“A house divided against itself cannot stand.” Gov Andrew Cuomo, quoting Abraham Lincoln, quoting Matthew 12:25 and Mark 3:25

“The paranoia of stupidity is always the worst, since its fear of destruction by intelligence is reasonable.” American playwright Arthur Miller

“You can’t always get what you wa-ant. But if you try some time, you just might find, you get what you need.” The Rolling Stones, from home, yesterday

Dear Students,

A book called The Starfish and the Spider, published in 2006, was about the strength of decentralized organizations. The metaphor is not ideal, but if a spider loses its leg, it’s crippled, and if it loses its head, it’s done for. A starfish can regenerate its cut-off leg, and in some species the leg can regenerate the whole starfish. The authors argue for the strength of acephalous or headless organizations. Wikipedia and the Internet are examples. The Aztecs quickly fell to the Spanish conquerors, but the dispersed, leaderless Apache Indian tribe resisted them for centuries.

Good News

1. The resilience of the United States as a headless organization is being tested as never before, at least since the American Revolution. How many times have we now heard, “It’s up to the governors”? Well, guess what? The governors have gotten the message! They are fighting the would-be COVID conqueror with the resilience of a headless organization. This includes Republican Governors Larry Hogan (Maryland), Mike DeWine (Ohio), and Charlie Baker (Massachusetts), and Democratic Governors Andrew Cuomo (New York), Gretchen Whitmer (Michigan), and Gavin Newsome (California). They keep asking for Federal help, and people are dying for lack of it, but they no longer expect it from the executive branch, and they are getting the job done.
2. The Congress is another leg of the starfish. It is drafting legislation to provide funds for millions of free tests a week, both for the virus (you have the disease) and for the antibodies (you had it). New York State, which accounts for almost half the U.S. cases and deaths so far, is pretty clearly over the worst. Following Germany and other countries that understand science, New York will implement massive random antibody testing to get a snapshot of how the virus spread through its population, calculate real mortality rates, and begin finding out who may be immune.
3. As for treatment, hydroxychloroquine has not yet worked but is still under study, as is the antiviral remdesevir, which looks much more promising. The use of convalescent plasma (from recovered patients) is also being aggressively studied. All three are in short supply, but doctors can request any of them for individual patients outside of controlled trials. Vaccines are in development in labs throughout the world.
4. Stay-at-home measures, social distancing, obsessive handwashing, masks, and other preventive strategies have dampened the curve in many states and in the U.S. as a whole, although they have not crushed the curve anywhere. Some states will begin returning to normal life in stages recommended this week by the Coronavirus Task Force, starting as early as the first week of May. Every person who voluntarily stayed at home has been part of the headless organization defeating the virus and saving literally countless lives.
5. Recessions and even depression do not costs lives, but contrary to intuition they save lives. This has been shown for the Great Depression, the Great Recession and other downturns. Deaths from auto and other accidents, heart disease, lung disease, and infant mortality all go down. Deaths from suicide and addiction probably go up, but overall deaths decline. Obviously if a recession coincides with a pandemic, a lot of people are going to die from the pandemic, but the idea that recession itself will cost lives in the aggregate is false.
6. Lady Gaga and Global Citizen yesterday presented One World: Together at Home, a two-hour concert from the homes of an astounding array of huge celebrities (see highlights here). As of today they have raised $128 million for WHO, the UN, and other headless organizations fighting the virus, some abandoned by the United States.

Bad News

1. However successful the states are on the headless starfish model, the absence of Federal funds, especially for testing, will hamper their response and cost lives. Some states are opening up too much too soon and are ignoring the fact that unknown numbers of their citizens are infected and spreading the virus without having symptoms. New research shows that sneeze droplets travel much farther than 6 feet.
2. There is another, negative aspect to headless organization emerging: large, angry protest movements both denigrating and flaunting public health measures. This has been framed in terms of “freedom” and “liberation” and encouraged from what is left of our country’s head, but the result is massive dense crowds of people with no protection against each other. This will have an effect similar to that of Mardi Gras in Louisiana.
3. Hydroxychloroquine trials have been disappointing so far, both because of lack of positive effect and cardiac side effects. Compassionate use of remdesivir has been more promising but it also has side effects and controlled trials must be completed before it is widely used. Ditto for convalescent plasma. Many vaccine experts doubt the timetable we have been encouraged to think about, which is 12 to 18 months.
4. Twenty public health experts interviewed for a long article in today’s New York Times have urged us to prepare for return of the virus after the first wave, and to see this as a process that may take years. Scientists have criticized the main model that the Federal government is relying on for its normalization plan, while others have provided more plausible models that see the virus returning in multiple waves.
5. Congress is at this writing deadlocked on major measures to provide funds for serious testing and alleviate economic suffering. Some health measures improve in recessions, but mental health measures are probably not among them, despite stress reduction for some people.
6. The impacts of poverty, racial oppression, age, and gender are clear in this pandemic as in so many diseases. Poor people, African-Americans, and the elderly are prime targets due to preexisting untreated conditions. Women are the majority in front-line occupations, although men are more like to get sick and die. Nothing will change in the long run without changes in our society and our health care system.

“Do I have it, Did I have it, Am I recovered, Am I Immune?” These are the critical questions that we cannot yet answer. Washington says there are plenty of test kits, but the governors (both parties) say there are no swabs to do the tests and no reagents for the labs to do the analysis. Imagine that you can sit for the SAT or the MCAT, but you don’t get a pencil. Or imagine that you get a pencil and fill in the bubble sheet, but it can’t be graded.

We can’t end social distancing except as guided by widespread testing which is not yet available.

Below or attached, two graphs of the influenza pandemic of 1918-20, which we studied early in our course. The first shows overall mortality in various cities. Notice that the bumps in mortality came in three waves, the first being the smallest. The second shows the difference between the curves in Philadelphia, which had a parade of 200,000 people on Sept. 28, 1918, and waited two weeks after the first case to implement social distancing, and St. Louis, which instituted social distancing two days after the first case.

Please, be a part of the worldwide headless organization that will defeat this virus.

I know you are disappointed to be losing months of your youth, months of normal college, and for many of you the ceremonies of graduation. I am truly sorry. But I want you to have the rest of your youth and the rest of your life, and that of your parents and grandparents. We will figure out a way to make it up to you about commencement.

The “paranoia of stupidity” that Arthur Miller refers to is driving some people into the streets and into the arms of the virus. Yours is the intelligence that can subdue that paranoia.

You can’t always get what you want, but if you try some time, you just might find, you get what you need.

Stay safe, Dr. K