Author: philg

Back on March 29, we looked at the Massachusetts forecast for coronaplague. Science said that “Nearly as many people in Massachusetts will die as in Florida” (I forgot to write down the number) and that 3,300 Floridians would die. Massachusetts would suffer peak hospital use on April 12:

Science offers a much uglier prophecy today. Our peak is due on April 18, 2020 (another week of suffering and nail-biting). A shocking 8,254 of us will die (out of 7 million). That’s a higher per capita rate than what New York (15,618 deaths out of a population of 20 million) will suffer and more than Florida (forecast at 6,770). The forecast for the entire country remains roughly constant at 81,766. We have less than 10 percent of the ICU beds that we need and only about one third as many hospital beds. In other words, if you’re not crazy you’d be getting into a car right now and driving to Tennessee or Texas (both forecast to have few deaths per capita and no shortage of health care resources; Steve Jobs chose to get all of his cancer care in Memphis, ultimately).

Bad news:

Worse news:

One thing that is very odd is the counting of deaths. In “Number of new COVID-19 cases worldwide is declining now?” I link to the official state reports of deaths. The forecast says that there were “78 deaths per day” (actual) on April 5, 2020. The New York Times today says that we have suffered only 154 deaths total in the greater Boston area (includes southern NH); worldometers says 260 total deaths so far in Massachusetts (I have a tough time believe many are occurring outside of the greater Boston area). The latest report from the state, which includes some deaths from over the weekend (apparently there is a reporting lag) says 356 people have died thus far, so maybe the correct data are being fed into the model.

It doesn’t look as though the U.S. as a nation will run out of health care resources to supply every COVID-19 patient with whatever the state-of-the-art therapy is (i.e., not much that is useful right now). However, since there is no load-balancing system for sending patients to idle hospitals, even within a city or state, some places seem to be at risk of dire Fall of Saigon-style situations. Massachusetts appears to be one of the worst prepared states, on the same scale as New York, but without the military support of a field hospital or a hospital ship.

[What about our shutdown? We’ve closed our schools, restaurants, and stores (except for marijuana and liquor). What did that do for us? The model site forecasts 4,182 deaths for Sweden (population 10 million; not shut down) and 8,254 for Massachusetts (population 7 million; shut down). I.e., we’re almost 3X as likely to die while alone at home watching Netflix compared to a Swede who is out eating and drinking with his/her/zer/their friends.]

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I’m a big believer that viruses are smarter than human beings. We haven’t been able to do anything about the common cold (nearly 1 billion cases per year in the U.S.), despite the enormous economic rewards waiting for anyone who can come up with a real therapy. We have no treatment for SARS or MERS despite recognizing the terrifying potential of these diseases. Tamiflu doesn’t stop the flu from killing people.

A smart numbers-oriented friend points out, however, that we have a lot more clinical data regarding COVID-19 than we did for SARS (8,000 cases) and MERS (a handful). He believes that we’ll therefore be able to emerge from our suburban bunkers relatively soon and actually be treated for COVID-19 (as opposed to being parked on a ventilator so that we can die with 86% probability at a slightly later date).

Keeping in mind that it took months for coronavirus tests to be invented, approved, and manufactured (still not in sufficient quantities except for those who are hospitalized), what’s your best guess as to when you can go into the hospital ED, have the nurse shout out “COVID-19” and then an assistant comes in with some pills or a shot that will keep the symptoms down to some reasonable level of misery?

My guess: between July 2020 and March 2021, with October 2020 as the best single month guess.

Related:

• “Why the coronavirus and most other viruses have no cure” (Philadelpia Inquirer)

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One of my flying connections co-owns five liquor stores (“package stores” in the local argot) here in the Boston area. His family has been doing this for four generations, which tells you how profitable it is during ordinary times.

How’s business? “We’re up 50 percent since the shutdown,” he said. “The main challenge is getting staff to come in. We’ve put in Plexiglas dividers and cut down on the number of shift changes. We sanitize between every shift, but they’re still afraid.” Was he forced to raise wages? “We gave every salaried employee a 25 percent bonus and are paying the part-timers time and a half.”

I wonder if more Massachusetts residents will die from alcoholism in the years following this shutdown than were saved (if any were saved) by spreading COVID-19 infections over an extra few weeks.

Some recent photos from a walk around Cambridge…

The Black Death caused some people to abandon religion, but Rainbow Flagism has not visibly suffered yet:

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The local church:

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This gathering place is closed:

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Some traditions cannot be abandoned:

In response to demands from the young and mostly invulnerable to COVID-19, I boiled some water and flattened the curve on this linguini:

Watched Fox News. Believed Trump. His personal curve was flattened. RIP. #SidewalkCoronaVictim

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The Wuhan-on-the-Hudson fiasco continues to unfold. They have all of the economic suffering of economic and societal shutdown and all of the exponential growth that was seen in countries that made no effort to “flatten the curve” (ft.com shows New York state actually growing faster than Lombardy during comparable weeks!).

My friends who work in health care there say that some hospitals are fairly quiet while others, just a mile or two away, are packed. There is no mechanism for sending patients who can wait a couple of hours for care to upstate hospitals that are more or less empty, nor even a mechanism for balancing the load among hospitals within New York City. (Let’s not even talk about New Jersey; they’re just as overwhelmed as NYC, but nobody in American media cares if someone in New Jersey dies, even if it is from COVID-19.)

The New York Department of Health has a $88 billion annual budget (see page 45; it is a bit confusing because in some years the “annual budget” really includes two years of Medicaid; you could also say that the real budget is closer to $94 billion because they moved mental health and “addiction services” out). This is partly for public health functions, such as the ones that left the state without any preparations for a flu or flu-like outbreak, and mostly to pay for unlimited procedures to be applied to those with low-income or no income (Medicaid; New York funds a lot of stuff that other states won’t fund and, correspondingly, had less money available for public health).

How much is $88 billion? Mexico spends about $1050 per person on health care. That includes health care for the rich, middle class, and poor. Mexico’s population is roughly 130 million so this works out to about $136 billion. In other words, with only 20 million people, New York spends close to as much on public health and welfare health insurance as Mexico does to care for its entire population, including cosmetic surgery for the richest people in Polanco. (How are the results in the Mexican system? Mexican life expectancy is about one year less than American life expectancy.)

Comparisons between coronavirus and war are common. What if we wanted to have a military force with supersonic fighter jets, nuclear-powered submarines, an aircraft carrier, nuclear weapons, ballistic missiles, nearly 1 million active-duty troops, and 2 million reservists? Somewhere around $70 billion is what Russia spends. In other words, New York state spends more for public health and welfare health care than Russia spends to fund what might be the world’s most powerful military (let’s hope that we never find out who is actually the strongest!).

Related:

• Suppose that everyone with COVID-19 got a ventilator: “What You Should Know Before You Need a Ventilator” (NYT, by a physician)
• Same newspaper, same day, but by a journalist: “‘Code Blue’: A Brooklyn I.C.U. Fights for Each Life in a Coronavirus Surge” (mostly contradicts the above and implies that an application of massive quantities of medical personnel and machines can save the typical patient seriously afflicted with COVID-19)
• Medicaid spending by state (most recent data is from FY2014; California was spending $4,200/year on a Medicaid enrollee. New York was spending $7,800)
• “Transgender programs flourish following New York Medicaid coverage” (New York taxpayers will fund a gender transition every year (or every month) for those who don’t work)
• NYS Infertility Demonstration Program: “The program subsidizes higher level infertility treatments in vitro fertilization (IVF) and gamete intra fallopian transfer (GIFT) for privately insured women for whom these procedures are not covered by insurance.” (Let’s most ignore the transgender exclusionary language (“women”) here, but remind readers that some men need IVF too!) If you struggle to make ends meet without subsidies, New York taxpayers will pay to generate some additional likely welfare recipients via IVF

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Pre-plague, our government was trying to put billionaire Robert Kraft in prison under the theory that it is legal to pay a woman by the month (half his age!), but not legal to pay a woman by the hour.

Now that the plague is here and, despite spending many $trillions on exotic medical procedures since the SARS outbreak, we forgot to buy any masks or ventilators. Who is helping to patch up the hole that we created? Robert Kraft! “New England Patriots plane brings back more than 1 million N95 masks from China” (USA Today):

The Patriots and government officials needed to overcome several bureaucratic and logistical obstacles. The plane remained grounded for less than three hours while the supplies were loaded. The crew did not exit the plane; otherwise, they would have been forced to quarantine for 14 days upon entering China. Flight crew members needed expedited visas that were processed quickly through a cooperative Chinese consulate in New York.

“I’ve never seen so much red tape in so many ways and obstacles that we had to overcome,” Patriots owner Robert Kraft told the WSJ. “In today’s world, those of us who are fortunate to make a difference have a significant responsibility to do so with all the assets we have available to us.”

Kraft, Baker, the U.S. State Department and others wrote to the Chinese government and consulate between March 24 and March 30 to obtain permission to pick up the masks and the proper permits, the WSJ reported.

According to the WSJ, the Kraft family paid nearly $2 million — roughly half the cost — for the masks.

This reminds me of Andrew Mellon. A rich guy who became Secretary of the Treasury under Republican presidents, he became Target #1 for FDR. From TIME:

Beyond tax rates, a broader New Deal tax philosophy took its toll. Tax authorities had once drawn a clear line between tax avoidance — the use of legal deductions — and criminal tax evasion. Roosevelt blithely blotted out that line, conflating evasion with avoidance. Anyone who seemed to pay too little became a target of F.D.R.’s prosecutors. One of those targets was Andrew Mellon, Treasury Secretary under Warren Harding and Hoover. Roosevelt’s Treasury Secretary, Henry Morgenthau, told prosecutor Robert Jackson, a future Roosevelt appointee to the Supreme Court, that when it came to Mellon, “you can’t be too tough.”

Wikipedia says that FDR’s prosecution of Mellon, for tax fraud, lasted from 1933 until after his death in 1937: “Months after Mellon’s death, the Board of Tax appeals handed down a ruling exonerating Mellon of all tax fraud charges.”

While Roosevelt was demonizing and trying to imprison Mellon, what was he up to? Donating his art collection and his money to create the National Gallery of Art (independent today and not part of the Smithsonian).

Kraft has a ways to go before donating the same percentage of his $billions to the nation that Mellon did, but can we say that he is on track to be our next Mellon?

Related:

• family law in Massachusetts (it would be a lucrative hour of work if a pregnancy could be obtained with Kraft here in the Bay State)

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What numbers do Americans care most about right now? I would love to know the following:

• what percentage of people in the Boston area are already infected with coronavirus (settle the Oxford v. Imperial College debate)
• how close to being overwhelmed are local hospitals in terms of beds and ICU beds in case someone in our family is unlucky enough to need one?

We can’t get the first number because nobody will go out and do a test for active virus in a representative subset of Boston-area residents. This wouldn’t be complete because it wouldn’t measure people who were infected and are now over COVID-19, but if the number is only 0.1% then it is time for double-secret lockdown to stop the spread!

With the second number we could decide whether to drive for an hour or two to a less-busy region before dropping a sick person off at a hospital ED. This would avoid the situation that I’ve heard about from friends who work in health care in NYC. A hospital in one neighborhood is overflowing while a hospital two miles away has empty rooms.

The Florida state government isn’t doing anything about the first number, but they’re gathering and publishing data regarding the second. See “Coronavirus: Here’s how many hospital beds are available in Florida” for a map.

How about Massachusetts? We are a “data dumb” state in which this information is perhaps not available to anyone. Doctors affiliated with individual hospitals can get stats for their own hospital and my moles inside two of the biggest Boston hospitals say that they still have rooms and ICU beds available. This is contrary to the prophecies from University of Washington, We supposedly ran out of ICU beds in the state on March 27 and ran out of hospital beds today.

Related:

• https://philip.greenspun.com/blog/2020/03/26/about-2-5-percent-of-boston-hospital-beds-occupied-by-covid-19-patients/
• “Online checkbook is one step in efforts to publicize state’s accounts” (Sarah Palin’s successful effort to make records of all state spending available online)

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In “Fair Allocation of Scarce Medical Resources in the Time of Covid-19” (NEJM) a group of physicians ponders the big question that we were predicted to have to deal with right around now: who lives (with a ventilator) and who dies (because there aren’t enough ventilators; though actually most COVID-19 patients who do get a ventilator will die nonetheless).

They’re silent on the question of whether taxpayers should have priority over convicted felons and undocumented migrants on welfare. They have not considered whether a beloved film actor such as Tom Hanks should be preserved ahead of a merely well-liked tire salesman. Should Eric Yuan, a founding engineer of Webex and the founder of Zoom, tech companies that have enabled Americans to learn and work through the plague times, get priority over a strip mall “massage” parlor manager? The docs can’t say.

But there is one thing that they do know: “Critical Covid-19 interventions — testing, PPE, ICU beds, ventilators, therapeutics, and vaccines — should go first to front-line health care workers and others who care for ill patients…”

In other words, the doctors think that doctors should be #1 for the ventilators!

[Coincidentally, I looked at all of the same issues and came to the conclusion that golden retriever owners should be #1 for the ventilators. After all, a golden who loses her master/mistress/zistress/theiress is more bereft than most other dogs would be.]

Related:

• https://philip.greenspun.com/blog/2020/04/02/why-the-u-s-is-out-of-ventilators-and-why-it-might-not-matter/

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