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This Coronavirus Is Unlike Anything in Our Lifetime, and We Have to Stop Comparing It to the Flu

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CORONAVIRUS

This Coronavirus Is Unlike Anything in Our Lifetime, and We Have to Stop Comparing It to the Flu

Longtime health reporter Charles Ornstein says that comparing the novel coronavirus to the flu is dangerously inaccurate. Not one public health expert he trusts has called that comparison valid. Here’s why.

by Charles Ornstein

by PRO PUBLIC

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As a longtime health care reporter, the unfolding coronavirus pandemic represents everything I’ve read about — from the early days of epidemiology to the staggering toll of the 1918 Spanish Flu pandemic— but had not covered in my lifetime.

And still, I have been caught off guard by the pushback from top elected officials and even some friends and acquaintances who keep comparing it to the flu.

“So last year 37,000 Americans died from the common Flu,” President Donald Trump wrote on Twitter on March 9. “It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!”

By Friday, Trump had declared coronavirus a national emergency, freeing up resources and removing hurdles for a faster response.

In the meantime, not one public health expert I trust — no one — has said this flu comparison is valid or that we’re overdoing it. Every single one, from former FDA Commissioner Scott Gottlieb to Harvard professor Ashish Jha, has said we’re not doing enough, that this is far more serious than it is being taken.

Here’s why that is:

This Is Far Deadlier Than The Flu

As Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and others have said, COVID-19 is deadlier than the flu. It’s deadlier for young adults. It’s deadlier for older adults. In China, early data shows that it was 10 times deadlier. This chart from Business Insidercompares U.S. flu deaths to deaths in China from COVID-19.

Ruobing Su/Business Insider

The flu kills less than 1% of infected people who are over age 65. By comparison, in China, COVID-19 killed 8% of those infected who were 70-79 and almost 15% of those infected who were age 80 or older. That’s a staggering difference.

Even for younger people, the difference was striking. Flu killed .02% of infected patients age 18-49. It’s 10 times that for COVID-19.

In other countries, such as South Korea, the death rate has been far lower.

But if 1 in 12 people age 70-79 who get the virus and 1 in 7 people age 80 or older who get the virus die, and the virus spreads to 20%, 40% or 70% of the population, we’re talking massive death tolls, the likes of which we have never seen before in our lives.

“I mean, people always say, well, the flu does this, the flu does that,” Fauci said Wednesday during congressional testimony. “The flu has a mortality of 0.1%. This has a mortality rate of 10 times that. That’s the reason I want to emphasize we have to stay ahead of the game in preventing this.”

Our Health Care System Doesn’t Have The Capacity To Deal With This

Epidemiological experts keep talking about the need to “flatten the curve.” What they mean by that is that we need to slow the speed at which new cases are reported. We may not be able to stop the spread of the coronavirus, but we have to try to manage it. If 1,000 new cases happen over a month instead of a week, the health care system is more able to handle them.

Here’s why this is a worry: Overall, our hospitals have fewer beds than other developed countries, according to recent data from the Organization for Economic Cooperation and Development. The United States had 2.8 beds per 1,000 residents. By comparison, Germany had 8 beds and China 4.3 per 1,000.

The United States looks better when it comes to intensive care beds, but there’s tremendous variation between regions and states. If we experience what parts of China and Italy saw, we won’t have anywhere for sick patients to go. We will quickly run out of capacity.

Even If We Have The Capacity, We May Not Have Enough Supplies

In a crisis moment, supplies like ventilators and N95 face masks will be key. But as National Geographic and other media have reported, the United States has only a fraction of the medical supplies it needs.

Others have reported shortfalls as well, and ProPublica has been hearing from health care professionals across the country who say their own institutions are running short of supplies. (Share your story here.)

U.S. Surgeon General Jerome Adams tweeted at the end of February, “Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

Another Challenge: Hospital Staff Have Been Exposed Too

And if that weren’t enough, there’s another problem. Health care workers who have been exposed to the virus are now quarantining themselves, further reducing available staff at hospitals. Kaiser Health News reported on the effects of this:

“In Vacaville, California, alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.

“Across California, dozens more health care workers have been ordered home because of possible contagion in response to more than 80 confirmed cases as of Sunday afternoon. In Kirkland, Washington, more than a quarter of the city’s fire department was quarantined after exposure to a handful of infected patients at the Life Care Center nursing home.”

This week, Banner Health in Colorado informed employees that a co-worker is among those with the coronavirus, The Colorado Sun reported. “People who came into prolonged, close contact with the woman in a Banner Health emergency room are being notified and asked to home-quarantine for 14 days, according to a source close to the investigation who spoke to The Sun on the condition of anonymity.”

And my ProPublica colleagues reported Friday how some EMS workers are also being quarantined because of exposure. (It didn’t help, of course, that the EMS system was slow to get up to speed on the threat.)

More than that, many health care workers have children and as schools begin to close, they have to figure out how to care for their own families.

People In Rural Areas Will Have Little Care Nearby Should They Be Affected By COVID-19

Rural areas in the U.S. are losing their hospitals entirely, and residents are having to travel hours for care. According to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, 126 rural hospitals have closed since 2010, including six so far this year. That’s about 6%.

An analysis by the Chartis Center for Rural Health and iVantage Health Analytics this year found that about a quarter of the nation’s 1,844 open rural hospitals are vulnerable.

As The Washington Post described it last year, “Hospitals like Fairfax Community [in Oklahoma] treat patients that are on average six years older and 40 percent poorer than those in urban hospitals, which means rural hospitals have suffered disproportionately from government cuts to Medicaid and Medicare reimbursement rates. They also treat a higher percentage of uninsured patients, resulting in unpaid bills and rising debts.

“A record 46 percent of rural hospitals lost money last year. More than 400 are classified by health officials as being at ‘high risk of imminent failure.’ Hundreds more have cut services or turned over control to outside ownership groups in an attempt to stave off closure.”

Coronavirus Ramps Up, Money Is Running Out

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Coronavirus Ramps Up, Money Is Running Out

(With razor-thin margins and Congress failing to reauthorize their funding, many nonprofit community health centers face running out of money in May)

By Phil McCausland
The clinician at International Community Health Services in Seattle took his time before entering the checkup room. He tried not to think about the clinic’s dwindling resources or the challenges of getting coronavirus testing kits as he soaped and scrubbed his hands pink, wrapped a heavy-duty mask around his face and snapped on disposable rubber gloves and a pair of goggles.

The full outfit is necessary every time he meets patients — largely low-income Asian Americans and immigrants who have Medicaid or no insurance at all — even as the clinic’s orders for medical supplies come in short and disinfectant levels run low.

Administrators reminded all the nurses and doctors to be careful, especially after the clinic admitted their first confirmed coronavirus case: a patient who arrived from a nearby nursing home, the Life Care Center of Kirkland, where several residents and workers have fallen ill.

Still, the potential risks are hard to forget: The news is preoccupied with the coronavirus outbreak and the state of Washington has reported 572 cases of the disease and 37 deaths as of Saturday.

Once the clinician entered the room, he took down his patient’s medical history, noted whom they may have come in contact with and weighed whether he would be allowed to administer one of the clinic’s few coronavirus tests — all while assuaging his patient’s fears after traveling to Vietnam at the start of a pandemic.

Time and resources at nonprofit community health centers, which serve approximately 29 million low-income Americans across 1,400 facilities like this one, are being stretched to their breaking point amid the coronavirus outbreak even as they could prove essential in combating its spread, Dr. Asqual Getaneh, the center’s medical director, said.

Their ability could be further handicapped very soon: Federal funding that accounts for 70 percent of these nonprofit health centers’ budgets will run out in May.

“The unknown is an added stress for everyone,” Getaneh said, who noted their pharmacies are running short on essential medications. “There’s also stress associated with whether or not we have the supplies to protect ourselves and take care of patients who are symptomatic. We’re told this is the tip of the iceberg for this epidemic, so we’re seeing a lot of people coming in and trying to figure out how best to deliver care.”

The Front Lines Of A Health Crisis

That is a challenge for these nonprofit health centers, which were first funded by the federal government more than 50 years ago as part of the “War on Poverty.” These clinics located in every state, from dense urban centers to rural towns and communities, have served a vital role in combating national emergencies such as the opioid crisis and the HIV/AIDS epidemic.

The trouble is they don’t know how long they can hang on, which would inhibit efforts to stymie the spread of the disease.

Because the House and the Senate have failed to reauthorize the Community Health Center Fund — a piece of the Affordable Care Act that provides more than 70 percent of the budget for these medical nonprofits — and make a commitment beyond temporary measures, many health centers have experienced staffing shortfalls and have cut back the services they provide.

The National Association of Community Health Centers sent a letter to Senate Majority Leader Mitch McConnell on Thursday asking that he prioritize the reauthorization of their funding, warning that millions of people are at the cusp of losing access to healthcare services through them.

Their situation is particularly concerning since they predominantly provide care to low-income people and immigrants on Medicaid and Medicare, as well as the uninsured who pay on a sliding scale at these nonprofits. These are all populations of people who are more likely to avoid going to the doctor for fear of the cost, but these clinics relieve the stress on hospitals and help flatten the spread of the disease.

Washington is seeing the worst of these cases, but the coronavirus is quickly spreading across the United States. Those states with fewer resources and larger uninsured rates are increasingly nervous about a wider outbreak — especially when they lack the ability to test for the disease.

Because the House and the Senate have failed to reauthorize the Community Health Center Fund — a piece of the Affordable Care Act that provides more than 70 percent of the budget for these medical nonprofits — and make a commitment beyond temporary measures, many health centers have experienced staffing shortfalls and have cut back the services they provide.

The National Association of Community Health Centers sent a letter to Senate Majority Leader Mitch McConnell on Thursday asking that he prioritize the reauthorization of their funding, warning that millions of people are at the cusp of losing access to healthcare services through them.

Their situation is particularly concerning since they predominantly provide care to low-income people and immigrants on Medicaid and Medicare, as well as the uninsured who pay on a sliding scale at these nonprofits. These are all populations of people who are more likely to avoid going to the doctor for fear of the cost, but these clinics relieve the stress on hospitals and help flatten the spread of the disease.

Washington is seeing the worst of these cases, but the coronavirus is quickly spreading across the United States. Those states with fewer resources and larger uninsured rates are increasingly nervous about a wider outbreak — especially when they lack the ability to test for the disease.

Worsening a crisis: Trump’s Proposed Medicaid Rule Change Could Shutter Rural Hospitals

With the fifteenth coronavirus case confirmed in North Carolina this week, the 42 community health care centers in the state that serve its 100 counties are gearing up to respond. But unlike Washington state, they will see a larger gap in health care coverage because North Carolina did not expand Medicaid.

North Carolina remains one of 14 states that hasn’t accepted the ACA’s federal funding, which would provide coverage to 194,000 more people. The conservative state Legislature has consistently cited fiscal and ideological reasons for their opposition to the program, causing them to turn down an estimated $40 billion since 2014.

With community health centers in the state largely serving those people who fall in that coverage gap, as well as those able to sign up for Medicaid, health care workers are preparing as best they can for the spread of the coronavirus at the level seen on the West Coast — albeit with even fewer resources.

“Between the federal funding challenges and covering a lot of uninsured patients, it makes it really hard to do anything when you are not financially secure and you have to plan month to month,” said Leslie Wolcott, the emergency preparedness coordinator for the North Carolina Community Health Center Association.

‘A Drop In The Bucket’

There are approximately 30 million people in the U.S. living without insurance and more than half of American adults put off medical care last year due to the cost, the Kaiser Family Foundation reported. Without these health centers, there is even more concern that these individuals will not visit the doctor because of the expense — a serious problem during a pandemic.

“In the best of times that funding situation is challenging to manage for these health centers,” Jennifer Tolbert the director of state health reform at the Kaiser Family Foundation, said. “But when you’re dealing with a pretty significant health crisis on top of that, it just really creates more challenges and puts the care of these vulnerable populations at risk.”

MARCH 7, 202003:29

VIDEOTrump says insurance companies will waive coronavirus treatment copays
And it’s not outright partisan opposition to the health centers that are stalling efforts. Despite their ties to the ACA, community health centers enjoy support from both parties. Even now Sens. Debbie Stabenow, D-Mich., and Roy Blunt, R-Mo., said they are working together to push a five-year funding measure through Congress that would expand the program further.

That funding, however, has often gotten tied up in unrelated political fights, and Stabenow said she was not particularly hopeful that they would get any legislation through until the last minute.

“We are very hopeful that in May, when their temporary funding runs out, that we can do a full bill and get the full authorization so that community health centers can plan,” she told NBC News, though she emphasized that it was much too late and the funds offered by Congress’s appropriation was too little.

The $100 million they’re receiving will quickly be exhausted by the clinics at the frontlines of this outbreak, said Dr. Ron Yee, chief medical officer of the National Association of Community Health Centers.

“We have no problem telling Congress this is a drop in the bucket in terms of the demand and how fast this disease is spreading,” Yee said.

Limited Access To Virus Tests

Yee noted they are also concerned about testing for the disease. He said clinics on the West Coast are rationing test kits and triaging those who come in with symptoms.

But a fearful public demanding more evaluations and a shortage of tests are further straining these health centers. While the White House announced that 1 million more tests would be available by Monday, doubts were raised about whether they will meet their own self-imposed deadline — one they already missed last week — and how many these nonprofits would receive.

Yee said they are in constant communication with the Centers for Disease Control and Prevention, but the federal agency has not said how many tests they will be provided. The agency did not respond to NBC News’ request for comment.

Meanwhile, North Carolina Health and Human Services Secretary Dr. Mandy Cohen told the state Legislature on Tuesday that there are only 300 test kits in the entire state to serve its population of 10.4 million people. This comes on the same day that Gov. Roy Cooper, a Democrat, declared a state of emergency there.

Even if the clinics had tests, however, because of the backlog of samples to be checked by the states’ public health departments, it can take several days to get results. The labs are just so overwhelmed.

As of now, the best many health care workers can do is tell patients to go home, stay there, take acetaminophen and call back if they experience shortness of breath.

“We’ve shown that we’re there on the front lines taking care of people,” Yee said. “Maybe Congress will come up with more funds or shift things, but we’ll take what we can get and use it the wisest way we can.”

Image: Phil McCauslandPhil McCausland McCausland

Phil McCausland is an NBC News reporter focused on rural issues and the social safety net.

Commentary: The Leadership Vacuum Gets Filled

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By John Krull
TheStatehouseFile.com

INDIANAPOLIS – Government matters.

That’s one lesson the exploding coronavirus crisis has delivered.

In the countries – China, Italy and, now, the United States – where the national government has tried to deny that a potential pandemic presents problems, leaders have made the situation worse.

In parts of China, all commerce and social interaction have been frozen for weeks. The cost in lost lives, frayed health, and forsaken productivity are beyond calculation.

In Italy, the entire nation is on lockdown. The country’s hospitals are overwhelmed, and its old people exist in a constant state of risk.

Here in the United States, the president consistently has tried to minimize the crisis by calling it a “hoax” – his favorite term for any bad news he just doesn’t want to hear – while healthcare and national security professionals in his administration have just as consistently sounded alarms.

While the president engages in absurd conspiracy theories, businesses have canceled conferences. States and communities have banned large public gatherings. Schools across the nation have been closed. Entire towns have been put under quarantine.

This, in its way, is heartening.

While the federal government, led by a president who prefers fantasy to reality, flails, state and local governments have stepped up to meet the challenge.

This has been true in states, such as New York and Washington, where Democrats occupy the governor’s offices. They have acted with vigor to perform the government’s first function – protecting the safety of the people the government is supposed to serve.

But it also has been true in states, such as Indiana, which are led by Republicans.

Here, Gov. Eric Holcomb has done the things President Donald Trump should have done at the national level. Holcomb recognized the threat, provided information about it in a transparent fashion and took immediate steps to provide for public safety

When the first coronavirus case was discovered in Indiana, the Holcomb administration called a press conference on the issue before the news was even an hour old. Since then, the governor’s response has been rock-steady, concerned but not panicked, confident but not oblivious.

This is as it should be.

Leadership, like nature, abhors a vacuum.

When the president of the United States refuses or is unable to lead, it is natural that others will step forward to fill the void.

In a country in which millions of Americans along all points of the ideological spectrum have found a reason to doubt the effectiveness of the government that draws its authority from their consent, this should provide some reassurance.

When one part of our system of representative government fails – as the executive and legislative branches of the federal government have and continue to do in this case – other parts of the government often find ways to bridge the gaps. The system’s safeguards may be imperfect, but they do exist.

That’s another important lesson from this crisis.

Still, another is this: Frequently, the most fundamental question to be answered about a leader isn’t about ideology.

It’s about competence.

We Americans tend to tie ourselves in knots over how of solving problems. We fret and fume over whether a proposed solution is progressive or conservative, Republican or Democrat in conception.

The truth is there are liberal solutions to problems. There also are conservative solutions. Republicans have some good ideas. So do Democrats.

All these solutions and ideas have benefits. They also have costs.

Certain solutions and ideas benefit some Americans more than others. That’s true across the board.

No party or leader has a monopoly on wisdom or virtue. This also is true across the board.

But the one thing the successful leaders – Republican or Democrat, progressive or conservative – have in common is the ability to recognize challenges when they exist and confront them in a realistic fashion.

That’s how our government is supposed to function. At its most basic level, the government is an instrument to exert the public will to solve public problems.

We’re seeing now at the federal level what happens when a leader doesn’t grasp that – doesn’t see public office as a duty and a trust, but only as an opportunity for personal aggrandizement.

But we’re also seeing at the state level the good that can happen when leaders do understand and meet their duties.

Together, the president who flails and the governors who act are teaching an important lesson.

Government matters.

FOOTNOTE: John Krull is director of Franklin College’s Pulliam School of Journalism and publisher of TheStatehouseFile.com, a news website powered by Franklin College journalism students.

The City-County Observer posted this article without opinion,  bias or editing.

THOU SHALT NOT STEAL

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THOU SHALT NOT STEAL

Gavel Gamut By Jim Redwine

www.jamesmredwine.com

It is easy to have sympathy for thieves if they steal from victims we do not know. Should the victims include acquaintances, friends, family or ourselves, our magnanimity wanes. And while our heartstrings are plucked by someone who steals bread to feed their family, if Jean Val Jean had stolen to feed a personal drug habit Victor Hugo might not have portrayed him as a tragic hero. When it comes to our attitude about punishing thieves it is pretty much, “Whose ox is getting gored?”

And over the last few thousands of years we Homo sapiens have applied sanctions on thieves that have ranged from, “go and sin no more”, to the death penalty. Those of us with Anglo Saxon DNA can search back just about one thousand years ago and find a death for theft to be de rigueur in the areas that became Great Britain. Of course, when a society does not have jails what can you do with someone who has no respect for the property of others?

Also, in today’s world, we still have countries where thieves are sometimes flogged or who have their hands amputated on occasion. The Book of Matthew (Chapter 5, verse 30) advises offending thieves to cut off their own hands whereas the Old Testament decrees if one steals food because they are hungry we should not hate them (Proverbs 6:30-31). But Exodus 22: 3-4 declares that a thief who cannot pay restitution should be sold into slavery.

In other words, we humans have tried about every possible penalty from turning the other cheek to execution when it comes to thieves. Usually, a first time offender in all legal systems is treated more leniently than a repeat villain. A thief of tender years normally calls for more sympathy than an experienced adult. And a thief who can pay restitution or who appears to be genuinely remorseful fares better than one who is more callous.

Now, Gentle Reader, you may be curious as to why you and I are considering whether it is better to kiss thieves on the top of their heads or to lop their heads off. Well, I confess my own approach to these issues during my ten years as either a prosecuting attorney or a defense attorney has fluctuated greatly, usually based on which side I represented in court. But it has been my forty years as a trial judge that has seen the greatest variation in my attitude toward dealing with thieves. I have tried practically every approach from rehabilitation to retribution. Suffice it to say I have not found a solution to theft; people are still doing it and on a fairly regular basis. My most recent encounter with the phenomenon of someone who has no respect for the property of others involved a friend of mine who had his tractor stolen right out of our pasture next to the cabin where Peg and I live.

Rape and armed robbery are much worse crimes than theft but the sense of being violated and feeling vulnerable is similar to all three. One immediately feels more generally fearful and angry. The one-time sanctity of our home and the confidence our friend had in the security of his property while on our property have been greatly diminished.

I do not ascribe to Dante Alighieri’s punishment for thieves as he set it forth in Circle 8 of his Divine Comedy. However,  it does graphically show how mankind may sometimes feel about thieves. Dante portrayed thieves as having their offending hands bound with flying reptiles that also pierce the thieves’ jugular veins causing the thieves to turn to ashes. The thieves are constantly being turned back to their human form then re-subjected to the flying reptiles. Such a vision for punishing thieves is interesting but hardly in keeping with modern penology. However, Dante’s hypothesized punishments for thieves he personally despised do call upon one’s darkest urge for revenge. Of course, revenge may be understandable but it is not justice.

When it comes to justice, if it ever does, for whoever stole our friend’s tractor, we can probably best hope for something less Draconian than Circle 8, say Circle 3, where thieves would spend eternity lying in filthy slush while being constantly pelted with an icy rain. However, such a penalty probably should not make it into modern law.

For more Gavel Gamut articles go to www.jamesmredwine.com

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COVID-19: Implications For Business

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COVID-19: Implications For Business

| Executive Briefing

By Matt Craven, Linda Liu, Mihir Mysore, and Matt Wilson
of McKinsey and Company
The coronavirus outbreak is first and foremost a human tragedy, affecting hundreds of thousands of people. It is also having a growing impact on the global economy. This article is intended to provide business leaders with a perspective on the evolving situation and implications for their companies. The outbreak is moving quickly, and some of the perspectives in this article may fall rapidly out of date. This article reflects our perspective as of March 9, 2020. We will update it regularly as the outbreak evolves.

What We Know, And What We Are Discovering

What we know. Epidemiologists are in general agreement on two characteristics of COVID-19:

  • The virus is highly transmissible. Both observed experience and emerging scientific evidence show that the virus causing COVID-19 is easily transmitted from person to person. The US Centers for Disease Control and Prevention estimates that the virus’s reproduction number (the number of additional cases that likely result from an initial case) is between 1.6 and 2.4, making COVID-19 significantly more transmissible than seasonal flu (whose reproduction number is estimated at 1.2 to 1.4) (Exhibit 2).
Exhibit 2
  • The virus disproportionately affects older people with underlying conditions. Epidemiologists Zunyou Wu and Jennifer McGoogan analyzed a report from China Centers for Disease Control and Prevention that looked at more than 72,000 cases and concluded that the fatality rate for patients 80 and older was seven times the average and three to four times the average for patients in their 70s.1 Other reports describe fatality rates for people under 40 to be 0.2 percent.

What we are still discovering. Three characteristics of the virus are not fully understood but are key variables that will affect how the disease progresses, and the economic scenario that evolves:

  • The extent of undetected milder cases. We know that those infected often display only mild symptoms (or no symptoms at all), so it is easy for public-health systems to miss such cases. For example, 55 percent of the cases on board the Diamond Princess cruise ship did not exhibit significant symptoms (even though many passengers were middle-aged or older). But we don’t know for sure whether official statistics are capturing 80 percent, 50 percent, or 20 percent of cases.
  • Seasonality. There is no evidence so far about the virus’s seasonality (that is, a tendency to subside in the northern hemisphere as spring progresses). Coronaviruses in animals are not always seasonal but have historically been so in humans for reasons that are not fully understood. In the current outbreak, regions with higher temperatures (such as Singapore, India, and Africa) have not yet seen a broad, rapid propagation of the disease.
  • Asymptomatic transmission. The evidence is mixed about whether asymptomatic people can transmit the virus, and about the length of the incubation period. If the asymptomatic transfer is a major driver of the epidemic, then different public-health measures will be needed.

These factors notwithstanding, we have seen that robust public-health responses, like those in China outside Hubei and in Singapore, can help stem the epidemic (Exhibit 3). But it remains to be seen how these factors will play out and the direct impact they will have. The economic impact too will vary considerably.

Exhibit 3

Economic impact

In our analysis, three broad economic scenarios might unfold a quick recovery, a global slowdown, and a pandemic-driven recession. Here, we outline all three (Exhibit 4). We believe that the prevalent pessimistic narrative (which both markets and policymakers seem to favor as they respond to the virus) underweights the possibility of a more optimistic outcome to COVID-19 evolution.

Exhibit 4

Quick recovery

In this scenario, the case count continues to grow, given the virus’s high transmissibility. While this inevitably causes a strong public reaction and drop in demand, other countries are able to achieve the same rapid control seen in China, so that the peak in public concern comes relatively soon (within one to two weeks). Given the low fatality rates in children and working-age adults, we might also see levels of concern start to ebb even as the disease continues to spread. Working-age adults remain concerned about their parents and older friends, neighbors, and colleagues, and take steps to ensure their safety. Older people, especially those with underlying conditions, pull back from many activities. Most people outside the transmission complexes continue their normal daily lives.

The scenario assumes that younger people are affected enough to change some daily habits (for example, they wash hands more frequently) but not so much that they shift to survival mode and take steps that come at a higher cost, such as staying home from work and keeping children home from school. A complicating factor, not yet analyzed, is that workers in the gig economy, such as rideshare drivers, may continue to report to work despite requests to stay home, lest they lose income. This scenario also presumes that the virus is seasonal.

In this scenario, our model developed in partnership with Oxford Economics suggests that global GDP growth for 2020 falls from previous consensus estimates of about 2.5 percent to about 2.0 percent (Exhibit 5). The biggest factors are a fall in China’s GDP from nearly 6 percent growth to about 4.7 percent; a one-percentage-point drop in GDP growth for East Asia; and drops of up to 0.5 percentage points for other large economies around the world. The US economy recovers by the end of Q1. By that point, China resumes most of its factory output; but consumer confidence there does not fully recover until the end Q2. These are estimates, based on a particular scenario. They should not be considered predictions.

Exhibit 5

Global slowdown

This scenario assumes that most countries are not able to achieve the same rapid control that China managed. In Europe and the United States, the transmission is high but remains localized, partly because individuals, firms, and governments take strong countermeasures (including school closings and cancellation of public events). For the United States, the scenario assumes between 10,000 and 500,000 total cases. It assumes one major epicenter with 40 to 50 percent of all cases, two or three smaller centers with 10 to 15 percent of all cases, and a “long tail” of towns with a handful or a few dozen cases. This scenario sees some spread in Africa, India, and other densely populated areas, but the transmissibility of the virus declines naturally with the northern hemisphere spring.

This scenario sees much greater shifts in people’s daily behaviors. This reaction lasts for six to eight weeks in towns and cities with active transmission, and three to four weeks in neighboring towns. The resulting demand shock cuts global GDP growth for 2020 in half, to between 1 percent and 1.5 percent, and pulls the global economy into a slowdown, though not recession.

In this scenario, a global slowdown would affect small and mid-size companies more acutely. Less developed economies would suffer more than advanced economies. And not all sectors are equally affected in this scenario. Service sectors, including aviation, travel, and tourism, are likely to be hardest hit. Airlines have already experienced a steep fall in traffic on their highest-profit international routes (especially in Asia–Pacific). In this scenario, airlines miss out on the summer peak travel season, leading to bankruptcies (FlyBe, the UK regional carrier, is an early example) and consolidation across the sector. A wave of consolidation was already possible in some parts of the industry; COVID-19 would serve as an accelerant.

In consumer goods, the steep drop in consumer demand will likely mean delayed demand. This has implications for the many consumer companies (and their suppliers) that operate on thin working-capital margins. But demand returns in May–June as concern about the virus diminishes. For most other sectors, the impact is a function primarily of the drop in national and global GDP, rather than a direct impact of changed behaviors. Oil and gas, for instance, will be adversely affected as oil prices stay lower than expected until Q3.

Pandemic and Recession

This scenario is similar to the global slowdown, except it assumes that the virus is not seasonal (unaffected by spring in the northern hemisphere). Case growth continues throughout Q2 and Q3, potentially overwhelming healthcare systems around the world and pushing out a recovery in consumer confidence to Q3 or beyond. This scenario results in a recession, with global growth in 2020 falling to between –1.5 percent and 0.5 percent.

Supply-Chain Challenges

For many companies around the world, the most important consideration from the first ten weeks of the COVID-19 outbreak has been the effect on supply chains that begin in or go through China. As a result of the factory shutdowns in China during Q1, many disruptions have been felt across the supply chain, though the full effects are of course still unclear.

Hubei is still in the early phases of its recovery; the case count is down, but fatality rates remain high, and many restrictions remain that will prevent a resumption of normal activity until early Q2. In the rest of China, however, many large companies report that they are running at more than 90 percent capacity as of March 1. While some real challenges remain, such as lower than usual availability of migrant labor, there is little question that plants are returning back to work quickly.

Trucking capacity to ship goods from factories to ports is at about 60 to 80 percent of normal capacity. Goods are facing delays of between eight and ten days on their journey to ports.

The Baltic Dry Index (which measures freight rates for grains and other dry goods around the world) dropped by about 15 percent at the onset of the outbreak but has increased by nearly 30 percent since then. The TAC index, which measures air-freight prices, has also risen by about 15 percent since early February.

In the next few months, the phased restart of plants outside Hubei (and the slower progress of plants within Hubei) is likely to lead to challenges in securing critical parts. As inventories are run down faster, parts shortages are likely to become the new reason why plants in China cannot operate at full capacity. Moreover, plants that depend on Chinese output (which is to say, most factories around the world) have not yet experienced the brunt of the initial Chinese shutdown and are likely to experience inventory “whiplash” in the coming weeks.

Perhaps the biggest uncertainty for supply-chain managers and production heads is customer demand. Customers that have prebooked logistics capacity may not use it; customers may compete for prioritization in receiving a factory’s output, and the unpredictability of the timing and extent of demand rebound will mean confusing signals for several weeks.

In our experience, seven actions can help businesses of all kinds. We outline them here as an aid to leaders as they think through crisis management for their companies. These are only guidelines; they are by no means exhaustive or detailed enough to substitute for a thorough analysis of a company’s particular situation.
Protect your employees. The COVID-19 crisis has been emotionally challenging for many people, changing day-to-day life in unprecedented ways. For companies, business, as usual, is not an option. They can start by drawing up and executing a plan to support employees that is consistent with the most conservative guidelines that might apply and has trigger points for policy changes. Some companies are actively benchmarking their efforts against others to determine the right policies and levels of support for their people. Some of the more interesting models we have seen involve providing clear, simple language to local managers on how to deal with COVID-19 (consistent with WHO, CDC, and other health-agency guidelines) while providing autonomy to them so they feel empowered to deal with any quickly evolving situation. This autonomy is combined with establishing two-way communications that provide a safe space for employees to express if they are feeling unsafe for any reason, as well as monitoring adherence to updated policies.
Set up a cross-functional COVID-19 response team. Companies should nominate a direct report of the CEO to lead the effort and should appoint members from every function and discipline to assist. Further, in most cases, team members will need to step out of their day-to-day roles and dedicate most of their time to virus response. A few workstreams will be common for most companies: a) employees’ health, welfare, and ability to perform their roles; b) financial stress-testing and development of a contingency plan; c) supply-chain monitoring, rapid response, and long-term resiliency (see below for more); d) marketing and sales responses to demand shocks; and e) coordination and communication with relevant constituencies. These subteams should define specific goals for the next 48 hours, adjusted continually, as well as weekly goals, all based on the company’s agreed-on planning scenario. The response team should install a simple operating cadence and discipline that focuses on output and decisions, and does not tolerate meetings that achieve neither.
Ensure that liquidity is sufficient to weather the storm. Businesses need to define scenarios tailored to the company’s context. For the critical variables that will affect revenue and cost, they can define input numbers through analytics and expert input. Companies should model their financials (cash flow, P&L, balance sheet) in each scenario and identify triggers that might significantly impair liquidity. For each such trigger, companies should define moves to stabilize the organization in each scenario (optimizing accounts payable and receivable; cost reduction; divestments and M&A).
Stabilize the supply chain. Companies need to define the extent and likely duration of their supply-chain exposure to areas that are experiencing community transmission, including tier-1, -2, and -3 suppliers, and inventory levels. Most companies are primarily focused on immediate stabilization, given that most Chinese plants are currently in restart mode. They also need to consider rationing critical parts, prebooking rail/air-freight capacity, using after-sales stock as a bridge until production restarts, gaining higher priority from their suppliers, and, of course, supporting supplier restarts. Companies should start planning how to manage supply for products that may, as supply comes back online, see unusual spikes in demand due to hoarding. In some cases, medium or longer-term stabilization may be warranted, which calls for updates to demand planning, further network optimization, and searching for and accelerating the qualification of new suppliers. Some of this may be advisable anyway, absent the current crisis, to ensure resilience in their supply chain—an ongoing challenge that the COVID-19 situation has clearly highlighted.
Stay close to your customers. Companies that navigate disruptions better often succeed because they invest in their core customer segments and anticipate their behaviors. In China, for example, while consumer demand is down, it has not disappeared—people have dramatically shifted toward online shopping for all types of goods, including food and product delivery. Companies should invest in online as part of their push for omnichannel distribution; this includes ensuring the quality of goods sold online. Customers’ changing preferences are not likely to go back to pre-outbreak norms.
Practice the plan. Many top teams do not invest time in understanding what it takes to plan for disruptions until they are in one. This is where roundtables or simulations are invaluable. Companies can use tabletop simulations to define and verify their activation protocols for different phases of response (contingency planning only, full-scale response, other). Simulations should clarify decision owners, ensure that roles for each top-team member are clear, call out the “elephants in the room” that may slow down the response, and ensure that, in the event, the actions needed to carry out the plan are fully understood and the required investment readily available.
Demonstrate purpose. Businesses are only as strong as the communities of which they are apart. Companies need to figure out how to support response efforts—such as by providing money, equipment, or expertise. For example, a few companies have shifted production to create medical masks and clothing.

The checklist in the exhibit can help companies make sure they are doing everything necessary.

The coronavirus crisis is a story with an unclear ending. What is clear is that the human impact is already tragic and that companies have an imperative to act immediately to protect their employees, address business challenges and risks, and help to mitigate the outbreak in whatever ways they can.

For the full set of our latest perspectives, please see the attached full briefing materials, which we will update regularly. We welcome your comments and questions at coronavirus_client_response@mckinsey.com.

For more of the latest information on COVID-19, please see reports from the European Centre for Disease Control and Prevention, the US Centers for Disease Control and Prevention, and the World Health Organization; and Johns Hopkins University’s live tracker of global cases.

 

More Than 2,600 Stores Are Closing In 2020 As The Retail Apocalypse Drags On

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More Than 2,600 Stores Are Closing In 2020 As The Retail Apocalypse Drags On. Here’s The Full List

BUSINESS INSIDER
Hayley Peterson
Mar 15, 2020

More than 2,600 stores are closing in 2020 as the retail apocalypse drags on. Here’s the full list.
Modell’s and Art Van Furniture filed for Chapter 11 bankruptcy in March, and the two companies plan to close more stores along with Walmart.
Read More »

Former Judge Resigns From the Supreme Court Bar

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DannenbergJURISPRUDENCE

Former Judge Resigns From the Supreme Court Bar

In a letter to Chief Justice John Roberts, he detailed why he’s lost faith in the court.

By DAHLIA LITHWICK

James Dannenberg is a retired Hawaii state judge. He sat on the District Court of the 1st Circuit of the state judiciary for 27 years. Before that, he served as the deputy attorney general of Hawaii. He was also an adjunct professor at the University of Hawaii Richardson School of Law, teaching federal jurisdiction for more than a decade. He has appeared on briefs and petitions as part of the most prestigious association of attorneys in the country: the Supreme Court Bar. The lawyers admitted to practice before the high court enjoy preferred seating at arguments and access to the court library, and are deemed members of the legal elite. Above all, the bar stands as a sprawling national signifier that the work of the court, the legitimacy of the institution, and the business of justice is bolstered by tens of thousands of lawyers across the nation.

On Wednesday, Dannenberg tendered a letter of resignation from the Supreme Court Bar to Chief Justice John Roberts. He has been a member of that bar since 1972. In his letter, reprinted in full below, Dannenberg compares the current Supreme Court, with its boundless solicitude for the rights of the wealthy, the privileged, and the comfortable, to the court that ushered in the Lochner era in the early 20th century, a period of profound judicial activism that put a heavy thumb on the scale for big business, banking, and insurance interests and ruled consistently against child labor, fair wages, and labor regulations.

The Chief Justice of the United States
One First Street, N.E.
Washington, D.C. 20543
March 11, 2020
Dear Chief Justice Roberts:
I hereby resign my membership in the Supreme Court Bar.
This was not an easy decision. I have been a member of the Supreme Court Bar since 1972, far longer than you have, and appeared before the Court, both in person and on briefs, on several occasions as Deputy and First Deputy Attorney General of Hawaii before being appointed as a Hawaii District Court judge in 1986. I have a high regard for the work of the Federal Judiciary and taught the Federal Courts course at the University of Hawaii Richardson School of Law for a decade in the 1980s and 1990s. This due regard spanned the tenures of Chief Justices Warren, Burger, and Rehnquist before your appointment and confirmation in 2005. I have not always agreed with the Court’s decisions, but until recently I have generally seen them as products of mainstream legal reasoning, whether liberal or conservative. The legal conservatism I have respected– that of, for example, Justice Lewis Powell, Alexander Bickel or Paul Bator– at a minimum enshrined the idea of stare decisis and eschewed the idea of radical change in legal doctrine for political ends.
I can no longer say that with any confidence. You are doing far more— and far worse– than “calling balls and strikes.” You are allowing the Court to become an “errand boy” for an administration that has little respect for the rule of law.
The Court, under your leadership and with your votes, has wantonly flouted established precedent. Your “conservative” majority has cynically undermined basic freedoms by hypocritically weaponizing others. The ideas of free speech and religious liberty have been transmogrified to allow officially sanctioned bigotry and discrimination, as well as to elevate the grossest forms of political bribery beyond the ability of the federal government or states to rationally regulate it. More than a score of decisions during your tenure have overturned established precedents—some more than forty years old– and you voted with the majority in most. There is nothing “conservative” about this trend. This is radical “legal activism” at its worst.
Without trying to write a law review article, I believe that the Court majority, under your leadership, has become little more than a result-oriented extension of the right wing of the Republican Party, as vetted by the Federalist Society. Yes, politics has always been a factor in the Court’s history, but not to today’s extent. Even routine rules of statutory construction get subverted or ignored to achieve transparently political goals. The rationales of “textualism” and “originalism” are mere fig leaves masking right wing political goals; sheer casuistry.
Your public pronouncements suggest that you seem concerned about the legitimacy of the Court in today’s polarized environment. We all should be. Yet your actions, despite a few bromides about objectivity, say otherwise.
It is clear to me that your Court is willfully hurtling back to the cruel days of Lochner and even Plessy. The only constitutional freedoms ultimately recognized may soon be limited to those useful to wealthy, Republican, White, straight, Christian, and armed males— and the corporations they control. This is wrong. Period. This is not America.
I predict that your legacy will ultimately be as diminished as that of Chief Justice Melville Fuller, who presided over both Plessy and Lochner. It still could become that of his revered fellow Justice John Harlan the elder, an honest conservative, but I doubt that it will. Feel free to prove me wrong.
The Supreme Court of the United States is respected when it wields authority and not mere power. As has often been said, you are infallible because you are final, but not the other way around.
I no longer have respect for you or your majority, and I have little hope for change. I can’t vote you out of office because you have life tenure, but I can withdraw whatever insignificant support my Bar membership might seem to provide.
Please remove my name from the rolls.
With deepest regret,
James Dannenberg
Supreme Court John Roberts Judiciary

Trump Administration Takes Major Step To Improve Implementation Of The Endangered Species Act

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EPA, with its federal partners, issues improved method for evaluating pesticide impacts, resulting in a more efficient and transparent review process and delivering better protection for the country’s endangered species

U.S. Environmental Protection Agency (EPA) announced a new method for conducting biological evaluations under the Endangered Species Act (ESA) to assure that pesticide registration review actions under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) do not jeopardize endangered species. The updated method ensures that—when available—the agency will use high-quality historical data that reflects where and how certain pesticides are used.

“Responsible pesticide use is an essential tool for managing America’s farmland,” said EPA Administrator Andrew Wheeler. “EPA’s improved methodology will better protect and promote the recovery of endangered species while ensuring pesticide registration review decisions are conducted in a timely, transparent manner and are based on the best available science. I want to thank our federal partners for working together to implement the 2018 Farm Bill and for helping EPA bring our pesticide assessment process into the 21st Century.”

ESA is a proven and critical tool for ensuring the recovery and protection of the nation’s most vulnerable species and habitats. However, for decades EPA’s approach for assessing pesticide risks to endangered species resulted in costly, time-consuming litigation and delays in pesticide registration decision-making.

EPA’s new “Revised Method for National Level Listed Species Biological Evaluations of Conventional Pesticides” (Revised Method) will better protect and promote the recovery of endangered species while ensuring pesticide registration review decisions are conducted in a timely, transparent manner and based on the best available science. With this action, EPA is fulfilling its commitment under the 2018 Farm Bill to ensure that pesticides can continue to be used safely with minimal impacts to threatened and endangered species.

“The required review of crop protection chemicals under the Endangered Species Act is an issue that has frustrated America’s farmers, ranchers, and producers for far too long. Under President Trump’s leadership, we are cutting the red tape to unleash the full potential of American agriculture,” said U.S. Department of Agriculture Secretary Sonny Perdue. “I am proud to join forces with my colleagues as we move forward on a protocol to allow the tools farmers need to feed, fuel, and clothe this nation and the world to reach market while also ensuring our environment is protected.”

“The Revised Method is an improved framework for Endangered Species Act pesticide consultations,” said the U.S. Department of the Interior Secretary David Bernhardt. “By incorporating actual pesticide usage data into these assessments, they will be accurate and legally defensible. We look forward to working with the EPA to apply this framework and review public comment on the draft carbaryl and methomyl biological evaluations.”

“As EPA’s finalized method of conducting evaluations demonstrates, the whole-of-government approach to regulatory reform is bearing fruit,” said U.S. Department of Commerce Secretary Wilbur Ross. “Actual use of pesticides is an important factor to consider as we work to protect endangered species. The Department looks forward to working closely with our public and private partners to ensure that the rules are good for both our economy and our environment.”

“Under President Trump’s leadership, the Administration is committed to supporting agricultural communities and environmental protection,” said CEQ Chairman Mary B. Neumayr. “Since 2017, CEQ has worked collaboratively with EPA, DOI, USDA, and DOC to improve the ESA pesticide consultation process and today’s announcement reflects the Federal government’s commitment to a process that promotes timely and effective decision making and advances rural prosperity.”

The final Revised Method incorporates high-quality pesticide usage data into the agency’s biological evaluation (BE) process for the first time and was informed by input from a wide range of stakeholders, including states, tribes, environmental NGOs, and agricultural stakeholders.

In conjunction with today’s announcement, EPA is also releasing for public comment draft BEs for the insecticides carbaryl and methomyl which were conducted using the final Revised Method. EPA will accept public comment on the draft BEs for 60 days following publication in the Federal Register. After carefully considering public comments, EPA will finalize the BEs. If the agency determines a pesticide may affect a listed species or its critical habitat, the agency will consult with the Fish and Wildlife Service and the National Marine Fisheries Service (the Services). The Services will then issue a biological opinion to determine if the population of a species would be adversely impacted and, if so, propose ways to reduce risks.

To view the pre-publication notice for the draft biological evaluations for carbaryl and methomyl, the final Revised Method document, and learn more about how EPA protects endangered species from pesticides, visit: https://www.epa.gov/endangered-species

Choice Board And Commission On Aging Board Positions Open

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The Division of Aging is looking for individuals with an interest in serving older Hoosiers and persons with disabilities. If you have ideas to share about how we can help support independence and quality of life for Hoosiers, consider applying for an appointment to the CHOICE Board or Commission on Aging.

Both the CHOICE Board and Commission on Aging currently have a number of vacancies to fill. Please visit the Division of Aging’s Boards and Commissions webpage for more information or email DAComments@fssa.in.gov with your interest and questions.

The Division of Aging is a program of the Indiana Family & Social Services Administration. If you have questions about Aging programs and services, visit us online at www.IN.gov/fssa/aging.

“Right Jab And Middle Jab And Left Jab” March 15, 2020

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“Right Jab And Middle Jab And Left Jab” March 15, 2020

“Right Jab And Middle Jab And Left Jab” was created because we have a couple of commenters that post on a daily basis either in our “IS IT TRUE” or “Readers Forum” columns concerning National or International issues.
The majority of our “IS IT TRUE” columns are about local or state issues, so we have decided to give our more opinionated readers exclusive access to our newly created “LEFT JAB and Middle Jab and RIGHT JAB”  column. They now have this post to exclusively discuss national or world issues that they feel passionate about.
We shall be posting the “LEFT JAB” AND “MIDDLE JAB” AND “RIGHT JAB” several times a week.  Oh, “LEFT JAB” is a liberal view, “MIDDLE JAB” is the libertarian view and the “RIGHT JAB is representative of the more conservative views. Also, any reader who would like to react to the written comments in this column is free to do so.
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