A Lot Can Happen In One Month

The entire country is in the middle of a 15-day national "Slow the Spread" campaign in which Americans are being asked to take extraordinary social distancing measures to slow the spread of Covid-19 across the country.

These national recommendations by the President have been supplemented by various measures by the nation's Governors. All the information below can be found at kff.org.

Schools are effectively closed across the nation.

In 43 states, bars and restaurants are closed except for take-out and delivery service.

Large gatherings are limited in 40 states.

Non-essential business have been ordered closed in 22 states.

13 states are on state-wide mandatory quarantines. Another 8 have this measure in effect for certain counties or for high-risk groups. These states account for almost 50% of the population of the United States.

Covid-19 cases continue to grow across the United States.

As of today, there were over 66,000 cases in the country of which over 11,000 were confirmed in the last 24 hours.

Governor Cuomo just announced new totals that show New York cases are now almost 31,000.

Let's look where these cases are in New York state.

98.7% of all the cases in New York state are in 7 counties in and around New York City.

Consider that New York now has 15 times the number of cases in either California or Washington.

The counties in other states bordering New York City are in the Covid-19 epicenter.

New Jersey is now the state that has the second highest number of cases---4,402 as of today. Two-thirds of cases in New Jersey are coming from those counties considered to be in the New York Metro area.

90% of the cases in Connecticut are in the three counties considered to be in the New York City metro area in the map above.

Looking at the numbers above, what that really means is that the New York City metro area has more cases than the rest of the country combined. In fact, almost 60% of all the cases in the United States are within the confines of that map above.

Looking at this data it is becoming increasingly apparent that this is a public health crisis in the New York City metro but it is a public health concern in a good part of the rest of the country.

Source: kff.org

Why did this happen?

A big reason is the New York authorities were much too slow to take action against the spread of the virus.

Governor Andrew Cuomo is the new darling of the Democrat party based on his daily press conference and his "straight-talk" on the crisis. Some have even suggested that Democrats might turn to Cuomo should Biden stumble or prove incapable to serve as President between now and the election.

In fact, Cuomo is now being given a better chance to be the Democrat nominee for President than Bernie Sanders according to the PredicitIt betting market.

Cuomo is doing a good job right now in responding to the crisis. However, what we are seeing in the New York City metro area is a direct result of earlier inaction by Governor Cuomo and New York City Mayor DeBlasio who did not take the threat serious enough earlier.

For example, here is a tweet by DeBlasio on March 2 where he tells New Yorkers to get on with their lives and get out on the town.

Here is DeBlasio's Health Commissioner urging people to participate in the Chinese New Year parade and celebration at the same time the virus was raging in China and 10 days after President Trump had banned travel from China. She tells people to not change any plans due to "misinformation" spreading about coronavirus.

Something was clearly spreading and it was not misinformation.

I wrote previously about the actions Governor Mike Dewine took in Ohio beginning on March 9. Dewine declared a state of emergency on the same day when Ohio announced its first three cases of coronavirus. He urged all state universities go to online classes. He declared that all large gatherings were banned.

On March 12 Dewine announced that all schools statewide should close. He instructed all college students to return home.

By March 15 all bars and restaurants were ordered closed except for take-out and delivery orders.

On March 22 Dewine issued a state-wide stay at home order for all but employees and businesses involved in essential services.

During that 7-10 day period a number of other states followed the lead of Dewine in Ohio.

One that did not was Andrew Cuomo. Bill DeBlasio also was slow to act.

In fact, it was not until March 17 that Mayor DeBlasio first mentioned the possibility that New York City might have to consider a "shelter in place" order.

Even worse, Cuomo rejected the idea as out of hand. This is from a headline from NY magazine on March 18.

On Tuesday, Mayor Bill de Blasio announced he was considering a shelter-in-place order for New York City, and that he would make the determination in the next 48 hours. The order, if implemented, would restrict New Yorkers from leaving their homes “except for essential needs,” like shopping for food and visiting health-care providers.

Apparently, New York governor Andrew Cuomo didn’t take the possibility seriously at all. “Any blanket quarantine or shelter in place policy would require State action and as the Governor has said, there is no consideration of that for any locality at this time,” a statement from Cuomo’s office read.

Give credit to DeBlasio for being ahead of Cuomo on this one but DeBlasio dragged his feet for a long time on closing New York City schools. He was refusing to close New York City schools as late as March 14.

It is clear now that New York City should have been taking the actions they finally undertook at least a month ago.

That is especially true considering that the New York City metro area is such an international travel hub.

In Cuomo's press conference today he asked the rhetorical question as to why New York has 15 times the number of cases as any other state. He said it was his personal opinion it was due to,

1) the density of the population and the close proximity that people had with others.
2) the fact that New York was an international travel hub.

I agree with those conclusions. However, those were well known before this epidemic started. It would seem that Cuomo and his public health officials should have been extra vigilant and proactive knowing these obvious facts. New York was more vulnerable to a virus that comes from abroad than any other area due to these factors.

Where was Cuomo when Trump announced the China travel ban? I could not find any mention where Cuomo or DeBlasio supported the President at the time when so many other Democrats and members of the media were criticizing Trump. That bipartisan support would have meant a lot. You can bet that political correctness had a lot to do with it.

Why have they also been strong supporters of sanctuary city status for New York knowing the obvious vulnerabilities that New York City has and that Cuomo openly acknowledged today?

What were Cuomo and DeBlasio focused on in February?

They were both fighting with Trump because the federal government was no longer going to allow New York residents to enroll in the Global Entry program that expedites people through U.S. Customs because the state had started giving driver's licenses to illegal aliens.

Source: New York Globe

Source: USA Today

We can see now that the China travel ban probably has had a lot to do with the lower number of cases on the West Coast. It cut off the seeding of more cases early into Washington and California that sees more air travel from Asia. However, flights from China still continued to Europe and Iran. The virus found another way to get into the country and New York City was the best target.

As I have written before, the criticism Trump took over China is probably a big reason that he did not move quicker on stopping European flights. I was of the view that Trump should have stopped those flights several weeks earlier. That was his biggest mistake in all of this in my opinion.

Where were Andrew Cuomo and Bill DeBlasio in calling for stopping the flights from Europe during February knowing New York was exposed as that international travel hub? They should have been calling for Trump to ban the flights at that time. Why did they not lobby for that action to be taken?

Everything in New York is now a reactive response and it is all playing catch-up.

Where do things go from here?

I believe that there is almost no choice other than to lock down the New York City metro from the rest of the country. Flights need to be stopped in and out. Trains, buses and other public transportation that brings people in or out of the metro area need to also cease. A ban on all personal and non-essential travel in and out of the area may also be necessary if the numbers don't start dropping.

At this point it will do no good for Ohio or Nevada or Florida to go through extreme measures for several weeks to stop the spread only to have people from the most affected area in the country bring new cases of the virus in.

The problem is that many people in the New York area have already left the metro area to avoid the shutdown. Drs. Fauci and Birx have told anyone who has been in the New York City area and gone somewhere else the last couple of weeks to self-quarantine where they are so as not to seed more cases elsewhere. Whether people do that will have a lot to do with whether more extreme measures will have to be taken.

Governor Cuomo is warning other parts of the country that their turn is coming. In another month it could be them. He is correct. That can happen. However, a lot of that will depend on how well New York curbs the epidemic locally and how well we contain people from that area infecting the rest of the country.

Unfortunately, Cuomo should have been thinking more about all of this a month ago.

I remain optimistic that we are going to get through this and it will be quicker than most people would predict right now.

I think states like Ohio might be weeks away from getting most of their lives back. We may not see MLB baseball for awhile. At-risk individuals may need to isolate themselves. There may not be a Memorial Day parade this year. We should see results soon from the actions that have been taken.

However, it will be months before New Yorkers will. How long? I don't know.

Let me put it this way for you golf fans.

I think there is a fair chance that the Memorial Tournament will be played in Dublin, Ohio beginning June 4.

I think the chances are almost zero that the U.S. Open will be played in Mamaroneck, New York beginning June 18.

Stay tuned.

A lot can happen in one month.

We all should understand that now.

It would have been nice if Andrew Cuomo and Bill DeBlasio would have understood that one month ago.

Covid-19 by the Numbers

One of the interesting things about the Covid-19 pandemic is that it is not only a health care challenge but it is also a numbers game.

I am a numbers guy so I have found myself most interested in examining the numbers surrounding the Covid-19 virus.

Pandemics are caused by a compound number of infections occurring over larger and larger geographic areas. They only end when the compounding number of cases can be stopped.

There are two key numbers in any pandemic situation.

The infection rate. In other words, how many people will typically be infected by one person with the virus? This is also referred to by public health experts as the R0.

The mortality rate. What percentage of those infected will succumb to the disease?

One of the unknowns about Covid-19 is that we don't know either of these numbers with certainty. It is a new virus and there is not enough data right now.

The best estimate is that it is 1.5x-3.5x more contagious than the seasonal flu.

It is also 3x to 12x more deadly than the seasonal flu.

This graph shows where it is believed that Covid-19 falls on those measures compared to other high profile communicable diseases. For example, the seasonal flu only has a fatality rate of .10%. That means 1 in 1,000 who contract the virus will die because of it.  Covid-19 might be 1%---10 times greater.

These unknowns are a big reason why public health officials are erring on the side of caution right now. The data thus far does show that the hospitalization and mortality rate are undoubtedly higher than the seasonal flu. How much higher is the big question right now.

What has also made the numbers challenging to analyze with Covid-19 is the lack of broad testing.

The media and others have tried to make a big deal of the failure to get enough test kits and testing sites out in the public to determine the true amount of Covid-19 in the community.

However, the reality is that there is generally very little testing done with the seasonal flu compared to those infected. Those tests kits also could not be used for Covid-19 as it was an entirely new strain.

For example, the CDC is currently estimating that there have been 38 million cases of the seasonal flu this year but only about 270,000 of those have been confirmed by testing. About 1.2 million tests were conducted with around 22.5% showing positive tests for the flu. In other words, less than 1% of all cased of the flu are confirmed by a test. Most people realize they are sick, rest and recover at home and are never tested. Of the most severe cases, there have been 390,000 hospitalizations and 23,000 deaths so far this season.

This year has been a particularly brutal flu season even without accounting for Covid-19. My personal physician recently sent me a letter in which he stated this is the worst influenza season he has seen in 28 years of practice.

This is the CDC graph comparing hospitalizations from the flu compared to other recent years.

Source: CDC

This may also further explain the pressure on the hospital system in some parts of the country as we are dealing with Covid-19 in addition to a higher than normal seasonal flu. It also may be the case that doctors like my own have been seeing Covid-19 mixed in with regular flu cases all along. We won't know until more testing is done. That includes an eventual antibody test that will tell us just how many people have been exposed to the virus in the population.

When you put the entire testing situation in context I think it is rather remarkable how quickly the test numbers have been ramped up considering there really weren't millions of test kits sitting on the shelf when it began. After all, how could there be a reliable test if it was a new strain of virus that only surfaced in the last several months?

There also seems to be no doubt that the large increase in confirmed cases right now is being driven more by increased testing than anything else.

Here are the number of Covid-19 tests that have been administered and reported since President Trump was able to create the public-private partnership with commercial labs and not rely on the CDC and state public health agencies for testing. It should be noted that not all labs are reporting all tests into the database right now. However, those that are have found a pretty consistent 10% positive rate for all those tested (note the exception for New York mentioned below.)

This is what the Surgeon General said about the number of tests, and what they mean, over the weekend on Twitter.

This is another interesting graph that compares the number of tests in various countries in the world compared to the number of confirmed cases. It is based on data from a few days ago but I found it interesting in how there seems to be a pretty consistent pattern of finding that the number of confirmed cases group pretty close to the line I drew onto the graph that represents a 10% Covid-19 infection rate among those tested.

It probably should not be a surprise that the countries that deviate most favorably from that line (Russia, Australia, South Korea) have done the most tests.

Again, this is several days ago and the United States testing is accelerating quickly. The most recent test numbers for the United States are now over 280,000 according to the source I used above. (VP Pence stated at the press conference tonight that the test results processed is actually at 313,000.)

Test numbers are now increasing by at least 50,000 per day and the Surgeon General believes that 100,000 is possible. At that rate the United States is going to surpass South Korea in total testing within the next week and in two weeks it could be close to South Korea's test totals on a population adjusted basis.

A key metric as testing continues to expand within the population is whether we begin to see the positive tests as a percentage of total tests fall below 10%. This would tell me that we are making progress. However, there is a long way to go in achieving that number in New York which Dr. Deborah Birx stated tonight is currently seeing a 28% positive rate from testing. The rest of the country is testing positive at 8%.

That tells me that we are going to see more stringent measures in the New York area. It is difficult to see how any flights or any but the most essential travel should be going on between New York and other parts of the country right now.

The number that is still the most important in all of this is the number of deaths. We might not get all the data on the number of tests. We clearly may never know (just like the seasonal flu) exactly how many total cases there have been. However, the number of deaths should be a pretty definitive number.

However, even that is not easy. To really understand how dangerous Covid-19 is we need to determine exactly what the excess mortality is. Yes, someone could have died and tested positive for the virus but they could have also died from the seasonal flu or something else. It is the excess mortality that we really need to identify.

I have been trying to analyze this angle but I cannot find any reliable numbers to put this in the proper context.

For example, we now know that no country has had more deaths than Italy from the virus. Over the last several days Italy has been seeing an average of over 600 deaths per day attributed to Covid-19.

However, what does this mean without knowing what "normal" is?

Italy's population is approximately 60 million people. Last year it had 634,000 deaths. In 2020, before this pandemic began, it was projected to have 640,000 deaths for the year. That is an average of 1,753 per day. However, we know that deaths in all countries tend to increase in the winter season.

For example, here is a graph that shows the seasonality in the number of deaths in the United States for 2017 when deaths averaged 7,708/day for the entire year. However, during the winter months deaths averaged about 8,400---9% more.

Source: CDC

If we apply that same percentage to Italy, we would expect around 1,900 deaths under normal circumstances. They are attributing 600 deaths to Covid-19. That is a large percentage of the normal rate of 1,900. However, is that really excess mortality?

If Italy's total deaths right now are running 2,500 per day then this is as serious as it can be. That is a number that is over 30% higher than normal.

However, what if total deaths are 2,000 per day? This would suggest that excess mortality is only about 100 per day. This would only be a 5% increase over the normal daily average.

It seems to me that the excess mortality number is the most important data point in all of this. It is especially important as the President and others have to look more critically this week at the trade-off between our public health and our economic health.

Perhaps total deaths is not a number that we have routinely collected or monitored on a daily basis across the United States. It probably is a number than gets reported from death certificates in the various states on a monthly basis to the CDC.

Even if we have the number on a daily basis it probably lags a couple days compared to deaths because of the lag in getting the death certificate signed and filed.

However, I am a numbers guy. I think President Trump is one as well.

If I was sitting in his chair I would be demanding to see the total death numbers across the United States every day and compare it to the numbers that were projected before all of this started in order to determine the excess mortality number from Covid-19 in real time.

We need better data than what I am seeing. I would also not want to get this number a year from now and find out we destroyed the economy by not having the right data when we needed it.

I don't see any other way to really assess where we are and what our next steps should be as a nation to combat the virus.

The worst thing we could have done in this situation is to not take it seriously.

What is the next worst thing? We took it way too seriously when the data later shows we vastly overreacted.

Excess mortality numbers in real time would help insure that doesn't occur.

Looking Over The Cliff

On January 30, just as the reality of what the impacts of the coronavirus on China were becoming known, I commented that the economic impacts of the virus could very well be more contagious than the virus itself.

This was based on observing the extraordinary measures the Chinese government took in shutting down human and economic activity to combat the virus.

As we saw the virus escape China and start spreading around the world, we saw the economic impact playing out more and more, even before government entities got directly involved.

I wrote this on March 2.

We have already seen international air travel drop dramatically. I would expect that we will soon see the same in domestic air travel. I would expect restaurants, bars, theaters and other venues that host large numbers of people around Seattle, and in places in California where cases have been identified, will see precipitous drops in business. Retail shops will also suffer except for grocery stores which may struggle to keep their shelves full due to panic buying.

We may see this story unfold across this country if the virus cannot be contained. It may get very, very ugly before it gets better. Most people will survive the virus. It is an open question how many will survive the potential economic fallout.

Of course, that is exactly where we are right now.

There is no question that most everyone will survive Covid-19.

The question now is how many will survive the economic impacts that will follow the drastic measures that have been implemented by authorities to combat the measure.

Will we discover in the end that the cure was really much more deadly than the disease?

In my view, this is the week that we really need to look over the cliff at the possibilities.

I have stated previously that I believe the measures that President Trump and his task force team recommended for the 15-day period we are in makes sense.

I think the economy can survive and rebound from that shock. We will have sustained some damage but it is the type of thing we can bounce back from. People and businesses may have had to take off from work or closed for this amount of time previously and been able to withstand the disruption. There is some margin in their lives or business to deal with a couple weeks like this. After all, people take vacation time. Some businesses close for the same reason or to remodel or retool.

However, it seems to me that every day beyond that point the longer term risk to our economy will grow exponentially. I have to think that the human costs from that exponential risk will soon be greater than the human costs of the disease.

A virus like Covid-19 becomes more deadly because of the compounding effects it has on a population. We have seen that all over the world.

However, an economy unravels through compounding effects as well. Customers don't come to a restaurant or store. The owner has to lay off her employees. The owner eventually can't pay their rent. The property owner can't pay the loan on the building. The bank ends up with a bad loan. Everyone then cuts back on their own spending. Tax revenues to the government fall. Government services need to be increased. Large fiscal deficits occur. The cycle continues as the compounding continues.

A point is reached at which you have fallen so far into the abyss it is next to impossible to climb out.

We are looking over the cliff right now.

For example, one analyst recently estimated that having 50% of the economy shut down equates to a annualized loss of GDP of 1% per week. Since our economy has only been expanding in the range of 2%-3% per year, at the end of this two week period we could have already effectively wiped out an entire year of economic growth.

This analyst might actually be optimistic.

Here is the headline on the most recent forecast by Goldman Sachs of the economic effects we are looking at.

Credit:www.markets.buseinessinsider.com

Goldman Sachs sees a long, slow ride back as shown in the graph below.

If you can't process what is over the cliff let's look at some data from China that indicates that both numbers above may be optimistic.

This shows an index that generally tracks China's business services economy that I found on Zero Hedge. The graph goes through the end of February.

Here is graph showing the broader composite index for economic activity in China.

Deutsche Bank forecasts that China's economy will shrink by 31.7% overall in the first quarter.

Let's look at something that is a little easier to grasp for a specific industry we are all familiar with.

Credit: Zero Hedge

China auto sales were down 79% in the month of February.

Credit: Zero Hedge

Speaking of compound effects, if there are no auto sales at the dealership there is no need to manufacture cars and trucks for a period of time. There is no need for the parts that go into those vehicles. There is no need for the trucks that deliver the parts or assembled cars. There is no need for the gasoline that fuels the trucks. The compounding continues far and wide much like a virus spreads through the population.

So much will be affected as time goes from what is happening now and the next few weeks.

This past week my dentist contacted me to say she was shutting down her practice for several weeks. That means no money coming in for her and her staff. I have heard that the ADA has recommended that all dental practices close.

My doctor's office called to say they were postponing all routine visits so as to have capacity for flu cases and Covid-19.

Someone was at Home Depot and they said residential contractors have seen their business evaporate because no one wants anyone in their home.

At the same time, interior paint sales are surging as a lot of people are tackling home projects that they didn't have time for before.

Look at this graph that shows the drop-off in New York City subway usage.

With the virtual shutdown of New York now taking effect, the coming week's numbers will be even worse.

There are cliffs everywhere we look.

Make no mistake, business was going to suffer even without any direct government action due to the public's concern about Covid-19 in the first place. Under the best of circumstances it is going to take time for people to regain their confidence in human interactions and commerce.

However, over the next week or so government is going to have to be looking over the cliff and make a judgment of whether the cure that has been prescribed by our authorities might actually be worse than the disease.

Expect to see more questions about this with every succeeding day.

More difficult days...and decisions...are ahead.

Looking Back In Time

At times like these, when the speed of events is moving so quickly, it is difficult to look back in time to put everything in context.

Let's take a look back and see what I am talking about. In many respects, if we look back only three months ago, it seems like an eternity.

The U.S. House of Representatives impeached President Trump on December 18, 2019. Little did anyone know that a virulent virus was already circulating around Wuhan, China at the same time.

Nancy Pelosi delayed sending the articles of impeachment to the Senate in an attempt to pressure Mitch McConnell to modify the Senate rules on the impeachment trial that had been adopted for the impeachment trial of Bill Clinton two decades earlier.

That gambit failed but it resulted in start of the Senate trial being delayed. The articles were finally delivered on January 15. The trial in the Senate began a week later on  January 22. This was probably a delay of two weeks beyond when it normally would have started if Pelosi would have delivered the articles of impeachment immediately after the House voted in December.

Alex Azar, the Secretary of Health and Human Services, has stated that the CDC first became aware of the Chinese virus on January 3. Offers of assistance and medical support were offered to the Chinese by the United States but were rebuffed.

On January 14 the World Health Organization (WHO) was quoting Chinese authorities that there was "no clear evidence of human-to-human transmission" of coronavirus.

Those Chinese authorities clearly were misleading (lying to?) the WHO and the rest of the world.

On January 22 the first case of the Chinese virus was confirmed in the United States. Ironically, that was the same day that the Senate trial began on the impeachment of Donald Trump.

It was only nine days later on January 31 (in the middle of his impeachment trial) that President Trump announced his restrictions on travel from China into the United States.

Remember that Trump did this in the middle of the Senate impeachment trial when he had to know he was going to be roundly criticized by Democrats and those in the mainstream media. He did it any way to predictable results. (Hat tip to @lyndseyfifield for the research for the four following examples of how the press castigated Donald Trump at the time he announced the China travel ban).

New York Times, January 31, 2020

The media quoted so-called public health experts who said that this was exactly the incorrect response.

Credit: StatNews

This then created a narrative from the media that Trump was not following the "science" but following the lead of conservative lawmakers and "far-right" supporters.

The Washington Post basically took the Communist Chinese talking points in slamming the President and pointed out that Trump was disregarding the WHO's recommendations against travel restrictions. Yes, the same WHO who stated two weeks earlier that there was no clear evidence that coronavirus could be transmitted through human to human transmission.

The WHO said that restricting travel or trade would not help. Where are they on that opinion now?

Credit: Washington Post, 1/31/20

What did Joe Biden have to say about Trump's actions at the time?

“This is no time for Donald Trump’s record of hysteria and xenophobia,” Biden said during an Iowa campaign event right after Trump announced the China travel restrictions. Biden also said at the time that Trump was "fear mongering".


What about Chuck Schumer?

Let me remind you again that President Trump took this action and had to take all of this criticism during the middle of the impeachment trial.

Donald Trump was not formally acquitted on the two articles of impeachment until February 5.

It is pretty remarkable when you think about it.

How many others would have had the courage to do what Trump did knowing he was going to be called a racist, a xenophobe and fear monger in the course of his impeachment trial?

We now know that Trump's decision was one the most important and consequential decisions that was ever made by a President under the circumstances. It would have been easy to hunker down and do nothing in light of the impeachment trial. I am sure he was told by many advisors to do just that.

If you doubt the importance of that decision look at the current statistics of Europe compared to the United States. Europe did not restrict flights from China as Trump did. Italy did do it the day after Trump but the rest of Europe stayed open. People in Europe could also travel freely within the EU.

The United States has seen confirmed cases increase dramatically the last few days as testing ramps up. However, the differences between Europe and the United States regarding coronavirus case loads and deaths are dramatic.

A lot of the difference has to be traced back to the China travel ban.

(All data from WorldOMeters.com as of 3/20/20, 22;10 GMT)
EU countries considered in numbers below--Italy, Spain, Germany, France, Switzerland, Netherlands, Austria, Belgium, Norway, Sweden, Denmark) The population of these countries is approximately the same as that of the United States.

EU confirmed cases    119,141
US confirmed cases      18,876

EU deaths                       7,048
US deaths                          237

I have stated before that I think that Trump waited too long in banning travel from Europe.

Say what you want about President Trump but he is not a conformist in the way most politicians are. He is not afraid to separate himself from the herd. He has done it a number of times on a number of issues.

However, he is not immune from the pull of conformity and the target you become when you don't follow the herd. For example, for several weeks I have believed that flights from Europe (especially Italy) should have been banned. We are now learning from the CDC that 70% of all new cases in the United States have been traced back to Europe. 

It is not easy separating yourself from the herd. It goes against most human instincts. It always feels safer and secure to conform. After all, there has always been much greater risk to stray from the herd or crowd. 

Why didn't President Trump shut off flights from Europe earlier? Do you think the earlier heat he took on China might have had something to do with that? We shut the door on China but left the backdoor open with Europe. We are paying the price for that now.

Of course, the criticism of President Trump now is that he did not act strongly enough and early enough. Or he is peddling false hope and optimism. We are starting to hear that he is listening too much to the scientists and not enough to the economists.

Of course, we don't know how much the entire impeachment fiasco might have resulted in some level of distraction and disruption within the White House that might have allowed for better preparations.

Anyone can be a Monday morning quarterback. Even me.

However, I think the record above shows that Donald Trump has navigated this about as well as any human being could with imperfect facts and data.

We should all pray that he will continue to be blessed with the discernment and decision making necessary to continue to protect the people of the United States of America.

Surreal Is Our New Reality

I could call it surreal.

However, it is our new reality.

It is stunning the extent that which our lives have been transformed in the last 10 days.

Surreal is our new reality. All sporting events cancelled. Schools closed. Cruise lines shut down. Air travel at a near standstill. Restaurants and bars shut down. Shopping malls closed. Millions trying to work from home. Millions of others suddenly out of work.

I wrote this on January 31 when we were barely a week past the first coronavirus case being reported in the United States.

We often don't realize the precarious perch that our lives are built on. A lot of that is based on the confidence that underlies our economic system. It doesn't take much to disrupt that equilibrium and the confidence that goes with it. When people don't have the confidence to do business, shop, travel and interact, the economy quickly tanks.

People are now realizing what I was talking about. I wish it were not true.

I have to believe that we will soon experience unemployment rates that will exceed anything that most of us have seen in our lifetimes.

If the current surreal reality continues for several months we may challenge some of the numbers seen in the Great Depression.

Jobless claims soared to 281,000 last week and that was before most of the restaurant, bar, store and theater closings that went into effect this week. We will soon these numbers in the millions.

Of course, I don't need to say anything about the stock market.

Over $12 trillion of value has been wiped out in less than a month in the United States alone. Global values have taken somewhere near a $25 trillion hit.

That value evaporated faster than in any stock market sell-off in history.

Washington is talking about a $1 trillion economic aid package. That seems like a lot until you put it into a broader perspective.

I have not heard many talk about it but we are surely blessed in all of this that we are taking this economic hit at a time when we were at an economic high. Stocks were at all-time highs. Unemployment was the lowest in almost half a century. It would be far, far worse having to deal with a poor economy and struggling stock market before we were hit with this pandemic.

For some context, here is the Dow over the last five years. Yes, it is bad, but imagine having to confront this in 2016. Or 2009?

There is a reason that pilots attempt to climb if they run into a problem in the air. It always helps to have as much altitude as you can when you are flying an airplane. The more altitude you have, the greater margin you have to overcome any issue, and the better chance you will have to land the aircraft safely. The strong economy over the last three years is a significant advantage for us compared to where we could be.

It is hard not to ask the question whether all of this surreal reality is worth it?

We will likely never know. Once a course is taken it is often impossible to consider the alternative. Whatever decision is made is quickly affected by other choices and actions that compound and don't permit one to easily determine if the "road not taken" might have actually been a better path. Mind you, I did not say easier. There are no easy roads whichever way we go right now.

I have no doubt that the public health professionals are making the best recommendations and decisions they can based on what data they have. However, the problem is that we are dealing with so many unknowns with this virus.

John P.A. Ioannidis is professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center. In other words, he is someone that knows a whole lot more about this than I do.

In a recent opinion column Dr. Ioannidis questions whether we are dealing with a once-in-a century pandemic or a once-in-a century evidence fiasco due to the fact that big decisions are being made without reliable data.

At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.

Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?

I am persuaded that the current path we are on for this two week period makes the most sense right now since it is better to err on the side of caution.

However, how long can this be sustained and at what cost?

Even more than new therapeutics and vaccines, what we need most right now is better data to assess the threat and danger to society of the virus together with the ultimate economic cost that we may have to pay to combat it. Rationale minds need to then balance those two important factors as it relates to our society.

At one point is the cure worse than the disease?

How bad is Covid-19? We just don't know right now. It is still playing out.

However, the Visual Capitalist put together this excellent graphic to show the history of the world's greatest pandemics.

There truly is nothing new under the sun. Mankind has been challenged before and come out better on the other side. We will once again.

However, the human costs of most of these pandemics have been extraordinarily high in lives lost.

May we get the best data available as soon as possible to make sure that we are making the best decisions to limit the human costs, first and foremost. That is not necessarily easy as Dr, Ioannidis points out.

One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health. Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric. At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.

Surreal only works for so long. Every click of the clock the human cost will compound one direction or the other as relentlessly as the virus spreads in communities in the United States and the world.

We need better data if we are going to make better decisions.

The sooner the better. That is the real reality.