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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.

 

Good-bye America ?

By Shlomo Maital

 

     A terrible leaky social safety net, social and economic inequality, poor schools, a broken divisive political system, a worse-than-awful President (worst in history) – and a pandemic. It has finally caught up to America.  All its problems seem to be converging, at one point in time.  Here is how Bloomberg News sums it up:

¨   In the three months since isolation measures were first imposed in a belated effort to slow the spread of Covid-19, the world’s largest economy has become a basket case. One quarter of small businesses and two-fifths of restaurants have closed. Some 1 in 4 American workers is out of a job.

¨ At least 40 million people have filed for unemployment. And while the virus has devastated almost every economy it’s touched, individual Americans entered the crisis in an especially vulnerable position. The planet’s wealthiest country is renowned for having one of the weakest social safety nets among developed nations. It is home to more than two-fifths of all millionaires but has the highest poverty rate and the widest wealth gap among its peers.

¨ Despite a booming stock market (increasingly disconnected from the reality of everyday people) and robust job growth (largely low-paying service jobs) in recent years, more than 38 million Americans scrape by. The causes of U.S. inequality are well known, but they have jumped to the fore now that the nation is transfixed by disease, recession and outrage. —Josh Petri

  ¨ Racial repression is built into the American economy, Peter Coy writes in Bloomberg Businessweek. Almost two centuries after the U.S. defeated the slave states, the color of money is still white.

¨  Over the past four decades, the cost of policing in the U.S. has almost tripled, from $42.3 billion in 1977 to $114.5 billion in 2017, according to an analysis of U.S. Census Bureau data conducted by the Urban Institute on behalf of Bloomberg Businessweek. That budget is 10 times greater than the Centers for Disease Control and Prevention (which led the Trump administration’s botched response to the pandemic) and 12 times greater than the Environmental Protection Agency ( which has been dismantling environmental protections). Crime, however, has been trending downward since the early 1990s. As protests over police killings of unarmed black people continue, this disconnect is leading to calls to defund law enforcement agencies and instead fund mental health and social services.

¨ Trump’s performance during national upheaval and the pandemic appears to be having a disastrous effect on his reelection bid. Polls show him performing poorly in 2020 battleground states, and one of his campaign’s most recent ads, entitled “Make Space Great Again” violates NASA guidelines.

¨   Americans filed almost 2 million applications for unemployment benefits last week, reflecting a slowing of the torrent of job losses. Trump administration officials say they expect to spend up to $1 trillion in the next round of economic stimulus, though of course that’s up to Congress. Senate Majority Leader Mitch McConnell, who has said Democratic-leaning states crushed by the virus shouldn’t get financial help (despite being the biggest source of those federal dollars), said any new bailout wouldn’t occur until after July 20.

 

Israel’s COVID-19 Success: Smart? Lucky? Or Just …Young?!

By Shlomo Maital

Israel is deemed to have had relative success in controlling the coronavirus pandemic. It has been counted among the ranks of South Korea, Austria and Taiwan, all of which acted rapidly and effectively, and as a result had relatively favorable statistics.

   However, a closer look at the data reveals a different picture.

           Source: Meirav Arlosoroff, The Marker, May 28/2020.    

A study by Prof. Zvi Eckstein, formerly deputy governor of the Bank of Israel, reaches the following conclusion. Israel and Austria had similar rates of infection — about 1,800 cases of COVID-19 per million inhabitants.  

   Israel had significantly lower death rates than the EU average (about 1%, compared with 6.3% for the EU), and lower than Austria, (4%). (See Figure above).

     However, Eckstein notes, Israel has significantly younger populations that EU nations, and than South Korea and Taiwan, owing to a relatively high fertility rate. In addition, the mortality rate from COVID-19 is particularly high among the elderly, over 65 and over 80. In many countries, most of the elderly are in homes for the aged, which have been notorious incubators for the coronavirus in many countries. In Israel, a relatively larger proportion of the elderly live in their own homes or with children. In Israel, as in the US, there have been tragic cases of infection and death in homes for the elderly, but proportionately fewer such homes limited these tragedies.

     So, was Israel smart? Lucky? Or, simply, does it have a younger population, less vulnerable? According to Eckstein, probably the latter. Perhaps this may shorten the very long line of political leaders and officials who would like to take credit.

Why New York Dropped the Ball – Part Two

By Shlomo Maital

In my previous blog, I quoted Charles Duhigg, The New Yorker, who explored why Seattle escaped the “valley of virus death”, largely, while New York City foundered in it. I focused on what Seattle did right. Now, I would like to share with you what New York City did wrong. You guessed it – it has to do with politicians, who feud.

[Special thanks to New Yorker for freely sharing all their great reporting on COVId-19].

And…once again, it is long – 2,500 words. But I think worth reading.

   “The initial coronavirus outbreaks in New York City emerged at roughly the same time as those in Seattle. But the cities’ experiences with the disease have markedly differed. By the second week of April, Washington State had roughly one recorded fatality per fourteen thousand residents. New York’s rate of death was nearly six times higher.

   “There are many explanations for this divergence. New York is denser than Seattle and relies more heavily on public transportation, which forces commuters into close contact. In Seattle, efforts at social distancing may have been aided by local attitudes—newcomers are warned of the Seattle Freeze, which one local columnist compared to the popular girl in high school who “always smiles and says hello” but “doesn’t know your name and doesn’t care to.” New Yorkers are in your face, whether you like it or not. (“Stand back at least six feet, playa,” a sign in the window of a Bronx bodega cautioned. “COVID-19 is some real shit!”) New York also has more poverty and inequality than Seattle, and more international travellers. Moreover, as Mike Famulare, a senior research scientist at the Institute for Disease Modeling, put it to me, “There’s always some element of good luck and bad luck in a pandemic.”

   “It’s also true, however, that the cities’ leaders acted and communicated very differently in the early stages of the pandemic. Seattle’s leaders moved fast to persuade people to stay home and follow the scientists’ advice; New York’s leaders, despite having a highly esteemed public-health department, moved more slowly, offered more muddied messages, and let politicians’ voices dominate.

     “New York’s mayor, Bill de Blasio, has long had a fraught relationship with the city’s Department of Health and Mental Hygiene, which, though technically under his control, seeks to function independently and avoid political fights. “There’s always a bit of a split between the political appointees, whose jobs are to make a mayor look good, and public-health professionals, who sometimes have to make unpopular recommendations,” a former head of the Department of Health told me. “But, with the de Blasio people, that antagonism is ten times worse. They are so much more impossible to work with than other administrations.” In 2015, when Legionnaires’ disease sickened at least a hundred and thirty New Yorkers and killed at least twelve, tensions between de Blasio and the Health Department came to a head. After de Blasio ordered health officials to force their way into buildings in the Bronx to test cooling towers for contamination, even though the outbreak’s source had already been identified, the officials complained that the Mayor was wasting their time in order to brag to reporters that he’d done everything possible to stamp out the disease. When the deputy commissioner for environmental health, Daniel Kass, refused City Hall’s demands, one of the city’s deputy mayors urged the commissioner of health, Mary Bassett, to fire Kass. She ignored the suggestion, but Kass eventually resigned. He later told colleagues he felt that his rebellion had made coöperation with City Hall impossible.

   “Dan Kass is one of the best environmental-health experts in the country,” Bassett, who now teaches at Harvard, said. “New York has one of the best health departments in the United States, possibly the world. We’d all be better off if we were listening really closely to them right now.”

   “In early March, as Dow Constantine was asking Microsoft to close its offices and putting scientists in front of news cameras, de Blasio and New York’s governor, Andrew Cuomo, were giving speeches that deëmphasized the risks of the pandemic, even as the city was announcing its first official cases. De Blasio initially voiced caution, saying that “no one should take the coronavirus situation lightly,” but soon told residents to keep helping the city’s economy. “Go on with your lives + get out on the town despite Coronavirus,” he tweeted on March 2nd—one day after the first COVID-19 diagnosis in New York. He urged people to see a movie at Lincoln Center. On the day that Seattle schools closed, de Blasio said at a press conference that “if you are not sick, if you are not in the vulnerable category, you should be going about your life.” Cuomo, meanwhile, had told reporters that “we should relax.” He said that most infected people would recover with few problems, adding, “We don’t even think it’s going to be as bad as it was in other countries.”

     “De Blasio’s and Cuomo’s instincts are understandable. A political leader’s job, in most situations, is to ease citizens’ fears and buoy the economy. During a pandemic, however, all those imperatives are reversed: a politician’s job is to inflame our paranoia, because waiting until we can see the danger means holding off until it’s too late. The city’s epidemiologists were horrified by the comforting messages that de Blasio and Cuomo kept giving. Jeffrey Shaman, a disease modeller at Columbia, said, “All you had to do was look at the West Coast, and you knew it was coming for us. That’s why Seattle and San Francisco and Portland were shutting things down.” But New York “dithered instead of telling people to stay home.”

   “By early March, the city’s Department of Health had sent the Mayor numerous proposals on fighting the virus’s spread. Since there weren’t enough diagnostic kits to conduct extensive testing, public-health officials proposed “sentinel surveillance”: asking local hospitals to provide the Department of Health with swabs collected from people who had flulike symptoms and had tested negative for influenza. By testing a selection of those swabs, the department could estimate how rapidly and widely the coronavirus was moving through the city. In previous outbreaks, such studies had been tremendously useful in guiding governmental responses—and this spring Los Angeles effectively deployed the strategy, as did Santa Clara County, in California, and the state of Hawaii.

“In New York City, the Health Department began collecting swabs, but the initiative met swift resistance. Under federal health laws, such swabs have to be anonymized for patients who haven’t consented to a coronavirus test. This meant that, even if city officials learned that many people were infected, officials wouldn’t be able to identify, let alone warn, any of them. The Mayor’s office refused to authorize testing the swabs. “They didn’t want to have to say, ‘There are hundreds, maybe thousands, of you who are positive for coronavirus, but we don’t know who,’ ” a Department of Health official told me, adding, “It was a real opportunity to communicate to New Yorkers that this is serious—you have to stay home.” The effort was blocked over fears that it might create a panic, but such alarm might have proved useful. After all, the official told me, panic is pretty effective at getting people to change their behavior. Instead, the Mayor’s office informed the Health Department that the city would sponsor a job fair to find a few new “disease detectives.” That event was held on March 12th, in Long Island City. The Department of Health official said, “We’re in the middle of a catastrophe, and their solution is to make us waste time interviewing and onboarding people!” (The Mayor’s office eventually relented on the sentinel-surveillance samples, and testing began on March 23rd—almost a month after samples were first collected. By then, the outbreak was well under way.)

     “As New York City schools, bars, and restaurants remained open, relations between the Department of Health and City Hall devolved. Health supervisors were “very, very angry,” one official told me. In particular, health officials were furious that de Blasio kept telling New Yorkers to go out and get a test if they suspected they were infected. On March 4th, he tweeted, “If you feel flu-like symptoms (fever, cough and shortness of breath), and recently traveled to an area affected by coronavirus . . . go to your doctor.” This was the opposite of what city health supervisors were advising: people needed to stay inside and call their doctor if they felt sick. Making trips to doctors’ offices or emergency rooms only increased the odds that the virus would spread, and the city’s limited supply of tests needed to be saved for people with life-threatening conditions. De Blasio’s staff, however, had started micromanaging the department’s communications, including on Twitter. Finally, on March 15th, the Department of Health was allowed to post a thread: “If you are sick, STAY HOME. If you do not feel better in 3 to 4 days, consult with your health care provider”; “Testing should only be used for people who need to be hospitalized”; “Everyone in NYC should act as if they have been exposed to coronavirus. . . . New Yorkers who are not sick should also stay home as much as possible.” One City Council member told me that health officials “had been trying to say that publicly for weeks, but this mayor refuses to trust the experts—it’s mind-boggling.”

   “As the city’s scientists offered plans for more aggressive action and provided data showing that time was running out, the Mayor’s staff responded that the health officials were politically naïve. At one point, Dr. Marcelle Layton, the city’s assistant commissioner of communicable diseases, and an E.I.S. alum who is revered by health officials across the nation for her inventiveness and dedication, was ordered to City Hall, in case she was needed to help the Mayor answer questions from the press. She sat on a bench in a hallway for three hours, away from her team, while politicians spoke to the media. (Layton declined interview requests.) At press conferences, Layton and other physicians played minimal roles while de Blasio and Cuomo, longtime rivals, each attempted to take center stage. The two men even began publicly feuding—arguing in the press, and through aides, about who had authority over schools and workplace closures.

   “Eventually, three of the top leaders of the city’s Department of Health met with de Blasio and demanded that he quickly instate social-distancing rules and begin sending clear messages to the public to stay indoors. Layton and a deputy health commissioner, Dr. Demetre Daskalakis, indicated to de Blasio’s staff that if the Mayor didn’t act promptly they would resign. (The next day, Layton’s staff greeted her with applause, and at least one employee offered to give her some money if she had to make good on the ultimatum.) De Blasio was in a corner: he had long positioned himself as a champion of the underclass, and closing schools would disproportionately hurt the poor and vulnerable. What’s more, unions representing health-care workers had threatened that nurses, orderlies, and others might stay home unless there was a plan to provide child care.

     “Nevertheless, de Blasio finally acceded to the health officials’ demands. On March 16th, after a compromise was reached with the health-care unions, city schools were closed, and Cuomo ordered all gyms and similar facilities to shut down. The messaging remained jumbled, however. Right before the gym closure was set to take effect, de Blasio asked his driver to take him to the Y.M.C.A. in Park Slope, near his old home, for a final workout. Even de Blasio’s allies were outraged. A former adviser tweeted, “The mayor’s actions today are inexcusable and reckless.” Another former consultant tweeted that the gym visit was “Pathetic. Self-involved. Inexcusable.”

     “De Blasio and Cuomo kept bickering. On March 17th, de Blasio told residents to “be prepared right now for the possibility of a shelter-in-place order.” The same day, Cuomo told a reporter, “There’s not going to be any ‘you must stay in your house’ rule.” Cuomo’s staff quietly told reporters that de Blasio was acting “psychotic.” Three days later, though, Cuomo announced an executive order putting the state on “pause”—which was essentially indistinguishable from stay-at-home orders issued by cities in Washington State, California, and elsewhere. (A spokesperson for de Blasio said that City Hall’s “messaging changed as the situation and the science changed” and that there was “no dithering.” A spokesperson for Cuomo said that “the Governor communicated clearly the seriousness of this pandemic” and that “the Governor has been laser focused on communicating his actions in a way that doesn’t scare people.”)

   “To a certain extent, de Blasio’s and Cuomo’s tortured delays make sense. Good politicians should worry about poor children missing school just as much as they worry about the threat of an emerging disease. “That’s why E.I.S. training is so important,” Sonja Rasmussen, a former C.D.C. official, told me. In a pandemic, “the old ways of thinking get flipped around.” She added, “You have to make the kinds of choices that, if you aren’t trained for them, are really hard to make. And there’s no time to learn from your mistakes.”

   “Today, New York City has the same social-distancing policies and business-closure rules as Seattle. But because New York’s recommendations came later than Seattle’s—and because communication was less consistent—it took longer to influence how people behaved. According to data collected by Google from cell phones, nearly a quarter of Seattleites were avoiding their workplaces by March 6th. In New York City, another week passed until an equivalent percentage did the same. Tom Frieden, the former C.D.C. director, has estimated that, if New York had started implementing stay-at-home orders ten days earlier than it did, it might have reduced COVID-19 deaths by fifty to eighty per cent. Another former New York City health commissioner told me that “de Blasio was just horrible,” adding, “Maybe it was unintentional, maybe it was his arrogance. But, if you tell people to stay home and then you go to the gym, you can’t really be surprised when people keep going outside.”

   “More than fifteen thousand people in New York are believed to have died from COVID-19. Last week in Washington State, the estimate was fewer than seven hundred people. New Yorkers now hear constant ambulance sirens, which remind them of the invisible viral threat; residents are currently staying home at even higher rates than in Seattle. And de Blasio and Cuomo—even as they continue to squabble over, say, who gets to reopen schools—have become more forceful in their warnings. Rasmussen said, “It seems silly, but all these rules and SOHCOs and telling people again and again to wash their hands—they make a huge difference. That’s why we study it and teach it.” She continued, “It’s really easy, with the best of intentions, to say the wrong thing or send the wrong message. And then more people die.”

 

Why Seattle Saved Lives – and New York City Did Not!

By Shlomo Maital

   In “The Pandemic Protocol”, The New Yorker, By Charles Duhigg, April 26, 2020, the question is asked: Why has Seattle largely escaped the ravages of COVID-19, while New York City has been ravaged?

   The short answer by Duhigg: A bit of luck (a flu test study whose swabs later revealed the widespread presence of COVID-19, and city leadership which listened closely to scientists (Seattle, by the way, is the world capital of epidemiologists).

   Here are the numbers. As of April 27, Seattle (King County) had 5,863 cases of COVID-19, and 408 deaths. As a % of Seattle’s population, 744,955,   that comes to: 0.8 % of the population contracted the virus, and 0.05% of the population died from it.

     For New York City, 160,000 cases have been identified, or over 2% of the population, 8.4 million; there have been 12,287 deaths, or 0.15% of the population.

   Basically, Seattle proportionally has had a third of the COVID-19 cases that New York City has. True – Seattle is less dense than NYC, and has fewer homeless and poor…

   But why? Why did Seattle largely escape? In short: Seattle did its lock down a week or 10 days before New York City did. And those few days were enough to save many many lives. But why did Seattle get this head start?

   Here is the story. Warning: It’s long, 2,300 words. The heroes? Seattle-based scientists – and a little-known King County executive named Dow Constantine. His wisdom and prompt action saved many many lives.   The story by Duhigg is rather long, but worth reading:

   “The first diagnosis of the coronavirus in the United States occurred in mid-January, in a Seattle suburb not far from the hospital where Dr. Francis Riedo, an infectious-disease specialist, works. When he heard the patient’s details—a thirty-five-year-old man had walked into an urgent-care clinic with a cough and a slight fever, and told doctors that he’d just returned from Wuhan, China—Riedo said to himself, “It’s begun.”

   “For more than a week, Riedo had been e-mailing with a group of colleagues who included Seattle’s top doctor for public health and Washington State’s senior health officer, as well as hundreds of epidemiologists from around the country; many of them, like Riedo, had trained at the Centers for Disease Control and Prevention, in Atlanta, in a program known as the Epidemic Intelligence Service. Alumni of the E.I.S. are considered America’s shock troops in combatting disease outbreaks. The program has more than three thousand graduates, and many now work in state and local governments across the country. “It’s kind of like a secret society, but for saving people,” Riedo told me. “If you have a question, or need to understand the local politics somewhere, or need a hand during an outbreak—if you reach out to the E.I.S. network, they’ll drop everything to help.”

   “Riedo is the medical director for infectious disease at EvergreenHealth, a hospital in Kirkland, just east of Seattle. Upon learning of the first domestic diagnosis, he told his staff—from emergency-room nurses to receptionists—that, from then on, everything they said was just as important as what they did. One of the E.I.S.’s core principles is that a pandemic is a communications emergency as much as a medical crisis. Members of the public entering the hospital, Riedo told his staff, must be asked if they had travelled out of the country; if someone had respiratory trouble, staff needed to collect as much information as possible about the patient’s recent interactions with other people, including where they had taken place. You never know, Riedo explained, which chance encounter will shape a catastrophe. There are so many terrifying possibilities in a pandemic; information brings relief.

     “A national shortage of diagnostic kits for the new coronavirus meant that only people who had recently visited China were eligible for testing. Even as EvergreenHealth’s beds began filling with cases of flulike symptoms—including a patient from Life Care, a nursing home two miles away—the hospital’s doctors were unable to test them for the new disease, because none of the sufferers had been to China or been in contact with anyone who had. For nearly a month, as the hospital’s patients complained of aches, fevers, and breathing problems—and exhibited symptoms associated with covid-19, such as “glassy” patches in X-rays of their lungs—none of them were evaluated for the disease. Riedo wanted to start warning people that evidence of an outbreak was growing, but he had only suspicions, not facts.

   “At the end of February, the C.D.C. began allowing the testing of patients with unexplained respiratory-tract infections or “fever and/or symptoms of acute respiratory illness.” Riedo called a friend—an E.I.S. alum at the local department of health. If he sent her swabs from two patients who had needed ventilators but had tested negative for influenza and other common respiratory diseases, would she test them for covid-19? At that point, there had been only sixteen detections of the coronavirus in the U.S., and only the one in Washington State. “I can’t remember why we picked those two patients,” Riedo told me. “I was sure they’d be negative. But we thought it would be good to start collecting data, and it was a way to make sure the testing lab was working.” The health official told him to send the samples to her lab.

   “Riedo remembered that other local researchers had been conducting a project called the Seattle Flu Study. For months, they had collected nasal swabs from volunteers, to better understand how influenza spread through the community. During the previous few weeks, the researchers, in quiet violation of C.D.C. guidance, had jury-rigged a coronavirus test in their lab and had started using it on their samples. They had just found a positive hit: a high-school student in a suburb twenty-eight miles from Seattle, with no recent history of foreign travel and no known interactions with anyone from China. The boy wasn’t seriously ill; if the researchers hadn’t done the test, the infection probably never would have been detected. The genetic sequence of the boy’s virus was unnervingly similar to that of the man with the first known case, even though the researchers couldn’t find any connections between them. The frightening implication was that the coronavirus was already so widespread that contagion was passing invisibly among community members.

   “On February 28th, around the time that Riedo learned of the covid-19 cluster at the Life Care nursing home, the news was also relayed to another E.I.S. alum, Dr. Jeff Duchin, the top public-health physician for Seattle and surrounding King County. To Duchin, the cluster suggested that there was already an area-wide outbreak. He told Dow Constantine, the King County Executive, that it was time to start considering restrictions on public gatherings and telling residents to stay home. This advice struck Constantine as possibly crazy. There were only two dozen covid-19 diagnoses in the entire nation. Life looked normal. How could people be persuaded to stop going to bars, much less to work, just because a handful of old people were sick?

“At that moment, there were no known U.S. coronavirus fatalities. Schools, restaurants, and workplaces were open. Stock markets were near all-time highs. But when Riedo stopped to calculate how many of his hospital employees had been exposed to the coronavirus he had to quit when his list surpassed two hundred people. “If we sent all of those workers home for two weeks, which is what the C.D.C. was recommending, we’d have to shut down the entire hospital,” he told me. He felt like a man who, having casually swatted at a buzzing insect, suddenly realized that he was beneath a beehive.”

   Constantine told me, “Jeff recognized what he was asking for was impractical. He said if we advised social distancing right away there would be zero acceptance. And so the question was: What can we say today so that people will be ready to hear what we need to say tomorrow?” In e-mails and phone calls, the men began playing a game: What was the most extreme advice they could give that people wouldn’t scoff at? Considering what would likely be happening four days from then, what would they regret not having said?

   “Even for public-health professionals, the trade-offs were painful to contemplate. At a meeting of public-health supervisors and E.I.S. officials in Seattle, an analyst became emotional when describing the likely consequences of shutting Seattle’s schools. Thousands of kids relied on schools for breakfast and lunch, or received medicine like insulin from school nurses. If schools closed, some of those students would likely go hungry; others might get sick, or even die. Everyone also knew that, if the city shut down, domestic-violence incidents would rise. And what about the medical providers who would have to stop working, because they had to stay home with young kids? “It was overwhelming,” one E.I.S. official told me. “Every single decision had a million ripples.”

   “Yet the burdens caused by closing the schools could make an enormous difference in curtailing the spread of the virus: all kinds of parents would have to stay home. In 2019, Seattle had closed schools for five days after a series of snowstorms. Afterward, the Seattle Flu Study discovered that traffic in some areas had nearly disappeared, public-transit use had tumbled, and the transmission of influenza had dropped.

   “Constantine thought that announcing school closings was a potent communication strategy for reaching even people who weren’t parents, because it forced the community to see the coronavirus crisis in a different light. “We’re accustomed to schools closing when something really serious happens,” Constantine told me. “It was a way to speed up people’s perceptions—to send a message they could understand.”

     “While the logistics of classroom closures were being worked out, Constantine contacted Brad Smith, the president of Microsoft—which is headquartered in Redmond, east of Seattle—and asked him to consider ordering employees to work from home. “Microsoft is a big deal here,” Constantine told me. “I thought if they told everyone to stay home it could shift how the state was thinking—make the pandemic real.” Microsoft, as a tech company, was poised to switch quickly to remote work, and could demonstrate to other businesses that the transition could occur smoothly. On March 4th, with only twelve known covid-19 fatalities across the nation and no diagnoses among Microsoft workers, the company told employees to stay home if they could. Smith told me, “King County has a strong reputation for excellent public-health experts, and the worst thing we could have done is substitute our judgment for the expertise of people who have devoted their lives to serving the public.” Amazon, which is also headquartered in the area, told many of its local employees to work from home as well. “That’s a hundred thousand people suddenly staying home,” one Seattle resident told me. “From commute traffic alone, you knew something big had happened.”

   “On February 29th, Constantine held a press conference. He had asked Riedo, Duchin, and Kathy Lofy—another E.I.S. alum and the state’s top health officer—to play prominent roles. Duchin spoke first, and it was as if he had prepared his remarks with the Field Epidemiology Manual in hand. “I want to just start by expressing our deep and sincere condolences to the family members and loved ones of the person who died,” he said. He explained what scientists knew and did not know about the coronavirus, and noted, “We’re in the beginning stages of our investigation, and new details and information will emerge over the next days and weeks.” He predicted that “telecommuting” was likely to become mandatory for many residents, and repeated several times an easy-to-remember sohco: “more hand washing, less face touching.” Duchin told me that his words had been chosen carefully: “You have to think about managing the public’s emotions, perceptions, trust. You have to bring them along the path with you.” Since then, Washington State politicians have largely ceded health communications to the scientists, making them unlikely celebrities. “Hey people!! Jeff Duchin is the real deal,” one fan tweeted. A newspaper hailed him as “a bespectacled, calming presence.”

   “Constantine told me that he understands why politicians “want to be front and center and take the credit.” And he noted that Seattle has many of “the same problems here you see in Congress, with the partisanship and toxicity.” But, he said, “everyone, Republicans and Democrats, came together behind one message and agreed to let the scientists take the lead.”

   “By the time Seattle’s schools were formally closed, on March 11th, students and teachers were already abandoning their classrooms. The messaging had worked: parents were voluntarily keeping their kids home. Cell-phone tracking data showed that, in the preceding week, the number of people going to work had dropped by a quarter. Within days, even before Washington’s governor, Jay Inslee, issued official work-from-home orders, almost half of Seattle’s workers were voluntarily staying away from their offices. When bars and restaurants were officially closed, on March 15th, many of them were already empty. Constantine himself had been working from home for a week. He was giving interviews all day, and always underscored to reporters that he was speaking from his bedroom, and that the noises in the background were coming from his children, who were home from school. After he heard that the county’s basketball courts were still being heavily used, he ordered them closed.”

     In Seattle, mainly the scientists spoke, not the politicians. And the politicians listened.

     Seattle should be carefully studied; our understanding has already been illuminated thanks to Duhigg’s fine reporting.  Well done, Duhigg.

     I urge everyone to read the full article in The New Yorker, online.

Six Facts About the Wuhan Coronavirus

 By Shlomo Maital

 

Wuhan coronavirus

   Here are six things you should know about the Wuhan coronavirus, now sowing panic worldwide. (Based in part on Dr. Dan Werb’s New York Times article.) [1]

  1. China is an integral part of the global economy, and its factories supply parts for other countries’ supply chain ecosystems. China’s economy itself is 20% of the world economy – so any negative impact on China’s economy impacts the world directly, at once, and indirectly, over time. I know Israeli hi-tech firms whose products are made in China that have already been hard hit.   The Wuhan virus is teaching the world that ‘globalization’ is a fact and that when the virus bell tolls, it tolls for everyone everywhere.
  2. A key data point is so-called R0 – how many additional people are infected, on average, when one person falls ill with the coronavirus? The answer is, apparently, 1.4 to 2.5.   Is this good or bad? Both. It is higher than SARS (Severe Acute Respiratory Syndrome), whose R0 is only 0.5. It is far lower than measles or polio. And it is just a bit higher than seasonal flu. But the point is, it does spread easily and rapidly.  
  3. Another key data point: How deadly is it? Not very.   About 2% of those who fall ill die from it, mainly from pneumonia and after-effects. Those who die are mostly those whose immune system and general health are poor. And in any event, a lot more people die of seasonal flu than from coronavirus. But don’t forget, that 2% does not really matter. If you can die from it, then the coronavirus sows panic —   we humans are poor at perceiving accurately probabilities, and if something bad CAN happen, then we (rightly) worry that it WILL.
  4. Why did it start in China? Ducks and pigs. Chinese farms raise both. Ducks eat parasites in rice paddies, so they do good. But their “unique biology” makes them repositories for “a vast number of viruses”, while with pigs, various strains of viruses mix together and evolve and mutate into new strains able to infect humans (e.g. swine flu).   Having said that, it appears that the Wuhan coronavirus may have come from bats or other animals, sold in a Wuhan market.
  5. What is coronavirus? Why is it called that? According to Dr. Werb, “The family of coronaviruses (so-called because they resemble glowing crowns) that includes the new Wuhan strain are exceptionally challenging to control. It gets its name from the shape of the virus, like a kind of crown, (corona is ‘crown’ in Latin) or like the circular corona of the sun. Coronaviruses are responsible for the common cold, pneumonia and bronchitis, but the coronavirus family is sprawling and includes deadlier outliers like Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome (MERS), which have fatality rates of up to 15 percent and 35 percent, respectively.”  
  6. Why can’t we just take a pill or a vaccine shot and solve the problem? Why doesn’t the body’s own system of antibodies defeat them?   Viruses in general, and coronaviruses in particular, are really ‘smart’. Here is what I learned about how they foil the immune system.

      “When a virus enters the body, a race begins between responding immune cells and the infecting pathogen. The pathogen replicates and finds a target cell or organ that will allow it to thrive.   So, the effectiveness of a response depends on the immune system winning the race to clear the pathogen before it causes irreversible damage to the body.   Immune cells called “B cells” make antibodies. A pathogen such as a virus is a large molecule with different components, called antigens. When a B cell recognizes an antigen, it is activated and interacts with other immune cells to receive directions. When an “invader” cell attacks, the body’s immune system checks its ‘memory’ to see if it has seen it before. Because memory cells have already undergone quality improvement, they can respond quickly after reinfection to produce a large number of plasma cells secreting high-quality antibody.   Therefore, memory cells can clear the infection much more rapidly than the initial infection. This means the pathogen doesn’t have time to damage the body. However viruses change, mutate and evolve. Flu is highly variable and changes each season, or evolves in ducks and pigs; variations are why we require yearly vaccinations. And with Wuhan coronavirus, which ‘surprised’ the world, no vaccine exists yet, nor will we have one for many months.”         

[Source:  http://theconversation.com/explainer-how-viruses-can-fool-the-immune-system-43707%5D

   So, what is my prediction? Will coronavirus become a global pandemic, like the 1918-19 infuenza epidemic that killed between 20 million and 40 million people, more than in World War I (including my grandfather Israel)? Or will we manage to control it?

   No, it will not become a pandemic. It will slash a few points of global growth. We should learn the main lesson that Wuhan coronavirus comes to teach us. We have created a superb global ecosystem, where nations become wealthy by doing what they do best and selling the result to others, buying from others what THEY do best. This creates an enormous interdependent ecosystem, with major advantages but one big disadvantage – any bad virus that starts in one place spreads rapidly all over, because of millions who travel regularly. Shutting down travel, and trade, is devastating, but at times necessary. And there will be lots of those viruses, because they are very clever, they change, mutate and adapt, and continually surprise us, making off-the-shelf solutions irrelevant and fooling our immune systems regularly.

   We will need a new, efficient, clever and rapid global cooperative mechanism to deal with this new threat. But the current political poison against global cooperation may make this really difficult to attain.  

[1] Dr. Dan Werb, New York Times, Jan. 30/2020, To Understand the Wuhan Coronavirus, Look to the Epidemic Triangle.

Blog entries written by Prof. Shlomo Maital

Shlomo Maital

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