I’m not even going to try to organize this post.
I am in self quarantine 6 days after having either the mildest cold I can remember or a mild case of Covid 19 (this means alone in an Air BnB away from my family too). The pattern is the same I have read about countless times on the web. A brief mild fever and 5 coughs. Then nothing for about a week. Now I can expect nothing or maybe my lungs seize up.
I am sure my experience is very common. When this rotten pandemic is over, I will get the antibody test to find out if I have had Covid 19 or not.
Last week I taught twice my normal load (I will Not say how little that is) all by web. I have read again and again that, when working from home, one should get out of bed and put pants on as a matter of … for some reason. I have ignored this advice (I show pdfs to the class as my disembodied voice explains them — they don’t see me).
I am now all alone and bored (just normal teaching next week starting 17.5 hours from now). I will bore you after the jump.
OK so hydroxychloroquine update. I have read many times that non MDs including Donald Trump and me should shut the f up and let doctors handle it. I am not going to do that. Recall I am an economist not a medical doctor. Caveat Lector.
I did advocate prescribing hydroxychloroquine for everyone who tests positive for Sars Cov2. I stand by that recommendation (except for people with well known counterindications principally cardiac arrythmias). I note that it is current practice at least at Montefiore Hospital in New York. I think the balance of week indirect pre-clinical evidence that hydroxychloroquine blocks coronavirus replication and the known risks, side effects, counterindications and drug interactions implies that it should be prescribed. As it is being prescribed. By actual medical doctors.
I also wrote that it shouldn’t be mixed with azithromycin. I was quoting the Physicians’ Desk Reference. It appears that actual MDs disagree with me on that, and I have to admit that they probably know better. The issue is that both prolong the QT gap in EKGs (the actual contraction of the ventrical). This means that combining them can be dangerous. Momentarily overcome by a trace of humility and common sense I don’t claim to know best (for once).
I also advocate prescribing Remdesivir. This is not currently allowed. Remdesivir is not approved for anything, so prescribing it requires permission for compassionate use. It was given to the first US Covid 19 patient who got better then next day. Here I think that the Pure Food and Drug act should be amended, because it is currently killing people. I have long argued this (also it was already amended by the 21st century cures act). I think that the case of Covid 19 is further proof, as if any were needed, that current regulation based on the principle of first do no harm, second do no harm, third do no harm is not appropriate for treatments of diseases which kill people (Last year I was thinking of stage 4 cancer and a death rate of 98% not 2% but it applies to Covid 19 too. The 98% is an actual calculation from an article in the New England Journal of Medicine and is not a number I pulled out of the air — a more realistic calcuation is 99% or maybe 100%).
I advocate giving both unless there is a detected dangerous interaction. I wouldn’t oppose giving a lot to animals to check before prescribing both.
Now I ask why isn’t Remdesivir approved for treatment of MERS and SARS Cov1 ? There is evidence from failed efforts to treat Ebola that it is safe. Their could be much more evidence that it is safe (animal trials have been done (I assume) trials with healthy human volunteers should have been done). The problem is that you can’t prove it is effective without any patients. That means a drug useful against an epidemic can not be approved before you have the epidemic. Also approval takes time, so it won’t be approved very soon (clinical trials are ongoing). This does not make sense.
It is current policy based partly on current law and mostly on current FDA regulations. With the benefit of hindsight, I think it is clear that the law should be changed (as I wrote without the benefit of hindsight here ).
I assure you that I have read two counterarguments.
1) That is illegal. It violates current regulations and policy. This is not an argument for keeping the law and regulation as they are. It isn’t a policy argument. I can’t refute it because there is nothing there to refute.
2) If you do that, you might regret it with the benefit of hindsight. This is true of my proposal and of all proposals ever. Again I can’t refute the argument, because there is no argument to refute. It depends on assuming that chosing to stick with business as usual is not choosing. That if we do nothing we can’t be blamed for the outcome. This is not an arguable position. It makes no sense.
Consider applying that logic to sticking to business as usual rather than fighting global warming. The argument has been made that we shouldn’t impose costly measures which might not be necessary. It is obviously nonsense. But for some reason refraining from giving a pharmaceutical is not considered similar to refraining from imposing a carbon tax (or cap and trade or whatever). I can see no logic in the argument. I can’t present a counter argument without detecting an argument to counter.
OK so why didn’t Gilead prove that Remdesivir is safe ?
First this would have done them no good as it wouldn’t be approved for sale if not proven effective and you can’t prove something effective against a probable future epidemic with no currently sick patients.
Second, it is a high risk investment with a small chance of a huge social payoff. The market system is not a good approach to making such decisions. There are two reasons
2a) it is a huge risk high expected return investment. In theory, the risk that Remdesivir is not needed is diversifiable. In simple models it is not priced (it wouldn’t affect Gilead’s beta). Simple models are silly. Managers have to fear diversifiable risk which can lead to their being fired. In fact, since they are evaluated on relative performance, diversifiable risk is especially frightening to managers. This is a failure of really existing capitalism. It doesn’t appear in the simplest models because the simplest models are silly.
2b) we will not play the game by the rules. The rules say that if a firm has a patent, then the firm can charge what the market will bear for their product. We would be willing to pay a trillion for the cure for Covid 19 if it were necessary (Congress just voted 2.2 trillion to aleviate some side effects of the epidemic). But it won’t be necessary. A firm won’t be given a trillion for patenting the cure. If they tried to get that much, the managers would be torn limb from limb. We won’t play by the rules we have written (or rather they aren’t a simple in the real world as in silly models and Remdesivir can and will be requisitioned using the Defence Procurement Act. Since we will not pay as much as we would be willing to pay if we had no choice, we will not provide socially efficient incentives to firms to invest in preparation for possible horrible situations.
These are market failures. We should have paid public money to prepare for a possible coronavirus pandemic. It’s not as if there weren’t warnings.
I note that there was a candidate ebola vaccine developed *before* the West African Ebola epidemic. It wasn’t tested for safety and immunogenicity. It was not produced and stored. It was not available. Thousands of people died. This shouldn’t have happened.
OK so what else went wrong ? It turns out that there was a project to buy a huge number of cheap ventilators. Read this article.
Here there is a problem with imperfect competition so incumbent firms want to prevent innovation and competition. But the main problem is that there was a contract and it was not enforced. A company made a promise. It was taken over and the new owners didn’t keep the promise. They did not pay a large enough penalty for breaking the promise to make it optimal for them to keep the promise. Things shouldn’t work that way.
Also, of course, testing. Here the problem was not the technology. The CDC test kits can be used and are being used. The problem is that the CDC ordered state health agencies to stop testing until they figured out what was going on. This is based on the assumption that no action is acceptable, that the status quo is acceptable and that with business as usual while the virus spreads one can have the status quo.
Also the FDA. In the article I find “cautious” and “caution” referring to running a terrible risk of a pandemic. The words are used even now that it is no longer a risk but a current catastrophe. Again the problem is that sticking with business as usual is safe for the FDA director even if it is deadly.
Now the FDA hasn’t approved Remdesivir and hasn’t approved sterilizing masks so they can be re-used. Always it is the logic of better safe than sorry when the choice it to accept horrible danger (now certain mass death) rather than running the risk of trying something new.
I have been ranting about this for about a decade now. It’s not new to me.