Thursday, December 31, 2020

President Pence?

Just over a year ago, on December 18, the House of Representatives approved two articles of impeachment against President Donald Trump, for abuse of power and obstruction of Congress.

The articles were submitted to the Senate on January 16, 2020, which voted to acquit the president of both charges on February 5.

Suppose, however, at least 67 Senators had voted to convict the president on one or both of the articles. Donald Trump would have been removed from office and Vice President Mike Pence would have assumed the role.

A more emotionally stable President Pence would have been less divisive and may well have handled the pandemic more responsibly than the man he replaced.

Pence would logically have been the Republican candidate for president in the 2020 election. With the anti-Trump fervor gone, the nation could have rallied around Pence, supporting his efforts to develop a more coherent strategy to combat COVID-19.

The Republican party would be in a far better place inaugurating a President Pence on January 20. Its fealty to President Trump led it down a blind alley promoting false claims of a fraudulent election, claims that undermine our democracy and relegate the party to infamy.

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Wednesday, December 30, 2020

The Pandemic Paradox

As we end this tumultuous year, 2020, which has been defined by the coronavirus, deaths in the U.S. from COVID-19 are approaching 330,000 from over 19 million confirmed cases. These numbers understate reality because not all cases and deaths have been diagnosed.

Why did it turn out so, the infections accelerating this fall as the weather turned colder and the U.S. responded with que serĂ¡, serĂ¡ and a shrug?

The Paradox

The pandemic is a paradox which the country has not been able to solve.

Many who are infected with COVID-19 have no symptoms, many have mild symptoms, most recover — yet the virus is the third leading cause of death in the U.S., the cumulative death toll the same as the population of Salt Lake City or Birmingham, according to Scientific American.

The highly contagious disease spreads largely by close contact among people and, in some cases, transmission across longer distances. Limiting gatherings with others avoids exposure, by definition. When that is not possible, wearing a mask to reduce the probability of either inhaling the virus or expelling reduces the risk of infection. Yet government and business policies implementing these steps, either as regulations or simply recommendations, have been decried by some as unconstitutional infringements on personal liberty.

The life of an infection is relatively short — weeks — yet the U.S. has not been able to contain it after 11 months. It has consistently spread across the country, infecting all regions, even those knowing for months it was coming. December — not yet history — has been the worst month for deaths since the first peak in April.

Confirmed COVID-19 infections in the U.S. Source: Johns Hopkins University, 12/30/20.

Why is this pandemic such a paradox, when the U.S. has the medical expertise, the infrastructure, and financial resources to counter it? Why is it so difficult to manage, when other countries have demonstrated strategies that work?

I’ve concluded we lack government leadership, a coordinated and unified response, and both community and individual resolve. These interconnected deficits, amplified by a vocal minority of naysayers, have created a controversy about wearing masks and a false either/or choice between reducing infections or sustaining the economy.

What Can We Do?

Eleven months in, can we do anything to mitigate this tragedy or must we await the country being vaccinated, accepting the collateral infections and deaths while hoping they don’t affect us personally?

I think the following steps would yield measurable improvement, reducing infections and death until enough of us are vaccinated for the country to reach herd immunity. These steps must be implemented consistently across the nation, a “united we stand, divided we fall” strategy.

1. Stay in place for 14–21 days to minimize new infections.

The idea is for everyone to stay in place to let the current infections play out without causing new infections.

The incubation period for COVID-19 infection is 5–6 days average and up to 14 days, according to the World Health Organization. The BMJ reports data from culture studies indicates people can become infectious 1–2 days before feeling symptoms and will remain infectious for up to seven days. CDC guidance is a person with a mild case of COVID-19 remains infectious for “no longer” than 10 days after symptoms appear, while a person with a more severe or critical illness will “likely” be infectious for no more than 20 days.

The life of the infection defines the time we need to stay in place. While some exceptions will be required — seeking medical care, getting groceries — wearing masks and reducing the number of people in stores will reduce the probability of infection.

Everyone staying in place must be done nationally at the same time; otherwise the virus will cross borders and spread from areas with high infection to those with low infection — just as we’ve seen it cross the country this year.

2. Quarantine international travelers entering the U.S.

As other countries and some U.S. states have done, incoming travelers must quarantine for an appropriate time to minimize the risk of bringing in the virus and spreading infection.

A 14-day quarantine has been the norm, based on the incubation period for infection, although this time could be reduced if the quarantine is combined with testing.

Our near-empty hotels can provide the rooms, meals, and testing centers for travelers.

3. Implement a multi-layer testing strategy.

The foundation of a multi-layer testing strategy is in-home antigen tests with near real-time results, with a protocol of one or two tests per week per person following the national stay-in-place period. This policy would apply nationwide, for anyone going to public places (e.g., offices, stores, churches).

If a test is positive, the person quarantines while confirming the infection with either additional in-home antigen or local PCR tests.

Although the antigen tests may not be as accurate as PCR tests, they can be widely accessible, and the near real-time results will enable anyone infected — especially if they are asymptomatic — to protect others from becoming infected. See

Ideally, the test results would be reported to public health officials to provide community data on the positivity rate. To balance individual privacy with public health, the data — even from a positive test — could be reported anonymously (by zip code, perhaps). Someone with a positive test could be asked to contact local health officials. Anyone becoming seriously ill will presumably show up at a hospital.

4. Provide additional economic relief.

Given the economic impact of staying in place, adding to the year-long effects, it’s reasonable for the federal government to provide additional economic relief: unemployment, rent and mortgage assistance, and business support. Considering this national disaster, the “cost” to the federal deficit is an investment in the economy, particularly with interest rates so low.

I believe if this strategy had been employed in the spring, when the coronavirus was first spreading in the U.S., the number of infections, deaths, and attendant economic devastation would be considerably less than what we’re living through. Had we been united around a nationwide response, the virus would not have been able to dance through our patchwork of local and state plans and political divisiveness.

While Operation Warp Speed’s development of vaccines is heartening and will, hopefully, enable us to return to a more normal life by the end of 2021, we have a long winter and spring to endure. A strategy built around these principles will alleviate the nation’s suffering near-term.

SARS-CoV-2 won’t be the last pandemic to threaten the globe. Developing such a strategy will help us better prepare for the next time.

Caveat: I claim no medical expertise. Nonetheless, I think the framework is a sound approach and should be appropriately tweaked to reflect the latest medical knowledge of the virus.

This post also published on Medium.

Monday, December 14, 2020


On this day, Monday, December 14, I note several milestones worth remembering:

Joe Biden was officially elected president and Kamala Harris vice president with the vote of the Electoral College — actually 50 separate tallies, one in each state. The totals were 306 to 232, coincidentally the same split as in 2016, when Donald Trump was elected.

The first SARS-CoV-2 vaccinations, developed by Pfizer, were given across the U.S. after the FDA approved use of the vaccine late Friday. The U.S. has ordered some 100 million doses, enough to cover 50 million people, each requiring two shots 21 days apart. Vaccines being developed by several other companies are being tested, with Moderna’s version set to be reviewed by an independent panel of the FDA this Thursday.

That is a hopeful sign in the face of the grim milestones that more than 300,000 Americans have died of COVID-19, over 110,549 are now in the hospital, and 1,358 died so far today, according to data on The COVID Tracking Project website.

Another positive milestone would have been President Trump conceding the election and graciously congratulating the new president and vice president. He didn’t. Even before the election, he was claiming voter fraud and a stolen election, offering no proof to support his wild claims. Is Donald Trump delusional or just a massively sore loser, intent on destroying as much of the government as he can on his way out of Washington?