Pandemic Journal (# 1): Kristof and Osterholm Analyses

Sunday morning’s news outlets reported that worldwide there now are over 300,000 persons who have contracted the coronavirus disease (COVID-19)  and at least 12,944 have died of this infection while the U.S. statistics are more than 24,300 cases and more than 370 deaths. My State of Minnesota has 169 confirmed cases and its first death while the state’s most populous county (Hennepin with the City of Minneapolis), where I live, has  57 confirmed cases and no deaths.

This blogger has decided to periodically post his reactions to living through this pandemic.

This first post will focus on some of today’s overall perspectives from those who know about what is happening: Nicholas Kristof, a New York Times columnist, who has talked with a lot of experts, and Michael Osterholm, now at the University of Minnesota as Regents Professor, McKnight Presidential Endowed Chair in Public Health, the Director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School.[1]

Other posts will discuss other important developments in the crisis as well as his personal reactions to these problems.

Kristof’s Analysis[2]

One of the most disturbing Sunday articles was by Nicholas Kristof, who set forth what experts are seeing as the “worst case” and “best case” for the U.S. in March 2021, one year from now.

Worst Case

“More than two million Americans have died from the new coronavirus, almost all mourned without funerals. Countless others have died because hospitals are too overwhelmed to deal adequately with heart attacks, asthma and diabetic crises. The economy has cratered into a depression, for fiscal and monetary policy are ineffective when people fear going out, businesses are closed and tens of millions of people are unemployed. A vaccine still seems far off, immunity among those who have recovered proves fleeting and the coronavirus has joined the seasonal flu as a recurring peril.”

The U.S. “badly bungled testing, and President Trump repeatedly dismissed the coronavirus, saying it was ‘totally under control’ and ‘will disappear,’ and insisting he wasn’t ‘concerned at all.’ . . .The United States has still done only a bit more than 10 percent as many tests per capita as Canada, Austria and Denmark.”

“By some counts, the United States is just eight days behind Italy on a similar trajectory, and it’s difficult to see how America can pirouette from the path of Italy to that of South Korea. The United States may already have 100,000 infected citizens — nobody knows. That’s too many to trace. Indeed, one can argue that the U.S. is not only on the same path as Italy but is also less prepared, for America has fewer doctors and hospital beds per capita than Italy does — and a shorter life expectancy even in the best of times.”

“Mitre, a nonprofit that does work on health care, calculated that coronavirus cases are doubling more quickly in the United States than in any other country it examined, including Italy and Iran.” Two experts’ models suggest “that up to 366,000 I.C.U. beds might be needed in the United States for coronavirus patients at one time, more than 10 times the number available.”

Therefore, the U.S. “should be urgently ramping up investment in vaccines and therapies, addressing the severe shortages of medical supplies and equipment, and giving retired physicians and military medics legal authority to practice in a crisis.” But that is not happening. Moreover, the U.S. “isn’t protecting health workers with the same determination” as China did after its initial failure to do so.“In the worst-case scenario, will social services collapse in some areas? Will order fray? Gun sales are increasing, because some people expect chaos and crime.” The U.S. “is in a weaker position than some other countries to confront the virus because it is the only advanced country that doesn’t have universal health coverage, and the only one that does not guarantee paid sick leave. With chronic diseases, the burden of these gaps is felt primarily by the poor; with infectious diseases, the burden will be shared by all Americans.”

Best Case

“Life largely returned to normal by the late summer of 2020, and the economy has rebounded strongly. The United States used a sharp, short shock in the spring of 2020 to break the cycle of transmission; warm weather then reduced new infections and provided a summer respite for the Northern Hemisphere. By the second wave in the fall, mutations had attenuated the coronavirus, many people were immune and drugs were shown effective in treating it and even in reducing infection. Thousands of Americans died, mostly octogenarians and nonagenarians and some with respiratory conditions, but by February 2021, vaccinations were introduced worldwide and the virus was conquered.”

According to Dr. Larry Brilliant, an epidemiologist, “The best case is that the virus mutates and actually dies out.” Another expert,  Dr. Charles G. Prober, a professor at Stanford Medical School, agreed. Two other lethal coronaviruses, SARS and MERS, both petered out, and that is possible here. “My hope is that Covid-19 will not survive.”

“Several countries have shown that decisive action can turn the tide on Covid-19, at least for a time.” This especially is true for Singapore, Taiwan, South Korea and Hong Kong that “responded with the standard epidemiological tool kit: vigilance and rapid response, testing, isolating the sick, tracing contacts, quarantining those exposed, ensuring social distancing and providing reliable information. They did not shut down their entire countries.”

It is possible that the U.S. and other Northern Hemisphere nations soon will experience warmer weather that will dampen the coronavirus as was true with two of the four other coronaviruses.

“There is hope that some antiviral medicines currently in clinical trials will be successful.”

Finally there is hope that “the coronavirus may be less lethal than was originally feared, so long as health care systems are not overwhelmed.”

Yet another expert, “Dr. Tara C. Smith, an epidemiologist at Kent State University, summed up all of these considerations: ‘I’m not pessimistic. I think this can work.’ She thinks it will take eight weeks of social distancing to have a chance to slow the virus, and success will depend on people changing behaviors and on hospitals not being overrun. ‘If warm weather helps, if we can get these drugs, if we can get companies to produce more ventilators, we have a window to tamp this down.’”

Our Responses

“This crisis should be a wake-up call to address long-term vulnerabilities. That means providing universal health coverage and paid sick leave.”  The coronavirus legislation adopted last week does not do that. “It guarantees sick leave to only about one-fifth of private-sector workers. It’s a symbol of the inadequacy of America’s preparedness.”

“More broadly, the United States must remedy its health priorities: We pour resources into clinical medicine but neglect public health. . . . The United States has a decentralized and spotty public health system, and it has endured painful budget cuts, yet historically public health has saved more lives than clinical medicine.”

Osterholm’s Perspective[3]

U.S. Difficulty in Appreciating Risk of Pandemics

First, the U.S. government and citizens “had almost this sense of invincibility that we had a border that would not allow such infectious-disease agents to penetrate … . We, of course, know that is folly. A microbe anywhere in the world today can be anywhere in the world tomorrow.”

Second, “we tend to lack creative imagination. {Yet those ]who knew health care knew that health care [had been] carved down to the bone for which there was no resiliency of any substantial nature, no excess capacity, no monies to stockpile large volumes of protective equipment.”  In addition, there has been “no real understanding of the vulnerability of this country outsourcing all of its drug supply manufacturing to places like China.”

Third, “I think it’s human nature to not want to believe this” risk.

This January Osterholm wrote a notification for the CIDRAP leadership forum, saying, “ “I now am absolutely convinced this is going to be a pandemic. This will be a worldwide epidemic. We will see major transmission around the world. And what has happened in Wuhan [China] will happen in other places.” But this warning had no impact on U.S. policies.

 U.S. Needs ‘New Normal’

 U.S. and others need to find a new normal, a way to live with COVID-19. We “can’t shelter in place for 18 months. This isn’t going to work.” Instead, we need a national goal.

We must “make every effort to … protect those most vulnerable. And we [need to] continue to emphasize social distancing, … [and] keep the hospitals from being overrun. We [must] keep doing that until we get a vaccine. . . . It won’t be perfect. Some people will get sick, some may die.”

“People are really concerned. They’re scared … but they’re not panicking. They want straight talk.” They want the truth, and they are not getting it from the Trump administration.

“[A recent British scientific paper] said crowd size really makes no difference. We really have no data on crowd size. Their modeling says we have to have contact … that if you shook hands with all 50,000 people in an arena, you got a problem. But if you didn’t, the risk of transmission is not nearly as great as people think it is. We also don’t have good data that we have major transmission in schools from kids to kids and that they take it home to Mom and Dad.”

“Singapore did not close schools. Hong Kong did. We saw no difference. . . . {On the other hand,] I do know it makes a difference in saving lives in a hospital when you take out 20% of nurses, doctors, respiratory therapists who can’t work because they’re at home [to watch their kids]. I know that is a risk in putting grandparents in so that some can keep working.”

He is hopeful about some new potential treatments for COVID-19, such as chloroquine, that are being studied, but that, he says, is not a strategy.

Conclusion

As a retired lawyer in his 80’s with no experience or expertise on these global health issues, I concur in Professor Osterholm’s assertion that others and I want the truth from our government and national and local leaders. That truth will include admissions that they do not yet know certain important factors, that they are investigating those issues in a focused, disciplined, scientific manner and that the rest of us need to follow developments in the pandemic and follow the straightforward instructions: wash your hands frequently and carefully, maintain at least six-feet social distancing with other people and do not join groups of (10?) or more people. As noted above, other posts will explore my personal reactions to all of this situation.

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[1] Osterholm also currently holds, and has held, other important positions in this field and is the co-author of “the 2017 book, Deadliest Enemy: Our War Against Killer Germs, in which he not only details the most pressing infectious disease threats of our day but lays out a nine-point strategy on how to address them.” (CiDRAP, Michael T. Osterholm, PhD, MPH.)

[2] Kristof, The Best-Case Outcome for the Coronavirus, and the Worst, N.Y. Times (Mar. 20, 2020).

[3] Burcum, Coronavirus pandemic: What’s ‘normal’ now? What’s next? An interview with Michael Osterholm, StarTribune (Mar. 22, 2020). /

 

Declining U.S. Rankings in Important International Socio-Political Indices

There are many international rankings of socio-political characteristics of the countries of the world. Here are at least six in which the U.S. ranking is declining.[1]

Freedom of the Press Index. The U.S. ranking has declined from 41 in 2016 to 48 in 2019in this index by Reporters Without Borders. Despite the importance of freedom of press in the First Amendment to the U.S. Constitution, the U.S. this year is behind all of Europe, Australia, Canada and New Zealand as well as far below Papua New Guinea and right below Romania.

This Index is “determined by pooling the responses of experts to a questionnaire devised by RSF [Reporters Sans Borders]. This qualitative analysis is combined with quantitative data on abuses and acts of violence against journalists during the period evaluated. The criteria evaluated in the questionnaire are pluralism, media independence, media environment and self-censorship, legislative framework, transparency, and the quality of the infrastructure that supports the production of news and information.”

Human Development Index. This index from the U.N. measures life expectancy, education and per capita income. For the most recent year (2018), the U.S. is 13th behind most of our European friends, Australia and Canada.

Level of Corruption Index. Compiled by Transparency International, this Index for 2018 (the most recent year) has the U.S. as 22nd in 2018 with a score of 71/100 versus 18th in 2016. The U.S. is far below Denmark, Sweden, Australia and Canada as well as below Estonia and just a little less corrupt than the United Arab Emirates and Uruguay.

The U.S. along with Brazil and the Czech Republic was listed as a “country to watch” in 2019. According to Transparency International, “With a score of 71, the United States lost four points since last year, dropping out of the top 20 countries on the CPI for the first time since 2011. The low score comes at a time when the US is experiencing threats to its system of checks and balances as well as an erosion of ethical norms at the highest levels of power.”

Income Inequality Index.  The Gini Coefficient measures perfect equality as 0 and perfect inequality as 1. In the mid-1970s the U.S. had a coefficient of 0.406 and in the mid-2000s as 0.486. Other reports of this Index by the CIA had the U.S. at 39th with a score of 0.450 (2017) while the World Bank said 59th with 0.410 (2013).

Global Peace Index. This Index is produced by the Institute for Economics and Peace (IEP) as the world’s leading measure of global peacefulness. This report presents the most comprehensive data-driven analysis to date on peace, its economic value, trends, and how to develop peaceful societies.” From a ranking of 124th in 2018, the U.S. has declined to 128th out of 163 in 2019.

Social Progress Index. This ranks countries by their average score for scores for three broad dimensions: Basic Human Needs, Foundations of Wellbeing, and Opportunity. For 2019 the U.S. had a score of 84.78 for a ranking of 25 out of 146 countries after declining since 2014. All of the G7 countries are ahead of the U.S. in health and education.

Conclusion

These indices are examples of contemporary efforts to reduce complex socio-political phenomena to digital numbers and thereby enable the construction of tables and rankings. Theoretically one could make a detailed analysis of the assumptions and sources of the data used to make these tables and rankings in order to make an informed conclusion about the validity of the indices. But the overall conclusion of these indices that the U.S. is not Number One would be shocking to many Americans.

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[1] Kennedy, The U.S. Is Falling, World View (Summer 2019) ;Reporters without Borders, World Press Freedom 2019; UN Development Programme, Human Development Indices and Indicators (2018) Transparency International, Corruption Perceptions Index 2018 ;World Bank, GINI Index (World Bank Estimate)–Country Rankings; CIA, Distribution of Family Income—GINI Index ;Institute for Economic and Peace, Peace Index 2019; Social Progress Imperative, Social Progress Index (2018); Kristof, Keynote Address, American Oxonian (Winter/Spring 2018).

 

Cuba Pays $60 Million of Indebtedness to Major Creditor Nations     

The week of October 15 Cuba paid $60 million of indebtiness to 14 wealthy creditor nations. Last year Cuba paid $40 million to the same group. The total debt is $2.6 billion after the creditors in 2015 forgave $8.5 billion of $11.1 billion upon which Cuba had defaulted through 1986 plus charges.[1]

These creditor nations known as the Club of Paris are the following: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Italy, Japan, the Netherlands, Spain, Sweden, Switzerland and the United Kingdom.

Under the 2015 agreement, Cuba agreed for the first time to grant the creditors equity in development projects, in areas like manufacturing and agriculture, in exchange for a portion of their debt holdings. Many of these restructuring agreements include the establishment of so-called counter-value funds, under which a percentage of debt is discounted in exchange for the potential profits stemming from participation by a creditor country’s firms in Cuba joint-development projects.

The counter-value funds have an estimated combined value of around $750 million of the $2.6 billion owed. Japan, Spain, France and Italy – Cuba’s largest Paris Club creditors – are furthest along in negotiating swaps.

  • For example, a $46 million French project to develop cattle ranching and dairy products in central Camaguey province is ready to sign, according to France’s ambassador to Cuba, Jean-Marie Bruno.
  • Another example is Spain which has a project ready to manufacture cardboard and another aluminium structures for construction capable of resisting earthquakes and hurricanes, both involving Spanish companies.

This access to Cuban development projects gives the European countries and companies an advantage over U.S. companies who are banned by various U.S. laws from such projects.

This payment happened during dire economic times for Cuba due to the political and economic crisis in its ally Venezuela, declines in Cuban exports and tourism due, in part, to the damages caused by Hurricane Irma.

Cuba’s payment in these circumstances showed the importance Cuba attaches to the 2015 agreement with this group of major creditor nations.

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[1] Reuters, Cash-Strapped Cuba Makes Debt Payment to Major Creditors-Diplomats, N.Y. Times (Oct. 18, 2017); Chow, Cuba Reaches Deal to Pay $2.6 Billion in Arrears to Paris Club, W.S.J. (Dec. 12, 2015); Paris Club, Agreement on the Debt Between Cuba and the Group of Creditors of Cuba (Dec. 12, 2015).