Relevant and even prescient commentary on news, politics and the economy.

Healthcare Insurance Coverage Information

The Kaiser Family Foundation has put up  comparisons of one new way (if passed) to obtain healthcare coverage and two existing ways of obtaining healthcare coverage (subsidized coverage) for those who lost job-based health insurance since in the Covid-19 pandemic. I had talked about two of the ways previously.

Options

The two existing options (besides over priced Cobra) are:

  • Medicaid, for which 47% of those lacking insurance are eligible (Kaiser’s estimate) and,
  • ACA Subsidized Marketplace Coverage, for which 31% may be eligible dependent on income.

A third possible option alluded to above is the subsidization of 100% of the cost of COBRA (now 65% subsidized of cost of employer sponsored healthcare) premiums as provided in the House  HEROES Act recently passed. This new bill could win some Republican backing in the Senate even with McConnell blocking it and calling for a stipulation to be inserted in the bill to release companies, providers, hospitals, etc. of liability. As written, the Heroes Act would be a windfall for employers, healthcare providers and insurers as well as individual recipients. The first three pluses favoring Republicans are likely to support.

Comparisons

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Trump Issues an Executive Order and . . .

Yea, Trump Issuing another Executive Order is a big so-what. What else is new?

This one is a little different and concerns social media websites.

“In a country that has long cherished the freedom of expression, we cannot allow a limited number of online platforms to hand pick the speech that Americans may access and convey on the internet.  This practice is fundamentally un-American and anti-democratic.  When large, powerful social media companies censor opinions with which they disagree, they exercise a dangerous power.  They cease functioning as passive bulletin boards, and ought to be viewed and treated as content creators.

The growth of online platforms in recent years raises important questions about applying the ideals of the First Amendment to modern communications technology.  Today, many Americans follow the news, stay in touch with friends and family, and share their views on current events through social media and other online platforms.  As a result, these platforms function in many ways as a 21st century equivalent of the public square.

Twitter, Facebook, Instagram, and YouTube wield immense, if not unprecedented, power to shape the interpretation of public events; to censor, delete, or disappear information; and to control what people see or do not see.”

The Executive Order then goes on to complain about;

  • Flagging” content as inappropriate, even though it does not violate any stated terms of service,
  • making unannounced and unexplained changes to company policies that have the effect of disfavoring certain viewpoints, and
  • deleting content and entire accounts with no warning, no rationale, and no recourse.

Trump complains about Twitter placing warning markers on comments favoring his agenda and ignoring commentary on Russian collusion which everyone knows is a hoax??? Good thing he does not come to Angry Bear we would spam him for the loon he actually is.

Fear of Getting COVID-19 Can’t Be Used As An Excuse To Vote Absentee

The Texas state supreme court reversed lower courts decisions declaring coronavirus a valid excuse to vote absentee. The lower courts had ruled a lack of immunity to Covid 19 is an adequate reason to be able to vote absentee. While the Texas SC did levy some leeway to their decision, voters suffering  additional health conditions making them vulnerable to the virus could still cite the “disability” excuse to vote absentee. Several justices filed concurrences, but none wholeheartedly adopted the Democrats’ and voter groups’ arguments.

On the federal level, a federal trial court judge sided with the Democrats, but that decision has temporarily been put on hold while the conservative U.S. Court of Appeals for the 5th Circuit hears the case.

Of course, the Texas AG has stated he will still go after those he believes violated state election law.

And “when looting starts, shooting starts

And with a wee bit of urban poetry, Trump tosses out his wisdom  jive to warn rioting protestors in Minnesota who are angry over the perceived murder of an African American by the Minneapolis police officers. The 3rd Precinct of the city’s Police Department and the base for the four officers involved in the incident was broken into and set on fire by protestors after they broke into the building.

I think I would have used “the” before shooting and looting.

Trump drops another pearl  at our feet tweeting; “These THUGS are dishonoring the memory of George Floyd, and I won’t let that happen.” If anyone can believe this, let me know. Trump had no qualms about displaying his racism pre-presidency and afterwards. You can tell it is an election year.

Mayor Jacob Frey responded to Trump’s usual deflections; “Weakness is pointing your finger at somebody else during a time of crisis. Donald Trump knows nothing about the strength of Minneapolis.”

It will be interesting to see how the DOJ responds to Trumps call for an investigation as AG Barr has already shown his prejudice against people who are perceived to be disrespectful of police officers.

 

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Mask-less While Standing in A Crowd

This is the same stuff/sh*t, I am seeing in Michigan. I wish I could give them one week of Covid so they could learn. The following is from Digby at Hullabaloo:

I just watched another 60 something mask-less Republican woman in Arizona standing in a crowd of others just like herself tell the news media that she thinks the Coronavirus is not worse than a cold or the flu and she has no fear of it. (She also weirdly said that they don’t even have a name for it yet, which she didn’t explain.)

Maybe she will listen to this fellow:

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The Cass County, Indiana, Easter Effect

As noted in my last post, I have been looking at data. This usually causes trouble, and today is no exception.

As anyone who was paying attention predicted, the “Easter Effect”–a large gathering of people (“EC” or Otherwise) in an enclosed area that likely has multiple asymptomatic carriers (and likely a few with symptoms) is a recipe for infection. With a two- to three-week gestation period, that there was going to be an increase in cases at the end of April was well known. The only question was how much. Without running the numbers carefully, it looks as if it was about 10% above trend.

But the overall data covers for a lot of local sins. If you look at the places that have a high percentage of people infected, the relatively large Metropolitan Areas are no surprise: Providence, Worcester (MA), and NYC suburbs and exurbs (think Rockland, Westchester, Nassau, Suffolk, and Orange Counties in NY State; Passaic, Union, Hudson, Bergen, and my own Essex County in NJ).

But Cass County, Indiana, is running at over a 4% infection rate. With a County size of about 38,000 people, they’re reporting just under 1,600 cases.

Will anyone be surprised that those cases were not evenly distributed? Not really convinced this is what people have in mind when they say, “He is Risen”:

My source is the New York Times’s County-level data (h/t Charles Gaba at acasignups.net); their source is probably the Indiana State Deparment of Health, which has been getting an A+ for their data from the Covid Tracking Project.)

Data excerpt attached below.

CassCountyTable

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Hydroxychloroquine After Action Report

I was a vehement advocate of prescribing hydroxychloroquine (HCQ) off label while waiting for the results of clinical trials. I wasn’t all that much embarrassed to agree with Donald Trump for once. Now I feel obliged to note that my guess was totally wrong. I thought that the (uncertain) expected benefits were greater than the (relatively well known) costs.

The cost is that HCQ affects the heart beat prolonging the QT period (from when the atrium begins to contract to when the ventrical repolarizes and is read to go again). This can cause arrhythmia especially in people who already have heart problems. I understood that one might argue that all people with Covid 19 have heart problems but didn’t consider that argument decisive (I probably should have).

The positive expected value of the uncertain benefits was based on strong in vitro evidence that HCQ blocks SARS Cov2 infection of human cells in culture. (this is a publication in the world’s top general science journal).

Already in early May, there was evidence that any effect of HCQ on the rate of elimination of the virus must be small. In this controlled trial conducted in China, the null of no effect is not rejected. Much more importantly, the point estimates of the effects over time are all almost exactly zero. I considered the matter settled (although the painfully disappointed authors tried to argue for HCQ and that their study was not conclusive).

There are now four large retrospective studies all of which suggest no benefit from HCQ and two of which suggest it causes increased risk of death. I am going to discuss the two studies most recently reported.

One is a very large study (fairly big data goes to the hospital) published yesterday in The Lancet. In this study patients who received HCQ had a significantly higher death rate with a hazard of dying 1.335 times as high. The estimate comes from a proportional hazard model with a non parametric baseline probability and takes into account many risk factors including crucially initial disease severity. It is also important that only patients who were treated within 48 hours of diagnosis were considered.

I am, of course, dismayed by this result. I am also puzzled, because it is quite different from the result obtained in a smaller retrospective study published in JAMA

I think the practical lessons are that it seems unwise to give Covid 19 patients HCQ. Also maybe Robert Waldmann should be more humble. After the jump, I will discuss the two studies in some detail and propose an explanation of the difference in results.

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Who Ordered This Stuff?

I am reading this on Bloomberg entitled “Saudi oil rush threatens to disrupt stabilizing U.S. oil market.”

These shipments are planned, Saudis are not sending this over out of the goodness of their hearts. Furthermore, the shipments themselves take roughly 21 days to get to the US. The orders were placed over 3 weeks ago. When you have a lot of US capacity which produces at a higher price and we are seeking to become oil independent and we are seeking to become manufacturing independent; why would you destroy your capability if we want made in America product? Who is the perpetrator?

Bloomberg: “Over 30 tankers laden are set to arrive in the U.S. Gulf Coast and West Coast during May and June, according to ship tracking data compiled by Bloomberg. The more-than 50 million barrels of Saudi crude on the water threaten to disrupt a positive supply development: U.S. crude stockpiles declined for the first time since January and inventories at the Cushing, Oklahoma storage hub contracted by the most in months.

Director of oil and products research at Morningstar Inc., Sandy Fielden: ‘The expected Saudi deliveries could push U.S. inventories back to builds depending on their timing. If the shipments land at a rate that isn’t balanced by falling production or an uptick in exports, then we’ll see a domestic build.'”

What a surprise. What he is saying here is if you see two shipments a week which surpasses demand rather than one shipment per week to match demand, inventory will build once again and prices will drop. Fracking as a business will decrease. Once again, we will be at the mercy of an unstable Middle East and now the Russians.

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The Amateur Epidemiologist II

I am interested in critiquing my understanding of the simplest SIR epidemiological model and also praising a critique of an effort to extend the model and guide policy developed by some very smart economic theorists.

First the useful point is that this post by Noah Smith is brilliant. As is typical, Smith argues that the useful implications economic models depend on strong assumptions so economic theory isn’t very useful. He praises simple empirical work instead.

I will discuss Smith contra Acemoglu, Chernozhukov, Werning and Whinston and Smith pro Sergio Correia, Stephan Luck and Emil Verner after the jump, but really Smith is better at presenting Smith than I am.

It made me wonder. In the simplest model herd immunity stops an epidemic when 1-1/R0 of people have been infected. R0 as I recently learned and everyone now knows is the number of people who would catch a pathogen from one infected person if no one had any resistence. Over time people develop resistence so Rt < R0. If 1-1/R0 of people are resistent, then Rt =1. A bit later Rt<1 so each infected person will lead to a geometrical decreasing series of expected infections so total infections would be 1-1/R0 plus a (small) constant over the number infected at that critical time t. The SIR has susceptible, infected and resistent. The idea is that if one has not been exposed one is vulnerable. If one becomes infected, one carries and sheds the pathogen for a while and then one recovers. After one recovers one is immune and won't get it again. The key assumption in the model is that for every infected people R0 people are exposed (and infected if not immune) and that those people are chosen at random out of the entire population. It is necessary to assume that spread is equally likely from Mr A to Ms B if they share a house or live on opposite sides of the country. This is a silly assumption and the model is the old model used to teach kids and not, I'm sure, current research. It is also the model always used to guide public policy decisions (see me contra benchmark models http://rjwaldmann.blogspot.com/2016/10/benchmarks-model-and-hypotheses.html ) In population biology and evolutionary biology the silly assumption is called "pan mictic" in economics it is called "random matching". The assumption is made very often because doing without it can get one stuck in really hard math. I would like to put a few minutes of effort into trying to figure out if the random matching assumption affects the level of infection needed for herd immunity (of course everyone knows it matters a lot). Below I will always assume R0 =3. Model 2 the population is actually divided into N equal subpopulations and there is no spread from one to the other. The disease starts with one case in one sub population. It will spread until a few more than two thirds of that population has been infected. Spread will stop when 1/(3N) of the whole population is infected. the relaxation of random matching assumption reduceces the incidence needed for herd ommunity by the factor N. This works for any N. Model 3 very like model 2. Half of people have innate immunity to the virus. People transmit the virus to on average 6 other people (on average 3 have innate immunity). the virus will spread until 5 of 6 are immune. that means (5/6)-(1/2) = 1/3 must acquire immunity (by getting infected). So 1/3 not 2/3. OK can we be sure that the number who will get onfected is less than 2/3 ? Consider Model 4. people live one to a square of an invisible chess board (which is a really big square) they transmit the pathogen to those with whoù they share an edge. R0 = 3 (I get it from 1 neighbor and early in the epidemic give it to my other 3 not yet infected neighbors). How many people get infected ? All of them Katy. The currently infected are always in the border zone between the resistent and the vulnerable. So R0 = 3 implies herd immunity will stop the spread at some level which ranges from 1/(3N) for N as big as I like, to 100%. R0=3 and a priori reasoning without arbitrary assumptions which we know are false and make for convenience tells us nothing at all. Without some assumption about mixing, matching, and population structure, the core SIR assumptions have no implications. Maybe economists and epidemiologists have more in common than we thought.

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Antiviral Rumors

Tired: Remdesivir
Wired: Merimopodib
Inspired: Both

Merimopodib (of which I just read for the first time) is an inhibitor of an enzyme used to make Guanosine. Viruses need a lot of Guanosine (and other nucleosides) to reproduce, so it is an antiviral. It can be taken orally and there is a known safe dose.

A preprint asserts that a combination of Remdesivir and Merimopodib completely blocks SARS-CoV-2 replication in vitro.

Here is the abstract

The IMPDH inhibitor merimepodib provided in combination with the adenosine analogue remdesivir reduces SARS-CoV-2 replication to undetectable levels in vitro [version 1; peer review: awaiting peer review]
Natalya Bukreyeva, Rachel A. Sattler, Emily K. Mantlo1, Timothy Wanninger, John T. Manning, Cheng Huang, Slobodan Paessler, Jerome B. Zeldis

Home Browse The IMPDH inhibitor merimepodib provided in combination with the adenosine…

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BRIEF REPORT
The IMPDH inhibitor merimepodib provided in combination with the adenosine analogue remdesivir reduces SARS-CoV-2 replication to undetectable levels in vitro [version 1; peer review: awaiting peer review]
Natalya Bukreyeva1, Rachel A. Sattler1, Emily K. Mantlo1, Timothy Wanninger1, John T. Manning https://orcid.org/0000-0002-2130-20541, Cheng Huang1, Slobodan Paessler1, Jerome B. Zeldis2

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel coronavirus responsible for the ongoing COVID-19 pandemic, which has resulted in over 2.5 million confirmed cases and 170,000 deaths worldwide as of late April 2020. The pandemic currently presents major public health and economic burdens worldwide. No vaccines or therapeutics have been approved for use to treat COVID-19 cases in the United States despite the growing disease burden, thus creating an urgent need for effective treatments. The adenosine analogue remdesivir (REM) has recently been investigated as a potential treatment option, and has shown some activity in limiting SARS-CoV-2 replication. We previously reported that the IMPDH inhibitor merimepodib (MMPD) provides a dose-dependent suppression of SARS-CoV-2 replication in vitro. Here, we report that a 4-hour pre-treatment of Vero cells with 2.5µM MMPD reduces the infectious titer of SARS-CoV-2 more effectively than REM at the same concentration. Additionally, pre-treatment of Vero cells with both REM and MMPD in combination reduces the infectious titer of SARS-CoV-2 to values below the detectable limit of our TCID50 assay. This result was achieved with concentrations as small as 1.25 µM MMPD and 2.5 µM REM. At concentrations of each agent as low as 0.31 µM, significant reduction of viral production occurred. This study provides evidence that REM and MMPD administered in combination might be an effective treatment for COVID-19 cases.

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Asking the Wrong Questions: Reflections on Amazon, the Post Office, and the Greater Good

The Greater Good

“If they can get you asking the wrong questions, they don’t have to worry about answers.” — Thomas Pynchon, Gravity’s Rainbow

 

Originally written in 2018 on the Save The Post Office blog and featured at Angry Bear in 2019, retired North Carolina Post Master Mark Jamison wrote on the issues facing USPS while in competition with Amazon, UPS, and FedX. The same issue has been brought to the forefront again with President Trump refusing to give a subsidy to the USPS, unless the USPS raises prices to deliver packages for Amazon, and also punishes Amazon’s Owner Bezos. The answer remains the same, “no” and Mark explains why.

I have not written or said much about postal issues for the last couple of years. After seven years of writing articles for Save the Post Office and other websites, as well as contributing numerous comments to the Postal Regulatory Commission, what more was there to say?

I spent thirty years of my working life at the Postal Service. I’ve put in countless hours reading USPS reports, OIG reports, GAO reports, and who knows how many pleadings before the PRC. I have written numerous articles about the general idea of the postal network as an essential public infrastructure, the arcane minutiae of postal costing and the actions of the PRC, and the machinations of a Congress that seemed more inclined to bloviate and posture than attempt to solve a serious problem affecting millions of Americans and thousands of communities, large and small, rural and urban.

I never stopped thinking about these issues, but what more was there to say? And why bother, really, when the politicians and managers that could actually make changes seemed inclined to let inertia and the status quo slowly erode the capabilities of the postal network while degrading hundreds of thousands of good middle-class jobs?

And then President Trump had one of those brain farts he periodically shovels out over Twitter.

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THE Important Graphic from April’s Unemployment Report

What happens when you downsize a large number of people? Well, it depends on the cohort downsized. In this case,

Figure 1

That’s correct; Average Hourly Earnings skyrocketed from $28.67 to $30.01: up $1.34.

For context, that one-month change matches the average hourly earnings growth from September/October of 2018 until March of this year–18 months of increases in a month. And all it took was eliminating the jobs of about 6% of the U.S. population (not just workers).

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