U.S.

Consider the Children

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Doug Hassebroek and his children play outside in their backyard during the coronavirus outbreak in Brooklyn, N.Y., April 3, 2020. (Caitlin Ochs/Reuters)

This is the last Morning Jolt until May 26; enjoy your Memorial Day weekend.

Our Response and Reopening Plans Are Designed for Robots

Jason Pargin is the former editor of Cracked.com. He usually writes comedy, but also often offers really keen insights on human nature, which is arguably one of the purposes of comedy. Pargin asked for the right term for the fallacy that a policy, plan, or idea will work as long as human beings act like perfectly programmed robots, instead of the myriad, unpredictable, flawed, flesh-and-blood creatures that we are. (A strong contender for the right term, but perhaps not quite on the nose, is “the engineer’s fallacy,” the idea that the logical solution is the best solution, regardless of how that solution actually works in the real world.)

Pargin observed, “Whatever it’s called, I feel like some of us have strayed into it in the pandemic — assuming that humans would simply go without real-life contact with other humans for months on end. Assuming they function on a cold, machine-like calculation of risk rather than emotion/impulse.”

The “It is too risky to reopen now!” crowd needs to come to terms with the fact that we are wrapping up week ten of the restrictive measures, and the public mood and willingness to obey those measures is going to be really different now than it was in week one or two. As of this writing, the highest Rt factor in the country right now is North Dakota at 1.02.

Earlier this week, South Korean high-school seniors returned to classes. But almost any measure, South Korea’s response to the coronavirus ranks near the top. Compared to Americans, South Koreans have much more respect for authority, much higher levels of social trust, and much more willingness to sacrifice for the good of their community. That country’s preexisting habits for mask-wearing, respecting quarantine, and avoiding dumb risks are pretty much a health-policy expert’s idealistic fantasy.

And this happened:

Students at 66 schools in Incheon, just west of Seoul, had to leave after two students at one of the schools tested positive for the virus Wednesday. The two students didn’t attend classes on Wednesday, but authorities decided to temporarily close all schools in their area, according to the Incheon Metropolitan City Office of Education.

The two students had been in a karaoke room visited by another student who tested positive for the virus after taking private classes from a person who visited an Itaewon club, according to Incheon city officials.

Teenagers are going to sneak out to the karaoke clubs — or someplace to get together, particularly when protective measures stretch into their third month. Ironically, South Korea didn’t try a full-spectrum lockdown like some states here; they quickly put together a comprehensive test-and-trace program, with considerable cellphone-based tracking and monitoring.

Here in my neck of the woods, some kids have been playing in the tunnels of the Authenticity Woods storm-drain system. I might not have believed the stories from neighbors if I hadn’t seen it myself; during one of my walks recently, a couple of kids popped out of a manhole like ninja turtles. I wouldn’t encourage any kids to do that, but I can’t entirely begrudge their appetite for mischief and some rule-breaking. Since mid-March, their lives have been overtaken by once-unthinkable rules.

You can keep kids out of school and away from all organized activities in order to keep them and their loved ones safe from a potential infection with the coronavirus. But some South Korean kids are going to end up in the karaoke bars, and some American kids are going to start wandering through the storm drains. There is no “everybody avoids all risky behaviors” option, so we need to find “the fewest number of people take the least-consequential risks” option.

I can’t begrudge those kids in my neighborhood because in-person school classes have been canceled since mid-March, along with all afterschool activities, Little League, flag football, performing arts, church groups, you name it. Playgrounds are fenced off, the gym is closed, everyone is supposed to social distance from Grandma and Grandpa, restaurants and ice cream parlors only do take-out . . . you’re left with the public parks. On top of it all, the weather’s been lousy most of this spring. A couple families are trying socially distancing play dates. This week, just about all the summer camps and programs were officially canceled, too, ensuring the next few months will be more of the same. (Apparently outdoor summer camps are too dangerous, but the New York City subway system is still running. I suspect fear of lawsuits is influencing our decisions as much as fear of the virus.)

By mid-March, no one could deny we were facing a seriously disruptive threat. Now we’re heading into Memorial Day weekend, and the message to the nation’s children is, “Sorry kids, we may have had nearly three months, but our leaders can’t figure out any solution that gets us back to anything resembling normal human interaction. Forget everything we said about too much screen time and how Fortnite turns your brain to oatmeal.”

There are few responses less helpful than the ill-considered cry, “Kids today are overscheduled! The summer of 2020 will be like summer when we were kids! They’ll be unsupervised!” This coming summer will be nothing like when we were kids — assuming your summers were Stranger Things-ish without the monsters. Back when you were a kid, no one expected you to stay six feet away from other people! You could get together with your friends without their parents freaking out. Back when you were a kid, your world had plenty of places where people gathered in large groups with no risk — movie theaters, arcades, carnivals, theme parks, water parks, public pools, baseball games, museums, zoos, aquariums. Most of those places will either be closed this summer or greatly curtailed. Back when you were a kid, the local grown-up who seemed determined to make sure no one was having any fun was the odd one; today we have no shortage of “Karens.”

It’s not all gone. We can still do backyard barbecues. We’ll still have popsicles on a hot day. If you live near a beach or lake, most of them are reopen or will reopen soon. Maybe the mini-golf courses will reopen with metered use? We might be able to salvage this summer, but that doesn’t mean shoehorning this global catastrophe into our preexisting narrative about how these darn kids today are spoiled by their helicopter parents.

Our state, local, educational, and societal leaders’ inability to put together a good solution for our kids for the summer raises real doubts about the ability to put together a good solution for our kids for the autumn. Hopefully your child is doing fine in distance learning; a lot of them aren’t. It is mostly disastrous for kids with special needs. We laugh at the comedy videos of parents struggling with the insanities of distance learning, because they’re true. Teaching is a full-time job, and a lot of parents are expected to take on that job while trying to do their other full-time job from home. Over at Slate, they fairly ask what the point of distance learning for kindergartners is.

ADDENDUM: “If Americans had known we had thousands of infections on February 29, people would have accepted a lockdown on March 1!” William Saletan argues. Yes, and if pigs had wings, they would fly. That counterfactual is pretty moot to the question I attempted to answer, which was whether it was realistic to expect Americans to go into lockdown on March 1. People weren’t going to alter their behavior until they perceived danger, and the danger was not as easily perceived then. We can argue that it should have been — I’d argue that it should have been; you probably read what I was writing back then — but it wasn’t.

It didn’t help that for most of January and February, many voices in our national media had confidently declared that the common flu was more dangerous than the coronavirus. A Wired headline helpfully informed us, “Travel Bans and Quarantines Won’t Stop Coronavirus.

You’ll notice that quite a few responses to that piece angrily reacted as if it was an attack on Trump. He’s not really the focus of the piece; the focus is that the Columbia study is wishing we had taken a course of action the public would have been unlikely to support at the time, based upon what was known. Then there were the angry responses that thought the piece was a defense of Trump. I suspect they stopped reading before the paragraph that includes, “President Trump’s management of this crisis has been pretty bad.” Quite a few people in the comments sections angrily contended that lockdowns don’t work. Again, this is a separate question from whether Americans would have accepted those orders on March 1.

One of the more frustrating aspects of our public discussion at this moment — particularly on social media — is that whatever part of the pandemic is being discussed, people want to steer it back to their preferred aspect of it: “Yes, but Trump is bad!” “Yes, but Bill de Blasio is bad!” “Yes, but China is bad!” “Yes, but Fox News said the virus wouldn’t be that bad!” “Yes, but the WTO said it wasn’t contagious!” “Yes, but Amazon is making a lot of money!” “Yes, but masks don’t work unless they’re used properly!”

U.S.

Quarantine for Thee, but Not for Me

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New York Police Department officers keep an eye on people as they control social distance on a warm day amid the coronavirus outbreak at Domino Park in Brooklyn, New York, U.S., May 16, 2020. (Eduardo Munoz/Reuters)

On the menu today: Certain elites have simply opted out of quarantine rules; wondering how much our news environment should be able to shift to non-virus news; the CDC says you’re less likely to catch the coronavirus from touching objects.

One Pandemic and Quarantine for the Elites, Another for Everyone Else

Our fight against the coronavirus is slowly and steadily improving, but . . . we’re still a long ways away from out of the woods. From the numbers on Worldometers, 1,552 Americans succumbed to the disease Tuesday and another 1,403 Americans on Wednesday. We’re trending down significantly from the roughly 2,500 per day at the beginning of the month, but . . . that’s still about a half a 9/11 per day. We’re diagnosing about 20,000 to 30,000 new cases a day; we were above 30,000 new cases per day for most of April.

The economic aftershocks have been calamitous. There’s never been a higher demand at food banks. Our kids are still out of school, and across the country, summer camps, programs, and other activities are being canceled. Schools aren’t sure if they will reopen in the fall, meaning that this just-barely-adequate-if-we’re-lucky “distance learning” may continue, in a situation that Michael Brendan Dougherty observes leaves parents with all of the costs of homeschooling but none of the benefits. Most kids haven’t seen a non-sibling peer in person in two-and-a-half months; the plan, I guess, is to continue this isolation through most of the rest of the year. In any other circumstance, we would consider that child abuse. In just about any other hardship that can befall a child, they still get to see their friends!

We’ve still got giant problems to work out. It’s one thing to reopen society in a way that accounts for a contagious virus; it’s another thing to reopen society in a way that accounts for a contagious virus and lawyers that are eager to sue people. The CDC says swimming pools should be safe as long as people take the usual social-distancing precautions outside the water, but across the country, cities are deciding to keep their public pools closed. The restaurant and bar industry, the movie-theater industry, the hotel and tourism industry, theme parks, airlines — all of them are desperately trying to figure out how to stay afloat with a small fraction of their usual customer base. Removing the government restrictions is one step, but people still need to feel safe using those businesses before they’ll come back in significant numbers.

Everybody’s enduring hardship in one form or another. Well, almost everybody.

From the beginning, we’ve seen evidence that the wealthy and well-connected could more or less buy their way out of the inconveniences and hardship of quarantines. This April story by Vicky Ward at CNN stuck with me:

Last week, a Washington, DC-based media executive who is used to attending 200 cocktail parties a year decided that he could take talking to his microwave no more.

In contravention of the city’s shelter-in-place executive order, he secretly attended two different dinner parties in Georgetown, an affluent DC-neighborhood.

When he first told me this, I assumed I had either misheard or misunderstood. “Virtual dinners right?” I asked. “No” was the reply. These were the old-fashioned, in-person sort.

Each time, he explained, the host’s instructions were the same. For both dinners, he entered through the back gate of the property, so disapproving neighbors would not see him. He was told in advance that neither he, nor any other guests, could take any photographs or talk about the party.

The first dinner was hosted by a movie producer. A group of four listened to music and sat under heated lamps six feet apart in the garden where they were served dinner. According to the executive, none had been in contact with anyone who had suffered Covid-19 — as far as they knew. All had been isolating.

At that dinner party, the food was prepared by a live-in chef, who was masked and gloved, and then served by the producer’s wife.

At the second party, held over the weekend at the home of a Democrat political operative, one of the guests brought the food: “lamb to belatedly celebrate Easter.” In attendance were an ambassador, a city councilman and a well-known lobbyist. The night was balmy and they all sat outside for hours.

“People did not want to leave,” the media executive told me, speaking on the condition of anonymity, to avoid being Covid-shamed — a new shorthand term for people behaving with apparent indifference to the safety of others. “But everyone had been cooped up for so long, there was much to discuss.”

I’ll give you a moment to cope with the shock that a Washington-based media executive, a movie producer, a Democratic political operative, a Washington city councilman, and a well-known lobbyist and their spouses believed the rules didn’t apply to them. At least the ambassador could hide behind diplomatic immunity. (Where’s Roger Murtaugh when you need him?)

Apparently, quarantines are for the little people. If quarantines are optional for the wealthy and well-connected, we should not be surprised that they find them much more tolerable and worthy of extension than everyone else.

Last week, the New York Times reviewed data and concludes, “roughly 5 percent of residents — or about 420,000 people — left the city between March 1 and May 1. In the city’s very wealthiest blocks, in neighborhoods like the Upper East Side, the West Village, SoHo and Brooklyn Heights, residential population decreased by 40 percent or more, while the rest of the city saw comparably modest changes.” If you are wealthy enough to own a second home, you have another place to go if you deem the risk of remaining at your current residence too high.

Today in the New York PostDavid Marcus unleashes a furious rant that his home city’s strict quarantine rules are choking the life out of the city:

Beloved haunts, storied rooms, perfect-slice joints are shuttered, many for good. The sweat equity of countless small-business owners is evaporating. Instead of getting people back to work providing for their families, our mayor talks about a fantasyland New Deal for the post-coronavirus era.

Open the city. All of it. Right now. Broadway shows, beaches, Yankees games, the schools, the top of the freakin’ Empire State building. Everything. New Yorkers have already learned to socially distance. Businesses can adjust. The elderly and infirm can continue to be isolated.

One other indicator of the divide between those who are minimally impacted by the pandemic restrictions and the rest: Have you noticed how a portion of the news environment is moving on from the pandemic, even though our daily lives have not?

Are News Institutions Getting Tired of Covering the Coronavirus?

I go back and forth on how much the focus of the news should shift away from the pandemic, and how quickly. In normal times, the Michael Flynn unmasking revelations and arguments would be front-page news, day after day. You can tell that much of the world is eager to argue about Matt Lauer trying to return to public life, or how mean Alison Roman was to those poor celebrities like Chrissy Tiegen and Marie Condo. Jonathan Safran Foer takes to the New York Times to instruct us, “If you care about the working poor, about racial justice, and about climate change, you have to stop eating animals.

You can see how many people are itching to return to the familiar culture-war fights — Kamala Harris introduced a resolution declaring use of the term “Wuhan virus” racist. The Atlantic unveiled a new special section on conspiracy theories, although I still haven’t found an article discussing the cover story in New York magazine asking whether Donald Trump has been an asset of Russian intelligence since 1987. The Washington Post warns that southern states are being reckless in how they’re reopening.

(Connecticut has now reopened retail stores, offices with an encouragement to continue working from home, university research programs, and outdoor zoos. I await the Washington Post feature story on how new clusters of coronavirus spread could soon flare across parts of the Nutmeg State.)

I’m not saying that non-coronavirus news doesn’t matter at all. But you’ve probably noticed that this newsletter turned into nearly all-coronavirus, all-the-time in March and hasn’t looked back. Sometimes I miss the old familiar political news and discussion, too. But the pandemic and its aftershocks are the biggest story in the world right now, one that shoves all other news — even traditionally big stories such as a presidential election or North Korea — into the background.

I wonder if coronavirus fatigue is driving increasing servings of silliness in our news diet.

For the past two months, one of the most dangerous places in the world has been a nursing home in New York state. Chris Cuomo teased his brother, New York governor Andrew Cuomo, about the size of his nose with a giant nasal-swab prop. I remind you this is CNN in prime time, and not Saturday Night Live. The brothers’ bickering was cute at the beginning of this pandemic, but we’re now approaching the end of its tenth week.

Don’t Touch That! . . . but It Probably Won’t Kill You

The Centers for Disease Control and Prevention adjusted its coronavirus guidelines slightly Wednesday, emphasizing that the virus spreads easily from person to person but “does not spread easily” in other ways, such as touching objects.

We would get through this ordeal easier if everyone in positions of authority could be a little more honest about what they know, what they think they know, and what they don’t know. I’ll be honest: I thought, based upon what we were seeing, that spread in places such as the New York City subways was driven in large part by people touching the same objects — poles, handrails, buttons, turnstiles, etc. Apparently, that was a smaller factor, and the primary factor was just people coming within six feet of each other.

ADDENDUM: Advice from Nicholas Kristof that many are sure to ignore: “The odd thing about reporting on the coronavirus is that the nonexperts are supremely confident in their predictions, while epidemiologists keep telling me that they don’t really know much at all. Some of that epidemiological humility should seep into public discourse.”

U.S.

What We’re Getting Right and Wrong with Reopening

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A Dana Inc. assembly technician wears a face mask, as the auto industry begins reopening amid the coronavirus outbreak, at the Dana plant in Toledo, Ohio, May 18, 2020. (Rebecca Cook/Reuters)

We didn’t want to adapt, but we adapted.

All fifty states have now partially reopened. For those who argue it’s too early, note that the lockdowns started ten weeks ago. Sure, the medically or scientifically ideal policy might be to keep every American in their homes nonstop every day for three months, but that was never a realistic option. We flattened the curve, our hospitals were not overwhelmed, and now we face the equally difficult challenge of making life go on as the pandemic continues and, we hope, starts to wane. Today let’s look at what’s going right at this current moment, and what’s going wrong.

What’s Going Right

  • A primary election held in Wisconsin did not create a surge of new cases. Sixty-seven people in the state who tested positive said they had voted that day, but epidemiologists point out that they cannot prove that those patients caught the virus from going out to vote. Nearly 411,000 people showed up statewide to vote.
  • The Dow Jones Industrial Average closed Tuesday at 24,206. On March 23, it closed at 18,591. That’s still far from the February peak of 29,551, but at least one part of the economy has bounced back significantly from the crash and appears fairly optimistic about growth in the coming months.
  • A new study estimates that 68 percent of unemployed workers who can receive benefits are eligible for payments that are greater than their lost earnings. Many on the right would normally recoil from this, worrying that the unemployment benefits would create a disincentive to work. But this moment is nothing like normal economic circumstances. We’ve just seen 21 million jobs lost in a five-week period. There’s a lot less need to worry about a disincentive to work when no one is hiring! Laid-off food service workers and janitors making about 150 percent of their previously meager salaries does not seem like a terrible problem to have during a deep recession and widespread anxiety.
  • Crime rates went down in most U.S. cities.

What’s Going Wrong

  • The United States has lost 92,000 souls to the coronavirus. We will pass 100,000 deaths shortly, and the big question is whether our death toll reaches 200,000. At this point, someone might argue, “Yes, but they were mostly elderly.” But that doesn’t really make their deaths less tragic or painful, and the virus’s toll has included plenty who wouldn’t be considered elderly. In the cases of those in nursing homes in places like New York and New Jersey, many will fairly ask whether different state policies on readmitting recovering patients could have prevented some of those deaths.

Perhaps our greatest weakness in this crisis has been the inability to speak honestly about difficult truths — among political leaders, among the media, among ordinary citizens. Today, Kevin Williamson tears into a couple of prominent examples:

Governor Andrew Cuomo of New York said the other day, “as I said from day one, I’m not going to choose between public health and economic activity.”

Everybody knows it is a lie, beginning with Governor Cuomo. We are going to choose between public health and economic activity. We are going to try to strike some intelligent balance between competing concerns, and, even if we do our very best, innocent people are going to get hurt on both sides of that balance, and some of them will surely die — either from COVID-19 or from the economic consequences of the lockdown.

We do not have very many adults in government, but if we did, those adults would understand — and make a point of dwelling on the fact — that every decision of any consequence in public policy involves tradeoffs. We are going to choose between liberty and security, between protecting the rights of the criminally accused and the interests of crime victims, between efficiency and stability, between our commitment to free speech and our desire to counteract disinformation, between the interests of today’s social-welfare beneficiaries and tomorrow’s taxpayers.

Pretending that there is no choice and no tradeoffs does not liberate us from choosing. Mostly, it ensures that we choose poorly and that the choosing is left to ignorant and irresponsible demagogues.

Perhaps Americans’ perpetual dissatisfaction with their leaders — manifested in that low approval rating for Congress, no matter which party is running which chamber — is an indication of how often our leaders fail to deliver on their promises of easy solutions with no trade-offs. But if we keep believing those same unrealistic promises and unworkable happy-talk . . . is the problem with those leaders . . . or with us for believing in them?

ADDENDUM: Yesterday, I had a chance to chat about the coronavirus and China with political commentator, military historian, retired U.S. Marine lieutenant colonel, and infamously controversial historical figure Oliver North on his program. It should appear here sometime soon.

World

How Much of a Risk Do Our Children Face?

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Descending to the subway in Beijing, China, March 10, 2020 (Thomas Peter/Reuters)

On the menu today: the new multisystem inflammatory syndrome in children and questions about what China knew — and how much we should trust any medical data out of China; the World Health Organization accepts watered-down semi-accountability; the president tells the country he’s embracing better living through chemistry; and a new study pours a bit more cold water on the “wet market” theory of the virus’s emergence.

We Need More Information from China, and Quickly

Late last week, the Centers for Disease Control and Prevention issued a health alert about a “recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19).” The syndrome is described as “severe inflammatory responses with Kawasaki disease-like features” — a high fever that lasts, abdominal pain so serious some parents initially think it’s a burst appendix, and for many kids, diffuse rashes.

The good news is that this inflammatory response is still pretty rare — a couple hundred cases in a country with about 50 million kids under age twelve — and fatal reactions are rare among those who catch this syndrome. Most of the kids seem to heal just fine. But one of the few silver linings of this virus in the early months of this pandemic had been the belief that children were not vulnerable to it. This inflammatory syndrome is the sort of factor that greatly complicates decisions about reopening schools in the fall and whether to go ahead with any summer programs.

A couple of days ago, the Washington Post’s Josh Rogin offered one of the most disturbing and unnerving thoughts since the beginning of this crisis: “Either the Chinese government knew nothing about the delayed effects COVID19 has on children (which seems unlikely) or they knew about it but didn’t tell us. We must find out which of these is true.”

It is possible that all data about the coronavirus we get out of China will be suspect. There’s simply too much distrust, driven in large part by the fact that Wuhan authorities and Chinese government insisted the virus could not be spread from person to person until January 20, weeks after doctors on the ground knew it was contagious.

But there are other odd incongruencies between the public conclusions of Chinese doctors and ones elsewhere. Back on April 23, Chinese doctors “inadvertently posted” a “draft manuscript” of a clinical study in that country declaring that the drug remdesivir was “not associated with a difference in time to clinical improvement” among coronavirus patients.

But a week later, White House health advisor Dr. Anthony Fauci announced that data from trial testing of remdesivir showed “quite good news” and sets a new standard of care for COVID-19 patients. He said that while the mortality rate wasn’t dramatic — 8 percent for the group receiving remdesivir versus 11.6 percent for the placebo group — the study revealed a “clear-cut positive effect in diminishing time to recover.”

Did the Chinese study just have different results from the luck of the draw of the patients they studied? Or did some people in China want to downplay the effectiveness of a drug manufactured by Gilead in La Verne, Calif.?

This is a big question that will only get bigger in the months ahead. Doctors at the University of Beijing’s Advanced Innovation Center for Genomics think they have isolated, identified, and developed antibodies that will work as both a treatment and temporary vaccine. (Researchers at the American pharmaceutical company Sorrento Therapeutics think they’ve made a comparable breakthrough.)

At some point soon, the Chinese government is going to declare that they have a vaccine. Does the world embrace it? Or do other countries regard a Chinese vaccine warily, wondering if it’s as unreliable as the 10 million defective tests, masks, and medical equipment that China shipped in the opening months of the pandemic?

Then there’s this study of Wuhan residents, suggesting that achieving “herd immunity” would take a long, long time to complete:

While strict lockdown measures in China’s outbreak epicentre Hubei province helped break the chain of local transmission, people in cities like Wuhan could be vulnerable to a second wave of infections because there is a low level of antibodies in the population. A study of 11,000 residents of Wuhan in April found that 5 to 6 per cent tested positive for coronavirus antibodies, Caixin reported last week.

“Lots of people in China have no background immunity and would be at risk if there is a second wave,” Mr Hui said.

Five months after the outbreak, the initial epicenter has just 5 or 6 percent exposure?

If there’s any spot in the world you would think people would have high levels of antibodies, it would be a hospital in Wuhan, right? Apparently not: “Wuhan’s Zhongnan Hospital found that 2.4 percent of its employees and 2 percent to 3 percent of recent patients and other visitors, including people tested before returning to work, had developed antibodies, according to senior doctors there.”

Why do so many studies that come out of China make so little sense?

We Know WHO Can’t Be Trusted

Today at the World Health Assembly — the meeting of member nations of the World Health Organization — a majority of member states are expected pass a somewhat watered-down resolution introduced by Australia calling for an “impartial, independent and comprehensive evaluation, including using existing mechanisms, as appropriate, to review experience gained and lessons learned from the WHO-coordinated international health response to Covid-19.” The resolution does not specifically mention China and should proceed “at the earliest appropriate moment.”

Some corners of the Australian press are taking a victory lap: “While the wording of the draft resolution did not specifically refer to China or to Wuhan, it was broadly in line with what [Prime Minister] Scott Morrison and others have been advocating.

It is difficult to get too excited. WHO’s director-general, Tedros Adhanom Ghebreyesus, will still be the one ultimately responsible for overseeing the investigation that will review his own actions. If any of our progressive friends wonder why so many Americans have so little faith in international organizations, a World Health Organization that prioritizes keeping Beijing happy over, you know, world health is as powerful an example as you can find. All coalitions face internal conflicts and pressures; effective ones manage to remember and prioritize the original priority of the coalition in the face of internal disagreement. Ineffective coalitions let “maintaining the coalition” turn into the primary activity and priority of the coalition.

The fact that there appears to be no serious talk of replacing Tedros is a clear sign that despite the weekend’s leaks of internal criticism, too many people within the World Health Organization see their institutional reputation as inseparable from Tedros’s reputation. If the director-general announced he intended to step down once the pandemic was under control, we could at least hope that the next director-general would have the right priorities and be willing to stand up to China when circumstances warrant.

The assembly kicked the can down the road on the question of whether to allow a delegation from Taiwan attend as an observer. You could make the argument that Taiwan has handled the pandemic better than anyone: “Despite its proximity to China, Taiwan has only reported 440 coronavirus cases and seven deaths so far even without a large-scale lockdown.

You may recall James Griffiths, a producer and commentator at CNN, writing at the end of April that China had handled the outbreak better than the United States, earning him plenty of criticism. Griffith’s latest on the WHO meeting at least acknowledges that “the pandemic has left China in one of its most vulnerable positions in terms of global influence, with criticism from multiple directions, not just traditional rivals like the US, but also countries with which Beijing has had strong ties in the past. One only need look at the never before seen levels of public support for Taiwan around the world to see how China’s clout is considerably weakened.”

We Pay More Attention to What Trump Says Than to What Trump Does

I guess we’re all arguing about hydroxychloroquine again, huh?

Even though the letter from Sean Conley, physician to the president, only says “we concluded the potential benefit of the treatment outweighed the relative risks” and doesn’t actually say that Conley prescribed or that the president is taking it. Or when the president started taking the medication.

I’ve read the medical journal articles; one of the central takeaways, which I relayed in an article earlier this month, is that chloroquine and hydroxychloroquine actually slow down parts of a patient’s immune system by making the cells not work as well together. This is actually desirable if the patient is in a “cytokine storm” — when the body’s immune system kicks into overdrive and starts attacking healthy cells in important organs.

Yes, I’ve seen the arguments that hydroxychloroquine helps the body absorb zinc, resulting in a stronger immune system; you can read a not-yet-peer-reviewed paper here, about an ongoing clinical trial here, a new NIH clinical trial here, and an encouraging study from NYU here. All of these studies are on people who have already caught COVID-19, not as a preventative treatment.

From a WebMD article last month:

“My concern about the drug in the pre-infection state or the infected state is that they block the innate immune pathways that may allow the immune system to detect virus and to start a response against it,” says Art Krieg, who has spent decades studying this process. He sees both drugs as likely to be more useful to treat late stages of the disease, as has been done in China and elsewhere.

Krieg, founder and chief scientific officer of Checkmate Pharmaceuticals, a Cambridge, MA-based startup developing immune treatments for cancer, says he’s particularly worried about health care workers and others who may try these drugs outside of clinical trial. Without a trial, he says, they won’t know if the drug is actually increasing their risk of severe infection.

One of the extraordinarily frustrating aspects of this public argument is the number of people who insist chloroquine or hydroxychloroquine must be either a wonder drug or absolutely useless; a disturbing number of people cannot seem to grasp that a treatment could work for certain patients in certain circumstances and not others.

I suspect my readership is far too smart to ever take an unacceptable risk, but just in case you know anyone who’s a quart low in the common-sense department, do not ingest prescription medication without consulting a doctor. Even if the President of the United States insists a drug is super-duper terrific and he’s taking it himself.

ADDENDUM: An intriguing new study, spotlighted by the Daily Mail:Phylogenetic tracking suggests that SARS-CoV-2 had been imported into the market by humans.” The short version is that samples of the virus taken from the market in January 2020 look more like SARS at the latter stages of the 2003-2004 outbreak than the viruses at the beginning of the outbreak. In other words, the viruses at the market early on looked like they had already adapted to beat a human being’s immune system.

This doesn’t completely eliminate the possibility of the virus emerging from the wet market . . . but it’s another piece of counter-evidence. This study points in the direction of a human being who had the virus coming to the market and spreading it, not some undercooked bat or pangolin.

World

Forget about Pompeo’s Dog, We Need to Be Watching China

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People wearing masks walk past a portrait of Chinese President Xi Jinping on a street as the country is hit by an outbreak of coronavirus in Shanghai, China, February 10, 2020. (Aly Song/Reuters)

On the menu today: Many countries head into the World Health Assembly wanting the World Health Organization to investigate the origins of SARS-CoV-2; China makes a power grab in Hong Kong; a strange report about the World Military Games held in October of last year in Wuhan; and outbreaks in northern China that are inconvenient for Beijing’s preferred narrative.

If You’re Not Watching China Right Now, You Can’t Understand the World

I suspect that this morning, many other news sources will helpfully inform you that the president of the United States said or tweeted something outrageously controversial, that some Americans in a red state are not following social-distancing recommendations, and that House Speaker Nancy Pelosi wants a “bipartisan” compromise after the House passed a $3 trillion wish-list stimulus bill on a near-party-line vote. Right now on MSNBC, the top story is that the State Department inspector general was investigating whether Secretary of State Mike Pompeo required a department employee to walk his dog. Congress is almost certain to investigate.

Meanwhile, far from Washington, the coronavirus pandemic is driving big and consequential developments, particularly relating to China — but apparently that’s just not seen as interesting or newsworthy in U.S. newsrooms.

The World Health Organization is hosting its World Health Assembly today — everyone is meeting online for quarantine reasons — and one of the first speakers was Chinese leader Xi Jinping, who said his country would support “a comprehensive review of the global response to the Covid-19 pandemic led by WHO after the virus is brought under control.

We can all see the global response to the COVID-19 pandemic. We’re living in it. What most of us want is a comprehensive review of where this virus came from and how it jumped into humans so we can reduce the likelihood this ever happens again. Heading into the assembly, sixty countries, including all members of the European Union, Canada, Australia, New Zealand, and Japan, drew up a resolution demanding an investigation into the origins of the coronavirus.

There is some indication that WHO management beyond director-general Tedros Adhanom Ghebreyesus are starting to feel some pressure. Some of the staffers around Tedros appear to be offering their own defensive leaks to Reuters, contending that they didn’t think China was doing such a great job in the early days of the outbreak, and tried to warn Tedros, but he refused to listen:

After meetings with President Xi Jinping and Chinese ministers, Tedros Adhanom Ghebreyesus was impressed by their knowledge of the new flu-like virus and their efforts to contain the disease, which by then had killed scores in China and started to spread to other countries.

The advisers encouraged Tedros to use less effusive language out of concern about how he would be perceived externally, the person familiar with the discussions said, but the director-general was adamant, in part because he wanted to ensure China’s cooperation in fighting the outbreak.

“We knew how it was going to look, and he can sometimes be a bit naive about that,” the person said. “But he’s also stubborn.”

Tedros knew there was a risk of upsetting China’s political rivals with his visit and his public show of support, according to the person familiar with the discussions — an account backed by a WHO official. But the agency chief saw a greater risk — in global health terms — of losing Beijing’s cooperation as the new coronavirus spread beyond its borders, the two sources said.

“That’s the calculation you make,” said the person familiar with the discussions.

For what it’s worth, the WHO denied the report in German media that Xi Jinping had called Tedros, asking him to delay releasing information about the virus:

The UN agency said a German magazine’s report about a telephone conversation between WHO chief Tedros Adhanom Ghebreyesus and Chinese President Xi Jinping on January 21 was “unfounded and untrue”. Der Spiegel reported that Mr Xi asked Dr Tedros during the call to hold back information about human-to-human transmission of the virus and delay declaring a pandemic.

The magazine quoted Germany’s foreign intelligence agency, BND. Der Spiegel also claimed the BND concluded up to six weeks of time to fight the outbreak had been lost because of Chinese stalling. WHO said Dr Tedros and Mr Xi “have never spoken by phone” and added that “such inaccurate reports distract and detract from WHO’s and the world’s efforts to end the COVID-19 pandemic”.

One flaw in the Der Spiegel account is that on January 21, Chinese officials admitted that the virus could be transferred from one human to another. But they also said, “there was no danger of a repeat of the Severe Acute Respiratory Syndrome (SARS) epidemic that killed nearly 800 people globally during a 2002-2003 outbreak, which started in China, as long as precautions were taken.” The previous day, WHO stated some “limited human-to-human transmission” occurred between close contacts.

A Pandemic Is a Convenient Time for a Power Grab

There is good reason to believe that the Chinese government sees the global pandemic as an opportunity. With almost every government of every country in the world attempting to get a handle on the outbreak, China is free to make moves that otherwise would bring international rebukes. In Hong Kong, pro-Chinese lawmakers are having their rivals dragged out of the chamber:

. . . Another day of chaos inside the city’s House Committee, a body that helps scrutinize bills, with protesting pro-democracy lawmakers dragged from the chamber by security guards and scuffles between rival camps.

It was the second time in two weeks that clashes have broken out as pro-democracy supporters try to kill a bill that would ban insulting China’s national anthem.

The committee has been without a leader since October, meaning no bills have made it to the legislature for a vote, including the national anthem bill.

Pro-democracy lawmakers have used filibustering to stop voting for a new chair.

On Monday, the pro-Beijing camp installed its own committee chair, armed with an external legal opinion saying they had the power to end the deadlock.

But the pro-democracy camp said the move was a coup, citing the legal opinion of the legislature’s own lawyers.

In another demonstration of growing Chinese power in Hong Kong, “Secretary of State Mike Pompeo said on Sunday he believed China had threatened to interfere with the work of U.S. journalists in Hong Kong, and warned Beijing that any decision impinging on Hong Kong’s autonomy could affect the U.S. assessment of Hong Kong’s status.”

There is no word on who was walking Pompeo’s dog at the time.

A Curious Report about October’s World Military Games in Wuhan

Back on April 22, I wrote about the World Military Games, an Olympic-style competition, that was held in Wuhan and began October 18 and ended October 27. I concluded the piece, “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.”

For what it is worth . . . some German, French, and Italian athletes who competed at the games have told the U.K. newspaper the Daily Mail that they came home sick after the competition. This could be non-coronavirus illnesses, and memories influenced by the power of suggestion; it would probably be a good idea to see if these competitors have coronavirus antibodies in their systems. (Note that even if the antibody tests come back positive, it is possible that these competitors caught the virus sometime after they returned from Wuhan.)

But if a significant number of athletes who competed in Wuhan, and who have avoided contact with potential carriers since then, test positive for antibodies . . . that would strengthen the argument that the virus was floating around Wuhan much earlier than we currently believe.

And that would be particularly intriguing in light of the report that there “was no cellphone activity in a high-security portion of the Wuhan Institute of Virology from Oct. 7 through Oct. 24.

Meanwhile, in Northern China . . .

How is China’s fight against the virus going, as far as we can tell through state-controlled media? Nowhere near as bad as the initial outbreak in Wuhan, but not great:

Jilin city, the second-largest city in Jilin province, saw bus and rail services halted and residential compounds closed off last week after the discovery of six new cases of infection. Recently reopened schools were closed again.

These six people had contact with another cluster in the adjacent city of Shulan, which was earlier put under lockdown, suggesting that some amount of undetected spread has already taken place before.

Overall, at least 22 infections spread across three cities in two provinces — Jilin city and Shulan in Jilin province, and Shenyang city in Liaoning province — have now been linked, making it one of China’s biggest clusters that has emerged in months.

No doubt, leaders in Beijing would like the world to believe that their heavy-handed quarantine methods are the most effective. (They unleashed the problem upon the world, and they get to show the world the best solution.) Sure, China’s methods may look draconian . . .

Residents of the province’s Jilin city must show certificates of health, including a recent negative nucleic acid test, if they wished to leave the city, state media reported.

In Shulan county, which is under the city’s jurisdiction, train service has been halted until the end of the month.

The industrial city of Shenyang in neighboring Liaoning province is requiring visitors from Shulan county to undergo a 21-day quarantine on arrival, according to state broadcaster CCTV.

. . . but if draconian methods keep people alive, who’s to complain, right?

Of course, if those draconian methods don’t really stop the spread of the disease . . . then the Chinese government is giving its people the worst of both worlds. Orwellian surveillance, sweeping restrictions on daily life, welding apartment doors shut for those found to have had the virus . . . and they still are at risk of contacting the virus.

ADDENDUM: Sometime when I wasn’t looking, my Twitter followers surpassed 100,000. (I suspect Twitter will purge another batch of bots soon and probably knock me below that threshold again.) If you’re one of them, thank you for following . . . except for the trolls. I can only imagine how frustrated the folks interested in politics are by my pop-culture thoughts, and how bewildered the people who want more information about the labs in Wuhan are when I react to news about the New York Jets.

U.S.

Being Wrong Is Human and Will Happen. But Staying Wrong Is a Choice.

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Health workers start the process to test people in a car as they use a newly approved saliva-based coronavirus test at a site in Edison, N.J., April 15, 2020. (Eduardo Munoz/Reuters)

On the menu today: We could all dunk on people who were wrong in their early assessments of this pandemic, but the more pressing question is who is not learning from getting things wrong during this outbreak; one mainstream publication notices that the conventional wisdom on Florida was far from the truth; why the media’s reflexive partisan sympathies are leading Americans to not understand the virus and what policies work best to mitigate it; and a funny and brutally honest assessment of what’s coming to higher education.

Errors Are a Part of Life, but We Shouldn’t Cling to Them

According to the Johns Hopkins University Coronavirus Research Center, as of this writing, the U.S. death toll from the virus is 85,906. Worldometers, which tends to run ahead of JHU count, puts the toll at 86,912.

You noticed that the arguments of “It’s just the flu!” or “This is comparable to the flu!” or “The flu kills more people each year!” stopped sometime in the past few weeks, didn’t you? Even the skeptics can count. (As our Robert VerBruggen noted, even that “the flu kills 80,000 Americans per year” statistic is a debatable statistical estimate.)

You may recall that at the end of March, President Trump said, “so if we can hold that down, as we’re saying, to 100,000, it’s a horrible number, maybe even less, but to 100,000, so we have between 100 [thousand] and 200,000, we altogether have done a very good job.” Many commentators, particularly on the Left, thought Trump had not merely moved the goalposts from his past statements that the virus would go away, or that it was not as dangerous as the flu, but was setting an absurdly low bar for a “good job.” At the end of March, the United States had barely 4,000 deaths. Surely, Trump had to be setting expectations at an unrealistically high number, so he could come back later and claim victory, right?

No, apparently not!

You may recall that by April 8, when deaths were at about 17,000, the IHME model — which week by week proved to be just too flawed to be useful — revised its projection to indicate the virus would kill 60,000 people in the United States over the next four months. That revision was 33,000 less than a week earlier, prompting many to argue that either the model was simply too imprecise to give any meaningful conclusions, or that the virus was less dangerous than initially thought.

It’s five weeks later, and we’re at 85,906.

I think highly of Dr. Anthony Fauci and think just about everything he says during this outbreak is worth careful consideration. But there’s no getting around the fact that some of his early assessments were really off base, too. On January 21, the day the first U.S. case was discovered, Fauci said during an interview, “obviously, you need to take it seriously and do the kind of things the (Centers for Disease Control and Prevention) and the Department of Homeland Security is doing. But this is not a major threat to the people of the United States and this is not something that the citizens of the United States right now should be worried about.” In another interview on January 26, he repeated, “The American people should not be worried or frightened by this. It’s a very, very low risk to the United States, but it’s something we, as public health officials, need to take very seriously.”

They call it a novel coronavirus because it’s new, not because everyone is supposed to finish writing a novel during quarantine. Because it is new, all of us are trying to understand it, and our previous experiences may or may not be applicable to this virus and this outbreak. I suspect that the way countries reacted to SARS-CoV-2 was heavily shaped by their experiences with the original SARS, H1N1, Middle East Respiratory Syndrome, Ebola virus, and Zika. Hong Kong, South Korea, Japan, Taiwan, Singapore — all of those countries’ populations have endured much more severe outbreaks of contagious diseases in recent years. All of those countries’ populations have been conditioned to take any reports, or even rumors, about contagious diseases seriously. Other than H1N1, those previous outbreaks barely affected the United States and its citizens. Our experience told us that viruses in far-off lands almost never become a serious problem in this country.

The Hoover Institution’s Richard Epstein got an enormous amount of grief for writing an essay posted on March 16 about policies for the outbreak, initially estimating that the toll of the coronavirus would be only 500 people, and then revising it upward to 5,000, and then later to 50,000. Epstein called it, “the single largest unforced intellectual error in my entire academic career, when I included numerical estimates about the possible impact of the coronavirus in terms of life and death. Those estimates were obviously ridiculously too low.”

Epstein’s numbers were wildly off-base, but his concluding point in that essay wasn’t cuckoo for Cocoa Puffs:

The first point is to target interventions where needed, toward high-risk populations, including older people and other people with health conditions that render them more susceptible to disease. But the current organized panic in the United States does not seem justified on the best reading of the data. In dealing with this point, it is critical to note that the rapid decline in the incidence of new cases and death in China suggests that cases in Italy will not continue to rise exponentially over the next several weeks. Moreover, it is unlikely that the healthcare system in the United States will be compromised in the same fashion as the Italian healthcare system in the wake of its quick viral spread. The amount of voluntary and forced separation in the United States has gotten very extensive very quickly, which should influence rates of infection sooner rather than later.

All of us, from the president and Fauci to the kids down the street are trying to grapple with the unknown. Just about all of us are going to get something wrong at some point. Here we are, May 15, and we’re still not entirely sure whether children are largely immune to this virus, or whether some portion will develop “multisystem inflammatory syndrome” some months or weeks later. (The current leading theory is that this is some sort of delayed reaction by a child’s immune system after fighting off the virus.) Thankfully, this syndrome appears to be unlikely to kill children.

We think we’re less likely to catch the virus outside — it may be much, much less likely. Vitamin D might be a factor — or maybe it’s a more general sense that the vitamin is just good for your immune system in general. We’re not sure how long the antibodies against this virus will stay in human bodies. We’re pretty sure masks help, but we’re not sure how much, or how effectively people will wear them. A prominent virologist thinks he caught the virus through his eyes on a crowded flight because he was wearing a mask and gloves the entire time. It appears humans can spread the virus to dogs, but dogs cannot spread the virus to people.

What we know can change. Perhaps our appetite for rubbing someone’s nose in their getting something wrong has created an enormous disincentive for anyone ever admitting they’re wrong — and an inadvertent incentive for stubbornly clinging to an assessment, even in the face of mounting counter-evidence.

Gee, Media World, Why Would Americans Be Divided Right Now?

Yesterday, Mike Allen’s newsletter over at Axios lamented, “America’s cultural wars over everything have weakened our ability to respond to this pandemic. We may be our worst enemy . . . An existential threat — such as a war or natural disaster — usually brings people together. Somehow, we’ve let this one drive us apart.”

Gee, do you think that deeply divided partisan reaction has anything to do with the fact that so much of the discussion of this virus and the response has been a wildly oversimplified and often flat-out factually wrong “Goofus and Gallant” tale of blue-state and red-state governors? Contrast the media coverage of Phil Murphy opening the Jersey Shore for Memorial Day weekend with that of Florida. Contrast the coverage of Brian Kemp reopening his state of Georgia and Jared Polis reopening his state of Colorado. Think about who’s discussing state policies regarding nursing homes and who isn’t.

Yesterday, Politico’s Marc Caputo and Renuka Rayasam acknowledged the obvious: A lot of people in the media want to tell a tale of heroic Andrew Cuomo and dumb Ron DeSantis, and they aren’t going to let a little thing like the data get in the way of that:

Florida just doesn’t look nearly as bad as the national news media and sky-is-falling critics have been predicting for about two months now. But then, the national news media is mostly based in New York and loves to love its Democratic governor, Andrew Cuomo, about as much as it loves to hate on Florida’s Republican Gov. Ron DeSantis.

First, let’s just come out and say it: DeSantis looks more right than those who criticized the Sunshine State’s coronavirus response. According to the latest Florida figures, fewer than 2,000 have died, and around 43,000 have been infected. That’s a fraction of the dire predictions made for Florida when spring breakers swarmed the beaches…

Cuomo also has something else DeSantis doesn’t: a press that defers to him, one that preferred to cover “Florida Morons” at the beach (where it’s relatively hard to get infected) over New Yorkers riding cramped subway cars (where it’s easy to get infected). In fact, people can still ride the subways for most hours of the day in New York, but Miami Beach’s sands remain closed. Maybe things would be different if DeSantis had a brother who worked in cable news and interviewed him for a “sweet moment” in primetime.

Speaking of New York and the Worst . . .

Remember, in what feels like another era, when New York City mayor Bill de Blasio ran for president? And the vast majority of the country — including Democrats — spent five minutes listening to him and asked, “How the heck did this guy ever get elected to anything?”

You can make a strong argument that de Blasio and his team are the single-most destructive group of leaders in the country during this crisis. Yes, Trump blurts out something nutty like his injecting disinfectant comments with metronomic regularity. I would still argue de Blasio is worse, and it’s not just because he spent January, February, and early March telling New Yorkers to continue their usual routines, insisting into March that New Yorkers could not catch the virus from riding the subway.

But the head of his public hospital system, Dr. Mitchell Katz, advised the mayor on March 10, there is “no proof that closures will help stop the spread,” according to the New York Times. Fans of “herd immunity” have an ally in Katz, who concluded, “The good thing is greater than 99 percent will recover without harm. Once people recover they will have immunity. The immunity will protect the herd.” But he might not even be the worst figure in the city’s health system.

New York City’s health commissioner blew off an urgent NYPD request for 500,000 surgical masks as the coronavirus crisis mounted — telling a high-ranking police official that “I don’t give two rats’ asses about your cops,” The Post has learned.

Dr. Oxiris Barbot made the heartless remark during a brief phone conversation in late March with NYPD Chief of Department Terence Monahan, sources familiar with the matter said Wednesday.

Monahan asked Barbot for 500,000 masks but she said she could only provide 50,000, the sources said.

“I don’t give two rats’ asses about your cops,” Barbot said, according to sources.

The NYPD has recorded 5,490 cases of coronavirus among its 55,000 cops and civilian workers, with 41 deaths, according to figures released Wednesday evening.

Can we please do away with this reflexive belief among the media that Democratic officeholders and their appointed staff are inherently wise and good and compassionate and smart? Because this far-too-credulous faith in the good judgment of Democratic officeholders — and knee-jerk certainty that Republican officeholders are stupid and malevolent and reckless, and must always be wrong — is probably costing some people their lives.

ADDENDUM: A funny, and likely extremely accurate, assessment of what’s going on in higher education from Scott Galloway at New York University’s Stern School of Business:

At universities, we’re having constant meetings, and we’ve all adopted this narrative of “This is unprecedented, and we’re in this together,” which is Latin for “We’re not lowering our prices, b*****s.” Universities are still in a period of consensual hallucination with each saying, “We’re going to maintain these prices for what has become, overnight, a dramatically less compelling product offering.”

In fact, the coronavirus is forcing people to take a hard look at that $51,000 tuition they’re spending. Even wealthy people just can’t swallow the jagged pill of tuition if it doesn’t involve getting to send their kids away for four years. It’s like, “Wait, my kid’s going to be home most of the year? Staring at a computer screen?” There’s this horrific awakening being delivered via Zoom of just how substandard and overpriced education is at every level. I can’t tell you the number of people who have asked me, “Should my kid consider taking a gap year?”

U.S.

What Does the Post-Pandemic Presidency Look Like?

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President Donald Trump speaks to the media about a deal to end the partial government shutdown at the White House in Washington, D.C., January 25, 2019. (Jim Young/REUTERS)

On the menu today: a long look at the myriad challenges facing the person to take the oath of office to be president on January 20, 2021.

Being President Is Going to Stink for Years to Come

Imagine that through some entirely unforeseeable sequence of events, the person who takes the oath of office to serve as President of the United States on January 20, 2021, is not Donald Trump or Joe Biden but . . . you.

How would you feel? Some of you might feel excited, but I suspect quite a few people would feel trepidation and pressure and think, “Ugh, what did I ever do to deserve this?”

Being president is going to stink for at least the next two years, and probably more — even by the historical standards of a job that appears to be powerful and glamorous but that tends to age its occupants about a decade for each term. The task of overcoming this virus and recovering from its enormous cost in human lives, human health, and economic ruin will rank among the greatest challenges in American history, and for a long while, the job of the president is going to be an endless series of hard choices, picking from menus with only bad options.

We don’t know exactly how our lives will be in January, but it’s not so far away that we can’t get some ideas.

If we’re lucky, we will have a vaccine. On the home page today, I talk about what the two months of self-quarantining and lockdowns have bought us in our fight against the virus. Perhaps the most pleasant surprise comes from the market-research firm MorningStar, which reviewed the work of a variety of pharmaceutical companies and concluded, “encouraging preclinical data, strong partnerships and funding, and rapid clinical progress all seem to indicate that use in high-risk populations could be possible by the end of 2020, with tens of millions of doses potentially available by that point.”

If that comes to pass, we would be able to inoculate our most vulnerable populations, and that would be a big step. But it would still take a long stretch of 2021 to bring the vaccine to all Americans, and any morally responsible American government would recognize a need to help the rest of the world get vaccinated, too. Depending upon how much this virus mutates and how much our immune systems can adapt to the changes in the virus, we may need regular vaccinations against it for the foreseeable future.

Yesterday, World Health Organization emergencies director Dr. Mike Ryan ruffled some feathers by warning that the coronavirus may never “go away.” He pointed out that we have a vaccine for measles, yet the measles killed 140,000 people worldwide in 2018 — mostly in the Third World, where people don’t have access to the vaccine. When roughly 130 million children are born each year, and the vaccination rate is 86 percent for the first shot and 70 percent for the second dose, you’re still going to leave a lot of vulnerable children out there.

And if and when that vaccine is developed and available for the general public . . . how does America handle the anti-vaccination crowd for this virus?

The American economy in January 2021 will probably better than it is now — a really low bar to clear! — but it will probably not be “back.” The Congressional Budget Office crunched the numbers for a projection and concluded the unemployment rate would “decline to 9.5 percent by the end of 2021. Under that projection, the unemployment rate at the end of 2021 would be about 6 percentage points higher than the rate in CBO’s economic projection produced in January 2020, and the labor force would have about 6 million fewer people.” By one count, “100,000 small businesses have shut permanently since the pandemic escalated in March.” One analyst thinks that by the time the pandemic is over, a million small businesses will have shut their doors permanently. People’s life savings will be gone.

Certain industries will probably never be the same. Air travel will probably only return slowly, and with it, most businesses connected to tourism — hotels, restaurants, shops, rides, amusement parks. Any business that involves large gatherings — conventions, concerts, sporting events without considerable television revenues — will be slow to recover. Movie-theater chains have no idea how they’ll get through this. Film and television production is halted. Professional sports leagues will carry on, but no one will be watching in person for a long while.

Will Americans trust nursing and long-term care homes with their elderly parents anymore? If enough Americans look at the past few months and conclude they can’t trust them with mom and dad, do those facilities bring in enough money to stay open?

Our medical community has responded in a way that should inspire legends of their heroism being told and retold for generations. But the cost of that Herculean effort, in terms of burnout, is going to be enormous. (I came across a quote from a doctor declaring, “physicians are the highest profession in terms of rates of suicide, that’s pre-COVID,” and that doesn’t seem to be statistically quite right. That said, I’ll bet the suicide rate among doctors is way higher than most expect, and the experience of watching patients die, over and over again, must be extremely psychologically stressful. Thankfully, most of us encounter death rarely and can put aside the grim thoughts about our own mortality. Doctors — and cops and firemen and other key professions — get reminded of this every day.)

When 2021 arrives, how many of America’s doctors will retire? Or need a lengthy sabbatical? Or be struggling with physical- and mental-health issues of their own?

The American education system can handle hobbling through the second half of the spring semester with distance learning. Teachers, kids, and parents are stressed, but almost everyone is doing the best they can in unforeseen and extraordinarily difficult circumstances. But if the nation’s schools don’t restart under something resembling normalcy in late August and September . . . do we run the risk of a generation of kids who are at least partially less-educated than their peers? The nation’s children have endured months of social distancing, and apparently have more months of this to come. Just what is that doing to their minds?

Reformers warned about the unsustainability of America’s higher-education system, with its runaway tuition hikes, for decades now. Now, large university systems are concluding that the fall semester will be entirely online, much most of the concluding spring semester. Why on earth would any parents or students pay a premium for a program run entirely through their computer?

The world beyond our borders is not going to be safer in the era of the coronavirus. China realizes the world will blame it if it doesn’t convince the world to blame America first. Iran is not going to become freer, more stable, or less extreme with a terrible, ever-increasing death toll. The same goes for most of Africa — 500,000 could die because their AIDS treatments are disruptedSouth America, or India. God only knows what’s happening in North Korea right now. America’s food supply chain is secure, but many countries’ ability to get enough food to their people is not. Around the world, people are angry, scared, experiencing enormous economic disruption, and looking for scapegoats. It’s a fertile field for extremists looking to recruit new followers.

For most of 2020 and perhaps into 2021, Americans will not be able to gather in crowds. Handshakes may well be gone.

I think the aspect of this ordeal that I am contemplating the most these days is the psychological effect on all of us. We have been through tough times before, but this experience is different.

You may have noticed that in both your history education and the general discussion of American history in our culture, you read, heard, and saw very little about the 1918 Influenza outbreak. (The name is a little misleading; the waves of the pandemic continued into 1919, and even had a minor wave in 1920.) It’s odd hearing a decent amount about events shortly before, during, and after the outbreak — the sinking of the Titanic, the Ford Model-T coming to the market and the development of automobiles, the digging of the Panama Canal, the sinking of the Lusitania, World War I, Woodrow Wilson’s presidency, the Roaring Twenties . . . but the deadliest pandemic in world history is so rarely mentioned, it’s almost airbrushed out of the picture.

On some level, that’s what the survivors of that pandemic wanted. Kenneth C. Davis, author of  More Deadly Than War: The Hidden History of the Spanish Flu and the First World War, told PBS that once that pandemic was over, Americans just wanted to forget it. “The Spanish flu aspect of [World War One] has really been buried and hidden in history . . . It’s particularly complicated by the fact that so many people who lived through the Spanish flu didn’t want to talk about it or remember it — even some of the doctors who were on the front lines of trying to figure out this medical mystery of what was killing so many people, so quickly and so violently.”

Those insufferable commercials and celebrity videos declare, “We’re all in this together.” But we really aren’t. As I joked on the pop-culture podcast, if celebrities are going to declare that this is a time of unity and shared experiences, they should at least try to make their spacious southern California estates behind them look a little less luxurious. It has always been that if you were rich or well-connected, you could get through a crisis more easily than the poor and powerless. We’ve rarely had people feeling the need to show us how well they’re getting through it. Idris Elba is a terrific actor and I’m glad he recovered from the coronavirus. But when he proposes, “I think that the world should take a week of quarantine every year just to remember this time. Remember each other. I really do,” he is demonstrating that his quarantine was basically a pleasant “staycation.”

You thought populism was a powerful force in the world’s politics before the coronavirus? Just wait until afterwards. At this point, it is impossible to ignore the fact that most of the people calling for the reopening of society either no longer have a paycheck or are at risk of losing theirs. But everyone making the decisions to extend the lockdowns or publicly supporting that decision still has his. Even if they have the best of intentions and an accurate sense of the risk, the haves are choosing to further immiserate the have-nots.

It is as tall an order, and as complicated and multifaceted, as any president has faced — comparable to the challenge of the Cold War, or World War II, or the Great Depression, or the Civil War. Few in their right minds would want to be president right now. Even if you make many more right decisions than wrong ones, people will still be frustrated with the sweeping changes to our life, all driven by a virus jumping into humans from some bat. These will be remembered as extraordinarily different times.

Maybe you’re the kind of person who looks at the White House now and is thrilled at the prospect of four more years of this kind of steadiness, single-minded focus, overflowing empathy and magnanimousness, and even-headed rationality from President Donald Trump. Or maybe you’re the kind of person who watches Joe Biden’s remote interviews and remarks from his basement in Delaware and can’t wait to see that eloquence, concentration, attention to detail, and original ideas and sharp-minded incisiveness in the Oval Office next January. We are truly blessed to have these two vital, fresh, hale and hearty options before us this November.

ADDENDUM: Todd Myers with a surprising observation that the lockdown is not making the air cleaner, as many environmentalists contend: “According to the EPA’s air-quality monitors, levels of particulate matter — known as PM 2.5 — are not lower now and have, in fact, been higher recently than the median level of the last five years. Consisting of particles smaller than 2.5 microns, PM 2.5 includes natural sources such as smoke or sea salt, as well as human-caused pollution from combustion.”

U.S.

The Era of Hard Truths

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Shoppers keep social distance as they wait in line on the sidewalk outside a grocery store in Washington, D.C., April 14, 2020. (Jonathan Ernst/Reuters)

On the menu today: why our response to the virus has always been hobbled by our individual and collective difficulty accepting hard truths; why we shouldn’t be surprised that doctors and politicians disagree because of their different incentives; a tough question of matching the most vulnerable workers to the work that needs to be done before the pandemic can come to an end; and all kinds of helpful advice to parents from all of those wise sages on Twitter.

Americans Struggle to Deal with Hard Truths

Think back to March 9, when Utah Jazz center Rudy Gobert touched all the microphones of the assembled reporters. The National Basketball Association, growing worried about the potential spread of the coronavirus, had barred reporters from the locker rooms and instead had players appear for post-game press conferences in a separate room. Gobert apparently thought the precautions were ridiculous and that the league was being paranoid. Two nights later, Gobert tested positive for coronavirus, prompting the NBA to suspend the season.

Rudy Gobert is not a bad person. He was shocked and remorseful about what he had done and he subsequently donated $500,000 to an employee relief fund and local charities. There is no indication that he’s the kind of person who would deliberately put someone else at risk of contracting a dangerous virus. So why did Gobert touch all the microphones? Because the idea that he could be putting people at risk just by standing close to them, or merely touching an object they would later touch, was just unthinkable to him. It was a truth he was not ready or willing to accept.

We’ve all been forced to accept and adapt to some hard truths — maybe even once unthinkable ones. As of this writing, the American death toll is above 83,000 and we’re approaching 300,000 deaths worldwide. Our official figures are probably undercounting the true toll, as the overall mortality rate since mid-March is significantly higher than the official number of coronavirus deaths. (Some of these were probably people with non-coronavirus health issues such as strokes and heart attacks, who didn’t go to a hospital in time.) The unemployment rate is at Great Depression levels. Certain industries such as airlines and tourism have collapsed and are unlikely to recover for at least a year, maybe significantly longer than that. Our food supply chain is scrambling to cope with disruptions, shut-down restaurants, and meat-packing plant closures. Almost every school in America is closed and our “nonessential” businesses are only now starting to reopen after about two months.

For a long time in American life, most people could look at the news most days, shrug, and say “Eh, this is much ado about nothing, things will turn out okay.”

Even our worst natural disasters — such as Hurricane Katrina — only affected one region of the country at once. The 9/11 attacks were absolutely horrific and terrifying, but most of America outside of New York and Washington managed to return to something resembling “normal” daily routines pretty quickly. The Great Recession was painful and slow, but even at its worst, about 90 percent of the workforce kept going to work, the schools remained open, and food was on the shelves. Things that seem like a big deal to those of us who follow the news closely — the massive hack of the Office of Personnel Management, Healthcare.gov, unprofessional behavior in the U.S. Secret Service, Fast and Furious, IRS abuses — were no big deal to millions upon millions of Americans. Many probably never even heard much about them. Whether or not we think people should ignore these developments, it is undeniable that most of the general public chose to ignore them and suffered no real consequence for tuning it out. Most Americans got used to being able to tune out the news and the problems of the rest of the world and preferred to think about happier topics such as reality TV or sports or video games or whatever. No matter how excited the people on the television seemed to be screaming about Lehman Brothers or Ebola or Russia or the Deep State, things always seemed to turn out okay.

But now . . . things are not turning out okay.

The coronavirus pandemic is the first problem in American life in a long time that has affected the life of just about everyone. It is the first crisis in a long time that people from coast to coast cannot choose to ignore. Your local hospital canceled your nonessential visit. Your employer laid you off or furloughed you. You cannot visit your elderly relative in a nursing home. Businesses around you are closed — other than your supermarket and pharmacy. The shelves in your store may not have had toilet paper a few weeks ago — or meat now. Your local restaurants are either now only take-out and delivery or have shut down entirely. Your locality may be requiring you to wear a mask, and you’re not allowed to gather in groups. Every major event and gathering is canceled. Your children’s school is closed.

What’s more, no one in any position of authority seems to know when things will go “back to normal.” I suspect that’s what’s really frightening Americans. We can endure a lot, as long as we know there’s an end date, a light at the end of the tunnel.

We thought South Korea was showing us the better way and were ahead of us — but they just had a new spike in cases. France and Germany saw sudden rises, just as they were getting ready to loosen restrictions. Spain’s daily death toll is remaining stubbornly high. Forget worries about a second wave; no one is sure we’re done with the first one yet.

Doctors and Politicians Do Not Have the Same Incentives

Yesterday’s Senate hearing featuring Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, had a much-discussed exchange between Fauci and Senator Rand Paul. Unsurprisingly, quite a few people are choosing to see the exchange as yet another familiar battle between “wise doctor and foolish Republican senator” — who, oh, by the way, is a doctor himself and who already was diagnosed with and beat SARS-CoV-2.

Fauci’s job is to tell us the truth, as best he can determine, in his medical judgment. His job isn’t to sugarcoat it or make the truth easier to hear or bear. Fauci’s job is not to be popular. He’s not up for reelection. While he would probably prefer to not leave the American public with a sense of despair, he’s not obligated to try to make us feel better about what the truth is. To paraphrase a wise not-so-old philosopher, his facts don’t care about our feelings.

Politicians, however, do care a great deal about what the public wants to hear. And year by year, decade by decade, our electorate has shown very little patience for any lawmaker that tells the public hard truths that it would rather not hear. We don’t like hearing that we’re spending more money that we’re taking in, and that interest payments on our debt will grow larger and larger in the future. We don’t like to hear that 60 percent of federal spending is Social Security, Medicaid, and Medicare, and that reducing the deficit would require more than just cutting less popular programs such as foreign aid. (Polling indicates many Americans think foreign aid is about 25 percent of the federal budget; it makes up less than 1 percent.)

The Fauci approach — “tell the truth, whether or not people want to hear it” — is only half the challenge. The other half is getting people to act upon truths they did not want to hear.

We don’t like hearing that we need to eat healthier and exercise more. We don’t like hearing that we have to save more and spend less. We don’t like being reminded that we should be prepared for disasters — either natural or manmade. Those who like public transportation as a tool against climate change do not like hearing that public transportation could be a particularly dangerous vector for infectious diseases.

The biggest story of this pandemic is how quickly we can come to terms with some very hard truths. Among them:

The challenge before us is to figure out a way to live with these hard truths. “Everyone stay in your homes until further notice” is not really living.

How Do We Match Vulnerable Workers with Work That Needs to Be Done?

When you read “the Avik Roy plan,” it stinks. But the plan has the advantage of being realistic; it does not assume that any of our problems magically get better in the coming year.

If your risk categories include being 40 and over, or having diabetes, high blood pressure, heart disease, asthma, smoker, kidney dialysis, any kind of cancer treatment or recovery, or being overweight . . . that’s a lot of Americans who need to consistently practice strict social distancing “until further notice.” A wiser and sharper group of leaders would already be brainstorming how to match these demographics — who still need to make a living — with work that needs to be done to alleviate the pandemic and can be done while social distancing.

ADDENDUM: I’m so glad that the world has so many non-parents to tell parents how easy this summer will be on kids, without any summer camps, summer schools, summer jobs programs, sports leagues, public pools, large gatherings of any kind, and minimizing time with grandparents. You see, back when these folks were young, they did all kinds of things and these darn kids today are just too spoiled and it’s all the fault of overprotective helicopter parents! By no stretch of the imagination could the coming summer be a difficult one for children across the country and around the world! I’m so glad that Twitter gives all of these people a venue to share this wisdom to the rest of us.

Yesterday I also learned, any expression of concern about the state of the nation’s children experiencing several months of isolating social distancing means that you don’t care about the elderly or unemployed, in the eyes of a total #*$#ing moron.

World

China Is a Bad Actor, and American Media Need to Recognize This

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A doctor puts on protective goggles before entering the isolation ward at a hospital following the outbreak of the coronavirus in Wuhan, Hubei Province, China, January 30, 2020. (China Daily/Reuters)

A large portion of Washington media have decided the big story of the day is President Trump telling CBS White House correspondent Weijia Jiang “Ask China,” after she asked, “Why does [the rate of U.S. testing to other countries] matter? Why is this a global competition to you if every day Americans are still losing their lives and we’re still seeing more cases every day?” The general argument is that Trump’s response to Jiang was racist.

Rather than the ten-millionth “can you believe President Trump said that?” story, let’s take a look at what’s actually going on in China.

Despite Their Claims, China Has Not Beaten the Coronavirus

There is widespread consensus outside of China that whatever the actual tally of coronavirus deaths in that country was, the sum was significantly higher than the officially released numbers. The Washington Post felt sufficient confidence to write on April 3 that evidence such as the number of hours that crematoriums were working and the number of urns returned by funeral homes added up to a death toll around 42,000 to 47,000.

Back in mid-April, Wuhan health officials revised their local death toll from 2,579 to 3,869. 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.

(If you’re wondering about those 21 million cell phone subscriptions that disappeared, Chinese cell phone companies stated that they were cancelations driven by economic and lifestyle changes during the outbreak. While I think the Chinese government’s capacity for dishonestly, coverups, and propaganda is considerable, hiding 21 million deaths would be a real logistical challenge.)

China also contends that it has had only a handful of new cases in a country of more than a billion people in March, April, and so far in May, and only one death since April 17. As far as the Chinese government is telling the world, they have the coronavirus beaten once and for all.

Or maybe not: “Authorities in the central Chinese city of Wuhan, where the pandemic coronavirus was first detected, have ordered fresh Covid-19 tests for all of its 14 million residents after a cluster of new community cases. The unprecedented move came after reports on the weekend of six new coronavirus cases from the same residential compound, known as Sanmin.”

And it’s not just Wuhan again: “On Sunday, Chinese authorities reclassified Shulan, a city near the Russian and North Korean borders, as high risk, after a cluster of cases connected to a woman with no known history of travel or exposure to the virus.”

We know the Chinese national and Wuhan local authorities never like admitting bad news unless they have to, and when they do admit bad news, it is likely drastically understated.

For a long time in the Soviet Union, understanding what was really going on requiredreading between the lines” — noticing changes in standard phrases, the absence of certain expected points, or other ways to hint at or allude to arguments that ran counter to the official Communist Party line.

Notice this article that originally appeared in the Chinese business publication Caixin:

As of Friday, the national drug regulator approved 30 testing kits for the virus, including 19 nucleic acid tests and 11 antibody tests. The combined manufacturing capacity of testing kits surpassed 9 million a day, according to the National Medical Products Administration.

Statistics from Dongxing Securities showed that in normal operation, medical institutions in China could test a total of 1.66 million people a day, matching the basic needs of massive testing as social activities resume.

But access to testing has been uneven. While big cities including Beijing, Guangdong and the epicenter Wuhan have greatly expanded capacity and allowed residents to take tests as they wish, people in remote areas such as Heilongjiang still face difficulties.

There is “no chance” that the coronavirus pandemic will end soon, and countries must prepare for a “new normal” amid plans to reopen, said Zhang Wenhong, head of the infectious diseases department of Huashan Hospital of Fudan University in Shanghai and director of the city’s COVID-19 clinical expert team.

Does this sound like a country that has had only a handful of cases in the past ten weeks?

Chinese movie theaters briefly reopened in March, then suddenly closed again. They remain closed indefinitely.

Nobody Wants to Be Dependent upon Chinese Imports Anymore

Meanwhile, the United States isn’t the only country that suddenly finds the thought of being dependent upon Chinese exports of medical equipment and supplies unacceptable:

Japan’s cabinet in April earmarked 248.6 billion yen ($2.33 billion) for subsidies to businesses that move production back to Japan, covering up to two-thirds of relocation costs.

Though the amount made up less than 1% of the 108 trillion yen coronavirus stimulus package, it clearly put China on guard. Beijing not only pressed Japanese authorities to explain the meaning of the measure, but also polled Japanese businesses in China on whether they planned to leave.

Yet, the argument gained new life again when Chief Cabinet Secretary Yoshihide Suga, in an interview with Nikkei, stressed the need for greater self-reliance.

“Looking at masks, for example, 70% to 80% are produced in China,” he said. “We must avoid depending excessively on particular countries for products or materials and bring home production facilities for goods needed for daily life.”

Suga has been Abe’s right-hand man and a key player in his government since Abe returned as prime minister in 2012. Suga’s remarks reflect something much broader than a temporary policy response to the current crisis.

Does the Chinese government look and sound like a group of leaders that are confident that they are winning the battle of world opinion? They’re banning Australian beef imports after Australia called for an inquiry into the origin of the outbreak. A Chinese coast-guard ship intentionally rammed and sank a Vietnamese fishing vessel last month. Chinese coast-guard ships are straying into Japanese territorial waters. Chinese and Indian soldiers are throwing rocks at each other and getting into fistfights at their border. The Chinese economy is probably in for the same long, painful climb out of recession that we and the rest of the world are likely to experience in the coming year.

Does this county look stable to you? Or does China look like a powder keg, with a lot of angry people who have a whole lot of good reasons to be angry? And does the government in Beijing look like a bunch of strategic masterminds, or do they look like they have only one play in their playbook: attempting to steer public anger into angry nationalism, over and over and over again?

Trust Only Those Who Get Arrested

Finally, elsewhere in China, a new study out of the Shandong First Medical University concludes, “Our paper shows very clearly that these events occur naturally in wildlife. This provides strong evidence against SARS-CoV-2 being a laboratory escape.”

Notice that the Chinese authorities want to blur the line between “occurred naturally in wildlife” and “laboratory escape.” You can take naturally occurring viruses into a lab, either as part of a sample or as part of a research animal, and then that virus can get out of that lab — either through the accidental infection of a lab worker, or through the improper disposal of biological material. This literally happened twice separately with SARS in a laboratory in Beijing in 2004.

I can understand why a Chinese scientist would insist a laboratory mistake is impossible. Zhang Xuezhong, a prominent Chinese legal scholar, argued on social media that restrictions on freedom of expression had made it more difficult for the country to contain the outbreak, and criticized the Chinese government’s arrest and suppression of Wuhan doctor Li Wenliang. He promptly got detained by police for a day and later released.

With consequences as fast and dire as that, do you think any Chinese scientist is going to admit, “yes, mistakes happen, and this virus could have been one of ours”?

My guess is that unless you’re making a deliberate effort to keep up with news out of China, you haven’t heard much about any of these developments.

You’ve probably heard about that restaurant in Colorado that was open and crowded on Mother’s Day. You’ve probably heard about the president and vice president not wearing masks. You may have heard about Twitter establishing new rules to fight disinformation about the coronavirus — but you probably haven’t heard that those rules won’t apply to the January World Health Organization tweets declaring that the virus could not be spread from one human to another.

We have a national media — news pages, editorial pages, radio, television, web, and cable news — that is just clogged with people who know how to tell one story and who only want to tell one story: “Democrats are the good guys, Republicans are the bad guys.” Even if you agreed with that — I obviously don’t — the world is way more complicated than that. When a story like this virus and China come along, they can only perceive the events through that preexisting lens.

ADDENDUM: Because you’re probably looking for things to look forward to: Baseball will probably be back sometime around July 4; the film version of Hamilton is coming to Disney+ this July 3; Disney still intends to release the live-action “Mulan” in theaters in July; and the second season of “The Mandalorian” will arrive as scheduled in October.

Politics & Policy

We Need to Take a Hard Look at Nursing-Home Policies

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Margaret Hildebrandt, 93, poses for a photo while in self-quarantine due to the coronavirus, Sunderland, Md., March 18, 2020. (Linda So/Reuters)

On the menu today: a deep dive into how different state governments are handling nursing home lockdowns and reopenings, and note about South Korea’s handling of the pandemic.

Stop Yelling at Beachgoers and Start Yelling at Governors over Nursing-Home Policies

When confronted with terrible news, the immediate instinct of far too many Americans is that it must somehow be the fault of the people they already disliked. The Babylon Bee’s satire was painfully accurate once again with their recent headline, “‘Those Dumb Red-Staters Going To The Beach Deserve To Die,’ Man Tweets From New York Subway Train.”

On March 30, the American Health Care Association and National Center for Assisted Living issued updated guidelines, based upon CDC findings, declaring that, “unless a person is tested for COVID-19 and negative before admitting them to your building, you should assume the person has COVID-19 regardless of their having or not having symptoms . . . We strongly urge [long-term-care] facilities to begin now creating separate wings, units or floors by moving current residents to handle admissions from the hospital and keep current resident separate, if possible.” This was typed out in bright red font for emphasis.

On March 20, the Society for Post-Acute and Long-Term Care Medicine issued a statement declaring, “nursing homes should not be forced by local hospitals or officials to accept new admissions who demonstrate clinical evidence or a positive test for active COVID-19, unless they are considered non-infectious based on current CDC guidelines.” The California Association of Long Term Care Medicine issued a similar resolution. Dr. Michael Wasserman, the head of the group, told NPR, “If you push folks out of the hospitals to make space and you push them into nursing homes a couple weeks later, for every one of those you send to the nursing home, you may get 20 back in the hospital.”

All of these health associations and institutions grasped how dangerous it would be to have recovering but still potentially contagious patients in the same buildings as larger groups of elderly people who need care.

As noted late Friday, the state governments of New York and New Jersey enacted regulations that required nursing and assisted living homes to readmit residents who had been treated for coronavirus, whether or not they were fully recovered, in an effort to reduce the use of hospital beds. The New Jersey Department of Health explicitly prohibited the facilities from requiring patients to be tested for the virus before admission or readmission.

Yesterday, New York governor Andrew Cuomo reversed that policy. This policy has been in place since March 25, so for the past six weeks and four days, nursing and long-term care homes in New York state have not been able to say, “we won’t let that patient in, because we fear that patient could expose our other residents to the virus.”

California enacted this policy for ten days, then adjusted it; now the state is promising to pay senior and adult care residential facilities up to $1,000 per day to accept recovering coronavirus patients.

Michigan’s governor Gretchen Whitmer did not enact a policy requiring nursing and long-term care homes to take in recovering coronavirus patients. But the state of Michigan permitted long-term homes to take in these patients, as long as the patients were isolated and the homes determined they had sufficient personal protective equipment. By mid-April Whitmer required nursing homes and other long-term care facilities create “a separate unit” for residents who have tested positive for COVID-19, or send them to a facility in the region that has one. Meanwhile, the state’s lists of nursing homes with coronavirus cases were painfully incomplete.

Not every state did this. Louisiana explicitly banned the transfer of patients from hospitals to nursing homes if the patient has active coronavirus, has a pending test, or has undiagnosed, active respiratory symptoms.

Connecticut set aside four facilities — two of which had been previously vacant, two which set aside separate floors — to house recovering coronavirus patients. Washington opened specialty wings in three assisted-living facilities.

Back on March 29, Massachusetts moved residents out of certain homes to set up ones specifically for recovering coronavirus patients, and when the locals complained, the state’s Department of Public Health explicitly stated that the approach followed by New York, New Jersey, and California would be too risky: “Without designated coronavirus care sites, hospitals would have to discharge COVID-19 patients to any skilled nursing facility with open capacity, which could put the rest of the healthy residents at risk, a DPH spokesperson said.”

But it is worth noting that by April 24, the New York Times reported, “Nursing homes in Massachusetts are also being asked to take coronavirus patients, but only if they verify that they have adequate staff and protective gear and can isolate the infected. In return, those homes will collect 15 percent more in reimbursements for every Medicaid patient.”

Can anyone think of any potential danger from giving a nursing home a greater financial incentive to accept coronavirus patients?

In Pennsylvania, the problem was somewhat different. The Philadelphia Inquirer revealed this morning that by mid-March, the state health department had a “robust and aggressive plan” to respond to coronavirus cases in nursing homes . . . but for some reason state agencies just didn’t do what the plan called upon them to do:

The quick response plan was circulated within the Health Department, with emails showing staff nurses and others were asked to volunteer. In the third week of March, it was shared with providers, said Zachary Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents more than 400 long-term care facilities.

But the plan was never fully implemented, and a similar — though far more limited — effort wasn’t activated until mid-April, long after major outbreaks had already taken hold.

(I am reminded of the city of New Orleans having a lot of plans for hurricane response and evacuation before Hurricane Katrina, and then not enacting them when it counted.)

Pennsylvania’s state government is also unwilling to say which long-term care facilities have coronavirus cases and deaths:

The Pennsylvania Department of Health has repeatedly refused to release data showing coronavirus deaths at specific long-term care facilities across the commonwealth.

Efforts by The Caucus, a publication of LNP Media Group, to obtain the names of affected long-term care institutions with coronavirus cases and resulting deaths have been rejected by the agency, which regulates, inspects and licenses the facilities.

Florida’s health department tried to work out agreements between hospitals and nursing homes; some nursing homes in the state have isolated patients returning from a hospital for 14 days, whether or not they’ve tested positive for the coronavirus. But the state is still dealing with a rising number of cases and deaths in these homes, in part because of insufficient testing of the staff working there:

There is little mystery behind what is considered the main culprit in this grim statistic: asymptomatic carriers — many of them long-term care staff members, who are getting tested infrequently or too late. But despite state efforts to ramp up testing, administrators at nursing homes and assisted-living facilities told the Miami Herald and Tampa Bay Times it is a piecemeal program that is failing to identify risk and completely contain the virus among the state’s most vulnerable.

All of these states barred visitors to nursing homes, cutting off the elderly from their children and grandchildren. And then some states brought in coronavirus patients, and then I guess they just hoped that the ventilation systems wouldn’t spread the virus too much.

These decisions are so spectacularly wrongheaded, so epically foolish, that those responsible deserve to be remembered forever. Think about how much ink has been spilled, telling us what a great job is being done by Cuomo, Whitmer, New Jersey governor Phil Murphy, California governor Gavin Newsom, and Pennsylvania governor Tom Wolf, and how lucky those states’ residents are to have such visionary and indefatigable leaders.

You will probably see someone citing these numbers and declaring that the death toll from this pandemic is the result of a handful of blue state governors. That is not quite accurate.

Even if a state enacted a strict policy like Louisiana, it cannot guarantee that the coronavirus will not end up in a nursing home or long-term care facility. According to the New York Times, Louisiana ranks 10th in the country in the number of deaths in long-term care facilities with 784 — 35 percent of the deaths in the state. Because coronavirus patients can be asymptomatic, staff may be unknowingly spreading it around — or anyone who enters the facility, like deliverymen or paramedics. New York tops the list with 5,380 deaths in nursing and long-term care homes, but that sum is only 20 percent of the state’s total. New Jersey has 4,825 deaths in nursing and long-term care homes, 52 percent of that state’s total. Massachusetts ranks third in the country with 2,837 deaths, and 59 percent of that state’s total. Pennsylvania ranks fourth, with 2,518 deaths, making up two-thirds of all deaths in the state.

Even good policies can be enacted too late. Connecticut ranks fifth, with 1,627 deaths, 55 percent of that state’s total.

ABC News this morning: “The deadliest place for COVID-19 transmission remains in nursing homes, which now account for more than 26,000 deaths in the U.S., according to public figures released by 35 states and Washington, D.C. That means that of the data available, nursing homes account for one-third of the nation’s fatalities from the ongoing viral outbreak, a new ABC News analysis shows.”

For most of America, today begins week nine of quarantine, lockdown, social-distancing, and other measures. Across much of the country, the rules are getting loosened a bit, and communities are taking the first tentative steps to reopening. The chances are good that you’ve found the past eight weeks, at minimum, deeply frustrating, and perhaps even agonizing. Businesses closed, jobs lost, kids at home from school, everyone isolated, keeping six feet apart, wondering how much longer they can keep living their lives with just neighborhood walks and take-out and delivery and Netflix and every darn commercial beginning, “in these uncertain times . . .”

And all this while — with everyone in America sacrificed in the name of keeping the most vulnerable safe — state administrators deliberately placed those who were still contagious with the virus under the same roof as large groups of elderly Americans and just hoped it would work out okay.

ADDENDUM: Over the weekend, Michael Kim laid out a detailed firsthand description of South Korea’s far-reaching measures to handle the potential spread of the coronavirus — a level of invasive monitoring and mandatory quarantines that many Americans would find unacceptable. “If you’ve been to a place where someone who has coronavirus has also visited, someone will contact you to get tested and undergo self-isolation for another 14-day period . . . There’s absolutely no protests or demonstrations about the anti-freedom measures or invasion of privacy. I’m not an expert in Korean politics but it seems like everyone accepts these measures as required to address this pandemic.”

Kim’s description is useful to keep in mind every time you encounter a “why can’t the United States respond as well as South Korea has?” complaint. South Korea has a different culture, different expectations for balancing individual liberty and responsibility to others, a different level of trust in their government, and a smaller, more densely populated population. (Maybe if you’ve spent almost 70 years living with the threat of a sudden bloody invasion by your neighbors to the north, you listen to government warnings more and you don’t blow off talk of a deadly threat as hype.)

World

Let’s Talk About the Swedish Approach

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A man walks past the Royal Swedish Opera, amid the coronavirus outbreak in Stockholm, Sweden, April 27, 2020. (Fredrik Sandberg/Reuters)

It’s not easy to shop these days, but Sunday is Mother’s Day, so remember to go out and get her something — even if it’s just a card and flowers from the grocery store. I’ve got the best. Thank you for everything, Mom.

On the menu today: a long look at Sweden, a short look at Mexico, and the return of the pop-culture podcast.

The Swedish Approach Won’t Work in a Less-Healthy Nation

“We should do what Sweden did! Try to get to herd immunity as fast as we can!”

Within National Review, John Fund and Joel Hay are more or less advocates or enthusiasts for the Swedish approach, and Nick Frankovich and Ramesh Ponnuru are skeptics.

As of this writing, Sweden has 24,623 cases of coronavirus and 3,040 deaths. Sweden has 2,438 cases per million people and 301 deaths per million people. The United States has 3,906 cases per million people . . . but only 232 deaths per million people.

Sweden currently ranks tenth in the world in deaths per million people. It is worth noting that an outbreak in a tiny, densely populated country can rocket a country to the top of the list. At this moment, San Marino, a microstate entirely surrounded by Italy, ranks first. Andorra, a tiny country between Spain and France, ranks third. Sint Maarten, the Dutch-speaking half of an island in the Caribbean, ranks eighth. The United States ranks 13th, with the Isle of Man stuck between us and Sweden.

Perhaps the most important point in the discussion around Sweden is the recognition that different countries’ populations will have different preexisting health conditions; what works for one won’t necessarily generate the same results.

Begin with the question of scale. If you look at the top ten most populous countries in the world, many of them are authoritarian, dealing with significant poverty, or both: China, India, Indonesia, Pakistan, Nigeria, Brazil, Bangladesh, Russia, Mexico. (Read to the end of today’s newsletter for an important related point.)

Heading into a crisis like this, the United States has to ensure access to personal protective equipment, hospital beds, ICU units, tests, potential treatment drugs, for the potential treatment of 330 million people (although I suppose you could rule out the population under 18). That’s just a much more difficult task than securing what’s needed to prepare for a viral outbreak in Hong Kong (7 million people), Taiwan (23 million people), or South Korea (51 million people). All of those countries have handled the outbreak well, and significantly better than the U.S. — but we should keep the degree of difficulty in mind.

Sweden has about 10 million people. Much like the United States, Sweden is having serious outbreaks of the virus in nursing homes, and complaints about insufficient access to personal protective equipment. Much like the United States, their rate of testing is increasing much less quickly than their leaders wanted.

When you compare populations, other key differences become clearer. Sweden has about 4 million citizens over the age of 60; the United States has about 150 million. (UPDATE: Nationmaster puts this sum at 148.6 million, but the Population Reference Bureau and the Census Bureau put it at about 52 million. The point stands that the U.S. has many, many times more elderly to protect from the virus.) With 7.6 million people living in urban areas, Sweden ranks 57th in the world in that metric. We rank third with almost 240 million. Neither of our population densities is particularly high by world standards, but ours is a little higher.

A Goldman Sachs assessment noted that the Swedish approach wouldn’t work for many other European countries: “Its population density is about half that of Italy, and Sweden has a high proportion of single-occupancy households, and a relatively low proportion of multi-generational households.”

Perhaps most importantly, Sweden is literally the least-obese country in the world, just 12 percent. We rank 16th, with 33 percent of our population being obese. (Some put the percentage of obese Americans closer to 40 percent.)

A study of coronavirus patients admitted to the intensive care unit at university hospitals at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania found “an inverse correlation between age and body mass index” — meaning the younger a person was in the ICU, the more likely they were to be obese. (“Obese” means a body mass index over 30; for someone who is 5 feet, 9 inches tall, that would be 203 pounds or more.)

From this, it is not hard to imagine an attempt at “herd immunity” in the United States that would result in a much higher death rate, because we have more people who are obese. We can argue about why America has more obese people, but there’s little that can be done to change that fact now or in the near future. (If losing excess weight was easy, everyone would be doing it already.)

Now imagine Sweden’s minimalist approach in the U.S. and how that would effect not just obese Americans, but those with heart disease, high blood pressure, diabetes, asthma, smokers, those undergoing cancer treatment, bone marrow or organ transplants, HIV, kidney disease or undergoing dialysis, liver disease, lupus, any other potential immunocompromised condition, and those 65 and over. We have a lot of people who are “healthy enough” to function on a day to day basis, but who have at least one condition that would make a fight with coronavirus life-threatening. Your mileage may vary, but I look at the millions upon millions of Americans who could lose that fight with the virus and find the Swedish approach unworkable here — just too much risk to too many people.

Right now, the Sweden fans are arguing, “But they’re not going to have a second wave!” We will see. We’re still quite a long way from being finished with the first wave. There are good reasons to think that the second wave in the United States may not be as bad.

As for the notion that this approach spared the Swedish economy . . . the Wall Street Journal looks at the country and concludes that they’re going to have a slightly less bad economic recession — not that they will be spared:

Sweden’s decision not to impose a mandatory national lockdown has drawn global attention from policy makers eager to judge the strategy’s impact on public health and the economy. But it turns out the situation here is not as different as it might first appear.

Even without legal prohibitions, many Swedes are voluntarily following authorities’ social-distancing recommendations and limiting travel, pushing down domestic consumption. And the country can’t insulate itself from lockdowns among its trading partners. Exports are falling.

The result: Sweden’s economy is contracting, but not by as much as some others in Europe. Meanwhile, it is recording deaths per capita from the virus that are considerably higher than in neighboring countries — though below levels seen in France, Italy and the U.K.

Shops, restaurants and even nightclubs have been allowed to stay open in Sweden. There are no curbs on the manufacturing and services industries. But that doesn’t mean life is normal here.

Despite recent warm weather, streets are quieter and business is slower because many Swedes, like Ms. Sandblom, take government guidelines seriously and even go beyond them to avoid catching the highly contagious pathogen.

All of that is contributing to what Sweden’s government estimates will be a 6 percent contraction in domestic consumption this year. Combined with a forecast 10 percent drop in exports, Swedish authorities predict, the result will be a 7 percent decline in overall 2020 economic output.

Maybe that looks good in light of today’s utterly abysmal jobs numbers. But it seems to me that much of the discussion around Sweden is driven by a desire to believe that there is an easier path out there, that our leaders are just too dumb to see it, and that by yelling loudly about it enough, America will alter its course.

People hate the lockdowns — now wrapping up week eight — with good reason. Thankfully, most states are starting to loosen the rules here and there; as the weather improves, more people will want to spend more time outside and enforcement is going to start being impossible. Post-lockdown America will not mean post-coronavirus America.

Big Countries Are Either Hit Hard by the Virus or Lying about It

A few moments ago, I wrote: “If you look at the top ten most populous countries in the world, many of them are authoritarian, dealing with significant poverty, or both.” This means that the United States is arguably the only country in the world that has high population, considerable wealth compared to other countries, and can be trusted to count and report its coronavirus cases and deaths in a reasonably accurate manner. (Yes, yes, I hear you, I said “reasonably accurate,” and whatever the flaws in our data, our numbers are sure as hell more accurate than the ones coming out of Beijing or Moscow.)

And it appears the Mexican government isn’t being honest about their situation, either:

The Mexican government is not reporting hundreds, possibly thousands, of deaths from the coronavirus in Mexico City, dismissing anxious officials who have tallied more than three times as many fatalities in the capital than the government publicly acknowledges, according to officials and confidential data reviewed by The New York Times.

The tensions have come to a head in recent weeks, with Mexico City alerting the government to the deaths repeatedly, hoping it will come clean to the public about the true toll of the virus on the nation’s biggest city and, by extension, the country at large.

But that has not happened. Doctors in overwhelmed hospitals in Mexico City say the reality of the epidemic is being hidden from the country. In some hospitals, patients lie on the floor, splayed on mattresses. Elderly people are propped up on metal chairs because there are not enough beds, while patients are turned away to search for space in less-prepared hospitals. Many die while searching, several doctors said.

The End of Grading Presidents on Performance

An observation from Ramesh about the idea that most elections are referendums on the performance of the incumbent: “In retrospect, it appears that the referendum theory of presidential elections was an artifact of a less politically polarized time. When a lot of voters floated between the parties, presidents could win or lose landslides based on their perceived performance. Now we have two hardened and roughly evenly matched party coalitions with more uniformly antagonistic views, and almost all voters lean toward one or the other of them.”

ADDENDUM: As promised yesterday, a new, long, and uncensored edition of the Jim and Mickey Show, tackling lockdown life, those horrible commercials that begin “in this time of uncertainty . . .” ESPN’s The Last Dance, a bit about Tiger King, a lot about Counterpart, the outbreak of Karens, when or if we’ll ever go back to movie theaters, and more.

U.S.

What’s Going On with New York?

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A Times Square Alliance street sweeper worker walks though a nearly empty Times Square in New York City, April 7, 2020. (Mike Segar/Reuters)

On the menu today: New York City’s coronavirus case numbers are gradually improving, but they’re still a long way from out of the woods, how the virus is creating dire days for big-city public-transportation systems, and a new study indicates that the colossal mistakes of the Big Apple in the early days of the outbreak helped set the course for the rest of the country.

The Coronavirus and the Dire Future for Big City Public Transportation

As of this writing, the most recent date where New York City’s official data gives the number of new cases is Monday, May 4, where the city had 711 new diagnosed cases of the coronavirus.

The Worldometers chart breaks down new cases by today and yesterday, but not further back.

Still, Monday’s new case total in New York City is higher than the Wednesday’s case total for Alaska, Hawaii, Vermont, Wyoming, Maine, Idaho, West Virginia, North Dakota, South Dakota, Nevada, Oklahoma, Oregon, South Carolina, and New Hampshire . . . combined.

New York City’s new case total for Monday is higher than the new case total reported Wednesday in the states of Kentucky, Arkansas, Utah, New Mexico, Mississippi, Tennessee, Alabama, Rhode Island, Missouri, Iowa, Nebraska, Washington, Wisconsin, Kansas, Connecticut, Arizona, Louisiana, Delaware, Colorado, North Carolina, Florida, Ohio, the District of Columbia, or Michigan. Only twelve states have higher number of new cases — and that includes the rest of the state of New York. Of course, some of this reflect the city’s larger and denser population — if New York City was a state, its 8.3 million residents would be around our 11th-largest — but the upshot is that while New York City is “bending the curve,” that curve still has a long way to go.

“The problem has stopped getting worse” is not the same as “the problem is solved.”

We should also note that no one would paint either New York State or the city as being a slouch when it comes to lockdowns . . . and yet they still saw the horrific and rapid spread that they did. Back on March 20, New York governor Andrew Cuomo issued new restrictions declaring, “non-essential workers should stay inside their homes at all times except for critical travel, such as going to the grocery store or pharmacy.” The lockdown will be in place until at least May 15, with subsequent extensions likely depending upon conditions in particular regions.

It took a long time for the lockdown to “bend the curve,” and somehow, people staying at home are apparently still catching the virus. Cuomo noted with surprise yesterday:

The majority of recently hospitalized coronavirus patients in New York are people who have followed the precaution of staying home, Gov. Cuomo said Wednesday.

The governor said it was “shocking” that 66 percent of new coronavirus hospitalizations are people who are either retired or unemployed and not commuting to work on a regular basis.

“This is a surprise: Overwhelmingly, the people were at home,” Cuomo said during a briefing on Long Island. “We thought maybe they were taking public transportation, and we’ve taken special precautions on public transportation, but actually no, because these people were literally at home.”

A total of 46 percent of new cases were unemployed and 37 percent were retired. Age also played a factor, the data shows that 73 percent of people being hospitalized were 51 and older, the survey found.

(Virologists strongly suspect air-conditioning and ventilation systems can spread the virus when it is airborne. Back in 2004, the World Health Organization determined that one outbreak of SARS was driven by bad plumbing, ventilation systems, and thin walls and ceilings between apartments. Maybe keeping everyone at home in apartment buildings is putting them at higher risk from their neighbors?)

Notice Cuomo’s comment about initially suspecting a connection to public transportation in the most recent cases.

Back on April 13, a Massachusetts Institute of Technology researcher released a paper concluding, “The Subways Seeded the Massive Coronavirus Epidemic in New York City.

The world has a lot of enthusiasts of mass transit — often environmentalists who want to reduce carbon emissions — who do not want to hear or believe that the New York City subway system could be particularly dangerous, and they argued the MIT report “fails to provide statistical evidence and ignores significant confounding factors.

Throughout much of the early months of 2020, city officials insisted New Yorkers could not catch the virus by riding public transportation. City Health Commissioner Dr. Oxiris Bardot told the public February 6, “we’re telling New Yorkers, go about your lives, take the subway, go out, enjoy life, but practice everyday precautions . . . If it were likely that it could be transmitted casually, we would be seeing a lot more cases.” She repeated March 4, “there’s no indication that being in a car, being in the subways with someone who’s potentially sick is a risk factor, because, again, it goes back to the issue of casual contact.” On March 5, Mayor de Blasio specifically rode the subway to demonstrate that the system was safe. “I’m here on the subway to say to people nothing to fear, go about your lives and we will tell you if you have to change your habits but that’s not now.” The next day in a radio interview, the mayor declared, “If someone’s on the same train car as another person, that does not, from what we know so far, create a dynamic where you have an opportunity to catch this disease. It’s just a different reality.” (By March 15, the city closed all public schools.)

Yet the idea of subways being one of the main vectors of the virus’s spread makes complete sense: lots of people, often crowded together with much less than six feet separating them, breathing recirculated air, sitting in the same seats, touching the same poles and handrails and turnstiles and subway card machines. On any given weekday, between five and six million people use the city subways, with about 150,000 people entering at the Grand Central 42nd Street station alone. Yesterday, Cuomo acknowledged the obvious: There just isn’t enough room on most trains at most times for people to remain six feet apart.

The consequences of this argument will be long-lasting. Everyone knows we’re going to be living with this virus for a while; if the subways are perceived as the place you’re most likely to catch the virus, people will avoid it for at least the coming year, and maybe more. People who can afford alternative ways to get around will choose those options. The inability to get around the city safely will be one more factor driving the exodus from New York, and perhaps other large American cities. All the hassles of owning a car in the city will become much more tolerable if the alternative of public transportation might kill you. With Uber, Lyft, or a cab, you’re running the risk of being exposed to one driver and the possibility of a virus left behind the previous passengers — bad, but still not as many people as the subway at almost any time of the day.

And beyond the question of whether public transportation will have enough riders to remain financially viable, contemplate whether large metropolitan public transportation systems will be able to find workers.

A Metro Transit Authority conductor wrote in the New York Times this week: “We work at the epicenter of the epicenter, with a mortality rate substantially higher than that of first responders. Common sense tells you that subway trains and platforms are giant vectors of this virus. We breathe it in along with steel dust. As a conductor, when I stick my head out of the car to perform the required platform observation, passengers in many stations are standing 10 inches from my face. At other times, they lean into the cab to ask questions. Bus drivers, whose passengers enter right in front of them, are even worse off.”

Even worse, the transit authority’s management handled this as badly as any cynic would fear:

In mid-March, a bulletin came out mandating that conductors make an announcement every 15 minutes. Wash hands, soap and water, sanitizer, elbow-sneeze. “Together we can help keep New York safe.”

The irony was that we didn’t have soap and water. At my terminal at that time, the restrooms were closed for three days after a water main break. Most employee restrooms are in similarly bad shape. Crew rooms are packed.

The M.T.A. takes stern action against workers seen without goggles or cotton knit safety gloves. Yet we had to work without protection against the coronavirus.

At first we were warned not to wear masks. The M.T.A. said it would panic the public. It said masks were dangerous for us. Later it said we could wear masks we bought ourselves. But by then there were few masks for sale.

As New York Goes, So Goes the Country

But you don’t have to live in or close to New York City to be affected by the bad decisions of the city’s leaders:

New York City’s coronavirus outbreak grew so large by early March that the city became the primary source of new infections in the United States, new research reveals, as thousands of infected people traveled from the city and seeded outbreaks around the country.

The research indicates that a wave of infections swept from New York City through much of the country before the city began setting social distancing limits to stop the growth. That helped to fuel outbreaks in Louisiana, Texas, Arizona and as far away as the West Coast.

The findings are drawn from geneticists’ tracking signature mutations of the virus, travel histories of infected people and models of the outbreak by infectious disease experts.

“We now have enough data to feel pretty confident that New York was the primary gateway for the rest of the country,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health.

Yesterday I noted that there’s a lot of frustration and anger in the country about the way the virus has disrupted, interrupted, and in far too many cases, ended lives, all looking for a target. From where I sit, if you want human beings to blame, the Chinese government is the entity that deserves the most blame, by a wide margin.

But if you absolutely must blame some Americans, Bill de Blasio and his team look like the fairest choice. No doubt, President Trump made all kinds of inane, inaccurate, unrealistic, and wildly overoptimistic comments in the first months of this outbreak. But at least he didn’t literally encourage people to keep spending time in one of the most contagious spots.

ADDENDUM: I know today’s news is pretty grim, but chin up: The pop-culture podcast will emerge from hibernation very shortly.

U.S.

Why Hydroxychloroquine Didn’t Turn Out to Be a Miracle Pill

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A scientist holds a sample during coronavirus testing at New York City’s health department during the coronavirus, April 23, 2020. (Brendan McDermid/Reuters)

A lot to chew over today: why the drug hydroxychloroquine will prove to be a life-saver for some coronavirus patients and useless or even a life-ender for others; why the country needs to “embrace the suck” and be able to accept, process, and respond to bad news; why we are likely to be forced into a reopening plan that lots of Americans will vehemently dislike; and the 2020 campaign’s forgotten man.

We Need to Stop Expecting a Miracle Pill

Part of the frustration in dealing with a really bad situation is a ravenous hunger for magic bullet solutions. One reader wrote in, contending that hydroxychloroquine is effective 100 percent of the time if it’s administered early enough, so why not reopen society and give everyone a prescription for hydroxychloroquine at the first sign of the virus?

Chloroquine and hydroxychloroquine actually slow down parts of a patient’s immune system by “interfere with lysosomal activity and autophagy, interact with membrane stability and alter signalling pathways and transcriptional activity, which can result in inhibition of cytokine production and modulation of certain co-stimulatory molecules” — which is a jargon-heavy way of saying it makes your immune system’s cells not work as well together.

People might wonder why anyone would want to take a drug that weakens their immune system. Hydroxychloroquine can be an effective drug for lupus, because with lupus, the body’s immune system becomes overactive and starts attacking healthy, normal cells. It is also used to treat arthritis, because in patients with rheumatoid arthritis, their immune system attacks the lining of their joints. With patients suffering from malaria, the parasite actually can send out “messages” that distract the body’s immune system, causing it to attack healthy red blood cells and ignore the real threat: “While the immune system is busy defending the organism against fake danger, the real infection proceeds inside red blood cells, allowing the parasite to multiply unhindered at dizzying speed. By the time the immune system discovers its mistake, precious time has been lost, and the infection is much more difficult to contain.” Hydroxychloroquine effectively calms down the immune system and along the way binds to the malaria parasite, breaking it apart.

The coronavirus identified as SARS-CoV-2 can generate a “cytokine storm” — when the body’s immune system kicks into overdrive and starts attacking healthy cells in important organs. Dr. Randy Cron, an expert on cytokine storms at the University of Alabama at Birmingham, told the New York Times last month that in about 15 percent of coronavirus patients, the body’s defense mechanism of cytokines fight off the invading virus, but then attack multiple organs including the lungs and liver, and may eventually lead to death. As the patient’s body fights its own lungs, fluid gets into the lungs, and the patient dies of acute respiratory distress syndrome.

From this, you can get a sense of how and why hydroxychloroquine might be effective in some circumstances and not others. If the patient’s immune system is strong enough to fight off the coronavirus, but is at risk of going into overdrive and setting off a cytotkine storm, administering the right amount of hydroxychloroquine might put their immune system back in the Goldilocks zone — strong enough to fight off and defeat the virus, but not so strong that it starts attacking vital organs by mistake. It’s also easy to see why we would only want people taking this drug under a doctor’s recommendation and possibly supervision — take the drug too early, and you suppress the body’s immune system just when it needs that system functioning well to fight off the invading virus. Take the drug too late, and the damage to the vital organs can’t be overcome.

Tocilizumab is another immunosuppressant drug that is being used in trials to treat the coronavirus. Because President Trump hasn’t mentioned it, you’re hearing almost nothing about it, and no one is writing angry op-eds about it.

In Order to Get Through This, We Need to Be Able to Handle Bad News

“Embrace the suck” is a military slang term meaning, “The situation is bad, but deal with it.”

One of the recurring points in discussing this virus over the past — ugh, has it only been three months? It feels like three years — has been American culture’s difficulty in accepting and processing bad news and responding to it. We don’t want the situation to be so terribly bad, so we either flatly insist that the situation can’t be so bad, or we look for any sign that the situation might not be as bad.

In January, we saw many inaccurate reassurances that Americans should be more worried about the common flu than this new virus that emerged in Wuhan, China. Back on January 30, former Obama White House health advisor Dr. Ezekiel Emanuel told CNBC: “Everyone in America should take a very big breath, slow down, and stop panicking and being hysterical. We are having a little too much histrionics on this.” (Now Emanuel believes that Americans will not return to large events until “fall 2021 at the earliest.”) And Emanuel was far from alone in his assessment that the coronavirus was not much of a threat.

In reading the debates about the virus and how to handle the ongoing outbreak, you get the sense that some people placed bets early on and are determined to see those early assessments turn out right. Some people insist that because the CDC’s website has the official death count at 39,910 that the more commonly cited numbers from Johns Hopkins or Worldometers must be a widespread, sinister effort to overstate the virus’ toll. Never mind that right there on the CDC website, at the bottom, it says, “data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.”

I can’t begrudge someone for recoiling from the thought that more than 71,000 Americans have succumbed to the virus. But that doesn’t mean that a smaller number must be the more accurate one, particularly when the source tells you that the data are incomplete. And for everyone reading this who jumped out of their chair eager to write me about the factors that could be contributing to an undercount or overcount, I wrote about them in the Corner yesterday.

Reopening Society with Manageable, but Still Existent, Risk

By the way, as much as I enjoy reminding Ezekiel of his terribly wrong early assessments, he’s also willing to tell the New York Times that a functioning American society requires some acceptance of some level of risk:

Bazelon: Should we make reopening school the highest priority, even though there are going to be trade-offs, and maybe some increase in deaths?

Emanuel: Well, I think as long as teachers can opt in and administrators can opt in and parents can opt in. Maybe I’m crazy, but I think a lot of parents would consider it and be willing to run some risk to themselves.

He’s not crazy — or at least not on this particular point.

With no enthusiasm, I contend that the United States is going to have to enact some version of the evolving plan laid out by Lanhee Chen, Bob Kocher, Avik Roy, and Bob Wachter; with additional contributions from Mark Dornauer, Gregg Girvan, and Dan Lips. (I keep calling it “the Avik Roy plan” because I know him.)

I’m not going to lie to you. This plan stinks. It just happens to stink less than all of the other options. The Avik Roy plan assumes we can’t create a vaccine in the coming year, we can’t test everyone as often as we would like, and that we won’t get a miraculous treatment that mitigates the danger of the virus.

You should read the whole thing — a shorter version was in the Wall Street Journal — but here’s probably the most controversial decision: 

To start, states and localities should work as quickly as possible to reopen pre-K and K-12 schools. Children have a very low risk of falling seriously ill due to Covid-19, and the majority can and should return to school this academic year. Switzerland, for example, is planning to reopen schools on May 11, based on research showing that school closures were among the least effective measures at reducing European Covid-19 cases.

Children who live with the elderly or other at-risk individuals should continue to stay home. Teachers and staff from vulnerable populations should stay home as well, with paid leave. School districts should immediately begin to develop virtual lesson plans for those who must remain home.

(Keep in mind, some state government officials are already saying that distance learning may continue at the beginning of the school year in late August and early September.) The plan continues . . .

Similarly, we should reopen workplaces to healthy, non-elderly individuals who don’t live with vulnerable people. At-risk individuals with jobs should continue to have opportunities to work from home or to receive paid medical leave.

If you’re wondering about whom the plan means when they say “at-risk individuals” . . .

Individuals between the ages of 40 and 65 should consider continuing to stay home if they have any underlying conditions that make them more susceptible to death or hospitalization with COVID-19, such as cardiovascular disease, high blood pressure, diabetes, severe asthma, chronic obstructive pulmonary disease (COPD), kidney failure, severe liver disease, immunodeficiency, and malignant cancer. It is worth noting that a large percentage of the over-40 population has one of these conditions, and so it will be essential to monitor COVID-19 cases over time for evidence that helps us narrow the categories of risk, and also evidence regarding the relationship between positive antibody tests and immunity.

That’s a lot of Americans to leave working at home, continuing social distancing, avoiding groups, parties, and strangers more or less indefinitely.

But some version of this is probably going to be the least-bad way to establish a sufficiently reopened society and economy, while protecting those most at risk to succumbing to the virus.

ADDENDUM: Maybe it’s just me, because I’m hip-deep in medical journals these days, but . . . is anyone else periodically forgetting that Joe Biden is running for president? Like, “Oh yeah, this is a presidential election year, I forgot about that . . .”

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.

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