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Roadmap for Pandemic Resilience
By Shlomo Maital
Roadmap for Pandemic Resilience: Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society. Danielle Allen et al. Harvard: Edmond J. Safra Center for Ethics, April 20, 2020.
As the world struggles with growing numbers of coronavirus cases, experts are putting their heads together, to try to figure out an effective strategy for pandemic resilience – living with this vicious virus, adapting to it, adjusting to it – and carrying on. This 56 page book provides ten measures for an effective strategy of pandemic resilience in the US. I believe it holds for other nations too. These steps are do-able! It requires:
- Innovation in testing methodologies. (Speed, accuracy, cost are all vital. And scale!)
- A Pandemic Testing Board established by the federal government with strong but narrow powers that has the job of securing the testing supply and the infrastructure necessary for deployment. One agency to do this – not 50 states competing!
- Federal and/or state guidance for state testing programs that accord with due process, civil liberties, equal protection, non-discrimination, and privacy standards. (Let’s have uniform standards for Mississippi, Alabama and New York)
- Readiness frameworks to support local health leaders, mayors, tribal leaders, and other public officials in setting up test administration processes and isolation support resources.
- Organizational innovation at the local level linking cities, counties, and public health districts, with specifics varying from state to state. (Cities, counties and public health districts need to work together seamlessly).
- Federal and state investment in contact tracing personnel, starting with an investment in 100,000 personnel (recommendation from JHU Center for Health Security). (The US has far far fewer such personnel today. Other countries have proved that contact tracing is vital).
- Clear mechanisms and norms of governance and enforcement around the design and use of peer-to-peer warning apps, including maximal privacy protection, availability of open source code for independent and regulatory audit, and prohibitions on the use of any data from these apps for commercial purposes, ideally achieved through preemptive legislation.
- Support for quarantine and isolation in the form of jobs protections and material support for time in quarantine and isolation as well as access to health care.
- An expanded U.S. Public Health Service Corps and Medical (or Health) Reserves Corps (paid service roles), and addition of Health Reserves Corps to the National Guard units of each state. (Harvard’s School of Public Health is in a rundown antiquated building; ever seen the gleaming new business school? Can we get our priorities right here, rather than mopping up the money
- * National Infectious Disease Forecasting Center to modernize disease tracking.
How many of these 10 commonsense ideas are now in place in the US? In your country? In my country. Very very few…..
…And – Another Helpful Drug!
By Shlomo Maital
Why do many COVID-19 sufferers die? A group of researchers at Hadassah Medical Center, Jerusalem, may have found a major cause.
Many COVID-19 patients die when blood clots form and damage key organs. According to the Jerusalem Post: “Hadassah researchers discovered that patients who form fatal blood clots have an increased level of alpha defensin protein in their blood.”
At least 30% of patients with coronavirus develop blood clots that block the flow of blood to their kidneys, heart and brain, as well as the lungs, according to international research.
The research team has discovered what they believe causes coronavirus patients to become seriously ill and even die. They also say they have a way to treat the cause before it’s too late.
According to Jerusalem Post’s Maayan Jaffe-Hoffman, “The Hadassah team studied more than 700 blood samples from 80 patients who were admitted to the medical center during the first peak of the coronavirus outbreak in Israel. The results show that alpha defensin speeds up blood clot formation, which can cause pulmonary embolism, heart attacks and stroke. In addition, when blood clots form in the alveoli, whose function it is to exchange oxygen and carbon dioxide molecules to and from the bloodstream, this can lead to respiratory distress and eventually intubation. [Alveoli are the tiny air sacs at the end of the bronchioles (tiny branches of air tubes in the lungs)]”..
Multiple studies have shown that around 80% of coronavirus patients who are intubated have died, The Hadassah team is en route to a solution: administering the drug colchicine to coronavirus patients. Colchicine is an approved drug used in the prevention and treatment of gout attacks, caused by too much uric acid in the blood.
They have completed testing colchicine on mice and found that it successfully inhibited the release of alpha defensin. Now, they are waiting for the necessary approvals to test it on human coronavirus patients.
The researchers said that clinical trials would look at use of the drug both for severe cases and administering it to patients with mild or moderate symptoms to see if it will help decrease the chances of their developing a severe case of the disease.
Dexamethasone – At Last?
By Shlomo Maital
Two hours ago, the New York Times printed this news story, by Benjamin Mueller:
LONDON — “Scientists at the University of Oxford said on Tuesday that they had identified what they called the first drug proven to reduce coronavirus-related deaths, after a 6,000-patient trial in Britain showed that a low-cost steroid prevented the deaths of some hospitalized patients. The steroid, dexamethasone, a well-known anti-inflammatory drug, appeared to help patients with severe cases of the virus: It reduced deaths by a third in patients receiving ventilation, and by a fifth in patients receiving standard oxygen treatment, the scientists said. They found no benefit from the drug for patients who did not need respiratory support.”
How does it work? Apparently, as a steroid drug, it prevents the body’s immune system from over-reacting and making the patient even more ill. “Experts said it appeared that the steroid tamped down the overactive inflammatory response to the virus in some patients, known as a cytokine storm, rather than inhibiting the virus itself.”
Dexamethasone was first made in 1957 and was approved for medical use in 1961. So it is nearly 60 years old! Dexamethasone is cheap! In the United States, a month of medication typically costs less than US$25. In India, a course of treatment costs about 50 cents US. This is because the drug is now available as a generic. More than a million prescriptions a year are given in the US.
Wealth Inequality: A Bleak Picture
By Shlomo Maital
source: McKinsey Global
Shocking episodes of police violence against African-Americans have again brought the ugly fact of racism in the United States to the fore.
Underlying it, reflecting it, is the equally shocking chronic inequality of median family wealth between white and black. The graph above, from McKinsey, a global consulting company, shows that since 1992, the median white family has wealth from six to ten times greater than the median black family. The graph ends in 2016 – the wealth inequality has doubtless grown under Trump, because of the massive gift of wealth his tax cut gave, to already-wealthy whites.
African-Americans are equally intelligent, equally hard-working (or more so), equally creative. So why can they not accumulate wealth? Is it because they lack opportunities, in schooling, education, employment and political voice? And why are they dying in large numbers, from COVID-19, well beyond their proportion (12-13%) in the population?
The bitter irony between right-wing US cries of Make America Greater (was it ever, since the end of slavery?), and the terrible injustice of inequality, Make America Fairer, is registering, belatedly, on many Americans, as protests continue. Let’s hope enough of them remember this in 140 days exactly, on Tuesday November 3 – the presidential election.
An Antibody “Cocktail” for COVID-19: Bottoms Up!
By Shlomo Maital
In medical research, sometimes old tried-and-true ideas become new.
In HIV AIDS research, researchers tried to find an antibody that would defeat the virus, if injected or consumed by patients. It didn’t work. The virus always found a way. The solution? Cocktails – combinations of antibodies, which taken together the virus could not defeat. And to this day, those who are HIV positive do quite well, relatively, when they regularly take the new ‘cocktail’. One of those drugs is called “Retrovir”. David Ho is generally regarded as the HIV cocktail pioneer, supported by the Rockefeller Foundation.
A similar approach proved effective with the Ebola virus. Late last year it was reported that: “ …a team of scientists demonstrated that a two-antibody cocktail called MBP134 could fully protect nonhuman primates and ferrets against lethal Ebola virus infections.”
Now comes a biotech company called Regeneron, which has embraced the same principle. According to CNN and Peter Sullivan, writing for thehill.com:
Regeneron is testing a cocktail of two antibodies to both treat and prevent the coronavirus, developed using people who have recovered from COVID-19 as well as genetically modified mice. The company did not give a firm timeline for its work, but these antibody cocktails could be ready sooner than a vaccine. A competitor company also working on the idea, Eli Lilly, said its antibody treatment could be as ready as early as September; it started trials earlier this month.
“We have created a unique anti-viral antibody cocktail with the potential both to prevent and treat infection,” Dr. George Yancopoulos, chief scientific officer of Regeneron, said in a statement. The antibody cocktail “could have a major impact on public health by slowing spread of the virus and providing a needed treatment for those already sick — and could be available much sooner than a vaccine.”
We learned from treating HIV AIDS that a two-pronged approach is needed: Develop anti-viral drugs, while you develop anti-viral vaccines. To this day no vaccine for HIV has been found.
This is happening with COVID-19 as well. Drugs and vaccines. Meanwhile, a vast army of hard-working scientists all over the world are collaborating, sharing results, and working day and night, to defeat this wily virus.
They give us reason for much hope.
Feeding the Hungry: What We Learn from the Sikhs
By Shlomo Maital
Can you name the world’s fifth-largest organized religion? I could not. It is the religion of the Sikhs. There are 30 million adherents in the world, including 500,000 in the United States. Most Sikhs are in India.
And we can learn a great deal from them. According to today’s New York Times [1]
“An essential part of Sikhism is langar, the practice of preparing and serving a free meal to promote the Sikh tenet of seva, or selfless service. Anyone, Sikh or not, can visit a gurdwara and partake in langar, with the biggest ones — like the Golden Temple in Amritsar, India — serving more than 100,000 people every day. “
All across the US, as hunger spreads in the wake of the pandemic, Sikhs have mobilized their gundwara, or places of worship, to feed the needy. No special preparations were required – the Sikhs have been doing it for years.
Sikhism is based on the teachings of Guru Nanak, the first Guru and the nine Sikh Gurus that succeeded him. The tenth Guru, Guru Gobind Singh, named the Sikh scripture Guru Granth Sahib as his successor, terminating the line of human Gurus and establishing the scripture as the eternal, religious spiritual guide for Sikhs Guru Nanak taught that living an “active, creative, and practical life” of “truthfulness, fidelity, self-control and purity” is above the metaphysical truth, and that the ideal man is one who “establishes union with God, knows His Will, and carries out that Will.”
Sikhs are feeding anti-racist protestors and, for instance, “Last week, a dozen or so volunteers from the Queens center served 500 portions of matar paneer, rice and rajma, a creamy, comforting dish of red beans stewed with tomatoes, and 1,000 bottles of water and cans of soda to demonstrators in Sunnyside. They also offered dessert: kheer, a sweetened rice pudding. Where we see peaceful protest, we are going,” said Himmat Singh, a coordinator at the World Sikh Parliament, an advocacy group providing volunteers for the Queens Village efforts. “We are looking for justice. We support this.” “
“Since the pandemic began, soup kitchens have had difficulty keeping up with demand. Shuttered schools and even fine-dining restaurants are using their kitchens to prepare and serve hot meals. But few other places are as well positioned to handle the sheer scale of assistance required right now as the gurdwaras. Most have large, well-equipped kitchens, a steady stream of volunteers and no shortage of ingredients, thanks to regular donations from community members. During the last annual Sikh Day Parade in New York, in April 2019, the Queens Village kitchen — which has a walk-in cooler, multiple freezers, 50-liter stockpots and a huge grill that can cook dozens of rotis at once — produced 15,000 meals in a single day.”
“The Sikhs’ biggest challenge isn’t keeping up with demand. It’s letting people know that they’re here — without making a big show of it or proselytizing, which is forbidden.”
As the “build the wall” President continues to spread division and hatred of minorities and immigrants, communities like those of the Sikhs continue to act quietly and effectively, to implement their values. We can learn a lot from them. We can learn and embrace “langar” and “seva”.
Canada has a Sikh Minister of National Defense, Harjit Singh Sajjan, who earlier had a distinguished career in the Canadian Armed Forces. Perhaps one day, Canada will have a Sikh Prime Minister – and the US, a Sikh President.
One day soon, as NYT columnist Tom Friedman observed today, America will have a “minority majority” (that is, the racial minorities, black and brown, will be a majority of the country). Maybe then, as former President George W. Bush once said, America will be “kinder and gentler”.
[1] Priya Krishna, “Protests open paths for Sikhs to serve”, NYT June 11 2020, p. 5
Creative Ideas: Anybody Can!
By Shlomo Maital
Over the years, in teaching Workshops on creativity and innovation, mostly to MBA students and managers, I always began the workshop by asking participants: On a scale of 1 to 10, who thinks they score 9 or 10 on creativity?
Very very few people raised their hands. And the rest of the workshop was devoted to persuading my students that “when it comes to creative ideas: anyone can!” The creative brain is much like our biceps (a muscle) — exercise it and it gets far stronger and more productive.
Confirmation comes from Avery Blank, writing in the June 9 issue of Forbes magazine. Here is her finding:
“People underestimate the originality of their ideas, according to recent research from INSEAD, The Open University of Israel and Technion. People assume that others have the same ideas as them. Like many assumptions, this assumption is often incorrect. The danger of believing in this assumption can stop you from acting, whether that is presenting your idea in a meeting, writing an article on a topic or starting a business venture. Stop thinking that you do not have unique ideas, because you do.”
OK, so – what can we ordinary folks do, to be more creative. Blank proposes three steps:
- Hold on to the idea. If you have an idea, capture it. Your idea might be the key to helping your team pivot in a more successful direction or helping your organization to be more innovative. Don’t dismiss your thoughts.
- Resist the urge to always think more. Some people equate more effort with better. That is, some people believe that thinking more on an idea will make that idea better. While this could be true sometimes, it is not necessarily always the case. There is a lot of creativity at the start of the ideation process. When you are brainstorming, you don’t feel boxed in. You feel more comfortable letting your mind go, thinking about the possibilities and less on the probabilities.
- Now speak up. You could have a unique idea, but no one will know it if you stay silent because you think your idea is not good enough. Research shows that people underestimate their originality. Now that you are aware of this bias, try to overcome it and share your idea.
Blank concludes forcefully: “You have more originality than you think, so don’t discount all your thoughts as uninteresting or commonplace. When you have an idea, capture it. Don’t think that you have to always think on the idea more to make it more original. Finally, just say it. The difference between a person who is seen as having a unique idea and a person who is seen as not having a unique idea can be found in the act of speaking up.”
I believe there is a gender-bias problem with creativity. Women have lots of ideas. But in mixed groups or teams, men often simply do not listen to women, who speak more softly and often lack sharp elbows. These days, we cannot afford to let great ideas go to waste. Let’s listen to the women — look how female heads of state in Taiwan, Finland, Norway, New Zealand and Germany have outdone their male counterparts elsewhere!
p.s. this is my 1,700th blog.
Crude Oil at $190 in 2025? It’s Not Insane
By Shlomo Maital
Recently, at the height of the pandemic panic, the price of crude oil was actually negative. That is: “I’ll pay you to take a barrel of crude.” Why? Demand collapsed, all the storage tanks were full – and shutting down production was exceptionally costly.
Now comes a serious report from investment bankers JP Morgan, “Supercycle on the Horizon.”, published in March. The report states,
“The combination of the supply and demand side dynamics suggests that the global oil market could move into large and sustained deficits past 2022, reaching an extreme 1.7 mbd (million barrels per day) by 2025. Running this scenario through our pricing model suggests these balances would lead to Brent oil prices [the benchmark for crude oil prices] rising steadily from 2022 onwards, averaging around $80/bbl in 2023, $100/bbl in 2024 and $190/bbl in 2025.”
What?? From zero to $190 a barrel? What in the world?
The reasoning is simple. Low prices are slashing development of new oil fields to zero, and forcing some smaller fracking companies out of business. This means that when demand for oil recovers, as it will, the supply will not be able to meet it. Since the demand for oil is price-insensitive — we need gasoline to run our cars, and have to pay whatever it costs — small shortfalls in supply can lead to huge rises in price. We have seen this repeatedly, in 1973, 1979, and later. Now, 1.7 billion barrels per day is a very small shortfall, out of total daily production of 100 million barrels – only 1.7%! But it is enough to let prices soar, moving up a near-vertical supply curve.
Note that JP Morgan is not alone (and even if they were, it is worthwhile to heed what they say – investment bankers’ business is based on a clear-eyed view of the future, because they put their money where their mouths are). Goldman Sachs also thinks the price oil will sore: its “Top Projects 2020” report released in late May said so in writing.
OK, what does this mean for us ordinary folks? Maybe – when you consider replacing your current automobile, think about an all-electric. I intend to. With a charging station in your garage, and with batteries improving all the time, your range on one charge is sufficient for most daily driving. Someone I know who has an all-electric says his gas tank needs refilling (you use gasoline when your electric battery is empty) about once a year.
But, won’t soaring crude oil prices make electricity costly? Probably not. Because overall there is a worldwide glut of natural gas, and it is likely to continue, as more and more countries bring natural gas supplies on line. More and more electricity is being made with natural gas.
Food for thought.
Will the Dollar Be the Next COVID-19 Victim?
By Shlomo Maital
Will the dollar be the next victim of COVID-19? Bloomberg’s Stephen Roach, former Morgan Stanley chair and now a Yale U Professor, thinks it might. Here is why.
Here in short is his argument: “Already stressed by the impact of the Covid-19 pandemic, U.S. living standards are about to be squeezed as never before. At the same time, the world is having serious doubts about the once widely accepted presumption of American exceptionalism. Currencies set the equilibrium between these two forces — domestic economic fundamentals and foreign perceptions of a nation’s strength or weakness. The balance is shifting, and a crash in the dollar could well be in the offing.”
The dollar for 75 years, since 1945, has been a safe haven for investors – a port in a storm, for their money. This may no longer be true. As US deficits mount – so far this fiscal year alone, the federal deficit totals $738 billion, and will likely double, out of a $20 trillion GDP, or a 7% deficit.
Since Americans save very little, US deficits have been funded by, among others, China, which has bought massive amounts of US Treasury bonds in the past. This is highly unlikely to continue, given the toxic atmosphere between Trump and Xi Jinping. So the only way the US will be able to finance its massive deficit spending, will be for the Federal Reserve to buy Treasury bonds, implying an enormous tsunami of cash flowing into the economy. Short-term, this may be OK; but long term, it could well undermine the value of the dollar, as the world becomes awash in them.
The dollar problem predates the pandemic. Roach observes: “The seeds of this problem were sown by a profound shortfall in domestic U.S. savings that was glaringly apparent before the pandemic. In the first quarter of 2020, net national saving, which includes depreciation-adjusted saving of households, businesses and the government sector, fell to 1.4% of national income. This was the lowest reading since late 2011 and one-fifth the average of 7% from 1960 to 2005.”
So – to simplify: If Americans do not save, and if the US government is dissaving, and borrowing like mad – who will lend it the money? Americans? No. Foreigners? Probably not. So if nobody is willing to lend to the US, except the Federal Reserve, the only alternative is to flood the world with cheap dollars. And that may spell doom for the global value of the dollar.
This may be wrong. But it is worth thinking about – one more thing to worry about, because the global economy depends on the dollar as a main key currency.
Don’t Count Too Much on a Vaccine
By Shlomo Maital
Dr. William Haseltine
The Tyee is an independent online Canadian news magazine that primarily covers British Columbia. [Thetyee.ca]. Contributing writer Andrew Nikiforuk writes about a world-leading virologist Dr. William Haseltine, vilified in the past for doubting an AIDS vaccine could be produced (apparently, it can’t), and now sharing doubts about a COVID-19 vaccine. His views are worth heeding…. Warning: This blog is 1,000 words, twice as long as usual!
“William Haseltine: People should regard everyone they meet as infected and act accordingly. ‘That’s the only safe assumption you can make. And don’t assume that if you’ve been infected, you’re protected.’
When William Haseltine told a group of fellow scientists in 1986 that an AIDS vaccine would be unlikely because of the difficult nature of the virus, he was booed off the stage. His colleagues even threw stuff at him. “But we still don’t have a vaccine for AIDS,” he recently told Reuters. “We don’t know for sure that a [COVID-19] vaccine won’t be developed, but I can say with the same conviction — don’t count on it.”
In the last couple of weeks the virologist also has offered some jarring observations on the nature of the coronavirus, self-promotion by drug labs, the hazards of rapid reopenings and our global unpreparedness for what is yet to come.
Here are Haseltine’s eight key observations…
- Beware of those who purvey premature hope.
Haseltine’s years of experience cause him to caution against being manipulated by emotion. A number of firms have been giving “a false impression of progress” on the vaccine front, he worries. Cambridge-based Moderna, for example, made headlines last week with news of a safety trial on just eight healthy individuals for its vaccine. The value of the company’s stock exploded. Although the company said their experimental vaccine raised neutralizing antibodies, it said nothing about levels
- Even a vaccine that works likely won’t solve the pandemic.
Haseltine also wants citizens to appreciate this bit of wisdom: a vaccine will not likely end this pandemic for several reasons.
For starters the most affected population, people over the age of 60, are the most difficult population to develop vaccines for. As the immune system ages, the effectiveness and duration of vaccines wanes with it. “It is very difficult to develop a vaccine for older people,” notes Haseltine.
Second, coronaviruses make difficult vaccine candidates because they produce many proteins that allow them to trick and evade the immune system.
Third, Haseltine doesn’t think an adenovirus-based vaccine such as the one proposed by CanSino Biologics, and now being tested in Halifax, will do the trick either.
- A flattened curve is not a road to victory.
Haseltine also thinks many people aren’t taking the disease seriously enough. The veteran virus fighter compares COVID-19 to polio. It, too, was a cold virus with a nasty bite. One in 200 people infected came down with paralysis and of those 10 to 15 percent died of muscle paralysis. It, too, spread through what white coats call “the oral-fecal route” on people’s hands and contaminated surfaces.
As the world experiments with reopening after the first wave, often without adequate testing, contract tracing and isolation facilities in place, people should regard everyone they meet as infected and act accordingly.
“That’s the only safe assumption you can make,” he said. “And don’t assume that if you’ve been infected, you’re protected.” He advises people not to let down their guard or stop wearing a mask in crowded places until their city and region hasn’t recorded a COVID-19 case for a month.
- ‘Herd immunity’ is a dubious prospect.
Haseltine also thinks you can forget about herd immunity as some kind of saving grace. There is a reason that we all get colds every year and that’s because immunity to the four corona viruses that cause colds doesn’t last long.
“There’s no such thing as herd immunity for this disease. I doubt it will ever exist,” Haseltine said in a Reuters interview, because “people who have had it are getting reinfected.” He thinks Sweden made a bad mistake going for herd immunity, and then cites the nation’s death rate which is higher than any other Scandinavian country.
- We remain woefully unprepared.
The next thing Haseltine wants you to think about is our chronic and ongoing lack of pandemic preparedness. COVID-19 caught the world with its pants down because governments and corporations ignored all the warnings. If you want to know how predictable pandemics can be just watch the film Contagion, says Haseltine.
Nearly 15 years ago the emergence of SARS and then MERS demonstrated that coronaviruses could be an existential threat. Although researchers started work on 20 potential drugs for these coronaviruses, they all got shelved.
“Those drugs lay dusty on the shelves in China, in Singapore, in Hong Kong, in Europe, in the United States, and in the [United Arab] Emirates and Saudi [Arabia] where they were discovered and shown to work in animal models of both SARS and MERS.” The reason: there was no economic model to develop them. Haseltine thinks it is more likely researchers will find a suitable drug treatment for the virus before they develop a safe vaccine.
- Nature is not nearly as controllable as we wish.
The pandemic is also sending people a deep and profound message, says Haseltine. “We are part of Nature. We don’t control Nature. Do we control volcanoes? Do we control hurricanes? Viruses are part of nature and their job is to grow in us,” Haseltine recently told Reuters.
- Much bigger threats loom.
Globalization and human population growth have created pretty good ecosystems for new colonizing viruses. Every day the viral world makes trillions of random mutations and some of these mutations produce viruses that can adapt to human environments better than others. More pandemonium is coming, warns Haseltine.
“It is only a matter of time before a coronavirus that is far more lethal and contagious than this one emerges to ravage the world’s population,” says Haseltine. “When that happens, we will no longer be talking about a global death toll in the ‘mere’ hundreds of thousands.” He also suspects the world is overdue for a deadly influenza outbreak capable of removing one to two billion people from the planet.
- Changes in behavior can save us now. And far more certainly than any vaccine.
Last but not least, we should pay more attention to the most important part of this story: changing human behaviour can stop COVID-19 dead in its tracks.
TIMnovate 