17 April 2020 – Friday – #33

It occurred to me this morning that there will be at least one clear signal when it’s okay to “open up the economy.” I woke up thinking about what test I might give my friends who insist it’s important to open up the economy, which I believe is their subconscious euphism for make life the way it was. The test was staring me in the face. It was in the letter from United Airlines to its employees from which I excerpted yesterday.

The test for my friends who tell me it’s time to open up the economy is this question: when is your next flight?

Before you tell me it’s time to “open up the economy,” tell me when you’re flying. That tells me that you believe it’s safe out there. If you’re not flying, it’s not for lack of available seats. It’s because you don’t feel safe sitting for hours in a sealed metal tube sharing Covid-19 enriched air with other people.

So, please, book your flight and then tell me it’s time to open up the economy. In the meantime, pay attention to the people who are dying while we, who sit in the safety of our homes working remotely, want things to be normal. When it’s safe for you to fly, it’s safe for them to work.

Yesterday the first Covid-19 fatality was reported at Smithfield plant in Sioux Falls, which now has 644 confirmed cases of Covid-19.

I stumbled onto this meat processing story because I was comparing South Dakota Covid-19 statistics to its neighboring states. As you may remember, South Dakota is going full Trump in it’s response. Governor Kristi Noem has not ordered social distancing, which is known to reduce Covid-19 infections. She wants the economy to keep going. Instead, on the advice of the president and his son-in-law, she has invested in hydroxychloroquine treatments. Unfortunately for South Dakota, studies show hydroxychloroquine does not improve Covid-19 outcomes.

It’s sad that meat processing workers in South Dakota and elsewhere are dying. It didn’t have to be. Processors could have invested in safer working condidtions. Some made small workplace modifications like suspending plastic sheets between workers, modifications that were enough to cover their legal liability, but clearly not enough to stop Covid-19 infections.

Instead of taking the pain up front when they had more flexibility, meat processors have to fix a health problem with no crebility that they care about anything other than profit. As meat processors close down plants in response to Covid-19, the entire meat industry is adjusting. On the suppy side, cattle auctions have stopped. On the demand side, meat prices are expected to rise.

“I lost him because of that horrible place. Those horrible people and their supervisors, they’re sitting in their homes, and they’re happy with their families.”

Angelita Rodriguez, 73, widow of Augustín Rodriguez, 64, the first Covid-19 fatality at Smithfield’s Sioux Falls pork processing plant, through a translator

To my friends who aren’t buying airline tickets and want things back to normal, remember that people are dying and critical food supply chains are breaking. It’s not that easy to “open up the economy.”

Also, Americans have to remember that US enemies are initiating and amplifying messages Americans share on social media to open the economy and use untested treatments like hydroxychloroquine. This is a perfect time for Russia, China, and North Korea to whittle away at US power. In fact, they are. So, my friends who aren’t buying airline tickets and claiming hydroxychloroquine is a valuable treatment and want to open up the economy, think about who wants you to propogate those messages.

Then there is Singapore to consider. Singapore is a cautionary tale that even when we think we can “open up the economy,” Covid-19 can come roaring right back.

Recent uptick in Singapore Covid-19 cases

Singapore had Covid-19 infections under control until last week when clusters of infections broke out in worker dormitories.

Time for a Trump rant. Apologies in advance. On 28 March, nearly three weeks ago, I wrote that Trump’s invocation of the Defense Procurement Act forcing auto makers to produce ventilators was a capitulation to Covid-19. It was his first concrete action acknowledging the reality of Covid-19 was something too large to paper over with messaging. It seemed like a sea change. I was hopeful that the president’s capitulation to the virus was a turning point in his administration’s response, that “things would happen,” as they say.

Things have not gone well since. The federal government has failed miserably to coordinate Covid-19 activities or provide critical medical supplies (other than hydroxychloroquine). Presidential son-in-law Jared Kushner has taken time off from his Middle East peace assignment to put his managerial heft behind Operation Airbridge, an effort to secure critical Covid-19 supplies so secretive that even FEMA, the government agency in charge of emergency responses, doesn’t know what’s getting shipped where.

FEMA has reported that the agency does not actually know how much PPE is being sent on the Project Airbridge flights until they’re loaded overseas, which [U.S. Representatives] Thompson and Maloney say makes it “unclear” how federal authorities determine where to send the flights to, if they don’t actually know what supplies will be available. The Times also reports that the federal government is seizing or canceling PPE orders placed by states—despite telling the states that they should be getting their own supplies—since the Airbridge strategy requires distributors to send half of their shipments to whatever regions the federal government has prioritized, with only the other half going to companies or states that had actually placed orders. And what areas the federal government deems a priority appears to be shaded by personal politics, as the Times notes that Kushner has pushed supplies to states that have happened to get President Donald Trump on the phone, even if they haven’t submitted formal requests.

Lawmakers Want to Know: WTF is Jared Kushner Doing, Vanity Fair, 9 April 2020

As with Middle East peace, Kushner has no idea what he’s doing. The administration’s problems go far beyond Trump’s reliance on someone as inept as Kushner to pull off a supply chain miracle. The president argues with state governors instead of coordinating their efforts. He announces a Great American Revival before Covid-19 has peaked in the US. He blames WHO and China because, unlike countries like South Korea and Germany that paid attention to WHO, he doesn’t want us to notice he cannot articulate a coherent Covid-19 response.

The Trump Administration is failing to manage not only its Covid-19 repsonse, but also the faltering economy. One shining example is Federal Housing Finance Agency Director Mark Calabria, formerly a top aide to Vice President Mike Pence. Calabria is clinging to his libertarian free market principles in the midst of the worst economic meltdown since 1929. In declining to backstop mortgage lenders because idealogically he insists on shrinking Fannie Mae and Freddie Mac, he could single-handedly destroy the US housing market in the middle of a pandemic. Regardless of your philosophical leanings, this is hardly the best financial environment to risk restructuring a key component of the US economy.

Now, surprise!, it looks as though the White House also is using Covid-19 funds to pay off its friends. While avoiding congressional oversight of the US$2 trillion Covidd-19 stimulus package, the Trump administration quietly awarded US$55 million for N95 masks to Panthera, a bankrupt Virginia company with no office and no employees. Because the Trump Organization’s most profitable properties are closed by public health orders, it seems entirely possible Trump is using deals like this to bail out his own business empire with taxpayer money.

Trump made another capitulation yesterday, a political capitulation, by officially turning over the country’s Covid-19 resonse to state governors. That is to say, officially acknowledging what has been going on for the past three weeks, that the governors, not the president, are managing America’s Covid-19 response. Is yesterday’s capitulation the end of Trump’s political career? Is it his surrender to Biden? My fear is that Trump is looking at Duterte in the Phillipines and Orban in Hungary for ways to hold on to power.

Whew, okay, done with that rant.

Two more things.

There’s some good news on Remdesivir other than it’s easier to type than hydroxychloroquine. Clinical studies suggest that critical Covid-19 patients are responding to the HIV antiretroviral. Two patients died, but many recovered in less than a week. I want to emphasize this was a clinical study without a control, so no one knows yet whether Remdesivir is an effective Covid-19 treatment.

The totality of the data need to be analyzed in order to draw any conclusions from the trial. Anecdotal reports, while encouraging, do not provide the statistical power necessary to determine the safety and efficacy profile of remdesivir as a treatment for Covid-19.

Gilead Sciences statement regarding recent Remdesivir studies

There are enough glimmers of good anecdotal results from Remdesivir and Truvada (see yesterday’s entry) to suggest some cocktail of HIV ARVs may at least attenuate Covid-19 mortality.

There’s some bad news on the nursing home front. This one is a little close to home. Brad reported that two people at his mother’s retirement home tested positive for Covid-19. My mother reported this morning that two people tested positive at sister facitilty to her retirement home.

US news is focused on the 17 bodies found in an abandoned New Jersey nursing home. Rachel Maddow reported yesterday that 52% of Covid-19 deaths in Pennsylvania are at retirement homes. The same is true here in Spain. Reports today say that over half of Spain’s Covid-19 deaths have been at nursing homes, often abandoned the same way the New Jersey facility was.

Whle this news is terrible, especially for those of us with relatives in retirement and nursing homes, it is instructive. If we make sure these facilities have decontaminiation protocols and follow them, we can reduce Covid-19 mortality by as much as half.

I’m 46,918 words into this project. That’s about 1/2 of a novel. I’m writing this for my own sanity. If it helps with yours, please share on your social feed or email to friends who might find it useful, too. Thanks!

16 April 2020 – Thursday – #32

A couple days ago, I wrote about Covid-19 statistics in South Dakota and its neighboring states Nebraska and North Dakota. South Dakota has twice as many per capita Covid-19 cases as its neighbors because its governor hasn’t ordered social distancing.

Sadly, 300 employees at the Sioux Falls Smithfield processing plant, which produces five percent of US pork products, have tested positive for Covid-19. This, along with the four employee deaths at a Tyson processing plant in Georgia, highlight the dangers not only of maintaining the food supply through the pandemic, but also of lifting lockdowns prematurely.

At a Tyson facility in GA, workers are still shoulder-to-shoulder on the deboning line, many earning less than $14/hour. Four employees have died of COVID. The workers I talked to there said they felt like they have to choose between their health and their livelihood.

Charlie Gile, NBC News producer

It’s a reminder that prematurely lifting lockdowns is mostly a white privelege thing. Until there’s a vaccine, remote workers and office workers won’t die in numbers like the production and retail workers who make our physical world livable.

In case you don’t remember, South Dakota Governor Kristi Noem does have a response to Covid-19. Her response is extensive hydrochloroquine trials. I hope she hangs up on Jared Kushner and reads this.

Unfortunately, the first hydroxychloroquine trial I’ve seen with a reasonable sample size and a control group indicates the drug provides no benefits and poses cardiac risks. 84 patients received hydroxychloroquine within 48 hours of hospital admission, and 97 did not. According to the researchers, “These results do not support the use of HCQ in patients hospitalised for documented SARS-CoV-2-positive hypoxic pneumonia.”

And, in case you thought Dr. Raoult’s hydroxychloroquine trials were too good to be true, those same trials Trump relied on to say he had the Covid-19 magic bullet, well, they were. In his second “study,” Raoult claimed 98% cure rate. No health institution was reporting anything close to that anecdotally, let alone in a proper trial.

Until there’s a proper study, don’t trust anything will save you from Covid-19. Even nebulized hydrogen peroxide, which, for some reason, I expect Trump to tout next.

The fundamental cause of the trouble is that in the modern world the stupid are cocksure while the intelligent are full of doubt. Even those of the intelligent who believe that they have a nostrum are too individualistic to combine with other intelligent men from whom they differ on minor points.

Bertrand Russell, Triumph of Stupidity, his essay about the rise of the Nazi movement

There always will be quacks and the people who love to tweet about them, but there also is great science in action. The effort to create a Covid-19 vaccine is unprecedented. Within six months of the first Covid-19 cases, over 100 vaccines are in development. By comparison, in the 40 years since the first US AIDS cases, there have been six human trials of HIV vaccines (HIV still infects about two million people per year).

Here’s a great overview of the pipeline of Covid-19 vaccines. Johnson & Johnson has the most aggressive stated delivery of January 2021 for a Covid-19 vaccine available through FDA Emergency Use Authorization. That’s if nothing goes wrong. What could possibly go wrong? A whole list of complex things like safety, efficacy, scaling, and distribution. Oh, and funding. Remember Trump stopped paying WHO yesterday. Well, many of these Covid-19 vaccine efforts are funded by WHO.

Most vaccine efforts from large pharmaceutical companies expect a scaleable product by late 2021. That seems like a reasonable timeframe for planning purposes.

My social feed is again full of people worried that the lockdown is an over-reaction, that “the cure is worse than disease,” that public health isn’t taking the economy seriously. In my mind, this is a symptom of on-going angst from staying at home with nothing to do but watch the value of retirement and bank accounts plummet. People’s concerns about money are rational. And irrational. We humans are like that.

The world is headed for a worldwide depression. If you’re not clear about that, read this no-nonsense update from United Airlinee to its 100,000 employees about its current condition.

Travel demand is essentially zero and shows no sign of improving in the near-term. To help you understand how few people are flying in this environment, less than 200,000 people flew with us during the first two weeks of April this year, compared to more than 6 million during the same time in 2019, a 97 percent drop. And we expect to fly fewer people during the entire month of May than we did on a single day in May 2019.

United Airlines letter to its employees

The falling economy adds to the feeling of loss of control that Covid-19 leaves in its wake. Many people aren’t happy when they lose control. In Michigan, for instance, Operation Gridlock brought thousands of protestors to the state capitol with calls to “lock her up.” “Her” being not, of course, Hillary Clinton, but Michigan Governor Gretchen Whitmer, who’s ordered a statewide lockdown.

I’m wondering if the Michigan protestors thought guns would make them safer from the virus. They should try shooting one. More likely the protestors want guns in case Covid-19 makes people do irrational things. Did any of them remember to bring a mirrror?

Then there’s Ohio, which has pulled off a great Covid-19 social distancing response with a commensurate low death rate. Not everyone is happy with these great results, though. Here’s a great photo of protestors who want to reopen Ohio.

One Wyoming study asserts that the US actually comes out US$5.2 trillion ahead in spite of huge economic losses from the lockdowns. It estimates the lives saved by social distancing and assigns a value of US$10 million to a life, a common amount the government uses to value human life. This seems like as reasonable a way as any to assess the economic benefit of lockdowns, but there are plenty of other studies people can cite in their social media feeds to assert that the lockdowns cost more than they’re worth. I think this debate will fill many PhD theses.

My pat response to “the cure is worse than the disease” is: take a vacation to Ecuador. If you don’t like government lockdowns, try Guayaquil’s de facto lockdown after its healthcare system collapsed and Covid-19 mortality reached 1,000 – 2,000 deaths per million.

Another way to look at it is, take a vacation to Taiwan or Vietnam, where testing and quarantines were so effective, these countries Covid-19 mortalities don’t register on Covid-19 comparison charts. You’ll have to quarantine for 14 days when you arrive, but then you can enjoy life without Covid-19. Taiwan now is exporting masks to Europe and the US to help their Covid-19 responses. Of course there is a White House scandal. You knew there had to be. The scandal is that while Trump was telling Americans masks weren’t necessary, the White House placed an order with Taiwan so its staff would have masks.

However fast we “reopen the economy” (I still don’t know what that means), the I-told-you-so-ing will swamp my social media feed. This is a preview of what I expect.

Get ready for I Told You So

If anything really sucks during the time of Covid-19, it’s dating. I was having lots of fun meeting men in Barcelona before 10 March. I even paid for a Grindr subscription a couple weeks before the lockdown. Without a subscription, Grindr limits how many men you can “see” and sorts them by vicinity. Because of the Generator Hostel a block away, that meant that my Grindr view of gay Barcelona was swamped by nearby young male travelers. Not that that’s so bad, but I wanted to explore a little further than 500 meters from the apartment.

Now that I have a Grindr subscription, I can hardly believe my extended, ahem, range. I “see” men all over Barcelona and even as far away as France (I know, I know, “I see London, I see …”). I even can have more involved interactions (wink, wink) when we decide to move over to WhatsApp or Zoom. But, you know, the thing that sucks about all this online wooing is that actual physical intimacy is weeks away.

I almost felt sorry for myself. Then Brad sent me this.

Clearly I’m not doing the online dating thing right.

I’d love it if you help me meet men. In the meantime, if you like what you read, please share me with your friends.

15 April 2020 – Wednesday – #31

First up, two Public Service Announcements.

For my US friends, a reminder that today is NOT tax day. It’s 15 July this year.

For my Spanish friends, your tax deadline has been postponed from 20 April to 20 May this year.

You’re welcome.

I had my own little meltdown yesterday. I’m having trouble pointing to any one thing that set it off. I finished writing the fourth draft of Dear Mustafa, so I was in a celebratory mood. Since I couldn’t invite anyone over, I celebrated by grocery shopping and watching my laundry dry.

Laundry drying on author’s terrace.

I considered enhancing the visuals of drying laundry with vermut. Instead, with nothing on my calendar (again), I chatted up a Los Angeles friend who’s been setting up digital marketing deals with Italian fashion companies only to see his entire clientele dry up in the last month. I also chatted with a Mexican friend who lives just up the hill in Gracia about the silver lining, as it were, of her dental problems: they allow her to go outside to visit her dentist.

After dinner I watched Obama’s endorsement of Biden. My friend Matt said I had to. Maybe it was the jug wine, but this video seemed to send me over the edge.

I think it was the voice of reason and patience that tipped my emotional state. Here’s a guy that held fire for four long years before coming out with his guns blazing. If he was able to observe the unfolding disaster of his successor in the White House quietly for four years, I thought to myself, I should be able to make it through a few months of isolation. Thankfully my new friend Cristián was around to process all the crazy feelings this endorsement speech triggered. I’m sure there will be more episodes of feelings. I’m sure I’m not alone in this extravaganza of feelings.

Yesterday I compared Sweden to its neighboring countries and South Dakota to its neighboring states, concluding from the available data that governments failing to implement lockdowns during a Covid-19 epidemic are responsible for at least two times more deaths than otherwise, and three times more deaths on top of that if the epidemic then overwhelms the country’s healthcare system.

Also yesterday on the international Covid-19 response front, Gail sent me an article comparing the Covid-19 responses of six countries: Sweden, Germany, South Korea, Brazil, New Zealand, and South Africa. The difference in Covid-19 responses will provide empirical comparative data that should lead to better Covid-19 policy choices going forward. I’ve discussed Sweden, Germany, and South Korea before.

Brazil’s President Bolsonaro is taking a queue from Trump’s early “the cure is worse than the disease” messaging. As with local US politicians, local Brazilian officials are not on board with the Bolsonaro’s Covid-19 strategy and are implementing their own Covid-19 responses.

New Zealand is attempting a Covid-19 elimination strategy that includes testing, contact tracking, and a 14 day quarantine for visitors entering the country. This is risky, but easier to achieve in New Zealand than other countries due to New Zealand’s insularity. Of note, the country has acknowledged the needs of the poor during the pandemic.

New Zealand has heightened awareness of a pandemic’s impact on the poor. During the Spanish Flu pandemic it governed Western Samoa as a protectorate. The government failed to warn or protect the territory from the arrival of a ship carrying the flu. As a result, 22 per cent of the population died. New Zealand didn’t apologize until 2002.

South Africa imposed a three week lockdown on 27 March and has implemented a Covid-19 testing program. The country is managing ongoing tuberculosis and HIV infections. That means the country is administering BCG vaccinations (since 1971) and HIV ARVs, both of which are being studied for treatment of Covid-19. South Africa receives Covid-19 assistance from China.

Wait, did someone say BCG vaccinations? I wrote at length about the relationship between BCG vaccinations and significantly (10x!) reduced Covid-19 mortality on 9 April. Jim tipped me off that two days later South Australian Health and Medical Research Institute (SHAMRI) announced a 500 person trial of BCG vaccine for Covid-19 prophylaxis. According to the announcement, “SAHMRI has partnered with the Murdoch Children’s Research Institute (MCRI) to roll out the trial, with the backing of the World Health Organisation (WHO).” The trial may roll out to other parts of Australia as well.

Another possible Covid-19 treatment has shown up at another Australian research organization, Melbourne’s Monash Biomedicine Discovery Institute. In vitro tests show the head lice medicine ivermectin blocks Covid-19 RNA from entering cells to reproduce. In vitro results are a long way from a therapy, but ivermectin is cheap and easy to manufacture if it does treat Covid-19.

Covid-19 makes for tough politics. The political wrangling continues in Madrid. Here, many Spaniards have the same attitude towards President Sánchez’ Covid-19 response as Americans towards Trump’s.

Sánchez defends his management of the Coronavirus crisis. He wants “total victory” against the virus, political unity and an economic reconstruction plan. Casado says there is a complete lack of trust: “No one trusts you”.

Matthew Bennett, Spanish political commentator

The truth is that politicians are in a damned-if-you-do-damned-if-you-don’t position while waiting to end lockdowns. However, much of Trump’s Covid-19 response has been clearly counterproductive in terms of both health and economy.

During yesterday’s Covid-19 briefing, Trump said the US was defunding WHO. Yes, that’s the same WHO funding lots of Covid-19 activities like the above-mentioned BCG vaccine trial in Australia. Bill Gates, who is pouring billions of his own dollars into the Covid-19 response, called US defunding of WHO “as dangerous as it sounds.” Trump also is slowing delivery of stimulus checks by several days in order to print his name on them. During Trump’s marathon 2-1/4 hour briefing, 93 Americans died of Covid-19.

Meanwhile, Republicans are testing messaging that the US economy is more important than American lives. This is a variation on the “cure is worse than the disease” argument.

“… it is always the American government’s position to say, in the choice between the loss of our way of life as Americans and the loss of life, of American lives, we have to always choose the latter.”

U.S. RepresentativeTrey Hollingsworth (R), Indiana

Who wins with this argument? Hint: not minorities and not the poor, who already are suffering disproportionately. Like “Make America Great Again,” choosing “our way of life as Americans” is code for “profit trumps everything.” The choice to “open up the economy” is an enormous puzzle that has different winners and losers depending on how it’s solved.

If you’re gung-ho to open the economy, take a look at these photos. AP photographer Emilio Morenatti is documenting visiting health care workers and emergency medical personnel caring for Spain’s home-bound elderly in Barcelona. His photos capture the agony both of society’s vulnerable and of the people who try to keep them alive.

When I look at these photos again today, I think this is what must have triggered my little emotional meltdown yesterday. These are among the people who suffer most when we open up the economy the wrong way. When you advocate your Covid-19 position, consider the data and think about not only who will benefit, but also who will suffer most from the policy you advocate.