Give Us This Day Our Daily Bread: Coronavirus and Food Security

As Bloomberg reports in Countries Starting to Hoard Food, Threatening Global Trade:

It’s not just grocery shoppers who are hoarding pantry staples. Some governments are moving to secure domestic food supplies during the conoravirus pandemic. 

Kazakhstan, one of the world’s biggest shippers of wheat flour, banned exports of that product along with others, including carrots, sugar and potatoes. Vietnam temporarily suspended new rice export contracts. Serbia has stopped the flow of its sunflower oil and other goods, while Russia is leaving the door open to shipment bans and said it’s assessing the situation weekly. 

To be perfectly clear, there have been just a handful of moves and no sure signs that much more is on the horizon. Still, what’s been happening has raised a question: Is this the start of a wave of food nationalism that will further disrupt supply chains and trade flows?

Yesterday, the United Nations warned that coronavirus measures could lead to food shortages, as The Guardian reports in Coronavirus measures could cause global food shortage, UN warns:

Protectionist measures by national governments during the coronavirus crisis could provoke food shortages around the world, the UN’s food body has warned. 

Harvests have been good and the outlook for staple crops is promising, but a shortage of field workers brought on by the virus crisis and a move towards protectionism – tariffs and export bans – mean problems could quickly appear in the coming weeks, Maximo Torero, chief economist of the UN Food and Agriculture Organisation, told the Guardian. 

“The worst that can happen is that governments restrict the flow of food,” he said. “All measures against free trade will be counterproductive. Now is not the time for restrictions or putting in place trade barriers. Now is the time to protect the flow of food around the world.”

At present, the UN’s warning is ominous, but not dire. Yet the food shortage threat will only increase, as the coronavirus crisis continues, and the northern hemisphere moves into the heart of its growing season. Encore for The Guardian:

While the supply of food is functioning well in most countries at present, problems could start to be seen within weeks and intensify over the following two months as key fruit and vegetables come into season. These types of produce often have short ripening times and are highly perishable, and need skilled pickers to work quickly at the right time. 

“We need to be careful not to break the food value chain and the logistics or we will be looking at problems with fresh vegetables and fruits soon,” said Torero. “Fruit and vegetables are also very labour intensive, if the labour force is threatened because people can’t move then you have a problem.” 

As governments impose lockdowns in countries across the world, recruiting seasonal workers will become impossible unless measures are taken to ensure vital workers can still move around, while preventing the virus from spreading. 

“Coronavirus is affecting the labour force and the logistical problems are becoming very important,” said Torero. “We need to have policies in place so the labour force can keep doing their job. Protect people too, but we need the labour force. Major countries have yet to implement these sorts of policies to ensure that food can keep moving.” 

Countries such as the UK, with a sinking currency and high level of imports, are also likely to see food price rises unless the government takes action or retailers absorb some of the costs, he said. 

The most important role governments can play is to keep the food supply chain operating, intervene to ensure there are enough workers, and keep the global food markets from panicking, according to Torero. 

“If traders start to become nervous, conditions will get difficult,” he said. “It just needs one big trader to make a decision [to disrupt the supply of staple crops] and that will affect everywhere. Governments must properly regulate, that is their biggest function in this situation. It’s very important to keep alive the food value chain: intervene to protect the value chain [including the supply of workers] but not to distort the market.”

The United Kingdom

I lived in the United Kingdom for three years prior to my stint in Geneva, and for one one year after. At that time, UK food prices were much lower than Swiss ones. Now, as those who monitored Brexit discussions no doubt already know, the UK is dependent on imports for roughly half of its food, 53 per cent, to be exact.

As Tim Lang writes in The Conversation, Coronavirus: rationing based on health, equity and decency now needed – food system expert:

Food security is no laughing matter at the best of times, but I gasped when I first read the Department for Environment, Food and Rural Affairs’ (Defra) annual food civil contingencies infrastructure report in 2018. It is barely a page long (in public at least) and assures us everything is OK and that the food system is resilient and able to withstand shocks. As the coronvirus racks the nation and panic buying continues, this complacency is about to be tested. 

Few analysts of the UK food system are anything other than sober about its fragility. There is little storage. All operates on a just-in-time basis in which food travels down the supply chain – literally, just in time for when the next link or process needs it. Food businesses have been realigned to cut delays and storage. Consumers have come to expect constant flows of food, without hiccups or gaps. New industries have emerged, notably logistics and satellites which track this all from farm to shop. We are trucker-dependent now. 

Only 53% of food consumed in the UK is produced in the country. Others feed the Brits. Some scientists calculate that UK external dependency is even greater, with hidden use of external land to provide animal feed. 

While this distortedly efficient food revolution has been rolled out, the UK food trade gap – the difference between exports and imports by value – has widened. In 2018, food worth £46.8 billion was imported, with exports worth only £22.5 billion, leaving a food trade gap of £24.3 billion. Much of the imports are vital for health, the £10bn imports of fruit and veg in particular. UK fruit and veg growing has sunk. The UK’s main “oral” export these days is whisky. Even meat – supposedly Britain’s forte – is in the red. If borders close or supply chains snap, what then?

Lang believes that the UK may soon be facing a food crisis, and calls for the government ito think about imposing a system of rationing, rather than allowing a free for all to ensue.

A crunch point for UK food policy and planning is surely approaching. The coronavirus crisis is already spawning worrying actions. Whereas under Brexit no-deal threats, stoicism ruled and “preppers” – people stocking up – were generally few. Today shelves are being stripped and queues form for supermarkets to open. It’s why colleagues and I have called on the UK prime minister to set up a rational system of rationing – based on health, equity and decency – to see the country through this crisis.

The alternative is for food retailers to engage in de facto rationing, according to whatever principles they care to apply, rather than those that would prevail in a transparent public rationing system. Lang again:

Meanwhile, it is the food retailers who are beginning to ration supply. This is unacceptable in a democracy. If to happen, it ought to be in the open – and guided by health and sustainability. Surely the “public good” lies in feeding all well, according to need not income. Those values are what got the UK through the second world war, as our Churchill-inspired prime minister ought to know.

by Jerri-Lynn Scofield, Naked Capitalism | Read more:
Image:UN’s Food & Agriculture Organization Global Perspectives Studies/Bloomberg

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Trump vs. God On Easter Pay Per View

Alex Schaefer, Money to burn
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Gilead Sciences Backs Off Monopoly Claim For Promising Coronavirus Drug

[ed. Previously: Coronavirus Treatment Developed by Gilead Sciences Granted "Rare Disease" Status, Potentially Limiting Affordability (The Intercept/Duck Soup).]

Gilead Sciences on Wednesday announced that it has submitted a request to the Food and Drug Administration to rescind the exclusive marketing rights it had secured for remdesivir, an antiviral drug that shows promise in treating Covid-19, the disease caused by the new coronavirus. As The Intercept reported on Monday, the FDA had awarded Gilead seven years of exclusive marketing rights to the drug through the Orphan Drug Act, even though the statute was designed to induce pharmaceutical companies to make treatments for rare diseases that affect fewer than 200,000 people in the United States.

Although the new coronavirus will almost certainly infect that many people, Gilead had exploited a loophole that grants orphan drug status if a company files for it before the official number of cases hits 200,000. As of Wednesday afternoon, there were more than 438,000 confirmed cases worldwide, with more than 59,000 in the United States.

After a public outcry, Gilead issued a press release stating:

Gilead has submitted a request to the U.S. Food and Drug Administration to rescind the orphan drug designation it was granted for the investigational antiviral remdesivir for the treatment of Covid-19 and is waiving all benefits that accompany the designation. Gilead is confident that it can maintain an expedited timeline in seeking regulatory review of remdesivir, without the orphan drug designation. Recent engagement with regulatory agencies has demonstrated that submissions and review relating to remdesivir for the treatment of Covid-19 are being expedited.

Still, public health experts remain concerned about the potential for Gilead and other pharmaceutical companies to engage in price gouging during the global pandemic. And while pharmaceutical companies are testing dozens of drugs as potential vaccines and treatments for the new coronavirus, some legal scholars have pointed to an obscure statute to help ensure that companies won’t price critical drugs out of reach.

The law, known as Section 1498, gives the government the right to override a patent at any time as long as the company receives “reasonable compensation.” Essentially functioning as a kind of eminent domain for patented products, the provision breaks the monopoly and permits low-cost competition. And if drugs such as Gilead’s antiviral remdesivir and other potential treatments and vaccines for the coronavirus are priced out of reach, it could give the government critical leverage to negotiate lower prices. Through the Defense Production Act, the government could even start producing lifesaving treatments itself.

“The government should use every tool that it has to make sure that any coronavirus treatment or vaccine is affordable, including taking away monopolies through 1498,” said Zain Rizvi, a drug-pricing expert at Public Citizen. (...)

The federal government regularly used Section 1498 in the 1960s and 1970s to purchase generic drugs when the patented versions were far more expensive. But pharmaceutical companies railed against the provision and while it has been used for other inventions it has rarely been used for drugs since. In 2001, during the anthrax scare, just the threat of using 1498 proved effective when the government was trying to secure access to the antibiotic ciprofloxacin, which could be used to treat people who were exposed to anthrax. After then-Secretary of Health and Human Services Tommy Thompson raised the possibility of using the provision, Bayer cut the price of ciprofloxacin in half.

In 2017, a group of academics at Yale Law School made the case for the government’s use of Section 1498 to procure a lifesaving treatment for hepatitis C called Sofosbuvir, also manufactured by Gilead, which is too expensive for many people who need it. Sofosbuvir costs $48,000 for a 24-week course, or about $1,000 a pill. Because of the exorbitant price, insurers have refused to cover it for all of the roughly 5 million people infected with hepatitis C, instead making the drug available to only the sickest patients.

by Sharon Lerner, The Intercept |  Read more:

Image: David Paul Morris/Bloomberg/Getty

[ed. Amazing what some bad PR and public pressure can accomplish during a crisis. And what obscure information comes to light. Like Section 1498. That's some pretty heavy leverage. Also, just in (Friday 3/27): after endless dithering the President has finally been convinced to use the Defense Production Act to speed up production of ventilators. Why so long? Perhaps because of this. Or this. Or, maybe it's just because he likes haggling.]

Cellphone ‘Heat Map’ Shows Distribution of Florida Spring Breakers After Party

A heat map highlighting cellphone location data within the U.S. is providing a frightening insight into the movements of humans amid the ongoing coronavirus pandemic.

The data, collected by location technology company X-Mode, was recently plugged into the geospatial data visualization platform known as Tectonix as part of an effort to track the coronavirus across the globe.

In just one example of the project’s findings, cellphones on a beach in Fort Lauderdale, Florida, during spring break were selected and tracked. When the festivities ended, the cellphones were seen sprawling out across the Eastern half of the country, potentially bringing cases of the highly contagious virus with them.

X-Mode states that the data used is “anonymized,” meaning a cellphone’s location is not linked to its user’s identity. Tectonix took that raw data and honed in specifically on devices moving between 3 and 10 miles per hour in an attempt to pinpoint cellphone owners believed to be walking or traveling with bikes or scooters.

Aside from Florida, the project has also released its analysis of New York City, which is currently the epicenter of the pandemic in the U.S. Just like Florida, the data on New York, specifically Manhattan, shows widespread movement throughout the month of March.

by Mikael Thalen, Daily Dot | Read more:
Image: Tectonix

[ed. Click on the link for the video. Just to be clear, this is an example of geo-tracking (which may be useful for assessing travel restrictions) not the actual spread of the virus (just partygoers dispersing from unsafe conditions). Also, if you're concerned about anonymity and privacy issues turn off your smartphone location setting.]

How to Make Your Own Hand Sanitizer

Properly scrubbing your hands is one of the best ways to stop the spread of germs and viruses, and to ensure you don’t get sick yourself. But if you don't have access to soap and clean water, or if you're out and about and nowhere near a sink, you should carry hand sanitizer to protect your health.

As you're no doubt aware, bottles of hand sanitizer (Purell, Wet Ones, and the like) sell out quickly during public health crises. But don't worry—making your own hand sanitizer is remarkably easy. You just have to be careful you don't mess it up. Make sure that the tools you use for mixing are properly sanitized; otherwise you could contaminate the whole thing. Also, the World Health Organization recommends letting your concoction sit for a minimum of 72 hours after you're done. That way the sanitizer has time to kill any bacteria that might have been introduced during the mixing process.

(Note: To reiterate, nothing beats washing your hands. Hand sanitizer—even the real, professionally made stuff—should always be a last resort.)

We actually have two recipes for you, and links to find the ingredients. The first is one you can make with stuff you likely already have in your cabinets and under the sink, so it's effective in emergency situations. The second recipe is more complex, but easy to make if you have the opportunity to do some shopping and planning ahead of time. Another note: a lot of these items are quickly going out of stock because of high demand. There's a higher chance of finding them at your local drug store, but your first priority is to stay indoors.

Potency Matters

You’re going to need some alcohol. According to the Centers for Disease Control and Prevention, your sanitizer mix must be at least 60 percent alcohol to be effective. But it's better to get way above that—aim for a minimum of 75 percent. A bottle of 99 percent isopropyl alcohol is the best thing to use. Your regular vodka and whiskey are too wimpy and won’t cut it.

The Quick (Gel) Recipe

Isopropyl alcohol (also here)
Aloe vera gel (also here)
Tea tree oil (also here)

Mix 3 parts isopropyl alcohol to 1 part aloe vera gel. Add a few drops of tea tree oil to give it a pleasant scent and to align your chakras.

The aloe mixture gets the job done, but aloe also leaves your skin annoyingly sticky. So, here's a recipe that's less sticky and more potent, based on the mix recommended by the WHO.

The Better (Spray) Recipe

Isopropyl alcohol (also here)
Glycerol or glycerin
Hydrogen peroxide
Distilled water
Spray bottle

by Boone Ashworth, Wired |  Read more:

Image: Jena Ardell/Getty

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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.

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:

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.

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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).]

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.

by Ed Yong, The Atlantic |  Read more:

Image: Joan Wong
[ed. See also: The Doctor Who Helped Defeat Smallpox Explains What's Coming (Wired).]

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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.

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).]

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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.

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

[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:

• 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:

• Is government spending sufficiently laser-focused on overcoming the public-health crisis?
• Is the economic rescue package adequate to sustain the population’s wellbeing?

Considering the second criterion first, government injections of so-called helicopter money (direct cash handouts) to help keep the population afloat should be recurrent, rather than the one or two disbursements now being discussed. Expanded unemployment benefits, together with expanded eligibility for food stamps and other such payments, would also help provide the means to pay for essential goods and services.

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).]

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