28 April 2020 – Tuesday – #44

The Spanish government allowed children to go out for an hour a day starting two days ago. My friend Cristián told me yesterday that Spain will let adults out for exercise on Sunday. Today El País says the government is reviewing results today of the program to allow children out before it decides to let adults out, too. Each region in Spain has a different proposal how to proceed.

Like all things Covid-19, nothing seems certain.

Take, for instance, Covid-19 screening. A Yale team has determined that many people with Covid-19 infections do not present with a fever. That means two things. One is that facilities like my mother’s retirement home that rely on fever to test for the presence of Covid-19 in its staff fail to detect all infections. The other is that we’re six months into Covid-19 and no one has developed reliable Covid-19 screening standards.

Clinicians are in the same boat. The US medical field may have though it was prepared for Covid-19, but it’s learned that the viral attack is more complicated than a bad case of pneumonia. Six months into Covid-19 and we’re still running into unforeseen medical problems.

But the degree to which doctors and scientists are, still, feeling their way, as though blindfolded, toward a true picture of the disease cautions against any sense that things have stabilized, given that our knowledge of the disease hasn’t even stabilized. Perhaps more importantly, it’s a reminder that the coronavirus pandemic is not just a public-health crisis but a scientific one as well.

Intelligencer, “We Still Don’t Know How the Coronavirus Is Killing Us,” 26 April 2020

If you’d asked me at the beginning of 2020 which country would have a food supply chain problem during a major pandemic, I wouldn’t have answered the US. A couple weeks ago, though, Covid-19 fatalities started shutting down meat processing plants in South Dakota and Iowa. Now Tyson has warned of a US meat shortage entirely due to inadequate Covid-19 safety measures at processing plants.

Almost a third of U.S. pork capacity is down, and JBS said Sunday it will shutter another beef production facility in Wisconsin. Brazil, the world’s No. 1 shipper of chicken and beef, saw its first major closure with the halt of a poultry plant, and key operations are also down in Canada, the latest being a British Columbia poultry plant.

Bloomberg, “Americans on Cusp of Meat Shortage With Food Chain Breaking Down,” 27 April 2020

It turns out the concentration of US meat distribution that allows the US to deliver so efficiently so much meat at such low cost is also its Achilles heel. If the US had a less efficient, more diverse supply chain, meat would cost more, but the system would have better redundancy to sustain single-point failures. Tyson’s meat supply alert is a harbinger of things to come as countries start relaxing their Covid-19 lockdowns.

Which brings me to the future. We live in a world full of precarious supply chains many of which are likely to break due not only to Covid-19 outbreaks, but also to political responses to lock down borders and stop trade. The free market principles that enabled the world to drive up efficiency and drive down costs are the same principles that discount black swan events like Covid-19. We didn’t build in redundancy because it’s not efficient. Or it didn’t seem efficient two months ago.

We also live a world where institutions are breaking and labor is being displaced at a dizzying pace. In the US everything from the court system, which can’t keep schedules, to the postal service, which is running out of cash, are at risk. Courts and the USPS are bedrock American institutions. Jails are becoming de facto test labs for Covid-19 herd immunity. The US State Department has closed up shop. Almost. I could go on.

All this change has people speculating what a post-Covid-19 world looks like, or at least what a world coping with Covid-19 might look like. If the Spanish flu is any indicator, it will be a world where we’re coping with Covid-19 outbreaks for a while.

Epsilon Theory published one such look at a post-Covid-19 world called “First the People.” I call your attention to this piece not because I agree with much of it, but because it’s asking the right questions. What are the stories we’ve been telling ourselves? Which of those narratives is holding true after Covid-19 showed up? Americans have bought into efficient meat distribution because they could feed the world, but Covid-19 hit the pause button on that video.

Marc Andreessen, who has oodles of capital to deploy, also has written about a post-Covid-19 world in “It’s Time to Build.” It shouldn’t be a surprise that someone with investment money sees Covid-19 as an opportunity to build stuff. But, to his credit, Andreessen is asking what has kept us from building the things that we haven’t built like housing and first class education. Covid-19 provides clarity about what we’ve failed to do.

The airlines are figuring out their vision for a post-Covid-19 world. It involves rearranging the furniture.

Reconfigured aircraft seating for Covid-19 protection.

I’m not sure I’m on board with this vision unless the seats are much larger. But then, I also don’t have a clear vision for a post-Covid-19 world. I have lots of questions and more time than I’d like during my isolation to think about them.

Covid-19 is a deadly foe, a foe that is forcing us to check our assumptions as we watch our institutions and systems break and adjust. As I watch the US and Spanish governments scrambling to let us outside, I wonder what we might have done differently to make these decisions easier, and what we need to differently going forward.

In better and less futuristic news, a Covid-19 vaccine looks likely to go to large scale trial as early as September. Oxford University’s Jenner Institute has a head start with a MERS vaccine already tested for human safety. In recent days, its Covid-19 vaccine candidate, a genetically reworked version of its MERS vaccine, has passed muster in an animal study with rhesus macaques.

Having seen promising HIV vaccine candidates come and go for forty years, I’m not getting my hopes up until I see human trial results. I understand that finding a Covid-19 vaccine should be easier because there’s been success with viruses similar to Covid-19, but it would be a bit of miracle for the first candidate to pan out.

But as the first to reach such a relatively large scale, the Oxford trial, even if it fails, will provide lessons about the nature of the coronavirus and about the immune system’s responses that can inform governments, donors, drug companies and other scientists hunting for a vaccine.

New York Times, “In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead,” 27 April 2020

Even if a large scale test fails this early, though, it will help other vaccine candidates. And there are lots of vaccines (and treatments) in the pipeline. Brad found the lists to prove it. With about 100 vaccine candidates, the larger problem will be deciding which of those deserve full funding. If you listened in to yesterday’s great video on Covid-19 vaccines, you already know it takes about US$1/2 billion to bring a vaccine to market.

I still have friends asserting that Covid-19 is not a big deal and we need to “get back to normal.” I’ve pretty much stopped arguing with them. I simply point out that in its first month, Covid-19 killed more Spaniards than the flu did for an entire year. Ditto for Americans. That’s without factoring in how many lives were saved by lockdowns and how many deaths weren’t properly ascribed to Covid-19. In a bad flu season, the flu swamps the US healthcare system. You can do the math with Covid-19.

Looking at pages of Covid-19 obituaries reminded me that during the AIDS crisis, the best way to find out who died in San Francisco’s gay community was the obituary section in the Bay Area Reporter. There was no World Wide Web, no search engine. It was a weekly ritual to scour the obits for friends and acquaintances. Since I knew a lot people by first name, the tiny photos helped identify the kids who worked at ice cream parlors or the bartenders who poured my cocktails.

As the deaths grew, the Bay Area Reporter capped the length of each obituary to keep its page count reasonable. This obituary story is repeating itself with Covid-19. The Boston Globe expanded its obituary section to 20 pages, estimating that would be enough for the surge of Covid-19 deaths. Now it’s increased its obituary section to 21 pages.

I don’t want to be a total Debbie Downer today, so let’s end with this PSA: Please stay home and wash your hands.

I was excited to see in yesterday’s site statistics that someone (not me!) searched for coviddiarybcn.com. Ah, the first glimmer of brand recognition! Thanks for your support. Please share on your social feeds or email your family and friends.

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