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(Un)Happy Birthday, America – There’s a Hole in your Bucket

By Shlomo Maital

   Happy birthday, America; you are 244 years old today. But it’s an unhappy birthday.   Here is why.

    “New America” is falling behind “Old Europe”. The term Old Europe was used by Secretary of Defense Donald Rumsfeld in January 2003. It was used in scorn. President Trump continues to mock Europe, and even mock even its brilliant German leader Angela Merkel.

     But guess what? Experts believe, as in this New York Times article, that “Europe may bounce back first” (July 3) – long before the US.   But why? America spent relatively far more on relief measures – a staggering $2.7 trillion, or 13% of its GDP!, on economic relief to individuals, firms and states. And more will come soon.

   What went wrong?

   The US spent vast sums on those who did not need it – like big corporations. (Sound Republican to you? Remember the Trump tax cut?). Much money was thrown away through incompetence – thousands of dead people got checks in the mail.   A lot of money went toward unemployment payments – companies laid off people so the government could save them money. So expanding unemployment caused layoffs, rather than prevent them.  America has a terrible leaky bucket – a near-non-existent social safety net. Just when the pandemic really really needed one with no holes in it.

   Europe? Unemployment rose relatively little. The German government reintroduced kurzarbeit– used after the 2008 crisis, in which work hours are shortened and spread around over workers rather than fire or lay off people. Most of Europe simply used its existing safety nets to help those in need, and the safety net expanded nearly automatically. Most people kept their jobs — which means you don’t have to rehire them, something US firms will be hesitant to do.

   In the US, with Trump boasting about 11% unemployment (yes, it’s down from 14%), consumers are highly uncertain about their future. And they are just not spending. With consumption at 70% of GDP, no US recovery is possible without consumer confidence. And it is lacking, especially with an election looming on Nov. 3.  

   America’s bucket is leaky. Somehow it has not managed to create a waterproof bucket for its poor, its ill, its uneducated, its immigrants, etc., in 244 years. So it IS an unhappy birthday.  And the specter of that terrible day in 1619, when the first African slaves landed in America, continues to haunt this troubled nation.

   Now, a strong US leader could look across the ocean and figure out why Europe, old Europe, crusty old Europe, has done so well, and try to copy its social safety net.

   But that would take vision and humility. Those qualities, too, seem to have leaked out of the bucket.

Build Back Better – Toward an Emergence Vision

By Shlomo Maital

   In the US, Israel and other nations, we are seeing a disastrous collapse of leadership. There is no vision regarding the future, and how we are to emerge from the pandemic. Churchill once said, if you’re going through hell – keep going. But where? How? Our leaders shrink into the shadows and fall silent. Let someone else take the blame.

   Here is a blueprint for emergence. Start with a mantra – three words. Build back better. No, we will not go back to the ‘good old days’, they actually weren’t that good, as the virus proved. We will build back – but better.

   How?   We start with a careful audit, by experts. What were the range of social, political, educational and economic failings before the pandemic? Inequality, apathy, ill health, poor schools…   write the entire list.

   Second, strategic plan. How can each of these ills be repaired? And most important, how can we use creativity, with minimal resources, to tackle the problem? Schools can shift to project-based learning – that won’t require huge new resources, kids will thrive.

   The Bible says (Psalms) in Hebrew, without vision, a nation literally falls to pieces:

      . אין חזון יפרע עם    

So  Give us a vision. Build a strategic plan. Tell every part of society where they fit into it and what they must do. Do it bottom up – canvas all of society for ideas. Get people to pull together. Today, in Israel, each interest group – small business, artists, performers – demonstrates on their own, with the guiding principle: the squeakiest wheel gets the most grease. A bad system.

   Crises produce new leaders. I eagerly await the new leaders who will step and bring us their vision – and help us implement it.

University Labs – to the Rescue! Paul Romer’s Plan

By Shlomo Maital

Nobel Laureate Paul Romer, NYU

   I am collecting material on “emergence strategies” – how nations will release citizens from lockdown and isolation, and my sense of doom is growing. In the 1918 influenza pandemic, the second wave killed far far more people than the first, after the first wave subsided and everyone went back to business as usual.

   Muddying the picture further are politicians, who pander to the ignorant and think doing so will get them re-elected. If they are, they will mount the victory podium by stepping on the bodies of hapless victims – a lot of them.

   This is why I believe we should all listen carefully to Nobel Laureate in Economics Paul Romer, NYU, and his plan. (See “Roadmap to Responsibly Reopen America” available at )  The bottom line: Employ university labs to produce COVID-19 tests, at scale — millions of them. It IS do-able!

    Romer writes, in the introduction to his Roadmap: “America is confronting two crises: an economic crisis laying waste to our livelihoods and a health crisis threatening our lives. The twin crises are deeply intertwined: our economy cannot be re-opened without credibly addressing fears of infection and resurgence.   The immediate reaction, a national lockdown, was successful in slowing the virus. We must now shift to a plan that balances the need to protect our health and reopen our economy by locking down only those who are infectious. This paper presents a simple, scalable, and credible solution: introduce a comprehensive “test and isolate” policy, making it safe for Americans to return to work and keeping the infection rate below 5% of the population. Until a vaccine is developed and deployed, the simplest and safest path to this outcome is a national testing strategy that marshals our existing resources to test everyone in the U.S. once every two weeks and isolates all those who test positive. It does not rely on any new technologies, is far less disruptive and costly than our current policy, and will work even in a worst-case scenario. Below is a roadmap to a future in which the American people are confident that their health and our economy’s future are protected against this virus.”

   Here are the main elements of his plan:   1. Expand the pool of testing capacity, mainly by establishing a network of university labs, which DO have the capacity to scale up and test effectively; 2. Find a revenue stream that can be used to find those who are spreading the disease; 3. Starting testing essential workers (e.g. healthcare), and expand to, e.g. grocery clerks; 4. Expand to those who need urgently to return to work. 5. Finally, offer tests to everyone…EVERYone!

    The plan calls for testing every person in the U.S., with essential workers taking priority. Anyone who tested positive would be isolated. Tests would be administered “regularly,” with every two weeks the recommendation. That would mean 25 million tests per day.

In order to get testing to those levels, Romer advocates for removing regulatory barriers and establishing a network of university and national labs.   It would also require substantial funding – about $100 billion altogether, including the costs of infrastructure and training.  Those funds would be issued in block grants to the states. $100 b. is a lot – but a drop in the bucket, compared to the trillions the US is spending now on emergency bailouts.

   Romer notes there are hidden costs in NOT testing widely. Under lockdown, Romer says,”the U.S. economy loses $500 billion per month. Lifting the lockdown without mass testing to ease that fear may only reduce losses by about $100 billion.”

   The US has many Nobel Laureates in Economics. Why not bring them to Washington, put their heads together, and work out a well-considered strategic long-range plan for emergence? Including Romer’s?   The economists now serving in the Trump administration are either Wall St. rapacious capitalists (Mnuchin) or low-level cranks (Kudlow). This does not bode well for the US.

Learn from Spain:

We WILL Err – but how?

By Shlomo Maital

Spain has suffered terribly from the new coronavirus. The numbers tell the tale:

Cases overview








For a nation of 47 million, this is a terrible toll. It is explained in part by Spain’s late start in lockdown, and its Mediterranean open lifestyle, in the cafes and markets, during a warm spring.

   But it seems to have peaked. The number of new cases peaked in Spain, at 8,000, daily, on April 2, and has now declined to about 4,000. So Spain is gradually beginning to emerge from lockdown, to revive the economy, in a planned careful and staged manner.

   I think other countries should watch Spain carefully, talk to Spanish experts, learn about their plan, adapt the plan to their own nations’ needs and nature…and in general, we need a global brainstorming conference. An international Zoom of experts.

     Take Korea. There has been a resurgence, there, a second wave, but not huge, 100 cases. OK – what happened? Is the immunity conferred by having the COVID-19 and recovering from it sufficient to give permanent immunity? Or can a huge dose of the virus come back and attack you again? Let’s find out from Korea.

       How is Singapore handling the ‘track down those who spread it’? We will need to have a system for that, when we (many of us) return to work.

       We should have a website clearing house for things countries have learned, but a credible one, with only vetted proven entries by real experts.

         What do we know about this vicious viral enemy? Can we compile a COVID-19 handbook – here is what we know, and how we know it, and what the source of the data is.

     And regarding emerging from the ‘shelter at home’ lockdown — Trump says this is the most important decision of his life. HIS decision? If I were an American, would I feel reassured in having TRUMP???? make the decision?   When his ‘base’ is calling for the resignation of Fauci, a credible epidemiology expert, who urges caution?

       We will make mistakes and already have. Trump’s January-February fumbling cost many lives. Maybe, it is best to err on the side of caution, as we emerge from lockdown. Let’s study Spain carefully.  

Emerging from Plague: Thinking Ahead

By Shlomo Maital

With many nations still weeks from the ‘apex’ (the peak number of COVID-19 cases), it seems premature to discuss what the press and experts call ‘exit’ strategies – the period AFTER the plague. The word itself is wrongheaded. Exit strategies are what startups do, when they succeed in creating value and need to capture the wealth and return it to their investors and founders. Usually, by acquisition or issuing shares and selling them.

We do not seek an ‘exit’ strategy. We need an ‘emergence’ strategy, when we come out of our tunnels and rabbit holes and resume our regular lives. Words matter. There is no ‘exit’ from COVID-19, because it will remain endemic for a long time. There is ‘emergence’…with great caution.

How best can this be done? How should our governments be planning emergence?

Here are some wise thoughts by Prof. Ron Balicer, a person with whom I’ve worked, Chief Innovation Officer at Israel’s Clalit Health Services (a large HMO) and a member of the Health Ministry’s Epidemic Management Team. His article was published in the daily Haaretz newspaper.

“Mathematical models and past experience show that the spread of infection in communities living in overcrowded conditions can spark a renewed and serious outbreak among all segments of society. From an epidemiological perspective, Israel’s population (as well as, to a large extent, that of the Palestinian Authority) constitutes interconnecting “communicating vessels” with immediate collateral impact.

“In the current setting, the most stable and reliable marker of population-based trends in disease dissemination is the trend in the numbers of severely ill and respirator-aided Covid-19 patients. However, this marker lags behind the real-time spread by several weeks. If we continue to see that this marker is stabilizing – a collective sigh of relief will be heard. In the meantime, we must not wait for absolute certainty before planning the next phase of contending with this crisis and its attendant closure: the exit strategy.

“I propose two preconditions for initiating this strategy:   The first is a significant halt in the exponential rate of the disease spread, and the availability of a substantial number of free beds in intensive care units, which will serve as the buffer and allow a margin of error to prevent a collapse should easing of the lockdown spur a sudden increase in infections.   Let’s use some numbers as an illustration: In the optimistic scenario in which there are up to 100 seriously ill or respirated people in Israel on the eve of Passover, the distance between where we are now and the point of health system insufficiency is 4-5 doublings of the number of people needing artificial respiration. In recent weeks we’ve seen that the doubling time is three days, with faster rates in some localities.

“The second condition required before embarking on that strategy is to obtain a real-time intelligence assessment, detailed and updated, regarding the rates of infection among different communities. This is a precondition for resorting to a rapid intervention vis-a-vis every new patient, as is happening in countries that have managed to successfully curb the epidemic to date.

       “In other words, there needs to be an efficient system of conducting lab tests for Covid-19 among a wide swathe of the population, in order to exercise an effective exit strategy. To that end, Israel is hopefully gaining what will be an exceptional per-capita testing capacity, even in comparison to the advanced countries. The 30,000 daily tests we hope to be able to conduct in a few weeks’ time should be conducted dynamically and judiciously in order to facilitate this intelligence assessment.

“An exit strategy requires a change: a transition from social distancing and full lockdown enforced on the entire population in a sweeping and non-selective manner, to a new status quo. This new routine could be based on three components: a fast and focused effort to locate and tackle infected individuals; a differential and dynamic lockdown policy among targeted communities; and designated policies for allowing recovered immune patients to return to normal life and take a continuously increasing role in sustaining the economy.

“All this needs to be done while adapting the economy to working remotely with strong delivery services, to daily conduct based on social distancing and environmental hygiene in every workplace, and to continued construction of medical infrastructure, with maximal protection of medical teams.

“As part of the new status quo, the older population will remain as isolated “islands” within each community for a longer period, having its physical, emotional and social needs met on a daily basis.

[“There are several components –] The first component involves the efficient and determined tracking down of newly infected people and their rapid removal from the infective pool. This demands a rapid “closing of the circle” capacity. The multi-stage process of locating people suspected of being infected and having them tested for Covid-19, the rapid quarantine of sick people removed from home, an epidemiological investigation and a quick isolation of their contacts – all this must be accomplished with speed and precision. Moreover, it must be done in large numbers of cases and contacts.

For this condition to be met, a combination of capabilities – which at present are suboptimal – must be achieved. These include extensive and carefully thought-out testing of all people who have been in contact with the new cases; the ability to obtain results quickly for those who tested positive, and their removal from their families to hotels or other facilities; both manual and electronic epidemiological investigation, contact tracing and their quarantine; and firm enforcement of social-distancing instructions, among all segments of society.

“The second component is a geographically differential lockdown/quarantine policy, dynamically updated according to the available data. Communities in which there is persistent transmission of the virus, and those with individuals who are particlarly vulnerable, must remain under a stricter lockdown, whereas communities in which transmission has effectively been mitigated can enjoy a continued easing of restrictions.

“The country can be divided into sub-regions. Imagine that one day the radio announces that areas A, B and D can go to work from now on, whereas area C (i.e., Jerusalem or Rahat) is still to be confined to home. On another day, area A might be asked to reinstate a four-week lockdown, in view of ensuing infection. Obviously, such a policy won’t completely prevent “leakage” between areas and communities, but it will significantly head it off, and with the other components in place, this may be sufficient.

“In order to facilitate and supervise such a policy, an ongoing process of real-time intelligence-gathering must be established, including the continual monitoring of self-reported symptoms and continuous screening for infected people, in order to detect potential outbreaks as early as possible.

“The third component: Once serologic blood tests will become largely available, we will be able to conduct mass testing and define a growing number of recovered immune individuals. This group will assume an increasing role in re-operating businesses with few restrictions. Moreover, older people who got sick and recovered could also return to a “new normal” routine.

“In my view, easing of the closure will take place as a continuous, gradual process of experimentation and re-assessment, in cycles of several weeks each. In each cycle, significant restrictions will be lifted, followed by a tense watchful waiting period of several weeks, required to evaluate its impact on the dissemination rates. If the doubling time does not accelerate significantly, and the safety margin of available intensive care beds has not been reduced to the danger level, further easing of measures can be then implemented.”

Blog entries written by Prof. Shlomo Maital

Shlomo Maital