Bill Gates on Covid: Most US Tests Are ‘Completely Garbage’

For 20 years, Bill Gates has been easing out of the roles that made him rich and famous—CEO, chief software architect, and chair of Microsoft—and devoting his brainpower and passion to the Bill and Melinda Gates Foundation, abandoning earnings calls and antitrust hearings for the metrics of disease eradication and carbon reduction. This year, after he left the Microsoft board, one would have thought he would have relished shedding the spotlight directed at the four CEOs of big tech companies called before Congress.

But as with many of us, 2020 had different plans for Gates. An early Cassandra who warned of our lack of preparedness for a global pandemic, he became one of the most credible figures as his foundation made huge investments in vaccines, treatments, and testing. He also became a target of the plague of misinformation afoot in the land, as logorrheic critics accused him of planning to inject microchips in vaccine recipients. (Fact check: false. In case you were wondering.)

My first interview with Gates was in 1983, and I’ve long lost count of how many times I’ve spoken to him since. He’s yelled at me (more in the earlier years) and made me laugh (more in the latter years). But I’ve never looked forward to speaking to him more than in our year of Covid. We connected on Wednesday, remotely of course. In discussing our country’s failed responses, his issues with his friend Mark Zuckerberg’s social networks, and the innovations that might help us out of this mess, Gates did not disappoint. The interview has been edited for length and clarity.

WIRED: You have been warning us about a global pandemic for years. Now that it has happened just as you predicted, are you disappointed with the performance of the United States?

Bill Gates: Yeah. There’s three time periods, all of which have disappointments. There is 2015 until this particular pandemic hit. If we had built up the diagnostic, therapeutic, and vaccine platforms, and if we’d done the simulations to understand what the key steps were, we’d be dramatically better off. Then there’s the time period of the first few months of the pandemic, when the US actually made it harder for the commercial testing companies to get their tests approved, the CDC had this very low volume test that didn’t work at first, and they weren’t letting people test. The travel ban came too late, and it was too narrow to do anything. Then, after the first few months, eventually we figured out about masks, and that leadership is important.

So you’re disappointed, but are you surprised?

I’m surprised at the US situation because the smartest people on epidemiology in the world, by a lot, are at the CDC. I would have expected them to do better. You would expect the CDC to be the most visible, not the White House or even Anthony Fauci. But they haven’t been the face of the epidemic. They are trained to communicate and not try to panic people but get people to take things seriously. They have basically been muzzled since the beginning. We called the CDC, but they told us we had to talk to the White House a bunch of times. Now they say, “Look, we’re doing a great job on testing, we don’t want to talk to you.” Even the simplest things, which would greatly improve this system, they feel would be admitting there is some imperfection and so they are not interested.

Do you think it’s the agencies that fell down or just the leadership at the top, the White House?

We can do the postmortem at some point. We still have a pandemic going on, and we should focus on that. The White House didn’t allow the CDC to do its job after March. There was a window where they were engaged, but then the White House didn’t let them do that. So the variance between the US and other countries isn’t that first period, it’s the subsequent period where the messages—the opening up, the leadership on masks, those things—are not the CDC’s fault. They said not to open back up; they said that leadership has to be a model of face mask usage. I think they have done a good job since April, but we haven’t had the benefit of it.

At this point, are you optimistic?

Yes. You have to admit there’s been trillions of dollars of economic damage done and a lot of debts, but the innovation pipeline on scaling up diagnostics, on new therapeutics, on vaccines is actually quite impressive. And that makes me feel like, for the rich world, we should largely be able to end this thing by the end of 2021, and for the world at large by the end of 2022. That is only because of the scale of the innovation that’s taking place. Now whenever we get this done, we will have lost many years in malaria and polio and HIV and the indebtedness of countries of all sizes and instability. It’ll take you years beyond that before you’d even get back to where you were at the start of 2020. It’s not World War I or World War II, but it is in that order of magnitude as a negative shock to the system.

In March it was unimaginable that you’d be giving us that timeline and saying it’s great.

Well it’s because of innovation that you don’t have to contemplate an even sadder statement, which is this thing will be raging for five years until natural immunity is our only hope.

Let’s talk vaccines, which your foundation is investing in. Is there anything that’s shaping up relatively quickly that could be safe and effective?

Before the epidemic came, we saw huge potential in the RNA vaccines—Moderna, Pfizer/BioNTech, and CureVac. Right now, because of the way you manufacture them, and the difficulty of scaling up, they are more likely—if they are helpful—to help in the rich countries. They won’t be the low-cost, scalable solution for the world at large. There you’d look more at AstraZeneca or Johnson & Johnson. This disease, from both the animal data and the phase 1 data, seems to be very vaccine preventable. There are questions still. It will take us awhile to figure out the duration [of protection], and the efficacy in elderly, although we think that’s going to be quite good. Are there any side effects, which you really have to get out in those large phase 3 groups and even after that through lots of monitoring to see if there are any autoimmune diseases or conditions that the vaccine could interact with in a deleterious fashion.

Are you concerned that in our rush to get a vaccine we are going to approve something that isn’t safe and effective?

Yeah. In China and Russia they are moving full speed ahead. I bet there’ll be some vaccines that will get out to lots of patients without the full regulatory review somewhere in the world. We probably need three or four months, no matter what, of phase 3 data, just to look for side effects. The FDA, to their credit, at least so far, is sticking to requiring proof of efficacy. So far they have behaved very professionally despite the political pressure. There may be pressure, but people are saying no, make sure that that’s not allowed. The irony is that this is a president who is a vaccine skeptic. Every meeting I have with him he is like, “Hey, I don’t know about vaccines, and you have to meet with this guy Robert Kennedy Jr. who hates vaccines and spreads crazy stuff about them.” (...)

What goes through your head when you’re in a meeting hearing misinformation, and the President of the United States wants you to keep your mouth shut?

That was a bit strange. I haven’t met directly with the president since March of 2018. I made it clear I’m glad to talk to him about the epidemic anytime. And I have talked to Debbie Birx, I’ve talked to Pence, I’ve talked to Mnuchin, Pompeo, particularly on the issue of, Is the US showing up in terms of providing money to procure the vaccine for the developing countries? There have been lots of meetings, but we haven’t been able to get the US to show up. It’s very important to be able to tell the vaccine companies to build extra factories for the billions of doses, that there is procurement money to buy those for the marginal cost. So in this supplemental bill, I’m calling everyone I can to get 4 billion through GAVI for vaccines and 4 billion through a global fund for therapeutics. That’s less than 1 percent to the bill, but in terms of saving lives and getting us back to normal, that under 1 percent is by far the most important thing if we can get it in there.

Speaking of therapeutics, if you were in the hospital and you have the disease and you’re looking over the doctor’s shoulder, what treatment are you going to ask for?

Remdesivir. Sadly the trials in the US have been so chaotic that the actual proven effect is kind of small. Potentially the effect is much larger than that. It’s insane how confused the trials here in the US have been. The supply of that is going up in the US; it will be quite available for the next few months. Also dexamethasone—it’s actually a fairly cheap drug—that’s for late-stage disease.

I’m assuming you’re not going to have trouble paying for it, Bill, so you could ask for anything.

Well, I don’t want special treatment, so that’s a tricky thing. Other antivirals are two to three months away. Antibodies are two to three months away. We’ve had about a factor-of-two improvement in hospital outcomes already, and that’s with just remdesivir and dexamethasone. These other things will be additive to that.

You helped fund a Covid diagnostic testing program in Seattle that got quicker results, and it wasn’t so intrusive. The FDA put it on pause. What happened?

There’s this thing where the health worker jams the deep turbinate, in the back of your nose, which actually hurts and makes you sneeze on the healthy worker. We showed that the quality of the results can be equivalent if you just put a self-test in the tip of your nose with a cotton swab. The FDA made us jump through some hoops to prove that you didn’t need to refrigerate the result, that it could go back in a dry plastic bag, and so on. So the delay there was just normal double checking, maybe overly careful but not based on some political angle. Because of what we have done at FDA, you can buy these cheaper swabs that are available by the billions. So anybody who’s using the deep turbinate now is just out of date. It’s a mistake, because it slows things down.

But people aren’t getting their tests back quickly enough.

Well, that’s just stupidity. The majority of all US tests are completely garbage, wasted. If you don’t care how late the date is and you reimburse at the same level, of course they’re going to take every customer. Because they are making ridiculous money, and it’s mostly rich people that are getting access to that. You have to have the reimbursement system pay a little bit extra for 24 hours, pay the normal fee for 48 hours, and pay nothing [if it isn’t done by then]. And they will fix it overnight.

Why don’t we just do that?

Because the federal government sets that reimbursement system. When we tell them to change it they say, “As far as we can tell, we’re just doing a great job, it’s amazing!” Here we are, this is August. We are the only country in the world where we waste the most money on tests. Fix the reimbursement. Set up the CDC website. But I have been on that kick, and people are tired of listening to me.

by Steven Levy, Wired |  Read more:

Image: Jeff Pachoud/Getty

Reading the First Drafts of Anna Karenina

We know that Tolstoy’s reading of a collection of Alexander Pushkin’s fiction on March 18, 1873, brought on an urge to write; sometime later that day, his right hand picked up his pen and, instead of trying again to inspire himself about the court of Peter the Great in 1700, he began describing a modern high-society party where a floozy of a wife was carrying on an affair under the nose of her good, honest husband. The thought of that cuckolded husband mocked by a depraved society evoked more pity and alarm in Tolstoy than the thought that that same wife would kill herself. Her husband, who had been humiliated while she lived and cheated, would soldier on. Or would he kill himself too? Tolstoy wondered. How her suicide would happen, Tolstoy didn’t know or care. The poor husband!

Sofia wrote, in her “Various Notes for Future Reference”:

Last night L. suddenly said to me: “I have written a page and a half, and it seems good.” I assumed this was yet another attempt to write about the Peter the Great period, and didn’t pay much attention.

She must have heard something like this often enough from her husband that his vague mention of that night’s accomplishment did not impress her:

But then I realized that he had in fact embarked on a novel about the private lives of present-day people.

How exactly did she realize that? Had Tolstoy stood up and walked over to her and shyly handed over the page and a half? Did she start to read it and become confused? But, Levochka, what does this have to do with Peter’s time? That’s not true of Peter’s time!

She only remarked in the notes to herself: “So strange, the way he just pitched straight into it.”

. . . this evening he read various other excerpts from the [Pushkin] book, and under Pushkin’s influence he sat down to write. He went on with his writing today, and said he was well pleased with it.

In the next four years of working on Anna Karenina, Tolstoy would communicate having had one, maybe two more experiences of being “well pleased” with what he had written that given day. Some of the pleasure of these first two days of work may have had to do with his relief of escaping the complications of the Peter project.

Sofia added a detail concerning the second day of his work that helps dissolve the image we might conjure up of artists as relentless slaves to their work. Tolstoy was not working all day; sometimes he was out playing: “At the moment he is out looking at the fox with his two sons, their tutor Fyodor Fyodorovich and Uncle Kostya. This fox runs past the bridge near our house every day.”

That fox might be seen running through Tolstoy’s procrastinating mind for the next several years; mostly in periods of feeling unable to write, he would, grumbling about his frustration, get up from his desk and go hunting.

Sofia was now excited for him, for them, and on March 19 wrote her sister Tatyana: “Last night Levochka suddenly unexpectedly began writing a novel of contemporary life. The subject of the novel—an unfaithful wife and all the drama proceeding from this.” After Tolstoy had been working happily on Anna Karenina for a week, he wrote to Strakhov. After commiserating with his friend’s health problems, he shyly opened up: “Now I’ll tell you about myself, but please, keep it a great secret, because nothing may come of what I have to say.”(...)

The resolution of his doubts had to be about quitting the Peter project. The light from Pushkin’s brilliance exposed Tolstoy’s efforts’ seeming lifelessness.

It’s as if Tolstoy woke up in Pushkin-world and put on his own seven-league boots and started striding over the heads of all the other writers:

Not only Pushkin, but nothing else at all, it seemed, had ever aroused my admiration so much before. The Shot, Egyptian Nights, The Captain’s Daughter!!! And then there is the fragment The guests were arriving at the country house. Involuntarily, unwittingly, not knowing why and what would come of it, I thought up characters and events, began to go on with it, then of course changed it, and suddenly all the threads became so well and truly tied up that the result was a novel which I finished in draft form today, a very lively, impassioned and well-finished novel which I’m very pleased with and which will be ready in two weeks’ time if God gives me strength, and which has nothing in common with all that I’ve been wrestling with for a whole year.

Let’s consider this prediction of Anna Karenina being “ready in two weeks’ time” as one of the biggest miscalculations in literary history. And what could Tolstoy have meant by “a novel which I finished in draft form”? Some of us think of drafts as compositions that run all the way from the beginning to end. All the material is on the page; it just needs to be rewritten, reordered, revised. But Tolstoy didn’t mean that. His “draft” of the novel consisted of a few scenes and a list of notes.

His first plan, a story in four parts plus an epilogue, looks like this:

Prologue. She leaves her husband under happy “auspices.” She goes <to meet> to console the bride and meets Gagin [the name of the future Vronsky].

Part 1.

Chapter 1. The guests gathered at the end of winter, and were awaiting the Karenins and talking about them. She arrived and conducted herself indecently with Gagin. 

Chapter 2. She has it out with her husband. She reproaches him for previous indifference. “It’s too late.” 

Chapter 3. <In the artels> Gagin from the riding-ring gathers himself to go to the meeting. His mother and brother advise him to go to her. <Party at her place. The husband.> 

4th Chapter. Dinner at the Karenins’ with Gagin. The husband, conversation with the brother. St[epan] Ark[ad’ich] calms things down on the account of the German party and on account of his wife. 

5th Chapter. The races—he falls. 

Chapter 6. She runs to him, reveals her pregnancy, revelation to her husband.

The basic story had come to him in a few scenes. He would not hereafter be inventing all the plot points. Those of us who have read the novel can recognize these notes’ connections to it. But Tolstoy has not created the Anna we know yet. The most cinematic pre-cinema scene in literature, the horserace, is in place—with the consequent fall. Tolstoy never imagined Vronsky winning that race. No matter what, Vronsky will fall off his horse, and his fall will precipitate Anna’s announcement of her pregnancy to her husband.

by Bob Blaisdell, LitHub | Read more:

Image: Anna Karenina, uncredited
[ed. If you haven't read this masterpiece yet, what are you waiting for!]

On the 75th Anniversaries of the Atomic Bombings of Hiroshima and Nagasaki

U.S. leaders knew we didn’t have to drop atomic bombs on Japan to win the war. We did it anyway.

At a time when Americans are reassessing so many painful aspects of our nation’s past, it is an opportune moment to have an honest national conversation about our use of nuclear weapons on Japanese cities in August 1945. The fateful decision to inaugurate the nuclear age fundamentally changed the course of modern history, and it continues to threaten our survival. As the Bulletin of the Atomic Scientists’ Doomsday Clock warns us, the world is now closer to nuclear annihilation than at any time since 1947.

The accepted wisdom in the United States for the last 75 years has been that dropping the bombs on Hiroshima on Aug. 6, 1945, and on Nagasaki three days later was the only way to end the World War II without an invasion that would have cost hundreds of thousands of American and perhaps millions of Japanese lives. Not only did the bombs end the war, the logic goes, they did so in the most humane way possible.

However, the overwhelming historical evidence from American and Japanese archives indicates that Japan would have surrendered that August, even if atomic bombs had not been used — and documents prove that President Truman and his closest advisors knew it.

The allied demand for unconditional surrender led the Japanese to fear that the emperor, who many considered a deity, would be tried as a war criminal and executed. A study by Gen. Douglas MacArthur’s Southwest Pacific Command compared the emperor’s execution to “the crucifixion of Christ to us.”

“Unconditional Surrender is the only obstacle to peace,” Foreign Minister Shigenori Togo wired Ambassador Naotake Sato, who was in Moscow on July 12, 1945, trying to enlist the Soviet Union to mediate acceptable surrender terms on Japan’s behalf.

But the Soviet Union’s entry into the war on Aug. 8 changed everything for Japan’s leaders, who privately acknowledged the need to surrender promptly.

Allied intelligence had been reporting for months that Soviet entry would force the Japanese to capitulate. As early as April 11, 1945, the Joint Chiefs of Staff’s Joint Intelligence Staff had predicted: “If at any time the USSR should enter the war, all Japanese will realize that absolute defeat is inevitable.”

Truman knew that the Japanese were searching for a way to end the war; he had referred to Togo’s intercepted July 12 cable as the “telegram from the Jap emperor asking for peace.”

Truman also knew that the Soviet invasion would knock Japan out of the war. At the summit in Potsdam, Germany, on July 17, following Stalin’s assurance that the Soviets were coming in on schedule, Truman wrote in his diary, “He’ll be in the Jap War on August 15. Fini Japs when that comes about.” The next day, he assured his wife, “We’ll end the war a year sooner now, and think of the kids who won’t be killed!”

The Soviets invaded Japanese-held Manchuria at midnight on Aug. 8 and quickly destroyed the vaunted Kwantung Army. As predicted, the attack traumatized Japan’s leaders. They could not fight a two-front war, and the threat of a communist takeover of Japanese territory was their worst nightmare.

Prime Minister Kantaro Suzuki explained on Aug. 13 that Japan had to surrender quickly because “the Soviet Union will take not only Manchuria, Korea, Karafuto, but also Hokkaido. This would destroy the foundation of Japan. We must end the war when we can deal with the United States.”

While a majority of Americans may not be familiar with this history, the National Museum of the U.S. Navy in Washington, D.C., states unambiguously on a plaque with its atomic bomb exhibit: “The vast destruction wreaked by the bombings of Hiroshima and Nagasaki and the loss of 135,000 people made little impact on the Japanese military. However, the Soviet invasion of Manchuria … changed their minds.” But online the wording has been modified to put the atomic bombings in a more positive light — once again showing how myths can overwhelm historical evidence. (...)

MacArthur thought the use of atomic bombs was inexcusable. He later wrote to former President Hoover that if Truman had followed Hoover’s “wise and statesmanlike” advice to modify its surrender terms and tell the Japanese they could keep their emperor, “the Japanese would have accepted it and gladly I have no doubt.”

by Gar Alperovitz and Martin J Sherwin, LA Times |  Read more:

Image:Toru Yamanaka / AFP/Getty Images
[ed. See also: Reparation for the Frightful Wounds Inflicted on the Whole Human Family (National Catholic Register).]

Links

As the curve flattened, misconceptions took hold. Perhaps the biggest was that social distancing was a policy that would need to be enacted only once, for a brief period, after which the virus would be defeated and life would return to normal. With this fantasy in mind, politicians began to argue that the time had come to reopen. A number of factors—mounting economic distress, inevitable claustrophobia and fatigue, the President’s deranged tweets about “liberating” certain states, an explosion of justified protest against police brutality and racial injustice—combined to weaken the consensus around social distancing. Across the country, and despite a lack of testing-based data about how widely the virus had spread, bans on gatherings were lifted. We were tired of being shut in and shut down; we wanted to go back to the world we’d left behind in March. We told ourselves, erroneously, that our social-distancing efforts had defeated the virus.

The reality, of course, is that social distancing cannot cure or defeat covid-19. It only allows us to hide from the virus while scientists do their work. The overwhelming majority of Americans—perhaps as many as three hundred million people—are still susceptible to infection. As they venture back into a reopened world in which the virus is still circulating, they are at risk. In the past few weeks, this simple reality has asserted itself. In states as varied as Texas, Arizona, Florida, and California, we have seen a steepening of the curve. Since June 15th, case counts in the United States have exploded from roughly twenty thousand new cases a day to more than sixty thousand. The U.S. now leads the world in the production of new coronavirus cases. The sheer number of new cases and deaths is staggering. Since May 28th, when the hundred-thousandth American died of covid-19, sixty thousand more have been killed by the virus. The C.D.C. is now projecting that we will reach somewhere between a hundred and sixty-eight and a hundred and eighty-two thousand deaths by August 22nd. The harsh truth about our situation is clear: it isn’t over. (...)

In retrospect, one of the biggest weaknesses in our pandemic planning was that many infectious-disease experts, including me, focussed on the threat posed by a novel strain of influenza. We feared a repeat of 1918—and yet, because we now have the technology to create and mass-produce a new flu vaccine in only a few months’ time, a flu pandemic isn’t necessarily the worst-case scenario. As we are currently discovering, designing and testing an entirely new vaccine against a never-before-seen infectious disease is a far more uncertain and daunting task. The fact that the novel coronavirus is RNA-based, like H.I.V., intensifies the difficulty. It’s possible that a vaccine will arrive this year—but many experts think that it could be two years or even longer before a safe and effective shot has been developed, tested, manufactured, and made widely available.

The challenge, therefore, isn’t just flattening the curve but keeping it flat—holding the line not for months but for years. In a study published in Science in April, researchers at the Harvard T. H. Chan School of Public Health estimated that, in the absence of a vaccine for the coronavirus, periods of social distancing would be necessary into the year 2022. (Their analysis was, in its own way, optimistic: it incorporated the possibilities of new treatments for covid-19, increases in I.C.U. capacity, and the spread of durable immunity over time.) The researchers noted that, even after social distancing lets up, governments will need to continue tracking the virus and addressing occasional outbreaks. In that sense, there’s a good chance that the pandemic may not be over until 2024.

America’s Coronavirus Endurance Test (New Yorker)

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June 2021. The world has been in pandemic mode for a year and a half. The virus continues to spread at a slow burn; intermittent lockdowns are the new normal. An approved vaccine offers six months of protection, but international deal-making has slowed its distribution. An estimated 250 million people have been infected worldwide, and 1.75 million are dead.

Scenarios such as this one imagine how the COVID-19 pandemic might play out1. Around the world, epidemiologists are constructing short- and long-term projections as a way to prepare for, and potentially mitigate, the spread and impact of SARS-CoV-2, the virus that causes COVID-19. Although their forecasts and timelines vary, modellers agree on two things: COVID-19 is here to stay, and the future depends on a lot of unknowns, including whether people develop lasting immunity to the virus, whether seasonality affects its spread, and — perhaps most importantly — the choices made by governments and individuals. “A lot of places are unlocking, and a lot of places aren’t. We don’t really yet know what’s going to happen,” says Rosalind Eggo, an infectious-disease modeller at the London School of Hygiene & Tropical Medicine (LSHTM).

“The future will very much depend on how much social mixing resumes, and what kind of prevention we do,” says Joseph Wu, a disease modeller at the University of Hong Kong. Recent models and evidence from successful lockdowns suggest that behavioural changes can reduce the spread of COVID-19 if most, but not necessarily all, people comply.

Last week, the number of confirmed COVID-19 infections passed 15 million globally, with around 650,000 deaths. Lockdowns are easing in many countries, leading some people to assume that the pandemic is ending, says Yonatan Grad, an epidemiologist at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts. “But that’s not the case. We’re in for a long haul.”

If immunity to the virus lasts less than a year, for example, similar to other human coronaviruses in circulation, there could be annual surges in COVID-19 infections through to 2025 and beyond.

How the Pandemic Might Play Out In 2021 and Beyond (Nature)

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America’s about to make a double digit percentage of its population homeless. Something like 20 to 30%, or more of American small businesses have or will shut down by the end of the pandemic. The jobs won’t all come back and those that do will pay worse and feature worse treatment than the ones before (which were mostly not well paid and featured routine meanness.)

We’re talking about 30 million to 60 million homeless.

These are staggering numbers.

The United States will feel third world. Oh, parts already did, when I landed in Miami airport the first time I immediately thought “third world”. Relatively prosperous third world, but third world.

Those places will be worse ((and Florida, as I predicted near the beginning of the crisis) has handled the pandemic noticeably badly.)

Of course, for many, little will change. They’ll keep their jobs, they’ll be fine. I recently witnessed a discussion of infosec jobs, talking about how for a person with a degree and a couple certification $120,000 was a lowball. There will still be good jobs, and you’ll still be able to lose everything in a few months if you become seriously ill.

But when those people who are hanging on go out in the streets, they’ll see, even more than now, the fate that awaits them if they slip.

So much of American meanness, and the culture is mean in the details of its daily life, comes from this fear. Because it is so easy to slip into the underclass, even if one “does everything right”, Americans are scared, even terrified, all the time. They suppress it with massive amounts of drugs (most of them legal), and most deny it, but the fear drives the cruelty.

America Is About To Feel Like A 3rd World Nation; and American Social Collapse Is Far Closer than Most Will Admit (Ian Welsh)

Image: Ana Kova
[ed. Doomscrolling (so you don't have to). See also: Here’s How to Crush the Virus Until Vaccines Arrive (NYT)]

NRA In Disarray

Hours after the National Rifle Association was hit by a lawsuit from New York’s attorney general on Thursday seeking to have the gun lobby dissolved over allegations that millions of dollars were diverted to pay for the lavish lifestyles of its leaders, the NRA’s CEO, Wayne LaPierre, hit back.

In typically pugnacious fashion, LaPierre issued his own counter-suit against the attorney general, Letitia James. In a rallying cry to NRA members, he accused her of “weaponizing” her regulatory powers and “politicizing” her office in an “affront to democracy and freedom”.

If LaPierre, 70, was hoping to spark a new culture war between the hyper-conservative group he runs and one of New York’s top Democrats, it is not clear the strategy will work this time. For almost 30 years LaPierre has used the same aggressive tactic to build up the NRA into the world’s largest and most feared gun advocacy group, with 5 million members, steering it in an ever more partisan direction that has culminated with its enthusiastic support for Donald Trump.

But misgivings about the inner workings of the NRA are not confined to prosecutors in the progressive outpost of New York. Inside the organization itself, there is a groundswell of discontent relating to the alleged misuse of millions of dollars from the association and its charitable arm, the NRA Foundation.

Speaking to the Guardian from Nashville, Tennessee, one of the NRA’s top donors was unrestrained in his criticism of LaPierre and the 76 members of the NRA’s board who he accused of collectively turning a blind eye to alleged financial impropriety.

“It makes me feel sad and depressed,” Dave Dell’Aquila said shortly after the New York lawsuit had been lodged. “And angry. Extremely angry. I’m angry that a 152-year-old historic institution has been taken down under Wayne LaPierre and his management team, while the board of directors let this happen.”

Were LaPierre tempted to try to squeeze Dell’Aquila into the same gun-hating, freedom-loathing pigeonhole in which he crams Letitia James, he would have a tough job. It’s not just that the former tech company boss is a lifetime member of the NRA and has given more than $100,000 to forward its core mission. (...)

Equally, the class-action lawsuit Dell’Aquila initiated in a federal court in Tennessee in August 2019 carries the weight of an insider.

The suit, brought against LaPierre personally as well as the NRA and its foundation, is strikingly similar to New York’s action. It recalls how Dell’Aquila donated $100,000 to the organization thinking it would go towards promoting shooting and hunting, gun safety, wildlife conservation and the right to gun ownership in the US.

It then recounts how he discovered that far from going towards these core objectives, his money was allegedly contributing towards the luxury habits of LaPierre and other top NRA executives. Through the 2018 investigation conducted by the NRA’s then president, Oliver North of Irangate fame, Dell’Aquila learned of allegations that over several years “LaPierre had received hundreds of thousands of dollars in clothing, private jet travel and other benefits”.

In particular, Dell’Aquila’s suit alleges, some $243,644 was spent on “luxury travel for LaPierre to the Bahamas; Palm Beach; Los Angeles; Reno, Nevada; Budapest, Hungary; and Italy”. The court document further cites spending of $274,695 at a Beverly Hills clothing store on suits for LaPierre – none of which was declared under IRS tax filings.

A similar theme is taken up by the New York suit. It accuses LaPierre and three members of his top team of creating a “culture of self-dealing, mismanagement and negligent oversight at the NRA that was illegal, oppressive and fraudulent”.

Such financial impropriety contributed to total losses to the NRA of an astonishing $64m, the prosecutors allege. Hundreds of thousands of dollars of charitable money went on private jet trips for LaPierre and his family, at least eight trips to the Bahamas over three years costing more than $500,000, and use of a 107ft yacht owned by an NRA vendor.

The CEO also allegedly went on an African safari, all expenses paid, and spent almost $4m on luxury limousines in the past two years alone. The suit says he negotiated without board approval a post-employment contract in which the NRA would pay him $1m a year for the rest of his life after he retires or steps down – a package worth $17m.

In its counter-suit, the NRA claims that the New York attorney general was trying “to silence the NRA’s advocacy and neutralize it as an opposing political force”. In his letter to NRA members following release of the legal action, LaPierre said: “The NRA is well governed, financially solvent, and committed to good governance.”

Responding to Dell’Aquila’s lawsuit, the NRA has argued that as a member of the group he has no standing to sue and has asked a federal judge to dismiss the case. A ruling on the motion could come any day.

But for now there’s no stopping Dell’Aquila. He is apoplectic above all about the post-employment contract, contrasting its largesse to the meagre incomes of many of the NRA’s members.

“I mean, how does Wayne have a $17m contract after he leaves the NRA? On top of the close to $2m he earns a year with stock and everything like that? Two million dollars to run a non-profit? You gotta be kidding me.”

by Ed Pilkington, The Guardian |  Read more:

Image: Bloomberg/Bloomberg via Getty Images

[ed. See also: The National Rifle Association faces its worst nightmare: accountability (USA Today via Yahoo News).]

Van Morrison

How the Pandemic Defeated America

How did it come to this? A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.

In the first half of 2020, SARS‑CoV‑2—the new coronavirus behind the disease COVID‑19—infected 10 million people around the world and killed about half a million. But few countries have been as severely hit as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID‑19 cases and deaths. These numbers are estimates. The actual toll, though undoubtedly higher, is unknown, because the richest country in the world still lacks sufficient testing to accurately count its sick citizens.

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me.

Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable. A sluggish response by a government denuded of expertise allowed the coronavirus to gain a foothold. Chronic underfunding of public health neutered the nation’s ability to prevent the pathogen’s spread. A bloated, inefficient health-care system left hospitals ill-prepared for the ensuing wave of sickness. Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable to COVID‑19. The decades-long process of shredding the nation’s social safety net forced millions of essential workers in low-paying jobs to risk their life for their livelihood. The same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories during the 2020 pandemic.

The U.S. has little excuse for its inattention. In recent decades, epidemics of SARS, MERS, Ebola, H1N1 flu, Zika, and monkeypox showed the havoc that new and reemergent pathogens could wreak. Health experts, business leaders, and even middle schoolers ran simulated exercises to game out the spread of new diseases. In 2018, I wrote an article for The Atlantic arguing that the U.S. was not ready for a pandemic, and sounded warnings about the fragility of the nation’s health-care system and the slow process of creating a vaccine. But the COVID‑19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS‑CoV‑2 is something of an anti-Goldilocks virus: just bad enough in every way. Its symptoms can be severe enough to kill millions but are often mild enough to allow infections to move undetected through a population. It spreads quickly enough to overload hospitals, but slowly enough that statistics don’t spike until too late. These traits made the virus harder to control, but they also softened the pandemic’s punch. SARS‑CoV‑2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,” Zeynep Tufekci, a sociologist at the University of North Carolina and an Atlantic contributing writer, asked me.

Despite its epochal effects, COVID‑19 is merely a harbinger of worse plagues to come. The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us. It needs a full accounting of every recent misstep and foundational sin, every unattended weakness and unheeded warning, every festering wound and reopened scar.

A pandemic can be prevented in two ways: Stop an infection from ever arising, or stop an infection from becoming thousands more. The first way is likely impossible. There are simply too many viruses and too many animals that harbor them. Bats alone could host thousands of unknown coronaviruses; in some Chinese caves, one out of every 20 bats is infected. Many people live near these caves, shelter in them, or collect guano from them for fertilizer. Thousands of bats also fly over these people’s villages and roost in their homes, creating opportunities for the bats’ viral stowaways to spill over into human hosts. Based on antibody testing in rural parts of China, Peter Daszak of EcoHealth Alliance, a nonprofit that studies emerging diseases, estimates that such viruses infect a substantial number of people every year. “Most infected people don’t know about it, and most of the viruses aren’t transmissible,” Daszak says. But it takes just one transmissible virus to start a pandemic.

Sometime in late 2019, the wrong virus left a bat and ended up, perhaps via an intermediate host, in a human—and another, and another. Eventually it found its way to the Huanan seafood market, and jumped into dozens of new hosts in an explosive super-spreading event. The COVID‑19 pandemic had begun.

“There is no way to get spillover of everything to zero,” Colin Carlson, an ecologist at Georgetown University, told me. Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of “bush meat,” an exoticized term for “game,” but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip—and viruses have come bursting out.

by Ed Yong, The Atlantic |  Read more:

Image: Dina Litovsky / Redux

Sølve Sundsbø, Tony Thornburg, LUNCHEON #5 S/S 2018
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[ed. My nephew, Tony]

Columbus Knox, Untitled (Musician and Dancers), 1990.
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Abolish the Police? CHOP Revisited

Faizel Khan was being told by the news media and his own mayor that the protests in his hometown were peaceful, with “a block party atmosphere.”

But that was not what he saw through the windows of his Seattle coffee shop. He saw encampments overtaking the sidewalks. He saw roving bands of masked protesters smashing windows and looting.

Young white men wielding guns would harangue customers as well as Mr. Khan, a gay man of Middle Eastern descent who moved here from Texas so he could more comfortably be out. To get into his coffee shop, he sometimes had to seek the permission of self-appointed armed guards to cross a border they had erected.

“They barricaded us all in here,” Mr. Khan said. “And they were sitting in lawn chairs with guns.”

For 23 days in June, about six blocks in the city’s Capitol Hill neighborhood were claimed by left-wing demonstrators and declared police-free. Protesters hailed it as liberation — from police oppression, from white supremacy — and a catalyst for a national movement.

In the wake of the killing of George Floyd by the Minneapolis police, the Black Lives Matter movement is calling to defund the police, arguing that the criminal justice system is inherently racist. (...)

On Capitol Hill, business crashed as the Seattle police refused to respond to calls to the area. Officers did not retake the region until July 1, after four shootings, including two fatal ones.

Now a group of local businesses owners — including a locksmith, the owner of a tattoo parlor, a mechanic, the owners of a Mexican restaurant and Mr. Khan — is suing the city. The lawsuit claims that “Seattle’s unprecedented decision to abandon and close off an entire city neighborhood, leaving it unchecked by the police, unserved by fire and emergency health services, and inaccessible to the public” resulted in enormous property damage and lost revenue.

The Seattle lawsuit — and interviews with shop owners in cities like Portland and Minneapolis — underscores a key question: Can businesses still rely on local governments, which are now rethinking the role of the police, to keep them safe? The issue is especially tense in Seattle, where the city government not only permitted the establishment of a police-free zone, but provided infrastructure like concrete barriers and portable toilets to sustain it. (...)

The impact of the occupation on Cafe Argento, Mr. Khan’s coffee shop on Capitol Hill, has been devastating. Very few people braved the barricades set up by the armed occupiers to come in for his coffee and breakfast sandwiches. Cars coming to pick up food orders would turn around. At two points, he and his workers felt scared and called 911. “They said they would not come into CHOP,” said Mr. Khan, referring to one of the names that protesters gave to the occupied Capitol Hill area. “It was lawless.” (....)

A confusing array of security teams wandered around, armed with handguns and rifles. Some wore official-looking private security uniforms. Others wore casual clothes and lanyards identifying their affiliation with Black Lives Matter. A third group wore all black with no identifying labels and declined to name their group affiliation.

When a tall man in a trench coat and hiking boots walked over to question Mr. Khan, the man spread his coat open, revealing several pistols on harnesses around his chest and waist. He presented a badge on a lanyard that read “Black Lives Matter Community Patrol.”

His name is Rick Hearns and he identified himself as a longtime security guard and mover who is now a Black Lives Matter community guard, in charge of several others. Local merchants pay for his protection, he said as he handed out his business card. (Mr. Khan said he and his neighbors are now paying thousands of dollars a month for protection from Iconic Global, a Washington State-based private security contractor.)

Mr. Hearns has had bad experiences with the police in his own life. He says he wants police reform, but he was appalled by the violent tactics and rhetoric he witnessed during the occupation.

by Nellie Bowles, NY Times | Read more:
Images: Grant Hindsley for The New York Times
[ed. Paying for protection. Isn't that a Mafia thing? CHOP was just a total predictable fuck-up right from the get go, and no one can claim moral high ground now that the whole sordid mess is over. Here's a pretty good summary from the comments:

I live two blocks from the former "CHOP" zone, this is my neighborhood, I had frequent many of the businesses affected. I'm a Democrat who voted for Sawant over an Amazon backed candidate (chagrin leaves a bitter taste). What I witnessed was a total break down of civil society. It felt like the beginning of the end, my worst fears realized. No one has "won" anything. We lost a mayor, the city council, the police, our neighborhood, any sense that ANYTHING was being done, except perhaps letting the temper tantrums of petulant children play out. Except these kids didn't live here, had guns, intimidated my neighbors, and ruined property. The police pouting in their corner, grasping for power, patently ignoring legitimate calls for help. The wild west. The valuable BLM message completely hijacked by self-appointed, disaffected, white, non-residents playing "security". The ANTITHESIS of peaceful protest. An abdication of responsibility to the residents and businesses already in shock from the various crisis roiling all around. I saw no "parlay" or communication from any party. Ignorance, anger, garbage, and destruction on full display. Frustration, acrimony, lots of finger-pointing but zero attempts at any robust peacemaking. To say that I am disappointed by Seattle's response to a desperate need is an understatement. Shame on all parties! And congratulations! A valuable and cathartic opportunity completely squandered! I am actively looking for somewhere else to live.

See also: Owner of Seattle shop who called police during CHOP protests says he's being harassed online (K5).]

Covid-19 Relief Bill: Stalemate Over State And Local Funding

As the four lead negotiators prepare for their eighth meeting on a COVID-19 relief package Thursday afternoon, House Leader Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) are projecting confidence.

Despite the seeming impasse on a deal, the two were noticeably fired up at a Thursday morning press conference, seasoning their talking points with impassioned lectern slapping and an anecdote about the high-spirited Democratic leaders singing a song together before the press conference started.

They’ve publicly refused to budge on the biggest planks of their plan, reportedly eking out billions of dollars in concessions from the White House negotiators, Chief of Staff Mark Meadows and Treasury Secretary Steve Mnuchin. Those two are facing immense pressure from a fractured Republican caucus, some of whom are desperate to take a deal home to their constituents — and some of whom refuse to spend a dime more in federal aid.

One of the key sticking points that has emerged in negotiations is direct funding to states and municipalities.

Democrats have proposed over $1 trillion, about six times as much as was spent in the last relief package. That boodle would be split into $500 billion for states, $375 billion for municipalities and counties, $20 billion for territories and $20 billion for tribes. They’ve also sprinkled additional dollars on top for helping states to fund Medicaid, education and other priorities.

Republicans, as Politico reported Wednesday, have counter-offered $150 billion.

“I just don’t think it’s enough,” Wendy Edelberg of the Brookings Institute’s Hamilton Project said of the Republican proposal. “Even as the labor market was improving, the one sector that has repeatedly had negative employment numbers is the state and local sector.”

And that’s a problem, policy analysts told TPM — one we’ve seen before.

“One of the lessons of the Great Recession is that it affected state and local government very harshly due to property taxes, then unemployment getting very high, then income taxes falling,” said Stephanie Aaronson, director of economic studies at the Brookings Institute. “It’s part of the reason that the recovery from the Great Recession was so slow — state and local spending was a drag on overall spending for almost a decade.”

And states are in a worse place now than they were then. State budget shortfalls are on track to exceed $500 billion this year, according to the Center on Budget and Policy Priorities. Even calculating in federal aid from the COVID-19 relief packages Congress has passed, plus states dipping into their rainy-day funds, that number still hovers around $360 billion — a figure that dwarfs the $283 billion they lost after the Great Recession.

Almost all of the states have to maintain a balanced budget, largely a result of bills passed in the last 30 years. During shortfalls, that means they have to impose austerity measures like raising taxes and slashing spending. Those measures can have ripple effects — in the aftermath of the Great Recession, for example, one of the results of those strictures was sky-high tuition at state colleges, which contributed to the growing student loan debt crisis.

“A lesson of the Great Recession is even though we got a lot of great federal stimulus, it was offset by state and local austerity efforts that hurt the recovery,” Arnab Datta, senior legislative counsel at Employ America, told TPM.

To try to offset that, one of the integral differences in the aid Democrats are proposing for states this time around is that it can be used to make up for revenue shortfalls. The aid in the last package could only be put toward expenditures related to fighting the pandemic, such as the cost of providing health care.

The funding would also stop the bleeding among the public-sector jobs state and local governments maintain, stemming layoffs which would strain unemployment benefits, another tenet of the relief package. Without the aid, “states will have to start laying off workers — which they’ve been doing but not in huge numbers,” said Aaronson.

Pelosi is touting the state and local employment piece as the one of the key reasons the funds are needed.

“Health care workers, first responders, teachers, sanitation and transportation workers are employed by state and local government,” she said Thursday on CNBC. “If they don’t get the money, many of these people, millions of them, will be unemployed and go on unemployment insurance, so what money is that saving?”

The Republican proposal, which Senate Minority Leader Mitch McConnell (R-KY) seemingly lacked the support to put up for a vote, omitted any direct state and local aid. He has denounced the $1 trillion Democratic proposal as a “slush fund.”

by Kate Riga, TPM |  Read more:

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Neil Young

Neil Young Sues Trump Campaign For Using ‘Rockin’ In The Free World’ Without Permission (TPM)

[ed. But this one's ok.]

Rebecca Reeve, Untitled (Marjorys World Series II, 27) 2013
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How Not to Lose the Lockdown Generation

Picture this: You live in rural Arkansas and tragedy strikes. A family member has fallen ill with that contagious respiratory illness that has already killed so many — but you don’t have enough space in your small home to quarantine them in a room of their own. Your relative’s case doesn’t appear to be life-threatening, but you are terrified that their persistent cough will spread the illness to more vulnerable family members. You call the local public health authority to see if there is room in local hospitals, and they explain that they are all stretched too thin with emergency cases. There are private facilities, but you can’t afford those.

Not to worry, you are told: A crew will be by shortly to set up a sturdy, well-ventilated, portable, tiny house in your yard. Once installed, your family member will be free to convalesce in comfort. You can deliver home-cooked meals to their door and communicate through open windows — and a trained nurse will be by for regular examinations. And no, there will be no charge for the house.

This is not a dispatch from some future functional United States, one with a government capable of caring for its people in the midst of spiraling economic carnage and a public health emergency. It’s a dispatch from this country’s past, a time eight decades ago when it similarly found itself in the two-fisted grip of an even deeper economic crisis (the Great Depression), and a surging contagious respiratory illness (tuberculosis).

Yet the contrast between how U.S. state and federal government met those challenges in the 1930s, and how they are failing so murderously to meet them now, could not be starker. Those tiny houses are just one example, but they are a revelatory one for the sheer number of problems those humble structures attempted to solve at once.

Known as “isolation huts,” the little clapboard houses were distributed to poor families in several states. Small enough to fit on the back of a trailer, they had just enough space for a bed, chair, dresser, and stove, and were outfitted with large screened-in windows and shutters to maximize the flow of fresh air and sunshine — considered essential for TB recovery.

As physical structures, the TB huts were an elegant answer to the public health challenges posed by crowded homes on the one hand and expensive private sanatoriums on the other. If houses were unable to accommodate safe patient quarantines, then the state, with Washington’s help, would just bring an addition to those houses for the duration of the illness.

It’s worth letting that sink in, given the learned helplessness that pervades the U.S. today. For months, the White House hasn’t been able to figure out how to roll out free Covid-19 tests at anything like the scale required, let alone contact tracing, never mind quarantine support for poor families. Yet in the 1930s, during a much more desperate economic time for the country, state and federal agencies cooperated to deliver not just free tests but free houses.

And that is only the beginning of what makes it worth dwelling on the TB huts . The cabins themselves were built by very young men in their late teens and early 20s who were out of work and had signed up for the National Youth Administration. “The State Board of Health furnishes the materials for these cottages and NYA supplies the labor,” explained Betty and Ernest Lindley, authors of a 1938 history of the program. “The total average cost of one hut is $146.28,” or about $2,700 in today’s dollars.

The TB cabins were just one of thousands upon thousands of projects taken on by the 4.5 million young people who joined the NYA: a vast program started in 1935 that paired young people in economic need, who could not find jobs in the private sector, with publicly minded work that needed doing. They gained marketable skills, while earning money that allowed many to stay, or return to, high school or college. Other NYA projects including building some of the country’s most iconic urban parks, repairing thousands of dilapidated schools and outfitting them with playgrounds; and stocking classrooms with desks, lab tables, and maps the young workers had made and painted themselves. NYA workers built huge outdoor pools and artificial lakes, trained to be teaching and nursing aides, and even built entire youth centers and small schools from scratch, often while living together in “resident centers.”

The NYA served as a kind of urban complement to FDR’s better-known youth program, the Civilian Conservation Corps, launched two years earlier. The CCC employed some 3 million young men from poor families to work in forests and farms: planting more than 2 billion trees, shoring up rivers from erosion, and building the infrastructure for hundreds of state parks. They lived together in a network of camps, sent money home to their families, and put on weight at a time when malnutrition was epidemic. Both the NYA and the CCC served a dual purpose: directly helping the young people involved, who found themselves in desperate straights, and meeting the country’s most pressing needs, whether for reforested lands or more hands in hospitals. (...)

According to a survey conducted by National Center for Health Statistics and the Census Bureau last month, 53 percent of people aged 18-29 reported symptoms of anxiety and/or depression. Fifty-three percent. That’s more than 13 percentage points higher than the rest of the population, which itself was off the charts compared with this time last year.

And that still may be a dramatic undercount. Mental Health America, part of the National Health Council, released a report in June based on surveys of nearly 5 million Americans. It found that “younger populations including teens and young adults (25<) are being hit particularly hard” by the pandemic, with 90 percent “experiencing symptoms of depression.”

Some of that suffering is finding expression in another invisible crisis of the Covid era: a dramatic increase in drug overdoses, with some parts of the country reporting increases over last year of 50 percent. It should all be a reminder that when we talk about being in the midst of a cataclysm on par with the Great Depression, it isn’t only GDP and employment rates that are depressed. Huge numbers of people are depressed as well, particularly young people.

This is, of course, a global crisis. U.N. Secretary-General António Guterres recently warned that the world faces “a generational catastrophe that could waste untold human potential, undermine decades of progress, and exacerbate entrenched inequalities.” In a video message, he said, “We are at a defining moment for the world’s children and young people. The decisions that governments and partners take now will have lasting impact on hundreds of millions of young people, and on the development prospects of countries for decades to come.”

As in the 1930s, this generation is already being referred to as a “lost generation” — but compared to the Great Depression, almost nothing is being done to find them, certainly not at the governmental level in the U.S. There are no ambitious and creative programs being designed to offer steady income beyond expanded summer job programs, and nothing designed to arm them with useful skills for the Covid and climate change era. All Washington has offered is a temporary break on student loan repayments, set to expire this fall.

Young people are discussed, of course. But it is almost exclusively to shame them for Covid partying. Or to debate (usually in their absence) the question of whether or not they will be permitted to learn in-person in classrooms, or whether they will have to stay home, glued to screens. Yet what the Depression era teaches us is that these are not the only possible futures we should be considering for people in their late teens and 20s, especially as we come to grips with the reality that Covid-19 is going to be reshaping our world for a long time to come. Young people can do more than go to school or stay home; they can also contribute enormously to the healing of their communities.

by Naomi Klein, The Intercept |  Read more:

Image: Robert Nickelsberg/Getty Images

'Kitchen Sink Time': Speed Vs. Accuracy

Unfortunately, the latest data now shows that testing is falling across much of the U.S. According to Johns Hopkins University, the average number of COVID-19 tests conducted per 1,000 people declined in the past week in 30 states — more than half the country. Nationally, the average number of daily tests dropped by 8.75 percent during the same period, from 822,470 on July 29 to 750,517 on Aug. 4. (...)

The good news is that there might be a simple solution: new tests that prioritize speed over sensitivity.

Storms aside, the main reason U.S. testing is going down instead of up is because the type of testing we’re doing — PCR (polymerase chain reaction) — seems to have reached its limit. PCR tests are the gold standard for diagnosing COVID-19, and rightly so: They correctly identify more than 98 percent of positive cases.

But they’re also slow, and getting slower. As the virus spreads, more and more potentially exposed Americans are demanding tests, forcing overwhelmed U.S. labs to compete with other countries for the supplies required to process so many samples. Often, labs run out. As a result, crippling backlogs have been delaying test results for so long they’ve essentially become worthless. (...)

Americans seem to be getting the message. “Long wait times and long turnaround times means people are just giving up,” Dr. Ashish Jha, director of the Harvard Global Health Institute, tweeted Tuesday.

The collapse of U.S. testing has, in short, exposed its fatal flaw. Costly and cumbersome PCR tests are fine when an outbreak is relatively modest; in that situation, you can afford to invest in a slower, labor-intensive test that won’t miss any positive cases because you want to stop the virus from spreading before it’s too late.

But when it’s already too late — when more than 4.8 million infections have been reported and nearly 160,000 people have died — the PCR infrastructure can’t keep up.

That’s why experts such as Dr. Michael Mina, an assistant professor of epidemiology at both Harvard Medical School and the Harvard T.H. Chan School of Public Health, are suggesting we scrap it and start over.

“We need to change the whole script of what it means to test people,” Mina recently explained.

Imagine a $1, at-home, paper-based test that’s as easy to distribute and use as a pregnancy test. Imagine waking up in the morning, adding saliva or mucus to a tube of chemicals, waiting 15 minutes, dipping a paper strip in the tube and reading your results — instantly.

Now imagine every single person in America doing this every couple of days.

So-called rapid antigen tests aren’t science fiction. In fact, they already exist. Two such tests, made by BD and Quidel, have received emergency authorization from the Food and Drug Administration, though both still require instruments to run. (The governors of six states announced this week a joint bid to purchase a total of 3.5 million of these antigen tests.) Another $1 antigen test has been put to use in Senegal. And U.S. companies such as E25Bio and Sherlock Biosciences have developed at-home tests as cheap and easy as the one described above.

These are not the same thing as the antibody tests you might have heard of, which detect virus-fighting substances in the blood of people who were infected previously (and may therefore have immunity). Rapid antigen tests are meant to detect ongoing, active infections.

So why isn’t the U.S. government mass-producing antigen tests and distributing them freely to everyone? The major hurdle, so far, has been what news stories tend to describe as “accuracy.” But “sensitivity” is a better way to think about it.

by Andrew Romano, Yahoo News |  Read more:

Image: uncredited

[ed. See also: Fast, Less-Accurate Coronavirus Tests May Be Good Enough (NYT).]

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Noisy Paradise
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Coronavirus Vaccine Will Not Change World Right Away

In the public imagination, the arrival of a coronavirus vaccine looms large: It’s the neat Hollywood ending to the grim and agonizing uncertainty of everyday life in a pandemic.

But public health experts are discussing among themselves a new worry: that hopes for a vaccine may be soaring too high. The confident depiction by politicians and companies that a vaccine is imminent and inevitable may give people unrealistic beliefs about how soon the world can return to normal and could lead to resistance to simple strategies that can tamp down transmission and save lives in the short term.

Two coronavirus vaccines entered the final stages of human testing last week, a scientific speed record that prompted top government health officials to utter words such as “historic” and “astounding.” Pharmaceutical executives predicted to Congress in July that vaccines might be available as soon as October, or before the end of the year.

As the plotline advances, so do expectations: If people can just muddle through a few more months, the vaccine will land, the pandemic will end and everyone can throw their masks away. But best-case scenarios have not materialized throughout the pandemic, and experts – who believe wholeheartedly in the power of vaccines – foresee a long path ahead.

“It seems, to me, unlikely that a vaccine is an off-switch or a reset button where we will go back to pre-pandemic times,” said Yonatan Grad, an assistant professor of infectious diseases and immunology at the Harvard University T.H. Chan School of Public Health.

Or, as Columbia University virologist Angela Rasmussen puts it, “It’s not like we’re going to land in Oz.”

The declaration that a vaccine has been shown safe and effective will be a beginning, not the end. Deploying the vaccine to people in the United States and around the world will test and strain distribution networks, the supply chain, public trust and global cooperation. It will take months or, more likely, years to reach enough people to make the world safe.

For those who do get a vaccine as soon as shots become available, protection won’t be immediate – it takes weeks for the immune system to call up full platoons of disease-fighting antibodies. And many vaccine technologies will require a second shot weeks after the first to raise immune defenses.

Immunity could be short-lived or partial, requiring repeated boosters that strain the vaccine supply or require people to keep social distancing and wearing masks even after they’ve received their shots. And if a vaccine works less well for some groups of people, if swaths of the population are reluctant to get a vaccine or if there isn’t enough to go around, some people will still get sick even after scientists declare victory on a vaccine – which could help foster a false impression that it does not work.

A proven vaccine will profoundly change the relationship the world has with the novel coronavirus and is how many experts believe the pandemic will end. In popular conception, a vaccine is regarded as a silver bullet. But the truth – especially with the earliest vaccines – probably will be far more nuanced. Public health experts fear that could lead to disappointment and erode the already delicate trust essential to making the effort to vanquish the virus succeed.

The drive to develop vaccines is frequently characterized as a race, with one country or company in the lead. The race metaphor suggests that what matters is who reaches the finish line first. But first across the line is not necessarily the best – and it almost certainly isn’t the end of the race, which could go on for years.

“The realistic scenario is probably going to be more like what we saw with HIV/AIDS,” said Michael Kinch, an expert in drug development and research at Washington University in St. Louis. “With HIV, we had a first generation of, looking back now, fairly mediocre drugs. I am afraid – and people don’t like to hear this, but I’m kind of constantly preaching it – we have to prepare ourselves for the idea we do not have a very good vaccine. My guess is the first generation of vaccines may be mediocre.” (...)

All approved vaccines must be shown to be safe and effective, but that does not mean they perform the same. The measles vaccine is one of the best – 98% effective at preventing disease. But the flu vaccine clocks in most years at 40% to 60% effective. And some vaccines work less well in groups of people – older people, for example, have less robust immune responses and need a special high-dose flu vaccine, or one with an extra ingredient called an adjuvant.

U.S. regulators will require a coronavirus vaccine to be 50% effective, and if a shot just barely clears that bar, public education will be required to help communicate how many people need to receive it to establish herd immunity – a threshold at which enough of the population is immune to stop the spread, when the virus is truly tamed.

“If you get a vaccine that just meets the guidelines, the chances are you’re not going to be able to achieve herd immunity,” said Walter Orenstein, associate director of the Emory Vaccine Center. “You tamp down transmission, substantially. It decreases your risk of getting exposed, but it doesn’t eliminate it. But a 50% effective vaccine is a lot better than 0% effective vaccine. I would take it.”

by Carolyn Y. Johnson, Seattle Times (via Washington Post) |  Read more:

Image: REUTERS/Dado Ruvic/Illustration