World

Whichever Model You Use, This Virus Is Going to Kill a Lot of People

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A health worker in protective gear waits to hand out self-testing kits in a parking lot of Rose Bowl Stadium in Pasadena, Calif., during the coronavirus outbreak, April 8, 2020. (Mario Anzuoni/Reuters)

Happy Cinco de Mayo. When this thing is all over, we need to have a two-week festival of all the holidays we’ve been forced to celebrate under limited circumstances. On the menu today: some blunt talk about death projections, why even fatality rates that seem really low will still add up to many deaths before herd immunity is reached, and why the American media shouldn’t trust Russian boasts on the coronavirus or any other topic.

The Death Projections Are Not Promising

The big story this morning is a study by the Johns Hopkins Bloomberg School of Public Health, used in a draft government report, that projects the United States will have 200,000 cases of coronavirus infection per day by June 1, “a staggering jump that would be accompanied by more than 3,000 deaths each day.” The White House and the Centers for Disease Control and Prevention insisted it was a draft report and not officially endorsed, even though the report has the CDC logo on it.

Those 200,000-cases-per-day and 3,000 deaths-per-day sound like a lot more than where we are now, but it isn’t that far away. Our daily deaths have gone past 2,400 several times in the past few weeks. A common cry at the beginning of this outbreak, from those who deemed the threat overstated, was that the flu killed 80,000 Americans per year. (It turns out that number is a debatable estimate as well. The CDC takes the reported rate of hospitalization, extrapolates that out to the entire U.S. population, and calculates the total deaths and non-hospitalization cases from that sum.)

As of this writing, we’re almost at 70,000 deaths; it will probably surpass that threshold by the time you read this. We’re going to hit 80,000 deaths sometime in the next few days if we’re unlucky and next week if we’re lucky. If you don’t like a particular model or doubt its assumptions, fine. It shouldn’t really alter the broad conclusion: This is a really bad public-health crisis, and even if we’re past the worst, we’re a long way from out of the woods.

On Face the Nation this past weekend, former FDA commissioner Scott Gottlieb warned Americans to expect numbers along these lines:

SCOTT GOTTLIEB: I think when you look out to the end of June, it’s probably the case that we’re going to get above a hundred thousand deaths nationally. I think the concerning thing here is that we’re looking at the prospect that this may be a persistent spread, that while the doubling time has come down dramatically to about twenty-five days. So, the amount of days it takes for the epidemic to double in size is about twenty-five now, from day– days or less than a week at the outset of this epidemic. We may be facing the prospect that twenty thousand, thirty thousand new cases a day diagnosed becomes a new normal and a thousand or more deaths becomes a new normal as well. Right now, we’re seeing, for about thirty days now, about thirty thousand cases a day and two thousand deaths a day. And if you factor in that we’re probably diagnosing only one in ten infections —

MARGARET BRENNAN: Mm-Hm.

SCOTT GOTTLIEB: — those thirty thousand cases are really three hundred thousand cases.

It’s worth noting that our number of cases has steadily increased, even with almost all of the country in various states of quarantine and lockdown over the past seven, now going on eight weeks. Gottleib noted, “while mitigation didn’t fail, I think it’s fair to say that it didn’t work as well as we expected. We expected that we would start seeing more significant declines in new cases and deaths around the nation at this point. And we’re just not seeing that.”

This doesn’t mean social distancing and all of our other measures are useless. But it appears that between America’s essential workers, people going to the supermarket and picking up take-out food, going to the pharmacy or needed medical treatments, and other necessary violations of the social distancing ideal — and yes, some unnecessary ones — SARS-CoV-2 is still spreading around at a frustratingly persistent rate.

With parts of the country gradually and partially reopening, we should expect the virus to spread at least a little further and a little faster. As the numbers get worse in the coming weeks, you’re going to hear a lot of people who oppose reopening insisting that various states are being reckless and those who are demanding an end to the full lockdown are being selfish. As I’ve tried to emphasize over the past few weeks, most Americans wanted to help protect others from the virus, and they’ve been willing to pay a terrible price, mostly economically, to do so. They also delayed their own medical treatment for non-life-threatening conditions, put off vaccinating their kids, and stayed out of hospitals so much that some are furloughing staff. They’ve accepted a catastrophic hit to their jobs and businesses and life savings. They’ve accepted a de facto suspension of their children’s education, or at least accepted a barely acceptable substitute. Our food supply chains are starting to buckle under the strain.

Medically, the best possible response to the virus might be to keep Americans in their houses and apartments for months upon months. But that’s just not physically, economically, socially, or psychologically possible.

I frequently hear people insisting that the most-frequently cited death rate figures for the virus are useless, because we don’t know how many people have the virus and are asymptomatic. (We’re probably undercounting the deaths, too; our overall mortality figures are jumping outside the normal range.)

Here’s a simple but dark way of looking at it: We have 250 million adults in the United States. Some medical experts think we can achieve herd immunity with as little as 60 percent having the virus, some think it’s more like 82 percent. If we only need 60 percent of Americans to catch it to achieve herd immunity, we’re talking about 150 million American adults. One-tenth of one percent of that sum is 150,000 people. For every tenth of a percentage point in the fatality rate, count 150,000 dead Americans.

The University of Bonn researchers studied the outbreak in the region of Heinsberg and calculated the fatality rate of 0.37 percent.

A .37 percent fatality rate, applied over 150 million Americans, calculates out to 555,000 fatalities.

Hey, Remember When Russia Was Supposed to Be a Coronavirus Success Story?

We can gripe about how the U.S. government has responded to this virus, but not many countries have handled this particularly well. The European countries have had way more deaths per capita. Back on March 21, CNN reported, with way too much credulity, “does Russia have coronavirus under control? According to information released by Russian officials, Putin’s strategy seems to have worked.”

By early April, it became clear that the Russian government, with its far-reaching surveillance, top-of-the-line propaganda, and extensive authoritarian powers . . . was in about as much trouble as our free societies. “We have a lot of problems, and we don’t have much to brag about, nor reason to, and we certainly can’t relax,” Putin told senior officials April 13 in a televised video conference. “We are not past the peak of the epidemic, not even in Moscow.” Today, “Russia now has the world’s second-fastest rate of new infections behind the United States. It is the seventh most-affected country in terms of infections, having surpassed China, Turkey and Iran last week.”

ADDENDUM: If you’ve been enjoying ESPN’s The Last Dance, chronicling the life of Michael Jordan and the rise and reign of the Chicago Bulls, you’re probably wondering, “who could ever defend the late Jerry Krause, the Bulls’ general manager for the Jordan era and the designated villain of this epic sports story?

The answer is Philadelphia Inquirer columnist Mike Sielski, who points out that Krause did make a lot of good decisions in the draft and free agency, and who makes an all-too-convenient villain in ESPN’s storyline. As entertaining as The Last Dance is, a lot of it amounts to the greatest basketball player of all time, the charming guy who had commercials of children singing how they wanted to be like Mike, taking on a guy who looks like the Penguin from Batman comics and who always seems to be scowling. Sielski astutely observes, “Aside from a token compliment here or there from Kerr or Bulls owner Jerry Reinsdorf, no one is standing up for Krause in the documentary: no family member, no colleague, no one. There is something cheap, unseemly, and quite telling about the inclination to continue bullying a man who isn’t around to defend himself.”

World

Testing and Masks Can Help Only So Much

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Dr. Greg Gulbransen hands a test for the coronavirus after taking a nasal swab from a toddler at his pediatric practice in Oyster Bay, N.Y., April 13, 2020. (Lucas Jackson/Reuters)

May the Fourth be with you. On the menu today: a chat with a top hospital scientific director about the potentials and limitations of testing and masks, the Department of Homeland Security confirms some more of our suspicions about the Chinese government, some elected leaders experience a surprise outbreak of humility, and relishing ESPN’s two-hour mental vacations to the 1990s.

What Testing and Masks Can and Can’t Do for Us

I recently had a chance to pick the brain of a scientific director from one of the top ten hospitals in the United States, who has been briefing powerful decision makers since the coronavirus epidemic began.

This director didn’t want to be quoted by name, lest his assessments cause headaches for his institution. I asked him what the biggest misperceptions about the ongoing pandemic are, and he offered some important points for those who think that America needs to be locked into this semi-shut-down status quo until a nationwide frequent testing regime is in place.

“Politicians and other decision makers like university presidents — who are just politicians of another stripe — are a highly risk-averse species,” this scientific director told me. “If they can avoid making a tough decision, they will, and as long as they think that if we test enough people, we can identify and quarantine everyone who is infected and make the problem go away.”

As he sees it, there are two problems with tests that are largely being overlooked. “One is that they’re only as good as the sample being collected. The technology is as close to perfect as you’re going to get in a diagnostic test. But if you don’t sample where the virus is, the test result will be a false negative. A recent scientific paper that has not yet been peer-reviewed concluded that the real-life sensitivity of tests where persons were collecting their own samples was down around 60 percent, which is pretty much unacceptable when testing for a contagious disease. It turns out, and this is no surprise, that you can’t rely on people to stick a swab far enough up their nose or down their throat to get a useful specimen.”

He added, “the second problem is that the test is only a one-time snapshot, and it doesn’t mean that a person isn’t going to be contagious tomorrow, or even later today. That has serious policy implications and may be the only way to get people to understand that we can’t bring the risk down to zero.”

From where I sit, demanding “We need more testing!” has turned into a comfortable dodge for elected officials and opinion leaders. As laid out last week, just about every company capable of producing tests is looking at ways to expand and speed up production of tests; by the end of the month, America’s producers think they’ll be making 1.6 million to 2 million per day. The Defense Production Act has already been invoked to ensure that Puritan Medical Products in Maine “will quickly establish a new manufacturing facility capable of doubling its current monthly output of 20 million to 40 million swabs.”

The federal government does not have a magic button to press to increase production to 5 million new tests a day. The rate of production is limited by the access to supplies, raw materials, reagents, manufacturing equipment, and trained workers. Before the outbreak, we had more than 157 million Americans in the workforce. Even if we could produce 5 million tests a day, that unreachable-for-a-while threshold would mean testing every American once a month. Clearly, we want to test some Americans more than others; medical personnel working on patients and those working in nursing homes are a higher priority than someone living in an area with few cases, or those working at home and minimizing their contact with others.

This medical director also has doubts that masks will be as effective as some lawmakers hope.

“Go out to the supermarket or the hardware store or wherever else people are being instructed to wear a mask or other facial covering, and you’ll see about half of them have pulled the mask down off their nose because it’s uncomfortable to breathe,” he said. “That totally defeats the purpose. There are people spending stupid amounts of money to buy N95s, and then wear them with big gaps around their mouth because they don’t take the time to learn how to use them properly — and they keep using them, even after they’re physically broken down and can’t seal properly. If I wanted to be one of those Karen scolds, I could get my [thrills] all day lecturing those folks, but since this is the epidemiologic equivalent of TSA Security Theater, and the typical American puts personal comfort and convenience first, it’s not worth doing. Then again, I’m not one of those persons who gets their [thrills] bossing others around.”

For what it’s worth — which is not much — my perspective is for most of the public, imperfect or partial protection is better than no protection. Imagine that you came across a burning building and hear someone crying for help inside. Because you’re a brave and noble person, you choose to run inside to rescue that person. As you’re about to run in, someone hands you a bandana and says, “use this, so you don’t collapse from smoke inhalation!” But another person says, “No, the smoke particles are too fine! The bandana won’t do much good!” Even if the bandana only improves your odds a little, you’re going to wear it, because you want every little advantage you can get. If wearing a mask lessens the chance you’ll get the virus, why not?

DHS: Boy, China Imported a Lot of Medical Equipment in January

The Associated Press reports on a Department of Homeland Security analysis paper, concluding the Chinese government downplayed the severity of the outbreak so that they could buy up medical supplies:

Not classified but marked “for official use only,” the DHS analysis states that, while downplaying the severity of the coronavirus, China increased imports and decreased exports of medical supplies. It attempted to cover up doing so by “denying there were export restrictions and obfuscating and delaying provision of its trade data,” the analysis states.

The report also says China held off informing the World Health Organization that the coronavirus “was a contagion” for much of January so it could order medical supplies from abroad — and that its imports of face masks and surgical gowns and gloves increased sharply.

Those conclusions are based on the 95 percent probability that China’s changes in imports and export behavior were not within normal range, according to the report.

 As much as I have enjoyed researching and exploring the possibility of a lab accident being the trigger that fired off this pandemic, that question is unlikely to ever be answered satisfactorily and is somewhat moot. Once Chinese authorities knew they had a contagious virus, they did everything possible to protect themselves and nothing to protect the rest of the world — with 430,000 air passengers traveling from China to the United States from New Year’s Eve to April 4.

Our Humbled Leaders

I’m not sure where the “never apologize” philosophy came from — probably someone deeply insecure, who sees admission of any fault or weakness as fatal — but we are seeing some surprising humility from certain leaders.

Dr. Anne Schuchat, the number two official at the U.S. Centers for Disease Control and Prevention, told the Associated Press, “The extensive travel from Europe, once Europe was having outbreaks, really accelerated our importations and the rapid spread. I think the timing of our travel alerts should have been earlier.

Ohio governor Mike DeWine said this week that his state’s order requiring the wearing of masks in public “was just a bridge too far. People were not going to accept the government telling them what to do.

And Vice President Mike Pence said he realized he made a mistake not wearing a mask while visiting the Mayo Clinic: “I didn’t think it was necessary, but I should have worn a mask at the Mayo Clinic and I wore it when I visited the ventilator plant in Indiana” two days later, Pence said at a Fox News virtual town hall on Sunday, nodding sheepishly.

This is uncharted territory. People are going to make mistakes. Most of these decisions involve competing values, and in many cases, there may be no “good” answer, just “less bad” ones. The most important thing is to keep steering ourselves closest to the best answer.

ADDENDA: Like Matthew Continetti, I’ve been enjoying the ESPN documentary series The Last Dance — surprised how much I enjoyed it, since I’m not a huge NBA or Chicago Bulls fan. Watching last night, I realized how much of the series is about the era, not just the greatest player of all time or the team. A news report from Michael Jordan’s rookie season noted he was “more popular than a Cabbage Patch Doll.” The era of these Bulls was when the ’80s turned into the 1990s — and Continetti puts his finger on why two-hour vacations in those past decade seem like such a balm at this time:

The end of History was short-lived. After 9/11, Krauthammer took to calling the 1990s not an end but a “holiday from history.” What a pleasant holiday it was. And how large a part Michael Jordan played in it. I can’t be the only child of the Reagan years for whom memories of Stormin’ Norman Schwarzkopf, Bill Clinton and Gennifer Flowers, and H. Ross Perot are intermixed with recollections of Bulls Starter Jackets, pairs of Air Jordan sneakers, All-Star Weekend, and NBA Inside Stuff with Ahmad Rashad on Saturday mornings. To watch The Last Dance is to revisit America before the fall of the World Trade Center, before Afghanistan and Iraq, before the global financial crisis, Syria, Ukraine, and the rise of China. It was a stronger, more self-confident place. And a naive and superficial one.

World

‘Conspiracy Theories’ and China’s Full-Court Press in American Media

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People wear masks at the Nanjing Pedestrian Road, a main shopping area,, in Shanghai, China, January 24, 2020. (Aly Song/Reuters)

On the menu today: a deep dive into how American media are falling over itself to cheer China’s “success” against the virus, faulty materials sent from China are harming our personnel, and thoughts on Joe Biden’s TV appearance this morning.

Stop Praising China’s “Methods” 

The Washington Post offers a top-of-the-web-page “Fact Checker” column with the headline: “Chinese lab conducted extensive research on deadly bat viruses, but there is no evidence of accidental release” and much to my surprise . . . I don’t have a lot to complain about. Give the Post credit — they’re much more evenhanded than NPR was. In my coverage, I have tried to emphasize that all we have is circumstantial evidence — although it is a stack of circumstantial evidence that is starting to pile up.

A lot of media institutions cite a quote from a virologist expressing skepticism of the theory, or touting the professionalism of Chinese scientists, and more or less conclude, “case closed.” I think the only way this will be definitively ruled out is if some biologist can determine, beyond any conceivable doubt, that SARS-CoV-2 had to pass through a pangolin before jumping into humans. We know other untreatable SARS-like viruses can jump directly to humans, thanks to research by the University of North Carolina in partnership with (ahem) the Wuhan Institute of Virology.

The Post fact-checkers acknowledge that the honest answer to questions about the origins of this virus are “we don’t know,” and thus the lab-accident theory can’t be ruled out — even if one thinks that Chinese virologists are among the best and most diligent in the world:

Records of accidents in U.S. labs reveal multiple inadvertent infections and exposures to lethal microbes, including the pathogens linked to anthrax, Ebola and the plague. While no comparable records are available for Chinese labs, a Chinese scientific paper last year described widespread systemic deficiencies with training and monitoring of high-security laboratories where disease-causing pathogens are studied.

“Maintenance cost is generally neglected; several high-level BSLs [biological safety level labs] have insufficient operating funds for routine, yet vital processes,” said the paper by Yuan Zhiming, a chief scientist at Wuhan, published in the Journal of Biosafety and Biosecurity. Most laboratories “lack specialized biosafety managers and engineers,” he wrote.

While the source of the outbreak ultimately may be unknowable, the claim that the laboratory could not have been involved in the virus’s release “is not credible,” said Richard Ebright, a professor of chemistry and chemical biology at Rutgers University.

David Relman, a Stanford University professor of microbiology, said the outbreak at a minimum underscores the need for more stringent standards and comprehensive monitoring of research involving pathogens with the ability to inflict widespread harm on human health and economies.

“There are far too many examples of lab accidents. Our own CDC and everyone else has had accidents, even with very dangerous agents,” Relman said. “There is simply no way around it, since humans are flawed — inconsistent, distractible — creatures.”

As noted yesterday, we have confirmed cases of high-level Chinese scientists selling off lab animals on the black market, and dumping biohazardous and infectious material into the sewers . . . a sewer system where wet market cooks go hunting for “gutter oil.”

I’ve got no beef — no pun intended — with someone who looks at all the evidence and says, “I think the virus originating from an animal brought to the market is more likely.” That’s a very reasonable suspicion — scientists have been worrying about new viruses coming out of wet markets for years! I do have a problem with people who insist that any suspicion of human error in a laboratory in Wuhan amounts to a conspiracy theory.

It doesn’t help that there are genuine conspiracy theorists out there arguing that this was a bioweapon, and that China was willing to expose many of its own citizens in order to harm the rest of the world. It also doesn’t help that a lot of people, in the general public and media alike, keep using the term “made in a lab” — meaning deliberately engineered — and “originated in a lab” — meaning came from an animal or sample being used for testing — interchangeably.

But by and large, the people touting the theory that this is a deliberately engineered and deliberately released bioweapon are easily spotted conspiracy theorists. No, it is not surprising that Alex Jones thinks SARS-CoV-2 is a bioweapon. Jones also claims the virus can be cured by toothpaste. (“Crazy man says something crazy” is not news. If you turned to the medical advice of Alex Jones to protect your health, you essentially sent an engraved, calligraphed invitation to trouble to come your way.)

I’m not that worried about those conspiracy theorists, who are mostly on the fringe and preach to the already converted. I am much more worried about prominent Americans who look at this ongoing global calamity — more than 3.3 million cases and 234,000 deaths worldwide, as of this writing — and conclude that the Chinese government is the hero in this story. Right now, a surprising number of prominent Americans are loudly insisting that China has handled this virus outbreak correctly, and the United States has not. The U.S. federal, state, and local governments have made their share of mistakes in this crisis. But that doesn’t make Beijing the good guys or role models.

In The Atlantic, Jack Goldsmith, formerly of the Bush administration-era Department of Justice and currently with Harvard Law School and Andrew Keane Woods of the University of Arizona Law School, contended, “In the debate over freedom versus control of the global network, China was largely correct, and the U.S. was wrong.”

Bill Gates insists “China did a lot of things right at the beginning” and insists that criticism of China’s regime is “a distraction, I think there’s a lot of incorrect and unfair things said, but it’s not even time for that discussion.”

Our Jack Butler noticed an “analysis” piece over at CNN declaring, “China’s model of control has been blamed for the coronavirus crisis, but for some it’s looking increasingly attractive.” Griffiths concluded, “China, despite being where the virus first emerged, has coped with the ensuing pandemic far better than many other countries, even though those countries had a longer warning time and greater chance to prepare.”

Back on March 26, NBC News declared, “as U.S. struggles to stem coronavirus, China asserts itself as global leader.” The network later tweeted out: “U.S. reports 1,264 coronavirus deaths in over 24 hours. Meanwhile in China, where the pandemic broke out, not a single new coronavirus death was reported.

Foreign Affairs ran an essay with the headline, “Xi Jinping Won the Coronavirus Crisis.” CBS News and ABC News ran uncut Chinese state-run media footage, touting the defeat of the virus in Wuhan. CNN literally reran a Chinese state-run news agency’s story claiming the Chinese Navy had done a better job of controlling the virus than the U.S. Navy.

Even coverage of the regime’s draconian steps to contain the virus are spun as demonstrations of toughness and resolution. USA Today declared, “This is what China did to beat coronavirus. Experts say America couldn’t handle it.” Er, no, we wouldn’t “handle” state authorities dragging people out of their homes and welding doors closed to keep the infected trapped in their homes.

From this coverage, you would have no idea that the Chinese government lied about the contagiousness of the disease for three to six weeks, that the official numbers on cases and deaths from Beijing aren’t even close to the truth, that almost all of the wet markets — allegedly the source of this virus — remain open, or that vast swaths of the medical equipment Chinese manufacturers are shipping out don’t work.

Just what on earth is going on here?

There is this weird wave of pro-Beijing cheerleading going on right now, and I can’t tell whether it’s anti-Trumpism run amok, it reflects the parent companies of media institutions having extensive business interests in China, or whether some American elites look at the stability and social control of authoritarian China and see a system they would like to emulate. It may not matter that much; these are all bad reasons to echo the propaganda of a regime that has at least a million, and perhaps as many as 3 million, ethnic minorities in concentration camps.

The Chinese Did Not Help Massachusetts Personnel

Let us close the week by taking a second look of that much-covered and much-praised account of masks from Chinese manufacturers being brought to Massachusetts on the New England Patriots plane. You probably saw the coverage; it was the sort of event that forced even me to say “Good job, Patriots owner Robert Kraft”:

Gov. Charlie Baker, who came up with the idea to get the Patriots’ team plane involved, praised the Krafts, two other governors and even numerous Chinese officials and government agencies for getting the respirator masks to front-line health care workers.

“We all know this pandemic is being fought across the globe and we couldn’t have accomplished what we’ve done here without willing partners in China that worked with us to bring this to fruition,” Baker said. “Ambassador Huang Ping at the Chinese consulate in New York was instrumental with the success of this effort.”

Now fast-forward to this week, after the masks have been used by police on patrol for a while:

When the Brockton Police Department received hundreds of protective respirator masks from the Massachusetts Emergency Management Agency earlier this month, they came as a welcome gift to officers increasingly worried about exposure in the line of duty. The masks were soon distributed to each of the department’s 200 sworn personnel. More were packed into kits and placed inside cruisers.

But on Friday, the department received notice from the agency that new tests showed the masks to be severely deficient, filtering just 28 percent of airborne particles — far below what is considered safe for front-line workers. The department immediately recalled the masks.

“We had the masks out there for quite some time before we found out about the deficiencies,” said Brockton Police Chief Emanuel Gomes. “They were in daily police use. . . . Officers were using these on every call.”

. . . And many health care workers in Massachusetts have been wary; earlier this month, several questioned the quality of the KN95 masks the state received from China in an April 2 shipment brought by the New England Patriots team plane.

At the time of that shipment, Governor Charlie Baker repeatedly described the masks as N95s, but many turned out to be KN95s. State officials said they have received additional masks from the federal government that are also KN95s.

Sharon Torgerson, a spokeswoman for the state’s COVID-19 Response Command Center, said this week that the masks in that shipment were “a combination of KN95 and N95.”

She did not directly respond to a question about whether Massachusetts officials knew some of the masks they were buying from China were KN95. “Most of the masks available from China are KN95,” she said.

Massachusetts spent about $2 million for the masks in the Patriots’ shipment, Torgerson said.

China sent defective masks and received $2 million and received a gushing press conference with profuse expressions of gratitude in return. God knows how many cops, first responders, and other personnel have been walking around the state of Massachusetts thinking they were adequately protected when they were not.

It turns out that the claims of a great achievement of an endeavor involving the New England Patriots plane were overinflated and that good people got cheated out of something they deserve.

ADDENDUM: Joe Biden appeared on MSNBC’s Morning Joe this morning. When asked by Mika Brzezinski why he would not allow a search for Tara Reade’s name in his official Senate records and papers being kept at the University of Delaware . . . Biden simply didn’t answer and stared at the camera, in one of the more awkward silences you will ever hear.

U.S.

The Competing Risks of Reopening

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A man crosses a nearly empty Fifth Avenue in midtown Manhattan during the coronavirus outbreak, March 25, 2020. (Mike Segar/Reuters)

On the menu today: the much-less-discussed risks and human costs of the country remaining in full lockdown; the eye-popping, jaw-dropping leadership failures in New York City; and at long last, a look at something lighter: whether Star Trek: Picard lived up to the hype.

Why Is It So Hard to Understand Competing Risks?

Over in Politico, John Harris writes that everyone is willing to accept some deaths in the return to normalcy, whether or not they can bring themselves to openly admit it — which he contends represents the end of the conservative argument against “moral relativism”:

Like [Colorado governor Jared] Polis, I am willing to accept that some people must die in order to accommodate the return to whatever the post-pandemic version of normal is. Perhaps unlike Polis, I have a strong preference that “some people” doesn’t end up including me. I’ll extend the same wish for anyone who happens to be reading this column. The fact that the governor—like his Republican counterpart in Georgia, Brian Kemp, like Nancy Pelosi or Donald Trump—doesn’t know specifically who will die of coronavirus makes their choice of how fast to open less excruciating but no less profound in its moral implications.

I don’t think that Harris is accurately defining moral relativism, but even beside that point, he glides over the fact that people will die if we are to continue the lockdown, too.

Pediatricians across the U.S. are seeing a steep drop in the number of children coming in for appointments right now — only about 20 percent to 30 percent of the volume they would normally see this time of year.” This means kids aren’t getting the vaccinations that they normally would.

Cancer patients needed to postpone most non-life-and-death treatments for about seven weeks: “The new order comes as a relief to cancer patients, many of who had to either postpone surgeries or find alternative treatment options for the time being. While some more urgent surgeries were allowed to proceed following the March 13th executive order, such as surgeries to treat particularly aggressive cancers, many patients — notably, many breast cancer patients, who are able to treat their disease temporarily with hormone-regulating medication — were forced to delay their surgical procedures.”

That spiking death rate in major cities reflects the spread of SARS-CoV-2 — but it also could reflect people who would otherwise go to a doctor or hospital staying home out of fear of catching the virus at the hospital, and paying the ultimate price:

Experts say it’s possible that some of the jump in at-home death stems from people infected by the virus who either didn’t seek treatment or did but were instructed to shelter in place, and that the undercount is exacerbated by lack of comprehensive testing. It’s also possible that the increase in at-home deaths reflects people dying from other ailments like heart attacks because they couldn’t get to a hospital or refused to go, fearful they’d contract COVID-19.

. . . In other parts of the U.S., 911 calls for medical assistance have dropped. In Seattle, an early epicenter of the pandemic, data shows that EMT and paramedic calls dropped by more than 25% in the first 10 days of April compared with the same time frame last year. It’s unclear how much, if any, of that drop is due to people being fearful of interacting with the health care system.”

Dr. Harlan Krumholz wrote in the New York Times earlier this month, “I have heard this sentiment from fellow doctors across the United States and in many other countries. We are all asking: Where are all the patients with heart attacks and stroke? They are missing from our hospitals . . . We actually expected to see more heart attacks during this time. Respiratory infections typically increase the risk of heart attacks . . . Times of stress increase the risk of heart attacks and strokes. Depression, anxiety and frustration, feelings that the pandemic might exacerbate, are all associated with a doubling or more of heart attack risks.”

For seven weeks, this country minimized human activity in order to stop the spread of the virus, a remarkable sacrifice to help protect the most vulnerable — with the asterisk that there’s always the chance that those of us who don’t think we’re so vulnerable . . . turn out to be vulnerable.

The Biggest Failures Came in Our Biggest City

Delays and unheeded warnings, a mayor bellowing to “the Jewish community” that “the time for warnings has passed,” the mayor’s wife heading up the recovery panel, decomposing bodies found in U-hauls and tractor-trailers, politicians constantly fighting with public-health officials . . .

“There’s always a bit of a split between the political appointees, whose jobs are to make a mayor look good, and public-health professionals, who sometimes have to make unpopular recommendations,” a former head of the Department of Health told me. “But, with the de Blasio people, that antagonism is ten times worse. They are so much more impossible to work with than other administrations.”

Ask yourself: Is it really Florida and Georgia that are beset by the worst leadership in this crisis? Are there a certain number of people who would prefer to discuss the controversial decisions of Republican governors, because the failures and bad decisions of the most prominent Democratic mayor in the country are so glaringly consequential?

Finally, Something Much Lighter: Assessing Star Trek: Picard

Over the last two months, this newsletter has covered some dark and depressing topics: catastrophic economic projections, problems in our food supply chain, the lies of the Chinese regime. Trust me, dear readers, I never expected to find myself researching the use of anal swabs to collect virus samples from bat guano.

With April nearly complete, let’s turn to something lighter: Did the return of Patrick Stewart to his role of Jean-Luc Picard live up to the hype?

Patrick Stewart is as good as he ever was, meaning Picard the character is as good as ever. Picard the television series . . . was more of a mixed bag. The show felt like a meal where each of the component ingredients was fine but didn’t quite bake correctly. It was one more screenwriting draft away from really gelling.

The creators clearly wanted to create a Farscape/Firefly/Guardians of the Galaxy “crew of misfits” around Picard, and that’s a fun concept. But from the first episode, Picard’s decision-making makes little sense. Retired and on bad terms with his old bosses at Starfleet, Picard finds himself suddenly facing a ticking-clock life-and-death crisis, unlike any he’s faced since his retirement. And he . . . spends time assembling these misfits, instead of calling up the crew and de facto family that we watched him lead for seven years on syndicated television. Geordi and Worf get mentioned once, and I don’t think Dr. Crusher or Guinan get mentioned at all. This is like the late Norman Schwartzkopf recruiting for a commando raid by just seeing who’s hanging around the unemployment office. Even odder, Picard reaches out to “Raffi,” the one former crewmate who he already knows hates his guts. There’s something of a partial explanation later once we finally see Riker and Deanna; the pair are still coping with the death of their son, and it explains Picard’s initial reluctance to involve them. But . . . he does anyway, at least for one episode.

Once assembled, Picard’s new gang is generally fine; perhaps the most fun concept is that Captain Rios’s private-ship maintenance crew is a multitude of holograms that all look like him but speak with different accents. (The engineer hologram speaking with a Scottish accent was a great shout-out to the original series’ Scotty. I’d like to think that Starfleet honored Montgomery Scott by requiring all engineers to speak with that accent.)

The sudden and then considerable presence of Jeri Ryan’s old Voyager character Seven of Nine feels like either an effort to serve the fans, or test-marketing a spinoff series. Other than the fact that both her and Picard were former Borg, there wasn’t any particularly good reason to include her character; the two characters have never met onscreen before, but the show seems to presume that they have some sort of know-each-other-by-reputation built-in relationship.

It might have worked better to have the crew recruit Picard rather than the other way around. Our gang of misfits finds out about some terrible plot that’s way beyond their ability to stop, Starfleet thinks it’s a bunch of nonsense, leaving them no choice but to turn to the retired, semi-disgraced Picard.

Some will see the moral and institutional decline of Starfleet depicted in Picard to be a heavy-handed metaphor for the way most in Hollywood see the Trump era. But I found this mood of disappointment and disillusionment to be pretty fitting for the national moment and beyond the usual partisan cheerleading from the entertainment industry. You don’t have to be a Trump-hater to wonder if America has fallen short of its professed values. The decision of Starfleet to not help the Romulans, as their sun was about to go supernova, feels like an apt comparison to the Obama administration’s refusal to get involved in the Syrian Civil War — or Rwanda, or the Balkans, or any other time our country has lamented a faraway massacre but dragged its feet or declined to get involved. And those of us who watched enough previous Star Trek shows and movies know that in the preceding decades, the Federation has been invaded twice by the Borg and suffered serious casualties both times, and then nearly lost a war to the Dominion, as depicted on Deep Space Nine. This is a society that should be feeling insecure, wary, and less certain of that its values work because of recent difficult and traumatic events — a situation that many will find comparable to our own. The utopia of the Federation makes for boring storytelling; it’s much more interesting to see how people can hold onto their values and ideals when their circumstances challenge them the most.

Picard clearly aimed to tackle big questions such as “what does it mean to be alive” and “who defines what is really alive?” (If you squint, the villains’ insistence that synthetic beings — basically vat-grown, flesh-and-blood robots — could not possibly count as ‘alive’ looks a little like a pro-life critique of abortion.) But the first season wrapped up those questions a little too neatly and quickly in that final episode. Our protagonists witness the brief appearance of a near-omnipotent ancient malevolent race of sentient artificial life capable of wiping out “trillions” of lives . . . and once the immediate threat ends, they shrug and move on.

The problem was that this series wanted to have its cake and eat it, too. It wanted to give Picard his noble, self-sacrificing death, and to have its titular character around for another season. It wanted to depict a paranoid, fearful Federation in decline, and to have Riker show up with a state-of-the-art fleet to save the day. It wanted to have Dr. Jurati — whose name is more or less the way telemarketers greet me — accept the consequences for her cold-blooded murder of an innocent man, and to also remain a happy part of the crew. A bit like The Rise of Skywalker, the Picard series kept walking up to the precipice of a huge and consequential change, and then lost its nerve and backed away quickly.

When Patrick Stewart first announced he would be returning for this series, he told an audience of fans, “he may not be the Jean-Luc that you recognize and know so well. It may be a very different individual; someone who has been changed by his experiences. Twenty years will have passed — more or less exactly the time between the last movie and today . . . It will be, I promise, I guarantee, something very, very different.”

The finished product of Picard feels like a struggle between two visions — between one of a Star Trek series showing a beloved character in an extraordinarily different set of circumstances in his life, and a reboot that would amount to Star Trek: The Next Generation, Part Two. The fans wanted to see Data, and Riker and Troi, and to see Stewart saying “engage!” And they got it! Which . . . doesn’t quite mesh with the series theme of accepting change.

By the way, series creators, the insertion of four-letter words in Picard does not make the show ‘edgy.’ I always figured that the absence of profanity from previous Star Trek series meant that those words had fallen out of use in the intervening centuries.

ADDENDUM: It appears this April will be the most-read month in Morning Jolt history. Thank you for the privilege of being part of your day.

U.S.

Everything You’ve Ever Wanted to Know about Coronavirus Testing

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Dr. Roxana Sauer looks into a car as she prepares a test kit for a COVID-19 coronavirus test during a media event at a drive-in coronavirus check at the hospital of Gross-Gerau, Germany, March 9, 2020. (Kai Pfaffenbach/Reuters)

On the menu today: Everybody and their brother keeps emphasizing that this country needs a lot more testing for the coronavirus . . . but has anyone walked you through what the logistical hurdles and complications are? If you want something beyond someone pounding the table and repeating “we need more testing!” then read on.

The Technicalities of Large-Scale Testing

You’ve heard it over and over again — “The key to reopening our society safely is testing, testing, testing.”

The United States has had a nice jump in recent weeks, from about 140,000 tests per day to around 200,000 per day. But it’s still well below what most public-health experts think we need to really keep the outbreak under control in even a partially reopened society. Our economy is trying to function with as little human interaction as possible, and we see the results. Reopened businesses are going to get people in physical contact again, and even if everyone tries to follow social-distancing guidelines, we’re going to get more infections. To minimize the spread of SARS-CoV-2 in our workplaces, we need ubiquitous, fast testing.

President Trump declared yesterday that the United States will be able to conduct five million tests a day “very soon.” That would be a considerable feat, considering that the country has conducted just under 5.8 million tests since this crisis began. Public-health laboratories and the CDC have conducted about a half-million tests.

So just what is the holdup?

The first step in any medical testing process is developing the test, which has thankfully been pretty fast and easy, considering no one had heard of this virus before December. All medical testing operates on generally the same system: collecting some sample from the patient and seeing if it matches confirmed examples of infection. For coronavirus testing, a sample is collected by sticking a swab up the patient’s nose until it reaches the back of the nasal passage and collecting the body’s “secretions” — i.e., mucus. Then the swab gets sealed in liquid and sent off to a lab — although the waits are getting shorter (more on that later). The process of testing is called quantitative reverse transcription, which basically amounts to taking genetic material called RNA from the sample and making a lot of copies of it, and seeing if it matches confirmed examples of infection.

While we are seeing breakthroughs in testing techniques on an almost weekly basis, the general gist is that the simpler the test is to administer, the tougher it is produce; the easier it is to produce, the tougher it is to administer. “The first Covid-19 tests were simple to make but required specialized expertise. Many early tests take about four hours — two hours of hands-on work, two hours in the machines. Roche and Abbot instruments, available in some academic laboratories, can run 80 to 100 samples at a time. They’re partially automated but still require skilled technicians.”

You may have heard about Abbott Laboratories’ new rapid test, which can provide results for the patient within a matter of minutes, instead of hours or days — or for some patients in the past two months, more than a week. By April 25, Abbott had shipped one million tests to sites in all 50 states. The bad news is that some doctors are worried this is a less safe form of testing: “Running a test involves swabbing a potentially infected person’s nasal passage and swirling the specimen in an open container with liquid chemicals, raising the potential of releasing the highly contagious virus into the air.” And then there are concerns about accuracy: Researchers at the Cleveland Clinic tested 239 known positive samples using the Abbott rapid test, and the test came back positive . . . 85 percent of the time. Having 15 percent of those who are infected walk around thinking they don’t have the virus could cause considerable problems. (Back in 2018, the CDC concluded that the most commonly used rapid flu tests are only 50 to 70 percent accurate.) Clinicians have to calculate — is the ability to do a lot more tests a lot more quickly worth a 15 percent error rate?

Then companies have to manufacture the tests. As of this writing, the Food and Drug Administration has granted 50 companies “emergency use authorizations” to produce tests for for detection of the coronavirus. They range from big names the average consumer might have heard of, like Abbott Laboratories, Roche, LabCorp, and Quest Diagnostics, to smaller, more obscure companies.

How quickly a company can manufacture tests depends in part upon how quickly and easily they can obtain the supplies. Puritan Medical Products of Guilford, Maine says it is currently manufacturing “over 1 million swabs for COVID-19 testing a week.”

Puritan is “one of only two manufacturers in the world that produce nasal swabs recommended by the U.S. Centers for Disease Control and Prevention. The swabs are highly specialized because they have to be long and skinny enough to reach to the nasopharynx, or the upper part of the throat behind the nose. They also must be made of synthetic fiber and cannot have a wooden shaft, according to the CDC.”

Earlier this month, White House trade advisor Peter Navarro told CNN that the administration would invoke the Defense Production Act to get more swabs produced at Puritan. “With DPA support, Puritan will be able to increase its industrial capacity in machine tooling, people, and facilities with the broader goal of increasing nasal swab production from 3 million to more than 20 million within 30 days of the contract award.”

Besides the swabs, those processing the tests need reagents, chemicals that react in the presence of the virus. For what it’s worth, Michael Bevan, director of supply chain services at ARUP Labs, told PolitiFact that he was “not aware of any of the components for the COVID testing platforms that are being manufactured in China.” Some of the chemicals used to produce the reagents do come from China, but there are also some smaller U.S. suppliers.

The supply chain for assembling a diagnostic test kit is complicated, and one delay at one producer can hold up the assembly and distribution further down the chain.

Once a company has all the component parts, swabs, and reagents, it can start assembling them and sending them out the door. All of the big testing companies have dramatically increased their capacity over the past two months. But reaching that several-million-per-day threshold, even collectively, is still a steep climb.

Marc Casper, president and CEO of Thermo Fisher Scientific, said at a White House event Monday that his company “met our original commitments of producing 5 million kits a week, and we’re up to scaling that to double that in the coming weeks in terms of supporting testing around the world.”

At that same event, Steve Rusckowski, president and CEO of Quest Diagnostics said that for his company, “by the end of May, we’ll be close to 250,000 a day, about 7,000 a month. So you put those two numbers together, and it’s about 10 million tests by the end of May that we’ll be doing at Quest Diagnostics.” Quest Diagnostics states that by mid April, they were “processing as many as 50,000 COVID-19 tests per day.”

LabCorp CEO Adam Schechter said, “just 45 days ago, we said we could do several thousand tests a day. We can now do 60,000 tests a day, and we’re continuing to expand that capacity every single day.” He added that regarding serology testing — which is the test for antibodies in a person’s system, indicating that they have already caught and fought off SARS CoV-2 — “we can currently do about 50,000 today, and we’ll be able to do several hundred thousand per day by the middle of May.”

Once the tests are assembled and shipped, someone who knows what they’re doing has to administer the test. The responsibility of the testing process is gradually shifting from U.S. public labs and hospitals to pharmacies across the country.

Larry Merlo with CVS Health said at the White House event that since last month, “we have opened large-scale testing facilities across five states in partnership with the administration and working with the governors of Rhode Island, Massachusetts, Connecticut, Georgia, and Michigan . . . These sites are enabling us to test approximately 1,000 individuals a day with real-time results. We now have a capacity to test about 35,000 individuals each week. And this afternoon, we announced plans to expand that capacity even further.”

Merlo added that beginning next month, CVS will install testing capabilities in up to 1,000 pharmacies in its stores. “We’ll be using our drive-throughs and our parking lots with swab testing. So again, you’ll see that coming online, you know, in May.” Richard Ashworth, president of Walgreens, added that his company would be expanding testing capabilities across all states, including Puerto Rico. “We’ll be able to triple the volume that we do now, in partnership with our lab partners.”

Walmart CEO Doug McMillon said Monday, “We’re now up to 20 sites across 11 states. By the end of next week, we’ll be to 45, and by the end of the May — end of May, we’ll be at 100.”

Heyward Donigan, the CEO of Rite Aid, said Monday, “we are currently operating 40 percent of the current test sites in 25 locations across eight states. We’re doing about 1,500 a day.”

The good news is that week by week, the pace of testing in the United States should increase considerably. The bad news is that despite the president’s pledge that the country would be completing five million tests per day “really soon,” that seems unrealistic considering the current capacity and even with the promised expansions.

It did not help that back on March 13, President Trump addressed the country in the Rose Garden and promised a “sweeping national campaign of screening, drive-through sample collection and lab testing,” — vastly overstating the expectations for a handful of small pilot projects.

That said, even if Trump had not oversold a small group of pilot programs, all of the logistical, supply, manufacturing, distribution, and processing issues described above would still exist. The president’s habit of making grandiose promises with little regard for how those promises will be kept is a problem, but not the problem. The problem is that the world’s medical equipment manufacturers cannot turn on a dime and increase their production capacity tenfold or a hundredfold overnight.

One final thought: We’ve seen separate bits of promising news on a potential vaccine from Oxford University and Pfizer Pharmaceuticals in the past two days. If they are correct that there is a real chance that we get the miracle of a working vaccine by autumn, our manufacturers need to start thinking now about what they would need to do to produce the vaccine on massive scale.

ADDENDUM: Kevin Williamson’s latest has me wondering about the argument of a Joe Biden presidential campaign. He more or less pitched himself as the “return to normalcy” candidate. If the vaccine does not come through, and we are living with this virus throughout 2020 and into 2021 and for the foreseeable future . . . and mind you, we are every bit at risk from some other future virus as we were to this one . . . what happens to a “return to normalcy” candidate when normalcy cannot return?

World

We’ve Held Our Breath for Long Enough

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Nurse Tina Nguyen administers a nasal swab at a coronavirus testing site in Seattle, Wash., March 26, 2020. (Lindsey Wasson/Reuters)

On the menu today: Why we need a ‘reopened America,’ which will not be the same as pre-coronavirus America; some really promising news on the hunt for a vaccine; and what we’re really arguing about when we discuss the likelihood that this virus can be traced back to a lab in Wuhan.

‘Reopen America’ Is Not a Synonym for ‘Ignore the Coronavirus’

If you tune in to the latest episode of The Editors podcast, you’ll notice intermittent notes of impatience in my rants. The United States and the world have to make a series of difficult decisions, choosing from a menu of bad options that all involve considerable risk. I quipped that this is a time for the grown-ups to make a decision. The metaphorical children in our national debate, the folks who cannot handle nuance or grasp different degrees of risk and who instantly demonize any position that isn’t theirs, ought to be quiet.

Most of the country is in week seven of quarantine, lockdown, shelter-in-place or other restrictions. These rules look different on April 28 than they did on March 28.

The country enacted a set of rules that were designed to help hospitals to continue to operate safely; in the process, they cut off most of the revenue for hospitals. I cannot think of a more spectacularly ironic headline than “Mayo Clinic to furlough or reduce pay of 30,000 employeesin the middle of a global health crisis.

Thankfully, more states are recognizing that “elective procedures” — meaning anything that is not life and death, up to and including cancer treatments — need to get started again. Among these are Indiana, Pennsylvania, Iowa, Utah, Arkansas, Florida, Colorado. Tennessee restarts them May 1, and some hospitals in Kansas are restarting them May 4. Here in Virginia, Governor Ralph Northam last week extended the ban on elective surgeries another seven days, but those procedures should be getting started Friday.

The cries to begin the gradual, evidence-driven, locality-based, safety-focused reopening of our society and economy are not driven by boredom, or greed, or selfishness, or ignorance. Perhaps medical officials really believe it would be ideal if 290 million Americans or so stayed in their homes, or only left them minimally, for two months or more. Keep the kids home from school, have everyone telecommute if they’re able or simply be furloughed if they’re not, and just . . . wait out the virus. The only problem with this plan is that it cannot function with human nature or modern economics. You can only keep people on financial life support through massive spending bills for so long, and we’ve seen massive problems in administering these programs.

Our food supply chain is hitting all kinds of problems. The entire U.S. oil industry is on the brink of disaster. The CBO fears unemployment will still be 10 percent or more through most of 2021. A little less than half a school year is more or less barely at par at best and unsalvageable at worst. Working parents are at the end of their rope. (Social distancing, working parents, previous expectations of the workplace: Pick any two.) Our current ongoing policies — mandatory isolation, decreased access to community support, and high levels of stress and anxiety are basically a “perfect storm” for increasing the suicide rate.

We have all metaphorically held our breath as long as we can. We need oxygen.

The New York Times reports what many of us expected: Americans have honored the quarantine rules for a while, a month or more . . . but then as the weather got better, Americans started leaving their homes more:

As the lockdowns drag on, the weather gets warmer and some states move to reopen, researchers at the University of Maryland have found that more people across the country are going outside, that they are doing so more frequently and that they are traveling longer distances.

The changes in behavior, tracked using cellphone location data, have been measured in the past two weeks and can be seen in all but three states.

However, note this paragraph:

The Maryland Transportation Institute’s research is based on anonymized cellphone location data that is updated daily. A trip is counted if the end point is more than a mile from the person’s home and he or she stays there for more than 10 minutes, Dr. Zhang said. That way, the research does not pick up people who are just checking the mail, going for a jog or walking the dog.

(I don’t know about you folks, but my step-counting wristband says I’m walking well more than a mile from my house most days, and I sometimes stop for a while. So that would technically count as a ‘trip’ even though I’m not interacting with anyone besides my family. I said, I’m not interacting with anyone besides my family, Karen!)

I think almost everyone has the good sense to realize that “reopened America” is not going to be the same as pre-coronavirus America. We’re all going to continue wearing masks, perhaps gloves, and trying to stand six feet apart. We’re going to be eating at home more or using take-out and delivery. It won’t be the same, but it will be a step.

The Smartest Thinkers, Tackling the Toughest Questions

All kinds of promising news on the vaccine and treatment front this morning. Start with Oxford University:

Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.

Now, they have received promising news suggesting that it might.

Scientists at the National Institutes of Health’s Rocky Mountain Laboratory in Montana last month inoculated six rhesus macaque monkeys with single doses of the Oxford vaccine. The animals were then exposed to heavy quantities of the virus that is causing the pandemic — exposure that had consistently sickened other monkeys in the lab. But more than 28 days later all six were healthy, said Vincent Munster, the researcher who conducted the test.

“The rhesus macaque is pretty much the closest thing we have to humans,” Dr. Munster said, noting that scientists were still analyzing the result. He said he expected to share it with other scientists next week and then submit it to a peer-reviewed journal.

Next up, the Wall Street Journal describes an unusual secret gathering of billionaires and scientists, which is usually the villainous conspiracy in a thriller novel:

They call themselves Scientists to Stop Covid-19, and they include chemical biologists, an immunobiologist, a neurobiologist, a chronobiologist, an oncologist, a gastroenterologist, an epidemiologist and a nuclear scientist. Of the scientists at the center of the project, biologist Michael Rosbash, a 2017 Nobel Prize winner, said, “There’s no question that I’m the least qualified.”

This group, whose work hasn’t been previously reported, has acted as the go-between for pharmaceutical companies looking for a reputable link to Trump administration decision makers. They are working remotely as an ad hoc review board for the flood of research on the coronavirus, weeding out flawed studies before they reach policy makers.

The group has compiled a confidential 17-page report that calls for a number of unorthodox methods against the virus. One big idea is treating patients with powerful drugs previously used against Ebola, with far heftier dosages than have been tried in the past.

The Food and Drug Administration and the Department of Veterans Affairs have already implemented specific recommendations, such as slashing manufacturing regulations and requirements for specific coronavirus drugs.

National Institutes of Health Director Francis Collins told people this month that he agreed with most of the recommendations in the report, according to documents reviewed by The Wall Street Journal and people familiar with the matter. The report was delivered to cabinet members and Vice President Mike Pence, head of the administration’s coronavirus task force.

Wow. When you’ve got a Nobel Prize in Biology and you feel like you’re the least qualified guy in the room — I guess that would be like being Christian Laettner on the 1992 Dream Team — who’s the rest of the team? Hippocrates, Jonas Salk, Louis Pasteur, and Florence Nightingale?

The group has a couple of intriguing conclusions already, including dismissing hydroxychloroquine as a useful treatment, and their warning about antibody testing probably ought to give us laymen reason for caution.

The group also disparaged the idea of using antibody testing to allow people back to work if their results showed they had recovered from the virus. Mr. Cravatt, a chemical biologist, declared it ‘the worst idea I’ve ever heard.’ He said that prior exposure may not prevent people from giving the virus to others, and that overemphasizing antibody testing might tempt some people to intentionally infect themselves to later obtain a clean bill of health.

What We’re Debating When We’re Discussing the Labs in Wuhan

In case you missed it on the home page yesterday, I saw a few good points but some glaring omissions in a recent story by National Public Radio about the possibility of the virus emerging from a lab accident in Wuhan. There’s also an aspect that strikes me as the subtext of this debate that I think we might as well drag out into the light:

It is also important to understand that a great many people in powerful positions, both inside and outside of China, are consciously or subconsciously hoping the pandemic cannot be traced back to a lab accident.

If the source of the virus is a wet market or natural exposure — say, a farmer going into a cave to collect guano to use as fertilizer — then the villains of the story are familiar and aligned the status quo. No one likes poachers of exotic animals or endangered species. Experts have warned about the dangers of wet markets for years. While it will be difficult to significantly reduce the use of wet markets, or to tackle the $19 billion-per-year international wildlife trafficking trade, there are very few economic or political elites who openly support pangolin smuggling or dining on bats.

However, there are a lot of economic or political elites who invested a great deal of their credibility on the idea that the Chinese government could be a trustworthy and responsible partner in prosperity, despite regular disagreements with other countries about topics such as human rights, freedom of expression, and trade-rule enforcement.

This virus has, as of this writing, infected more than 3 million people worldwide and killed more than 209,000 people. China’s relationship with the rest of the world has never been more strained. Internal pressures in China have rarely been worse. Around the world, populations are scared, frustrated, newly unemployed, financially ruined, and angry. The revelation that a Chinese lab was the ultimate source of all this misery could set off violent repercussions for the Chinese government, the Chinese people, or Chinese Americans.

We shouldn’t want the trail to lead back to a Wuhan laboratory. But that doesn’t mean we can avert our eyes from anything suggesting it does.

ADDENDUM: If Disney indeed goes ahead with a Star Wars television series that will be a prequel to Rogue One . . . with it be called Rogue Zero? Rogue One Half?

Stellan Skarsgard is always terrific. I’d love a Craig Mazin-directed series about how the Death Star project was the Chernobyl of the Galactic Empire.

World

Authoritarian Regimes Are Not Your Friend

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A security officer wearing protective gear gestures at the photographer at the arrival hall of Beijing Capital Airport in Beijing, China, March 4, 2020. (Thomas Peter/Reuters)

We start the week with one big deep dive into just how many defective pieces of medical equipment have been shipped to desperate countries by Chinese manufacturers.

How China Scammed the World with More Than Ten Million Defective Tests, Masks, and Gear

You have probably heard about reports of various countries ordering medical equipment from China, only to find upon delivery that the equipment is defective, poorly made, and unusable. What you probably don’t know is just how massive the scale of these botched orders is.

Even by the Chinese government’s own numbers, they’re producing jaw-dropping quantities of medical equipment that aren’t up to the right standards: “As of last Friday, China’s market regulators had inspected nearly 16 million businesses and seized more than 89 million masks and 418,000 pieces of protective gear, said Ms Gan Lin, deputy director of the State Administration of Market Regulation, at a press briefing.”

And that’s just the stuff they’re catching before it goes out the door.

Almost every country that is dealing with the SARS-CoV-2 outbreak has ordered masks, tests, or personal protective equipment from China, only to open the boxes and find that the deliveries are unusable. In some cases, the equipment was distributed and used before the poor quality was discovered — offering false protection to medical personnel and exacerbating the spread of the virus instead of mitigating it.

Let’s begin closest to home, in Missouri: “Approximately 48,000 KN95 masks that were distributed to Missouri’s first responders are being recalled. The Missouri State Emergency Management Agency said it is recalling approximately 48,000 KN95 masks that ‘do not meet standards.’ SEMA said the recalled masks may bear the names ‘Huabai,’ ‘SANQUI,’ or be unmarked, with Chinese characters on the cellophane packaging, or other names.”

Spin a globe, point your finger, and when the globe stops, there’s a good chance it will reach a country that received defective equipment when it needed functioning gear and tests the most.

India tested nearly a half a million people before they realized that they can’t be certain that the tests they had obtained from China aren’t giving accurate results:

According to the sources, teams constituted by ICMR are analysing the rapid antibody test kits, procured from two Chinese firms, to check their efficacy after some states reported that they are faulty and giving inaccurate results.

The Indian Council of Medical Research (ICMR) on Tuesday had advised states to stop using the rapid antibody test kits for the next two days after it received complaints from states that they are not fully effective.

“We have received complaint from one state and so far discussed the issue with three states. High variations ranging from 6 to 71 percent have been reported between the results of the rapid tests and RT-PCR tests. We will advise states not to use these testing kits for the next two days,” Dr Raman R Gangakhedkar, head of epidemiology and communicable diseases at the ICMR.

Spain has all kinds of horror stories, one of which is finding that a huge batch of tests was faulty — a batch that was sent to replace a previous shipment of faulty tests:

The Spanish government is trying to get back the money it paid for 640,000 antigen coronavirus tests that it purchased via a Spanish distributor from a Chinese company called Bioeasy. The move comes after the health authorities found that the kits – which were meant to replace another lot that was found to be faulty – don’t work either. As happened the first time around, these tests do not have the sensitivity required to detect the virus, meaning that there is a high chance that they won’t detect the coronavirus in a person who has been infected.

Spain had distributed 180,000 tests to be used on health-care workers and the elderly living in nursing homes . . . before finding out the error rate was so high, the test results were meaningless.

The Spanish Health Ministry had to recall more than 350,000 defective masks.

After the defective masks were discovered, more than 100 health workers were forced to go into isolation as the pandemic raged through the country.

The General Hospital of Alicante, Spain found cockroaches in a shipment of protective gowns.

Belgium: “The University Hospital of Leuven (UZ Leuven) refused a shipment of 3,000 masks from China because the equipment was not reliable enough, Herman Devrieze, head of the prevention department at UZ Leuven, told local TV station ROBtv on Sunday evening.”

In the Netherlands:

The Dutch government has ordered a recall of around 600,000 masks out of a shipment of 1.3 million from China after they failed to meet quality standards. The defective masks had already been distributed to several hospitals currently battling the COVID-19 outbreak, news agency AFP and Dutch media reported. The Dutch Health Ministry has kept the rest of the shipment on hold.

An inspection revealed that the FFP2 masks did not protect the face properly or had defective filter membranes. The fine filters stop the virus from entering the mouth or nose. The masks failed more than one inspection.

“A second test also revealed that the masks did not meet the quality norms. Now it has been decided not to use any of this shipment,” said the Health Ministry said in a statement to news agency AFP.

In Austria, more masks that aren’t so protective: “A large delivery of FFP2 and FFP3 protective masks destined for South Tyrol, which were procured from China with the help of a sporting goods manufacturer and which were first transported to Vienna-Schwechat with an AUA machine, cannot be used . . . The Red Cross was taken aback during a visual inspection of the masks because gaps were visible in the area of ​​the cheeks.” The order was for 500,000 masks.

United Kingdom: “Found to be insufficiently accurate by a laboratory at Oxford University, half a million of the tests are now gathering dust in storage. Another 1.5 million bought at a similar price from other sources have also gone unused. The fiasco has left embarrassed British officials scrambling to get back at least some of the money.”

The Czech Republic: Doctors found an error rate of up to 80 percent in the tests they received from China. “Health-care authorities and some government members said the 300,000 quick tests purchased by the state only worked if patients had been infected for at least five days.”

Turkey: “Turkish Health Minister Fahrettin Koca confirmed later on Friday that Turkey had tried some rapid antigen tests arrived from China, but authorities ‘weren’t happy about them . . . We didn’t release them for public use.’ Koca also said that Turkey had received a different and viable testing kits that are based on antibodies from China. ‘We have 350,000 of them now,’ he said.  A member of the Turkish health ministry special science board on coronavirus said that the batch of testing kits were only 30 to 35 percent accurate.”

Slovakia: “The 1.2 million Chinese antibody tests that the Slovak government bought from local middlemen for 15 million euros ($16 million) are inaccurate and unable to detect COVID-19 in its early stages, according to Prime Minister Igor Matovic, who only took office last month. ‘We have a ton and no use for them,’ he said. They should ‘just be thrown straight into the Danube.’”

Canada: “The Canadian government says about one million of the face masks it has purchased from China have failed to meet proper standards for health care professionals and will not be distributed to provinces or cities . . . [Separately], the City of Toronto announced in early April it was recalling more than 60,000 faulty surgical masks made in China and provided to staff at long-term care facilities, and is investigating whether caregivers were exposed to COVID-19 while wearing the equipment. The masks were distributed and then recalled after reports of ripping and tearing.”

Australia: “The ABC has learnt that in recent weeks, Australian Border Force (ABF) officers have intercepted several deliveries of personal protective equipment (PPE) that have been found to be counterfeit or otherwise faulty. One law enforcement official, who spoke on the condition of anonymity, estimated the ABF had already seized 800,000 masks with a combined value of more than $1.2 million on the Australian market.”

The government of Georgia — the nation, not the state between South Carolina and Florida — canceled a contract for up to 200,000 rapid tests after concluding they weren’t reliable.

Finland found two million masks ordered from China were unusable, and the head of the country’s emergency supply agency resigned. That country ordered its masks from “a payday lender and reality TV star” in China.

Nepal determined that the 75,000 rapid diagnostic tests they had ordered from China were so faulty they were unusable.

Finally, one Pakistani news channel says that hospitals in that country opened up boxes of masks from China, only to find they had been made out of . . . underwear.

Add up all of these accounts and you get 10,276,000 faulty tests, masks, and pieces of personal protective equipment. And these are just the ones we know about. The stuff that was visibly unusable right out of the box, while frustrating, is the least damaging. It’s the tests that showed negative when they were positive and the non-protective masks given out to health-care workers that are catastrophic.

On March 30, Chinese Foreign Ministry spokesperson Hua Chunyin contended that the coverage of the faulty equipment was driven by political agendas. “Our sincerity and assistance is real. If problems occur in this process, the Chinese side will talk to relevant departments. Problems should be properly solved based on facts, not political interpretations.”

On January 23, China stopped all public transportation in Wuhan and all outbound flights. On February 3, China’s civil aviation authority urged domestic carriers to continue flying international routes. The country knew they had an outbreak of a contagious disease but made sure its citizens were still traveling the world.

Then, as the outbreak accelerated, China was there to sell the suffering countries medical equipment — “demanding yes-or-no decisions from buyers with full payment upfront in as little as 24 hours.

In the Wall Street Journal, Spanish writer Jorge González-Gallarza Hernández thinks it is time for countries to ban imports of medical equipment from China, arguing that the complete lack of quality control makes their exports a menace to public health: “Because no other country matches China in the sale of defective equipment — and at a time when Beijing boasts about recovering from Covid-19 — countries facing steep contagion curves should err on the side of caution and look for the best equipment elsewhere. For all Beijing’s lofty talk of wanting to help the world, it has no export-restriction system to prevent the foreign sale of shoddy equipment.”

Of course, it’s not just China. Back in March, Russian state media announced that the government was sending 600 ventilators, 100 military virologists and epidemiologists, eight medical teams, disinfection equipment, a field laboratory for sterilization and chemical prevention, and other similar tools to Italy to fight the coronavirus pandemic in that hard-hit country. “Italian officials speaking anonymously to La Stampa said as much as 80 percent of the delivered material was useless, and that the operation appears to be a public-relations stunt with little practical benefit to the country’s healthcare system.”

How many times do Western countries need to learn and re-learn the same hard lesson? Authoritarian regimes are not your friend. They do not have your best interests at heart, they are not trustworthy, and they do not particularly care if you live or die.

And under no circumstances should a free society be dependent upon an authoritarian regime for the medical equipment it needs to survive a crisis.

ADDENDUM: Good news! In Michigan, Governor Gretchen Whitmer is finally willing to revise her sweeping restrictions: “Landscapers, lawn-service companies, plant nurseries and bike repair shops can resume operating, subject to social-distancing rules. Stores selling nonessential supplies can reopen for curbside pickup and delivery. Big-box retailers no longer have to close off garden centers and areas dedicated to selling paint, flooring and carpet.”

White House

Eat More Potatoes, America

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President Trump in Washington, D.C., February 6, 2020 (Joshua Roberts/Reuters)

On the menu today: dissecting some recent comments from President Trump about coronavirus treatments, and why the latest “I can’t believe he said that!” comments in Washington are pretty small potatoes compared to much larger problems — such as the ability of American consumers to continue to have access to potatoes of any size.

Is It Really Too Much to Ask That We Focus, People?

In just about every major publication in the country today, the lead story is that President Trump has once again said something outrageous in yesterday’s briefing about the virus response. “So supposing we hit the body with a tremendous — whether it’s ultraviolet or just a very powerful light — and I think you said that hasn’t been checked because of the testing” — referring to Bill Bryan, the acting undersecretary of science and technology for the Department of Homeland Security. “And then I said, supposing you brought the light inside the body, which you can do either through the skin or some other way, and I think you said you’re going to test that, too. I see the disinfectant that knocks it out in a minute, one minute. And is there a way we can do something like that by injection inside or almost a cleaning? As you see, it gets in the lungs, it does a tremendous number on the lungs, so it would be interesting to check that.”

As usual, the president is vaguely, sort of in the ballpark of a valid idea, and half-remembering it and describing it in way that sounds ridiculous. Columbia University’s Center for Radiological Research has developed lighting that uses “far-UVC, which can kill viruses and bacteria without harming human skin, eyes and other tissues, as is the problem with conventional UV light.” We could put that lighting in public places and mitigate airborne viruses that way. But that far-UVC light isn’t going to get into your lungs or the rest of your body.

CNN writes, “Fact check: Trump wrongly suggests sunlight could help cure coronavirus.” During the briefing, Trump said to coronavirus task force coordinator Dr. Deborah Birx, “I would like you to speak to the medical doctors to see if there’s any way that you can apply light and heat to cure, you know, if you could. And maybe you can, maybe you can’t.”

Once again, the president appears to be half-remembering accurate information and repeating it in a way that is inaccurate to the point of near-incoherency. When you go out in the sun, your body generates Vitamin D from cholesterol, and there is some evidence that Vitamin D helps the body fight off viruses. It’s not a cure, or a treatment, or a viral bulletproof vest, but it probably modestly improves the odds of your body fight off viral infections:

Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration.

I wish the president wouldn’t spitball half-baked ideas during these briefings, but “maybe you can, maybe you can’t” is not the same as declaring sunlight is a cure. But the media has a narrative, and it’s going to stick to it. Despite all the mockery last month, NBC News reports again, “An Arizona man died in late March after having ingested chloroquine phosphate — believing it would protect him from becoming infected with the coronavirus. The man’s wife told NBC News that she had watched televised briefings during which Trump talked about the potential benefits of chloroquine.” Major media continue to act as if the president’s comments amounted to, “Okay everyone, time to start eating fish tank cleaner!”

Elsewhere, the dominant message from the national media is variations of “President Trump is just the worst,” with Vanity Fair informing us the president’s team wanted to “flood” New York and New Jersey with hydroxychloroquine and The New Yorker contending that President Trump “refuses to mourn” the more than 50,000 victims of the coronavirus. The Dallas Morning News is motivated to inform readers that “the Trump administration did not put a professional dog breeder from Dallas in charge of COVID-19 response,” despite what they may have read on social media.

Look, in a matter of days, we have seen this president insist that the decision to reopen states is his because his authority is “total,” then tell the nation’s governors “you are going to call your own shots,” and then tweet out a message to “LIBERATE” Minnesota, Michigan, and Virginia, states with Democratic governors. We have seen him both praise and rebuke Georgia governor Brian Kemp for his decisions to reopen his state. The president is winging it. He’s often responding to the last idea he heard, or the last person he talked to or saw on television, or whoever’s in front of him at the moment. I wish he wasn’t this person, but he is, and he’s going to be our president until at least January 20, 2021. (Knocking on wood for his health.) We’re not going to hold another impeachment process during a viral outbreak.

Whether you love this president or hate him or fall somewhere in between, this is the guy we have in the Oval Office for, at minimum, the next nine months. (The meandering comments of President Trump’s Democratic alternative are not really an overflowing fountain of reassurance, either.)

Because the media and President Trump are in this well-established symbiotic relationship driven heavily by “YOU WON’T BELIEVE WHAT THE PRESIDENT JUST SAID” coverage, a lot of days the media act like the most important development in the coronavirus story is what the president said that day. But most days, that’s among the least important and consequential developments.

What’s more important and consequential right now? How about the U.S. food supply chain?

This Is What We Ignore When We Obsess Over What’s Happening in Washington

Americans aren’t necessarily going to starve, but we are probably going to see a lot less food on our store shelves in the next couple months as these problems in the supply chain get worked out. Tyson Foods just closed its huge meat processing plant near Pasco, Washington for coronavirus testing. That plant produces enough beef in one day to feed 4 million people and employs 1,400 workers. That company also closed its processing plants in Logansport, Ind., and Waterloo, Iowa. More than a dozen meatpacking plants are now closed across the country.

Minnesota farmers are talking about culling 200,000 pigs. It’s easy to say the farmers should just give their product away to the hungry — but who’s going to take the live pig and turn it into bacon? And who reimburses the hog farmer for his labor?

It’s a similar story in the seafood industry, which is highly dependent upon demand from restaurants. Very few people want take-out fish.

In produce, farmers have seen 95 percent of their restaurant customers disappear, almost instantly, as well as what they produced for school lunches:

Americans may see less selection or more expensive food than they’re used to as well as a smaller variety of fresh fruit and vegetables. If independent farmers go out of business, some consumers may lose access to locally-produced food.

“We may find that the food selection is reduced,” said Andrew Novakovic, a professor of agricultural economics at Cornell’s Charles H. Dyson School of Applied Economics and Management. “It’s fairly likely we’re going to be eating more canned foods and have less fresh fruits and vegetables available.”

America’s food producers set up their supply chains to cater a certain percentage to restaurants and a certain percentage to supermarkets, and while you might think, “food is food,” supermarkets and their shoppers have different needs from restaurants:

“Seldom does a consumer go to a grocery store and want to buy a 5-pound bag of shredded cheese,” said Mark Stephenson, director of Dairy Policy Analysis at the University of Wisconsin, Madison. “They wanted maybe 1-pound bags at a time. You can’t just put 1-pound bags through a 5-pound line. Not possible. You have to have a different piece of equipment set up differently. We’ve had an industry that’s had to shuffle a great deal to move product from where it was produced before to where it needs to be today.”

Lots of industries are going to find themselves in situations similar to the oil industry’s current troubles. Those who produce the initial form of the product keep generating it, while the processers and middlemen can’t find enough customers, either retail or wholesale. A backlog of supply builds up — and remember, meat, fish and produce can spoil, oil doesn’t — and then no one knows what to do with all the excess supply.

We are really not prepared for the oversupply problems:

Tamas Houlihan, executive director of the Wisconsin Potato & Vegetable Growers Association, said about 60 percent of potatoes produced in the United States are processed for the food service industry. Without restaurants and schools to use up last year’s potatoes, Houlihan said there will be storage problems when the 2020 crop is harvested.

“It’s going to be a really bad situation in the fall. We just know there’s going to be a huge oversupply of potatoes. And when that happens, the price plummets and our growers can’t even recoup their cost of production,” Houlihan said.

Eat more potatoes, America.

Do you see how this makes the usual “Can you believe President Trump said this?” coverage — or its reverse, “You won’t believe that this cable news figure said about Trump!” — seem irrelevant and unimportant? I’d say we have bigger fish to fry, but as you saw above, we can’t even get that fish to the market. We are in the middle of the biggest news story of the century, a problem that touches every single life on the planet and is a threat to just about everyone in one form or another — physically, mentally, economically, socially. And some people can’t break out of their politics-as-usual thinking patterns.

Since the outbreak hit, I’m just less interested in what the political ramifications are, at least for now. I’m not interested in some “academic researchers” concluding that more Trump voters are dying than Hillary Clinton voters.

ADDENDUM: You know, I’m happy with the New York Jets selecting offensive tackle Mekhi Becton last night. When’s the last time you saw a six-foot seven-inch, 364-pound man run a 40-yard dash in 5.1 seconds?

U.S.

Moving Out and Not Coming Back

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A used face mask on a street in New York City, March 14, 2020 (Eduardo Munoz/Reuters)

On the menu today: The possibility of another wave of Americans moving out of the big cities, the likelihood of some future pandemic further down the road, and how the Red America–Blue America divide is likely to be altered when we emerge from this crisis.

The Coming De-Urbanization of America

Yesterday on my work Facebook page, a reader asked, “Why is it that the places Covid-19 show up the most are in Democrat controlled areas?” As much as I’d like to believe that all the troubles in the world can eventually be traced back to Bill de Blasio, I responded, “Probably because ‘the places it shows up the most’ are large densely-packed cities with a lot of international and domestic air travel and high use of mass transit, where Democrats have been winning elections more than Republicans for at least a generation and in many cases several generations.”

You can split red and blue America in a lot of ways — race, age, religiosity — but arguably the strongest factor is geography. The “Big Sort” that Bill Bishop described has been at work for two decades. Sure, there are conservatives and Republicans who live in big cities and inner-ring suburbs, just rarely in the numbers that could make a difference. And there are progressives and Democrats who live in rural areas and exurbs, but again, rarely in the numbers that could make a difference in elections.

Kevin Williamson has noted that conservatives often don’t even try to persuade city-dwellers of the value of their ideas, and lapse into a casual to overt contempt of life in the big city.

Meanwhile, it is not hard to find examples of urban progressives looking at rural America with a combination of contempt, disdain, pity, smug superiority . . . heck, it’s not hard to find urban progressives who see suburbanites as somehow inferior and worthy of scorn, never mind residents of small-town America.

At some point the coronavirus crisis will end, but one of the extraordinarily difficult lessons of this ordeal is that the catastrophic scenarios that sound like something out of science fiction can happen in real life, and that the vast majority of us are at the mercy of fate in these scenarios. As mentioned last week, whichever way SARS-CoV-2 jumped into humans — a lab accident, wet markets, exotic-animal trader, a farmer using bat guano for fertilizer — it can happen again with another virus. Right now, as you are reading this, all around the world, scientists are working on dangerous viruses and pathogens in biosafety-level four, three, and two labs. Almost all wet markets are still open in China; all around Asia, the often-illegal trade in exotic species continues with minimal impediments; and farmers all around the world continue to use guano as fertilizer, prompting human beings to go into caves, and risk exposure to viruses that no human being has ever encountered before. Those viruses will probably be less deadly and contagious than SARS-CoV-2. But someday, humanity could encounter one that is even worse.

We will get through this crisis in a year or two. But we have no guarantee that additional pandemics aren’t waiting for us further along in this decade, or the next one, or the one after that. Maybe we’ll be lucky and the fudging-the-numbers-slightly meme declaring that we face a terrible plague once a century, in years ending in ’20, will turn out to be right.

We in the United States never suffered another terror attack on the scale of 9/11, but that didn’t mean that the threat of terrorism did not shape our thinking for at least a decade afterwards, and probably even to today. We will be thinking about the risk of global pandemics and how to mitigate them for a long time to come. And that will start to influence Americans’ decisions about where they want to live.

Today in the Wall Street Journal, Anne Kadet writes about the New York City residents who are moving out, and not coming back:

They’re hardly the only family spurred by the pandemic to make a fast move, said Alison Bernstein, founder and president of Suburban Jungle, a company that specializes in matching city clients with their ideal suburban town, and helped the Usherenkos find their new home. “This whole thing is catastrophic and petrifying for families in urban areas,” she said. “People want out of the city and now.”

Ms. Bernstein said demand for her firm’s services is up 40% from the same period last year. Some are prompted by safety concerns. Others worry the shelter-in-place edict will drag on, confining them to small city apartments.

Carlo Siracusa, president of Residential Sales for N.J.-based Weichert Realtors said while inventory is low due to sellers pulling homes off the market, demand remains high because of a new wave of city dwellers shopping in the suburbs.

“They’ve been confined to a small space the last 45 days and want out,” he said. “There’s a sense of urgency.”

Are cities still worth it? Many will conclude they are. The opportunities are unparalleled, lots of jobs are there, the arts scenes are thriving, the professional sports teams are there. Nearby international airports allow you to get anywhere in the world fairly easily. Cities have more people closer together than towns and suburbs, so they just have more things going on — fascinating museums, festivals, marathons, concerts, pedestrian-only streets lined with quirky shops, distinct ethnic neighborhoods, small businesses, unique non-chain restaurants, skyscrapers and observation decks, broad boulevards, huge libraries, inviting public squares. Even the train stations can be beautiful. People who appreciate all the joys of a city — and who can still afford the cost of living — won’t easily give up all of that. Our cities will not empty out.

But they may shrink, and this outbreak is likely to accelerate the trend of seeing urban life as a luxury for the wealthy and young and a necessity for the poor and old.

Whatever you want to call the trend in urban planning over the past two or three decades — I’d characterize it as Richard-Florida-ization — it has reoriented American big cities’ offerings, enhancing their appeal to certain groups of people, often at the cost of other groups of people. Florida now gets mocked as “the Patron Saint of Avocado Toast,” but I think the demographic numbers don’t lie. Cities are terrific and exciting places for young people, particularly college students and recent college graduates, and double-income, no-kids couples — and probably retirees as well. But once a couple has a child, urban life becomes a lot more difficult and less appealing. A small apartment can become unbearable with a new baby. The public schools are hit-and-miss at best. Bigger kids want a yard to play in, or maybe a swing set. The cost of living starts to be prohibitive.

And now we are learning, once again, that densely packed cities are particularly dangerous places to be during a disease outbreak.

If you’re living in New York City right now, the good news is that you’re living amongst some of the best doctors and medical personnel in the world. But you probably live in an apartment. Leaving that apartment requires using an elevator (use a glove to touch the buttons) or the stairs (don’t touch the railings or doorknobs with your bare hands). Once you get on the street, you can try to keep space between yourself and everyone else, but there are just lots of people around. Advocates for public transportation insist the connection between the subway system and the virus is ‘tenuous,” but . . . how many other places are you forced into relatively close contact with lots of strangers with circulated air for a significant stretch of time? How many people use those stairway railings each day? How many people touch the turnstiles and subway poles?

Life in a small town or the suburbs is no guarantee of protection from the coronavirus. Tiny Cynthiana, Ky., population around 6,300, had a cluster of cases, fourteen in the town and surrounding county. My stretch of suburbia, Fairfax County, has 2,306 cases. But we’ve got 1.1 million people spread out over 406 square miles — roughly the size of Los Angeles. At least we can walk around our neighborhoods and the trails in the woods with minimal fear of exposure.*

The world has been forced to embrace telework and experiment with working from home like never before. The need for white-collar workers to all be in one central location — and paying some considerable rent for that office space — is shrinking before our eyes.

When authorities require or recommend you stay inside your home, your home becomes exponentially more important — not just a place to sleep and store your stuff. Kitchens matter when you’re cooking almost every meal at home. A yard, patio, deck, porch, or gazebo gives you the ability to enjoy fresh air within your own space.

Who knows if the coming year or two will have on-and-off social distancing and stay-at-home orders? All of those glorious amenities of the city aren’t that appealing if they’re closed.

Some reacted to the previous trend of the urbanization of America with satisfaction. After “White Flight” and “Brain Drain” and so many bad trends in American cities in the 1970s and 1980s, many urban areas were finally enjoying a renaissance. A handful became “innovation hubs for the knowledge economy” — New York City, Seattle, Austin, Boston, Silicon Valley — enjoying an explosion of jobs — with a much slower increase in the amount of available housing. Rents and the cost of real estate skyrocketed, creating glittering cities with much of the rest of America on the outside looking in.

And now some people in the cities may not want to live in them anymore. “Blue America” might be moving to the suburbs or right into “Red America” — and maybe we would be better off if we saw each other as neighbors, instead of rivals in a never-ending culture war.

*This does not assure our local “Karen,” who is very upset that my wife and I walk side-by-side instead of single-file.

ADDENDUM: It will probably not surprise you to learn I think Senator Tom Cotton has the assessment of the likelihood of SARS-CoV-2 arising from an accidental exposure of a naturally occurring virus just about right:

While the Chinese government denies the possibility of a lab leak, its actions tell a different story. The Chinese military posted its top epidemiologist to the Institute of Virology in January. In February Chairman Xi Jinping urged swift implementation of new biosafety rules to govern pathogens in laboratory settings. Academic papers about the virus’s origins are now subject to prior restraint by the government.

In early January, enforcers threatened doctors who warned their colleagues about the virus. Among them was Li Wenliang, who died of Covid-19 in February. Laboratories working to sequence the virus’s genetic code were ordered to destroy their samples. The laboratory that first published the virus’s genome was shut down, Hong Kong’s South China Morning Post reported in February.

This evidence is circumstantial, to be sure, but it all points toward the Wuhan labs. Thanks to the Chinese coverup, we may never have direct, conclusive evidence—intelligence rarely works that way—but Americans justifiably can use common sense to follow the inherent logic of events to their likely conclusion.

World

We’re Still Learning About the Pandemic’s Early Days

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Hospital staff in protective garments walk at a checkpoint to the Hubei Province exclusion zone at the Jiujiang Yangtze River Bridge in Jiujiang, Jiangxi Province, China, as the country is hit by an outbreak of a new coronavirus, February 1, 2020. The banner reads: “Committed to the fight to prevent and control the epidemic.” (Thomas Peter/Reuters)

On the menu today: California drops a bombshell, confirming that the first American death from coronavirus occurred February 6, not February 28; a long look at the World Military Games in Wuhan in October 2019, weeks before the known start date of the virus outbreak; and a good proposal for accountability in U.S. policies regarding China.

Maybe the Coronavirus Was Floating Around America Earlier Than We Thought

This discovery out in California is pretty significant. This doesn’t verify all of the “I had a bad flu in November or December — I’ll bet I had coronavirus” self-assessments, but it does remind us that a lot of what we know about this virus and the spread of it can and should be revised with new information.

Medical officials in California’s Santa Clara County, in the heart of Silicon Valley, indicated late Tuesday that the first U.S. death connected to the coronavirus happened weeks earlier than previously believed.

Two deaths on Feb. 6 and Feb. 17 were not initially thought to have been COVID-19-related, but further testing has revealed that they were, the county medical examiner said Tuesday.

“Today, the Medical Examiner-Coroner received confirmation from the CDC that tissue samples from both cases are positive for SARS-CoV-2 (the virus that causes COVID-19),” the Santa Clara County Medical Examiner-Coroner said in a statement.

A fatality reported by officials in Washington state Feb. 29 was initially thought to be the earliest U.S. death from the novel coronavirus.

Keep in mind, that first death is three weeks before the U.S. confirmed its first case of unknown origin back on February 26. This means the virus was probably spreading around some California communities in early February, perhaps even late January. The first known U.S. case was announced back in January 21, in a person who had returned from travel to Wuhan January 15, in Washington State. Santa Clara is not near Washington, and so far there’s no indication that these two deaths in Santa Clara can be tied to that traveler who lived 860 miles away. Were there more asymptomatic cases coming into California in January? Were there more asymptomatic cases coming into other places in the United States in January?

A lot is at stake as we try to piece together those first carriers and the early spread of the virus. It is not overstating it to say the way the world thinks about and remembers this virus and its terrible human toll depends upon what we can uncover about its origins.

The Coronavirus and the World Military Games in October

In all of the hubbub of mid-March, as the scale of the danger of SARS-CoV-2 and the far-reaching shutdown of American live became clear, it was easy to miss Lijian Zhao, spokesman for the foreign ministry of China, making Twitter accusations that the virus was a U.S. bioweapon. Even easier to miss was his tweet linking to a paper contending the virus was linked to U.S. attendance at the Military World Games, which took place in Wuhan in October 2019. (That paper has since been taken down from the web.)

The 7th World Military Games, an Olympic-style competition, was held in Wuhan and began October 18 and ended October 27. The event was a big one for the city and for China, complete with elaborate opening and closing ceremonies. “More than 9,000 athletes from over 100 countries competed in more than 27 sports, a record number of participants. This year’s games also presented a number of other firsts: the first time the games were staged outside of military bases, the first time the games were all held in the same city, the first time an Athletes’ Village was constructed, the first time TV and VR systems were powered by 5G telecom technology, and the first use of all-round volunteer services for each delegation.”

At the end of March, the state-run Global Times newspaper claimed that the coronavirus, which was first discovered in Wuhan, was in fact manufactured in a U.S. military lab and brought to China by a cyclist who took part in the World Military Games. They cited the work of a man they labeled an “investigative journalist,” who in 2017 contributed to the brief shutdown of part of the port of Charleston, S.C., over a false claim of a dirty bomb on a container ship.

One Chinese publication contended that “the location of the US Guest House in the Military Games is not far from the South China Seafood City” — the now-infamous Huanan Seafood Market that the Chinese government contends is the source of the virus. Characterizing the U.S. team as “soy sauce soldiers” — weak — the publication wrote, “the always strong American soldiers did not perform as well as the community security in the military games. When something goes wrong, there must be a demon. In addition, after the end of the Military Games, the United States suddenly tightened the Chinese visa to the United States. If these soy sauce soldiers are biochemical soldiers, then all the problems can be solved.” (That’s run through Google translate.)

That cyclist, by the way, is Army Sergeant 1st Class Maatje Benassi. She was hit from behind and crashed in her final lap — bruising her ribs and cracking her helmet– but still finished eighth in her competition. Those who think she achieved all of that while carrying a secret U.S. bioweapon in her body must believe she is downright superhuman.

Elsewhere at World Military Games, the Chinese team in the middle-distance orienteering competition was disqualified for “extensive cheating.” (The idea of the Chinese merely lying about previous preparation of an orienteering course seems so quaint now.)

The earliest anyone has dated a case of the coronavirus is November 17, according to unspecified “government data” cited by the South China Morning Post. (For what it’s worth, that newspaper is considered pretty sympathetic to Beijing and could have good sources.)

From that date onwards, one to five new cases were reported each day. By December 15, the total number of infections stood at 27 — the first double-digit daily rise was reported on December 17 — and by December 20, the total number of confirmed cases had reached 60.

The first verified case cited in a medical journal described the onset of symptoms on December 1, in the account in The Lancet.

It is worth noting that as seen with the California news above, the more the world studies the coronavirus, the more it realizes what it thought it knew wasn’t necessarily true. It is conceivable that somewhere out there, someone contracted the coronavirus before December 1, or even before November 17. But right now, any theory of the spread that assumes this virus jumped into humans significantly earlier than December is writing checks that the available evidence can’t cash.

One research paper by a group of virologists affiliated with Chinese research labs as well as Los Alamos National Laboratory and the University of California San Diego, studied the genome of the virus strains, trying to determine when the virus jumped into humans. They wrote, “our results also suggest that the virus originated on November 24, 2019, which is in further agreement with our earlier studies.”

(Also note these researchers concluded, “the human SARS‐CoV‐2 virus, which is responsible for the recent outbreak of COVID‐19, did not come directly from pangolins.” To summarize a lot of writing in the past month, the “lab accident” theory is extremely unlikely if the virus had to jump through pangolins, and more possible (but far from proven) if it could jump directly from bats.)

The incubation period of SARS-CoV-2 — the amount of time between the initial infection and the onset of symptoms — can range anywhere from two to eleven days, according to researchers at the Dutch National Institute for Public Health and the Environment. The absolute earliest you could get any initial infection of Patient Zero — eleven days from the date cited by the source of the South China Morning Post — is November 6. That is nine days after the military games ended in Wuhan.

Some might well turn China’s conspiracy theory around and accuse the host country of attempting to infect a new virus into military personnel of 110 countries around the world, right before they returned to their home countries. In addition to military personnel from the United States, the games in Wuhan hosted military personnel from almost all of the NATO countries, South Korea, bordering countries like Russia, India, Pakistan, Nepal, Myanmar, Vietnam, and quite a few countries in Africa, where the local health-care systems would be terribly unprepared for a threat on the scale of SARS-CoV-2. If SARS-CoV-2 had quietly spread among the military personnel at the games in Wuhan before they returned, the host country could have set off a health crisis in the ranks of military forces all around the world.

I’m as up for a good “China-as-villain” narrative as the next guy, but the known facts just don’t fit this theory. For starters, as far as we know, no athletes who participated in the games in Wuhan have been diagnosed with coronavirus — and that’s not the sort of information that could be easily suppressed simultaneously by lots of militaries around the world. The timeline doesn’t fit, even with lengthy incubation period. And even if the Chinese military did want to set off some sort of terrible bioweapons attack on the militaries of the world, there would be no way to ensure they didn’t get exactly the kind of disaster that befell their own country and civilians. If a malevolent government was going to do something like this, it would make much more sense to do it at a global military event even they weren’t hosting — and particularly not when they were hosting the military games in a city with two separate laboratories researching coronaviruses in bats.

For those wondering how the personnel on the USS Theodore Roosevelt aircraft carrier got infected, it is believed the soldiers initially caught the virus during a port call in Da Nang, Vietnam, on March 5.  “Dozens of sailors had spent at least one night in a hotel where two British nationals tested positive for the virus.”

ADDENDUM: James Durso writes in an interesting op-ed in The Hill that it is time for Congress to hold hearings on lobbyists and Chinese efforts to influence and alter American policies:

Congress can hold productive hearings about lobbying by public and private Chinese entities, Beijing’s funding of Confucius Institutes at colleges and gifts to think tanks and universities the government sometimes refers to for expert advice. It can also examine Chinese involvement in U.S. entertainment and media companies and the technology sector and predatory investment in distressed U.S. companies suffering from the pandemic-induced slowdown. There’s also the long-standing U.S. reliance on China for rare earth elements and what can be done to encourage production in North America.

Go for it, Congress. There’s a real chance for bipartisan cooperation on this one.

World

Does China Have This Under Control?

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Staff members wearing face masks are seen at the Leishenshan Hospital, a makeshift hospital for treating patients with the coronavirus, in Wuhan, Hubei Province, China, April 11, 2020. (Aly Song/Reuters)

On the menu today: a deep dive into what we know about how China is handling the outbreak of the coronavirus today; an ominous report out of North Korea that may just be much ado about nothing; and a surprise cancellation suggests that we’ll still be seeing coronavirus-related cancellations in the autumn.

How Is China Handling Its Coronavirus Outbreak Now?

As of yesterday, China’s National Health Commission claims that the country has 82,758 reports of confirmed cases and 4,632 deaths. (And not a single case in the entire 2 million people in the People’s Liberation Army.) Four days ago, Wuhan health officials revised their local death toll from 2,579 to 3,869. The Wall Street Journal quoted some Wuhan residents who said they believed the death toll had to be higher. One half of the previous total is 1,289.5; the increase was 1,290 — almost as if someone arbitrarily decided to raise the existing death toll by fifty percent.

China may be hiding cases, deaths, and the full extent of the outbreak, but the bigger the epidemic, the harder it is to hide. The situation in China is better than at the height of the outbreak, but how much better? To the extent that non-Chinese sources can report on conditions in Chinese cities, life appears to be returning to something resembling a non-crisis state. Everyone must wear masks just about everywhere, and you have to regularly update your health conditions on your government-monitored app:

At checkpoints throughout the city, police and security guards demanded that anyone seeking to come and go present a QR code on their mobile phones that rates the user’s risk of catching the coronavirus. Green codes granted unrestricted movement. A yellow code required seven days of quarantine. Red meant 14 days of quarantine.

Local governments created the algorithms behind the ratings at the behest of China’s State Council and rolled them out in Wuhan and hundreds of other cities on apps hosted by China’s largest tech companies: Alibaba Group, Tencent Holdings, and Baidu Inc. To receive a rating, users must download an app embedded in one of the tech giants’ ubiquitous payment, messaging, or search engine platforms. The apps work differently by city and province, but they typically require users to register with basic information — name, national identity card number, phone number, and home address. Subsequent questions are more invasive, quizzing users on health status and travel history, and asking them to identify any close contacts diagnosed with the virus.

The Guardian’s correspondent in Wuhan describes “employees wait[ing] in lines outside of office buildings to have their throats swabbed, to make sure they do not have the virus before going back to work.”

But every now and then, some report slips out indicating that China is still dealing with a significant problem.

On April 6, “an official newspaper said there could be 10,000 to 20,000 such [asymptomatic] cases in Wuhan. The report was swiftly deleted online.”

Chinese authorities are still claiming they’ve defeated the virus at home, and almost all of the new cases are coming in from travelers abroad. Unsurprisingly, this official spin is fueling xenophobia and racism among Chinese citizens. You probably saw the reports of out-in-the-open discrimination like the McDonalds in Guangzhou declaring that “black people” were not permitted inside. In Beijing, ambassadors from African nations say they and their staff are being hassled and harassed.

Today, “the province of Shaanxi [in northwestern China] reported 21 new infections from abroad, as well as seven cases with no clinical symptoms, all travelers on a commercial flight from Moscow bound for the Chinese capital of Beijing.”

In the capital city, “Beijing’s Chaoyang district, home to dozens of foreign embassies, has been designated a high-risk area after a family of three became infected, the first new cases in the city for 27 days according to the Beijing Centre for Disease Prevention and Control.”

Chinese state media are continuing to claim that the virus is a U.S. bioweapon.

Of course, getting any real information out of Wuhan is a challenge. “Residents in Wuhan who spoke to the Guardian said they had been intimidated by local police and forced to promise not to speak out.”

In the past week, government officials in the United Kingdom, France, Germany, and Australia have criticized China for a lack of openness about information about how the virus first appeared. (That’s not necessarily an endorsement of the lab-escape theory.)

The outbreak began in Wuhan in December. (I know an unnamed Chinese government source told the South China Morning Post the first case was November 17, but no one else can verify or provide any specifics.)

Wuhan eased its lockdown April 8. If there’s any place on earth that has something close to herd immunity, Wuhan should be the place, as this was the initial epicenter of the outbreak. Then again, maybe no other place outside China can be compared to Wuhan, as the government there used tools and methods to control the spread of the disease that no Western society would ever accept, such as welding doors shut, monitoring the streets with drones, forcing people to stay at home if their temperature was high, even if they had no other symptoms, using facial-recognition software to track the healthy and the sick, and so on.

And if there’s any place in Wuhan that you would think would have lots of people with antibodies against this virus, it would be at the hospitals. And yet . . . one recent study suggests that the percentage of people there with antibodies is way lower than the recent ones of Santa Clara and Los Angeles County:

Wuhan’s Zhongnan Hospital found that 2.4% of its employees and 2% to 3% of recent patients and other visitors, including people tested before returning to work, had developed antibodies, according to senior doctors there.

“This is a long way from herd immunity,” said Wang Xinghuan, the head of Zhongnan hospital, one of the city’s largest. “So a vaccine may be our last hope.”

Wuhan was on lockdown for 76 days. If you use the closure of public schools as the start of America’s “lockdown,” most states have been in lockdown for 37 days (March 16) to 29 days (March 24).

Kim Jong-un Is Gravely Ill! Or He’s Just Fine. We’re Pretty Sure It’s One or the Other.

You sit down, ready to consume the news from overnight, bracing yourself for some terrible coronavirus-related development . . . and then you find out that North Korea’s Kim Jong-un has turned into Schrödinger’s dictator, apparently simultaneously alive and near-death.

CNN appeared to have a huge scoop last night: “The US is monitoring intelligence that North Korean leader Kim Jong Un’s health is in grave danger following a surgery, a US official with direct knowledge tells me.”

(By the way, an obese 37-year-old suddenly having serious complications from surgery? That couldn’t be tied into any particular virus that North Korea insists hasn’t entered their country, could it?)

The CNN article never quite says “he’s on his deathbed.”

Kim recently missed the celebration of his grandfather’s birthday on April 15, which raised speculation about his well-being. He had been seen four days before that at a government meeting.

Another US official told CNN Monday that the concerns about Kim’s health are credible but the severity is hard to assess.

Daily NK, an online newspaper based in South Korea that focuses on North Korea, reports that Kim reportedly received a cardiovascular system procedure on April 12.

Kim received the cardiovascular system procedure because of “excessive smoking, obesity, and overwork,” according to the news site, and is now receiving treatment in a villa in Hyangsan County following his procedure.

But this morning, the South Koreans and Chinese are throwing cold water on the reports, and they presumably would be in a better position to know. As much as the North Korean regime would want to keep their leader’s serious illness quiet, at some point other countries watching Pyongyang would see high-ranking officials changing their routines, indicating that something significant was going on. Intelligence agencies can’t always tell what happened, but they can often tell that something new and unexpected has happened:

South Korea and China have played down speculation that Kim Jong-un is seriously ill, after a Seoul-based website reported that the North Korean leader had undergone heart surgery.

Daily NK claimed Kim, who has not been seen in public for 10 days, was being treated at a private villa following the procedure this month.

CNN, meanwhile, cited an anonymous US official as saying that Washington was “monitoring intelligence” suggesting that Kim was in “grave danger.”

But Kang Min-seok, a spokesman at South Korea’s presidential Blue House, said there was “nothing to confirm rumours about chairman Kim Jong-un’s health, and no special movement has been detected inside North Korea as of now.”

South Korea’s Yonhap news agency quoted an unnamed government official saying that reports Kim was seriously ill were “not true.”

An official at the Chinese Communist party’s international liaison department, which deals with North Korea, told Reuters there was no reason to believe Kim was critically ill.

Strange as it sounds, maybe it’s better for all of us if Little Rocket Man pulls through okay. Right now, if you try to call any world leader or organization to warn them about a sudden crisis, you’re probably going to get some version of the message, “We’re sorry, all circuits are busy now. Please try again later.” If Kim Jong-un’s crazy little heart keeps beating, at least we know who’s in charge over there, and we don’t have to worry about a struggle for succession in a country with nuclear weapons.

Good News If You Can’t Stand Crowds

Events with big crowds are probably not coming back into our lives until 2021. Germany just canceled Oktoberfest, which actually begins in mid-September and ends in early October.

ADDENDUM: Well, now we all know what to get our wonderful mothers for Mother’s Day next month: a big, beautiful barrel of oil. You never know when you might need one, and at these prices, who can say no, right?

U.S.

Non-COVID Patients Need Care, Too

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New Jersey Army National Guard medical personnel assist New Jersey citizens at a COVID-19 coronavirus community-based testing site at Bergen Community College in Paramus, N.J., March 20, 2020. The drive-thru testing center will be open seven days per week, 8:00 a.m. to 4:00 p.m. In order to be eligible for testing, individuals must be current New Jersey residents and experiencing symptoms of respiratory illness. (Specialist Michael Schwenk/US Army National Guard)

On the menu today: a non-coronavirus medical problem facing America that probably can’t be put off any longer; enormous excitement about that study of the coronavirus in Santa Clara, Calif., and some evidence of why that study’s suggested ratio of unknown infections to known infections can’t fit the worst-hit places, laying out all the possible factors that made New York City the epicenter of the outbreak in America; and one large U.S. company does the unthinkable: It decides it doesn’t need aid money that badly and gives it back to the government.

Make America Care for Non-Coronavirus Patients Again

As the United States begins its first tentative steps out of a widespread and unprecedented lockdown, allow me to recommend that the one of the first changes we make is lifting the restrictions on “elective” medical procedures. Alaska, Oklahoma, and Texas have already done so.

“Elective” procedures sound like they’re optional; when some people hear that phrase, they may envision plastic or cosmetic surgery. What they mean, in most states, is non-emergency, a procedure that is not a matter of life and death. But there are a lot of procedures that are important, even if they’re not life-and-death.

I offered this thought as a quick tweet Friday and was deluged with heartbreaking responses about people living with delays in cancer surgery, hip surgery, knee surgery, in-vitro fertilization, ear tubes, chemotherapy, cardiac rehabilitation, physical therapy, CT scans, cardiology, endocrinology, neurology, cataract surgeries, colonoscopies, and more. And then there are the more minor procedures that are still annoying — people who can’t see the dentist, teens with braces who can’t get them removed by the orthodontists. Some dermatologists are soldiering on as best they can, trying to diagnose rashes through telemedicine. All kinds of non-life-threatening aches and pains that usually would get resolved with a doctor’s visit have been put off until hospitals give the all-clear sign.

(In some cases, oncologists may worry that regular cancer treatments like chemotherapy will weaken the immune system of the patient, making them more vulnerable to a coronavirus infection.)

The states, institutions, and doctors that delayed those procedures were not callous or “Chicken Littles.” They needed to ensure that hospital beds and personal protective equipment were available in quantities sufficient to handle an influx of coronavirus cases. Thankfully, most hospitals have not been overwhelmed and right now — knocking on wood — it looks like they aren’t likely to get overwhelmed anytime soon. Those hospitals had — and probably continue to have — legitimate worries about having non-coronavirus patients in the same hospital as coronavirus patients, particularly if those non-coronavirus patients’ immune systems aren’t 100 percent. Hospitals will have to think through whether they can set up separate and appropriately divided coronavirus and non-coronavirus emergency rooms, coronavirus and non-coronavirus halls and wings, etc. This is likely to be the sort of decision that has to be made on a hospital-by-hospital basis.

But don’t tell me that Americans are greedy and selfish in the face of this crisis. Americans who were expecting to have surgeries and treatments to relieve chronic pain and serious health problems accepted delays — in some cases, delays of five weeks or more — just so we could collectively increase the odds that everyone else would have a better shot at surviving coronavirus. We have a lot of heroic doctors, nurses, technicians, support staff, janitors, emergency medical technicians, and other people who work in those hospitals. But we probably ought to reserve a round of applause for everybody out there who accepted a delay in treatment — even if they didn’t have much of a choice.

On Friday, four big medical associations — the American College of Surgeons, the American Society of Anesthesiologists, the Association of perioperative Registered Nurses, and the American Hospital Association — laid out their general principles and a “game plan” for the resumption of regular medical procedures. They want the hospital and surrounding area to see a steady decline in coronavirus cases over two weeks before reopening for regular business. They need to ensure they have sufficient protective equipment and staff. This all sounds like common sense, and the sort of thing that bright, responsible leaders and staff should be able to work through, day by day.

One side effect of all this is that because these procedures are how these hospitals make most of their money, a lot of hospitals, particularly in rural areas, are struggling to keep their doors open. (Please hold off on the debate of whether this is how hospitals should make their money. Right now, we need to live in the here and now and discuss how things are, whether or not this is how you think things should be.)

One of the crazier side effects of this pandemic is hospitals being forced to lay off workers because they don’t have enough cash coming in and because care for coronavirus patients uses up so many resources. This is not a small problem; as of April 17, at least 140 U.S. hospitals have announced furloughs and layoffs; last month’s catastrophic jobs report indicated 43,000 jobs in the health-care industry were lost. On Friday, health-care giant Tenet announced a temporary furlough of 3,400 workers.

To the extent we can, as safely as we can, let’s reopen the doctor’s offices and all the non-coronavirus health care that’s been forced onto hiatus for more than a month.

The Rosetta Stone of Santa Clara and the Mystery of New York City’s Disaster

On Friday afternoon, a lot of people started touting the Stanford study of infection rates in Santa Clara as if it was the Rosetta Stone of this pandemic. It’s easy to understand why. That study suggested that for every test that detects the coronavirus, between 50 and 85 people are walking around with it, either asymptomatically or with such minor symptoms that they don’t think it’s the coronavirus and aren’t concerned.

People want hope right now, and that study argued, “we’re a lot closer to herd immunity than most experts think we are, because massive amounts of our people have already caught it and fought it off.” It would be wonderful if what this study is suggesting is true.

But there are some reasons to think the conclusions are far too optimistic. You can find scientists and statisticians who are a lot smarter than me picking apart that study. But allow me to lay out just one way that the study’s conclusion doesn’t fit with what we know.

If we really are detecting only one out of 50 cases because we are doing so little testing, as that study suggests, applying that ratio to other places gives you some really odd results. As of Sunday, New York City has 134,000 cases. If you multiply that by 50, you get 6.7 million cases. If you multiply the number of cases by 85, you get 11.39 million cases.

New York City only has 8.5 million people in the five boroughs, about 20 million in the wider metropolitan area. If your estimated number of cases in an area is more than the number of human beings living in that area, you’re probably overestimating somewhere along the line.

Even if we take that low end of that estimate, that fifty infected people are walking around for every detected case . . . do we think almost 80 percent of New York City residents are walking around with the coronavirus? (I doubt this is the case, but if it were, this percentage would be knocking on the door of herd immunity, and we would expect the number of new cases to drop like a stone.) The “fifty people have it for every diagnosed person” theory would mean 12.1 million New Yorkers have it out of 19.4 million; 4.2 million New Jersey residents out of 8.8 million, and 1.8 million Massachusetts residents out of 6.8 million.

Then again . . . Massachusetts is experiencing a surge of patients right now.

Mind you, we know that some people are walking around asymptomatic. Maybe it’s ten for every diagnosed case? Twenty? I was already a fan of Robert VerBruggen’s data-driven reporting and analysis before this virus came along, and he seems to be in that not-too-optimistic, not-too-pessimistic sweet spot.

One of the great mysteries of this epidemic is why New York City is getting so relentlessly hammered compared to the rest of the country. We can point to a slew of possible reasons — the city is an international air-travel hub, it has high population density, it has about a million people over age 65, it has heavily used enclosed mass transit like subways, commuter rail, and buses, it had Mayor Bill de Blasio telling people to go about their lives until the epidemic was obvious . . .

But a lot of big cities in the United States have these factors to varying degrees: a lot of international travelers, somewhat comparable population density, significant numbers of seniors, heavily used mass transit, and at least comparably idiotic mayors. But no city in the United States is even close to the number of cases in New York.

As of Sunday afternoon, New York City had 134,000 cases.

Cook County, Ill., which includes Chicago, has 20,395 cases.

Wayne County, Mich., which includes Detroit, has 13,471 cases.

Los Angeles County, Calif., has 12,021 cases.

Philadelphia County, Pa., has 9,214 cases.

Miami-Dade County, Fla., has 9,165 cases.

Suffolk County, Mass., which includes Boston, has 7,696 cases.

Orleans Parish, which includes New Orleans, has 6,000 cases.

Harris County, Texas, which includes Houston, has 4,653 cases.

Dallas County, has 2,428 cases.

San Francisco County has 1,160 cases.

The fear is that New York, while having all of these factors, shows what happens when this virus hits a place that just isn’t prepared or taking precautions. Probably no place else in America will get hit quite so badly — but that doesn’t mean that cases won’t increase in other places. We’re probably past the first peak. But sending people back to work means the number of cases and deaths will increase, and we will get at least another peak . . . perhaps a series of peaks and troughs.

I realize lots of people want to find any shred of evidence suggesting this won’t be that bad. But right now, it’s already pretty darn bad. It may well be less bad sometime soon. But we need to be prepared psychologically, medically, socially — for this to get really, really bad.

ADDENDUM: Something you don’t see every day: a business giving back taxpayer-funded aid:

Shake Shack, one of several large restaurant chains that got federal loans through the coronavirus stimulus law meant to help small businesses, said Sunday night that it is giving all $10 million back.

“We now know that the first phase of the PPP was underfunded, and many who need it most, haven’t gotten any assistance,” [Danny Meyer, Shake Shack’s founder and CEO of its parent company, Union Square Hospitality Group, and Randy Garutti, Shake Shack’s CEO] wrote, urging Congress to ensure that “all restaurants no matter their size have equal ability to get back on their feet and hire back their teams.”

“Our people would benefit from a $10 million PPP loan, but we’re fortunate to now have access to capital that others do not,” they wrote. “Until every restaurant that needs it has had the same opportunity to receive assistance, we’re returning ours.

U.S.

What Is the Limit of American Patience?

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Empty street in Manhattan following the outbreak of the coronavirus in New York City, March 15, 2020. (Jeenah Moon/Reuters)

We have confirmed the widespread rumor that it is Friday.

Today’s Jolt begins with some good news, moves on to math, and points out hard truths about how long the public will continue to consent to government lockdowns.

Hurrah! Signs of Some Effective Treatments for COVID-19!

Everyone prefers the good news, so let’s start with that.

It’s early, but remdesivir might be a really effective treatment for COVID-19.

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

There’s another extraordinarily simple treatment that is generating great results, at least in some patients: simply having them lie on their stomachs.

Doctors are finding that placing the sickest coronavirus patients on their stomachs — called prone positioning — helps increase the amount of oxygen that’s getting to their lungs.

“We’re saving lives with this, one hundred percent,” said Dr. Mangala

Narasimhan, the regional director for critical care at Northwell Health, which owns 23 hospitals in New York. “It’s such a simple thing to do, and we’ve seen remarkable improvement. We can see it for every single patient.”

“Once you see it work, you want to do it more, and you see it work almost immediately,” added Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital.

As for chloroquine and hydroxychloroquine, the drugs that somehow turned into a partisan football because President Trump touted them, the evidence continues to be mixed. For perspective in how we discuss health and medicine in this country, compare the number of articles that mention the recent study indicating that chloroquine can cause heart arrhythmias to the number of articles that mention Rita Wilson’s description of the side effects. Apparently nothing seems real in American life until it happens to a celebrity.

Better treatments should mean a better survival rate, which should make the consequences of a gradual reopening the economy less dire. The debate about this huge decision in the last several days has been extraordinarily frustrating. The “reopen the economy” side is accused of being callous and selfish, and the “keep people home” side is accused of being blithe about economic catastrophe.

We’re Going to Have to Choose Between Two Bad Options

I have a sneaking feeling that a certain number of people who are touting “herd immunity” have only the vaguest sense of how difficult achieving that goal will be. Yesterday in the Corner I tried to lay out the range of outcomes. Even if you make extremely optimistic assumptions — that herd immunity could be achieved with 40 percent of the population getting the virus, and that the death rate for those infected will be one half of one percent — you get about 660,000 dead Americans by the time you achieve herd immunity. If you make an extremely pessimistic assumption, that it will require 95 percent infection to reach herd immunity, you get 1.56 million dead Americans.

The actual infection rate required is probably closer to the worst-case scenario than the best-case one. A recent study out of Los Alamos National Laboratory calculates that for SARS-CoV-2, herd immunity would kick in at about 82 percent of the population having the virus — roughly 270 million people. If that calculation is correct, and the virus has a one-half of one percent death rate, we would see 1.35 million people die before herd immunity was achieved.

In all of these cases, I’ve assumed a death rate of one half of one percent. I keep hearing people insisting, “We don’t know how many people have the virus, so the death rate numbers are meaningless.” But imprecise and meaningless are not synonyms. A few weeks ago, virologists generally believed the death rate was one percent. Right now if you divide the numbers of deaths by the number of confirmed cases, you get a much higher percentage in most countries; in Italy, it’s 13 percent! But the current death rate is higher because we’re not measuring asymptomatic cases — so not only is Italy’s death rate unrepresentative, it is possible that when all is said and done, and we know exactly how many people caught it and died, we will find the death rate is below one percent. But it is probably not going to be way below one percent. One half of one percent is roughly half the early consensus; I think that’s more likely to be a too-optimistic percentage than a too-pessimistic percentage.

Also please read Robert VerBruggen’s assessment of the “everyone’s got it” theory, the notion that right now American society has a large percentage of people walking around asymptomatically. He notes a study cited in The Economist speculates that the U.S. could be detecting only one out of every thousand cases. If the country currently has about 678,000 cases, and we’re only detecting one in a thousand, it means we have 678 million cases in a country with about 330 million people. So, uh, no, we’re not missing 999 out of every thousand cases.

Robert also notes that one percent of the population of the state of New York has been diagnosed positive, so unless everyone in the state of New York has it, we are not failing to detect 99 out of 100 cases. He looks at a variety of studies and thinks our limited ability to test the public means we are probably detecting one out of ten or one out of 20 cases.

As of this morning, the United States has 678,210 confirmed cases. If our testing is only detecting one out of every ten Americans who have it, then 6.7 million Americans either have the virus or had it and fought it off. If you take our current total of 34,641 deaths and divide that into our suspected total of 6.7 million cases — remember, some who are currently testing positive will die — it comes out to a death rate of one half of one percent.

If we’re detecting one out of every 20 cases, that means about 13 million Americans have the virus or had it and fought it off. Applying the current death total to that sum suggests a death rate between two-tenths of one percent and three-tenths of one percent.

There’s one other reason I don’t think a large percentage of Americans are walking around infected and asymptomatically. New York City looks like the clearest example of what happens when this virus spreads in an unprepared population.

When you lay out these numbers, a lot of people jump to the conclusion that this is an argument for keeping everyone in America locked up indefinitely. It is not. I just want everyone to know what we are in for as we take steps to reopen the economy.

I think a lot of Americans on both sides of the aisle — and particularly a chunk of the apolitical — believe that there has to be some “good” solution to this problem, and that someone who is sufficiently smart or wise would find one. I think they are psychologically unprepared for a situation where there are no good solutions, only varying degrees of bad — a no-win situation. It says something about American society that one of the most popular tales of Star Trek was the “Kobayashi Maru,” an academy test where the simulation ended in failure no matter what the student did, because the purpose of the test was to see how students coped with failure. James Kirk beat the test, because he snuck in and reprogrammed the test to allow him to succeed, insisting that the original testing parameters were flawed — “I don’t believe in the no-win scenario.”

That’s a terrific example of American optimism, determination, and a faith that with enough ingenuity, some “winning” solution can be discovered. And who knows, maybe later today some scientist will have a “eureka!” moment and discover a vaccine. But until that happens, we have to deal with the situation as it is. We can choose the path of continued lockdowns that absolutely crush our economy and will eventually lead to bad health problems of their own — depression, alcoholism, drug abuse, suicides. Or we can choose the path of reopening the economy and inevitably an increase in exposure, more infections, and more deaths.

This Is Not a Time for Governor Eric Cartman

Because an end to the lockdowns must arrive, and it must arrive probably in a matter of weeks. New York governor Cuomo wants his state to remain shut down until May 15. Virginia governor Ralph Northam still thinks residents of his state will obey the stay-at-home order until June 10.

If governors want people to limit how much they leave their homes, they must suppress their inner Eric Cartman, bellowing, “Respect my authority!” If lawmakers turn this into a test of wills with their constituents, those governors will lose, and public order will be the ultimate victim. Most police forces do not want to get involved with arresting people for minute violations of quarantine restrictions. For starters, arresting people involves getting physically close to them! They’re having a bad enough time dealing with people checking their mail while not wearing any pants.

Michigan governor Gretchen Whitmer’s executive order, declaring stores of more than 50,000 feet must close areas of the store that sell carpet or flooring, furniture, garden centers or plant nurseries, or paint, is bonkers. It is not what you sell that represents the danger of spreading the virus, it is the interaction with other customers and sales staff. There is no medical difference between shopping at a grocery store, convenience store, or pharmacy and shopping at any other store. There is no medical difference between daytime and nighttime. If a locality wants people to stop hanging out in groups in the parking lot of a convenience store or take-out restaurant, fine.

Also note that new research indicates that lower levels of Vitamin D may increase vulnerability to the coronavirus. One of the ways people get Vitamin D is by being outside in sunlight. Maybe this isn’t the best time to keep everyone in America stuck inside indoors!

We may not be quite at the limit of American patience for the lockdowns, but we are not that far away from it.

The city of Los Angeles shut down for seven weeks during the Influenza Pandemic of 1918, through most of October and November. On December 2, movie theaters reopened, as did stores, churches and schools. But that proved too early; by mid-December, the schools had to close again, as cases had started rising again.

Most of the country is in its fifth week of the coronavirus-driven shutdown and self-quarantining. Colleges and universities started moving to online classes March 10. The following day, Washington and Ohio put limits on large gatherings, the NBA suspended the season that night, Tom Hanks and Rita Wilson announced they tested positive, and President Trump gave his Oval Office address. Public schools started closing in twelve states on March 12, and for kids in Virginia, that was the last day of attending school for the school year. By Monday, March 16, the federal government issued new guidelines urging people to avoid social gatherings of more than ten people and to restrict discretionary travel.

In a world where every American had near-unlimited financial resources and the psychological stamina to remain in their homes indefinitely, we could keep the quarantines going for two months or three or as long as it was needed to beat this virus. But we don’t live in that world. Americans need to get out of their houses, they need to get back to work, they need to be able to shop for something besides groceries and medication, and they need to be able to interact with each other — even if it’s while wearing masks and standing six feet apart. They need to be able to go to the parks and beaches and lakes, and to soak up that sunlight. They need to be able to get into restaurants and sit in small groups while spread apart.

We’re doing this to save lives. But we also need to make sure that those lives we’re saving still have an actual life to live.

ADDENDUM: Every now and then, this crisis spurs the creation of something that seems like an improvement upon pre-coronavirus life. Take-out mixed drinks. Virtual happy hours with far-off friends. Car insurance rates are dropping, because people are driving so much less these days. Regulations are getting suspended left and right. And now airlines might not keep their middle seats.. Sure, this will make flying more expensive, but lots of people won’t want to fly for a while . . . and did anybody ever like getting stuck in the middle seat?

World

It Is Important to Know This Virus’s Origins

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A man passes by a billboard depicting Chinese President Xi Jinping as the spread of the coronavirus continues in Belgrade, Serbia, April 1, 2020. (Djordje Kojadinovic/Reuters)

On the menu today: one long deep dive into the Fox News report that unnamed “sources” are increasingly confident that the origin of this virus is an accidental release or infection from a laboratory, and how every possible transmission path paints the Chinese government as incredibly reckless and unconcerned about the risk to human life around the world.

Fox News: ‘Increasing Confidence that COVID-19 Likely Originated in a Wuhan Laboratory’

I can’t quite spike the football yet; I wish Bret Baier and Gregg Re of Fox News had been able to use named sources, and that these sources could have at least hinted at anything not yet publicly known about the labs in Wuhan that made them suspect that SARS-CoV-2 started from an accidental release.

But you can feel the ground shifting underneath your feet:

There is increasing confidence that COVID-19 likely originated in a Wuhan laboratory, though not as a bioweapon but as part of China’s effort to demonstrate that its efforts to identify and combat viruses are equal to or greater than the capabilities of the United States, multiple sources who have been briefed on the details of early actions by China’s government and seen relevant materials tell Fox News.

This may be the “costliest government coverup of all time,” one of the sources said.

The sources believe the initial transmission of the virus was bat-to-human, and that “patient zero” worked at the laboratory, then went into the population in Wuhan.

The “increasing confidence” comes from classified and open-source documents and evidence, the sources said. Fox News has requested to see the evidence directly. Sources emphasized — as is often the case with intelligence — that it’s not definitive and should not be characterized as such. Some inside the administration and the intelligence and epidemiological communities are more skeptical, and the investigation is continuing.

What all of the sources agree about is the extensive cover-up of data and information about COVID-19 launched by the Chinese government.

Documents detail early efforts by doctors at the lab and early efforts at containment. The Wuhan wet market initially identified as a possible point of origin never sold bats, and the sources tell Fox News that blaming the wet market was an effort by China to deflect blame from the laboratory, along with the country’s propaganda efforts targeting the U.S. and Italy . . .

China “100 percent” suppressed data and changed data, the sources tell Fox News. Samples were destroyed, contaminated areas scrubbed, some early reports erased, and academic articles stifled.

If someday there is an outbreak of a new, strange, and deadly virus in the Cumberland area of northwest Atlanta, people will understandably wonder if the virus first manifesting there had anything to do with the fact that the headquarters of the U.S. Centers for Disease Control and Prevention is nearby. If someday there is an outbreak of a new, strange, and deadly virus in Frederick, Md., people will understandably wonder if the outbreak has anything to do with the nearby U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick.

And when there is an outbreak of a novel coronavirus that originated in bats in Wuhan, China, people understandably start to wonder if it has anything to do with the two laboratories in the city that were doing research on novel coronaviruses in bats.

A few people sometimes ask whether it really matters whether this virus originated from someone being less careful than they needed to be with a bat in a laboratory or biological material from the bats. I assume these are good faith questions, and not some sort of effort to preserve the good name of the Chinese government. Indeed, to the doctors trying to save lives right now, and to those suffering the effects of SARS-CoV-2 right now, the scenario that brought the virus into humans doesn’t matter that much, at least at this moment.

But if we want to ensure nothing like this happens again, we need to know how this virus first got into humans.

The irony is that every possible transmission path paints the Chinese government as incredibly reckless and unconcerned about the risk to human life.

If it originated from a person eating bat or pangolin at a wet market, then we need to take steps to ensure that bat and pangolin consumption and trade stops everywhere in the world. (This would probably be a good idea even if the virus didn’t come from bat and pangolin consumption.) Every time a person comes in contact with one of these animals in a setting without proper health and safety protocols, they run the risk of a new strain of the coronavirus jumping from animals to humans. The danger has been clear for more than a decade. A 2007 study from virologists at the University of Hong Kong concluded, “The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”

Chinese state-run media says that 94 percent of the wet markets in China are still open. No, not all of them sell exotic animals, but law enforcement and health inspections were lax at best.

As of this writing, this virus has infected 2 million people and killed more than 135,000. If wet markets are the source of the virus, humanity is every bit as vulnerable to a new strain of the coronavirus today as we were with the first patient, back in November or December.

The Chinese government is incredibly reckless and unconcerned about the risk to human life because they keep the wet markets open. Put another way, right now in your community, you’ve got to stand in line six feet apart to get into your local supermarket, but Beijing won’t even shut down the exotic animal butchers.

Bat guano is used as fertilizer in many countries, and that guano can be full of viruses. One of the alternative theories to the wet market theory is that some farmer or guano trader went into a cave, collected the guano for fertilizer, and SARS-CoV-2 got into his system, and then he went into Wuhan and started infecting others. (You would figure we would have seen some cases in some agricultural community somewhere outside of Wuhan first, but perhaps those first cases were mild or not properly diagnosed.) If this is the source of the virus, we need to get people to stop going into caves and using the guano as fertilizer. Even if this isn’t the source of the virus, we need people all around the world to know that going into a cave and coming in contact with bats and their guano puts them at serious risk for infectious diseases. Already, if you come into contact with a bat in your house, the CDC wants you to get checked by a doctor and perhaps vaccinated against rabies.

Scientists have known that bats carry a wide variety of coronaviruses since at least 2006. The Chinese government is incredibly reckless and unconcerned about the risk to human life because they allow farmers to keep using bat guano as fertilizer. Somehow this regime can make doctors and journalists disappear, but they can’t convince farmers to use anything else to help the crops grow or make animal smugglers disappear.

In a strange way, the “lab accident” scenario is one of the most reassuring explanations. It means that if we want to ensure we never experience this again, we simply need to get every lab in the world working on contagious viruses to ensure 100 percent compliance with safety protocols, all the time. You might contend that that sort of thing is impossible, but we’ve never had an accidental launch of a nuclear weapon. It is probably easier to get every scientist working on contagious diseases in the world to always follow the safety rules, than to get every farmer in the world to stop using guano as fertilizer, or to hunt down every exotic animal smuggler in the world.

This current pandemic means the world will never stop researching coronaviruses; the need to understand them better, and how to combat them once they’re in a human body, is too great.

But back in 2014, the U.S. government started getting worried about certain kinds of research — specifically, any experiments that involve enhancing a virus’s pathogenicity or by increasing its transmissibility among mammals by respiratory droplets. After instituting an unprecedented three-year pause on the research, the U.S. National Institutes of Health announced new rules designed to make the research process safer. But the NIH cannot control how other countries’ labs operate or shut down a foreign lab that makes them nervous.

We know that back in 2014, scientists like Simon Wain-Hobson, a virologist at the Pasteur Institute in Paris, and Richard Ebright, a molecular biologist and biodefence expert at Rutgers University, were publicly expressing concerns that this research represented too much risk for too little benefit.

We know, from reporting by Josh Rogin, that Jamison Fouss, the consul general in Wuhan, and Rick Switzer, the embassy’s counselor of environment, science, technology, and health, repeatedly visited the Wuhan Institute of Virology and in January 2018, wrote back to Washington “During interactions with scientists at the WIV laboratory, they noted the new lab has a serious shortage of appropriately trained technicians and investigators needed to safely operate this high-containment laboratory . . . the researchers also showed that various SARS-like coronaviruses can interact with ACE2, the human receptor identified for SARS-coronavirus. This finding strongly suggests that SARS-like coronaviruses from bats can be transmitted to humans to cause SARS-like diseases. From a public health perspective, this makes the continued surveillance of SARS-like coronaviruses in bats and study of the animal-human interface critical to future emerging coronavirus outbreak prediction and prevention.”

A few years ago, the Chinese government announced plans to “build between five and seven biosafety level-4 (BSL-4) labs across the Chinese mainland by 2025.” In Lynn Klotz’s eerily prescient assessment in February 2019, she wrote, “For an already identified 14 labs creating or researching mammalian-airborne-transmissible, highly pathogenic avian influenza, the potential 16 percent probability of a laboratory release into the community over five years of research (a result found in a study now being prepared for publication) is already uncomfortably high.”

In addition to the U.S. and China, BSL-4 laboratories operate in Argentina, Australia, Brazil, Canada, the Czech Republic, France, Gabon, Germany, Hungary, India, Italy, Russia, South Africa, Sweden, Switzerland, Taiwan, and the United Kingdom.

There’s one other wrinkle to keep in mind. Right now, everything we know about the Wuhan Institute of Virology indicates it is a research laboratory that was studying coronaviruses in the name of health research. The original SARS outbreak in 2002-2003 had more than 5,300 cases in China and killed 349 people. It is entirely natural and expected that Chinese health officials and doctors would want to know more about coronaviruses, to be prepared to fight some future outbreak.

But this is not to say that Chinese government has no interest in biological weapons. China signed the Biological Weapons Convention in 1984, but a July 2019 report by the U.S. State Department noted that China “possessed an offensive biological warfare program from the early 1950s to at least the late 1980s” and that “the United States has compliance concerns with respect to Chinese military medical institutions’ toxin research and development because of the potential dual-use applications and their potential as a biological threat.”

This does not mean that SARS-CoV-2 is a biological weapon. What it means is that the Chinese government’s interest in and enthusiasm for researching contagious viruses may not be entirely driven by altruistic reasons.

ADDENDUM: Maybe this experience will scramble the usual partisan alliances. Progressive Democrat Ted Lieu is calling out World Health Organization director-general Tedros Adhanom Ghebreysus for excluding Taiwan from being a Member of the World Health Organization:

Taiwan not only got it right at the crucial early stages of this virus, it has done a good job suppressing it.

U.S.

Some Good News from the Nation’s Hospitals

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A medical worker makes a phone call at Maimonides Medical Center during the outbreak of the coronavirus in Brooklyn, N.Y., April 14, 2020. (Caitlin Ochs/Reuters)

The traditional tax day is almost here, but this year, the Internal Revenue Service is allowing Americans to file until July 15. You can also defer federal income tax payments due on April 15, 2020, to July 15, 2020, without penalties and interest, regardless of the amount owed. But if you’re getting a refund, you’ll want to file as soon as possible.

On the menu today: A look at hospitals in our worst-hit cities . . . and some pretty good news.

Tentative but Extremely Promising News in the Nation’s Hospitals

Let’s begin today with the best possible news: As of this writing, it appears that the vast majority, if not all, of the states and localities in the United States have expanded their hospital capacity in excess of what is current expected to be needed for the coronavirus outbreak. Reuters offers this surprising figure: “New York, which ramped up its hospital bed capacity to around 90,000, has had only about 18,000 patients hospitalized for the past several days.”

Before everyone jumps on the “ah-HA! This outbreak wasn’t as those eggheads said it was going to be” train, keep in mind that the death toll in New York state is now beyond 10,000 people, and for a while, some New York City hospitals indeed received more patients than they could handle. Physician Helen Ouyang writes a first-person essay in the New York Times about the worst moments at one city hospital:

I happened to have been assigned to work at one hospital for a chain of shifts, so I hadn’t been inside one of our other hospitals in over a week. As soon as I open the E.R. doors there, I shrink from the sights and smells. Patients are now triple-bunked into single-person spaces, curtains pushed aside. In one room, three men, who appear to be in their 80s or so, are side by side in their stretchers, each one pulling at his oxygen mask, confused, their frail limbs swinging in the air. Some have sat in their own feces for a day. Puddles of urine have pooled around the wheels of some patients’ stretchers. Nurses are out sick; the remaining ones are coping the best they can. I have gotten texts from colleagues about the chaos here, but I thought that those were just about one bad day, that they had already gone through the worst.

The bad news is that the nightmare scenario did strike certain hospitals for several days. But the good news is that, at least for now, these facilities don’t seem overwhelmed anymore. Generally, New York City hospitals are now finding the pace of incoming patients manageable — not easy, but manageable:

Once considered the epicenter of the coronavirus outbreak for the city, the city’s Elmhurst Hospital saw 13 deaths within a 24-hour period and lines of people along adjacent streets waiting for testing at the end of last month.

Now, the hospital’s CEO says they are seeing fewer people for testing and treatment. The volume of patients is growing at a slower rate every day.

“I think that means we are starting our peak,” said Israel Rocha, CEO of Health + Hospitals/Elmhurst. “That means very soon here in Elmhurst in Queens we will start our trajectory down and that means our community is on the road to recovering from COVID-19.”

Staten Island has taken over the Bronx for the highest rate of cases per 100,000 people, according to health officials. That could be caused by the state’s efforts to increase testing.

The executive director of Staten Island University Hospital says they are seeing a leveling off in the number of new cases. Between the two campuses, Dr. Brahim Ardolic says they get around 60 new patients related to the coronavirus a day.

Across the Hudson River in New Jersey, the general sense is that the state is keeping up with the demand for care — there’s not a ton of excess capacity, but there’s just enough where it is needed most.

“We’re all cautiously optimistic,” said Dr. Stephen Brunnquell, president of the physician network at Englewood Health, referring to his daily call with the chief medical officers of hospitals in Bergen and Passaic counties. “We’re getting the job done.”

Admissions fluctuate from day to day, but the trend line is flatter. More patients are being sent home. Test results come back more quickly. Ventilators to help the most critically ill have arrived from the state’s central repository. Personal protective equipment is in hand for a few days, a previously alarming timeline that now seems reassuring.

“When the water keeps rising, we keep finding higher ground,” said Brunnquell.

At The Valley Hospital in Ridgewood, Paul Simon’s “Homeward Bound” emanates from the public-address system 15 or so times a day — every time a COVID-19 patient is discharged.

New Jersey Health Commissioner Judith Persichilli reported Tuesday that 8,185 residents statewide were hospitalized with confirmed or presumed COVID-19, an increase of 4 percent from the previous 24 hours. A quarter of the patients were in intensive care, as of 10:30 p.m. Monday, and 20 percent — 1,626 people —  needed ventilators to breathe.

Hospital chiefs in the Garden State now say the “main challenge now is neither hospital beds nor ventilators, but staff to put them into use.”

After New York City and northern New Jersey, Detroit might be the part of the country hardest hit by the virus. This particular anecdote is disturbing:

Photos shared among emergency room staff at Sinai-Grace Hospital in Detroit show bodies being stored in vacant hospital rooms and piled on top of each other inside refrigerated holding units brought into the hospital’s parking lot.

CNN acquired the photos from an emergency room worker.

Two other emergency room workers confirm the photos are an accurate portrayal of the scene taking place at the hospital during early April, during one 12-hour shift they describe as overwhelming.

The two sources tell CNN that at least one room, which is typically used for studies on sleeping habits, was used to store bodies because morgue staff did not work at night, and the morgue was full.

But that was early April, and at least right now, hospitals in the state are keeping pace with the outbreak.

Michigan doctors and other health experts say they’re beginning to see signs that Michigan is turning a corner in its battle with coronavirus COVID-19, especially in southeast Michigan.

Caseloads are easing in Henry Ford hospitals, according to the CEO of the Henry Ford Medical Group in Detroit.

An emergency room doctor for Detroit Medical Center told MLive she’s seeing “significantly” fewer patients than just a week or two ago, while a McLaren Health Care doctor says he’s “cautiously optimistic” about the trend in metro Detroit.

The number of new coronavirus cases reported Monday, April 13, was 997, down considerably from the peak of 1,953 on April 3. On Tuesday, April 14, Michigan reported 1,366 new cases.

There’s a quote in that story that is useful to keep in mind: ‘The peak is only halfway there.”

One other location worth keeping an eye on in the coming weeks is Prince George’s County, Md.: “Prince George’s County hospitals have been inundated with critically ill coronavirus patients and are sending some to facilities outside the county when they run out of beds, hospital officials warned Tuesday. The majority-black suburb of 900,000 residents had 72 covid-19 deaths and 2,356 confirmed cases as of Tuesday — more than any other county in Maryland or in the neighboring District.”

Across the river in northern Virginia, the outlook is brighter. “‘This changes every day and will change significantly every week, but their current modeling at the hospital, and this is for all of Northern Virginia, is that they have the capacity to handle any surge that is currently modeled,’ said Dr. Stephen Haering, director of the Alexandria Health Department, in an online meeting Tuesday night of the mayor and city council.”

In Washington State, the situation is similar to New Jersey: Hospitals can manage the current pace of incoming patients. “Although we are still at a plateau, we haven’t seen a decrease in the number of COVID-19 patients,” Dr. Timothy Dellit, UW’s CMO, told KOMO News after the presentation. “The hospitals are able to manage the current level of surge, and hopefully it won’t get worse. We don’t think that it will as long as we stick with the current measures in the state.”

A few weeks ago, people were really worried about New Orleans turning into the next New York, but so far, that hasn’t happened.

The state had raced to surge its medical capacity, especially in the New Orleans area, as modeling over the past month showed the region on track to run out of hospital beds in ventilators. But a 1,000-bed temporary hospital facility at the Ernest N. Morial Convention Center only housed 84 patients Tuesday, which Edwards’ administration said was good news and indicated the state’s stay-at-home order was working as intended.

One theory worth further study: We know viruses are affected by humidity and very generally speaking, high humidity is worse for their spread than dry environments. Also, wind disperses viruses. Did the weather help give Louisiana a break?

Chicago and the surrounding areas in Illinois have a lot of cases, but thankfully they have a lot of capacity — or so far, enough.

As of April 13, 4,283 known COVID-19 patients and suspected COVID-19 patients were hospitalized. COVID-19 patients in an intensive care unit (ICU) totaled 1,189, and 796 patients are on a ventilator. Suspected COVID-19 patients are individuals under investigation and assumed to have COVID-19 for the purpose of medical treatment.

As of April 13, Illinois has a total of 30,134 hospital beds, 2,987 of which are intensive care unit (ICU) beds. The state has 33 percent of all ICU beds available, 994 of 2,987, and 58 percent of ventilators are available, 1,742 of 3,140.

It’s a similar story in Florida, where the Miami area is starting to creep up in cases.

As of Monday afternoon, there were 59,809 staffed hospital beds statewide and 34,708 were filled, according to numbers self-reported by hospitals. That leaves 25,101 (or 41.97 percent) of the beds available. That’s an increase in availability since Friday afternoon, when just 33.16 percent of Florida’s hospital beds were available.

Miami-Dade’s hospital bed availability — which has dropped to 14.67 percent on Friday afternoon — is back up to 40.66 percent (3,363 beds available out of 8,271).

Of the state’s 6,088 adult ICU beds, 3,874 are filled, leaving 2,214 (36.37 percent) available. Of Florida’s capacity of 592 pediatric ICU beds, 258 (43.58 percent) remain available.

Around the rest of the country, the use of hospital and ICU beds is well below capacity.

Massachusetts has about 5,000 non-ICU beds, 2,000 ICU beds, and 1,000 beds in field hospitals remaining unused. Wisconsin hospitals have about 500 ICU beds still available.

Keeping in mind that all models are projections, not predictions — meaning they tell you where things are, and where they are most likely but not certain to go, based upon what it known at the time — by one estimate, half of the United States has reached its pandemic peak. That’s really good news!

But as we learned from the Joker, Jeffrey Meier, and Wayne Chrebet, there’s always a catch. As we’ve seen from workplaces like the Smithfield plant, various supermarkets and grocery stores, and Amazon warehouses, if Americans go back to work, more Americans will catch the coronavirus. Workers can wear masks and gloves, but human error will inevitably arrive in some form or fashion: Some workers won’t wear the masks all the time, or they won’t wear them tightly enough, and so on. Some workplaces can adapt to trying to keep people six feet apart, but a lot of jobs require workers to be closer together on assembly lines and such.

So the question is, even under a gradual reopening of the economy, does that increase the number of cases beyond what the country’s hospitals can handle?

We have to reopen the economy, and fairly soon. The Saint Louis Federal Reserve president estimates the United States is losing $25 billion in lost output every day. But if we don’t do this carefully and wisely, we end up right back in the high-spread, overwhelmed-hospital mess we’ve been trying to avoid.

ADDENDUM: I’m scheduled to chat with Larry O’Connor around 1 p.m. Eastern today; he wrote some kind words about my coverage in his recent Townhall column.

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