A Few Brief and Blunt Answers

Christiane Amanpour is a journalist at CNN. Donald McNeil Jr. is a science writer for The New York Times. She asks him questions about the virus. He gives informed yet blunt answers.

Three minutes on how our federal government screwed this up.

Less than three minutes on our testing shortfall (Warning: our president says words during the first thirty seconds, so be careful).

Even less on the difference between medicine and public health (Mr. McNeil doesn’t discuss how the president and his minions sabotaged our preparedness by cutting budgets and firing qualified people; it would have been good to hear McNeil speak bluntly about that).

Update:

The Times issued a statement saying Mr. McNeil “went too far in expressing his personal views”. His editors discussed the issue with him and reminded him that “his job is to report the facts and not to offer his own opinions”. There are some things corporate journalists are not supposed to say in public, even though they say such things in private and what they say is true. 

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.

We’re Being Tested, But Not in the Right Way

There is good news on the coronavirus front. But not in this country.

From the Popular Information newsletter:

South Korea, a country of about 51 million people, conducted nearly 200,000 tests as of Monday. In South Korea, you could get tested for coronavirus in a drive-thru lane, without ever getting out of your car. The strategy appears to be working. “[T]he country has seen a steady decline in new infections over the last few days,” NBC News reports.

Initially, the United States conducted very few tests because the T—- administration decided to develop its own test kit rather than using functional kits from the World Health Organization or commercial suppliers. That test did not function properly.

But that problem appears to be solved….

So how many Americans have been tested? The CDC is not releasing comprehensive data on testing, so the best information comes from three guys updating a Google Doc. Aggregating state data, they’ve found only 7,695 Americans have been tested, as of Wednesday evening [NOTE: The latest number is 8,909 — but if we were conducting tests at the same rate as South Korea, we might have done 1.2 million by now].

As a result, coronavirus is still spreading undetected in many communities….The lack of testing increases the chances that things will get much worse.

As it turns out, having a functional test kit isn’t enough to perform a coronavirus test. You also need something called an “RNA extraction” kit to “prepare samples for testing.” And there is a shortage of these RNA extraction kits in labs across the country.

CDC Director Robert Redfield admitted to Politico that the shortage of RNA extraction kits was a major roadblock. “I’m confident of the actual test that we have, but as people begin to operationalize the test, they realize there’s other things they need to do the test,” Redfield said. Asked what he would do to address the shortage, Redfield replied, “I don’t know the answer to that question”….

The main supplier of RNA extraction kits is Qiagen, a Dutch diagnostics company. Qiagen “confirmed that its product is backordered due to ‘the extraordinary pace’ at which the world has increased coronavirus testing over the last few weeks.” In other words, other countries obtained the supplies they needed to conduct testing faster than the United States. Now that T—- administration officials realize that testing needs to accelerate quickly, the supplies are no longer available.

Here is what Dr. Marc Lipsitch, a professor of epidemiology at Harvard, had to say about the inability of the United States to conduct testing at scale:

The lack of testing in the United States is a debacle. We’re supposed to be the best biomedical powerhouse in the world and we’re unable to do something almost every other country is doing on an orders of magnitude bigger scale.

Recall that the administration had people with the relevant background and expertise to handle this precise situation. T—- fired them in 2018 and never replaced them….

Asked about the reduction in expert staff, T—- defended the decision and said he could get the experts back “quickly” if needed.

Unquote.

We’re lucky that something like COVID-19 didn’t come along sooner. We’ve been at elevated risk since T—- sat down in the Oval Office. (Actually, it did come along sooner when hurricane Maria destroyed much of Puerto Rico in 2017, but nobody much cared about a horrible government response to a disaster that didn’t affect “real” Americans.)

In Case You’re Wondering How Prepared We Are

So far, the number of confirmed coronavirus cases in the US is low. But there are now confirmed cases in at least 32 (now 35)(now almost 50) countries. The number of new cases outside China has doubled every 5.5 days since January. 

Today, an official of the Centers for Disease Control and Prevention (CDC) said:

Ultimately, we expect we will see community spread in the United States. It’s not a question of if this will happen but when this will happen and how many people in this country will have severe illnesses.

From journalist Judd Legum of Popular Information (a site worth visiting):

In 2018, the Trump administration ousted Rear Adm. Tim Ziemer, who served as the Senior Director of Global Health Security. Ziemer was a member of the National Security Council, where he was responsible for coordinating “responses to global health emergencies and potential pandemics.” Ziemer was lauded as “one of the most quietly effective leaders in public health.” His work on malaria during the Obama administration helped save 6 million lives.

“Admiral Ziemer’s departure is deeply alarming,” Congressman Ami Bera (D-CA) said in May 2018. “Expertise like his is critical in avoiding large outbreaks.” Beth Cameron, who served on the National Security Council in the Obama administration, said that Ziemer’s ouster was “a major loss for health security, biodefense, and pandemic preparedness” and noted that it “is unclear in his absence who at the White House would be in charge of a pandemic.”

John Bolton, who was serving as Trump’s National Security Adviser at the time, did not just remove Ziemer. He decided to eliminate the position, and “the NSC’s entire global health security unit.” Bolton also forced out Tom Bossert, a highly regarded expert who was Ziemer’s counterpart at the Department of Homeland Security. “Neither the NSC nor DHS epidemic teams have been replaced,” Foreign Policy reported in January.

Trump slashed funding for the CDC’s epidemic prevention activities, forcing the agency to end its work “in 39 out of 49 countries because money is running out” in 2018. The program, which started in 2014, was designed to “help countries prevent infectious-disease threats from becoming epidemics.” Among the countries no longer included: China.

Trump has also tried to decimate funding for the U.S. Public Health Service Commissioned Corps, which is tasked with fighting the spread of disease. Congress, however, has refused to comply. So the Trump administration has simply let the group slowly atrophy, failing to replace members who quit or retire….

Who is in charge of the United States’ response to the coronavirus? You might assume it is the CDC. You would be wrong.

There were several hundred Americans aboard a cruise ship, the Diamond Princess, that experienced an outbreak of COVID-19 near Japan. The Americans were evacuated and, before they were flown home, 14 tested positive for the coronavirus. The CDC advised that these infected passengers should not be flown home with the rest of the group, arguing that they could infect the others.

The CDC, however, was overruled by the “State Department and a top Trump administration health official.” The decision was made even though to government “had already told passengers they would not be evacuated with anyone who was infected or who showed symptoms.” CDC officials were so distraught that they “demanded to be left out of the news release that explained that infected people were being flown back to the United States.”

At the moment, there is no “clear chain of command for pandemic response.”

… There are also serious problems with the system set up to identify new outbreaks.

The test developed by the CDC to detect the coronavirus has not been able to be verified as accurate by most labs. As a result, just “three of the more than 100 public health labs across the country have verified the CDC test for use.” This has “hampered CDC’s plan to screen samples collected by its national flu-surveillance network for the coronavirus.” These issues “could impede the U.S. government’s ability to detect scattered cases before they snowball into larger outbreaks”….

Inside the White House, the concern has been around how the coronavirus could impact T—-‘s reelection. Senior officials fear “a sustained outbreak could slow global markets and upend a strong U.S. economy that has been central to [his] political pitch.”

T—- has been eager to downplay the threat of the coronavirus in public, recently expressing confidence that the virus would dissipate in a few weeks when the weather gets warmer….

There is no scientific basis for [this] claim, which is based on the assumption that the coronavirus will follow the same pattern as the seasonal flu. Columbia University epidemiologist Stephen Morse called T—-‘s comments “wishful thinking” and warned against being “lulled by hopeful, but quite possibly wrong analogies.”

Unquote.

From Senator Richard Blumenthal of Connecticut:

This morning’s classified coronavirus briefing should have been made fully open to the American people—they would be as appalled & astonished as I am by the inadequacy of preparedness & prevention.

We have a president whose main concern at the moment isn’t keeping people healthy. It’s how the spread of the disease will affect him. He’s also a pathological liar who doesn’t believe in science. Maybe this won’t be so bad, but that’s how prepared we are.

It’s Not “Dementia Don” Anymore. Now It’s “Very Stable Genius”.

This morning, a few minutes after the president watched his admirers at Fox News talk about his mental health, three messages appeared on the president’s personal Twitter account. Here they are, presented as one amazingly coherent (for him) paragraph:

Now that Russian collusion, after one year of intense study, has proven to be a total hoax on the American public, the Democrats and their lapdogs, the Fake News Mainstream Media, are taking out the old Ronald Reagan playbook and screaming mental stability and intelligence. Actually, throughout my life, my two greatest assets have been mental stability and being, like, really smart. Crooked Hillary Clinton also played these cards very hard and, as everyone knows, went down in flames. I went from VERY successful businessman, to top T.V. Star to President of the United States (on my first try). I think that would qualify as not smart, but genius….and a very stable genius at that!

It’s very hard to believe that the president still has enough of his marbles to have written that all by himself. It’s false to the point of delusion, of course, but well-written. I would have said someone else definitely wrote it, except that the peculiar way “T.V.” is written is one of the president’s stylistic quirks. (“T.V.” written as an abbreviation appears 32 times in the searchable Trump Twitter Archive; the simple “TV” appears much more often.) Perhaps the president dictated his response to somebody familiar with his unique style, and that person polished his ravings for  public consumption.

If the president did write that paragraph this morning (which I doubt), the explanation could be that he’s more competent after he’s had some sleep. We know he tires easily. (That new Fire and Fury book says he often gets in bed by 6:30 p.m.) His dementia probably gets worse as the day wears on.

At any rate, the president’s poor mental health is receiving additional attention, which is a good thing. Vox has an interesting interview with Bandy Lee, a psychiatrist at the Yale School of Medicine, who strongly recommends that the president receive (or be forced to receive, if necessary) an emergency psychiatric evaluation. Its purpose would be to determine whether he is a threat to public health. Dr. Lee says it isn’t a question of diagnosing him. It’s a matter of determining how dangerous he is:

Assessing dangerousness is making a judgment about the situation, not the person. The same person may not be dangerous in a different situation, for example. And it is his threat to public health, not his personal affairs, that is our concern….

[Once] you declare danger, you are calling first for containment and removal of weapons from the person and, second, for a full evaluation — which may then yield diagnoses. Until that happens, physicians and mental health professionals are expected to err on the side of safety and can be held legally liable if they fail to act. So we’re merely calling for an urgent evaluation so that we may have definitive answers.

In doing that, we are fulfilling a routine, public expectation of duty that comes with our profession — the only part that is unusual is that this is happening in the presidency….

Those who most require an evaluation are the least likely to submit to one. That is the reason why in all 50 states we have not only the legal authority, but often the legal obligation, to contain someone even against their will when it’s an emergency.

So in an emergency, neither consent nor confidentiality requirements hold. Safety comes first. What we do in the case of danger is we contain the person, we remove them from access to weapons [Note: including nuclear weapons in this case] and we do an urgent evaluation.

This is what we have been calling for with the president based on basic medical standards of care.

We shouldn’t expect the president to be given a formal evaluation any time soon, of course. Josh Marshall of Talking Points Memo seems to think it isn’t necessary anyway, although he doesn’t distinguish between being diagnosed and being evaluated as a threat. That’s because we (including Republican politicians) already know there’s a very serious problem:

We are now back on to the feverish debate about whether or not Donald Trump is mentally ill or suffering from the onset of dementia. The most important thing to know about this debate is that it simply doesn’t matter. If the entire psychiatric profession got together and examined Trump and pronounced him entirely free of any mental illness, his behavior wouldn’t be any less whacked or dangerous in a President….

In common sense, everyday rather than clinical language, Trump is clearly unstable, erratic, impulsive. In a word, he’s nuts and not well. As citizens, we are entirely able and entitled to make these determinations. They are ordinary English language descriptors that the psychiatric profession doesn’t control and shouldn’t want to control. The entire debate over whether Trump is “mentally ill” is simply a diversion, premised on the idea that we need either permission or dictation to say he is not able to safely or competently fulfill the job of President. We don’t. The observed behavior is really all that is necessary and all that matters.

So where does that leave us? As the pressure mounts, the president will likely become more unhinged and more dangerous. Unless he goes totally batshit crazy, it’s unlikely that his staff or Congressional Republicans will do anything about it. Even then, they might cover up his incapacity. That’s what happened when President Woodrow Wilson had a series of strokes in 1919. His wife and the president’s associates secretly ran the government in his place.

Sometimes quietly, the Trump administration continues its assault on working people, the poor, immigrants and the environment. Republicans in Congress and the Department of Justice are increasing their efforts to protect the president and his co-conspirators, even as the evidence against them mounts. Now they’re even going after the president’s opponents (yes, let’s investigate the Clinton Foundation and her emails again). Fox News keeps broadcasting state propaganda. Puerto Rico is still suffering. War, either in Eastern Europe, East Asia or the Middle East, is probably more likely than it was a year ago.

Fortunately, we made it through 2017 without too many crises, aside from the disastrous effects of climate change on the weather. The various investigations now underway may interfere with the Republican agenda. January’s new Congress might provide some oversight of the executive branch. If we make it through 2018 relatively safely, there may be better times ahead.

In that positive vein, here are some words from Theodore Parker, a 19th century Unitarian minister who influenced Abraham Lincoln and Martin Luther King, among many others. Parker believed that slavery would be abolished one day:

I do not pretend to understand the moral universe; the arc is a long one, my eye reaches but little ways; I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. And from what I see I am sure it bends towards justice.

Meanwhile, In Gun News

It’s been reported recently that the US government doesn’t keep track of how many people are killed by the police. The FBI relies on individual police departments to report “justifiable homicides” they commit, but a study by The Wall Street Journal found that “hundreds of police killings are uncounted in federal stats”.

That’s why The Guardian created “The Counted”. It’s an attempt to document everyone killed by America’s police departments during 2015. The database includes people shot to death, as well as those who died under other circumstances, such as the 15 people hit by police cars. As of today, the database contains 506 deaths, 442 by gunshot. You can look at the database and see brief accounts of each incident here.

In a related Guardian article, it’s pointed out that:

… police in the US often contend with much more violent situations and more heavily armed individuals than police in other developed democratic societies. Still, looking at our data for the US against admittedly less reliable information on police killings elsewhere paints a dramatic portrait … : the US is not just some outlier in terms of police violence when compared with countries of similar economic and political standing. America is the outlier … [my emphasis].

One way to reduce both the number of violent situations the police confront and the number of people they kill would be to reduce the number of firearms in circulation. (If you want to get shot by a police officer, the most efficient way is to acquire a gun and then point it at a cop, like David Schwalm did last month.)

And one way to reduce the number of firearms in circulation would be to enforce something like Connecticut’s “permit to purchase” law. From Salon:

Connecticut’s “permit to purchase” law, in effect for two decades, requires residents to undergo background checks, complete a safety course and apply in-person for a permit before they can buy a handgun. The law applies to both private sellers and licensed gun dealers.

Researchers at Johns Hopkins reviewed the homicide rate in the 10 years before the law was implemented and compared it to longitudinal estimates of what the rate would have been had the law not be enacted. The study found a 40 percent reduction in gun-related homicides….there was no similar drop in non-firearm homicides.

The relationship between tighter regulations around handguns and fewer gun-related homicides is in keeping with previous research out of Johns Hopkins on what happened after Missouri repealed its own permit law.

When Missouri repealed its permit law, the number of homicides went up, which shouldn’t have been a surprise. The John Hopkins researchers found a 23% increase in gun-related homicides in the five years after the law was repealed.

There Is A Cure For Science Denial

Once Florida is underwater and we all have polio, it will be better.

That’s what Samantha Bee concludes in the Daily Show video here. Left-wing stupidity isn’t one of my usual topics, but it appears to be the relevant phenomenon in this case. The title of the video is “An Outbreak of Liberal Idiocy”.