US Between Scylla and Charybdis Covid-19
Politics / Pandemic Apr 03, 2020 - 12:44 PM GMTBy: Richard_Mills
I’m just going to come right out and say it: The United States is not equipped to deal with a pandemic. The nation of 327 million, despite having the number one economy in the world, and by far the most powerful military, is shockingly ill-prepared, not only in terms of having the proper supplies to fight the hard-to-kill coronavirus, but also regarding its lack of focus, its dearth of leadership, and perhaps most failingly, its inability to mobilize a population against a common viral enemy.
On Monday, US stocks rallied, due to traders optimistic over efforts to deliver rapid testing of the coronavirus, and multinational Johnson & Johnson announcing a potential vaccine candidate.
Prompt and widespread testing in other countries, like South Korea, has been effective in curbing the spread of covid-19. But the US testing regime has proved woefully inadequate. There are not nearly enough test kits available, it took too long to start testing, and the kits have been slow to deliver results to an anxious population.
The new test from Abbott Laboratories can apparently produce results in a few minutes, and is designed for use in hospitals, doctors’ offices and urgent care clinics. The Chicago-based company will start distributing the test kits this week and plans to ramp up manufacturing to 50,000 tests per day.
Clearly that is good news.
However the stock market rally implies that the coronavirus can be beaten by a new vaccine and/or “instant” test whereby everybody, including those who show no symptoms, can be tested, separating the healthy from the sick so the able-bodied can go back to work and the infected are quarantined.
The reality though, all the medical experts are saying, is that with the outbreak in the United States so far advanced, to flatten the curve will require a full shutdown. Half measures will not be enough.
How we got to this dire point and what could come next are the questions addressed by this article.
Half measures
“Between Scylla and Charybdis” is an apt way of describing the two equally difficult ways of fighting the coronavirus, the US must choose between. The expression comes from Greek mythology, where Odysseus, the traveling hero of Homer’s epic poem ‘The Odyssey’, must take a route between Scylla, a six-headed monster, and the whirlpool Charybdis.
Does the country bend to the collective will of the medical community, and go for an all-out lockdown of the economy, in every county of every state, even though it would surely precipitate another, certainly worse market sell-off and push the economy even further onto its knees? Or can the US avoid that, by fixing the problems with the coronavirus response - by getting enough masks, gowns and ventilators for its over-worked, exhausted front-line workers, plus put a vigorous testing regime in place, something that should have been done weeks ago, thereby flattening the curve without flat-lining the economy?
Whichever path is chosen, it must be done properly. If the powers-that-be in the White House and Congress don’t follow the “preventative” route of aggressive testing, of bulking up the army of front-line health workers, of getting them the proper equipment, the ranks of these workers will be decimated, and more people will die. A scarcity of ventilators will lead to judgment calls by intensive care physicians, whether to intubate patients or let them succumb to the disease, alone in quarantine - horrible decisions will have to be made. On the other hand, if a full-on lockdown is not done right, there will be massive community spread and the same outcome will result: more patient and health care workers will die because people are being sent to hospitals that are understaffed and underequipped.
Dr. Anthony Fauci, the country’s leading expert on infectious diseases, and a member of the White House’s coronavirus task force, says a middle-of-the-road estimate is between 100,000 and 200,000 Americans could die from covid-19. As of this writing, the United States has nearly 20,000 new cases, out of 163,479 total infections, and 3,148 deaths - of which 565 are new.
What’s troubling to us, at AOTH, is that many important decision makers in the United States believe the way to stop coronavirus without killing the economy is to follow President Trump’s flawed logic of letting off on the restrictions, while allowing more business activity, even though doing so would likely accelerate the number of covid-19 cases.
Trump famously said he expected church pews to be full on Easter Sunday, just one of several statements the unconventional, often anti-science president has made, based on hunches and limited reasoning.
Desperate to re-start the economy - up to a month ago his ticket to re-election in November - Trump has remained focused less on steeling the public for its worst pandemic of modern history, than on defending his political image by claiming personal credits and attacking any form of criticism.
Over the weekend, however, the real-estate tycoon turned commander-in-chief acknowledged things had turned for the worse - the death rate doubling from Thursday to Sunday - forcing him to extend social distancing guidelines from April 15 to April 30.
Bizarrely, on Sunday he referenced the probable death of 100,000 patients as a kind of victory, admitting that keeping large swaths of the economy shuttered could prevent the deaths of 2.2 million or more:
“If we can hold that number down ... to 100,000, it’s a horrible number, maybe even less ... we all, all together have done a very good job,” Trump said.
Meanwhile, as the US covid-19 map darkens, ominously reflecting climbing infections, some elected officials are having to make macabre calculations, figuring out how many deaths are acceptable, weighed against millions of jobs lost and trillions worth of foregone economic output.
Minnesota Governor Tim Walz has a plan to clamp down on commerce and social activity for now, but re-open the state for business by May 4. According to Reuters, Walz is imposing a strict “stay at home” order for two weeks, then a relaxed version for a few more weeks, “to give hospitals the time to prepare.” The Mid-Western state could see 2.4 million infections, models predict, and 74,000 deaths if there are too few hospital beds and a shortage of ventilators.
Testing problems
Others believe that ramping up testing people for coronavirus could allow for a re-opening of the economy. The Reuters article has Trump advisor Stephen Moore stating that testing might allow the States to replicate South Korea’s success in reducing infections, without halting its economy.
The Northeast Asian nation’s response, however, differs from America’s in a fundamental way: it implemented nation-wide testing within days, not months of the outbreak appearing on its shores. Another Reuters article states:
South Korea rolled out widespread testing within days, launching an extensive program to test people who do not have symptoms but may be able to infect others, isolate confirmed patients and trace their contacts.
The country won praise for containing the spread of the disease with comparatively little disruption. It has 9,583 cases and 158 deaths, and managed to bring the daily tally of new infections to about 100 or fewer for the past three weeks.
Much of the program’s success is down to a team of experts at the Korea Centers for Disease Control and Prevention (KCDC), who developed an algorithm to find the pathogen, as well as testing techniques, as early as Dec. 17, when a South Korean family contracted pneumonia after a trip to China. The first coronavirus patient appeared in Korea a month later.
Its testing methodology was approved on Jan. 4, three days before Chinese authorities had even identified the virus, and by early March, the country was able to run up to 20,000 tests a day, using five firms that manufactured the test kits for domestic use and export.
Contrast the efficiency of Korea’s response to the United States, where a lack of planning and restrictions that barred testing people without symptoms, that may yet have the virus, and people returning from overseas flights, worsened the situation.
In a comprehensive article about the testing protocol’s failures, New Yorker magazine explains how problems began on Feb. 5, 16 days after a Seattle resident who had visited Wuhan, China, was confirmed as the first case of covid-19 in the United States.
New test kits developed by the Centers for Disease Control would have allowed 50,000 patients to be tested, and much faster than previously, because specimens would not have to be sent first to Atlanta to be evaluated.
When the kits arrived at state or local labs, however, many of them didn’t work; the problem was with the reagents. Until new reagents could be manufactured, the decision was made to test for covid-19 exclusively at the CDC, at a time when the labs most needed the tests. The New Yorker states:
[T]he three-week delay caused by the C.D.C.’s failure to get working test kits into the hands of the public-health labs came at a crucial time. In the early stages of an outbreak, contact tracing, isolation, and individual quarantines are regularly deployed to contain the spread of a disease. But these tools are useless if suspected cases of a disease cannot be tested. The void created by the C.D.C.’s faulty tests made it impossible for public-health authorities to get an accurate picture of how far and how fast the disease was spreading. In hotspots like Seattle, and probably elsewhere, covid-19 spread undetected for several weeks, which in turn only multiplied the need for more tests.
“Once you’re behind the eight ball, it’s very hard to catch up,” Alberto Gutierrez, the former head of the F.D.A. Office of In Vitro Diagnostics and Radiological Health, which regulates tests, told me. “The problem was that containment was not done very well. At this point, we’re looking at exponential growth, and we need to figure out how to meet an exponential demand.”
The Guardian notes the Trump administration rejected an offer of test kits by the United Nations, as far back as January 31, in favor of developing its own, which as we know, turned out to be faulty. The administration promised millions of test kits would be available, which turned out to be a lie.
There was also favoritism. Within three days at the beginning of March, the CDC managed to test just 77 people in the US, while the Utah Jazz basketball team alone managed to test 58 people. In Washington State, which at the time had the most cases in the country, test kits had to be rationed.
On March 28 the CEO of Roche, the first company to win the FDA’s approval of a test kit, told CNBC that “Demand continues to be much higher than supply,” despite the company delivering over 400,000 kits thus far, and that “the reality is that broad-based testing is not yet possible.”
The turnaround time for tests at outpatient clinics and ERs is currently running from four to seven business days. Another problem, is the demand for worldwide testing, has led to shortages of chemicals (reagents) needed to process the tests, including at hospitals like SUNY Downstate medical center in hard-hit New York, NPR reported.
In Canada, some labs are facing a testing backlog due to diminishing supplies of reagents.
“Testing is the biggest problem that we’re facing,” confirmed Peter Slavin, president of Massachusetts General Hospital, during a recent roundtable on covid-19 at Harvard Medical School, via Harvard Business Review. Slavin says that while South Korea has tested around 4,000 people per million, the US has run only 5 tests per million, despite both reporting their first cases at the same time, on Jan. 20 and 21.
HBN emphasizes testing is valuable not only for identifying who is infected, where the infection occurred, and how the virus was transmitted, but for making decisions about patient treatment and resource allocation, such as how many ventilators are needed in which hospitals.
Essential workers faltering
Of course, all the testing in the world won’t help contain the outbreak if there is not a staff of trained workers at the ready to receive covid-19 patients, gowned up with protective gear including N95 masks, goggles, face shields and ventilators. By now everyone has seen the images on television of front-line hospital workers having to make do with scarves wrapped around their necks and gowns fashioned out of garbage bags.
There is increasing evidence that hospital employees are being pushed to their limits, many are working without proper equipment, and more and more are falling sick.
The upshot? There may soon be a shortage of health care workers to treat patients hit with the spiraling number of coronavirus cases. A few excerpts from an article on this topic run March 26 by Vox, demonstrate the point with alarming alacrity:
With the number of confirmed Covid-19 cases in the US expected to soon surpass anywhere else in the world, the medical workforce is more strained than ever. Doctors and nurses are reporting gear shortages, lax protocols, and a high level of stress in their workplaces — with the worst still to come. Some of them told Vox that they consider getting infected with the coronavirus an inevitability.
Staffing problems are already becoming acute in New York City, the epicenter of the US pandemic so far with more than 20,000 cases and approaching 300 deaths, as of March 25. City officials were not able to provide any numbers on how many medical workers there have tested positive for Covid-19, but doctors work in fear for their own safety.
If too many doctors and nurses get infected themselves and can’t care for patients, or if hospitals lay off workers because they are losing revenue with many of their other operations on hold, the health system’s capacity is going to deteriorate even further.
Doctors and nurses may have a higher chance of getting seriously ill from the coronavirus if they do get infected. The numbers from the initial Wuhan, China, outbreak indicate 15 percent of the roughly 1,700 Covid-19 cases for medical personnel as of mid-February were critical or severe. Five had died.
“The burden it’s placing on our hospitals, with the lack of equipment — we feel ill-prepared for it,” said Stefan Flores, an assistant professor of emergency medicine at Columbia University in New York City.
“It’s like showing up to war with a knife at this point. I don’t know if I am going to have a mask the next day,” Flores said. He keeps two or three masks in a bioprotective bag at the end of the workday, washing it and preventing it from being soiled, because he doesn’t know when they’re going to get more. He leaves them in a designated section of his apartment.
An ER doctor in Pennsylvania told Vox that as hospitals face personal protective gear shortages, incomplete protection from exposure means more doctors and medical staff out sick. That will lead to worse outcomes overall for coronavirus patients.
Front-line health workers aren’t the only workers being hit hard by covid-19. There are also the thousands of emergency personnel who must be healthy to reliably transport patients, attend emergencies, fight crime and continue all their regular duties, which often involve close interaction with the public, amid quarantines and lockdowns.
In New Jersey, 163 police officers had tested positive for coronavirus as of Sunday, with 1,272 under quarantine across the state. In New York city, on Monday, 14% of its police, 5,000 officers, called in sick. The New York City Fire Department has only a few weeks worth of protective gear left and the number of infected currently stands at 46.
"Our calls continue to grow," Fox News reported FDNY Commissioner Daniel Nigro, saying. "They have been ratcheting up for the last few weeks. And, of course, many of them are for respiratory issues. Not all of them are for this COVID-19 virus but many of them are."
Back in Canada, six Toronto firefighters have tested positive for the virus.
In an earlier article we reported how food producers are worried about how international travel restrictions will prevent migrant workers from traveling out of their home countries, places like Mexico and the Caribbean, to work at fruit/ vegetable farms and slaughterhouses of developed countries.
The problem is fast becoming an issue, as spring planting time in the Northern Hemisphere nears.
Another concern is grocery supply chains being weakened by workers falling ill from the virus. Last week, Sanderson Farms reported the first case of a worker at a major US meat producer testing positive for covid-19. BNN Bloomberg said the employee and six more were sent home to self-quarantine. Another case has been confirmed at Smithfield Foods, the world’s biggest pork producer, in South Dakota. The news outlet states:
The infections speak to a growing threat to the world’s food supplies. Massive operations where workers pick berries together, cut meat side-by-side on a production line or load warehouse trucks in sometimes close proximity risk slowing down. Some facilities may have to shutter for cleaning and worker quarantines. Produce could end up rotting in fields if there aren’t enough healthy workers.
“If we can’t flatten the curve, then that is going to affect farmers and farm laborers -- and then we have to make choices about which crops we harvest and which ones we don’t,” said Al Stehly, who operates a farm-management business in California’s North San Diego County, growing about 250 acres of citrus crops, 250 acres of organic avocados and 60 acres of wine grapes. “We hope no one gets sick. But I would expect some of us are going to get the virus....”
At many meat-processing plants, workers are “essentially elbow to elbow,” said Thomas Hesse, president of United Food and Commercial Workers Union Local 401, the largest private sector union in Western Canada that represents 32,000 members, mostly in food processing and retailing. Though employees are usually wearing protective gear, the risk of contagion is difficult to completely eliminate.
In Vermont, some dairy farmers have made arrangements for milking cows if they become sick. A plea for volunteers through social media has signed up 80 volunteers as back-up milkers.
Replacing farm labor even temporarily could be tough. Research by Zero Hedge reveals that luring people into the food processing industry may not be as easy as it sounds, especially as the government is mailing people checks specifically to prevent them from going to work. Wages in the industry are generally low and the labor is described as "back-breaking".
National lockdown
Having run through the alternatives, and given how far up the coronavirus curve the United States has traveled, with yet no signs of a peak, we conclude that a national lockdown is the only way to stop the virus from spreading in as short a time frame as possible, in order to both prevent people from getting sick and dying, and to plug the gaping hole in economic losses that is hemorrhaging more money and workers, and market values, by the day.
How to do it? As we see it, the best way, really the only way, at this point, is for the government to pay people to stay home. Yes, we know this will worsen the economy. It has to. But the economy is already in tatters.
While second-quarter data has yet to come out, and we fully expect it to break records for its severity of losses, very possibly a quarterly GDP decline not seen or likely to be seen in a generation, we can get an informal picture of economic output essentially stopping, courtesy of satellite imagery and company photos. Shots of grounded airplanes, a desolate Miami beach in March compared to its normal bustle in November, and empty parking lots at Google’s and NASA’s headquarters in Mountain View, California provide three examples.
Yes, the economy looks bad now, and a national shutdown, say for a month, would obviously make it worse, but the government needs to take a really big dose of foul-tasting medicine, think of it as a Buckley’s formula times 327 million, in order for the whole country to feel better, beat the coronavirus and get back to normal.
We’ve shown you that half-measures won’t work - with hundreds of thousands infected, it's too late to begin widespread testing, even with a test that only takes five minutes to register a result. Most of the world’s protective equipment, and medicine, is made in China. Some US companies, on the President’s orders through the Defense Production Act, have begun re-tooling factories, like auto plants, to manufacture masks and ventilators. Can these facilities do enough and in time to slow the relentless march of coronavirus? I don’t like their chances.
Meanwhile the people who matter most to helping patients infected with coronavirus are falling prey to the illness themselves. How long before they are furloughed in such large numbers as to prevent hospitals from making people well again? When not enough firefighters are available to cover shifts? When cops aren’t showing up to work to police cities whose crime rates are increasing - like break-ins at shuttered small businesses? When grocery chains, their suppliers’ farm & meat processing plant workers quarantined en masse, are having trouble getting fresh and canned goods to stores in the volumes demanded by consumers relegated to eating at home?
Further to the point, we advocate a national lockdown because it works. China has proven it. On Feb. 10, China reported 2,478 new cases of covid-19. Two weeks later, World Health Organization experts said the number had fallen to 409 cases, a drop of nearly 98%.
“China has rolled out perhaps the most ambitious, agile, and aggressive disease containment effort in history,” the WHO report states. How did they do it? By locking down the epicenter city of Wuhan and nearby cities in Hubei province - effectively putting at least 50 million people under mandatory quarantine for a month.
Quarantining the 10 most populous US cities would only account for about half of the 50 million China was able to isolate from the general population.
Contact tracing, the practice of tracking down those who came into contact with a patient, was another critical part of the Chinese response. The government sent an army of health care workers to Wuhan, where over 1,800 teams of five traced tens of thousands of contacts, who were followed up on to self-isolate.
Pay them to stay home
In a previous article we discussed the $2 trillion emergency aid package – the largest in US history – on which White House and Senate leaders struck a deal last week - to help absorb the economic hit from covid-19.
While the $1,200 checks doled out to every American will certainly help the 3.3 million Americans who filed for unemployment insurance last week, we argued that the stimulus is similar to the Great Recession bailout that did nothing for the little fella, drafted as it was, by self-serving politicians and geared towards their corporate paymasters.
The politicians holding the purse strings are singing hymns from the same prayer book they used in 2008-09 - that is, get the consumer to spend, spend, spend, in order to get economic growth moving again.
But the consumer is holed up at home, the power to earn a living regulated by governments whose normal functions have been usurped by covid-19.
What they most want is for consumers to go back into debt, thereby filling the pockets of bankers, who hold the real power in America.
Instead of issuing checks in an amount that for most Americans would not even cover one mortgage payment, and offering half a trillion dollars in loans to distressed businesses, including $50 billion to the airline industry which, we remind readers, squandered the opportunity to prepare for the pandemic by spending $43.7 billion since 2012 on stock buybacks (which also enriched insiders who sold stock at an artificially inflated share price, pocketing enormous profits), the government should just pay people directly to stay home.
We know that many of the people who are facilitating community spread of the coronavirus are employees or small-business owners who can’t afford not to work. Make it easy for them to self-quarantine, hang onto their health care benefits (by paying those too), and avoid a disruptive layoff, which also creates a problem for their employer in replacing him/ her.
It sounds radical, and prohibitively expensive, but it’s not. Remember, China locked down 50 million people in a month. If America really wanted to, it could do it, by imposing martial law, accessing FEMA emergency relief funds, and tasking the Fed to print trillions of dollars that go directly to the people who need it most, not to corporations whose likely response to the bailout will be to buy back shares, or issue dividends to shareholders, not re-hire laid off employees.
We aren’t the only ones thinking this way. A recent op-ed in the Wall Street Journal, penned by a Harvard professor, argues that Desperate times need extreme measures—and only in the face of the new coronavirus does it make sense for the federal government to send money directly to every American. Cash payments are the most direct way to reduce the economic harm that lockdowns will inflict on the one-fifth of workers employed in vulnerable service industries.
Another opinion piece in the Washington Post asserts that, the legislation is a good first step, but it may not go far enough: we should be prepared to make larger direct payments, to expand unemployment insurance further and to provide direct rent relief.
In short, we should pay people to stay home — and pay handsomely. Why? Because such a strategy works to stop an epidemic. Efforts to stabilize the “economy” must be structured to reinforce public health measures. We cannot make it a “sacrifice” to stay home under quarantine. We need to make staying home the lucrative option. If that seems too expensive to you, weigh it against the death of millions. The choice should be obvious.
Conclusion
The richest 400 Americans now control more wealth than the bottom 60% - it’s the greatest rich-poor divide since the 1920s.
A 2019 report by McKinsey Global Institute piles on more evidence of inequality getting worse. While the consulting firm notes the gap between developed and developing economies is shrinking, particularly with the rise of China and India, in many advanced economies, the trend is for the rich to pull away from the middling and the poor.
The current coronavirus stimulus program, worth a staggering $2 trillion (for perspective, that is about two years of deficits - every year the federal government adds a trillion dollars to the $23 trillion pile of national debt), is aimed at getting consumers and businesses to borrow more money, further enslaving them into debt servitude. It does little for the average Joe and Jane, something that could be rectified by funneling all that money into paying people directly, to stay at home.
Of course, it’ll never happen. Such a notion to many Americans on the right of the political spectrum smacks of socialism. Conservatives are already complaining that expanding unemployment insurance will encourage workers to stay out of the workforce and drag down the economy (yeah, right, how many employees would rather be paid a fraction of their wage for any extended period?)
What they most want is for consumers to go back into debt, thereby filling the pockets of bankers, who hold the real power in America.
The way I see it, we are heading towards another reckoning in North America (inequality in Canada is also growing), regarding the gap between the rich and the poor. It was already a tinderbox waiting for a match; the spark that ignites it just might be the crisis we now find ourselves in, that some are predicting could be twice as bad as the Great Recession.
What happens when their 1200 bucks runs out, when their unemployment benefits are done, and people realize they have once again been duped by the corporations, funded by the banks, who have no intention of rehiring laid-off employees, when share buybacks and insider selling continues, revealing even worse inequality than before coronavirus?
Now consider all of this is happening as the weather begins to heat up. Picture tens of thousands of unemployed, in major US cities, too poor to move elsewhere, to social distance, not even able to afford air conditioning. As the sweltering, fetid US summer nears, with one in three, or more, unable to work and pay their bills, we see social problems developing on a massive scale.
Last week there was outrage on social media when billionaire tycoon David Geffen, co-founder of Dreamworks, posted photos on Instagram of the $590 million yacht he is “quarantined” on. His “stay safe” message below drips with sanctimony:
The Red Cross is warning riots could be imminent in low-income neighborhoods, unprepared and without a cash buffer, who see extreme wealth equality getting worse amid the economic downturn which could easily, if it carries on long enough, rival the severity of the Great Depression.
On Monday, Amazon workers in Staten Island, New York, and Instacart’s grocery delivery workers nationwide walked off their jobs, demanding better protections against the coronavirus and higher pay.
This is what happens when we carry on as usual - letting the bailout be concentrated on corporations and banks rather than the people who need it most, who are failing to self-isolate, self-quarantine and social distance, who are going to work rather than staying home, because they have to, as the virus continues to spread, hospitals run out of equipment and front line health workers/ emergency workers/ farm laborers drop dead.
There is a better way, and we’ve explained what it is: lock the country down for a month, pay everybody to stay home, pay their health care benefits too. It’s extremely tough medicine to swallow especially in entrepreneurial America but failing to do so could lead to dystopian consequences nobody wants to envision.
By Richard (Rick) Mills
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