We’re in the middle of a slow-motion catastrophe.  The consequence of disease, depression, and Donald. Here are a few thoughts about what we can do about this dire situation.

The Pandemic: The best summation of our current situation was written on April 18 by New York Times science and health reporter Donald G. McNeil Jr, “The Coronavirus in America: The Year Ahead.”  (https://www.nytimes.com/2020/04/18/health/coronavirus-america-future.html)  “In truth, it is not clear to anyone where this crisis is leading us… Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus it will find us.”

“Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen… Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.”  Donald Trump is not willing to apply these criteria and is pushing states to reopen early.  Some Republican governors are obliging.

Donald McNeil noted: “[Recently, a science writer] analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.  He calculated that those voters could be 30 percent more likely to die of the virus.”

McNeil does not believe that we will see a COVID-19 vaccine soon: “Dr. Fauci has repeatedly said that any effort to make a vaccine will take at least a year to 18 months…. All the experts familiar with vaccine production agreed that even that timeline was optimistic. Dr. Paul Offit, a vaccinologist at the Children’s Hospital of Philadelphia, noted that the record is four years, for the mumps vaccine.”

This is the new normal.  Until we have a vaccine — or the equivalent — we have to keep doing what we are doing despite what Donald Trump, and his lackeys, say.  We have to continue to follow the advice of health professionals and scientists: shelter-in-place, minimize social contacts, and support polices that will lead to a rapid increase in testing and, hopefully, the discovery of a vaccine.

The Economy: Because of the COVID-19 pandemic the global economy has collapsed.  There’s debate about whether we are in a recession — negative GDP growth for two quarters — or a depression — a more severe recession.  For those who are out of work, or whose savings have been destroyed, these distinctions do not matter.  What’s important is recognition that we are in a financial emergency unlike anything we have experienced.

For the unemployed who are sheltering in place, there’s a natural tendency to want to go back to work.  Donald Trump has said, “We cannot let the cure be worse than the problem itself.”  Many of his followers believe him and nurture a belief that if they go back to work they will not contract COVID-19.  (This has led to the premature opening of states such as Georgia.)

The problem with this position is that it flies in the face of grim reality: COVID-19 is a highly infectious disease with a grim mortality rate (6.9 percent worldwide).  Not everyone who contracts COVID-19 gets sick but those that do often are very sick — ask Chris Cuomo about his symptoms.  (Those who get sick suffer from Hypoxia — loss of oxygen in the body.)

Not only is COVID-19 very dangerous and contagious, but also many who get it do not develop symptoms — perhaps 14 percent or more (https://www.nejm.org/doi/full/10.1056/NEJMc2009316 ).  That means that until we get widespread testing, we will not be able to identify the silent COVID-19 carriers in our community.  (It’s not sufficient to merely take someone’s temperature to see if they are “sick” or not.)

Therefore, if folks go back to work early and do not maintain social distancing — that is difficult to do in jobs like hair stylist or massage therapist or fitness instructor — then they run the risk of spreading COVID-19 and making the situation worse.

There are no simple choices here.  As long as Trump is President, we are likely to pursue unwise economic policies.  Nobel-prize-winning economist Joseph Stiglitz (https://www.theguardian.com/business/2020/apr/22/top-economist-us-coronavirus-response-like-third-world-country-joseph-stiglitz-donald-trump?CMP=Share_iOSApp_Other ) recently observed, ““If you leave it to Donald Trump and Mitch McConnell [the Republican Senate majority leader] we will have a Great Depression. If we had the right policy structure in place we could avoid it easily.”  Stiglitz noted, “14% of the [U.S.] population [is] dependent on food stamps… the social infrastructure [can] not cope with an unemployment rate that could hit 30% in the coming months.”

What this means is that we have to both hunker down — suffer through the impact of the depression — and do everything we can to get Trump out of office (and elect a progressive Senate and House of Representatives).  Trump is making a bad situation worse.

Donald Trump:  We’re way past the point where we hoped that Trump would grow into the job.  What we see is what we’re stuck with for the next nine months.  Trump is incapable of the leadership this catastrophe requires.

It would be better if Trump retired from the scene and left the day-to-day decision making to Vice President Pence and congressional leaders.  But, of course, Trump won’t do this.  He will continue to blunder around the oval office like the proverbial bull in the china shop.

Trump is dangerous.  First we saw him deny that COVID-19 was a problem.  Then we saw him claim that his Administration had everything under control.  Next he claimed that “Anybody that wants a test [for the coronavirus] can get a test.”  Then we saw him push hydroxychloroquine as a miracle cure…

Now we’re seeing Trump try to open up the economy before it is safe to do this: “We cannot let the cure be worse than the problem itself.”  He’s actively supporting armed protestors that are trying to “liberate” states like Michigan.  He’s at the edge of fomenting civil war.

There are 270 days before Trump is out of office.  During the next 9 months he’s liable to say and do a lot of crazy things.  And no Republican will stand up to him.

What we have to do is stay cool.  And we must work as hard as we can to remove Trump, and his Republican lackeys, from office.

On April 14, California Governor Gavin Newsom detailed what will be required before the Golden State can begin to open up, shake off the effects of the COVID-19 pandemic. Newsom’s grim assessment stands in marked contrast to the position of Donald Trump.

While acknowledging that California has made significant progress “flattening the curve” of the pandemic, Newsom cautioned that it was premature to declare victory: “As we contemplate reopening parts of our state, we must be guided by science and data, and we must understand that things will look different than before.” (https://www.gov.ca.gov/2020/04/14/governor-newsom-outlines-six-critical-indicators-the-state-will-consider-before-modifying-the-stay-at-home-order-and-other-covid-19-interventions/ )  California currently has 28,156 Coronavirus cases and a mortality rate of 3.4 percent — compared with 5.1 percent for the U.S.

Newsom presented a six-part plan that will enable California’s leaders to determine when to begin to “dial back” the current stay-at-home order:

• The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed;
• The ability to prevent infection in people who are at risk for more severe COVID-19;
• The ability of the hospital and health systems to handle surges;
• The ability to develop therapeutics to meet the demand;
• The ability for businesses, schools, and child care facilities to support physical distancing; and
• The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary.

1.Testing: Throughout the United States, approximately 1 percent of the population has been tested  — 3.4 million.  California has only tested 227,600 — .5 percent.  Newsom points out the obvious: we need to do more testing.  Two questions need to be examined: “How prepared is California to test everyone who is symptomatic?” and, “Does California have the ability to identify contacts of those who are positive to reduce further transmission?”  (Of the 28,156 California COVID-19 cases, 10,146 are in Los Angeles County; where, so far, testing has been inadequate.)

2. Protecting the most vulnerable:  In California, the coronavirus has struck all sectors of the community.  Seniors and “special circumstances” populations are particularly vulnerable.  Newsom pointed out two obvious questions that need to be examined before we modify the stay-at-home order: “Are older Californians and the medically vulnerable living in their own homes supported so they can continue appropriate physical distancing?  and, Has California developed a plan to quickly identify and contain outbreaks in facilities housing older Californians, those living with disabilities, those currently incarcerated, and those with co-morbidities? ” Obviously adequate testing is a pre-requisite.  But so is additional financial support for older Californians.

3. Strengthening hospitals and health systems:  California’s hospitals/health systems are barely covering our current caseload — 25,833 active cases; there’s a statewide shortage of masks and PPE (personal protective equipment).  Newsom wants to address these shortages to make sure California has the capacity to deal with a sudden influx of coronavirus cases.  “Do we have adequate bed capacity, staff and supplies such as ventilators and masks? Can our healthcare system adequately address COVID- 19 and other critical healthcare needs?”  It’s estimated that California is short several hundred million masks.  Recently Newsom signed a deal to procure millions of masks each month. (https://calmatters.org/health/coronavirus/2020/04/california-coronavirus-mask-shortage-solution-deal-newsom/ )

4. Developing Therapeutics:  “Have we built a coalition of private, public, and academic partners to accelerate the development of therapeutics?  Have we identified potential therapeutics that have shown promise?”  When Governor Newsom speaks of therapeutics he means not only a COVID-19 vaccine but also the related antibody-blood test.

5. Strengthening the ability for businesses, schools, and child care facilities to support physical distancing: Newsom mentioned that the new California normal will likely include substantial social-distancing measures.  “Have we worked with businesses to support physical distancing practices and introduced guidelines to provide health checks when employees or the general public enter the premises?  Do we have supplies and equipment to keep the workforce and customers safe?”  Once again, an important element of this is fast reliable testing.

6. Developing the ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary: “Are we tracking the right data to provide us an early warning system?  Do we have the ability to quickly communicate the need to reinstate these measures?”

Several things jump out from Newsom’s presentation.  The first is that we won’t be ready to start reopening California until we have substantially more tests — we’ve only tested 227,600.  Newsom talked about ramping up testing to a level of “tens of thousands per day.”  In two weeks, he plans to report back on our progress reaching this goal.  By May 1, the Golden State should have at least tested 1 million (2.5 percent).

By May 15, California should have received it’s first big delivery of masks and PPE.  If this happens, and testing has expanded — to perhaps 10 million residents, this might be the time to begin reopening the Golden State.

The second thing Governor Newsom made clear, is that  when California reopens things will look different as.  For example, when we go to our favorite restaurant we’ll be wearing masks and be tested at the door; the restaurant is likely to configure fewer tables and have disposable menus.

The third thing that Gavin Newsom made clear is that he is an authentic leader.  Watching the April 14th Newsom speech was to be reminded how inadequate Donald Trump is.  Newsom was calmly informative — he spoke for about 30 minutes and then handed the microphone to the state’s public health officer, Sonia Angell. It was impossible to imagine Trump giving a similar presentation.

Postscript: On April 17, Donald Trump presented his recovery “plan” (https://assets.documentcloud.org/documents/6840739/Guidelines-PDF.pdf ) and punted to the states: “You’re going to call your own shots,” Trump told U.S. governors, according to an audio recording provided to the New York Times.  Trump acknowledged the importance of comprehensive testing but did not propose a national plan for rapid testing.  In California, we’r fortunate to have a governor who has stepped into this leadership breach and prepared a real plan for recovery.

It’s disconcerting to be in a novel situation where we have no control over what’s going to happen next. That’s where we find ourselves in the midst of the Coronavirus pandemic. In California, we’ve been sheltering-in-place for two weeks and Governor Newsom indicates that it will continue “for as long as it takes.”  Here’s my prediction of how this is going to play out.

1.Shelter-in-Place isn’t going to end soon.  Life won’t return to “normal” until there is a Covid-19 vaccine.  Until there is a reliable, widely-available vaccine, most of us are going to have to live sequestered lives.  Experts, such as Dr. Anthony Fauci, tell us we won’t have a vaccine for at least a year.  (https://www.newsweek.com/coronavirus-vaccine-treatment-antiviral-speed-covid-19-1491292)  So be prepared to hunker down for an extended period.

In Sonoma County, where I live, county officials have just received the results of a detailed analysis of how effective our “shelter-in-place” program has been. (https://www.pressdemocrat.com/news/10871235-181/during-a-surge-1500-sonoma) The good news is that it seems to have made a big difference in the number of cases here (95).  The bad news is that the number of Covid-19 infections will not peak until June and then begin a gradual decline that will stretch out for 300 days — unless we have a vaccine.

2. The United States is going to be segmented into quarantine zones.  We can already see this with the news that states adjacent to New York, New Jersey, and Connecticut are restricting travel from the three states — that have about 50 percent of the U.S. Coronavirus cases.

Meanwhile, “shelter-in-place” orders vary from state to state.  That’s a particular problem in the South where the number of Coronavirus cases is exploding, particularly in Florida and Louisiana.  That suggests that certain areas of the United States will soon become so toxic that travel restrictions will be issued.  BB’s prediction: There will be four quarantine zones: the northeast; the south — including Texas; the center — Nebraska to Ohio; and the west — Colorado to California.

3. Some states will “recover” from the Coronavirus crisis before others do.  That doesn’t mean their shelter-in-place programmed will be over.  It means that these states have “flattened the curve;” for example, Washington started social distancing on March 11 (https://www.washingtonpost.com/nation/2020/04/01/lockdown-coronavirus-california-data/) and for the past week, the number of new Covid-19 cases has diminished.  Here in California, there’s a growing consensus that we have “flattened the curve,” particularly in the San Francisco Bay Area where we began aggressive social distancing on March 14.

As noted above, the Sonoma County shelter-in-place program appears to be effective but will  continue for the foreseeable future — until there’s a vaccine.  Before that happens, we’ll hit several important milestones.

Milestone I: In a major area, there are no new cases.  Obviously, it will be a good sign if there are no Coronavirus cases in your area.  Sonoma County forecasts this will happen around the end of 2020.  That won’t mean that we can abandon “shelter-in-place” but it will mean that there will be a heartening reduction in demand for hospital facilities; and we can adopt other interventions, such as aggressive contact tracing.

Milestone II: There’s a test available that permits us to identify individuals who are immune to the Coronavirus.  Several companies are working on an antibodies test: “The tests are designed to detect whether a person has developed antibodies to the COVID-19 virus, indicating that they were at one time a carrier and may have built up immunity.” (https://www.businessinsider.com/coronavirus-germany-covid-19-immunity-certificates-testing-social-distancing-lockdown-2020-3 )  “Gerard Krause, the [German] epidemiologist leading the project, [said] that people who are immune ‘could be given a type of vaccination card that, for example, allows them to be exempted from restrictions on their work.'”

An American biotech company is testing the entire community of Telluride, Colorado, to determine which of the 8000+ residents have Covid-19 antibodies.  (https://abcnews.go.com/Health/antibody-testing-colorado-town-provide-forward/story?id=69856623 )  Once again, the notion is that these residents would be exempt from the “shelter-in-place” restrictions.

Here in the Sonoma County, once we get antibodies tests, we’ll first use them to test those on the frontlines of the pandemic: healthcare professionals and first responders.  Then we’ll test other critical professionals, such as employees at nursing homes and community health centers.

Milestone III: Creation of Safe Zones.  On Monday, Donald Trump announced that 1 million citizens had been tested for Covid-19.  Given that the U.S. population is 330.5 million, that means that .3 percent of residents have been tested.  Trump said that tests were being generated at the rate of 100,000 per day. (https://www.wired.com/story/video-coronavirus-testing-in-the-us/ )  That’s woefully inadequate.  Even if the U.S. tested 1 million citizens per day, it would take more than 11 months to test us all.  (On March 29, the New York Times (https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html ) detailed the U.S. decision errors that led to this testing crisis.)

If you are in an area where there are few or no Covid-19 patients, you may wonder why folks in your area need to be tested and why you have to shelter-in-place.  The answer is that a large percentage of those infected with the Coronavirus are not symptomatic.  “As many as 25 percent of people infected with the new coronavirus may not show symptoms, the director of the [Federal] Centers for Disease Control and Prevention warns.” (https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html) You, and everyone in your area, needs to be tested so you know whether you are truly safe.

Unless there’s a dramatic increase in the rate of testing, there’s no alternative but to “shelter-in-place.”  In the meantime, we can use the test kits we receive to test potential Covid-19 cases and to create safe zones.

Sonoma County has 95 Coronavirus cases.  We’ve tested 1915 individuals in a county of 500,000 residents (.38 percent) — our testing has been delayed by the unavailability of swabs.  As we receive more intact test kits, the logical way to use them — beyond testing suspected Coronavirus patients — is to first test healthcare providers, and their families, and then emergency responders, and their families.  At a certain volume of test availability, we will be able to create safe zones; for example, determine that a cluster of nursing homes is Covid-19 free.

How long will we shelter in place?  Months.  Probably as long as it takes to develop and deploy a Covid-19 vaccine.