Coronavirus #5

Five days ago I computed and showed elsewhere Deaths/Cases from the coronavirus for Italy, Spain, Switzerland, and the USA. The ratios for Italy and Spain were several times those for Switzerland and the USA. Calculating the same ratios today shows (a) higher ratios for all four countries, and (b) Italy and Spain remain several times those for Switzerland and the USA.

This Worldometer page says the following about such ratios. "Once an epidemic has ended, [the case fatality rate] is calculated with the formula: deaths / cases. But while an epidemic is still ongoing, as it is the case with the current novel coronavirus outbreak, this formula is, at the very least, "naïve" and can be "misleading if, at the time of analysis, the outcome is unknown for a non negligible proportion of patients."

Of course, the ratio might be "naïve" and "misleading" if used to predict the ratio when the pandemic will end. However, that was not my purpose. My purpose was clearly to compare the countries' healthcare system's effectiveness of response to the pandemic, and I don't believe the above argument undercuts that. There is a competing explanatory hypothesis -- Italy and Spain have a higher fraction of their populations ages 65+. But I am keeping my doubt that age differences fully explain the fatality differences.

Italy and Spain both have far more government control of healthcare and health insurance than Switzerland and the USA. Italy and Spain also spend far less per capita. They are indicative real world examples of single-payer healthcare and Medicare for All. Bernie Sanders and Medicare for All promoters advocate both much more government control and spending far less.

Doctors in Italy have said there is a severe shortage of ventilators and younger patients have higher priority than older patients. This doctor tearfully says the same about Spain. Yet an advocate of Medicare for All, whom I wrote about three days ago, naïvely asserts by innuendo that there will be no waiting lines if there is Medicare for All. Tell that to those older patients in Italy and Spain. At the latest count Switzerland has more cases per 1,000 population than Italy and is not far behind Spain. Yet in Switzerland there is much more concern about a shortage of staff than there is a shortage of ventilators (link). 

Coronavirus - Medicare for All

This article argues that ‘The coronavirus is making the case of Medicare For All even stronger.’ In my opinion the argument is feeble and includes plenty of cherry-picking.

It describes the USA as merely a “for-profit” healthcare system, whereas the USA is already Medicare-for-all-over-age-65 and the majority of hospitals are non-profit. It insinuates that rationed care and waiting lines are symptomatic of a “for-profit” healthcare system, and implicitly assumes rationed care and waiting lines will not be the case if the USA adopts Medicare-for-All. 

Their comparison fails to include Italy, Spain, and Switzerland. Italy and Spain have two of the most Medicare-for-All like systems in the world. Their healthcare spending per capita is much less than Switzerland's or the USA's, like Medicare for All advocates assert it should be. Italy and Spain are doing comparatively poorly dealing with the coronavirus pandemic. Based on the Worldometer's latest statistics, Italy’s mortality rate (deaths/cases) is 10.19%. Spain’s is 7.58%. Switzerland has nothing like Medicare. While the government subsidizes its purchase, all health insurance is provided by private insurers. While Switzerland has even more cases per 1,000 population, the mortality rate (deaths/cases) is 1.65%, much less than Italy or Spain. The USA’s is close, 1.52%.

The article lauds South Korea’s and Taiwan’s healthcare systems and cites the low impact of the coronavirus in the two countries. The author uses them as innuendo to assert that it’s because their healthcare systems are instances of Medicare-for-All. In fact South Korea’s is far from it. There is a national health plan. However: “77% of the population have private insurance. This is due to the fact that the national health plan covers at most 60% of each medical bill” (link). 

Taiwan’s healthcare system is more like Medicare-for-All. The mortality rate from COVID-19 is very low, but so is the number of cases per 1,000 population. I can’t explain the latter. See update below. The author asserts the existence of “high traffic with mainland China,” an innuendo that Taiwan's exposure to the coronavirus is as high as, maybe higher than, other countries. Anyway, the healthcare system has not faced a stress test similar to Italy, Spain, Switzerland, or even the USA.

Switching the topic, Bernie Sanders is the most vocal advocate of Medicare for All in the USA. He has also expressed his contempt for billionaires. His world view implicitly takes for granted a fixed supply of goods and services. How that supply comes about doesn't interest him. He has shown no understanding of it. He views billionaires as “profiteers” and greedy hogs of that supply he takes for granted, depriving other people of their “fair share.” He regards the existence of billionaires as a "moral outrage." Contrary to his world view, multi-billionaires Elon Musk and James Dyson are working on producing more ventilators in the battle against the coronavirus. In Bernie’s ideal world, they would not have the money they are pouring into these efforts.

Update 3/27: Fear of China Made Taiwan a Coronavirus Success Story

Coronavirus - finance #2

Firstly, the Families First Coronavirus Response Act is enacted law and hence apart from the not yet (7:00 a.m.) enacted legislation to pay $1,200 ($500 for children) to about 90% of the US population and provide unemployment compensation. It pertains to sick leave and family leave.

TurboTax summarizes the Act here. The following list is more brief, showing only the topics.

Relief for Regular Employees
- Emergency Sick Leave.
- Paid Sick Leave.

Relief for Self-Employed and Small Businesses
- Self-Employed Tax Credit for Sick Leave.
- Self-Employed Tax Credit for Family Leave.
- Small Business Tax Credit for Paid Sick Leave.
- Small Business Tax Credit for Paid Family Leave.

MarketWatch has this story.

The relief for self-employed and small businesses is in the form of tax credits. Thus it is far from immediate and doesn't solve current cash needs brought us by the pandemic shutdown. Of course, a self-employed person who makes estimated tax payments could reduce them. On the other hand, the self-employed people who don't make estimated tax payments don't have that opportunity. I bet the latter is the case for nearly all gig workers such as Uber or Lyft drivers.

Regarding the relief for regular employees, it appears there is no overall exception for an employer with only one or a handful of employees, which could be devastating for the employer. There is an exception for employers with less than 25 employees, but it appears to be about requiring the employee being able to return to work with the same employer after leave. One news article referenced by the Wikipedia page says, "Republicans were able to insert language exempting smaller businesses from the requirements." However, it wasn't clear what said exemption is.

Importantly, self-employed people are not eligible for unemployment compensation. That may change soon for some, e.g. gig workers. Related:
Unemployment benefit claims skyrocket to 3.283 million.
Coronavirus stimulus relief plea from self-employed to Washington: 'We need help now'

Coronavirus #4

Italy has been the country hardest hit by the pandemic. News coverage here in the USA often refers to Italy. I haven't heard or seen news stories about its neighbor Switzerland. (Italian is the main language in a southern part of Switzerland bordering Italy.) The following are stats captured only minutes ago from the Worldometer for the two countries.

Country	Total Cases	Total Deaths	Tot Cases/ 1M pop	Tot Deaths/ 1M pop
Italy	69,176	6,820	1,144	113
Switzerland	9,117	122	1,053	14

The number of cases per thousand population aren't greatly different, but the number of deaths per thousand population are very different. Why is that? I cannot thoroughly explain it. Part is probably that Switzerland's over age 65 population is somewhat smaller, 18.4% versus Italy's 23%. However, this might be offset by Switzerland's higher percent of smokers. I have some suggestive ideas. One big difference is per capita health care spending. Switzerland is second highest in the world -- the USA being #1 -- and Italy below average among OECD countries. Switzerland's per capita spending was $7,719 in 2016; Italy's only $3,391 (Link). Switzerland had more hospital beds per 1,000 population in 2017 -- 4.53 versus Italy's 3.18 (link).

Public and compulsory spending on healthcare as a percent of the total in Switzerland is somewhat  lower than Italy. I suspect the compulsory part for Switzerland is much higher, because the people are required to buy insurance with the government subsidizing the purchase. This page doesn't mention anything like Medicare. The compulsory health insurance is provided by private insurers. Unlike the USA, there appears to be no employer-provided health insurance.

Italy appears to have a Medicare-like system, but for all ages. In other words, it's Medicare for All. It's called the National Health Service. "In 2019, Italy's healthcare system was regarded, by World Health Organization's ranking, as the 2nd best in the world after France." Link. The WHO ranked Switzerland #20. Isn't that ironic? Yet Bernie Sanders wants the USA to be a lot more like Italy!

Edit 3/25/2020: Markets vs socialism: South Korea, Italy, COVID-19  Hat tip to dream_weaver.

Addenda 3/26/2020: Somebody replied to the above with the following point. There is no treatment for coronavirus, so I doubt that the healthcare system is what makes it different in this case.

I replied as follows. It seems more accurate to say there is no good cure for coronavirus.  This article is about treatment. Some patients have been given drugs experimentally, which has helped some, and many are recovering from the virus. Aren't ventilators, which are often in news stories such as this one, a treatment? If a patient with COVID-19 has great difficulty breathing, can be put in a hospital on a ventilator, and survives, that strikes me as better than no hospital and no ventilator.  It sounds plausible to me that the patient is better off in Switzerland than Italy or Spain.

One thing I read about recently that is attributed to the high prevalence of coronavirus in Italy (and Iran) is the “One Belt and One Road” (OBOR) initiative. See here and here.

Hope that helps.

Coronavirus - finance

I wrote the following three days ago elsewhere:

Trump-Mnuchin, Sen. McConnell, and Sen. Schumer have all proposed "stimulus" plans in response to financial hardships due to the coronavirus.

Relying on the news stories I have seen, Trump-Mnuchin's plan is stupid in my opinion. It pays everybody and hence is far off-target. Why send $1,000 to Warren Buffett, Bill Gates, Jeff Bezos, the Clintons, or even me? Why send $1,000 to people who are retired, people who still have good paying jobs, or are wealthy? Sen. McConnell's plan is quite a bit better. His plan gives $1,200 to singles with 2018 adjusted gross income (AGI) < $75,000 and married filing jointly couples with 2018 AGI < $150,000. It gives $0 to singles with 2018 AGI > $99,000 and married filing jointly couples with 2018 AGI > $198,000. However, the link between 2018 AGI and current financial difficulty is weak. While Sen. Schumer's plan lacks detail, I believe his basic idea of expanding unemployment compensation is far more on-target -- people who were employed, but lost their jobs due to the coronavirus. Many of them were in low-paying jobs that were hit hard, e.g. at restaurants. His plan is probably slower to implement, but its aim is far better. 

Since then I have learned some more details about McConnell's proposal. For low income folks the amount could be less than $1,200 and as low as $600. Also, any amount received could result in a lower tax refund after 2020. Finally, the IRS lacks the ability to act quickly or accurately. It will not be able to send so many payments as quickly as the pols want, and will make plenty of mistakes in the process (link).

Bernie Sanders wants to outdo both Trump-Mnuchin and McConnell (link). The latter two proposals of $1,000 or $1,200 stipulate a one-time event, with maybe a repeat later, e.g. in a few months. Bernie Sanders wants to give everybody -- no income test -- $2,000 "each month for the duration of this pandemic!" I thought he hated billionaires. Why does he want to start handing Bill Gates, Warren Buffett, Jeff Bezos, Mike Bloomberg et al $2,000 per month? The dictator-wannabe fascist shows total ignorance about producing and market distribution of goods or services and the skills and efforts needed to run a business. He often condemns profit like it is the root of all evil, and fails to understand that his salary as a Senator and his book royalties are or nearly are also 100% profit (since the costs incurred to obtain them are zero or negligible).

Elon Musk has said he could convert part of his business to produce ventilators and masks to deal with the pandemic. He has talked with Medtronic (symbol MDT), a maker of medical devices about ventilators and respirators. Suppose Musk's business or Medtronic do achieve said production. (Medtronic has already increased its ventilator production by more than 40%, and is on track to more than double its capacity in response to demand triggered by COVID-19. Link.) If revenues minus costs < 0, would Bernie Sanders say that is morally acceptable, even heroic? However, if revenues minus costs > 0, would Sanders say it is evil? Suppose an anti-coronavirus drug or combination of drugs is found that saves millions of lives and results in a drug manufacturer getting millions of dollars in revenue. Ditto for a vaccine. A big part of costs would likely be unclear. Regardless, I pose the same questions to Bernie Sanders. 

Coronavirus #3

I wrote on March 17: "Whether or not what's happened so far warrants the level of fearful reaction -- sometimes panic -- is a question better left for experts, not me or the general public, nor most politicians and media people."

My penchant for quantifying resists suppressing. Extrapolating numbers suggests that deaths in the USA will be well below annual deaths from flu. My extrapolating is risky in that I have no good way to quantify contagion - the extent of the spread of the virus, especially from asymptomatic transmission. Anyway, some crude numbers follow.

The number of new deaths reported by China is on the decline, which suggests the final death tally will be less than twice the number so far. As of the latest update, China's death tally was 3248. Twice that is 6496. Pro-rating for the USA's much smaller population suggests about 1,500 deaths in the USA. That is well below the low end of the range of annual deaths from flu.

Doing the same kind of extrapolation based on Italy -- where the severity relative to the population count is much greater than in China -- is more tentative. Italy may not have reached its peak yet. On the other hand, the percent of the population age 65+ and who smoke are higher than the USA's, and the Italian habit of hugging and kissing -- sadly -- helps the virus spread. Still, extrapolated deaths in the USA are in the mid-range of annual deaths from flu.

Doing the same kind of extrapolation based on Switzerland -- bordering Italy but with culture and health care more similar to the USA -- yields approximately 4,400 deaths in the USA. The latest USA tally is 276.

+++++++++++

There is some hopeful news.
French study finds anti-malarial and antibiotic combo could reduce COVID-19 duration

Here is a rather long article about the pandemic.
https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56
Be your own judge.

Coronavirus #2

This video of Dr. Drew Pinsky (thanks to Anthony) and this ProPublica article show very different opinions about comparing COVID-19 to a common flu. Dr. Pinsky compares them. The ProPublica author reporter Charles Ornstein stridently insists they should not be compared. By what standard? He gives four somewhat legitimate arguments, with nothing to say about how those situations may quickly change.  His worst argument is that the mortality rate -- when he wrote -- is several times higher than an ordinary flu!

1. Computing a mortality rate for COVID-19 at this time is premature. The denominator -- the number infected -- hasn't had time to be fully determined yet. A much higher tally of the denominator will very likely reduce the mortality rate.
2. He asserts that no public health official that he trusts has compared it to the flu. How many does he know and trust? Would he knee-jerk distrust any who did compare it to the flu? Does he trust any private health experts?
3. He says, "This coronavirus is unlike anything in our lifetime," while having nothing to say about SARS or MERS, which are also coronaviruses. Why not?

Charles Ornstein is clearly panic-struck. On the other hand, Dr. Pinsky says nothing about SARS or MERS. I add that despite SARS being first identified in 2003 and MERS being first identified in 2012, no vaccine has been developed for any coronavirus. Of course, massive efforts are now  underway to find one.

Lastly, here is a far more informative interview. Dave Rubin interviews Dr. Amesh Adalja, an infectious disease MD, about what most people need to know about the coronavirus pandemic.