America the Combustible

From Michelle Goldberg in The New York Times:

So many things make America combustible right now: mass unemployment, a pandemic that’s laid bare murderous health and economic inequalities, teenagers with little to do, police violence, right-wingers itching for a second civil war and a president eager to pour gasoline on every fire. “I think we’re indeed in a moment where things are going to get a lot more tense before they get more peaceful,” said the University of Michigan historian Heather Ann Thompson, who won the Pulitzer Prize for her 2016 book “Blood in the Water: The Attica Prison Uprising of 1971 and Its Legacy.”

Already the Minneapolis protests have spread to other cities….

These demonstrations were sparked by specific instances of police violence, but they also take place in a context of widespread health and economic devastation that’s been disproportionately borne by people of color, especially those who are poor. “Sociologists have studied collective behavior, urban unrest for decades, and I think it’s safe to say that the consensus view is that it’s never just about a precipitating incident that resulted in the unrest,” Darnell Hunt, dean of social sciences at U.C.L.A., told me. “It’s always a collection of factors that make the situation ripe for collective behavior, unrest and mobilization.”

Keith Ellison, Minnesota’s progressive attorney general, told me that [many people] “have been cooped up for two months, and so now they’re in a different space and a different place. They’re restless. Some of them have been unemployed, some of them don’t have rent money, and they’re angry, they’re frustrated.”

That frustration is likely to build, because the economic ruin from the pandemic is just beginning. In some states, moratoriums on evictions have ended or will soon. The expanded unemployment benefits passed by Congress as part of the CARES Act run out at the end of July. State budgets have been ravaged, and Republicans in Washington have so far refused to come to states’ aid, meaning we’ll likely soon see painful cutbacks in public jobs and services.

“Where people are broke, and there doesn’t appear to be any assistance, there’s no leadership, there’s no clarity about what is going to happen, this creates the conditions for anger, rage, desperation and hopelessness, which can be a very volatile combination,” said Keeanga-Yamahtta Taylor, an assistant professor of African-American studies at Princeton. “I would not at all be surprised to see this kind of reaction elsewhere over the course of the next several months.”

But if America feels like a tinderbox at the moment, it’s not just because of pressure coming from the dispossessed. On Wednesday, the journalists Robert Evans and Jason Wilson published a fascinating and disturbing look at the “boogaloo” movement — “an extremely online update of the militia movement” — on the investigative website Bellingcat. “The ‘boogaloo Bois’ expect, even hope, that the warmer weather will bring armed confrontations with law enforcement, and will build momentum towards a new civil war in the United States,” Evans and Wilson write… [they report that the “movement” has been facilitated by, of course, Facebook].

People associated with the subculture had a significant presence at the lockdown protests, but some, motivated by hatred of the police and a love of bedlam, took part in the Minneapolis demonstrations as well….

Most American presidents, faced with such domestic instability, would seek de-escalation. This is one reason civil unrest, for all the damage it can cause to communities where it breaks out, has often led to reform. Change has come, said Thompson, when activists have “created a situation where the people in power actually had to act in order to bring back some meaningful public peace.”

Now, however, we have a president who doesn’t much care about warding off chaos. “In every other time when protest has reached a fever pitch because injustices very much needed to be remedied, the country ultimately tried to find a new equilibrium, tried to address it enough to reach some sort of peace,” said Thompson. “We now have a leadership that’s been crystal clear that it’s perfectly OK if we descend into utter civil war.”

Some of the tropes are familiar, but we haven’t seen this movie before. No one knows how dark things could get, only that, in the T—- era, scenes that seem nightmarish one day come to look almost normal the next.

From The Hill:

St. Paul, Minn., Mayor Melvin Carter (D) said Saturday that all of the protesters who were arrested in his city the previous night were from out of state as demonstrations in and around Minneapolis over George Floyd’s death descended into violence.

Carter said there was not a high number of arrests in St. Paul on Friday night due in part to a curfew but suggested that out-of-staters were behind much of the agitation fueling the violence.

“… We didn’t make an enormous number of arrests, but every single person we arrested last night, I’m told, was from out of state. What we are seeing right now is a group of people who are not from here,” Carter said at a press conference.

“As I talk to my friends who have been in this movement for a very long time, who wake up in this movement every day, and I ask them what they’re seeing, what they’re feeling, what they’re hearing, to a person, I hear them say, ‘We don’t know these folks. We don’t know these folks who are agitating. We don’t know these folks who are inciting violence. We don’t know these folks who are first in to break a window,’” he added.

Unquote.

There are protests around the country with no violence at all. Those won’t be in the news (or on blogs) as much as the ones where there’s violence. Still, we’re looking at a long, hot, probably angry summer.

With fringe elements of whatever political persuasion possibly looking to make trouble, we shouldn’t assume who is behind any violence that occurs. We can assume, however, that the president, who just made up some crap about “vicious dogs” and “ominous weapons” being deployed at the White House, and who has the obscure Insurrection Act of 1807 (which allows him to call in the military) at his disposal, will only make things worse.

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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Getting Ahead of Themselves

As pressure builds to “reopen” America, it should be noted that if you remove the New York metropolitan area (which includes northern New Jersey) from the statistics, the number of Covid-19 cases is increasing. The New York metro area has been hit the hardest and is now showing improvement. But the situation is getting worse elsewhere, including states where Republican politicians are eager to move past all this unpleasantness.

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Here are the trend lines for four states with right-wing governors in thrall to Dear Leader:

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From Andy Slavitt, former administrator of Medicare and Medicaid:

Like many countries, we picked a strategy to beat COVID-19. We just decided not to stick to it. It’s a long and difficult road, and after we climbed halfway we decided it was too hard and chose to roll back down the hill.

There is, however, a plan to slowly and steadily bring the economy back, but only by solving the public health crisis. It was put forward by [the] White House all of three weeks ago. It had gates and stages, and hinged on conditions on the ground. But none of the conditions have been met.

Rather than wait, [the Toddler] grew impatient. He wants life to go back to the way it was before the pandemic. He wants the economy growing. [He wants to be re-elected, not judged a “loser”!]

Our expectations are simple. The truth, no matter how hard. To know that our safety matters. A plan which uses all our tools and best thinking that we stick with. Candor in discussing the tough trade offs.

We’re not getting that.

Instead, in Slavitt’s words, we’ll get:

… a food fight between the hardened realists who can tolerate death to “get our country back”, and the “public health mafia who are willing to kill the economy for the sake of a few people who will die soon anyway.” And if those people say that the death toll is going to be big, they’re just alarmists.

Many in the news media will present this as one more political controversy requiring balance between “both sides”. Dana Milbank of The Washintgon Post sees it as something else:

This is state-sanctioned killing. It is a conscious decision to accept 2,000 preventable deaths every day, because our leaders believe the victims [will be] poor schlubs who work in meat-processing plants… It is deliberately sacrificing the old, factory workers, and black and Hispanic Americans, who are dying at higher rates….

All we can do is pray for a vaccine breakthrough and hope summer weather helps. That’s because our president abandoned the fight. [He] can lie all he likes about the adequacy of testing and supplies, and blame his predecessor, his opponents and the media for his incompetence. It [won’t] matter to the virus.

Finally, some not exactly optimism from Tom Tomorow:

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They Pity Us

The US response to the coronavirus crisis has been paralysed by a contradiction that the Republicans have inserted into the heart of US democracy. On the one hand, they want to control all the levers of governmental power. On the other, they have created a popular base by playing on the notion that government is innately evil and must not be trusted.

From Fintan O’Toole, who writes for The Irish Times (behind a paywall):

Over more than two centuries, the United States has stirred a very wide range of feelings in the rest of the world: love and hatred, fear and hope, envy and contempt, awe and anger. But there is one emotion that has never been directed towards the US until now: pity. [Note: There was pity after 9/11, but for a very different reason.]

However bad things are for most other rich democracies, it is hard not to feel sorry for Americans. Most of them did not vote for D—- T—- in 2016. Yet they are locked down with a malignant narcissist who, instead of protecting his people from Covid-19, has amplified its lethality. The country T—- promised to make great again has never in its history seemed so pitiful.

Will American prestige ever recover from this shameful episode? The US went into the coronavirus crisis with immense advantages: precious weeks of warning about what was coming, the world’s best concentration of medical and scientific expertise, effectively limitless financial resources, a military complex with stunning logistical capacity and most of the world’s leading technology corporations. Yet it managed to make itself the global epicentre of the pandemic.

As the American writer George Packer puts it in the current edition of the Atlantic, “The United States reacted … like Pakistan or Belarus – like a country with shoddy infrastructure and a dysfunctional government whose leaders were too corrupt or stupid to head off mass suffering.”

It is one thing to be powerless in the face of a natural disaster, quite another to watch vast power being squandered in real time – wilfully, malevolently, vindictively. It is one thing for governments to fail (as, in one degree or another, most governments did), quite another to watch a ruler and his supporters actively spread a deadly virus. T—-, his party and Rupert Murdoch’s Fox News became vectors of the pestilence.

The grotesque spectacle of the president openly inciting people (some of them armed) to take to the streets to oppose the restrictions that save lives is the manifestation of a political death wish. What are supposed to be daily briefings on the crisis, demonstrative of national unity in the face of a shared challenge, have been used by T—- merely to sow confusion and division. They provide a recurring horror show in which all the neuroses that haunt the American subconscious dance naked on live TV.

If the plague is a test, its ruling political nexus ensured that the US would fail it at a terrible cost in human lives. In the process, the idea of the US as the world’s leading nation – an idea that has shaped the past century – has all but evaporated…..

It is hard to remember now but, even in 2017, when T—- took office, the conventional wisdom in the US was that the Republican Party and the broader framework of US political institutions would prevent him from doing too much damage. This was always a delusion, but the pandemic has exposed it in the most savage ways.

What used to be called mainstream conservatism has not absorbed T—- – he has absorbed it. Almost the entire right-wing half of American politics has surrendered abjectly to him. It has sacrificed on the altar of wanton stupidity the most basic ideas of responsibility, care and even safety.

Thus, even at the very end of March, 15 Republican governors had failed to order people to stay at home or to close non-essential businesses. In Alabama, for example, it was not until April 3rd that governor Kay Ivey finally issued a stay-at-home order.

In Florida, the state with the highest concentration of elderly people with underlying conditions, governor Ron DeSantis, a T—- mini-me, kept the beach resorts open to students travelling from all over the US for spring break parties. Even on April 1st, when he issued restrictions, DeSantis exempted religious services and “recreational activities”.

Georgia governor Brian Kemp, when he finally issued a stay-at-home order on April 1st, explained: “We didn’t know that [the virus can be spread by people without symptoms] until the last 24 hours.”

This is not mere ignorance – it is deliberate and homicidal stupidity. There is, as the demonstrations this week in US cities have shown, plenty of political mileage in denying the reality of the pandemic. It is fuelled by Fox News and far-right internet sites, and it reaps for these politicians millions of dollars in donations, mostly (in an ugly irony) from older people who are most vulnerable to the coronavirus.

It draws on a concoction of conspiracy theories, hatred of science, paranoia about the “deep state” and religious providentialism (God will protect the good folks) that is now very deeply infused in the mindset of the American right.

T—- embodies and enacts this mindset, but he did not invent it. The US response to the coronavirus crisis has been paralysed by a contradiction that the Republicans have inserted into the heart of US democracy. On the one hand, they want to control all the levers of governmental power. On the other they have created a popular base by playing on the notion that government is innately evil and must not be trusted.

The contradiction was made manifest in two of [his] statements on the pandemic: on the one hand that he has “total authority”, and on the other that “I don’t take responsibility at all”. Caught between authoritarian and anarchic impulses, he is incapable of coherence.

But this is not just D—- T—-. The crisis has shown definitively that [his] presidency is not an aberration. It has grown on soil long prepared to receive it. The monstrous blossoming of misrule has structure and purpose and strategy behind it.

There are very powerful interests who demand “freedom” in order to do as they like with the environment, society and the economy. They have infused a very large part of American culture with the belief that “freedom” is literally more important than life. My freedom to own assault weapons trumps your right not to get shot at school. Now, my freedom to go to the barber (“I Need a Haircut” read one banner this week in St Paul, Minnesota) trumps your need to avoid infection.

Usually when this kind of outlandish idiocy is displaying itself, there is the comforting thought that, if things were really serious, it would all stop. People would sober up. Instead, a large part of the US has hit the bottle even harder.

And the president, his party and their media allies keep supplying the drinks. There has been no moment of truth, no shock of realisation that the antics have to end. No one of any substance on the US right has stepped in to say: get a grip, people are dying here.

That is the mark of how deep the trouble is for the US – it is not just that T—- has treated the crisis merely as a way to feed tribal hatreds but that this behaviour has become normalised. When the freak show is live on TV every evening, and the star is boasting about his ratings, it is not really a freak show any more. For a very large and solid bloc of Americans, it is reality.

And this will get worse before it gets better. T—- has at least eight more months in power… [He] will pump more hatred and falsehood, more death-wish defiance of reason and decency, into the groundwater. If a new administration succeeds him in 2021, it will have to clean up the toxic dump he leaves behind. If he is re-elected, toxicity will have become the lifeblood of American politics.

Either way, it will be a long time before the rest of the world can imagine America being great again.

[The same applies to this part of the world.]

The Plan Is To Have No Plan

From Jay Rosen, a journalism professor at New York University:

This is my read on what the government’s guidance and actions amount to…. My purpose in posting it is to challenge the American press to be a lot clearer in its descriptions.

The plan is to have no plan, to let daily deaths between one and three thousand become a normal thing, and then to create massive confusion about who is responsible— by telling the governors they’re in charge without doing what only the federal government can do, by fighting with the press when it shows up to be briefed, by fixing blame for the virus on China or some other foreign element, and by “flooding the zone with shit,” Steve Bannon’s phrase for overwhelming the system with disinformation, distraction, and denial, which boosts what economists call “search costs” for reliable intelligence.

Stated another way, the plan is to default on public problem solving, and then prevent the public from understanding the consequences of that default. To succeed this will require one of the biggest propaganda and freedom of information fights in U.S. history, the execution of which will, I think, consume the president’s re-election campaign. So much has already been made public that the standard script for a White House cover up (worse than the crime…) won’t apply. Instead, everything will ride on the manufacture of confusion. The press won’t be able to “expose” the plot because it will all happen in stark daylight. The facts will be known, and simultaneously they will be inconceivable.

“The plan is to have no plan” is not a strategy, really. Nor would I call it a policy. It has a kind of logic to it, but this is different from saying it has a design— or a designer. Meaning: I do not want to be too conspiratorial about this. To wing it without a plan is merely the best this government can do, given who heads the table. The manufacture of confusion is just the ruins of Trump’s personality meeting the powers of the presidency. There is no genius there, only a damaged human being playing havoc with our lives. 

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…