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The FDA Burns

If you think the FDA has been slow at approving new coronavirus tests just look at their process for approving sunscreen products.

EWG: The FDA first began working to update sunscreen regulations more than 40 years ago. In February 2019, the agency at long last issued a proposed set of final rules, but they were never adopted.

According to EWG, the Environmental Working Group, the FDA has been too slow to test old ingredients for safety and too slow to allow new ingredients on the market thus leaving us with sunscreen products which are neither as safe nor as effective as they should be. In particular, Europe has better sunscreen protection than the United States. Here’s EWG:

Americans have fewer choices and notably poorer protection than Europeans do from ultraviolet A rays in their sunscreen options. Although most U.S. sunscreens prevent sunburn effectively when used correctly, they aren’t as good as European sunscreens at preventing the more subtle skin damage produced by lower-energy UVA radiation. UVA rays have less energy and don’t burn the skin, but they can cause the skin to age, suppress the immune system and contribute to the development of melanoma.

…Between 2003 and 2010, sunscreen makers applied for FDA permission to use eight sun-filtering chemicals developed by European companies. Four of these – Tinosorb S, Tinosorb M, Mexoryl SX and Mexoryl XL – appear to be more effective than avobenzone, the most common UVA filter permitted by the FDA. The FDA’s failure to respond to these applications prompted Congress to pass the Sunscreen Innovation Act of 2014 (FDA 2014). This act requires the FDA to review new applications for sunscreen active ingredients within 300 days, but it doesn’t relax the standards companies must meet to prove new ingredients are both safe and effective.

In 2015, the FDA responded that the companies involved had not submitted enough information to prove their chemicals were, in fact, safe and effective for use (FDA 2015). The agency asked for more data, including complete study results, measurements of ingredient levels in people’s blood, and long-term studies on systemic toxicity and potential endocrine system disruption. The FDA has also proposed that all sunscreen ingredients, including those already in use, need to have adequate safety testing data.

Some information the FDA wants, such as complete copies of studies, might be easy for sunscreen makers to produce. But in other cases, the companies could take years to satisfy FDA requests. In the meantime, Americans are being shortchanged.

I first wrote about this issue in 2013 and seven years later, despite Congress passing a law in 2014, the FDA still has not acted.

My rule is very simple. I don’t think the FDA is better than the EMA so if any drug or device is approved in Europe it ought to be available for purchase in the United States with a label saying “Approved by the EMA. Not approved by the FDA.” (By the way, we do have reciprocity type agreements with Canada and New Zealand for food so this would not be unprecedented.)

Hat tip: John Thacker.

Addendum: You should actually get more sun to avoid vitamin D deficiency which is bad for a variety of reasons including, in my estimation, greater susceptibility to COVID.

Shoring Up the Vaccine Supply Chain

Supply chains were hit hard early in the pandemic. Disinfectant couldn’t be produced because of a lack of bottles, tests couldn’t be processed because nasal swabs or PPE wasn’t available, the decline of passenger air traffic hit commercial delivery and so forth. I worry about forthcoming stresses on the vaccine supply chain. Billions of doses of vaccine will be demanded in the next year and a lot will depend on complicated supply lines including cold storage, air traffic, styrofoam, vials, bags, needles and many other inputs. Companies and the awesome team at CEPI (give them all a Nobel prize) are planning for vials and needles and other inputs but there are many non-obvious inputs higher up in the supply chain that also need shoring up.

Shark livers–they make vaccines better! From https://www.dutchsharksociety.org/do-you-have-a-shark-on-your-face/

Writing in Bloomberg, Scott Duke Kominers and I look at some of the odder inputs to vaccines like horseshoe crab blood, shark livers and the vaccinia capping enyzme, VCE. We are actually not too worried about horseshoe crab blood and shark livers as these are used in other industries. Shark livers, for example, are used to produce a lot of cosmetics so we should be able to divert supply as needed. VCE, however, is rarer.

DNA and mRNA vaccine technologies have shown promising results, and two of the leading vaccine contenders, from Pfizer Inc. and Moderna Inc., use mRNA technology. But mRNA has never been used to produce a commercial vaccine for humans, let alone at scale. And scaling these technologies may not be easy. In particular, mRNA degrades rapidly. To prevent this, it must be “capped” by a very rare substance called vaccinia capping enzyme.

Just over 10 pounds of this VCE is enough to produce a hundred million doses of an mRNA vaccine — but the current manufacturing processes for VCE require so much bioreactor capacity that making 10 pounds would cost about $1.4 billion. More important, global bioreactor capacity cannot support production at that level while also producing other vaccines and cancer-fighting drugs.

If we work hard now, we may be able to find more efficient means of producing VCE. Expanding bioreactor production and repurposing bioreactors from existing large-scale industrial applications will also help to lessen the pressure on the supply chains for multiple types of vaccines.

In addition to supply chains per se we also face the problem that companies are not raising prices enough. Ironically, this means that we need more public investment.

Of course, we might think that private companies would have incentives to coordinate supply chains themselves — and to some extent, they are doing so. But many have pledged to keep their vaccine prices close to costs, both out of altruism and because they may fear public backlash (or legal action) if they’re perceived as “price gouging” in the middle of a pandemic. And if companies don’t stand to profit much from Covid-19 vaccines, then they don’t have much incentive to invest in increasing capacity. In short: If prices can’t rise, then the only way to encourage companies to invest more in production is to reduce their costs — and that means we need public investment.

More generally, it’s not too late to be building more vaccine capacity and to repurpose bioreactor capacity from non-GMP sources, perhaps including veterinary and food sources. There are lots of vaccines in development. The science is promising. We need to take action now so that we can deliver on that promise.

Read the whole thing.

Monday assorted links

1. New podcast on (serious) natural philosophy.

2. Laos fact of the day.

3. “Her TikTok account as of August 2020 has over 78 million followers.”  Link here, can you name her?

4. Thread on the basics of herd immunity claims.  And the NYT covers herd immunity.  A very good piece in fact.  Semi-herd immunity says I, or “imperfect immunity” to use the terminology of the article.  And you will note the extreme epistemological conservatism emanating from the mainstream experts interviewed.  Appropriate in some ways, not in others.

5. Was Winky Dink the first interactive TV show?

6. “They promised us driverless cars, and all northern Virginia got was this 15 mph one-route public transit shuttle.

7. WSJ review of new Bruno Macaes book on America.  The predictions of the book are holding up very well so far!

The new quicker, cheaper, supply chain robust saliva test

The FDA has just approved a new and important Covid-19 test:

Wide-spread testing is critical for our control efforts. We simplified the test so that it only costs a couple of dollars for reagents, and we expect that labs will only charge about $10 per sample. If cheap alternatives like SalivaDirect can be implemented across the country, we may finally get a handle on this pandemic, even before a vaccine,” said Grubaugh.

One of the team’s goals was to eliminate the expensive saliva collection tubes that other companies use to preserve the virus for detection. In a separate study led by Wyllie and the team at the Yale School of Public Health, and recently published on medRxiv, they found that SARS-CoV-2 is stable in saliva for prolonged periods at warm temperatures, and that preservatives or specialized tubes are not necessary for collection of saliva.

Of course this part warmed my heart (doubly):

The related research was funded by the NBA, National Basketball Players Association, and a Fast Grant from the Emergent Ventures at the Mercatus Center, George Mason University.

The NBA had the wisdom to use its unique “bubble” to run multiple tests on players at once, to see how reliable the less-known tests would be.  This WSJ article — “Experts say it could be key to increasing the nation’s testing capacity” — has the entire NBA back story.  At an estimated $10 a pop, this could especially be a game-changer for poorer nations.  Furthermore, it has the potential to make pooled testing much easier as well.

Here is an excerpt from the research pre-print:

The critical component of our approach is to use saliva instead of respiratory swabs, which enables non-invasive frequent sampling and reduces the need for trained healthcare professionals during collection. Furthermore, we simplified our diagnostic test by (1) not requiring nucleic acid preservatives at sample collection, (2) replacing nucleic acid extraction with a simple proteinase K and heat treatment step, and (3) testing specimens with a dualplex quantitative reverse transcription PCR (RT-qPCR) assay. We validated SalivaDirect with reagents and instruments from multiple vendors to minimize the risk for supply chain issues. Regardless of our tested combination of reagents and instruments from different vendors, we found that SalivaDirect is highly sensitive with a limit of detection of 6-12 SARS-CoV-2 copies/μL.

No need to worry and fuss about RNA extraction now.  Here is the best simple explanation of the whole thing.

The researchers are not seeking to commercialize their advance, rather they are making it available for the general benefit of mankind.  Here is Nathan Grubaugh on Twitter.  Here is Anne Wyllie, also a Kiwi and a Kevin Garnett fan.  A further implication of course is that the NBA bubble is not “just sports,” but also has boosted innovation by enabling data collection.

All good news of course, and Fast at that.  And this:

“This could be one the first major game changers in fighting the pandemic,” tweeted Andy Slavitt, a former acting administrator of the Centers for Medicare and Medicaid Services in the Obama administration, who expects testing capacity to be expanded significantly. “Rarely am I this enthusiastic… They are turning testing from a bespoke suit to a low-cost commodity.”

And here is coverage from Zach Lowe.  I am very pleased with the course of Fast Grants more generally, and you will be hearing more about it in the future.

Bill Gates is Angry

But people aren’t getting their tests back quickly enough.

Well, that’s just stupidity. The majority of all US tests are completely garbage, wasted. If you don’t care how late the date is and you reimburse at the same level, of course they’re going to take every customer. Because they are making ridiculous money, and it’s mostly rich people that are getting access to that. You have to have the reimbursement system pay a little bit extra for 24 hours, pay the normal fee for 48 hours, and pay nothing [if it isn’t done by then]. And they will fix it overnight.

Gates is correct. If companies were paid for speed they would increase capacity and move immediately to a stack processing (LIFO) model, as I described yesterday.

The whole interview is worth reading. Gates is restrained but you can tell he is angry. Bill has had it with the FDA, Trump, Mark Zukerberg, stupid anti-vaxxers like Robert Kennedy (who he was forced to listen to to get access to Trump), Congress and much more. I don’t blame him one bit. I am angry too.

Stack-Push-Pop COVID Testing

A COVID test that doesn’t come back in a few days is close to useless and PCR tests are taking a long time to process:

NYTimes: Most people who are tested for the virus do not receive results within the 24 to 48 hours recommended by public health experts to effectively stall the virus’s spread and quickly conduct contact tracing, according to a new national survey by researchers from Harvard University, Northeastern University, Northwestern University and Rutgers University….People who had been tested for the virus in July reported an average wait time of about four days. That is about the same wait time for those who reported taking a test in April. Over all, about 10 percent of people reported waiting 10 days or more.

…“A test result that comes back in seven or eight days is worthless for everybody — it shouldn’t even be counted,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security and a physician in Pittsburgh. “It’s not a test in any kind of effective manner because it’s not actionable.”

One seemingly severe but potential solution is to change how tests are processed. Right now it’s mostly first come, first-served but this means we can easily have a situation where everyone eventually gets a test result but all the results are useless because they take a week or more to process. I propose instead that any test that can’t be reported back in 3-4 days be thrown out immediately. Labs should focus only on processing tests that can be reported back quickly.

One way of thinking about this is to use a stack or last-in first-out (LIFO) model for testing. In a stack model the newest test request is pushed onto the top of the stack and the next test to be processed is popped off the top of the stack. One disadvantage of this model is that some test requests will never be processed (they should be removed from the bottom of the stack and returned as null results). Some people will be angry.

But the stack model of testing has a huge advantage over first-come, first-served. Namely, just as many tests will be completed as under the current model but the tests results will all come back faster and be much more useful. What would you rather have, guaranteed stale test results or fresh results with some possibility of a null return? Since a stale result is not much better than a null it seems obvious that the stack system is superior. Most importantly, faster, more useful tests will help to end the crisis by reducing the number of infections.

Addendum: See also my posts Pooled Testing is Super-Beneficial and Frequent, Fast, and Cheap is Better than Sensitive on other methods to improve testing.

The Hawaii bastion has fallen

“We must accept the new reality: The virus is widespread on Oahu,” said Anderson, noting that it’s becoming increasingly difficult for contact tracers to pinpoint the source of infection as the virus grows more and more prevalent.

Hawaii now has seen 2,448 positive cases of coronavirus since state health officials started reporting testing results in March. More than 500 of those cases were reported in the last seven days, and most of them are on Oahu.

Historically, about 1% to 2% of tests conducted in Hawaii have come back with positive COVID-19 results. But in recent days that percentage has crept up close to 5%.

“Any time it gets over 5%, there’s reason for concern,” Anderson said. “Some of the states where they’re having large outbreaks have high rates of over 10%. And, obviously, we don’t want to be there.”

The growing prevalence of COVID-19 in Hawaii could jeopardize the state’s ability to reopen public schools, bring college students back to campus and invite visitors to return to Hawaii, said Hawaii Gov. David Ige.

Here is the full story.  Of course it is much better to have cases now — when superior treatments are available — than back in March or April.  Still, the containment strategies that are supposed to work for the most part…do not in fact work.

Infected versus Infectious

As I said in my post Frequent, Fast, and Cheap is Better than Sensitive we shouldn’t be comparing virus tests head-to-head, as if all tests serve the same purpose. Instead, we should recognize that tests have comparative advantages and a cheap, fast, frequent testing regime can be better in some respects than a slow, infrequent but more sensitive testing regime. Both regimes can be useful when used appropriately and especially when they are used in combination.

Eric Topol has a good graphic.

Image

As Topol also notes:

In order to get this done, we need a reboot at @US_FDA, which currently requires rapid tests to perform like PCR tests. That’s wrong. This is a new diagnostic category for the *infectious* endpoint, requiring new standards and prospective validation.

The FDA has sort-of indicated that they might be open to this.

Much, much too slow, of course. Matching a virus that grows exponentially against a risk-averse, overly-cautious FDA has been a recipe for disaster.

How to restart the baseball season sustainably

You may have read that a number of early games in the season have been cancelled due to many of the players testing positive for Covid-19.  There is talk of the season being unsustainable, but it seems a simple remedy has not yet been tried — dock a player 30 percent of his salary if he tests positive.  That should limit the degree of nightclubbing and carousing, keeping in mind that the already-infected are probably some of the worst offenders and they have been “taken care of.”  Furthermore, the players would have a strong incentive to monitor each other, not wanting to be on the receiving end of an infection from a teammate.

While that arrangement presumably runs counter to the collective bargaining agreement, that agreement can and should be revised if season cancellation is the true alternative.

If need be, the fines can be redistributed to the players who never test positive, thus keeping total compensation constant.

Incentives don’t always work, but if you haven’t even tried them something is amiss.  Do I hear “35 percent”?  “Forty”?  “Thirty-seven percent and three lashes”?

Frequent, Fast, and Cheap is Better than Sensitive

A number of firms have developed cheap, paper-strip tests for coronavirus that report results at-home in about 15 minutes but they have yet to be approved for use by the FDA because the FDA appears to be demanding that all tests reach accuracy levels similar to the PCR test. This is another deadly FDA mistake.

NPR: Highly accurate at-home tests are probably many months away. But Mina argues they could be here sooner if the FDA would not demand that tests for the coronavirus meet really high accuracy standards of 80 percent or better.

A Massachusetts-based startup called E25Bio has developed this sort of rapid test. Founder and Chief Technology Officer Irene Bosch says her firm has field-tested it in hospitals. “What we learned is that the test is able to be very efficient for people who have a lot of virus,” she says.

The PCR tests can discover virus at significantly lower concentration levels than the cheap tests but that extra sensitivity doesn’t matter much in practice. Why not? First, at the lowest levels that the PCR test can detect, the person tested probably isn’t infectious. The cheap test is better at telling whether you are infectious than whether you are infected but the former is what we need to know to open schools and workplaces. Second, the virus grows so quickly that the time period in which the PCR tests outperforms the cheap test is as little as a day or two. Third, the PCR tests are taking days or even a week or more to report which means the results are significantly outdated and less actionable by the time they are reported.

The fundamental issue is this: if a test is cheap and fast we shouldn’t compare it head to head against the PCR test. Instead, we should compare test regimes. A strip test could cost $5 which means you can do one per day for the same price as a PCR test (say $35). Thus, the right comparison is seven cheap tests with one PCR test. So considered a stylized example. If a person gets infected on Sunday and is tested on Sunday then both tests will likely show negative. With the PCR test the infected person then goes to work, infecting other people throughout the week before being the person is tested again next Sunday. With the cheap test the person gets tested again on Monday and again comes up negative and they go to work but probably aren’t infectious. They are then tested again on Tuesday and this time there is enough virus in the person’s system to show positive so on Tuesday the infected person stops going to work and doesn’t infect anyone else. Score one for cheap tests. Now consider what happens if the person gets tested on another day, say Tuesday? In this case, both tests will show positive but the person doesn’t get the results of the PCR test until next Tuesday and so again goes to work and infects other people throughout the week. With the cheap test the infected person learns they are infected and again stops going to work and infecting other people. Score two for cheap tests.

Indeed, when you compare testing regimes it’s hard to come up with a scenario in which infrequent, slow, and expensive but very sensitive is better than frequent, fast, and cheap but less sensitive.

More details in this paper.

Moskos on Surging Crime in NYC

Peter Moskos warns about rising crime in NYC in the NYDaily news.

Violence in New York is up….In the last 28 days (through July 12), compared to last year, shootings have more than tripled (318 vs. 97). Last week was even worse. If the last 28 days become the new normal, 2021 will have more than 4,100 shootings, a level not seen in well over 20 years.

Undoubtedly bail reform, protests, looting, COVID-19, and the release of prisoners because of COVID all play a role, though how much is debate. What’s less known is how the NYPD has been methodically declawed by design.

Years of political advocacy have resulted in the intentional erosion of legal police authority. There is less prosecution. Most miscreant activities have been decriminalized. The city survived and even benefited from many reforms, but now the camel’s back is breaking.

…For many, this is a feature, not a flaw. A new breed of progressive prosecutors has battled to see who can prosecute the least. As a result, arrests in 2019 decreased 35% from 2016. Reducing incarceration is desirable, and New York has been doing so literally for decades without jeopardizing public safety.

More recently, since November, because of bail reform and COVID releases, the number of jailed inmates dropped another 40%. People are coming out of jail, and few are going in. Many applaud this because incarceration disproportionately affects Black and Brown people.

But so does non-enforcement and the rise in violence. In 2018 (the latest year with published data), 95.7% of shooting victims in New York City are Black or Hispanic. Just 4.3% of victims are white or Asian. When violence goes up, more Black and Hispanic people are shot.

A highly speculative version of the immunological dark matter hypothesis

The COVID-19 pandemic is thought to began in Wuhan, China in December 2019. Mobility analysis identified East-Asia and Oceania countries to be highly-exposed to COVID-19 spread, consistent with the earliest spread occurring in these regions. However, here we show that while a strong positive correlation between case-numbers and exposure level could be seen early-on as expected, at later times the infection-level is found to be negatively correlated with exposure-level. Moreover, the infection level is positively correlated with the population size, which is puzzling since it has not reached the level necessary for population-size to affect infection-level through herd immunity. These issues are resolved if a low-virulence Corona-strain (LVS) began spreading earlier in China outside of Wuhan, and later globally, providing immunity from the later appearing high-virulence strain (HVS). Following its spread into Wuhan, cumulative mutations gave rise to the emergence of an HVS, known as SARS-CoV-2, starting the COVID-19 pandemic. We model the co-infection by an LVS and an HVS and show that it can explain the evolution of the COVID-19 pandemic and the non-trivial dependence on the exposure level to China and the population-size in each country. We find that the LVS began its spread a few months before the onset of the HVS and that its spread doubling-time is \sim1.59\pm0.17 times slower than the HVS. Although more slowly spreading, its earlier onset allowed the LVS to spread globally before the emergence of the HVS. In particular, in countries exposed earlier to the LVS and/or having smaller population-size, the LVS could achieve herd-immunity earlier, and quench the later-spread HVS at earlier stages. We find our two-parameter (the spread-rate and the initial onset time of the LVS) can accurately explain the current infection levels (R^2=0.74); p-value (p) of 5.2×10^-13). Furthermore, countries exposed early should have already achieved herd-immunity. We predict that in those countries cumulative infection levels could rise by no more than 2-3 times the current level through local-outbreaks, even in the absence of any containment measures. We suggest several tests and predictions to further verify the double-strain co-infection model and discuss the implications of identifying the LVS.

That is a new paper from Hagai and Ruth Perets, another link here, via Yaakov.

Mood affiliation, the police, and rising crime rates

Had a thought on the discussion of rising crime over the last few months inspired by your MR posts on mood affiliation that I wanted to pass along:

There’s been a bit of discussion lately about increased shootings in major cities in the wake of the George Floyd protests, and the two main narratives trying to explain them have been “protests fueling higher tensions” and “cops backing off and not patrolling as much or doing their jobs”. Interestingly, the latter seems to be based on a model where fewer cops and patrols results in more crime, so you might naively expect people who hold that belief would be more likely to believe that simple defunding and reduction of police presence would lead to more crime generally.

But if you believe that mood affiliation predicts opinions better than factual consistency, then it matters more that the former position sounds like “cops to blame, cops bad”, while the second sounds more like “cops are important, cops good”. And most commentators care more about the correct affect towards the police, rather than consistent models of reality, so you largely have commentators that are pro-defund police, but blame their lack of presence for crime increases, or commentators that are pro-police, think defunding would lead to increases in crime, but are less willing to entertain the idea that recent increases in crime are caused by the choices of officers.

That is from an email by Benjamin Hawley.

Swedish update, and which places need to fear second waves?

Your recent question intrigued me. Do you have any new info/opinions on what’s happening in Sweden? Despite no mask wearing, continued indoor dining (at least judging from recent photos on instagram), their case AND death daily counts are plummeting (looks like an inverse exponential). This would also explain excess deaths returning to normal throughout US. Bizarrely, my cursory reading of Swedish newpapers online did not result in any recent articles discussing the dramatic decline in cases there!

One theory circulating is they achieved herd immunity on the math: 10x true seroprevalence (from CDC tests in US) * 2x true immunity (from Tcell things not measured by antibody tests that I don’t fully understand) * 0.75% reported case penetration * 2x for relatively low tests per capita rate = 30% true immunity (likely much higher in densest areas where spread would be much faster resulting in maybe >70% immunity in Stockholm). This puts them r0 < 1.

The nice thing about this hypothesis is that it’s easily falsifiable. If true immunity rates are 20x reported case load (dropping last 2x factor since test rate higher in US), then Florida should have just gotten to the 1.4% necessary to trigger similar immunity in dense cities and from now on, cases per day should follow an inverse exponential.

This would also explain why NYC has not seen a resurgence despite very similar reopening as SF and LA – they achieved dense herd immunity in May and thus the subsequent decline in reported cases was driven by herd immunity rather than more strict closures or mask compliance, reversing either of those factors now doesn’t reverse immunity. To be clear, I’m not disputing that distancing or mask wearing works – they do. But so does infecting everyone quickly. No value judgements on what’s the better policy decision here, just trying to make a predictive statement.

At least, one can hope!

That is my email from Mayank Gupta.  In my view, some version of this view is looking more true with each passing day.  We also are not seeing second waves in hard-hit northern Italy.  Still, many surprises remain and we should not leap to premature conclusions.

To be clear, I was and still am pro-lockdown (without regrets), pro-mask, pro-testing, and I believe Denmark followed a better path than did Sweden.  Long-term damage (rather than death) still may be a significant risk, and furthermore many parts of the world may be far more vulnerable than the United States.  Still, you need to put all of the moralizing and partisanship aside and ask what we are learning from the new data, and I think Mayank Gupta has put it (probabilistically) very well.  And see this related Atlantic piece, though I would have some quibbles with it.  And here is a bit more commentary on the new T-cell results.

In any case, always be prepared to revise!  I believe that within a month we will have a much better sense of these questions.

Addendum: You will note these hypotheses also significantly raise the probability of much earlier animal-to-human transmission, especially in Southeast Asia.  A very good baseline principle for reasoning is simply “Origins usually go back longer and earlier than what you first might think!”

Second addendum: If you go back to March, leading epidemiologist Michael Osterhalm argued: “We conservatively estimate that this could require 48 million hospitalizations, 96 million cases actually occurring, over 480,000 deaths that can occur over the next four to seven months with this situation.”  Covid-19 has been terrible, and the performance of the executive branch (and many governors) absymal, but do those look like good predictions right now?  (Hospitalizations for instance have yet to hit 250k.)  If not, why not?  How hard have you thought about this question?  (Added note: one correspondent suggests that Osterhalm misspoke and in fact meant 4.8 million hospitalizations — note that still would be off by quite a large margin, almost a factor of twenty.)

Fight the Virus! Please.

One of the most confounding aspects of the pandemic has been Congress’s unwillingness or inability to spend to fight the virus. As I said in the LA Times:

If an invader rained missiles down on cities across the United States killing thousands of people, we would fight back. Yet despite spending trillions on unemployment insurance and relief to deal with the economic consequences of COVID-19, we have spent comparatively little fighting the virus directly.

Economists Steven Berry and Zack Cooper have run the numbers:

By our calculations, less than 8 percent of the trillions in funding that Congress has allocated so far in response to the virus has been for solutions that would shorten or mitigate the virus itself: measures like increasing the supply of PPE, expanding testing, developing treatments, standing up contact tracing, or developing a vaccine. A case in point is the most recent House Covid-19 package. It calls for $3 trillion in spending; less than 3 percent of that total is allocated toward Covid testing. As Congress considers next steps, it’s imperative to shift priorities and direct more funding and effort toward actually ending the pandemic.

Berry and Copper point to the vaccine plan that I am working on as an example of smart spending:

…a group of prominent economists, including Nobel Laureate Michael Kremer, has proposed spending a $70 billion dollar vaccine effort. The proposed expenditure is both much larger than anything proposed by the White House or Congress and also quite cheap compared to the potential benefits.

…[Similarly] Nobel Laureate Paul Romer and the Rockefeller Foundation have each sketched out $100 billion plans to increase testing. We say: Let’s fund both, allocating half the funds directly to states, who can spend to activate the vast capacity of university labs, and also fund Romer’s plan to scale up $10 instant tests for true mass testing. We could create a $50 billion dollar challenge prize that rewards the first 10 firms that develop effective treatments for Covid-19 — $5 billion each. We could fund Scott Gottlieb and Andy Slavitt’s bipartisan $50 billion contact tracing proposal. We could allocate $100 billion to fund the libertarian leaning Mercatus Center’s proposal for advanced purchase contracts to procure massive quantities of PPE.

What makes this all the more confounding is that spending to defeat the virus will more than pay for itself! As I said in my piece in the Washington Post (with Puja Ahluwalia Ohlhaver):

Economists talk about “multipliers” — an injection of spending that causes even larger increases in gross domestic product. Spending on testing, tracing and paid isolation would produce an indisputable and massive multiplier effect.

Who gains by killing the economy and letting people die? Yes, it’s possible to spin some elaborate conspiracy about someone, somewhere benefiting. But in talking with people in Congress the message I hear is not that there’s a secret cabal with a special interest in economic collapse and dying constituents. In a way, the message is worse. Multiple people have told me that things move slowly, no one is stepping up to the plate, leadership is absent. “Who is John Galt?,” they sigh. Ok, they don’t literally say that, but that sigh of resignation is what it feels like in the United States today at the highest levels of government.