COVID-19 Resources

Here I gather and summarize, and sometimes comment on, various news articles, opinion pieces, and other documents pertaining to COVID-19, the disease caused by the coronavirus 2 or SARS-CoV-2 virus, and its socioeconomic impacts. Although I am not an expert in infectious diseases, I am seeking to understand the disease and its implications as well as I can. I created this document as a way for me to track useful articles on the subject, and perhaps the document will be useful to others seeking to get a handle on the crisis. Obviously this is not anything like a comprehensive collection of relevant links. This document was created on March 24, 2020, and subsequently edited. As of March 27, I still have dozens of articles to sort through.

The Promise of Mass Testing

As far as I can tell, there are a few potential ways out of this social and economic catastrophe. It seems to me that mass testing is probably the most important step, at least before effective antivirals or an effective vaccine is developed. At a certain level of mass testing—I have no idea what that level is—doctors could begin to track the disease and isolate the sick, which would allow those not sick (recovered or never infected) to begin to resume their normal activities. I realize this would have been a lot easier had widespread testing been available in the U.S. from the outset, but I’m hopeful that mass-testing can soon catch up with the disease.

San Miguel County, Colorado

One company looking to expand testing is United Biomedical , a subsidiary of which is run by Lou Reese and Mei Mei Hu (part-time residents of Telluride, Colorado).

Peter Diamandis interviewed Reese and Hu on March 21.

In the interview, Hu says that her company is working on tests as well as a vaccine. The company developed diagnostics for a previous SARS viral outbreak, and it also sells enormous numbers of vaccines for pigs. Reese says that, following a mutated disease, his company developed, produced, and distributed a new swine vaccine within a month. Hu discusses the differences between “PCR” swab tests and blood antibody tests. PCR tests yield lots of false negatives. “Accuracy is a concern.” Antibody tests, which this company is working on, can tell whether someone had the disease and then recovered. Reese says his company is ramping up production of tests very quickly. One short-term plan is to test every person in San Miguel County, Colorado, twice. Reese says mass-testing offers “a path to a new normal for your community.” I am hopeful that this county-wide testing will provide useful data regarding the spread and lethality of the disease. Reese says that his company is ready to begin human tests of a new vaccine immediately or this summer, depending on regulatory requirements.

United Biomedical’s March 19 release describes the program and offers a somewhat technical explanation for how the tests work.

Colorado Public Radio published a story March 19 about this effort (under an incredibly stupid headline). The story notes that San Miguel County has around 8,200 residents. (My guess is that Telluride Ski Resort probably facilitated spread of the disease, what with all the visitors.)

Colorado Sun also published an article about this effort, on March 20. Hu told the publication, “Data is power. This will be one of the first times where we screen a whole population. What you do by testing en masse is you say, ‘What is active outbreak prevalence?’” Author Jesse Paul makes a great point: “Perhaps most significantly: The testing may be able to show how many people in Telluride and San Miguel County are infected with coronavirus but aren’t aware of it.”

On March 25, San Miguel County Sheriff Bill Masters said that he expected public testing to begin on March 26 and ramp up slowly. A March 24 release from the county reports, “San Miguel County Department of Public Health and Environment today received the results for the first group of those who had the COVID-19 ELISA blood test. The group of 645, first responders and their families, all tested negative. Two parties had a mild signal change, although not enough to change the negative test results. In some cases, this can indicate early seroconversion. Public Health has spoken directly to these two individuals.”

A March 25 release from San Miguel that testing there will proceed through the end of the month in several phases.

“The San Miguel County Department of Public Health and Environment, assisted by dozens of volunteers, collected more than 300 blood samples on Thursday [March 26] from a pre-selected group of teachers and their families.” (March 26)

San Miguel County released some photos from the March 26 testing campaign.

Testing Elsewhere in Colorado

On March 26, Jennfer Brown of the Colorado Sun reported, “Up to 7,500 health care workers and first-responders in Colorado will get tested for the new coronavirus under a federal program providing test kits.”

Ouray County, Colorado, has rejected a plan to give everyone in the county antibody tests (Ouray County Plaindealer, March 26). “Dr. Drew Yeowell, the county’s EMS medical director who is also an emergency room physician, and Dr. Joel Gates, who operates Mountain Medical Center, . . . said they saw little benefit to the community if the county undertook the same testing being performed in San Miguel County.” Yeowell said, “Don’t waste this money on a test that will not help now. It will help with data, it will help with epidemiological data later down the road.” My take: This seems like absolute insanity to me. How could it not help to know who has already developed immunity to the disease?

General Testing Notes

Gretchen Vogel writes (March 19): “New blood tests for antibodies could show true scale of coronavirus pandemic.” Vogel writes, pointing to a site that collates testing developments, “Labs and companies around the world have raced to develop antibody tests.” Vogel focuses on the efforts of the Icahn School of Medicine at Mount Sinai in New York.

On March 23, Erik Larson posted an article, “We Need A COVID-19 Testing Moonshot For Better Decision-Making.” He calls for random testing for at least 10 percent of the population.

On March 25, Nate Silver reported, “The US has conducted about 400k tests now.” He says we still need a lot more testing but have started to catch up. (I believe these are almost entirely the swab tests that look for viruses but not antibodies.)

On March 25, the Independent reported, “New 15-minute home test kits for coronavirus will be made available to the British public within days, said a Public Health England (PHE) director [Sharon Peacock]. Thousands of tests will be sold in chemists such as Boots or delivered by Amazon to people with symptoms who are self-isolating as soon as next week. Matt Hancock, the health secretary, said the government bought millions of the tests on Tuesday and is ordering millions more. The antibody test involves pricking a finger. . . . The test will detect the presence of the antibodies IGM, which emerges in the early stages of infection, and IGG, which increases during the body’s response to the virus.” See also a related Guardian article.

Colorado Governor Jared Polis said during a March 25 media conference, “”We have been so disappointed by the lack of testing supplies. This is so frustrating, because the only real way to address this virus in a way that we can return to [normal] life, sooner rather than later, and that means socially normal, it means economically normal for your jobs, is what South Korea has done. And it’s what Taiwan has done. And it’s what we need to do here as soon as possible. And that is scale up testing. . . . The only real solution [is] mass testing.”

Medscape, March 25: “Could Half the UK Population Have Been Infected by COVID-19? Scientists [some] were sceptical of University of Oxford modelling that suggested sizeable UK infection rates of COVID-19, but say the findings underline the need for extensive testing.” The Oxford paper too emphasizes “the immediate need for large-scale serological surveys to assess the stage of the SARS-CoV-2 epidemic.”

A Nature article from March 23 goes into considerable detail on testing, with a focus on PCR (polymerase chain reaction) testing, along with the companies that provide tests.

“The current trouble [with testing] is a critical shortage of the physical components needed to carry out tests of any variety. Among these components are so-called viral transport media, which are used to stabilize a specimen as it travels from patient to lab; extraction kits, which isolate viral RNA from specimens once they reach the lab; and the reagents that do the actual work of determining whether the coronavirus that causes COVID19 is present in the sample. Perhaps the most prosaic shortage, but also the most crucial, is a lack of test swabs, which look like glorified Q-tips.” (Robert P. Baird, New Yorker, March 24)

The Catastrophic U.S. Testing Failure

Early on, the U.S. federal government actively suppressed the rollout of testing for the coronavirus. In my view, this is the single most important story about the spread of the disease in this country (at least as of March), and this suppression, more than anything else, resulted in the widespread economic shutdowns the country has endured.

In a March 19 editorial, the New York Times summarizes, “To suppress and control a pandemic of this magnitude, countries also must find and isolate every person infected with Covid-19—including those with mild cases.” The editorial touts South Korea as a model for rolling out testing much faster.

A March 10 article from the New York Times (Sheri Fink and Mike Baker) reports that “Dr. Helen Y. Chu, an infectious disease expert in Seattle,” wanted to conduct testing, but “officials repeatedly rejected the idea.” “By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval.” This testing revealed the disease had already spread in the U.S. At one point, “state regulators told them to stop testing altogether.”

The Times summarizes that “regulations and red tape . . . have impeded the rapid rollout of testing nationally.” The article also reviews how the Centers for Disease Control and the Food and Drug Administration played pass-the-buck games regarding testing. Chu told the paper, “We felt like we were sitting, waiting for the pandemic to emerge. We could help. We couldn’t do anything.” Meanwhile, the CDC’s own test “was producing invalid results,” leading doctors to beg the FDA to allow others to provide the testing. “Private and university clinical laboratories, which typically have the latitude to develop their own tests, were frustrated about the speed of the F.D.A. as they prepared applications for emergency approvals from the agency for their coronavirus tests.” Dr. Alex Greninger of the University of Washington Medical Center in Seattle said, “This virus is faster than the FDA.”

Washington’s epidemiologist for communicable diseases, Dr. Scott Lindquist, told the Times that, while on a phone call with the representatives from the CDC and FDA, “What they said on that phone call very clearly was cease and desist to Helen Chu. Stop testing.” Eventually the federal agencies eased their grip and let some testing proceed.

Sam Baker wrote a March 16 article for Axios about the testing problems. He summarizes, “Widespread, accurate testing has been a key component of other countries’ success in bringing their outbreaks under control.” In a March 13 article for the site, Caitlin Owens, notes that, finally, the “FDA posted relaxed testing guidelines on Feb. 29.”

Ashish Jha of the Harvard Global Health Institute told NPR for a March 12 article, “Without testing, you have no idea how extensive the infection is. You can’t isolate people. You can’t do anything. And so then we’re left with a completely different set of choices. We have to shut schools, events and everything down, because that’s the only tool available to us until we get testing back up. It’s been stunning to me how bad the federal response has been.”

“Startups touting at-home coronavirus tests suspend plans after FDA warning,” reports Erin Brodwin for Stat. This pertains to swab tests mailed to people’s houses and then mailed from individuals to testing labs. “Experts warned that the new tests may not meet the Food and Drug Administration’s high standards for traditional approval, however, and cautioned that consumers might not get an accurate result if they didn’t swab deep enough in their nose or throat.” Nurx and Carbon Health planned to continue with such tests, claiming FDA compliance, but “an FDA spokesperson said the agency’s guidelines specifically exclude at-home tests.” My take: Blocking in-home testing, whatever its limitations, seems profoundly malicious.

In a March 25 video, economist Alex Tabarrok discusses the catastrophic failure of the U.S. government in impeding tests.

“America’s chance to contain the coronavirus crisis came and went in the seven weeks since U.S. health officials botched the testing rollout and then misled scientists in state laboratories about this critical early failure. Federal regulators failed to recognize the spiraling disaster and were slow to relax the rules that prevented labs and major hospitals from advancing a backup. Scientists around the country found themselves shackled as the disease spread.” (Brett Murphy and Letitia Stein, USA Today, March 27)

CPR reviews some of the stress and hardship caused in Colorado by lack of testing (March 27).

Vaccines, Antivirals, and Plasma Therapy

If we have very-effective antivirals or other treatments, problem solved. If we have an effective vaccine, problem solved. What are the prospects for getting those?

New York is trying to treat the sick with blood plasma from recovered patients (Alex Tabarrok, March 25).

Several companies are working on a vaccine (March 26).

The Response in Other Countries

Japan

The rate of disease spread in Japan may be considerably higher than many people now think. Tyler Cowen reviews recent concerns (March 26).

Safety Protocols

Dr. Jeffrey VanWingen shared a 13-minute video about how to get delivered food safely into your home.

Other Colorado News

Hey, it’s where I live.

Two million medical masks are on their way to Colorado from Chinese factories, a supply expected to last a month. (Denver Post, March 23) Note: My personal guess is that Coloradans still have millions of construction-grade n95 masks in their personal stocks, and that if there is a serious need these could be donated if people can be notified of the need and some way to collect them can be devised.

The Ventilator Shortage

We’ve already heard reports out of Italy of doctors having to choose which patients get ventilators—and which do not. Many people fear that regions of the U.S. will face similar shortages. See also the section about businesses responding for instances of businesses working on ventilators.

On March 25, I speculated whether relieving liability for people and businesses that provide emergency-use ventilators might facilitate the increased production of such. A doctor commented that there are different types of ventilators, and only certain kinds are suitable for treating the disease at hand, which made me wonder whether figures regarding stocks of the machines take into account the differences in functionality.

In the UK, “James Dyson designed a new ventilator in 10 days. He’s making 15,000 for the pandemic fight,” reports CNN. “In the United States, Ford has announced that it’s working with 3M and GE Healthcare to produce medical equipment including ventilators and protective gear. GM and Tesla have also pledged to make ventilators.”

Maybe Masks Can Help

As hospitals faced shortages of “personal protective equipment,” the public was urged not to buy or use things like masks. But it seems like, once producers ramp up mask output, maybe widespread use of masks might help.

Antonio García Martínez points to an article indicating that “respiratory protective devices” have been useful in reducing the spread of the flu.

Biology and Spread of the Disease

This document focuses more on the political and economic angles of the disease. Obviously the underlying biological science is enormously important. Karen Levy compiled a list of “key literature” that focuses more on this science. Bioethics.net also lists a number of resources.

Our World in Data is tracking the spread of the disease at the global and national level.

In Stat (March 17), John P.A. Ionnidis points out that “we are making decisions without reliable data.” We have very little idea how widely the disease has spread and, therefore, how deadly it is. He points out the case fatality rate on the Diamond Princess cruise ship was one percent—but that population is not representative. He writes, “In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns.” He also points out, “[I]f the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases . . . that are not adequately treated.” He also points out that locking down the economy long-term also will kill people.

On March 25, the New York Times published a heartbreaking video taken of Elmhurst hospital in Queens, New York, by Dr. Colleen Smith. She said, “We had to get a refrigerated truck to store the bodies of patients who are dying. We are right now scrambling to try to get a few additional ventilators, or even CPAP machines. . . . Everything is not fine. I don’t have the support that I need, and even just the materials I need, physically, to take care of my patients. And it’s America, and we’re supposed to be a First World country.”

“The coronavirus isn’t mutating quickly, suggesting a vaccine would offer lasting protection.” (Washington Post, March 24)

Neil Ferguson offered some updates for UK, as reported by a March 25 article by New Scientist. Given more hospital capacity and more distancing practices, he now predicts fewer than 20,000 deaths in the UK from the disease. He anticipates increased testing capacity in the UK. He now things the disease spreads more readily than previously assumed (with an R-naught of over three). He doubts claims that perhaps half the UK population already has been infected.

As of March 26 there are some hopeful signs that cases may be tapering off in Washington state (Washington Post).

Colorado doctor Bryan Alvarez discussed testing, antivirals, vaccines, and more in his March 27 interview with me.

Economic Consequences and Strategies

Nobel economist Vernon Smith argues the long-term consequences to the economy are less horrible than some people assume. He writes, “I believe the economy today lives in suspense, not free-fall. . . . Supply chains will refill and stabilize quickly, as the pandemic passes, securities markets will recover, and growth will continue to reduce poverty everywhere.”

Alex Broadbent and Benjamin Smart point out that economic shutdowns could be particularly deadly in Africa.

David L. Katz wonders in a March 20 op-ed for the New York Times, “Is Our Fight Against Coronavirus Worse Than the Disease?” One of his ideas to to better-protect the most-vulnerable people. Thomas Friedman expands on Katz’s ideas in a March 22 op-ed. The basic idea is that we might try a tight 14-day lockdown followed by targeted isolation and quarantine. Separately, Katz (March 22) offers a “framework for risk-based interdiction of coronavirus.”

The BBC reports that the coronavirus lockdown has dire economic consequences for many people in India.

I thought I’d record a comment of mine from Twitter: “Strangely, the widespread economic shutdown as a response to the coronavirus is a byproduct of a) our relative wealth that lets us do this without mass starvation and b) the ability of doctors to improve health. If docs couldn’t help, there’d be no point to flattening the curve.”

“What is the exit strategy?” asks a March 25 article by Stat‘s Sharon Begley. “An emerging consensus points to aggressive tracing of contacts of sick people, much broader testing, targeted quarantines, and new online tracking technology as strategies that would facilitate the easing of social distancing measures.”

The Specter of Rationing

Obviously in certain circumstances doctors may be forced to decide who gets treated and who does not. I worry, though, that emphasis on rationing or triage when it comes to ventilators and care more generally may hide innovative approaches that could expand care.

Paul Hsieh, a radiologist and columnist, asks, “How Will Doctors Allocate Scarce Medical Resources During The COVID-19 Coronavirus Pandemic?” He reviews various approaches and documents.

Stupid Regulatory Burdens

It is, of course, debatable which regulatory burdens are always prudent, which never are, and which should be lifted in times of emergency. Here I include descriptions of regulations that were lifted or eased because of COVID-19.

I listed various examples of counterproductive regulations (some of which have been lifted or eased) in a Tweet thread. Some of the main examples of this are regulators holding up testing, “certificate of need” laws hampering the availability of hospitals and various supplies, license rules restricting where health professionals may practice, and anti-price “gouging” laws that contribute to shortages.

Various distilleries have switched to making hand sanitizer and distributing it for free. But at least some distilleries have run into the problem of facing a tax if they don’t “denature the alcohol,” even though “denaturing agents are nearly impossible to find.”

Paul Matzko reviews some of the intensive FDA regulations with which companies must comply before they can sell surgical masks.

Restrictions on midwives makes it harder for healthy women to give birth at home, away from COVID-infected patients, Elizabeth Nolan Brown points out.

Restrictive immigration policies in the U.S. is preventing doctors from working here, writes Shikha Dalmia (March 26).

Colorado sales-tax rules strongly discourage interstate cross-regional shipping by small firms. I Tweeted March 26: “My local brewer cannot deliver to me, because we’re barely across a county line and CO’s insane sales tax rules are getting in the way. I call on [Colorado Governor Jared Polis] to lift all non-state shipping sales taxes during this emergency. Save lives, save businesses.”

Minimum wages create “sticker” labor markets, and higher minimum wages now could be especially harmful, argues Tyler Cowen (March 27).

Sendhil Mullainathan and Richard H. Thaler review several legal and regulatory burdens that could be lifted (March 24): Medical licensing restrictions, malpractice suits (I’d say broader threats of legal liability), patent suspension (something I’m vary wary of), and privacy rules.

“As Coronavirus Outbreak Hit, Trump Administration Refused To Ease Hand Sanitizer Tariffs” (March 27). Sheesh.

Laws against Price “Gouging”

I’m making this its own section because I regard such laws as particularly moronic and destructive.

Economist Steven Horwitz points out that, when stock is limited, higher prices encourages customers to cut back to more-essential uses. The term “price gouging” itself is nonobjective: “There’s no economic content to it. It’s a term that people use to complain when they think prices are too high.”

“When Resources Are Scarce, Price Gouging Can Spur Production, Prevent Hoarding, and Encourage Conservation. But Only if Governments Allow It.” (Scott Beyer, March 25)

Political Responses

I am not trying to track the political response generally, but I’ll drop in a few notes of especial interest to me.

On March 25, Colorado Governor Jared Polis announced a statewide stay-at-home order. I mentioned a few of the highlights of his remarks. His office released a FAQ. On March 22 Polis had announced less-severe measures.

Texas and Ohio declared abortions to be nonessential and hence outlawed during the crisis.

Possible Long-Term Positive Trends

It’s hard to think about the positives at a time like this, but I think there may be some silver linings.

Biases and Crackpots

The coronacrisis presents an opportunity for “us” to think more seriously about our own biases and the biases of others. It seems obvious to me that various “limited government” types have jumped on less-severe predictions of the disease’s damage in order to lambast government interventions. (I am skeptical of some of the government interventions, but I’m trying to base my evaluations on the most-reasonable estimates of the facts.) At the same time, Progressives and others too have tended to look at the crisis through ideological lenses.

Comparing the temporary lockdown to a police state or to a Communist dictatorship is a bit much, yet that’s what Colorado State Senator Jerry Sonnenberg does (March 26).

Jason Salzman records some less-helpful remarks by Colorado conservatives about the coronavirus (Colorado Times Recorder, March 26)

Companies Stepping Up

This list is not intended to be comprehensive-I don’t think it would be possible to build a comprehensive list—but it includes cases I’ve heard. News pertaining to ventilators is listed in that section.

I listed quite a few examples of this in a Tweet thread.

Colorado: “Johnstown man leading the way in Colorado to print 3D face masks in wake of shortage.” (Complete Colorado, March 25)

Colorado: “Frederick manufacturer steps in to make N95 masks for non-medical use as coronavirus outbreak continues.” (Daily Camera, March 26)

“I spoke with [Elon Musk] late last night. He’s donating hundreds of ventilators to New York City and State, including our public hospitals. We’re deeply grateful. We need every ventilator we can get our hands on these next few weeks to save lives.” (Mayor Bill de Blasio, March 27)

Donald Trump ordered General Motors to produce ventilators. But GM has already been ramping up to do that, so it’s unclear (to me) how much of the federal “negotiations” were carrot and how much were stick (March 27). As one of my friends asked, why didn’t the feds simply solicit bids?

“Nike Creating Medical Face Shields and Equipment for Healthcare Workers” (March 27).

“Harbor Freight Tools to donate entire medical supply to 24 hour emergency rooms” (March 22).

“Denver Mattress Co. factory making face masks to protect against coronavirus” (March 28).

Odd News and Humor

Huh. “Pornhub donating 50,000 masks to NYC first responders, making premium content free during coronavirus outbreak.”

A Portland strip club was forced to close, so the dancers are doing deliveries instead.

Image: NIAID