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. On April 28, I stopped adding new material to this document (which had grown unwieldy) and started a “COVID-19 Updates” page for subsequent material.
Spread and Mortality Updates
Items in this section only are in reverse chronological order, starting with March 29 updates. This is intended to offer only some snapshots, not anything like comprehensive data. For all national data I’m accessing Our World in Data, unless otherwise stated. Our total deaths remains a frightening “hockey stick.”
April 11: Colorado is up to 274 total deaths. Daily global deaths ticked up (to 7,049), while U.S. deaths ticked up (to 2,087). The New York Times has some stunning video from New York-area hospitals.
April 7: Colorado had a brutal day with 29 new deaths (total of 179). However, as Chris Vanderveen notes, report dates don’t necessarilly reflect actual dates of death. On this day COVID-19 was the leading cause of death in the U.S.
The Institute for Health Metrics and Evaluation has some projections for Colorado “assuming full social distancing through May 2020.” I’m not sure what “full” means in this context; obviously many people (including families) are going to frequently come within six feet of each other. Anyway, the group projects that Colorado has already hit its peak ICU bed need and that the state will suffer 302 COVID-19 deaths by August 4.
The state reports 148 total deaths, 5,172 reported cases, and 976 hospitalized. (Still no word on how many of those hospitalized have been released.) The state estimates 17,000 to 18,0000 Coloradans have had COVID-19.
April 5: Daily U.S. deaths from the disease have increased to 1,344. For April 4, the increase was 1,104.
April 3: Colorado COVID-19-related deaths have hit the triple digits with 111.
Daily U.S. deaths have taken a terrifying turn following the March 30 dip, with 909 in the past day and 661 the previous day.
Colorado is up to 509 total hospitalizations (it’s unclear how many of those people have been released) and 69 deaths, 18 more just in the last day.
This is hopeful news: Daily U.S. deaths have actually declined a bit. We’ll see if that’s a trend.
The world is up to 30,451 COVID-19-related deaths, 3,461 in the past day. The U.S. is up to 2,191 total deaths, 484 in the last day.
Colorado is up to 45+ COVID-19-related deaths, and 2,078 positive tests plus “presumed positive” cases.
Robert Wiblin summarizes (March 29): “COVID-19 remains fully controlled in South Korea, and largely controlled in Taiwan and Singapore. If China is to be believed there’s virtually no domestic transmission. Even Italy is seeing the rate of new cases & deaths decline substantially.”
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.
March 29 update: “Testing is running so efficiently, that Incident Command has decided to open up testing to [more] Telluride residents . . . today.”
9News (Katie Eastman) published an informative update on March 30: “The antibody tests were donated by a couple in Telluride who owns a biotech company, and as of Monday afternoon, the county had tested more than 3,200 people after beginning testing last week. ” 9Health Expert Dr. Payal Kohli said, “I think San Miguel County could be a prototype for the rest of the country. So the point of mass testing everybody is that if we can identify this sub-group of people who have already developed immunity and recovered from it, we could actually lift the social distancing from those individuals and allow at least some portions of our economy to come back to normal.”
April 1 Update: I reviewed a number of updates coming out of San Miguel County in a Tweet thread. Highlights: Testing continues. Tests for 4,285 residents taken as of March 31. Samples flown to New York state for processing, which takes several days. San Miguel has also done PCR/swab testing, revealing six positive cases.
San Miguel County antibody tests, partial results (announced April 1): 97% negative, 2% indeterminate, <1% positive. I’m really surprised the negative rate is so high. CPR (April 2) has more precise numbers: “Of the almost 1,000 people tested for COVID-19 in San Miguel County, eight have come back positive and another 23 have either indeterminate or borderline results.”
ABC ran a March 28 story about the San Miguel Effort. Lou Reese said, “The goal of this is to show you can predictably get an entire county back to its new normal as quickly as possible by using testing.”
On April 6, United Biomedical announced delays in San Miguel County testing results. “We understand the critical importance of timely test results and the immense stress that everyone is under, however industry-wide disruptions due to the COVID-19 epidemic—especially in New York state where our facility and majority of staff are based—have led to an unexpected backlog in processing results.” So the county has suspended drawing samples from residents. The Denver Post has more.
Jacob Sullum has a nice summary of the preliminary results (April 8). The key paragraph: “Counting only the positive results, and assuming this initial sample is representative of the county, these findings suggest that something like 0.8 percent of the local population has been infected by the virus. Including the indeterminate results raises the rate to about 3 percent.” I don’t think the preliminary results are representative (I think they include more first responders), and I don’t think the county is representative of the state. Still, I’m keen to see the completed results.
Testing in San Miguel County continues despite reported delay (Colorado Sun, April 10). United Biomedical is “working around the clock to process results from our friends and neighbors.”
“San Miguel County [CO] delays next phase of radical COVID-19 testing experiment” (April 16).
“Universal COVID-19 testing in San Miguel County hits delays” (April 27).
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)
Abbott Laboratories plans to ship a 15-minute swab (active virus) test under emergency FDA approval. “The medical-device maker plans to supply 50,000 tests a day starting April 1, said John Frels, vice president of research and development at Abbott Diagnostics” (Bloomberg, March 27).
KUNC explains why testing rates dramatically affects “case fatality” rates. Generally, the wider the testing, the more people test positive with less-severe symptoms (March 28).
Robert Wiblin reports (March 29) that randomized testing in Iceland might suggest a case fatality rate of “only” 0.2 percent—or maybe more sick people will die soon.
Robert Zubrin suggests what to me seems like an obvious step: Do some randomized testing among the U.S. population (March 30). “No one can know what the right course of action is, because the available data to provide a basis for these enormously consequential decisions is woefully inadequate.”
Alex Tabarrok summarizes (March 30): “[T]est, trace and isolate can be very effective. Paul Romer’s simulations are here and he notes that a COVID-19 test does not have to be especially accurate for the test, trace and isolate strategy to work. Indeed, you don’t even need to trace, if you test enough people.”
See also testing information in the section below, “The Response in Other Countries.”
“Mayo Clinic expects COVID-19 antibody test to be ready Monday” (April 1).
Strikes me as clever: “Testing capacity in Germany will be increased by up to factor 10 to up to 400,000 a day (!) by doing pooled testing. E.g. mix 16 samples and if negative – all are negative, otherwise binary search for the positve(s). Could of course be used worldwide” (March 31).
Shikha Dalmia writes (April 6): “A possible way out till we have a vaccine or a treatment is through near-universal and repeated testing that allows the U.S. to replace mass lockdown with targeted quarantining of infected individuals while others continue to work. This is not possible right now because the tests available require medical professionals to take a nasal swab and carefully transport it for analysis, a process that takes several days. . . . But a home testing kit that isn’t prohibitively expensive and gives unambiguous results within minutes like a home pregnancy test would change everything.”
“To End the Pandemic, Give Universal Testing the Green Light” (Wired, April 7).
“Large serosurvey studies” for antibodies have started up (or will soon begin) in Seattle, New York, San Francisco, Los Angeles, Boston, and Minneapolis, reports Michael Busch of Vitalant Research.
Jason Brennan notes that the data used in COVID-19 is obviously flawed due to lack of adequate (randomized) testing (April 9).
Nowhere close to herd immunity: “Less than 1% of Austrians infected with coronavirus” (April 10).
Paul Romer summarizes his strategies for testing (April 10).
A good sign: “First at-home COVID-19 testing kit authorized by the FDA” (April 21).
Fast Company says the U.S is testing around 150,000 people per day (April 23). The realistic need is for a least a half-million tests per day and perhaps 30 million. (This is consistent with Paul Romer’s figures.) The article mentions August as a target goal for universal testing. “Ashish Jha [is] the director of the Harvard Global Health Institute, which has estimated that the U.S. should run 500,000 to 700,000 tests a day by mid-May.” Jha said, “You realize we’ve shut our entire economy down because we don’t have enough swabs—how is this not just a travesty? Millions of Americans are losing jobs. We’re losing hundreds of billions of dollars a day of economic activity. . . . If you wake up one morning and you have a fever and you have a sore throat, you should be able to pick up the phone, call somebody, and go get tested that morning. And if you’re positive, you get a phone call from a public health worker who does contact tracing and identifies everybody you’ve hung out with in the past five days. And then they call all those people and get all of those people tested. And that’s how you can pick up a bunch of asymptomatic carriers . . . it’s public health 101. If you go through this strategy, you have a pretty good shot of getting most people who are infected on any given day. . . . I do think big technological breakthroughs are coming. I want to speed it up.”
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).
This is damning. Note the word “allowed” here. Ed Pilkington and Tom McCarthy report for the Guardian (March 28), On January 28, “the Wall Street Journal published an opinion article by two former top health policy officials within the Trump administration under the headline ‘Act Now to Prevent an American Epidemic.’ [They] laid out a menu of what had to be done instantly to avert a massive health disaster. Top of their to-do list: work with private industry to develop an ‘easy-to-use, rapid diagnostic test.’ . . . It was not until 29 February . . . that the Trump administration put that advice into practice. Laboratories and hospitals would finally be allowed to conduct their own Covid-19 tests to speed up the process.”
“When the story of this pandemic is written, the handicapping of our response by inadequate diagnostic capacity will be a major theme” (Amesh Adalja, March 22).
“Oh shit, what are we going to do now?” asked Jennifer Rakeman, an assistant commissioner in the New York City health department, when she saw that the CDC’s test didn’t work (April 3).
David Henderson reviews the complete failure of the CDC on the testing front and explores ways private business responded (April 8).
“Over January and February, agencies within the Department of Health and Human Services not only failed to make early use of the hundreds of labs across the United States, they enforced regulatory roadblocks that prevented non-government labs from assisting” (April 9). Scott Becker, executive director of the Association of Public Health Laboratories, said, “And meanwhile, the academic laboratories who had developed their own tests also were not able to test because the regulations didn’t allow it at that time.” CDC Director Robert Redfield said on January 28, “The virus is not spreading in the U.S. at this time and CDC believes the immediate health risk from 2019-nCoV to the general American public is low.”
Politico takes us “Inside America’s unending testing snafu” (April 22). The site suggests that the U.S. is doing around a million tests per week and needs to be doing “4 million to 30 million tests per week to begin reopening the country.” (I’ve seen much higher estimates for testing needs.) The story details problems with supply chains, product compatibility, coordination.
“C.D.C. Labs Were Contaminated, Delaying Coronavirus Testing” (April 18).
See also the section above on testing; I think that mass testing has to be part of any exist strategy. Also see material elsewhere on the views of John Cochrane.
“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.”
As I mentioned on Twitter, we don’t face a binary choice between (relatively) full lockdown and going back to the way things were. Probably we’ll face a prolonged period of slow reopening. A big part of this transition will be increased public hygiene. I personally am hopeful that eventually enough N95 masks will be in production to not only meet the needs of healthcare providers but to become available again to the general public. Scott Gottlieb offers an extensive plan (March 29) for reopening the economy that includes improved hygiene: “Public hygiene will be sharply improved, and deep cleanings on shared spaces should become more routine. Shared surfaces will be more frequently sanitized, among other measures.”
Amesh Adalja (March 22) points out that quality of life does matter (and is intimately related to physical health). He calls for “voluntary social distancing” and “cocooning” of high-risk people. He makes the now-standard recommendations that “we” ramp up hospital capacity and testing.
Some people have suggested “cocooning” at-risk people rather than quarantining everyone. Alex Tabarrok (March 22) offers a couple of reason to think that might not work: First, even if “only” younger, healthier people get infected, that still would overwhelm hospitals and result in many deaths; and, second, “cocooning” the elderly when many younger people are contagious is practically impossible.
“In Germany, High Hopes For New COVID-19 Contact Tracing App That Protects Privacy” (April 2).
Joseph Walker has a pretty good run-down of exit strategies (April 8).
Some excellent points here (Stat, April 9). Because much of the U.S. has restricted so many activities, “officials can’t tell which measures have been the most effective.” “It is also difficult to ‘decouple’ the effect of those government policies from any voluntary measures people took to protect themselves, health economist Rahi Abouk of William Paterson University and computational social scientist Babak Heydari of Northeastern University.” Another point: Gerardo Chowell said, “Sustained universal mask-wearing and frequent hand-washing have the potential to dramatically reduce the transmission rate of the virus after the first wave.” See also Abouk and Heydari’s April 8 paper (also discussed below) and the Cowell et al. April 1 paper.
Ezra Klein worries (April 10), “Until there’s a vaccine, the United States either needs economically ruinous levels of social distancing, a digital surveillance state of shocking size and scope, or a mass testing apparatus of even more shocking size and intrusiveness.”
April 13 note: I’m increasingly wondering why variolation (intentional infection under relatively safe conditions) is not widely discussed as potentially part of the answer. If only a few percent of Americans did this, that could be enormously helpful. Once we’re past “the peak” and more protective gear comes online, why not devote that hospital capacity and gear to variolation?
“We Can Track COVID-19’s Spread Without Violating Privacy” (April 14).
Here’s something I posted on April 14: Here are all the strategies I know of to mitigate the damage of COVID-19 to health and prosperity. What I don’t know is what really works and how the pieces fit.
- Active-viral (swab) tests with a) targeted isolation of the sick and (maybe) b) identification of the healthy.
- Increased mask wearing by the general public, perhaps with eventual select N95 use.
- Increased public sanitation (more hand-washing, cleaning, no/low-touch restrooms).
- Antiviral tests to know who can safely “go public.”
- Contact tracing, voluntary, maybe private.
- Controlled intentional infection (variolation) for a subset of the population (military, health workers, “critical” workers). (Hanson)
- Ramped up hospital capacity to treat more sick people at once.
- More telework.
- Continued limits on public gatherings.
- Effective antivirals.
- An effective vaccine solves.
“Public health leaders are calling for communities around the country to ramp up capacity and get ready for a massive contact tracing effort to control the coronavirus” (April 14). This seems enormously labor-intensive, but maybe it’ll work.
NPR (April 16) reviews what I take to be today’s standard wisdom: Rapid testing, contact tracing, isolate the sick, cocoon the vulnerable, expand hospital capacity, and search for effective treatments.
April 18 update: It’s about time I link to Tomas Pueyo’s influential article of March 19, “Coronavirus: The Hammer and the Dance.” It argues for initial strong countermeasures followed by a gradual loosening of restrictions. See also Pueyo’s April 1 follow-up, “Coronavirus: Out of Many, One.”
“The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said (April 18). I’ll point out here that variolation would dramatically increase the number of antibody donors.
In 2017, the CDC released a document, “Community Mitigation Guidelines to Prevent Pandemic Influenza” (hat tip Onkar Ghate). Note the term “voluntary” here: “Categories of NPIs [nonpharmaceutical interventions] include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).”
Oncologist Ezekiel Emanuel and economist Paul Romer say the answer is a lot more testing (Atlantic, April 18). How many tests? Matthew Harrison and Ashish Jha say around a half million tests per day; Romer thinks 20 to 30 million or more per day. They write, “If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.” They outline several ways that testing might be expanded.
A March 28 document from the American Enterprise Institute, lead author Scott Gottlieb, offers “a road map to reopening.” Gottlieb also coauthored an April 17 document from Johns Hopkins, “Public Health Principles for a Phased Reopening During COVID-19: Guidance for Governors” (direct pdf link). This paper notes that, probably, “in the absence of social distancing, COVID-19 has a reproduction rate of between 2 and 3.” Reopening needs to be compatible with keeping the rate below 1, which will involve continued social distancing. Moving to “Phase II” reopening is a tall order: “A shift to Phase II could be considered when the following 4 criteria have been met: (1) the number of new cases has declined for at least 14 days; (2) rapid diagnostic testing capacity is sufficient to test, at minimum, all people with COVID-19 symptoms, as well as close contacts and those in essential roles; (3) the healthcare system is able to safely care for all patients, including having appropriate personal protective equipment for healthcare workers; and (4) there is sufficient public health capacity to conduct contact tracing for all new cases and their close contacts.”
** Starred Entry: The Safra Center at Harvard released its 56-page “Roadmap to Pandemic Resilience” on April 20. The subtitle indicates its approach: “Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society.” The basic plan is to progressively expand those key strategies until the economy is fully reopened around August.
“We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy. We acknowledge that even this number may not be high enough.”
“Massive testing plus contact tracing plus social isolation with strong social supports, or TTSI, can rebuild trust in our personal safety and the safety of those we love. This will in turn support a renewal of mobility and mobilization of the economy.”
“The cost of such a testing and tracing…program—$50 to 300 billion over two years—is dwarfed by the economic cost of continued collective quarantine of $100 to 350 billion a month.”
“We do not propose a modest level of TTSI intended to supplement collective quarantine as a tool of disease control. Rather we recommend a level of TTSI ambitious enough to replace collective quarantine as a tool of disease control. TTSI should replace stay-at-home.”
An editorial note: The Harvard paper says we need a Pandemic Testing Board to “coordinate” the supply chain because “the market has not so far supplied the necessary scale of test production.” But the federal government long actively suppressed outside testing, and the health care system looks nothing like a free market, being dominated by government spending and controls. To me, this is a standard case of government controls leading to more government controls. This is not an argument against government intervention at this point; it is simply an argument that it’s ridiculous to blame “the market” for not working when government has substantially destroyed the market.
“Approximately 40% of the U.S. workforce is in essential services, according to the Department of Homeland Security,” and testing is especially needed there. Around 20 percent of the workforce can effectively work from home.
Tomas Pueyo’s April 23 article advocates universal public mask wearing, physical distancing, and hygiene. “What we want is to avoid prolonged, direct, confined contact with people if it’s in a closed area, and we have close contact for a long period of time. In such an environment, two meters is likely not enough space.”
Lyman Stone argues (April 20), “Ordering people to cower in their homes, harassing people for having playdates in the park, and ordering small businesses to close up shop regardless of their hygienic procedures simply has no demonstrated effectiveness. These policies should be replaced by stringent mask requirements, large-scale centralized quarantine protocols, and renewed emphasis on empowering people to protect themselves and their neighbors by adopting social distancing during their everyday life.” Stone further discusses the matter in an April 23 Tweet thread.
The Rockefeller Foundation released its “Testing Action Plan” on April 21. This is a great opening: “Pandemics sicken and kill people in three ways: first by overwhelming patients’ immune defenses, then by swamping hospital networks, and eventually by cutting off a community’s economic lifeblood. Hence, ‘saving lives or saving the economy’ is a false choice.” The report suggests “the bold, ambitious, but achievable goal of rapidly expanding testing capacity to 30 million tests per week over the next six months.” It also calls for a “Healthcare Corps” to test and trace, as well as for better use of data.
The Heritage Foundation-led National Coronavirus Recovery Commission also released its “Recommendations for Recovery” on April 20. Summary: “Phase 1: Returning to a More Normal Level of Business Activity at the Regional Level. Phase 2: Slowing the Spread While Expanding Testing, Reporting, and Contact Tracing.” Not everyone is a fan. Will Wilkinson writes (April 22), “The Heritage Foundation has released a re-opening plan woefully light on testing that’s unlikely to put the economy on a path to recovery, but certain to get Americans killed.” Among his complaints: The report “specifically rejects aiming for mass testing.” Wilkinson himself endorses the Harvard report, saying (April 21), “A Massive Surge in Testing Is the Only Way to Safely Restore Our Liberty and Economy.”
Bill Gates has a nice write-up (April 23) of the standard approach to the epidemic.
Paul Romer released his “Roadmap to Responsibly Reopen America” in late April. He writes, “We must now shift to a plan that balanc-es the need to protect our health and reopen our economy by locking down only those who are infectious. This paper presents a simple, scalable, and credible solution: introduce a comprehensive ‘test and isolate’ policy, making it safe for Americans to return to work and keeping the infection rate below 5% of the population.” As a point of reference, as of April 25, the U.S. has 890,524 confirmed cases. It’s not even clear to me that the total number of actual cases is now less than 5 percent. I doubt it’s less than 2 percent. Anyway, Romer’s plan is basically to test every person twice per month. He proposes scaling up testing, starting with “essential” workers.
T. J. Rodgers argues (April 26) that America’s tight shutdowns did not have much effect on number of deaths (per capita), relative to other factors.
Vaccines, Antivirals, and Other Treatments
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?
Some people are working on a “DIY vaccine” (March 13). Seems sketchy to me.
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).
It looks like the HIV drug leronlimab might be effective in treating some people with COVID-19 (March 28).
Moderna Therapeutics is among the companies racing to develop a vaccine (March 23).
“Johnson&Johnson CEO Alex Gorsky announced Monday that a potential vaccine against COVID19 has been developed. Clinical trials are said to start in September, with an available vaccine as soon as 2021” (March 30).
“Controlled human challenge trials of SARS-CoV-2 vaccine candidates could accelerate the testing and potential rollout of efficacious vaccines. By replacing conventional Phase 3 testing of vaccine candidates, such trials may subtract many months from the licensure process, making efficacious vaccines available more quickly. Obviously, challenging volunteers with this live virus risks inducing severe disease and possibly even death. However, we argue that such studies, by accelerating vaccine evaluation, could reduce the global burden of coronavirus-related mortality and morbidity. Volunteers in such studies could autonomously authorize the risks to themselves, and their net risk could be acceptable if participants comprise healthy young adults, who are at relatively low risk of serious disease following natural infection, they have a high baseline risk of natural infection, and during the trial they receive frequent monitoring and, following any infection, the best available care” (March 31). Via Jason Crawford.
Distributed Bio thinks it might be able to give people antibodies for the virus behind COVID-19. “We took a series of five antibodies from around 2002 that were able to neutralize SARS. We were able to use technology in our laboratories to evolve those antibodies against SARS to adapt them to recognize COVID-19” (March 31).
Bill Gates is spending billions to develop a vaccine (knowing full well some of his funded ventures won’t pan out). You rock Bill (April 2).
I have no way to independently evaluate this, but: Dr. Vladimir Zelenko of New York “said he has now treated 700 coronavirus patients with 99.9% success rate using Hydroxychloroquine, Zinc Sulfate and azithromycin” (April 3). This sounds too good to be true, so I’ll look out for criticisms.
Israel: “Six critically ill coronavirus patients in Israel who are considered high-risk for mortality have been treated with Pluristem’s placenta-based cell-therapy product and survived” (April 8).
Bad news out of China for using chloroquine for COVID-19 (April 9).
“Critically ill Evergreen man first in Colorado to receive ‘convalescent plasma’ to help fight COVID-19” (April 7).
Jason Crawford wrote up his thoughts about the problems with the ventilator stockpile (April 1).
“No Hydroxychloroquine Benefit in Small, Randomized COVID-19 Trial” (April 16).
Early signs suggest the antiviral Remdesivir might be an effective treatment (April 16).
“The current COVID-19 pandemic plainly underscores the need to vastly accelerate mass vaccination in every phase” (April 20).
The Milkin Institute has organized a “vaccine tracker.”
“Rutgers physicians and University Hospital are leading the way in using blood plasma from patients who recovered from COVID-19 to treat new patients who are severely ill with COVID-19 infections” (April 20).
“Let Volunteers Take the COVID Challenge. Young, healthy, informed people should be allowed to participate in vaccine trials (Conor Friedersdorf, April 21). To me it is insane that this is even an open question. Of course this should be allowed.
Donald Trump rightly took enormous criticism for suggesting on April 23 that perhaps ingesting or injecting disinfectant might help cure COVID-19. Trump also said that UV light on or inside (?) the body might help. There’s actually some scientific basis for the claim that UV light might be useful in treating certain infections. A 2015 study suggests that “ultraviolet blood irradiation” might help with hepatitis C. There’s actually a substantial history of people using UV light to treat bacterial infections; the idea is to run a person’s blood through a special machine. Of course there is no evidence this might work for SARS-CoV-2, but offhand it doesn’t seem crazy that this might help.
“A purified inactivated SARS-CoV-2 virus vaccine candidate (PiCoVacc) confers complete protection in non-human primates against SARS-CoV-2 strains circulating worldwide by eliciting potent humoral responses devoid of immunopathology” (April 17).
Matt Ridley runs through a variety of possible treatments (April 25). “If someone recovers, their own body produces antibodies that smother the virus. These days it’s possible to mass-produce exact copies of the antibodies that work, using genetic engineering. . . . Regeneron has rushed a new cocktail of Covid-19 antibodies through the same procedure and hopes to have it ready to test in early summer.” He concludes, “If people can take a pill that drastically reduces their chances of dying, and clears up their symptoms before they need to be admitted to hospital, then we may not have to wait for a vaccine to end the lockdown and achieve herd immunity.”
Oxford’s Jenner Institute is looking to test a SARS-CoV-2 vaccine on 6,000 people by the end of May (April 27). “The first few million doses of their vaccine could be available by September.”
Variolation and Herd Immunity
I’m breaking this out as a new section on April 22 and moving various related links and comments here. To my mind, variolation is the most interesting idea that hardly anyone is talking about. My best guess is that variolation (intentional, controlled infection) would be a lot better than people getting randomly infected. But it’s unclear to me whether the U.S. is headed toward herd immunity—if so than to me variolation seems like a clear winner. And I doubt the practice can every overcome political and medical inertia anyway, regardless of how much sense it makes.
Variolation: Robert Hanson suggests, “Just as replacing accidental smallpox infections with deliberate low dose infections cut smallpox deaths by a factor of 10 to 30, a factor of 3–30 is plausible for Covid19 death rate cuts due to replacing accidental Covid19 infections with deliberate small dose infections” (March 30). I’d at least like to see this become a legal possibility.
Alex Tabarrok thinks variolation might work, especially among small groups, such as the military (April 13).
“People are going to infect themselves with the coronavirus, and there is nothing we can do to stop them. But we can make it less dangerous” (April 16). This seems like an excellent reason to introduce controlled variolation.
The New York Times published an article (March 25) critical of a Federalist article that seemed to advocate the equivalent of “chickenpox parties.” This is unfortunate, because no serious person is advocating any such thing, and there’s a huge difference between a “party” and controlled variolation under a doctor’s care. The article at least hints at a serious response: “Dr. Daniel J. Morgan, a professor of epidemiology and public health at the University of Maryland School of Medicine, said he would not endorse intentionally infecting people, but added that it was worth considering ways to increase herd immunity while protecting vulnerable patients. ‘I think that we do need to be open-minded about all potential ideas if we don’t see a great effect from social distancing,’ he said.” But this is confused. What other way is there to hasten the shift to herd immunity, but for variolation? The only alternative is accidental infection, which is much more dangerous for the infected person and for others.
I’m linking to this article by Gideon Meyerowitz-Katz (March 30) just because it is so peculiar. Here is the main argument (and I use that term loosely here): “Herd immunity without a vaccine is by definition not a preventative measure.” No kidding. The relevant questions are these: 1) Is herd immunity inevitable in a given area or generally?, and, 2) Is herd immunity the least-bad way to handle this crisis, given the realities, even if it were avoidable? Of course the article ignores the difference in mortality rates between the young and healthy and the health-compromised and elderly, which matters to who might worry less about getting infected and who might need to be carefully cocooned, and it does not take into account the likely risk reductions of variolation.
I make the conditional case for variolation in my April 24 column. I hope that people actually read what I’m proposing here. The context is the massive failure to develop adequate testing to date. Maybe that can and will change. But, if it doesn’t, herd immunity may be inevitable. In that context, reaching herd immunity in a controlled way is radically less-bad than reaching it an uncontrolled way. That’s the potential role of variolation. Note the bits here about “doctor’s supervision” and “controlled study.”
“Maybe the Experts Were Right About Covid-19 the First Time. They originally wanted herd immunity, realizing lockdowns would incur the disasters we’re seeing” (Joseph Sternberg, April 23).
Some people in Cuba intentionally infected themseves with HIV (!) because they thought life would be better in an AIDS santarium (Vice, 2017). I think the lesson here is that desperate people will do desperate things. In America, I’ve seen news accounts of people saying they went to social events to intentionally get COVID-19. Obviously it’s really bad if people get that desperate. Part of the solution is to convince people that another course is better for them, and part of the solution is to make sure another course actually is better for them.
** Starred Entry: Daniel Tillett offers an intruiging approach to variolation: Seek out “a natural attenuated SARS-CoV-2 strain” to use. The basic idea is to infect people with less-harmful variants of the virus to give them immunity protection against more-harmful variants. This strikes me as a very important idea. See his articles from April 5 and April 12. Hat tip to Irfan Khawaja. Tillett’s first article discusses some of the strains that have already been discovered and reviews some of the history of using “attenuated viruses” in variolation. He writes, “If we can find one of these non-pathogenic viral strains out in the wild we could give it to everyone in the world and solve our diabolic problem.” He emphasizes that people with mild symptoms still can have a relatively dangerous strain of the virus. He does caution that there is some indication that “long term immune response . . . fades quickly after just two months.” He says bluntly, “There is a non-trivial chance that this approach may not work.” The second article outlines the steps needed to pursue this.
The National Post has an April 24 article about the proposal of Canadian doctor Eleftherios Diamandis to try variolation, and the stiff resistance he’s facing. Diamandis posted a paper online (date unknown). Here’s the summary: “We advocate that, in the current absence of any other sustainable solutions, hospitals could engage in controlled voluntary infection of volunteers with COVID-19 virus, for the purpose of achieving immunity.”
Michael Segal suggests (March 24), “Expose first responders to the coronavirus.”
Peter Singer and Richard Yetter Chappell make “the case for experiments on human volunteers” (April 27). They discuss possible “human challenge” trials for vaccines. They also discuss variolation. “In the New York Times, scientists Joshua D. Rabinowitz and Caroline R. Bartman note that people who receive a low dose of a virus are more likely to recover than those who receive a high dose, and that this holds for coronaviruses, too.” Bizarrely, those authors then reject variolation. But, Singer and Chappell argue, under the right circumstances, “it seems both reasonable and ethical to invite healthy young volunteers to receive a low dose of the virus, followed by quarantine and medical observation.” Certainly controlled infection is better than uncontrolled “coronavirus parties,” which some people already have held and in which more will be tempted to partake.
The Response in Other Countries
CNN (April 16) reviews the strategies of countries that handled the virus relatively well: Taiwan, Iceland, South Korea, and Germany. Some of the lessons: Be prepared, be quick, “test, trace, and quarantine,” “use data and tech” (but respect privacy), be aggressive, “get the private sector involved, “act preventatively,” “build capacity at hospitals.”
Tomas Pueyo has out an April 20 update on his “dance” strategy. Mainly this looks at what happened in various Asian countries (China, South Korea, Japan, Singapore, Taiwan, Hong Kong (city)). I’m pretty skeptical that the intensive lockdowns and tracking used in various Asian countries are either appropriate or practical especially in the U.S. But obviously the U.S. could have and should have done the main thing that South Korea did: “test as many people as you can.” A key line: “The bread and butter of South Korea is thus testing, contact tracing, isolations, quarantines, hygiene, masks, and travel bans. They didn’t need a heavy hammer because they mostly used a scalpel.”
“Within a week of its first confirmed case [on January 20, 2020], South Korea’s disease control agency had summoned 20 private companies to the medical equivalent of a war-planning summit and told them to develop a test for the virus at lightning speed. A week after that, the first diagnostic test was approved” (Guardian, March 28)
The rate of disease spread in Japan may be considerably higher than many people now think. Tyler Cowen reviews recent concerns (March 26).
“The government tracks the location of residents’ smartphones, so it knows exactly who had come within a few feet of an infected or potentially infected person. It uses the same location data to help enforce mandatory quarantines” (Axios, March 28). Of course, Singapore also effectively used testing and tracing.
Unfortunately, Singapore may be hitting a Second Wave of infections (April 8).
With cases rising, “Singapore has put in place strict safe distancing measures during what it calls a circuit breaker period to stem the spread of COVID-19. The measures—which include closing non-essential workplaces and schools—will be in place for one month until May 4” (April 14).
Singapore cases seem to have spiked because of “overlooked clusters of cases among migrant workers living in cramped dormitories and an underestimation of the speed at which those infections could spread through a city where lockdown measures had not been put in place” (James Griffiths, April 19).
“Taiwan is seen as one of the few places in the world which has successfully stemmed the spread of the coronavirus without resorting to draconian measures. But despite its efforts, it is still effectively locked out of membership in the World Health Organization (WHO) due to its complex relationship with China” (BBC, March 30). See more from PBS (April 1).
Apparently Germany is ramping up for randomized testing (March 30).
“German researchers plan to introduce coronavirus ‘immunity certificates’ [based on antibody tests] to facilitate a proper transition into post-lockdown life, as Chancellor Angela Merkel’s handling of the crisis has led to a boost in the polls” (March 29).
As of March 29, China seems to have largely contained the disease. However, some people are skeptical of China’s official figures.
Yes, China seems to be cooking the books (April 1).
The response in Italy has been notoriously bad. See “Lessons from Italy’s Response to Coronavirus” (March 27). However, this article notes, Veneto did better than Lombardy, largely because Veneto used “extensive testing” combined with tracing, targeted quarantines, and in-home care.
“The Swedish government has left it up to individuals to act responsibly and decide whether to stay home or not. . . . Public gatherings of more than 50 people are prohibited, but there are no restrictions on private meetings, meaning parties and corporate events can still go ahead. Libraries and swimming pools remain open” (April 1). I guess we’ll see how well this works.
“There is no Swedish experiment: it’s the rest of Europe that is experimenting – by locking down economies in response to a virus which may prove to be no more deadly than flu” (April 3). We shall see.
Nils Karlson comments on the Swedish model (April 5). He thinks it could work pretty well.
National Review also takes a favorable view on the Swedish Model (April 6).
Swedish deaths took a big jump on April 8 with 114 new deaths. I Tweeted, “It was a rough day for Sweden (114 new deaths), but it was also a rough day for the world (7,412) and the U.S. (1,906). Locked-down CO had a bad day yesterday (29). It’s not obvious to me that Sweden’s lighter touch yields a lot worse results (but maybe).”
Sweden: More death, less unemployment (April 7). Geoffrey Garrett suggests the interesting comparison is between locked down Norway and looser Sweden.
“Is Sweden’s lax approach to the coronavirus backfiring?” (April 9)
Johan Norberg remains optimistic about Sweden’s approach (April 17). “We are outliers in terms of policy, but not in terms of outcomes.”
Here are Sweden’s policies on quarantines:
Can a whole town or city be placed in quarantine?
No. According to the Swedish Communicable Diseases Act (2004:168), individuals can be put in quarantine but not town or cities. It is possible, however, to impose a lockdown on a particular geographical area (see question below).
What is a lockdown?
Under the Swedish Communicable Diseases Act (2004:168), an area corresponding to a few blocks may be put in lockdown. This means, among other things, that it becomes prohibited to access or leave the area. A lockdown can be used when one or more people have fallen ill with a life-threatening disease within a particular geographical area. The lockdown then serves to make it possible to find the source, and to identify any more cases of disease or transmission.
The aim with this intervention is to create a zone where an investigation can take place without risk of people entering or leaving and risking further transmission of disease. When the investigation is finished and anyone exposed has received the appropriate care or waited through the incubation period, the lockdown should be lifted.
“The Swedish experiment looks like it’s paying off” (Fredrik Erixon, April 20).
“How did the Swedes do? They suffered 80 deaths per million 21 days after crossing the 1 per million threshold level. With 10 million people, Sweden’s death rate‒without a shutdown and massive unemployment‒is lower than that of the seven hardest-hit U.S. states—Massachusetts, Rhode Island, Louisiana, Connecticut, Michigan, New Jersey and New York—all of which, except Louisiana, shut down in three days or less. Despite stories about high death rates, Sweden’s is in the middle of the pack in Europe” (T. J. Rodgers, April 26).
“As of Tuesday, Iceland had tested more than 17,900 people for the virus — nearly 5% of its population. . . . Iceland has yet to take many of the draconian measures seen across Europe and Asia . . . , though the island country has banned gatherings of 100 people or more and closed secondary and tertiary schools. Officials say more restrictive measures haven’t been needed because they were better prepared and armed with data to track the virus” (April 1).
Australia imposed fairly severe shutdowns at the state level, as Joseph Walker reviews (April 8).
With few new infections, New Zealand is largely opening back up, albeit with agressive contact tracing (April 27). But I think it’s worth bearing in mind that New Zealand is an island nation with fewer people than Colorado has, so it’s a lot easier to tighten things up relative to U.S. states.
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.
During a March 28 media conference Governor Jared Polis released a detailed document estimating RO and total mortality given different social distancing efforts. Assuming RO4, Polis’s office estimates peak ICU bed demand at 13,000 by the end of April and a total mortality of 33,200 by June 1. With RO4 and 60 percent social distancing, those numbers drop to 4,500 beds and 11,500 deaths. At R03, depending on social distancing (0 to 60), peak bed needs range from 11,600 to 900, and deaths range from 23,000 to 400. The upshot is that around twenty thousand lives depend on not overloading the hospitals, according to these estimates. The Denver Post wrote an article about this (as did other outlets).
Polis said that his office is basing its decisions partly on limited location tracking (cellphone metadata) via subscription services. It’s unclear to me what percent of Coloradans are so tracked, how this data is collected, or how exactly data makes its way to the governor’s office.
This is an unfortunate story. A Western Colorado distillery started making hand sanitizer but then “ran out of the other ingredients” (other than alcohol) to make it (March 31).
“Denver is ticketing people and business owners who are breaking the city’s stay at home order” (March 30).
CraftWorks, owner of my beloved Rockbottom Brewery, fired nearly 18,000 employees. Brutal (March 31).
“It’s almost like you can see a tsunami coming — and there’s nothing that you can do about it but stand there.” A Colorado legislator returns to work as an ER nurse (April 1).
Lots of Coloradans are buying guns (March 31).
Denver’s Swedish Hospital prepares to care for COVID-19 patients; quieter now but “ready for a surge.” (March 31).
On April 6 Colorado Governor Jared Polis delivered a remarkable speech. The ostensible purpose was to extend the statewide stay-at-home order until April 26. Following are some excerpts.
We can’t live without an open and functional economy and market. People need to be free to engage in commerce and transactions, trade and work. But we simply can’t function normally while we’re living day to day in mortal fear of a deadly virus.
I’m hopeful we can get things going sooner in Colorado [than April 30]. We’re not just hoping but working hard to be able to end as many of these devastating limitations on movement and commerce as quickly as possible.
The data and the science tell us that staying at home is our best chance, our only realistic chance, to avoid a catastrophic loss of life, the death of thousands of our friends, our neighbors, our family members.
We’re also in a race against the clock. Because if too many people get seriously ill all at once from the virus, our healthcare system simply won’t have the capacity to handle all of those sick patients.
Without an adequate supply of masks and gloves for our healthcare workers or ventilators for the critically ill, and without the testing supplies that we need for mass testing and effective containment, our only option is to limit the number of person-to-person interactions.
Like many of you, I’m beyond furious that we’ve been forced to shut down large portions of our economy, putting tens of thousands of people out of a job, because, as the wealthiest nation on the face of the earth, we still don’t have access to the supplies and testing we need to mount a proper, more targeted response.
But if the choice is between a temporary shutdown and a catastrophic loss of life, the choice is clear. These closures and restrictions will be temporary. But when you lose a life, you lose it forever. And, in fact, the economic consequences would be even more severe, and more prolonged, if we completely overload our hospital system.
On April 5 the state released “crisis standards of care” that lay out explicit guidance for assigning potentially limited ventilators to an overabundance of patients. As CPR suggests, much of the motivation for these standards to is relieve hospitals of future liability.
“State releases new modeling findings” (April 6). The Sun has a good write-up on the different Colorado models (April 7). On April 6, experts with the state predicted that Colorado’s peak infection rate had not yet occurred.
Chris Vanderveen offers some important context on the fatality figures for Colorado (April 8). The upshot is that the data are messy; for example, the day that a death is reported may not be the day the death occurred.
A large meat-packing plant in Colorado temporarily shut down after dozens of employees tested positive for the virus (April 11).
After the feds overrode a Colorado order for ventilators and then Trump magnanimously sent the state a fraction of the total, lots of people are justifiably angry (April 10).
People on CO’s Innovation Response Team are gathering widely available cell phone location data to check levels of social distancing (Denver Post, April 15). I don’t think this is too concerning but I’m glad reporters are asking about it.
Colorado hospitals have started to release hospital discharge rates, which look promising (Chris Vanderveen, April 15).
As of April 16, the shutdown crunch is already hitting regional governments in Colorado. “Facing a possible $25 million shortfall because of the coronavirus pandemic, the city of Aurora announced Wednesday it’s furloughing 576 . . . mostly . . . seasonal, contingent and temporary workers” (April 15). “Boulder furloughing 737 workers as city tightens budget due to COVID-19” (April 14).
“Burglaries On The Rise Across Denver Metro Area” (April 17). Some people speculate that recent prisoner releases had something to do with this, but I have no idea.
Jesse Paul’s April 17 story indicates some tension within the governor’s team about how to proceed. “Scott Bookman, the state’s coronavirus incident commander . . . on Thursday was . . . emphatic that the state can’t be reopened until more testing capacity is in place.” But adequate testing simply is not available. Rachel Herlihy, the state’s epidemiologist, said, “So, instead of using a stay-at-home order, we want to use aggressive disease-control strategies. Isolation and quarantine. Perhaps some other social distancing strategies that would be a little less than a stay-at-home order. And then other screening practices at businesses and nursing homes and other settings that could also limit transmission.” But how will that work without testing?
Denver is going to use 150 contact tracers, but obviously they’re not planning to do anything like a thorough job of it. They’re focusing on “close contacts” and basically ignoring public activity. That will help but it’s unclear to me how much (David Sachs, April 22). Morever, the city is hoping to get up to 2,000 tests per week, which seem woefully inadequate to me.
In Colorado “the testing simply hasn’t come” (Denver Post, April 22). We’re partly reopening anyway. “Public health experts say 152 tests per 100,000 people each day is the gold standard for community-wide testing in order to safely lift restrictions such as stay-at-home orders. . . . Colorado is currently testing 26.5 people per 100,000 residents.” Of course some people think we need many times that number of tests, but partly the difference rests in assumptions of how fully we reopen. Here is another key paragraph: “If the state keeps social interactions to 65% less than normal—the level Polis is shooting for—and took no other precautions, the number of people needing intensive care beds would exceed the number available in late July or August, the Colorado Department of Public Health and Environment and Colorado School of Public Health predicted in a new modeling report released Monday.” Of course the point is to implement a variety of other measures, including mask-wearing.
CO government is just now “negotiating a contract with Centennial State Lab to do testing for the state,” a company that says it has been prepared to process “up to 1,300 of its tests a day” for the past six weeks (Shaun Boyd, April 21).
Governor Polis wants the state to shift from “stay at home” to “safer at home.” Here’s what that means, practically: “About half the workforce will be able to return to their jobs the first week of May . . . but employers are urged to continue to allow telecommuting if possible. Workplaces that do reopen will have to abide by strict guidelines, including checking the temperature of employees as they enter the building. Retail will first open to curbside delivery and then be allowed to gradually open with strict precautions. Hair salons, tattoo parlors, dog groomers and personal trainers will be allowed to resume services, but also with stringent social distancing measures. Restaurants and bars will still be closed to in-person dining—at least at first—and schools will remain shuttered” (Jesse Paul, April 20). Also no gatherings of more than ten people. The goal is to maintain social distancing of 60–65 percent rather than the current 75–80 percent.
The emergency hospital facility at the Colorado Convention Center “was previously targeted to open Saturday with up to 2,000 beds, now will have about 600 beds” (April 20).
I discuss Ezekiel Emanuel and Paul Romer’s ideas for testing and point out that Colorado simply doesn’t have anywhere near that testing capacity (April 21).
Data from rt.live make me wonder whether Colorado can actually open up at all without an immediate surge in cases. We seem to be just barely under R0 of one (April 18).
Colorado is trying to ramp up contact tracing to handle 500 cases per day (John Ingold, April 21). To this add local and perhaps federal tracing. But it’s still unclear if the underlying testing will be in place or if the tracing levels will be nearly enough.
Jared Polis delivered an April 20 media conference in which he said that Colorado does not have the testing capacity or the ability to trace contacts sufficiently to rely mainly on that strategy. In an April 21 article, I wrote about what a comprehensive testing strategy would look like and noted that such doesn’t seem likely. In his April 22 media conference, Polis said that moderately more testing will come online in Colorado soon. He emphasized that this moderate amount of testing must be used in conjunction with still-dramatic levels of social distancing to keep the disease spread under control. I summarized via Twitter much of Polis’s presser.
“One of the local hospitals in Denver [National Jewish] is now offering COVID-19 antibody blood testing, for $94. No physician referral required. Available 7 days a week, requires appointment in advance” (Paul Hsieh, April 22).
Again I ask: If extending Colorado’s stay-at-home order would have “a negligible impact in severity of the peak” (April 23, Jared Polis’s terms), then how can it now have a meaningful impact? What’s the magic difference between April 23 and April 27?
“Colorado received a Battelle Critical Care Decontamination System that cleans and disinfects used N95 respirators for reuse. It can decontaminate up to 80,000 used N95 respirators per system per day, with a single respirator able to be reused up to 20 times without degradation” (April 23).
“Colorado’s COVID-19 death count expected to jump this week as state adds older cases to dataset” (April 23). Stats will now include “probable” deaths.
The Ventilator and PPE 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. Doctors already face shortages of protective gear such as N95 masks. See also the section about businesses responding for instances of businesses working on ventilators and masks.
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.”
A problem with substituting CPAPs for ventilators is that the former apparently can aerosolize the virus (March 27).
“MIT Will Post Free Plans Online for an Emergency Ventilator That Can Be Built for $100” (March 28). I suspect it’s better than nothing in certain circumstances.
Bad news, as summarized by Rob Wiblin (March 30): “Osterholm (Director of the Center for Infectious Disease Research & Policy at UMinnesota) warns that the shortage of tests, PPE and ventilators will get worse rather than better in coming months as global demand grows faster than supply.” But isn’t production also ramping up?
“A planeload of desperately needed medical supplies arrived in New York from China. . . . The first plane, funded by the Federal Emergency Management Agency, carried 130,000 N-95 masks; nearly 1.8 million surgical masks and gowns, more than 10.3 million gloves; and more than 70,000 thermometers.” (March 29).
The FDA has approved mask sterilization by Battelle. Supposedly “masks can be decontaminated up to 20 times without degrading their performance” (March 30).
Here’s a crazy story (Washington Post, April 3): The Obama Administration started development of plans to build a high-speed mask production machine. In 2018, O&M Halyard delivered plans to the Department of Health and Human Services, which sat on them. But it’s unclear if the company actually could have delivered.
Alabama: “County Received 5,000 Rotted Masks From National Stockpile” (April 2).
A Texas company that produces surgical masks, Prestige Ameritech, owned by Mike Bowen, complains that, because it is normally undercut by Chinese competitors, it cannot now ramp up production as much as it might otherwise. But this April 3 story by Dave Lieber has an obvious protectionist bent, and its details don’t all add up. Here is the political slant: “The story of Bowen’s unhappiness is a cautionary tale about what can happen if Americans searching for cheaper prices send entire industries offshore to countries like Mexico and China.” A local politician told the writer, “Last time he geared up and went three shifts a day working his tail off. As soon as the issue died, he didn’t have any sales. He had to pay unemployment for all these people, and he had to gear down.” So it seems the business didn’t correctly anticipate demand. Anyway, the business is now ramping back up. Lieber writes, as though this were somehow a surprise, that “Bowen asks hospitals to sign contracts.” Well, duh. Maybe there’s a case for long-term politically subsidized production of surgical masks in the U.S., but this article doesn’t make the case.
“There is no indication that the Obama administration took significant steps to replenish the supply of N95 masks in the Strategic National Stockpile after it was depleted from repeated crises” (USA Today, April 3).
“The White House and FEMA are swooping in to grab masks, thermometers, and other items in a secretive process with apparently little recourse. These actions are abusive from a civil liberties perspective, and such command‐and‐control methods make no practical sense either” (Chris Edwards, April 8).
Some doctors think ventilators have been over-used, anyway (April 8).
U.S. tariffs have contributed to shortages of protective gear (Reason, April 9).
Silencing and Punishing Doctors
My view: Telling doctors they can’t talk to the media about lack of protective equipment is dangerous, as that obscures relevant information from people.
“Hospitals Tell Doctors They’ll Be Fired If They Speak Out About Lack of Gear” (Bloomberg, March 31).
Dr. Zubin Damania is outraged by attempts to silence doctors (March 31).
“A Nurse Bought Protective Supplies for Her Colleagues Using GoFundMe. The Hospital Suspended Her” (April 7).
California: “10 coronavirus-unit nurses are suspended, potentially for weeks, for refusing to work without N95 masks” (April 17).
“Across the country, thousands [of doctors and nurses] fear that speaking up about shortages of personal protective equipment and staff will lead to disciplinary action and possibly get them fired” (April 21).
Safety Protocols and Coping Methods
Dr. Jeffrey VanWingen shared a 13-minute video about how to get delivered food safely into your home.
Psychologist Eileen Feliciano offers her “Mental Health Wellness Tips for Quarantine” (March 23). Good stuff.
Gena Gorlin collected resources about psychological health during the crisis (April 2).
Masks Probably 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. (On March 31, I changed the title of this section from “Maybe Masks Can Help” to “Masks Can Probably Help.”)
I’d like to get a sense of how much universal public mask wearing of a) cloth masks and b) N95 masks would help curb spread of the disease. It seems like it could help quite a lot. Here’s one way to ask the question: Relative to the social distancing measures, how much would mask wearing have curbed spread of the disease?
“Simple DIY masks could help flatten the curve” (Washington Post, March 28). On the other hand, maybe not. Or maybe so! To me, an important question is whether N95 masks, widely distributed and worn, could help contain the spread of the disease.
Some data suggest that wearing a mask is actually more effective and reducing contagion than hand-washing (March 28).
Paul Novosad points out that, even if cloth masks are mostly worthless, but still 10 percent effective, wearing them would be enormously beneficial (March 27).
David Price points out that the COVID-19 virus mostly is spread hand-to-face, not via airborne particles. This suggests that, even if masks are not at all effective against airborne particles, widespread use of masks in public still could radically reduce spread of the disease. Then if you add in some effectiveness against airborne particles, masks seem like a clear winner.
“Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population” (2008 study).
“C.D.C. Weighs Advising Everyone to Wear a Mask” (March 31). I don’t understand why this is so difficult. Here is the correct principle: “So long as healthcare providers do not have sufficient masks, give all available appropriate masks to them. Once good (hopefully N95) masks become more widely available, everyone should wear them in public.”
Nassim Nicholas Taleb colorfully explains why the WHO is wrong not to recommend universal public mask wearing (March 31).
“If masks are limited, conserving them for the people who need them most makes sense. But that message was lost amid the confusing claim that masks somehow protect health-care workers but are useless for everyone else” (Ed Yong, April 1).
David Kopel argues that public mask wearing is helpful (April 3). On April 3 Colorado Governor Jared Polis advised all Coloradans to wear cloth masks in public.
“Polypropylene [a plastic] is a commonly used material for N95 masks.” In addition to blocking and trapping particles, these masks work through “electrostatic attraction” (Forbes).
Unfortunately, “both surgical and cotton masks seem to be ineffective in preventing the dissemination of [viruses] from the coughs of patients with COVID-19 to the environment and external mask surface” (April 6). But, if I’m reading the relevant study correctly, surgical and cloth masks reduced the projection of particles somewhat, and the cloth mask actually beat the surgical mask. Moreover, the study suggests that a big problem is particles getting around the edges of the mask. Tighter seal, better results (presumably).
Amesh Adalja warns that some people may offset the safety gains of masks by engaging in riskier behavior. He also points out that people can actually spread the virus by mishandling their masks (April 7). Wearer beware.
“Data do not back cloth masks to limit COVID-19” (April 9).
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.
Dr. Dave Price suggests that the main way the disease is transmitted is from hands to face. He thinks that, to get the disease from airborne particles you have to have a lot of exposure. He says that, if you keep your hands clean, refrain from touching your face (he suggests wearing a mask for this purpose), and giving others some distance, “You don’t have to be scared of the outside world now. You don’t have to be scared of your neighbor.”
This 2015 talk by Bill Gates, in which Gates warns about a coming pandemic, is chilling, in retrospect. One thing he suggests: “We need a medical reserve corps.” On April 2 Gates talked with Trevor Noah about the pandemic.
CNN reports (March 30) that the Lancet Infectious Diseases journal has an article claiming the true mortality rate of COVID-19 is probably around 0.66 percent. Here is the paper, which focuses on China.
Oh great: “MIT researcher says droplets carrying coronavirus can travel up to 27 feet” (March 31).
JSTOR has collected some background reading on viral diseases (March 27).
In a ten-minute video, Dr. Peter Attia discusses how to interpret screening tests for COVID-19 (April 6). This is a really important yet counter-intuitive insight: In a large population where a small fraction have the disease, a very-accurate test still can show huge numbers with false positives. Yet a negative result is pretty reliable. Attia has a page devoted to COVID-19.
New evidence that school closures probably don’t do much good (April 7).
Trevor Bedford argues that “COVID-19 was first introduced into the USA in Jan/Feb 2020” (not in the previous Fall) and that California has not achieved “herd immunity” (April 12).
Peter Attia interviewed Amesh Adalja about various aspects of the disease (April 13).
SARS-CoV-2 kills immune-system T-cells in a lab (April 12).
This seems like a bad trade-off: In some countries measles vaccines have been halted because of COVID-19 concerns (April 13).
“There is mounting evidence that one of the primary ways people are dying from Covid-19 is cardiovascular complications, and obesity, diabetes, and hypertension can all place additional strain on the heart” (April 6).
A report about antibody testing in Santa Clarita County CA indicates a disease prevalence of 2.49% to 4.16% with a corresponding fatality rate of 0.12% to 0.2% (April 17). Quick reaction: This squares with other studies showing relatively low prevalence of the disease among the general population; nowhere near herd immunity. But the fatality rates look quite favorable here (relative to other, much-higher estimates). Here’s a media report about the study. Jason Crawford provides several sources critical of the study. My take: One-off studies are of limited value, but multiple studies, in aggregate, can give us a much better idea of what’s going on. I have yet to see a study that suggests anything other than that most actual cases have not been officially diagnosed.
David Lilienfeld points out (April 17) that mortality is hardly the only thing to worry about. Possible problems for survivors include long-term lung damage, joint problems, liver damage, and neurological damage.
The coronavirus gives some people, especially young people, “Covid toes” (April 22).
There’s preliminary evidence that SARS-CoV-2 has strains of pretty dramatically different “pathogenicity” (April 21).
Preliminary results from antibody testing in Los Angeles County suggests an infection rate of 2.8–5.6 percent and a fatality rate of 0.1–0.3 percent (April 20).
Science explains the dynamics of the disease (April 17). The virus “‘can attack almost anything in the body with devastating consequences,’ says cardiologist Harlan Krumholz of Yale University and Yale-New Haven Hospital, who is leading multiple efforts to gather clinical data on COVID-19. ‘Its ferocity is breathtaking and humbling.'” Here is a key figure: “roughly 5% of patients . . . become critically ill.” Many of “these patients end up on ventilators. Many die. Autopsies show their alveoli became stuffed with fluid, white blood cells, mucus, and the detritus of destroyed lung cells.” Immuno “cytokine storms” often seem to be at play, but some people doubt the importance of this. The disease also can damage the heart, liver, kidneys, extremities, brain, and intestines.
New York City: Preliminary antiobody test results indicate a true infection rate of 21.2 percent (April 23). As I Tweeted, based on presumed COVID-19 deaths of 15,411 and a city population of 8,399,000, that suggests a true-infection fatality rate of 0.87 percent. That’s a lot higher than the fatality rate of the usual flu, at 0.1 percent, but less than half the fatality rate of the 1918 flu, at 2 percent.
“A new study of thousands of hospitalized coronavirus patients in the New York City area, the epicenter of the outbreak in the United States, has found that nearly all of them had at least one major chronic health condition, and most — 88 percent — had at least two” (New York Times, April 23).
COVID-19 seems to be causing more strokes, even in younger people with few symptoms (April 24).
Trevor Bedford estimates as many as 600,000 new cases of COVID-19 per day in the U.S. (April 24). At this point, can we seriously catch this beast through test-trace-isolate?
About the claim that 88 percent of ventilated patients died in New York, John W. Scott has the following way about the better way to state the results (April 23): “Among the 1,151 pts who were mechanically ventilated, at a median follow up of 4.5 days, 3% had gone home, 25% had died, & 72% were still in the hospital. The eventual mortaily rate will thus range between 25% (282/1151) and 97% (1113/1151).”
** Starred Entry: In a really important Tweet thread (April 26), Trevor Bedford explains “the benefits of reducing transmission even if suppression is not attainable.” The basic idea (as a couple of my Facebook friends helped me grasp) is that the percent of popular infection required for herd immunity varies by level of R0. So, even if the outcome is herd immunity, it matters very much how low we get R0. Bedford’s main point is that test-trace-isolate, even if done badly, can drive down R0 and save potentially millions of Americans from infection. Following is Bedford’s graph illustrating the point.
A hard thing to figure out is how much COVID-19 is pushing up overall deaths. After all, some deaths marked down as caused by COVID-19 are partly, largely, or mostly also caused by other health conditions. At the same time, some people are avoiding going to the hospital for serious conditions, so we’d expect deaths from other conditions to increase. At the same time, suicide deaths may or may not be up due to COVID-19-caused isolation. Auto accidents definitely are down. The Financial Times did a useful study (April 26) finding “122,000 deaths in excess of normal levels across 14 countries.” The report concludes, “Global coronavirus death toll could be 60% higher than reported.”
Effects of Government Actions on Social Distancing
Clearly it is wrong to assume that government orders are completely responsible for social distancing, as, given the fears surrounding the disease, many people would have increased social distancing with or without government orders. But it’s obviously not the case that people would have practiced as much social distancing without government orders. I’m really interested in trying to figure out how much government orders increased social distancing beyond what it would have been without any orders. (This section was added April 9.)
John Cochrane suggests that the main justification for government restrictions is that walking around in public while infected or possibly infected imposes external harms. I think that’s right. But I think there’s something else going on here: Some people are highly irrational, and some people tend to follow the crowd (there’s a lot of overlap between those groups). I think government restrictions can give those people a little extra push to move to social distancing.
I am aware that the state of Colorado, and I assume other states as well, has pretty detailed information from cellular location data and traffic data regarding the level of social distancing.
Jason Crawford points to some interesting data from San Francisco indicating that social distancing already was on the rise by the time of the March 16 “shelter in place” order but that the order seems to have some pretty definite effects. The order seems to have had the most effect on “grocery and pharmacy” and “workplace.” The decline in grocery store use is a little odd, given that grocery stores are “essential.” But it looks like people stocked up prior to the order. I also take this to imply that shelter-in-place orders (and the like) have a “threat effect” (based on anticipated enforcement) as well as an “education effect” (the order itself helps to scare people into greater social distancing).
A group out of the London School of Hygiene and Tropical Medicine ran a survey-based study and found that social-distancing guidelines in the UK resulted in “a 73% reduction in the average daily number of contacts observed per participant. . . . This would be sufficient to reduce R0 from 2.6 prior to lockdown to 0.62” (via Lionel Page, April 9). Of course, this study doesn’t show how distancing would have changed absent government restrictions.
Important finding: “While strong policies such as statewide stay home mandate and non-essential business closure have strong causal impact on reducing social interactions, most of the expected impact of more lenient policies (such as large gathering ban and school closure mandates) are already reaped from non-policy mechanisms such as voluntary actions and public awareness” (Abouk and Heydari, April 8). The refined point: “Reductions in out-of-home social interactions are driven by a combination of policy and voluntary measures and point to the strong causal impact of state-wide stay at home and more moderate impact of non-essential business closures and bar/restaurant limits. At this stage of the outbreak and for the US, other policy measures such as school closure mandates or large gathering bans seem to have had no significant causal impact on keeping people at home.” The paper stresses the limitations of its data.
David Boaz reviews some evidence that people were social distancing prior to government orders (April 15).
A 2014 paper regarding the flu: “School closure, whether proactive or reactive, appears to be moderately effective and acceptable in reducing the transmission of influenza and in delaying the peak of an epidemic but is associated with very high secondary costs. Voluntary home isolation and quarantine are also effective and acceptable measures but there is an increased risk of intra-household transmission from index cases to contacts. Work place-related interventions like work closure and home working are also modestly effective and are acceptable, but likely to be economically disruptive.”
Problems with Calculating Deaths
This seems like a rather important matter to figure out (Robert Wiblin, April 3): “We aren’t sure how many people who become infected with COVID-19 die, but on March 31 the Oxford Centre for Evidence Based Medicine (CEBM) reduced their best-guess estimate from 0.51% down to 0.1–0.26%. Among other things, they think some people who have been classified as dying of COVID-19 didn’t actually die of the disease but rather of serious existing conditions, and they just happened to have COVID-19 when they died. 0.1–0.26% is lower than most other expert estimates.” As I posted on Twitter, “To better-answer the sort of question raised here, I wish doctors would say whether they thought COVID-19 was the ‘sole,’ ‘dominant,’ ‘contributing,’ or ‘incidental’ cause of death in relevant cases. Indeed, it seems like that would helpful for all causes.” However, there are other things that could affect death rate as well. The BBC indicates (April 1) that in the UK COVID-19 deaths include even incidental infection, whereas in the U.S. docs “are asked to record whether the patient died ‘as a result of this illness’ when reporting Covid-19 deaths” to CDC. Fwiw, the Economist claims (April 4), “Covid-19’s death toll appears higher than official figures suggest.”
On the other hand. . . Why the COVID-19 death count may be under-reported in the U.S.: People who die of it, but who are not tested, do not show up in the official tally (Washington Post, April 5).
Doctors’ assumptions are probably pretty good here, but still . . . “COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have causedor contributed to death” (National Vital Statistics System, March 24, via Western Journal).
See also the section on economic consequences. This section pertains to suicides, lack of care in other areas, domestic violence, suicide, and substance abuse.
“Isolation during pandemic leading to more severe domestic violence in El Paso County, DA says” (April 22).
“Transplants plummet as overwhelmed hospitals focus on the coronavirus” (April 22).
“People with deadly ailments are avoiding Colorado hospitals because they’re afraid of catching coronavirus” (April 22).
“Do Not Delay Urgent Medical Care Due To The COVID-19 Coronavirus Pandemic” (Paul Hsieh, April 20).
Lessons from History
The Denver Post has a really nice deep-context article by John Aguilar about the Colorado response to the 1918 flu epidemic (March 29). It’s informed by authors of two books about the epidemic, John M. Barry and Jaime Breitnauer. The disease “infected nearly 50,000 Coloradans and left approximately 8,000 dead. . . . The governor of Colorado urges residents not to gather in crowds. Schools close, movie theaters shutter and public transit limits ridership. Denver’s mayor bans meetings, religious services and parties.”
However, it’s unclear to me to what degree social distancing made a difference in terms of the overall infection rates and death counts. Today, we realize that, if we lock down and then lighten up on distancing, the disease will again spread faster. The main point of distancing today is to not overload the hospitals, where doctors actually can keep lots of people with COVID-19 alive who otherwise would die. But ventilators didn’t even exist back then. The article does mention that doctors used oxygen, so presumably that helped keep some people alive who otherwise would have died. And oxygen was in limited supply during 1918.
Social distancing does seem to have reduced overall mortality rates even in 1918. An economics paper claims that “non-pharmaceutical interventions” did “decrease influenza mortality” in 1918 (Sergio Correia, Stephan Luck, and Emil Verner). Jason Crawford offers one theory about why that might be: Perhaps distancing delays contagion until strains become less virulent. Robert Wiblin suggests that maybe even simple medical interventions, such as hydration, made a difference. Maybe the availability of oxygen did make a big difference; that seems like the closest analog to the availability of ventilators today. A scientist-friend suggests that there were huge nurse shortages in 1918, which would help explain why distancing reduced overall mortality. So far, my best guess is that these two factors—less overloading of treatment facilities and waiting for reduced virulence—are behind whatever drop in total mortality there was due to distancing.
Infectious disease expert Amesh Adalja says that the 1918 epidemic “showed us how targeted social distancing could be used to blunt the force of an outbreak in specific geographic areas” (March 29). This article doesn’t present a theory for how this worked.
The Romans practiced social distancing and quarantines during the plague of 542.
In 1957, Maurice Hilleman developed a vaccine against that year’s flu outbreak in a matter of months. “That’s the only time we ever averted a pandemic with a vaccine” (April 7).
Quarantining was common in past pandemics. “Yet whatever viruses were swirling around, and however deadly or debilitating they were, life—and commerce—carried on. After all, an outbreak of one sort of another happened almost every season, almost everywhere” (March 18).
James Hankins has more on the Black Death (March 28).
“When Denver backed off social distancing in the 1918 pandemic, the results were deadly” (April 22).
Effects on Civil Liberties and Social Fabric
“Is government response to health crisis causing irreversible damage to civil liberties?” This is a good Colorado-focused discussion by reporter Patrick Armijo (April 6).
Why governments went after people for attending church services in their cars is beyond me (National Review, April 12).
Krista Kafer has a nice discussion of the authoritarian impulse that COVID-19 has unleashed both among pockets of the public and among government officials (April 16).
“Michigan Gov. Gretchen Whitmer Provides a Lesson in What States Shouldn’t Do To Stop a Pandemic” (Shikha Dalmia, April 16). “Arguably the country’s most draconian and nonsensical provisions.”
I wrote about an extraordinary media conference held by Colorado Governor Jared Polis on April 15 in which a reporter asked him to respond to charges that stay-at-home orders around the state are Nazi-esque. At the same time, there really is a “rat out your neighbor” vibe among segments of the population. I write, “How about people chill out, stop tattling on each other, stop pushing the limits of Godwin’s Law, realize that these are incredibly tense times full of pain and uncertainty, and attempt to set aside the screaming matches in favor of nuanced discussions.” Reporter Charles Ashby adds additional context to the story (April 16): “Comments on the Mesa County Department of Health Facebook page . . . have compared the department to Nazis after it posted a message earlier this week calling on people to report on others they suspect were not complying with its orders.”
“Numerous cases have been filed challenging some of these policies, arguing that they violate the First Amendment, the Second Amendment, constitutional protection for abortion rights, the Takings Clause, and other provisions of federal and state constitutions” (Ilya Somin, April 15).
“While these [social distancing] steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high” (April 10).
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.” My March 31 op-ed expands on this point: “Always look at the bright side of a lockdown.”
“State Shutdowns Have Taken at Least a Quarter of U.S. Economy Offline” (April 5).
Economist Tyler Cowen foresees a long period of a “pandemic yo-yo” causing severe economic damage (April 9).
Investor Michael Burry is among those who think the economic shutdowns were unwarranted (April 6).
The March 26 paper, “Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu,” has gotten a lot of attention. Philosopher Ben Bayer notes (April 8) that the sorts of restrictions imposed in 1918 are not like the wide-scale lockdowns now in place. Bayer extends his comments in an April 14 article, where he also discusses a paper by Michael Greenstone and Vishan Nigam.
On April 9, the Cato Institute hosted an online conversation with economists John Cochrane, Anna Scherbina, Emil Verner, and Ryan Bourne. Cochrane points out “this was a preventable disaster,” yet, because “we” did not prevent it, lockdowns became the “panic-button response.” He continues, “This was a preventable disaster, and we have to make sure that the response is to not do this again. How do you fight this right? You fight it early, hard, and fast. You test, you trace, you isolate, you lock down the hotspots. You don’t shut down an entire economy.” Cochrane points to one problem with the “essential” / “non-essential” distinction: Often not enough safety precautions are taken by “essential” businesses. During the question period, Cochrane also points to the need for second-best solutions, such as taking temperatures and reporting symptoms through an app. Scherbina estimates that the costs of doing nothing would have been around $9 trillion. She discusses the difference between “suppression” and “mitigation” and advocates short-term suppression. Verner summarizes the March 26 paper he co-authored. The key point is that social-distancing measures did not hurt, and if anything helped, the economic situation.
In an April 10 presentation, Tyler Cowen discussed the economic, social, and political impacts of COVID-19. Princeton’s Bendheim center is hosting numerous economists to discuss the issue. Here is my summary: “Cowen foresees more webinar use, U.S. public opinion turning against China, sustained fear of a Second Wave of infection, overreaction following initial underreaction, a sustained ‘rally around the flag’ effect many places, a rise of “centrist authoritarianism,” a hard time for libertarians as well as for elements of the Progressive left (‘microaggressions’), a hard and longlasting reduction in immigration, a major hit to pro-density movements, the dismissal of Medicare for All but more government in healthcare, bad times for Mexico and Brazil politically, possibly higher-quality government in the U.S., possible hospital solvency problems, semi-permanent damage to restaurants and small retail, higher regard for Amazon-Apple-Netflix-Google, ‘brutal’ times for U.S. colleges as they lose out-of-state tuition and talented foreign students, more Chinese nationalism, more autocracy in some places (e.g., Hungary), a ‘much better world’ in 20 years, a ‘slow decay’ of social distancing, relatively good recovery of manufacturing, rough times for small open countries, more alignment with the U.S. or China by smaller countries, a decline of GDP as a useful indicator, pronounced U.S. federalism in the near-run, cash-strapped states tempted to reopen prematurely, and an EU that perhaps ‘limps through’ the crisis. He says there’s some chance a good treatment will mitigate the worst impacts. He also discusses why he favors so-called price-gouging.”
Paul Romer gave a presentation on April 3: “We’ve never seen a crisis hit this fast. And the magnitude is I think now on track to exceed the magnitude during the crisis of the Great Depression. Reasonable estimates are that we’ll get to 30 percent or more unemployment, which is more than we saw during the depths of the Great Depression.” Romer discussed the critical importance of isolating the sick to bring down spread of the disease and reopen the economy more quickly. He pointed out that “we” need testing to figure out the best ways to administer tests. He also said that a drawn-out discussion about individual tracking and privacy is a waste of time.
Tyler Cowen critiques (or at least questions) epidemiological models basically on the grounds that they do not adequately account for how incentives and models themselves affect people’s behavior (April 12).
“Plenty of futurists and visionaries . . . have long argued [that] digital technology would bring about the ‘death of distance’ and create a geographically untethered workforce, free to live and work wherever. . . . Don’t bet on it. Despite the increasing adoption of digital technology in American workplaces, economic activity has become more—not less—concentrated” (April 13).
Damn. “Covid-19 Could Push Half A Billion People Into Poverty” (Niall McCarthy, April 9).
Heather MacDonald (April 16): “The economy is people’s lives. It’s people’s lives in the sense that firstly, it is the way in which we produce things. It is the way in which we create wealth that leads to the building of homes and hospitals and schools and everything else. But also because a huge economic downturn would have an incredibly detrimental impact on human lives, on health, potentially on life expectancy.”
“U.N. warns economic downturn could kill hundreds of thousands of children in 2020” (April 16).
“The Coronavirus Will Kill 500-1,000 Colleges” (Richard Vedder, April 7).
“The UN [warns] that the coronavirus pandemic will push an additional 130 million people to the brink of starvation. Famines could take hold in ‘about three dozen countries’ in a worst-case scenario” (April 22).
Debating the Efficacy of Lockdowns
I started this section April 16, so I’m sure relevant links appear in other sections. It seems obvious that whether lockdowns work to reduce the spread of the disease, and how well they work, and what specific sorts of restrictions work best, are empirical matters. I take it as a given that reducing social interaction slows the spread of the disease; that’s almost definitional for a human-to-human respiratory disease. But figuring out the precise effects of particular restrictions, and comparing the benefits to the costs, and comparing the given restrictions with counterfactual measures, are really difficult.
Lyman Stone is not sold on lockdowns (April 16). One point he raises is that incidental contact with an infected person (as opposed to prolonged contact) may not be as important (which I think is accepted wisdom). He does see a role for widespread voluntary social distancing.
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.
Who gets the ventilator in Colorado? “The decision framework is broken down into four separate tiers. The first tier is generally the likelihood of survival and how long the person is expected to live. The second tier aims to prioritize care for pediatric patients, health care workers and first responders. The third tier is considered a tie-breaker. If there are two patients, a firefighter and a nurse, for example, the person who is a sole caregiver or pregnant would be prioritized. The last tier is a ‘random allocation’ of resources ” (April 5).
Stupid Regulatory Burdens and Government Failures
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.
“Oregonians can pump own gas, fire marshal temporarily allows for self-service” (March 28).
“COVID-19 Immigration Restrictions Make Labor and Food Shortages a Real Possibility” (March 28).
New Jersey refuses to let people pump their own gas even on an emergency basis (March 30).
Until this emergency, therapists were largely prevented from helping clients via telemedicine (March 30).
“America Could Import Countless More Face Masks if Federal Regulators Would Get Out of the Way” (March 31).
A small group looking to build an N95 mask production facility is facing lengthy regulatory delays (March 31).
“The FDA is thwarting distilleries trying to make hand sanitizer amid coronavirus pandemic” (March 31).
“L.A. Bureaucrats Shut Down Restaurants for Selling Groceries Without a Permit” (March 31). Even this obviously reduces crowding at grocery stores.
“Colorado agriculture industry sounds alarm as U.S. halts Mexico farm visas” (March 31).
“Colorado restaurant and bar employees can now legally deliver food, drinks” (April 4). Which means they couldn’t before.
Hobby Lobby explains how to make cloth masks using Hobby Lobby supplies (April 1). Such masks are now universally recommended in public. So, naturally, Colorado has outlawed shopping at Hobby Lobby for mask supplies.
“Gov. Polis offers regulatory rollbacks through executive orders, new laws” (April 6).
The World Health Organization and the U.S. federal government failed, points out Shikha Dalmia (April 13).
“Some factories are trying to retool to start making PPE, but a combination of regulatory barriers and demand uncertainty is limiting them from scaling up and is preventing others from starting at all” (April 8).
“General Motors is being charged import taxes on parts it needs to build ventilators. Its requests for relief have gone unanswered” (April 13).
“There is one significant obstacle that has hindered the production of sanitizer, however: an FDA requirement that distilleries obtain extra ingredients to denature their alcohol” (Jacob Grier, April 1).
“The KN95 mask is a Chinese alternative to the scarce N95 mask, but the FDA refuses to allow it into the country” (March 20). I think this policy has since changed.
“How Excessive Regulation Helped Ignite COVID-19’s Rampant Spread” (Leaps, March 31).
“New FDA Policy Significantly Limits Serological Testing” (April 13).
Sheer stupidity. “Boston Restaurants Want To Sell Groceries. Bureaucrats Say No Way” (April 14).
“Suspend regulations that prevent research labs from conducting diagnostic checks” (April 15).
“New York MTA [Metropolitan Transit Authority] Forbade Employees from Protecting Themselves by Wearing Masks” (April 20).
“Maui Brewing Co. under investigation by Maui liquor commission for hand sanitizer giveaways” (April 20). The “problem” is the brewery dared to give “away the product with purchase to customers.” Good grief.
The FDA finally approved at-home testing, but several states ban it (Walter Olsen, April 22).
Problems with Deciding What Work is Critical or Essential
Crazy story out of New Zealand: “Millions of dollars worth of chilled meat may be headed to landfill if independent butchers are not allowed to reopen within the next five days” (March 31). Butchers are not “essential.”
I point out (March 31): “Marijuana went from being outlawed for decades [in Colorado] to being allowed for medical purposes in 2000 and legalized for recreational use in 2012. And now it is a ‘critical’ industry, along with liquor stores and gun shops, and hence open for business (with restrictions).”
Determining what work is “critical” (“essential”) ain’t so easy and is largely arbitrary (April 1). This piece focuses on construction workers.
The Colorado Attorney General ordered Comfort Dental and at least one other dentist to stop performing “non-critical” procedures. One dentist who received a letter from the AG told 9News that his office dealt with “pain and further morbidity” and “emergency care.” The dentist continued, “We have an obligation to our patients to alleviate pain and infection and damage that cannot be reversed” (April 2). I’m pretty skeptical that Paul Weiser, the AG, is better-equipped than dentists to determine which dental procedures are “critical.”
“For at least some Colorado dentists, a lack of clarity in state orders around providing health care leaves them fearful of potential disciplinary action should they be second-guessed when making reasoned professional medical decisions about the urgency of dental care” (Complete Colorado, April 10). Reports: “people with dental issues are flooding emergency rooms.”
The AG’s office also shut down Hobby Lobby and certain real-estate activities. Another detail: “In Summit County . . . the public health department has restricted critical businesses from selling non-essential items.” In related news, Vermont has ordered Walmarts and other stores not to sell “non-essential” items.
Books for kids are essential items, but “dildos are not essential items” (April 3). I guess it depends on who you ask.
Colorado Governor Jared Polis’s office asked construction crews to limit work to “truly critical” activities (April 3). As I half-joked on Twitter, maybe we can come up with a “Doubleplus Critical” category.
Apparently appliance stores are non-essential in Denver (April 2). One appliance sales director told 4news, “Right now people need appliances more than ever. They need refrigeration for the food they are buying right now. They obviously need cooking supplies stoves and ranges.” April 4 update: Summarizing his March 31 / April 2 story for 9News, Marshall Zelinger Tweets, “Based on my initial reporting, it wasn’t an issue of critical or essential/non-essential, it was about following the rules on number of people in business.” However, it remains unclear to me precisely what Denver is complaining about or how they expect appliance stores to operate. Audra Streetman of CBS4 provides a document from Denver declaring that the Appliance Factory is “non-essential” and can maintain appliances but not make “in-person retail sales.” Streetman confirms that, as of April 4, one store is “taken orders over the phone for delivery” but not making in-person sales.
Denver has also gone after Game Stop, Hobby Lobby, and other shops (CBS4, April 4).
I wrote a column for Complete Colorado (April 6), “The mental gymnastics around what’s ‘essential’.” A line: “So, if you’re keeping score, marijuana is essential, whiskey is essential, stoves and refrigerators are essential depending on where you buy them, masks are universally recommended, but mask-making supplies are non-essential.” Note: After learning that some fabric stores in Colorado are accepting orders for curb-side pickup, I sent a letter to the state AG seeking clarification.The AG replied that I should ask the governor’s office, which I did.
Denver shuts down Bass Pro Shop, even though the store sells guns, which are considered “essential” (April 8).
Reporter Jim Benemann writes (April 10), “We’re O’Toole’s fans. Must be frustrating for shuttered nurseries to see Home Depot / Lowes allowed to sell shrubs, plants and Aspen while little guys are closed. Ain’t right.”
Michigan has outlawed gardening seeds for vegetables in otherwise-open stores (April 10).
In Colorado it was almost effectively illegal to buy or sell a house during the “stay at home” order. In a bit of excellent reporting, Marianne Goodland of Colorado Politics tells the story (April 9). “A directive from the Colorado Division of Real Estate would have banned in-person showings, inspections, walk-throughs or any other part of the real estate transaction process, save for the closing itself.” But the bureaucratic agency backed off after Governor Jared Polis expressed a quite different understanding of the rules.
Police arrested the owner of a Colorado smoke shops (April 10).
“‘Choosing winners and losers’: Behind the battle to be deemed essential. Lobbyists for industries from retail to reefer have been hustling to make the case that they’re too important to be shut down” (April 10). It’s so strange that politics is political.
German virologist Hendrik Streeck believes, “There is no significant risk of catching the disease when you go shopping” (April 9). Seems like this is an important thing to figure out as we move forward with restrictions!
“Bike shops in Aspen learned this week that while the state of Colorado’s stay at home public health order deems bicycle maintenance and sales as an essential business, Pitkin County’s guidelines do not” (April 11).
At least one town forbade the sale of mosquito repellent (April 4).
For a time Los Angeles forbade restaurants from selling groceries (April 1).
David Harsanyi asks (April 13), “Under what imperious conception of governance does Michigan governor Gretchen Whitmer believe it is within her power to unilaterally ban garden stores from selling fruit or vegetable plants and seeds? What business is it of Vermont or Howard County, Ind., to dictate that Walmart, Costco, or Target stop selling “non-essential” items, such as electronics or clothing?”
Rob Natelson lays out the ways that Colorado’s stay-at-home order is both overbroad and underinclusive (April 14). More broadly, he argues the order is unconstitutional.
As far as I can tell, no one knows what in the hell is going on with the rules for Colorado real estate under the shutdown orders (Marianne Goodland, April 15).
“Parker [Colorado] tobacco shop refuses to close despite health department warning” (April 15).
“Colorado’s Attorney General directs Low T Centers to stop claiming its procedures to enhance male sex drive are ’emergency or life-saving procedures’ and to halt elective procedures at their three clinics in Colorado” (April 17).
“Institute for Justice Calls on Michigan Governor to Open Garden Centers” (April 16). “Growing food at home is the surest and safest way for Michiganders to meet their food needs in the midst of the ongoing pandemic.”
Colorado: “Public health bureaucrats, not experts in economics and business, … threaten the forcible closure of businesses based upon their subjective conclusion about what is the business’ primary commercial activity” (George Brauchler, April 17). Brauchler (a district attorney) offers the example of Smoker Friendly, which cells tobacco products but also various convenience goods. He also notes that the store Conn’s in Aurora sells appliances and laptops (useful for working at home) and yet is closed.
“WWE deemed ‘essential business’ by Florida Gov. Ron DeSantis” (April 14). Because of course it is.
Some recreational drugs are more equal than others (Jon Caldara, April 22).
Some “Colorado vape and smoke shops ignore orders to close amid COVID-19 pandemic” (April 20).
Colorado “Knife shop owner declares independence from Governor Polis’ shutdown orders” (April 23).
Laws and Efforts 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)
No one complains about nurses earning $10,000 per week to work in New York during the crisis, even though this is an obvious example of “price gouging” (April 1, via Mark Perry). We literally owe our lives to the price system.
Surprising no one who has ever spent more than a minute thinking about economics, extraordinary increases in demand tend to drive up prices of goods in limited supply. And these higher prices serve a function: They induce people to cut back to most-essential uses. But in times of emergency should a country prevent sellers from selling critical goods to high bidders elsewhere? Such is the topic of David DiSalvo’s March 30 piece for Forbes. Some commentators have responded to this article along the lines of “Damned capitalism!” But, besides the facts that other people in the world matter too, that American doctors are quickly learning how to sanitize and reuse masks, and that mask production is quickly ramping up in the U.S., consider this angle: “US authorities punishes anyone for ‘price gouging’ so importers and suppliers are reluctant to order PPEs from vendors for fear of being penalized. As a result, US importers and suppliers of N95 masks get outbid by foreign competitors so the US loses out” (Melissa Chen, April 1).
After Tyler Cowen posted Melissa Chen’s Tweets (see above), Joe Kristan quoted from them and tagged Iowa Attorney General Tom Miller. Miller wrote, “Thanks for sharing. We are working with businesses so they can sell needed medical supplies, make a reasonable profit and comply with the law.” Tyler replied, “Yes, you need to realize this is exactly the attitude that is making the crisis worse. The law needs to be waved.”
In an April 3 release by Reason, economist Michael Munger points out that “price gouging” is good or at least tolerable. He is careful to distinguish fraudulent pricing from the defensible sort of “price gouging,” which is simply charging a higher price for a good or service in time of limited supply or increased demand. In 2007 Munger wrote an article on the topic in the context of Hurricane Fran.
Several Democratic members of Congress have proposed the “COVID-19 Price Gouging Prevention Act,” which would outlaw “grossly” higher prices. They state: “Goods and services such as hand sanitizer, personal protective equipment and other medical supplies, and many other items would be covered by this bill because every American deserves access to these essential goods at a reasonable price” (April 8). But of course laws aren’t magic, and price controls reduce supplies and ensure shortages.
The Supreme Court of India has declared that, not only must testing developers not charge high prices for tests, but they must not charge any prices. As economist Alex Tabarrok notes (April 8), “The Supreme Court’s ruling will reduce the number of tests and dissuade firms from rushing to develop and field new drugs and devices to fight the coronavirus.”
The mayor of San Francisco, London Breed, placed “a cap on the fees that delivery services can charge restaurants during this emergency,” something I described as shocking stupidity as it will reduce the supply of delivery services (April 10).
Following is what Tyler Cowen had to say on April 10 about price-gouging laws and Amazon: “In most cases, speaking as an economist, I favor what is called price-gouging. I think that’s an unfortunate term. It almost always makes it sound bad. But when supply is elastic, that is, responsive to price, and more supply helps you, such as with masks, with testing, I would rather see the higher price, and call forth the more rapid supply, even if that means a level of profits in the short-run that people don’t like. So I would favor repealing laws that stop Amazon from ‘price-gouging,’ or let them carry third-party price gouging. But, to tell you the truth, I think if you repeal those laws, Amazon still would not do it. I’m not sure the laws are binding on Amazon. Let’s say you’re Amazon. Obviously you’re a huge company, you sell many, many things. If you let the price go up on masks, your profits go up by really a tiny amount. But the public ill will you take on and the future regulatory vulnerabilities are so high, I think you could get rid of all laws on price-gouging and Amazon and other major tech companies don’t want to be connected to it. . . . It’s actually a case where the conglomerate is inefficient. The conglomerate cares too much about its public image. . . . So that to me is actually the biggest critique of Amazon right now. We’re too reliant on conglomerates who are too afraid to piss off the public, and some . . . ‘dirty greed’ would put us in better stead.”
Agents with the federal government are now conducting sting operations on people who sell emergency supplies for “too much.” They went after a New York pharmacist. “The US Department of Health and Human Services (HHS) had established anti-hoarding measures for various “scarce” materials during the coronavirus pandemic. The list included, among other things, medical-grade PPE such as N95 respirator masks meant for doctors, nurses, and first responders. Around the same time, the Department of Justice announced the formation of a task force that would combat hoarding and price gouging” (April 12). Apparently it’s better to have no masks at all than to pay too much for one.
“Wisconsin takes action on 16 companies for suspected price gouging” (March 25).
“‘Price gouging’ during a crisis is a good thing” (Antony Davies and James Harrigan, March 14).
My April 14 column for Complete Colorado argues that laws against price “gouging” are harmful and unjust.
Apparently Canada doesn’t have laws against “price gouging,” which may help explain why shortages aren’t as bad there (Raymond Niles, April 22).
Political Responses and Debates
I am not trying to track the political response generally, but I’ll drop in a few notes of especial interest to me. See also the next section, “Free Markets and Pandemics.”
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.
Doctors are putting their lives in danger so ICE agents can wear N95 masks to hassle immigrants (March 31).
In Serbia Aleksandar Vucic assumes “full supremacy” (March 30).
“Turkmenistan has banned the word ‘coronavirus,’ as police officers arrest people for wearing face masks or discussing the pandemic in public” (March 31). From the “if we pretend it’s not there it can’t kill us” school of “thought.”
Trump Administration asks Thailand to please send protective medical gear. Thailand informs Trump Administration the U.S. is sending shiploads of protective medical gear to Thailand as aid (Politico, March 31).
Donald Trump ordered 3M to stop selling masks abroad, which is immoral and stupid (April 3).
Here is Alex Tabarrok on Trump stopping 3M from shipping masks to Canada: “‘We hit 3M hard today’ tweeted Trump, as if 3M were a foreign terrorist camp. Since January (well before the government began to act), 3M has been ramping up mask production” (April 4).
3M responded to Trump’s idiocy (April 3): “The Administration also requested that 3M cease exporting respirators that we currently manufacture in the United States to the Canadian and Latin American markets. There are, however, significant humanitarian implications of ceasing respirator supplies to healthcare workers in Canada and Latin America, where we are a critical supplier of respirators. In addition, ceasing all export of respirators produced in the United States would likely cause other countries to retaliate and do the same, as some have already done. If that were to occur, the net number of respirators being made available to the United States would actually decrease. That is the opposite of what we and the Administration, on behalf of the American people, both seek.”
“‘If we wait for a pandemic to appear, it will be too late to prepare,” said George W. Bush in 2005 (April 5).
“Appeals Court Allows Texas to Ban Most Abortions During Coronavirus Pandemic” (April 7).
“Colorado’s Governor says FEMA blocked the state’s purchase of 500 ventilators. Now 100 are sent here as a favor to a political ally [Senator Cory Gardner] of the President” (Kyle Clark, April 8).
“U.S. to seize exports of masks and gloves amid coronavirus crisis” (April 8). Maybe someone can explain to me the difference between this and piracy.
The federal government is also stealing protective gear from hospitals (Los Angeles Times, April 7).
Jason Brennan argues (April 16), “I can understand shutting down everything temporarily in an abundance of caution. But states are immediately obligated to collect the right kind of data the right way, so we can get a proper estimate of the real dangers and make decisions competently. They haven’t done so. The past month has seen government failure on a mass scale.” I guess the counterargument, at least on behalf of state governments, is that they can’t use tests that they don’t have.
“What Won’t Cure Corona: Lawsuits” (April 21).
This is crazy: “States have been forced to resort to smuggling shipments of personal protective equipment (PPE) after federal officials seized supplies ordered by hospitals without informing officials” (April 21).
Free Markets and Pandemics
I summarized a free-market response in a March 22 Tweet thread. Note here that I am not suggesting that the time to switch from a largely-controlled economy to a free market is during a crisis. Rather, I am outlining the ways that I think an already-free market would have functioned.
How do free-market advocates hope that something like COVID-19 would be handled within a capitalist country with a government tightly restricted to protecting rights? Here is my effort to offer a very-brief outline. Obviously each point is highly complex and controversial.
Government does have a legitimate function in enforcing quarantines to stop the spread of certain infectious diseases. But quarantines should be tightly targeted, based on objective evidence of threat, limited to necessity, and subject to timely review.
Research labs, hospitals, and other businesses would have the freedom to quickly adapt without having to beg slow-moving bureaucracies for permission. No one doubts that the federal government badly delayed the rollout of testing. Myriad regulations bog down market adaptation.
Government would not interfere with prices, and the price system would help motivate producers to rush in to fill market needs. Nor would government threaten to confiscate or nationalize people’s businesses or output.
In our economy people live with the expectation of welfare assistance and business bailouts. If those things were not available, people and businesses would do more stocking up and saving and would do more to develop contingency plans.
Mutual aid organizations normally would be more widespread and robust. In times of emergency, individuals would not look fundamentally to politicians to save them, but would instead tend to think more seriously about what they can do to help solve problems and help others.
Yaron Brook of the Ayn Rand Institute also suggests “how the market responds” in “a truly capitalist society” (March 28). He suggests that insurance companies would “monitor for health risks” out of their “economic interest to do so”; that insurance contracts would discourage risky behavior; that the price system would function to spur production and conserve consumption of relevant goods; that hospitals would quickly ramp up emergency plans; that private pharmaceutical companies and clinics would develop and implement mass-testing; and that private companies also would rush to develop treatments and vaccines.
Of course Chomsky believes: “Ventilator Shortage Exposes the Cruelty of Neoliberal Capitalism” (April 1). Alternate view: The reason we have ventilators at all is “neoliberal capitalism.”
Referring to a Bloomberg piece, economist Alex Tabarrok remarks (April 2): “This piece is utter rubbish. It asserts without evidence that economists want to reopen economy while epidemiologists say lockdown. In fact, in IGM survey, leading economists agree lockdown is necessary for health *and* economy.”
Objectivist economist Richard Salsman (April 2) criticizes Tyler Cowen’s approach of sanctioning robust government action during the crisis. Salsman calls for capitalism and opposes shutdowns, but it’s unclear to me what role Salsman for government curtailing the spread of infectious diseases.
Arthur Petersen’s April 11 article is the sort of thing that gives “free market” advocates a bad name. He stupidly claims that a person is “infinitely more likely” to die from other causes than from the coronavirus. He writes, “We are all going to die of something someday.” This totally ignores the lives saved through social distancing and the potential for the disease to grow wildly out of control without social distancing. The article is embarrassingly bad. God save us from our “friends.”
Government massively failed in its response to COVID-19 and throttled market responses, so, naturally, it is “libertarian principles of self-reliance and minimal government” which “are being tested as never before” (AP, April 12). The article quotes Michael Huemer and David Boaz to the effect that government sometimes properly intervenes in times of pandemic. Huemer is clear that what he means is that government sometimes properly can restrict social interaction to prevent or slow contagion. Other libertarians endorse the financial bailouts. Objectivist economist Richard Salzman blasted the “sunshine patriot” libertarians in a Facebook post and article (even though various other Objectivists essentially agree with Huemer). Meanwhile, Objectivist-friendly writer Robert Tracisnski writes, “We’re All Libertarians Now.”
I summarized some of my thoughts on this in an April 13 Tweet thread (edited lightly):
I’ve been reading about the debates on “libertarians” (I’ll say “free-market advocates” or FMAs) during the pandemic. Here I’ll thread some of my main thoughts.
1. There is a clear consensus among FMAs (and among many others) that government throttled the market response to the pandemic in important ways, such as by restricting outside testing, causing shortages through price-“gouging” laws, squashing the production of PPE through regulation, etc.
2. FMAs who argue that government may rightly restrict social engagement to slow the spread of a disease, to protect people’s rights, clearly have won the argument, to my mind. Counter-arguments are either non-existence or bad.
3. The main important fight is whether FMAs should tolerate or even support some financial bailouts during this crisis. I lean no but I’m not sure. People have become highly dependent on government bailouts, and a crisis is not a good time to shift suddenly to free-market policy.
I think Andy Craig’s March 25 article on “libertarianism” during the pandemic is basically sound.
“This pandemic is an indictment of socialized medicine,” argues Marc A. Thiessen (April 14).
Tickler: Insurance isn’t functioning to anticipate risks.
Knowledge in Society
Objectivist philosophers Ben Bayer and Onkar Ghate have an especially good conversation out on “seeing through misinformation during the pandemic” (April 8).
Possible Long-Term Positive Responses
It’s hard to think about the positives at a time like this, but I think there may be some silver linings.
If people implement the following long-term, that could permanently decrease deaths from flu and other communicable diseases (per population).
- Probably people will long-term take things like coughing/sneezing into a sleeve and thorough handwashing more seriously.
- Public-access restrooms should become no-touch to the greatest degree feasible. For men taking a whiz, there’s no reason to touch a door handle, urinal, sink, or soap dispenser.
- Automatic sinks need to actually dispense enough water to effectively wash hands. Many faucets are intentionally stingy with water, making effective hand-washing impossible. Jason Crawford suggested foot-operated sinks, which might also be cool.
- From what I gather, electric hand dryers basically suck up all the germs from the air and spit them back out onto your hands. We either need to dump these (as Phil Magness suggests), or else producers need to redesign them such that they destroy germs first, presumably by superheating them. (Note: It’s possible that some electric hand dryers already do this; I don’t claim to be an expert on this.)
- Perhaps people will be permanently more interested in getting the flu vaccine, which could reduce annual per capita flu deaths.
- Deliveries of things like groceries and alcohol might become permanently more popular. This could reduce person-to-person spread of various diseases. (I hope that Colorado law changes such that restaurants can continue to deliver alcoholic beverages, as they now can on an emergency basis.)
- People might be permanently interested in replacing certain face-to-face meetings with videoconferencing (as Charles Murray suggests).
- Another possible long-term silver lining of the current crisis is that it might provoke a lot more kids to get seriously interested in the biological sciences. (I wonder if this happened after 1918 and 1957.)
Error and Correction
In April, Anthony Fauci became something of a national celebrity for his tough talk about COVID-19 and his pushback against Trump’s inanity. But let’s remember what Fauci said “during an interview with radio show host John Catsimatidis” on or around January 26: “It’s a very, very low risk to the United States. But it’s something that we as public health officials need to take very seriously. . . . It isn’t something the American public needs to worry about or be frightened about. Because we have ways of preparing and screening of people coming in [from China]. And we have ways of responding—like we did with this one case in Seattle, Washington, who had traveled to China and brought back the infection.”
On March 30, Scott Aaronson posted the letter he wish he’d sent out on February 4. He points out that both federal bureaucrats and mainstream media sources initially downplayed the disease, whereas many “contrarian, rationalist nerds and tech tycoons” got it right from the outset.
Biases and COVID-19
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).
I don’t have time to fully delve into the claims of Richard Epstein and the criticisms of his claims. But I’ll offer some leads here. Epstein wrote an essay for the Hoover Institution in which he downplayed the severity of the COVID-19 outbreak. The libertarian Reason magazine gave him a large platform. Epstein did admit an error and changed his estimate of U.S. deaths from 500 to 5,000. Various libertarians I follow in social media lambasted Epstein. Isaac Chotiner wrote a useful and unflattering article about Epstein for the March 30 New Yorker. Scott Sumner writes an article critical of Epstein for the Library of Economics and Liberty (March 29).
Walter Olson complains that an article by Real Clear Politics misrepresents statements by Anthony Fauci (April 5).
Apparently one conspiracy theory going around (of many) is that 5G cellular networks somehow spead the disease (April 9).
Companies and Private Groups 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.
“Walmart, Target, CVS, and Walgreens will loan space for coronavirus test centers” (March 13).
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).
“Four Seasons Hotel offers New York City medical workers free rooms so they don’t infect their families with coronavirus” (March 25).
The Telluride Distilling Company produced hand sanitizer and donated it to first responders (March 27).
AirBnB has “activated [a] COVID-19 Relief program globally, with the goal to house 100,000 medics and responders” (March 30).
3M is “doubling [its] global output of N95 respirators and getting them to healthcare providers on the front lines of the pandemic” (checked March 30).
Charles Koch and Brian Hooks review some of the private efforts to help out (March 28), including charity efforts and groups offering educational resources for children.
“America’s biopharmaceutical companies are committed to developing solutions to help diagnose and treat those with COVID-19” (checked March 30).
Gourmet Table Skirts & Linens has switched to making medical masks (March 29).
“Mercedes Formula 1 engineers help develop coronavirus breathing aid” (March 30).
“Brooks Brothers converting NY, Mass and NCarolina factories from making ties and shirts to making masks and gowns. They are making 150,000 masks a day starting now” (March 30).
“Cherry Creek [CO] schools staff, students making medical face shields using 3D printers” (March 30). This uses government resources, obviously.
Guinness is donating a million dollars for this (March 30).
“How Christian Siriano Turned His Fashion House Into a Mask Factory” (March 31).
This is really extraordinary: Lindsay Medoff, a clothing designer, along with a couple of her friends, ran exhaustive tests on different fabrics to discover the best way to make cheap masks (April 2).
George Brauchler, a district attorney in Colorado, offers a nice tribute to such companies as My Pillow and Denver Mattress Company, which have shifted to production of medical gear (April 5).
Tesla released a video April 5 about the company’s plans to build medical ventilators.
“Apple is dedicated to supporting the worldwide response to COVID-19. We’ve now sourced over 20M masks through our supply chain. Our design, engineering, operations and packaging teams are also working with suppliers to design, produce and ship face shields for medical workers” (April 5).
Matt Hartley Lighting of Colorado has turned to 3D-printing protective face masks and shields (April 5).
Colorado company Woodward Inc. “will begin making low-cost ventilators” (April 6).
John Krasinski reviews several companies that have stepped up to make or deliver medical protective gear (April 5).
“Medtronic wins FDA approval to market lower-cost ventilator in U.S.” (April 9).
Mozilla, Intel, and other are opening up (some of) their patents in the effort to mitigate COVID-19 (April 8).
“Amazon builds its own testing lab for staff” (April 10).
Melanzana, an outdoor clothing manufacturer in Leadville, Colorado, has turned to making hospital masks (April 8).
“Apple Inc. and Google unveiled a rare partnership to add technology to their smartphone platforms that will alert users if they have come into contact with a person with Covid-19. People must opt in to the system, but it has the potential to monitor about a third of the world’s population” (April 10).
“National Mining Association members are doing their part by providing financial assistance, educational tools and personal protective equipment” (accessed April 13).
“A federal bankruptcy judge on Friday approved the sale of a shuttered Los Angeles hospital to Dr. Patrick Soon-Shiong, who plans to create a coronavirus research facility on the campus” (April 10).
Coloradan Harris Kenny is heading up a volunteer effort for 3D printed hospital protective gear (April 9).
Angel Flight West: Colorado pilots volunteer to deliver protective gear to rural hospitals (April 20).
** Starred entry: “Patrick Collison, the CEO of the payments company Stripe, and Tyler Cowen, an economist at George Mason University, launched Fast Grants. The concept is this: Scientists can submit an application for a grant in 30 minutes or less and get a response within two days” (April 21). “Fast Grants was immediately swamped by applications” and gave away its initial $12 million.
Regarding “the more than 40 workers at the Braskem America plant in Delaware County, Pa.”: “Working 12-hour shifts in two groups, the voluntary team worked for 28 days, making the raw materials used to produce a non-woven fiber needed to make personal protective medical equipment: N95 masks, hospital gowns, sanitary wipes, and other gear” (April 21).
Impacts on Journalism
“Coronavirus sends local news into crisis” (Axios, March 21). Dozens of papers are laying off journalists, others are suspending publication.
“Facebook Invests Additional $100 Million to Support News Industry During the Coronavirus Crisis” (March 30).
The Colorado Sun is a subscriber-driven “public benefit corporation” news organization. Editor Larry Ryckman reports “a surge in new members over the past month” (March 29). I personally hope that these sorts of subscriber-driven, online, no-paywall publications become the norm.
Michael Luo reminds us (March 29) that the New York Times has done very well with a paywall: It “now has more than five million subscribers, and its newsroom has swelled to more than seventeen hundred journalists—the largest it’s ever been.” Meanwhile other publications are (or look like) nonprofits. It doesn’t seem like paywalls universalize very well, especially for smaller publications.
Ben Smith’s take (March 29): “The time is now to make a painful but necessary shift: Abandon most for-profit local newspapers, whose business model no longer works, and move as fast as possible to a national network of nimble new online newsrooms.”
The virus is “devastating the news industry” (April 8).
“Hearst promises journalists at its newspapers no furloughs, no pay cuts” (April 8). Hearst has 24 dailies including the San Francisco Chronicle and Houston Chronicle.
Denver Post reporter Jon Murray reports (April 8, edited lightly), “Last week, Denver Post‘s owners ordered layoffs including four in the newsroom. Today we learned about the other shoe dropping: 3 weeks of unpaid furloughs, to be taken by 6/30. That’s 3 weeks out of the next 11. This is a request that is subject to negotiation and approval by our Guild.”
“Layoffs and furloughs ripple through Colorado newsrooms” (April 10).
During an April 17 media conference, a reporter asked Colorado Governor Jared Polis about possible state assistance for journalism. He replied, “Government intervention is a tough one. . . . We have a free and independent press. That is hard to reconcile with government assistance. The minute you have a Gov. Polis or a President Trump paying you, or propping you up, that causes if not a compromising of professional independence, if not an appearance of impropriety. In general, I would worry about having government support with the strings it came with that would prop up and influence an independent press.” I agree.
Stories of Economic Fallout
Obviously losing a job or a gig does not compare with losing one’s life. But it still sucks.
Colorado vocal band “Face and our related musical endeavors are our only forms of income…. [W]e’ve had every performance cancelled since [March 5] and well into the spring. This weekend [March 29] would have been our Carnegie Hall debut.”
Many Colorado businesses have been shut down, leaving people without income (March 29).
Colorado ski resorts dealt a “body blow” (March 28).
Some businesses are going strong, however, including Colorado gun shops (March 29). Of course various stores are hiring more delivery help.
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.
“Medical sexual fetish group in the UK donates its stock of PPE to the NHS” (March 28).
I’ve seen a lot of jokes about COVID-19. This is the only one I remember off-hand. It’s a pickup line: “If COVID-19 doesn’t take you out, can I?”
“Australian Dr. Daniel Reardon ended up in hospital after inserting magnets in his nostrils while building a necklace that warns you when you touch your face” (March 30).
“Trump Hands Coronavirus Briefing To MyPillow Exec Who Tells Americans To Read Bible” (March 31).
People Being Jerks
The Colorado Sun reports (via March 30 email), “People impersonating police and pulling over drivers to interrogate them about violating the stay-at-home order have been reported in Aurora, Greeley and Erie [CO] in the past few days.”
“Brooklyn woman, 86, dies after she’s knocked to the ground by stranger for violating coronavirus social distancing” (March 30).
“Rick Wiles, the Florida pastor who claimed that the effort to impeach President Trump was a ‘Jew coup,’ said the spread of coronavirus in synagogues is a punishment of the Jewish people for opposing Jesus” (March 30).
Louisiana: “Pastor holds church services hours after he was arrested for defying orders on limiting crowd sizes” (April 1).
“28 University of Texas spring breakers who flouted public health advice test positive for coronavirus” (April 1).
One woman who attended a church service said she wasn’t afraid of getting or spreading the virus because, she said, “I’m covered in Jesus’s blood.” Meanwhile, Kenneth Copeland destroys COVID-19 by blowing the Wind of God on it (April 4). (Note: Previously I linked to an item about Pat Robertson that apparently was rooted in a parody claim.)
“Israel health minister, who claims coronavirus is ‘divine punishment’ for homosexuality, tests positive for COVID-19” (April 7).
Colorado Brighton Police blatantly violate social distancing guidelines to arrest a guy playing softball with his family in an otherwise-empty park. This surely merits entry in the Stupidest Cops in the World contest (April 6). At least the police department apologized.
“Illinois Mayor Sends Police To Break Up Parties. They Found His Wife At One Of Them” (April 7). (I’m going to declare both parties jerks in this case.)
“To Enforce Social Distancing Rules, Cops Fined a Pennsylvania Woman Who Was Driving Alone” (April 7).
Apparently some people are luring Instacart deliverers with large tips and then deleting the tips” (April 9). That is a jerk move.
A judge in Brooklyn, when confronted with complaints about a packed courtroom, said, “If you don’t like it, you can leave.” Within two weeks he was dead from the disease (April 8).
“Florida man who spit in cop’s face now hit with federal bioweapons charges” (April 8). I don’t think these should be federal (as opposed to state) charges, but still!
Someone in Colorado left a nasty note telling a neighbor to stay home. The neighbor is a 911 dispatcher (April 14).
“Virginia pastor who defiantly held church service dies of coronavirus” (April 13).
“Man Who Bought $10,000 Worth of Toilet Paper and Hand Sanitizer Denied Refund” (April 16).
My Work on the Topic
I’ve linked to much of this above, but here’s an organized list. Most of these linked articles are published at Complete Colorado.
“It’s a good time for an extra dose of gratitude” (March 15)
“Liberty in the midst of a pandemic” (March 21)
“Polis just bet on individuals over harsher crackdown” (March 22)
“Bryan Alvarez on the COVID-19 Crisis” (March 28, video interview)
“Always look at the bright side of a lockdown” (March 31)
“The mental gymnastics around what’s ‘essential’” (April 6)
Related video interview with Jon Caldara about “price gouging”:
“Robin Hanson on Variolation as a Response to COVID-19” (video interview recorded April 21)
“Where’s the testing?” (April 21)
“Why not consider controlled, intentional infection?” (April 24)