Where we stand

I thought it useful to sum up my current views in a single paragraph, here goes:

I don’t view “optimal length of shutdown” arguments compelling, rather it is about how much pain the political process can stand.  I expect partial reopenings by mid-May, sometimes driven by governors in the healthier states, even if that is sub-optimal for the nation as a whole.  Besides you can’t have all the banks insolvent because of missed mortgage payments.  But R0 won’t stay below 1 for long, even if it gets there at all.  We will then have to shut down again within two months, but will then reopen again a bit after that.  At each step along the way, we will self-deceive rather than confront the level of pain involved with our choices.  We may lose a coherent national policy on the shutdown issue altogether, not that we have one now.  The pandemic yo-yo will hold.  At some point antivirals or antibodies will kick in (read Scott Gottlieb), or here: “There are perhaps 4-6 drugs that could be available by Fall and have robust enough treatment effect to impact risk of another epidemic or large outbreaks after current wave passes. We should be placing policy bets on these likeliest opportunities.”  We will then continue the rinse and repeat of the yo-yo, but with the new drugs and treatments on-line with a death rate at maybe half current levels and typical hospital stays at three days rather than ten.  It will seem more manageable, but how eager will consumers be to resume their old habits?  Eventually a vaccine will be found, but getting it to everyone will be slower than expected.  The lingering uncertainty and “value of waiting,” due to the risk of second and third waves, will badly damage economies along the way.

So there you have it.

Comments

The second wave of the Yankee flu of 1918 (the virus actually came from Kansas not Spain) hit around Sep/Oct and was the deadliest wave. Seems people throw out all abandon from months long cabin fever. Don't be one of those people.

US Intelligence knew about the coronavirus pandemic in November. Too bad Trump never get along with them.

https://abcnews.go.com/Politics/intelligence-report-warned-coronavirus-crisis-early-november-sources/story?id=70031273

Like the fact that writing a report is one of the best ways to make sure that Trump remains unaware of its contents. Instead, they should have given that information to Hannity or Fox and Friends, to ensure that the president would have been promptly briefed on its contents.

You mean the Heroes of the Pandumbic: Hannity. Rush. Dobbs. Ingraham.

https://www.youtube.com/watch?v=NAh4uS4f78o

To be honest, I stopped watching after a minute. I know that the mainstream media is deeply, deeply stupid, so there was little entertainment value in having that knowledge confirmed.

So what ABC news is saying is that both the Chinese government and the WHO have been lying about the timeline and extent of the crisis for months, and unidentified intelligence sources waited until now to leak this information to the world, but in a way that targets Donald Trump as the key bad actor?

I have no idea what ABC news is saying, but have been quite aware of what Trump has tweeted and said over the last several months. And to deny Donald Trump the role of key bad actor would seem to be very difficult to do, considering his saying that the pandemic will go away like a miracle, or in April, or that going to work a bit sick is fine, or wanting the churches filled on Easter.

Good luck finding anyone whose ratings are as high as his - a fact that he often notes in his various press appearances.

From the New York Times:

"Although city investigators had traced the lawyer’s whereabouts and connections to the most crowded corridors of Manhattan, the state’s efforts focused on the suburb, not the city, and Mr. de Blasio urged the public not to worry. “We’ll tell you the second we think you should change your behavior,” the mayor said on March 5.

For many days after the first positive test, as the coronavirus silently spread throughout the New York region, Mr. Cuomo, Mr. de Blasio and their top aides projected an unswerving confidence that the outbreak would be readily contained.

There would be cases, they repeatedly said, but New York’s hospitals were some of the best in the world. Plans were in place. Responses had been rehearsed during “tabletop” exercises. After all, the city had been here before — Ebola, Zika, the H1N1 virus, even Sept. 11.

“Excuse our arrogance as New Yorkers — I speak for the mayor also on this one — we think we have the best health care system on the planet right here in New York,” Mr. Cuomo said on March 2. “So, when you’re saying, what happened in other countries versus what happened here, we don’t even think it’s going to be as bad as it was in other countries."

There can be more than one dotard. Doesn't excuse the main dotard at all.

Sounds like they were profoundly over-confident, to the point one could easily call it incompetence.

Care to guess the source of this March 6 quote? “I think we’re doing a really good job in this country at keeping it down. We’ve really been very vigilant, and we’ve done a tremendous job at keeping to down.

But who would have thought? Look, how long ago is it? Six, seven, eight weeks ago — who would have thought we would even be having the subject? We were going to hit 30,000 on the Dow like it was clockwork. Right? It was all going — it was right up, and then all of a sudden, this came out."

But this is something far beyond overconfident, from the same source at the same March 6 event - “Anybody right now, and yesterday, anybody that needs a test gets a test. And the tests are beautiful. They are perfect just like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.”

There should be an accounting for misinformation by these folks.

A wall of shame.

So far, Hannity et al have received herd immunity from targeted criticism. Expect them to lead the charge on opening the doors.

But, that's what you would expect from an organization that depends for its income on:

Large sporting events (Fox Sports)...can't get advertising money when there are no games.

Newspapers: Newspapers are going broke because there are no ads for events, restaurants, etc.

But, then again, there is Donald, the resort owner:

Do you think that Donald is not thinking about himself when he has to shut his resorts and restaurants?

Do you think this never entered his mind, or that Fox never considered their financial interests?

The claim that US intelligence knew of the virus in November is misinformation

But the claim concerning January and February is as well founded as any other reporting based on classified information. As reported in the Washington Post on March 23, 2020. "U.S. intelligence agencies were issuing ominous, classified warnings in January and February about the global danger posed by the coronavirus while President Trump and lawmakers played down the threat and failed to take action that might have slowed the spread of the pathogen, according to U.S. officials familiar with spy agency reporting."

The COVID team and the travel lockdowns were put in place in Jan. Just because Schumer and Pelosi didn't pay attention, doesn't mean things weren't getting done.

And no, not ' Trump and lawmakers ', lawmakers interested in impeachment. But they took the time to call Trump a racist in January because he was doing something.

Perhaps they were distracted by Trump’s repeated statements downplaying the severity of the threat, saying it was under control, or that “like a miracle” it was going to go away?

At the time the medial folks were also downplaying it. Trump also has the job of not inciting panic. Telling people it'll be better by Easter gives them some hope it'll be over eventually and the message isn't all doom and gloom. The date can always be moved, it's the fact that there will be an end that's important.

After what happened in South Korea, anyone in a position of authority advocating full churches on Easter any time after the beginning of March clearly should not remain in a position of authority involving public health decisions.

It was a prediction of when it would be safe, not telling you to do. Now you're just being an idiot intentionally.

Is that he appears to be an utterly unintentional idiot. But no reason not to quote his words about what he wanted to see - "Wouldn’t it be great to have all the churches full? You’ll have packed churches all over our country … I think it’ll be a beautiful time.”

Imagine being on this site. Educated. Intelligent . . . and pretending not to understand Trump's statement was aspirational.

It's more accurate to say the China travel restriction was in place on Feb 2 but announced on Jan 31 (see section 6 of proclamation).

https://www.whitehouse.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-persons-pose-risk-transmitting-2019-novel-coronavirus/

Note only after the major airlines had stopped flying to and from china on their own. He just piggied on them to save his ass.

This.

Not sure how the "Trump blocked China travel and everyone was critical of it" statement goes unchallenged when neither are actually true.

"The COVID team and the travel lockdowns were put in place in Jan."

It's hard to claim the ban on travel added much value or was implemented on time. By the time the ban became effective, a number of countries had already experienced their first cases. It was more of an ass-covering move -- and the fact that his defenders are still talking about it is evidence of that -- than one action among many that formed a serious strategy for combating the spread. No other country went from 100 cases to over 400,000 in the span of just five weeks.

2 weeks before that the claim was that there was no human to human transmission. A few countries had infected people, but it seemed tat they got it from abroad.
"No other country went from 100 cases to over 400,000 in the span of just five weeks." Think that it might have to do with the CDC testing problems?

No other country decided to ignore the WHO test, if one wishes to be a bit more precise concerning an entire chain of bad decisions made by the U.S.

The WHO test was distributed to poor countries. Most rich ones created their own.

The WHO test was developed and first manufactured in Germany. "When Olfert Landt heard about the novel coronavirus, he got busy.

Founder of a small Berlin-based company, the ponytailed 54-year-old first raced to help German researchers come up with a diagnostic test and then spurred his company to produce and ship more than 1.4 million tests by the end of February for the World Health Organization. ... From there, however, U.S. efforts fell quickly behind, especially when compared with the efforts of the WHO, which has distributed more than 1 million tests to countries around the world based in part on the method developed by the German researchers.

As early as Feb. 6, four weeks after the genome of the virus was published, the WHO had shipped 250,000 diagnostic tests to 70 laboratories around the world, the agency said."

Did you mean to paste something that addressed my comment?

A month before the shit hit the fan, you need to bet on the WHO and their $4B budget OR the CDC and their $11B budget. The former does what they want, and largely ignores you. You have no control over their quality control and you must take their claims ("No human to human transmission!") at face value.

The CDC is 100% answerable to you, can provide detailed quality control and have been straight up over the decades.

Would you seriously pick the WHO over the CDC?

The CDC followed the exact same playbook for H1N1, and got to 1M tests in 30 days versus 125 days. But they had a catastrophic error in early tests. OK, so they should have paralleled path it.

But it the early days of testing likely wouldnt' have changed the outcome because the even in hotspots like Seattle just 7% of those tested-the sickest of the sick--had it. Additionally, you had a lot walking around that were asymptomatic and the test error rate dramatically exceeded the infection rate.

"2 weeks before that the claim was that there was no human to human transmission. A few countries had infected people, but it seemed tat they got it from abroad."

What are you trying to claim here? That Trump had an unusual level of foresight in banning travel from China? A number of other countries had taken the same action before Trump's own travel ban. And, indeed, the travel ban serves no purpose unless you assume human-to-human transmission is possible. As I said, it was too little too late and was not part of a larger, coherent, counter-pandemic strategy. For that, look to Taiwan, Singapore, South Korea and Japan.

> What are you trying to claim here? That Trump had an unusual level of foresight in banning travel from China?

Yes. What other OECD countries banned travel from China when Trump did? I will agree that they did too.

We just saw from the NYT that most of NYC infections came by way of Europe. During all of February Europe was saturated with the virus arriving from China, and then it was carried over to the east coast.

If the entire EU would have banned travel from afflicted regions when the US did, then the NYC - EU connection would not have happened.

Travel bans work. Every country you likely admire for their handling (TW, SK, etc) banned travel early.

> t's hard to claim the ban on travel added much value or was implemented on time.

No it's not. Some 7000 chinese arrived per day over the period in question. If 1 in 10,000 from Wuhan were infected, then it was likely a new infection every few days that arrived.

If you cut the number of arrivals in half, you buy yourself 6 days of ramp. If you cut the number of arrivals by 1/4, you buy yourself 6 days of ramp.

The math is very easy, and the experts believe (and simple math confirms) Trump's move--widely derided by his peers-- ensured and additional 2-3 weeks of prep time. Which is huge.

I’m wondering how many other forecasts of imminent doom the intelligence community presented to the president in November. Is it like the climate modelers, who run thousands of different scenarios, most of which are wildly off, but one of which might resemble a climate snapshot in five years. The modelers then pronounce: Our model predicted this, but no one listened.

Hopaulius - good observation. Consider this - I was very aware of the virus in China by mid January. But I didn't sell all my travel related stocks. I could have, but the WHO's head was telling me what an incredibly great job China was doing and that this wasn't a pandemic and that there was no need to shut travel. On Feb 1 Florence Italy declared "hug a Chinese day". Global stocks didn't start really crashing until after deaths started exploding in Europe later in Feb. Yet now the media tries to re-write history that practically everyone knew everything very early, except their political opponent.

Yeah, Peter Navarro just pulled this out of his a..s..s without any background information in January.

He must really be smart.

Maybe he reads the WAPO horoscope section for his information.

That video is quite slanted to bash only figures on the right and ignore the exact same behaviors on the left.

Nancy Pelosi encouraged people to ignore the virus and dine in restaurants in San Francisco Chinatown on video in late February. Bill de Blasio did the same into March.

The Daily Show, will say, hey we're not serious news, we're just entertainment and laughs, we don't have to be fair or reasonable. But people clearly interpret that as serious news.

Here's a more full length written rebuttal:

https://www.nationalreview.com/2020/04/coronavirus-pandemic-conservative-and-liberal-pundits-underestimated-threat/

I could not bother watching more than a minute, but it is just a repeating of what people were saying. Everyone is free to judge those statements, just like they can judge Trump's tweets and various public appearances.

But there seems to be a significant difference between underestimating and dismissing a pandemic.

Firstly, ABC is not a credible news org.

Secondly, do you know how many intelligence reports are created every single day?

While there may be 1,000s of intelligence reports made every day, there are only a handful of items in the PDB.

The intelligence agencies have explicitly denied that such a report existed. Since the first case of coronavirus in China could not have been much earlier than mid-November, the claim that intelligence agencies could have known about it is not credible.

> US Intelligence knew about the coronavirus pandemic in November.

The pentagon took the rare step of refuting this yesterday "....we can confirm the media reporting about the existence/release (of a report in November) is incorrect"

See the official statement from Shane Day, Director Defense Intelligence Agency.

And then ask yourself why ABC hasn't withdrawn their report. ABC relied on reporting of "two sources" who could easily share the first page of said report and make Shane Day look like a fool.

Next, ask yourself why YOUR news sources didn't flag this last night. This was a widely circulated correction by everyone EXCEPT ABC.

Then, ask yourself why, if the military knew this so far ahead of the WHO did they not share it with the entire world via backchannels?

Finally, ask yourself why, 24 hours later, ABC still hasn't corrected the record here.

Answer: They dont' care about accuracy. They only care about "dunking" on Trump. They are lying in the middle of a pandemic to hurt the person in charge.

Right. This was a horse manure dump on Trump.

NY Times is leading the fraud on this. Trump was informed on Jan 1, he started evacuations in Jan 29, and the first few evacuees had no virus, nothing was lost.

The best case for boomers is they escape from this crisis with only their political authority completely destroyed. I think forced expropriation of boomer assets is increasingly likely and probably deserved. You just can’t offload decades of shitty life style choices and crippling solipsism off on society and then not expect a backlash. Boomers are going to wake up to a world where but but but we are the ones that vote is no longer a license to bully other generations. But but but you can’t run. Ironically the lockdown they’ve pushed makes them even more susceptible to expropriation.

And I have a great job and great boomer parents who are going to leave me and my siblings F-U money. Imagine how the guy with shitty job prospects and indulgent checked out divorced parents who were too busy drinking, fucking, and ruining their family life feels. I woudn’t want to find out. If I were a boomer (quelle horreur) Id be out front of the get America back to work movement.

Well, you definitely have a F-U spirit, but it would be funny if you find out that your booomer parent's expected F-U money was taken through a forced expropriation of boomer assets.

Or maybe you did not connect the dots?

Or maybe my parents have plenty of overseas assets. Twenty percent haircut on domestic assets and maybe I can only buy you five times instead of six.

Interesting to hear, considering that from the perspective of the American government, such assets are already extremely easy to deny to anyone living in the U.S. Assuming, of course that those assets have been legally declared in terms of being accounts with a total value over 10,000 dollars, or which generate any income at all. An ancestral mansion is not a problem.

And you cannot buy me at all - not everyone is for sale, F-U money or not.

One hopes that your parents see this post and respond appropriately.

By moving more assets?

No by removing 1 ass from the will....

Are we certain Matt B isn't Ray Lopez?

Matt - You sound like a very angry guy. Are you on Vladimir’s payroll? There are a lot of successful people out there that got that way because of an open society. Yes it is not perfect. Yes it is not fair. So let’s move forward from where we are.

"We will overthrow the boomer generation and confiscate their wealth, but we won't do it by voting because that would be a hassle"

He doesn’t want a hassle? He’s a millennial!

Oh, they will vote, overwhelmingly vote to default on the horrendous 22 trillion in debt the boomers racked up, you can be 100% sure of that.

Are you sure you know how this works?

because of an open society
----
We are not an open society, I think we rank like 15th on the charts. We are not a democracy, we are mostly a republic. We are highly regulated with protections for all sort of private sectors, all the regulations and protections voted for by boomers a long time ago. Most, if not all, of the government debt racked by by boomers.

Simpy repeated some horseshit mantra does not make an argument.

It's not the lifestyles of the Boomers but that they cut virtually all slack in both the public and private sector. So when sh*t hits the fan, the government is useless because stockpiles run dry, corporations go bankrupt in a few weeks because they spent it all on buybacks, and since production was all sent overseas we can't do much except depend on the kindness of China, Taiwan, and a couple of billionaires. This is so stupid. Is the money and corruption so worth it that nobody bothered to ask what if X happens?

Bingo, gold star.

Who who did the same in the 60s? My the WW2 generation, ran us up against the wall with perfect stupidity.

Who put us up against the wall in 2040? Why the millennials. ERvedry generation does this crap for a very good reason. Looking back, both generations can see the bonehead decisions that backed us against the wall, we are more accurate looking backward which is why we default every generation.

Default is traditional, we do it every generation. It is volatile because the defaulting generation starts a fraud that can last some 30 years. We need to stop the fraud on this, and default normally, not overnight in a sudden heist behind closed doors, a la Nixon. Just accept the fact the government, especially the Swamp, loses on about 30% of its investments. I do not see the reason one generation has to fake it all the time, that is a no win for us all.

If you replace “boomers” with “Jews” you could pass for a 21st century English translation of Hitler

Progressives always sound the same. There is a reason Progressives were defeated in WWII.

So the US turned FDR out of office and elected a Republican. Who knew?

You'll mind FDR had all the classic marks of progressivism:
a fascinating proportion of his friends and family gained great wealth off of his administration, he implemented race/ethnicity based detention camps, forced through questionable policies, grabbed as much power as possible.

So Trump is a progressive?

https://www.bloomberg.com/news/articles/2020-04-09/fed-unleashes-fresh-steps-for-as-much-as-2-3-trillion-in-aid?srnd=premium

Fed to Buy Junk Bonds, Lend to States in Fresh Virus Support
----
Why not call them Public sector boomer retiring on the millennial dime?

The federal government bailing out retiring boomers who cheated on pensions and we the millennials with the interest costs?

Millennisal should refuse to pay for any of this boomer crap until some one third of it is default away, like real soon.

Collectivist nonsense.

You have to get boomer assets they die.
So, we need a Nixon shock soon. We would have preferred a better default sequence, the way Roosevelt did it.

But getting smooth default right is now impossible, the denialists have pushed us against the wall and our only default mechanism is abrupt and volatile, Nixon style.

Your critics forget one thing, you never voted for half the unpaid crap that boomers purchased from government.

One can argue that boomers were put in the same boat, having to pay for a bunch of worthless government crap the previous generation bought. But boomers defaulted, didn't they? Remember the Nixon shock? And the previous generation defaulted anyway, remember the Roosevelt gold policy?

Millennials will default, they have no intention of paying for 8 trillion in government losses over the last 40 years which they never voted for.

Generational default is natural, good. The problem is not default, the problem is the subsequent 'This time is different' fraud, the defaulting generation doing to same trick to their kids that their parents did to them. We need to stop the fraud and get on with regular defaults that we can bet on the way.

The optimal amount of time for maintaining restrictions is the time that it takes to eliminate the virus from the non-hopitalized/non-isolated population. That is about two and a half months. If the United States can fight World War 2 for 4 years the Vietnam War for 17 years and the War on Terror for infinity years, then, obviously, the United States can maintain reduced social contact for 80 days. It's nuttier than a lumpy chocolate bar to suggest the United States can't do it.

It’s not a matter of can’t but don’t want to. I’m a conscientious objector to boomer solipsism man.

A virus does not care about conscientious objectors.

This one does seem to care about whether you're a Boomer or not, though.

I agree with this comment. The Tyler Cowen take seems overly pessimistic.

During the 1957 pandemic a vaccine was developed and distributed fairly quickly and the markets strongly recovered and resumed a decade long Bull market within half-a-year.

I think we should assume that a clever scientific or cultural innovation will happen quickly. At the least temperature checks to enter public enclosures, masks and no touching will help a lot. Maybe a rating system of how vulnerable your “group” is?

It seems that our hyper real time culture has become biased towards panic and Myopia.

Cowen has always been a massive worrywart, and predicted pandemics with every new disease (SARS, bird flu, Ebola, Zika). So he got one right finally, and he's gonna ride this horse into the ground.

You are correct, he is overly pessimistic. And that's fine, and pretty normal. Pessimism always sounds smart, optimism sounds naive even if it's correct.

Crikey, look at the Trump Administration, and honestly tell me they can do anything consistent for even a week. 80 days ago, they were denying that Covid19 was a problem in the U.S., it would go away like a miracle, all over by April, it was a hoax, if you feel a bit sick you can go to work, anyone talking about preparing for a pandemic is fearmongering, etc., tragically further etc.

The emperor really doesn't have any public health clothes at this point. Look at how Tyler or many Americans commenting write, believing in some fashion that the U.S. is typical somehow, instead of a complete contrast to East Asia or Europe.

The USA outside of NY and a couple blue states has had a phenomenal response to Y2Flu. There is only so much even an active, highly competent administration like we have currently can do to overcome the complete and abject failure of governance in NYS. NYS is governed by fifth rate people. Outside of a coup that’s New York’s problem.

Thankfully more red state leadership like that of desantis prevented New Yorkers from spreading their pestilence to states like florida. I imagine when this is all over the failure to quarantine NY for 18-24 months will likely be seen as really the only avoidable mistake.

Do you seriously believe what you write? Or is this meant to be comedy, because if so, it is gold. "an active, highly competent administration like we have currently"

Thomas, saying that Trump said the virus was a hoax is being intentionally misleading. He was saying that trying to blame it on him was a hoax like various impeachment hoaxes.
Now I'd like you to catalog the numerous policy stupidities of Bill de Blasio and his administration. Such as encouraging people to enjoy large social events and go to parades in NYC! And I'm pretty sure he was listening to the geniuses at the NY Times, not the Trump administration.

Buckalew comments seem either troll-ish or parody. Although they could be highly motivated as well.

The US ex NY would be #2 in the world in total cases behind the US with NY. The rest of the US isn't doing too hot.

We'd go from 45 deaths/ mil to 27. Just better than Germany. Even at 45 we're doing pretty damn good compared to most of europe, most of which are 2-5x worse. Hope that holds. NY seems to be leveling off.

The U.S. is about one to two weeks behind Europe which is why deaths as percentage of total population is a poor measure of containment. The only meaningful metric is the growth rate in cases. The U.S. went from having 100 cases on March 3 to having an astounding 430,000 cases today.

As far as individual cities or regions are concerned, the obvious pattern is that a new place -- typically a place with a lax attitude toward controlling the spread of infections -- reaches a critical mass of new cases about every week or two and then that place gets swamped until it gets its situation under control. First it was Wuhan, then Daegu, then Lombardy, then NYC along with parts of France and Spain. Excluding NYC from any sort of measure is pointless because in another week or two you will need to start excluding another one or two "outliers."

Looking at the US as a single location, or even as 52 locations, is not a good way of modeling this. We have locations that have Southern Europe style numbers (Because they caught this early and have cities that have Southern European city densities), others are built more like Germany, and got infections later, and will have Germany-style numbers. We also have rural boondocks, which have completely different times and patterns of infection. America is not a week behind Europe as a whole: I completely depends.

And it's not as if everything will be the same as in NYC: You find cities like St Louis which closed down the day after NY did. This gives a much better final prognosis, because, in practice, they cut 3 or 4 doublings before R0 shrinking policies happened. Other areas didn't.

Pandemics don't deal in nations, but in a network of population centers. And they are all acting differently.

"and will have Germany-style numbers"

The Germans sure as hell don't want to have Germany style numbers.

Any model will contain simplifications. The U.S. is hardly unique when it comes to geographic and demographic diversity as well as different experiences with covid-19 to date. It has the disadvantage of federal, state, and local authorities constantly bitching at each other in petty turf wars and who has the authority to what and under which circumstances. This makes it more likely we will continue to see new outbreaks in places that resist social distancing or implemented it too late.

A lot of other countries completely shut down domestic travel and, as extreme and unpleasant a step as that is, will probably make it easier to isolate existing hot spots and prevent new hot spots from creeping up.

"The US ex NY would be #2 in the world in total cases behind the US with NY. The rest of the US isn't doing too hot."

True, the US isn't doing too hot, it is probably a little higher than median for OECD countries.

That being said, only an ignorant person uses total numbers for something like this. The correct unit of measure is per capita.

On a per capita basis, the US is doing much better than: Spain, Italy, Belgium, Netherlands, France, UK, Switzerland, Luxembourg, Sweden, etc.

the only relevant map for Trump is the electoral one...the use/misuse of pronouns re ownership of supplies more than telling

For per capita, China and India wins, which I believe paints a very misleading picture.

"which I believe paints a very misleading picture."

The only reliable stats are probably those in the OECD countries. That's the comparison I was making.

"Thankfully more red state leadership like that of desantis..."

Florida has 14,000 cases, more than South Korea or Australia, which have bigger populations. Both DeSantis and Cuomo exercised poor judgment and did too little too late. Less than one month ago, Cuomo was being a public tough guy talking about how there would never be a New York City lockdown on his watch -- and that he would overrule the NYC authorities if they tried to implement one -- while DeSantis waited until literally one week ago to order a lockdown in his own state.

CA, TX and FLA have nearly 100M people..more than Germany. Combined, those 3 states have had 1000 deaths. Germany has had 2.5X that.

Texas is 7 deaths per million. Florida is 17. New York state is 360. You are a fool to lump FLA and NY together.

Whatever CA, TX and FL are doing we should all be doing. They are significantly better than the best big country in Europe

“leadership like that of desantis prevented New Yorkers from spreading their pestilence to states like florida”

Yes, we should leave the ‘spreading’ to spring breakers and cruise ship passengers that disembark without being tested (even though people were infected/died onboard) as they return home from Florida.

Thomas, it's certainly true the Trump administration couldn't find it's own colon with an endoscope and an instructional video. But they're just the flies on top of the carcass that is America and I believe there is good red meat underneath.

America is more than the idiots they voted in. There are competent people throughout America who are up to meeting the challenge the pandemic present. It's a pity they have to bypass and work around some A grade idiots, but it can be done. That's what we do.

As just a small example, our host can look at what's working in the battle against the virus *COUGH*Australia*COUGH* and write about that. There's no need to go off on strange conjectures and investigate unlikely scenarios. Just look at what works and state what needs to be done and then repeat, repeat, repeat until it sinks in.

Once enough people who are not idiots are doing that, the signal of sensible will cut through the idiocy.

'bypass and work around some A grade idiots'

Like those claiming that church meetings/services should be exempt from public health measures?

'the signal of sensible will cut through the idiocy'

You really should watch the youtube link concerning heroes of the pandumbic. That is the sort of distilled idiocy that is designed to ensure that no signal of the sensible will cut through to its audience. You can see the desired effect reflected in many comments here. And don't worry, the same heroes are already letting Americans know that thanks to the wise leadership of the Trump Administration, a much higher American death toll was prevented.

https://www.nytimes.com/2020/04/08/nyregion/new-york-coronavirus-response-delays.html

Los Angeles had as much potential for disaster but seemed to be a bit more competent.

Cars vs Subways? Suburbs vs big city? Weather/climate? Just spitballing here.

Earthquake/wildfire preparedness vs no need for such?

Or a lack of an (ultra) Orthodox Jewish community to create clusters? "Four heavily Orthodox neighborhoods in Brooklyn have especially high rates of the novel coronavirus, according to data released by this city’s Department of Health. ... Haredi, or ultra-Orthodox, men are accustomed to attending communal prayers three times a day, and social lives revolve around synagogue and lifecycle celebrations like weddings. Haredi families are also larger than average and tend to live in dense neighborhoods in the city.

In some haredi neighborhoods, social distancing measures like school closings came later than in the rest of the city.

Israel is experiencing an even more extreme phenomenon, as more than a third of the total population of the haredi city of Bnei Brak is estimated to have coronavirus, according to the Times of Israel." jta.org/2020/04/02/united-states/brooklyns-orthodox-neighborhoods-have-especially-high-rates-of-coronavirus

In a crisis, the anti-Semitism, which generally festers in silence or whispers, is shouted from the rooftops.

Prior_approval never hid his antisemitism in the first place...

This has less to do with any particular faith and more to do with groups that force their members to meet during a very contagious pandemic. Here's a list of leaders of all faiths who died during this terrible time:

https://apnews.com/38cf1d543a51c062d51632620df6ee86

Sure hope the Times of Israel passes everyone's oh so sensitive anti-semitism feelers. www.timesofisrael.com/in-the-eye-of-nys-coronavirus-storm-ultra-orthodox-face-rising-anti-semitism/

Rockland County is home to about 90,000 Haredi — or ultra-Orthodox — Jews, many of them Hasidim. Located about an hour’s drive from New York City, “the county has the largest Jewish population per capita of any US county, with 31.4%… being Jewish,” according to the New York State official website. .... With over 66,000 cases and 1,342 deaths reported as of this writing, New York State is now considered the epicenter of the coronavirus in the US. As it spreads across the state, the virus has hit religious communities particularly hard; as of March 30, Rockland County had reported more than 2,500 cases.

After several news stories emerged about large ultra-Orthodox gatherings despite strict social distancing guidelines, as well as reports of coronavirus clusters in places such as the Borough Park neighborhood of Brooklyn, which reported nearly 300 cases last week, communities faced increased scrutiny and were blamed for spreading the virus. "

For real anti-semitism, read the link - it is disgusting what Ocean County Fire Marshal wrote, for example. But the fact remains that covid19 spreads in situations where worshippers congregate, regardless of their faith. And the problem is not just in NY, as the Times of Israel also reports on this - "Synagogues have been the top places for spreading the coronavirus in Israel, with infections in prayer houses accounting for nearly a quarter of known cases not brought in from abroad or contracted at home, according to a report published Tuesday."

The virus cares nothing about religion, it spreads when conditions are right.

The same case can be made for Iran, seemingly, as their spread seems to have originated in Qom, considered a holy city. Hopefully someone will enjoy calling out that observation as Islamophobic, in a comment section clearly filled with SJWs always on the look out for bigotry and intolerance..

Here is a sample of American style lockdown, completely ignoring what happened in South Korea.

Florida - Ron DeSantis - DeSantis’ updated order removes language that provided an exception for local ordinances that went beyond the state order. ... That specifically pertains to a religious exemption that allows churches to continue holding services.
Michigan - Whitmer - "Consistent with prior guidance, a place of religious worship, when used for religious worship, is not subject to penalty under section 14," reads the new order.
New Mexico - Lujan Grisham - “Mass gathering” does not include “individuals” congregated in a church, synagogue, mosque, or other place of worship.
Delaware - Carney - "We're taking reasonable precautions, but we can't take every precaution," explained Father Lentini. "We're not going to celebrate mass in a hazmat suit.
Texas - Abbott - Texas Gov. Greg Abbott issued a statewide stay-at-home order, though he declined to refer to it as such, that also designated religious services as essential. Some religious groups in Texas — it’s unclear just how many — are still welcoming parishioners.

This is sad too - In Oklahoma, Missouri and Arkansas, there are no statewide orders closing nonessential businesses.

Religious leaders are dying left and right. If people defy large gathering bans, then there isn't much anyone can do unless you are South Korea. The West lacks the cajones to properly do enforcement. Then there's this guy:

"A Virginia pastor who claimed the coronavirus was "mass hysteria" created by the media, has died after contracting Covid-19."

https://www.christiantoday.com/article/virginia-pastor-said-coronavirus-mass-hysteria-dies-covid-19/134568.htm

> 80 days ago, they were denying that Covid19 was a problem in the U.S., it would go away like a miracle, all over by April, it was a hoax,

And why should they have been? That was Jan 19, and the day before China had said there were no problems, it was a pnumonia you caught at a wet market, and didn't exhibit any human to human transmission. And the WHO, with all their doctors, agreed with China.

That same day, China was in the midst of a massive outdoor potluck in Wuhan.

Two days later, Johns Hopkins started their real time tracking map.

And a day after that, 23rd January, China slammed the gates on Wuhan did we really get an inkling.

That was the first real indication of how serious this was. What Trump said at the time matters little. In the background, his actions were largely unmatched by his peers on the world stage. And certaintly far more aggressive that Biden, Pelosi and Shumber.

Remember, Pelosi got to pick Virus or Impeachment for her mid-winter project. She picked impeachment. Bzzzzt. Wrong door.

This is just sad to read, "rather it is about how much pain the political process can stand." How public health decisions became a political morass in the U.S. is still being played out in a way that you do not see in other countries with higher death rates or higher per capita infection rates.

Smarter people have given up making predictions that are essentially based on fairy dust and moonbeams regarding a novel virus, but others cannot resist. Who will remember what an idiot Richard A. Epstein was, with his prediction of 5000 Covid19 deaths in America already exceeded in NYC alone.

Anyone else have an idea how we can lose something we don't have now? Considering the performance of the U.S. in isolation makes a certain sense, there being little reason to expect other countries that do have a coherent national policy regarding public health measures, such as South Korea, Germany, or Italy, to yo-yo in such unfortunate fashion.

Leading to the interesting thought that the U.S. will be a nation isolated by other nations able to handle Covid19, finally achieving the vision of many who voted for Trump. In other words, a Chinese or Danish passport will allow international travel, while an American passport will be considered a red flag and thus denied entry.

Richard A. Epstein said that there would be 50,000 deaths in the US, not 5,000. He revised his 5,000 estimate quite a while ago. The 50,000 is close to the estimates of the predominant models right now.

No, Epstein originally wrote 500, said that was a mistake and revised it to 5000. If he has revised it again so that the American total is now his original global fatality total, that is sadly hilarious. At this rate, one could expect him to make a precise prediction of total 2020 Covid19 death sometime in February or March 2021. From his latest version - "This article has been revised on April 6, 2020"

Mr. Epstein has no integrity.

At Hoover, the article from March 16 where he initially pegged the death toll in the U.S. at 500, now has a "Correction & Addendum" from March 24 that refers to his "original erroneous estimate of 5,000 dead in the U.S." claiming that " it is a number ten times smaller than I intended to state..." giving no indication that his "original" estimate was already revised up by an order of magnitude.

Unfortunately for Mr. Epstein, he is a vain man who seems never to turn down a chance to get his name in the press, so there's still this March 18 interview with Reason where he pegs the number of deaths at 50,000 WORLDWIDE, and is claiming 500 deaths in the U.S.

Scott Adams also predicted 5,000 US deaths on Periscope when there were ~1,500 total US deaths, but later "clarified" his prediction to be one of "net deaths".

Leading to the interesting thought that the U.S. will be a nation isolated by other nations able to handle Covid19, finally achieving the vision of many who voted for Trump. In other words, a Chinese or Danish passport will allow international travel, while an American passport will be considered a red flag and thus denied entry.

Yeah, let's have a 'coherent national policy', like they do in Europe. Why settle for 48 deaths per million like the mediocre Americans when you can achieve 167 per million like the elegant French?

What common sense policy ideas are there for reopening daycares and schools? There is no way a high enough percentage of kids are gonna obey any social distancing, proper mask wearing, hygiene, etc. They will become vectors of spread and then parents will be sick and unable to work, etc. Gonna be a mess.

Do we know yet how big of a vector kids are to their parents? We really need to have a definitive answer to that question this summer so we can decide on whether to reopen schools in the fall.

Singapore left schools open for a while and didn't obviously suffer from that decision so it's still an open question. The biggest sources of infection seem to be religious services, social gatherings, medical facilities, gyms and any sort of situations or places where people are crowded together.

But how are schools not on the list of places where people are crowded together? The hall ways between classes in any middle school and high school are packed to the brim. Maybe the issue is that kids get weaker forms of the illness and aren't coughing and spreading it as much??? I dunno.

In Washington state, daycares are deemed essential for the purpose of caring for the children of essential workers. Also though the schools are closed for general education, they have been commandeered to provide free lunches to students in their homes, delivered by school bus. And some schools are being required to provide in-person education to special-needs students, i.e. those least likely to follow social distancing protocols.

Wuhan is back in business. I dislike China's attitude toward a free press and censorship but in the coming weeks please get as much information as you can from that region. Questions about potential waves of outbreaks, rebounding of business, sentiment of cautious consumers, hopefully more legitimate data about COVID, herd immunity, and others could be answered. Grab some Chinese speakers and scrutinize everything.

Difficult to get information after China expelled US journalists

I think they only expelled five journalists. Even one would not be good, but this doesn't alter the overall flow of information much. There are other much more important reasons why it is difficult to get information out of China.

Expelling five is probably sufficient to make the remaining reporters, and their employers, much more careful in their reporting.

If any reporter produced solid evidence China was lying about having the Coronavirus under control I'm sure they would never find work as a journalist again. If there is one thing news organizations can't stand it's increased viewership, more clicks, and the approbation of the free world.

Crazy comment sections seem to be on the rise.

I think that your point on possible drugs is spot on, they will help.

But what will help is unemployment. As it rises people will look into the actual death rates from COVID-19 and support for the lockdowns will fade. It will become bitterly partisan, until the clear majority in favor of returning to normal wins, at which point revisionist history will kick into full gear.

It's hard to see how drugs will help to reduce transmission to any meaningful extent.
You could imagine a hypothetical drug that, say, reduced the infectious period by half (from ~6 days to 3 days). For it to be useful, you would either have to have the entire population take it continuously (so that they are covered when they develop symptoms), or you could target it to those who have developed symptoms in the last day or two. If you're doing that, you could just isolate them at home instead.

Outside that hypothetical world, there is no sign yet that any drug at all shows significant efficacy. If there was a robust prediction market I would wager that we won't find any drug which reduces either mortality or contagiousness of covid-19.

Precisely, it isn't as if drugs are not being tested in real life in a number of countries at this point. None of them seem effective in any sense till now.

Plasma from recovering patients may be useful, as further tests/treatments are being performed in China and Switzerland.

I’d ❤️ love to take that bet.

Happy to if you know of an active market.

for some background - I am a doctor and obviously hope that there will be an effective treatment. I think the prior probability of any drug having a dramatic effect in covid-19 is very low, based on our prior experience with similar respiratory viruses.

Correct me if I'm wrong, but my understanding is that this is a similar virus to the common cold, which is also hard to beat with drugs, which is why there is no vaccine for the common cold, but the 1957 pandemic was a type A influenza that are much easier to create vaccines for.

Colds are caused by dozens of different viruses including (less commonly) coronaviruses. The lack of a cold vaccine is due to the fact it would actually require the development of dozens of vaccines for what is a rather mild disease.

That’s certainly one reason, but cold viruses also don’t seem to trigger durable immune responses over more than a year or two. It’s not clear that we can make an effective long lasting vaccine, but hundreds of groups around the world are trying.

Antivirals are a completely different question. No targeted antiviral has ever had a significant effect in a respiratory virus (including influenza), and that rate of failure is not for lack of trying.

Thanks for the response! So does this mean Tyler is being overly optimistic about there being drugs to treat this pandemic? Or is he maybe banking on drugs that focus more on treating the symptoms and the respiratory infection?

Thanks for the response!

First from what I'm seeing this is not a fun virus to get. I don't mean if you are in the unlucky 1-5% but even the symptomatic side is finding this more than just having a cold or even a flu. I don't think people are going to be eager to leave lockdown and just get over this.

Second, drugs are a wild card. If drugs can reduce the severity of this illness leaving the weakest people on a ventilator for days rather than weeks, helping people avoid hospitalization then it can turn this more into a flu than something worse.

Third, I suspect social distancing and mask wearing can keep R*<1. If R*<1, the virus goes extinct. It's just that simple. If you can get the virus to go extinct or dormant for an extended period of time, you start getting us into 2021 by which time vaccines can hopefully start coming online that puts an end to this.

huge +1 we're screwed

Odd how in the country with basically the lowest death rate from Covid19 till now, support for the government has not been stronger than ever before. The only place where Covid19 seems to be a partisan issue is the U.S.

I think after the second outbreak, we'd probably just become a lot more tolerant of aggressive surveillance and centralized quarantine as part of a "test-and-trace" campaign combined with social distancing/masks . . . for better or for worse in terms of long term consequences. That would probably be seen as more acceptable than going into a second lock-down.

I think this is mostly right. It's what most realists like myself have been predicting and why some countries thought a more modest mitigation strategy would work best in the long run. The key is the self-deception.

I don't want to say what's "optimal" because that will depend on a future we can't predict. What's optimal varies drastically if effective treatments or a vaccine takes 10 years rather than 2 months.

The most likely case is that we tell ourselves that we still aren't willing to kill grandma for the dow while meanwhile the partially effective treatment that we've hung our hopes on only saves 1 in 3 grandmas that would have died anyway.

But kids need to get into school and out of my hair and that sushi isn't going to eat itself.

The current strategy is that grandma gets it but not all grandmas at the same time.

If there is hospital capacity, then there is no justification for further restrictions. And if hospital capacity isn't an issue over the next very short while, there is ample justification to loosening things up to see what happens.

There is no vaccine, so whatever percentage of the population has no natural immunity will get the virus. What we are doing right now is slow the transmission.

Lets be clear about what the strategy is.

Right, overwhelmed hospitals are a very, very bad thing.

And there are other reasons for kicking the can down the road. If there is a next wave, we might have some better treatments than we have now.

This seems like obvious common sense. Right now, keep the house from burning down. Plan for what comes next, but it seems like Tyler is just pouring out his anxieties here. Maybe it's cathartic. Things have changed so much in the past two months, it seems silly to speak with too much confidence about stuff that is two months out.

"Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient unto the day is the evil thereof."

I think you're misrepresenting the current strategy. The current strategy doesn't really care what the hospital capacity is. The current goal is to suppress it as much as possible in hopes that treatments and/or a vaccine comes along that will remove significant risk from spreading corona.

That strategy may change but many suppression strategies are already clearly holding the virus well below hospital capacity levels. eg, both in Oregon and California, the states are sending out medical support such as ventilators to places such as NY. Oregon's governor is saying she won't relent on the suppression strategy until the state has gone 10 days without a death.

Maybe you guys need a healthy Twitter network, and from that a few times daily memorial for someone's loss. Or a story of the pain and awfulness experienced by someone who did survive.

Often young, connected, vital.

And anyone foolish enough to wave those off as the old or weak has defined themselves.

Certainly as someone I never have to take seriously again.

Maybe not specifically to these authors, just needed to stick it in the middle of the page.

"The exchange between O'Reilly and Hannity is a useful reminder that, beneath the faux piety and the pandering to the credulous among the religious and sentimental (the War on Christmas!), the beating heart of Trumpist conservatism has always been the most vulgar social Darwinism." - @BillKristol

Legit. Where I'm coming from.

No one is better off with a Twitter network.

You’re not addressing Tyler’s point either. 18-24 months of 2-3 month on-again off-again lockdowns and the entire system falls apart. Real goods and services have to be made, you can’t print your way out of a supply shock.

The optimal is a Wuhan style quarantine where appropriate and then gradual easing. That’s not in the cards in the 21st century West....

The key variable is how many QALY have to be lost through a global systemwide economic collapse before it equals QALY lost through Corona.

And you sir have an entirely broken worldview.

You care much less about world events than your little personalities on comment sections.

It's like you can only interpret this virus in terms of what I say.

You have a very bizarre habit of assuming you know everyone’s worldview. Of course i care about world events, we’re potentially going to slow walk our way into a Great Depression 2.0 and I have a mortgage and family.

Regardless, since you’re an outdoors type:

http://www.urbanphysics.net/Social%20Distancing%20v20_White_Paper.pdf

If you’re still walking or hiking around outside you need a N95 respirator. The six feet rule will be revised by the CDC eventually but it’s woefully inadequate.

You have an adequate supply to equip your family, sent from China (without being seized by the American government in transit). Unlike the vast majority of the families of medical personnel treating sick people, but they likely have mortgages to pay too, so what can an individual do but wash their hands in such situations.

You just might want to ask someone who actually knows how to use such equipment about proper fitting, though 3M does provide videos. Just putting one on is absolutely no guarantee of that filtration level.

When they train Docs they use a smell test for N95 masks.

The respirators may be out of stock but the saccharin tests are not.

Again framing it around your imaginings of me.

1) I'm actually staying in the backyard these days.

2) I think I'd be brave enough to donate any unopened N95 I had to a healthcare drop-off:

https://www.latimes.com/california/story/2020-03-23/coronavirus-medical-safety-gear-shortage-how-can-people-help

I can go with home-sewn on my rare trips out, though I certainly look forward to consumer-level disposable masks in vast quantities.

Th Bank of England will now apparently give the government a blank check by financing the government directly. Wonder if anyone is talking to the Fed about this idea?

Pandemics really do create strange times.

Mid May? Watch what happens in Wisconsin over the next couple weeks. A natural experiment. If there is no change, then the justification for lockdown disappears everywhere except densely populated cities.

So what falls apart next? What does it look like when 40% of the businesses, services like doctor's offices, dentists etc. simply disappear? When do municipalities start seeing a crunch, their revenues have disappeared as well. What about all those fragile pensions that depend on 8% return seeing no contributions and no investment returns?

The hospitals are not overrun. Start opening things up. At least enough to stop the loss of employment.

There seem to be enough ventilators, the PPE stuff probably will be sorted out in another week. Now is the time to unleash the ability of the economy to solve problems, this problem being how to operate an economy and contain the spread.

Maybe it is as simple as limiting travel and large gatherings. The rest can go on as normal.

Wisconsin will probably have 150 to 200 deaths this round. During the bad flu season of 2017/18, 400 Wisconsinites died.

Yes. There is a possibility that this flu will kill fewer than a bad flu year.

I'm not questioning decisions made over the last weeks. When you have something that is unknown but with very scary characteristics, overreaction is prudent. But we know quite a bit more now.

Better still, keep an eye on Japan and Sweden. Fair chance they blow up, but if they don't...

Sweden and Japan are having completely different experiences with coronavirus. If Sweden was as large as the U.S., they would already have 23,000 deaths. In Japan, the virus has been there over two months and there are only 94 deaths, up from 45 deaths two weeks ago in a population of 126 million.

Japan's experience has indeed been different from the rest of the developed world .

So far.

But will that last? Shinzo Abe declared a state of emergency in Japan a couple of days ago.

The experience in Spain, Italy, France, the UK and Germany suggest it is nowhere as simple as limiting travel and large gatherings.

The experience in New Zealand, Singapore (with a relapse), Taiwan and South Korea show C-19 can be contained. C-19 will however effectively kill tourism, and hence countries like Greece's economy where 20%-40% of GDP is tourism (France, Spain, Italy also get a health boost from tourism).

I wonder who the OP cited is? Is that TC our host talking?

Right, some businesses will come back as soon as the government lets them, others won't because their old customers see them as high risk: e.g., golf courses would be popular if they were allowed to open because they appear to be pretty safe, but ski resorts would likely not be because skiing appears to have been a bad vector.

Once everybody gets masked up, going to the department store to buy shoes would be reasonable, but not going to the makeup counter to try on lipsticks.

Orthodontists will be in big trouble until they get some heavy duty protective gear, but perhaps optometrists could be back in business quickly if we all had masks to wear.

I wrote about recreational sports businesses here: golf and tennis (at least singles) seem pretty safe to reopen soon, but skiing and basketball not:

https://www.takimag.com/article/post-lockdown-hacks/

Well done article, but this I quibble with: "Course superintendents responded by raising the cup above the level of the green and encouraging golfers to count a putt as holed if it bounces off the elevated cylinder." That's absurd. I've only been golfing a few times (but at nice courses like that Las Vegas PGA course, with the impossible to make hole looking down at the greens, where 90% of golfers lose their ball to the rocks), and I can tell you golfers will 'game' this cylinder by putting hard to hit the cylinder, even at an angle, and count it as a made put, where ordinarily the ball would continue over the hole or not go in.

Bonus trivia: I saw somewhere that Trump cheats at golf, I think Bloomberg said this.

And Mike got completely out-trolled by the Donald when he tried the “Trump cheats at golf” routine- Trump tweeted “Bloomberg cheats at ...mini-golf”. It doesn’t pay to try to out troll Trump

BHO was an enthusiastic golfer, too. With legions of dedicated paparazzi devoted to chronicling his life, no one ever bothered to give us his golf scores, which implies that they may not have been very good.

Do we know Trump's golf scores?

About 280 and 96.

Oh wait that’s weight and IQ

Cheating at golf is like masturbation. The only ones not doing it are liars.

Nothing is simple. The second order effects are going to be showing up, and they are as unpredictable at this time as the epidemic was two months ago.

A doctor's association suggested yesterday that another month and we will see 45% of doctor's offices close down. Dentists are saying similar things. I don't know if that is the case, just as no one knew what the epidemic would look like two months ago. When does property crime skyrocket?

There are no easy answers, but to suggest that shutting down the economy for another couple months is going to even accomplish what it is purported to do is tenuous.

In BC the numbers of recovered cases is growing faster than new ones. Hospital capacity is fine, nursing homes are probably the most dangerous places to be right now. The operating businesses don't seem to be spreading the disease, with spacing and now more PPE usage. I can see the limits on the size of gatherings being maintained. And quarantines or isolation for travellers from overseas or across borders. When it began they had space and number limits for restaurants, I don't see why that couldn't be opened up again, as well as other retail. Every store that sells food has a limit of the number of people allowed based on their floor area, to maintain spacing, why not everywhere do the same?

Surely there are technologies for surfaces that will kill or are inhospitable to viruses, why aren't these being installed so places can operate? Aerosol spread can be controlled by UV or other technologies. Masks actually do work after all. When they are readily available, it isn't hard to show people how to use them safely. Lots of people outside of the chattering classes wear them at work already.

Grocery stores all have plexiglas barriers between the checkout people and the customers. They wash all surfaces between customers. That seems to work quite well preventing spread.

Density is a problem and it may not be possible to have a densely populated city operate while there is a virus about, but most of the country isn't like that. Surely it is possible to have multiple answers to the same problem based on local conditions or even local tolerance for risk.

Once we get masks for everybody, there would be a lot of paid work that could be done retrofitting to reduce R0: for example, replacing door knobs and handles with copper fixtures on which viruses die 5x or 10x faster than on steel. Cities can figure out new health codes and hire a lot of health inspectors to grade retail outlets. Maybe affluent people will want sinks installed on their front porches so they can wash up before coming into the house like some people do in Japan. I could imagine a lot of work to do to make ourselves safer. Have the government offer 1% loans for this kind of anti-infection retrofitting.

Be careful with cloth masks-the data there isn’t good....

Cloth masks are just a placebo, and a social statement-- "I care".

Cloth masks help prevent the spread, if the infected are wearing them.

Jury is still out on whether they prevent infection to the wearer.

Germany has more recovered patients (46,300) than total active cases on March 27 (43,862). Active cases have fallen by 8,000 over the past two days.

Germany is listing patients as recovered far faster than the US is. It's not a matter of timing either. They are just releasing them much quicker. I'm not sure which approach is correct.

Or possibly younger patients.

And according to German sources, where the typical Chinese ICU case lasted two weeks, in Germany the ICU time is 3 weeks, affecting bed availability calculations. This does not sound like releasing patients more quickly.

"This does not sound like releasing patients more quickly."

Other people would probably look at the statistical data versus some bizarre comparison between China and Germany ICU usage when discussing the US and Germany's recovered statistics. But I'm sure that made sense to you when you wrote it.

3 weeks ago Germany and the US both had under 20K confirmed cases. Germany currently lists 46K recovered vs the US listing 25K recovered.

To put it statistically: Germany lists 41% of it's confirmed cases recovered
The US lists 6% of it's confirmed cases recovered.

This has nothing to do with ICU usage and more to do with how mild cases are being recorded. There's clearly a different standard being applied. I have know idea if it matters or if one standard is better than the other.

If someone has been tested and diagnosed in BC with the virus they are tracked by public health nurses, a call every day until it is resolved. A week no symptoms, then two tests a day apart.

It is quite difficult to get a test here, and if you have the symptoms you are told to stay home, no test. Not sure if those ones are counted.

It's important to constantly question and cast aspersions on all good news, while simultaneously shouting even the slightest rumor of bad news immediately and at full volume.

We need everyone on board with these guidelines until the first week of November. Step it up, people!!

One of the few positive aspects of this.

Why wait until May? We might as well reopen now!

Tyler, I assume your paragraph refers to the United States, and with respect to that country I'm inclined to agree with you. But the USA is perhaps the an idiosyncratic case here, for various reasons. Plus you have a highly global audience, and you have highly cosmopolitan personal knowledge.

So...I'd ask you to expand your predictions to include other countries.

Specifically, suppose you could have an "Anti-Coronavirus Draft," just like the NBA draft but instead of drafting players to play basketball, you'd be drafting countries to fight against coronavirus.

So, pick the top say eight countries (equal to the minimum number of NBA players that must suit up for a game) on your draft chart, and state what you consider to be the "ceiling" of each country. Is it "complete local eradication"? Is it "effective containment"?

Every virologist and immunologist I know says that finding an antiviral is way harder than developing a vaccine, unless you have dumb luck. The only treatment that works so far is derived from the blood of survivors who, in a libertarian free market, should be charging astronomical sums while they can.

Ask your medical expert friends if bats/pangolins/civets infected with various strains of CoV-SARS developed any antibodies and if we can use those antibodies in humans?

We simply don't know, but it's possible that those exact kinds of experiments may have played a role in the creation of this virus. Even BSL-4 facilities can't perfect containment 100% of the time. To be prudent, we should be much more careful with related infection experiments, for fear of starting another round with an even deadlier and related virus.

Tyler, would be good to hear your thoughts on China's financial condition and response to the pandemic. They still have yet to announce a big stimulus plan like every other major economy has. That maybe due to their debt issues, in both quality and quantity, which may restrict their range of options. In a globalized world, we are all in this together so if the world is to see a shorter recession/depression it needs the world's second largest economy to respond with confidence.

https://www.nytimes.com/2020/04/09/business/economy/coronavirus-china-economy-stimulus.html

One thing that makes this pandemic so uneasy for Americans is that our freedom is held hostage by our neighbors. The more reckless their behavior the more strained the healthcare system, the longer the lockdowns persist, and the more power given to the state for containment. It's enough to turn the most rugged individualist into a panicked busybody.

What I hope to see is American capitalism respond with myriad products and services to reduce the chance of infection. I haven't been to a grocery store in a month, but I hear that many have installed plate glass between checkout clerks and customers. There are all sorts of things like that that could be done, and there are workers to do it. What we need are right now are masks so that there would be little risk in, say, hiring workers to install plexiglass.

Here's a good summary of the status of coronavirus vaccines and treatments: https://www.nytimes.com/2020/04/08/health/coronavirus-vaccines.html As for Cowen's blog post, it seems about right. I suspect those who are in a rush to lift the lockdown don't appreciate the difficulty and cost of ramping up and ramping down a business. I work with many outpatient surgery centers (ASCs), which CMS has given authority to convert to and operate as hospitals at hospital reimbursement rates (either pursuant to an arrangement with a licensed hospital or on their own) until the Covid-19 crisis has passed. It certainly is appealing, especially since most ASCs have closed as non-essential. But in gong through the details of ramping up and, just as important, ramping down, the cost and potential for major billing and collection issues during the ramping up and ramping down has discouraged the conversion. An aside, the purpose of CMS's order is to free up space in hospitals for Covid patients; in the same order, CMS stated that ASCs and other non-hospital medical facilities should remain Covid-free. Hospitals, in defiance of CMS, want to convert ASCs into ICUs for Covid patients, and the largest hospital association has anounced that hospitals should not and will not enter into arrangements with independent ASCs for the ASCs to operate as Covid-free hospitals. So much for cooperation.

That tells me that there isn't much of a problem with the virus. There are a few cases in hospital, and they want them moved out so they can get the large facility operating again, and put the covid19 cases in a smaller facility.

Is that the case?

I can only speculate as to the hospitals' motive, but I suspect hospitals would like to dump the Covid patients on someone else (the ASCs) and go back to the high-revenue relatively low risk procedures they prefer.

Exactly. That makes good sense. Otherwise the whole hospital facility is open to potential infection, requiring rigorous, complicated and error prone infection protocols.

Is this another situation where a complex bureaucracy is putting up barriers to good health practice? Infected hospitals are a catastrophe; segregating infected and non infected into different facilities is really good practice. Is making it complicated is a bureaucratic failure.

Not that I want to take work away from you ...

Hospitals will evolve to have Covid-19 wings, sealed off from the other sections, I think.

Tyler I agree with your views and given this scenario is likely to be repeated in every country to a lesser or greater degree, Governments everywhere are going to have to "print more & more money" to keep as many people and businesses alive as possible. The amount of resulting Government debt will be unsustainable and prevent recovery if it can't be written off. So I believe there needs to be some attempt on common & internationally accepted guidence on what level/type of Government financial support can ultimately be written off and effectively treat the situation as if time had stopped at the point before the epidemic started in each country, given it is going to be hard enough to restart from a much lower base even after all the supports. I believe without some vision of this happening many people will loose hope and societies will break down. So I would like to hear views on how this can be done. I would welcome links to previous discussions related to this topic as I have only recently joined this forum.

In strain analysis news:

https://medicalxpress.com/news/2020-04-coronavirus-nyc-february-europe.html - strain analysis indicates growth in NYC cases from strains from Europe (specifically via England), starting in Feb. So current caseload comes from at least a month and a half exponential growth.

https://medicalxpress.com/news/2020-04-covid-genetic-network-analysis-snapshot.html - Structure, mutations of virus into branches with high success in East Asia and Europe. Maybe Asian variant is less transmissible and this accounts for some of apparent success in SK (e.g. no unifying policy / technical success, mainly strain luck).

> strain analysis indicates growth in NYC cases from strains from Europe (specifically via England),

Yes, so, if EU would have shut down travel from hot regions when US did, then EU would have fared much better AND NYC would have fared much better.

Trump's moves continue to impress.

Not implausible but it will imply need for continuing "activism" by the Fed and more inflation than heretofore found acceptable to maintain anything like NGDP targeting to prevent the continuing supply side shocks from opening up any 'aggregate demand gaps.

Here is the timeline of the Moderna mRNA vaccine (mRNA-1273) which could be the first available.
—Phase 1 started : Test toxicity and tolerance of vaccine: 2 injections 3 weeks apart : 45 volunteers : March 16 , April 6
—Phase 2 study vaccine effectiveness. antibody profile, start May 1st : 300 people
—Phase 3 large scale testing of effectiveness and safety start September 1, a few thousand people
Green light -> mid November ( earliest for health care workers ) availability and mass manufacturing ready.

Psst. I've got this vaccine that's been tested on a few thousand people. Wanna take it?

Look at the first Polio vaccine. It gave something like 1 in a million people polio. Is that rate still acceptable?

I think there were some problems with the Brodie vaccine (1935) and some mishaps with the Salk vaccine ( some doses were not inactivated).
This was a long time ago.
This is a different kind of vaccine It’s an mRNA vaccine. It’s not infectious. It’s inherently safe. It doesn’t use killed or live attenuated pathogens.
This vaccine is a self-amplifying mRNA and is capable of directing its self-replication, through synthesis of the RNA-dependent RNA polymerase complex. It generates multiple copies of the antigen-encoding mRNA, and expresses high levels of the heterologous gene when introduced into the cytoplasm of host cells, in a way that mimics production of antigens in vivo by viral pathogens, triggering both humoral and cellular immune responses

Let's get it ready for September than

Moderna's problem is that they're not doing a challenge trial where they purposefully infect vaccine recipients with the virus. If they did, they'd know if it works or not by the end of this week.

Just a suggestion, if you use 'Re' (effective reproduction number) instead of 'R0' (the basic reproduction number, as in a world without interventions) your meaning will be more clear and you will help correct some of the gibberish that is being passed around.

“At some point antivirals or antibodies will kick in “
There’s a big role to play for immunosuppressive drugs like Tocilizumab ( Actemra) as severe cases die of lung damage due to hyper inflammation ( cytokine storm) , often while viral loads have declined. This also happened with SARS-CoV1.
Interestingly , bats, who harbor a higher proportion of zoonotic viruses than any other mammalian order, when challenged by these viruses, exhibit no or minimal signs of disease, even when high viral loads are detected in the sera
They are able to significantly dampen inflammation while asymptomatically hosting a greater variety of viruses.
(dampened activation of the NLRP3 inflammasome in bat primary immune cells compared to human or mouse counterparts. )
https://www.nature.com/articles/s41564-019-0371-3

We really don't know much, but it seems as lung problems are not the only potentially fatal effects.

"The novel coronavirus mainly attacks the lungs. But doctors have been increasingly reporting cases of another battlefield raging within the body: the heart.

More than 1 in 5 patients develop heart damage as a result of COVID-19 in Wuhan, China, one small study published March 27 in the journal JAMA Cardiology suggested. While some of these patients have a history of heart conditions, others do not. So what's going on?

Cardiologists say several scenarios could be unfolding: The heart may struggle to pump blood in the absence of enough oxygen; the virus may directly invade heart cells; or the body, in its attempt to eradicate the virus, may mobilize a storm of immune cells that attack the heart.

"We know that this is not the only virus that affects the heart," said Dr. Mohammad Madjid, an assistant professor at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). The risk of developing heart attacks, for example, is thought to increase about sixfold when a person is infected with the flu virus, according to a study published in 2018 in the New England Journal of Medicine.

What's more, during most influenza epidemics, more patients die from heart complications than from pneumonia, according to a review published March 27 in the journal JAMA Cardiology. Viral infections can disrupt blood flow to the heart, cause irregular heartbeats and heart failure, according to the review.

So while it doesn't "come as a surprise," that novel coronavirus called SARS-CoV-2 can lead to heart damage, it may be occurring more frequently in these patients than it does in people infected with other viruses, Madjid, the lead author of the review, told Live Science.

The double-edged sword
The virus might be directly attacking the heart.

"We're seeing cases of people who don't have an underlying heart disease," who are getting heart damage, said Dr. Erin Michos, the associate director of preventive cardiology at Johns Hopkins School of Medicine. Heart damage isn't typical in mild cases of COVID-19, and tends to occur more often in patients who have severe symptoms and are hospitalized, she said." www.livescience.com/how-coronavirus-affects-heart.html

Here are the complications associated with 12550 Covid-19 deaths in Italy ( from The italian National Institute of health report)
Respiratory failure was the complication most commonly observed in this sample (96.1% of cases), followed by acute kidney damage
(25.0%), superinfection (10.6%) and myocardial damage
acute (10.4%). As you can see respiratory failure was # 1 but some patients had several

Tyler seems to want to have a different conversation than everyone else. The optimal time arguments are about what should happen. Tyler doesn't seem to want to contribute to that conversation. Instead he's making predictions about what might happen. Fine for what it is, but that's not where he can be most effective.

I think it is easy to have this pessimism. I see a lot of people who are bad at social distancing. They allow themselves "this" because they think they're good when they did "that." They don't realize that their exceptions drastically lower effectiveness.

So I don't know. Maybe.

But if numbers rebound too quickly or too obviously, we can hope that will drive the message that people need to get serious to knock this thing out.

Don't shop when you're out of eggs. Wait until you are out of food.

And that includes pickles.

There is no knocking this thing out until there are vaccines or effective treatments. It will run it's course. All anyone can do is slow it down.

Yes but if you can slow down something that is exponentially growing you can get a significant reduction in infections.

It sounds like your mental model is that by "run its course" everyone has to get it sooner or later. That's not really the case in any pandemic. There are people who are never exposed and never fall ill.

We can and should maximize that number now.

It is not only time, but preparedness and change in products or behavior that transmit disease.

So, let's figure out how we can make mass transit less conducive to germ spreading...sanitizers on board, as you enter a station, limits on crowdedness, new products that sanitize themselves with contact, UV washes of surfaces when no one is on the subway or bus, etc

Outdoor eating and food delivered to picnic sites.

Since families which live with each other are already exposed to each other, lifting 6 foot rules for family units when then attend an event together, and separate them from other family units by six feet,

On the spot covid testing, testing, testing, and giving a pass to those who pass.

Testing all kids before they go back to college, except for Liberty University,

There are going to be a few cases like NYC with high density and pathological dependence on mass transit - subways, buses. People will also likely be reluctant to use taxis or ride share. They have a real problem.

But generally, we will reopen most of the economy, as it becomes apparent that the collateral damage from the shutdown exceeds the damage from the virus. I give it about 3 more weeks.

Or not.

https://www.texasmonthly.com/news/coronavirus-spread-rural-counties-university-texas-researchers/

I think a lot of people have a mistaken, or idealized, view of modern world life.

Most people don't live "five acres and independence(*)".

It is much more spoke and hub. If a virus gets into "your" Walmart or hardware store or Costco, it's all over your county. And any ICU beds you have are full.

* - a famous depression era book

Modern "rural" life

It's possible that this will be the thing that finally brings down home prices in dense cities. Lots of businesses and people are going to decide to locate to less dense areas where they can stay open. Look for another crisis in the real estate market.

Not a chance. If anything, businesses in blue states have learned that the Governor can shut down your business for any reason (or no reason). It doesn't matter if you are downtown or way out in the smaller burbs -- if you're in a blue state, you're screwed.

Businesses may flee blue states (as they already are) but it won't be strictly a "city thing."

Urban commercial real estate is going to get creamed. People aren't going to want to go to that skyscraper downtown when they've had six months to realize being a lawyer, an accountant, a software developer, or a marketing person works pretty well working from home.

Not saying everybody will stick with the new trend, but it doesn't take that many to mismatch supply and demand.

...that probably has legs. A whole lot of folks have discovered telecommuting isn't so hard. When we go back to some kind of 'normal' my own work team will probably allow one of the 4 of us to work from home a day each week, with all of us there on Mondays.

So Garfield remains correct then.

...is when you realize deep inside that Garfield is always correct.

In my own extended family, there are 5 people I know of who have been working from home for weeks. Four have IT/analytic heavy jobs. Two of those went to a family beach house in Florida and have been working from there.

The fifth is a manager living in the UK, who is in the process of being transferred to the US. He’s at home in the UK and doing his old UK job in the morning and his new US job in the afternoon.

A sixth, in the print advertising business, has been working from home for a decade, but that business just imploded, he’s been on leave, and his job is probably gone along with his employer.

It’s interesting to think about how all this would have played out 30 years ago pre-Internet.

"A whole lot of folks have discovered telecommuting isn't so hard. "

To be specific, a lot of people that knew they could do their job remotely but couldn't change company policy now have a lot of evidence in their favor. The big shake up will be when the bean counters run the numbers on halving their required office space and associated utilities. They'll outsource their job locations to their employees houses. Then some employees will inevitably object to the idea of the company expecting them to provide an office at their expense.

This is how change happens, we don't know the details but clearly change is coming in this area. Some side benefits include less driving = less pollution and auto fatalities and traffic.

I don't view this as particularly pessimistic. It's not a direct consequence of the disease; it's something the disease made us think harder about. We're getting to the future a little more quickly because of the disruption.

I've kind of liked working from home. And I'll save $6k a year on parking. I don't care if I never see the inside of that outrageously expensive office again. I just need the damn air travel industry to come back so I can see clients once in a while.

As I said before, zoning is the way we will come out of this. China is effectively doing this - any new visitor to China has to undergo mandatory quarantine until they are proven clear of the virus. New Zealand will go the same way. The US needs to go to zoning in the 48 states, divide the US into virus free areas and none virus free areas. Within the virus free areas there can be free movement, but anyone coming from a virus area into a virus free area will need to go through mandatory quarantine. Of course the mandatory quarantine can eventually be waived for people if there is a proven antibody test to show you have already had the virus, or maybe they will accept a statement of proven infection followed by recovery from a hospital.

The other thing that needs to be mentioned is that people who are vulnerable are already in hiding now, perhaps they were not as cautious a few weeks ago. So the number of people needing hospitalization in any one location is probably peaking now just because of that effect. Just keeping older people away from their grandkids is probably 90% of the factor - kids are germ spreaders and we now the vast majority of them are non-symptomatic. We don't need to mandate this, people are generally clever enough to figure it out.

I might fit the hiding out profile.

But as Louisiana is showing, obesity is a big risk factor for severity, and it's not like we have non obese regions anymore.

Maybe there is something deeply ingrained in the human nature that danger far away is just that.

And so we continue to make exceptions of new hot spots.

I get where Tyler's coming from.

The US will never do this, it’s probably not constitutional, and I can’t imagine who would he capable of enforcing it.

We can’t even quarantine NYC

As a constitutional and legal matter, the federal government should have and does have the power to prevent the spread of diseases across state lines. The CDC cites 42 U.S.C. 264 as the basis of its authority to regulate interstate movement in the event of a pandemic. I can't imagine any federal judge trying to get in the way with such an obvious threat to public health and welfare at stake.

He said a lot more than regulate interstate travel in his comment.

Regardless, we cannot and will not do anything he listed. Even if it’s the correct response, I doubt we have the capacity and societal trust to pull something like that off.

The reporting on Fox News has started to drive me crazy. When they talk about how the projections are off they show how ignorant they are about exponential growth. For example, a 5% reduction in cases at an earlier stage of infection can translate into a 50% reduction in new cases rather quickly. When Laura Ingram talks about how far off some of the predictions have been it is because small changes in an exponential growth leads to big changes in the numbers rather quickly. They should be praising the effectiveness of what steps are working. Instead in a street near mine about 50 people held a BBQ. Given the general infection rate that means that there was a 2-5 % chance that one of the participants was positive. A small risk, but why take it. Especially given that if somebody was positive that will rather quickly become over a dozen. Each positive person infects three others, who infects thee others, etc. The Fox talking heads like Carlson and Ingram show their ignorance for what exponential growth in the virus means - that small measures can have big effects. Instead they give comfort to those who want to hold BBQ's. The virus can not survive without the ability to infect new people. Please take the small steps needed to stop feeding the beast. Your small sacrifice can have a huge impact for society while you protect yourself. If you ignore it we can descend into the nightmare that is some Detroit hospitals. Please speak out against ignorant TV hosts.

If you ever produce a model with a best and worse case scenario, and the results are outside of those bounds, your model failed.

And has that happened? Or has the model adjusted due to a change in data? In this case, it is not shocking to see a 50% reduction in predicated cases if any early intervention was only slightly more effective than anticipated. That is the nature of exponential growth.

"According to Sanderson, if the rate of spread dropped from 15% to 5% per day thanks to society’s collective efforts, then the U.S. could be looking at less than 15,000 cases by the start of May – rather than over a million.

“So, if people are sufficiently worried, then there's a lot less to worry about,” said Sanderson. “But if no one is worried, that's when you should worry.”

https://abcnews.go.com/Health/mathematicians-preventative-measures-huge-impact-coronavirus-spread/story?id=69620937

The "Best Case Scenario" was based on social distancing.

It was likely a political decision to make the "best case scenario" 200k dead.

It was effective as a political tool.

We could be out of this fairly quickly if we took some reasonable risks and got out of the mind-set of normal drug approvals.

Why do vaccines take so long to develop? Ideally, you want to stimulate a strong immune response but also not kill or sicken people who take the vaccine. This takes time. Once you find the right answer (what exactly are you giving and at what concentration) you need to scale-up production. This is fine for diseases that have been constant problems and maybe Covid will fall into this category. What is likely is that Covid will burn itself out long before any vaccine is available, if we follow the normal template.

What I suggest is a kind of variolation, but with much more control and far less risk and which could provide almost immediate (modest) benefits.

Viruses can be made in cell culture by transfecting with plasmids which contain the viral genome. Lately this has been done and modified by taking out some piece of the viral genome such that any viral particle made in this process can not replicate but can still enter a target cell. This is the basis of viral gene therapy.

What I suggest is to use the same technology to make Covid-19 virus but leave-out some essential function, I think the reverse transcriptase gene makes sense. We could widely administer dilute dosages at pilot scale. The risk would be low and while there would likely be low immunity, it would increase the viral load needed to cause illness and would allow for higher dosages to be safe once production ramps up to the point where they are available.

A crash program could be providing low dosages in a month and higher ones in three.

Is it possible to make a contagious vaccine?

Apparently it is ... https://www.popsci.com/contagious-vaccine-virus/

Yes. I believe "weakened" vaccines are contagious. They are great, in that they can give very strong immunity in one dose. The problem is that it takes a lot of time to find just the right amount of weakening that makes it good at providing immunity but still safe.

You can of course make a fully virulent virus in a lab and in dilute form it would be an effective if risky vaccine. But if you leave out something essential, like the RT, it could not reproduce in Humans. But just because it could not reproduce in Humans, doesn't mean it can't cause harm. Gene therapy patients have died from being given too high a dose of virus. The virus cannot replicate but it certainly hurts the cells it infects and can over-stimulate the immune system--if given at a high dosage.

Weakened viruses vaccines are more difficult to make than most other types of vaccines-so hopefully we don’t have to depend on them to cope w/Coronavirus in the near term. Long term they are a great solution but not shorter term.

The oral version of polio vaccine is contagious some percentage of the time. That's why universal vaccination is so important: being vaccinated offers you protection from both polio itself as well as the unlikely but still possible scenario in which you catch a weakened form of polio from someone else who was vaccinated.

The U.S. switched to shots for polio for this reason: they are much less likely to get you sick or to give you a contagious disease but they offer excellent protection if you come into contact from an infected person.

Here is what our current testing regimen looks like at a major midwestern hospital:
Attached is the current process for ordering COVID testing on asymptomatic pre-operative patients who are felt by the [Chief of Service] to warrant inpatient testing. This prioritize inpatient testing list was created by [in house public health expert] on the behalf and approval of the [Institution’s] Executive Faculty.

Please note that this is a fluid process and subject to change.

Important points:
- There is still a limited number of test available in house. Yesterday, over 300* tests were performed which is near current capacity. Priority for testing is symptomatic inpatients and [hospital’s] physicians and clinical staff. If shortages in testing availably occur, those groups will have priority for in house testing.
- The current turnaround time is 24-48 hrs. There currently are no rapid tests available at [ou our hospital]. The federal government determines where these tests are deployed and [our city] is not a priority area at this time. If the test is not back by the time the patient needs surgery, then COVID PPE should be used. Consider outpatient testing when feasible.
- Asymptomatic patients who have a COVID test ordered in house will be placed in COVID precautions. They can be tested in place, but will need to be placed in precautions until the test returns. This is an automatic flag in the system. A positive test in a non-isolated patient who was tested in house would result in staff substantial exposures, potential staff furloughs and significant nursing staff morale issues on your units.

*for a 2,000+ bed hospital.

Bruegel days, nights by Bosch . . . medieval the next, anyone?

I just find it absolutely hilarious that's it only April 9, and Tyler has already abandoned his apocalyptic fear-mongering, and has to resort to saying that the recovery will be "slower than expected." Incredible!!!

Suburban/Semi-Rural, old small town, rustbelt, SW Pennsylvania.
Many small businesses are still working if they are not "Walk in" retail type of business (Jewelry stores, beauty parlors). The owners and management are still showing up. Unless they're selling greeting cards, the thinking seems to be, "My Business is Essential!" even if it's not on some Gov list. Another rationalization is "We are supporting an essential business". Maybe mostly true, because in these parts, that's the only kind of businesses left.
No booze though! All the (I'm going to guess 100k or so) alchies are driving out of state to get their essential supplies.

Is the Fed now, de-facto, the fourth branch of the US government? Unelected, unaccountable, but with nearly unlimited financial power?

It's far less dysfunctional than the other 3 branches.

Yuk yuk, at least the Fed lies with numbers instead of hand waving.

You gotta put the Fed on top.

IMO Debt is only useful for 2 things:

1. Moving some consumption to earlier in life.
2. Allowing more efficient businesses to grow faster.

Any policy that favors debt should be phased out, starting with the mortgage deduction.

Well debt has an advantage over equity in that you have to pay off debt (even if it is low interest rate). That does force approaching an enterprise with a measure of realism rather than aspiration.

In times of tail risk, which is right now, debt is the worst thing imaginable. Unpredictable means high risk, high interest rates. Equity quickly adjusts, with any losses or gains reflected immediately, and there is no outside cost if it goes to zero.

Right now is a moment of short term uncertainty.

The financial markets seem to be telling us that things are not going to be as bad as predicted and are on the mend. That is real people betting with real money rather than the assorted opinions of the usual pundits and windbags. Maybe we should hear from an economist, who might understand this?

Welp... the strong correction in March might suggest another sector to look at for advice about the future (or least to down weight the reliance on the signal coming from the financial sector).

The financial sector is telling you that 95% of the population will come through this Ok and the better days are less than two years away. But we are fighting to keep 5% of the population alive. Which isn't easy or cheap.

But what are the lives of about 17 million people worth?

More of a question than a comment but why can’t business districts, shopping centers, retail avenues within five to ten block segments, set up testing check points.

Pass your covid test you can work and shop for the day. You fail you get quarantined....

Don’t allow any economic activity to occur without passing the covid test.

X Prize Abbot labs testing hardware and open source it’s mass production.

Seems to me the only real solution is in demanded testing being everywhere.

It’s not an optimal solution as there will be possible delays in getting people through.

But Universal Studios and Disney process thousand of people a day through pat downs, bag checks and metal detectors....

This is a great outcome. It sounds like Alex Tabarrok's idea to test 8 billion persons and get an instant result and repeat every 60 seconds. Why not repeat every 60 milliseconds.

We should strive for improved testing obviously and see what falls out of that achievement. New revelations might suggest near term and medium term outcomes long before we are able to test 8 billion persons instantly.

I gather you're under contract to produce these column. The trouble is, you actually haven't a clue.

The 'natural' R* of this virus seems to be something like 2-3.

If R* becomes less than 1, the virus goes extinct.

At the moment, I'm going to guess we've reduced our human-human interaction by about 90% (mass transit is reporting ridership is down 90+% so that's a good proxy).

So not sure this is how epidemiology works but that would imply our efforts have made R* about 0.3 or less. If that is maintained, we should be able to smash the virus down.

The question is what happens if we let up. R* will rise but if we let up with mask wearing, social distancing and holding off on really intensive human interaction (think concerts, major sports, etc), we can keep R*<1.

So no it isn't "grandma will get it eventually, just not at the same time as all other grandmas". The total number of people who get it should be less with our 'flatten the curve effort'.

Some positives that could help:
* Getting testing online so we can actually use testing like we should.
* Finding some drugs that really do lessen symptoms, decrease how much virus infected people shed, etc.
* Getting antibody testing online so people who've cleared the infection could be positioned to care for those who don't have it. Imagine a nursing home where 25% of the population of patients had it and 50% of the staff cleared it. The staff could be targetted so people who are not immune are not caring for people that didn't get it.

Some additional considerations:

* Changes in social practices have a cumulative impact on R*. If everyone is wearing a cloth mask that only offers, say 10% protection, everyone doing it multiplies the impact. Those shedding the virus cut down on how much they shed and everyone else's mask lowers its spread.

* R* falls automatically as more people have been infected. If 25% of the population has cleared the virus, then the virus will find 1 out 4 people it tries to infect will be dead ends.

* Even small changes in social custom have never been modeled.

1918 had secondary outbreaks but I suspect it is because the public thought the infection was over and people rushed out to return to normal plus more. This time around I think people will know they are 'returning to normal' with the virus still out there.

The picture could be even better. If masks cut infections by 40%. And 50% of those infected get a mild form. (And they isolate during infection.)

So far I have seen two Walmart employees died. If that is accurate that is really sort of amazing. All those people working in groceries, what is the infection rate. Or the data is just missing.

The most dangerous places in the country appear to be health care facilities, nursing homes, and cruise ships. Make hospitals safer, better protect health care workers, and we go a long way to reducing deaths.

Wash hands, maintain distance, wear masks, hope for drugs that reduce fatality, get a vaccine, hope for the best.

R* is not set in stone and no one has ever seen people shift behavior on a society-wide scale like this before. Most importantly this is being done mostly without panic but with science. People are not burning down the houses of those who get sick or blocking off towns.

Taking worse case scenario there, none of the drugs end up doing much good. No vaccine is able to be made on scale for nearly two years or more. Shortages limiting testing do not clear for months more. I think we can keep R* below one for an extended period of time and get us to the point where we drive the virus into remission and keep it there.

Boomer here.

We’ve been self-isolating since the first week in March. I have treatable high blood pressure, but why take any risks?

We just go out to food shop for breakfast thingies. Mostly we order dInner for delivery - they put it by the front door steps - and have the leftovers for next day lunch.

We FaceTime with the kids and grandkids and our siblings. So far everyone is healthy and none have lost jobs.

Even if they give the all-clear we will probably self-isolate for at least two weeks longer.

But we’re both retired with SocSec and pensions so may not be representative of boomers at large.

Sorry it’s you kids that’ll be paying for our generation’s major screwups but in life - as in everything - timing is the key.

Good luck everyone and stay well!

Well, the younger generations wouldn't exist without the older generations (for better or worse), which is usually forgotten and is *by far* the most significant way the older generations affected the younger ones. Everything else pales in comparison.

Not forgotten, but well remembered was the 1972 boomer default. Somewhat forgotten was the 1932 Roosevelt default. But no forgotten is the 2020 millennial default. So smooth defaults which are not volatile and quite normal are easily had if we can remember correctly. We cannot remember correctly, we are stuck with folks like you, who forget or who never understood.

Well, you parents certainly made a mistake bringing you into existence. There was no other mistake they could have made that would have annoyed me quite as much in light of their consequences.

First, thanks for posting this. Lots of food for thought from someone I greatly respect.

I wonder, though, why you're so optimistic (in my mind) on finding medical treatments for this.

My understanding is that developing vaccines for coronaviruses (like the common cold) is nearly impossible, which is why we don't have a common cold shot like we have a flu shot each year. This is also why that one (amazing) official was able to stop the 1957 pandemic in its tracks with a vaccine -- it was a type A influenza and not a coronavirus.

Any additional insights on this front would be greatly appreciated!

Not an expert at all here but one relevant factoid that gives hope is that this is a virus that mutates very slowly so that favors both immunity for people who've passed the virus and the option for an effective vaccine to be viable.

Thanks for the response!

My understanding is that if it works for a high enough percentage of the population you get herd immunity. If we spent this much effort looking for a cold vaccine we might be able to do it, but why bother for a disease that is trivial in its impact. (Although I understand that Novavax does make a cold vaccine.)So far mutations have been minor. So let's not assume the worst. Plus they are trying multiple vaccines.

I wonder if others have better insight.

Thus, every successful nation relies on leadership from the public sector, and compliance from the private sector. Or else...

Is the policy prescription inherent in that paragraph that we should remain shut down as long as we can take it politically?

C'est un nouveau mode de vie que nous allons vivre actuellement. Toutefois on ne toujours pas encore convaincu de pouvoir bien reprendre nos habitudes de travail. Peut être que le rythme même changera. Malgré la conviction de l'espoir fait vivre.

So to conclude the generation default issue.
WW2 cheated the boomers, the boomers cheated the millennials, the millennials will cheat their children.

It cannot be helped, we are not an open economy, we are a highly government dominated economy with the typical unsustainable debt we accumulate every generation. We have a solution. e are going to a system of automated shadow financing. We have no choice, we have to eliminate the central banking systems, and mathematicians and the shadow bankers know how to do it.

So we never actually paid off the debt that we incurred in WWII. Did the WWII generation cheat us? If they did to whom are we burdened too? Ohhh people that own bonds. Ohhh wait, that's us. Go figure.

You post it multiple times across multiple threads almost every day. What exactly do you mean?

You’re quite optimistic there exists a pot of non-insanity at the end of this rainbow.

But yeah you're probably right. Dude's a loony.

Me?

Things like Lending Tree, we know how to do it, we know how to issue currency, we know how to price debt. The main thing is mathematicians know how to spread the risk among the deposits and loans.

The Fed is unable to do this, they have government obligations. Hence the generational defaults which go back to the founding. Read the chapter headings in Uncle Milts Monetary History, the chapter heading are actually organized by generational default.

Once you have the chapter heading in mind, then read the Book 'This time is different' The authors go through the mechanisms of how these defaults all occur, and after each default the government promises not to do it again.

It is a history, repeatable act. But the key that makes it work is that the children are too young to understand and so a fraud can be perpetuated. Eventually the children get more information then their parents allow and figure it out.

Like clockwork. We are at the stage where millennials have the clue they were cheated, but do not yet have the clue that they will cheat their chlldren the same way. It

The absurdity is going partly away, mathematicians solve repeated problems that occur with denial, the is our specialty, we have no priors. But more important, mathematicians have abstract tree theory, central bankers do not.

If you can't state your case plainly you have no case.

Plain as day, history on my side. We do not engage in repeated defaults unless their is a loop in the system. And out Fed is very repeatable. every eight year like clockwork we get our regularly scheduled down turns.

This is a problem that mathematicians could solve, and they have. The resulting proofs are interpreted and passed immediately to Fintech, like Coinbase and Lending Tree. They ujpdate this algorithms, they extract business from regulated banking.

Note, retail banking is rolling up and being taken over by shadow banking, a huge growth mostly fueled by the mathematicians.

We solved thsi problem specifically because we did not want to deal with a bunch of generational denial, we mathematicians do bother with the priors crowd, we go straight to the solution.

And we have Moore's law on our side. We can create automatic trading pits, like Lending Tree and Coinbase. We can make nearly perfect, efficient FX exchange pits. When JPM drops regulated banking they are engaging in shadow banking underneath, and the shadow bankers now can overwhelm the central bankers.

Game over folks, almost 20 billion in development across the Fintech industry has taken the punch away from stupid ideas like Siegniorage taxes. When the virus crisisd slows you will find the entire economy hidden from the Fed, they will have no idea and the only Millennial choice will be default now and restructure the Fed. That was the plan before the virus and will be the plan after.

You're not capable of simple English then? I guess we'll all see what the future holds soon enough.

On the bright side he didn’t make any anti-Semitic or racist comments.

For an MR loon, that’s actually better than average.

Isn't it interesting how history can make even the smartest among us look like fools so often? Will anyone's reputation for prescience come out of this unscathed? Perhaps a larger dose of skepticism is in order? Isn't that model (the magic word of our epoc) that was predicting 200,000 deaths a week ago now predicting 60,000? Do we have a model predicting what it will say next week?

Prediction is hard, especially about the future.

If you dodge a bullet do you get angry that you didn't get a bullet wound?

Where we stand in two shorter paragraphs:
"All that has changed is that we are in a self-imposed economic slowdown that has been created purely to save the lives of our most vulnerable people.
Which is one of the most compassionate things our society has ever done. To me, this is a remarkable and wonderful moment and I would not have guessed that such a capitalist country would ever have the balls to do it."
- Mr. Money Mustache

> Which is one of the most compassionate things our society has ever done.

Hopefully it was tongue in cheek. We just gave up 1/10 of our GDP ($2T) to allow ~250K that were likely going to die in a year anyway to live another 6 months. So we bought, rough numbers, 125K life years for $2T, or $16M per life year.

Bad investment in those terms.

I'll take the under.

If we had done nothing, probably 5-10M dead IMO.

But we wouldn't have done nothing. When people suddenly started dropping by tens of thousands per day, it's not like people would just keep going to work, concerts movies etc. You would have had a bottom up shutdown driven by mad panic.

We didn't buy anything with the shutdown, we were minimizing losses.

No, it's easy. Everyone's doing it non-stop. The predictions are obsolete by sunup. No matter, we'll just make another batch. After all, there are no penalties, so why would anyone refrain? Only a fool would do that.

Remember R(o) is a socially determined factor in the models. It is a property of people, not the virus. A virus is just a piece of code in a little package you have to keep out of your body and it can't move, crawl, or fly or do anything but reproduce itself.

If you visualize 70+% of the people wearing personal protection equipment (PPE) with masks to prevent inhalation of the virus along with external garments that are sanitized (for virus, not all pathogens) every time you go out by heating to 60ºC in a clothing dryer, oven or sauna that would be functionally equivalent to having 70+% of the population with immunity and the virus could not spread.

Meals out with friends or bars still won't work, but everything else can work. Vacations, jobs, sports, etc. can all work with masks and reasonable biosecurity of heating your external garments.

We probably can’t stop this virus. We have to manage it. I appreciate that Tyler appears to accept this now, even if his admission is based on politics rather than reason. In a perfect world, I guess he and others would hide out forever. And they can. But others can’t. And surely everyone can’t or none of this matters anyway.

If you can’t stop Covid and the key is to manage ICUs, then hiding out and keeping hospitals empty seems like the worst strategy one could implement. My county is nothing like NYC. We have 31 patients in the hospital among 8 hospitals and little to no maintenance care is being done on the public. Yet, PPE shortages are common precisely because we yelled “fire” and sent everyone scrambling. We are a powder keg of Covid and we are piling up future visits. This seems foolish. What am I missing? it looks like a Hail Mary for a cure or test-and-trace.

Death from Covid is horrible. Our society struggles to have an open conversation about it. Good intentions are not a strategy for dealing with the ugliness that is to come.

Letting the heads of hospitals or other medical professionals run the show is probably not a good idea. Their input is invaluable, but they are frontline fighters. Where is the Churchill, the wartime consigliere? I would have hoped that economists would be able to handle and measure the trade-offs we MUST make.

The problem can be very easily managed if people are required to wear simple masks in busy places like shops that only give a limited protection. Because R_0 isn't all that large, about 3 when not taking any measures, you only need to reduce the transmission probability of the virus by a factor of 3. And this reduction of the transmission probability only needs to be realized as an average on the scale of the population, not at the individual level.

Simple face masks have been shown to be able to reduce transmission of the more easily transmissible flu virus by a factor of 2 to 3. Then together with other mild social distancing measures one can reduce R_0 to below 1. The economy can then be re-opened, air travel can be restarted without problems. If the virus is re-introduced as it sure will be, then with R_0 below 1, there won't be a second wave. There will be a limited spread of the virus every time an infected foreigner infects people here, but for R_0 < 1, the total number of people infected by that person and the persons infected by that person etc. etc. will be:

R_0 + R_0^2 + R_0^3 +... = R_0/(1-R_0) = 1/(1/R_0 - 1).

So, for R_0 = 0.8, an infected tourist will on average only cause 4 people to get infected here before the cluster of infections dies out all by itself.

The real problem in this sort of a situation where in the entire country there are no more that a dozens of such small clusters of infections, is that the entire country has to stick to rules like wearing face masks to make sure R_0 does indeed stay below 1. The probability that any random person has the virus will be something like one in a million, and yet that person has to wear a face mask in the shop. Making sure people do this is then as difficult as making sure people were seat belts in their cars, that they don't drink alcohol while driving etc. etc.

Here is a wild thought......perhaps the poor overall response from our elected officials....starts at the voting booth. We are obviously getting the level of competence that we stood for. ie. Fla. Governor who doesn't have the courage to do the right thing to save lives? Or...our President?

Comments for this post are closed