A lot of people are arguing for their favorite health care policy in the middle of the national response to the novel coronavirus pandemic. If you have politically engaged friends the left, as we do, then you’ve seen no end of claims that the solution is single-payer healthcare “for all” (Taiwan has it!), never mind that the four countries with the highest per capita infection rate, at least as of this writing, all have universal health care. On the right, people are passing around this article, which points the finger at state “certificate of need” laws.
There is no doubt a legitimate argument to be had about the correct balance between the capacity of the nation’s hospitals and the cost of that capacity. Of course, if we are all in the moment focused on flattening the curvebecause of capacity constraints, then we are all — in this moment — going to wish we had more of it, never mind the cost during all of those times when there is no global pandemic.
The national numbers do not answer the question of the right balance, but they do suggest that — nationally — we are in good shape compared to most other countries hit with Covid-19. See the chart below, and then multiply the beds per 100,000 by 10 to get the beds per 1,000,000, which aligns it with the column on this table.
OK, we’ll do the math for you. As of today, Italy and Spain have many more Covid-19 cases than their total critical care capacity (recognizing both that there are many people in hospitals for other reasons, but also that most cases of Covid-19 do not require hospitalization). Germany and the United States are still far below capacity, at least measured against known Covid-19 cases, with the United States in very good shape.
On the national numbers.
The issue for all actual people, of course, is that the local burden on the system might well be far above, or far below, the local capacity to deal with them. If Seattle’s many great hospitals are overwhelmed, it will not matter that there are plenty of beds in Tulsa or Wheeling. Look at this map. The national policy and national capacity barely matters to the discussion.
So, whether or not we have “enough” critical care capacity as a nation, and whether or not there is an obvious public policy solution that would have provided more, it is impossible to know whether any such policy would have allowed for more, or less, in the places that will turn out to need it.
Ranked by cases of Covid-19 per million people, the bottom countries — meaning the worst — as of this afternoon, are as follows (cases per million people are the far right column):
Marshaling all our personal knowledge of the world and, even, our offensive but perhaps relevant prejudices, we struggle to see a useful pattern here. Indeed, in these admittedly early days these data would seem to mock the hope that rising temperatures might contain the virus.
Yesterday our vast network of spies sent us an interesting analytical report from JP Morgan. Sadly, we cannot link it since it came by email. Strictly in the interests of the public health, however, we share this interesting fair use excerpt relating to the prospects for relief from the novel coronavirus as the northern hemisphere warms up:
Update: tracking COVID-19 outbreaks and geographical vulnerability bands (March 12, 2020) This is controversial and many scientists are still uncertain about it, but there has been some research on COVID-19 outbreaks as a function of latitude, temperature and humidity. A paper just released from the Institute of Human Virology at the University of Maryland [(link to pdf)] which makes the following observations: • The most severe community outbreaks have occurred in regions along a narrow east-west distribution roughly along the 30-50 N” corridor at consistently similar weather patterns (5-11°C and 47-79% humidity). Cities at greatest risk below are on the border of the yellow zone and the green zone • Average temperatures (5-11°C) and relative humidity (47-79%) in affected cities are similar to each other, and also similar to laboratory conditions conducive to coronavirus survival (4°C and 20-80% relative humidity). None of the infection concentrations have occurred (yet) in places with minimum temperatures below 0°C either. • Outbreaks have been lower (so far) in places with large populations and substantial travel connections with China, such as Bangkok
Which cities are most at risk? The table below show cities with community spreading and those deemed at risk by the authors of the study using their (in my view highly simplified) approach, simply due to the latitude and average temperatures/humidity of each. The authors note that the cities below will experience rising temperatures and humidity in the weeks ahead, and if temperature and humidity do affect the transmission of the COVID-19 virus, the passage of time could help. As the “ideal temperature/humidity” zone for the survival of the virus moves further north over time, the authors believe it would overlap with population centers with much lower density.
However, let’s be cautious here. The authors cite the decline in Wuhan infections as possibly being related to warming weather when there are many other factors involved: the rising effectiveness/severity of the quarantine, increased knowledge of the virus and social distancing by citizens, and “herd immunity” once a large percentage of the population has already been exposed to the virus. This paper makes an important contribution to virus severity tracking and suggests that weather may play a role, but the results are far from conclusive this early in the outbreak (for example, the only cities circled on the map are ones with >6 deaths as of March 5; there are a lot more cities that would have circles today, and I do not have an updated map overlaying these circles on latitudes/temperature zones). To me, the primary value of the paper is to highlight cities with potentially high risk, and secondarily, that we wait and see if weather may mitigate it. I would NOT recommend any reduction of density reduction and social distancing simply out of the view that weather will solve the problem. [Bold emphasis added.]
The same report, which is regularly updated, had an earlier bit that suggested the mechanism.
Update: Could the onset of spring and summer slow virus transmission rates? (March 4, 2020) There have been press articles and government statements on the possibility that COVID-19 infection rates could fall as the winter comes to an end. There are three main theories as to why the flu season in temperate regions peaks in winter months: • More clustering of infected and uninfected people indoors due to colder temperatures • Colder, drier air is more conducive to airborne travel of viruses; colder air allows viruses to survive for longer periods and to travel longer physical distances • Lower levels of winter sunlight may play a role given the ability of UV light to sterilize surfaces and kill both viruses and bacteria Some details: • Scientists have found that influenza peaks in periods of low humidity, low temperatures, low solar radiation and low precipitation. In other words: in cold, dry winter months • In lab studies using animals, scientists also found that high temperatures and high humidity slowed the spread of influenza sharply, and at very high humidity levels, the virus stopped spreading completely • During the SARS epidemic in 2003, infection rates declined from March to May as temperatures rose. However, there were other factors changing at the same time (changes in hospitalization rates, greater provision of gear to medical personnel, higher quarantine rates and the natural erosion of epidemic severity over time) so results were not conclusive with respect to weather in isolation. Even when combining all these factors, researchers were only able to explain two thirds of the change in SARS infection rates • Why might infection rates be impacted by temperature? o Low winter humidity might impair the function of mucus, which traps and expels foreign bodies like viruses or bacteria. Cold, dry air can render mucus drier and less efficient at trapping a virus o In addition, influenza “virions” (an infective virus outside a host cell) appear to be much less stable in conditions of higher humidity, when respiratory droplets fall to the ground more quickly • It’s not just the heat, it could be the sun as well. Direct and scattered radiation from the sun can break down viruses that have been transmitted to surfaces (“fomites”), but is much less abundant in winter. UV light is so effective at killing bacteria and viruses that it’s used in hospitals to sterilize rooms and equipment o One study found that in Brazil, there’s a correlation between increased influenza hospital admissions and solar UV-blocking by smoke during the burning season o The US military reported that UV radiation sterilization virtually prevented the spread of influenza among patients in a veterans hospital, during the same time that an epidemic of influenza ravaged similar patients in nearby non-irradiated rooms • However, COVID-19 is not the same as influenza and SARS, and its reaction to changes in temperatures, humidity and sunlight is still unclear. SARS did not completely subside until late May 2003, which suggests that temperature factors, if they did mitigate the disease, took time to work • If weather DOES play a role in COVID-19, then infection rates could FALL in the Northern Hemisphere as temperatures rise, but RISE in parts the Southern Hemisphere in June/July/August when temperatures fall there (i.e., what happens with the flu each year)
If you absorb no other Covid-19 news today, read this summary of a panel of public health officials three days ago. It gives us no pleasure, other than the pointless frisson of self-regard, to point out that many of our speculations of February 29 are looking more likely to become true.
The next two weeks will see a surge of testing in the United States, and then a surge in cases. This site keeps track in damned close to real time, for those of you following along from home. We expect that the media frenzy and inevitable finger pointing will go to at least “11”. So you might not want to jump back in to the stock market until we get through that.
The debate about the poor availability of testing in the United States will rage for a long time, because it feeds our competing national political narratives. Read this actually excellent account in the New York Times for an early first draft of history. Did we blow it — and we definitely have blown it — because of too much big government, or too little? Your reading of the history is a Rorschach test for your political alignment. Did we fail because our federalist system relies too much on state and local governments and we have a president who is poorly suited to driving the federal agencies toward a common goal? Or did we fail because the permanent professional government is inherently confused, indecisive, and excessively lawyered up? One can read that article both ways, which is, by the way, a rare enough thing in the New York Times.
We propose a third way of looking at the testing problem and the American response thus far. In the approval of new medical tools (drugs, laboratory tests, and medical devices), our system — including direct federal and state regulators and our civil liability regime — massively prefers safety (avoiding sins of commission, if you will) to the introduction of new technology that might save lives. We don’t put a feather on the “safety” side of the scales, we weigh it down with an anvil, and are thereby far more willing to commit the sin of omission (doing nothing) than commit the sin of approving a technology that is dangerous or ineffective.
Voters, politicians, government officials, and the press overwhelmingly favor the “safety paramount” approach of the United States. Unfortunately, the highly deliberative manner of the American approach becomes dangerous in a rapidly spreading pandemic. Much as the media and citizens wish it were otherwise, we cannot change our system, or even our bureaucratic impulses, suddenly. Even if lives depend on it.
Then there is the question of federalism. By design, even in matters of public health, the foundation of our government’s response is, first, state and local, however much the poorly educated or cynical in the media and among voters expect it to be federal. In a pandemic, that is probably more a bug than a feature, insofar as we are not able to marshal a simultaneous national policy and enforce it immediately. (It is far from obvious, however, that a polyglot multicultural continental nation can respond under any circumstances with the efficiency and compliance of, say, South Korea or Singapore, but that is an argument beyond the point of the post.)
Our system and culture, however, is not without its advantages. At the governmental level, we can see the policy mistakes in one state or city and avoid them in jurisdictions that are following along a few days behind. You might say that is worse than a perfect national policy, but it is better than a flawed national policy. The people who want the federal government to make all policy in these situations almost always assume that it will execute better than any other state. That is an extremely fraught assumption.
We have, however, cultural advantages. The independence of our private sector is a huge asset, even in the current crisis. In many countries, businesses do not make a move on a matter of public interest without consulting with the government, or waiting for government direction. In the United States, with our liability regime and history of initiative — something for both left and right! — some businesses move very quickly, and that builds tremendous public relations and liability pressure on the others to follow in a hurry. In the current experience, large American businesses (the “corporations”, for those of you looking for a label) have been running ahead of almost all levels of government in useful communications and effective policies to contain spreading, and are saving lives in so doing.
The approval of a vaccine may challenge us again. The usual “safety paramount” approach is to run a huge double-blind trial, in which half the people who enroll get the drug, and the other half get a placebo. That traditional process takes a long time, and people poorly educated in medical ethics may put pressure on the players (the manufacturers, investigators, and the FDA) to skip the placebo arm, or short-cut the trial. That may make sense, balancing the risks of the situation, but the manufacturers will want protection from liability if it turns out the rushed vaccine harms some people in addition to protecting millions. That will be a beautiful political moment.
Your Editor self-identifies as an Iowan, and — like most Iowans — is a fool for Iowa propaganda. To wit: “Iowa biotech firm says it has produced enough coronavirus tests for 700,000 patients.”
Coralville-based Integrated DNA Technologies began producing test kits after the Food and Drug Administration amended rules last week to allow private labs to create products that detect the virus.
On Friday, the company told the Des Moines Register it had delivered materials that enabled testing of 700,000 individuals for the coronavirus that causes COVID-19. A company spokeswoman said it is ready to send additional materials for more testing.
Note that the reported constraint, per The Des Moines Register, was FDA “rules.” With the greatest respect and delicacy, we suggest that the FDA is only occasionally a “forest-for-the-trees” regulator.
For the many people wondering whether aggressive action to curb the spread of the novel coronavirus is worth the cost or the hassle or the loss of intimacy, this graphic captures the big public health issue:
If the infection spreads quickly in a jurisdiction, the rush of cases will exceed the capacity of hospitals and other health care providers. Not only will those patients not get the care that they need, but other patients who need care for acute conditions may suffer or die because they are crowded out.
If we flatten the curve, not only do we reduce the risk of crowding out, but we buy time to build capacity — say, by installing more ventilators — and get to a vaccine.
So flatten the curve. An infection delayed can be a life saved.
Austin has not yet had a documented case of Covid-19, and the city fathers are trying hard to keep it that way, or at least trying hard to appear doing so. Not that we are cynical about this — we are not, actually — but neither are we unmindful of the political stress around this crisis at all levels of government.
The city of Austin has imposed potentially crippling limitations on events that gather more than 2500 people, which are a big part of the city’s brand, as it were. Events expecting more than that number must get separate approval from health officials, presumably conditioned on prevailing Covid-19 risk under all the circumstances and plans to mitigate it. University of Texas sporting events are continuing as usual, supposedly because people do not travel from far away to attend them.
Except, you know, from all over Texas, including Houston and San Antonio where there are documented cases, and never mind the fans of the visiting teams.
That might be where one would sound cynical, if one were so disposed.
Regardless, all of this makes us wonder whether the politicians in charge of Milwaukee and Charlotte are so happy to be hosting the Democratic and Republican conventions in July and August. If the novel coronavirus remains “a thing” this summer, and we expect that it will, will they do the right thing?
By now everybody knows that the city of Austin effectively ordered the cancellation of SXSW on account of Covid-19 concerns. This was the right thing to do, even though, in our case at least, it is a ginormous bummer. SXSW is our favorite week of the Austin year, a long-planned staycation for me and Mrs. Blueberrytown, and this year we were honored to be selected as a “mentor” and were thereby graced with a platinum badge in compensation.
Imagine you just lost your free boondoggle to Hawaii or London or whatever you people enjoy. It is a lot like that for us.
Why was cancelling SXSW the right thing to do? Well, because people fly in from all over the world, including especially the virus-ridden Left Coast. There hasn’t been a known case in Austin yet, and the longer we defer that day the better. The more we learn about this bad boy before we catch it, the likelier we are to get through it without permanent damage, benefit from drug therapies, and avoid spreading it to people we love. Or, for that matter, people we could easily do without, but still want to avoid the guilt of infecting.
We have had a few thoughts since last Saturday, when — from our suite in the Palazzo in Las Vegas, shortly before the craps roll of a lifetime — we penned our original Covid-19 speculations, none of which have been proven wrong, but few of which have turned true. These are more like “musings,” in no particular order.
We’ve been practicing social distancing. Remembering not to shake hands takes practice, so don’t wait until your city is scouting for pauper graveyards to start doing it.
Notwithstanding our first preference for Japanese-style bowing, without, of course, the silly hierarchy — we are Americans, goddamn it! — in our nerdy circles the Vulcan greeting, accompanied by “live long and prosper,” seems to combine hep n’ cool irony with an actually relevant message, the sort of best wishes that are suddenly top of mind.
LOS ANGELES – SEPTEMBER 15: Leonard Nimoy as Mr. Spock in “Star Trek: The Original Series” episode ‘Amok Time’. Spock shows the Vulcan salute, usually accompanied with the words, “Live long and prosper.” Original airdate, September 15, 1967. Image is a screen grab. (Photo by CBS via Getty Images)
The good news in all of this is that it is killing off the “business hug,” which we deplore. And, no, we do not deplore business hugging because of a Pence-like obsession with #metoo issues, but because hugging for us is about sharing intimacy and connecting closely with a loved one. Business hugging is artificial at best, degrading if you think about it. If a few people have to die to kill off business hugging, the price will be worth it.
Relax. That was a joke. Goddamn.
The world’s economy is stopping like a car door slamming, do not believe otherwise. Why? Because nobody wants to kill their grandmother, or Willie Nelson. There are, however, a lot of questions to which we do not know the answers.
Are we heading in to a recession, with multiple quarters of economic decline, or does this thing look like a “V”? Our guess is that it all depends on March and April. If the global infected population doubles every few days, we’re in it for the long haul. If it takes weeks to double, then people are going to adjust, and cautiously get back on planes and such. If you are really courageous, start buying plane and cruise tickets for later in the year. They may be the best investment you make this month.
The CEOs we know are spending a ridiculous amount of time planning around this farookin’ disease. Right now, securing supply chains, protecting their employees, and avoiding exposure in the inevitable blood-sucking “you shoulda done” lawsuits are their biggest concerns. And, of course, nobody is spending any time thinking about innovation or growth, unless they run a biotech company pointed at viruses.
Companies that need current cash flow to service their debt could be in a lot of trouble. Leverage is not your friend in such times. Cash has gone from trash to beautiful, glorious, invigorating stuff you want to rub all over your body. Well, only if it is in crisp, uncirculated bundles. But you get our point.
With the ongoing collapse of the stock market, we are rapidly getting less unequal! Bernie problem solved! Add to that the mother of all oil price wars and the return of ZIRP and working people who do not lose their jobs will be, as our beloved father was wont to say, “fartin’ in silk.”
We were on a brewery and distillery crawl in Austin yesterday — something of a last hurrah, we suppose — and we learned that people do not appreciate frequent reporting on the status of this website. Not everybody reacts to stress the same way. So if you love watching infection counters, as we admit we do, keep it to yourself.
The news is that global cases are up roughly 4000 in the last 24 hours, from roughly 106,000 to roughly 110,000. That sounds bad, and for the individuals involved, it is. We find it comforting. An increase of around 4% in a day implies a doubling every 18 days. If that rate persists, Covid-19 seems manageable, suggesting that we would not hit a million cases around the globe until around the end of April. That buys a lot of time to prepare.
This is worth your time, especially if it leads you to adjust your helmet over inconveniences.
It feels like the right time to do our best to be a better citizen. Hunt down your local blood bank and give blood, because apparently there is a shortage looming.
Follow the example of Ted Cruz, if presented with the opportunity. “Opportunity” being, of course, a euphemism.
The press coverage is extremely tedious, with no end of argument about whether President Trump is, or is not, incompetent. How about hoping that he is, or that the remnant of his team is? So far, the evidence is mixed, but the United States has one of the lowest per capita rates of known infection in the traveling world. Let’s hope it stays that way, even if it is Trump’s fault.
Speaking of Trump, what controversial Covid-19-oriented executive order will he issue next? Given the soaring infection rates in the cradle of Western Civilization, we speculate Trump will soon ban travel from Europe. Do not go there unless you are prepared to stay for a while.
Is Time going to make the novel coronavirus its “Person” of the Year? Sitting here in early March, that seems like a lock.
Somebody needs to invent an inexpensive little wristband that vibrates if you raise your hand to scratch your face.
Politico brings us this gem, “Warren joins Senate’s club of failed presidential hopefuls,” without much wondering how we got here.
The Senate is indeed packed with failed presidential candidates, including Democrats Michael Bennet, Cory Booker, Kirsten Gillibrand, Kamala Harris, Amy Klobuchar, the aforementioned Warren, and GOP losers Lamar Alexander, Ted Cruz, Rand Paul, and Marco Rubio. (Romney doesn’t count for these purposes, for reasons that shall become obvious.)
The article points out that only three presidents have ever emerged directly from the United States Senate: Warren Harding (who ought to have wrecked it for everybody), JFK, and Barack Obama. So why do so many run, and so few make it?
We argue that technological transformation has created a systematic mismatch in American presidential politics. State governors and generals have, on average, greater proof of executive function, and voters, given the opportunity to think about it, can see it, feel it, and have largely agreed.
However, the profound changes in American media and political fundraising of the last 10-15 years have dramatically shifted public exposure in favor of Washington’s legislators, particularly senators. Senators have many more opportunities than governors and generals to flap their gums in front of cable news cameras and develop relationships with Twitter-happy Washington journalists. This relatively recent shift in favor of senators means that our least tested executive leaders – by which we mean people capable of driving institutional behavior – build all-important national name recognition and concomitant Internet fund-raising capacity much more quickly than the governors and generals who are more capable leaders and executives. Add to that the silly debate format pushed by the leading campaigns and the media — which format favors the leading campaigns and the media — and the voters never really have a chance.
It is a real problem, and it is not obvious how we fix it. Do not, however, expect the average quality of presidential candidates to improve until we do.
Iran’s leadership is reportedly getting hammered by Covid-19, the disease caused by the novel coronavirus. In certain circles, one does not need look hard for consequent schadenfreude, and, in spite of our generous nature, we admit to temptation in that direction.
But then we worry about karmac blowback.
We in the United States are in the middle of a presidential campaign. What are the odds that one or more of the current septuagenarian candidates, including perhaps the sitting POTUS, will be exposed and perhaps even threatened, just as Iran’s leadership? Given the travel, exhaustion, and relentless exposure to people from all over the country, there is a non-zero chance that the virus will infect one or more of them soon.
