Month: March 2020

New Yorkers won’t be getting coronavirus at work…

by philg

… they’ll get it while shopping at Whole Foods instead, according to my friends there.

Last night I managed to FaceTime with some friends who live in Greenwich Village. They’re locked down in a 19th floor 4BR apartment with a 20-year-old daughter home from college, a boy who is a high school junior, and a daughter in her last year of middle school.

Thus far, the online education efforts of New York Public Schools consist mostly of homework assignments. There is little attempt made to provide instruction via video.

The family leaves the apartment only every other day for a walk outside. The kids are on Zoom with their friends all day, but do not socialize with other children in person. The primary coronavirus exchange points in NYC right now seem to be grocery stores. Mask-wearing is not that common for either customers or staff. In this family’s opinion, at least, whatever spreading of the virus that would have happened if New York had kept the office buildings open is occurring just as effectively in the grocery stores. Whole Foods in their neighborhood is crowded enough for a disease to spread.

In their opinion, it would be much smarter in New York had kept its economy going, but given everyone a mask and gloves for use in public.

Related:

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If All Lives Have Equal Value, why does Bill Gates support shutting down the U.S. economy?

by philg

The Gates Foundation‘s main message is “All Lives Have Equal Value” (secondary message: send $billions in Microsoft profits over to Africa without it ever being taxed!).

Bill Gates is a righteous opponent of Donald Trump’s hopes to reopen the U.S. economy. From The Hill:

Asked about suggestions being floated in the U.S. about relaxing social distancing measures to avoid severe economic damage, Gates said there is “no middle ground” between the virus and the cost to businesses.

Gates, who did not mention Trump in the interview, said that “it’s very irresponsible for somebody to suggest that we can have the best of both worlds.”

Are these positions consistent? If some of the most pessimistic epidemiologists are correct, shutting down the U.S. economy might save a few hundred thousand American lives. For this to be true, the virus has to thrive in hot/humid weather, the Army Corps of Engineers has to be incompetent at setting up field hospitals, all drug therapy attempts have to fail, etc. But maybe all of those worst-case assumptions will be correct.

For every saved American, though, aren’t we guaranteed to cause more than one death in a poor country? The U.S. is 15 percent of the world economy. Our shutdown is going to make us poorer so we’ll buy less from the world’s poorest countries. People in those poorest of countries who were at a subsistence standard of living in 2019 are going to be without sufficient funds for food, shelter, and medicine in 2020. Even citizens of medium-income countries, e.g., those who work in industries that are tied to trade with the U.S., might be unable to afford previously affordable life-saving medical interventions.

So if Bill Gates actually believes that All Lives Have Equal Value, shouldn’t he be saying “keep the the U.S. economy open, sweep up any dead bodies, and keep buying stuff from countries where they desperately need the cash”?

[Update, 4/9: I have supplied this post to friends on Facebook who are most zealous regarding “saving lives” via a U.S. economic shutdown. Although in pre-plague times these same people were generally huge advocates for “thinking globally” and advocating for the vulnerable anywhere on Earth, they are hostile and confused when told that their shutdown might be an inconvenience or worse for someone in another country. It has proven to be an interesting window into the logic of the American Righteous. Planet Earth is exquisitely interconnected such that bringing a reusable shopping bag to the Columbus Circle Whole Foods will stop global warming and thus keep the seas from inundating Jakarta. On the other hand, we can stop trading with a country where people are living on $2/day and there will be no adverse consequences for those people.]

Related:

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Are roommates in Manhattan and San Francisco ready to kill each other?

by philg

“Shelter in place” orders may be a bit unpleasant for the typical American suburban family or those Americans wealthy enough to have their own apartments. But what about for densely packed roommates in our cities where housing costs far outstrip median incomes?

Consider four young people in New York City who are sharing a $3500/month two-bedroom apartment. On entering this arrangement they may have said “I don’t really need to know or like these other people because I’m never going to be here. I work 10 hours per day and then I’m out in the city until bedtime.” Now they’re together with these virtual strangers 24/7.

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Will New York run out of hospital beds?

by philg

As noted in “About 2.5 percent of Boston hospital beds occupied by COVID-19 patients”, it is tough to find out the information that is most relevant to a worried individual, i.e., how full are the hospitals? (and, therefore, will they run out of space/beds before I need one?).

New York is the epicenter of the U.S. epidemic. The “how full” percentage can be teased out of a CNBC article from yesterday:

New York coronavirus cases continue to surge, topping 37,258 on Thursday as the state scrambles to find enough hospital beds and ventilators to handle the coming onslaught of patients, Gov. Andrew Cuomo said.

More than 5,300 residents have already been hospitalized and the state is projecting that will climb to 140,000 over the next two to three weeks, he said. At least 1,517 people have been discharged, he added.

In other words, there are about 3,800 COVID-19 patients in New York hospitals right now. What’s the capacity? A separate web search yields the answer: 57,261. So roughly 6.6 percent of New York’s hospital beds are occupied by COVID-19 patients.

The situation is described in our media as a crisis, e.g., “13 Deaths in a Day: An ‘Apocalyptic’ Coronavirus Surge at an N.Y.C. Hospital”. Maybe that’s not an exaggeration, though. If the system into which we pour 17 percent of GDP (maybe more like 25 percent in 2020!) was already stretched, perhaps the breeze of 6.6 percent additional demand blew it over.

Will the surge of 140,000 show up? If these are mostly in the same week that would certainly be ugly in a state with 57,261 hospital beds (the president that New Yorkers hate is sending one of the Navy’s two hospital ships to NYC, but that will add only 1,000 beds). But why do they have to stay in New York? U.S. case statistics show that Pennsylvania has only 2,218 cases (1/20th as many as New York) and 42,817 beds. Even if coronavirus were to affect all states equally it won’t affect them all at the same time, right? Could this be a case where diversity is our strength? Prepare some ambulance buses to take 10-20 patients at a time to wherever there is significant excess capacity, even if that is across a state line. If Pennsylvania ever does get into a Wuhan-on-the-Hudson scenario, New York’s peak demand will be over at that point and New York hospitals can return the favor by taking Pennsylvania residents in.

Related

  • World Bank data on hospital beds per 1,000 people (Japan and Korea at more than 13; Germany at 8.3; France at 6.5; Spain, Italy, and the U.S. around 3)
  • As of today, we have no idea what the prevalence of coronavirus infection is in the U.S. Out of every 100,000 people we have tested fewer than 600 (nytimes). This is not a random sample either, but typically people who are hospitalized (or elites with the sniffles!).
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Tokyo Olympics 2020 T-shirts will be discounted or valuable collector’s items?

by philg

Tokyo 2020 has fallen victim to coronavirus. What happens to all of the T-shirts and other gear printed with “Tokyo 2020”? Will these be valuable collector’s items for those with a black sense of humor? Or discounted and/or shredded in favor of “Tokyo 2020 in 2021” (they’re still trying to call it “Tokyo 2020”?)?

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Invest in Estonian-style e-governance to be ready for the next plague?

by philg

Quite a few Boston-area businesses have shut down their physical offices. Employees of Amazon, for example, are working from home. Towns and cities, however, can’t close down their respective Town Halls and City Halls because the only way to access quite a few government services is to show up in person. The same enterprise of state/local government that tries, via its public health department, to get everyone to stay home, may ironically end up being one of the only information processing operations that insists that everyone show up and get within contagious distance.

Supposedly Estonia allows citizens to do almost anything that they’d do at a city hall from the disease-free safety of their own homes.

The U.S. track record for government-run IT is admittedly mixed, e.g., with the $1 billion healthcare.gov insurance site. But maybe if we could adopt the Estonian system unmodified for state and local transactions we would be able to save time in non-plague periods and save lives in plague periods.

Readers: What do you think? Should people have to brave coronavirus to get (or issue) a building permit?

Related:

  • “Estonia, the Digital Republic” (New Yorker, 2017)
  • e-Estonia (Wikipedia)
  • e-governance (from Estonians themselves): “Estonia is probably the only country in the world where 99% of the public services are available online 24/7. E-services are only impossible for marriages, divorces and real-estate transactions – you still have to get out of the house for those.” (don’t get too excited about those family law transactions; they are not as lucrative as in the U.S. From a 2017 post: “In all three Baltic countries I learned that having sex with the richest person in the country would yield only about 200 euros per month in child support” (similar to nearby Sweden))
  • “Estonia: Tough campaign stop for Bernie Sanders”
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Number of new COVID-19 cases worldwide is declining now?

by philg

The last four World Health Organization Coronavirus disease situation reports, 63-66, show an almost flat number of new tested-and-reported COVID-19 cases worldwide each day:

  • 40,788
  • 39,825
  • 40,712
  • 49,219
  • 46,484 (report 67; March 27; bold face because added as an update)
  • 62,514 (report 68; March 28)
  • 63,159 (report 69; March 29)
  • 58,411 (report 70; March 30)
  • 57,610 (report 71; March 31)
  • 72,736 (report 72; April 1)
  • 72,839 (report 73; April 2)
  • 75,853 (report 74; April 3)
  • 79,332 (report 75; April 4)
  • 82,061 (report 76; April 5)
  • 77,200 (report 77; April 6)
  • 68,766 (report 78; April 7)
  • 73,639 (report 79; April 8)
  • 82,837 (report 80; April 9)
  • 85,054 (report 81; April 10)
  • 89,657 (report 82; April 11)
  • 85,679 (report 83; April 12)
  • 76,498 (report 84; April 13)
  • 71,779 (report 85; April 14)
  • 70,082 (report 86; April 15)
  • 76,647 (report 87; April 16)
  • 82,967 (report 88; April 17)
  • 85,678 (report 89; April 18)
  • 81,153 (report 90; April 19)
  • 72,846 (report 91; April 20)
  • 83,007 (report 92; April 21)
  • 73,920 (report 93; April 22)
  • 73,657 (report 94; April 23)
  • 81,529 (report 95; April 24)
  • 93,715 (report 96; April 25)
  • 84,900 (report 97; April 26)
  • 85,530 (report 98; April 27)
  • 76,026 (report 99; April 28)
  • 66,276 (report 100; April 29)
  • 71,839 (report 101; April 30)
  • 84,771 (report 102; May 1)
  • 91,977 (report 103; Saturday, May 2)
  • 82,763 (report 104; May 3)
  • 86,108 (report 105; May 4)
  • 81,454 (report 106; May 5)
  • 71,463 (report 107; May 6)
  • 83,465 (report 108; May 7)
  • 87,729 (report 109; May 8)
  • 95,866 (report 110; Saturday, May 9)
  • 61,563 (report 111; May 10)
  • 88,891 (report 112; May 11)
  • 82,591 (report 113; May 12)
  • 81,577 (report 114; May 13)
  • ….
  • 100,284 (report 123; May 22)
  • …
  • 118,526 (report 137; June 5)

Original text, before the data points in bold were added: Almost, but not quite flat, right? After four days it grew from around 40,000 to around 50,000. But consider these data against the background of a rapidly ramping up testing infrastructure. More people are being tested, not just celebrities and political elites with mild symptoms and peasant hospital inpatients. If dramatically more people are being tested every few days (and therefore fewer mild cases never get noticed/recorded as COVID-19), don’t the above data suggest that the actual number of new cases (humans actually infected as opposed to the proper subset of humans tested and reported as infected) is going down?

Massachusetts Update:

3/27 analysis: Not an obvious exponential growth process and, even if it were, patients aren’t generally tested until admitted to a hospital (i.e., current growth in cases reflects a growth in infections that happened 1-2 weeks ago)

[Update, evening 3/27, text message from friend: “I asked [physician wife] how her nurse friend is doing at the hospital. She said she has not worked in a week because the ER is so dead she can’t get hours. The hospitals are empty.”]

3/28 analysis: The Massachusetts data are worrisome. The number of reported tests stayed constant from March 27-28, but the percentage of positives grew. We have no information about when samples were taken, however, so this growth could have occurred several days earlier. (Test results show up in this report on the day that the tests are completed.) The WHO data suggest that the answer to the question posted in the headline is “no” (though it is tough to say given that the WHO situation report does not say how many tests are being performed worldwide).

3/29 analysis: Massachusetts testing actually fell. Only 17 percent of tests were positive, about the same as the average of the two previous days. Linear growth is a better fit than exponential growth. The WHO data suggest weak exponential growth.

3/30 analysis: Massachusetts testing fell again, but 21 percent tested positive. Suggests that doctors are now better at figuring out who needs to be hospitalized (since it is hospitalization that leads to being tested). WHO data show a slightly reduced number of both cases and deaths.

3/31 comment: Where’s the exponential growth?

4/1 comment: Okay, maybe we do have (slow) exponential growth in both worldwide and Massachusetts cases.

4/2 comment: The world is doing better than Massachusetts, but if Farr’s law is in operation, it is tough to guess the top of the bell curve.

4/3 comment: Sweden (open) has 2X the population of Denmark (locked down), so the 519:279 ratio of new cases works out to roughly the same as the population. The ratio of deaths (43:19) is also roughly the same as population ratio. So it looks as though the Swedish epidemiologist’s prediction that government policy would have a minimal effect is proving correct. For the world overall, it has been 11 days and still the number of new cases has not doubled. WHO is still not publishing data regarding how many tests are being performed, so there is no way to know if this slow doubling corresponds to a 4X increase in testing and a falling number of actual new infections or a steady rate of testing and a doubling-every-two-weeks rate of actual new infections. Massachusetts data suggest doubling every 8-9 days. They also confirm the wisdom of the New Yorkers who fled via Gulfstream to their Nantucket mansions: only 9 cases on the island.

4/4 comment: Sweden continues to have roughly the same number of new cases, per capita, as Norway and Denmark, and Swedish hospital/ICU capacity remains sufficient (and public). It seems to be essentially impossible to die from COVID-19 in Norway. Do they have a better treatment that they’re not sharing? Or do they record the death of someone with underlying conditions differently? Or are they keeping people on ventilators beyond the point at which the Swedes would have given up hope?

4/5 comment: Sweden has 365 new cases; Denmark has 320. Keeping in mind that Sweden has 2X the population, this suggests that the Danish “lockdown” is not “making a difference” as rich Americans like to say. Massachusetts is back to the same number of new cases as 9 days ago. Farr’s law, but with an extremely poor fit to a Gaussian?

Monday, 4/6 comment: Sweden has 387 new cases; Denmark has 292. I.e., Sweden continues to have a lower per-capita new-case rate despite the lack of a lockdown. Sweden even has a lower per-capita death rate, 28:18. Spain and the UK are contributing hugely to the world total of new cases, each with roughly 6,000. Massachusetts numbers are back where we’d expect them to be, perhaps due to reduced lab activity on Sunday.

4/7 comment: Sweden has 376 new cases; Denmark has 312. The per capita new death ratio is no longer favorable to Sweden, however, at 4.75X (small sample, however; Denmark had only 8 deaths). Globally, COVID-19 has killed more than 72,000 people, i.e., about the same as the number of Americans killed each year by taxpayer-funded (via Medicaid) opioid addiction and overdose. But the new case count seems to be declining in accordance with Farr’s law. The Massachusetts numbers are worrisome. New cases are stubbornly high and 356 people have died so far (roughly the same, per capita as in Sweden; i.e., a poor argument for our state’s school closure and other shutdown efforts).

4/8 comment: Sweden has 487 new cases; Denmark has 390 (i.e., more per capita in the locked-down country). Worldwide new cases are still on a plateau. Massachusetts cases continue to grow, consistent with a doom-and-gloom forecast from University of Washington that Massachusetts will end up worse than New York, adjusted for population. Fully 2.6 percent of people in Massachusetts with confirmed cases are already dead, suggesting that we are not better at caring for patients than were the doctors working in Wuhan (death rate roughly 1.4 percent). As in China, though, our data are skewed by limited testing.

4/9 comment: Sweden is at 726 new cases; Denmark 331 (comparable when adjusted for population size). Worldwide new cases continue on a plateau. Massachusetts in shutdown seems to delivering the exponential growth that the media was hoping to see from wide open Sweden.

4/10 comment: Sweden has 722 new cases; Denmark 233. Sweden has more new cases adjusted for population, but Massachusetts, with more than 2,000 new cases, is a dramatically higher rate (roughly 4X). Deaths in Massachusetts, 96, represent a higher rate, adjusted for population, than Sweden’s, at 106.

4/11 comment: Let-it-burn Sweden has 544 new cases; lock-it-down Denmark has 184. Sweden is 1.5X the rate, adjusted for population. Sweden had 77 deaths versus 87 in shutdown Massachusetts (i.e., MA residents are dying at 1.6X the rate when adjusted for population).

4/12 comment: Sweden has 466 new cases; locked-down Denmark has 177. Sweden suffered 17 deaths; Denmark 13. I.e., adjusted for its 2X population, wide-open Sweden has a higher rate of new cases and a lower rate of deaths. Massachusetts has gone off the rails compared to Sweden. With 2,615 new cases, Massachusetts has 8X the new case rate of Sweden’s. With 70 deaths, locked-down Massachusetts has 6X the death rate of Sweden.

4/13 comment: Sweden at 332/12; Denmark at 178/13. Massachusetts at 1392/88.

4/14 comment: Sweden at 465/20; Denmark at 144/12; Massachusetts at 1296/113. Adjusted for population, Massachusetts has 4X the new cases and 8X the deaths.

4/15 comment: Sweden at 497/114; Denmark at 193/14; Massachusetts at 1,755/151. It seems that there

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Update on the coronapanic fueled by Imperial College

by philg

Previously from the U.K.:

Yesterday: “UK has enough intensive care units for coronavirus, expert predicts” (New Scientist)

[the expert[ said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower.

New data from the rest of Europe suggests that the outbreak is running faster than expected, said [expert]. As a result, epidemiologists have revised their estimate of the reproduction number (R0) of the virus. This measure of how many other people a carrier usually infects is now believed to be just over three, he said, up from 2.5. “That adds more evidence to support the more intensive social distancing measures,” he said.

Who is this “expert” telling the Brits to chill out? Neil Ferguson, the lead author of the March 16 Imperial College paper that told the British to freak out.

(Professor Ferguson doesn’t explicitly say “my Oxford competitors are right and I was wrong”, but upping R0 to “just over three” supports the Oxford theory. Let’s assume “just over 3” is about 3.4. He previously was thinking 2.5. How do these compare? If we just do the simple exponential and don’t bother to consider people meeting the already-infected, after 8 exchanges of germs, the disease has spread 12X more widely under this quietly buried tweak. That’s the difference between 5% of the population and 60% that are infected and, by inference (since 60% of Britons aren’t dead), a huge difference in the lethality of COVID-19.)

How about the peak? The Imperial College model has a chart showing mid-May, without mitigation attempts and June with even the most basic actions, such as isolating sick people. Most of the Britons who need “critical care” won’t be able to get it.

Now it seems that the peak will arrive in “two or three weeks,” i.e., no later than Easter(!) and, as noted above, nearly everyone who needs critical care will get it (but, unfortunately, 20,000 will still die).

The text of the March 16 paper is just as inconsistent with the latest statement as the graphs. On page 16 of that paper, he says that “even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB”. So in a perfect world where the UK never ran out of critical care capacity and therefore every patient had access to all useful medical interventions, 250,000 would die just in Great Britain (not including Northern Ireland). He is saying now that, in an imperfect world where the hospitals are hanging on the hairy edge of figuring it out, 20,000 will die in the entire UK (including Northern Ireland). [see comments below for some discussion]

‘I am surprised that there has been such unqualified acceptance of the Imperial model,’ Professor Gupta [of Oxford] told the Financial Times.

Perhaps Imperial College professors don’t accept the Imperial model!

(And what does 20,000 deaths actually mean? Are they people who would have lived another 50 years in great health? Or mostly people who would have died within a year or two from an underlying condition?)

What does this mean for the U.S.? Unclear. The “chill out” opinion assumes a competently run health care system that already has policies in place for rationing care (i.e., super old/sick people that were in the ICU in the U.S. in 2019 would have been unplugged and buried in the U.K.). “In the UK’s health system, rationing isn’t a dirty word” says that the U.K. won’t spend more than $40,000 to keep someone alive for another year in good health. That’s the cost of a handful of ED visits here in the U.S., without even being admitted! If we used U.K. standards, half of the older people who are admitted to a hospital would be given three ibuprofen and sent home in an Uber Comfort.

[March 28, 2020 update, from “As the rest of Europe lives under lockdown, Sweden keeps calm and carries on” (Guardian):

Anders Tegnell, Sweden’s state epidemiologist, believes it is counterproductive to bring in the tightest restrictions at too early a stage. … His team at the Public Health Agency of Sweden is critical of the Imperial College paper that warned this month that 250,000 people in the UK would die if the government failed to introduce more draconian measures. A week later Johnson ordered the police to implement a partial lockdown to combat the virus, telling people they “must stay at home”.

“We have had a fair amount of people looking at it and they are sceptical,” says Tegnell. “They think Imperial chose a number of variables that gave a prognosis that was quite pessimistic, and that you could just as easily have chosen other variables that gave you another outcome. It’s not a peer-reviewed paper. It might be right, but it might also be terribly wrong. In Sweden, we are a bit surprised that it’s had such an impact.”

]

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Why do we care about COVID-19 deaths more than driving-related deaths?

by philg

Working with third-year medical students involves much struggling with SQL, R, and data, but also chatting about the topics of the day. This year it is coronavirus, of course. Of the nine M3s that I work with most commonly, at least one believes that he has already had COVID-19 and recovered. Absent significant testing capability for infection or antibodies, however, these bright young people are as much in the dark as anyone else.

Leaving aside the true alarmists, estimates of likely U.S. deaths from COVID-19 seem to range from 50,000 to 500,000 in a “life goes on” scenario. The prospect of this many deaths has motivated us to shut down society and mobilize for what people say is a “war” (let’s hope it isn’t like any of the wars that the U.S. has fought and lost since 1960, e.g., Vietnam War, War on Cancer, War on Poverty, Iraq War, Afghanistan War, etc.).

This is as it should be, right? Let’s take a mid-range estimate. The prospect of 275,000 people dying is terrible and should motivate us to bold action. Yet roughly 36,500 Americans die every year in motor vehicle-related accidents (NHTSA data from 2018, the latest available).

This led to a discussion regarding human psychology. We are pretty confident that there will be more than 275,000 car-related deaths over the next 8 years in the U.S. Maybe this should motivate us to bold action, but it actually does motivate us to do almost nothing.

In the 24th year of the smartphone, we don’t bother with a car-to-smartphone communication system, for example, that would reduce pedestrian fatalities (since the car would know where all of the pedestrians were; I wrote about this in 2016; ordinary Bluetooth range seems to be roughly 100 meters outdoors). Considering the nation as a whole, we don’t invest much in separated (e.g., with a curb) bike lanes like they do in Denmark and Holland. We don’t cut the speed limit on the Interstate back to 55 or lower. We don’t say that cars have to have electronic governors so that it simply is impossible to speed (“I’m sorry, Dave, I feel you pressing the accelerator, but I can’t go faster than 35 mph on this stretch of road”). We don’t re-engineer the road network to eliminate traffic lights in favor of (a) traffic circles, and (b) overpasses. We don’t put in a car-to-traffic light communication system so that the car knows when the light is red and will hit the brakes before we inadvertently drive through an intersection (imagine a traffic light that broadcasts in Bluetooth “I am the light at Massachusetts Avenue and Vassar St. and am currently green for Vassar St.”). We don’t ask America’s nerds to stop working on clever Internet ad technology and try to come up with innovative ideas for reducing the carnage on our roads. We’re willing to invest $trillions to reduce the death toll from coronaplague, but hardly a dime to build centerline dividers on more of our two-lane roads so as to eliminate head-on collisions.

As with most discussions about psychology, we came to no conclusion!

Readers: What is the answer? Why do we accept that hundreds of thousands of Americans will die in the next 10-20 years because of our failure to invest in engineering and infrastructure today, but we can’t accept that up to hundreds of thousands of Americans will die in the next year because we didn’t do a sufficiently thorough shutdown?

Related:

  • Sweden’s Vision Zero, kicked off in 1997, which worked to reduce fatalities until it stopped working in 2013.
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Move to avoid estate tax before coronavirus kills us?

by philg

Now that the grim reaper seems to be among us, is it time to move away from the 12 states that assess estate taxes? Massachusetts, for example, deprives heirs of 10-16 percent of the value of their inheritance, for estates valued at over $1 million (i.e., for anyone who dies while owning a decent apartment or house in the Boston area). The highest state tax rate is reached even for those whose estates aren’t worth enough to be taxed at all by the Federales.

What about income tax? A lot of us will have to work from home for the next two years. Why not do this from the Ritz Dorado Beach in Puerto Rico and cut income tax to 4 percent via Act 22? Puerto Rico seems to have eliminated its estate and gift taxes in 2017 so even if 183 days per year of heat and humidity don’t protect you from coronavirus your savings will be protected.

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