Latest wrap-up of region's COVID-19 response

The front entrance of MGH, in Boston

Here is the most recent wrap-up the region’s COVID-19 developments from The New England Council (newenglandcouncil.com):

• “Harvard Medical School Researchers Publish COVID-19 Rehabilitation Study – Researchers at Harvard Medical School have published a study detailing rehabilitation plans crafted for patients in Boston and New York-based hospitals. The team has treated over 100 patients and points to continued studies to address persistent COVID-19 symptoms. Read more here.

• “Mass General Releases Guidance on Weaning Patients Off Ventilators – Clinicians at Massachusetts General Hospital have released an article with an accompanying video to demonstrate effective ways to wean patients with serious COVID-19 infections off of ventilators. The materials offer step-by-step instructions and were published in The New England Journal of Medicine. Read more here.

• “Health Leads Releases Joint Statement on Ensuring Racial Equity in the Creation and Distribution of a COVID-19 Vaccine – Health Leads has released a statement, in conjunction with a number of other organizations and individuals, emphasizing the importance of supporting underserved communities in recovering from COVID-19. The statement includes strategies for ensuring equity in vaccine distribution. Read more here.’’

Llewellyn King: The case for continuous scientific research

Oxford’s Jenner Institute laboratories seen from the atrium

WEST WARWICK, R.I.

There is something fabulously exciting about watching science riding to the rescue. The gloom about the coronavirus pandemic began to lift dramatically in the past several days as good news about vaccines came out.

Out front Oxford University, with a well-established history in vaccines, announced that it had started trials on people and that it might have a vaccine by September. It has a manufacturing partnership with AstraZeneca, a giant European pharmaceutical company, and it is hoped that a million doses can be produced by September, even as there is not absolute certainty that it will work. Sarah Gilbert, professor of vaccinology at Oxford’s Jenner Institute, says she is “80 percent” certain that it will.

Incidentally, some of tests on rhesus macaque monkeys were done at the National Institutes of Health’s Rocky Mountain Laboratories, in Hamilton, Mont.

Labs in all major countries are in close pursuit of Oxford. What does seem certain is that the time when a viable vaccine can be brought to market is shrinking. The next challenge will be to manufacture proven vaccines in the hundreds of millions of doses needed.

To me the big thing is not who finds a vaccine, but rather how science answers the call to arms when the challenge is there – and financial support is provided. Much critical research in many of the coronavirus vaccine efforts has been provided not by governments, but by the Bill and Melinda Gates Foundation.

There is reason to wonder why Gates has been out in front of many governments, including the United States. This points to government failure to adequately support research and to prepare non-military defenses. Not every threat a modern nation faces comes from national armed forces.

Across the spectrum of research, private money is raised to do the work which should be in the government’s purview. Money for science is a struggle: There are competing philosophies, political and scientific, about research. To begin with, all research is messy. The scientific method, as Michael Short of MIT reminded me recently, is based on try, fail, try again; test, prove, then proceed.

Conservatives have tended to be skeptical about a lot of science, pooh-poohing the study of obscure microbes and what they see as dubious investigation. They have consistently demanded quantifiable results from the government’s scientific establishment, looking for practical applications and unhappy about research for its own sake. They have forgotten the real driver of all science: to know.

Liberals have favored, as you would expect, the social sciences over the hard ones. They are more prepared to treat social studies as science than high-energy physics.

What is lacking is something which we used to have in Congress: the Office of Technology Assessment which was the scientific equivalent of the Congressional Budget Office. As with the often-quoted CBO, the OTA was a tool for members of Congress; a means for them to get complex scientific issues right and help them to understand the budgeting for those.

The OTA was created in 1972 and looked to be a firm part of the support system of Congress. But the Newt Gingrich-led House axed it in 1995. There have been several attempts to bring the OTA back in the House; last year a bill was introduced that would have reestablished it at a modest $6 million, but no action was taken.

The OTA provided a valuable service in saving members of Congress from themselves; advising them when they come back from their constituencies believing hearsay as scientific fact -- the same thing that has bedeviled President Trump in his briefings on the COVID-19 crisis.

I was well acquainted with the OTA and I always thought its greatest value was not in its formal advice, but rather in its informal help to members -- who often confuse what they are told by sources as disparate as their children and lobbyists -- from saying something about science that did not hold up.

As it is, we are all standing where we can see the scientific cavalry saddle up and ride out. This is heart-pumping, reassuring and confirms that science should not be neglected for budget or other reasons. To have a viable scientific infrastructure is to be defended from non-military attack, ranging  from cybersecurity to a virus. Scientists agree on this: There will be more.

Llewellyn King is executive producer and host of White House Chronicle, on PBS. His email is llewellynking1@gmail.com and he is based in Rhode Island and Washington, D.C.

David Warsh: Unlike in 1929-33, we know where we are

SOMERVILLE, Mass. 

“A medically induced depression.” The phrase has stuck in my mind because an especially dear friend was treated with a medically induced coma several years ago, after his heart stopped for a few minutes sending oxygenated blood to his brain. For several days his life hung in the balance. Such were the odds that, if he survived, it would probably be with significant cognitive impairment. He recovered completely, having suffered no damage at all. Another miracle of modern medicine.

I don’t know any more than that about medically induced coma except for this: for a time the treatment was the centerpiece of the Milwaukee protocol, designed to prevent death after the onset of rabies symptoms in humans. The treatment has been discredited, since it saved only the first of more than 26 patients on whom it was tried. Rabies vaccines, of course, have spared countess others. 

Vaccines are one more reminder of how far we have come in the last hundred years, in both medicine and economics.

How far since the 1918-20 pandemic of the Spanish flu? The “blue death” infected something like a quarter of the world’s population and killed between 17 million and 50 million persons. In 1928, Alexander Fleming discovered penicillin in a petri dish on his workbench, touching off a cycle of brilliant research and development by others that led, in 1940, to the first successful treatment of infection with an antibiotic.

Vaccines? Viruses are another matter; antibiotics are no help against them. The technology surrounding DNA makes it possible to produce a reliable vaccine for Covid-19 within a year or two. But if, like most readers of The Double Helix: A Personal Account of the Structure of DNA (Touchstone, 2001), by James Watson, you think the road to the secret of life began with the phage group at Cold Spring Harbor and Caltech in 1945, you would enjoy The Nobel Prizes: Cancer, Vision, and the Genetic Code (World Scientific, 2019), by Erling Norrby, an MD/PhD involved for many years with the award of the medicine prizes. He traces the beginning of the story back to Peyton Rous, a Johns Hopkins University physician who in 1911 discovered viruses that caused cancer in chickens. In The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris (Norton, 2019), medical historian Mark Honigsbaum makes clear how subsequent advances in medicine have generated overconfidence that the infectious disease situation is under control.

What have we learned since the Great Depression? The Fed and Congress and the governments of dozen other nation prevented a repeat in 2008 by lending first freely, then forcibly, to financial institutions threatened by panic. The best book I know about it is Last Resort: The Financial Crisis and the Future of Bailouts, by Eric Posner (University of Chicago, 2018). Thanks to the events of 2008, we have a better idea, too, of how the Depression got started, thanks to Gary Gorton, Toomas Laarits and Tyler Muir.

In 1930: The First Modern Crisis, they argue that banks stopped lending after the 1929 stock market crash and purchased safe assets instead. In essence, the banks were running on each other, producing the 21 percent drop in industrial production that has mystified economists. In the present crisis, faced with a pandemic instead of a mysterious slump, the authorities shut down social commerce and embraced mitigation.

Robert Gordon, of Northwestern University, explains

“The difference between the 1929-33 collapse in the economy vs. 2020 is that we understand now what is happening. We have a massive shutdown in production relative to the incomes of (a) all the people who have kept their jobs and (b) all the stimulus money going to the unemployed (roughly $1,000 per week) plus (c) the $1200 per-person payments. As a result 2020:Q2 [of the National Income and Product Accounts] is going to witness a massive increase in the personal saving rate, as consumption declines steeply relative to income. The closest analogy is rationing in World War II, where many types of consumption were rationed to equal zero. The difference is that GDP is falling today rather than rising because there is no current equivalent of WW II military production.”

There are plenty of things we would like to know, and don’t, beginning with how to get out of the current mess as quickly as possible. Vox’s Ezra Klein on the major plans to curtail social distancing being offered in hopes of restoring commerce to its customary vigor: “It’s scary,” Klein reports; he sees nothing normal about the foreseeable future. “Until there’s a vaccine, the U.S. either needs economically ruinous levels of social distancing, a digital surveillance state of shocking size and scope, or a testing apparatus of even more shocking size and intrusiveness.” 

We’ll figure it out, just as we have in the past, learning by doing. It is hard to imagine daily life returning to normal before the election. As in 1918, pandemics take lives while cures take time.

xxx

New to Economic Principals’ bookshelf: EuroTragedy: A Drama in Nine Acts, with a new afterword (Oxford, 2918), by Ashoka Mody.

David Warsh, an economic historian and veteran columnist, is proprietor of Somerville-based economicprincipals.com, where this essay first ran.