Great time to be in the aircraft charter business?

My friends in the charter business are saying that demand is up at least 15 percent due to coronavirus paranoia (how many Americans need to be hospitalized before we say that it isn’t “paranoia,” but rather ordinary “fear”?). A private plane never looked better!

But, on the other hand, with a huge slate of activities and events being canceled, people won’t need transportation in the first place. Will we see a brief lift in charter and then a catastrophic collapse?

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What is the point of closing universities and companies if K-12 schools remain open?

A lot of U.S. universities seem to be sending the students home to catch glimpses of the truth via Internet (it will be like Plato’s cave, but with LED backlighting instead of a climate-destroying wood fire?).

The stated reason for this mass exodus is that this will slow the spread of coronavirus. But U.S. K-12 schools are generally staying open. Doesn’t that ensure the rapid spread of any epidemic, even if children themselves are not usually symptomatic? Almost everyone has at least some contact with a family with children. As long as the K-12 schools are open, children have contact with each other.

Here’s part of an email from the superintendent of our local public school (Lincoln, Massachusetts)…

The Governor’s Press Conference held yesterday afternoon shared the current status of COVID-19 cases in our state and emphasized how quickly the levels of cases can escalate. In light of the data and the recommendations provided by Governor Baker and Commissioner of Education Jeff Riley, we are putting additional plans in place to ensure that we do everything we can to mitigate the spread of COVID-19 within our school communities. Right now, the level of risk in our school communities is low.

The Massachusetts Department of Elementary and Secondary education is not approving remote learning for pre-K through grade 12 schools.

Finally, I want to remind everyone that events such as this can bring out the best in a community and can also bring out the worst. Please remember that the strength of our community and how we get through this event is dependent upon how we care for each other and reach out to those in need. We may have a tendency to look out for ourselves, intentionally or unintentionally profile others, or carry out actions that are felt as microaggressions. Let us all rise to the occasion and do all that we can to support each other to ensure that every student, staff member, and family feels supported, safe, and cared for. I recommend we all read this document regarding civil rights related to COVID-19. https://content.govdelivery.com/accounts/USED/bulletins/27f5130.

From the linked-to U.S. Department of Education letter:

There has been an increasing number of news reports regarding stereotyping, harassment, and bullying directed at persons perceived to be of Chinese American or, more generally, Asian descent, including students.

Nobody had the heart to tell our school superintendent that nearly all of the Asian families decamped some years ago to Newton, Lexington, and Brookline, whose school systems put up higher test scores. We would have to fight our way through quite a bit of traffic (in our Warren-stickered Teslas, naturally) if we wanted to microaggress an Asian.

Readers: If you’re not too busy unintentionally profiling Chinese Americans, can you please educate me on how “social distancing” in the U.S. is useful when K-12 schools remain open?

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Doctor at a big hospital in Massachusetts cannot order a coronavirus test

A friend is a physician at a Boston-area hospital with nearly $1 billion in annual revenue and more than 250 beds.

This evening I asked what he would do if a patient came in with the full slate of obvious coronavirus symptoms. “If his condition is critical, I can admit him,” Doctor Friend said, “but I can’t order a coronavirus test. In fact, the hospital has been trying to get the word out to people not to come to the hospital if they want a test.”

How is that possible? “We can’t do a coronavirus test in-house,” he responded. “I’ve heard that Quest is gearing up and will have millions of tests available soon. Once they’re ready, we can order tests through Quest.”

If a doctor in a big hospital in a big city cannot order a test, how can we have any confidence in what we’re told are the latest infection numbers for the U.S.? How can anyone know how many of our neighbors are infected with coronavirus and how many simply have a bad cold or a mild flu?

Separately, I ran into a friend who runs a small pharmacy with his brother. “Our sales are up 30 percent,” he said. “Mostly cleaning products, hand sanitizer,and so forth. We were able to buy some alcohol at twice the usual price and then we marked it up to $8, but now we’re sold out of almost everything.” Is any of this stuff useful to an average consumer? If the family doesn’t have coronavirus, what is the value in sanitizing everything? If a family member does have coronavirus, what is the value in cleaning up after the fact? “Unless you have new people coming into your household every day,” he replied, “I don’t see what difference it would make versus just washing your hands on returning home. But it makes people feel good to do something.”

He did not think that this round of coronavirus would turn out to be significant. He thought that it would, like the flu, kill some older people and then disappear for the summer.

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China will close its borders to Americans soon?

Right now we’ve tried to close our border with China. The US State Department says don’t go there. Airline flights have been cut back.

Yet what if the widely mocked Chinese government turns out to have been the only example of taking effective measures to stop the virus from spreading? China will soon be free of coronavirus while a pandemic rages in most of the world’s countries (thinly populated Finland escaped the 1348 Black Death, but they’ve already suffered from COVID-19).

A Japanese friend based in Shanghai told me that the Chinese are beginning to establish quarantines for visitors arriving from South Korea and Japan (confirmed via Reuters). When do they say that Americans aren’t welcome or have to be in a dog kennel for two weeks?

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Immigrants are not on welfare…

… but there will be a epidemic of coronavirus in the U.S. if the millions of immigrants who can’t afford health care at U.S. rates are denied health insurance welfare (Medicaid).

“Washington’s Ferguson, 17 other state AGs protest immigrant ‘public charge’ changes during coronavirus outbreak” (Seattle Times):

Ferguson and the others asked the administration Friday to stop implementing the new version of a rule that allows some immigrants to be denied green cards if they’re deemed likely to be dependent on the government, based on life circumstances such as having received public benefits, including Medicaid in certain cases.

The Washington attorney general sent a letter to U.S. Department of Homeland Security (DHS) and Citizenship and Immigrant Services officials, arguing the new “public charge” rule is undermining efforts to limit the spread of COVID-19 by deterring immigrants from using medical benefits or applying for them, according to the attorney general’s office.

The same folks and the same media regularly inform us that immigrants are the hard-working engine of the U.S. economy and an insignificant number are collecting welfare benefits, such as Medicaid.

“17 attorneys general ask administration to delay public charge rule during coronavirus outbreak” (CNN):

“DHS received warnings of the potentially devastating effects of the Rule if its implementation were to coincide with the outbreak of a highly communicable disease — a scenario exactly like the one confronting our communities with the COVID-19 public health emergency,” the letter says. “Your agency completely failed to consider such legitimate concerns.”

“DHS openly concedes the Rule could lead to ‘increased prevalence of communicable diseases,’ disenrollment from public programs, and increased use of emergency rooms as a primary method of health care,” it says. “Washington State has already had ten deaths attributable to COVID-19. The State is doing everything in its power to limit the spread of the disease and prevent additional fatalities.”

Ferguson says states, cities, and counties are “undertaking similarly dramatic efforts to limit the spread of the disease and mitigate its harmful effects” and deterring immigrants from using medical benefits “undermines and frustrates our public health professionals’ efforts, putting our communities and residents at unnecessary risk.”

From CNN in 2018, “Stephen Miller’s detestable assault on citizenship”:

The most troubling aspect about Miller’s proposal is that it plays into biases about immigrants — that they are all on welfare, that they are gaming the system, that they are a burden on the country. In fact, a 2013 Cato Institute study noted that poor immigrants use public benefits at a lower rate than poor native-born citizens.

So… an insignificant number of immigrants marching toward citizenship are on welfare, but if this insignificant number does not get Medicaid, native-born Americans will be felled like pine trees in a Georgia paper forest.

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Is the death rate from the Diamond Princess a reasonable worst-case estimate for the coronavirus death rate in the U.S.?

Apologies for the macabre subject, but with everyone freaking out about the coronavirus, I’m wondering if it makes sense to step back and ask why the Diamond Princess wasn’t a worst-case scenario. The ship held 3,700 people. The virus spread all around the ship before anyone knew what was going on. Then everyone on board was kept on board, all breathing from the same ventilation system, eating food from the same kitchen (almost surely prepared by at least some workers who had the virus, but didn’t know it). Out of 3,700 passengers and crew, 6 have died (Business Insider).

That’s a death rate of 1/6th of 1 percent (0.16 percent), and concentrated among people whose immune systems were weakened due to other factors (i.e., people who might have died a year later from the flu).

The U.S. overall is not more crowded than a cruise ship. Why should we expect more than 0.16 percent of Americans to die when this is all over? That’s unfortunate, of course, and a huge number when multiplied by 330 million: 535,000. But it is not an economy-ending or country-ending number. And, since our country is not in fact as densely populated as a cruise ship, the real number might be far less than this upper bound. It might be closer to the 80,000 who died from the flu in 2017-2018 (source). And there might not be that many additional deaths because the same people who get killed by the flu are also susceptible to COVID-19.

One factor that could explain how the death rate could be higher: as the disease spreads, hospitals and other health care resources will be spread thin. But, on the other hand, knowledge about how to treat the infection will improve. If these two factors cancel out, we’re back to the Diamond Princess being the worst-case scenario. Finally, consider that the cruise ship demographic is older and more fragile than the general population.

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Why hoard paper towels for coronadoomsday?

Earlier this week, I met a friend in the paper products aisle at Costco. She said “This place has been stripped barer than a line of actresses auditioning for a role with Miramax.”

We later learned that they’ve been sold out of paper towels since the last week of February. Why? Food and water are plainly useful after the collapse of civilization, but why paper towels? Will armed bands roaming neighborhoods mock those whose kitchens aren’t sparkling clean? If it is about sanitizing surfaces, shouldn’t the run be on Lysol wipes?

The good news and bad news is that there is no shortage of gefilte fish and matzah:

What happens when rich suburbanites panic? There is a run on extra virgin olive oil:

Readers: Why the madness for hoarding paper towels?

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Lessons from the Black Death regarding coronavirus

The Black Death: The World’s Most Devastating Plague” by Dorsey Armstrong, a professor at Purdue, talks about places that were spared from most of the waves of plague that swept through Europe starting in 1348.

If we don’t want to die from coronavirus, what can we do?

Iceland was an example of a place that escaped plague for more than 50 years. It took a long time to reach Iceland by ship so asymptomatic carriers of the plague couldn’t walk off into port in Iceland. More likely they, and all of their crewmates, would die before reaching Iceland.

People today travel by plane, however, which is nearly instantaneous. So the “far away by ship” advantage does not seem likely to be realized by any country today.

Finland remained substantially plague-free, says the author, despite having land borders with Sweden, Norway, and Russia, as well as being integrated into the sea trading network of the time that had spread the disease so quickly throughout the Mediterranean and to the British Isles. The secret in Finland was low population density.

Wikipedia says, regarding the influenza pandemic of 1918: “In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population).” Our population is more than 3X the 1918 level and therefore our population density is more than 3X the 1918 level. So the Finland trick cannot work for Americans in general. But maybe for an individual American it could. Move to a non-urban area of a spread-out state, e.g., Alaska or Wyoming. Follow Barbra Streisand and the rest of the Hollywood #Resist crowd to Canada (or pick a different low-density country, such as Argentina).

The professor says that governments that shut down or severely restricted links to the outside world ended up saving most of their citizens and/or subjects. So maybe North Korea or a similarly restricted nation will be comparatively safe?

The professor says that cities with good sanitation did not escape the plague, but death rates were lower. So Japan and Switzerland might have fewer cases of coronavirus? “Mortality burden of the 1918–1919 influenza pandemic in Europe” says that Switzerland was not significantly different from France (but sparsely populated Finland suffered only half the death rate).

Integrating what we know from the Black Death and present-day statistics and conditions, Iceland and New Zealand seem like the most obvious places to run for a re-enactment of the Decameron. They’re islands. They have lower population densities than the U.S. They have comfortably high living standards. However, we need to cross Iceland off the list due to the fact that it operates an international airline hub. People from more than 50 different countries might show up on a typical evening. That leaves… New Zealand.

Fun fact: We get the word “quarantine” from the Venetian government’s requirement that ships coming into Dubrovnik wait at a nearby island for 40 days before coming into contact with the townspeople.

At least we’ll never have to worry about plague per se, again, right? Actually… the bacterium has evolved antibiotic resistance in Madagascar (CDC) and the fleas that carry it have evolved insecticide resistance.

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A radiologist on coronavirus

From a forthcoming chapter in Medical School 2020:

“I don’t think people realize what is coming. The virus is reported to have almost a 20 percent infection rate. On the cruise ship, one asymptomatic person infected 600 people. Our health system covers about 1 million people. We have 54 ICU beds. The numbers just don’t work.” He continues: “On top of this, this will be a supply crisis. Our health system reverts back to the medieval when we don’t have common medications. Penicillin is not made in the US anymore. There is going to be a huge shortage of needles. China supplies everything, and they are shut down.” Is he stockpiling? “Oh yeah.”

This conversation occurred last week. Our anonymous hero was shadowing the radiologists.

Separately, I was at a dinner party on Friday evening in a West LA house that Zillow estimates is worth $3.6 million. The guests on previous occasions spent about 90 percent of their time displaying their virtuous concern for others: Trump-hatred, wanting to help the vulnerable, social justice, etc. During this dinner, however, 90 percent of the conversation was about the rich white guests’ personal fears of contracting the coronavirus, whether to modify travel plans to minimize the risk, etc. (They mixed in a bit of Trump hatred by talking about how the $5 trillion/year Federal government would be powerless to do anything regarding coronavirus due to incompetent leadership by Trump and Pence. They have almost total faith in the power of the Federal government to solve problems, but only if the correct President and VP are installed at the top.)

[At least one Bernie supporter from 2016 had moved into the Elizabeth Warren camp. To judge by the dinner crowd, Warren’s appeal is strongest to women who don’t work and feel aggrieved that some people earn and/or have a lot of money. Bernie’s message is fundamentally about optimism that a slightly tweaked government (just one little tax on billionaires!) can deliver on every American’s dream while Warren is skimming off the most resentful subset of Bernie 2016 supporters?]

Given the large number of destitute people wandering around Los Angeles and/or camping on the sidewalk, I’m not too surprised that rich white people in LA have their personal welfare as Priority #1. But until coronavirus hit, there was some kind of social taboo about giving voice to this priority. Fear of death, apparently, has caused people to abandon any feeling of shame regarding selfish concern.

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