without regard to what anybody says or thinks.


Trump’s leadership (“new hoax”) has signaled the rest of the right-wing media to run wild with conspiracy theories. Don Jr. claimed Democrats

seemingly hope that it comes here and kills millions of people so that they could end Donald Trump’s streak of winning

Conservative Treehouse has made much of the fact that Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, who warned the country to “prepare for the expectation that this could be bad” is none other than Rod Rosenstein’s sister! How much more evidence of a sinister conspiracy do you need?

There is a strong argument to be made that various resistance government officials like Dr. Messonnier, in alignment with democrat resistance politicians, are attempting to weaponize fear and talking-points about the coronavirus in order to inflict maximum damage upon the Trump administration; regardless of both psychological and actual economic impact to the public.

And conservative radio host Wayne Dupree drew the obvious conclusion:

Looks like this is yet another instance of D.C. swamp creatures using any opportunity to undermine President Trump.

It’s all about Trump. It’s not about those 3,000 people worldwide who have died. It’s about Trump.


OK, Trump may be hopeless at recognizing reality and dealing with it, but he can delegate responsibility to more competent, trustworthy people, right? That also seems unlikely. His top priority is always his own ego. He needs to be 100% right at all times, and he hates it when somebody in his government implies that he’s made a mistake. (Sharpiegate was an almost comical example of how far he’ll go to maintain the claim that he’s right.)

Vice President Pence has been put in charge of the government’s COVID-19 efforts. His task force is a mixture of political hacks and people with genuine public-health knowledge. It’s not clear yet which are the decision-makers and which are there for political window-dressing. It could go either way.

Pence quickly moved to control messaging.

The vice president’s move to control the messaging about coronavirus appeared to be aimed at preventing the kind of conflicting statements that have plagued the administration’s response.

The latest instance occurred Thursday evening, when the president said that the virus could get worse or better in the days and weeks ahead, but that nobody knows, contradicting Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infectious Disease.

At the meeting with Mr. Pence on Thursday, Dr. Fauci described the seriousness of the public health threat facing Americans, saying that “this virus has adapted extremely well to human species” and noting that it appeared to have a higher mortality rate than influenza.

“We are dealing with a serious virus,” Dr. Fauci said.

Dr. Fauci has told associates that the White House had instructed him not to say anything else without clearance.

It’s hard to consider Pence a trustworthy figure here. He has a history of giving his moral and religious convictions priority over public health. Plus, the presence of Treasury Secretary Steve Mnunchin and economic advisor Larry Kudlow on the task force indicates the major focus of Trump’s concern: the stock market and the economy. The center of Trump’s re-election case is that stocks are at record highs and unemployment at record lows. If the public stops believing those things — say, because they stop being true — Trump might lose in November. That — and not the possibility of thousands and thousands of deaths — is the problem that grabs his attention.


Finally, it would be nice to believe that in a life-and-death situation, decisions would be made for the public good, without trying to leverage public angst to advance the regime’s political hobby-horse issues. Well, guess again. Saturday, Trump announced that he was very strongly considering closing the southern border.

There’s really no reason to do that. Mexico so far has fewer COVID-19 cases than we do, and fewer than Canada. (It would make more sense for Mexico to close its border with us.) But Trump always wants to close the southern border, so why not use the virus as an excuse?