Tag Archives: COVID-19

Debt, Schmet

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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

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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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We’ve Been Hoping for a Tipping Point

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Yet a tipping point, the last straw, will probably never arrive. A number of citizens of this formerly great country will spray disinfectant on their corn flakes before pouring the milk, but President Lysol will stumble and bumble on for nine more months. Nevertheless, it’s encouraging to see the word “resign” appear in a reputable publication, not the feverish musings of a humble blogger.

From Jack Holmes of Esquire:

Of course there are people who will defend him no matter what, but it’s hard not to think that the watching Elite Political Media’s refusal to say what is right in front of them has also aided and abetted the madness. Could he have made it this far without people who are so scared of being accused of Bias or not being Objective that they can’t bring themselves to call a loon a loon? The latest example comes via The New York Times…They did not feel they could just say this is dangerous, not to mention fucking crazy. … if a guy walked into the lobby of the New York Times building yelling at people to drink bleach, he would be removed from the premises in short order. But when the president does it, we’ve got to check in with the experts to know what an 11-year-old knows….

In fairness, [the] Times story was delivered with some trademark low-key Times humor. But we need to get a little more direct here. Something really has to give. At what point are you misleading your readers by not pointing out that what just happened was fucking crazy, and they’re not crazy to think so? There is a need among some, particularly in Washington, to believe the president is not completely batty. The prospect that he has no idea what he’s doing, and in fact may not be all there, is psychologically difficult for some to grapple with. It’s also scary for some folks to think about just saying what’s in front of them and feeling the backlash from his supporters. So evening-news programs and newspapers spend a lot of time cleaning up what the president says, pruning the overgrown hedges into something vaguely coherent in their reports.

…. When are we going to demand more than a circus from the people in whom we now have so much of our futures invested, willingly or not? We should be calling for this guy to resign on a daily basis. He should be impeached again for gross incompetence. Mike Pence looks like fucking FDR by comparison. Most of the president’s supporters will never hold him to any standard that he might not meet. In fact, they will continually lower the bar to accommodate him, because they have already invested too much of themselves in this to go back. The sunk cost is too high. It’s up to everyone else to plainly say that he should not have this job any longer. We hired him, on a temporary basis, to manage the Executive Branch of our government. He should be fired.

Unquote.

Note: A spokesman for the governor of Maryland says that after receiving more than 100 calls, the state issued a reminder that “under no circumstances should any disinfectant product be administered into the body through the injection, ingestion or any other route”. 

And just think, the 100 people who made those calls are some of the smarter ones.

The Toddler Strikes Again — Pandemic Edition

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From Crooked Media’s informative newsletter:

The T—- administration abruptly removed the doctor who led the federal agency working on a coronavirus vaccine because he pushed back against the administration’s efforts to promote [the president’s] favorite unproven drugs. Now he has become a whistleblower: “I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way.”

Dr. Rick Bright said he was dismissed as director of [Health and Human Service’s] Biomedical Advanced Research and Development Authority (BARDA) because he insisted that the government invest funding into scientifically vetted treatments, vaccine research, and critical supplies, and resisted widespread use of chloroquine and hydroxychloroquine to treat coronavirus symptoms. (On Tuesday, a panel of experts [at the National Institutes of Health] specifically advised against the use of hydroxychloroquine outside of clinical trials.)

Bright believes he was transferred to a smaller role at NIH as an act of retaliation. He said he’ll request an investigation into the politicization of BARDA, including how the administration has pressured scientists to “fund companies with political connections and efforts that lack scientific merit.”

A vague but stunning accusation of political corruption hobbling the government’s response to one of the most deadly crises the country has ever faced….

Remember during Trump’s impeachment,a mere 400 years ago, when we learned that Trump fired an experienced career diplomat because she wouldn’t go along with his corrupt Ukraine scheme? We’ve just seen him do the same thing to a career scientist in a key public health role, in the middle of the worst public-health crisis in our lifetimes. Somebody ask [Republican Senator] Susan Collins if she still thinks T—- learned his lesson. 

This Might Explain Something Very Odd About Covid-19

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One of the strange things about this virus is how patients can suddenly deteriorate, sometimes to the point of death. A highly-experienced emergency room doctor named Richard Levitan may have just explained why — he also suggests a way we might easily keep more people alive.

He lives in New Hampshire but volunteered to work ten days at New York City’s Bellevue Hospital, where he trained. This is from his article in today’s New York Times:

Here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?

We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps keep the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until their oxygen levels plummet. In effect, the patient is injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.
Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.

There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.

Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.

Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.

All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.

Unquote.

This is a pulse oximeter. You may have stuck your finger in one at your doctor’s office, without really knowing why. I have one that looks like this.

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This little device measures the oxygen in your blood by sending infrared light through your finger. You can buy one for as little as $30. Some cost up to $60. If Dr. Levitan is right, they’re going to become very popular.