The Morning Jolt

U.S.

Bad News Abounds

Speaker of the House Nancy Pelosi speaks to news reporters ahead of a vote on the coronavirus relief bill on Capitol Hill in Washington, March 25, 2020. (Tom Brenner/Reuters)

Today is the Morning Jolt I’ve dreaded writing, because the news is almost entirely bad. The Senate economic relief bill is passed, but much later than it should have been; the first coronavirus-related attempted terrorist attack occurs in Missouri; far too much bad news from our nation’s hospitals; and an important note about CPAP machines.

Most Kidney Stones Pass Faster and Easier Than This Economic Rescue Bill

The Senate passed the relief bill. If you’ve been listening to The Editors or Three Martini Lunch, you’ve heard me argue that speed matters a lot more than getting the bill perfectly right in this circumstance. If taxpayer money ends up in the hands of those who don’t need it, some of those people will donate it to causes that do need the money; and if they don’t, there are ways to claw back the money later. Heck, raise taxes on the highest incomes if you have to in a year or two if you have to, but don’t let the current crisis get worse over the fear that somebody somewhere might get a check they don’t need.

I could even see a theoretical argument for taxpayer money going to the Kennedy Center, as that institution employs a couple thousand people — including not-so-wealthy folks such as ticket-booth operators, ushers, janitors, stage hands, set workers, etc. — and right now no one is buying tickets to see any shows. Then again, if you think about institutions who probably have enough generous wealthy supporters to get them through a hard time, the Kennedy Center has to be up near the top. The top institution would probably have to be Harvard University, with its $40 billion endowment; the school has chosen to lay off dining hall employees. Harvard’s president and his wife have both tested positive for coronavirus. The only silver lining is that this has spurred one good joke: “If you thought the coronavirus was insufferable now, wait until it starts bragging about getting into Harvard.”

The important thing was to get the money out the door as quickly as possible. For many people, rent or the mortgage is due on the first day of the month. The money in this bill will not get there in time. The good news is that some states and localities have temporarily suspended evictions — but nowhere near all. And those restrictions are very temporary. In Pennsylvania, it is until April 3; in Virginia, it is until April 6; in Illinois until April 8. If you’re a small business owner whose previously steady income has suddenly dropped to near-zero, the outlook for May doesn’t look so good right now, either.

Each day that the money doesn’t arrive, more businesses are forced by the lack of business to lay off their workers. More are forced to close their doors. Restaurants realize they can’t get by on the much more limited income from take-out and delivery. Bars can’t survive on take-out drink orders. You think anyone is buying a car these days? How many people are having home remodeling or other projects done? Retail was already getting kicked in the teeth by online shopping before most of the nation’s governors ordered them to close their doors. We have slammed the brakes on almost every part of our economy besides health care, grocery stores, and essential government services. Even during the Great Recession, consumer demand declined and dwindled, but it didn’t suddenly disappear one day. Even Thanos left half the world’s consumer demand in place.

It is an unprecedented economic crisis that requires an unprecedented response. This morning, we learned that 3.2 million Americans filed for unemployment insurance, by far the highest on record ever. California is seeing about 100,000 residents per day file for unemployment. State websites for claims can’t handle the incoming traffic.

All of the usual policy priorities needed to take a raincheck at least for now, if not for the duration of the crisis.

It seemed not enough people on Capitol Hill seemed to realize this, and the worst offenders appeared to be Representative Jim Clyburn, House speaker Nancy Pelosi, Senate Democrats as a whole — “voting en masse Sunday night against the coronavirus bill they helped negotiate” — Bernie Sanders, and Alexandria Ocasio-Cortez. All of them, at one point or another, either delayed or threatened to delay passage of the bill because of their pre-coronavirus policy priorities. They saw a moment of leverage for their personal legislative priorities and felt they could strongarm the Republicans into agreeing. They believed, with understandable confidence, that every media institution would quickly rewrite headlines such as “Democrats Block Stimulus Package” into “Partisan Divide Blocks Stimulus Package.” A lot of conservatives want to believe that congressional Democrats lost this fight. I’m not so sure.

But what made the usual wrangling, leverage battles, and games of chicken over this bill particularly galling is . . . there’s another relief bill coming right after this. Congress is going to be passing bills to help Americans from the CoronaRecession for months, maybe into next year. Any policy goal that wasn’t directly tied to the coronavirus could easily wait until next month, or summer, or autumn, or next year.

Oh, and separately, today is Pelosi’s 80th birthday.

Our First Attempted Coronavirus-Related Terrorist Attack

We have our first case of coronavirus-related terrorism. “A domestic terrorism suspect in Belton, Missouri who allegedly planned to carbomb a hospital struggling with the coronavirus pandemic died while the FBI was trying to arrest him Tuesday, the agency confirmed. It is currently unclear whether FBI agents shot him or how he died.” (Is “carbomb” now a verb?)

This country has a lot of garden-variety homegrown extremists, radicals, and lunatics. We’ve already had cases of nutjobs deliberately coughing on strangers and claiming they’ve given their victims the virus. (According to the U.S. Department of Justice, people who do this can be charged with making a terrorist threat because the coronavirus is considered a ‘biological agent.’)

We have a contagious viral outbreak that is genuinely scary and stressful to even the calmest, most rational, even-keeled people out there. Now put people in a situation where they have to keep their distance from everyone except their immediate family to avoid spreading the coronavirus — a formula for “going stir crazy” behavior. Now add state and local officials shutting businesses down and enforcing quarantines, curfews, and other restrictions right out of the most paranoid fantasies of the radical militia groups.

Bad situation, right? And this isn’t even contemplating the possibility of hostile states attempting to exacerbate our tensions or attempt their own attacks at our time of greatest tension.

You see how bad things are? I haven’t even gotten to the actual coronavirus yet.

Lots of Bad News, and an Important Note about CPAP Machines

New York City’s ICUs are expected to fill up by Friday. Governor Cuomo says the state’s hospitals are on the verge of running out of ventilators. Medical personnel in their 40s are succumbing to coronavirus. Virus testing lines are stretching down the block. Refrigerated trailers are being brought in to handle the number of corpses. What seemed unthinkable is now here; the city looks like something out of a zombie plague movie or video game.

New Orleans could well turn into the next epicenter after New York. One reason is the fact that the city went through with Mardi Gras — lots of people crowded together; other reasons are that “heart disease, respiratory conditions, physical disability, diabetes, and obesity — all risk factors for death from COVID-19 — are more prevalent in Louisiana than in other parts of the country. In New Orleans, many people live in close quarters, making social distancing almost impossible.”

ResMed, one of the manufacturers of CPAP devices, reached out about Tuesday’s Morning Jolt, which mentioned the U.S. Food and Drug Administration’s declaration that “machines typically used for treatment of sleep apnea (either in the home or facility setting) may be used to support patients with respiratory insufficiency provided appropriate monitoring (as available) and patient condition.”

The short version is that while those machines could work, those machines have to be modified — and for now, ResMed is converting to making the kinds of machines better suited for treating COVID-19.

Carlos M. Nunez, M.D., chief medical officer at ResMed:

FDA guidance the weekend of March 21, 2020 suggests to manufacturers of respiratory equipment, that modifications to devices capable of providing modes of ventilatory support that may be clinically applicable for COVID-19 patients, can be considered if it would not create undue risk for patients – the FDA guidance does not suggest that CPAPs can be used as is today to treat the respiratory symptoms of COVID-19. The FDA still requires the modifications to be made in a manner that is consistent with existing safety, quality and manufacturing standards.

ResMed is currently exploring options for achieving this. However, converting in-market CPAPs to support more advanced modes of ventilation requires careful assessment to ensure risk is acceptable, and must meet labeling requirements set forth by FDA. While we are exploring our options, we are also converting the manufacturing resources typically used for PAP devices to support manufacturing bilevel and non-invasive ventilation devices that are more suited to the care of COVID-19 patients, and today are ramping up production of invasive-capable and non-invasive ventilators to double normal levels, while working closely with the U.S. government and other government agencies to assess their needs.

Just as you shouldn’t start eating fish tank cleaner because of a particular drug, you probably shouldn’t use a CPAP machine to treat a coronavirus patient, unless you’re a doctor and you know what you’re doing.

ADDENDUM: In the middle of all this bad news, I had a nice chat with Teri Christoph of the Smart Girls Podcast, which you can listen to here. It’s part of their series, “The Isolation Interviews.” . . .

. . . I’m sure everyone is looking for little bites of normalcy. I found a bit for a few hours yesterday, cooking shrimp and gnocchi. If you’re feeling stressed, try doing something that involves a different part of your brain and body than you usually use. Concentrating on something else will force all of the depressing and worrying thoughts out of your head, at least for a while.

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