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Coronavirus Treatment Case Report

“First Case of 2019 Novel Coronavirus in the United States” Holshue et al 2020

I quote

Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development10,11) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion. Vancomycin was discontinued on the evening of day 7, and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus.

On hospital day 8 (illness day 12), the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.

This suggests that Remdesivir is an effective treatment for Covid 19. I told you so. A guess in Angry Bear March 2 2020 a Case in the New England Journal of Medicine March 5 2020.

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Walter Bagehot Explains to the Fed What They Should Have Done on Thursday

The day before yesterday, the Fed made a somewhat unusual announcement of $500,000,000,000 of REPO offers a day for three days in a row. The idea was to let banks unload risky assets before they panicked nipping a financial crisis in the bud.

This move was controversial. Unfortunately many critics act as if the Fed was giving away $ 1,500,000,000,000 rather than buying assets with it. I hazard a guess that the Fed will profit from the operation (their efforts to save the financial system in 2009 generated the largest profits recorded in human history as an unintended side effect). However, it is also clear that the transaction amounts to a subsidy to banks. The Fed will pay a higher price than would have cleared the market. $ 1.5 Trillion will do that. Back in 2009 the Fed bought mortgage backed securities at the market rate when they were the only buyer in the market. This means that the open market operation was a massive subsidy (which also generated record profits).

The fact that the Fed pays much more than the market would without their intervention is pleasant for banks. Driving up the price of risky assets is part of the point of the operation. However it is also very irritating.

Fortunately someone figured out what they should have done. Walter Bagehot explained it clearly in 1873. The idea is that the central bank should lend freely accepting as collateral assets which would be accepted by private agents in normal times but not during the crisis. But Bagehot did not advise lending at the rate which prevailed before the crisis. Rather the maxim is lend freely at a penalty rate

 

First. That these loans should only be made at a very high rate of interest. This will operate as a heavy fine on unreasonable timidity, and will prevent the greatest number of applications by persons who did not require it. The rate should be raised early in the panic, so that the fine may be paid early; that no one may borrow out of idle precaution without paying well for it; that the Banking reserve may be protected as far as possible.

 

Another way of putting it is that the Fed should buy risky assets at a price markedly lower than the pre.crisis price and contract to sell them back to banks at normal prices after the crisis is expected to be over. This is the REPO is the same as a collateralized loan irritating finance terminology issue (also there is no O in repurchase so why the hell is it called a REPO).

Another way of putting it is that we don’t want solvent firms to go bankrupt and be liquidated. In plain English this means if one can save a firm with a loan, then one should. The idea is that the firm should still exist when the crisis is over. In other words, the shares of the firm will still have positive value and won’t be worthless pieces of paper.

Bagehot’s point is that we also want that positive value to be low. Firms (which must be depositary institutions according to the Federal Reserve Act) should still exist even if they have to borrow from the lender of last resort. But to make sure it is the lender of very last resort, they shouldn’t be worth much.

Any value of a firm which needed the lender of last resort is basically a gift to owners who messed up and a moral hazard.

To combine this with the need for equity capital, it is possible to TARP, that is make the penalty rate loan junior to other debt as preferred shares not bonds.

Another point is that sometimes obtaining annual profits of only $97,700,000,000 is not satisfactory performance.

The main point is that if the Fed can make $97,700,000,000 while also granting a massive subsidy, then the previous arrangement was not efficient. The problem is that entities with deep but not infinitely deep pockets can’t always bear risk. The solution is for the government to be the residual claimant. That’s called socialism and the market says it works.

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Life in Rome

I am in a city with a curfew (enforced ?) where only pharmacies, supermarkets and those stores where someone from China sells all sorts of household stuff are open. Rome hasn’t reached the dread levels of Wuhan and Milan, but the Italian government is trying to get ahead of the curve.

It is strange and alarming that there is little traffic (it is also impressive that Romans don’t obey the traffic code even when there is little traffic). People are really trying to stay home all the time (I was semi home bound before it was cool).

I have learned about the activities which people consider absolutely necessary. A large fraction of people walking around are walking dogs. Many people are wearing masks (absolutely sold out everywhere) and gloves. I discover there are some things I have to touch. These include an ATM (alarmingly often) and cash.

One striking thing is that people wait outside of the supermarkets and pharmacies. This is a rule that does not have to be enforced — people are scared. Good thing it’s not cold in Rome during March (or February or actually ever at all in the globally warmed year of our lord 2019/2020). This makes me notice the high rates of infection in Iceland and Norway. I guess up there (where I have been in July with a rain coat) the choice is risk of Covid 19 or of frostbite.

The extreme measures (not just ordered but orders which are actually obeyed, by Romans) are impressive because as of the day before yesterday there were only 200 cases in Lazio (region which includes Rome). The fact that one of the cases was governor Zingaretti (also head of the Italian Democratic Party) might have made a difference.

The news spreads even faster than the virus. Down here the health care system is under strain but not overwhelmed (yet) but people read about (and see on TV) reports on how in Lombardy Triage has reaquired it’s original meaning. During World War I, It was red = critical, yellow = serious monitor but not critical, black = doomed. In normal times black now means deceased.

In Lois Armstrong Airport New Orleans during Katrina there were living people with black tags (for will not survive a flight and so will die here). I was appalled. Now in parts of Northern Italy there aren’t enough respirators for patients who would die without one. This is part of why the Italian case fatality rate is high. It is also important that Italians have had low fertility for decades and are old on average.

I guess I haven’t written anything that people don’t know already. I will update when the wave of contagion overwhelms us. I fear that I will be giving readers a hint of future action in their home town.

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Novel Coronavirus and Better Unsafe than Sorry

It is possible that a known pharmaceutical called remdesivir inhibits the reproduction of the Covid-19 coronavirus. It inhibits (some) RNA dependendent RNA Polymerases — the type of enzyme the virus uses to replicated its genome and express its genes. It is known that it is a potent inhibitor of the RNA dependendent RNA Polymerases used by the MERS coronavirus

update: here is a good site for Covid-19 data.

So what will be done with remdesivir ? What should be done ? Is what will be done anything like what should be done ?

I think I can guess what will be done. Different groups will work on different projects. Some labs will attempt to produce and purify the Covid-19 RNA dependent RNA polymerase to check if remdesivir inhibits it too. The patent holder, Giliad Science will start a two Phase III trials of remdesivir. Results will be reported and then the FDA will decide whether to approve it for use.

This is good as far as it goes, but I don’t think it goes close to far enough.

I think that aside from the trials, Remdesivir should be given to patients and contacts of patients. It is known to be safe (from the trial which shows that it doesn’t cure Ebola). Also a whole lot of it should be produced starting a month ago.

The first proposal implies changing the law — making an exception to the Food and Drug Act. It also requires some organization without shareholders to bear the liability for side effects (The bill should make the US Federal Government liable). It goes completely against the standard logic that it is against patients’ interests to treat them with unproven drugs. There are two reasons to abandon that logic. First it is unconvincing in general. Second the risk of reacting too slowly to a budding pandemic is huge.

The mass production of Remdesivir is a simpler decision. The risk is a high chance of wasting tens or hundreds of millions of dollars. The risk of business as usual is a small chance of tens of millions of deaths, because drug shortages prevent effective control of the epidemic.

The logic of regulation and policy is first do no harm and better safe than sorry. Safety is not currently possible. A small c conservative approach is also small c crazy.

update:

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The Economic Anxiety Hypothesis has Become Absurd(er)

I am old enough to remember when many very serious people ascribed the rise of Donald Trump to economic anxiety. The hypthesis never fit the facts (his supporters had higher incomes on average than Clinton’s) but it has become absurd. The level of self reported economic anxiety is extraordinarily low

Gallup reports “Record High optimism about Personal Finances in U.S.” with 74% predicting they will be better off next year.

Yet now the Democratic party has an insurgent candidate candidate in the lead. I hasten to stress that I am not saying Sanders supporters have much in common with Trump supporters (young vs old, strong hispanic support vs they hate Trump etc etc etc). But both appeal to anger and advocate a radical break with business as usual. Both reject party establishments. Also Warren if a little bit less so.

Trump’s 2016 angry supporters still support him *and* they are still angry. He remains unpopular in spite of an economy performing very well (and perceived to be performing very well).

Whatever is going on in 2020, it sure isn’t economic anxiety.

Yet there is clearly anger and desire for radical change.

I don’t pretend to understand it, but I think it probably has a lot to do with relative economic performance and increased inequality. I can’t understand why the reaction of so many Americans to this would be to hate immigrants and vote for Trump, but, then I don’t watch Fox News.

One other thing which it isn’t is rejection of the guy who came before Trump. Obama has a Real Clear Politics average favorable rating of 59% and unfavorable of 36.1 % vastly vastly better than any currently active politician. (Sanders is doing relatively very well at net -2.7 compared to Obama’s + 22.9) He is not rejected. He is not considered a failure. Yet only a small majority is interested in any sort of going back to the way things were.

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Andrew McCabe is not a Ham Sandwich

I am not a lawyer, but I think lawyers agree that grand juries are a pointless relic of the middle ages. There’s nothing to be done, because they are mentioned in the 5th amendment, but they are silly. Over here east of the English Channel they don’t exist. Decisions about possible indictments are made by judges.

One problem with grand juries is that the prosecutor is the only lawyer allowed in the room (unless a witness happens to be a lawyer). Also, since there isn’t yet a defendant, targets or possible future targets can’t present their case. So, the cliche is that a commpetent prosecutor could convince a grand jury to indict a ham sandwich. There is, it seemed, no limit to the feebleness of a case sufficient to enable a prosecutor to convince jurors to indict. Note the past tense of “seemed”.

Thus my interest in the extremely boring case of former sometimes acting FBI director Andrew McCabe (they guy who was fired 2 days before his pension vested). He is accused of being other than frank when discussing the possibility of misconduct which harmed Hillary Clinton. This makes him a minor player in Trump’s deep state fantasy in which everyone who has anything to do with any investigation of Trump is alleged to be an anti Trump criminal based on any alleged misconduct (which is usually misconduct harmful to Hillary Clinton because there was a whole lot of that).

The DOJ has just announced that the investigation is closed and that no charges will be sought (note the difference from the Comey press conference about how no charges against Clinton would be sought even though she dd not meet James Comey’s exalted ethical standards and respect for rules [other than the one he was breaking by calling a press conference]).

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Three Cheers for Aigerim Toleukhanova

She’s the reporter who asked Secretary Pompeo “Did you retaliate against NPR?” and what sort of message that sends to countries “whose governments routinely suppress press freedoms?”. I was already impressed that the US secretary of state was getting a lesson on respect for the free Press in Kazakhstan whose dictator used to be the general secretary of the communist party of the Kazakh Soviet Socialist Republic (and has been in office ever since and Nursultan Nazarbayev holds the title of “Leader of the Nation.”

But now I learn she works for the US government at propaganda Radio Free Europe/Radio Liberty (not even the relatively normal Voice of America).

I think she is now officially a subordinate of Sect Pompeo (they used to be funded by the CIA but the secret leaked when I was in elementary school). In any case, that woman has ovaries.

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Ballance in The Washington Post All Time Silver Medalist

Senate to emerge from impeachment trial guilty of extreme partisanship, Paul Kane

The absolute need to balance blame for Republican partisanship with false claims about Democrats overcame Mr Kane’s interest in elementary logical consistency. He wrote

none of the rank-and-file senators made a single real effort to negotiate their own compromise on witnesses.

“Nope. I’ve made phone calls, I’ve sent emails,” Sen. Christopher A. Coons (D-Del.) said Friday. “And the returns have been polite but brief.”

So his proof that there was not a “single real effort to negotiate” is based on describing an effort to negotiate. Evidently, Senator Coons is not a rank and file Senator.

This is just the most extreme example of undying devotion to Jack Ballance, which is stronger than any interest in logical consistency. Immediately before, Kane asserts with no evidence whatsoever, that Democratic Senators had their arms twisted by Schumer and resented it

“For all their griping about the firm grip McConnell and Senate Minority Leader Charles E. Schumer (D-N.Y.) have on their caucuses, ”

The entire “news analysis” presents no evidence of such griping in the Democratic caucus. Not only is there not a named source (corresponding to the explicitly griping Lisa Murkowski) but there is no un-named source, nor any reference to any news article which contains any hint of such griping.

He presents no evidence that Schumer had to twist arms to convince a Democrat or an Independent that there should be witnesses at a trial. He asserts this as a fact, but does not feel any need to provide the hint of the shadow of a clue that there is anything behind his assertion except for his own fanatically blind ideological centrism.

Also right after the block quote he asserts

“Just 16 months ago, Coons and then-Sen. Jeff Flake (R-Ariz.) angered both leaders when they forced an extra week of consideration of the nomination of Justice Brett M. Kavanaugh,”

I am aware of no evidence that the delay in the confirmation of Kavanaugh angered Schumer. I think there is no such evidence. I think the word “both” was added due to blind fanatical bothsidesism.

Kane laments the change from the Senate in which Coons and Flake reached a bipartisan compromise. A casual reader would assume he is saying that Coons has changed and is no longer willing to make a “real effort to negotiate”. He should not assume that all Post readers know that Coons didn’t compromise with Flake this time, because Flake is no longer a Senator. T

The reason for the change is clear. After the Republicans picked up two seats, there are at least 50 disciplined Republican Senators who can be counted on to put loyalty to the party above loyalty to the country, the constitution and their recently sworn oath.

The Senate hasn’t become more partisan (more Republicans voted with the Democrats this time). It has become more Republican. That is why it has ceased entirely to fulfill its constitutional role.

Now I don’t insist that Kane reject the Republican party, but I do insist that he never reject facts and logic again. I think it would be best for him to quit and look for a job which he is willing to do.

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Two Chears for Nicholas Fandos

The standard rule that reporters cover both sides of a debate and find some source to contest lies rather than doing it in their own name (and the name of the newspaper) has not survived Mitch McConnell’s office.

In the New York Times, Nicholas Fandos notes that “A senior Republican aide in the Senate” lied on a very simple fact which is in the public record.

The aide, speaking on the condition of anonymity to detail internal strategy, argued that in doing so, the House had denied Mr. Trump proper due process rights afforded to Mr. Clinton, suggesting the current president was not given a chance to contest the House’s record.

The House invited Mr. Trump to mount a defense before the Judiciary Committee during its impeachment proceeding, including requesting witnesses and documents, but the president’s legal team declined, saying it would not dignify an inquiry it deemed illegitimate with a response.

So it is very good that the lie was clearly described as a lie. I accept the Grey Lady’s style which does not allow the use of the appropriate plain English words “lie” or “lied”. I think it would be better to have written that a source resorted to flat out lies when attempting to justify McConnell’s decision to break his work, without quoting the lie and just noting that the source lied. But I don’t expect to convince anyone.

However, I do not think that anonymity should be granted without the qualifier that the reporter will name the source if the reporter is convinced that the source lied.

I do not think anything is gained by allowing people to infect the discussion with flat out lies. Reporters will not recklessly burn sources in ambiguous cases, as that will be punished. Reporters will be punished for adding the qualifier. Therefore, I think it must be made a matter of policy that reporters are not allowed to hide the names of liars.

I note also that the justification for the grant of anonymity is based on another lie. The aid aims to convince the public with an argument. The claim that the deliberation was meant to be private is simply another lie. This shows the worthlessness of the rule that reporters must explain why they grant anonymity. The practice is to report a lie used to request anonymity as an un-contestable truth.

Also, I am not a lawyer, but I think that the senior aid slandered the House of Representatives and its Judiciary Committee. The claim is false. It is a matter of very public record that it is false. Needless to say the House of Representatives is as public a figure as there can be, and Senate aids are as close to having “speech or debate” immunity as is anyone who doesn’t actually have that immunity. Given those considerations, I think the aid is liable for slander. The statement was a damaging flat out lie. He or she must have known that it was a lie. The highest possible standard is very low compared to the level of the tort.

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John Lewis should read this

American hero John Lewis has Pancreatic Cancer.

He should look at these two studies of the only treatment that has actually worked and a similar treatment.

Also read this article in The Lancet.

and in particular “Of the 18 patients given the maximum tolerated dose, 11 (61%) achieved an objective (complete or partial) response.”

American heroine Ruth Bader Ginsburg might also be interested if she has a relapse.

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