Monday, April 20, 2020

OUR PANDEMIC(S)

OUR PANDEMIC(S)

We are in the midst of a pandemic. 

As of today, on a worldwide basis, over 2.4 million people have been diagnosed with coronavirus or Covid-19.  Of those, approximately 636,000 have recovered, leaving about 1.6 million active cases. More than 166,000 people have died.  In the United States, there are approximately 764,000 cases, 652,000 of which remain active.  Over 40,000 people have died here.  The United States leads the world in diagnosed and active cases and in the number of deaths. In the most-infected state -- New York --  242,000 cases have been diagnosed and almost 14,000 have died.

In Europe as a whole, their number of diagnosed cases exceeds ours, as do their number of deaths. But Germany, which did early testing, a form of contact tracing and quarantining, has kept its death total (4,600) low relatively speaking and on average has also had far fewer cases than the worst states in Europe -- Spain and Italy.  For the same reason, South Korea had similar success, as has Singapore. The latter was truly effective, having turned testing and tracing into a  fatality rate of less than 1%.

In New York, the number of new cases appears to have flattened, as is the case in California and Washington state.  This does not mean there are no new infections or that the contagion has been contained.  It does mean that, barring resurgence, there will be enough hospital beds to take care of patients that emerge going forward.  And it also is evidence that social distancing and quarantining works.

There is a growing concern that the economic devastation from the pandemic will exceed the physical devastation.  Over 22 million Americans are now unemployed, the rate having gone from a low of 3.5% to estimates now putting it at levels of the Great Depression in the 1930s (or over 20%). The recently passed stimulus package provides up to $1200 to individuals; the amount declines as your annual income closes in on $100,000 and ends at that level.  The stimulus package also provides $350 billion in loans cum grants to small businesses as so-called paycheck protection; last Thursday, however, that fund was exhausted and no new applications could be accepted.  The package contains $150 billlion for state and local governments, $100 billion for hospitals, $58 billion for commercial airlines, over $400 billion for the Federal Reserve, and $20-30 billion each for farmers, ranchers, schools  and food programs.

Despite the enormity of the package, it is widely considered inadequate to the ultimate need.  Brandeis Prof. Robert Kuttner estimated that we would need a package on the order of 25% of GDP to get throught the crisis, which would require roughly quadrupling the current assistance.  He bases this on what it in fact took to catapault America out of the Great Depression. NY's Gov. Cuomo has already explained that the amount his state is getting under the current package is nowhere near what has been and will have to be spent.  And the jockeying on Capitol Hill has already begun around talk of additional legislation, with Republicans holding back and Democrats demanding more.

Part of the calculation, of course, is that the amount of ultimate government assistance necessary to the task will inevitably depend upon when America can get back to work and what that will look like whenever it happens.  The administration has proposed a set of guidelines that would implement re-opening in three phases, each tied to satisfying so-called "gating criteria" beforehand.

In Phase One, schools, daycare facilities, camps and bars would remain closed, as would visits to hospitals or senior living facilities, but  large venues like restaurants, movie theatres, sport venues and churches could operate with "strict distancing protocols", as could gyms. In Phase Two, the closed facilites (schools, daycare, camps, bars) reopen, the last with "diminished standing room occupancy", and the strict distancing protocols become "moderate" in the large venues.  And finally, in Phase Three, the distancing requirements become "limited" and employers regain full access to their worksites.

The gating criteria require that cases decline for continuous fourteen day periods prior to entering each phase.  Under the plan, states are responsible for testing and contact tracing of their populations,  sufficient equipment (ventilators, PPE, etc.), sufficient hospital capacity (defined as the ability to treat "without crisis care"), the "ability to surge ICU capacity", and "robust" testing for at-risk health care workers.  States must have  plans to protect workers in critical industries, those in high-risk facilities like nursing homes, and employees and users of mass transit.  They must also be able to "monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase."

None of the states hard hit by the pandemic have anywhere near the ability to do the testing and tracing required to determine on a continuous months long basis that cases have declined, that no new infections have emerged, and that no resurgent outbreak has occurred, the latter of which is almost certain in the event that any "phase" is entered into prematurely or the virus itself is seasonal.  In addition, and as has been demonstrated throughout the pandemic, the states hardest hit have regularly confronted shortages in needed protective equipment.  Though the predicted run on ventilators never materialized, that was only because governors imposed stay-at-home orders and social distancing protocols that flattened the curve of new cases and lessened the run.

The policy is quintessential Trump.  It is high on optics but otherwise shallow and insufficient if the goal is to actually solve the problem and re-open the country without renewing Covid-19's lease on life.  The key to implementing the policy is testing and contact tracing and Trump has decided that this must be the responsibility of the states.  The states, however, have told him they do not have the capacity to do the job. The result, therefore, will be a swiss-cheese approach where states decide to go forward (or not) based on incomplete data in the face of the apocalyptic twins of physical disease and/or economic depression.  To avoid the latter, they will risk the former, or vice versa.

The policy is also quintessential Trump in that it allows him to claim credit and apportion blame without accepting any responsibility.  If a state reopens and avoids a resurgence, he can claim his guidelines were the solution.  If, however, a state reopens and the coronavirus is resurgent, he can claim the state lacked the resources they should have had in place beforehand.  Similarly, if a state does not reopen or others reopen faster, he can claim that the resulting economic hit is also the responsibility of governors who did not adequately prepare.  None of his claims will be true because the lack of preparedness, and in particular the absence of sufficient testing capacity, was itself caused by Trump's early denial that there was any problem.

But truth never matters to him. 

Neither in his personal life.

Nor his professional one.

Meanwhile, his absurd show goes on.

Early last week he announced, czar-like, that he was the public offcial with the ultimate authority to determine if and when any state could relax its emergency protocols and return to work.  This was nonsense, essentially because it is not the law.  On Thursday, however, when he announced the guidelines, he reversed himself, telling the nation's governors that they "would call the shots" on  re-opening.  Unfortunately, he also made it clear that the states themselves would be responsible for insuring that there was adequate testing and then claimed, falsely, that such capacity in fact existed. 

Finally, on Friday, as far-right activists in recent weeks sponsored rallies in a half dozen states demanding an end to stay-at-home orders, Trump launched his all caps "liberate" tweets, seen by the protestors as a Presidential call to arms.  His "LIBERATE  MINNESOTA" tweet that morning was followed in the afternoon by a few hundred pro-Trump protestors packed tightly on the sidewalk outside the governor's residence yelling "USA". Underscoring their demand that the quarantine end, one protestor hoisted a sign that said "If ballots don't free us bullets will."

The call to violence was not unique. 

A QAnon conspiracy theorist with 50,000 twitter followers called for armed insurrection after Trump's liberate tweets, as did a thousand other tweets from a host of on-line extremists. A comment to Trump's "LIBERATE VIRGINIA" tweet said the time was now for insurrection to "earn our freedom . . . like our forefathers did in 1776."  And one of the organizers in Minnesota specifically predicted that "violence . . . will happen. People in our culture are not designed to obey these kind of orders."

It's not entirely clear what specific "orders" annoy them to the point of armed insurrection. The stay at home requirements incident to quarantining obviously qualify, but it is not clear that distancing, masks  and bans on group gatherings of more than ten are not equally offensive.  The Minnesota protestors who crowded onto the sidewalk outside the governor's house were more than happy to shout their epitaphs sardine-like from the street, their mouths unmasked,  and the "culture" whose "design" is  at odds with the orders they loathe includes baseball and football, where packed stadia will become petri dishes of death if opened too soon.

Trump knows he is validating these groups and that they are essentially advocating a return to the status quo ante either immediately or without regard to whatever science may tell them.  But they, like Trump, have no respect for government or science, and he is willing to feed them the red meat they need to remain loyal.  Apart from last week's "guidelines", his signature moves on Covid-19 thusfar have been to blame China (which deserves it), vilify the World Health Organization (WHO) (which doesn't), and attack Democratic governors for the testing and equipment  failures of the government Trump himself is supposed to be running. To that trilogy he has now added inciting/supporting the nut-job and violent far-right.

My college friend and long-time ABC television journalist John Donvan recently noted that, unlike past crises such as 9/11, Covid-19 was not uniting America.  He's right.  There's been no rally round the flag effect.  Trump's guidelines come across as buck passing, fourteen pages of putative instructions to individuals, employers and states that cannot be implemented absent testing capacity the federal government could and already should have put together but hasn't. His daily (and lengthy) press conferences are campaign performances where he routinely attacks journalists, disclaims responsibility, and lies. 

And the citizenry, not surprisingly,  has retreated to its respective red and blue silos.  

America is a nation of myths.

There's the founding myth in which We the People rose up as a whole to throw off the yoke of British colonialism.  There's the governing myth in which the people democratically determine their fate in a land where all are created equal.  There's the economic myth where rugged individuals get ahead in a free market whose only limitation is one's capacity for work. And there's the cultural myth of exceptionalism where we are uniquely moral beacons of progress and virtue.

Each of these myths has within it a kernel of truth. 

But only a kernel.

18th century colonists did declare independence and then wage a war of attrition where British exhaustion and the timely arrival of the French fleet in the Chesapeake Bay turned the world upside down  at Yorktown. But on the way there, and at any one time, somewhere between 40 and 70 per cent of those-to-be-liberated were either rooting for the other side or did not care who won.  Similarly, the famous Declaration did declare as "self-evident" the "truth"  that "all men are created equal". But its authors owned slaves or prospered in economies that relied on slavery at some level, and when it came time in 1787 to create a government, that corruption was more more than respected; it was accepted. 

Going forward, for every rugged individual who spawned the likes of Carnegie and  Rockefeller, Jobs and Gates, there was the pauper, the wage-slave, the unemployed and the uninsured.  And for every moral beacon, every Gettysburg, every moon shot,  there was an abject moral failure, a Cherokee Trail of Tears, a Klan, a coup, a casting couch.

Sometimes our myths are confirmed.

Sometimes they are are refuted.

Which, unfortunately,  is what we are doing now.

Because red and blue, the unbridgeable division in which we now live, the one which our President has decided to actively advance as his only available avenue to reelection,  the one that makes it impossible to act rationally because we are too busy arguing irrationally, is its own pandemic.  

And it's killing the founding myth of unity, the governing myth of equality, the economic myth of prosperity, and the cultural myth of moral exceptionalism.

There truly is no Republican or Democratic approach or solution to this Covid-19 crisis. The notion that we have to be guided by science and data, and that we have to hang together lest in Franklin's prescient warning we wind up doing so separately, is inarguable.  

Dumb and divided has never won a war.

And any effort to play regions or states off against each other, to force them into a price-gouging competition  for scarce resources, to fail to unleash and exploit the power of the federal government to provide the tools neeeded to manage and conquer the crisis, or to set things up so that the finger of blame can be pointed at one or the other party for any death or depression that may ensue . . .

Will not win this one.




Monday, April 6, 2020

HIDING BEHIND IGNORANCE

HIDING BEHIND IGNORANCE

Ignorance is bliss.

Or so the saying goes.

But for longer than I can remember, I have thought the precise opposite.

Knowledge is power. 

The truth shall set you free. 

Thanks to the scientific method, we have discovered more and learned more than any humans who came before.  From the wheel to the internet, travelling first the highways and by-ways of cleared paths and wooden planks, then of cobblestones and macadam, and ultimately of mere ether, we've been able to produce more and exchange more and communicate more and  know more . . . than any before.

Things that would, and in fact did, lay prior generations low have been discarded in the dustbin of history.  The microscope gave us germ theory and made soap and water, basic sanitation, our first and often most effective defense against disease.  The telescope gave us the laws of gravity and then of relativity, which more or less explains light and electromagnetism and, if that's too abstract for you, allows satellites to take us home. 

That's right.

The GPS in your car could not exist without Einstein.

Ignorance, the absence of knowledge, often the intention to never pursue it, is horror, the horror that stokes fear and  famine, abuse and neglect, suffering and pain . . . 

And death.

Yet it persists.

It has to be, it seems to me, more than an inherent disposition.  It's certainly not the case that we humans are omniscient, so arrogance in the wake of the accomplishments made possible by science is not the right attitude.  Even the scientific method abhors that.  In fact, it demands the precise opposite, a rational skepticism that makes all hypotheses testable and disprovable. The idea, in other words, is not to turn the Newtons and Einsteins . . . and Dr. Faucis . . . into modern day gods. If a claim is tested and rebutted, no PhD can make it true.

And people know this. 

Right?

So what is Donald doing?

Every day now, generally between the hours of 5 and 6 pm, the doors to the White House briefing room swing open and the President of the United States enters with a supporting cast and holds forth for upwards of two hours.  These press briefings are themselves the product of cornonavirus.  Before the pandemic, Trump's go to venue was the "rally", where a swarm of like-minded Trumpists were regaled for  hours by a stream of consciousness chest-thumping and litany of insults against all opponents, perceived and real; at his last two, on February 28 and March 2, Trump called coronavirus the new Democratic "hoax" during the first and falsely claimed he had always taken the disease "seriously" at the second.  Once the rallies became  impossible,  Trump took to the briefing room, where he has otherwise been more than scarce for the last three years.

At these briefings, all the usual Trump-tics are on display.  Questions he dislikes become vehicles for attacks, often vicious, on the press.  Pre-written statements are read, generally in a way (i) that makes it clear he is reading them for the first time and (ii) with odd pauses (and an allergy to punctuation) that allow him to insert random editorial comment. 

Sometimes what he says is accurate.  On Sunday, for example,  he reported that the available models suggested the next two weeks would be the worst. Other times, however, he is in a la-la land located somewhere between denial and displeasure.  The former is in evidence as he (falsely but repeatedly) proclaims the test shortage solved (today he even falsely claimed that anyone coming off a plane is being tested), the latter as he waffles from hyping the need to get back to work lest the cure be worse than the disease to admitting that we are in this for the long haul.  Easter has been mentioned so often as a target (or aspirational) re-open for business date that comedians now confess surprise he hasn't decided to just move the holiday and take it up with Jesus (or His Dad) later.

There's also a Wizard of Oz element to these events.  The strings in this case are members of his supporting cast, there to prop-up the man behind the curtain (or presidential seal).  A la Toto, however, the curtain/seal is often pulled back as various interlocutors reveal the reality behind it.  Often times, Dr. Fauci comes forward to either deliver hard scientific facts or take the edge off one of Trump's more ludicrous pronouncements (it was Fauci, for example, who turned Trump's Easter rising into a mere "aspiration", quelling the nerves of millions who thought April 12 might end the world as we know it). 

Last week, again lifitng the Oz-like curtain, Trump's guy Friday, Jared Kushner,  proclaimed that the  federal stockpile of medical equipment (ventilators, masks, gowns and drugs) was "our stockpile" and not "the states'" for them to "use".  And yesterday, after again suggesting the use of hydroxychloroquine to combat the virus, but no doubt wary of one behind-the-curtain scene too many, Trump himself refused to allow Dr. Fauci to be asked about the drug's efficacy.

Both Kushner's comment and Trump's suppression were astounding.

The former revealed a stunning lack of either knowlege of or appreciation for the purpose of any federal stockpile of medical supplies. Contra Jared, it is to be used precisely in situations like this, where states are confronted with a crisis, the scope and cause of which extends far beyond their borders and for which they lack sufficient capacity.  

Neither Trump nor Kushner have retracted the statement, all of which has convinced the commentariat that the President's politcal plan here is to blame the states for the country's overall lack of preparedness.

Good luck with that.

Especially when the virus hits the states that voted for him.

As it now has. 

In droves.

As to the silencing of Dr. Fauci, it is a warning light blinking red.

Had Dr. Fauci been allowed to speak, he undoubtedly would have repeated what he has often said in the past.  As an anti-viral treatment for this case, hydroxychloroquine has not been fully tested, has not been proven effective even against other viruses like the flu, is known to have potentially fatal side effects, especially for those with heart problems, and has to remain available to treat diseases against which it is efficacious.  The notion, as Trump puts it, that we "have nothing to lose" if the drug is used here is not remotely accurate.  There may be a lot to lose, especially if it is given to the wrong patient, and testing protocols are literally the only way that prospect can be avoided. 

This does not mean the drug should be side-lined until a years-long approval process is completed.  It does mean, however, that the President should shut up and let medical professionals do their job.  They can decide if and when to take the extraordinary step of recommending the drug for a coronavirus patient.

What Trump doesn't get, and has never gotten, is that -- whether they should or shouldn’t, even now, and even after three years experience -- his words matter.  This isn't a TV show.  It's real.  A lot of people (still) think they can rely on the President.  The couple in Arizona who self-administered an apparent variety of hydroxychloroquine certainly thought so; indeed, one of them said so.

The other is dead.

As are many who heard Trump tell them in January and February that this whole Covid-19 thing was much ado about nothing, a political "hoax". 

Back then, he said we'd all "be fine", that the virus could go away "miraculously" in April when the weather warmed a bit. 

Now, having failed to do the early testing, identifying and quarantining that could have contained the crisis in ways no longer possible,  we are living a latter-day version of Eliot's Waste Land, where hundeds of thousands are expected to die and April truly is "the cruelest month".

The notion that "ignorance is bliss" was actually borne from a poem by Thomas Gray, an 18th century English poet.  In his "Ode on a Distant Prospect of Eton College", Gray recounts the innocent pleasures of childhood and contrasts them with the inevitable pain of much that lies ahead.  In that world, the child's world, where "ignorance is bliss/'Tis folly to be wise".

That is the world of Donald Trump, our man-child president.

And, ironically, it is also the  defense he and his seconds mount against attacks on his most outrageous nostrums. 

When asked why he persisted in painting a rosy picture of Covid-19 back in January and February, or why he constantly mentions the idea of an earlier return to normal, his recurring Easter-vision as it were, or even why he shut up Dr. Fauci yesterday, some version of Gray's bliss is always embraced. 

On the early comments, say his defenders, he was trying to convey optimism in the midst of uncertainty, a sort of  Alice-like move where saying so either makes it so or at least takes the edge off.  On the Easter re-opening, it "would be a beautiful thing", said Trump,  hundreds packed into churches scattered throughout the land living a veritable second resurrection in celebration of the first. And on silencing Fauci yesterday,  the President basically argued that -- in  answering the hydroxychloroquine question for, as Trump put it, "the fifteenth time"-- the doctor would have turned the bliss of  hoped-for cure into the  bane of uncertain reality.

The irony here  is that Trumpists would flirt with anything suggesting a juvenile disposition. Babies, afterall, do whine and kids often lie.  Nevertheless, in Trump's world, "ignorance" really "is bliss" and it really is "folly to be wise".  For the rest of us, who actually grew up, it's just folly.

One would have thought that the Founders, those illuminati who gave us the Declaration of Independence and the Constitution and who otherwise had such a clear-eyed view of the foibles of human nature, would have created some sort of protection on this front. 

And in truth they tried. 

They required that anyone be at least thirty-five years old to qualify for the presidency.  Back then, when the life expectancy of an average male was forty-seven, this was a reasonably safe age to pick, old enough to be wise but young enough to last.  Most of the Founders, moreover, were pretty young  themselves.  The average age of the signers of the Declararion was forty-four and a dozen were younger than thirty-five.  And ten years later, when they wrote the Constitution, they hadn't turned into wizened gray heads (and any whose were had likely been powdered).

In Federalist No. 64, John Jay explained that the Founders wanted as President only those who "have become the most distinguished by their abilitites and virtue, and in whom the people perceive just grounds for confidence."  He claimed that "The Constitution manifests very particular attention to this object", and then explained that by "excluding men under the age of thirty-five . . .  it  confines the electors to men . . .  with respect to whom they will not be liable to be deceived by those brilliant appearances of genius and patriotism, which, like transient meteors, sometimes mislead as well as dazzle."

Oh well, no one in the 18th century could have known that their era's transient meteor would be  our era's television reality show host with an unbridled twitter feed.  In fairness, moreover, the Founders, according to Jay, also thought that limiting the presidency to those over thirty-five would insure that "the people have had time to form a judgment" about those running for President, that in having been given enough time to be  forewarned, they would necessarily be forearmed.  We, of course,  had more than twice the time they prescribed  to take in the Donald so . . .

Nothing's perfect.

And, by the same token, ignorance sometimes is bliss.  Children should be protected. At the expense of maturation or development or, worse yet, parental love, it is always folly to make them wise. 

Even for adults, ignorance can be, if not blissful, at least useful. The renowned Harvard philospher John Rawls suggested his famous "veil of ignorance" as a way for us to objectively think about distributional justice.  What would you suggest as a fair distribution of the world's goodies, Rawls asks,  if you couldn't assume you'd be who you are, born when you were, to whom and with whatever they had and could provide?  What kind of society would you create if you did not know, and could not assume,  your own place in it?

Maybe Trump should try that on.

Rawls's veil of ignorance.  

Something the President could use to think.

Rather than hide behind.

He'd at least have to tell Jared to cut out the "his" stockpile crap.