Here's an act of self-harm that is spreading from coast to coast. Stanford University is "pausing" all faculty searches. "Provost Drell will permit hiring processes to continue if 'discussions have taken place with the finalist about terms of the offer,' or if a formal offer has been extended to a candidate for a faculty position, but any pending offer for a staff position must be put on hold immediately.  On August 31, 2019, the end of the university’s fiscal year, Stanford reported its endowment was $27.7 billion."

That's the author's sequencing, not mine. Drell is tossing out a lot of faculty time and effort, for starters. She's throwing people who almost got jobs back into a terrible job market. And for how much savings--one year of payroll for how many new faculty?  Unknown.  (Update: On April 1st, UC Berkeley announced their own hiring freeze, counting $100 million in covid-related costs, on a $3 billion base).

Another example, from Brown University at the other end of the financial spectrum.  Their provost   is not canceling searches already "well under way," but has frozen future hiring other than "a very few critically strategic hires in the year ahead."  A number of very wealthy elite universities are following suit (Emory, Columbia, Penn . . ): see Bryan Alexander's growing spreadsheet and also this very long one.

Here's a third case, from a state system with 23 campuses and over 450,000 students.

 "All open searches are to be stopped"-- unless the top 2 campus officers agree that it's "vital." They are now the sole originators of searches, "if they deem it necessary." How many searches are cancelled--hundreds across all  campuses? We don't know.

Translation for all three, and the other freezes  now occurring: "we expect the ship to take on water in the coming storm.  So first we'll throw early career researchers overboard."

Note two other features. These senior officials don't offer financial modeling to explain or justify the freezes. Second, these are top-down decisions, devoid of shared governance. They identify no consultation with the units affected. A full range of operational answers aren't produced. What will this do to your major? to your students graduating? to their learning? to department functions? How will this affect your research, short, medium, and long term? What does this do to your doctoral program? How does it affect doctoral education in any particular discipline. There's no information.

Academia has long let financial factors dominate or simply ignore educational ones, to the long-term detriment of education. Administration becomes a transmission belt in which a crisis in the outside world immediately becomes a crisis in the institution. In addition to hurting education, this kind of management robs the institution of agency. It also fails the essential public job of countercyclical actions that resist the cycle of  shutdown--consumption crash--job loss--no money--more closures.

But wait, you say, this is the Great Depression 2.0.  3.3 million new unemployment claims last week, all sorts of back-of-the-envelope fun being had by Fed economists, etc.. Shouldn't the funding collapse override all other factors? 

No. Hell no. A thousand times no.

Managers must always think about the welfare of their whole institutions, which means considering multiple factors when allocating funds. In this case, that includes how a cut or a freeze will affect

1. immediate institutional solvency
2. long term institutional solvency
3. the university's immediate operations, like teaching and research
4. the university's long term operations, like teaching and research
5. university personnel (sunk effort, effectiveness, fairness, morale, continuation, recovery)
6. the disciplines represented in the university
7. the overall profession of college teaching and research

That's a short list, and you can see an item like (5) can be broken out into many parts. The items at the top are not more important than the rest.  Managers don't really get to pick one or two of these and ignore all others  But that is what Provost Drell and Chancellor White et al. are doing: only getting to (1) or (2) on a  long list, and not to the rest--to impact on courses, curriculum, departmental health, student access, success, food and housing, not to mention the continuity of the professions that keep universities alive.

Drell and White aren't to blame for the defective managerial culture in higher ed nationally, but they are enacting it here. Universities have long dealt with present fiscal crises by sacrificing the future: in addition to their epic passages of deferred maintenance and the like, they have addressed chronic financial shortfalls by hiring temporary faculty rather than permanent ones or by hiring no new faculty at all.  They have not invoked items (3) through (7) above and said to their legislatures, governing  boards, senior managers, wealthy donors, etc., "we cannot offer quality instruction, which in universities always includes a research dimension, by adjuncting more than X percent of our faculty."  (X was traditionally 1/3rd averaged across the sector.)  They have not said this. The long-term results have been

• massive shrinking of the tenure-track job market
• destabilization of doctoral study (doing intellectual as well as personal damage)
• transformation of advanced study into precarity
• endangerment of the quality and continuity of academic disciplines

Management is an intellectually challenging practice, at least when done right. And doing it well is crucial to the health of academic life. Although I'm very aware of the university's many negative legacies and practices, I'm also an institutionalist, a bit churchy in my sense of the value of universities as intricate and animating systems. I also grew up on Michel Foucault, who, for all his pessimism about the deployments of law, rights, and liberal institutions to impose rather than check power, saw sovereignty as partially replaced by governmentality, in which various powers engaged in the disposition of all the elements of a system, in some kind of efficacy.  I have a lot of respect for the difficulty of the administrative job and for people trying to do it well.  But that is not what is happening here.  Managers are now getting set to wreck another academic generation, having failed to rebuild the public university employment base after the last big crisis in 2008.

A few concluding policy thoughts:

• Tenured faculty need to bring this repeated sacrifice of the rising academic generations into the sphere of institutional politics.  This means strong objections to pauses, freezes, closures, and future downgradese.  We need to fight this, and design alternatives. 
• Universities must demand new federal stimulus funds-- beyond the $14 billion (on a nearly $60 billion request) that POTUS signed last week--specifically to maintain the academic workforce. See Michael's post for context and argument. Another giant federal stimulus bill is going to have to happen in the next few weeks. The main point of stimulus funds is sustaining employment.  Given the employment crisis in the society at large, universities should be increasing hiring and trying to employ more people, to ease the pressure on other sectors. Universities should use the crisis to absorb unemployed PhDs from former years and put them to work in the jobs these graduates of our doctoral programs sacrificed years of their lives to do.  More tenure-track employment will also upgrade instruction such that the undergrads we've sent home are more likely to come back. See MLA Executive Director Paula Krebs' excellent short piece on this topic.
• The federal government should allocate bailout funds to universities only on the condition that they reverse hiring chills and freezes, maintain their workforces, and try the countercyclical economic work of expanding them.

We don't need another massive hit to a higher ed system that was already weaker in 2020 than it was in 2008. We can't take another bloodbath in the academic job market. We need a New Deal for higher ed, starting with the doctoral job market.

Covid-19 has brutally laid bare the devastating impact of several decades of privatization and capitalist globalization.  The rapidity of the virus' traversing of the globe, its powerfully unequal impact on different countries, and on different segments of the population within countries, are all linked together by the simultaneous expansion of the movement of goods and people and the evisceration of the public welfare and public health in many countries.  In the United States, to take the case closest at hand, the absolute under-funding of public health and the refusal to prepare for pandemics adequately is now reaping havoc on the population and on the doctors and nurses who are trying to heal them.  Three decades of diverting resources to commercializing publicly-funded research has only made this situation worse.  As the LAT has reported, Jerry Brown, with his usual lack of foresight, managed to dismantle a program that Arnold Schwarzenegger had created to respond to pandemics; in this he is an odd precursor to Donald Trump even if he did oppose him on many other things.  As I watch my medical colleagues struggle with insufficient safety equipment, a lack of ICU beds, an inability to test on a mass scale, and the exhaustion of overwork, I often wish that I lived in a modern country.

In the United States, of course, the pandemic is striking at a society riven by increased inequality.  Wage stagnation and the growth in corporate profits, along with its effect, the gig economy, has left more and more people without the resources to ride out the crisis.  Unemployment claims have skyrocketed to remarkable levels.  Neoliberal policy and practice have displaced alternative forms of rationality; public goods and solidarity are devalued in favor of individual capital; they return only in their ghostly mirror image of ethno-nationalistic anger.  Knowledge, both of nature (climate change, epidemiology) and of society are denied in the name of the populist wisdom of the president's gut.

Universities, of course, are deeply embedded in these crises--both the immediate and the long-term.  Colleges and universities across the country have moved to remote learning; moving staff, students, and faculty off-campus, shutting down labs, and, where they have medical centers trying to move as many resources as possible to support them.  Despite some skepticism, this was clearly the right thing to do.  But we should acknowledge the likely damage that it will cause: not only in student learning, but in financial resources, faculty and staff careers, scholarship disrupted if not derailed, and the damage to thinking together that is, or at least should be, the hallmark of the community of scholars.

At the same time, higher education has itself been embedded in growing inequality.  If knowledge is devalued, some part of that is due to the reality that colleges and universities have themselves contributed to inequality: seeking out prestige through selectivity, eagerly participating in the games of rankings, and turning towards satisfying the demands of donors over public needs.  This latter behavior, of course, is rooted in, and reinforces, the relative decline of public funding.  The return of the private took place in the decade following the dramatic expansion in the numbers of women and people of color on campus, not to mention the decade of student revolt.  Universities have been paying for this ever since.

But if higher education faces daunting challenges, it is not to soon to think about what we want in the aftermath of the pandemic.  There is an opportunity here for new thinking.  No, I don't mean giving in to the ed-tech gurus or those administrators now circling the crisis like vultures, wishing to strip away from students their residential education, and from faculty their control over curriculum and its forms. If the forced separation that Covid-19 has taught us anything it is that certain aspects of universities and colleges are essential and that they can only be saved by rethinking that which is not.

First, rather than proof that the future is online, the present retreat into distance learning is revealing the exact opposite.  Students have made clear exactly how much they value the residential experience-- just as faculty are remembering how important the shared classroom is for education.  The problem, as Chris and I have been arguing for years, is not the reality of in-person instruction but its lack of proper funding.  Universities will need to develop a new public contract; more people--not fewer--should be enabled to have the residential experience if they choose.  This means increasing public resources to reduce price across the whole spectrum of costs.

As I suggested a few weeks back in the days before Covid, universities especially need to more effectively defend the importance of research and graduate education across all disciplines.  Although attention now is focused appropriately on the search for medical remedies and care, the pandemic shows once again how deeply important knowledge of culture, politics, history, and society are for responding to crises, as those domains largely control the development of the crises themselves.  STEM is not going to answer the questions of the costs of privatization or the effects of the emphasis on commercialized tech transfer; nor will it help us solve the problem of homelessness or housing; or provide people with the perspective to learn from previous crises; nor, even on its own, enable us to try to prevent climate catastrophe.  Those are all eminently political and social problems and need to be understood as such.  Nor will STEM help UC address the ethical issues of allowing graduate students to lose their healthcare or live in their cars in the middle of a pandemic.  We need far more natural science--both pandemics and the climate crisis demand it.  But we need social and cultural knowledge as well.

To even begin to do these things, two large shifts will be necessary, if not sufficient, conditions. The first is an end to the pretense that tuition and philanthropy can overcome the challenges facing public higher education.  The rote repetition of some UC leaders that "free college is a dangerous idea," bears more than passing resemblance to the apocryphal "let them eat cake."

The same can be said for the repeated claims of UCOP that a tuition increase is better for poorer students than having the state buy it out.  This is true from one perspective of course--but it depends on concealing the fact that this situation is a result of a policy decision at OP, not built into the nature of things.  UC could just as easily decide to spend the same percentage of the state buyout on financial aid. They simply don't. 

But even these points remain trapped in the wrong ballpark.  States do have budget limitations; the answer is going to have to come in a new national contract.  I know that at the moment, with a knowledge-despising president and a science-denying party in control of the executive, judicial, and half of the legislative branch this seems like an impossibility.  But if the 2 trillion dollar stimulus should put paid to any myth, it is that Republicans care about budgets or deficits when their own access to public money is at stake.   Covid-19 increases the credibility, by the day, to modern monetary theory's notion that the real challenge in economic life is the underused capacity of the real economy.  From the Green New Deal to a new social contract for health and education, universities must take the lead.  Or they will have failed to live up to their name.

This will mean hard choices for the community of scholars as well.  Those colleges and universities who recover from this crisis will need to think deeply about their purposes and not simply fall back into patterns formed over the last several decades.  Managers will need to reject their dependence on precarious faculty whose numbers expanded in the name of market flexibility. Faculty will need to think through what is essential in their teaching and research organizations and the hyper-individualism and localism that they can fall prey to.  Both faculty and administration will need to rethink authority so that decisions are made by those--even within the university--who are closest to practice and knowledge.  And underlying all of these decisions and debates will lie the most important one: are colleges and universities--and those who work in them--going to continue to see who can triumph in the struggle for private prestige?  Or are they going to work to help produce a revitalized, and international, public good?

It will be the struggle of the 2020s.

This prepublication paper (March 25th) uses newer data than that of the Ferguson et al. paper (March 16th) that I drilled into last week.  It also focuses on the U.S. situation, broken out by state. And the executive branch seems to be using it to design shutdown policy. The headlines:

The University of Washington paper projects 81,114 deaths, with a very large Uncertainty Interval (UI) belying the precision of those numbers (at left).  This is in the ballpark of the lower bound of Anthony Fauci's estimate of 100,000-200,000 deaths. These are high numbers.  The bottom is about  3 times typical death counts from influenza.  But they are 20 times lower than the "doing nothing" estimate in the Ferguson et al. paper. The two papers agree on the scale of reduction that suppression measures achieve.

(UPDATE: This number of total fatalities was revised to 93,765 on April 2nd. It was revised downward in the wake of sustained social distancing measures, and has stood at around 60,400 since April 9th).

The authors also modeled health care capacity, estimating demand for hospital beds peaking at 7 percent above the national bed count, and Intensive Care Unit demand peaking at 25 percent above the national ceiling.  This means that suppression measures do not eliminate the health system crisis (this looked better in the Ferguson et al's projections for the UK).

The  UW team couldn't estimate ventilator shortages because they couldn't find reliable counts for these. Bed and ICU shortfalls are expected to vary greatly by state, with "peak excess demand" for beds being particularly bad in New York, New Jersey, Connecticut, and Michigan, and excess demand for ICUs being more widely spread across the country.  California is in comparatively decent shape on both fronts, though that isn't saying much.  Excess ICU demand is figured below.

All the estimates (reduced deaths, very serious but perhaps non-catastrophic excess hospital demand) assume social distancing that approximates Ferguson et al.'s suppression regime.  I find this to be the least convincing aspect of this paper.

For states that have not implemented 3 of 4 measures (school closures, closing non-essential services, shelter-in-place, and major travel restrictions), we have assumed that they will be implemented within 7 days, given the rapid adoption of these measures in nearly all states. At this point in the epidemic, we have had to make arbitrary assumptions in our model on the equivalency between implementing 1, 2, or 3 measures – and we have implicitly assumed that implementing 3 of 4 measures will be enough to follow a trajectory similar to Wuhan – but it is plausible that it requires all 4 measures. (8) 

I see two obvious problems with this. First, we are not seeing "the rapid adoption of [suppression] measures in nearly all states."  Duringthis past week, many Republicans politicized social distancing as anti-business.  Although some Republican governors have not followed this line, Covid suppression has now been polluted by the country's toxic political discourse. POTUS is angling for ways to pin an extended shutdown (anything past Easter Sunday on April 12) on the libs, and his proposal for a NY-NJ-CT quarantine didn't have to be implemented to tar the country's leading Democrat stronghold as a disease-carrying Gommorah. Florida governor Ron de Santis has set up border checkpoints partly aimed at excluding New Yorkers; at the same time, Rhode Island's Democrat governor is proposing door-to-door searches for infected New Yorkers.  The American political system may not be good at public health, but it is world-class at finger-pointing. This does not bode well for a national suppression regime and its 20x reduction in mortality.

Second, I see no reason to assume, as the authors do, that "implementing 3 of 4 measures will be enough to follow a trajectory similar to Wuhan."  That is the best-case trajectory, in which full shutdown in  Wuhan on January 23rd led to no new cases by March 15th.  (That included a peak rate of daily deaths 27 days after that shutdown date.)  Wuhan implemented all 4 of 4 measures and then some--Wuhan authorities also instituted an app that used personal data to restrict movement for people rated "red" or "yellow," and broke disease clusters through family separations, in which some members were sent to medical dormitories for isolation.

In other words, the UW model may be way too optimistic--landing us back in a mitigation model which halves deaths (to about a million in the U.S.) while overwhelming the medical system.

This study notes but, as far as I can tell, ignores two other major differences between Wuhan (and South Korea) on the one hand and the U.S. on the other.  One is our lack of mass testing, including testing of people without Covid-19 symptoms.  Testing allows the health care system to identify people who need total isolation and/or treatment, making social distancing much more efficient.  The U.S. seems to have missed the crucial testing window (the New York Times' investigation of the serious failure of Trump's executive branch is worth reading in full). The other is China's massive mobilization of equipment and facilities--the new hospital constructed in two weeks and the like.  In stark contrast, the U.S. story is of shortages--of ventilators, of masks and gowns, of swabs, and, soon, of trained and healthy medical personnel.  All this also casts doubt on our powers of suppression. We will have to fall back on brute isolation, which is of course is the longest and the most costly mode economically--and educationally.

The paper ends on this note:

Our estimate of 81 thousand deaths in the US over the next 4 months is an alarming number, but this number could be substantially higher if excess demand for health system resources is not addressed and if social distancing policies are not vigorously implemented and enforced across all states.

We are thus encouraged to continue the most stringent version of a difficult lockdown with the clear possibility that the disease itself will be much less lethal than we have been assuming.

I do take this as encouragement.  We could start seeing a real ebbing of fatalities and infections in the Wuhan 60-day period: by mid-May in the New York region, and not too much later elsewhere. (See Bryan Alexander's Three Scenarios for other possibilities.)

Stay strong--indoors.

April  3rd.   The Washington Post has a big piece entitled, "Experts and Trump's advisers doubt White House's 240,000 coronavirus deaths estimate."  There's nothing new that we haven't covered here, but it's interesting to note the ongoing refusal of the White House "to explain how they generated the figure" of 100,000-240,000 national Covid-19 deaths, beyond the mashup of the two studies we've analyzed here - Ferguson et al. at Imperial College and the UW model discussed here, from the Institute for Health Metrics and Evaluation, with its user-friendly projections, one of which appeared in Deborah Brix's briefing.   "But what remains unclear and alarming to many modelers is whether the White House is using their data to create a coordinated, coherent long-term strategy." The answer is no they're not, for example, implementing a national stay-at-home order called for by Anthony Fauci.

April 5th Covid-19 continues to receive saturation coverage, but the single most interesting piece to me was NYT coverage of the German response to the virus. So far, Germany's case-mortality rate is 1.4 percent, nearly a tenth that of Italy and about half that of the United States. Some reasons why: the German infections "started as an epidemic of skiiers" coming back from Italy and Austria, so younger people were infected first. Second, Germany has run many more tests, so they capture a higher share of infections than Italy or the U.S. (their denominator is bigger). The piece goes through other crucial factors:"early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed."  The U.S. can't really draw on any of these.

I thought ruefully of UC Health when I read this passage:

Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.

“We have so much capacity now we are accepting patients from Italy, Spain and France,” said Prof. Susanne Herold, the head of infectiology and a lung specialist at the hospital who has overseen the restructuring. “We are very strong in the intensive care area.”

All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people. By comparison, that rate is 12 in Italy and 7 in the Netherlands. By now, there are 40,000 intensive care beds available in Germany.

Separate item: People say the infection numbers are bad but the death counts are good.  A WaPo piece reminds us that they're bad too.  Covid-19  caused deaths are likely undercounted worldwide, perhaps by a lot.
 
April 12th

Today is Easter Sunday, which POTUS wanted to be America is Open for Business Day.  It isn't.  For example, Kansas Gov. Laura Kelly's executive order to close churches was opposed by Republican legislative leaders, but yesterday they lost before the Kansas Supreme Court.

Yesterday was also Peak Resource Use in the UW (or "Chris Murray") model I've discussed here.  Peak fatalities were to occur April 10th.  Early infection zones--Washington State, New York, and California--are all heading in the right direction.  Other areas (New Orleans, Detroit) are not yet.  The South remains a wild card.  Here in Santa Barbara County, we had 264 cases as of 5 pm on April 11th, with two deaths, a number that has held steady for a week.  Many of the new infections are in the Federal Prison in Lompoc.

Some states have released some incarcerated people in response to the pandemic (like Gov. Tom Wolf of Pennsylvania).  The Federal Bureau of Prisons is screening prisoners to release some into home confinement.

California is going to be closed at least through the end of the month, and LA County among others through mid-May.  But the debate on openings is heating up in Europe.

April 17th

STAT has an interesting overview of the criticisms of the methodology of the University of Washington model covered here.

Shutdowns are now spreading as fast as the coronavirus. On March 19, Gov. Gavin Newsom ordered 40 million Californians to stay home, claiming that the infection rate puts the state on track for 25.5 million infections.  The order has no end date.  New York and other states and counties have since followed suit: by noon on March 21st, 75 million US residents were under some kind of lockdown.

In this post I'm going to talk about what I've learned during a sustained effort to apply analytical expertise to a topic outside of my normal subject areas, as I try to build a base for a series of citizen judgements about health policy, and also the related areas of educational and economic policy that I know more about.

This learning process has changed my mind about a number of Covid-related issues: for example, when I learned March 10th of UCSB's shutdown--at the end of my senior seminar, thanks to Jenna, multitasking on her email again!--I was a skeptic about the benefits of widespread closures. Now I'm a believer: I think that widespread social distancing is our only chance to avoid levels of infection that would overwhelm hospitals and clinics and lead to much excess death.  At the same time, I'm also more optimistic about reducing infections than I was a week ago.

The main part of this post close-reads the one published infection model that I've been able to find-Neil Ferguson et al.'s paper, from Imperial College London.  The U.S. Centers for Disease Control and Prevention (CDC) has not released its modeling, though it was discussed in a bootleg version by the New York Times.  My caveat up front is that the SARS-CoV-2 infection model I analyze does not offer any certainty about the future. But I will talk about the powers of the suppression regime we've entered into, and how the disease might be made less deadly than many of us now assume.

An overview:

• The policy of virus suppression does appear to reduce Covid-19's spread. I'll define this and other terms below, since terminology is all over the place in media reports. (The one journalist I've found to have interviewed Neil Ferguson--Nicholas Kristof of the New York Times--conflates mitigation and suppression.)  Suppression has worked well in South Korea, Singapore, and post-lockdown Hubei in China when social distancing is combined with mass testing. 
• The U.S. simply does not have the testing capability to do the most effective form of suppression.  (Santa Barbara County has brilliant and frequently exercised emergency services.  As of March 22nd it has 13 confirmed Covid-19 cases, a shortage of test kits, and 200 tests out whose results won't be in for awhile.) The U.S. has not been able to do contact-tracing, which would have allowed a much more efficient form of isolation than the mass version we're doing now.  In spite of some encouraging reports of new equipment coming on line, the U.S. is in the midst of what statistician John A. Ioannidis calls an "evidence fiasco," and its public health capacities have been downsized (personnel down 20 percent since 2008, according to David Himmelstein) to the point that we're likely stuck with the crudest, most disruptive, and most economically damaging form of suppression. 
• This has implications for rebuilding social and public capabilities that I'll save for a later post on how SARS-CoV-2 is putting neoliberalism out of its misery--and how to keep that from causing further misery for diverse publics.
• A theory point: public officials are using projections of high infection and death rates to install suppression regimes, but these suppression regimes are designed to invalidate the numbers that justify them (by producing much lower rates of infection and death).  Either you infect 81 percent of California by doing nothing, or you lockdown California and get a much lower infection percentage.  You don't do both.  I elaborate on this point because it's important for people not to think lockdown = death (regardless), but to think the opposite.  
• A policy point: public officials must not bullshit the public with exaggerated numbers, withheld models (CDC!), and mashup policies that will encourage cheating. Newsom did the right thing, but he didn't give clear, honest reasons for it.  That has to change.

To take the last point first: Where did Newsom get the number that he used to shut down most of the state economy without an end date? We don't actually know. The LA Times reports, "the governor’s office declined to provide an explanation of the state’s projection that 25.5 million Californians will be infected with this virus. Instead, a spokesman for the governor said the state’s mitigation efforts could lower that estimate."

The last part is true (though "mitigation" is the wrong word, as I'll explain), but the public should be told the source.  In the meantime, I'll guess that Newsom's people got that number from the now-famous pandemic modeling paper I mentioned at the top, Ferguson et al. Their baseline reproduction number (Ro) for the disease is 2.4--meaning each case typically goes on to infect 2.4 other people. You can get to 25.5 million Covid-19 infections by taking California's Covid infection count when Newsom spoke--around 1000--and giving it an exponent of 2.45.  (Updated: See Akos Rona-Tas's correction of this speculation below, under March 23.)

The Ferguson paper derived that Ro in part from from the spread of the virus in Wuhan, China, before the government began its many non-pharmaceutical interventions (NPIs)--forced quarantining, widespread testing, etc.  (Wuhan's Ro was previously reported as 3.11).  The projection that 56 percent of the California population will become infected appeared as a math error in Newsom's letter to Trump requesting a hospital ship: it's actually 64 percent, or alternately, 39.56 million Californians * 0.56 = 22.15 million inflections.  The point isn't the bad math but the need to offer credible numbers and explain clearly where they come from.  People will take honest, fully disclosed estimates more seriously.  Health policy needs to be open to establish the trust that government now desperately needs, to discourage cheating, and to allow meaningful democratic judgment about overall policy. 

Public officials, including Newsom, seem to be now focused on using big numbers to stampede the masses into social distancing, RTFN. This is understandable, since, in the suppression arsenal, social distancing is pretty much all we've got.  But one major effect of their statements is to muddle the difference between mitigating and suppressing a pandemics: the former allows infection rates like 55 percent. The latter slows growth rates and can put them into reverse.  Suppression also requires a rigor that people won't pursue if they don't understand the massive difference it can make.

To put this in the form of a question, could the U.S. and the European Union (and other regions) achieve suppression and thus decline in the number of new cases?  The current tracking in California is not good.

But look at  the South Korean case pattern.

South Korea had our hockey stick and has now bent it down into slower growth of new cases.  As is now widely discussed, South Korea, Singapore, Hong Kong, Taiwan, and now Wuhan have slowed the spread.  This is the effect of suppression strategies.  There's some important news here, which is that Covid-19 infections rates can be reduced, and its case-mortality rate can be kept low (not the 3.4 percent reported by the World Health Organization, but about 1 percent in South Korea, or 0.54 percent for cases under age 60).  Germany currently has a 0.3 percent case-mortality rate. SARS-CoV-2 kills people by doing horrible damage to their lungs (see the images around 0'30" in this Santa Barbara Cottage Health grand rounds lecture).  And yet the virus does so little to so many other victims that 86 percent of cases in China were undocumented prior to travel restrictions. 

On to the model: the Ferguson et al. paper draws on previous work with influenza pandemics to compare three responses-- doing nothing, mitigation, and suppression.  Doing nothing seems to have been the preferred option of the Boris Johnson and Donald Trump governments until about March 15th-16th  (Johnson, Trump), with the Johnson government allegedly working on a trust that infection would create "herd immunity" without disrupting the economy.  At least in the UK, they seem to have taken on board the Ferguson et al. calculations that "doing nothing" will lead to infection in 81 percent of the population (at  2.4 Ro), producing 510,000 deaths in the UK, plus 2.2 million deaths in the United States, both over a 2 year period.

With doing nothing now ruled out, the alternatives that Ferguson et al. modeled are mitigation or suppression. Suppression is China after January 23rd and South Korea, among others; Britain is moving to suppression with one escalating announcement after another (which may defeat the purpose).  Some parts of the U.S. are now doing suppression, including New York and California. The Ferguson paper divides these two strategies into two groups of non-pharmaceutical interventions (NPIs).

 The most effective set of mitigation measures are:

• Case isolation in the home (CI): symptomatic cases stay at home for 7 days.
• Voluntary home quarantine (HQ): all members of a household with a case stay home for 14 days
• Social distancing of those over age 70 (SDO).

Note that this falls short of "lockdown," which includes social distancing for the whole population (SD) and, in most cases, closures of schools and universities.

Mitigation is the famous "flattening the curve." The serious cases that need hospital services are pushed out over time, with the goal of relieving some of the stress on the health care system. Mitigation is "predicted to reduce peak critical care demand by two-thirds and halve the number of deaths" (8).  Assuming the ratio of infections to critical care cases is constant, and that the syntax means mitigation yields 2/3rds of the "do nothing" infection rate, this leads to 54 percent of the population being infected, and to 1.1 million deaths in the U.S.  (When Kristof quotes Ferguson saying his best case is 1.1 million deaths, I think he ran Ferguson et al.'s two regimes together: in my view, the sentence should read, "his best case for mitigation" is 1.1 million deaths.

Clearly mitigation isn't good enough.  A million deaths in the U.S. is unacceptable, and the model suggests that under mitigation health care systems will still be overwhelmed (10). Since something like Italy's hospital crisis and high fatalities are the combination everyone wants to avoid, the UK, the EU, California, and now several other U.S. states have moved into suppression.

A side note: I would normally read the quotation to mean that mitigation reduces peak care demand (and infections) by 2/3rds, down to 1/3rd of their previous level, which is a 27 percent infection rate.  I don't know if that's what Ferguson et al. meant, but it's still more than double this year's seasonal flu rate (so far this season, flu has killed 22,000 Americans). 

Much of the U.S. is now following Italy, France, Spain, and other countries into suppression. The key benefit is that it reduces the reproduction number (Ro) to close to 1 or below, which China has shown is feasible.  Here's a nice stretch goal for the West.

 In the Ferguson et al. model, suppression adds to mitigation's measures:

• school and university closures (PC)
• social distancing expanded to the whole population (SD)

I've reproduced the table that shows the results. I'd recommend starting in column 1 with the baseline Ro of 2.4 (510,000 "do nothing" deaths) and look at the medium case of 200 (which means that the full suppression program is suspended when ICU cases fall below 200 in Great Britain, and are re-engaged when they rise above that number). (The paper does not have a similar table for the U.S.) 

California is now doing the full suppression program.  If you look at the right-hand column under Total Deaths you can see the results.  Deaths in Great Britain drop from 510,000 to 24,000, or by a factor of around 20.  The U.S. equivalent would be 110,000 deaths, not Kristof's 1.1 million.

Note two other features of this model.  The interventions all have finite periods: mitigation is modeled over 3 months (to mid-June 2020) and suppression over 5 months (to mid-August 2020).  They don't extend to the full 18 month "vaccine" period, nor are they open-ended.

Second, they are adjusted according to thresholds of infection and hospitalization that can be selected and monitored.  Governments have a great deal of agency here.  In other words, this new coronavirus is bad, but it is not an irresistible event like a giant asteroid hitting the earth.

A big catch is that the versions of suppression in South Korea, Taiwain, Hong Kong, Singapore, and China include mass testing.  Neither the US nor the UK have done this, nor do we seen to have the capability to ramp this up.  There's been much excoriating commentary on this point.  I had been hoping that UC Health could make a big difference to California public health. A potentially exciting March 14th headline, "UC has a solution to the national shortage of coronavirus testing," didn't, with our weak public sector, mean UC is gearing up mass testing for the public, but that it has a private test for its own patients.  I've heard ambitious UC plans--in this week's board meetings, one UC regent suggested for the installation of MASH hospitals on empty land that UC owns. But because of testing and equipment shortages, UC medical centers have to focus on protecting themselves (see 0'44"-0'49" or so in this very useful UCSF infectious diseases division' grand rounds). I'll end by adding a few items to the summary list above:

• The virus is going to be terrible for public health workers, who deserve not only massive sympathy and support but also personal protective equipment, which they may now have more hope of getting.  Mass testing also depends on cranking out PPE.
• Public health interventions in Asia have had enough success with suppression to give  credibility to the Imperial College model--most interestingly, its suggestion that deaths can be reduced by an order of magnitude. 
• On the other hand, hospital access remains a potential catastrophe.  Full suppression reduces ICU need to 1/3rd of "doing nothing."  In the bootlegged C.D.C.’s scenarios, "2.4 million to 21 million people in the United States could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill."
• Still, suppression seems to make a big difference even if it is leaky: the Ferguson et al modeling assumed incomplete success and still got major reductions (see Table 2 on page 6).
• The US has a weak health system (or no health "system" at all, as Robert Reich rightly observes). This is a big problem. But the US has some other advantages: a lot of really good, dedicated health personnel, lower population density than Europe's or East Asia's and, ironically, dependency on the self-isolating feature of private cars.  Our version of suppression might be more successful than we now expect.
• Officials should give expiration dates to the current suppression regimes. They can be extended later, depending on conditions.  As I noted, the Ferguson et al. model assumes a kind of regular adjusting depending on infection numbers. (Hong Kong has reimposed quarantine and testing on arrivals after an uptick in cases.) Indefinite lockdowns are bad for both people and the economy.  Once people are scared indoors, and the infection curve is bent like South Korea's, governments should throw the lockdown into partial reverse, lest they create another Great Depression x 2.4.

I'll move on to political, economic, and university dimensions in other posts.  From the Haley Street Bunker: stay well, and keep your distance! 
Monday March 23rd

Statistical chemist Michael Levitt hammers on one of this post's key points: "The virus can grow exponentially only when it is undetected and no one is acting to control it."  The media, he says, should focus not on total number of cumulative cases but on rates of growth of new cases. 
Speaking of which,  South Korea's number dropped again, so the chart looks a bit better today.

The coming U.S. health crisis will owe much to a social system that can't anticipate non-market public needs.   That's not what this WaPo piece says in so many words, but it has all the raw material--shortages of masks, gowns, tests, ventilators.  What aren't we short of Covid-wise?

This piece, by a Mass General physician, specifies how the market power of large hospitals will mal-distribute emergency equipment: "We are currently taking an every-hospital-system-for-themselves approach, in which some hospitals will surely say “we’ll take them all” while others will lack the capital to make such large purchases in advance and therefore will be reliant on FEMA, which will be forced to ration scarce, lifesaving equipment. These already cash-strapped hospitals serving poorer populations will soon be put in even greater jeopardy.

From Akos Ronas-Tas (Prof of Sociology, UC San Diego): How Newsom got his numbers (over half of Californians being infected) is a mystery, but it is surely not by raising 1000 to the power of 2.45. I am no epidemiologist either, but the Ro produces an estimate only if you specify how many generations of infections you count. So if the base (generation 0) is 1000 and Ro is 2.4 (used by Ferguson), the first generation will be 1000*2.4=2400, the second generation 2400*2.40 = 5760 and so on. The total number infected will be by then 1000+2400+5760=9160, adding up generations 0,1 and 2. In the Ferguson paper they use a 6.5 day generation time. The key here is that Newsom made his prediction for 8 weeks out. So he is counting roughly 8 generations. The number of newly infected in the 8th generation will be 1000*2.4^8=1,100,753. You have to add to this those from the earlier generations. That will give you the total number of those infected (roughly, 1.9 million). Some of them will have recovered by then and happily immune, others would have died. I don’t see how this adds up to 25.5 million, either as the number of all people who have ever been infected, let alone all people needing care at a certain date.  You would get to a cumulative 26 million in 11 generations with 15 million new infections. That is 71.5 days, 10 weeks, still only late May.

You can make the model more complicated. Ferguson assumed a variable R in each generation and it should also vary across generation as the number of people getting immunity increases.

Here is a nice calculator that adds a few other considerations.

The real scary numbers come from the healthcare system. There are only 74,000 hospital beds in California, and 6,300 in SD  county, only 32% of which are available. This is probably similar in the state overall. But what you really need is ICU beds (only 800 available in SD county). There are about 50,000 ICU beds in the entire US and about 100,000 respirators. And you also have to add to this that beds, even ICU beds are useless unless you have trained personnel attending to them. So if we suppose only 2 million people being sick at the same time in CA, and only 10%  (100,000) needing hospital beds and only 4% (40,000) ICU beds, we have a major catastrophe. 

Tuesday, March 24

On the duration of the shutdown, Jeffrey Sachs invokes the example of China. Their ironclad version of suppression, including mass testing, suggests the spread of SARS-CoV-2 can be stopped in 60 days.  Sachs says 60-90 days.

This is not what's happening in Italy, where exasperated mayors berate their citizenry.

Buzzfeed does funniest home videos for the Covid quarantine. 

As India's government orders a 3-week "total lockdown,"  nearly 60 percent of the U.S. population is not under stay-at-home orders or being mass-tested.  The U.S. is therefore not, overall, doing suppression, but mitigation of SARS-CoV-2.  Note that this predicts some "flattening of the curve" of infection--reducing but not eliminating the overload on health care-- but not reversing the spread of the disease (Ro stays above 1). Some red state politicians are actively resisting social distancing (Texas, Mississippi), as is POTUS himself.

Speaking of testing, California is way behind New York, working "piecemeal."

This piecemeal approach, said Harvard epidemiologist Michael Mina, is a key problem with testing in California and nationwide.

“We have a decentralized healthcare system and we have no way to scale for government means,” Mina said. “Everything is privatized, everything is individualized in our country and it’s become our Achilles’ heel in this case.”

   
Wednesday, March 25  It's Bailout Day!

NYT summary.  Essential first take by David Dayen. Trigger warning: wow will this analysis not reassure you that any economic reforms are in the offing.

Yes we have no protection: "A very American story about capitalism consuming our national preparedness and resiliency"  Painful contrast between the American scramble for the most basic equipment and Germany's highly successful health system for radically minimizing fatalities.

Half-assed LAT reporting on the coming fiscal crisis of the state of California.  No real info, and other annoying stuff. How do you find the school lobbyist who will say this will be really bad for the schools, and then add, "under current law, it is likely that schools could withstand a total statewide revenue loss of around $5 billion. But more than that and schools will face significant problems."  So your own lobbyist just told the state that a 7 percent cut is fine. 

Where's higher ed in the stimulus bill? Inside Higher Ed's summary:

Six-Month Loan Deferment in Senate Bill
March 25, Noon. Student loan borrowers would be allowed to defer making payments for six months, without interest, through Sept. 30, according to a summary of the $2 trillion stimulus package Senate leaders agreed to at 1 a.m. Wednesday morning. The full bill is still being written and hasn’t yet been released.

But according to summaries of the bill making the rounds among education advocacy groups and obtained by Inside Higher Ed, the measure will also include changes sought by advocates such as not requiring Pell Grant students to repay money to the federal government if their terms are disrupted by the coronavirus emergency.

However, the bill is expected to disappoint advocates who had embraced Democratic proposals in the House and Senate, in which the federal government would have made the payments on behalf of borrowers, reducing their balances by at least $10,000. The summary did not mention any loan cancellation.

A separate summary contains $30.75 billion in grants to “provide emergency support to local school systems and higher education institutions to continue to provide educational services to their students and support.” That amount appears be about $29 billion less than what higher education institutions could potentially get in the bill proposed by House Democrats, but $21 billion more than what Senate Republicans had initially proposed, one higher education lobbyist said.  Associations representing institutions that were disappointed with the previous proposals were still waiting for the full bill before they commented on the level of funding.

The bill requires the secretary to defer student loan payments, principal, and interest for six months, through Sept. 30, 2020.

Thursday, March 26

Covid revealing America's rear guard place in the world 

Zero Hedge's mashup of hostility to the shutdown, mixing vulnerability of SARS-CoV-2 to treatment (it isn’t a superbug) with statistical problems (extensive) with lockdown’s effect on the economy (bad but unavoidable). Playing rural roulette because lockdowns are Democrat.

Suppression works, says none other than Neil Ferguson!!

He said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower.

But don't go back outside! Because, on the other hand,

This measure of how many other people a carrier usually infects is now believed to be just over three, he said, up from 2.5. “That adds more evidence to support the more intensive social distancing measures,” he said.

Special bonus for modeling fans: Oxford now has a model too. More on this coming soon.

Hope for a UK Covid-19 home test within two weeks.

And We're Number 1 - in Covid-19 cases.

Statement to the UC Board of Regents by Shane K. M. Wood, President, UC Irvine Associated Graduate Students; Department of Theater and Drama

The Pandemic we find ourselves currently enduring has shown just how precarious the lives of our students across the state are. Within days of the rolling campus closures, the student governments from each campus began receiving reports of students who would be losing their housing because of lack of work or inability to move as has been suggested for social distancing. In particular, our graduate population has been specifically impacted, many scrambling to create online classes with little to know training while being expected to also contend with all the other logistics

When speaking about the need for more funding for our graduate students, it is often mentioned that the state is cautious of another economic downturn and therefore will not contribute more money to the system. Frankly, this is an unacceptable stance to take. Our graduate students are a huge economic driver for the UC System and the state as a whole. Not only are we responsible for a large portion of undergraduate education, but also the research our system, state, and society depend on--including the continual study of the Covid-19 virus and the media, literature, and art we’re being urged to utilize during social isolation.

As the graduate students navigate the next few months, foregoing personal research, travel, and coursework as they continually adapt to the changing needs of this pandemic, the Regents must urge the state to begin investing in its graduate students, not only to support the current population doing this essential work, but to allow the UC to get back on track once this crisis is over to continue the enormous growth of the graduate population that is being asked of each campus.

A logical start is to insist that state commitment for graduate students be raised and expanded to cover the additional costs that this 20% increase in graduate numbers will represent to the state. The UC simply cannot commit to this increase without a firm commitment from the state for their increased and continued financial investment in this vital population.

Dear UCR Senate Colleagues:

As everyone prepares for Spring Quarter “remote learning” classes, i want to offer some advice and insight that is informed by what’s been happening at other UC campuses and universities around the country.  As always, feel free to email me at my personalUCR email address if there’s anything you think i should communicate to campus administration and leadership.

1. “Remote learning” is an emergency measure.  These teaching adjustments are temporary ones.  Treat them as such, even if the suspension of in-person classes is extended beyond April 3 to the full Spring Quarter.  We’ll be back in the classroom after we get through this crisis.  We do not need to magically transform ourselves into YouTube or TikTok stars!  We just need to get through this period as functioning teachers.

2. Don’t pressure yourself to produce the equivalent of serial TED talks, Academy Award-winning documentaries, or high profile Netflix specials.  Instead, teach to the best of your ability, don’t worry about “production values,” and work with the tools you’re most comfortable using. Communication with our students is the most important thing, and this emergency situation doesn’t change that. Consider low tech and no tech solutions to engage students as well. The “Keep Teaching” UCR website is a one-stop resource that is constantly being updated, so please use it:  https://keepteaching.ucr.edu/

3. Emergency remote learning is not a backdoor to coerce the faculty into permanent online teaching (or de facto strikebreaking).  Any proposed permanent online curriculum must be fully reviewed by the Academic Senate’s Committee on Courses, as well as the faculty Executive Committees at each College/School, at a minimum.

4. Please offer concise, constructive feedback to the hard-working staff who are supporting us with daily updates of the UCR “Keep Teaching” website!  This team works out of the Center for Teaching and Learning (also known as XCITE, Exploration Center for Innovative Teaching and Engagement), and has pledged to me that they will be as responsive as possible to faculty input.  I recently learned that a total of six staff members (including the Directors) are tasked with running remote learning for the entire campus.  Campus infrastructure in this area is extremely limited.  Feel free to reach out directly to [local emails omitted].

Stay safe and healthy, everyone.

dylan

Dylan Rodríguez
President-Elect, American Studies Association (2020-2021)
Chair of the Academic Senate, UC Riverside Divisio (2016-2020)
Professor, Department of Media and Cultural Studies
University of California, Riverside