COVID19 update, May 2, 2020 edition: Remdesivir gets FDA approval; detailed German statistics

(1) The top news item of the day is probably that Gilead Scientific’s antiviral drug remdesivir was given FDA Emergency Approval for use in COVID19 patients. Remdesivir is not a “magic bullet”, but it’s a start.

(2) Roger Seheult MD, pulmonologist and medical school instructor, gives a 1.5 hour recap video on what we know about COVID19.

(3) Miscellaneous updates:

  • the Ma`ayanei haYeshua [Wellsprings of Salvation] hospital in Bnei Brak, Israel (a COVID19 hotspot) has deployed an Israeli-developed UV-C room sterilization system. This is of broader relevance than COVID19, and if successful, will prove very helpful in the protracted and increasingly worrying struggle against hospital “superbugs” — bacteria resistant to every known antibiotic. (Such bacteria tend to develop in hospitals and long-term care settings through “Darwinian selection”, as both infections and treatment with aggressive antibiotics are frequent.)
  • Die Welt has a detailed video (in English, with German subtitles) on significant progress with a vaccine in the USA
  • worrisome reports about some peculiar COVID19-like pediatric syndrome noted in earlier updates: these now appear to have been identified as Kawasaki’s disease, which is of uncertain origin but some sort of autoimmune etiology is suspected. Coincidence or new cases triggered by COVID19 infection?
  • disturbing reports of COVID19 “reinfections” in South Korea appear to have been false positives in the test
  • Abbott’s new rapid COVID19 test, which claims 99% accuracy, has been approved for use in Europe.
  • if you give people perverse incentives to cook the books, and don’t balance that out with a deterrent for the act of cooking — well, don’t be surprised if books get cooked. NYC funeral director on candid recording about people who obviously died from otehr causes being coded as COVID19. Mind you, I am sure the un-inflated COVID19 mortality in NYC would be quite bad enough (“thanks” to very high pollution density and the subway as “the mother of all superspreaders”) — but those numbers struck me as anomalously high from the start. (As discussed in previous updates, numbers from Italy and Belgium are inflated for different reasons.)

(4) In contrast, countries like South Korea and Germany have rather more scrupulous reporting standards. I’ve linked previously to the daily Korean CDC reports: here is the detailed daily update (in English) from the Robert Koch-Institute (Germany’s infectious diseases authority, named after the discoverer of the tuberculosis pathogen). A few highlights from the daily report:

  • Only 19% of all cases occurred in persons aged 70 years or older — but these account for 87% of deaths.
  • cases per 100,000 people in age cohorts are fairly homogenous across age cohorts 20-29 through 70-79, climb sharply in the highest age cohorts, and drop steeply for ages 10-19 and especially 0-9.
  • mortality in age cohorts 0-9 and 10-19 are ONE (1) patient each, while age cohorts 20-29 and 30-39 account for just 6 and 14 deceased out of a total of 6,472. Yes, Virginia, ages below forty account for just 0.3% of all dead, and all ages below fifty for just 1%. Fifty-somethings add another 3.2%, sixty-somethings another 9.0%.
  • Their technique of estimating the effective reproductive number R consists of dividing the 4-day moving average of new cases by the one 4 days earlier. At present it is R=0.79, with a 95% confidence interval of 0.66–0.90. Any R value below 1 implies that the epidemic will wither away, while any value over 1 implies slower or faster exponential growth.
  • the report points to a European Union website with all-causes excess mortality graphs. These serve as a useful “sanity check” on COVID19 death reporting criteria for different countries.

Chesterton’s parable of the fence

The British writer G. K. Chesterton is probably best known to the general public as the author of the “Father Brown” series of mysteries. Among English-speaking Catholics, he is also well known as an apologist for their faith. Agree or disagree with his views, friend and foe recognized his intellect.

In one of his apologetic works (“The Thing”, quoted here, and discussed here from a different religious perspective) he coined an interesting parable:

In the matter of reforming things, as distinct from deforming them, there is one plain and simple principle; a principle which will probably be called a paradox. There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”

This paradox rests on the most elementary common sense. The gate or fence did not grow there. It was not set up by somnambulists who built it in their sleep. It is highly improbable that it was put there by escaped lunatics who were for some reason loose in the street. Some person had some reason for thinking it would be a good thing for somebody. And until we know what the reason was, we really cannot judge whether the reason was reasonable. It is extremely probable that we have overlooked some whole aspect of the question, if something set up by human beings like ourselves seems to be entirely meaningless and mysterious. There are reformers who get over this difficulty by assuming that all their fathers were fools; but if that be so, we can only say that folly appears to be a hereditary disease. But the truth is that nobody has any business to destroy a social institution until he has really seen it as an historical institution. If he knows how it arose, and what purposes it was supposed to serve, he may really be able to say that they were bad purposes, that they have since become bad purposes, or that they are purposes which are no longer served. But if he simply stares at the thing as a senseless monstrosity that has somehow sprung up in his path, it is he and not the traditionalist who is suffering from an illusion.

Meaning no disrespect to Chesterton’s splendid prose, allow me to paraphrase and elaborate in plain(er) contemporary English.

Suppose you are walking along a road and see it blocked by a fence. Is your first impulse: “this fence is oppression! We must tear it down!” Chances are you are a left-liberal “progressive” — especially if you flip 180 degrees to “we must keep the fence, and saying otherwise is hate speech!” after being told that the fence was erected by or at the behest of one of your mascot groups.

Is your first impulse rather, on seeing or suspecting that the fence was erected by the state: “down with the state! down with the fence!” Then, if told that the fence was erected because there was a cliff behind it, or quicksand: “it is my dog-given right to drive off a cliff or into quicksand if I choose to do so, and the state has no business making such a fence!” Chances are you’re a doctrinaire big-L Libertarian. (A more sensible libertarian might advocate tearing down the fence but putting up warning signs, saying “proceed at your own risk”.)

Or is your first impulse that the fence is sacred just because it has always been there, and we must not question why? Chances are you are a reactionary.

Or, finally, is your first thought: “Hmm, that fence wasn’t put there overnight by leprechauns. We must find out how that fence came to be and why. It’s quite possible that the fence was built for reasons that are no longer relevant, and that we can safely tear it down; it’s also possible that the fence is still sorely needed. Until we have a straight answer to this question, let’s not mess with it.” That is what it means to be a conservative. Not to be afraid of anything new, not to oppose reform or evolution —  but to go about it cautiously and thoughtfully, and mindful of the Law of Unintended Consequences.  A conservative with libertarian sympathies (like myself) may err on the side of allowing people to make their own mistakes rather than “protecting them against themselves” — but still would not tear down the fence unthinkingly. I might be more rash, if I were alone on a desert island. But in the immortal words of John Donne:

No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend’s
Or of thine own were:
Any man’s death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee.

 

 

 

Scenes from Europe before the storm

Scene one: At a reception at an unnamed organization, as I was talking shop with a few colleagues, I overheard conversation from the next cluster of people over. They were discussing churches being repurposed as libraries, discos, shops, a hotel, and, increasingly… mosques. What struck me (as an non-Christian who largely grew up in Europe) was not that they were discussing this matter. It was the perfunctory tone in which they did so — as if the subject matter was the rainy weather or a 10% increase in the price of vegetables.

Scene two: a number of people — card-carrying New Class members, what else? —  lamenting the “xenophobia” of the common ‘native-born’ people. Needless to say, they live in neighborhoods that are largely insulated from the mass ‘refugee’ wave and its fallout.

Scene three: a former mail carrier in his eighties struck up a conversation with me, after he figured out I was fluent in his language and familiar with the country. He pointed out that, while he had a sizable pension after his 45 years of service, a refugee family that had just moved in across the street got more in welfare payments than his , plus a nearly rent-free house.

The man pointed out he had voted Socialist all his life. But he was so sick and tired of being called a ‘racist’ for even mild criticism on Muslim refugees that he was switching his allegiance to a shady far-right party I myself never would want any truck with. Upon being queried, he basically said: ‘if they’re gonna call me a racist anyway’

Now if I had a Euro for every time in five days I’d heard variations on this theme: “if the Eurocrats and media are  gonna brand us racists anyway, we might as well be hanged for a sheep as for a lamb”, I could have at least paid for a roundtrip flight. Behold the incentive structure the New Class has created.

When things blow up, it will not be pretty. Having largely grown up in Europe, this is heart-wrenching to see.

In some countries, conservative-leaning politicians are trying to stem the tide by reforms that aim at eliminating the worst abuses and at stanching the fiscal hemorrhage from a generally unsustainable welfare state. One such party leader, Bart De Wever of the Belgian N-VA party, actually has the audacity to invoke Edmund Burke — the father of modern conservatism — as an intellectual founding father. One can only hope he and others like him can offer an alternative to, on the one hand, mindless ‘multicul’, and on the other hand, ‘blood-and-soil’ thinking that might lead Europe down equally dark alleys.

Any glimmer of hope is welcome. It is two minutes to midnight.

 

Some of the worst things imaginable have been done with the best intentions

The front page of the Yediot Achronot had a story (sensationalist as is the wont of that paper) about a family tragedy.

Briefly: The head of the hematology department of a large hospital (I will not spell out his name out of concern for the privacy of the family — bad enough that the gutter press chose to do otherwise) was faced with a 34-year old daughter (he himself was 66) who struggled with cancer for over 3 years. Eventually she gave up and insisted that he put her out of her misery, which he did, and subsequently committed suicide, leaving a wife and two more children behind.

It is written “do not judge your fellowman until you have stood in his place” (Avot 2:4). I have not (G-d spare me) stood in this doctor’s place but have been in a closely related situation, which made me lose all respect for the (euthanasia-happy) medical establishment of the European country involved. (For the political establishment of said country, I lost none since I had none left to lose by then ;-)) Suffice to say that the participants in this “Greek tragedy” have suffered, and continue to suffer, enough without me shooting off my mouth on this specific case.

However, now the usual suspects (hyper-secularists, as well as those emoting rather than thinking) are calling for a law permitting active euthanasia — notwithstanding that Israel calls itself ‘a Jewish state’ last time I checked, that Jewish law prohibits active euthanasia in the strongest terms, and that it is also utterly incompatible not just with the Hippocratic Oath but with the Jewish versions thereof. (The situation regarding passive euthanasia is rather more complex, as has been recognized by a 2005 law.)

There is a well-known legal maxim in English: “terrible cases make for bad law”. Sometimes, moved to pity from a few individual heart-rending cases, lawmakers create laws, or judges legal precedents, that would have addressed these specific cases but have unintended consequences hundreds or thousands of times greater in magnitude for years or even centuries to come. Furthermore, dark forces can manipulate public sentiment on a few such terrible cases to generate public pressure for a change of law that suits their nefarious ends  — in this manner, somewhere in Europe, a nation was made to set the first steps on a slippery slope that led first to mass euthanasia of the mentally ill and special-needs children as having “lives not worth living” and “being too great a burden on those caring for them”, which then turned out to be the dress rehearsal for the murder of one-third of my people (plus an even larger percentage of Roma gypsies, as well as millions of Slavs).

It is, incidentally, interesting that the “T4-Aktion” (as the Nazi euthanasia program was known after the address of the headquarters of the program, Tiergartenstrasse 4 in Berlin) stands alone in the history of the Third Reich as an example where a widespread public outcry (backed, admittedly, by some prominent Catholic and Lutheran clergy) forced the regime to back down and discontinue it at least publicly.

It would be a tragedy on a cosmic scale if, moved by the Greek tragedy of a few individual families, the Jewish state of all countries would set the first steps down this “road to Hell paved with good intentions”. Fortunately, I would imagine that public support for such a law is mostly limited to the ‘Haaretz readers’ audience among the secular public, close to zero among the traditional public and the minority religions, and zero full stop among the Orthodox public.

Who bears the cost of moral vanity?

This question is asked by Eric S. Raymond. Go read the whole thing.

A high-ranking Taliban commander is captured in Pakistan, and the (now entirely predictable) dance begins. Says the Guardian:

Mullah Barader has been in Pakistani custody for several days, with US and Pakistani intelligence officials both taking part in interrogations, according to the officials. Though Barack Obama has banned US agencies from using forms of torture such as waterboarding, Pakistani questioning techniques are frequently brutal.

That’s right. Because the American chattering classes have their panties in a bunch about acts of “torture” that don’t do any permanent damage to the victim, Barader is in the hands of Pakistanis who are likely to [fornicate] his [excretions] up the old-school way, with knives and cattle-prods and blowtorches. And yet, this is supposed to count as a moral victory.

All the manufactured indignation about Guantanamo Bay has similarly perverse effects. When you tell U.S. troops that every enemy combatant they accept a surrender from is going to be made into an international cause celebre that will be used to damage their war effort, the effect will be — count on it — that they stop accepting surrenders. This means that all the soi-disant “innocents” swept up in these operations will become innocent corpses. Instead of being stuck in a facility that’s a resort hotel compared to any prison in the Mideast, they’ll be dead — victims of someone else’s moral vanity.

I was born and educated into the class that produces “gentry liberals”, but I’ve come to loathe them. This is why. It’s always someone else who pays the cost of their posturing. Very often, it’s the people they claim to be helping[…]

They’re so very, very convinced of their moral superiority, they are. The pious anti-torture crusaders, the “economic-justice” cod-Marxists, the no-growth environmentalists, the gun banners, and all their kin in the tribe of wealthy white left-liberals. Armored by their certitudes and their sheepskins and their class privileges, they sail serenely above the deadly consequences of their meddling. Not for them any need to worry about second-order effects or process costs or who actually pays the cost for their delusions, oh, no. They are the anointed, and lofty intentions are their sovereign excuse however much damage they do.

Truly, I hate them all. Perhaps I hate them more intensely because I so narrowly escaped being one of them. But it’s really the invincible stupidity and myopia that gets me, and the way their “compassion” stinks of narcissism. Some days I think if I could have just one wish, it would be this: let their folly come back on their own heads.

I understand. All too well.

UPDATE: Make sure to read this related post: On being against torture.

And relatedly, in “Marginal devolution”, ESR discusses how unintended consequences of morally vain employment policies cause structural unemployment.