Thursday, March 26, 2020
Face Masks: Much More Than You Wanted to Know
There’s been recent controversy about the use of face masks for protection against coronavirus. Mainstream sources, including the CDC and most of the media say masks are likely useless and not recommended. They’ve recently been challenged, for example by Professor Zeynep Tufekci in the New York Times and by Jim and Elizabeth on Less Wrong. There was also some debate in the comment section here last week, so I promised I’d look into it in more depth.
As far as I can tell, both sides agree on some points.
They agree that N95 respirators, when properly used by trained professionals, help prevent the wearer from getting infected.
They agree that surgical masks help prevent sick people from infecting others. Since many sick people don’t know they are sick, in an ideal world with unlimited mask supplies everyone would wear surgical masks just to prevent themselves from spreading disease.
They also agree that there’s currently a shortage of both surgical masks and respirators, so for altruistic reasons people should avoid hoarding them and give healthcare workers first dibs.
But they disagree on whether surgical masks alone help prevent the wearer from becoming infected, which will be the focus of the rest of this piece.
1. What are the theoretical reasons why surgical masks might or might not work?
Epidemiologists used to sort disease transmission into three categories: contact, droplet, and airborne. Contact means you only get a disease by touching a victim. This could be literally touching them, or a euphemism for very explicit contact like kissing or sex. Droplet means you get a disease when a victim expels disease-laden particles into your face, usually through coughing, sneezing, or talking. Airborne means you get a disease because it floats in the air and you breathe it in. Transmission via “fomites”, objects like doorknobs and tables that a victim has touched and left their germs on, is a bonus transmission route that can accompany any of these other methods.
More recently, scientists have realized that droplet and airborne transmission exist along more of a spectrum. Droplets can stay in the air for more or less time, and spread through more or less volume of space before settling on the ground. The term for this new droplet-airborne spectrum idea is “aerosol transmission”. Diseases with aerosol transmission may be spread primarily through droplets, but can get inhaled along with the air too. This concept is controversial, with different authorities having different opinions over which viruses can be aerosolized. It looks like most people now believe aerosol transmission is real and applicable to conditions like influenza, SARS, and coronavirus.
Surgical masks are loose pieces of fabric placed in front of the mouth and nose. They offer very good protection against outgoing droplets (eg if you sneeze, you won’t infect other people), and offer some protection against incoming droplets (eg if someone else sneezes, it doesn’t go straight into your nose). They’re not airtight, so they offer no protection against airborne disease or the airborne component of aerosol diseases.
Respirators are tight pieces of fabric that form a seal around your mouth and nose. They have various “ratings”; N95 is the most common, and I’ll be using “N95 respirator” and “respirator” interchangably through most of this post even though that’s not quite correct. When used correctly, they theoretically offer protection against incoming and outgoing droplet and airborne diseases; since aerosol diseases are a combination of these, they offer generalized protection against those too. Hospitals hate the new “aerosol transmission” idea, because it means they probably have to switch from easy/cheap/comfortable surgical masks to hard/expensive/uncomfortable respirators for a lot more diseases.
Theory alone tells us surgical masks should not provide complete protection. Coronavirus has aerosol transmission, so it is partly airborne. Since surgical masks cannot prevent inhalation of airborne particles, they shouldn’t offer 100% safety against coronavirus. But theory doesn’t tell us whether they might not offer 99% safety against coronavirus, and that would still be pretty good.
2. Are people who wear surgical masks less likely to get infected during epidemics?
It’s unethical to randomize people to wear vs. not-wear masks during a pandemic, so nobody has done this. Instead we have case-control studies. After the pandemic is over, scientists look at the health care workers who did vs. didn’t get infected, and see whether the infected people were less likely to wear masks. If so, that suggests maybe the masks helped.
This is an especially bad study design, for two reasons. First, it usually suffers recall bias – if someone wore a mask inconsistently, then they’re more likely to summarize this as “didn’t wear masks” if they got infected, and more likely to summarize it as “did wear masks” if they stayed safe. Second, probably some nurses are responsible and do everything right, and other nurses are irresponsible and do everything wrong, and that means that if anything at all helps (eg washing your hands), then it will look like masks working, since the nurses who washed their hands are more likely to have worn masks. Still, these studies are the best we can do.
3M makes about two dozen versions of the N95, for different industrial and medical purposes. Generally they’re constructed from nonwoven materials—infinitesimal plastic strands blown together to form a random thicket that, under a microscope, “is going to look like pickup sticks,” says Nikki McCullough, 3M’s global leader for occupational health and safety. “If you’re a submicron particle, it’s quite the journey through there.” The filters can block invaders as small as 0.3 microns, or about 1/100th the thickness of a human hair. The virus is smaller than that, at about 0.125 microns, but it often travels within larger particles when an infected person coughs or sneezes.
As far as I can tell, both sides agree on some points.
They agree that N95 respirators, when properly used by trained professionals, help prevent the wearer from getting infected.
They agree that surgical masks help prevent sick people from infecting others. Since many sick people don’t know they are sick, in an ideal world with unlimited mask supplies everyone would wear surgical masks just to prevent themselves from spreading disease.They also agree that there’s currently a shortage of both surgical masks and respirators, so for altruistic reasons people should avoid hoarding them and give healthcare workers first dibs.
But they disagree on whether surgical masks alone help prevent the wearer from becoming infected, which will be the focus of the rest of this piece.
1. What are the theoretical reasons why surgical masks might or might not work?
Epidemiologists used to sort disease transmission into three categories: contact, droplet, and airborne. Contact means you only get a disease by touching a victim. This could be literally touching them, or a euphemism for very explicit contact like kissing or sex. Droplet means you get a disease when a victim expels disease-laden particles into your face, usually through coughing, sneezing, or talking. Airborne means you get a disease because it floats in the air and you breathe it in. Transmission via “fomites”, objects like doorknobs and tables that a victim has touched and left their germs on, is a bonus transmission route that can accompany any of these other methods.
More recently, scientists have realized that droplet and airborne transmission exist along more of a spectrum. Droplets can stay in the air for more or less time, and spread through more or less volume of space before settling on the ground. The term for this new droplet-airborne spectrum idea is “aerosol transmission”. Diseases with aerosol transmission may be spread primarily through droplets, but can get inhaled along with the air too. This concept is controversial, with different authorities having different opinions over which viruses can be aerosolized. It looks like most people now believe aerosol transmission is real and applicable to conditions like influenza, SARS, and coronavirus.
Surgical masks are loose pieces of fabric placed in front of the mouth and nose. They offer very good protection against outgoing droplets (eg if you sneeze, you won’t infect other people), and offer some protection against incoming droplets (eg if someone else sneezes, it doesn’t go straight into your nose). They’re not airtight, so they offer no protection against airborne disease or the airborne component of aerosol diseases.
Respirators are tight pieces of fabric that form a seal around your mouth and nose. They have various “ratings”; N95 is the most common, and I’ll be using “N95 respirator” and “respirator” interchangably through most of this post even though that’s not quite correct. When used correctly, they theoretically offer protection against incoming and outgoing droplet and airborne diseases; since aerosol diseases are a combination of these, they offer generalized protection against those too. Hospitals hate the new “aerosol transmission” idea, because it means they probably have to switch from easy/cheap/comfortable surgical masks to hard/expensive/uncomfortable respirators for a lot more diseases.
Theory alone tells us surgical masks should not provide complete protection. Coronavirus has aerosol transmission, so it is partly airborne. Since surgical masks cannot prevent inhalation of airborne particles, they shouldn’t offer 100% safety against coronavirus. But theory doesn’t tell us whether they might not offer 99% safety against coronavirus, and that would still be pretty good.
2. Are people who wear surgical masks less likely to get infected during epidemics?
It’s unethical to randomize people to wear vs. not-wear masks during a pandemic, so nobody has done this. Instead we have case-control studies. After the pandemic is over, scientists look at the health care workers who did vs. didn’t get infected, and see whether the infected people were less likely to wear masks. If so, that suggests maybe the masks helped.
This is an especially bad study design, for two reasons. First, it usually suffers recall bias – if someone wore a mask inconsistently, then they’re more likely to summarize this as “didn’t wear masks” if they got infected, and more likely to summarize it as “did wear masks” if they stayed safe. Second, probably some nurses are responsible and do everything right, and other nurses are irresponsible and do everything wrong, and that means that if anything at all helps (eg washing your hands), then it will look like masks working, since the nurses who washed their hands are more likely to have worn masks. Still, these studies are the best we can do.
by Scott Alexander, Slate Star Codex | Read more:
Image: Jamie Chung, Bloomberg
[ed. See also: How 3M Plans to Make More Than a Billion Masks By End of Year (Bloomberg). Excerpt:
[ed. See also: How 3M Plans to Make More Than a Billion Masks By End of Year (Bloomberg). Excerpt:
The N95 respirator is so named because, worn properly, it blocks at least 95% of airborne particles from entering a wearer’s mouth and nose, while still allowing respiration through the microscopically porous shell. This design protects a person from medical and other hazards; flimsier, looser-fitting surgical masks are intended to prevent the wearer from infecting others with expelled mucus, blood, or spit.
3M makes about two dozen versions of the N95, for different industrial and medical purposes. Generally they’re constructed from nonwoven materials—infinitesimal plastic strands blown together to form a random thicket that, under a microscope, “is going to look like pickup sticks,” says Nikki McCullough, 3M’s global leader for occupational health and safety. “If you’re a submicron particle, it’s quite the journey through there.” The filters can block invaders as small as 0.3 microns, or about 1/100th the thickness of a human hair. The virus is smaller than that, at about 0.125 microns, but it often travels within larger particles when an infected person coughs or sneezes.
Timing is Everything
Why Elizabeth Warren Is Everywhere On Coronavirus Response (HuffPost).
Image: Wikimedia Commons/Gage Skidmore
[ed. Sometimes timing is everything. And I'll link again: Where is Joe? (apparently at home, mostly, taking little jabs at Trump now and then). See also: Warren offers infectious-disease plan amid China outbreak (NY Times) (from January). Yes, January, 2020. Over two months ago. Right now, I'd love to have someone in the White House with a plan that, for instance, went beyond risking millions of deaths just to restart the economy by Easter. And what about everyone else? Where are they? (Bernie excepted, he's been out there every day). Read it and weep: here and here (TNR).]
Wednesday, March 25, 2020
How the Pandemic Will End
[ed. Important.]
Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.
A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. “What if?” became “Now what?”
So, now what? In the late hours of last Wednesday, which now feels like the distant past, I was talking about the pandemic with a pregnant friend who was days away from her due date. We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.
As we’ll see, Gen C’s lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.
“No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,” says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.
As my colleagues Alexis Madrigal and Robinson Meyer have reported, the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,” says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.
The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.
With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.
Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle.
Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”
I. The Next Months
Having fallen behind, it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.
Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one. By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happen—and quickly. (...)
II. The Endgame
Even a perfect response won’t end the pandemic. As long as the virus persists somewhere, there’s a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.
The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.
The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.
It depends, for a start, on making a vaccine. If this were a flu pandemic, that would be easier. The world is experienced at making flu vaccines and does so every year. But there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch. The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.
But it’s also the fastest step among many subsequent slow ones. The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.
“Even if it works, they don’t have an easy way to manufacture it at a massive scale,” said Seth Berkley of Gavi. That’s because Moderna is using a new approach to vaccination. Existing vaccines work by providing the body with inactivated or fragmented viruses, allowing the immune system to prep its defenses ahead of time. By contrast, Moderna’s vaccine comprises a sliver of SARS-CoV-2’s genetic material—its RNA. The idea is that the body can use this sliver to build its own viral fragments, which would then form the basis of the immune system’s preparations. This approach works in animals, but is unproven in humans. By contrast, French scientists are trying to modify the existing measles vaccine using fragments of the new coronavirus. “The advantage of that is that if we needed hundreds of doses tomorrow, a lot of plants in the world know how to do it,” Berkley said. No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.
It’s likely, then, that the new coronavirus will be a lingering part of American life for at least a year, if not much longer. If the current round of social-distancing measures works, the pandemic may ebb enough for things to return to a semblance of normalcy. Offices could fill and bars could bustle. Schools could reopen and friends could reunite. But as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.
Much about the coming years, including the frequency, duration, and timing of social upheavals, depends on two properties of the virus, both of which are currently unknown. First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect. “Much of the world is waiting anxiously to see what—if anything—the summer does to transmission in the Northern Hemisphere,” says Maia Majumder of Harvard Medical School and Boston Children’s Hospital.
Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere in the middle, people who recover from their encounters might be protected for a couple of years. To confirm that, scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.
Scientists can use the periods between those bouts to develop antiviral drugs—although such drugs are rarely panaceas, and come with possible side effects and the risk of resistance. Hospitals can stockpile the necessary supplies. Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll and Ashish Jha recently wrote, “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”
Whether through accumulating herd immunity or the long-awaited arrival of a vaccine, the virus will find spreading explosively more and more difficult. It’s unlikely to disappear entirely. The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,” Kissler says. In this future, COVID-19 may become like the flu is today—a recurring scourge of winter. Perhaps it will eventually become so mundane that even though a vaccine exists, large swaths of Gen C won’t bother getting it, forgetting how dramatically their world was molded by its absence.
Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.
A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. “What if?” became “Now what?”
So, now what? In the late hours of last Wednesday, which now feels like the distant past, I was talking about the pandemic with a pregnant friend who was days away from her due date. We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.
As we’ll see, Gen C’s lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.“No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,” says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.
As my colleagues Alexis Madrigal and Robinson Meyer have reported, the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,” says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.
The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.
With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.
Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle.
Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”
I. The Next Months
Having fallen behind, it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.
Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one. By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happen—and quickly. (...)
II. The Endgame
Even a perfect response won’t end the pandemic. As long as the virus persists somewhere, there’s a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.
The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.
The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.
It depends, for a start, on making a vaccine. If this were a flu pandemic, that would be easier. The world is experienced at making flu vaccines and does so every year. But there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch. The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.
But it’s also the fastest step among many subsequent slow ones. The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.
“Even if it works, they don’t have an easy way to manufacture it at a massive scale,” said Seth Berkley of Gavi. That’s because Moderna is using a new approach to vaccination. Existing vaccines work by providing the body with inactivated or fragmented viruses, allowing the immune system to prep its defenses ahead of time. By contrast, Moderna’s vaccine comprises a sliver of SARS-CoV-2’s genetic material—its RNA. The idea is that the body can use this sliver to build its own viral fragments, which would then form the basis of the immune system’s preparations. This approach works in animals, but is unproven in humans. By contrast, French scientists are trying to modify the existing measles vaccine using fragments of the new coronavirus. “The advantage of that is that if we needed hundreds of doses tomorrow, a lot of plants in the world know how to do it,” Berkley said. No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.
It’s likely, then, that the new coronavirus will be a lingering part of American life for at least a year, if not much longer. If the current round of social-distancing measures works, the pandemic may ebb enough for things to return to a semblance of normalcy. Offices could fill and bars could bustle. Schools could reopen and friends could reunite. But as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.
Much about the coming years, including the frequency, duration, and timing of social upheavals, depends on two properties of the virus, both of which are currently unknown. First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect. “Much of the world is waiting anxiously to see what—if anything—the summer does to transmission in the Northern Hemisphere,” says Maia Majumder of Harvard Medical School and Boston Children’s Hospital.
Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere in the middle, people who recover from their encounters might be protected for a couple of years. To confirm that, scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.
Scientists can use the periods between those bouts to develop antiviral drugs—although such drugs are rarely panaceas, and come with possible side effects and the risk of resistance. Hospitals can stockpile the necessary supplies. Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll and Ashish Jha recently wrote, “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”
Whether through accumulating herd immunity or the long-awaited arrival of a vaccine, the virus will find spreading explosively more and more difficult. It’s unlikely to disappear entirely. The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,” Kissler says. In this future, COVID-19 may become like the flu is today—a recurring scourge of winter. Perhaps it will eventually become so mundane that even though a vaccine exists, large swaths of Gen C won’t bother getting it, forgetting how dramatically their world was molded by its absence.
by Ed Yong, The Atlantic | Read more:
Image: Joan Wong
[ed. See also: The Doctor Who Helped Defeat Smallpox Explains What's Coming (Wired).]
[ed. See also: The Doctor Who Helped Defeat Smallpox Explains What's Coming (Wired).]
Tiger King
“Tiger King” is Netflix comfort food of the highest order: it immerses viewers in a mind-boggling lifestyle and series of scandals, and yet the term “true-crime” doesn’t do justice to its greatness. This is animal-print Shakespeare; a sociological excursion into the minds of eccentric Americans who are addicted to the power that comes from owning tigers, AKA big cats. Theirs is a dramatic, intricate hierarchy, and co-directors Eric Goode and Rebecca Chaiklin study its every facet. “Tiger King,” arriving on Netflix today, includes approximately five different true-crime tales (including arson, a disappearance, and an alleged murder plot), and bundles them into one obsession-ready seven-episode series. It’s the kind of story that’s rife for binging as much as extensive conversations about all the bonkers stuff that unfolds.
To top it off, after watching "Tiger King" you can get lost in the YouTube channel of the doc's main focus Joe Exotic, whose original country ditties ("Here Kitty Kitty") are used to accompany many of the miniseries' major developments. Joe Exotic is, in his own words, “A gay, gun-carrying redneck with a mullet,” and is also the owner of the G.W. Zoo in Oklahoma, where he breeds tigers for his zoos or for other owners, to the horror of animal rights activists. Joe is larger than life and fixated on fame, so much that he creates his own reality show about running the zoo. (The show's producer, Rick Kirkham, encapsulates Joe as “a mythical character living out in the middle of Bumf**k, Oklahoma, who owned 1,200 tigers and lions and bears and monkeys and sh*t.”) A lot of the amazing footage that gives “Tiger King” its big laughs and scope comes from Exotic’s consistent documentation—and a lot of these videos have been on YouTube for years.
But “Tiger King” only starts with Joe Exotic. It branches out to his workers, his two husbands, and also zoo-owning peer Bhagavan “Doc” Antle, who exercises his own god complex at his South Carolina Zoo, and believes that there's nothing sexier to people than a tiger. Then there’s Jeff Lowe, who sneaks cubs into Las Vegas penthouses, among other cons. One tiger owner, Mario Tabraue, was the inspiration for Tony Montana in “Scarface,” and talks about his actual crimes in between footage of tending to his big cats. To give you some perspective on the scandalous figures who populate “Tiger King,” Tabraue only appears for a few minutes.
Each player here has a decades-long love of wild animals, an enigmatic presence in front of a camera, and a cadre of dark secrets. Perhaps no one has more than Carole Baskin, whose popular Big Cat Rescue tiger haven down in Florida is aligned with PETA against Joe and other breeders. As you can imagine, Joe hates her as much as he loves his cats, and his bravado knows no censorship when it comes to disparaging her, threatening to kill her, or trying to convince the world that it was Carole who made her missing ex-husband Don disappear. Part of the hilarious madness of “Tiger King” comes from how Joe and Carole’s shared passion is a life sentence, the two constantly clashing, often in the most petty ways, because they have a wildly different approach to the same dream of tiger preservation.
The aesthetics of this story alone—Americana, tiger memorabilia, guns, bizarre facial hair—are a gold mine for a true-crime story, and many other stories would stay at the surface. But “Tiger King” digs deeper, seeking to explore what kind of person would own big cats, or give their life to someone who does. With nary a weak episode, “Tiger King” establishes rich dynamics of possessiveness, of individual kingdoms that can be destroyed from the inside just as much as the outside. This makes everyone's many back-stabbings all the more vivid, especially as Joe later on has to fight for ownership of his zoo, while balancing his political aspirations.
Take episode two, “Cult of Personality,” which focuses on the control that Joe, Doc, and Carole have over the people in their enterprises. Joe has workers who are given miserable living conditions and are fed with expired meat; Don has a cult of women animal trainers that he grooms from a young age; Carole has volunteers who skip Christmas in order to tend to her big cats. Are these leaders providing a sense of direction to their helpers, or taking advantage of them? “Tiger King” has no answers about this, but it gives everyone a chance to comment on the other, and a full picture is painted in the process. Every key player tries to analyze and rat on somebody else, like whenever Joe talks about Carole’s business, his words then reflecting back on himself. Everyone also clings to overdue karma, and thinks that the police didn't do their job regarding the series' multiple baffling, unsolvable crimes.
To top it off, after watching "Tiger King" you can get lost in the YouTube channel of the doc's main focus Joe Exotic, whose original country ditties ("Here Kitty Kitty") are used to accompany many of the miniseries' major developments. Joe Exotic is, in his own words, “A gay, gun-carrying redneck with a mullet,” and is also the owner of the G.W. Zoo in Oklahoma, where he breeds tigers for his zoos or for other owners, to the horror of animal rights activists. Joe is larger than life and fixated on fame, so much that he creates his own reality show about running the zoo. (The show's producer, Rick Kirkham, encapsulates Joe as “a mythical character living out in the middle of Bumf**k, Oklahoma, who owned 1,200 tigers and lions and bears and monkeys and sh*t.”) A lot of the amazing footage that gives “Tiger King” its big laughs and scope comes from Exotic’s consistent documentation—and a lot of these videos have been on YouTube for years. But “Tiger King” only starts with Joe Exotic. It branches out to his workers, his two husbands, and also zoo-owning peer Bhagavan “Doc” Antle, who exercises his own god complex at his South Carolina Zoo, and believes that there's nothing sexier to people than a tiger. Then there’s Jeff Lowe, who sneaks cubs into Las Vegas penthouses, among other cons. One tiger owner, Mario Tabraue, was the inspiration for Tony Montana in “Scarface,” and talks about his actual crimes in between footage of tending to his big cats. To give you some perspective on the scandalous figures who populate “Tiger King,” Tabraue only appears for a few minutes.
Each player here has a decades-long love of wild animals, an enigmatic presence in front of a camera, and a cadre of dark secrets. Perhaps no one has more than Carole Baskin, whose popular Big Cat Rescue tiger haven down in Florida is aligned with PETA against Joe and other breeders. As you can imagine, Joe hates her as much as he loves his cats, and his bravado knows no censorship when it comes to disparaging her, threatening to kill her, or trying to convince the world that it was Carole who made her missing ex-husband Don disappear. Part of the hilarious madness of “Tiger King” comes from how Joe and Carole’s shared passion is a life sentence, the two constantly clashing, often in the most petty ways, because they have a wildly different approach to the same dream of tiger preservation.
The aesthetics of this story alone—Americana, tiger memorabilia, guns, bizarre facial hair—are a gold mine for a true-crime story, and many other stories would stay at the surface. But “Tiger King” digs deeper, seeking to explore what kind of person would own big cats, or give their life to someone who does. With nary a weak episode, “Tiger King” establishes rich dynamics of possessiveness, of individual kingdoms that can be destroyed from the inside just as much as the outside. This makes everyone's many back-stabbings all the more vivid, especially as Joe later on has to fight for ownership of his zoo, while balancing his political aspirations.
Take episode two, “Cult of Personality,” which focuses on the control that Joe, Doc, and Carole have over the people in their enterprises. Joe has workers who are given miserable living conditions and are fed with expired meat; Don has a cult of women animal trainers that he grooms from a young age; Carole has volunteers who skip Christmas in order to tend to her big cats. Are these leaders providing a sense of direction to their helpers, or taking advantage of them? “Tiger King” has no answers about this, but it gives everyone a chance to comment on the other, and a full picture is painted in the process. Every key player tries to analyze and rat on somebody else, like whenever Joe talks about Carole’s business, his words then reflecting back on himself. Everyone also clings to overdue karma, and thinks that the police didn't do their job regarding the series' multiple baffling, unsolvable crimes.
by Nick Allen, RobertEbert.com | Read more:
Image: Netflix
[ed. See also: Netflix’s Tiger King Is the Only Show Crazier Than the World Outside Right Now (Slate).]
[ed. See also: Netflix’s Tiger King Is the Only Show Crazier Than the World Outside Right Now (Slate).]
Seashells Transform Suburban Bathroom Into Tropical Hideaway
A wicker basket filled with seashells and placed on top of a toilet tank has magically transformed Dale and Paula Watson's suburban bathroom into a serene tropical oasis, sources reported Thursday.
"I can't believe the difference adding those seashells made," said Paula Watson, who had somehow been transported from a beige, run-of-the-mill bathroom to an unforgettable island paradise thousands of miles from the Greater Cleveland area. "Every time I walk in here now it's like, 'Wow, where am I? Cancún?'"
According to household sources, the extraordinary transformation took place at approximately 10:32 a.m., when Watson neatly arranged a handful of seashells inside a round wicker container and looked up to suddenly find herself at a beachside resort where all the troubles of modern life just melted away.
The magical seashells, which are able to conjure up the cool, tropical breeze of a seaside cabana, were personally gathered by the couple during a recent trip to Myrtle Beach.
"It's like our own little island getaway right at home," said Dale Watson, who stood as if surrounded by palm trees and soft white sand beaches in the spot where there had only been a shower mat and curtain before. "I feel like I should be eating grilled mahimahi right now."
"This is the way life should be," Watson added. "Time just slows down in here." (...)
Although delighted with the transformation, Paula Watson said she had plans to improve the 80 square feet of island paradise by adorning the blissful space with vanilla-scented coconut candles, a ceramic clown-fish figurine, and sand-dollar shaped soaps.
"I love our secluded little vacation destination, but we can always spruce it up a little," Watson said. "It would be neat to get a large glass container and fill it with beach sand, a piece of coral, and more seashells."
"It's like bringing the Pacific Ocean to us!" she added.
Watson also admitted she's had her eye on a nautical-themed light-switch-plate cover featuring a seahorse, which would further transform the tropical hideaway into the magnificent kingdom of Atlantis, a stunning underwater realm where dolphins and mermaids dance and play.
This is not the first time that Watson's home has undergone such an incredible metamorphosis. In 2004, a framed painting of two deer instantly turned the family den into a rustic hunting lodge, while in 2005, the corner of the living room became an old English cottage after a porcelain tea set and a vase with dried flowers were added to an end table.
At press time, the tranquility of the secluded tropical getaway had been shattered when Paula Watson walked in on their 16-year-old son, Christopher, masturbating to an old issue of Good Housekeeping.
"I can't believe the difference adding those seashells made," said Paula Watson, who had somehow been transported from a beige, run-of-the-mill bathroom to an unforgettable island paradise thousands of miles from the Greater Cleveland area. "Every time I walk in here now it's like, 'Wow, where am I? Cancún?'"
According to household sources, the extraordinary transformation took place at approximately 10:32 a.m., when Watson neatly arranged a handful of seashells inside a round wicker container and looked up to suddenly find herself at a beachside resort where all the troubles of modern life just melted away.The magical seashells, which are able to conjure up the cool, tropical breeze of a seaside cabana, were personally gathered by the couple during a recent trip to Myrtle Beach.
"It's like our own little island getaway right at home," said Dale Watson, who stood as if surrounded by palm trees and soft white sand beaches in the spot where there had only been a shower mat and curtain before. "I feel like I should be eating grilled mahimahi right now."
"This is the way life should be," Watson added. "Time just slows down in here." (...)
Although delighted with the transformation, Paula Watson said she had plans to improve the 80 square feet of island paradise by adorning the blissful space with vanilla-scented coconut candles, a ceramic clown-fish figurine, and sand-dollar shaped soaps.
"I love our secluded little vacation destination, but we can always spruce it up a little," Watson said. "It would be neat to get a large glass container and fill it with beach sand, a piece of coral, and more seashells."
"It's like bringing the Pacific Ocean to us!" she added.
Watson also admitted she's had her eye on a nautical-themed light-switch-plate cover featuring a seahorse, which would further transform the tropical hideaway into the magnificent kingdom of Atlantis, a stunning underwater realm where dolphins and mermaids dance and play.
This is not the first time that Watson's home has undergone such an incredible metamorphosis. In 2004, a framed painting of two deer instantly turned the family den into a rustic hunting lodge, while in 2005, the corner of the living room became an old English cottage after a porcelain tea set and a vase with dried flowers were added to an end table.
At press time, the tranquility of the secluded tropical getaway had been shattered when Paula Watson walked in on their 16-year-old son, Christopher, masturbating to an old issue of Good Housekeeping.
by The Onion | Read more:
Image: uncredited
Coronavirus Treatment Developed by Gilead Sciences Granted "Rare Disease" Status, Potentially Limiting Affordability
On Monday afternoon, the Food and Drug Administration granted Gilead Sciences “orphan” drug status for its antiviral drug, remdesivir. The designation allows the pharmaceutical company to profit exclusively for seven years from the product, which is one of dozens being tested as a possible treatment for Covid-19, the disease caused by the new coronavirus.
Experts warn that the designation, reserved for treating “rare diseases,” could block supplies of the antiviral medication from generic drug manufacturers and provide a lucrative windfall for Gilead Sciences, which maintains close ties with President Donald Trump’s task force for controlling the coronavirus crisis. Joe Grogan, who serves on the White House coronavirus task force, lobbied for Gilead from 2011 to 2017 on issues including the pricing of pharmaceuticals.
“The Orphan Drug Act is for a rare disease, and this is about as an extreme opposite of a rare disease you can possibly dream up,” said James Love, director of Knowledge Ecology International, a watchdog on pharmaceutical patent abuse.
“They’re talking about potentially half the population of the United States,” said Love, adding that “it’s absurd that this would happen in the middle of an epidemic when everything is in short supply.”
The 1983 Orphan Drug Act gives special inducements to pharmaceutical companies to make products that treat rare diseases. In addition to the seven-year period of market exclusivity, “orphan” status can give companies grants and tax credits of 25 percent of the clinical drug testing cost. The law is reserved for drugs that treat illnesses that affect fewer than 200,000 people in the U.S. But a loophole allows drugs that treat more common illnesses to be classified as orphans if the designation is given before the disease reaches that threshold. As of press time, there were more than 40,000 confirmed cases of Covid-19 in the U.S, and some 366,000 worldwide.
The distinction could severely limit supply of remdesivir by granting Gilead Sciences exclusive protection over the drug and complete control of its price. Other pharmaceutical firms, including India-based pharmaceutical firm Cipla, are reportedly working toward a generic form of remdesivir, but patients in the U.S. could be prevented from buying generics with lower prices now that Gilead Sciences’s drug has been designated an orphan.
Today, Gilead abruptly announced that it would no longer provide emergency access to remdesivir, telling the New York Times that “overwhelming demand” left it unable to process requests for the drug through its compassionate use program. Hours later, the FDA gave the drug orphan status. Almost immediately, Gilead’s stock price shot up. Gilead did not immediately respond to a request for comment. The White House, on behalf of Grogan, declined to comment on the record.
The special orphan designation, which can also be granted to drugs when there is little reasonable expectation that a company will recoup its research costs, was given to remdesivir despite hefty support by the government for the development of the drug.
Gilead Sciences’ remdesivir was developed with at least $79 million in U.S. government funding, according to a paper published last week by KEI.
by Sharon Lerner, Lee Fang, The Intercept | Read more:
Image: David Paul Morris/Bloomberg via Getty Images
Experts warn that the designation, reserved for treating “rare diseases,” could block supplies of the antiviral medication from generic drug manufacturers and provide a lucrative windfall for Gilead Sciences, which maintains close ties with President Donald Trump’s task force for controlling the coronavirus crisis. Joe Grogan, who serves on the White House coronavirus task force, lobbied for Gilead from 2011 to 2017 on issues including the pricing of pharmaceuticals.
“The Orphan Drug Act is for a rare disease, and this is about as an extreme opposite of a rare disease you can possibly dream up,” said James Love, director of Knowledge Ecology International, a watchdog on pharmaceutical patent abuse.“They’re talking about potentially half the population of the United States,” said Love, adding that “it’s absurd that this would happen in the middle of an epidemic when everything is in short supply.”
The 1983 Orphan Drug Act gives special inducements to pharmaceutical companies to make products that treat rare diseases. In addition to the seven-year period of market exclusivity, “orphan” status can give companies grants and tax credits of 25 percent of the clinical drug testing cost. The law is reserved for drugs that treat illnesses that affect fewer than 200,000 people in the U.S. But a loophole allows drugs that treat more common illnesses to be classified as orphans if the designation is given before the disease reaches that threshold. As of press time, there were more than 40,000 confirmed cases of Covid-19 in the U.S, and some 366,000 worldwide.
The distinction could severely limit supply of remdesivir by granting Gilead Sciences exclusive protection over the drug and complete control of its price. Other pharmaceutical firms, including India-based pharmaceutical firm Cipla, are reportedly working toward a generic form of remdesivir, but patients in the U.S. could be prevented from buying generics with lower prices now that Gilead Sciences’s drug has been designated an orphan.
Today, Gilead abruptly announced that it would no longer provide emergency access to remdesivir, telling the New York Times that “overwhelming demand” left it unable to process requests for the drug through its compassionate use program. Hours later, the FDA gave the drug orphan status. Almost immediately, Gilead’s stock price shot up. Gilead did not immediately respond to a request for comment. The White House, on behalf of Grogan, declined to comment on the record.
The special orphan designation, which can also be granted to drugs when there is little reasonable expectation that a company will recoup its research costs, was given to remdesivir despite hefty support by the government for the development of the drug.
Gilead Sciences’ remdesivir was developed with at least $79 million in U.S. government funding, according to a paper published last week by KEI.
by Sharon Lerner, Lee Fang, The Intercept | Read more:
Image: David Paul Morris/Bloomberg via Getty Images
[ed. See also: ‘This Is a Massive Scandal’: Trump FDA Grants Drug Company Exclusive Claim on Promising Coronavirus Drug (Naked Capitalism).]
Insuring the Survival of Post-Pandemic Economies
Lockdowns of entire cities. Panic in financial markets. Bare store shelves. Shortages of hospital beds. The world has entered a reality unknown outside wartime.
Alarmingly, a growing chorus in the US – including President Donald Trump – is assuming that newly passed "stimulus" legislation will allow the COVID-19 lockdown to be eased as soon as Easter. In fact, the pandemic demands not only vast government spending but also intervention, including a temporary state-led reorganization of the entire economy.
By mandating that people isolate themselves at home, policymakers hope to slow, and then reverse, the rate at which COVID-19 is spreading. But a lockdown alone, or a burst of money creation, will not stop the pandemic or save our economies. The $2 trillion economic-rescue package just adopted by the United States is a case in point. The US needs government spending on the scale that it envisions, but it also needs government intervention to address a deepening public-health crisis. As such, many of the “stimulus” bill’s provisions appear misguided, some woefully so. Others move in the right direction, but are too piecemeal. (...)
The systemic insurance that is needed demands a government-led effort in four main areas:
Alarmingly, a growing chorus in the US – including President Donald Trump – is assuming that newly passed "stimulus" legislation will allow the COVID-19 lockdown to be eased as soon as Easter. In fact, the pandemic demands not only vast government spending but also intervention, including a temporary state-led reorganization of the entire economy.
By mandating that people isolate themselves at home, policymakers hope to slow, and then reverse, the rate at which COVID-19 is spreading. But a lockdown alone, or a burst of money creation, will not stop the pandemic or save our economies. The $2 trillion economic-rescue package just adopted by the United States is a case in point. The US needs government spending on the scale that it envisions, but it also needs government intervention to address a deepening public-health crisis. As such, many of the “stimulus” bill’s provisions appear misguided, some woefully so. Others move in the right direction, but are too piecemeal. (...)The systemic insurance that is needed demands a government-led effort in four main areas:
- Redirecting the economy’s existing productive capacity to overcome the rapidly growing shortages of equipment and services required to respond effectively to the pandemic.
- Supporting firms that are not directly involved in efforts to combat the crisis, so that they can continue to supply essential goods and services.
- Ensuring that the population has sufficient means to purchase these goods and services.
- Creating a financial facility to help those unable to pay their mortgage and meet other obligations, thereby mitigating cataclysmic risks to the financial sector.
Such systemic insurance goes well beyond current proposals to spend trillions of dollars, much of which is earmarked for policy initiatives that misdiagnose the crisis as one of deficient aggregate demand or as the result of an ordinary supply shock. Moreover, substantial sums are being dedicated to bailouts without explicitly conditioning the money on a firm’s participation in the effort to combat the health crisis and its economic consequences.
So, as officials around the world consider large outlays to combat the COVID-19 crisis, the most immediate questions that we face are whether the policies currently under consideration provide sufficient insurance against the systemic risks that are now mushrooming. The criteria are straightforward:
Policies aiming to stimulate employment, such as the cuts in corporate or payroll taxes advocated by US Senate Republicans, certainly won’t help combat the pandemic and its consequences for the supply of goods and services. Employees who are sick or apt to be sick, and thus a hazard to others, cannot be relied upon to maintain the production of goods and services.
What is now painfully clear is that there is a supply shortage of an unprecedented type: medical equipment and facilities. And it is equally clear that the policies under consideration in the US, which mostly rely on voluntary repurposing of existing manufacturing capacity, are woefully inadequate to close the growing gap.
Re-equipping factories to produce ventilators for patients and personal protective equipment (PPE) for medical personnel, for example, takes time. So these measures must be scaled up without delay. Moreover, such retooling requires substantial financial outlays, which are hard to make in a collapsing economy.
In order to repurpose existing capacity, the government should condition support for any private firm on the firm’s commitment to producing vital equipment (specified by a body of medical experts) and meet its payroll at reasonable wages. To avoid price-gouging, medical supplies must be priced at pre-crisis levels.
This conditionality should not only apply to firms producing equipment. The systemic insurance approach to allocating taxpayer funds would require that large service-sector companies such as airlines or hotel chains receive bailouts only if they repurpose their capacity to support the fight against the pandemic. Rather than standing idle waiting for passenger travel to resume, airlines should be provided funds to re-equip their airplanes to transport medical supplies and equipment, or to move sick patients to locations with the capacity to care for them. Similarly, hotel chains should be supported by the government only if they agree to repurpose their hotels to serve as temporary hospitals. (...)
But such a reorganization of our economies poses more than operational difficulties, especially in the US, where government has historically strictly limited its direct intervention in productive activities. Although governments’ intervention in modern economies takes many forms, ingrained ideas about the balance between the state and the market are even now impeding an adequate response to this crisis.
by Roman Frydman and Edmund S. Phelps, Project Syndicate | Read more:
Image: Getty
[ed. Indeed. So far it appears government policy and intervention efforts have mostly been about incentivizing business and consumer behavior rather than requiring that all possible resources be mobilized to target specific problem areas (lack of medical tests and equipment, quarantine facilities, medical personnel, supply chains, research, etc.), ie. trying to maintain a business as usual economy when the economy is anything but usual, and with health directives working in the opposite direction. See also: How the World’s Richest Country Ran Out of a 75-Cent Face Mask (NY Times); and Trump Resists Using Wartime Law To Get, Distribute Coronavirus Supplies (NPR).]
So, as officials around the world consider large outlays to combat the COVID-19 crisis, the most immediate questions that we face are whether the policies currently under consideration provide sufficient insurance against the systemic risks that are now mushrooming. The criteria are straightforward:
- Is government spending sufficiently laser-focused on overcoming the public-health crisis?
- Is the economic rescue package adequate to sustain the population’s wellbeing?
Policies aiming to stimulate employment, such as the cuts in corporate or payroll taxes advocated by US Senate Republicans, certainly won’t help combat the pandemic and its consequences for the supply of goods and services. Employees who are sick or apt to be sick, and thus a hazard to others, cannot be relied upon to maintain the production of goods and services.
What is now painfully clear is that there is a supply shortage of an unprecedented type: medical equipment and facilities. And it is equally clear that the policies under consideration in the US, which mostly rely on voluntary repurposing of existing manufacturing capacity, are woefully inadequate to close the growing gap.
Re-equipping factories to produce ventilators for patients and personal protective equipment (PPE) for medical personnel, for example, takes time. So these measures must be scaled up without delay. Moreover, such retooling requires substantial financial outlays, which are hard to make in a collapsing economy.
In order to repurpose existing capacity, the government should condition support for any private firm on the firm’s commitment to producing vital equipment (specified by a body of medical experts) and meet its payroll at reasonable wages. To avoid price-gouging, medical supplies must be priced at pre-crisis levels.
This conditionality should not only apply to firms producing equipment. The systemic insurance approach to allocating taxpayer funds would require that large service-sector companies such as airlines or hotel chains receive bailouts only if they repurpose their capacity to support the fight against the pandemic. Rather than standing idle waiting for passenger travel to resume, airlines should be provided funds to re-equip their airplanes to transport medical supplies and equipment, or to move sick patients to locations with the capacity to care for them. Similarly, hotel chains should be supported by the government only if they agree to repurpose their hotels to serve as temporary hospitals. (...)
But such a reorganization of our economies poses more than operational difficulties, especially in the US, where government has historically strictly limited its direct intervention in productive activities. Although governments’ intervention in modern economies takes many forms, ingrained ideas about the balance between the state and the market are even now impeding an adequate response to this crisis.
by Roman Frydman and Edmund S. Phelps, Project Syndicate | Read more:
Image: Getty
[ed. Indeed. So far it appears government policy and intervention efforts have mostly been about incentivizing business and consumer behavior rather than requiring that all possible resources be mobilized to target specific problem areas (lack of medical tests and equipment, quarantine facilities, medical personnel, supply chains, research, etc.), ie. trying to maintain a business as usual economy when the economy is anything but usual, and with health directives working in the opposite direction. See also: How the World’s Richest Country Ran Out of a 75-Cent Face Mask (NY Times); and Trump Resists Using Wartime Law To Get, Distribute Coronavirus Supplies (NPR).]
Tuesday, March 24, 2020
COVID-19: Protecting Health-Care Workers
Worldwide, as millions of people stay at home to minimise transmission of severe acute respiratory syndrome coronavirus 2, health-care workers prepare to do the exact opposite. They will go to clinics and hospitals, putting themselves at high risk from COVID-2019. Figures from China's National Health Commission show that more than 3300 health-care workers have been infected as of early March and, according to local media, by the end of February at least 22 had died. In Italy, 20% of responding health-care workers were infected, and some have died. Reports from medical staff describe physical and mental exhaustion, the torment of difficult triage decisions, and the pain of losing patients and colleagues, all in addition to the infection risk.
As the pandemic accelerates, access to personal protective equipment (PPE) for health workers is a key concern. Medical staff are prioritised in many countries, but PPE shortages have been described in the most affected facilities. Some medical staff are waiting for equipment while already seeing patients who may be infected or are supplied with equipment that might not meet requirements. Alongside concerns for their personal safety, health-care workers are anxious about passing the infection to their families. Health-care workers who care for elderly parents or young children will be drastically affected by school closures, social distancing policies, and disruption in the availability of food and other essentials.
Health-care systems globally could be operating at more than maximum capacity for many months. But health-care workers, unlike ventilators or wards, cannot be urgently manufactured or run at 100% occupancy for long periods. It is vital that governments see workers not simply as pawns to be deployed, but as human individuals. In the global response, the safety of health-care workers must be ensured. Adequate provision of PPE is just the first step; other practical measures must be considered, including cancelling non-essential events to prioritise resources; provision of food, rest, and family support; and psychological support. Presently, health-care workers are every country's most valuable resource.
As the pandemic accelerates, access to personal protective equipment (PPE) for health workers is a key concern. Medical staff are prioritised in many countries, but PPE shortages have been described in the most affected facilities. Some medical staff are waiting for equipment while already seeing patients who may be infected or are supplied with equipment that might not meet requirements. Alongside concerns for their personal safety, health-care workers are anxious about passing the infection to their families. Health-care workers who care for elderly parents or young children will be drastically affected by school closures, social distancing policies, and disruption in the availability of food and other essentials.Health-care systems globally could be operating at more than maximum capacity for many months. But health-care workers, unlike ventilators or wards, cannot be urgently manufactured or run at 100% occupancy for long periods. It is vital that governments see workers not simply as pawns to be deployed, but as human individuals. In the global response, the safety of health-care workers must be ensured. Adequate provision of PPE is just the first step; other practical measures must be considered, including cancelling non-essential events to prioritise resources; provision of food, rest, and family support; and psychological support. Presently, health-care workers are every country's most valuable resource.
by The Lancet | Read more:
Image: Denis Lovrovic/AFP/Getty Images
[ed. Thank a healthcare worker. They are the heros on the frontlines of this pandemic. I saw tonight that some cities were providing personal transportation for nurses, increased salaries, childcare, food security and other measures that will allow them to focus on what they're doing without becoming agents of infection themselves (imagine having to travel in a bus with hundreds of other people every day just to get to work). See also: A Lockdown Can Only Be a Strategic Pause (The Wire).]
Monday, March 23, 2020
Professors, Don’t Be Scared. Teaching Online Is Great.
When I was invited to teach an online reporting class for New York University’s online master’s in journalism program last fall, I had a few concerns. Though I’d taught in university classrooms before, I had no experience teaching online. This was the cornerstone class for a new, online-only program with 21 students logging in live from all over the world for three hours at a time. How would I connect with them, lead class discussion, and facilitate collaboration? How would I handle office hours without an office?
I’ve been thinking about that experience as a number of universities—the University of Washington, the University of Southern California, Harvard, Ohio State, and many more—have announced that they will be moving to online instruction to avoid the spread of COVID-19. Across the country, instructors who, like me, struggle with turning on the class projector will need to jump in and quickly master the much-needed skill of online teaching.
Twitter is full of critics as classes move online. As one tweeted: “These teachers really think these online classes gonna work? Half the time they not even tech savvy enough to log into their gmails.”
But teaching online wasn’t that different from the classroom experience I was accustomed to. It was often more fun than standing at a lectern working through a well-worn set of PowerPoint slides. The trick was making it as personal as possible and accepting that sometimes, the technology fails and you figure it out. In fact, instructors should look at this as valuable practice: Even without a communicable disease making the rounds, the online college experience is likely to become more common with lower overhead for universities and greater flexibility for students.
My class included students across the U.S. with a few international students including one who dialed in from India, sipping her morning coffee as I drank a diet soda. In the first class, a student from the Bahamas was logging in just days after Hurricane Dorian had ravaged the islands. Once, as part of her weekly pyrrhic quest for decent Wi-Fi, she joined us from the parking lot of a Dunkin Donuts. While students whose lives get in the way often struggle with in-person classes, the online nature allowed for flexibility. Another student lost his work visa on a trip home and continued the class from Canada.
I had worried that teaching online would get in the way of the classroom camaraderie that is so important for projects and discussion. But as the weeks wore on, the students got to know one another, perhaps better than if they simply filed in for class and left. As one student observed, in his regular classes, he was usually just staring at a lot of “backs of heads.”
Despite my initial concerns, I found the experience to be invigorating. Instead of the usual exhaustion after an eight-hour workday and a three-hour class, I was energized. Even the challenges ended up being rewarding. For instance, it was initially tough with introverted students—we didn’t have eye contact or opportunities for them to walk up to talk to me after class. So I looked for ways to connect with all of the students on personal level—and it paid off. One student who was not feeling connection early in class wrote me a note to say she appreciated the one-on-one attention and encouragement she received from me in a breakout room. (More on those in a minute.) From then on, she spoke more in class—maybe even more than she would have in an in-person course.
An odd feature on online communication is the number of exclamation points required to relay a simple message: “Nice work! Can’t wait to see the final version!” All those exclamation points paid off, and after the class, more students stayed in touch with me than usual, and one even sent a charming holiday card—in the mail.
I ran the class from a laptop in a conference room at the Atlantic in D.C., where I worked at the time, and sometimes from my second bedroom, a less attractive option given my dog’s habit of barking insistently during conference calls. (A peanut butter–filled bone and two doors between us helped.) I had students with dogs who would jump into laps and cats that would sashay over keyboards and once, two small children jumping gleefully on a hotel bed behind their mom as she discussed her work. This made for a relaxed experience and a deeper sense of who my students were outside of class.
To run the class, I used a version of Zoom video conferencing software customized for NYU users. Zoom staff were available via chat and email to troubleshoot problems, like having the right version of the software appear when I logged on. (Zoom is about to experience a major influx of users, but the CEO seems to be using this as a dare-to-be-great moment.) I worked with a talented co-instructor who helped lead and teach the class, an administrator and a full-time “educational technologist” who helped craft our online curriculum. We conducted three surveys during the semester to be sure that NYU’s online students were mastering the material as if they were live in a classroom. I’m pleased to report they were.
I’ve been thinking about that experience as a number of universities—the University of Washington, the University of Southern California, Harvard, Ohio State, and many more—have announced that they will be moving to online instruction to avoid the spread of COVID-19. Across the country, instructors who, like me, struggle with turning on the class projector will need to jump in and quickly master the much-needed skill of online teaching.
Twitter is full of critics as classes move online. As one tweeted: “These teachers really think these online classes gonna work? Half the time they not even tech savvy enough to log into their gmails.”But teaching online wasn’t that different from the classroom experience I was accustomed to. It was often more fun than standing at a lectern working through a well-worn set of PowerPoint slides. The trick was making it as personal as possible and accepting that sometimes, the technology fails and you figure it out. In fact, instructors should look at this as valuable practice: Even without a communicable disease making the rounds, the online college experience is likely to become more common with lower overhead for universities and greater flexibility for students.
My class included students across the U.S. with a few international students including one who dialed in from India, sipping her morning coffee as I drank a diet soda. In the first class, a student from the Bahamas was logging in just days after Hurricane Dorian had ravaged the islands. Once, as part of her weekly pyrrhic quest for decent Wi-Fi, she joined us from the parking lot of a Dunkin Donuts. While students whose lives get in the way often struggle with in-person classes, the online nature allowed for flexibility. Another student lost his work visa on a trip home and continued the class from Canada.
I had worried that teaching online would get in the way of the classroom camaraderie that is so important for projects and discussion. But as the weeks wore on, the students got to know one another, perhaps better than if they simply filed in for class and left. As one student observed, in his regular classes, he was usually just staring at a lot of “backs of heads.”
Despite my initial concerns, I found the experience to be invigorating. Instead of the usual exhaustion after an eight-hour workday and a three-hour class, I was energized. Even the challenges ended up being rewarding. For instance, it was initially tough with introverted students—we didn’t have eye contact or opportunities for them to walk up to talk to me after class. So I looked for ways to connect with all of the students on personal level—and it paid off. One student who was not feeling connection early in class wrote me a note to say she appreciated the one-on-one attention and encouragement she received from me in a breakout room. (More on those in a minute.) From then on, she spoke more in class—maybe even more than she would have in an in-person course.
An odd feature on online communication is the number of exclamation points required to relay a simple message: “Nice work! Can’t wait to see the final version!” All those exclamation points paid off, and after the class, more students stayed in touch with me than usual, and one even sent a charming holiday card—in the mail.
I ran the class from a laptop in a conference room at the Atlantic in D.C., where I worked at the time, and sometimes from my second bedroom, a less attractive option given my dog’s habit of barking insistently during conference calls. (A peanut butter–filled bone and two doors between us helped.) I had students with dogs who would jump into laps and cats that would sashay over keyboards and once, two small children jumping gleefully on a hotel bed behind their mom as she discussed her work. This made for a relaxed experience and a deeper sense of who my students were outside of class.
To run the class, I used a version of Zoom video conferencing software customized for NYU users. Zoom staff were available via chat and email to troubleshoot problems, like having the right version of the software appear when I logged on. (Zoom is about to experience a major influx of users, but the CEO seems to be using this as a dare-to-be-great moment.) I worked with a talented co-instructor who helped lead and teach the class, an administrator and a full-time “educational technologist” who helped craft our online curriculum. We conducted three surveys during the semester to be sure that NYU’s online students were mastering the material as if they were live in a classroom. I’m pleased to report they were.
by Liza Kaufman Hogan, Slate | Read more:
Image: NESA by Makers/Unsplash
Coronavirus Will Change the World Permanently. Here’s How.
For many Americans right now, the scale of the coronavirus crisis calls to mind 9/11 or the 2008 financial crisis—events that reshaped society in lasting ways, from how we travel and buy homes, to the level of security and surveillance we’re accustomed to, and even to the language we use.
Politico Magazine surveyed more than 30 smart, macro thinkers this week, and they have some news for you: Buckle in. This could be bigger.
A global, novel virus that keeps us contained in our homes—maybe for months—is already reorienting our relationship to government, to the outside world, even to each other. Some changes these experts expect to see in the coming months or years might feel unfamiliar or unsettling: Will nations stay closed? Will touch become taboo? What will become of restaurants?
But crisis moments also present opportunity: more sophisticated and flexible use of technology, less polarization, a revived appreciation for the outdoors and life’s other simple pleasures. No one knows exactly what will come, but here is our best stab at a guide to the unknown ways that society—government, healthcare, the economy, our lifestyles and more—will change.
Politico Magazine surveyed more than 30 smart, macro thinkers this week, and they have some news for you: Buckle in. This could be bigger.A global, novel virus that keeps us contained in our homes—maybe for months—is already reorienting our relationship to government, to the outside world, even to each other. Some changes these experts expect to see in the coming months or years might feel unfamiliar or unsettling: Will nations stay closed? Will touch become taboo? What will become of restaurants?
But crisis moments also present opportunity: more sophisticated and flexible use of technology, less polarization, a revived appreciation for the outdoors and life’s other simple pleasures. No one knows exactly what will come, but here is our best stab at a guide to the unknown ways that society—government, healthcare, the economy, our lifestyles and more—will change.
Image: DAQ
Slush Fund
That’s what Democrats are calling a $500 billion “Exchange Stabilization Fund” included in the massive Senate GOP proposal to rescue the U.S. economy from the coronavirus crisis. The fund, which would come under the control of Treasury Secretary Steven Mnuchin, is designed to aid distressed industries. It includes $58 billion for U.S. airline and air cargo companies, a source of significant controversy during the last three days of closed-door talks between senators of both parties and the White House.
But the language drafted by Senate Republicans also allows Mnuchin to withhold the names of the companies that receive federal money and how much they get for up to six months if he so decides. (...)
“We’re gonna give $500 billion in basically a slush fund to help industries controlled by Mnuchin with very little transparency? Is that what we ought to be doing?” asked Sen. Mazie Hirono (D-Hawaii.).
“We're not here to create a slush fund for Donald Trump and his family, or a slush fund for the Treasury Department to be able to hand out to their friends,” railed Sen. Elizabeth Warren (D-Mass.), who made corporate accountability a big part of her White House campaign. “We're here to help workers, we're here to help hospitals. And right now, what the Republicans proposed does neither of those. “ (...)
Senate Democrats had other high-profile issues that also led to their Sunday vote to block the stimulus bill. They sought four months of increased unemployment insurance support, but only got three months; they sought hundreds of billions of dollars in emergency funds for hospitals and other health-care providers to combat the coronavirus, yet Republicans budgeted just $75 billion; and they asked for hundreds of billions for a “State Stabilization Fund” to help state and local governments hurt by the looming economic slowdown, while Republicans offered far less.
But the key to the unanimous set of Democratic ‘no’ votes — and what made it easy for Senate Minority Leader Chuck Schumer (D-N.Y.) to line them up — was the “slush fund” accusation.
Image: Jake Sherman (Politico) via Twitter
[ed. See also: Demands for Workers-First Stimulus Grow as Senate GOP Fails to Ram Through $500 Billion Corporate 'Slush Fund'; and To Counter 'Corporate Handout' Pushed by McConnell, Progressives Intensify Demand for #AJustStimulus; and Sanders Calls for 'Unprecedented Legislative Response' to Coronavirus Crisis—Not Corporate Bailouts (Common Dreams). Finally, we must ask again: Where Is Joe? (Current Affairs).]
[ed. See also: Demands for Workers-First Stimulus Grow as Senate GOP Fails to Ram Through $500 Billion Corporate 'Slush Fund'; and To Counter 'Corporate Handout' Pushed by McConnell, Progressives Intensify Demand for #AJustStimulus; and Sanders Calls for 'Unprecedented Legislative Response' to Coronavirus Crisis—Not Corporate Bailouts (Common Dreams). Finally, we must ask again: Where Is Joe? (Current Affairs).]
Here's what progressives are saying should be priorities:
- Paid sick and family leave for households hit by the virus, regardless of employer size, immigrant status and including independent contractors;
- Emergency cash assistance on an ongoing basis, starting with $2,000 immediately to every adult, monthly for the length of the crisis;
- A Homes Guarantee including zero rent and a moratorium on evictions and foreclosures;
- A ban on essential utility shut-offs like heat, water, and electricity;
- and Student debt forgiveness to save people from financial ruin, as well as refunding students on room and board, tuition, and healthcare for this semester.
America: ‘At Home’ With Absurd Consumer Excess
Every culture has a custom or symbol that encapsulates its entire way of life. For example, a salami hanging from the ceiling of a cramped neighborhood deli is Italy. Japan is a tea ceremony or an orderly subway rush hour. And for us, that condensed cultural symbol is not the Declaration of Independence or the ragtag militia or the all-American con man with a bridge to sell you. It’s a big-box store called At Home.
Founded in 1979 and hitting the stock market in 2016, At Home hails—where else?—from Texas. They are not particularly well-known or widespread, with a little over 200 locations at present; however, they plan to double twice over in the coming years. Most of their stores are located in existing buildings vacated by the likes of K-Mart and JCPenney (and even, in Frederick, Maryland, a vacated Walmart). Consider how large one of these buildings is, and then consider that At Home is dedicated entirely to home goods and decor. Imagine a lovechild of Michael’s and the aforementioned Walmart, then imagine dropping acid in said store, and you may get a small sense of what it is like to browse At Home.
The 70s-vintage floor tiles and drop ceilings have been stripped, leaving only the shell of the K-Mart or other defunct chain, making the average At Home location look more like a Home Depot or Costco. Heck, the shopping cart bay at the entrance is bigger than lots of small stores. As long as you can think of something tangentially related to home organizing or decor, it exists in this gargantuan retail warehouse.
by Addison Del Mastro, The American Conservative | Read more:
Image: Addison Del Mastro
Founded in 1979 and hitting the stock market in 2016, At Home hails—where else?—from Texas. They are not particularly well-known or widespread, with a little over 200 locations at present; however, they plan to double twice over in the coming years. Most of their stores are located in existing buildings vacated by the likes of K-Mart and JCPenney (and even, in Frederick, Maryland, a vacated Walmart). Consider how large one of these buildings is, and then consider that At Home is dedicated entirely to home goods and decor. Imagine a lovechild of Michael’s and the aforementioned Walmart, then imagine dropping acid in said store, and you may get a small sense of what it is like to browse At Home.
The 70s-vintage floor tiles and drop ceilings have been stripped, leaving only the shell of the K-Mart or other defunct chain, making the average At Home location look more like a Home Depot or Costco. Heck, the shopping cart bay at the entrance is bigger than lots of small stores. As long as you can think of something tangentially related to home organizing or decor, it exists in this gargantuan retail warehouse.
A first-time visitor’s emotions are likely to run from exhilarated to wryly amused to vaguely discomfited, as the funhouse-mirror-like feeling of the place dawns. It is staggering how many aisles there are, how many sheer combinations and permutations of stuff. On top of this, the merchandise has an uncanny-valley feel to it, almost as if it has been generated algorithmically based on a Chinese computer’s idea of what an American with too much time and money would like to buy.
You can choose from 10 or 20 slightly different chairs in different colors; four different aisles of pillows with or without embellishments, in every color, texture, and size imaginable and then some; T-Rex skeleton bookends, T-Rex head decorative plaques, oyster shell bookends, plaques inscribed with shallow therapeutic babble, some of which gives the impression of having been engineered randomly out of a word bank. Others are a bit less random, following more of a “Verb phrase/adjective/noun” pattern; one plaque for a child’s room reads “Stay clever, little fox.” The next one reads “Dream big, little whale,” with cute animal illustrations and faux-driftwood frames. There are artichoke wreaths, artichoke-shaped fake flowers, and perhaps, somewhere in there, a “Welcome to Our Home” plaque framed by sketched artichokes. You can buy a plaster cactus, a plaster creepy cat, and a lot of other three-foot-tall plaster statuettes. Or you can pick from an ungodly variety of plastic plants at “The Greenhouse,” where the cheery dystopian slogan reads, “No sun? No problem.” And we’re just getting started. (...)
One is tempted to think of left-wing slam poet Andrea Gibson’s line about “the sweatshops our children call the North Pole.” Surely there is some cost to all this. Perhaps the environmentalists and the fundamentalists are right that we are racking up some sort of planetary bad karma. I recall a college professor of mine who remarked that in a couple of decades we will marvel at the idea of all-you-can-eat shrimp or 20 choices of peanut butter. Perhaps one day we will marvel at the thought that immeasurable and irreplaceable time, talent, and treasure was wasted on fake artichokes and plastic oyster shell bookends.
You can choose from 10 or 20 slightly different chairs in different colors; four different aisles of pillows with or without embellishments, in every color, texture, and size imaginable and then some; T-Rex skeleton bookends, T-Rex head decorative plaques, oyster shell bookends, plaques inscribed with shallow therapeutic babble, some of which gives the impression of having been engineered randomly out of a word bank. Others are a bit less random, following more of a “Verb phrase/adjective/noun” pattern; one plaque for a child’s room reads “Stay clever, little fox.” The next one reads “Dream big, little whale,” with cute animal illustrations and faux-driftwood frames. There are artichoke wreaths, artichoke-shaped fake flowers, and perhaps, somewhere in there, a “Welcome to Our Home” plaque framed by sketched artichokes. You can buy a plaster cactus, a plaster creepy cat, and a lot of other three-foot-tall plaster statuettes. Or you can pick from an ungodly variety of plastic plants at “The Greenhouse,” where the cheery dystopian slogan reads, “No sun? No problem.” And we’re just getting started. (...)
One is tempted to think of left-wing slam poet Andrea Gibson’s line about “the sweatshops our children call the North Pole.” Surely there is some cost to all this. Perhaps the environmentalists and the fundamentalists are right that we are racking up some sort of planetary bad karma. I recall a college professor of mine who remarked that in a couple of decades we will marvel at the idea of all-you-can-eat shrimp or 20 choices of peanut butter. Perhaps one day we will marvel at the thought that immeasurable and irreplaceable time, talent, and treasure was wasted on fake artichokes and plastic oyster shell bookends.
by Addison Del Mastro, The American Conservative | Read more:
Image: Addison Del Mastro
Sunday, March 22, 2020
The Best-Case Outcome for the Coronavirus, and the Worst
Here’s the grimmest version of life a year from now: More than two million Americans have died from the new coronavirus, almost all mourned without funerals. Countless others have died because hospitals are too overwhelmed to deal adequately with heart attacks, asthma and diabetic crises. The economy has cratered into a depression, for fiscal and monetary policy are ineffective when people fear going out, businesses are closed and tens of millions of people are unemployed. A vaccine still seems far off, immunity among those who have recovered proves fleeting and the coronavirus has joined the seasonal flu as a recurring peril.
Yet here’s an alternative scenario for March 2021: Life largely returned to normal by the late summer of 2020, and the economy has rebounded strongly. The United States used a sharp, short shock in the spring of 2020 to break the cycle of transmission; warm weather then reduced new infections and provided a summer respite for the Northern Hemisphere. By the second wave in the fall, mutations had attenuated the coronavirus, many people were immune and drugs were shown effective in treating it and even in reducing infection. Thousands of Americans died, mostly octogenarians and nonagenarians and some with respiratory conditions, but by February 2021, vaccinations were introduced worldwide and the virus was conquered.
The Best Case
I’ve been speaking to epidemiologists about their best- and worst-case scenarios to gauge what may lie ahead and see how we can tilt the balance. Let me start with the best case, since we could all use a dose of hope — which may even be therapeutic — before presenting a bleaker prognosis.
“The best case is that the virus mutates and actually dies out,” said Dr. Larry Brilliant, an epidemiologist who as a young doctor was part of the fight to eradicate smallpox. Brilliant was a consultant for the movie “Contagion,” in which a virus evolved to become more deadly, but that’s the exception. “Only in movies do viruses seem to become worse,” he explained.
Two other lethal coronaviruses, SARS and MERS, both petered out, and that is possible here. “My hope is that Covid-19 will not survive,” said Dr. Charles G. Prober, a professor at Stanford Medical School.
Several countries have shown that decisive action can turn the tide on Covid-19, at least for a time. China, astonishingly, on Thursday reported not a single new case of domestic transmission. While China is still vulnerable to a second wave, it has apparently shown that the virus can be squelched.
The West isn’t going to copy the coercive tactics of China, but Singapore, Taiwan, South Korea and Hong Kong have also demonstrated that, at least temporarily, the virus can be controlled.
[ed. But...]
by Nicholas Kristof, NY Times | Read more:
Image: Elaine Thompson/Associated Press
[ed. See also: Notes on a Nightmare Part 1 and Part 2 . Also, Where is Joe? (Current Affairs).]
Yet here’s an alternative scenario for March 2021: Life largely returned to normal by the late summer of 2020, and the economy has rebounded strongly. The United States used a sharp, short shock in the spring of 2020 to break the cycle of transmission; warm weather then reduced new infections and provided a summer respite for the Northern Hemisphere. By the second wave in the fall, mutations had attenuated the coronavirus, many people were immune and drugs were shown effective in treating it and even in reducing infection. Thousands of Americans died, mostly octogenarians and nonagenarians and some with respiratory conditions, but by February 2021, vaccinations were introduced worldwide and the virus was conquered.
The Best Case
I’ve been speaking to epidemiologists about their best- and worst-case scenarios to gauge what may lie ahead and see how we can tilt the balance. Let me start with the best case, since we could all use a dose of hope — which may even be therapeutic — before presenting a bleaker prognosis.
“The best case is that the virus mutates and actually dies out,” said Dr. Larry Brilliant, an epidemiologist who as a young doctor was part of the fight to eradicate smallpox. Brilliant was a consultant for the movie “Contagion,” in which a virus evolved to become more deadly, but that’s the exception. “Only in movies do viruses seem to become worse,” he explained.Two other lethal coronaviruses, SARS and MERS, both petered out, and that is possible here. “My hope is that Covid-19 will not survive,” said Dr. Charles G. Prober, a professor at Stanford Medical School.
Several countries have shown that decisive action can turn the tide on Covid-19, at least for a time. China, astonishingly, on Thursday reported not a single new case of domestic transmission. While China is still vulnerable to a second wave, it has apparently shown that the virus can be squelched.
The West isn’t going to copy the coercive tactics of China, but Singapore, Taiwan, South Korea and Hong Kong have also demonstrated that, at least temporarily, the virus can be controlled.
[ed. But...]
by Nicholas Kristof, NY Times | Read more:
Image: Elaine Thompson/Associated Press
[ed. See also: Notes on a Nightmare Part 1 and Part 2 . Also, Where is Joe? (Current Affairs).]
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