photo by Dimitri Houtteman courtesy of pixabay.com
Science News published an article about contact tracing on April 29. Since this article will probably be paywalled, I will include a thorough summary below.
The first step in isolating a case of the novel coronavirus is to identify the case. This can be done best by a positive antigen test with a nasopharyngeal swab or a saliva sample (see this article from April 24 about saliva tests on the Yale.edu web site). The Yale article is based on a study conducted at Yale New Haven Hospital with 44 inpatients and 98 health care workers and published on MedRxiv (prior to peer review) on April 16.
The saliva test is more convenient for the patient and can be done without risking contact with a medical professional, since it can be accomplished by simply spitting into a vial– even at home. The study claims that the test is more sensitive and consistent than the nasopharyngeal swab. The Food and Drug Administration (FDA) has already given Emergency Use Authorization (EUA) to the test as of April 13.
The saliva test was found to be effective at finding other respiratory pathogens (causes of airway illness) in previous studies here and more recently here. Saliva specimens were also found to have high viral loads in tests during the previous SARS epidemic in 2004. The Yale article (the first cited above) concludes:
“Once tests and laboratories are validated for using saliva, this could be rapidly implemented and immediately resolve many of the resource and safety issues with SARS-CoV-2 testing,” said Nathan Grubaugh, an assistant professor at the Yale School of Public Health and one of the senior authors of the study.
Another way to identify cases is by using the symptom checklist and making a presumption, based on agreement with most or all of the symptoms, that the novel coronavirus is the most likely cause. This would be less specific and only preferable if antigen testing was completely unavailable; however, given the high false negative rates for nasopharyngeal swab tests, it may be necessary to follow up even negative tests if all of the symptom criteria match up.
Once a case is identified, a case worker would set about identifying everyone with whom the case has had contact within the exposure and incubation window. Usually a case will pop up five days to two weeks after exposure to an infectious individual. A chain of exposure and infection could then be set up, with the case individual exposing others to infection within another window until the case is isolated.
Contact tracers would have to identify the predecessors and those who follow on. The people exposed to the case would be notified and urged to isolate themselves wherever possible. The people who may have passed the illness to the case will also need to be isolated, if possible; tracing of those people will be attempted. Setting up a chain of contacts and contactees, the contact tracer will notify everyone involved to the extent possible.
Contact tracing quickly becomes an insuperable task when the contacts are persons who have been widely exposed. People who work in public-facing jobs, like bus drivers, grocery store workers, policemen, ambulance attendants, doormen, hair and nail salon employees, nursing home medical assistants, and nurses all must be identified. If the original identified patient has had significant contact with such a person, it is critically important in order to reduce spread for that person to be taken out of circulation until their infectious status has been confirmed or refuted.
During the national isolation period of the last several weeks, we will find that many ill people have been infected by contact with someone working in a public-facing job. If these people cannot be isolated, there is no chance of containing this pandemic.
In many cases, tracing from an ill person will lead back to a cluster of infections. Isolation of these clusters, if done early enough, may reduce the spread to other groups and prevent new clusters from forming.
The Science News article describes the situation as of April 29: 5.8 million antigen tests had been performed, out of which 17 percent came back positive. To make any headway, the article states that enough tests will be needed so that less than ten percent of the results will be positive. In the last week, about 230,000 tests a day have been performed. One source estimates that at least five million tests a day will be needed by early June, building to twenty million a day later in the year.
To go with all these tests, an army of contact tracers will also be required. At the beginning of April, there were 2,200 contact tracers in the entire US. 100,000 tracers will eventually be needed, according to a Johns Hopkins estimate. The State of Massachusetts is already recruiting contact tracers to follow infections in that state.
We will also need digital contact tracing with smartphone apps like the ones in use now in Singapore and South Korea. These applications will inform people when someone tests positive who has been near the phone using the app, thus near the person using the phone. Such apps will only need to be 50-60 percent effective to work, including the uncertainty in whether the smartphone’s owner can actually isolate themselves.
Timing is key for these apps to be effective. The sooner a user can be notified of a positive contact, the sooner they can isolate themselves. A system based on a smartphone app could also be effective if the user is notified as soon as another displays symptoms– thus much sooner than when a positive test is found.
Most important is public acceptance of the contact-tracer’s role and of the smartphone app. The Science News article concludes:
[Says] Annelies Wilder-Smith, an infectious disease expert at the London School of Hygiene and Tropical Medicine, “We need a good communication strategy that starts now”… to build awareness and buy-in before systems are in place. Without widespread participation, even the most advanced technical tools won’t help curb the pandemic.
Even if the public is enthusiastic initially, buy-in may wane as the pandemic stretches on. In areas with ongoing outbreaks, it’s not inconceivable that someone could finish one two-week bout of self-isolation only to be pinged days later that they’ve come into contact with the virus again. … [D]ecisions will need to be made as to what counts as a meaningful contact. If merely walking past someone on the sidewalk who later gets confirmed with COVID-19 sparks a message to self-isolate, many may ignore requests. Massachusetts is trying for 15 minutes of exposure, but will transmission events be missed? Even if a system finds a sweet spot, people may be exposed multiple times in the coming months, and asked to self-isolate each time.
That may not seem sustainable, “but right now we’re shooting blindly, and millions of people who don’t need to be quarantined are stuck at home,” Wilder-Smith says. “No solution is perfect, but of all the worst scenarios, strict contact tracing and isolation is the best scenario, and I think that’s how you have to sell it.”
In summary, contact tracing is a difficult-to-accomplish but essential component of any plan to eliminate the virus or at least reduce the impact of infections and re-open society. Ending “social isolation” without contact tracing will inevitably lead to a resurgence of uncontrolled spread and new, overwhelming impacts upon our hospital system.
woodblock print courtesy of wikipedia: Miyamoto Musashi using his two-sword technique
If you thought the nine rules were hard, here are Miyamoto Musashi’s 21 precepts– infinitely harder (from Wikipedia):
(I have added in quotes the interpretation of the Dokkodo from Hyoho)
- Accept everything just the way it is.
“In no way should one act contrary to the great future that you have before you.”
- Do not seek pleasure for its own sake.
“Do not try to look for an easy life because in this world there is no such thing.”
- Do not, under any circumstances, depend on a partial feeling.
“Never harbor prejudice or an attitude about everything.”
- Think lightly of yourself and deeply of the world.
“Consider your own superficiality and try to have profound thoughts of others.”
- Be detached from desire your whole life long.
“To always be detached from desires or wants.”
- Do not regret what you have done.
“Never have regrets about oneself or what you have done.”
- Never be jealous.
“There should be no mind of envy or wrongdoing.”
- Never let yourself be saddened by a separation.
“Never have a mind of envy or attachment to all things.”
- Resentment and complaint are appropriate neither for oneself or others.
“There should be no thought of bearing a grudge against each other.”
- Do not let yourself be guided by the feeling of lust or love.
“There is no mind of thinking about a love life.”
- In all things have no preferences.
“One should not have likes or dislike for things.”
- Be indifferent to where you live.
“Do not have preference for a particular domicile.”
- Do not pursue the taste of good food.
“As to the choice delicious food with a relation to society in general.”
- Do not hold on to possessions you no longer need.
“One should never let future generations become attached to old weapons.”
- Do not act following customary beliefs.
“One should avoid superstition and taboo.”
- Do not collect weapons or practice with weapons beyond what is useful.
“To use equipment that you consider important and not keep that which is of no use.”
- Do not fear death.
“Follow your way with preparedness for death.”
- Do not seek to possess either goods or fiefs for your old age.
“As you get old your gained possessions are of no use.”
- Respect Buddha and the gods without counting on their help.
“Respect the gods and Buddha but do not count on them.”
- You may abandon your own body but you must preserve your honour.
“Do not abandon your good name even if it means sacrificing your life.”
- Never stray from the Way.
“Do not stray from the path of Hyoho.”
A deeper discussion of the “Dokkodo” by a master of “Hyoho” leads to confusion in English. Clearly there are subtleties of meaning, but the translation given in Wikipedia (numbered above) is simpler and more sensible.
Brandenberger Tor photo by ArtTower courtesy of pixabay.com
Germany is a federal republic, superficially similar to the way the US government is organized. The federation has been officially this way since the reunification of the country after the communist eastern half collapsed in 1990. German federal republics have substantial autonomy but the whole country has universal health care insurance (run by agreement among private companies rather than the government) and a highly organized economy with important worker protections that don’t exist in the US. These refinements have substantially eased the impact of the pandemic in Germany.
Early on, German response to the pandemic was confused and slow. With growing case numbers and deaths, reactions and federal response peaked in mid to late March, around the same time as the response in the US and the rest of Europe (with Italy in the lead). Since early April, multiple effective measures have been taken in Germany– as described below.
According to the Wall Street Journal (subscription required): “Germany’s success in battling the coronavirus pandemic has drawn international attention. The main lessons: Fight the virus locally, and keep politics out of it.”
The Worldometer says that Germany has had 163,331 confirmed cases of COVID-19, with 6,632 deaths and 126,900 recoveries. This would represent a raw case fatality rate of 4%, but there are many un-ascertained victims, despite intensive efforts at case-finding. The number of cases, including those without symptoms, could be ten times the number confirmed by testing. According to charts in the Wikipedia article (cited below), the number of new cases per day peaked in early April.
[German Chancellor Angela] Merkel has identified the reproduction factor — known by epidemiologists as R-naught — as a means of gauging how successfully countries have kept the virus in check and how much stress it could place on health services.
Germany’s latest R0 declined to 0.75 on Wednesday from 0.9 the previous day, according to the latest situation report from the country’s public health authority. That means that each person with the virus infects an average of 0.75 other people.
Wikipedia’s article on the outbreak in Germany is unusually specific about where the cases came from. The first known case was found January 27, and most cases early on “originated from the headquarters of a car parts manufacturer there [Munich]” and clusters were found “linked to a carnival event ” and related to the Italian outbreak. The specifics are due to careful contact tracing, an important feature of the German response to the pandemic. “New clusters were introduced in other regions via Heinsberg as well as via people arriving from China, Iran and Italy… from where non-Germans could arrive by plane until 17–18 March.”
The German response is organized according to a national plan “advised” by the Robert Koch Institute. In order to have an effective response, a plan had been previously developed which detailed a containment phase, a protection phase, and a mitigation phase. In the protection stage, curfews, home isolation, and restrictions on visitors to nursing homes and other vulnerable sites were instituted. Some of the federal republics had more restrictions than others. The third phase, mitigation, responded to widespread infections.
On April 1, plans for a smartphone app for Europe were announced that would provide users with information about contacts and keep track of movements to determine whether the user had been near someone who tested positive for the virus. On April 2, The Robert Koch Institute recommended that all persons, whether symptomatic or not, should wear face masks in public; this response was hobbled by a shortage of masks. “On 7 April, the Robert Koch Institute, in partnership with healthtech startup Thryve, launched the app Corona-Datenspende (Corona Data Donation) for voluntary consensual use by the German public to help monitor the spread of COVID-19 and analyse the effectiveness of measures taken against the pandemic. ” (Wikipedia)
A rapid antigen-testing kit which could report results in 2.5 hours was developed and implemented all over Germany in early April. With this kit, infection data and isolations could be quickly updated; previously results were not available for five to ten days.
Numerous problems were reported. Controversies over mask shortages, treatment of refugees, and other issues abounded. Details are available on the Wikipedia page for the pandemic in Germany. Notwithstanding all the problems, the hospital system in Germany was not overwhelmed (partly because the intensive care unit bed capacity was much higher in Germany than in Italy). The R0 (“R-naught”, the rate of passing on the infection from one person to another) has decreased to 0.75, meaning the pandemic is easing in Germany.
A contact-tracing system for smartphones, a rapid antigen-testing kit, and effective self-isolation have led to control of the pandemic in Germany. Universal health care insurance and a well-organized system of work furloughs have helped to reduce the economic impact. Our country would do well to emulate these features of the response to the pandemic. As things stand here, massive contraction of our GDP (gross domestic product) and a disproportionate economic and medical impact on the most vulnerable people in our society have impaired our country’s well-being.
Be Here Now– photo by Harald Lepisk courtesy of pixabay.com
According to the Worldometer, there were 2,390 deaths in the US yesterday attributed to COVID-19. These figures are approximate and almost certainly an underestimate. In addition to the attributed (or “confirmed”) deaths, there has been a surge in overall deaths since March. These numbers are even less definite, but some I have seen appear to indicate a doubling of the total death rate in the US– aside from the deaths due to the virus.
The death rate is a number that requires considerable study and time to nail down. It will be a year before the final numbers are compiled. Death certificates, bodies found at home after lying unnoticed for a long time, inquests, autopsies, burials– all this takes time.
This makes the administration’s claims that only 70,000 people will die from the new virus (never stating over what period of time) nonsense. It’s a moving target, and the numbers are mounting up. If an average of 2,000 people a day die over the next month, that will be another 60,000 people, just for the month of May. Who knows how long this will go on, and who knows what effect loosening restrictions will have.
According to multiple news sources (not counting Fox News and OANN (One America News Network)) the federal administration is not looking to use its awesome powers under the Defense Production Act (DPA) to increase the output of test swabs, vials, virus transport medium, testing reagents, face masks, N95 masks, disposable surgical gowns, or even ventilators. All of these things are needed. All can be manufactured here in the US with a guaranteed profit by US-run factories. All He needs to do is order the production, set a price, guarantee a profit, guarantee that any extras will be added to the National Security Stockpile, and sign off. But, following the advice of extremely short-sighted business friends of his, our president has chosen to sit on his hands and let his son-in-law secretly make sweetheart deals with rich friends to source these items from overseas and fly them here in private jets at outrageous markups.
The president and vice-president need to set an example and show how seriously they take this problem. Instead, the vice-president visits sick patients without wearing a mask. The president encourages protesters who flout “social distancing” precautions and chant “lock her up” against a governor who is merely trying to enforce “stay at home” rules.
Meanwhile, in some cities, 80% of the patients in the intensive care units (ICUs) are black. Infection rates among poor and black people are double or more the rates in well-to-do, white people. In some prisons, three-quarters of the inmates are testing positive for the virus. The pandemic is having a disproportionate effect on those least able to withstand its pernicious effects. The people with means are lurking in their second homes far away or even sheltering in bunkers, some stocked with two years worth of food. They’re hiding out until a vaccine is developed and they’re making sure that they’ll be first in line to be vaccinated.
This pandemic has laid bare the effects of unequal wealth and resource maldistribution. Some people have more than enough, and they won’t share it with those who are wanting. Shame on them.
The president is trying to distract the people from His poor choices and lack of leadership. He has failed to prepare us and is continuing to fail to use the powers he has to do what needs to be done to bring us through this crisis. He will try to distract by blaming the Chinese, particularly the Chinese Communist Party, for this pandemic. There is plenty of blame to go around. The Chinese government initially tried to cover up the reports of a new kind of pneumonia, but once the dimensions of the disaster became apparent, they shifted into overdrive to control its effects within their own country. They never realized that, by the time they acted to stop its spread, it had already escaped Wuhan, Hubei, and China, and had begun to circulate throughout the world.
Our actions at the outset worsened the spread. Repatriation of foreigners from the epicenter merely carried virus among asymptomatic people to all corners of the globe. Forty thousand people came to the US from China after the president’s order to “lockdown” the country. Thousands more came from Europe to New York and spread the pandemic there. The virus is so insidious that the only effective way to quarantine would have been to not allow anyone at all to leave Wuhan after January 15 (the day the first known patient in the US left Wuhan and returned to the United States).
The virus is carried by asymptomatic people who constitute the majority of those infected; it is only detected by nasopharyngeal swabs in about 75% of those who have it, even at the height of illness; it can be spread by tiny airborne particles, not just to people within six feet, but to everyone in crowded interior locations with poor ventilation (this was proven by incidents in buses and in offices that the Chinese published in scientific papers, regardless of the current debate over “possible airborne transmission”). All of these facts make control of this virus next to impossible without complete quarantines like those used in measles epidemics.
The Chinese government has been opaque about this virus and they have refused to allow foreign visitors to the epicenter and to the laboratories affected, but they have released sufficient information for us to figure out what we need to do. They gave us the virus genome, a critical piece of information that will lead to a vaccine. As a private citizen, I have been able to learn enough to know what needs to be done. There is no excuse for distractions and laying the blame on others. We are the ones who need to take care of it.
We cannot waste time arguing about who is to blame and how much they will have to pay us (as if we could force them to pay us without destroying the world’s economy). We must act now, even though it is far past time to begin– the more we wait, the more lives will be lost.
photo of book by Peter H courtesy of pixabay.com
A news release from NIAID (National Institute for Allergy and Infectious Diseases) dated April 29 provides more information on the positive results of a study of remdesivir in COVID-19. Here is an excerpt:
Preliminary results indicate that patients who received remdesivir had a 31% faster time to recovery than those who received placebo (p<0.001). Specifically, the median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059).
Medpage today also reported on this trial and another one by Gilead comparing five and ten-day courses of remdesivir. It appears that both courses of treatment were equally effective. Finally, the same article reported that the Chinese trial mentioned last week was “inconclusive” because not enough patients were enrolled to obtain statistical significance. Full results of that trial were published in the Lancet on April 29. 237 patients were enrolled, not enough to achieve statistical power to discern a difference (although patients on the drug recovered more quickly). The full article in Lancet is behind a paywall, but from what I read earlier, patients were not given remdesivir early enough to get full benefit from the drug.
That’s it for me today. Thanks for reading this far.
photo of book by Peter H courtesy of pixabay.com
Gilead pharmaceutical company announced this morning that it had received “positive results” from a trial of 800 patients with a placebo control in the treatment of COVID-19. No further details were given at this time. This was reported by multiple news sources including Bloomberg, CNBC, Fox Business, MarketWatch, the Boston Globe, and the New York Times. The PharmaLetter, however, reported that an Indian group had urged the Indian Government to revoke Gilead’s patent on remdesivir:
On April 9, the Cancer Patients Aid Association (CPAA) wrote to the Health Ministry and the Pharma Ministry urging them to revoke the Indian patent granted to remdesivir. The CPAA wants the drug available to those in need at affordable prices. Remdesivir was granted a patent as recently as February 2020.
In a letter to the Prime Minister’s Office and the Commerce Minister, CPAA Founder YK Sapru said the patent needs to be revoked given the lack of novelty and inventiveness – the main criteria necessary for patent protection to be granted to a novel compound.
Remdesivir is an analogue of the nucleotide adenine, a basic building block of the virus’ genetic structure: its RNA (ribonucleic acid). The virus depends on its genes to reproduce, and the genes consist of a long string (about 30,000 units) of ribonucleic acid building blocks. There are four RNA bases: adenine, uracil, guanine, and cytosine. These four bases are used in a code. Each base is a part of a triplet, which codes for an individual amino acid. Amino acids are linked up according to the code into proteins.
This coding system is ancient, going back well over a billion years to the beginning of life on Earth. Some scientists think that ribonucleic acid chains functioned in primitive life forms as proteins do today, that is, as enzymes and structural parts of primitive cells. This is controversial, but there is some good evidence that RNA formed the basis for a pre-protein life form billions of years old. RNA and its descendant, DNA, are now used to store the information needed to produce proteins, which are essential elements of all living things on Earth.
Apparently, remdesivir, as an analogue of adenine, is incorporated by the growing RNA chain and causes a defect in structure or premature termination of the chain. This stops the virus from creating new copies of itself and prevents the infection from spreading. Whether remdesivir is patentable or not (and this is probably not a serious challenge to the patent), it is potentially quite useful in treating COVID-19. Clearly, it needs to be administered as early as possible in the course of infection. If given too late, it may not prevent the over-reaction of the immune system called a cytokine storm which appears to be the final killer late in the course of the most serious infections.
Gilead may or may not have a really good drug on its hands, but it seems to have mastered the art of publicity. The company has pushed back against a Chinese study which appeared to show poor effectiveness, in part by challenging how the study was done and whether the drug was given early enough. If the current study can withstand critical scrutiny, we will see dramatic rises in stock value. Our question, going forward, is “How much will Gilead charge us (the US federal government and insurers) for administering remdesivir to patients who need it?”
If recent history is any guide, a lot of money will change hands. Gilead’s previous money-maker was a drug for Hepatitis C which costs thousands of dollars per tablet. Since hepatitis C is a major cause of disability, much of the cost is borne by Medicaid and Medicare, which are bankrolled by the US federal government. Now that Congress is throwing trillions of dollars at relief for the pandemic, it has good reason to regret that it did not establish a drug-cost negotiation clause to its Medicare part D (prescription drug benefit) plans.
Rules for living by Miyamoto Musashi
woodblock print courtesy of wikipedia
1. Do not think dishonestly.
2. The Way is in training.
3. Become acquainted with every art.
4. Know the ways of all professions.
5. Distinguish between gain and loss in worldly matters.
6. Develop intuitive judgement and understanding for everything.
7. See those things which cannot be seen.
8. Pay attention even to trifles.
9. Do nothing which is of no use.
–Miyamoto Musashi (Buddhist name Niten Doraku) 1584?–1645 CE(AD)
photo by Victoria Borodinova courtesy of pixabay.com
This post is a request for feedback from readers of this blog. I would like to know two things: first, do you see ads ever when you look at my blog posts? I’m guessing that I have too few readers to bother with anyone placing ads here, but I need to know from you because the ads (if they are there) are invisible to me, except for a placeholder which says, “from time to time you may see ads here.” That’s not enough for me, because one of the rules I live by is, “7. See those things which cannot be seen [i.e. are invisible]”. (See my post about the rules for living by Miyamoto Musashi, a world-famous medieval swordsman and author of “Five Rings”… or will I have to post the rules again? They begin with “1. Do not think dishonestly [i.e. be honest with yourself]”.) I have asked this question before, but never heard back from any readers, so I don’t know the answer yet.
Second, have you ever been forced to “register” with WordPress in order to read any portion of my blog posts? This just came up when I requested a naive reader (someone who doesn’t use a computer much and never looked at my blog before) to look at one of my most recent blog posts. They were asked to “register” with WordPress and then asked which domain name they wanted to use. This struck me as very odd and I suspect that WordPress is trying to corral people in order to increase their advertising revenue.
I can tolerate ads (after all, that’s what “free” is, as in “ad-supported” like the Weekly Reader) but I don’t like the idea of innocent readers being forced to register with WordPress when it’s supposed to be a freely available (anonymous) web hosting portal, or whatever you want to call it.
Please tell me if you have been asked to register, and if you see any ads.
Yes, I know, it’s not as bad as smoking cigarettes or Facebook, but it’s still a time-sucker, and we have so little time left. Tempus fugit (Time flies).
Lake Tekapo photo by Holger Detje courtesy of pixabay.com
New Zealand plans to loosen its coronavirus lockdown this week, since the count of new infections has dropped considerably, according to this article on the National Public Radio (NPR) website dated April 27. Five new cases showed up Monday, out of a population of just under 5 million. The country reported a total of 1472 cases, with 19 fatalities; there was a high of 89 new confirmed infections on April 9 but the trend has been markedly downward recently. According to CNN, 82% of cases have recovered.
A two week quarantine for all people entering the country was instituted on March 14 after the first case was reported on February 28. On March 19, all foreigners were banned from entering the country, a blow to New Zealand’s tourist business– but few tourists have shown an interest in travelling recently anyway. A stay at home order wasn’t instituted until March 23. Now, the lockdown will be eased, but businesses that involve close contact, like hairdressers and public gyms, will not yet be allowed to re-open.
The country’s universal health system has been partly responsible for the aggressive system of contact tracing, which now has a capacity to make 10,000 calls a day. The prime minister has appeared on Facebook Live and has answered questions with complete transparency, an important prerequisite for buy-in to isolation measures for the public. New Zealand also has a low capacity for intensive care beds and feels responsible for preventing travellers from transiting the country on the way to the Pacific Islands, which are even more vulnerable to being overwhelmed by uncontrolled spread of the virus.
To date, New Zealand has carried out about 126,000 tests and has a capacity for 8,000 more a day. Only 1% of tests have come back positive.
New Zealand’s experts, according to CNN, say that the key to preventing uncontrolled spread of the virus is a combination of good leadership and reliance on the advice of scientists. Opinion polls say 87% of the population approves of the government’s handling of the crisis. However, the country depends on tourism for a lot of its revenue, and the unemployment rate will increase to 13%. Despite the economic effects, the country plans to remain isolated for some time, possibly until there is a vaccine available.
Another response to the crisis: the Prime Minister, Jacinda Ardern, and her cabinet have taken a pay cut. This willingness to share the burden is another reason why so many approve of the government’s response.
This country’s defense against the novel coronavirus shows that it is possible for a democratic, open country to be effective in times of crisis with transparency, honesty, and willingness to listen to the experts in formulating policy. All these features stimulate public buy-in for radical measures that cause significant economic pain– and make authoritarian behavior unnecessary. How I wish that our country could follow a similar course.
rotten apple photo by Bill Kasman courtesy of pixabay.com
The New Yorker published an interview with the economist Jeffrey Sachs on April 21. The subject was the catastrophic American response to the coronavirus pandemic. He “was known as a ‘shock therapist,’ for advising the Soviet Union on its controversial transition to a free-market economy. Since then, Sachs has shifted his focus to poverty alleviation and international development, becoming one of the most visible academics in the world.” Highlights from the interview include the following:
The only way to have a viable economy and society is to control this epidemic. So it’s not really a trade-off. The question is how to be effective in controlling the epidemic and driving the transmission of the disease to very low levels. Simply letting the virus run through the society would be unacceptably costly, and that’s why essentially no country in the world is doing that. The real issue is to be effective in the response, and unfortunately the United States has not been effective so far.
With this statement, Sachs rejects the notion that there is a trade-off between controlling the virus and ruining the economy. The point is that people will be so afraid of contracting an infection that they will refuse to come out of their houses and the economy will be ruined anyway if the virus is not controlled.
Sachs is unsparing in his criticism of our political leadership, in particular the man at the top:
[redacted] is the worst political leader I have experienced in all of my professional life, which is forty years of working with governments at a high level. I’ve never seen anything like the narcissism of this man, and here we are, a country so rich in expertise, in resources, in capacities, and yet we’re watching a complete failure of a political response—with a massive loss of life—in real time. It’s quite shocking, because [redacted] not only does not know how to approach this issue but he blocks those who do.
(I apologize for not being able to redact certain names from the hyperlinks.)
Sachs believes that one of the reasons there are bad governments in poor areas is due primarily to poverty, rather than the other way around. That is, there are poor places with people who are competent and intelligent, who have no influence because they lack the necessary resources. Poverty is not the result of bad government; poverty is a cause of bad government.
Conversely, in wealthy countries, good government is not a given; well-to-do countries can have incompetent leaders, especially if the political system is corrupt. Sachs is very specific about the situation in the US:
We don’t lack the means to carry out good responses in the United States; we lack the leadership to do so, and there are reasons for that. Basically, American politics has become deeply corrupt over decades, and it became so corrupt that normal governance already collapsed many years ago. And people with resources and knowledge know it, but they haven’t cared, because things have more or less gone on O.K., and the stock market has been booming, and even though in almost any private conversation [redacted] is viewed as a complete dolt and a complete incompetent, that was more or less laughed off as manageable because he wasn’t doing too much damage, either.
That’s the real situation. Nobody here has viewed government as actually very functional for a long time, and not because it couldn’t be. It has been increasingly designed to fail. Specifically, it’s been designed to respond to powerful lobbies that want deregulation or tax cuts or some special privileges rather than to function in a normal way. And powerful people shrug their shoulders at that, because for the élites that’s been O.K., but it obviously hasn’t really been O.K. for a long time.
I can’t begin to paraphrase the excoriating language that Sachs uses– only to say that “he wasn’t doing too much damage” elides the reactionary judges that [redacted] has had confirmed to important positions in our judiciary branch, prior to the onset of the pandemic. Sachs does mention rising mortality rates due to “deaths of despair”, backtracking on climate change (supposedly, “the noise from windmills causes cancer”), and widening wealth and income inequality.
Sachs has a damning indictment for the American response to the novel coronavirus:
The United States is completely failing at the federal level to control this epidemic. It’s a tragedy. We’re losing tens of thousands of lives unnecessarily because of the shambolic failure of Trump and his team to mobilize the vast resources of our country, both human and material. At the same time, there are poor countries that are doing much, much better at controlling the epidemic. Take a country like Vietnam, which is a low-income country in East Asia, and close to China, but for a variety of reasons they acted very quickly to stop the transmission of the virus, to a much greater extent than we did.
There is also the way the US has responded to the need for international help to control the pandemic:
what I am recommending is that the International Monetary Fund [IMF] provide emergency financing at essentially zero conditionality, other than that it be used responsibly. And that the World Health Organization [WHO] work with governments that have the potential to supply additional equipment—that’s China, Korea, Japan, and a few others—and use the emergency financing and the availability of this urgently needed equipment to get it to these countries in need.
Yet the federal government, under the direction of [redacted], has suspended funding to WHO. We were the largest contributor, by far, to the budget of WHO, yet we are now attempting to undermine their work by going around them and directly funding organizations in other countries– without coordination and without the network of experts WHO has built up over the years. Not only will the federal government be culpable for thousands of unnecessary deaths in this country– we will also be a tree across the road for international efforts to contain the virus.
Sachs does not leave Barack Obama out of his critical line of sight. He blames Obama for believing that it was not politically possible to increase funding for international aid to fight malaria, AIDS, tuberculosis, and so on, the killers of many millions a year even in normal times. He says, “aid from the U.S. to developing countries is 0.16 per cent of G.D.P.” The cost of controlling malaria worldwide is only three to five billion dollars a year, and the US doesn’t even contribute most of that money.
He credits Bush for beginning the AIDS control program that saved many lives, even though Bush didn’t initially believe it was politically possible. He blames Obama for not having the political vision to expand these worldwide public health and development programs. Granted, Obama faced unprecedented opposition from the entire Republican Party, House and Senate, to all of his programs. That reactionary opposition continues today, with [redacted] trying to eliminate every program that had Obama’s name on it.
The capper comes in the last two paragraphs of the Sachs interview, in which he blames tax cuts for the rich in the destruction of the post- World War II international order:
So this is not fundamentally about resource constraints. It’s about caring, attention, philosophy of life, and politics, a sense of ethics and morality, a question of whether it’s really America First and everyone else be damned or whether it’s a question of trying to make a world that works more effectively. There are other things that are bigger, more expensive issues, like decarbonizing the energy system. But it’s also not a consequential number compared with the stakes of our lives, and it’s also neglected. Why?
Our political system for forty years now, since Ronald Reagan, has basically been dedicated to tax cuts, especially for rich people and corporations, and both parties—of course with the complete obsession of the Republican Party and maybe the semi-reluctance of the Democratic Party—have given tax cuts every two or three years since 1981. So now you’re coming to me and saying, Well, after this crisis, we’re going to have the fiscal crisis. We will, absolutely. We’re going to have a budget deficit this year of ten to twenty per cent of G.D.P., but at some point we’re going to say, What is important for our country? What do we really want to pay for?
(I apologize for the length of this blog post. I got carried away by the polemical value of Jeffrey Sach’s comments. I’m sorry that Barack Obama was too cautious but it is true that he was stonewalled by a united group of reactionary, racist conservative Republicans. It is also true that when Democrats win this November, the Republicans will suddenly pivot back to fiscal conservatism as an excuse to cut all federal programs other than the military.)
Conrad Theodore Seitz 