“We will allow gyms, fitness centers, bowling alleys, body art studios, barbers, cosmetologists, hair designers, nail care artists, aestheticians, their respective schools, and massage therapists to reopen their doors this Friday, April the 24th.” Gov. Brian Kemp (GA), 4/20

“If there’s a way that people can social distance, and do those things, then they can do those things. I don’t know how, but people are very creative.” Dr. Deborah Birx, White House Briefing, 4/21

“My daughters who are, you know, 13 and 14 and 11, I mean, right away they’re asking me, ‘How does that work, Daddy?’” Dr. Sanjay Gupta, CNN, 4/21

Dear Students,

Y’all remember what an experiment is, right? Like, you’re in a lab with a lot of mice genetically engineered to mimic Alzheimer’s. They build up clumps of amyloid in their brains, and they get even dumber than other mice. You find a molecule that binds to amyloid and say, “What if I could get it to attack the amyloid clumps?” You randomly assign mice to get or not get your cute molecule, and presto, the ones who get it clear the amyloid clumps from their brains. “Whoopee,” you think. You and some brain docs recruit a few brave volunteers with early Alzheimer’s to take Cute Molecule. (Hopefully they didn’t volunteer because they were already demented.) Did their amyloid clear? Equivocal, but then again you didn’t kill anybody. You move on to a larger trial, with a matched control group. You don’t know who got Cute Molecule in different doses or who got a vitamin pill, and neither do they. Double-blind. Results: still equivocal. Back to the drawing board. But wait. You analyze the results again and find that the highest dose of Cute Molecule helped some patients. “Whoopee!” More studies.

Those are experiments.

And then there are experiments. Like the one Doctor—oh, I meant Mayor—Carolyn Goodman of Las Vegas proposed. She told Anderson Cooper on CNN, “We offered to be a control group…and I was told by our statistician you can’t do that…and I said, Oh, that’s too bad because I know when you have a disease, you have a placebo that gets the water and the sugar and then you get those that actually get the shot. We would love to be that placebo side so you have something to measure against.” Her fascinating hypothesis: the parts of Nevada that stay locked down won’t have less COVID-19 disease than Vegas, which she encourages to reopen its casinos, bars, and restaurants.

Students, this is your chance to be one of those brave volunteers pioneering in Doctor—I mean Mayor—Goodman’s big experiment! Fly to Vegas and elbow in among those crowds of gamblers from everywhere in the reopened casinos. If you are serious about gambling, this is the experiment for you!

Or, come back to Georgia and get a massage, a tattoo, a haircut, a perm, or a manicure. Those are some of the businesses that Doctor—I mean Governor—Brian Kemp reopened in our state! Maybe you’ll be the experimental group and North Carolina, the adjacent state that’s staying locked down, will be the controls. Really, what’s the worst case scenario? You help prove that our neighbors to the north are right—AND you are going to look sooo good in your coffin!

Then there’s the experiment proposed by the Doctor-in-Chief or DiC. You can really help out here. Swallow, or better still, inject Lysol or another disinfectant. I think he meant, like, in your veins? Also, get some really bright (but maybe not too thick) flashlights, turn them on, and stick them in all the places where the sun doesn’t shine.

But I digress.

[See disclaimer here]

Good News

1. New York, by far the worst-hit state, is definitely healing. As the governor says, 400+ deaths a day is nothing to celebrate, but it’s far down from the peak, and the pressure is beginning to ease a bit in the hardest hit hospitals. Intubations have been lower than extubations for days, and New York (as promised) is sending ventilators to states that have not yet reached their peak. What goes around comes around.
2. The Starfish model that I wrote about last time is working for America. Most governors, including many Republicans, are leading their respective points of the star and ignoring the decayed head. This is making our country resilient enough to defeat the virus with an adaptive, headless network. Large majorities of Americans are keeping up social distancing and are worried about opening too soon.
3. A different point of the headless star, the U.S. Congress, passed another near-$500 billion relief bill, to save more of America’s small businesses from the virus (especially minority-owned businesses—the most vigorous part of the category). Also, the bill will strengthen production of personal protective equipment (PPE), swabs and reagents vital for testing, and actually deploy real testing programs.
4. NY and LA have instituted something I’ve been waiting for: random sampling of their populations for antibody testing. This gets a snapshot of the impact of the virus: where it has been, how many people had it without symptoms, how it spreads, who is most vulnerable, and what the real numbers are—total cases, which leads to believable case fatality rates.
5. A retired farmer in Kansas wrote Gov. Cuomo that he had saved five never-used N-95 masks from his farming days. His wife has one lung and is diabetic so he is saving four masks for his family. But he sent the fifth one to Cuomo, asking him to give it to a nurse or doctor in New York. The man said he didn’t expect an answer, but the Governor read it and reread it on national television. There wasn’t a dry eye in the house. That farming couple and others like them are another point of the resilient American star.

Bad News

1. The fact that New York is sending ventilators to other states of course means that they have not passed their peaks of need but are still on the upswing (Utah, Mississippi) or in a plateau (Texas) of deaths. (Interactive graphs here.)
2. Some states (Georgia, Florida, South Carolina, etc.), fortunately not many as yet, are as headless now as the nation is, and are pioneering ill-advised early opening. They can’t be effective points of the national starfish. But the mayors in most cities in those states—in Georgia, the mayors of Savannah, Augusta, Albany, Macon, Rome, and Atlanta—are the points of the now-headless state starfish. They will save the state, just as the wiser governors save the nation. The mayor of Savannah, for instance, has urged his citizens (in Georgia’s oldest city) to call their barbers and manicurists and pay for an appointment in the future, but not to go now.
3. All the money from Congress so far does not begin to meet the need. It does not help the states to support first responders, provide adequate PPE, or deploy adequate testing and especially, contact tracing. Senate Majority Leader Mitch McConnell has advised states to declare bankruptcy, which is not legal, rather than use Federal funds to help hard-hit states. Much more is needed to rebuild crumbling infrastructure and finally build the health care delivery system we need. This would provide millions of needed jobs and leave our children with a more workable country.
4. We are still woefully under-testing, and we need a ten-fold increase just to test for the virus itself. (The Rockefeller Foundation just issued a detailed plan for expanding testing and reopening the country). Crucial antibody (serological, you-had-the-disease) testing is far behind in numbers and most available tests are not accurate. A huge newly-trained force of people is needed to trace contacts.
5. All experts agree that a second wave of the pandemic is highly likely in the fall and will intersect disastrously with the regular flu season, which it didn’t do this year. This includes the head of the CDC, the Surgeon General, Dr. Fauci, and Dr. Birx, who all risk being fired by openly contradicting their boss on this prediction. The best we can hope for is that we will have learned and that the next wave, even if it is worse, will not catch us flat-footed the way the first wave did. Watch the secondary waves already occurring in Asian countries.

Many experiments are under way and we will see how they turn out. That includes controlled experiments on treatments and vaccines, and uncontrolled experiments by politicians on volunteers who do not understand the risks they are taking by participating. The Mardi Gras experiment resulted in a large increase in Louisiana cases. The Wisconsin in-person primary election on April 7th is believed to have caused at least 19 cases, including at least one poll worker. Daily new cases in Wisconsin have seen an upturn (here, and graph below) in the two weeks since the primary. Live, in-person worship services, funerals, and other religious gatherings have resulted in many deaths, including an outbreak in Albany, Georgia after a funeral and the death of a pastor in Virginia who led live services. His wife also got the virus, and their daughter begs us to understand how serious the risks are. We will see what happens in Georgia barber shops and on Miami beaches.

Stay safe. Let me know if you’d like me to continue these updates beyond the end of the semester.

Dr. K