Thursday, May 28, 2020

Back to School?

As this year's school year closes under the cloud of Covid-19 we will soon see much written about what the 2020/2021 school year will look like.

An advisory group to the Mayor of Washington, D.C.  recommended that schools in that city not fully reopen until a vaccine or cure is available.

Left unsaid is how long are we supposed to wait for a vaccine of a cure?

Six months? 1 year? 2 years? 6 years? Forever?

Considering all of the talk of racial and social injustice these days in ultra-liberal cities like Washington, D.C. (Donald Trump got just 4% of the vote in the city in 2016), how is keeping the schools closed going to help that situation? 64% of the students in public schools in the city are non-White.

Considering how important the decision is on reopening the schools you would think that there would be more consideration of exactly how many children have been diagnosed with Covid-19 thus far.

The latest CDC data shows that just 3.5% of all confirmed cases of Covid-19 have been in those 17 years of age and younger.

As of May 16, the CDC reported that there had not been 100 deaths from Covid-19 in a population of 103 million Americans among those age 24 and under. Just 12 of these were under the age of 15!

Let's put these numbers in context. 

For children ages 5-14, based on the numbers thus far, the odds of dying of Covid-19 are 1 in 5,885,546.

The odds of someone being stuck by lightning in a single year---1 in 700,000.

The odds of someone dying in a shark attack in their lifetime---1 in 3,700,000.

I know some will look at the numbers above and argue that the low number of cases and deaths with children is because we closed the schools. If not, we would have seen tens of thousands of cases.

We will never know for sure. However, we can look at Sweden which did not close their schools for reference.

What is their case experience among school age children?

It is actually lower than the United States.

Only 1.7% of cases in Sweden have been identified in those 19 years and younger.

Covid-19 Cases in Sweden by Age as May 26, 2020

Deaths in Sweden by age group. How many deaths have they had of those under age 30?


It is also important to understand that those in ages 0-17 typically account for about one-third of all cases of seasonal flu each year. Flu outbreaks do occasionally cause schools to close for short periods of time. However, a 3.5% infection rate with Covid-19 has already caused 3 months of school closures in most of the country.

The logic of keeping the schools closed in the Fall is escaping me based on the data above.

Nevertheless, you should expect that if schools do open that it will look like nothing that you have seen before.

Here are the major CDC recommendations for schools to reopen in the Fall:

Students should be six feet apart in classrooms

All students and staff should wear masks

No sharing of materials or supplies

Keep students with same group and same staff for as much of the day as possible

Close playgrounds and cafeteria. If not possible, stagger usage and disinfect in between

Stagger drop-off and pick-up times so students do not congregate in groups

No field trips, assemblies, performances or student meetings

School busses should have no more than one student per seat and every other seat should be empty

Anyone reading these recommendations should realize that the only feasible way to consider reopening schools under these guidelines would be to have split sessions in school supplemented by online learning. 

It is the only way to meet these guidelines considering both logistics and economics. The reality is that there is only so much classroom space, teachers and school busses to work with.

Parents should be preparing right now that their children will only be in school two or three days per week in the Fall if these guidelines are followed.

I heard yesterday that the City of Cincinnati Public Schools is considering an alternative plan that would have elementary students in school five days per week (recognizing the day care issues for younger children) while having all junior high and high school student stay at home with online learning. This would allow the school district to spread students out into the junior high and high school buildings for social distancing.

School budgets will be squeezed even if everything returns to normal quickly. Tax collections are a disaster because of the economic lockdown. The answer appears to be to provide only half of what one would expect (and what we are paying in taxes) for our schools.

Governor Newsom of California is already suggesting 10-20% cuts in school aid for next year.

Governor Dewine of Ohio stated on Meet the Press this past weekend that he is looking to the federal government for help in funding schools in the state. 

I predict we will hear a lot about this as the summer goes on. There will be a lot of political pressure put on the federal government to provide money and it will always be centered around schools, police, fire  and safety services. Never mind that education, public safety and services make up less than 20% of the budget of a state like Ohio.

I predict we will see particular pressure on private schools this year if the guidelines above have to be followed for re-opening in the Fall. Are parents going to be willing to pay full tuition for a half-way solution? Public school parents have no option. The taxes are going to be there and they have no choice. In fact, their taxes will almost certainly be going up soon. 

I predict we will see more interest in home schooling as an alternative. A recent survey of parents found that 40% of families say they are now more likely to consider home schooling or virtual school alternatives after the lockdown ends. 

Interestingly, political party affiliation made little difference in those who stated they were more likely to consider home schooling----46% of Democrats and 42% of Republicans.

Likewise, Blacks (50%), Hispanics (38%) and Asians (54%) were more favorably disposed to home schooling than Whites (36%).

Those survey results are supported by another poll by USA Today/IPSOS that found, by a 59%-36% margin, parents are more likely to pursue at-home options even if schools reopen in the Fall. Again, those with lower household incomes are more interested than those with higher incomes, and racial minorities are more interested than whites.

That poll also found that about one in five teachers say they are unlikely to return to school in the Fall because of frustration with the new reality and the lack of training in doing their jobs in an online environment far removed from their students.

I predict we will also see more interest in online educational services like Curriki that provide curricula and educational resources in support of K-12 education for teachers, students and parents. Curriki is an independent 501(c)(3) organization working toward eliminating the education divide by providing free K-12 curricula and collaboration tools through an open-source platform.

Curriki's digital library currently includes 81,000 free teaching and learning resources. I expect that the online school experience for most students relying on their own school's resources is haphazard at best. I have to imagine most of it is not much more than a rudimentary Zoom lecture session that allows for little student interaction.  

Utilizing the resources that are available at a site like Curriki can be a game changer for students and their parents to take real ownership of their education. Curriki also has the potential to be a universal platform that allows creative, compelling and interactive learning specifically designed for a virtual  experience that is scaleable. How many schools have the ability to build a real online presence on their own? Curriki is well positioned at the right place and at the right time to serve this need. Keep your eye on Curriki and others who can provide better virtual learning alternatives.

My final prediction is that if we are not seeing evidence of significant community spread of the virus when school is scheduled to open, that local school administrators and school boards will be put under tremendous political pressure by local community residents to return to normal operation.

This may lead to conflicts and confrontations between state and local officials that could make some of the recent protests in blue states that have refused to open look tame. My experience is that parents get a little upset when they believe their children have been treated unfairly or are being used.

People are more than willing to take common sense measures when it is clear it is necessary to do so. We have seen that for extended periods over the last couple of months.

However, with every passing day more and more people are starting to wonder whether they have been had as more facts like those I have cited above become better understood.

Let's see what happens over the summer. 

However, I think schools are going to have a hard time in arguing that they should not open under fairly normal circumstances in the Fall in most parts of the country if we are seeing conditions similar to what we are experiencing now with Covid-19.

I just don't see parents standing for it.

Then again, if parents do not put up much resistance, schools may be in even bigger trouble than they are today. 

Parents may have decided they have found a better way to educate their children without the noise, nuisance and noxious elements that can accompany the school experience for their kids.

Tuesday, May 26, 2020

The Science of Covid-19

We continually hear that we are supposed to follow the "science" when it comes to our response to Covid-19.

However, science is continually evolving.

Scientists also often disagree what the "science" is.

For example, consider that on this past Memorial Day weekend New York City allowed people to hang out on the beach but not go in the water.  California said that that you could go in the water but you could not hang out on the beach. Both say they are guided by the "science".

A group of scientists from Brazil recently wrote an open letter on the "science" of the Covid-19 pandemic. They make some wonderful points that more should take into account.

During this pandemic, the term “science” has been used “ad nauseam”, that is, has been repeated to exhaustion: “Science, science, science”, “I’m pro-science”, “For from the science, through the science and to the science I guide my decisions and acts” and “I am, therefore, fully right to do so”. It is clear that the intention here is to lead all of us to the idea of ​​decisions based on something unquestionable and infallible, as scientific as law, as the law of gravity.
But what kind of “science” is that to which they are appealing? And who, in the name of this “science”, would be allowed to speak? Science (I know that there are controversies, as scientists even debate on its meaning) is “the dispassionate search for the truth about the Universe and life”. But ironically, we seek truths that we don’t even know what those truths would be like, or where they would be found. For this reason, sometimes, ironically, even when scientists find a truth that is indeed true, yet they doubt that they have found it. We literally zigzag in the dark, searching for solutions to our problems.
Scientists are human beings, therefore, skeptics and enquirers who can and should speak for themselves, like all scientists have the right to do, but NEVER A SCIENTIST OR A GROUP OF THEM CAN DECLARE TO BE AUTHORIZED TO SPEAK IN THE NAME OF SCIENCE!

If anything, our experience with Covid-19 should have made all of this self-evident.

It seems as if we learn something new every day about the virus. Or we find out what we thought we knew, was wrong. All of this is expected when you are dealing with something that is novel and new like Covid-19.

However, what we should not expect to be told is that we must follow "the science" because someone decided that it is the "science" that supports their views while ignoring the "science" that doesn't support their views.

We see this clearly in views about the use of Hydroxychloriquine ("HCQ") which has become politicized ever since President Trump spoke favorably about it. Despite hundreds of positive examples of its use as a treatment for Covid-19 around the world there are those who want to to say it is not backed by "science". For example, here is an international poll of doctors done in April in which HCQ was deemed the "most effective" treatment for Covid-19. 

Is that science? No. However, it is just as true that we cannot yet say it is not backed by science. We are in period of discovery. We are in a period of doubt and what should be a period of debate in understanding the virology of Covid-19 as well as the best methods to treat it and mitigate its effects on the population.  

Quoting again from the Brazilian letter.

Richard Feynman put it this way: “Science is the culture of doubt”. And I would add, “science is the culture of debate, of divergence of opinions”.

Debate? Doubt? Divergence of opinions? Not in the world of science (and politics) we live in today.

All of this serves as useful context in evaluating the latest CDC pandemic planning scenarios that were released last week. These are designed to help inform the decisions of public heath officials and modelers to evaluate and recommend different community responses to the virus. You could say that it represents the best "science" that is known on the biological and epidemiological characteristics of Covid-19.

Different scenarios are presented by the CDC with Scenario 5 representing what is considered to be the current best estimate of viral transmission and disease severity in the United States of Covid-19.

That best current estimate is below.

The most significant change is that the CDC is now estimating that the Case Fatality Rate for Covid-19 in the United States is .4% overall.

For those age 0-49 it is one-eight of that---.05%.

The seasonal flu is generally believed to have an overall fatality rate of .1%.

Previous fatality estimates for Covid-19 were stated to be, at best, 1% of those infected. That would make Covid-19 ten times more deadly than the seasonal flu.

The CDC is now estimating a 1.3% fatality ratio for those age 65+ who end up with symptomatic cases.

However, according to CDC data, the seasonal flu of 2018/19 had a case mortality rate of .8% for the same age group. That would make it about 50% more deadly for the elderly than the seasonal flu. However, that is a long way from 10 times as deadly.

Those age 65+ are always more vulnerable to respiratory illnesses. The CDC data from the 2018/19 flu season shows that those in this age group made up only 9% of all cases in that flu season but accounted for 75% of all deaths.


We are seeing a similar pattern with Covid-19 with deaths of those age 65+ comprising 81% of deaths according to the most recent CDC data.

This chart from Business Insider using data from about the same time as the lockdowns began (March 18) provides some perspective on what the best estimates of mortality were at that time.

Viewing "the science" at that time it is hard to argue that the social distancing and economic lockdowns were not prudent decisions. I made that point at the time in these pages.

However, since that time I have continued to follow the facts and the data in making judgments about what our responses to Covid-19 should be.

I may alter my views more as additional evidence and information becomes available.

In the end, as the scientists in Brazil stated so well, isn't that what science requires?

Why then do so many take something with so many questions surrounding it and question why anyone would question our response to Covid-19?

As the latest CDC pandemic planning scenarios show, there is nothing settled about the science of Covid-19.

Monday, May 25, 2020

Memorial Day 2020

The United States is approaching 100,000 reported deaths related to Covid-19 this 2020 Memorial Day weekend.

Predictably, the usual sources were quick to politicize that sad milestone.

This is the front page from the The New York Times on Sunday. 

Democrat leaders had urged President Trump to order flags be lowered to half staff across the nation when the death toll reached 100,000 as a memorial to those who have died from Covid-19.

The President ordered the flags at half staff for the Covid-19 victims on Friday, Saturday and Sunday. However, I believe he was wise to not let the Covid-19 remembrance infringe on Memorial Day which honors those who have fought and died in service to our country.

Many on the Left want to compare Covid-19 deaths to those suffered in various wars. 

Here are the death tolls from major U.S. conflicts.

Credit: Wikipedia

Of course, these deaths have to be put into context considering the percent of the population of the United States at the time.

25,000 deaths in the American Revolutionary War appears to be very modest considering what was achieved. However, those deaths represented 1.0% of the population of the United States at the time.

By comparison, 100,000 deaths today is .03% of the population. In other words, there were 33 times more deaths in the Revolutionary War as a percentage of the population as compared to Covid-19.

Here are the deaths as a percent of population in the other major conflicts.

Credit: Wikipedia 

It is also interesting to note that there were 116,516 deaths in World War I. However, only half of that total were combat deaths (53,402). A large percentage of the remainder were due to deaths from the Spanish Flu which was notable for being atypically fatal to those aged 20–40 years.

Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic.

This chart shows the attack rate (left axis-red) and the mortality rate (right axis-black) of the Spanish flu in 1918/19. 

In total, 675,000 Americans succumbed to the virus which was .7% of the population at the time---that would be 23 times the numbers we have seen with Covid-19 thus far.

28% of Americans were infected by the Spanish Flu before it burned out. Interestingly, we saw a 21% infection rate on the Diamond Princess and a 22% infection rate on the U.S Navy aircraft carrier Teddy Roosevelt. This may suggest that the virus may have difficulty spreading beyond 25%-30% of the population. You may recall that previous models suggested a 70% attack rate with no social distancing. 

As more and more data comes in on Covid-19 deaths it is becoming clearer every day that the mortality risks of this virus skews very heavily to those that are older.

For example, look at this chart that was released by Colorado late last week showing deaths by age group.

Deaths per 100,000 is 3 for those under age 60. You can barely see the white sliver representing these deaths in this donut graph.

It is 377 per 100,000 for those over age 80.

Pennsylvania is now reporting more deaths for those over age 100 than in those under age 45.


My home state of Ohio updated its numbers on Friday and is now reporting that 1,247 deaths out of a total of 1,756 total deaths as of May 21, 2020 were from nursing homes. That is over 70% of all deaths in Ohio.

The median age of all deaths in Ohio is age 81.

It would be interested to see how many of these deaths were in hospice care in these nursing homes.

In the last several years the United States has seen about 2.8 million deaths per year. As you would expect, the majority of those deaths are of those over 75 years of age. 

This is the age distribution of deaths for 2017/18 which are the two most recent years for which national data is available.

As sad and sobering as the deaths involving Covid-19 are, it can be said that the mortality numbers we are seeing are following a natural order based on the data above.

The same cannot be said about deaths in wars. That is why I do not think it is appropriate when people try to compare Covid-19 fatalities to war deaths.

Deaths in wars generally tilt towards the young. The military casualties are also the fittest and healthiest that a society has.

For example, here is the age distribution of U.S. deaths in the Vietnam War.

69% of deaths were of those age 22 or under.

The same was true with the Spanish Flu. The bulk of deaths were under age 40.

A young life lost is not just a loss of life it is an unfulfilled life of potential that is also lost forever. It could truly be said that it is an incalculable loss. It also carries a high economic cost to society. Who knows what might have been produced or invented by this young talent over their lifetimes?

I have shown in the past how high that cost is in this chart by Professor Kevin Murphy of the University of Chicago that shows the value of longevity gains in the economy since 1900.

You can see the enormous loss in 1918/19 due to the Spanish Flu and World War I. Notice as well that the gains between men and women diverged in the 1940's (World War II) and the 1960-1970 period (Vietnam War).

Of course, if the New York Times really wants to get into incalculable losses it might want to report more on abortion deaths that numbered over 800,000 in the most recent reported year.

If you doubt the potential in these lives consider just a few names of those born who would probably be considered unplanned and unwanted today because of the difficult circumstances of their mothers when they became pregnant. You might recognize their names.

Steve Jobs. Oprah Winfrey. Marilyn Monroe. LeBron James. Jack Nicholson. Jesse Jackson.

We should also not forget Barack Obama whose white mother was 18 years old, unmarried and a freshman in college when she became pregnant by a black man in 1960. Ask yourself this question. Would that pregnancy continue today?

On this Memorial Day let's remember those that made the ultimate sacrifice for us.

Let us also acknowledge that all life is valuable and and should be valued.

We need to honor those who have contributed so much over their lifetimes but we also have a responsibility to see to it our society endures and prospers for generations to come.

If we don't, the sacrifices so many have made to which we pay homage today and those who have perished due to Covid-19 will be in vain.

There is a lot to consider on this Memorial Day 2020.

Thursday, May 21, 2020

Good News If True

Since Covid-19 arrived on the scene there has been so much conflicting information and advice about the virus.

The WHO initially stated that there was little evidence the virus could be transmitted via human-to-human transmission.

It later concluded that it was highly contagious via human-to-human contact.

The WHO stated right after President Trump announced the China travel ban in late January that "there is no need to restrict travel in order to slow the spread".

It later supported travel restrictions to slow the spread.

We were told to not wear masks.

Now everyone is told to wear masks.

We were told that states like Georgia and Florida which were late in adopting "shelter in place" and early in removing the lockdown would see an exponential rise in cases.

Here is the latest data from Georgia which has seen a continuation of a decline in cases since May 1 when the shelter in place order was lifted in the state.

Source: (05/21/20)

Deaths are in a steeper decline but this is a lagging indicator so we might need a couple more weeks to draw final conclusions on this trend.

Source: (05/21/20)

Here is Florida's latest data that shows as testing has increased substantially the percent of positive cases has been dropping steadily.


It is all very confusing.

It is also discouraging as people are increasingly saying to me, "I don't know who or what to believe anymore." 

Keeping all of the above in mind, I thought I would share some encouraging Covid-19 news with you.
Let's call it "Good News If True". It seems that we always need a caveat when it comes to Covid-19.

Covid-19 Does Not Spread Easily on Surfaces

There has been a significant concern from the beginning that contaminated surfaces such as door knobs and handles were major vectors for transmission of the virus.

The latest opinion of the CDC is that Covid-19 does not spread easily on surfaces.


"While touching infected surfaces has always been part of the messaging on how the virus spreads, the Centers for Disease Control and Prevention (CDC) recently shifted its stance online. The CDC now says that COVID-19 spreads from person to person contact, and then lists touching infected surfaces under a section titled, "The virus does not spread easily in other ways." 

Covid-19 Patients Testing Positive After Recovery Are Not Infectious

There has been a lot of concern in the past that individuals who had recovered were testing positive later. The latest research indicates that these individuals are just shedding dead virus and are not contagious.


Risks are very low for transmission of Covid-19 out-of doors

This is particularly good news as summer approaches. A Chinese study of 318 outbreaks found just one (.00314) incidence occurred out-of-doors and that involved just two individual cases.

Spread by asymptomatic carriers may have been overstated

An early study out of Germany stated that initial cases in that country were caused by an asymptomatic person who had visited from China. That study was relied on by a number of public health experts (including Dr. Fauci) to state that asymptomatic transmission was a serious concern. However, subsequent research indicates that the infected person in question was exhibiting symptoms that were not previously disclosed. A correction in the paper has been made. It may be the case that asymptomatic spread is less prevalent than previously believed.

Testing Is Increasing Rapidly While The Percentage of Confirmed Cases Is In Steep Decline

Source: (05/21/20)

The United States is now doing over  400,000 tests per day vs. 200,000 in early May.

The 7-day moving average of positive cases is 6.0% vs. 12.5% in early May.

New positive tests yesterday were 21,520 vs. about 30,000 per day in early May.

Who knows whether we can believe any of this good news considering the track record on what we have been told about Covid-19 in the past?

I did save the most positive news for last and this is most certainly true as I saw it with my own eyes today.

Pallets and pallets of toilet paper at Costco. Let's hope that this is a harbinger that better times are just ahead.

Let's hope the other news is just as true as we get beyond Memorial Day and head into the summer.

Tuesday, May 19, 2020

Colleges and Covid-19

We are in college graduation season but many are asking whether colleges and universities will ever be the same after Covid-19?

Not This Year
How many colleges will survive to do this again?

That is an open question but they clearly will not be the same in the upcoming academic year.

Colleges have faced economic challenges related to external events in the past. Some colleges closed as a result of the Civil War. My undergraduate alma mater, Miami University in Oxford, Ohio, which in 1838 was the fourth largest university in the country (behind only Harvard, Yale and Dartmouth), had to close due to declining enrollment in the aftermath of the Civil War and the financial panic of 1873. It closed that year and did not reopen again until 1885.

World War I and II presented similar financial challenges due to declining enrollments but a number of colleges received a financial boost as the military used many schools and their facilities for officer training and other uses.

Covid-19 presents no such possibilities when social distancing is directly contrary to the traditional college and university on-campus model.

The challenges are going to be monumental for colleges this Fall as The Wall Street Journal outlined in a recent article.

From schools already on the brink to the loftiest institutions, the pandemic is changing higher education in America with stunning speed.
Schools sent students home when the coronavirus began to spread, and no one knows if they will be back on campus come fall. Some colleges say large lecture classes and shared living and dining spaces may not return. Athletics are suspended, and there is no sense of when, or if, packed stadiums, and their lucrative revenue streams, will return.
Every source of funding is in doubt. Schools face tuition shortfalls because of unpredictable enrollment and market-driven endowment losses. Public institutions are digesting steep budget cuts, while families are questioning whether it’s worth paying for a private school if students will have to take classes online, from home.

Several surveys predict that colleges will face at least a 20% decline in Fall enrollment for a variety of reasons.

  • Ten percent of college-bound seniors who had planned to enroll at a four-year college before the COVID-19 outbreak have already made alternative plans.
  • Fourteen percent of college students said they were unlikely to return to their current college or university in the fall, or it was "too soon to tell." Exactly three weeks later, in mid-April, that figure had gone up to 26 percent.
  • Gap years may be gaining in popularity. While hard to track, there are estimates that 3 percent of freshmen take a gap year. Since the pandemic, internet searches for gap years have skyrocketed.
  • College students do not like the online education they have been receiving. To finish their degrees, 85 percent want to go back to campus, but 15 percent want to finish online.

These surveys also do not take account of the potential loss of foreign students who may find it difficult to even travel to the United States this Fall. 

It is important to also remember, as I have pointed out in these pages previously, that the largest group of foreign students in the United States over the last decade have been from China. 

The most recent year that data is available (2018), shows that over 1.5 million international students have been enrolled in U.S. colleges and universities. Almost 500,00 of those students were from China. 250,000 were from India.

These are the 10 national universities with the highest percentage of international students comprising their enrollment according to US News and World Report.

Credit: US News and World Report

Here is the list for private liberal arts colleges that will undoubtedly will face the greatest financial pressures from declining enrollment and higher costs. 

Credit: US News and World Report 

One expert on higher education predicts that 200 liberal arts colleges will have to permanently close their doors over the next year as a result of the financial aftermath of Covid-19.

Below is a chart from my earlier blog post, "Chinese College Invasion" which shows the universities with the highest numbers of students from China in 2015. I have not seen any recent updates of this data but this gives you a sense of how dependent a lot of universities have become to revenues from Chinese students over the last decade.

The University of Illinois and the University of Southern California with almost 8,000 Chinese students each.

Purdue and Northeastern with over 7,000.

Columbia, Michigan State and Ohio State with over 6,000.

You can expect that the impacts of Covid-19 will extend to college athletics as well.

We are already seeing cuts to athletic budgets. Several schools in the Mid American conference have already announced that they are cutting some team sports and making other cost saving measures. Western Michigan, Central Michigan and Eastern Michigan have all announced that athletic coaches and staff have had their pay cut. 

If the college football season is cancelled or disrupted it is going to have huge ramifications at Division 1 schools since football revenues make up such a large portion of athletic budgets. Schools like Ohio State, LSU and Oklahoma are generating over $100 million of annual revenues from football and that money is funding much of the other athletic programs (men and women) at these universities as well. If that money is not there expect a lot of pain for college athletics in 2020.

College towns like Ithaca, New York, Oxford, Ohio, Athens, Georgia and Boulder, Colorado will suffer great economic pains as well if students do not return to campus this Fall. 

The mayor of Ithaca, New York, home to both Cornell University and Ithaca College, recently laid out a grim forecast for his college town.

"If the students don't come back in the fall, we're in real cataclysmic trouble," Mayor Svante Myrick said during an interview with CNBC.
"It's not just pizza shops and it's not just bars. It's not just restaurants. It's barbershops. It's nail salons. It's accountants. It's law firms," Myrick said, according to the news channel. "The ripple effects of all of our students staying home and not coming back to campus, would be crippling."

I continue to be amazed that we are witnessing all of this economic carnage despite the fact that there still remains scant evidence that there is any significant mortality risk to those of college age.

For example, in Ohio there has yet to be one death of anyone under the age of 20. Five deaths for those under age 30. Those under age 50 make up 2% of all deaths. Those over age 80 make up 52% of deaths.

Credit: Ohio Department of Public Health, 5/19/20

The median age for deaths in Ohio is age 80. How many 80 year olds are frequently on a college campus interacting with students?

The California State University and University of California system, which generally have enrollments of over 770,000 across the state, have already stated they are unlikely to have on-campus classes in the Fall.

In California there has not been one death among any females under the age of 35 and males under the age of 25.

I was curious as to what colleges did during the 1918-19 Spanish Flu pandemic since that virus was much more fatal to the young than the old.

I found an article in my alma mater's student paper that described Miami University's response to the pandemic 100 years ago.

In the fall of 1918, Miami reached what was then the university’s highest enrollment yet — a whopping 905 students.

This increased enrollment was largely due to the newly-founded Students’ Army Training Corps (SATC), which the U.S. Department of War established in all universities that enrolled more than 100 male students. The SATC trained young college students for combat duty, and dozens of Miami students joined the war effort before it ended in November 1918.

Unfortunately for Miami, this promising semester was turned on its head when the Spanish flu hit Oxford in early October of that same year. Half of the students and a third of the faculty fell ill in just a few days.

Shortly after the flu arrived in Oxford, Miami sent all its female students home — aside from a few that remained on campus as nurse’s aides — and returned five weeks later when the virus had sufficiently died down. Male students remained on campus to continue their SATC training.

Though Miami never shut down its campus and still held classes, it placed a ban on large gatherings, canceled some sporting events and closed movie theaters and chapels.

Seven students eventually succumbed to the disease according to the article. 

If you think that the Spanish Flu pandemic did not have a major effect on our country consider this chart that I referenced in a blog post in 2013 about how improvements in life expectancy have contributed about as much overall to our overall economic welfare as have improvements in our material wealth over the years.

Economist Kevin Murphy of the University of Chicago puts those longevity gains as being worth an extra $3.2 trillion annually to the U.S. economy.

This is a chart that Murphy shared at a meeting I attended that shows the cumulative value of longevity gains since 1900.

Do you notice that enormous downward spike in 1918/19 for both men and women?

This is what I wrote about that chart in 2013.

You might ask what happened in 1918-1919 to set us back so far?  Those were the years of the so-called Spanish Flu pandemic that claimed over 500,000 lives in the United States most of which were healthy, young adults. Worldwide the flu killed 50-100 million.  The cost of these deaths carried a very high economic cost. Who knows what might have been produced or invented by this young talent over their lifetimes?  There is no greater loss than that of unrealized potential.
I also wrote this in the same blog post.

The deaths from this pandemic are also a cautionary tale for the future.  Are we prepared for dealing with something like this again?  It is something we need to be planning for.

Little did I know how correct I was when I wrote that.

What is my my advice today based on all the facts before us?

No school, college or university should be thinking of cancelling classes in the fall.

It is well past time for students to be in school. 

It is time to look at the facts and stop committing societal suicide.

Sunday, May 17, 2020

Warp Speed or Wish and a Prayer?

Last Friday President Trump announced a "Warp Speed" project  to produce a Covid-19 vaccine by the end of the year.

Unveiling details of “Operation Warp Speed”, a name that references a concept popularised by Star Trek and other science fiction, Trump said: “That means big and it means fast. A massive scientific, industrial and logistical endeavour unlike anything our country has seen since the Manhattan Project.”
He added: “Its objective is to finish developing and then manufacture and distribute a proven coronavirus vaccine as fast as possible. Again, we’d love to see if we can do it prior to the end of the year.”

Put me down as someone who sees this as more of a "wish and a prayer" than something that I would count on.

It seems to me that President Trump has been spending too much time listening to Dr. Fauci, Bill Gates and others who seem to think that vaccines are the answer to any health issue. 

Why do I have doubts?

First, vaccine development is not something that is done at "warp speed".  It is a difficult process and it takes time to not only figure out how to trigger the immune response in the body but to also insure that it is done safely with no side effects.

Let's consider HIV/Aids which Dr. Fauci and Dr. Birx have spent almost their entire careers working on.

Researchers have been attempting to develop  an HIV vaccine since the 1980's but we still have not seen one. In fact, an optimistic forecast is that we might have one by 2030. That would be about 50 years after the disease was first identified.

This would be a typical timeline for the development of a vaccine. Based on that, we should be looking for a vaccine in 2036.

Credit: The New York Times

Here are the development periods for different vaccines. This assumed an 18 month goal for Covid-19. President Trump's "warp speed" goal is half of that---9 months.

It should also be remembered that Covid-19 is a variant of a coronavirus. To this point there has never been a successful vaccine developed for any type of coronavirus. It is not because many haven't tried. The common cold is a coronavirus. You can imagine the potential market for a vaccine that prevents the common cold yet it has still eluded researchers for decades and decades.

We do have an advantage in attempting to develop a Covid-19 vaccine in that a lot of research was conducted on trying to develop a vaccine for SARS and MERS which are also caused by a coronavirus. However, these diseases died out fairly quickly and work quickly ceased.

Vaccine development is extremely costly. It is a high risk financial proposition. However, that is balanced by the fact that it can be extremely profitable. A therapeutic drug only offers potential profit of those who get sick. A vaccine offers profit potential from the entire population. In addition, in the United States, vaccine producers get liability protection. The same is not true for therapeutic drugs. 

A "warp speed" effort. Huge profit potential. Government backing of the effort. No product liability.

What could go wrong?

This is my other concern about putting much hope or belief in a vaccine solution to Covid-19.

It is important to understand that vaccine trials are very limited in their scope. It is impossible to do widespread testing of vaccines before they are released because of ethical concerns that we may actually be harming, rather than helping, patients.

Initial research and testing of vaccines is typically done with animals first. Have you ever heard of a guinea pig? They were the favorite choice from the early days of vaccine development. More can be done in the lab today but it is important to first see what the effects of any vaccine might have on an animal before thinking of testing it on a human being.


Early human trials are just done to see if there are any immediate side effects from the virus without determining whether it has any immunity benefits. This might involve just a few dozen (Phase 1) or few hundred (Phase 2) subjects to see if there are any ill-effects. Of course, this necessarily is only focused on short-term side effects that might show up. There is little long-term surveillance. In a warp speed effort there would be NONE.

It is also considered unethical and dangerous to purposely infect someone with the virus to see if the vaccine works. Therefore, the only thing that can really be measured in this regard is whether the test subject develops antibodies to the virus. However, this is also inexact as it is known that some people develop immunity with few antibodies being present and others have good antibodies and still get infected.

Pregnant women and children are almost certain to not be tested in any Covid-19 trials because it would be considered too dangerous to do so not knowing potential side effects. The same will be true for the highest risk group for Covid-19---those older and with vulnerable conditions---because this too would be too risky in a test situation.  Test subjects are likely to be the healthiest people that can be found because if something goes wrong they can most easily recover with minimal side effects. Those subjects are much more likely to be age 25 (those at least risk from the virus) than age 75 (those most at risk).

That alone gives me great pause for the safety of any vaccine that might be recommended for older people who are most vulnerable to the disease. How is anyone really going to know how safe this vaccine is for children and older people if no real testing has been done on these populations to begin with?

Count me as someone who would not be first in line for the vaccine even if it wasn't done at "warp speed" knowing what I know about the testing and trial process.

I am old enough to remember a similar effort at mass immunization led by the federal government related to concerns about the swine flu in 1976. That particular strain of flu was considered to have elements of the Spanish flu of 1918 and killed 50-100 million people worldwide. As a result, there was great concern by public health experts about a possible pandemic from that strain of the flu.

The CDC recommended that the federal government institute a mass immunization program for all Americans in order to slow any possible spread of the swine flu. Government funding was passed by Congress as was liability protection for the vaccine producers. 

I remember receiving the vaccine in downtown Atlanta not far from my office as part of a mass community immunization program sponsored by the government.

I was in a line with my co-workers very similar to this when I received the vaccine in the Fall of 1976.

However, it was not long before problems and side effects from the vaccine started to arise. A number of cases of Guillian-Barre syndrome were discovered in people shortly after they were immunized. A study showed that the incidence was four times higher in those that had been immunized as compared to those who were not. In addition, it was also reported that incidences of the flu were actually seven times higher among those that were immunized as those who were not.

Within three months of the immunization program being started, it was disbanded in light of the negative results. Only 25% of Americans ultimately received the vaccine.

These are the reasons that I am not overly optimistic about a Covid-19 vaccine being our savior at warp speed or any other speed. It all seems to be more a wish and a prayer than a realistic solution to our current situation based on any reasonable assessment of the relevant facts.

I continue to believe that therapeutics hold much more promise. We may not be able to prevent the infection from spreading but we should have a better chance of finding drugs and treatments to curb the disease process or find a cure that works quickly and safely.

All that being said, I don't discount that we could see some miraculous advances over the next several months to combat the virus one way or the other. There is a lot of focus on this disease. I dare say that there is more attention, and more resources, committed to this than most anything else in my lifetime for the simple reason that the stakes are so large. What is bigger than the entire world's economy?

Since the stakes are so large, so are the rewards for anyone who figures out how to solve the problem.

Incentives drive results. There is nothing that I am more sure of. That is the prescription for success in almost anything in life.

If you doubt that consider the fact that are already 254 therapies and 95 vaccines for Covid-19 already being explored.

I have no doubt that it will also prove true in dealing with Covid-19.

To believe that you do not need a wish and a prayer.

Thursday, May 14, 2020

The Covid-19 Political Playbook

It seems that everything today is politicized.

Covid-19 is no exception.

The 2020 election may be determined on which party gets it right on the decisions that are being made now on reopening the American economy.

Republican governors in states like Florida, Georgia, Texas, Tennessee and Ohio are moving forward to reopen the economy in their states.

Democrats in states like Illinois, Michigan, California, Washington and Virginia are extending lockdowns and shelter-in-place orders.

We are told that we have to follow the science. However, each of these states have public health directors and experts. How can one state decide to open and one decide to stay closed if the science is clear?

A lot of it is politics and one side or the other is going to look better than the other come November.

If states like Florida and Georgia get their economy going and do not see a big uptick in cases the Republicans are going to look pretty good.

Conversely, if these states have to shutdown again because of a surge in cases the Democrats are going to be quick to say "I told you so." It will also not be favorable for President Trump's election prospects.

If we don't see cases surge in the red states, it is going to put a lot of pressure on the Democrat states and it will be hard to keep a lid on protests in the state of those who want to get back to work, get their hair done, go to the gym or the beach. 

Due to the lack of consensus right now, both sides are walking a tightrope without a net. We are in uncharted territory.

In a normal world, there would be a lot of motivation by everyone to get back to work and reopen. Nothing works if money is not flowing in an economy. Everyone struggles---families, businesses, schools, government and social service organizations.

We saw that in the last major pandemic in the United States in 1917-1919. At that time decisions on shutdowns and quarantines were made exclusively at the local level. The federal government did almost nothing. Local officials knew they could not expect help from the state or federal government. They had to act in their own self interest knowing they were solely responsible for the outcome balancing both the public health and economic dimensions of the issue.

Cities did not shut down businesses during that pandemic as they recognized it would actually worsen their situation. They focused on isolating the sick, protecting the most vulnerable by closing schools (the young were the most likely to die from the Spanish flu) and banning mass gatherings which generally included closing saloons. They also did not order anyone to "stay-at-home" or try to limit civil liberties unless they were sick.

A 2007 paper in the Journal of the American Medical Association studied what is referred to as the "nonpharmaceutical interventions" in response to that pandemic.

Credit: JAMA, August 8, 2007

What I found interesting in the paper were the types of interventions and the durations of these actions compared to what we are experiencing today. The chart below summarizes the interventions and the median durations of each.  Notice that you don't see anything about any business closures as an intervention.

The median duration of any intervention (or combination of interventions), bans or closures was around 4 weeks. However, a combination of various intervention measures pushed the duration higher in the chart below. For example, closing schools, implementing quarantine measures and a ban on large gatherings in combination for a one week period would be considered 21 days of intervention in total.

This chart gives you a broader perspective on the varied responses that individual cities had to the pandemic.

One thing I found interesting in the paper was that New York City and Chicago never closed their schools during the pandemic in 1918 despite the fact that the young were most vulnerable to the virus. How times have changed.

I provide this as context to show that it is not natural or normal to want to go to extra lengths to continue an economic shutdown to curb the pandemic in a situation when hospitals are not overwhelmed and over half the deaths from the virus are from nursing home residents.

It is particularly abnormal when the resistance is from Democrats and the effects of the lockdowns are falling disproportionately on what they say they care so much about---middle or lower income workers, minority workers, education, health care and social assistance.

What is really going on here? Why are Democrat governors so willing to ignore what is happening to many of their core constituencies?

The only logical explanation is that the Democrats are using Covid-19 to play political games.

What other explanation is there when you look at the facts and consider the human and economic toll of the lockdowns?

What is the political playbook they are using?

 #1-Extend the economic lockdown and exacerbate the economic pain in order to damage President Trump leading up to the 2020 election in the hope that he can be defeated.

#2-Keep people out of work in order to create more dependency among them so that they believe that the only solution to their problems is government assistance. Doing this also acts as an attack on our private, employer-based health care system. If people do not have jobs they will necessarily require government-sponsored and subsidized health care that eases the way to transition to a single-payer system in the future.

#3-Create budget deficits at the state and local government levels that are so large that there is political pressure for the federal government to provide a massive bailout package that includes money for underfunded state and local public sector pension programs. It will be soon said that if this is not done we will soon see that there is no money for police and fire protection and money to pay teachers.

Democrats have been known to say that you should never let a crisis go to waste. Covid-19 seems to be another example of that.

Look no further than the measure that Speaker Nancy Pelosi unveiled earlier this week in the form of a fourth Covid-19 relief bill that she wants the House to vote on tomorrow. $3 trillion has been spent on three previous Covid-19  relief bills.

Pelosi proposes to spend an additional $3 trillion of which the first item mentioned in the bill is $1 trillion in aid for state and local governments. It includes a provision that would reinstate an unlimited state and local tax itemized tax deduction for high income taxpayers for two years. The bill would also provide an increased amount for a second round of economic impact payments to American households, extends the additional $600/month unemployment benefit into 2021, provides health care insurance subsidies, allocates $175 million for rent and mortgage subsidies and a 15% increase in food stamp benefits among other Democrat wish list items.

If this would pass it would bring Covid-19 federal government spending to $6 trillion. The Pelosi bill would equal the combined total spending in the first three relief bills that have already became law.

Of course, that federal spending is really deficit spending as we don't have current revenues to cover it. That means $6 trillion in new federal debt will be added to pay for all of this.

Let's put $6 trillion in additional debt in context.

We did not exceed $6 trillion in federal debt until 2002. In other words, it took 213 years to put on that much debt in the United States. Could we be on our way to adding that much debt in less than 100 days this year? 

Let's look at it another way. We added about $23 billion in debt at the federal level in response to the Great Depression between 1929 and 1939. In today's dollars, that would be $430 billion. We have already borrowed 7 times that amount in Covid-19 relief measures and Nancy Pelosi wants to borrow another 7 times that amount in one bill!

More sobering is to consider the fact that the United States added $216 billion in debt to fight World World War II between 1941 and 1945. In today's dollars, that would be about $3.5 trillion. In other words, in our response to Covid-19 we have already borrowed almost as much as we did to fight World War II. Pelosi's bill would mean that we would almost double that amount in spending on Covid-19 relief.

Most of what we are doing right now would be unthinkable to any of our forefathers.

It would simply be unfathomable for them to see the way that politics is shaping our response to Covid-19.

You have to think that they would also believe it was unconscionable to put the burden of this additional debt on future generations of Americans.