The Corner

The New York Times has a compelling graphic representation of the spread of the coronavirus.

Kentucky Republican senator Rand Paul received test results on Sunday showing that he was infected by the coronavirus despite the fact that he had no symptoms.

A source close to Paul says the asymptomatic senator requested the test for the virus, which can cause acute respiratory problems, because he had part of his lung surgically removed last year. 

Paul attended an event in Louisiville on March 7 where two other attendees would later test positive, but the senator did not self-quarantine while awaiting test results because he did not have symptoms and did not directly interact with the two individuals who tested positive for the coronavirus, the source added.

On Sunday morning, prior to learning of his test results, the Kentucky senator even used the Senate gym. State and local officials in many parts of the country, including Washington, D.C., have closed gyms amid the coronavirus epidemic to prevent its spread.

Owing to recent interactions with Paul, Utah senators Mitt Romney and Mike Lee both announced Sunday that they will self-quarantine for 14 days.

Five Republican senators are now under quarantine.

THE SENATE is now 48 R -47 D

Sens. Lee, Romney, Scott of Florida, Paul and Gardner are all quarantining.

— Jake Sherman (@JakeSherman) March 22, 2020

Troubled by the Virgin’s message to the seers at Fatima, Monsignor Eugenio Cardinal Pacelli — who would later become Pope Pius XII — warned the Italian architect Enrico Pietro Galeazzi that a day was soon coming when “Christians will search in vain for the red lamp where God awaits them.” “Like Mary Magdalene, weeping before the empty tomb, they will ask, ‘Where have they taken Him?’”

Many Catholics this weekend found themselves offering versions of Magdalene’s lament.

Scores of dioceses around the country have suspended public Masses in response to the viral outbreak. Some have stopped offering confessions for all but those penitents in need of extreme unction. In those areas of the country with particularly high incidences of COVID-19, the sacramental life of the Church has ground to a virtual halt.

This is first time that I can recall my diocesan bishop dispensing Catholics of their Sunday Mass obligation. It may well have happened before in my lifetime — my memory is fairly reliable, as these things go, but is not infallible. This Sunday has nevertheless been a strange disruption to one as myself who takes solace in the Church’s constancy.

Catholics in my diocese are still obliged to observe the Lord’s day — my writing this post probably violates the obligation to “rest” of my “labors,” come to think of it — which could include an activity such as streaming Mass from one’s computer, as I did this morning. The Tridentine Mass I watched was celebrated before an empty chapel, with one priest and one deacon. There were no hymns, no congregants, and no popular responsorials. I am a minimalist as far as popular participation in the liturgy is concerned, but it was altogether jarring to see the Lord’s sacrifice carried forth in such desolation.

I was also reminded of one appeal of hearing the Mass in the Church’s mother tongue — an appeal that obtains in general, but all the more so in a situation like this — namely, the small-c catholicity of the Latinate liturgy. In South Korea, Italy, Germany, or Sarasota, Fla., all Catholics watching the Tridentine Mass this morning heard to the same words, the same prayers, the same chants, recited in one language, common to all sons and daughters of the Church.

I’m eager to return to the marbled church where I worship, but until it reopens, I and hundreds of thousands of other Catholics around the country and the world will have to take solace in such things until we can glimpse the red lamp once again.

Aaron Ginn wrote a long, charts-and-statistics-filled blog post at Medium arguing that the available public health data shows that COVID-19 is less easily transmitted, less fatal, and more likely to fade away with the hot weather than the conventional wisdom would have you believe. Medium deleted the post, which is now hosted at ZeroHedge. Deleting arguments like Ginn’s is a bad and dangerous way to handle the still-roiling debate over what governments and society should do in order to react to the disease.

Whether or not you agree with Ginn’s arguments for, say, reopening schools, people like Ginn and Justin Hart are asking some important and detailed questions about what we know about the progress of the coronavirus. I am squarely in the camp that thinks swift and aggressive public steps have been a sensible and necessary response to a serious public health threat. We can come back more easily from the economic damage of an overreaction than from letting the virus run wild to see if it’s really as bad as we think. But it is unhelpful and hazardous to ignore the real, human costs of protracted lockdowns, which will require increasily strong justifications the longer they drag on. As Congressman Chip Roy explains, those lockdowns will at some point become unsustainable, and the debate over the conditions needed to end them will be important ones, turning on a mix of scientific data and our political and philosophical instincts about risk and liberty (more on which below from Theodore Kupfer).

How do we make those decisions? Stanford epidemiology professor John P.A. Ioannidis argues that the data we have so far should be taken with huge grains of salt for being incomplete and inconsistently collected:

Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%)…reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%. That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza… The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate he incidence of new infections. Sadly, that’s information we don’t have.

David Katz of Yale University’s Yale-Griffin Prevention Research Center (a CDC-funded public health research institution), argued in the New York Times for a similar caution in how far we go based on limited data:

The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are “mild” and do not require specific medical treatment. The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are…These conclusions are corroborated by the data from Wuhan, China, which show a higher death rate, but an almost identical distribution. The higher death rate in China may be real, but is perhaps a result of less widespread testing…We have, to date, fewer than 200 deaths from the coronavirus in the United States — a small data set from which to draw big conclusions. Still, it is entirely aligned with the data from other countries. The deaths have been mainly clustered among the elderly, those with significant chronic illnesses such as diabetes and heart disease, and those in both groups.

Ginn and Hart, unlike Ioannidis and Katz, are data guys without a medical background. Those of us who are amateurs at medicine in general and epidemiology in particular should have some humility in working through competing claims on these points. Generally applicable statistical principles are important, but so is knowing how they apply to a specific area. I’ve spent enough time over the years working with baseball statistics, public opinion polls, and analysis of stock price movements to recognize that the general concepts that are common across disciplines also need to deal with the specific characteristics of the real-world things being measured by the data.

But stifling those points of view and hand-waving them with “shut up, I’m an expert” is not a healthy way for democracies to make important decisions. Expertise is valuable at a time like this, but it is only effective so long as experts are able to marshal their expertise to explain to the public what we know about the answers to many of the questions Ginn’s piece raised: What are the real transmission rates and transmission mechanisms? How likely, really, is infection within a household, or from generally just being around asymptomatic people? How long does the virus survive in infectious form on surfaces? What is the likelihood that the virus can survive and spread in hotter climates, and what can we learn about that from where it has not spread so far? What are the real mortality rates compared to the baseline mortality rate of the ordinary flu?

Too many experts have an insular tendency to assume they will be believed just from credentials, because their friends believe them that way. And too many hear clever amateurs say “I’m asking questions” and immediately treat them like Holocaust deniers or moon-landing skeptics, when we are in fact dealing with a data set that is evolving daily and full of uncertainties. Interrogating the elite, expert narratives is important. That is doubly true when you remember that most of the population is getting its information from ignorant second-hand sources that are just as likely to be too alarmist as too dismissive.

University of Washington biology professor Carl Bergstrom took a more detailed crack on Twitter at debunking specific problems with Ginn’s analysis. More engagement of that sort with the details is better. The process of getting to the truth and having the truth accepted by the people – who, in America, are still sovereign – works better with an adversarial airing of differences rather than just trying to drive dissenting voices off their platforms. The consolidating elite and institutional consensus may look solid now, as it appears to span politicians and doctors, Republicans and Democrats, Americans and foreign governments. But elite groupthink has been wrong before. It is better now than later to ensure that it can justify itself to a world in which trust in elites and institutions has fallen precipitously in the past two decades.

There are a lot of known unknowns and paradoxes in these times of uncertainty. Here are a few.

1) Trump is criticized as both “racist” and “xenophobic” in his condemnations of the “Chinese” virus, while he’s also criticized for “appeasing” President Xi when he makes friendly references to their coronavirus chats. How can Trump be both?

Is he merely erratic? Perhaps any smart president at this moment would prefer both to galvanize Americans about the threat of Chinese near monopolies of industries key to the U.S. in extremis (such as medical supplies, pharmaceuticals, and rare earths) and  yet to not to so offend our  only importer that it cuts off a vulnerable U.S. in the middle of a crisis.

2) The media hype the increased number of cases (the denominator) without much attention to the number of deaths (the numerator) caused by, or perhaps mostly by, the virus. The numerator, however, is not increasing daily at a rate that’s commensurate with the denominator, despite a number of important other extenuating criteria:

a) Those seeking tests are mostly those with some sort of malaise or exposure, and yet they test overwhelmingly (so far) negative, perhaps at rates, depending on locale, of 80 percent to 90 percent negative (an increasingly not widely reported fact), and thus they may underrepresent percentages of the infected in the general population.

b) The real case number could be perhaps two or three times higher than tested positives, also given that many who are or were ill either did not get tested, or did not know they were ill, or did not know they were ill from the coronavirus.

c) If current daily small percentage declines in the fatality rate were to continue as the case numbers increase, we could approach flu-like levels as is almost true of Germany. This poses the dilemma: Did this encouraging trend occur because of our proper reaction to the virus, or were we mistaken about the lethality of the virus in the landscape of the U.S., or both, or neither?

We then are left with a paradox: Testing shows that many more Americans have had or have the virus than we now assume from prior tests, and many more Americans are recovering from it than we once expected.

3) The highest case numbers and deaths, as one would imagine, so far are in bicoastal, highly populated states, marked by either media and entertainment centers, numerous Chinese visitors and residents, or high-tech and financial nexuses — such as California, New York, New Jersey, and Washington State.

In some sense, our coverage and information of the virus reflect the greater influence of areas experiencing perceived greater viral ubiquity (though not always on a per capita basis) than say the experiences of Americans in a Kentucky, Utah, New Mexico, or Oklahoma.

Broadcasting from a studio or writing a column in New York, or living in Malibu or Beverly Hills, or working as a blogger-coder in Menlo Park, or working for Amazon in Seattle must affect a person’s perceptions and provide him greater exposure, compared with others who are in between such places — at least so far. ,

Even in California the natural reaction to the virus is quite different in Palo Alto than in rural Fresno County, a mere 200 miles away. These regional differences in reactions to the virus may soon be overwhelmed by a true national pandemic that finds its way into deserts, mountains, and great plains. But so far how we perceive the virus is in part influenced by how those in harder-hit states perceive it —especially in terms of relative fears of a deadly, second-phase viral explosion versus the all too human consequences of a great depression.

4) We should be somewhat suspect of data outside the U.S.

China, of course, for domestic and foreign-policy reason, has an interest in declaring victory and posing as the model of public-health policy —  the new savior to those threatened by its own perfidy (which it now fobs off on the U.S.).

Italy is probably sui genesis in the Western context, for a variety of now often noted perfect-storm reasons — e.g., it has a more elderly population, a larger than average Chinese expatriate population, laxity in stopping travel from China and closing its borders, a greater percentage of elderly male smokers, suspect emergency health care, perhaps greater frequency of younger people living at home with their elders, lower per capita income ($38,000 versus $60,000 in the U.S.); pre-virus, it also had much higher unemployment (10 percent versus 3.5 percent in the U.S.).

Germany so far seems to have both lots more per capita infections (0.02 percent versus 0.001 percent) than we do in the U.S., and yet it has far fewer fatalities per positive cases (0.3–0.4 percent) than does the U.S (1.1–1.2 percent). Yet in terms of per capita fatalities, the two countries are doing about the same (0.0001 percent of the general population dying from the disease).

One might wonder how Germany is both doing an average job of preventing infections and a superb job in preventing coronavirus deaths. Or one might suspect that Germany may be better in finding and testing more of the infected, while using a different standard of ascertaining actual coronavirus deaths.

In general, however, political, cultural, economic, and climatic disparities make it hard to rely on comparisons, other than in a general fashion, between countries.

5) So far, the lethality rate is the key datum, given that, from what we tentatively know, the vast majority of people who recover have had no greater percentages of permanent lung or other organ damage than did those with the flu (this could change, of course, with further study).

The morbidity of the infected may be as severe or more severe than with a severe flu, but we do not know this other than from media-generated frightening anecdotes.

So the point is that we wish to concentrate on getting the lethality rate down, both to save the most vulnerable and to reassure a terrified public that we might get to a point where their fears should be commensurate with those typical of a characteristically bad flu year.

A caveat here: Under the present set of radically changed circumstances of the past eleven years — the current role of China, a different media and domestic politics, an election year, etc. — the mindset of 2020 transferred back to 2009 would most likely have radically changed what was then public response to the H1N1 influenza A virus. Under today’s perceptions, an eventual 60 million (?) infected Americans, and 15,000 (?) deaths at some point would have prompted similar shutdowns and lockdowns.

6) We do not know where it is yet, but there exists a golden mean between proper mobilization against the COVID-19 and proper circumspection needed to avoid a recession or great depression. We all agree that what this means is a nearly normal economy as tens of millions are tested and those who test positive and their contacts are quarantined, isolated, or restricted in their activities in the manner of tuberculosis, early AIDS, or measles, freeing up resources to concentrate on the elderly and chronically ill. But no one knows when this golden mean should be enacted.

The psychology of erring on either side is important to note: Those calling far more severe precautions that will further harm the economy do so in the admirable agenda to lower the deaths (in the sense that one dead American is a tragedy), and they can quantify their efforts in the known number of dead.

In contrast, those who advise caution out of fears of an economic meltdown will never be able to quantify the greater number of fatalities from a depression than from an infection. It is more difficult to tie likely spikes in suicides, postponed or canceled medical procedures, increased substance abuse, crime, ruined lives, etc. directly to the virus, even though the link is highly likely.

Those who urge caution, regarding the economic impacts, are also more likely to be damned as putting money over lives, even if they are more worried about lives than money in the event that a severe recession follows. And, of course, exaggeration is a two-way street — those favoring a relaxation of the shutdown may also embellish the economic costs of the present stagnation.

Still, in general, the historical psychology of plagues and panics is instructive: Pessimists who call for Draconian measures are credited with saving lives, not endangering far more lives through the severe countermeasures they take.

In a crisis, pessimism is usually more likely than optimism or realism to galvanize needed responses — at least up to a point of avoiding widespread defeatism and nihilism.

Psychologically, the expert statistician is more likely to err of the side of predicting catastrophe than amelioration, given that one is a win-win proposition, and the other a lose-lose surety. In retrospect, the pessimist’s incorrect warnings nevertheless are to be credited for inducing the needed panic to enact necessary remedies, while he appears a savior if he is correct in his prognosis. So, in a crisis, it seems wiser to overestimate the dangers than to underestimate them.

In contrast, the realist or optimist, if proven wrong, appears reckless, insensitive, even murderous. Even when right, he is deemed either lucky despite his recklessness, or proven prescient only thanks to those less cheery who ignored his unrealistic prognostications and took extreme measures to achieve what he predicted on surely false and unreliable data. That may be why early spikes in the death rate caused panic, and later declines comparative inattention.

FDR perhaps found the right formula after Pearl Harbor. He warned Americans that full mobilization would be necessary to achieve what he assured them would be the sure defeat of Japan, at a time when U.S. Pacific forces were already doomed to suffer substantial losses for the next six months without let-up — and yet the U.S. Navy was also already prepped to build and launch an entirely new fleet by 1943–44, larger eventually than the world’s combined navies of the time.

7) Finally, reliable information is so scarce, and erroneous news is so volatile, politicized, and often sensational that any analysis is either outdated by the time it is read, or it’s based on conventional wisdom that almost hourly is revealed as fake news.

Despite the prior Ebola, MERS, SARS, and H1NI scares, the COVID-19 is the first truly worldwide meltdown, in the 21st-century globalized age of social media and the Internet. Instant unfiltered opinion adds to the panic and yet in some cases can aid rapid responses in finding cures and vaccinations. We are reacting much as did past plague sufferers (though with far more volatility), whose pandemics in terms of relative lethality were far more devastating.

Even in the preindustrial age, the sense of hysteria that accompanies a pandemic explains why both Thucydides and Procopius are more famous for their descriptions of the reactions to a plague than even their astute and empirical descriptions of its symptoms.

Congressman Chip Roy (R., Texas) argued on the homepage Friday that the “government needs to make a decision about when we are going to free up the economy.” From the true premises that uncertainty is bad for the economy and that an indefinite shutdown of social life is as uncertain as it gets, Roy makes the case that the government must select a date to lift the shutdown — a virus “D-Day.” By that date, the government will vow to have the epidemic under control, and it’ll mobilize all federal, state, and local resources toward keeping that vow. Our current path risks economic devastation and its attendant downsides.

There’s something attractive about this argument, but in an article in The New Atlantis, Ari Schulman gives the obvious objection:

It is not possible to place meaningful estimates on the true economic cost of [the worst-case scenario in which the virus spreads unchecked], except to say that there is good reason to believe it would be worse than the current shutdown. We simply do not have a good frame through which to view this future. Our world is too different from 1918 for the Spanish flu pandemic to offer much guidance. . . .

The most urgent task for the president and national leaders is to articulate the purpose of the shutdown, what it aims to achieve, and how we will know when we have. The current answer — “15 days to slow the spread” — is arbitrary and unpersuasive. The question is not How many more weeks or months? but Under what conditions can we relax blanket national closures?

Various answers suggest themselves. We might say that the shutdown can end when the case curve bends: That is, when new daily confirmed cases peak and decline. We might also look for the share of tests returning positive to steadily decline, suggesting that testing is finally widespread enough to capture most cases. Perhaps most importantly, we might look for a peak and decline in Covid-19 hospitalizations and deaths.

That doesn’t mean the shutdown is the only way to deal with the pandemic. As Schulman goes on to argue, the U.S. was forced to take such an extreme measure only because our early response was insufficient:

We already have a gold standard for fighting epidemics: early identification of symptomatic patients, contact tracing, isolation of those infected and exposed, and widespread random sampling of the population to detect new outbreaks among unidentified contacts. Only by identifying and isolating the sick can the healthy get back to work.

The crucial lesson is that we need not endure mass closure for the duration of the pandemic. We are only stuck doing it now because we were caught with our pants down, failing to implement the normal methods early enough.

This is not a hypothetical point: South Korea managed to control its outbreak without ever resorting to mass closures. It did so through a combination of massive testing, rigorous contact tracing, and isolation of the infected. Not only were people with symptoms tested and quarantined, but authorities went through considerable effort to track down people who may have been in contact with the sick and test them as well.

Daniel Tenreiro’s invaluable homepage updates make clear that we will satisfy the “massive testing” part of that formula. A reliable test-and-trace regime may be the road to normalcy.

In Sweden, midwives can be fired and deemed unemployable for refusing abortion. In Ontario Canada, doctors can face professional discipline for refusing to administer (or refer for) euthanasia. Ditto to refusing an abortion in Victoria, Australia. In California, a Catholic hospital is being sued–with the explicit blessing of the courts–for refusing to allow a transgender hysterectomy.

But now in Argentina, the right to obtain an abortion has been declared so fundamental that an objecting M.D. can be held criminally culpable for refusing to terminate a pregnancy.

That would seem to be a moral and legal impossibility. But Argentina just elevated the “medical conscience” controversy to a whole new level of concern — from the potential of not “only” having one’s professional license revoked, but also, to the loss of personal freedom for refusing to act against personal conscience based on deeply held religious, moral, or professional beliefs. From the BioEdge story:

An Argentine court has upheld the criminal conviction of a gynaecologist who refused to abort the child of a rape victim in 2017. Dr Leandro Rodriguez Lastra was sentenced to a 14-month suspended jail term, plus 28 months of disqualification from holding public office. Dr Rodriguez Lastro will appeal.

The victim was a 19-year-old in her fifth month of pregnancy, the result of sexual abuse by a relative. At first she used an abortion drug provided by an NGO. That failed and she was referred to the hospital where Rodríguez Lastra was head of gynecology.

The doctor said that abortion posed a risk to both the unborn child and the mother. However, the judges said that the only thing necessary for a legal termination of pregnancy was a formal request from the rape victim.

The child was later given up for adoption.

Good grief, it’s almost as if the court considered the doctor to be a co-conspirator with the rapist.

Adding to the topsy-turvy nature of that decision, instead of being dead the baby is alive in the world. Shouldn’t that outcome, at least, be a cause for celebration instead of condemnation in this difficult circumstance?

How can a doctor be imprisoned for obeying the Hippocratic Oath? Lastra is a licensed professional and the court decided that refusing to abort constituted a “failure to comply with the duties of a public official,” which was an affront to the mother’s “autonomy.” The BioEdge story quoted the court’s ruling:

“Faced with the intersection of so many vulnerabilities, the accused ignored the autonomy of the young woman, giving priority to the reproductive function that she symbolized as a woman, over her dignity, over her right to health and to be informed, accompanied, contained and respected in the process of interrupting the pregnancy, an interruption to which she had a right over any other right or interest”.

“ … ignoring a woman’s voice, ignoring her vital needs, subjugating reproductive rights, devastating the psyche and enslaving the body in order to force pregnancy after a rape, means denying the victim’s status as a subject of rights and is the incarnation of gender violence in its most painful form”.

And here’s a telling twist to the story: A few years ago, a different Argentinian court granted an orangutan a writ of habeas corpus to be released from a zoo. So, an ape was declared a wrongfully imprisoned “person,” while a doctor was declared a criminal for refusing to take innocent human life.

I can write those words. I understand their meaning. But I can’t comprehend such an utter rejection of human exceptionalism.

The numbers in Italy keep getting worse, with nearly 800 fatalities on Saturday. Why is it so bad? Hopefully, what we are seeing is still a reflection of the situation prior to the national lockdown and at some point soon we’ll begin to see the effect of the quarantines. But the velocity of the disease has been astonishing. As the New York Times notes, “the rate of increase keeps growing, with more than half the cases and fatalities coming in the past week.” As recently as March 9, when the earliest version of the national lockdown went into effect, the figure for deaths was 463.

The body count has been literally overwhelming.

The Times piece posits that the root of the problem has been the lockdowns have been behind the curve at every step.

It also wasn’t an ideal time for cultural exchanges with China:

On Jan. 21, as top Chinese officials warned that those hiding virus cases “will be nailed on the pillar of shame for eternity,” Italy’s culture and tourism minister hosted a Chinese delegation for a concert at the National Academy of Santa Cecilia to inaugurate the year of Italy-China Culture and Tourism.

Michele Geraci, Italy’s former under secretary in the economic development ministry and a booster of closer relations with China, had a drink with other politicians but looked around uneasily.

“Are we sure we want to do this?” he said he asked them. “Should we be here today?”

With the benefit of hindsight, Italian officials say certainly not.

The Telegraph points, unsurprisingly, to the old population in Italy, but also quotes an expert saying how Italy categorizes its deaths has played a role in the surge in numbers:

According to Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, the country’s mortality rate is far higher due to demographics – the nation has the second oldest population worldwide – and the manner in which hospitals record deaths.

“The age of our patients in hospitals is substantially older – the median is 67, while in China it was 46,” Prof Ricciardi says. “So essentially the age distribution of our patients is squeezed to an older age and this is substantial in increasing the lethality.”

A study in JAMA this week found that almost 40 per cent of infections and 87 per cent of deaths in the country have been in patients over 70 years old.

But Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities.

“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.

“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three,” he says.

STAT News reports on a new paper by Italian doctors in Bergamo arguing that caring for so many coronavirus patients in the hospitals is part of the problem:

One such step reflects the finding that hospitals might be “the main” source of Covid-19 transmission, the Bergamo doctors warned. The related coronavirus illness MERS also has high transmission rates within hospitals, as did SARS during its 2003 epidemic.

Major hospitals such as Bergamo’s “are themselves becoming sources of [coronavirus] infection,” Cereda said, with Covid-19 patients indirectly transmitting infections to non-Covid-19 patients. Ambulances and infected personnel, especially those without symptoms, carry the contagion both to other patients and back into the community.

“All my friends in Italy tell me the same thing,” Cereda said. “[Covid-19] patients started arriving and the rate of infection in other patients soared. That is one thing that probably led to the current disaster.”

Pray for Italy.

Ten American states now have more than 500 confirmed cases of coronavirus. In comparison, twelve Chinese clusters reached 500 cases (according to the available data, which is by no means totally trustworthy). Most of the outbreaks outside of Wuhan seem to have been contained early, whereas in the U.S., the number of cases within each cluster continues to grow exponentially. New York remains the epicenter of the domestic outbreak, with more than 11,000 confirmed cases. However, New York is carrying out more tests per capita than other states, so the numbers don’t necessarily reflect the severity of each statewide outbreak. Fifty-five percent of those infected in New York are between the ages of 18 and 55, which, while troublesome, bodes well for the death rate, as COVID-19 is most deadly in elderly populations. New York governor announced that he would send 1 million N95 facemasks to New York City and would continue purchasing medical resources, such as ventilators, to combat the virus.

After initial obstacles, the U.S. has succeeded in massively increasing its testing capacity. Over the past few days, the number of tests administered domestically has grown by nearly 40 percent each day. Yesterday, the FDA approved a test that could diagnose coronavirus in just 45 minutes. As the U.S. ramps up its ability to diagnose the virus, the most severe social-distancing measures could possibly be rolled back, but only if authorities pair testing efforts with tracing efforts, ensuring that those tested remain in strict quarantine. We’ll be watching tracing measures in the next few days to see whether states can capitalize on testing to reduce lockdowns.

The death toll continues to be severe in Italy. Seven hundred ninety-three people died yesterday alone, and the growth in the number of dead has been consistent over the past few days, meaning the national lockdown has not yet “flattened the curve” of deaths. One caveat: The high death rate in Italy may reflect the way in which Italian hospitals determine cause of death. An Italian doctor told the Telegraph that “all the people who die in [Italian] hospitals with the coronavirus are deemed to be dying of the coronavirus.” Other countries may attribute those deaths to preexisting conditions. “On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity — many had two or three,” the doctor continues. Still, the devastation is harrowing and shows no signs of abating.

The rate of new cases in the U.S. and U.K. remains staggeringly high compared with other countries’ at the same point in their outbreaks, whereas France seems to have succeeded in slowing down transmission over the past few days. One simple but crucial takeaway from the curves below is that masks are effective. Southeast Asian countries, many of whose residents were already accustomed to wearing masks, have rationed huge numbers of masks since January, and have seen remarkably low rates of infection. In the U.S., officials warned against purchasing masks, with some news reports saying masks don’t protect people. Perhaps this was a noble lie to direct masks to medical workers who need them most, but we’ll need to ramp up the civilian use of face masks to slow the spread of coronavirus.

As Alexandra notes, the New York Times rushed with unseemly relish to pour cold water on the possibility of using anti-malarial drugs chloroquine and hydroxychloroquine to treat COVID-19. Bloomberg News, however, has to win some sort of award for a piece blaring the alarmist headline “Virus Drug Touted by Trump, Musk Can Kill With Just Two Gram Dose”:

The drug touted by the U.S. President Donald Trump as a possible line of treatment against the coronavirus comes with severe warnings in China and can kill in dosages as little as two grams. China . . . recommended the decades-old malaria drug chloroquine to treat infected patients in guidelines issued in February after seeing encouraging results in clinical trials. But within days, it cautioned doctors and health officials about the drug’s lethal side effects and rolled back its usage. This came after local media reported that a Wuhan Institute of Virology study found that the drug can kill an adult just dosed at twice the daily amount recommended for treatment, which is one gram.

Well, yes, almost any medicine — especially one strong enough to fight an infectious disease — can also harm or even kill you from an overdose. That’s where the word “overdose” comes from. We’ve known since Paracelsus, the 16th-century father of toxicology, that “the dose makes the poison.” Yes, it’s an important caution to prescribing physicians to note that this is a drug whose potentially lethal dose is only twice the recommended daily treatment. But I’m guessing that most of the president’s Twitter followers do not have big stocks of chloroquine sitting on their shelves.

The inability to grasp the concept of dosages is endemic in reporting by journalists or commentary by pundits or politicians on any topic touching on science. What’s a carcinogen? Anything that can cause cancer in a sufficiently large dose. But lots of things can mess up your system in a sufficiently large dose. Enough water can kill you. Indeed, cancer itself is nothing more than an internal overdose of biological processes necessary to life. The same is true of a number of immune-system diseases. Climate-science reporting is full of this fallacy, too: The assumption that “enough carbon released into the atmosphere will change the climate” means “any carbon released into the atmosphere will change the climate.” In fact, there is all the difference in the world between pouring one bucket of water into the ocean, and pouring the ocean into one bucket of water.

Next time, be careful how much science reporting you consume. Too much can damage your brain.

Alexandra writes that journalists should not “cover a potential positive development” — viz., the possibility that anti-malarial drugs chloroquine and hydroxychloroquine can effectively treat COVID-19 — “from the angle of how best they can disparage the president.” What she leaves unsaid is that presidents should not talk about a potential positive development from an angle of optimism that outstrips the available evidence.

Trump said at a press conference that he “feels good” about these drugs. Today he tweeted that they “have a real chance to be one of the biggest game changers in the history of medicine.” Alexandra cites optimistic comments from a microbiologist to argue that Trump’s comments were “not unreasonable.” But is reasonableness a reasonable standard for public commentary from the president right now? Infectious-disease researcher Gaetan Burgio argues on Twitter that the evidence of the drugs’ utility is scant. Anthony Fauci said in a press conference that this evidence “was not done in a controlled clinical trial, so you really can’t make any definitive statement about it.” Physician Edsel Salvana points out that the drug can have bad side effects for people with heart conditions. The Times reporters also observe that people with lupus rely on the drug and that Trump’s comments may cause demand to spike.

We all hope this crisis ends as quickly as possible, and it seems possible to this layman that these anti-malarial drugs could be the solution. But there are many non-trivial reasons that medical research proceeds slowly and according to stringent evidentiary standards. It is one thing for a microbiologist to advance a speculative case for optimism on Facebook; it is another for the president to advance that speculative case in front of hundreds of millions of people. And it is hardly disparaging to hold the president to a high standard of responsibility during a crisis of this magnitude.

In an article published on Thursday and updated on Friday, New York Times reporters downplayed the possibility of using hydroxycholoroquine (HCQ), an anti-malaria drug, to treat COVID-19.

“With Minimal Evidence, Trump Asks F.D.A. to Study Malaria Drugs for Coronavirus,” the headline reads. And the subtitle: “The use of the existing drugs against the new virus is unproven, and some shortages have already been reported.”

The article went on to claim that the president had “exaggerated the potential of drugs available to treat the new coronavirus, including an experimental antiviral treatment and decades-old malaria remedies that hint of promise but so far show limited evidence of healing the sick.”

Another Times article on the topic bore the headline “Trump’s Embrace of Unproven Drugs to Treat Coronavirus Defies Science.”

No one should suggest, based on the available evidence, that HCQ is some sort of silver bullet that will cure COVID-19 and get us out of this global crisis. But neither should reporters cover a possible positive development from the angle of how best they can disparage the president. And Trump’s comments about the drug, though perhaps more optimistic than warranted, were not unreasonable.

According to the Times‘s own reporting, when discussing the recent studies on the effects of HCQ in COVID-19 patients, Trump “acknowledg[ed] he couldn’t predict the drugs would work.”

“I feel good about it. And we’re going to see. You’re going to see soon enough,” Trump said. Hardly comments bad enough to require the Times to cover hopeful scientific evidence with a laser-like focus on the flaws in the president’s tone.

Of course, like the president, I can’t predict whether HCQ will work. Nor am I a scientist with an advanced understanding of antimalarials. But based on what I’ve read, I think there’s reason for some optimism. On this subject, I found useful some commentary from American microbiologist and Dominican priest Nicanor Austriaco, who has a PhD in biology from MIT and is chief researcher at the Austriaco lab at Providence College.

In a Facebook post yesterday, Austriaco wrote that he was “struck by the attempts of these New York Times reporters to dismiss or minimize the impact of the possible use of hydroxychloroquine (HCQ) to treat COVID-19.” He noted that the results from the study in France — which found that HCQ, both on its own and in conjunction with the antibiotic azithromycin, successfully removed the SARS-CoV-2 virus that causes COVID-19 from a number of patients — were limited but promising, especially when reviewed in conjunction with data from a Chinese study finding that HCQ had anti-viral effects on SARS-CoV-2 in a test tube.

Of the Chinese study, Austriaco wrote, “They were able to provide a mechanism of action for this anti-viral activity, and it is a reasonable one. (For molecular biologists, mechanism makes all the difference in the world!) Briefly, it alters the pH of the parts of the cell necessary for viral reproduction.” He added that the “molecular evidence for anti-viral function” makes the clinical-study results more promising.

“In the end, despite what the NYT says, I am very optimistic about this development. I think that the headline is misleading,” Austriaco concluded. “Yes, there is minimal evidence but that is not unexpected in a pandemic. But the minimal evidence is actually pretty solid, given the practical limits of doing clinical trials in a global crisis. Yet, when both in vitro and in vivo studies converge, that is an optimistic sign. Especially when you have a mechanism of action that is reasonable and is in line with what we know about viral reproduction.”

This doesn’t mean we should all rush to the nearest beach this weekend, assuming that the miracle cure is on its way. But as pharmaceutical company Bayer seeks approval from the FDA to sell its chloroquine product in the U.S. to be used on an emergency basis to treat COVID-19, there’s no reason in the world for a leading newspaper to trivialize scientific evidence for the sake of attacking the president.

During today’s meeting of the U.S. Commission on Civil Rights, the liberal majority voted to issue a statement expressing “grave concern” regarding “growing anti-Asian racism and xenophobia” related to the coronavirus pandemic.

Of course, my conservative colleague Gail Heriot and I oppose expressions of racism, if any, related to the pandemic or otherwise. But we voted against the statement for several reasons. Our biggest objection related to the Commission’s suggestion that referring to COVID-19 with terms like “Chinese Coronavirus or Wuhan flu” is somehow fueling “[t]his latest wave of xenophobic animosity toward Asian-Americans.” This suggestion is consistent with those recently voiced by Democrats and mainstream media (but I repeat myself).

It’s common to refer to infectious diseases by their geographic origin. Examples include Asian flu, Bolivian hemorrhagic fever, Ebola, German measles, Japanese encephalitis, Lyme disease, Marburg virus, Middle East respiratory syndrome (MERS), Pontiac fever, Rift Valley fever, Spanish flu, Venezuelan hemorrhagic fever, and West Nile virus. Spanish flu was probably a misnomer. It may have originated in Kansas. But calling it Spanish flu was never an indication that people hated Spaniards. Nor is there any evidence that the names of any of the other diseases inspired “racism or xenophobia” toward races or ethnicities commonly identified with such regions.

Calling COVID-19 “Chinese Coronavirus” is accurate. It originated in China. But it didn’t merely originate there. As Victor Davis Hanson has noted, China’s Communist Party rulers hid its outbreak from the rest of the world for several crucial weeks. They misrepresented its contagious nature for several more. They permitted thousands of Chinese nationals to travel throughout the world while obfuscating the potential consequences. And the Chinese government is falsely claiming the U.S. military is responsible for introducing the virus. Under those circumstances, to object to calling the virus “Chinese Coronavirus” is, to say the very least, profoundly misguided.

Charles Fain Lehman has written an assessment for the Washington Free Beacon of the policy divide among congressional Republicans on how best to confront the economic dimension of the coronavirus outbreak. He argues that the debate maps at least partly onto pre-existing political struggles within the Republican Party, pitting those open to greater government intervention, such as senators Mitt Romney, Tom Cotton, and Josh Hawley, against more “libertarian”-leaning members.

This is true, to some extent. One can quibble somewhat with certain aspects of this analyis, however. Certainly, libertarians might resent being stuck with Senator Lindsay Graham as their ostensible philosophical representative. And when a policy expert at a think-tank Lehman describes as libertarian-leaning helps design the plan of one of the supposedly anti-libertarian members, one wonders how severe and serious the distinctions his assessment focuses on are, at least amid coronavirus. (Even if Samuel Hammond isn’t exactly a libertarian.)

There’s something meaningful to the fact that no one in Congress is really arguing for the federal government to do nothing, which is not what most libertarians would be on board with now anyway. Instead, they’re arguing over the best way to increase government involvement. This is an extraordinary crisis. Government does often grow in such times in ways that linger afterward. But we have no way of knowing at this time if the attitudes and policies that emerge now will carry on into the future (or if they should). Right now, we don’t even know what’s going to happen next week.

Or in 2024. Yet Lehman writes:

Cotton, Hawley, and Rubio are all considered potential contenders for the 2024 Republican presidential primary. A successful run by any of them could shift the balance of power in the party away from its more libertarian, business-oriented wing and into the hands of the nascent populist, worker-focused tendency awakened by, among other things, the electoral success of President Donald Trump.

Whether this framing is correct or not, the amount of things we know for certain is, at this time, incredibly low. We don’t know what Congress is going to do, whether America will successfully limit the spread of coronavirus, or how it will impact the 2020 election (or if it even will). Lehman may be right that politics isn’t stopping completely during this extraordinary event, even if its singular nature suggests caution regarding its utility as a reference point for politics beyond. But whatever happens, speculating about the 2024 presidential primary seems genuinely impossible right now.

Like many Americans, I’ve been tracking statistical reports about the coronavirus pandemic. In particular, I’ve been closely following Worldometer, which seems reliable, covers the globe, and gets updated frequently. It has been frustrating, though, to try to find good breakouts on fatality rate numbers.

I do not mean to suggest that this information is not out there. It just does not get the same attention as the total number of cases and the total number of deaths.

Reporting those two stats in isolation makes them seem especially alarming. If, hypothetically, on Day One there were 100 cases, and on Day 5 there were 1,000 cases, that would be a very troubling rate of increase, though it could be mitigated by a number of factors. (For example, if testing has improved in the interim, the surge in reported cases could reflect better information about the overall phenomenon, rather than just a rapid spread of the disease.) Similarly, if there were ten deaths on Day 5 after only one on Day One, that jump would seem frightening . . . but it would be a proportional increase in fatalities given the tenfold jump in reported cases — assuming the fatality rate has been reliably established.

As John McCormack noted last weekend, the omnipresent Dr. Anthony Fauci, longtime director of the National Institute of Allergies and Infectious Diseases, has testified that COVID-19 could be ten times more lethal than influenza. The latter has about a 0.1 percent fatality rate, so that suggests that the COVID-19 rate is about 1 percent. Yet, Dr. Fauci has written (in the New England Journal of Medicine), that “the case fatality rate may be considerably less than 1%,” if we assume that “the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases.”

That seems like a sensible assumption. After all, testing has skewed toward people who feel sick enough to report. We must also recognize, as Victor Davis Hanson has pointed out, that there are bound to be country-to-country variations (some of them stark) in fatality rates for the same disease due to differences in local conditions and populations. (Victor observes that the fatality rate for flu and related pneumonia is 16 times higher in Saudi Arabia than it is in Finland.)

The Worldometer charts do not break out fatality rate, so I ran some computations myself, using Worldometer’s underlying statistics. Those statistics are constantly updated. When I checked this morning, the U.S. fatality rate appeared to be about 1.5 percent (217 deaths out of 14,366 reported cases).

Our fatality rate is thus significantly lower than the global rate of 4.1 percent (10,080 out of 248,098). The U.S. number is comparable to South Korea’s 1.2 percent (100 deaths out of 8,652 cases). It is markedly better than Italy’s staggering 8.3 percent fatality rate (3,405 out of 41,035), the U.K.’s 4.4 percent (144 out of 3,269), and France’s 3.4 percent (372 out of 10,995). By contrast, we seem to be doing worse than Germany, which had lost 44 people out of 16,626 reported cases (a 0.3 percent fatality rate). I do not put much stock in the numbers out of China and Iran, whose regimes are not trustworthy. China is almost certainly lowballing at 4 percent (3,248 deaths out of 80,967 reported cases); Iran’s eye-popping 17.7 percent fatality rate (3,248 out of 18,407) is so astronomical, even compared to Italy, that I’m skeptical (though Iran is a troubled enough country that it could be reasonably accurate).

What I was most struck by was how consistent the U.S. fatality rate stayed during the most recent ten-day period.

Even as the number of newly reported cases spiked, from 290 on March 10 to 4,530 on March 19, the fatality rate hovered at slightly over 1 percent: The March 10 rate was 1.3 percent (4 deaths), and March 19 it was 1.2 percent (57 deaths). Obviously, it’s important to note that the daily deaths are not necessarily attributable to that day’s newly reported infection cases (in fact, they’re usually not).

There were some quirks over the ten days. The rate went as high as 2.6 percent on March 11 (307 new cases, eight deaths) and as low as 0.8  percent on March 12 (396 new cases, three deaths). But on the whole, and with the caveat that a ten-day stretch is too small a data set from which to draw confident conclusions, the daily rate roughly tracks the 1.5 percent fatality rate we have for total U.S. cases.

Clearly, we have to do what we can to minimize the incidence of COVID-19 infections: hygiene, social distancing, and heightened protections for especially vulnerable groups (the elderly and people with underlying medical problems). Nevertheless, there remains, as Dr. Fauci suggests, a good chance that the fatality rate could drop under 1 percent, once (a) testing is widely available and (b) more people with no symptoms or very mild cases inflate the “reported cases” category.

Again, spikes in reported cases are disturbing, and the death count is heartbreaking. Let’s keep our eye, though, on the fatality rate.