The Trickle-Up Bailout

"80% of the benefit of the bill went to just 43,000 taxpayers each earning over $1 million a year"

As we head into the second month of pandemic lockdown, two parallel narratives are developing about the financial rescue.

In one, ordinary people receive aid through programs that are piecemeal, complex, and riddled with conditions.

A law freezing evictions applies to holders of government-backed mortgages only. “Disaster grants” are coming more slowly and in smaller amounts than expected; small businesses were disappointed to learn from the SBA early last week that aid would be limited to $1000 per employee.

A one-time “economic impact payment,” reportedly delayed so recipients could experience the thrilling visual of Donald Trump’s name on the check, might help make half a rent payment. Unemployment insurance amounts have been raised, so tip and gig workers can now be ineligible for $600 a week more than before! The cost of a coronavirus test might be free, but you test positive, you could up paying $50,000 or more in hospital costs even with insurance. And so on.

Meanwhile, “relief” programs aimed at the top income levels were immediate, staggering in size and scope, and often appeared as grants rather than loans. One of the biggest layouts of the Covid-19 rescue was a political carrying charge that members of congress extracted just to get the larger bailout out the door – a pre-bailout bailout, if you will.

Although the $2 trillion coronavirus rescue was approved unanimously, a set of tax breaks was stuck in by Republicans, in the original version of the CARES Act put forward by Mitch McConnell.

When Donald Trump signed his whopper Tax Cuts and Jobs Act two years ago, the bill contained clauses to offset the loss of revenue that would entail from shaving down the top individual tax rate relatively a little (from 39.6% to 37%) and slashing the corporate tax rate a lot (from 35% all the way down to 21%).

One of those changes limited the amount of losses that could be used to offset taxable income in any given year. Another limited the amount of losses from so-called “pass-through” businesses (i.e. businesses that don’t pay corporate taxes) that wealthy individuals could use to offset taxable income. These provisions particularly impacted real estate developers (!), hedge fund managers, and other high net worth individuals with volatile revenue profiles.

The second provision only affected people making at least $250,000, or couples earning at least $500,000.

The CARES Act sought to wipe out or alter both provisions. Republicans also tried to include tax relief for multinationals who offshore profits, but that provision was stripped out in favor of these first two loopholes, seemingly reflecting their importance to the caucus.

As Steve Wamhoff of the Institute on Taxation and Economic Policy points out, the changes on the use of “pass-through” losses only benefit a select group. “It has to be stressed that this exclusively helps wealthy people,” Wamhoff says. “It only has an impact on people already making over $250,000.”

Because the CARES Act was rushed to the floor, members didn’t have all of the information they might have wanted before the vote. After the bill passed, Democratic staffers sent these tax provisions in the CARES Act, sections 2303 and 2304, to the Joint Committee on Taxation, to be scored. They were stunned to learn they would cost $195 billion over ten years.

In other words, what seemed like a run-of-the-mill offhand legislative pork provision ended up dwarfing the airline bailout and other main parts of the bill.

“The cost of caring for this small slice of the wealthiest one percent is greater than the CARES Act funded for all hospitals in America,” says Texas Democrat Lloyd Doggett. “It’s greater than CARES provided for all state and local governments.”

The JCT analysis found that 80% of the benefit of the bill went to just 43,000 taxpayers each earning over $1 million a year. The average tax break for those 43,000 individuals was $1.6 million, an interesting number when one considers the loudness of the controversy over $1,200 relief checks for everyone else.

by Matt Taibbi, Taibbi Substack |  Read more:

Image: uncredited

Georges Barbier, Le Silence De Mnasidika 1922
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How Coronavirus Almost Brought Down the Global Financial System

In the third week of March, while most of our minds were fixed on surging coronavirus death rates and the apocalyptic scenes in hospital wards, global financial markets came as close to a collapse as they have since September 2008. The price of shares in the world’s major corporations plunged. The value of the dollar surged against every currency in the world, squeezing debtors everywhere from Indonesia to Mexico. Trillion-dollar markets for government debt, the basic foundation of the financial system, lurched up and down in terror-stricken cycles.

On the terminal screens, interest rates danced. Traders hunched over improvised home workstations – known in the new slang of March 2020 as “Rona rigs” – screaming with frustration as sluggish home wifi systems dragged behind the movement of the markets. At the low point on 23 March, $26tn had been wiped off the value of global equity markets, inflicting huge losses both on the fortunate few who own shares, and on the collective pools of savings held by pension and insurance funds.

What the markets were reacting to was an unthinkable turn of events. After a fatal period of hesitation, governments around the world were ordering comprehensive lockdowns to contain a lethal pandemic. Built for growth, the global economic machine was being brought to a screeching halt. In 2020, for the first time since the second world war, production around the world will contract. It is not only Europe and the US that have been shut down, but once-booming emerging market economies in Asia. Commodity exporters from Latin America and sub-Saharan Africa face collapsing markets.

It is now clear that we can, if circumstances demand, turn the economy off. But the consequences are catastrophic. Across the world, hundreds of millions of people have been thrown out of work. From the street hawkers of Delhi to the personal trainers of LA, the service sector – by far the most important employer in the modern economy – has been poleaxed. Never before has the global economy suffered a shock of this scale all at once. In the US alone, at least 17 million people have lost their jobs in the last three weeks. A severe global recession is now inevitable.

The crucial question is how much of the world economy will survive the lockdown, and this depends on the availability of credit. Business runs on credit. The bits of the economy that do continue to function – the warehouses, the mobile phone providers and internet firms – all need credit. Wage bills for those still working are financed through credit. Even greater is the need of those who are not working. If they can’t get loans, bills will go unpaid, which spreads the pain. To survive the lockdown, millions of families and firms around the world are relying on grants and loans from the state. But tax revenues have collapsed, so states need credit, too. Across the world we are witnessing the largest surge in deficits and government debt since the second world war.

But who do we borrow from? Banks, financial markets and money markets provide the financial fuel of the world economy. Normally, credit is sustained by the optimistic promise of growth. When that dissolves, you face a self-reinforcing cycle of collapsing confidence, contracting credit, unemployment and bankruptcy, which spreads a poison cloud of pessimism. Like an epidemic, if left uncontrolled, it will sweep all before it, destroying first the financially fragile and then much else besides. It is not for nothing that we speak of financial contagion.

What began with the lockdown in Wuhan in January is more intense and more fast-moving than any recession we have seen before. In a matter of weeks we have been confronted with an economic outlook that is as grim as at any moment since the 1930s. But it could have been even worse. Imagine a situation in which, on top of the pain of the lockdown and the hellish scenes in hospital wards, we also face calls for austerity because the government cannot safely finance extra spending. Imagine that interest rates were surging, and the terms for credit cards, car loans and mortgages were suddenly getting stiffer. All of this may still happen. It is already happening to the weaker economies around the world. But for now at least, it has not happened in Europe and the US – even after the turbulence of March 2020, when the pandemic hit with full force.

What Europe and the US have succeeded in doing is to flatten the curve of financial panic. They have maintained the all-important flow of credit. Without that, large parts of their economies would not be on life support – they would be stone dead. And our governments would be struggling with a financial crunch to boot. Maintaining the flow of credit has been the precondition for sustaining the lockdown. It is the precondition for a concerted public health response to the pandemic.

During major crises, we are reminded of the fact that at the heart of the profit-driven, private financial economy is a public institution, the central bank. When financial markets are functioning normally, it remains in the background. But when they threaten to break down, it has the option of stepping forward to act as a lender of last resort. It can make loans, or it can buy assets from banks, funds or other businesses that are desperate for cash. Because it is the ultimate backer of the currency, its budget is unlimited. That means it can decide who sinks and who swims. We learned this in 2008. But 2020 has driven home the point as never before.

The last six weeks have seen a bout of intervention without precedent. The results have been momentous. A giant public safety net has been stretched out across the financial system. We may never know what went on behind the closed doors of the US Federal Reserve, the European Central Bank and the Bank of England during those critical moments in March. So far, only muffled sounds of argument have reached the outside. But as the virus struck, the men and women in those three central banks held the economic survival of hundreds of millions of people and the fate of nations in their hands. This is the story of how global financial meltdown was averted by central banks taking decisions that, just a month earlier, they would have dismissed as utterly impossible.

by Adam Tooze, The Guardian |  Read more:

Image: Peter Reynolds

The Lure of Fascism

Ours is the age of the rule by ‘strong men’: leaders who believe that they have been elected to deliver the will of the people. Woe betide anything that stands in the way, be it the political opposition, the courts, the media or brave individuals. While these demonised guardians of freedom are belittled, brushed aside or destroyed, vulnerable groups, such as refugees, immigrants, minorities and those living in poverty, bear the brunt. What can be done to halt or reverse this process? And what will happen if we simply stand by and watch? Some commentators see parallels with the rise of fascism in the 1930s. Others agree that democracy is under threat but suggest that the threats are new. A fair point, but with its dangers. Yes, we must attend to new threats, but old ones can reoccur too.

Stefan Zweig, the Austrian author of Jewish descent, saw his books burnt in university towns across Germany in 1933. His memoirs paint a picture in which everything was normal until it wasn’t. But it would be wrong to think that we can predict how things will turn out. Who foresaw where we are now? The French philosopher Simone Weil, writing in 1934, probably had it right: ‘We are in a period of transition; but a transition towards what? No one has the slightest idea.’

Liberal democratic institutions, such as those we have now, exist only so long as people believe in them. When that belief evaporates, change can be rapid. Beware leaders riding a wave of crude nationalism. Beware democracy submerging into a vague notion of the will of the people. But why now? In 1920s Germany, it was obvious. The novelist and journalist Joseph Roth remarked:

Without the free food [that the unemployed man in Hamburg] gets in assembly halls he would starve to death. And in these assembly halls, where people used to go to smooch and drink, they are now daubing swastikas and Soviet stars on the grimy walls.

Mass unemployment isn’t what threatens us today. [ed. It does now, post-virus] Instead, we’re facing something closer to the situation observed by Hannah Arendt in 1951:
It is as though mankind had divided itself between those who believe in human omnipotence … and those for whom powerlessness has become the major experience of their lives.

Powerlessness can lead to detachment. But it can also lead to exuberant support for whomever seems to be on your wavelength. This is what happened in the 1930s. In considering the parallels between then and now, the Irish journalist Emily Lorimer’s book What Hitler Wants (1939) – written in October 1938, a month before Kristallnacht, and just after the German occupation of Czechoslovakia – is a remarkable resource. Lorimer realised that the English translation of Hitler’s Mein Kampf (1925) was highly censored; for example, it left out Hitler’s detailed plans to invade England. Few English people could read German, so Lorimer set out to make an English-language digest and summary of the key elements of the book. She suggested that three key elements [ed. emphasis added] drove Hitler’s initial plans: a concern for workers’ rights; a desire to create a purely German state; and violent opposition to social democracy. (...)

At the heart of democracy is a tension between the rule of the majority and the protection of the rights of the minority. Protecting minority rights means that, in practice, liberal democracy limits the rule of the majority. Many countries have a written constitution, covering issues that are simply too important to be left to ordinary day-to-day politics. They need a special, drawn-out process for change. For some matters of even greater importance, change can happen only at the hands of the international community. And these, of course, are human rights. A simple majority should not be enough to overturn constitutional or human rights.

Fascism disagrees. Mosley wrote: ‘The will of the people is greater than the right of the minority.’ The leader is there to carry out the will of the people, irrespective of the consequences for particular individuals. No one has the right to stand in its way.

Liberal democracies have evolved a vast web of institutions that can interfere with an overreaching leader’s plans in different ways, and that collectively protect minority rights. The most visible are the formal mechanisms that limit power or authority. These include the rule of law and law courts. The upper house in parliament keeps watch over executive overreach. Local government provides an alternative source of concentrated authority. Healthy politics includes a ‘loyal opposition’, supporting the system but opposing the government of the day. The test for whether leaders understand this concept is if they dismiss expressed opposition as ‘treason’. Weil applies the Bolshevik leader Mikhail Tomsky’s comment on the feudal Russian regime to fascism: ‘One party in power and all the rest in prison.’ (...)

Authoritarian leaders, who believe that they have been elected with a mandate of radical national renewal, can become easily frustrated with the spider’s web of institutions that prevent them from exercising power as they wish. The press is biased; the news is fake; the judges are the enemies of the people; the universities crush free speech and promote subversive ideologies; the trade unions stand in the way of progress; local government is a viper’s nest; and the upper chamber is full of deluded, self-interested fools. The protective institutions of liberal democracy are being persistently chipped away.

by Jonathan Wolff, Aeon | Read more:
Image: Heinrich Hoffmann/Ullstein Bild/Getty
[ed. See also: Studying Fascist Propaganda by Day, Watching Trump’s Coronavirus Updates by Night; and We Won’t Know the Exact Moment When Democracy Dies (New Yorker).]

Makoto Kakizaki
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My Covid-19 Thinking: 4/17

[ed. I'm cutting to the chase here and just posting the author's conclusions (you can read the whole article at the link). If you're unaquainted with Rationalist thinking, I urge you to check out LessWrong. It's not easy reading. And if you decide it's not for you, that's ok too.]

I want to wrap this up so I don’t lose even more to the speed premium, so I don’t have time to give my full thoughts on this today. In On R0 and throughout this I should be making clear what I think the physical landscape looks like. This will all be the same picture I gave then, just more explicit/direct/compact.

Over time, people get better at reducing risk while not sacrificing too much to do so. Masks get worn and improved in type and quality, delivery services scale, people stop acting like 6.1 feet is safe and 5.9 feet will kill you (seriously, this one stings every time), companies implement temperature checks and new workplace designs, the people who aren’t with the program learn the program, and so on. Testing will expand eventually, including by corporations supplying for their employees. People who are immune are placed in exposed positions increasingly with antibody testing, and even those without testing in those positions have mostly been infected anyway at this point if they have been unable to take good precautions.

There is pushing back from people sick of distancing and who need to go work and earn a living, but they mostly do so in sensible ways. There’s some risk of crazy town if things are handled badly. So far only Michigan and Ohio show signs of it I’ve heard about, which is likely because Ohio reacted so well that people don’t get why they had to, and Michigan reacted poorly and people are mad about the implementation details being terrible.

Some areas are not set up to handle things well. In those areas, things get briefly bad, but they also burn out relatively quickly. Can’t handle it translates into particular groups being unable to handle things or choosing not to, so those groups burn through infections until they’re handling it.

I do think that there’s a lot of slack for private agents to step up and help a lot more, but it’s currently illegal to do so. When there is need of it, it will happen. Corporations and individual people have come out of all this looking really good.

Trump will continue to do his best to screw things up, and it will continue to screw things up, but I expect this to not be in ways that matter that much in the big picture. The real damage done was already done early on. He’s done an admirable job of not trying to actually do things, except for some banditry and piracy involving medical equipment. Could have been a lot worse. He briefly flirted with saying he had absolute authority, but backed down as is his pattern before we started once again saying “The United States are” and I don’t expect him to try again in a serious way.

We “reopen” the country in places in mid-May and others in June or July, but that doesn’t mean open. It means people are free to do what they want. Schools mostly or entirely won’t reopen this semester, so places that ‘open’ will still be largely closed slash in the new normal as we adjust. Mostly things shut down because private citizens and corporations shut them down, and they’ll reopen the same way. If Cuomo “reopened” New York I doubt much of anything would actually change the next few weeks.

Likely by end of year we’ve found a treatment protocol that makes this all a lot less deadly. I’m guessing combining the stuff we’ve already found that works and tossing the parts that doesn’t would do a lot.

The supply chain looks like it’s straining in places, and needs deregulation of the food supply so people can pivot to residential provision faster. My guess is things get somewhat worse for a bit, then this is allowed to happen slash people find workarounds as some restaurants become de facto grocery stores. When it gets bad we’ll figure it out quickly.

Eventually there’s a vaccine and it all finally ends.

What would I bet on right now, as one commentator asked? I don’t really want to bet on such matters, especially I don’t feel good about betting on more people dying. But certainly I’d bet against the things I think are essentially can’t happens, given reasonable odds. More detail is needed to know what else I would do; trading is very context dependent.

by Zvi, LessWrong |  Read more:
[ed. Also want to link to the original Imperial College COVID-19 Response Team report (pdf) that did so much to finally get governments and politicians to wake up to the severity of the crisis.]

Steely Dan

[ed. I seem to recall Donald Fagan saying this song best typified what he and Walter Becker were trying to achieve with Steely Dan. See also these past SD posts: here (Almost Gothic); here (Charlie Freak); here (Monkey in Your Soul/and the live Santa Monica version of Bodhisattva - starting at 2:25 to avoid the crazy inebriated introduction by Jerome Aniton); and here (mini-compilation: West of Hollywood, Jack of Speed, What a Shame About Me).]

White House Coronavirus Task Force Briefing

(Enter PRESIDENT TRUMP, VICE PRESIDENT PENCE, DR. ANTHONY FAUCI, DR. DEBORAH BIRX, and SURGEON GENERAL JEROME ADAMS. They all stand in close proximity to each other and touch each other and their faces repeatedly. Also, ATTORNEY GENERAL WILLIAM BARR stands holding a folder.)

TRUMP: Let’s get started. Lots of death. Hydroxychloroquine. Ratings. I am a doctor.

REPORTER: Millions of Americans are still waiting to get tested. Can you explain the delays?

TRUMP: First of all, sports. Secondly, anyone who wants a test gets a test. I wanted a test and I got a test.

(PENCE clears throat and gently moves toward the podium.)

PENCE: I want to build on what the president said by adding that though he is 100 percent right, I should also say that the vast majority of people who want a test will not get a test.

(DR. FAUCI leans over to the podium.)

DR. FAUCI: I want to build on what the vice president said by just adding that the virus will be with us for 18 months and kill 240,000 people.

(Horrified murmurs fill the room.)

REPORTER: So should the public be wearing masks?

(Everyone near the podium shrugs. DR. FAUCI coughs into his bare hand.)

TRUMP: Here is a man who makes pillows.

MAN WHO MAKES PILLOWS: I am a man who makes pillows.

DR. BIRX: I’d like to build on the statement of the man who makes pillows. We’ve had three months of conflicting messages on masks, so I want to clarify that it is not at all necessary that you wear a mask — unless you want to avoid contracting the virus.

(TRUMP looks at DR. BIRX, who is wearing a scarf.)

TRUMP: You could also wear a scarf. I am a scientist.

by Dave Eggers, McSweeny's |  Read more:
Image: Jim Watson/AFP via Getty Images

Bluetooth-Based Coronavirus Contact Tracing Finds Broad Support

Consensus seems to be building globally around the idea that Bluetooth-based contact tracing could be a practical use of technology to contain the spread of the coronavirus.

Why it matters: Both governments and advocacy groups agree that using Bluetooth to sense the proximity of users' phones could be more effective and less of a civil rights problem than tapping location-based data that apps and service providers often collect.

Driving the news:

• The EU on Thursday said that mobile apps can help slow the spread of the disease, when combined with ample testing and medical care resources. But it cautioned that such apps need to be interoperable and also protect privacy.
• The EU runs the globe's strictest privacy regime, so the guidelines it has offered suggest a path forward for the Bluetooth-based approach.
• The American Civil Liberties Union offered up its own guidelines on Thursday, calling for apps that minimize data retention and central storage, augment human contact tracing and are, among other things, voluntary, non-discriminatory, and built with input from health professionals. They should also be narrowly tailored to this epidemic and their use should end when the pandemic ends, or if they are shown to be ineffective at slowing its spread, the group said.

The big picture: A number of entities are working on similar technology approaches that would appear to be able to meet the goals outlined by the EU and ACLU.

Most prominently, this includes the joint Apple-Google effort announced last week, which aims to build a foundation for Bluetooth-based contact tracing in both the iOS and Android smartphone operating systems.

Other efforts include the PACT project from MIT and those from several groups in Europe. (...)

Meanwhile: Pew reported in a new survey that Americans are not only divided on whether they find tracking apps acceptable, but are also skeptical such apps will really be effective.

by Ina Fried, Axios |  Read more:

Image: Eniola Odetunde/Axios

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Miniature Art Gallery For Gerbils
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A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat

How many people have the coronavirus in the United States? More than two months into the country’s outbreak, this remains the most important question for its people, schools, hospitals, and businesses. It is also still among the hardest to answer. At least 630,000 people nationwide now have test-confirmed cases of COVID-19, according to The Atlantic’s COVID Tracking Project, a state-by-state tally conducted by more than 100 volunteers and experts. But an overwhelming body of evidence shows that this is an undercount.

Whenever U.S. cities have tested a subset of the general population, such as homeless people or pregnant women, they have found at least some infected people who aren’t showing symptoms. And, as ProPublica first reported, there has been a spike in the number of Americans dying at home across the country. Those people may die of COVID-19 without ever entering the medical system, meaning that they never get tested.

There is clearly some group of Americans who have the coronavirus but who don’t show up in official figures. Now, using a statistic that has just become reliable, we can estimate the size of that group—and peek at the rest of the iceberg.

According to the Tracking Project’s figures, nearly one in five people who get tested for the coronavirus in the United States is found to have it. In other words, the country has what is called a “test-positivity rate” of nearly 20 percent.

That is “very high,” Jason Andrews, an infectious-disease professor at Stanford, told us. Such a high test-positivity rate almost certainly means that the U.S. is not testing everyone who has been infected with the pathogen, because it implies that doctors are testing only people with a very high probability of having the infection. People with milder symptoms, to say nothing of those with none at all, are going undercounted. Countries that test broadly should encounter far more people who are not infected than people who are, so their test-positivity rate should be lower.

The positivity rate is not the same as the proportion of COVID-19 cases in the American population at large, a metric called “prevalence.”* Nobody knows the true number of Americans who have been exposed to or infected with the coronavirus, though attempts to produce much sharper estimates of that figure through blood testing are under way. Prevalence is a crucial number for epidemiologists, in part because it lets them calculate a pathogen’s true infection-fatality rate: the number of people who die after becoming infected.

But the positivity rate is still valuable. “It’s not a normal metric, but it can be a very useful one in some circumstances,” Andrews said. The test-positivity rate is often used to track the spread of rare but deadly diseases, such as malaria, in places where most people aren’t able to get tested, he said. And if the same proportion of a population is being tested over time, the test-positivity rate can even be used to calculate the contagiousness of a disease.

Because the number of Americans tested for COVID-19 has changed over time, the U.S. test-positivity rate can’t yet provide much detailed information about the contagiousness or fatality rate of the disease. But the statistic can still give a rough sense of how bad a particular outbreak is by distinguishing between places undergoing very different sizes of epidemics, Andrews said. A country with a 25 percent positivity rate and one with a 2 percent positivity rate are facing “vastly different epidemics,” he said, and the 2 percent country is better off.

In that light, America’s 20 percent positivity rate is disquieting. The U.S. did almost 25 times as many tests on April 15 as on March 15, yet both the daily positive rate and the overall positive rate went up in that month. If the U.S. were a jar of 330 million jelly beans, then over the course of the outbreak, the health-care system has reached in with a bigger and bigger scoop. But every day, 20 percent of the beans it pulls out are positive for COVID-19. If the outbreak were indeed under control, then we would expect more testing—that is, a larger scoop—to yield a smaller and smaller proportion of positives. So far, that hasn’t happened.

by Robinson Meyer and Alexis C. Madrigal, The Atlantic |  Read more:
Image: Adam Maida
[ed. See also: Our Pandemic Summer (The Atlantic).]

Coronavirus Vaccine Prospects

Time for another look at the coronavirus vaccine front, since we have several recent news items. Word has come from GSK and Sanofi that they are going to collaborate on vaccine development, which brings together two of the more experienced large organizations in the field. It looks like Sanofi is bringing the spike protein and GSK is bringing the adjuvant (more on what that means below). Their press release says that they plan to go into human patients late this year and to have everything ready for regulatory filing in the second half of 2021. For its part, Pfizer has announced that they’re pushing up their schedule with BioNTech and possibly starting human trials in August, which probably puts them on a similar timeline for eventual filing.

“But that’s next year!” will be the reaction of many who are hoping for a vaccine ASAP, and I can understand why. The thing is, that would be absolutely unprecedented speed, way past the current record set by the Ebola vaccine, which took about five years. More typical development times are ten years or more. But hold that thought while you peruse another news item today from J&J. They have an even more aggressive timeline proposed for their own vaccine work: they have already announced that they have a candidate, and they say that they plan first-in-human trials in September. Data will be available from those in December, and in January 2021 they say that they will have the first batches of vaccine ready for an FDA Emergency Use Authorization. Now that is shooting for the world record on both the scientific and regulatory fronts.

So let’s talk vaccine development, because everything is going to have to work perfectly for any such timetable to be realized. Here’s a good overview of the coronavirus vaccine world in Nature Reviews Drug Discovery. The official WHO list is here, and at BioCentury they have constantly updated open-access summaries of the vaccines and other therapies that are in the clinic and the ones that are still preclinical. They have also just published this excellent overview of the vaccine issues; I recommend reading that one after you’ve picked up some background from this post.

NRDD counts 115 (!) vaccine programs, of which 37 are unconfirmed (no further information available on them) and 78 are definitely real. Of those 78, five of them are in the clinic, although that number will be climbing rapidly. You have Moderna’s mRNA1273, which as the name tells you is an mRNA candidate, and Inovio’s INO4800, which is a DNA plasmid, There are two cellular candidates from Shenzhen Geno-Immune Medical Institute: LV-SMENP-DC, a dendritic cell vaccine that’s been modified with lentivirus vectors to express viral proteins, and an artificial antigen-presenting cell (aAPC) vaccine along the same lines. And finally there’s a more traditional protein-fragment vaccine, Ad5-nCoV from CanSino.

Let’s go into what all those mean. You will note the diversity of approaches in that list, and that’s not even the whole spread. When you go back into the preclinical candidates, you have in addition “virus-like particles”, viral vectors, both replicating and non-replicating, live attenuated viruses, inactivated viruses, and more. From this you may deduce correctly that there are a lot of ways to set off the immune response. What are the differences between them?

Types of Vaccines (...)

Adjuvants (...)

Developing a Covid-19 Vaccine: Efficacy (...)

Developing a Covid-19 Vaccine: Safety (...)

Developing a Covid-19 Vaccine: Logistics

Another big problem is going to be manufacturing and distribution. Many readers will have heard about the difficulties that sometimes occur during the flu-vaccine production process, leading to shortages. Depending on what vaccine technology comes out on top, manufacturing enough doses in a reproducible fashion could be quite challenging – space and finger fatigue don’t permit going into all the details, but they are many and complex. Keep in mind as well that many vaccines need “cold chain” distribution and storage, which is always a layer of complexity. What if an eventual vaccine needs more than one round of administration, as many of the adjuvant-formulated ones do? Keeping track of that and following up on it is yet another issue.

My guess is that scale-up and manufacturing could well be the biggest chance for the timelines mentioned earlier to blow up, so there is going to be a massive effort to front-load the work on these problems – this is why, for example, Bill Gates has already indicated willingness to fund factories for up to seven vaccines up front. The live-virus, attenuated virus, recombinant protein, and nucleic acid vaccines will all involve completely different production methods and formulations, and since we don’t know which way we’ll be going, this would seem the only way to address the issue. Pfizer and others have already said that they’re going to be working on production even before the efficacy data come in, which needless to say is not the usual business practice. I think we’ll get vaccine efficacy, one way or another, although it sure won’t be characterized as thoroughly as it normally would. And I think we’re already agreeing to cut corners on safety, whether anyone says so in as many words or not. But producing the vaccine on scale could be a bigger issue yet, and as the process goes on, that’s where I would keep an eye out for trouble.

by Derek Lowe, Science Translational Medicine |  Read more:

Image: Thana Prasongsin/Getty Images via:

Reflections on a Disaster (Update)

From the initial Duck Soup post: Reflections on a Disaster (4/1/2020). Updated occasionally to see how closely we're following the script.

Update (4/7/2020): I forgot to add the main issue of conflict once the response/execution process is in full swing (actually, the main issue right from the beginning): More Harm Than Good. At the time of this writing we're closing in on what experts hope will be peak contagion/recorded deaths. Expect to see an escalating struggle between health experts/politicians/others vs. economists/politicians/business leaders/others on the issue of when to ease up on social distancing measures (basically, defining "success"). I'm already seeing calls to isolate the most vulnerable (old, underlying health conditions, etc.) and letting everyone else take their chances (possibly developing 'herd immunity' in the process). In other words, pitting numbers of deaths against numbers of unemployed and the health of the economy - which itself is on life-support at the moment.

***

Ok folks, here we are a week and a half later (4/16/2020). How are things going? (I'm not doing millions of links, so Google them yourselves): Well, the President is pushing some vague authority to reopen the economy (even though he never shut it down in the first place, and governors are pushing back, forming regional coalitions). The small business stimulus program has already run out of money (some businesses never seeing a dollar). No money for individuals yet. The financial sector is a black hole and could blow up at any time on any number of issues including over-leveraged and inter-connected risk, and things like loan defaults on car and house payments (some kind of cascading failure process, like 2008). Rent and mortgage payment relief proposals are mired in the weeds. No widespread virus/antibody testing yet (still several weeks off at best). No expansive contact tracing. No widespread availablility of masks. No killer vaccine on the horizon, maybe new year at the earliest (and no clear leading candidate). Respiratory intubation procedures should be avoided if at all possible. Secondary infections and virus mutations reported (!), a significant setback for vaccine production if true. More to come. See original post.] 

See also: The Fight Against COVID-19: “Bending the Curve” & Then What? (Wolf Street); and Wishful Thinking on Ending Coronavirus Lockdowns (Naked Capitalism).

A Failure, But Not of Prediction

Vox asks What Went Wrong With The Media’s Coronavirus Coverage? They conclude that the media needs to be better at “not just saying what we do know, but what we don’t know”. This raises some important questions. Like: how much ink and paper is there in the world? Are we sure it’s enough? But also: how do you become better at saying what you don’t know?

In case you’ve been hiding under a rock recently (honestly, valid) the media not only failed to adequately warn its readers about the epidemic, but actively mocked and condescended to anyone who did sound a warning. Real Clear Politics has a list of highlights. The Vox tweet saying “Is this going to be a deadly pandemic? No.” Washington Post telling us in February “Why we should be wary of an aggressive government reponse to coronavirus (it might “scapegoat marginalized populations”). The Daily Beast complaining that “coronavirus, with zero American fatalities, is dominating headlines, while the flu is the real threat”. The New York Times, weighing in with articles like “The pandemic panic” and “Who says it’s not safe to travel to China”. The constant attempts to attribute “alarmism” over the virus to anti-Chinese racism. Etc, etc, etc.

One way people have summed this up is that the media (and the experts they relied on) did a terrible job predicting what would happen. I think this lets them off too easy. (...)

A few weeks ago, I wrote a blog post on face masks. It reviewed the evidence and found that they probably helped prevent the spread of disease. Then it asked: how did the WHO, CDC, etc get this so wrong?

I went into it thinking they’d lied to us, hoping to prevent hoarders from buying up so many masks that there weren’t enough for health workers. Turns out that’s not true. The CDC has been singing the same tune for the past ten years. Swine flu, don’t wear masks. SARS, don’t wear masks. They’ve been really consistent on this point. But why?

If you really want to understand what happened, don’t read any studies about face masks or pandemics. Read Smith & Pell (2003), Parachute Use To Prevent Death And Major Trauma Related To Gravitational Challenge: Systematic Review Of Randomized Controlled Trials. It’s an article in the British Journal Of Medicine pointing out that there have never been any good studies proving that parachutes are helpful when jumping out of a plane, so they fail to meet the normal standards of evidence-based medicine. (...)

Of course this is a joke. It’s in the all-joke holiday edition of BMJ, and everyone involved knew exactly what they were doing. But the joke is funny because it points at something true. It’s biting social commentary. Doctors will not admit any treatment could possibly be good until it has a lot of randomized controlled trials behind it, common sense be damned. This didn’t come out of nowhere. They’ve been burned lots of times before by thinking they were applying common sense and getting things really wrong. And after your mistakes kill a few thousand people you start getting really paranoid and careful. And there are so many quacks who can spout off some “common sense” explanation for why their vitamin-infused bleach or colloidal silver should work that doctors have just become immune to that kind of bullshit. Multiple good RCTs or it didn’t happen. Given the history I think this is a defensible choice, and if you are tempted to condemn it you may find this story about bone marrow transplants enlightening.

But you can take this too far. After highlighting the lack of parachute RCTs, the paper continues:

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

Did you follow that? For a good parachute RCT, half the subjects would have to jump out of a plane wearing a placebo parachute. The authors suggest maybe we enlist doctors who insist too stringently on RCTs over common sense for this dubious honor. (...)

But I would ask this of any journalist who pleads that they were just relaying and providing context for expert opinions: what was the experts’ percent confidence in their position?

I am so serious about this. What fact could possibly be more relevant? What context could it possibly be more important to give? I’m not saying you need to have put a number in your articles, maybe your readers don’t go for that. But were you working off of one? Did this question even occur to you?

Nate Silver said there was a 29% chance Trump would win. Most people interpreted that as “Trump probably won’t win” and got shocked when he did. What was the percent attached to your “coronavirus probably won’t be a disaster” prediction? Was it also 29%? 20%? 10%? Are you sure you want to go lower than 10%? Wuhan was already under total lockdown, they didn’t even have space to bury all the bodies, and you’re saying that there was less than 10% odds that it would be a problem anywhere else? (...)

People were presented with a new idea: a global pandemic might arise and change everything. They waited for proof. The proof didn’t arise, at least at first. I remember hearing people say things like “there’s no reason for panic, there are currently only ten cases in the US”. This should sound like “there’s no reason to panic, the asteroid heading for Earth is still several weeks away”. The only way I can make sense of it is through a mindset where you are not allowed to entertain an idea until you have proof of it. Nobody had incontrovertible evidence that coronavirus was going to be a disaster, so until someone does, you default to the null hypothesis that it won’t be.

by BMJ and Scott Alexander, Slate Star Codex |  Read more:
[ed. A parody perhaps but one that highlights the problems of being overly concerned with not inducing a panic (or being tarred as an alarmist). Also, do check out the bone marrow transplant link for more relevance to our current situation (and the complexities of "weasels who rush in".]

Covid-19 Updates (4/16/2020) Lego Edition

LEGO Unveils New 20,000-Piece Ventilator Set To Aid Supply Shortage. 

See also: Americans Begin Receiving Stimulus Checks:

Treasury Secretary Steve Mnuchin announced that 80 million Americans will receive a direct deposit for up to $1,200 this week as part of the government’s economic relief package, with early reports indicating the funds are being used on food, gas, rent, and other necessities. What do you think?

via: The Onion

[ed. Also, can't forget this classic (from 1/7/2001 - eight months before 9/11): Bush: 'Our Long National Nightmare Of Peace And Prosperity Is Finally Over' (The Onion). No good work is ever left unfinished.] 

Why Animal Crossing Is the Game for the Coronavirus Moment

Imagine escaping to an island paradise where bags of money fall out of trees and a talking raccoon can approve you for a mortgage.

With the world in the grip of a pandemic, that’s exactly the sort of escape that has captivated so many — not in their fantasies, but in the world of Animal Crossing: New Horizons. It’s the latest in a series that’s been around since 2001, but New Horizons is the first built-from-the-ground-up console release in 19 years. It’s also a conveniently timed piece of whimsy for gamers — and has become a phenomenon.

In Animal Crossing, players take on the role of a lone human on an island filled with pudgy anthropomorphic animals. Players are tasked with building a thriving society, filling it with shops, bridges and other accommodations for its residents. There are no high scores, vampire Nazis or final bosses. The game is played at a relaxed pace, in which the player can do as much or as little as they want on any given day. Upbeat acoustic jams or sultry bossa nova synths play in the background.

Already, early sales figures from Japan and Britain suggest that this is the strongest launch for an Animal Crossing game in history. (U.S. figures are to be released later this month.) And the game has extended its reach beyond its main platform, with users sharing screenshots on social media of their Japanese-inspired homes, custom T-shirt designs and perfectly arranged flower gardens. It became the No. 1 trending game on the platform, with Japan, the U.S., Korea, France and Spain at the top.

“It’s now the No. 1 most talked-about game in the world, dethroning the likes of Fate/Grand Order — which held that title for nearly two years — and Fortnite,” said Rishi Chadha, global head of gaming partnerships at Twitter. “The growth in conversation has been astronomical. Conversation volume since launch has grown over 1,000 percent and the number of people tweeting about the game has grown over 400 percent.”

Indeed, there have been more than 38 million tweets about the game since its release, many celebrating its ability to provide comfort and social connection in a time of isolation and struggle.

by Imad Khan, NY Times | Read more:
Image: Nintendo

Bailouts Won’t Save the Economy. More Coronavirus Tests Will.

No sooner had the ink dried on the last $2 trillion round of economic relief from the devastation wrought by the coronavirus pandemic than President Trump and Congress began contemplating the next bill to address the crisis. There is, after all, crisis to spare. You might think the emergency on Washington’s mind is the rapidly escalating number of U.S. infections and deaths, or perhaps the shortage of lifesaving personal protective gear and medical equipment such as ventilators and the ongoing dearth of reliable and available tests.

But the disaster that the next round of stimulus will address, according to media accounts, is the same as the last one: the financial losses to businesses and workers caused by the social distancing measures put in place to limit the spread of the new coronavirus. The severity of current social distancing restrictions is necessitated in part by the United States’ lack of capacity to identify the infected, trace and test their social contacts, and quarantine the sick. If you can’t be sure that everyone outside isn’t contagious, then you must stay inside.

Congress remains perversely determined to treat the symptoms, rather than the illness. On Wednesday, Newsday reported, “Senate Majority Leader Mitch McConnell this week proposed adding $250 billion for the popular small-business loan programs already in the recently enacted $2.2 trillion CARES Act relief and stimulus package. But House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer demanded Wednesday that that interim bill also include $150 billion for state and local governments ... and $100 billion for hospitals and a 15% increase in the maximum benefit to supplemental nutrition assistance for families.” In other words, Republicans and Democrats both just more of the very same things they got last time. In fact, Pelosi explicitly pointed to the last bill as “a good model” because it managed to draw bipartisan support.

It is true that some of these expenditures, such as aid to hospitals and state and local governments, will partly aid the essential efforts to treat the sick. And putting money in people’s pockets goes hand-in-hand with social distancing policies, by defraying some of the costs of closing non-essential businesses, which in turn threatens the reliable paychecks of thousands of workers. But this approach, while vital, has at best only slowed the virus’ spread. The disease must be halted in its tracks to allow the economy to be reopened. The only answer is to rapidly ramp up widespread public testing for Covid-19 and its antibodies. (...)

“I can’t believe that here we are the second week in April and we’re still talking about testing,” said Ashish Jha, director of the Harvard Global Health Institute. “We still can’t test for a virus that has shut the entire American economy down. I talk to conservative economists, and I say, ‘You know, we’re costing the American economy hundreds of millions of dollars a day because we don’t have testing capacity.’”

As Aaron E. Carroll, a medical school professor at Indiana University, noted in The New York Times on Monday, before the economy can be safely reopened, “Every time an individual tests positive, the public health infrastructure needs to be able to determine whom that person has been in close contact with, find those people, and have them go into isolation or quarantine until it’s established they aren’t infected, too... Building that capacity will take significant time and money, and the country hasn’t even started.” (...)

What would such a federal effort look like? For one thing, it would involve a lot more aid to state and local governments earmarked for the purpose. “It means a massive infusion at the state and local level, because the people who are going to do the testing, do the contact tracing, are all state and local people,” said Gregg Gonsalves, a professor of public health at Yale. “The last bill has $150 billion to state and local governments, but they’re losing sales and income tax revenue, so $150 billion doesn’t even begin to meet the lost revenue gap. Money has to flow to the states to do the shoe leather epidemiology.”

Congress also needs to direct the U.S. Centers for Disease Control and Prevention to give proper guidance and assistance to the state and local governments. “Contact tracing would have to be implemented by states,” said Jha. “But Congress could say, ‘You do it, we’ll fund it and put in some metrics to make sure it’s actually happening.’” The state and local departments of health would then, with federal dollars and oversight, hire staff of testers covered in personal protective gear such as masks and gowns.

We also simply must produce vastly more tests and build the lab capacity to turn them around quickly. Currently, patients can wait up to a week for results because the private labs that perform the tests often have a massive backlog. Jha estimates that, based on the current level of outbreak, roughly 500,000 to 600,000 Americans per day should be getting testing, which is roughly five times as many tests as we’re currently performing. It would also be helpful, since so many people who have been sick recently with flu-like symptoms don’t know if they had Covid-19, and many people who had it were asymptomatic, to develop and widely deploy a serological tests, which measure the disease’s antibodies in the blood. Then we’d have some idea of who can safely go back to work without risk of infection.

by Ben Adler, TNR |  Read more:

Image: Bloomberg / Getty Images

[ed. This seems so obvious it should go without saying. See also: Testing Falls Woefully Short as Trump Seeks an End to Stay-at-Home Orders (NY Times). And: Congress Has Abandoned the Country (TNR); but don't worry, they'll be back in May (maybe, hopefully).]

Alicia Keys & John Mayer

[ed. Everyone used to be so happy.]

Pandemic Journal: April 13, 2020

During the early days of quarantine, back when I was still trying to keep straight which Tolstoy princess had the mole and which had the mustache, and was still forcing my family to gather before the hearth every evening, as our forebears had, to hear the patriarch read poems aloud; before, that is, the fear of becoming very ill, or of losing our home, had really kicked in, I opened The New York Review of Books and turned to the classifieds. Twentieth-century artifacts still gamely chugging along, these notices offer all kinds of enticements: a farmhouse in the Dordogne or Tuscany, a kit for constructing a geodesic dome, a massage of uncertain propriety. I read the following ad:

A CHARISMATIC, AGING FRENCH rock star will compose and record an original song for you, your mom, your lover, or your pet in French, English or Franglais (recommended). US$200. Contact: lodbrogsagent@gmail.com; imrelodbrog.com

The classifieds in the Review tend to be written to a high standard, but there was something unusual about this one that I couldn’t quite describe—since, in fact, I didn’t yet fully detect it. I’d seen offers for commissioned artistic work over the years; this ad seemed quite consciously to offer not only the product itself, but an irresistible narrative. I wouldn’t have bit if I’d encountered it online, or if the singer hadn’t been French, or aging, or charismatic. Imagining that I would need stories to tell after the pandemic passed, I decided that $200 was a small price to pay for one. The song would be almost extra—it would be received as I suspected it was offered, as a kind of prop.

That morning I wrote to the email address listed in the ad:

Bonjour Monsieur, 

I am a US professor and I wonder if you would record a song for my two classes which have been suspended, English 120 and English 357? Something sentimental, using those names? I just posted your ad to Twitter and hope you get lots of business!!

Within an hour or so, the rock star’s agent—who identified herself only as “Lodbrog’s Agent”—wrote back from New York City, where the two of them were holed up. Imre Lodbrog would be delighted to compose a song for my classes, if I would send some additional instructions. So I sent a poem, Emily Dickinson’s “I’m Nobody,” and made just one request: that he use my course numbers in the refrain. I was amused by the idea of asking a charismatic French rock star to sing a heartbroken tune to a most unlikely amant: the catalog numbers of my classes. I proposed that Lodbrog—whose moody, gravelly songs I had, by that point, discovered online—also record a video, for an additional $200. Lodbrog’s Agent accepted my pitch, and we were off to the races.

By this point, I had begun to suspect that, in orchestrating my stunt, I had also become entangled in one. This wasn’t the story I imagined; it was not even, apparently, mine to tell. On Lodbrog’s website, under the section labeled “The Man,” I found, instead of a short bio, a mirror image of my curiosity, slightly intensified as though I’d arrived there after a years-long quest: “Who the hell is Imre Lodbrog,” it read: “Somebody said, ‘He’s like Serge Gainsbourg on ’shrooms.’” It seemed that the construction “Imre Lodbrog” had been designed, in part, as a ruse. But by whom, and why? A longer version of his classified appears under the section “Hired Gun,” describing him as “a softy and a socialist,” and offering his services on a sliding fee scale—as though $200 weren’t already an insane bargain. Beyond those scant details, nothing—except for a link to a book about Lodbrog that “we wrote.”

Last week the song arrived, a twangy, jangly number, utterly infectious, called “Cyrano”; today, the video appeared in my inbox, filmed in a New York desolated by the pandemic. Images of what looked to me like an intersection in the East Village—empty except for a few masked pedestrians—fade to archival footage of the same spot filled with dancers and revelers. The multiple fades of the video suggest the ghost lives we are now living. Both song and video give off a faint whiff of serioludere, with their intentionally broad gestures toward rock-star preening. And yet both are, to me, indescribably beautiful. Lodbrog’s Agent had written to ask if I was OK with his incorporating the story of Cyrano de Bergerac, because, as she put it, “he’s French.” I happily consented. It was a lark. But when I listened to the lyrics, I realized that Lodbrog had assumed the mantle of professor, teaching his own lesson to a group of captivated strangers, my students:

ENGLISH 120 ENGLISH 357
I AM NOBODY WHO ARE YOU?
NOBODY TOO AH PLEASED TO MEET YOU

DO YOU KNOW CYRANO
WHO SPOKE SOMEBODY’S LOVE THROUGH HIS HEART
OH MAN HOW DREARY TO BE
SOMEBODY

I AM HERE YOU ARE THERE
SO LET ME SING THIS LITTLE TUNE TO YA ALL
AND KEEP IT WARM UNTIL THE LIVELONG JUNE

The song continues in this vein for several more verses, adapting Dickinson’s existentially amiable little poem to this new scenario, where Lodbrog—a “nobody”—greets his fellow nobodies, me and my students. The beautifully open-hearted question, “Do you know Cyrano,” is Lodbrog’s own moment of pedagogy. If you don’t know him, I told my students, you should get to know him.

Lodbrog and his agent—whom I have discovered to be none other than Barbara Browning, the distinguished scholar of Brazilian music, and a dancer and performance artist who teaches at NYU—co-authored their quite wonderful book, Who the Hell Is Imre Lodbrog. I wouldn’t dare spoil their story, since it’s such a good one. As for this story, I have no idea how to tell it: Am I its author or its protagonist? Who the hell is Dan Chiasson?

“Cyrano” ends with a lovely conjuring of our current, frightening hiatus, and of some of the ways human connection might be reconceived in the time of Covid-19. Let’s hope Lodbrog is right about “the sunny livelong June”:

I AM THERE YOU ARE HERE
AND THAT’S THE MAGIC OF THE TRICK
A FEW WORDS AND A LITTLE TUNE
A TINY FLAME TO LIGHT UP THE GLOOM
UNTIL THE SUNNY LIVELONG JUNE
TO KEEP US ALL TOGETHER IN THIS EMPTY
CLASSROOM

by Dan Chiasson, NYRB | Read more:

[ed. Delightful.]