The Conversation
Opinion: A Seattle ER doctor on the coronavirus front lines: Is this new patient infected too?

My biggest fear is missing a case and potentially exposing hundreds of other health-care workers and patients
Published: March 24, 2020 By Nicholas Johnson

A nurse at the University of Washington Medical Center’s testing facility.

Getty Images

The Conversation is running a series of dispatches from clinicians and researchers operating on the frontlines of the coronavirus pandemic.

Inside, as usual, patient beds are near capacity, and the emergency department is filled with not only the usual mix of patients with trauma, stroke, chest pain and other concerns, but also dozens of people worried they might have COVID-19, the disease caused by the novel coronavirus.

I am an emergency and critical-care physician who cares for patients in the emergency department and intensive care units at Seattle’s Harborview Medical Center, a public hospital with 413 beds owned by King County and staffed by doctors from the University of Washington School of Medicine.

UW Medicine has seen dozens of COVID-19 cases since the first patient arrived here in late February.

Everything feels different in the hospital now. Door entrances are locked, streets outside are quiet, the building feels empty given the lack of visitors and outpatients but also bustling with a different kind of energy.

As emergency and critical-care doctors and nurses, we think about and train for these types of situations regularly, but nobody expects to be the epicenter of a pandemic in the U.S. But here we are, and as a result, my colleagues and I have been working to find out ways to help not only our patients but also other doctors around the country who will soon experience what we have, if they haven’t already.



Nicholas Johnson, a Seattle ER doctor courtesy Nicholas Johnson

Within a few days at Harborview, we went from normal operations in late February to thinking about how to protect ourselves, our colleagues and our patients with every encounter. Every time I see a new patient, the first question I ask myself, regardless of why they come in, is: “Could this be COVID-19?”

If the answer is yes, I begin the laborious process of “donning” personal protective equipment, moving the patient to one of our few isolation rooms, and then “doffing,” or removing, personal protective equipment. These words were barely in my lexicon two weeks ago. My biggest fear is missing a case and potentially exposing hundreds of other health-care workers and patients. In the last week, I have found myself putting on personal protective equipment for almost half of all patient encounters.

In the emergency department, this means not only having suspicion with every cough and runny nose, which are so common this time of year, but also considering whether patients who come in after car crashes, falls or even cardiac arrest may also be infected. This is in direct tension with the knowledge that resources, like personal protective equipment, testing and isolation rooms, are finite.

Read:See what life during a pandemic looks like for people across the U.S.

In the ICU, under normal conditions, the most rewarding parts of my job are spending time at the bedside with critically ill patients and having deep conversations with families, learning about the patient and what they value. This not only helps me make medical decisions in line with what my patients care about, but it also allows me to form important human connections that make the job enjoyable.

These interactions are deeply difficult now and often relegated to brief visits in full personal protective equipment or phone interactions. Instead of sitting face to face with patients, I now call their cellphones from outside of their room, making a personal connection that much harder. Face-to-face family meetings have been moved to telephone or telemedicine as well. Being in the ICU is lonely enough for patients; but that feeling of being alone has to be that much more profound with visitor limitations and health-care workers having to take extra precautions to keep themselves safe.

My colleagues and I are worried, but in odd ways unique to health-care providers who tend to worry about others more than themselves. I’m more worried about running out of protective gear or getting sick and not being able to take care of patients. I’m also worried about bringing the virus into my home, where I have a 1-year-old daughter and a 4-year-old son. Fortunately, children have not yet been heavily impacted by this disease, but my 70-year-old mother also lives with my wife and me, and she is in a higher-risk age group.

After hearing about health-care providers getting sick, I, like many of my colleagues, have reminded my spouse about my preferences if I were to become critically ill.
Lessons learned

In these challenging weeks, one thing I did not expect was the overwhelming number of emails and texts from friends and colleagues throughout the country, who recognized that, while Seattle was first, their day with COVID-19 was soon to come.

As a result, several colleagues and I began to collect “lessons learned” on our department’s website. Fortunately, UW Medicine has also been generous about sharing all of our protocols so that others can benefit from our experience. Some of these are basic, like training everyone to use personal protective equipment, but the number of guidelines and protocols that we’ve had to rapidly develop has been staggering, such as changing how we safely place breathing tubes without exposing ourselves.

To the public, I want everyone to know: We’re ready for this and we’re here for you, but we cannot do it alone. We need your help in so many ways.

Our health system is already taxed and busy; our hospital runs over 100% capacity most days, even before COVID. Please follow local public-health guidelines about social distancing and hand hygiene.

Please do not use or buy personal protective equipment. Not only is it generally not effective when reused, but it is in short supply. Donate it to health facilities if you have it. If we get sick, we can’t care for you.

Lastly, be kind and patient. We’re in this for months, at best. We need all the support we can get.

Nicholas Johnson is an assistant professor, Emergency Medicine & Pulmonary, Critical Care, and Sleep Medicine (Adjunct) at University of Washington School of Medicine in Seattle. This was first published by The Conversation — “‘My first question every time I see a new patient now is: Could this be COVID-19?’ A Seattle doctor on the frontlines”

Outside the Box
Opinion: Beyond the medical crisis, coronavirus will test our national sense of community
The risk is that rather than unify us, COVID-19 will only highlight our differences

Published: March 24, 2020 By Donald F. Kettl

Will we go our own way after this crisis? AFP via Getty Images

The COVID-19 bug doesn’t care about red states or blue states—or national borders, for that matter. This coronavirus lives just to eat and grow, and its pernicious biological drive has disrupted the lives of Americans to their core. But its biggest victim has been our shared sense of community and our confidence in government’s ability to help all of us, wherever we live.

We’re at an especially perilous time in the battle against the virus, not just because of the rapid spread of the disease but also because it threatens to drive us apart, especially on red-blue lines. Florida Governor Ron DeSantis, a Republican, for example, issued an order requiring anyone arriving on a flight from New York City to isolate themselves for 14 days, rather than follow the lead of other governors who asked their own citizens to stay at home.

In the middle of March, an NBC News/Wall Street Journal poll showed that 68% of Democrats were worried that the virus might infect a member of their family. For Republicans, the number was just 40%. Twice as many Democrats as Republicans, by about 80% to 40%, believed that the worst was yet to come.

That difference has narrowed as the virus has spread, with the Republican-Democrat gap in judging the seriousness of the problem narrowing from 21 points to 11 points in just a week, from March 16 to March 23. But at the core, there’s the inescapable conclusion that the problem has seemed very different depending on where people live and who they talk to.

On one level, this huge difference is scarcely surprising, because Americans have been getting wildly different messages from both elected officials and the media. Red-state and blue-state bases have tended to retreat even more into their respective echo chambers.

Read:See what life during a pandemic looks like for people across the U.S.

But on another level, the disease’s spread has reinforced the partisan divide. In the early days, it was easy for red-staters to convince themselves that the disease was a blue-state virus. After all, the virus began its assault in places like Seattle, San Francisco, and New York. The states that saw the disease hit last—or, at least, get diagnosed later—were red states like West Virginia.

And even though the disease pays no attention to voting patterns, the higher a state’s vote for President Trump in 2016, in general the lower the reported rate of infection (as of March 22, as measured on the Johns Hopkins University coronavirus tracking website).



Even these numbers produce confusing results, because some states have had far more testing than others while other states have used very different ways of reporting the tests. Some states report only positive results. Others include negative results.

Some have changed their reporting strategy in midstream. As a result, Yale School of Medicine expert Harlan Krumholz told the Washington Post, “We’re basically flying blind because we have so little idea about its penetration into our society and the number of people affected.”

That, in turn, has made it even easier for citizens to see the virus through partisan lenses.

The response has varied greatly as well. The virus is now quickly spreading everywhere, but red states have more hospital beds as a share of the population to accommodate patients. Many red states are more rural, so the beds might be farther from where people live. But it’s impossible to escape the conclusion that, just as the spread of the virus has varied, so is the capacity to respond.



The states that moved fastest to lock down their communities leaned blue in the 2016 presidential election. Within some red states like Texas, state officials have largely left it to local officials to decide about sheltering in place. “Local officials have the authority to implement more strict standards,” Gov. Greg Abbott, a Republican, said.

In a state as large as Texas, there are vastly different challenges in big cities like Dallas and Houston than there are in the hundreds of small communities scattered throughout the state. But there’s no escaping the fact that the state’s Republican governor has been on a different page than the Democratic mayors of the big cities, which have put tough measures into place.

Now, there’s certainly a case for flexibility in battling the virus. This is a vast country, and it presents different challenges in different places. However, India, with a far greater population, locked down the country. The Trump administration has resisted taking ownership of the response, and the president has pointed to the governors. Some governors have acted aggressively, while others have left the problem to their mayors. Without strong guidance, many local officials have been uncertain about just what to do.

As Texas State Rep. Erin Zwiener, a freshman Democrat from Driftwood (population: 144), put it, “I see my city councils, my city administrators, my county commissioners desperate for answers on what the right thing to do is, and they’re not getting answers; they’re getting general advice.”

In fact, it’s been up to the media to track which states are taking which actions. The New York Times, for example, has its own stay-at-home fact page, but even that has a ring of uncertainty. Its reporters ask anyone whose state or city isn’t listed to email a copy of the order to the reporters so the map can be updated.

At the national level, the lack of a call to community has been startling. That’s all the more important because COVID-19 is as much a political crisis as a medical one.

The March crisis has been the gradual recognition of the danger that COVID-19 poses. The April crisis will be the discovery that it spread differently in different places, that different places will have different capacity to respond, and that different leaders will lead differently.

Read:A Seattle ER doctor on the coronavirus front lines: Is this new patient infected too?

And the May crisis: Will the biggest victim of the virus be the nation’s sense of community? Will this ultimately become a unifying event that breaks through the nation’s pernicious polarization? After all, the disease pays no attention to party or anything else. The strategies that work best in fighting it work regardless of where people live. Like the response to Pearl Harbor and 9/11, it could be a great unifying force that reconnects community.

Or will we go down a road that emphasizes the differences that have already grown up around COVID-19? Of pushing leadership down to communities without often providing the support and guidance and resources they need to fight back? Will media coverage and public debate reinforce the differences that have already split the nation into vastly different communities?

The coming weeks will be crucial in fighting the disease. But these weeks could have even more lasting effects in defining who we are as a nation: whether COVID forges a community that joins together to fight a common foe, or whether it splits us into increasingly different communities that prove even harder to join together—or to govern.

Donald F. Kettl is the Sid Richardson Professor at the LBJ School of Public Affairs at the University of Texas at Austin. He is the author of “The Divided States of America: Why Federalism Doesn’t Work.” Follow Him on Twitter @DonKettl.

The Very Real Prospect Of $5 USD Oil

THAT WOULD MAKE WESTERN CANADA CRUDE PRICES TO BE TWO BITS.
By Tom Kool - Mar 20, 2020



The rebound in oil prices on Thursday didn’t last long as bearish sentiment once again took hold on Friday morning, with some analysts contemplating the possibility of $5 WTI.



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Friday, March 20th, 2020

Oil prices rebounded on Thursday on hopes of a trillion-dollar stimulus package from Washington, along with other stimulus measures from governments around the world. The rally was short-lived however, with a growing number of analysts see a deeper bottom for oil.

Citi: $5 oil is possible. Citigroup laid out a pessimistic scenario in which WTI falls to $5 per barrel. Energy Aspects said Brent could fall to $10. Mizuho Securities said some oil could even fall into negative territory absent shale shut-ins. “This is Operation Desert Storm, Enron, 9/11, Hurricane Katrina/Rita, Lehman Bros, combined,” Stephen Schork, president of the energy consultancy Schork Group Inc., told Bloomberg.

Majors could store jet fuel at sea. Oil companies are rushing to store oil at sea, but the glut has become so severe that the majors are looking at even storing jet fuel at sea. That practice is rare because jet fuel degrades more quickly than other fuels and is sensitive to contamination. “The industry generally expects products will be used within three months of being produced,” said George Hoekstra, an independent consultant, told Reuters.Related: Russia Sees Oil & Gas Income Fall By Almost $40 Billion

Texas considers the unthinkable – regulating production. Several oil executives have reached out to the Texas Railroad Commission, which regulates oil and gas in the state, asking for regulation on production in order to rescue prices, according to the WSJ. In Bloomberg Opinion, Texas Railroad Commissioner Ryan Sitton proposed rationing production, cutting output in the state by 10 percent.

North Dakota to keep inactive wells inactive. North Dakota regulators are considering moves that would allow oil producers to keep their wells inactive, rather than forcing them to choose between producing and reclamation. The logic would be trying to keep unwanted production offline.

Halliburton furloughs 3,500 workers. Halliburton (NYSE: HAL) furloughed 3,500 workers on Wednesday, putting them on limited work schedules for two months.

Moody’s: Oilfield services most at risk of credit shock. Moody’s said that weaker oilfield services companies are the most vulnerable to a credit shock. Roughly $32 billion in debt in oilfield services falls due between this year and 2024. Smaller regional players “face the brunt of the sector’s weakness, and therefore the greatest refinancing risk.”

Refiners look to cut processing. Low oil prices are typically good for refiners, but demand destruction is putting refiners in a bind. Refining margins for transportation fuels fell into negative territory in Europe and Asia. Marathon (NYSE: MPC) cut production at its Los Angeles refinery, California’s largest. Meanwhile, a growing number of refiners are sending staff home because of the coronavirus, including HollyFrontier (NYSE: HFC), Royal Dutch Shell (NYSE: RDS.A) and Valero (NYSE: VLO).

Total to cut spending and freeze recruitment. Total (NYSE: TOT) said that it would halt its share buyback program, its recruitment program and also cut capex, perhaps by as much as 20 percent.

Iraq calls for emergency meeting. Iraq’s oil minister called for an emergency OPEC meeting, but a meeting seems unlikely before June.

Shell suspends construction at cracker plant. Royal Dutch Shell (NYSE: RDS.A) suspended construction at its massive ethane cracker in Western Pennsylvania due to the coronavirus. The project has around 8,000 workers on site. Related: April Could Be Worst Month Ever For Oil

ConocoPhillips suspends flights to Alaska North Slope. The coronavirus has forced ConocoPhillips (NYSE: COP) to cancel flights for hundreds of workers to Alaska’s North Slope for at least two weeks.

Shale drillers getting crushed. More shale drillers are exploring debt restructuring as WTI sinks into the mid-$20s.

Shale industry lost $2.1 billion last year. A survey of 34 North American shale-focused drillers reported a combined $2.1 billion in 2019, according to IEEFA. That capped off a decade in which they spent $189 billion more than they generated.

Capex cuts top $31 billion. The global oil and gas industry has already slashed $31 billion from spending plans this month, following the historic collapse in prices.

Natural gas prices could rise on shale knockout. With the Permian basin on the ropes, associated gas production could decline as drilling dries up, tightening up the gas market. “We increase our 2021 price forecast to $2.45/MMbtu as we expect to see accelerating production declines next year,” Bank of America Merrill Lynch wrote in a note. At the same time, gas demand in the power sector is down as the U.S. goes on lockdown and appears set to enter into economic recession.

Oil crash could destroy biofuels market. The crash in oil prices makes ethanol comparatively expensive around the world.

What Happens If U.S. Shale Goes Bust?

By Haley Zaremba - Mar 24, 2020

This month has seen a spectacular oil price crash the likes of which we haven't seen in decades. The last time we had since a single day oil price drop as drastic as Monday, March 9 was way back in 1991, when the U.S. launched airstrikes directed at the Iraqi military in response to the invasion of Kuwait. The price drop earlier this month was similarly staggering, with Brent benchmark global oil prices down by 22 percent and United States prices down by 20 percent.  This cataclysmic crash was caused by a perfect storm of market-spooking factors: the accelerating global spread of the COVID-19 coronavirus pandemic and the continuing oil price war being waged by Saudi Arabia after the OPEC+ alliance, which formed in 2016 to include Russia, imploded at the beginning of this month. The implosion itself was caused by coronavirus, as the plummeting oil demand caused by the industry- and economy-stalling pandemic led Russia and Saudi Arabia to initiate talks to address the issue, which subsequently led to bitter disagreement and an ultimate disbanding of the alliance and then an all-out price war. 

The oil price war and subsequent crash have had devastating effects on U.S. shale, which was already struggling with diminishing profit margins. “Few U.S. shale firms can withstand prolonged oil price war,” Reuters proclaimed last week. “For the last five years, U.S. shale oil producers have been battling suppliers for lower costs and running equipment and crews hard to drive drilling costs down by about $20 a barrel,” the article reports. “The oil market rout last week, however, has left most shale firms facing prices below their costs of production.”

Subsequent news out of the Permian Basin has been grim, with World Oil reporting this week that “Shale plays, oil patch see tens of thousands of layoffs across the industry.” According to analysis by Texas Railroad Commissioner Ryan Sitton, tens of thousands of oil industry workers are being laid off across Texas, and World Oil writes that “while workers in just about every industry are threatened by the economic slowdown, few are more at risk than those in the oil patch.”

Related: Barclays Slashes Oil Price Forecast On Demand Shock

This news is what is leading a lot of us to ask, what would happen if the U.S. shale industry goes bankrupt? This is exactly the question that Robert Rapier sets about answering in an opinion column for Forbes this week. “The real consequences of letting the U.S. shale industry fail is to hand global control of oil production back to Saudi Arabia. Millions of Americans will lose jobs, domestic oil production will fall, and our oil imports will soar. Saudi Arabia will then be free to once again withhold production to drive up the price.” While some shale companies in the U.S. will inevitably go bankrupt in the coming months, if too much of the industry fails it could have a lasting negative impact on the United States’ national security. Ultimately, he argues, letting U.S. oil collapse is far too risky in the short term, even if moving away from fossil fuels is, ultimately, a net good.

“Look, you may think the U.S. oil industry deserves to go bankrupt. You may believe we should all be driving around in wind-powered electric vehicles or riding bicycles. But that’s not the world we live in today,” he writes. “Should we use less oil? Yes. And we will over time. But right now the U.S. still uses a lot of oil, and we will continue to do so for several years, even as we transition to electric vehicles.”

On the other hand, as oil is proving to be an increasingly volatile sector, and even Saudi Aramco is talking about peak oil by mid-century, isn’t it high time to let go? As climate action increases, the Financial Times warning that this oil crash is “only a foretaste of what awaits energy industry,” maybe it’s time to read the writing on the wall and more seriously divest from oil in favor of creating jobs and infrastructure in more progressive and forward-leaning energy sectors.

By Haley Zaremba for Oilprice.com

Governors reject Trump’s timeline to reopen economy; ‘Job one has to be save lives,’ Cuomo says

Amid coronavirus crisis, Maryland governor says White House running on ‘imaginary clock’

THE VERY OPPOSITE OF TRUMP

New York Gov. Andrew Cuomo speaks during a news conference

 Tuesday in New York. Associated Press

AUSTIN, Texas — Governors across the nation on Tuesday rejected President Donald Trump’s new accelerated timeline for reopening the U.S. economy, as they continued to impose more restrictions on travel and public life in an attempt to curb the spread of the coronavirus.

The dismissal of Trump’s mid-April timeframe for a national reopening came from Republicans and Democrats, from leaders struggling to manage hot spots of the outbreak and those still bracing for the worst.


In Maryland, Republican Gov. Larry Hogan, the head of the National Governors Association, expressed bewilderment at the White House, calling the messaging confusing and running on a schedule made of some “imaginary clock.”

The governors’ reaction revealed a striking disconnect between Trump and the state leaders closer to the front lines of a crisis that threatens to overwhelm U.S. hospitals and claim thousands of lives. In most cases, it’s state leaders — not the federal government — who are responsible for both imposing and lifting the stay-at-home orders and other restrictions intended to stop the contagion.

Trump’s optimism appears to reflect his desire to limit the economic damage from the outbreak. The president is eager to get the U.S. back to work as the crisis takes a political toll and the economy, which had been the cornerstone of his re-election bid, begins to wobble. He tweeted that people “will practice Social Distancing and all else, and Seniors will be watched over protectively & lovingly. We can do two things together. THE CURE CANNOT BE WORSE (by far) THAN THE PROBLEM!”

But governors suggested that view had little connection to the reality they’re facing. California Democratic Gov. Gavin Newsom said he and Trump are “clearly operating under a different set of assumptions.”

In New York, Gov. Andrew Cuomo on Tuesday said the infection rate was doubling every three days and pleaded for more federal help as the number of cases in the state surpassed 20,000.

“If you ask the American people to choose between public health and the economy, then it’s no contest. No American is going to say accelerate the economy at the cost of human life,” Cuomo told reporters Tuesday. “Job one has to be save lives. That has to be the priority.”

Illinois Gov. J.B. Pritzker said Trump was “not taking into account the true damage that this will do to our country if we see truly millions of people die.” A fellow Democratic governor, Michigan’s Gretchen Whitmer, told WWMT-TV/Sinclair Broadcast Group that Trump’s “off-the-cuff statements are really going to undermine our ability to protect people.”

As soon as next week, Trump wants to take another look at recommendations about business closures and self-isolation, and said Tuesday the country could reopened by Easter Sunday — less than a month away. “Our people want to return to work,” Trump tweeted.

Even some of Trump’s usual allies are continuing move ahead with tighter controls on travel, commerce and mobility, despite the president’s words. In Texas, Republican Gov. Greg Abbott has endorsed stay-at-home orders that continued to spread through the biggest cities. Arizona Gov. Doug Ducey said public health needed to come first, and South Dakota Gov. Krisiti Noem is stressing limiting business activity, not relaxing them.

“This situation is not going to be over in a week,” said Noem, whose state has more than two dozen cases. “We have another eight weeks until we see our peak infection rate.”

The U.S. is now more than a week into an unprecedented effort to encourage all Americans to drastically scale back their public activities. The orders closing schools, restaurants and businesses have largely come from a patchwork of local and state governments — with areas hit hardest imposing the most restrictions, while other communities are still weighing tighter rules.

That means the White House is eyeing ways to ease the advisories while some areas are still ramping up their responses.

Among the few statehouse leaders to publicly endorse Trump’s view was Texas’ lieutenant governor, Dan Patrick, 69, who on Monday suggested that people his age and older can “take care of ourselves “ as the nation gets back to work. The Centers for Disease Control and Prevention says people over 65 are at higher risk for the disease.

Friction between Trump and the governors has been steady throughout the crisis. The president said last week that states should be doing more to obtain their own critically needed supplies and while insisting that the federal government was not a shipping clerk. States, meanwhile, have been pressing the government to help procure necessary protective and breathing equipment.

“Some of the messaging coming out of the administration doesn’t match,” Hogan, the Maryland governor, told CNN. “We don’t think that we’re going to be in any way ready to be out of this in five or six days or so, or whenever this 15 days is up from the time that they started this imaginary clock.”

For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. Worldwide, more than 375,000 cases have been reported, and while most people recover in weeks, more than 16,000 have died from the virus.

Bill Gates on Trump call for quick end to lockdown: It’s tough to tell people ‘keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner’

Published: March 24, 2020 By Mark DeCambre

Getty Images

‘There really is no middle ground, and it’s very tough to say to people, “Hey, keep going to restaurants, go buy new houses, [and] ignore that pile of bodies over in the corner. We want you to keep spending because there’s maybe a politician who thinks GDP growth is all that counts.” ’— Bill Gates

That’s billionaire Bill Gates, the co-founder of Microsoft MSFT, +9.09% and noted philanthropist, sharing in a TED interview as described by the Vox Media site Recode his view on the drumbeat, notably from President Donald Trump, for an earlier end to public health policies aiming to mitigate the spread of a deadly pandemic that has brought much of the world’s business activity to a screeching halt.

Most of the U.S., including New York, New Jersey, Illinois and California, are under rules that limit movement and travel. Those efforts to dull the impact of the outbreak of COVID-19 are putting the U.S. economy into a recession and have tanked U.S. equity markets that were just a month ago at record highs.

See:Governors reject Trump’s timeline to reopen economy; ‘Job one has to be save lives,’ Cuomo says

The illness that carried by the novel strain of coronavirus first identified in China in December has been contracted by some 414,000 people and killed more than 18,000 across the globe, according to data compiled by Johns Hopkins University, as of Tuesday afternoon.


In the U.S., where the epidemic is likely still in its nascence, some 51,542 have been infected.

Trump, however, said on Tuesday during a Fox News interview in the White House Rose Garden that he hopes to have the country reopened as early as Easter on April 12, though most countries have taken months to achieve some semblance of managing the infection.

Trump has argued that a longer U.S. shutdown would make it more difficult for the economy to rebound from a recession. “The longer it takes, the longer we stay out, the longer that is to do,” he explained.

An early end to the lockdown in the U.S. has been viewed as ill-advised by many experts and politicians who fear that lives would be sacrificed in the bid to resume business-as-usual, and achieve a stock-market rebound, before the virus subsides.

New York Gov. Andrew Cuomo, whose updates on the virus’s impact on the Empire State have been closely followed, expressed views similar to those of Gates on Tuesday. “No American is going to say, accelerate the economy at the cost of human life, because no American is going to say how much a life is worth. Job [No. 1] has to be save lives,” the governor said.

See:‘You pick the 26,000 people who are going to die’: New York’s Cuomo, in plea to Trump administration for ventilators

Gates told TED, according to Recode, that “it’s very irresponsible for somebody to suggest that we can have the best of both worlds,” referring to mitigating the impact of the deadly pathogen on human lives and keeping the economy whirring.

U.S., and global, stock markets have been in turmoil due to the viral outbreak, with some at least partly attributing Tuesday’s biggest percentage gain since 1933 by the Dow Jones Industrial Average DJIA, +11.36%, up 11.4%, to a belief that Trump’s administration may push forward with reopening the U.S. economy, despite public health experts indicating that such a move would likely be premature. Noted infectious-diseases specialist Anthony Fauci suggested at a late-afternoon news conference at the White House that it might be worth exploring an idea floated by Trump that some sections of the country could have restrictions eased ahead of others.

The Dow surged 2,112 points on Tuesday, while the S&P 500 index SPX, +9.38% soared 9.4%, and the technology-heavy Nasdaq Composite Index COMP, +8.12% finished Tuesday’s session up 8.1%.

Gates, who boasts a net worth of $94.6 billion, according to Forbes (making him the second wealthiest man in the world behind Amazon.com’s AMZN, +1.95% Jeff Bezos) is among a group of billionaire philanthropists who have said they would give away at least half their wealth to charities under terms of the Giving Pledge. The Bill and Melinda Gates Foundation has donated $100 million to pandemics science and testing.

Opinion: When Finance Fails: Why Economists Didn’t See a Coronavirus Collapse 

Published: March 24, 2020 By Peter Sands

Illustration by Luke Brookes

If being the CEO of a major international bank and now the head of a global health organization has taught me one thing, it’s that there’s a chasm of mutual incomprehension between the worlds of global finance and global health.

Finance leaders haven’t taken seriously the economic risks attached to infectious disease outbreaks. Health leaders have failed to understand why.


Our unpreparedness for Covid-19 and our panicked, stumbling, and unbalanced global response have their roots in this divide.

Since history, analysis, and now direct experience suggest that infectious disease outbreaks pose one of the greatest threats to economic growth, why is that such risks are barely mentioned in many macroeconomic analyses?


In 2016, in my brief sojourn as an academic between Standard Chartered and my current role at the Global Fund, I sought to explore this question. Together with two colleagues at Harvard, I started by asking whether it was true that health risks were underestimated in economic forecasting. Taking a sample of 15 places that had suffered infectious disease outbreaks, including Hong Kong with SARS and Korea with MERS, we examined the relevant reports from the International Monetary Fund, the Economist Intelligence Unit, and Standard & Poor’s for both the two years after each outbreak and the two years before, some 400 reports in total. We wanted to see whether these renowned institutions had regarded the infectious disease outbreaks as having had a significant impact on the country’s economy after the fact, and whether they had considered the risk of an outbreak as a potential threat to the economy before it happened.

The results were striking. Taking the IMF, 63% of their reports written after the outbreaks in the 15 countries considered the impact on the economy worth mentioning. But not one IMF report for any of the 15 countries written in the two years before mentioned the potential risk to the economy of an infectious disease outbreak. The EIU and S&P fared no better.

I confess my efforts to bridge this gap have been largely unsuccessful. I devoted considerable effort in trying to get the IMF to incorporate health-related risks in its economic analyses, and specifically its periodic Article IV assessments of countries’ economies and policies, but failed. We ran workshops for business leaders so that they could explore what might happen to their businesses (including one in 2017 based on the scenario of a coronavirus more contagious than MERS emerging in China), but found ourselves largely talking to companies already involved in public health. Most recently, more than a month ago, I wrote to a few of the world’s leading institutional investors and central bankers, individuals I know personally, saying we really needed to talk about Covid-19. Most didn’t reply. One got their office to offer me a meeting sometime in the summer.

Since then, of course, stock markets have plunged, even more than in 2008. Central banks have made several attempts to arrest the rout, deploying all array of tools developed during the financial crisis. But despite trillions of dollars of support, markets have continued to sink.

Why have leading economists and financiers been so blind to the risks of infectious disease outbreaks? And why have the tools that proved so powerful in response to the financial crisis not been so effective in arresting the market rout this time?

One reason is that economic analysts are not immune to the broader human tendency to struggle with low-probability, high-impact risks. We typically lurch between wildly overestimating them (shark attacks, terrorism) and grossly underestimating them (financial crises, pandemics).

A second is that economists and financiers seem most comfortable assessing risks they think they understand. I recall a revealing conversation with one senior official at the IMF who said the reason they included factors like commodity prices in macroeconomic risk assessments, but not health risks, was simply that they understood commodities, but didn’t understand epidemiology, and that we had better data for commodities than for infectious disease outbreaks.

The global health community’s tendency to make every health issue an urgent global priority backed by often flaky, overblown analysis probably hasn’t helped either.

The answer to why the massive interventions by central banks and governments have so far proved less effective in arresting the market panic seems clear. During the global financial crisis, the actions taken by central banks and finance ministries addressed the consequences and the causes of the panic simultaneously. Injecting capital and providing liquidity did both. This time, central banks can help mitigate the immediate impact, but tackling the root cause, the pathogen itself, is beyond them. Until we get on top of Covid-19, all they can do is stop the economic and financial consequences spiralling out of control.

But this is where the policy response is wildly unbalanced. Trillions of dollars have been mobilized to mitigate the economic consequences. Yet so far it’s proved extremely challenging to mobilize hundreds of millions, let alone billions, to scale-up testing and treatment, and accelerate the development and launch of new diagnostics, therapeutics, and vaccines. For example, think how the market would react if scientists quickly identified a treatment for Covid-19 that would halve the mortality rate. Then ask why the world of finance isn’t falling over itself to step up to support initiatives like the Therapeutics Accelerator launched by the Bill & Melinda Gates Foundation, Wellcome, and Mastercard a couple of weeks ago. With initial funding of $125 million, this platform is designed to fund and coordinate large-scale trials of existing off-patent drugs as therapies for Covid-19, such as chloroquine and various antiretrovirals, and where these look promising, to support the scale-up of manufacturing. For on-patent drugs, like Gilead’s remdesivir, there’s a commercial incentive to invest, but for off-patent drugs there’s no such incentive. To play this role effectively, the Therapeutics Accelerator needs more like $3 billion.

Covid-19 is a health challenge with massive human and economic consequences. We must rebalance our response to put more resources toward fighting the virus itself. We must seize this opportunity to bridge the chasm between the worlds of health and finance.

Peter Sands is the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He is the former CEO of Standard Chartered.

Hantavirus is one thing you don’t need to worry about right now — as long as you avoid contact with rodents

A man reportedly died of the hantavirus in China. Here’s what it is and what you need to know.

FIELD MICE IN ALBERTA CARRY HANTAVIRUS, SO CAN PIGEONS


Hantavirus Pulmonary Syndrome (HPS) is spread by rodents, and very rarely from person-to-person. designer491/iStock

March 24, 2020 By Nicole Lyn Pesce

No, the world is not about to get hit with a hantavirus pandemic, too.

A man in China has reportedly died from the hantavirus, which is one of a family of viruses spread by rodents that can cause disease in humans. The man from Yunnan Province in southwest China was traveling east by bus to Shadong Province, and the 32 other people on board are also being tested for hantavirus, according to the state-run Global Times newspaper as reported by Newsweek on Tuesday.

This news has led some on social media to start panicking that another viral pandemic is ready to make the rounds, even as the novel coronavirus that causes COVID-19 has infected at least 387,382 people across the globe, and killed 16,767 and counting. (About 101,987 people have recovered, as well.) Hantavirus quickly topped the trending topics on Twitter TWTR, +4.69%, and Google AAPL, +10.03% searches for “hantavirus” also started climbing in the U.S. early Tuesday morning.

Dr. Tania Elliott from NYU Langone Health in Manhattan told MarketWatch that hantavirus has actually been around for a long time, “probably for centuries,” and that it is most prevalent in China with anywhere from 16,000 to 100,000 cases a year.

But unlike the coronavirus — which is believed to spread from person to person through droplets when an infected person coughs or sneezes — the hantavirus is primarily spread by contact with mice and their urine, feces or saliva. In fact, the CDC notes that, to date, “no cases of HPS (hantavirus pulmonary syndrome) have been reported in the United States in which the virus was transmitted from one person to another.” So avoiding the hantavirus basically comes down to avoiding contact with rodents, Dr. Elliott said.

Here’s what you need to know about hantavirus, as outlined by the CDC.

What is the hantavirus?

This family of diseases is spread mainly by rodents — particularly the deer mouse in the U.S. — and can cause different diseases in people around the world. Each hantavirus has a specific rodent host species. Hantaviruses in the Americas are known as “New World” hantaviruses, and can cause hantavirus pulmonary syndrome (HPS), with symptoms including fatigue, fever and muscle ache in early stages, and coughing and shortness of breath later on. Other hantaviruses, known as “Old World” hantaviruses, are mostly seen in Europe and Asia, and can cause hemorrhagic fever with renal syndrome (HFRS), with symptoms including intense headaches, back and abdominal pain, fever, chills, nausea and blurred vision. Both diseases are considered rare, but can be fatal.

How do people get infected with hantavirus?

The CDC notes that human hantavirus infections tend to happen sporadically, and most often in rural areas with forests, fields and farms that are appealing habitats for these rodent hosts — particularly the deer mouse in the U.S., although the cotton mouse, rice rat and white-footed mouse have also been known to carry hantaviruses.

The rodents shed the virus in their saliva, urine and feces, and people most commonly contract it by breathing in tiny droplets containing the virus that get stirred up into the air when fresh rodent urine, droppings or nesting materials are stirred up. This can happen while cleaning in and around your home, if you have rodents living there, too. Opening or cleaning sheds and previously unused buildings, particularly in rural settings, could also expose people to infected rodent droppings. Construction, utility and pest control workers can also come into contact with it while working in crawl spaces or buildings that may be infested with mice. And hikers and campers may be exposed when camping or sheltering in rodent habitats.

Researchers also believe that people can contract the hantavirus if they touch something that has been contaminated with rodent urine, droppings, or saliva, and then touch their nose or mouth. [Keep up that handwashing.] They suspect people can become sick if they eat food contaminated by urine, droppings or saliva from an infected rodent, as well. And in rare cases, the virus can be spread if a rodent carrying the virus bites someone.

Note: The CDC states that the hantaviruses that cause human illness in the United States cannot be transmitted from one person to another, such as from touching or kissing a person with it, or from a health care worker who treated someone with it. Only Chile and Argentina have seen a couple of rare cases of person-to-person transmission among close contacts of a person sick with the Andes Virus hantavirus.

How are people treated? Is there a vaccine?

The CDC notes there is no specific treatment, cure or vaccine for hantavirus infection. The earlier infected individuals are recognized and brought in to intensive care, the better. In intensive care, patients are intubated and given oxygen therapy to help them through any severe respiratory distress. Those with HFRS (hemorrhagic fever with renal syndrome) may also be hooked up to IVs to manage their fluids and electrolytes, and require dialysis in extreme cases. So the health body recommends that “if you have been around rodents and have symptoms of fever, deep muscle aches and severe shortness of breath, see your doctor immediately.”

How dangerous is it?

Developing HPS (hantavirus pulmonary syndrome) and HFRS (hemorrhagic fever with renal syndrome) can be fatal. HPS has a mortality rate of 38%. Depending upon which virus is causing the HFRS, death occurs in less than 1% to as many as 15% of patients. But both of these are also pretty rare, and while some patients have long recovery times of weeks or months, many patients make a full recovery without lasting complications.

Who is most at risk of hantavirus?

Anyone, healthy or not, who comes into contact with rodents carrying hantavirus is at risk of developing hantavirus pulmonary syndrome (HPS), unfortunately. Those living with a rodent infestation are those most at risk, the CDC says, and any activity that puts you in contact with rodent droppings, urine, saliva or nesting materials increases your chances of infection. In the U.S., people in rural settings were more likely to come in contact with the virus, such as a 2012 outbreak that involved 10 cases in people who had recently visited Yosemite National Park, or a 2017 outbreak of a hantavirus in 17 people in 11 states, which included Colorado, Georgia, Illinois, Iowa, Minnesota, Missouri, Pennsylvania, South Carolina, Tennessee, Utah and Wisconsin.

How can I prevent hantavirus, or minimize my risk?

The best thing you can do is eliminate contact with rodents at home, at work or at your campsite as much as you can. At home, seal up any holes or gaps in your house, apartment or garage that could let rodents in. Place traps in and around your home to combat any rodent infestation. And seal and clean up easy-to-get food. Sanitation is key.

You need to take precautions before cleaning up a space that could be the site of a rodent infestation, however. First, ventilate it by opening up door and windows for at least 30 minutes. Make sure you wear rubber, latex or vinyl gloves. Then do not stir up dust by sweeping or vacuuming up droppings or nesting materials; rather, spray the area with a disinfectant, or a mixture of bleach and water, and let it soak for five minutes. Use a paper towel to pick up the urine and droppings, and dispose of the waste in the garbage. Finally, disinfect items that might have been contaminated by rodents or their urine and droppings. Get more tips for safely cleaning up after rodents here.

And for more information, visit the CDC’s page on hantaviruses.

From vodka and gin to hand sanitizer: global distilleries rush to the rescue amid the coronavirus crisis

March 24, 2020 By Lina Saigol MARKETWATCH

French drinks maker Pernod Ricard had to externally source key ingredients, including glycerin and hydrogen peroxide, which it doesn’t usually use.

Bottles of Absolut Vodka. Getty Images

It was early last Monday morning when Melissa Hanesworth came up with the idea that Pernod Ricard should make hand sanitizer.

As vice president of North America Manufacturing at the $34 billion French drinks group, Hanesworth knew the company was well placed to help meet the world’s urgent need for the potentially lifesaving product, which has been in scarce supply as the coronavirus crisis escalates.


Surely, Hanesworth thought, Pernod RI, +3.61% could use its dozens of distilleries located across the globe to produce industrial quantities of the hand gel. She took the idea to the company’s regional boss Ann Mukherjee, who immediately gave it the green light.

Less than 24 hours later, the maker of Jameson Whiskey and Absolut Vodka had received all the government approvals it needed, and by the end of the week the first batch of its hand sanitizers were rolling off production lines in Fort Smith, Arkansas.


“It was incredible how fast we were able to get this done,” Mukherjee told MarketWatch in a telephone interview. “The trick to making hand sanitizer is that you have to denature it so people don’t consume it, which is the opposite of what we do.”

Pernod is one of several of the world’s biggest distillers who are racing to make hand sanitizer, which has become increasingly rare due to a massive surge in demand, to help governments battle the novel coronavirus. As of Monday, 354,677 people world-wide have now tested positive for the virus, according to the latest data from Johns Hopkins University tracker.


The Alcohol and Tobacco Tax and Trade Bureau said last week that it was waiving provisions of internal revenue law to authorize production of ethanol-based hand sanitizers by permitted distillers “to address the demand for such products during this emergency.”

The French drinks maker already had vast quantities of ethanol — the basic ingredient needed to hand sanitizers readily available — but it had to externally source other key ingredients, including glycerin and hydrogen peroxide, which it doesn’t usually use.

“Even sourcing the PET [polyethylene terephthalate] plastic containers to bottle the hand sanitizer in hasn’t been easy,” Mukherjee said.

Once they had gathered the ingredients, however, Pernod’s expertise as master blenders kicked in and after training some of its existing teams, they were able to skilfully mix the contents to make the hand gel.

The company followed the World Health Organizations’s recipe for high quality hand sanitizer. To be effective at killing germs, alcohol-based hand sanitizers should have an alcohol concentration of between 60-95%, according to the Centers for Disease and Control Prevention.

Mukherjee credits the The White House Coronavirus Task Force with helping Pernod overcome regulatory hurdles and obtain the necessary clearance to make the product in record time. “We are truly grateful that we were able to work with the task force and the U.S. government. We needed a quick turnaround across multiple bodies to do this”

President Donald Trump praised Pernod’s efforts at a press briefing on March 21. “They went out and repurposed their alcohol production capabilities in Arkansas, Kentucky, Texas, and West Virginia to make hand sanitizer. That’s a big difference. And they have been unbelievable,” he said.

This week, Pernod Ricard should produce 4,500 gallons of hand sanitizer in the U.S., with weekly production rising to at least 5,700 gallons by the end of March. Mukherjee said the quantities that it will be producing are completely being dictated by the government. “They give us the demand signals they are looking for based on need across the country.”

The company’s other global subsidiaries are also helping ramp up production. In France, Pernod will donate 70,000 liters of pure alcohol, which is the equivalent of 1.8 million individual 50 milliliter bottles, to Laboratoire Cooper, the country’s leading supplier of hydroalcoholic gels to pharmacies. This is alongside the additional initiatives in Ireland, Spain and Sweden.

Although Pernod won’t make any profits from its side gig, it will might provide workers with a morale boost, given the fact that it is facing hard times, like the rest of the corporate world. On Tuesday, the French group drastically cut its guidance for the year ending June 30, as the spread of the virus hit its business more severely than it had initially anticipated. Shares in Pernod were trading 3.41% higher at 9:30 a.m. GMT.

Diageo DGE, +8.09%, whose brands include Guinness beer, Smirnoff vodka and Johnnie Walker whiskey, said it would supply two million liters of alcohol to make hand sanitizer to help overcome shortages in health-care systems. It said the alcohol will help to make eight million 250ml bottles, and priority will be given to frontline health professionals battling the spread of the disease.

“Healthcare workers are at the forefront of fighting this pandemic and we are determined to do what we can to help protect them,” said Ivan Menezes, Diageo Chief Executive. “This is the quickest and most effective way for us to meet the surging demand for hand sanitizer around the world.”

Belgium-headquartered Anheuser-Busch InBev BUD, +5.09% is producing 50,000 liters of ready-to-use disinfectant alcohol, using the surplus alcohol from its alcohol-free beers, including Jupiler 0.0 and Beck’s Blue, for European hospitals. A further 26,000 bottles of hand sanitizers have also been produced from the alcohol removed from alcohol-free beers, and these will be given out to pharmacies and frontline workers across Europe.

Some smaller, U.K.-based artisanal brewers and spirits makers have also stepped up to the challenge. BrewDog has started bottling its first batch of hand gel ‘Punk Sanisiter’ and was due to deliver it to Aberdeen Royal Infirmary’s Intensive Care Unit in Scotland on Monday afternoon

SEE
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Fox News' coronavirus denial means 'viewers will die,' media critic says

Suzanne Smalley Reporter, Yahoo News•March 24, 2020

TRUMP AND FOX ARE RESPONSIBLE FOR AMERICANS DYING FROM COVID-19

As the coronavirus threat intensified in the U.S. in late February and early March, Fox News viewers received different information than Americans who got their news from other sources. Ben Smith, a longtime reporter and editor and the media critic at the New York Times, set out to understand why. His conclusion: Fox anchors consistently downplayed and even denied the existence of the coronavirus, a failure he blamed on Fox chairman Lachlan Murdoch’s laid-back management style, in contrast to the firm hand of longtime chief Roger Ailes, who resigned in 2016.

No one with real power over the big talent was engaged enough with the network's coverage to rein in broadcasters who asserted that the virus was fake, Smith said. He believes the network's coverage of the virus, which is widely seen as a major black eye for Fox, caused unnecessary deaths.

On March 9, when 700-plus American coronavirus cases had been confirmed, Sean Hannity told Fox viewers that political enemies of President Trump were using the virus to “bludgeon Trump with this new hoax.” In an interview Tuesday with the Yahoo News podcast “Skullduggery,” Smith told hosts Michael Isikoff and Daniel Klaidman that Fox didn’t just echo the president, who consistently downplayed the virus, but went even further with comments like Hannity’s, which actually called it fake.


Asked for comment, a Fox spokeswoman pointed to a statement that condemned the “cherry picking of clips” from opinion programs as “the definition of politicizing this serious threat.” The statement also highlighted how the story has changed, saying the pandemic “has evolved considerably over the last few weeks.”

As public criticism mounted over the tone of the network’s coverage, News Corp. founder Rupert Murdoch — Lachlan Murdoch’s father — reached out to Hannity with a warning to take the virus “seriously,” Smith reported. Fox host Tucker Carlson, whose reporting on the coronavirus was more aligned with mainstream medical advice, is now the object of scorn by rivals within the network who believe he is burnishing his reputation for independence at their expense.

Fox, which remains a powerful and lucrative media outlet with a firm grip on its audience and advertising dollars, might not be punished, Smith said — other than by facing the likely “consequences ... that some of their viewers will die.”

Smith believes the knee-jerk tendency among Fox commentators to defend Trump vigorously against criticism by the mainstream media caused them to lose sight of the substance of the story itself. Internally, some people at the network took the danger of COVID-19 seriously. Smith reported that Fox News CEO Suzanne Scott was concerned enough that she took proactive steps to better sanitize the network's communal areas. Scott also installed “sanitation stations” in all bureaus and on March 2nd cancelled the network’s “upfront presentation” - an important media industry event scheduled for three weeks later. But Scott had no influence over on-air coverage, and Fox hosts dismissed the threat until mid-March, when the White House itself began taking a different view.

Coronavirus and Fox News. (Photo illustration: Yahoo News; photo: Getty Images)

Download or subscribe on iTunes: “Skullduggery” from Yahoo News

Fox would likely not have lost its way on a story this major as recently as a few years ago, Smith said. Ailes — the former Fox News chairman and trusted Murdoch confidant who died in disgrace in 2017 after several women came forward to accuse him of sexual misconduct and rape — always resisted allowing politicians to dictate Fox coverage.

Smith believes that is no longer the prevailing attitude at the network. The president is personally close to certain Fox anchors, who Smith said often do not share Ailes’s view that “the politicians worked for him and not vice versa.”

The editor of BuzzFeed from 2012 until his recent hiring by the Times, Smith is known to be an astute media observer. Like many big stories, he said, the coronavirus has put the spotlight on great work from individual reporters, outlets and even platforms themselves. Social media coverage of the virus has been spectacular, Smith said, and has been particularly valuable as a forum for doctors and epidemiologists to speak to the public directly. In January, when many people were inclined to believe the conventional wisdom that the coronavirus was overhyped, Smith said, the “voices of both epidemiologists and doctors and nurses on social media ... cut through” when nothing else did.