One Way To Return To Work and School

Three professors think there is a good way for people to start going back to work and school. Their suggestion is partly based on how long people who get the virus usually become contagious, which is three days on average.

First, the population would be divided into two groups — like our cars were divided into two groups by odd and even license plates when OPEC made trouble in the 1970s and it was very hard to buy gas.

Grouping could be done using the first letter of everyone’s last name, such as A to L and M to Z. Doing the groups that way would give the members of a family the same schedule (of course, there would have to be flexibility to handle special cases).

Each group would then go to work or school on a schedule of four days on, ten days off. Group A to L would start work on a Monday, work four days, then take off ten days. Group M to Z would go to work or school the following Monday, work four days and then take off.

The result would be that people would be at work or school 40% of the time: four days instead of the usual ten every two-weeks (of course, there would have to be flexibility again, one reason being that somebody has to mind the store or the police station on Fridays and weekends).

Working or being educated would still be possible during our ten days “off” at home. The totally unemployed would be working part-time. The point is that we’d be taking a step toward a more normal existence for most people.

When I read the professors’ article, I wondered why they chose a four-day schedule if people are usually contagious after three days. Aside from how four days fits nicely into the fourteen days of two weeks, they believe that getting sick would be unlikely even if people were in close contact and someone became contagious at the beginning of the four days. They did some math:

Models we created at the Weizmann Institute in Israel predict that this two-week cycle can reduce the virus’s reproduction number — the average number of people infected by each infected person — below one. So a 10-4 cycle could suppress the epidemic while allowing sustainable economic activity.

More from the article:

Even if someone is infected, and without symptoms, he or she would be in contact with people outside their household for only four days every two weeks, not 10 days, as with a normal schedule. This strategy packs another punch: It reduces the density of people at work and school, thus curtailing the transmission of the virus.

The cyclic strategy is easy to explain and to enforce. It is equitable in terms of who gets to go back to work. It applies at any scale: a school, a firm, a town, a state. A region that uses the cyclic strategy is protected: Infections coming from the outside cannot spread widely if the reproduction number is less than one. It is also compatible with all other countermeasures being developed.

Workers can, and should still, use masks and distancing while at work. This proposal is not predicated, however, on large-scale testing, which is not yet available everywhere in the United States and may never be available in large parts of the world. It can be started as soon as a steady decline of cases indicates that lockdown has been effective.

The cyclic strategy should be part of a comprehensive exit strategy, including self-quarantine by those with symptoms, contact tracing and isolation, and protection of risk groups. The cyclic strategy can be tested in limited regions for specific trial periods, even a month. If infections rates grow, it can be adjusted to fewer work days. Conversely, if things are going well, additional work days can be added. In certain scenarios, only four or five lockdown days in each two-week cycle could still prevent resurgence.

The coronavirus epidemic is a formidable foe, but it is not unbeatable. By scheduling our activities intelligently, in a way that accounts for the virus’s intrinsic dynamics, we can defeat it more rapidly, and accelerate a full return to work, school and other activities.

Two Charts (Signs of the Times)

This first one is hard to believe. The rate on the government’s 10-year Treasury bond is around 0.70%. That’s the lowest it’s been for more than 150 years. Whoever buys one of these bonds is basically giving the government an interest-free loan, money the government could use to help people who’ve lost their jobs, small businesses that have lost their customers and local governments that are spending more and collecting less in taxes because of the virus.

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This second chart is easy to believe. It shows confirmed Covid-19 cases per million people. Although the president and his cronies claim that America’s response to the virus has been “spectacular”, compared to a country with a competent national government, South Korea, our response has been spectacularly bad. We’re the red line. South Korea is the blue.

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A Really Big Pile Indeed

The (Roughly) Daily blog has a visual guide to wealth in America (thanks, Ted). The text, which takes a while to find, includes a few key facts:

We rarely see wealth inequality represented to scale. This is part of the reason Americans consistently under-estimate the relative wealth of the super rich.

Jeff (Bezos) is so wealthy, that it is quite literally unimaginable.

You can use your scroll bar to see why you can’t imagine it. But don’t stop until you get to the wealth of the 400 richest Americans, a sum that’s super-unimaginable.

Remember during the presidential campaign when Senators Warren and Sanders called for a wealth tax and at least one billionaire wept bitter tears?

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It looks like they’re still selling the mugs, although, given current circumstances, nobody knows when they’ll be delivered.

Note: I can’t vouch for the visual guide’s accuracy, but according to other sources, Bezos’s pile is around 1,500,000 times more — that’s 1.5 million times more — than the median net worth of a U.S. household, and 12,600,000 times more than the median for households under 35. That’s a really big pile.

A Terrible List of “Hot Spots”

The New York Times has a long list of the worst virus outbreaks in the U.S. The list includes facilities with 50 or more cases.

Among facilities with more than 150 cases, jails and meatpacking plants predominate (presumably, the virus can survive longer where there’s meat). The U.S.S. Theodore Roosevelt and a few long-term care facilities, such as psychiatric hospitals, also have large numbers of cases.

Most long-term care facilities are relatively small and appear further down on the Times list. However:

Across the country, a pattern has played out with tragic consistency: Someone gets sick in a nursing home. Soon, several residents and employees have the coronavirus. The New York Times has identified more than 6,400 nursing homes and other long-term care facilities across the United States with coronavirus cases. More than 100,000 residents and staff members at those facilities have contracted the virus, and more than 17,000 have died. That means more than a quarter of the deaths in the pandemic have been linked to long-term care facilities.

It’s hard to imagine the suffering that’s going on behind closed doors (including the doors of houses and apartments).

Marion Correctional Institution — Marion, Ohio 2268
Pickaway Correctional Institution — Scioto Township, Ohio 1655
Smithfield Foods pork processing facility — Sioux Falls, S.D. 1095
Trousdale Turner Correctional Center — Hartsville, Tenn. 1037
U.S.S. Theodore Roosevelt — Guam 969
Cook County jail — Chicago, Ill. 940
Cummins Unit prison — Grady, Ark. 911
Lakeland Correctional Facility — Coldwater, Mich. 821
Bledsoe County Correctional Complex — Pikeville, Tenn. 585
Harris County jail — Houston, Texas 488
Neuse Correctional Institution — Goldsboro, N.C. 480
JBS USA meatpacking plant — Green Bay, Wis. 348
G. Robert Cotton Correctional Facility — Jackson, Mich. 347
Lansing Correctional Facility — Lansing, Kan. 336
Triumph Foods meat processing facility — St. Joseph, Mo. 295
Butner Prison Complex — Butner, N.C. 266
Sterling Correctional Facility — Sterling, Colo. 260
Paramus Veterans Memorial Home — Paramus, N.J. 256
Trenton Psychiatric Hospital — Trenton, N.J. 247
JBS USA meatpacking plant — Greeley, Colo. 245
Parnall Correctional Facility — Jackson, Mich. 243
American Foods Group meat processing facility — Green Bay, Wis. 241
JBS USA meatpacking plant — Grand Island, Neb. 230
Louisiana Correctional Institute for Women — St. Gabriel, La. 216
Shelby County jail — Memphis, Tenn. 205
Westville Correctional Facility — Westville, Ind. 200
Stateville Correctional Center — Crest Hill, Ill. 196
Hackensack Meridian Health Nursing and Rehab Care Center — Hackensack, N.J. 190
Franklin Medical Center prison hospital — Columbus, Ohio 185
Christian Health Care Center — Wyckoff, N.J. 183
The Harborage nursing home — North Bergen, N.J. 181
Tyson Foods meatpacking plant — Waterloo, Iowa 180
Andover Subacute and Rehabilitation Center II — Andover, N.J. 176
Redwood Springs nursing home — Visalia, Calif. 174
Central Detention Facility — Washington, D.C. 172
Lincoln Park Care Center — Lincoln Park, N.J. 168
PruittHealth Palmyra nursing home — Albany, Ga. 167
Tyson Foods meatpacking plant — Columbus Junction, Iowa 166
Soldiers’ Home — Holyoke, Mass. 163
Gallatin Center for Rehabilitation and Healing — Gallatin, Tenn. 162
JBS Beef Plant — Cactus, Texas 159
Dillwyn Correctional Center — Dillwyn, Va. 158
Northern State Prison — Newark, N.J. 158
California Institution for Men — Chino, Calif. 154
Perdue Farms meat processing facility — Cromwell, Ky. 154
Brookdale Paramus assisted living facility — Paramus, N.J. 153
George Beto Unit prison — Tennessee Colony, Texas 153
JBS USA pork production facility — Worthington, Minn. 151

A president who was reluctant to force the production of protective gear was willing to force meatpacking plants to stay open. Why? On one side are giant corporations who want to continue business as usual and millions of voters who would be affected by a shortage. On the other is a low-paid workforce mostly made up of people — immigrants, Latinos and African Americans — who don’t matter to the president at all. Q.E.D.

Debt, Schmet

The Nobel Prize in economics that Prof. Paul Krugman won isn’t technically a Nobel Prize, since it’s not one of the prizes Alfred Nobel created back in 1905. Krugman’s “Nobel Prize” (not “Noble Prize”) was actually the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel, established in 1968 by a donation from Sweden’s central bank to the Nobel Foundation.

Nonetheless, Krugman is very smart and knows a lot about economics. From his New York Times newsletter:

I get a lot of hate mail; in fact, I worry if a column doesn’t generate a big backlash, because it suggests that I may have been off my game. But it’s interesting to see what generates the most hate. In general, writing “Donald Trump is a terrible person” gets a sort of collective shrug…The real vitriol tends to come over monetary and fiscal policy.

In particular, I don’t think anything I’ve written has angered as many people as my declaration five years ago that debt is money we owe to ourselves — a point I naïvely imagined would be self-evident once people thought about it. But it turns out that challenging the notion that government borrowing imposes a burden on our children and grandchildren deeply offends many people, even though that notion makes very little sense.

So I don’t really expect people to be persuaded when I say that the response to Covid-19 is a near-perfect demonstration of my point. But let’s give it a try, anyway.

Here’s where we are right now. To contain the coronavirus, we’ve effectively shut down a significant part of the economy. Around 10 percent of U.S. workers are or were employed in “leisure and hospitality,” which has basically been locked down; even more are employed in retail trade, much of which has also been locked down.

For those of us still drawing a paycheck, this is annoying but not much more than that; I dream of coffee shops and concerts, but those aren’t necessities. For those who made a living by providing banned services, however, the lockdown is a financial catastrophe.

So we’re providing disaster relief on a huge scale: unemployment insurance, aid to small businesses and more. It’s still inadequate, and a lot of the money still isn’t making it to the people who need it most. But put that on one side, and ask: How are we paying for it?

The immediate answer is that the federal government is borrowing the money. New projections from the Congressional Budget Office suggest that federal debt, as a share of G.D.P., will be around 30 points higher by the end of next year than it was at the end of 2019.

But who will that money be owed to? The answer is, me — and people like me. That is, those who are still receiving more or less their normal incomes are spending less and saving more — yes, we’re buying more groceries and booze, but that’s vastly outweighed by reduced spending on restaurants and vacations. And those savings are, one way or another, being recycled via the federal government into aid for those less fortunate.

Some of the recycling is direct: My wife and I have, in fact, bought some U.S. government bonds. Most of it is indirect: You put more money in your bank account, the bank accumulates extra reserves in its account at the Federal Reserve, and the Fed buys government bonds. But the details aren’t especially important. At a fundamental level, the government is helping one group of Americans by borrowing from another group of Americans.

You might ask how the money will be repaid; actually, the odds are that it never will be repaid, which is OK but that’s a story for another time. There are also potential problems created by a high level of federal debt, although to be honest it’s unlikely that U.S. debt will be a real problem any time soon.

The key point for now, however, is that this debt-financed disaster relief isn’t coming at the expense of America’s future growth; it’s not making the country poorer, and it’s not cheating future generations. The debt we’re incurring now is money we owe to ourselves.

Unquote.

Krugman knows, of course, that some of America’s debt is owed to foreign countries, but it’s less than most people think.

As of this month, U.S. federal debt is $24 trillion. One quarter of that or $6 trillion is called “intragovernmental” debt. It’s money that’s owed by U.S. government agencies to other U.S. agencies. For example, the Social Security administration owns half of the $6 trillion (because Social Security invests its excess cash in U.S. government bonds).

The other $18 billion of U.S. debt is called “public” debt. Two-thirds of it or $12 trillion is owned by Americans, either individuals, companies or other entities. Foreigners own the other third or $6 trillion.

Krugman would be more precise, therefore, if he said that 75% of the government’s debt is money we owe ourselves. Foreigners are owed 25%.

For more on debt from Prof. Krugman:

America came out of World War II with huge debts — and experienced an unprecedented economic boom.

Britain emerged from World War II with debt of 270 percent of G.D.P. It never paid that debt off — but the ratio of debt to G.D.P. fell 80 percent over the next generation anyway.

New Jersey’s Steps to Reopening

Governor Murphy just presented the steps he thinks the Garden State needs to take before life can become more normal. Other states are doing the same thing. Murphy added that everything would be coordinated with neighboring states: “This isn’t just about NJ. Rushing ahead of our partners would risk returning our entire region back into lockdown mode”.

He didn’t announce a timeline:

Until we give the public confidence that they should not be fearful, we cannot take further steps. A plan that is needlessly rushed is a plan that will needlessly fail.

If businesses like restaurants, barber shops and theaters reopen, but their customers stay home, there won’t be any point to reopening.

The PowerPoint version:

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He skipped page 19 (is it a state secret?):

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People Have Said This Is the Best Article About the Virus

A science and health reporter, Donald McNeill, who specializes in “plagues and pestilences”, consulted “more than 20 experts in public health, medicine, epidemiology and history” and then wrote a long article for The New York Times. It’s called “ The Coronavirus in America: The Year Ahead”. It’s received a lot of praise. These are the parts (2,200 words or so) I found most interesting. The article has many links that aren’t included below.

What follows is divided into sections:

How Many Will Die
The Lockdowns Will End, But Haltingly
Immunity Will Become an Advantage in Society
A Vaccine Is Not Coming Soon
Treatments Are Likely To Arrive First
We Will Need International Cooperation

[ How Many Will Die ]

In fast-moving epidemics, far more victims pour into hospitals or die at home than doctors can test; at the same time, the mildly ill or asymptomatic never get tested. Those two factors distort the true fatality rate in opposite ways. If you don’t know how many people are infected, you don’t know how deadly a virus is.

Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C.  has suggested it might be 25 percent  of those who test positive. Researchers in Iceland  said it might be double that.

China is also revising its own estimates. In February, a  major study  concluded that only 1 percent of cases in Wuhan were asymptomatic.  New research  says  perhaps 60 percent  were. Our knowledge gaps are still wide enough to make epidemiologists weep.

“All models are just models,” Dr. Anthony S. Fauci, science adviser to the White House coronavirus task force, has said. “When you get new data, you change them.”

There may be good news buried in this inconsistency: The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually  faded into the seasonal H1N1 flu.

At the moment, however, we do not know  exactly how transmissible  or lethal the virus is. But refrigerated trucks parked outside hospitals tell us all we need to know: It is far worse than a bad flu season.

[ The Lockdowns Will End, But Haltingly ]

The next two years will proceed in fits and starts, experts said. As more immune people get back to work, more of the economy will recover.

But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.

Dr. Fauci has said “the virus will tell us” when it’s safe. He means that once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.

Detecting rising fevers as they are mapped by … smart thermometers may give an earlier signal…

But diagnostic testing has been troubled from the beginning. Despite assurances from the White House, doctors and patients continue to complain of delays and shortages.

To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.

In this country, patients who test positive are asked to stay in their homes, but keep away from their families.

Television news has been filled with recuperating personalities like CNN’s Chris Cuomo, sweating alone in his basement while his wife left food atop the stairs…

But even Mr. Cuomo ended up illustrating why the W.H.O. strongly opposes home isolation. On Wednesday, he revealed that his wife had the virus.

“If I was forced to select only one intervention, it would be the rapid isolation of all cases,” said Dr. Bruce Aylward, who led the W.H.O. observer team to China.

In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.

There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears…

Still, experts were divided on the idea of such wards. [One called for] mandatory but “humane quarantine processes.”

By contrast, [a Harvard epidemiologist] opposed the idea, saying: “I don’t trust our government to remove people from their families by force.”

Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.

Someone working in a restaurant or factory may have dozens or even hundreds of contacts. In China’s Sichuan Province, for example, each known case had an average of 45 contacts.

The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.

China hired and trained 9,000 in Wuhan alone. [It’s been] estimated that the United States will need at least 300,000.

[ Immunity Will Become an Advantage in Society ]

Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.

“It will be a frightening schism,” … a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”

Already, people with presumed immunity are very much in demand, asked to donate their blood for antibodies and doing risky medical jobs fearlessly.

Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense… Many companies are working on them.

Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them….

As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection, experts predicted. Younger citizens in particular will calculate that risking a serious illness may still be better than impoverishment and isolation.

“My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,” said Dr. Michele Barry…

It would be a gamble [since] even slim, healthy young Americans have died of Covid-19.

[ A Vaccine Is Not Coming Soon ]

Even though limited human trials of three candidates — two here and one in China — have already begun, [Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases] has repeatedly said that any effort to make a vaccine will take at least a year to 18 months.

All the experts familiar with vaccine production agreed that … that timeline was optimistic… The record is four years, for the mumps vaccine.

Researchers differed sharply over what should be done to speed the process. Modern biotechnology techniques using RNA or DNA platforms make it possible to develop candidate vaccines faster than ever before.

But clinical trials take time, in part because there is no way to rush the production of antibodies in the human body.

Also, for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less….

A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.

It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.

Challenge trials are used only when a disease is completely curable, such as malaria or typhoid fever. Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.

But in these abnormal times, several experts argued that putting a few Americans at high risk for fast results could be more ethical than leaving millions at risk for years….

As arduous as testing a vaccine is, producing hundreds of millions of doses is even tougher, experts said.

Most American vaccine plants produce only about 5 million to 10 million doses a year, needed largely by the 4 million babies born and 4 million people who reach age 65 annually…

But if a vaccine is invented, the United States could need 300 million doses [assuming 30 million of us are immune] — or 600 million if two shots are required. And just as many syringes.

“People have to start thinking big,” [one doctor] said. “With that volume, you’ve got to start cranking it out pretty soon.”

Flu vaccine plants are large, but those that grow the vaccines in chicken eggs are not suitable for modern vaccines…

European countries have plants but will need them for their own citizens. China has a large vaccine industry, and may be able to expand it over the coming months. It might be able to make vaccines for the United States…

India and Brazil also have large vaccine industries. If the virus moves rapidly through their crowded populations, they may lose millions of citizens but achieve widespread herd immunity well before the United States does. In that case, they might have spare vaccine plant capacity.

Alternatively, [another doctor said] the government might take over and sterilize existing liquor or beer plants, which have large fermentation vats: “ any distillery could be converted”.

[ Treatment Is Likely To Arrive First ]

In the short term, experts were more optimistic about treatments than vaccines. Several felt that so-called convalescent serum could work.

The basic technique has been used for over a century: Blood is drawn from people who have recovered from a disease, then filtered to remove everything but the antibodies. The antibody-rich immunoglobulin is injected into patients.

The obstacle is that there are now relatively few survivors to harvest blood from [note: in New Jersey at least, you have to be under 60, among other requirements]….

[A treatment involving] monoclonal antibodies … recently came very close to conquering the Ebola epidemic in eastern Congo, [and] are the most likely short-term game changer…

The most effective antibodies are chosen, and the genes that produce them are spliced into a benign virus that will grow in a cellular broth.

But, as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers….

Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.

But even if one were invented, production would have to ramp up until it was as ubiquitous as aspirin, so 300 million Americans could take it daily.

[Some keep suggesting] hydroxychloroquine and azithromycin… All the experts agreed … that no decision should be made until clinical trials are completed.

Some recalled that in the 1950s inadequate testing of thalidomide caused thousands of children to be born with malformed limbs. More than one hydroxychloroquine study has been halted after patients who got high doses developed abnormal heart rhythms.

“I doubt anyone will tolerate high doses, and there are vision issues if it accumulates,” [one doctor] said. “But it would be interesting to see if it could work [like pills used to prevent H.I.V.].

Others were harsher… “It’s total nonsense,” said … a former director of medical and biodefense preparedness at the National Security Council. “I told my family, if I get Covid, do not give me this combo.”

Chloroquine might protect patients hospitalized with pneumonia against lethal cytokine storms because it damps down immune reactions, several doctors said.

That does not, however, make it useful for preventing infections, as [some have] implied it would be, because it has no known antiviral properties.

Several antivirals, including remdesivir, favipiravir and baloxavir, are being tested against the coronavirus; the latter two are flu drugs.

Trials of various combinations in China are set to issue results by next month, but they will be small and possibly inconclusive…

[ We Will Need International Cooperation ]

A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet [the president] is moving to defund the W.H.O., the only organization capable of coordinating such a response.

And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries [including the United States]….

“If [the president] cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,” said … an economic historian… [A doctor added:] “What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”

Once the pandemic has passed, the national recovery may be swift…

The psychological fallout will be harder to gauge. The isolation and poverty caused by a long shutdown may drive up rates of domestic abuse, depression and suicide.

Even political perspectives may shift…. In the periods after both wars, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.

If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general…