Platt Perspective on Business and Technology

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 54

Posted in macroeconomics by Timothy Platt on August 11, 2020

This is my 59th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 54th installment to this specific series on that.

I began laying a foundation for comparing COVID-19 to other significantly impactful human disease outbreaks in Part 52 and Part 53 (with a brief digression into zoonotic diseases too.) And my goal for the first part of this posting is to bring that into specific focus, with a more detailed discussion of how such comparisons might even be made. So I will write here about COVIV-19 and the SARS-CoV-2 virus that causes it, but I will mostly be writing about potential and realized epidemic and pandemic diseases in general. As such, I am going to dispense with my usual World Health Organization, COVID-19 update start and begin with a consideration of a more general pathogen model. Then I will discuss human response to that and its emerging spread. And one of my primary goals leading from that, will be to propose some possible approaches for moving forward from where we are now with this pandemic. But first, and to set the stage for that, I repeat here an organizing framework for thinking about an event such as our current COVID-19 pandemic, as offered in updated form in Part 53 and as labeled here (in boldface) for purposes of this posting:

The disease mechanism: the pathogen that is causally responsible for a disease outbreak is a mechanism that can be considered to be responsible for that disease itself. So it and any disease spread arising from it can be seen as holding specific medical and epidemiological significance here.
The pandemic enabler that creates opportunity for that level and range of disease spread; epidemics and more widely spread pandemics are shaped by, and even enabled by sociological and sociopolitical forces too.
A basic response and resolution framework: effectively addressing an epidemic or pandemic and on both its pathogen-defined disease front and on its human response front, calls for a systematic infrastructure level response.

My goal here is to at least offer a first take analysis of some of the key factors that would enter into the first of those points, and with an initial emphasis of simply identifying the pieces that enter into them. I begin with the disease as an explicitly biological and medical phenomenon and with the pathogen and its properties. And I will couch the points of detail raised there in large part in question and comment form. And I will begin with the obvious: the question of what would bring a microbial species to human attention in the first place and certainly as a possible source of human risk or harm.

• What does this pathogen (this somehow contagious organism) do to people once it becomes symptomatic? COVID-19 initially presented itself in Wuhan China, as a pulmonary disease, so an initial response to this from before the pathogen responsible for it was even identified, is that. Subsequent experience with this disease and its pathogen has expanded upon that start as new courses of disease involvement and progression have been identified, at least in specific patient demographics.
• Where did it come from? This is actually several questions. It is a geography and locale question: COVID-19 first made its appearance as a human disease in an open market that sells wild animals of all sorts for food. It is also a question of original pathogen hosts. Did it come from an animal species, or did it arise as a novel mutation of an already existing microbe that was already present in human populations, with that mutation arising in a person? In this case, COVID-19 arose as a zoonotic disease. Initially, it was assumed that the first animal to human transmission was from a pangolin but it is now known that the closest genetic match relatives to the SARS-CoV-2 virus, and certainly anywhere near Wuhan, are endogenous to species of bats.
• Does this disease transmit directly from person to person, and if so how? This is a crucially important question. Cholera and related diseases transmit to people from contaminated water and from food that has been exposed to it. It does not transmit directly from person to person. Ebola does transmit directly from person to person, or from contaminated surface to contaminated surface, where that requires exposure to infected bodily fluids. So while it transmits readily by fomite and direct human contact routes, it does not transmit as an airborne illness. Measles is an airborne disease spread by contact with droplets that are spread when an infected person breathes, coughs, or sneezes. COVID-19, it turns out is largely an airborne disease too, though it also spreads by fomite transmission too, from contact with contaminated surfaces.

There is an important timing progression built into those first three points. The first of them is probably going to be fairly clear from the beginning of an initial outbreak, at least for a primary disease manifestation. The second of them takes time to answer. And the third of them can be a real learning curve challenge. COVID-19 is, unfortunately, a textbook example of that; here we are some eight months into this pandemic with close to 20 million confirmed cases of it worldwide and with that known to be a significant undercount of the actual number of people who have caught this disease, and we are still learning the basics of how it spreads and filling in crucial gaps in our understanding there.

• Who, demographically, is most at risk of catching this disease? What are the risk factors there?
• When do they become contagious for it and how long do they remain so?
• Are there asymptomatic carriers and do they actively spread this disease? How long are they contagious and what viral loads do they carry and spread while they are contagious?
• Who are more likely to fit this pattern, demographically?
• Who, demographically, is most at risk of serious complications or death from this disease?
• Are people who are infected with this pathogen and who will become symptomatic from it, contagious for it during their pre-symptomatic incubation period? And if so, for how long?
• Returning to the issues of fomite (surface or related) transmission, how are involved surfaces contaminated? How heavily are they contaminated? How long do they remain infectiously contaminated? And of course, what types of surface and surface conditions would foster disease transmission from them and for more extended periods of time?
• Returning to the issues of airborne transmission, when someone coughs, sneezes or breaths for that matter, and they release infectious viruses or other microbes into the air from that, they do so through the spread of droplets and micro-droplets. How large are these infectious particles (with this generally measured in microns, for droplet diameters)? The smaller they are, the longer they can remain suspended in the air as sources of airborne contagion, and the farther they can travel in airborne suspension as such. This is where our perhaps realistic, perhaps unrealistic presumption of 6 feet of separation for safety with COVID-19 enters this narrative.
• Measles viruses can remain suspended in the air as infectious particles for half an hour or more as naked viruses, not requiring a mucosal droplet sheath for protection. And that significantly contributes to it being among the most contagious diseases known, and it also explains to a significant degree why herd immunity is only possible for that disease when well over 90% of a population has personal immunity to it.
• And in either case: fomite or airborne transmission, how much of a viral or other pathogen load does someone have to be exposed to, to become infected with that disease? This is certain to be a question with multiple valid answers depending on factors such as the age and general health of the people involved, and whether they have a robust or compromised immune system.
• I have focused essentially entirely on fomite and airborne transmission in this series as they appear to be the two most likely and important transmission mechanisms for the SARS-CoV-2 virus, just as they are for other coronaviruses. That said, there are five generally recognized transmission mechanisms that pathogens can readily spread through: fomite, aerosol, oral (as in food and liquids ingestion), direct contact (from another person by whatever means), and vector (from a nonhuman host.) How many of these routes of transmission have to be taken into account as representing serious sources of risk for a given pathogen?
• Turning back to the issues of source and with possible vector transmission in mind, do other species carry this disease? Do they constitute ongoing uncontrolled reservoirs of it that could lead to new outbreaks or wider expansion of already occurring ones? The SARS-CoV-2 virus has been observed in a few other species as what are most probably rare events and not as sources of ongoing contagion concern. The flu strain responsible for the 1918 flu by comparison, sickened and killed members of a very wide range of species. And for a second example here, of this phenomenon, rabies is known to infect a wide range of species, some of whom become symptomatic from it and die from it and some of whom appear to more commonly serve as asymptomatic carriers.
• And then there is the question of mutations. And once again, I cite the flu virus in its seemingly endless mutational varieties as an example here, for how that can lead to public health and individual healthcare crises. Every year, people who seek vaccination coverage from the flu have to get revaccinated with what are hopefully going to be effective vaccine formulations for that year – with them covering the correct set of new viral variants that appeared likely to become the most important ones for a coming season. Even when a vaccination development system is as routinely standardized as that one it is, with its annual implementations, there is going to be guesswork, based on what is emerging in China, before it has had time to spread. So far at least, the mutations that have been found in the wild of open populations, have not shown the types of surface protein changes that would make them appear new to those who were infected with a more routine strain and who might have some immunity from that now.

But COVID-19 is so new still that we do not have any real answers to the questions implicit in that last bullet point. Even if we do see an effective vaccine against its virus, can that hold lasting value in the face of mutational change, or will it be necessary to get revaccinated and even yearly for this too?

Let me put COVID-19’s numbers up to now into perspective. Every year, according to US CDC studies, “between 291,000 and 646,000 people worldwide die from seasonal influenza-related respiratory illnesses each year” (see Seasonal Flu Death Estimate Increases Worldwide. The 1918 flu is estimated to have killed approximately 194,000 people in the United States alone, in October, 1918. COVID-19 killed over 700,000 people worldwide between the start of March, 2020 and now and even when only considering a greatly underestimated official confirmed count.

Is COVID-19 a contender for becoming the second worst pandemic ever, as categorically discussed in Part 53? Will mutational changes make it more deadly once contracted than it is now, or more readily transmitted or both? Will a mutation arise that undoes any seeming benefits that have accrued from survivor immunity, or from a vaccine against this virus when that becomes available, or some combination thereof? We do not know; no one can know the answer to any of these yet, baring for example the incontrovertible emergence of some specific new mutational form that explodes in numbers of cases it appears in. And that does not seem to have happened; the mutations that have been found for the SARS-CoV-2 virus to date at least, seem to be more benign than that.

So what would a perfect pathogen look like, where perfection would be measured in terms of the virus fulfilling its programmed goals of replicating and spreading to new hosts to further replicate? Let’s consider the above points of discussion as a recipe guide for that, if you will.

• Such a pathogen might kill its hosts but it would not do so too quickly. Effectiveness here means capacity to spread and that means a host it is infecting being able to spread it.
• Asymptomatic carriers would obviously help there and a great deal, as would pre-symptomatic carriers being able to transmit the pathogen during their incubation periods.
• And the more transmission routes that that pathogen can effectively transmit through the better, and particularly where those routes are really robust for that. For a working example of this robustness, consider the measles virus that as a naked particle, not requiring a protective droplet cover, can stay afloat at least in the air, for hours and longer. And for fomite transmission, consider the anthrax bacillus. Bacillus anthracis can and does sporulate, effectively going into what amounts to suspended animation while waiting for contact with a possible new host organism that it can revive and replicate in.
• For timing though, it is not necessary for a perfect pathogen as discussed here to last forever on a surface, or for it to float suspended endlessly in the air. It is only necessary that it remains viable long enough, by whatever transmission routes for it to transmit, and effectively enough to create high transmission rates from host to host.
• A capacity to initiate an active infection with a minimal number of copies of the pathogen: with a minimal infectious load or infectious dose as it is also called, can also help here.
• And having zoonotic reserves and in multiple host species, some of whom can carry it asymptomatically can help too. Though as I will discuss in the next installment to this series, human behavior can create that same infected reservoir population effect in enabling ongoing and recurring epidemic and pandemic spread capability too.

And with that, I will turn to the second set of human context issues as noted at the top of this posting when discussing epidemics and pandemics per se, and what it takes to create one: pandemic enabler issues and factors. I will delve into that in the next posting to this series, starting by adding a few more details to this posting’s disease mechanism oriented discussion. And then after completing my basic discussion of those first two sets of issues, I will turn to and discuss systematic response and resolution frameworks and possible approaches to achieving them.

And this brings me to the second part topic of this posting and COVID-19’s longer term issues, as proposed for here at the end of Part 53. My expressed goal here has been to continue a discussion of drug pricing as begun there, but doing so in any meaningful way will call for a more lengthy discussion than would make sense if appended to the above narrative. So I am now planning on completing this posting’s first part discussion as left off here and as just outlined for moving forward with it, in an upcoming Part 55. Then I will turn to consider drug pricing and related longer term, post-COVID-19 related issues as a single topic for a Part 56. I will, of course continue pursuing both here-and-now oriented issues, and longer-term post-COVID-19 ones as well, and through any foreseeable future, starting with the second part discussions list for longer-term consideration, as offered in Part 53.

Meanwhile, you can find this and my earlier COVID-19 related postings to this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 53

Posted in book recommendations, macroeconomics by Timothy Platt on August 6, 2020

This is my 58th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 53rd installment to this specific series on that.

As usual, I begin this posting with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic:

• August 03 at 01:39 GMT: 18,231,535 reported cases with 6,094,997 currently active, 12,136,538 now closed, and with 65,753 active in serious or critical condition (1 %), and 692,694 closed cases reported as deaths (6 %)
• August 04 at 01:25 GMT: 18,440,141 reported cases with 6,071,004 currently active, 12,369,137 now closed, and with 64,675 active in serious or critical condition (1 %), and 697,094 closed cases reported as deaths (6 %)
• August 05 at 02:22 GMT: 18,700,833 reported cases with 6,081,263 currently active, 12,619,570 now closed, and with 65,480 active in serious or critical condition (1 %), and 704,347 closed cases reported as deaths (6 %)
• August 06 at 0:35 GMT: 18,956,630 reported cases with 6,104,844 currently active, 12,851,786 now closed, and with 65,514 active in serious or critical condition (1 %), and 710,038 closed cases reported as deaths (6 %)

One of the biggest challenges that we face coming from this pandemic, is the ongoing belief as held by so many, in the palpably demonstrably false. That obviously includes the stridently insisted upon belief that social distancing and wearing masks or other face coverings are just adversarial political theatre, intended to rob those on the political right of their personal liberty. But even when considering those who see such disease containment as valid and even essential, many still hold their own disease enabling beliefs. And one of them, that I have been repeatedly challenging here, is the belief that since children and young children in particular rarely show COVID symptoms, they do not catch or transmit this virus. I have offered at least a brief succession of references to the contrary of that, in this series and certainly more recently in it. And add one more to that list as coming from a politically red, Trump supporting state:

Georgia Camp Outbreak Shows Rapid Virus Spread Among Children

And to quote from that news story:

• “Three-quarters of the 344 attendees and staff for whom the CDC was able to obtain test results tested positive for the virus.” And that was with incomplete reporting, so the actual transmission rate of the SARS-CoV-2 virus as potentially calculable from this event was probably underestimated there.

I will pick up on the implications of this type of cognitive disconnect and its consequences, later in this discussion thread, when address the question of what relevant historical data and insight mean when attempting to compare COVID-19 as a pandemic event to other historical human disease outbreaks, epidemics and pandemics. But with that in mind, I continue where I left off at preparing for that comparison itself, at the end of the first portion of Part 52 with its historical timeline and related commentary.

I said there that I would turn here to consider the 1918 flu pandemic and more recent events and I will do that. But before doing so I am going to further discuss one of the entries that I offered in Part 52, and I will add one more that is largely contemporaneous to it. The one that I will discuss further, as repeated from there is:

• In the New World, in what is now Mexico and Central America and further south extending into South America, the Cocoliztli, or pest in Aztec: a massive smallpox pandemic, is believed to have killed upwards of 15 million people. It is believed to have been brought there by European explorers and it is known to have contributed to the downfall of the Aztec and with time the Incan Empire too. We have to assume that 15 million figure is a significant underestimation so this might in fact be a second place contender too.

I begin expanding on this by offering a link to a sobering if well researched reference work: The Effect of Smallpox on the New World. This work and the specific research that it cites, estimate that smallpox killed off as much as a third of the entire population of Native Americans in North America and in just a few months. And it spread southwards with devastating impact too. And also see How Europeans brought sickness to the New World. But this is not just a story of a disease spreading East to West, from Europe to the New World. It is a story of a disease traveling from a region where it had already struck before and where it was known, to a region where it was completely unknown and where there had been no natural selection for even just the most nominal resistance to it. And that goes both ways here, where Europeans picked up New World diseases and brought them back home to their countries of origin too, and with devastating effect there.

The best known putative New World, to Old World, Europe disease exchange is syphilis. While there are those who would argue that this disease was already in Europe from before Columbus and his voyages, it is likely that his crew did in fact bring this disease back with them. The first known outbreak of it in Europe, tellingly occurred in Naples, Italy in 1494 and 1495. And this disease killed millions. It went on to become a major killer in the time of the Renaissance in Europe. And some studies argue that in the late 18th century, up to 20% of the citizens of London in the age range of 15 through 34 were treated for this disease. See this History of Syphilis for further details.

But to pick up on a detail that I noted in passing above, the now European syphilis of the late 15th and early 16th centuries was far more deadly than this disease is now. As Jared Diamond described it:

• “…when syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people’s faces, and led to death within a few months.” As quoted from:
• Diamond, J. (1997) Guns, Germs and Steel. W.W. Norton.

As bad as that seems, early European syphilis was actually worse. It, for example, also caused necrotic bone lesions that led to bone crumbling fractures. And it attacked the brain and central nervous system far more rapidly than it does now as tertiary syphilis or more specifically as neurosyphilis.

And with that, I turn to the best known of the major historical pandemics, and the one that COVID-19 is most commonly compared to: the 1918 flu pandemic. And I begin doing so by discussing its perhaps most common name: the Spanish flu.

This flu virus and the disease it caused did not arise in Spain, or even in Europe for that matter. So why was it called this? Blame nationalistic animosities for that. Similarly, when syphilis first began its march through Europe, the French called it the Spanish Disease, the Spanish called it the French Disease … and it is said that the English called it both, depending on who they were speaking with. They were unhappy with both the French and the Spanish at the time. Moving forward, president Trump and his followers have taken to calling the SARS-CoV-2 virus the China virus, or the Wuhan virus and for similar jingoistic nationalistic reasons.

• Divisiveness in the face of shared danger can only enable the source of that danger by limiting or even preventing anything like an effective commonly shared response to it.
• This was true for past epidemics and pandemics, and it is just as true now and with the evidence of that emerging and expanding before our eyes, every single day.

So far at least, every single point that I have made in this posting from its beginning, has in fact been relevant to the line of discussion that I will offer here when discussing pandemic severity, and the question of where COVID-19 stands for that in comparison to earlier historical epidemics and pandemics. This divisiveness and its implications for mounting a more widespread and even global response to such a crisis, does too.

There is an extensive reference library’s worth of material available now, regarding the 1918 flu and both in the popular press and in the professional literature. And this includes a wide range of books of note. But to restrict myself to one such reference work from that, I suggest:

• Barry, J.M. (2018 edition) The Great Influenza. Penguin Random House LLC.

I have already offered the more abstract and even dehumanizing dates and numbers for this event in the course of writing this series, as I have cited it as a source of comparison to what we now face. So I pick up on that narrative from a somewhat different perspective that will hold particular importance later on in what I will offer here.

The viral strain that was responsible for this event was readily transmissible from person to person, making it a deadly disease that was quite capable of spreading. But it was human behavior that gave it the means and opportunity to spread as widely and as quickly as it did and with the numbers of lives lost that resulted from that. The story of that pandemic, as narrated in Barry’s book, is one of heroes and of people of knowledge and insight, and of fools and people where were purblind in their folly for what they were unleashing in this disease from that.

This same conflict of vision and understanding and its consequences are what we face now, with the COVID-19 pandemic that we are currently going through. That failure to respond to crisis cost millions and millions of lives, avoidably lost in the Great Influenza’s 1918 through 1920 initial crisis period. And we are in fact still living with its direct sequels and every single year with our new flu virus variants. In a fundamental sense, we have never really left that pandemic behind us; we face its direct offspring every single year and with ever-increasing cumulative loss of life from it. We are seeing similar failures in leadership and in judgment and in willingness to take prudent steps to limit disease spread now, just as then. And we are almost certain to see recurrences of this disease, just as we see recurrences of the flu and on an ongoing basis and from now on – well after this immediate pandemic crisis ends. And yes, we have already seen hundreds of thousands of lives lost and avoidably so, this time too and even just as of now when we are still early in this pandemic.

We have not seen anything like the pandemic of 1918 through 1920 (with its ending blurring out beyond that) since then, and certainly up to the start of COVID-19. The disease comparison question that I have been at least approaching addressing here, is in fact one of whether this pandemic will worsen and worsen until it becomes at least a second place contender, as suggested for several earlier epidemics and pandemics in Part 52. That, ultimately, is up to us. And that brings me to a line of discussion that I have been building towards, and from early in Part 52 up to here: an at least brief and selective analysis of the medical and related side to this pandemic and of epidemics and pandemics in general, coupled with a corresponding listing and analysis of sociological and sociopolitical factors and forces that shape and set the scale of outcomes there. I will turn to that in the opening portion of the next installment to this series. And in anticipation of that narrative to come I add here that I will take a basic conceptual approach that I have offered here in this series for understanding these issues and I will add one more key element to that:

• The pathogen that is causally responsible for a disease outbreak is a mechanism that can be considered to be responsible for that disease itself. So it and any disease spread arising from it can be seen as holding specific medical and epidemiological significance here.
• But epidemics and more widely spread pandemics are shaped by, and even enabled by sociological and sociopolitical forces too.
• So effectively addressing an epidemic or pandemic and on both its pathogen-defined disease front and on its human response front, calls for a systematic infrastructure level response. (I have been addressing this from a more piecemeal perspective in second part discussions in these postings and will pursue a higher level perspective on this complex of issues in this anticipated discussion to come.)

I will add and at least begin to discuss at least a few possible remediations, and preventative or at least adverse consequences-limiting actions that might be taken now, and for moving forward from where we are now with COVID-19. That, I expect to offer on a more piecemeal basis, as I continue writing to this series.

And with that, I turn to the second portion discussion of this posting, and longer-term new normal considerations. I ended Part 51 with a to-address list of new normal, post-COVID-19 issues that have to be addressed in our healthcare and public health systems. And I begin here by repeating them as offered there, noting in advance that I have already at least begun to address the first of them and both there and in Part 52:

• Standardizing medical information, and the questions of what standards would be developed and used, and with what overriding purposes they would be developed and organized for – e.g. insurance use and coding for claims, versus standardization for more directly personal healthcare purposes.
• Controlling drug costs and drug availability issues and challenges.
• The challenge of hospitals and clinics that cannot provide first rate service, and where and why.
• And the emergence and elaboration of telemedicine as disruptively new change, and both as medical appointments might be held remotely and as new types of online connectable technologies are brought into this, informing such encounters.

The first of those points is all about information and its disconnects. I frequently write in this blog of economic friction as a macro-scale phenomenon, and of business systems friction as its microeconomic, more limited-in-scale counterpart. The above repeated first bullet point is ultimately all about friction: all about information development and communications challenges and their consequences, even if those challenges can erupt in conflict of interest forms.

There are a number of approaches that could be taken in addressing the second of those bullet pointed topics, including for example, acknowledging and limiting, through regulatory law or other mechanisms, systemic price gouging and certainly for lifesaving drugs that are well established but indispensible for those who need them. See, for an all too clear example of need there: Why Did That Drug Price Increase 6,000%? It’s The Law in that regard. But I am going to turn to and address some of the challenges that arise in new drug development and pricing here, and how pharmaceutical manufacturers and others in the supply chains leading to direct user consumers, follow practices that are geared against those consumers.

The type of established and known drug re-pricing that I just cited above, is at least directly visible to the marketplace and its customer members. Original, pre-increase prices are known and certainly at a directly consumer-facing level. The problem that I would raise and address here is one of transparency, or rather opacity and a lack of transparency as that reigns in essentially all pharmaceutical development. And the bottom line result of that here, is that consumers face out of control prices that match what would be expected at worst, from out of control monopolies.

• Monopolies stifle competition, and with a variety of toxic consequences that include but are not just limited to excessive pricing, loss of product alternatives and a stifling of innovation.
• A complete lack of transparency in business systems and in their decision making processes can lead to those same things and particularly where the businesses in an industry have what amounts to a captive audience that has to purchase their products and even as a matter of absolute necessity.

What does it actually cost to develop a new drug and bring it to market? How would fair pricing even be defined there, in any practical, implementable sense? There are at least two sides to those questions and to both answering them and even just to understanding them: the manufacturer’s side, and the marketplace and consumer’s side. And both have valid points on their side. My goal here is to at least briefly and selectively touch upon a few of them and from both sides, as they would apply here. And after offering that, I will offer a few thoughts as to how a modus vivendi might be arrived at between them, and with greater transparency requirements and business confidentiality and risk management requirements both included in any compromises reached.

I begin this with a disclaimer of sorts. I worked for a number of years as a research scientist, and with a fair amount of that devoted to molecular virology studies. And as a consequence I was at least occasionally invited to give talks at research facilities that were owned and run by pharmaceutical manufacturers. They were interested in what I was doing related to viral replication. That said, I am also a pharmaceutical consumer with health issues that have called for my taking medications and even expensive ones. I have never worked in the pharmaceutical industry but I do hold sympathies for the genuine challenges faced there, in developing new drugs and bringing them to market. At the same time, I have felt despair, as have many at the costs of some of the drugs that are out there and at how out of line with reality they seem to be, and probably are. So I have biases on both directions here, that probably balance out, and certainly when address these issues in more general terms. (Some disclaimer: I am claiming to be an honest broker here. That, at least, is my intention as I write this.)

I am going to continue this discussion as outlined above, in the next installment to this series as its second part. Meanwhile, you can find this and my earlier COVID-19 related postings to this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 52

Posted in macroeconomics by Timothy Platt on August 2, 2020

This is my 57th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 52nd installment to this specific series on that.

As usual, I begin this posting with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic:

• July 31 at 01:33 GMT: 17,464,995 reported cases with 5,855,674 currently active, 11,609,321 now closed, and with 66,390 active in serious or critical condition (1 %), and 676,409 closed cases reported as deaths (6 %)
• August 01 at 01:22 GMT: 17,754,183 reported cases with 5,913,018 currently active, 11,841,165 now closed, and with 65,563 active in serious or critical condition (1 %), and 682,885 closed cases reported as deaths (6 %)
• August 02 at 01:14 GMT: 17,999,275 reported cases with 5,992,616 currently active, 12,006,659 now closed, and with 65,696 active in serious or critical condition (1 %), and 687,807 closed cases reported as deaths (6 %)

Comparing the early morning data points of August 2 as offered here with their July 2nd counterparts, we see:

• An increase of 7,197,434 overall confirmed COVID-19 cases,
• With an increase in the number of deaths from that, that comes to 168,964 in total. (See Part 42 for the full set of July 2, 2020 numbers for this.)

As I have repeatedly said, and throughout this series up to now, these numbers are going to get a great deal worse in the coming weeks and months. So will their more localized national counterparts and for more nations than just the ones that we currently see as heading in that direction according to their reported numbers as compiled and organized by entities such as the World Health Organization.

What do I see coming, and by the end of 2020? Given the numbers that we see now, and the systematic failures that we see playing out in so many nations now in containing this disease and its spread, I see a tripling or worse in the total number of confirmed COVID-19 cases, and with a corresponding increase in the number of fatalities reported from this too. And if healthcare systems and the hospitals that enter into them become overloaded in harder hit areas and in enough of them, the percentage of closed cases that end up as deaths from this disease, will go back up again. That has progressively dropped down to approximately 6% now, but that trend is not guaranteed to continue.

• Whether this set of predictions holds true, in whole or in part, will depend entirely on how we behave. Our fate here is in our own hands and in those of our neighbors.

And with that, I add four recent in the news reports of particular relevance here:

Coronavirus Is Back With a Vengeance in Places Where It Had All but Vanished.
A Viral Epidemic Splinters into Deadly Pieces. To quote from this news piece: “There’s not just one coronavirus outbreak in the United States. Now there are many, each requiring its own mix of solutions.” This, I add, is a direct consequence of a failure to lead from the White House in either organizing or even supporting an overall national level effort to contain this disease. State by state ad hoc has cost many tens of thousands of lives that should not have been lost. And more will follow them in this and avoidably so.
Children May Carry Coronavirus at High Levels, Study Finds. And to quote from this: “Infected children have at least as much of the coronavirus in their noses and throats as infected adults, according to the research. Indeed, children younger than age 5 may host up to 100 times as much of the virus in the upper respiratory tract as adults, the authors found.”
• That effectively demolishes what should be the last of a too-long held cherished fantasy that children and particularly young ones do not get infected with the SARS-CoV-2 virus, except perhaps rarely. They catch this infection. And yes, in spite of the still wishful thinking of the researchers behind this study, they almost certainly do actively spread it to others too. For the research report itself that underlies that above-cited New York Times piece, see: Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19). (The authors of this paper hopefully suggest that since very young children have small lungs they probably cannot spread this virus very effectively. But even toddlers can and do catch and share seemingly every cold and other human-to-human transmissible infection that they get near, so common experience argues otherwise.)

And I finish this starting point note here by adding that it is now believed that at least in the United States, some of the local and statewide epidemiological reporting that goes into US CDC and World Health Organization reports has underestimated their actual numbers of COVID-19 cases by up to 13-fold! Are my above predictions too cautious? For a recent reference on that see: Coronavirus Infections Much Higher Than Reported Cases in Parts of U.S., Study Shows. And I quote from that here with: “The number of people infected with the coronavirus in different parts of the United States was anywhere from two to 13 times higher than the reported rates for those regions, according to data released Tuesday (n.b. July 21, 2020) by the Centers for Disease Control and Prevention.”

And that somber opening note brings me to the complex of issues that I said at the end of Part 51, I would at least begin address here, that can be collectively represented in this topics point as:

• The question of how COVID-19 compares with other, now historical epidemics and pandemics, and I add here other human infecting diseases per se.

I said there that I take a somewhat different approach to answering this type of question than most would, and I begin doing so here in human prehistory, and going back tens of thousands of years and more at that. And in that, I begin with the human genome: our inherited genetic history, and our shared human story as encoded there.

To be more precise, I begin with the one type of heritable genetic content that can be expected to enter into the basic human genome from the outside, and with time both routinely and at something of a predictable pace: the piece by piece inclusion of inserted genetic sequences as initially sourced from retrovirus infections. Every human genome from members of every community worldwide is replete with such inserted retroviral genetic sequences, most all of which are damaged remnants of early and long forgotten infections.

To put that phenomenon into perspective for its scale of impact, see this research paper from Genome Biology:

Endogenous Retroviruses in the Human Genome Sequence, which I quote from here with:
• “Around 8% of the genome is derived from sequences with similarity to infectious retroviruses, which can be easily recognized because all infectious retroviruses contain at least three genes, including gag (encoding structural proteins), pol (viral enzymes), and env (surface envelope proteins), as well as long terminal repeats (LTRs.)”

Inserted genetic sequences of this type that are added into a genome through a germline so they are replicated from generation to generation, rarely face any selective pressure to maintain them unchanged. So random mutations accumulate in them that can be used to at least roughly calculate when they first arrived there. And some and even many of these retroviral remnants are of truly ancient origin as part of the human genetic heritage. But how many of these events are recorded in this way, comparatively speaking? How rare, or how common is this type of event for amount of such genetic material that has been added in this way, in comparison to the scale of functionally important proportions of the human genome?

• The entire human genome is comprised of some 3.2 billion base pairs of DNA. This includes some 21,000 protein coding genes that collectively comprise approximately 1% of that genome. So remnant retroviral sequences account for about eight times as much of the human genome as its entire set of functional protein coding genes does.

Much of this inserted genetic material at least appears to be silent, but it is known that some of these virally sourced sequences do play active gene regulatory and other functional roles too, and in both normal and pathological gene expression. They have, in this become usurped into use by the more strictly human portions of the human genome if you will, and to both positive and negatively pathological effect. So there is a lot more to this particular story than I will even try to address here. But one detail that comes from this brief narrative should be clear and even without my explicitly stating it. The history of humanity as a species, and of the hominid line that we evolved from in general is a history of facing and fighting off infections. And this up to here only acknowledges one small portion of the full range of pathogen-based infections that humanity has faced: retroviral infections that can leave persistent traces of themselves that can be maintained from generation to generation and even very long-term.

And I add a few more points here. These are infections that enough people were infected by so their traces have not disappeared by chance. And they are infections that enough people have survived from, so as to continue the species. How many have died from these diseases too, and how has that ongoing gauntlet of challenges shaped our species through its natural selection compelling forces? There is no way to know any real answer to that, but there are a variety of viral pathogens that are known to infect other species of mammals with devastating lethality.

Rabbits in their various species are subject to a variety of them including myxomatosis and rabbit hemorrhagic disease, both of which have been found to cause well over 90% fatality in at least some outbreaks. And for wild rabbits the mortality rate for myxomatosis has been found to be as high as 99%! So absent any medical care, public health measures or personally protective efforts, viral infections can at least occasionally represent extinction level events and certainly over specific infected regions and for certain mutations of the viruses involved.

Think of that as a worst case possible baseline for what will follow in this discussion. Has the human species ever faced an infection or otherwise-cased threat that has even begun to approach that level of impact? The answer to that is in fact yes, with remnant evidence of that also found in our human genomes. And this is now known to have happened early in the human story, and at least once, when our then living direct ancestors came close to the edge of dying off entirely. See: Endangered Species: Humans Might Have Faced Extinction 1 Million Years Ago and Humans Were Once an Endangered Species.

My point here is very simple, when looking to both those rabbit diseases and to this early human ancestry event. Humans are not in some way immune from or exempt from extreme danger from suddenly emergent adversity, and high population counts do not necessarily offer protection either. I will in fact argue later on in this narrative that higher population densities can increase risk there. But with this offered, let’s turn from the more abstract to consider historical if perhaps largely earlier recorded human diseases, for which there are at least some documenting records. And I begin that by noting that every ancient civilization that has left us anything in the way of a written record of any scale, has left at least some mention of plagues, pestilences and epidemics.

• In 430 BCE, an epidemic ravaged the Greek city state of Athens, when it was at war with its rival, Sparta. It is not known precisely what pathogen was involved, but it is clear that it swept through that city state and its crowded living quarters and with its poor hygiene, and that upwards of 25% of its citizens died of it.
• The Antonine Plague of 165 to 180 A.D. is estimated to have killed between 60 and 70 million people when smallpox swept through the Roman Empire. It is believed that this was brought to the Roman Empire on trade ships and that it most probably initially originated in China. One of its more societally destabilizing effects was that it devastated the Roman Army, leaving their empire open to invasion. It also directly wrought havoc on Rome’s finances and economy, on its food production and supplies and more, and that this contributed to the eventual downfall of the Roman Empire as a whole.
• The Justinian Plague (so named because it first struck during the reign of Justinian I) struck the Byzantine Empire starting with a first major outbreak that lasted from 541 to 542 AD. But this kept recurring, at least until 750AD. And this was both the most devastating epidemic (and in fact true pandemic) in history up to then with somewhere between 25 million and 100 million lives lost just during that initial outbreak. (I have read estimates of up to half a billion lives lost from the 1918 flu pandemic so this is not the worst ever but it is a strong contender so far for second place for that.)
• And only considering genuinely devastating pandemics for a next entry here, I turn to the Black Death. Its precise dates are a bit uncertain and particularly for its ending but they are often given as 1346 through 1353 A.D. (The people of places such as Wales might disagree in particular with that ending date.) And this is believed to have killed somewhere between 25 million and 200 million people though no one really knows true counts for this for any of these disease events and certainly up to here in this narrative. This is the other contender for second place as the worst disease outbreak ever.)
• In the New World, in what is now Mexico and Central America and further south extending into South America, the Cocoliztli, or pest in Aztec is believed to have killed upwards of 15 million people. It is believed to have been brought there by European explorers and it is known to have contributed to the downfall of the Aztec and with time to the Incan Empire too. We have to assume that 15 million figure is a significant underestimation so this might in fact be a second place contender too.
• And to complete this list, the Great Plague of London (of 1665-1666) and the Great Plague of Marseille (of 1720-1723) both took some 100,000 lives. Those numbers only reflect deaths resulting from these disease outbreaks in those cities themselves, though many fled them in an effort to avoid these diseases, taking them with them.

This is a very incomplete list and even just for this timeframe, only briefly noting a few of the more impactful of these events as took place over a roughly 21 century span. But it should be enough to begin to put our current COVID-19 pandemic into at least an initial perspective. I am going to at least briefly discuss a selection of more recent disease outbreaks in a next series installment, beginning with the 1918 flu pandemic as touched upon repeatedly up to here in this series, and even briefly in this posting too. And then I will step back from these specific disease outbreaks to discuss in more general terms, factors and conditions that can and do lead to devastating severity in them. And in anticipation of that, I repeat here a point that I made in passing in Part 49.

• The pathogen that is causally responsible for a disease outbreak is a mechanism that can be considered to be responsible for that disease itself. So it can be seen as holding specific medical and epidemiological significance there. But epidemics and more widely spread pandemics are shaped by, and even enabled by sociological and sociopolitical forces too.

And this perspective will emerge as a defining source of consideration, when I look back at this developing line of discussion to specifically address the questions implicit in its starting point:

• How COVID-19 compares with other, now historical epidemics and pandemics, and I add here other human infecting diseases per se.

I am going to forgo the second portion discussion that I was initially planning to add in here, postponing that for a later posting, given the volume of text I have just offered here. So I will only add one recent highly relevant news story reference here that relates to that, which I will pick up upon in a subsequent posting:

Coronavirus Data in the U.S. Is Terrible, and Here’s Why.

We have tremendous amounts of data coming out of this pandemic and its advance, and certainly when compared to even the most thoroughly recorded of the historic epidemics and pandemics as discussed here. But so much of that data is of such poor and inconsistent quality, and with so much unstated variation as to what is even included categorically in the key variables measured there, that this creates tremendous challenges for managing this disease. COVID-19 is just uncovering already existing gaps, weaknesses and failures there, that were already in place in healthcare and public health systems and even in technologically developed nations such as the United States. What will we learn from that moving forward, and how will we act upon any such lessons learned as we seek to arrive at and implement our healthcare and public health new normals coming out of this pandemic (or at least its first real outbreak)?

I will continue both of these lines of discussion: my historical comparison one and this, in the next installment to this series. Meanwhile, you can find this and my earlier COVID-19 related postings to this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 51

Posted in macroeconomics by Timothy Platt on July 30, 2020

This is my 56th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 51st installment to this specific series on that.

As usual, I begin this installment with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic.

• July 29 at 01:36 GMT: 16,891,150 reported cases with 5,772,121 currently active, 11,119,029 now closed, and with 66,504 active in serious or critical condition (1 %), and 663,335 closed cases reported as deaths (6 %)

• July 30 at 01:58 GMT: 17,184,770 reported cases with 5,818,014 currently active, 11,366,756 now closed, and with 66,392 active in serious or critical condition (1 %), and 670,152 closed cases reported as deaths (6 %)

I begin the first part discussion of this posting by posing a question that is fundamental to effectively addressing, and with time resolving this pandemic crisis:

• What are the key factors: the key decisions and actions that have to be taken in order to speed up that process, and save lives and restore our economies in the process?

Ultimately, all possible such actions as raised there, gain their value in one shared way. They all would serve to systematically reduce and then stop disease transmission from individual to individual, and from that through communities. This obviously applies to social distancing and related exposure limiting measures, and to the use of face masks and gloves as appropriate. It also applies to the development and deployment of a vaccine against COVID-19, with that possibility a major goal that is being worked towards, worldwide.

I begin this discussion there, as the United States and a number of other nations have invested, and offered to invest billions of dollars or their local currency equivalents in both developing such a vaccine and in providing it to millions of their citizens and either free or at low cost. There are, as of this writing, 42 separate and distinct COVID-19 vaccines under development that have at least entered Phase 1 clinical trials to prove their basic safety. See this COVID-19 Vaccine Tracker as provided by the Regulatory Affairs Professionals Society. The US government has chosen three of them to help fund though Phase 3 trials now, with each calling for 30,000 volunteers, half of whom would receive the test vaccine, and half a saline solution placebo. And their goal is to validate a successful candidate that would:

• Significantly reduce the infection rate,
• Significantly reduce the percentages of those who are infected who go on to become seriously or critically ill from it, and/or
• Significantly reduce the mortality rate from this disease.

There are other such putative COVID-19 vaccines that are already in, or rapidly approaching Phase 3 trials. And all of these more advanced efforts look promising at least in laboratory studies, where their products in testing all provoke antibody production and T cell activation. Note: T cells are white blood cells that specifically target viral pathogens so that is a very positive indicator, as is antibody production per se. But that still leaves the question of whether this is the right antibody production and T cell response for actually combating this particular virus in actual people. Laboratory success does not always translate into public health success in this type of situation, where such a vaccine candidate has to be able to function in the more complex environment of full, active human bodies.

But let’s assume that one or more of these vaccines do work, at least initially. How long would they continue to hold immunizing value? And would they prevent infection or would they create asymptomatic carriers who do become infected if exposed to the SARS-CoV-2 virus but who do not become ill from it themselves? And how long would this immunity last, given whatever administration protocols are arrived at for them (e.g. single dose, or two doses spaced some interval of weeks apart for when they are administered)?

I have written of immediate immune system responses in this blog, with production and proliferation of early nonspecific IgM antibodies followed by production and proliferation of later more pathogen-specific IgG antibodies. They and associated T cell and other response mechanisms defeat an invading pathogen when a person becomes ill from a disease such as COVID-19, and their coordinated action leads to recovery from it. I have also written here of the development and maintenance of monoclonal memory cell lines that remember this infection after recovery, and that can lead with a very targeted response to the causal pathogen involved and essentially immediately, upon re-exposure.

• Effective response and recovery from infection with a pathogen such as this virus calls for a direct immune system response that is based on antibody and T cell activity.
• Fast highly targeted response as can be launched by maintained memory cells can stop reinfection before it can really start. Longer term immunity is all about memory cells and whether they are maintained or lost.
And this brings me to some points of fact that are particularly relevant here, for this discussion:

• While there are exceptions, as a general rule the strongest long-term immunity to a disease comes from recovery from it, as that can leave you with the most robust and persistent memory cell line for combating it upon re-exposure. So if people who were provably infected with the SARS-CoV-2 virus and who recovered from it, now come back with new infections from that same virus and with new positive diagnostic test results to show that, this would be very troubling.
• And with that, I offer this news story link: Can you get coronavirus twice? Doctors are unsure, even as anecdotal reports mount.
• These reinfection reports are considered anecdotal because it is possible that these people suffered relapses from a single infection with this virus, rather than fully recovering from it and becoming freshly infected with it again. So their cases are cautionary, rather than definitive in nature and certainly as of now. But their implications, if valid, have to be considered and strongly so in any planning going forward, and certainly given the severity of the consequences faced if immunity here does not hold.
• To round out that set of points, I add: Can You Become Reinfected With Covid-19? It’s Very Unlikely, Experts Say and this report from the US National Center for Biotechnology Information: Clinical recurrences of COVID-19 symptoms after recovery: viral relapse, reinfection or inflammatory rebound?
• I personally, take a more cautious approach for this and simply view possible reinfection as representing an open question. And then, if it does demonstrably occur, that raises more questions, including:
• How commonly do people who have been infected with this virus become susceptible to reinfection with it, and over what time frames? The implications there are very different if this is rarely or very rarely, than it would be if the answer is often and most likely within six months or less.
• And another such question would be: do those who are susceptible to reinfection share any readily identifiable personal health condition or demographic markers in common that would help to identify them in advance as needing special follow-up care? That follow-up would include they’re being more closely monitored for possible reinfection and they’re taking precautions post-recovery for preventing they’re becoming reinfected with the SARS-CoV-2 virus, and exactly as if they had never had it.
• And in this questions raised context, I add one final report as published by The Scientist: Studies Report Rapid Loss of COVID-19 Antibodies (which might or might not indicate development of a robust memory cell response.)

Depending on how the issues and questions as raised there, actually resolve through real world empirical findings, issues such as “immunity passports” might become moot. For a reference on that approach to possible more expansive reopenings, with possible recovery-based immunity supporting them, see this World Health Organization paper: “Immunity passports” in the context of COVID-19.

The possibilities raised here, if realized, would in fact impact upon any possible reopenings, however staged or paced. And if immunity does not persist for a meaningful length of time, this would challenge vaccination programs per se as a whole.

I raise these issues here as a source of contingencies that need to be considered, even if they are not likely and certainly in anything like their worst case scenario forms. But this still leaves open the issue of possible new mutations in the SARS-CoV-2. I have raised and discussed this complex of issues in this series, as a matter of general principles (see for example, Part 36.) So I end this portion of this posting by offering another cautionary note news piece that just came out: The Coronavirus Could Dodge Some Treatments, Study Suggests. And with that in mind, as to how mutations can facilitate the spread of this disease between people, I add this news piece on how at least some mutations in this virus can facilitate spread and infectivity within individuals too, affecting its severity as a pathogen: Mutation Allows Coronavirus to Infect More Cells, Study Finds. Scientists Urge Caution.

All of us, and regardless of our age, are vulnerable to this disease and even to its worst possible consequences. To put a very tiny, innocent and vulnerable face to this, I share a link to this family tragedy as reported by CNN: A 26-day-old baby tests positive for Covid-19 following autopsy in Pennsylvania. So the issues that I raise here and in similar ongoing discussions, have impact and meaning that none of us can safely ignore – that none of us should try to ignore as a matter of basic morality and responsibility.

I am going to turn in the first part of my next installment to this series to a complex of issues that I have been thinking a great deal about, and that a reader has recently asked me to explicitly write about here: the question of how COVID-19 compares with other, now historical epidemics and pandemics. We are now far enough along in this pandemic so that at least some answers there are coming into explicit focus. At the very least, some crucially important questions that relate to this are. In anticipation of that narrative to come, I admit that I will take a somewhat different approach to parsing and analyzing these issues than most would, but hopefully that will at least raise new questions that need to be resolved.

And with that, I turn to the second part of this posting, and to the longer-term and (ideally at least largely) post-COVID-19 new normals that might arise. I offered a to-address list at the end of Part 50 that I repeat here as I begin addressing them:

• Standardizing medical information and the questions of what standards and with what overriding purposes they would be so developed and organized – e.g. insurance use and coding for claims, versus standardization for more directly personal healthcare purposes.
• Controlling drug costs and drug availability issues and challenges.
• The challenge of hospitals and clinics that cannot provide first rate service, and where and why.
• And the emergence and elaboration of telemedicine as disruptively new change, and both as medical appointments might be held remotely and as new types of online connectable technologies are brought into this, informing such encounters.

And I begin with the first of those points and by stating the obvious:

• Medical information is systematically coded so as to characterize the individuality and the even sometimes overall idiosyncratically unique of particular individual patients, for how they follow standardized known patterns, for at least key aspects of their medical conditions.
• And on a testing and treatment side, standardization becomes a standard, essential fact too.

From a clinical and healthcare provision perspective this means organizing what is known about individual patients and their particular medical needs, in ways that support clinicians bringing the best of what is known in general that would fruitfully apply to them, to their patients. And cause-and-effect consistency does mean that different patients with similar medical issues will show a great deal of similarity for what they have and for how it might best be treated – with that individualized by taking into account their own particular medication sensitivities and other medically relevant considerations (such as any comorbidities.) So patients might still be individuals and they might need to be treated as such, but this still means they’re fitting known and even highly consistent patterns for key details and both for what their medical issues are and for how they might best be treated for them. Coding there, is primarily a matter of applying standardized medical terminology.

Alternatively and at least sometimes in conflict with that, healthcare insurance coverage providers have their own system of codes (in number and letter forms) and both for medical conditions and their issues and for tests, procedures and treatments offered. And they set reimbursement rates for services rendered, according to those diagnostic codes as submitted by healthcare professionals or the facilities they work for, or by patients themselves (at least situationally.) And when a patient arrives, for example at a hospital emergency room with multiple emergent medical issues, insurance-oriented coding systems can be used to determine what of that in fact can even be covered in part by a patient’s health insurance policy, of all of it. And this fact can and does influence how codes are selected and entered into that insurance company’s system, so as to generate as much reimbursement coverage as possible, and certainly where the hospital itself would have to eat some or even all of the difference there as a loss.

On that note, I add that I was heavily involved with hospital emergency rooms in the New York City metro area, that receive 911 call ambulances, and for seven years as a member of the New York City Regional Emergency Medical Advisory Committee – and I have never heard of a hospital that did not lose money in its institution’s overall budget and finance calculations, and on an ongoing basis.

Coding, or rather medical nomenclature and coding, and their use do not always align in any functionally productive sense. More importantly, the healthcare and reimbursement needs that they would variously address do not always match each other all that well. That is the basic challenge. I am going to continue this discussion in the second part of the next installment of this series, and will then continue on from there to the second of the above to-address topics points where I will discuss costs, focusing on pharmaceuticals for that.

Meanwhile, you can find this and my earlier COVID-19 related postings to this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 50

Posted in macroeconomics by Timothy Platt on July 27, 2020

This is my 55th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 50th installment to this specific series on that.

As usual, I begin this installment with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic. And I begin that by noting:

• July 22 at 01:22 GMT: 15,091,817 reported cases with 5,362,262 currently active, 9,729,618 now closed, and with 63,785 active in serious or critical condition (1 %), and 619,409 closed cases reported as deaths (6 %)

And to highlight the scale of change taking place and on a day-to-day basis since then, I skip ahead from that to:

• July 28 at 01:17 GMT: 16,634,647 reported cases with 5,752,992 currently active, 10,881,655 now closed, and with 66,560 active in serious or critical condition (1 %), and 656,069 closed cases reported as deaths (6 %)

The day-to-day increases that we all see in these numbers are deeply troubling, but look at what a six day change looks like! Just focusing here on two of the variables that I have been reporting on here, of this still selectively limited set:

• The total number of new cases jumped by 1,542,830 new confirmed COVID-19 infections in that still brief period of time.
• And the total number of reported deaths went up by 36,660.

This, I stress, was in just six days. It is easy to lose track of the ongoing scales of all of this when only looking day-to-day. It is vitally important that we never lose track of what those numbers mean, or of the fact that every single digit increase there, represents a unique individual person and their life.

I am going to start my more here-and-now first half of this posting by proposing a crucially important point of detail that I would argue is going to prove to be tremendously impactful moving forward, in shaping both our more immediately emerging situation with this pandemic and beyond.

But before offering that emerging understanding, I set the stage for doing so by reiterating some relevant points of observed detail as already noted in this series:

• It is now known and I add well established that on the order of 30% of all of those who become infected with the SARS-CoV-2 virus as adults, remain asymptomatic from it even as they go through what on average are fairly extensive periods of active infection in which they are actively contagious to others. And it is now known that older children contribute to that too and in a similar manner.
• And while wearing face coverings and social distancing and related disease containment measures are the only widely available tools that we actually have at our disposal that might limit the spread of this disease and save lives from it, they have all become toxically politicized and certainly in countries such as the United States where many people refuse to comply, claiming that these measures are just left-wing attacks on their personal freedom.

That combination of empirically valid truths is going to make it effectively impossible to prevent recurring waves of this disease, and both in areas that have never really brought itunder control and for areas where they ostensibly have too. That is because this combination of factors, coupled with “mask wearing and social distancing fatigue” from people who have grown tired of taking such protective measures but who have done so, will insure disease reemergence and even in cities and larger regions that have seen a virtual secession of at least overtly symptomatic cases.

This will all have a number of significant consequences. And one of them is that we can no longer hope to see a simple tapering off of, and ending of this pandemic that would follow anything like a simple here-then-gone pattern. And we may in fact never see a true end to this disease as an ongoing healthcare and public health issue, and even if an effective vaccination for it is developed. Remember, in that regard, the anti-vaxxers who I wrote of in Part 48 who are already refusing any vaccination against the SARS-CoV-2 virus for themselves or their families and even before one is tested and made available – simply because it is a vaccine.

COVID-19 is not going to slip quietly into history; we will see it fade and remerge and fade and reemerge and repeat and repeat and even if new mutational forms do not arise that would evade any immunity that might be gained from becoming infected and recovering, or from getting vaccinated against this disease.

And even if an effective vaccine is developed, how widely can it be made available and both in developed world nations and in the developing world?

I am offering this posting as a brief note as far as word length is concerned. But the basic point that I raise here will shape all that I add to this series from now on, and both for its here-and-now first part discussions and for its post-COVID-19, new normals oriented discussions. And I simply add here in that later context that any new normal to come will have to be affected by the ongoing at least sporadically reemerging presence of this disease.

I am going to turn in the first part of the next installment to this series, to at least begin to more fully consider a complex of issues that are now starting to come into explicit focus as new public health sourced data is developed: the combined issues of vaccination development and disease resistance as that might or might not remain in place or fade away. I have touched upon these issues already in this series, but will look further into them now, as emerging data takes that more out of the abstract and away from speculation.

I will also, as a second half of the next installment of this to come, begin addressing a set of topics points that I list here in anticipation of their discussions to come:

• Standardizing medical information and the questions of what standards and with what overriding purposes they would be so developed and organized – e.g. insurance use and coding for claims, versus standardization for more directly personal healthcare purposes.
• Controlling drug costs and drug availability issues and challenges.
• The challenge of hospitals and clinics that cannot provide first rate service, and where and why.
• And the emergence and elaboration of telemedicine as disruptively new change, and both as medical appointments might be held remotely and as new types of online connectable technologies are brought into this, informing such encounters.

Meanwhile, you can find this and my earlier COVID-19 related postings to this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 48

Posted in macroeconomics by Timothy Platt on July 21, 2020

This is my 53rd posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 48th installment to this specific series on that.

As usual, I begin this installment with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic:

• July 19 at 02:14 GMT: 14,422,471 reported cases with 5,205,991 currently active, 9,216,480 now closed, and with 59,913 active in serious or critical condition (1 %), and 604,823 closed cases reported as deaths (7 %)
• July 20 at 00:32 GMT: 14,633,037 reported cases with 5,294,335 currently active, 9,338,702 now closed, and with 59,878 active in serious or critical condition (1 %), and 608,539 closed cases reported as deaths (7 %)
• July 21 at 00:46 GMT: 14,845,017 reported cases with 5,333,949 currently active, 9,511,068 now closed, and with 59,807 active in serious or critical condition (1 %), and 612,829 closed cases reported as deaths (6 %)

I am going to focus, in the first portion of this posting, on three areas of immediately here-and-now relevance as we all collectively face this pandemic:

• Masks and other face coverings, and their actual usage rates,
• Vaccinations as they are being developed and as they will in time be deployed, and
• Herd immunity and how this might arise, but more importantly here, for how this possibility has become politicized.

These areas of consideration might seem to be quite separate and distinct from each other and certainly at first glance. But as I will argue here, there are also some significant synergies that arise between them too, effectively creating points at least of overlap between them, and certainly for their consequences.

I begin here with masks and with a New York Times article that outlines in some detail, as to where people are and are not wearing them in the United States:

A Detailed Map of Who Is Wearing Masks in the U.S.

Not surprisingly, the map accompanying this news piece shows the lowest levels of compliance with wearing a mask, where the pandemic numbers are surging upwards the most. But I cite this news piece for a different reason. The data that underlies this, was all self-reported by the people who were included in its surveys. They decided if they never, sometimes, usually or always wear a mask or face covering when going out in public. And that was how those 20% compliance intervals were determined, that show by color intensity on that map, from up 0% to 20% on through 80% or more. But what does this actually mean? That all depends on what you mean by “wearing a mask or other face covering.”

I live in a community that would self-report as being in that 80% or higher compliance range. But a face covering of whatever form can only offer protection if it is actually worn on a face and over its mouth and nose. So what does it mean if someone always puts their mask on, but with it kept below their face and across their throat? I see that all of the time, and from way too many people. And no, they generally do not bring those masks up over their faces if they find themselves in a more crowded situation where social distancing would not be possible. And what of the many, and certainly in hot weather, who have a mask on but only over their mouths and with their noses exposed, when they are breathing through their noses and any possible exposure to the SARS-CoV-2 virus would be by that route for them (or from them)?

This brings up several important points for me. The first is that self-reporting here, is meaningless because different people see “wearing” very differently, and consequentially so. So the only way to get meaningfully valid data on actual (effective) mask usage would be for epidemiological data collectors to take counts of what people are actually doing, in places with enough foot traffic to both create potential disease transmission risks and to provide statistically significant data sample sizes from the number of people counted.

This all becomes crucially important, to cite a second point that I would raise here, when public policy is based on what might be faulty overestimations of how much disease containment is being actively attempted and by the public at large. Poor data can only lead to poor planning and policy and that is certain to lead to poor outcomes.

And as a third point, I add that this can only lead to politicized arguments against wearing masks or other face coverings on the grounds that they do not work as promised by their (no doubt politically motivated) supporters. So the culture war, COVID-19 edition, continues. And overestimations of mask usage and other disease containment efforts can only serve to fuel that.

The second area of immediately here-and-now relevance that I would discuss here is that of COVID-19 vaccinations, as they are being actively developed and at a faster pace than has ever been attempted for any vaccine development effort, anywhere. I wrote earlier in this series that there were anti-vaccination groups that began speaking out against a possible COVID-19 vaccine from the earliest announcements that these development efforts were being carried out. We still have a ways to go before anything from that effort could be available for anything like more general use, but the anti-vaxxers are already actively speaking out against them with claims of their being unsafe, and even with claims of they’re being developed as a weapon aimed at the public as part of a vast conspiracy. See, for example:

There’s Another Insidious Side Effect of This Pandemic – More Anti-Vaxxer Activity, which I quote from here with:
• “The vaccine will inject you with an electronic chip, poison you, make you sick, they say” and
• “There’s no vaccine yet for treating the novel coronavirus, and scientists are multiplying efforts to find one. But already anti-vaxxers – a small but vocal group of people who don’t believe in vaccinations – have taken advantage of the pandemic to multiply disinformation on social media.”

And for further references on this phenomenon, added here because of the impact of these people on public health, and just from their already ongoing attacks against routine childhood vaccinations if nothing else, I add:

• This recent New York Times news piece: Mistrust of a Coronavirus Vaccine Could Imperil Widespread Immunity and
• This July, 2020 report from the Johns Hopkins Bloomberg School of Public Health: The Public’s Role in COVID-19 Vaccination: Planning Recommendations Informed by Design Thinking and the Social, Behavioral, and Communication Sciences.

And to further highlight the significance of both this public health challenge and the anti-mask movement as discussed above, with so many refusing to wear a face covering at all when out in public and so many refusing to wear one correctly when they do, I add this final reference for here:

Older Children Spread the Coronavirus Just as Much as Adults, Large Study Finds.

I have been saying this for months now and I am not alone in that, by any means. And I add in this context that I also assume that younger children get infected with the SARS-CoV-2 virus and spread it to others too, just like they share the common cold and seemingly everything else contagious that they come near. But now it is official, so to speak and certainly for older children. The population at risk of actively spreading this disease is larger than has been officially accounted for and certainly where public policy and related planning are based entirely on official recommendations from organizations such as the US CDC. This just makes the issues raised here in this posting, that much more pressing.

And the third area of immediately here-and-now relevance that I would discuss in this posting is that of herd immunity. I have discussed this approach to effectively ending this pandemic in earlier postings to this series, and particularly in its Part 25 where I roughly calculated, for order of magnitude purposes, the possible consequences of only pursuing this disease management course. The numbers offered there for possible total number of COVID-19 fatalities were grim. And no new findings have been developed in better understanding this disease that would bring anyone to lower them, or any of the other key statistics that arise with them. More has been found out about this disease and its spread, in fact, that would raise a question that extrapolations of that type do not go far enough, and particularly when you add in the numbers of COVID-19 survivors who will in all likelihood suffer life-long injuries and impairments from having had this disease. But those who oppose masks and face coverings, and even social distancing, and those who oppose vaccinations against this disease in anticipation of that becoming possible, still turn to herd immunity as a cure-all.

So all three of these basic approaches to addressing COVID-19, hold at least one key point of detail in common between them. They are all heavily politicized and with that creating barriers to actually bringing this disease under control. But they all hold at least one more point in common. They all at least in principle, hold at least a potential capability for helping to break chains of transmission from person to person to person here, by limiting the likelihood that an actively infected, contagious person find others who are both vulnerable to being infected and who are not physically blocking such exposure through their own behavior.

Obviously, if an infected contagious carrier of this virus wears a face mask and consistently when out in public and if they social distance and watch what they touch, following prudent guidelines there, they are a lot less likely to give this disease to anyone. But even when uninfected and vulnerable people come in contact with contagiously infected others who are not being careful about any of this, if they are taking basic safety precautions themselves, they are still a lot less likely to catch this disease.

Vaccinations and widespread vaccination in particular would break disease transmission chains and reduce if not eliminate the development of new disease clusters, and of any real size. That, at least is a public health goal there. Masks and other personally protective equipment, if properly and widely used, hold that same potential. And finally, herd immunity, and whether “naturally arising” as discussed in Part 25, or artificially induced through widespread vaccination, would accomplish that too. All three can at the very least contribute to what in total could be an overall effective means of limiting the spread of this disease and of stopping it as a pandemic and both locally, and with time globally as well.

But this all depends on widespread willingness to actually take advantage of these capabilities, and of the first two of them in particular as they are where it is possible to be proactive here. A gradual accumulation of immunity to the disease, to the extent that recovery from it leads to that, is only a reactive consequence. And this leads me to one final reference that I would offer here, that picks up on the issues of policy and planning as that might be based on faulty data, as touched upon above:

Inside Trump’s Failure: The Rush to Abandon Leadership Role on the Virus, which came with this tagline text:
• “The roots of the nation’s current inability to control the pandemic can be traced to mid-April, when the White House embraced overly rosy projections to proclaim victory and move on.”

The Trump administration is still doing that in the United States and with dire consequences to that are still unfolding around us all. And president Trump and the United States are not alone in pursuing such wistful folly. And that sad fact is reflected empirically in the data that the World Health Organization compiles and posts online every single day and on both a global and a nation by nation basis. And that sad fact is also reflected in the United States based epidemiological data, that the Trump administration is now trying to hide and block access to as discussed in Part 47.

And with this, I turn to the second topic area of this posting and a continuation of an already ongoing narrative that I have been offering here regarding possible healthcare and public health new normals, as they might arise as this pandemic ends.

I have been discussing healthcare access, healthcare insurance coverage as that fundamentally constrains what of that is even possible, and personally identifiable medical and related information and its accessibility and its privacy issues. And I have addressed these issues from both an individual and a public health perspective. Think of those and other related issues that I have also been touching upon here, as representing pieces to a larger overarching puzzle. And my goal here is to step back from the pieces to consider that puzzle as a whole.

I keep going back to those lessons not learned, coming out of the 1918 flu pandemic: the so called Great Influenza,” as I have written about that here in earlier postings to this series.

• What were the fractures and fault lines that both individual people and entire communities fell through then as that pandemic raged and as its consequences were so unevenly distributed and along racial and other discriminatory lines?
• What of them have simply persisted, unaddressed and right up to today and our here-and-now? We see at least some of the consequences of that failure every day if we look to the epidemiological numbers coming out of our current pandemic.
• But those numbers are consequences – effects in complex and impactful cause and effect systems. Only focusing on the effects might give us a sense of being concerned, but the only way to actually accomplish anything of value here is in facing and addressing those underlying causes too and how they arise and persist.
• What are we doing there? What can and should we do there that would have actual impact on this and change the effects – the outcomes reached?
• And with that I come back to the Trump administration in the United States, actively seeking to end the Affordable Care Act in the United States, and right now in the midst of a pandemic that is exploding for its numbers here, and when that would automatically take away the healthcare coverage of some 23 million people! This reflects what partisan politics can lead to when it becomes a goal in and of itself, divorced from any awareness of or interest in real world impact and consequences.
• But what can and should we do, societally? Any valid answers there, will all but certainly cut across any and all of our momentum-driven, blindered partisan divides and the barriers that we seem so eager to protect them with.
• Actually defining and carrying through on a comprehensive new normal that actually addresses the problems that we face here – longstanding ones included, will have elements that are certain to challenge and displease, and with no political party or perspective immune to facing that side of this.
• Actually creating a positive new normal that can work for us societally and without leaving out vulnerable individuals and even entire communities, will call for compromises and accommodations, and open acknowledgement of how it is not some “them,” some “others” who have made this change necessary.
• We have to acknowledge and we have to change and to drive change and even when that means stepping away from our standard as-usuals that have seemingly worked, at least for us.

I write this here in general and even abstract terms. But they only really take on meaning when considered for how they would play out in their details, and in the details faced by real people and real communities and in all of their diversity now. I am going to step back from my usual narrative thread as offered here, in a next installment to this series to raise and discuss some larger questions. And then after that I will return to these issues for the second part discussion of them in a next posting after that.

Meanwhile, you can find my earlier COVID-19 related postings in this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 47

Posted in macroeconomics by Timothy Platt on July 18, 2020

This is my 52nd posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 47th installment to this specific series on that.

As usual, I begin this installment with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic:

• July 16 at 01:54 GMT: 13,691,570 reported cases with 5,067,610 currently active, 8,623,960 now closed, and with 59,617 active in serious or critical condition (1 %), and 586,820 closed cases reported as deaths (7 %)
• July 17 at 01:11 GMT: 13,937,253 reported cases with 5,076,816 currently active, 8,860,437 now closed, and with 59,935 active in serious or critical condition (1 %), and 591,957 closed cases reported as deaths (7 %)
• July 18 at 01:31 GMT: 14,189,018 reported cases with 5,134,514 currently active, 9,054,504 now closed, and with 60,142 active in serious or critical condition (1 %), and 599,339 closed cases reported as deaths (7 %)

I offered Part 46 of this series as a digression into the frustration that many now feel, given the way that so many communities and their citizens fail to respond to this pandemic with any care or forethought. That most definitely applies to communities as found across much of the United States, though that nation holds no monopoly on toxically politicizing this crisis and at everyone’s expense.

I wrote of challenges faced there, and concluded that digressive note by saying that I have no real answers as to how to fix the impasse that we all now face from that. And I only add here that any realistic resolution to the challenges that I raised in Part 46, will have to include the voices of a diversity of perspectives, and with participation of people who start out politically motivated towards being COVID-19 deniers included. No one side or group can resolve this challenge on their own, and certainly when it is our failures to communicate and to be able to work together across our divides that are at the heart of our current impasse. And unfortunately, the only way to bring that diversity into a constructive dialog as a first step towards resolving it, would be if one or both of two conditions were first met. And I raise them here in terms of those who are opposed to being forced as they see it, to curtail their rights by having to wear masks, limit face-to-face business activities, stay out of indoor dining restaurants and more:

1. The only way that true ultra-conservatives who now see this as a left wing partisan political hoax, will take any of it seriously enough so that they would be willing to take the measures needed to limit COVID-19’s spread, is if they see with their own eyes what it can do to their own communities and even their own families. That, unfortunately, is already really beginning to happen, and certainly in states like Florida and Texas as already discussed in this series. But even seeing this with their own eyes might not prove to be sufficiently convincing for Trump’s roughly 40% of the voting population: his true believers. Fact based evidence certainly has not convinced him and he still acts and speaks and twitter posts accordingly. And regardless of any conflicting evidence, they still chose to believe in him.
2. So as a second essential requirement here, a voice has to arise that even extremists in denial will have to at least listen to and consider for what they say, who would argue in their terms and in their idiom, a need to social distance, a need to wear masks, and a need to otherwise contain this disease so as to slow and stop its spread. Visible evidence of the success of that approach in New York State: once the hardest hit of all states in the United States for this disease and now the one doing best for it, is not enough. An effective right wing spokesperson for constructive change in how we respond to this disease is going to be needed. But there is no competing voice that Trump’s ultra-conservatives would turn to and accept as their voice now, and I certainly do not see any rising contenders for that either, and anywhere.

So the numbers that I have been reporting in these postings for where we are now, in fighting this globally disease, will continue to go up and up and they will get much worse, and tragically so. This disease will not simply disappear as if by a miracle, as president Trump keeps declaring. And that extrapolation from where we are now will prove true even if the many who have been infected by COVID-19 up to now, and who have become seriously or critically ill from it, or who have died from it up to now, but who have not been counted in any official tallies, are never recognized for what they have endured and even if they are never added into any official counts. The actual numbers will keep going up and so will our more limited, officially confirmed case counts.

And with that, I turn to the news and recently and currently unfolding events as they inform this narrative. And I begin with president Trump as he has become a poster child exemplar of COVID-denial, worldwide, and a shining example of what his type of denial can bring and to so many. (Sorry for the sarcasm, but I do feel a measure of both despair and anger at what he does, and particularly when it is all so self-serving as he seeks reelection and at whatever cost and to however many.)

As president Trump sees things, the only way that he can get reelected, short of being offered even more massive election interference help from Russia than he received in 2016, would be if COVID-19 were to effectively disappear in the United States between now and November. Even he must realize on some level that that is not going to actually happen. So he has decided to take an alternative approach, and make it harder to see the scale of this pandemic in the United States, even if he cannot not actually make it invisible. What has this campaign included? Among other details, I would point to:

1. Reopening everything that he can force or intimidate into reopening and as quickly as possible, so as to restore at least a semblance of normality to the economy and to daily lives, while
2. Demanding a significant reduction in the numbers of diagnostic tests for COVID-19, claiming that they cause the disease.
3. And he has now decided to order all hospitals to stop reporting COVID data to his own government’s Center for Disease Control and Prevention: the primary clearing house for gathering, organizing and sharing such data in the country.

I have already discussed the first two of those points in this series, and with references that offer further details to them, so I will focus on the third of them here, as a new elaboration on this developing theme. And I begin doing so by offering these news references:

Trump Administration Strips C.D.C. of Control of Coronavirus Data (which came with this tagline text: “Hospitals have been ordered to bypass the Centers for Disease Control and Prevention and send all patient information to a central database in Washington, raising questions about transparency.”)
Trump Administration Orders Hospitals to Bypass CDC in Reporting COVID Data.
Coronavirus Data Has Already Disappeared After Trump Administration Shifted Control From CDC.

The Trump administration claims that it is carrying out this change because the CDC has been up to a week delayed in bringing its incoming data together and reporting it, and that is true. Their technology in place is such that a great deal of the data that comes into their offices from state and local sources, has to be manually entered into their database systems and with all of the delays and all of the opportunities of what should be avoidable data errors that this would bring. But the United States Department of Health and Human Services facility that is supposed to take over this task, is hamstrung in the exact same way and to at least the same degree – and its personnel are not up to speed for carrying out this type of work and at the volume of it involved here. But perhaps more to the point, that new facility for this is being directly, overtly, politically managed insofar as it is being directly hands-on run by Trump appointees who are going to oversee what is brought into their system, how it is going to be organized and labeled there, and how it is going to be shared and with whom. And that has already led to visible gaps in the data that is visible from there.

So the above Point 3 in Trump’s agenda here, is to control the pandemic data and make anything too troublesome in that, to simply disappear from public view – so the disease can too. And if it is not removed per se, it can always be relabeled and “reinterpreted” too.

I have presented Part 46 of this series as a digression, and in a sense it is. But it strikes to the heart of this pandemic and to what is driving it. The virus is a molecularly scaled device that infects and moves on to infect again, and repeat. That is the basis of this pandemic. But what makes this is a pandemic and a still expanding one is entirely in human hands and a matter of how we as vulnerable potential hosts to this virus act, and with that either limiting and stopping that infective spread or enabling it.

• What have we actually learned since the 1918 flu pandemic?
• What, in fact have we learned since the Black Death, or Great Plague as it is also called, of the mid-14th century?
• What have we actually learned from any of our historical plagues or pestilences of the past?

Looking at how many fail in their response to our plague and pestilence of today, a realistic answer to any of those questions should probably begin with “not much.”

And as I keep saying here, the numbers – the real numbers, keep going up and up and up and they will continue to do so and even where it should be the most possible to bring a disease of this type under control.

And with that, I turn to the second, more forward looking portion of this posting where I have as a matter of intention if nothing else, been focusing on possible healthcare and public health oriented new normals to come, as this pandemic ends and becomes history for us.

I began a more detailed discussion in Part 42 of personal medical and related information and its legitimate use, and its legitimate security and access control issues too. But as important as individually sourced, personally identifying information is in this context, it only represents one aspect of a larger and more comprehensive medical information management challenge. Another face to this can be found in healthcare-related business intelligence and in how this pandemic has made that a prime target, and for both private sector, and for state and state sponsored actors. I will focus here on the later of those two general categories and begin with China, as the surreptitious and otherwise irregular acquisition of trade secret and other confidential and proprietary data from business sources has been an ongoing tool for developing their own businesses and industries as they strive to make them world class, competitively.

At least initially looking beyond the confines of medical and related information per se in this, one of their most powerful information acquisition tools can be found in the mandatory technology transfer agreements that so many foreign businesses and types of them have had to enter into, with Chinese counterpart ventures, if they are to be permitted access to China’s vast markets. And a basic pattern can be found in how these agreements play out, that I would illustrate here with a transportation systems example. (I cite this example for its clarity and completeness.)

Currently, the largest manufacturer of railroad rolling stock in the world is the Chinese CRRC Corporation Limited. In 2018, the most recent year for which I have precise numbers, CRRC generated 20.9 billion Euros worth of revenue from sales of rolling stock worldwide. Their closest competitors, Alstom, Siemens and Bombardier generated 8.1, 7.9 and 7.2 billion Euros of revenue during that same period. So CRRC generated 90% as much revenue then, as the combined revenue generation of its three largest and most powerful competitors. For a reference on this, see Leading Rolling Stock Manufacturers in 2018, by Revenue of Rail Activities.

CRRC began as a smaller locally Chinese partner with these three foreign based businesses, and with others in their industry and sector as well. And they all separately teamed up with CRRC under the auspices of China’s legal mandates and government required licensure agreements that included specific technology transfers from them to this, their local Chinese partner business. In return, they were given opportunity to bid for business in China, and with direct access to their market for rail technology for any bid that they could win. And they did make some sales there. And then they ran into the Chinese government’s red tape and all that that added to their costs and both directly monetarily and through the costs of delays. And CRRC ran with this flood of proprietary information, selecting best of breed options and possibilities out of all of it. And they build the best of it into their own separate business line production and sales efforts. They capitalized on every single advancement and on every synergy that they could create from all of that, and with government support that made it possible for them to undercut any and all competing manufacturers for price and both within China and with time, globally as well. So they are the biggest and the most powerful business in this important manufacturing arena now.

That is most definitely not a medical or a pharmaceutical example but it illustrates a number of points that apply much more generally. A first is that China does offer foreign businesses at least a possibility of being able to tap into the revenue and profits possibilities of the largest nationally based marketplace on this planet, and that allure can be overwhelmingly compelling and certainly if a business only thinks short-term there. And the second point that I would raise from this is that China’s government and its Communist Party and its businesses: state run and private sector all included here, work together and ruthlessly in an ongoing effort to capture and dominate business sectors and entire industries, and globally. And they, of course, make use of their technology transfer agreements as a tool for achieving that.

But when approaches for capturing critically important business intelligence through legally framed initiatives such as this cannot be used, state run and state allowed and supported cyber hacking is resorted to as well, and on a vast scale. And with that in mind I turn to a specifically medical and pharmaceutical example that comes directly from the flow of news coming out of this pandemic: COVID-19 vaccination research:

U.S. to Accuse China of Trying to Hack Vaccine Data, as Virus Redirects Cyberattacks. China has been actively involved in this.
U.S. Says Chinese, Iranian Hackers Seek to Steal Coronavirus Research. Iran has been too.
Russia Is Trying to Steal Virus Vaccine Data, Western Nations Say: “The hackers have been targeting British, Canadian and American organizations racing to create coronavirus vaccines.” And so has Russia too.
Russia Trying to Steal COVID-19 Vaccine Data, Say UK, U.S. and Canada: “Hackers backed by the Russian state are trying to steal COVID-19 vaccine and treatment research from academic and pharmaceutical institutions around the world, Britain’s National Cyber Security Centre (NCSC) said on Thursday.” And all of this continues, and at a progressively faster pace as research has continued there, and with that leading to there being more critically important information that would be considered to be worth stealing.

And while China, and Russia and Iran have all made reputations for themselves for their state sponsored and supported cyber-espionage activities, it is certain that others are actively involved in this effort too, and certainly given the pressures and imperatives arising from this pandemic. Being a first or even just an early source of an effective vaccination for COVID-19 would be invaluable and in much more than just a strictly monetary sense and for any nation to be able to claim.

Any meaningfully effective new normal, for our healthcare and public health systems has to include effective protection of information that is developed and held by businesses too. And in that regard, I note that:

• The initial distinction that I made here between individual personal medical information and medical intelligence as business knowledge blurs in any real world circumstance, and certainly when it involves vaccination research or similar product development activities. Such data is of necessity replete with individually identifiable medical information about everyone involved in any trials entered into there.
• And that same individualized data challenge arises for businesses that, for example, develop and hold genetic information about their customers, as discussed in Part 42 here, that are not themselves healthcare in nature at all. So this is not just about how the companies that hold this data might use it or intentionally share it with other businesses through licensing or other agreements (e.g. insurance companies to continue with that genetic data example.) It is about cyber-crime vulnerability and its consequences too, where that can have unexpected healthcare and public health impact.

I am going to continue my dual narrative approach to discussing this pandemic in a next installment to this series, in a few days. Meanwhile, you can find my earlier COVID-19 related postings in this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 46

Posted in macroeconomics by Timothy Platt on July 15, 2020

This is my 50th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 46th installment to this specific series on that.

As usual, I begin this installment with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic:

• July 14 at 01:40 GMT: 13,235,751 reported cases with 4,963,845 currently active, 8,271,906 now closed, and with 58,881 active in serious or critical condition (1 %), and 575,525 closed cases reported as deaths (7 %)
• July 15 at 02:06 GMT: 13,457,458 reported cases with 5,029,011 currently active, 8,428,447 now closed, and with 59,579 active in serious or critical condition (1 %), and 581,221 closed cases reported as deaths (7 %)

I have as a general pattern here, divided the vast majority of these postings into two sections with a first of them focusing on more here-and-now issues related to this pandemic and the disease that has created it. The second of those two posting sections has then dealt with longer-term issues and with a focus on what might come after this pandemic as our new normals take shape and become our new routine realities. But the two are inextricably interconnected as the range of possibilities that can even be considered in any new normal future, will of necessity be grounded in our here-and-now and in how our current expectations, plans and actions work out. And our here-and-now in that, and its possibilities are equally constrained by the basic, unconsidered, axiomatic assumptions and presumptions that we bring to the table with us. And certainly when they are grounded in all but religiously held ideological partisanship, they are likely going to be very resistant to change, and regardless of the depth and significance of any reality checks that COVID-19 and it emerging details might raise. In that regard, to be more specific here, the types of epidemiological numbers: the types of factual empirical data that I repeat here in these postings, do not necessarily matter.

So a great deal of the first part of each of this series’ postings has been about how we societally, and both intranationally and internationally, have failed here. A great deal of this first part narrative progression in this series has been about the Why of our all seeing such rapidly expanding numbers, and for all of the types of epidemiological metrics that I keep citing here at the start of these postings.

But let’s take that out of the abstract and with some specific national details, to more fully illustrate at least what this means as our emerging new reality in this more here-and-now context. So I continue my first part of posting narrative here, today, starting with the World Health Organization’s most recent data, as sourced to them from the United States. Note: I turn to that organization rather than the US CDC to ensure that these numbers and the above cited global ones would be equally current, making more direct comparisons between them more valid. And with that, here are the United States totals for the same date and time as offered globally, above:

• July 15 at 02:06 GMT: 3,545,077 reported cases with 1,805,739 currently active, 1,600,195 now closed, and with 16,337 active in serious or critical condition (1 %), and 139,143 closed cases reported as deaths (9 %)

I have been doing a great deal of thinking as to the why of this, and both for how self-destructive partisanship is shaping our response to this disease and in so many places, and for how mounting evidence keeps proving how self-destructive, so much of that really is. Wearing protective face masks and social distancing are just partisan political rhetoric from a liberal left and from extremists of that ilk? Telling people that they should not congregate in large numbers in enclosed places such as indoor dining restaurants and bars, and certainly where disease containment and other efforts to prevent viral spread are not possible there, is just a callous challenge to freedom and personal liberty? And the numbers keep going up and up and up and particularly when many in an area would answer those questions with “Yes!” And the state of Florida, to cite just one possible cautionary warning example here, has now seen several single day increases in their total number of COVID-19 positive cases of 15,000 and more.

Yes, a significant and growing number of states that are now seeing massive second waves, have begun pulling back from their quick and unconsidered first reopening attempts. But on a federal level, the Trump administration is still demanding that all schools reopen as normal, and with full classrooms, in the Fall in a few short months, and regardless of the number of new cases, or the numbers of serious and critical cases of this disease, or of deaths from it. The United States as a whole is entering a massively scaled second wave for COVID-19 infections that has already dwarfed the first and it is still rising. And president Trump has now more or less officially declared that internationally renowned experts on infectious disease and epidemiology, such as Dr. Anthony Fauci are his political enemies for challenging him on his opinions and decisions.

Florida is not alone in what it is going through now, and neither is the United States as a whole. But both have been trend setters for how negative consequences can arise and expand outward, in a situation such as the one we face now with this pandemic.

This addresses something of the Why and I add the How of this crisis, at least for how it has proven impossible in the United States to in any way step out ahead of it. What can we do to in any real way correct that problem? That is a lot more difficult to even begin to answer.

At least in principle, we need to find a way as a society, to be a society again and not just an assortment of self-isolating groups whose members see other groups there, and their members as being evil for their being different. I keep going back in my thinking about that side to this challenge, to a posting that I first offered here early in the 2016 Republican Party nominations process, leading up to that year’s national election: Thinking Through the Words We Use in Our Political Monologs. We are divided because we do not, and seemingly cannot talk with each other, and with emphasis there on “with.” We talk past each other when we seek to communicate across our boundaries and barriers at all. And how can we come together to face and resolve a national crisis when we are divided that way, and when we cannot act together as if we were still a single nation at all?

• If a crisis like a global pandemic, ravaging our nation cannot bring us together, what can?

We are most certainly not going to come together as a single people while Donald Trump is still serving as president. But even if Joseph Biden is elected in November, and even if he wins that election overwhelmingly and with his party taking control of both houses of the US Congress, that in and of itself cannot resolve this impasse. And that is because Trump is not a cause here. His election and the fact that his base remains loyal to him no matter what he says or does, simply verifies a truth that should already be well known. Trump is a symptom here and not a cause. So what can we do about that? How can we heal that festering wound so we can deal with our larger shared problems, this pandemic included?

I cannot offer any answers to these questions, but see a need to raise them here as they and the challenges that they represent underlie all that I write of here, as the United States and its citizens would deal with this pandemic.

And with that, I end this admittedly digression of a posting and with a goal of returning to the narrative threads that I intended to pursue here, as I ended Part 45. I will turn to that dual here-and-now, and what-comes-next discussion in a next installment here, in a few days. Meanwhile, you can find my earlier COVID-19 related postings in this series at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

China, the United States and the world, and the challenge of an emerging global COVID-19 coronavirus pandemic – 45

Posted in macroeconomics by Timothy Platt on July 12, 2020

This is my 49th posting to specifically address the COVID-19 pandemic that we now face and that by now has found its way into essentially every nation on Earth, and into every facet of our lives. And it is also the 45th installment to this specific series on that.

As usual, I begin this installment with newer updates to a set of basic epidemiological findings, sharing more recent globally sourced data as offered by the World Health Organization as to the current overall state of this pandemic:

• July 10 at 02:08 GMT: 12,387,420 reported cases with 4,642,636 currently active, 7,744,784 now closed, and with 58,454 active in serious or critical condition (1 %), and 557,395 closed cases reported as deaths (7 %)
• July 11 at 01:43 GMT: 12,625,150 reported cases with 4,729,344 currently active, 7,895,807 now closed, and with 58,898 active in serious or critical condition (1 %), and 562,769 closed cases reported as deaths (7 %)
• July 12 at 01:26 GMT: 12,839,626 reported cases with 4,794,334 currently active, 8,045,292 now closed, and with 58,831 active in serious or critical condition (1 %), and 567,575 closed cases reported as deaths (7 %)

I focused in the first, more here-and-now half of Part 44 on the issue of how the SARS-CoV-2 virus, responsible for COVID-19 is spread and on how our understanding of that keeps changing and both because of new emerging empirical data and as a consequence of ideologically grounded political persuasion. Think of that posting as having offered more of an in-principle side to a line of reasoning, as to why we are seeing second wave spikes now in the levels of new COVID-19 cases, and particularly in more southerly states.

I then offered some specific numbers for where and how those state-by-state second waves are taking shape, in a posting that went live yesterday as of this writing: Donald Trump, Xi Jinping, and the Contrasts of Leadership in the 21st Century 27: when facing the disruptive challenges of a global pandemic 1.

More southerly states that have hotter weather on average than their northern counterparts, and that are reopening for indoor dining and drinking in their restaurants and bars and even regardless of their COVID-19 numbers, are seeing massive increases in their numbers of new reported COVID-19 cases since they began their reopenings. But there are northern states that have large numbers of people in them who are becoming infected too, and certainly when their numbers are considered as a proportion of their overall populations – and particularly when many of them persist in adhering to Trump’s COVID-denial vision and who refuse to wear masks or social distance. They are seeing the same thing. And in fact it is one of those northern states: Idaho, that is now in the lead in that undesirable race, with the most severe new case spike of all of them, with that showing as a just under 1,500% increase in new cases as of July 10. And it is all but certain that this number will continue to go up and up too, and from newly infected citizens completing their pre-symptomatic incubation periods and becoming visibly infected with this virus if for no other reason.

• This says that while air recirculation in closed spaces, as found in indoor dining and bar contexts, might be a significant factor here,
• COVID-denial, and a failure to attempt to contain this disease is still more important.

And I add here that Idaho has been accomplishing its second wave, leading up to that percentage point increase in new infections in just under 10 weeks. Where will their exponential growth in their new case numbers take them from here, as they and other severely affected states still argue over what to do and what to close down again, reversing their initial reopening efforts in an attempt to stop this?

I keep coming back to lessons known but never actually learned from the 1918 flu pandemic, and from the consequences faced then from premature and ill-considered reopenings. I have cited references to that on several occasions now in this blog. States that moved too quickly to reopen then, and that planned out and executed their reopenings on the basis of politics and political pressures, saw massive economic downturns and challenges and increased business failures, as well as increased morbidity and mortality rates and increased numbers of people who were sickened, even if they did recover. And their economic and related challenges: self-inflicted from how they failed to acknowledge the fact based reality around them, slowed their real eventual recoveries and in ways that persisted long-term as states that recovered first captured interstate commerce and other markets, and otherwise came to economic dominance over them – and once again, long-term.

• President Trump claims to be a business man. He claims to be the quintessential business man, and even with his history of business failures and bankruptcies that he had to be bailed out from.
• In our globally interconnected reality of this 21st century, and just about exactly one century after the end of that 1918 flu pandemic, it is not just that some American states that pursue a more reasoned reopening approach will prevail over other American states who fail in this. It is that the United States as a whole will face long-term consequences from Trump’s failed policy and practices, and from his toxic politically motivated rhetoric of denial. Other nations that manage this better and that recover first, will gain that advantage on a nation to nation scale and with the United States way too likely to lose there.
• And the perhaps-irony of this, is that this cautionary note for what we have to be prepared to do, in order to prevent that happening, is necessary because of the decisions and actions of someone who seeks to “make America great again.” He at least uses that as a self-promoting marketing line, at any rate.

And with this offered, I share four new here-relevant links:

• A New York Times news piece: The Coronavirus Can Be Airborne Indoors, W.H.O. Says with its tagline text: “The agency also explained more directly that people without symptoms may spread the virus. These acknowledgments should have come sooner, some experts said.”
• And see this World Health Organization document with its still work-in-progress updates: Transmission of SARS-CoV-2: implications for infection prevention precautions.
• And see: New Coronavirus Cases in U.S. Soar Past 68,000 (n.b, new cases in a single day), Shattering Record with its tagline text: “The number of daily global cases also broke a record, with the United States as the biggest source of new infections. The U.S. death toll is also on the rise.”
• And Daily Virus Death Toll Rises in Some States with this quoted from there: “In several states where the virus has surged in recent weeks, the death toll is edging up. That may end a long period in which the national toll has steadily declined.”

And with that I repeat a refrain that I still see as valid, even as I intensely dislike that fact. The numbers that I offer at the top of each of these series installments, are going to get a lot worse. And there are compelling reasons for that, that wistful thinking and denial cannot counter or undo.

And with that I offer one more World Health Organization update to add to the three that I started this posting with:

• July 13 at 00:48 GMT: 13,027,835 reported cases with 4,881,245 currently active, 8,146,599 now closed, and with 58,925 active in serious or critical condition (1 %), and 571,076 closed cases reported as deaths (7 %)

And finally, with that in place I turn to the second half discussion that I would offer here in this posting: a continuation of a longer-term and post-COVID-19 oriented narrative as to what we might see emerge as our new normals.

I was initially planning on continuing a discussion of patient records and healthcare information, and the challenge of balancing a need to at least selectively share such information in order to address specific public health challenges, with a need to protect personal privacy. I focused on that complex of issues in Part 42 and Part 44 and will return to it in the next installment to this series. But I am going to pursue a somewhat different line of discussion here, in this second half narrative, in effect building from the above and my first half discussion of today.

What are we likely to see, post-COVID-19 in a globally reaching marketplace context as our emerging new normal, for where the vast majority of essential healthcare related resources are going to be produced? What nation will come to capture and even dominate the markets for personally protective equipment such as medical masks and disposable gloves, face shields and disposable booties and medical personnel gowns? They already dominate those markets, and they also produce a majority of essential emergency room and intensive care unit specialty equipment such as ventilators too. That new normal with most likely just emerge as a repetition of the same old normal that has led to so many problems and in so many nations as we all face this COVID-19 pandemic challenge now: China.

• Developing nations are being crushed right now by this pandemic, and both from a public health and a loss of life perspective, and economically as well. They are not in general going to be in a position to retool any significant share of what manufacturing capability they have, in order to meet those needs and certainly when an outside national source has been offering them those products now, and even if that has not always been in the quantities that they need or as quickly as desired.
• Yes, developed nations and even a significant number of them have been producing some personal protection equipment within their own borders now, in the face of this crisis. But they still buy from China for this too. And that sourcing approach applies to and is likely to continue to apply as fully for these nations when it comes to local production of equipment such as ventilators, as it does for their production of minimal profit margin items such as disposable personally protective equipment. Yes, businesses outside of China have retooled production lines for that purpose and they have made ventilators in particular for this crisis. But will they continue to do that, as this crisis ends? I seriously doubt that and certainly when government supported manufacturers in China can undercut them on prices and every time, and when this type of production does not even particularly fit into the business models that they will want to return to in any real recovery.
• And as for the United States: president Trump could have responded to a fundamental lack of these resources during the first pandemic wave here, by invoking the Defense Production Act. He could have done this for testing kits too, and with a demand that reagents and swabs and all of the rest that go into them, be interchangeable between manufacturers. But he has simply left this to others, and he has effectively left that to China in particular.

We have seen near misses that might have become global pandemics and quite a few of them in recent decades. And we will see more of them, post-COVID-19. We are in fact already seeing that, even if news of it is being overwhelmed by a COVID-19 narrative. See, for example:

Scientists Say New Strain of Swine Flu Virus Is Spreading to Humans in China which came out with this tagline: “A new study warns that the strain of H1N1, common on China’s pig farms since 2016, should be “urgently” controlled to avoid another pandemic.”
• And China Study Warns of Possible New ‘Pandemic Virus’ From Pigs. And I offer this quote here from that news piece itself: “A team of Chinese researchers looked at influenza viruses found in pigs from 2011 to 2018 and found a “G4” strain of H1N1 that has ‘all the essential hallmarks of a candidate pandemic virus’, according to the paper, published by the U.S. journal, Proceedings of the National Academy of Sciences (PNAS).”

There has been ongoing concern that when the flu season starts up again in the late Fall and early Winter in the Northern Hemisphere, it is going to be difficult to tell if someone has a seasonal flu or COVID-19, at least symptomatically. We might have a lot more than that to contend with as a source of diagnostic confusion, in the coming months. And this is before we even begin to see an end to the COVID-19 pandemic that we now face.

Whether we are spared this particular dual (or more) disease identification and treatment problem or not, we will see a next genuine pandemic after COVID-19 and a next and a next, and very significant global pandemics in that too. So it will be very important who owns and controls essential manufacturing for addressing such challenges moving forward – and particularly when this power is likely going to be in the hands of an authoritarian of the likes of Xi Jinping with his global ambitions.

I am going to continue this series in a next installment in a few days, as has become my usual pattern here. Meanwhile, you can find my earlier COVID-19 related postings at Macroeconomics and Business 2 and its Page 3 continuation, as postings 365 and following.

Donald Trump, Xi Jinping, and the contrasts of leadership in the 21st century 27: when facing the disruptive challenges of a global pandemic 1

Posted in macroeconomics, social networking and business by Timothy Platt on July 12, 2020

This is my 28th installment in a progression of comparative postings about Donald Trump’s and Xi Jinping’s approaches to leadership, as they have both turned to authoritarianism and its tools in their efforts to succeed there, as can be found at Social Networking and Business 2 and its Page 3 continuation. And in a fundamental sense this is also a continuation posting to another series that I have been offering here: China, the United States and the World, and the Challenge of an Emerging Global COVID-19 Coronavirus Pandemic, as can be found at Macroeconomics and Business 2 and its Page 3 continuation.

I have written in some detail of president Trump’s leadership failures and in both of those series, and of how he has created a massive power vacuum from that and both internationally and within the United States too. And I have written in at least as much detail of Xi’s ambitions and of his China Dream: his Zhōngguó Mèng (中国梦), as he has developed and promoted that as both his own and his nation’s road map for restoring a presumed lost golden age of Chinese power and influence.

We are facing a wide ranging and deeply impactful pulling-inwards and disengagement on the part of the United States, that is driven by chaos and uncertainty as that flows and at least seemingly continuously, out of the White House. And as I have noted in the above-cited COVID-19 series, Xi has actively sought to capture every advantage that he can out of that as he advances his own causes.

• COVID-19 is an unmitigated disaster for the United States, and certainly given the complete failure of leadership that we all see coming out of the Trump administration,
• As all fifty states have to find their own separate ways forward with this challenge, and all too often through competing with each other for limited resources,
• And as the numbers of new cases of this disease skyrocket in so many of them,
• And with no real effort made from a federal government level to develop or pursue a coordinated response to any of that.
• And this intranational failure is mirrored by the Trump administration’s efforts to undermine transnational and global efforts to combat this pandemic too, with for example his direct attacks on international agencies such as the World Health Organization.
• Trump attacks his own Centers for Disease Control and Prevention (CDC) because he does not like it that they disagree with him as to the seriousness of this challenge. And he takes the same approach when dealing with other nations and when dealing with international organizations too.
• COVID-19, is and has been a source of crisis for Xi and his China, and certainly in the short term.
• But Xi has being turning that into a long-term golden opportunity for himself and his country too, and both within China,
• And with public sector and private sector representatives of Xi’s policies reaching out globally and in all directions in order to develop and sign agreements and long-term commitments of productive engagement, and worldwide. And here-and-now support for more effectively dealing with COVID-19 crises in those countries has opened a great many doors for them in that.

Donald Trump is back to actively denying the reality of this pandemic and even as the number of new cases of it skyrocket in the United States, and particularly in the so called politically “conservative” red states that largely hew to his opinions and advice, and certainly where that means his actively speaking and acting out against containment efforts to limit disease spread, such as social distancing and the use of masks or other face coverings. For a more recent news piece on that, that quantifies this as of July 10th for a whole series of red states that on the whole support Trump politically, see:

How Coronavirus Cases Have Risen Since States Reopened with its tagline:
• “The current surge in coronavirus cases in the United States is being driven by states that were among the first to reopen their economies, decisions that epidemiologists warned could lead to a wave of infections.”

To put that in numerical perspective, citing only a few of the states that really stand out there:

• Georgia has seen a 245% increase in its number of confirmed COVID-19 cases since it reopened,
• Tennessee has seen a 279% increase,
• Alabama has seen a 547% increase,
• Texas, a 680% increase,
• Arizona, a 858% increase,
• South Carolina, a 999% increase,
• Florida, a 1,393% increase and
• Idaho as seen a 1,491% increase.

And those are almost certainly just undercounts as the states seeing those large new case counts, are also facing inadequate testing capabilities for even identifying their new COVID-19 cases. But to be fair, reopening failures are not just a red state issue, so for example, California has seen a 275% increase in its number of new COVID-19 cases. And that is also failed reopening-related.

I discuss this type of finding in my above-cited COVID-19 series, from more here-and-now public health and healthcare perspective, but I make note of it here as well for a different reason. The disorganized paralysis and the partisan ideology-based rhetoric and the coercive political and federal government pressures that that leads to, would be enough to block any real action on the part of the United States now, in addressing China’s or any other outside challenges. And that would continue to hold true even if president Trump were to actually somehow become presidential at this late date. Momentum and his lack of credibility would ensure that. Basically, what Trump has done is to give Xi a free hand, for carrying out all that he would do, and anywhere and everywhere.

I have written in this series of how Trump’s personal behavior, and his decisions and actions as president have undermined and weakened America’s relationships with America’s strongest and most loyal allies while offering comfort to those who would take adversarial positions against the United States. In this period of pandemic crisis, he continues that while increasing the tensions and dysfunctionalities that prevail within the United States itself – and even as his poll numbers drop as a result, lessening his chances of getting reelected.

That pattern continues on, and in fact becomes more glaringly pronounced on a daily basis. And that has consequences that extend way beyond America’s borders.

• While Trump might speak of Xi as an adversary, his actions and his failures to act have in effect made him Xi’s most active and compelling enabler now, and certainly in this time of disruptive change and challenge. If anyone can help Xi Jinping to actually realize his China Dream, it is Donald Trump. And by all appearances he is doing that; at the very least he is really trying.

What does this mean? And what more specifically are Xi and his government and his nation’s closely government controlled private sector businesses doing to take advantage of all of this?

There are two faces to Xi’s China Dream, both of which merit detailed discussion. I have at least briefly and selectively touched upon the internal, within-China face to this in my COVID-19 series and certainly in installments there such as its Part 27 and Part 35, where I raise the specter of China’s Communist Party and government taking giant strides towards achieving a total surveillance state over their people by leveraging the very real threats of this pandemic to justify entirely new levels of tracking and control. And China has in fact been very actively pursuing that course and with great effectiveness.

But for purposes of this series, or at least this phase of it, I will focus on how China is reaching outwards, leaving more internal developments for another time and other discussion. I will focus outwards from China here, and on how Xi defines and would achieve that critically important half of his China Dream. But contrary to the official policies and assertions of the People’s Republic of China and of Xi’s administration there, I will include their increasingly repressive moves on Hong Kong in what follows, as representing coercive attack against a foreign people. I will take that same approach when considering their increasingly actively threatening moves against Taiwan and their government and their people too. So with these points in mind, think of this narrative as also being a continuation of my also ongoing series: Xi Jinping and his China, and Their Conflicted Relationship with Hong Kong – an unfolding Part 2 event, as can be found at Macroeconomics and Business 2 (where I discuss Taiwan too.)

I will in fact begin this part of this overall narrative from there, as China’s officially declared demand for “recovery” of those two lands, officially thought of as having been stolen from China during its decades of humiliation, are a cornerstone to Xi’s China Dream as a whole. (See Part 19 of this series for a brief orienting discussion of what “decades of humiliation” mean there, and both to Xi himself and to the basic Chinese narrative that he is capitalizing on, and its view of this history. I delve into that dark period of China’s history in that posting and in subsequent installments to that series as well as, and in my above-cited Hong Kong series too.) And after addressing that, I will look further outward to how Xi’s China is reaching out to the world at large now, and certainly in this its time of golden opportunity. And I will at least begin to discuss these issues, as outlined here, in my next installment to this series.

Then after completing this pandemic context narrative thread, I will return to a discussion of issues that I left off from at the end of Part 26, as outlined there. The pre-pandemic overall goals and priorities that have underlied Xi’s Dream still hold, after all. Meanwhile, you can find my Trump-related postings at Social Networking and Business 2 and its Page 3 continuation. And you can find my China writings as appear in this blog at Macroeconomics and Business and its Page 2 continuation, at Ubiquitous Computing and Communications – everywhere all the time, and at Social Networking and Business 2 and its Page 3 continuation. And you can find further related material as cited here as noted above.

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