Fallibility versus Bad Faith

To state the obvious, our institutions are not infallible.  They are made up of human beings, and they make mistakes, especially when acting on incomplete information.

COVID is an obvious case. There can be no doubt that our scientists made many mistakes.  They were uncertain how it spread and encouraged hand washing and surface cleaning, which turned out not to be a major form of spread.  They discouraged congregating in outdoors events, which later proved to be safe.  And they did not immediately recognize the importance of masks. They may have focused too much on halting the spread, resorting to lockdowns, and ignored the lasting social damage such actions could cause. They may have taken too much of a one size fits all approach, not recognizing that so densely populated a city as New York may have different needs from a more sparsely populated area.  And when the vaccine came out, they seriously overestimated its efficacy, believing it was 90% effective in preventing infection, which soon proved to be false.

Our right wing media and leaders point to each and every one of these mistakes and use them to claim that they were right and scientists and mainstream media were wrong all up and down the line.  But guess what. COVID was a completely new virus that never existed before.  Expecting our scientists to know everything about it from day one is completely unrealistic.  And yes, I get that it is frustrating to receive a torrent of ever changing advice, focusing on hand washing for a time and denigrating masks, and then later focusing on masks and denigrating hand washing.  But such is the nature of learning on the fly. As for vaccines, the usual practice is to test a new vaccine for five years before approving its use. Certainly if that had been done in the case of COVID, all its limitations would have been learned and matched with appropriate instructions by the time it came out.  Which would still be at least a year from now.

And while right wingers crow over every mistake that scientists and mainstream media made and take it as vindication, somehow they never mention their own mistakes along the way.  Like that COVID did not exist at all.  Or that it was a Chinese bioweapon.  Or that it was no worse than seasonal flu. Or that it would all disappear in April. Not to mention any number of completely nutty claims about vaccines and possible cures.  But somehow all of this either gets dropped down memory hole or is still claimed today.*

Much the same applies to denunciations of the FBI investigation of Trump for possible Russia ties. The FBI knew that Russia was hacking the DNC server and releasing the results through Wikileaks in a manner calculated to cause maximum harm to the Clinton campaign. They learned that a low-level Trump campaign staffer might have gotten advance notice. So the FBI suspected that there might be a channel of communication between the Trump campaign and Russian intelligence and began to investigate that possibility.  Ultimately, the investigation determined that no such channel existed, although it did uncover quite a bit of scandalous behavior by the Trump campaign with respect to Russia.  The conclusion by the right wing was that  no such investigation should ever have been launched. In other words, counter intelligence investigations should not be launched unless the investigators know in advance that the investigation will be successful. That's not how investigations work.  

By point of comparison, Congressional committees endlessly investigated Hillary Clinton's role in the attack on the US embassy in Benghazi in hopes of finding some misconduct that would sink her election chances.  No such misconduct was found, although it did turn out that Hillary sent State Department e-mails on a private server. How many Republicans would apply the same conclusion there -- that the committees should never have launched their investigations unless they knew in advance what they would find?

Much the same applies to right wing criticism of the Trump/Russia scandal. I will concede Republicans some points in advance.  The Steele Dossier ultimately turned out to be worthless.  Once it was published, a whole lot of Trump critics (myself included) were all too credulous that there was a well-developed conspiracy. There can be no doubt that media coverage went fairly far down the rabbit hole, speculating about what sinister things lay beneath the surface. It also over-interpreted some things that were visible on the surface. It turned out that there were no sinister Russian machinations behind the change in the Republican platform to remove a call for sending lethal weapons to Ukraine.  Jeff Sessions meetings with certain Russian diplomats were wholly innocent.  And so forth.  Right wingers tout all these things in order to demonstrate that the whole thing was a hoax and the mainstream media went off the deep end.

They prefer to ignore some of the genuinely scandalous things that the mainstream media managed to uncover.  Like that Trump's son and son-in-law met with Russian operatives offering "dirt" on Hillary.  Or that Trump had operatives trawling the dark web looking for Hillary's missing e-mails, unconcerned that they might be dealing with hostile spies.  And so forth.  

Still, right wingers do have a point when they complain that from the Trump election until the Mueller Report, the mainstream media went down the rabbit hole and spent way too much time pursuing conspiracy theories. How dare the MSM trespass on the right wing media's territory!

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*Not excusable are some of the things that scientists said on genuinely political grounds, such as discouraging masks as ineffective in order to save them for healthcare workers, or encouraging Black Lives Matter protests after denouncing anti-lockdown protests. These things deserve to be criticized as political and unscientific.  I just question some of the critics' standing to complain about anything being politicized.

Where Do We Go Now With COVID?

Clearly we are moving in the direction of normalcy -- in the direction of treating COVID like just another disease.  I don't think we are there yet, although maybe we might get there when the omicron wave dies down.  A lot of it will depend on whether the omicron wave is the last, or whether there will be future waves, a thing no one can know right now.  But assuming we do return to normalcy soon, it does not logically follow that we should have done nothing from day one, nor does it mean that we should refuse to take the sort of precautions against COVID that we would take against any other disease.  

Further thoughts:

When can we return to normalcy and treat COVID like any other disease?

Given continued reports of overloaded hospitals, I would say that it is still too early to drop all precautions and go back to everyday life.  So when will it be time?  I would say, when the healthcare system stops being overloaded.  And, given talk of pervasive but mild spread of Omicron with huge numbers of people sick but manageable numbers in the hospital, or with schools closing or becoming dysfunctional due to the large numbers of people out sick, I would say when there are not disruptive levels of absenteeism.  There are COVID pills out that are nearly 90% effective in preventing hospitalization, but in short supply.  Maybe if we are able to produce enough to actually reduce hospital admissions by that much, we can move on and return to normalcy.  And maybe normalcy will be a part-time condition, interrupted by occasional waves.

What will normalcy look like?

Well, here is the problem.  To a lot of people returning to normalcy means returning to exactly the way things were before the pandemic, including no vaccines and no need for testing and treatment.  But the same people who reject any sort of change, including taking vaccines, often seem to be willing to make changes in their lives, such as taking prophylactic Ivermectin, nebulizing hydrogen peroxide, or even drinking your own urine. So why do all that but refuse a shot?  So my "plan," such as it is, for dealing with COVID makes the unrealistic assumption that we have a reasonable population, though not a perfect one, something like the population of an Asian or Nordic country.  

What is a reasonable but not perfect population?

So what do I mean by a reasonable but not perfect population?  Roughly speaking, I mean a population that takes COVID seriously but gets pandemic fatigue, a population that is willing to take actions to fight the pandemic, but not unlimited actions, a population whose vigilance declines over time, a population that is best able to sustain actions that are not too burdensome and are most easily incorporated into a routine.  A reasonable but not perfect population would get the vaccine. It would be disappointed and somewhat resentful at finding out protection was short-lived, but would not reject the vaccine altogether.  It would get boosters, but go to less and less trouble to be boosted the more often it was required.  A reasonable but not perfect population would be able to tolerate (say) a two-month lockdown but not willing to return to lockdown under any but the most extreme circumstances.  It would get increasingly neglectful of distancing or hand washing or surface cleaning or home testing over time but not denounce any of them as intolerable tyranny.  It could probably sustain masks for a long time (masks aren't much work; Asian countries do it), but would be more likely to wear them in a public or commercial context than among friends, relatives, or coworkers.  In short, a reasonable but not perfect population would have normal human weakness but would not follow conspiracy theorists.  It would be willing to test after exposure, but limited in its tolerance for quarantine in the absence of either symptoms or a positive test.*

So what would a return to normalcy look like for a reasonable but not perfect population?

A reasonable but not perfect population would be willing to take the sort of precautions against COVID that they would against any other disease.  A reasonable but not perfect population would get vaccinated and get its boosters.  It might be necessary to take boosters into the schools or the workplace or every pharmacy or whatever to make it easy enough to get boosted. A reasonable but not perfect population would self-test if they had symptoms.  A reasonable but not perfect population would stay home if the test was positive (or maybe even it was negative; you really should stay home if you have a contagious disease).  This probably means a reasonable but not perfect population would have reasonable but not perfect employers and a reasonable but not perfect government that would arrange for paid sick leave for people with contagious disease, including paid sick leave to stay home with sick children.  Our reasonable but not perfect employers and government would also give people time off to get vaccinated and deal with after-effects, but would strongly encourage people in the same school/workplace/household to get vaccinated at different times to avoid everyone from being out sick at the same time.  Finally, a reasonable but not perfect population would seek early treatment if they had the disease. Incidentally, Paxlovid, the so-called COVID pill requires the patient to take three pills twice a day for five days.  A reasonable but not perfect person might get careless, so a little telemedicine, i.e., calls from the prescriber to make sure they were keeping up to date, might be in order.  Ditto for Remdesivir, which requires three IV infusions on three successive days.

What can would a reasonable but not perfect population do until then?

To all appearances, the omicron wave will subside well before there are enough therapeutics to keep the hospitalization rate low enough to allow a return to normalcy.  What would a reasonable but not perfect population do until then?  Once the omicron wave subsides, I think we can drop most restrictions and go to something only a little more restrictive than normalcy:

• Get vaxed.
• Get boosted.  (Make boosters as accessible as possible by coming into schools, work places, etc)
• Self test if you have symptoms (This would require our hypothetical reasonable but not perfect population to have a reasonable but not perfect regulatory regimen that does not make self-testing prohibitively expensive or difficult to find.  Other countries have done it).
• Stay home if it is positive. (Same comment on paid sick leave)
• Seek treatment if you are high risk

To this I would add the latest in culture wars -- asymptomatic testing.  Everyone should keep a stash of five or so home tests for use.  If you test positive, inform your contacts.  Your contacts should self-test each day for five days (or whatever is called for).  They don't have to isolate so long as it is negative.  If it is positive, they should quarantine, notify their contacts, and seek treatment if they are high risk.  I would also recommend that schools, work places, and other institutions keep a stash of tests.  If a student, employee, etc. has symptoms, they should test and isolate if positive.  Their contacts should be tested, quarantined if positive, but allowed to show up if negative, subject to daily testing for the next five days (or whatever is called for).  Schools in Los Angeles found this to be just as effective in stopping the spread as quarantining everyone, with mush lower rates of absenteeism.

However, asymptomatic testing is somewhat intrusive and does lead to higher rates of absenteeism than not testing.  The usual suspects are therefore arguing that asymptomatic testing is just a "soft lockdown" and that asymptomatic spread does not happen.  Of course the goal here is not to allow the disease to spread unchecked, which would lead to even higher absenteeism.  And whether or not asymptomatic spread is possible, presymptomatic spread is definitely real. In fact, people are often at their most contagious in the day or two before symptoms.  If true asymptomatic spread does not happen, maybe we can shorten the quarantine period to two or three days to determine who is truly asymptomatic and who is merely pre-symptomatic.  Or develop a good enough mask to allow asymptomatic or pre-symptomatic people to stay at work.**  Or maybe with enough vaccines and tests we will reach the point where the great majority of cases are asymptomatic and we truly can ignore them.

Finally, a reasonable but not perfect population with a reasonable but not perfect government would take advantage of the lull to stockpile tests and N-95 masks, explain the importance of N-95 versus cloth and improve ventilation, with priority to restaurants, bars and gyms because people could not mask there.  Maybe these precautions would be unnecessary, but they certainly are not burdensome.

What would a reasonable but not perfect population do during a wave?

If another wave were to hit a reasonable but not perfect population, they would wear high quality masks and use the ventilation systems they had installed in the interim. There is some reason to believe that if everyone wears a high quality mask, it will make a significant difference.  Maybe even enough, combined with good ventilation, that we truly can treat risk tolerance as a matter of individual choice, and that a person who likes frequenting no-mask venues like restaurants, bars, and gyms poses no danger to others.  Except that there is still the matter of overloading the healthcare system. And besides, restaurant, bar and gym owners presumably don't want to be seen as risky venues and centers of disease.  So what can you do?

Well, there has been a lot of talk and some action about requiring a vaccine card to attend a no-mask venue, which seems reasonable.  Maybe a reasonable but not perfect population could tolerate adding a negative test as a requirement.  (Rapid antigen test should be sufficient, though I can see some room for dispute how to handle it).  Large events (conferences, concerts, travel, etc.) should probably also require a negative test during a wave.  And, given that a reasonable but not perfect population will probably not be willing to wear masks in family and social gatherings, we should encourage everyone to test for such occasions.  A perfect population, with sufficient tests, would test routinely (say, twice a week) during a wave.  But that is probably too much to ask of real world people, except maybe for a very short time.

Why bother, if everyone is going to get it sooner or later?

Aside from not overloading the healthcare system, I can see at least two reasons.  One is that we don't know everyone is going to be infected sooner or later.  If masking, ventilation, and testing deprive the virus of victims, then it will die down and even die out. But even if the virus comes roaring back once people stop masking and testing, there are reasons to think later is better than sooner.  For one, we may get more treatments in the future that will end the risk of overloading the healthcare system.  For another, we may come up with an omicron specific booster so that infection won't be inevitable (even if it requires more boosters down the line).  Or even an Army super-vax that will not give out with every new variant (though who knows if it will require boosters).  In short, as with many things, it is worth kicking the can down to road to see if we can come up with a better long-term solution in the meantime.

That's all fine and good for a reasonable population.  But how to you talk sense into the actual, real-world US population?

Ummm --

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*I will get personal here.  I am a fine well-educated liberal willing to get boosted, wear masks, work from home, test in case of symptoms, etc.  But when I found out I was infected, I called my contacts and only urged them to get tested.  There was no way I was going to ask them to quarantine for 14 days!

**That would no doubt be popular with economic royalists, who would see it as a great way to keep symptomatic employees at work too.

Understanding Why COVID Vaccines Disappointed

 

Clearly COVID vaccines have been a disappointment.  When we first heard the announcement that there were vaccines that were 90% effective, we could hope the pandemic would finally be over and we could go back to normal.  It was actually fairly predictable that there would be new variants that would be vaccine resistant.  That is a routine occurrence with corona viruses and is the reason to get annual flu shots.  But the vaccine companies said if a new variant came about, they could simply plug in the new protein spike.

Well, it hasn't turned out that way.  It turns out that the protection from COVID vaccines wanes quickly and that new variants spread faster than companies can modify the vaccine and get it out.  What went wrong?

Possibly because normally the full test phase takes five years, but COVID vaccines were approved in less than one.  Moderna developed its vaccine within two days of receiving the virus sequence.  The delay was in testing.  By giving emergency use and cutting short the testing, we allowed a vaccine that we had limited knowledge about over the long run.  

This is not a criticism. On the contrary, given that the choices were approving a vaccine before we fully understood it and allowing the pandemic to continue without a vaccine, early approval was clearly the better choice.  But there were tradeoffs at work, and one such tradeoff was that we authorized the vaccine before working out the sort of bugs that would have been worked out with a longer trial period.

If trials had continued for five years, the vaccine manufacturers would have realized that immunity starts waning fast after 5-6 months and requires a booster.  They would, no doubt, have learned how long booster-driven immunity lasts and how often later boosters are required.  And when the announcement came out that drug manufacturers had a vaccine that was effective, but required six-month boosters, everyone would have known about its limitations in advance and not felt angry or betrayed when the vaccine turned out to have a limited duration.

Of course, we would also have had to face delta, omicron, and who knows what else without the benefit of a vaccine.

2021 Was a Bad Year, but Better Than 2020

Remember 2020

Let there be no doubt.  2021 has been a bad year.  But even at its worst, it has still been an improvement from 2020.

Consider a rough recap of the headlines from 2020.  Impeachment.  COVID.  Lockdowns. Panic buying.  Empty shelves.  No toilet paper. Anti-lockdown protests. Black Lives Matter.  Mass riots.  Devastating forest fires, with many people refusing to leave their homes for fear of Antifa.  So many hurricanes we ran out of names. Election.  Trump refuses to accept results.  COVID again, and the prospect of a long, dark winter.

And now a rough recap of 2021.  January 6 insurrection.  Inauguration. Vaccines.  A seeming return to normalcy.  Breakthrough infections. Delta variant.  Disastrous withdrawal from Afghanistan. High crime.  Inflation.  Supply chain problems.  Virginia election.  Omicron variant sweeping away all anti-COVID measures, and the prospect of a long, dark winter.

More 2020

Obviously it ain't great. The vaccine we had hoped would restore our pre-pandemic life turns out to offer only a short-lived protection against infection, with a longer protection against hospitalization and death, but even that (I suspect) will wear out. It turns out we need regular boosters, and that this virus produces regular mutations. At the same time, treatments have improved, and a highly effective treatment (and perhaps a more robust vaccine) are coming down the pike.  The economy has made a comeback, but consumption has outrun production, causing inflation, declining real wages, and shortages. Widespread shortages of staples have given way to spot shortages of various products that can be gotten around.  There has not been a return to widespread riots and civic disturbances, but crime rights are alarming.  Natural disasters have been bad, but not as bad as last year.  And so forth.

Or let me offer the comparison in table format:

	2020	2021
COVID	Rampant spread, inadequate testing, no vaccine or effective treatment	Vaccine, frequent breakthrough infections, omicron variant, beginnings of effective treatment
Economy	Lockdowns, widespread unemployment and business failure	Rapid recovery, consumption outpacing production, 6% inflation
Shortages	Widespread shortages of staples	Sporadic shortages of various products
Civil disturbances	Widespread riots	High crime
Natural disasters	Devastating fire season, so many hurricanes we ran out of names	Bad fire and hurricane seasons

So, yes, things are bad.  But it is still an improvement over 2020.

Do Right Wingers Have Anything Positive to Contribute to the COVID Debate?

 So, I am strongly critical of Joe Biden putting all his eggs in the vaccine basket, for not focusing on testing, ventilation, vaccinating the rest of the world, etc. But that is altogether different from saying that I think right wingers have any sort of standing to criticize him.*

Right wingers were dead set against lockdowns, and in the clear light of hindsight, they had a point. Lockdowns are not only extremely economically burdensome, they also have a high social cost that we have not yet recovered form. Lockdowns were necessary in places like New York where the initial outbreak was very bad, but perhaps they could have been avoided without too much cost in other places. In the clear light of hindsight, our side should have looked passed locking down to stop the spread and immediately prioritized stopping the spread without shutting everything down.

But the right-wing viewpoint overall has been opposition to any attempt to stop the spread, either on the grounds that everyone was going to be infected sooner or later, so let's get it over with, or on the grounds that any government action to stop the spread was tyrannical, and that the absence of government action was infinitely more important that the absence of pandemic.  Also present in the equation is the conviction that since zero COVID is not a realistic goal, there should also be zero mitigation.

So it, granted that vaccines alone are not stopping COVID, is there any approach that right wingers would support?

Masks

Masks, by contrast, have a much lower social cost that shutdowns.  Granted, they are somewhat hot and uncomfortable, but, for the most part, masks are indefinitely sustainable.  Asian countries such as Japan have been able to carry on in a mostly normal fashion while wearing masks.  In the early days of the pandemic, even Fox News personalities endorsed masks, largely because Anthony Faucci and oppsed them.  But when Faucci and the CDC changed their minds, why didn't Fox hosts just gloat that they were right and the experts were wrong and accept their victory?  The answer appears to have been, first of all, that it would remove masks as a culture are issue and, second, admitting that there could be a serious problem during a Trump presidency. So ever since CDC officials endorsed masks, masks have been intolerable tyranny.

Again, there are some legitimate objections to masks.  One is that cloth masks are of limited effectiveness.  That can be overcome by promoting surgical masks and (especially with the Omicron variant on the loose), N-95 masks.  The other is the complaint that if we always have to wear masks, what is the point of getting vaccinated.  So I will agree, there should be metrics as to when masks are and are not seen as necessary.

The biggest burden of masks, however, is to restaurants, bars, and gyms.  Clearly it is not feasible to wear a mask while eating or drinking, and masks seriously inhibit strenuous exercise.  So is there a feasible way to stop the spread of COVID in restaurants, bars and gyms without unduly burdening them and, if so, would right wingers agree to it?

Vaccine passports

The most obvious way to keep restaurants, bars and gyms to stay open without being major sources of spreading COVID is to require customers to present proof of vaccination.  Republicans all over the country have been fighting that tooth and claw as tyranny and demanding that the unvaccinated not be treated as second class citizens.  And, it should be added, there have been enough breakthrough infections, to say nothing of Delta and Omicron variants, to make clear that vaccine passports alone will not keep restaurants, bars and gyms from being sources of spreading COVID.

Testing

Then there is testing. Certainly if we had cheap and abundant rapid tests kits we would have a very useful tool in fighting the pandemic. Schools have found they can reduce absenteeism with no increase in contagion by testing students who may have been exposed and allowing them to stay in class so long as they test negative.  The same technique could be used in work places as well. People are being encouraged to test before social gatherings. If rapid tests were cheap and abundant, restaurants, bars, and gyms could avoid being spreaders by testing customers.  Ideally, people could even be encouraged to routinely self-test to see if they were infected.

In at least one sense, Biden has done us a favor here.  By clearly mishandling testing, he has taken the partisanship out of the issue. Now we can all denounce him for not getting enough tests out. Nonetheless, I don't recall any great rightwing clamor for more testing until the failing became so obvious as to make the outcry universal.  

And suppose we did have an abundance of cheap, rapid tests.  Can anyone doubt what the result would have been?  Does anyone believe that people who see masks, vaccine mandates, and vaccine passports as intolerable tyranny would submit to routine testing?  And certainly if the goal is to have no changes whatever in one's routine as a result of the pandemic, any suggestion of regular self-testing would be intolerable.

Ventilation

Once again, this has been a major part of fighting COVID in Japan. And improved ventilation would have the advantage of not making most people have to do anything at all.  I do recall one Twitter comment that this at last would be something that would not be controversial.  Color me unconvinced.

Why would anyone oppose improving ventilation?  Mostly because of the cost to business and the burden of regulation. Republicans generally oppose health and safety regulations as intolerable burdens to business.  Furthermore, large chains would be better able to afford the upgrades and mom and pop operations.  Of course, the cheapest and simplest way to improve ventilation is simply to open a window. But that can be quite uncomfortable depending on the season, and can let in flies and mosquitos.  And presumably there would be down time while the systems were installed.

Speaking for me, I would favor a major government investment in helping restaurants, bars, and gyms upgrade their ventilation. But let there be no illusions that even this would escape the culture war.

Treatment

The one thing right wingers are absolutely in favor of when it comes to COVID is finding an effective treatment. And effective treatment is certainly good, so far as it goes.  Still, it would be good to keep in mind the old adage that an ounce of prevention is worth a pound of cure. Speaking for me, I would be in favor of a COVID fighting approach that is about 80% prevention -- whether in the form of vaccines, testing, ventilation, or masks when necessary -- and about 20% treatment when prevention fails.  But then again, I am no expert.  Maybe prevention will just be so full of holes that something closer to 50-50 would be more realistic.  But the right wing view appears to be that any attempt at prevention is intolerable tyranny, and that our approach should be zero percent prevention and 100% cure.

Right wingers are currently in the process of gloating because all attempts at mitigation against Omicron have failed, thereby proving we should never have attempted mitigation in the first place, and should have focused entirely on cure.  And right wingers can correctly point to many mis-steps in the search for prevention.  But there have been plenty of others in the search for a cure.  I am thinking if a recent tweet by ant-vaxer Jesse Kelly:

I’m not anti-vaccine. I might have gotten one. I wanted to wait and see how it worked. But then you shut down all other treatments. And then you insisted people shouldn’t be allowed to work without one. Now you insist boosters are needed. I’ve seen all I need to see.

If I’m standing in a room with ten doors and you tell me to ignore nine of them and only take one, I’m gonna be a little suspicious. If you then start threatening me if I don’t take that one, well now I’m never walking through it.

It is unclear what the other "doors" he is talking about refer to. Certainly people on his side of the aisle have decisively rejected the mask door.  And, for the reasons cited above, just about any other prevention door.  So is he referring entirely to treatments?  Well, yes, plenty of treatments have been investigated and proven not to be effective.  Hydroxchloroquin, for instance, or Ivermectin.  Donald Trump's infamous speculations about using bleach can be dismissed as a brain fart, something so obviously dangerous that there was no need to worry about anyone actually doing it.  Rather more alarming was an attempt by Ben Carson and Mike Lindell to promote oleandrin, and extract from the oleander plant, and highly poisonous.  This struck me as more dangerous because most people would probably not know that oleandrin was poisonous and just might try it. Fortunately it never got anywhere.

And contrary to what Kelly says, there are other treatments now, most notably monoclonal antibodies.  To the extent Ron DeSantis has done anything constructive in this pandemic, it has been in making monoclonal antibodies acceptable to right wingers.  Except it turns out there are also problems with putting all your eggs in the monoclonal antibody basket. Monoclonal antibodies are of limited effectiveness against the omicron variant. Other treatments are coming down the pike, but they, too, are rolling out slowly.  But if putting all your eggs in the vaccine basket has proven ineffective, putting all your eggs in the cure basket has its failings as well.

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* I will give credit to my Republican employer.  He is a big supporter of tests and said that if Donald Trump had been President, he would have move to expand testing once vaccines failed.  Color me skeptical. Donald Trump has never been able to admit to making a mistake, and if he relied on vaccines, he would have a very hard time admitting failure.  On the other hand, I do believe that if Donald Trump had been President and the vaccines had failed, there would be a loud an vociferous chorus on the left for more testing.  

Biden and COVID: A C-minus to be Generous

 

A week or two ago, I could see COVID test kits on at least some pharmacy shelves.  In some places they were sold out, in some they were locked up and controlled, and in some places still plentiful. Currently they are sold out at stores, though still available online.  I felt mixed about this. Present on the shelves meant people were not buying enough.  Sold out meant not enough were being made.  Other countries have test kits everywhere.  Why can't we?

Vanity Fair and the Washington Post are running stories on the Biden Administration's abject failure to make tests cheap and plentiful, as they are in many other countries.  Biden's excuse -- the omicron wave was not foreseeable.  Maybe not, but the problem was obvious well before the omicron wave began.  It should have been obvious when Israel and the United Kingdom, ahead of us in vaccinations, began having a secondary wave of breakthrough infections.  It should certainly have been apparent when the delta wave began this summer.  I am no expert, but I have been beating this drum since August.  Public health experts have been making the argument from the start of the Administration.  And now Biden says he wishes he had acted two months ago. No, you should have acted at least six months ago.  I can excuse thinking that a vaccine that appeared 90% effective would be sufficient.  But by June it was apparent from evidence in Israel that immunity began to wane after about six months, and the delta variant was on the march.  At that point, it should have been apparent that vaccines alone would not be sufficient and you should have started looking at other options.

Vanity Fair outlines some of the bureaucratic obstacles to a better testing regimen:

Difficulties include a regulatory gauntlet intent on vetting devices for exquisite sensitivity, rather than public-health utility; a medical fiefdom in which doctors tend to view patient test results as theirs alone to convey; and a policy suspicion, however inchoate, that too many rapid tests might somehow signal to wary Americans that they could test their way through the pandemic and skip vaccinations altogether. These are obstacles.  They are not excuses.  The whole point of effective leadership is to cut through this sort of red tape.  A good start would be to free the tests from the FDA by reclassifying them as public health, rather than medical.  If that didn't release enough tests onto the market, invoke the Defense Production Act.  If that was still not enough, go on the same wartime footing for tests as for vaccines. 

And while the recent focus has been on tests there are other measures that Biden could have taken as well -- measures such as expanding production and distribution of N-95 masks, offering financial support for quarantines, improving ventilation, or ensuring that vaccination is international and world-wide.  That last is particularly important. Done right, it just might have prevented the delta and omicron variants from developing at all.

A few things I will say in Biden's defense.  First, the failure to get India and South Africa vaccinated in time to stop delta and omicron was the whole world's fault and not ours alone.  Second, omicron will probably swamp any possible testing response, no matter how good.  And, finally, regardless of what Biden did, it would no doubt become a culture war issue and meet with aggressive right-wing attempts to block it.  More on that in my next post.

Reflections on Omicron

 

Things feel very strange now -- terrifying and hopeful at the same time.  Terrifying that we are about to have the biggest wave of COVID yet, one that will dwarf all others, though it is expected to be brief.  Hopeful in that for the first time there is an effective treatment that may finally remove the danger of overloading the healthcare system.  Hopeful in that the US Army may come forward with a super-vaccine effective against all variants (though for how long remains to be seen).  Terrifying in that the treatment will take several months to be widely available.  We don't have months.  The Omicron wave will be receding before effective treatment, let along an effective vaccine, becomes widely available.  In the meantime, we are trying to put out a forest fire with an eyedropper.  

So, hell for the next month or so. And then, dare we hope for a return to normalcy?  Can normalcy return after the wave of hell?  Did it feel like this last November, when Pfizer announced its vaccine even as we braced for a long, dark winter?

Two strange quotes haunt me, quotes about hope and joy after terror.

One comes from the epilogue of Orson Welles' War of the Worlds radio broadcast.  We hear the catastrophic of Martian appearing everywhere, the army overrun, New York overcome by mysterious black smoke, and one last radio broadcaster asking is there anyone there.  Then a handful of survivors in an post-apocalyptic landscape, scrounging about until they find the Martian have succumbed to earth disease they had no resistance to.  And then, somehow, everything goes back to normal and the narrator gives the epilogue:

Strange to watch children playing in the streets. Strange to watch young people strolling on the green where the new spring grass heals the last black scars of the bruised earth. Strange to watch the sight seers enter the museum where the disassembled part of a Martian marching are kept on public view.

Very strange indeed.  How everything went from total destruction to as if nothing had happened is never explained.  (Listen to the broadcast, by the way.  It is most satisfyingly creepy.  In particular, the prologue about people going on about their lives, unaware of the looming catastrophe feels way too real when I look back on the beginning of 2020).

 The other quote is from the long-forgotten movie 2010: The Year We Made Contact, a sequel to 2001: A Space Odyssey. 2010 is a Cold War movie, about a joint US-Soviet expedition to Jupiter to find out what happened to the rocket ship that was lost in 2001.  Cold War tensions rise, both in the expedition and on earth, and WWIII seems eminent when Jupiter is transformed into a new sun, and this miracle inspires world peace.  (The problems a new sun would cause are unaddressed).  Yes, the whole framework seems laughable in retrospect, but the filmography makes it uplifting, especially the astronaut's message to his son, "Your children will be born in a world of two suns. They will never know a sky without them. You can tell them that you remember when there was a pitch black sky with no bright star, and people feared the night."

If this new vaccine and new treatment truly mean we can return to life as it was before the pandemic, that is the sort of message we should tell our children to tell their children.

Comments on Biden

Some accounts have suggested that Democrats did badly because Joe Biden is unpopular and is dragging them down.  I am inclined to this that over personalizes it.  Biden is unpopular because people are generally unhappy with how things are going -- whether COVID restrictions, gas prices, general inflation, crime, etc.  Interesting note: Quarterly growth fell to 2% annualized for the third quarter of 2021.  Joe Biden's popularity fell at about the same time.  Coincidence?  Possible, but it seems unlikely.

Will he get a boost from passing legislation in Congress?  Who knows?  Republicans are getting hysterical and calling it communism, but they never managed to build up the same sort of all-out outrage over the infrastructure bill or Build Back Better that they did over Obamacare.  My guess is the legislation will not have much effect one way or the other.  What will make a difference in improvement in overall conditions.

My assessment of Biden now is that is showing the strengths and weaknesses of a longtime Senator serving as President.

The strengths:  He is really good at the horse trading and wheeling and dealing to get complex legislation passed a deeply divided legislature.  After all, that is what me made a thirty-plus year career in doing.

The weaknesses:  He hasn't shown much executive competence, despite serving eight years as Vice President.  It is my understanding that his main role as Vice President was serving as liaison with the Senate in negotiating legislation. 

This raises an important question.  Is it, after all, a mistake to elect so many Senators as President.  Might it be better to choose state governors, who have more executive experience, and tend to be pragmatic and focused on getting things done.  A governor turned president could have a Senator as Vice-President to do the negotiating with Congress.*  An obvious objection might be that Democratic governors then to be blue-state governors who would seem too liberal for swing voters.  But there are other options like John Bel Edwards (Louisiana) or Tom Wolf (Pennsylvania).

What will make a difference is an improvement in overall conditions, meaning, primarily, the economy. 

The two main drags on the economy are COVID and supply chain issues.  Supply bottlenecks are also an important factor in inflation, which is a major source of discontentment.  

As for COVID, while everyone is fighting over vaccines, an effective treatment is now in the pipeline.  Biden should mobilize the same resources for manufacture and distribution of treatment that he did with vaccines.  Also testing.  Free home test kits from the FDA and reclassify them as public health.

There has been some improvement on the front, by the way.  Just a few weeks ago, when I went to order a home test kit online they were nowhere to be found.  Home tests can now be ordered, but they are still expensive and not widely available in stores.  We need home test kits to be plentiful as toothpaste.  I am hoping that test kits will be like hand sanitizer, gloves, masks, and other medical supplies -- nowhere to be found until suddenly they were everywhere.

Incidentally, Biden faces a dilemma here. Right now, widespread availability of testing is widely popular and has not become a culture war issue.  If he keeps quiet about ramping them up, he will not get credit.  But if he makes a big announcement, COVID testing will become yet another culture war issue that right wingers must resist at all costs.  And I have to wonder even in the absence of widespread announcements, if test kits become widely used, how long will people who see vaccine passes and masks as intolerable tyranny submit to testing.  My advice is to keep quiet.  If every drugstore has test kits, people will find them and use them, if only to know when they need treatment.

As for supply chains, I don't pretend to know, but Biden needs to focus like a laser on clearing them up.

And, of course, deal with any other crises that may come up, whatever they may be.

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*Other options:  Someone who has done both. Or someone who has served in Congress and held a Cabinet post.

Schools and School Boards: The Procedural Side

 I am firmly of the opinion that democracy is hard because it requires us to place procedure ahead of substance.  So any attempt to address schools and school boards has to start with procedural matters that shouldn't be hard, but apparently have to be emphasized.

Naturally I am inspired by the right-wing uproar over Attorney General Merrick Garland's memo calling on the Department of Justice to coordinate with local officials in dealing with threats to school board members.  The memo states "While spirited debate about policy matters is protected under our Constitution, that protection does not extend to threats of violence or efforts to intimidate individuals based on their views. Threats against public servants are not only illegal, they run counter to our nation's core values."  Naturally Republicans took this to mean criminalizing public comments at school board meetings. 

So let's start with some basic common sense.  Parents showing up at school board meetings to express their views is entirely appropriate.  Disrupting meetings, shouting down other speakers, and turning public meetings into shouting matches is not appropriate. Such conduct is especially inappropriate when done by activist from out of town, with no children in the schools, attempting to thwart the wishes of the majority, which has happened in some cases (though by no means all). That being said, such disruptions are merely inappropriate and not a crime, much less a federal offense.  There is no reason to prosecute such conduct, but it is entirely reasonable for school boards to remove disrupters from meetings and do is necessary to maintain order, just like any other public (or private) body.  And threatening school board members (or anyone else, for that matter), or stalking, trespassing, vandalism, or brandishing weapons are crimes and should be treated as such.  

This should be so much common sense and not at all grounds for controversy, but apparently some people are not able to distinguish between showing up at school board meetings and speaking and threatening school board members.  And, in fairness to the right wing, the National School Board Association letter that inspired the DOJ memo really did go too far, calling such threats and intimidation "domestic terrorism" and suggesting prosecution under the PATRIOT Act.  

I did some basic background looking into what federal laws might be invoked.  In general, I think it is best to make clear what is and is not considered a crime and what could not could not be subject to federal prosecution, so that people will have clear guidance on what is and is subject to prosecution.  (And yes, I realize this also communicates what loopholes to exploit).  The most obvious federal offense here is a federal ban on threats or extortion by mail or other "interstate communications" such as e-mail, texts, phones, etc.  Using any of these methods to send a ransom note for a kidnapping carries a sentence of 20 years.  Using these methods to threaten kidnapping or bodily harm with intent to extort money or any "other thing of value" carries a 20 year sentence.  Using these methods to transmit threats of kidnapping or bodily harm without extortion carries a sentence of five years.  Using these methods to threaten damage to property or reputation, or criminal charges in an attempt to extort carries a two year sentence.  Threats to property or reputation without an attempt at extortion are apparently not federal crimes.  Showing up in person and committing stalking, harassment or vandalism, though certainly more menacing to the target, are not federal crimes.

Kidnapping obviously is not an issue here.  Are threats demanding that an official resign from office or change his/her vote, or that a candidate drop out from the election considered extortion?  I don't know.  Nor do I know how direct a threat or attempt at extortion has to be to qualify.  No doubt there are federal precedents.  But clearly any letter, e-mail, text or phone call threatening bodily harm or kidnapping is a federal crime carrying a sentence of five years.  Just recently our local newspaper announced that someone was being charged under federal law for sending threatening e-mails to a local meteorologist who had run for Senate as a Republican and was considering a run for governor.  It commented that this carried a potential sentence of five years.  The same sentence is entirely appropriate for anyone threatening school board members.

What about domestic terrorism?  Well, our terrorism statute defines domestic terrorism as:

[A]ctivities that—
(A) involve acts dangerous to human life that are a violation of the criminal laws of the United States or of any State;
(B)appear to be intended—
(i) to intimidate or coerce a civilian population;
(ii) to influence the policy of a government by intimidation or coercion; or
(iii) to affect the conduct of a government by mass destruction, assassination, or kidnapping; and
(C) occur primarily within the territorial jurisdiction of the United States

Clearly threats to school board members (1) are a violation of the criminal laws of federal or state law, and (2) occur within the territorial jurisdiction of the US.  I do not think there is much doubt that they are intended to influence policy of a government by intimidation or coercion.  But I do not see what is being described as dangerous to human life.  However, if things were to escalate from mere threats to shooting at school board members, running them off the road, or putting pipe bombs in their mail boxes, that would look very much like domestic terrorism.

And one other point.  Isolated threats against school board members are a local issue to be handled locally.  When threats become pervasive, it becomes a national issue and appropriate for federal prosecution. 

What to Do About COVID: Test, Test, Test

Also interesting about having COVID: My Republican but not ant-vax boss's reaction to getting the disease after being vaccinated.  His conclusion was that the vaccine is worthless in preventing infection, although it may make infection less severe.  Given that he was the first infection in is study group in months, that sounds overly harsh, but it is indisputable that vaccines lose their effectiveness quickly, and that frequent boosters will probably be necessary.

Perhaps even more significantly, he has become opposed to any attempt to prevent spread.  At least, he opposes masks and disinfecting surfaces.  He does see it as appropriate for me to have an air filter in my office since I deal with elderly clients, but opposes any further use of air purifiers. And his is generally opposed on principle to any attempt to stop the spread.  Everyone will end up getting it, he says, so why bother.   Instead, he wants a cure.  And the good news is that we may be months away from having an effective treatment.  So (I said) isn't it better to delay people getting it until treatment is available.

And, in fact, there seems to be a general opposition to any sort of prevention or mitigation on the right, in favor of cure. Most recent is the case of Allen West, unvaccinated, infected, and hospitalized, who has promoted the superiority of treatment by monoclonal antibodies over vaccines because vaccine "enrich[es] the pockets of Big Pharma," as opposed to monoclonal antibodies which, also come from big pharma. And certainly plenty of right wingers are angry at the prospect of having to get regular booster shots and see it as an affront.

I really do not understand this insistence that we must forego all prevention and mitigation and focus entirely on cure. I can understand it over lockdowns, which carry high economic and social costs and are only sustainable in the very short run (a few months at most).  I can sort of understand it over masks, which, though mostly sustainable over the long run, are uncomfortable and not sustainable for restaurants, bars, and gyms.  But why the resistance to vaccines?  And even if vaccines require regular boosters, why the outrage over that?  

I think it might be because right wingers hope that if everyone gets COVID everyone will have long-term immunity.  And there might be something to the approach if COVID was like, say, measles, and getting it once did give lifetime immunity.  But it belongs to the same category of virus as cold and flu, which give only a short-lived immunity.  Cases of re-infection have occurred.  While information on the subject remains sketchy, some evidence points to the possibility of immunity lasting as little as three months to as long as five years, with a median of 16 months.  

So far as I can tell, right wingers want to go back to their pre-pandemic lifestyles with no change whatever and no disruption, not even small changes like getting regular shots.  How many people get sick or die as a result is simply unimportant.  But what they ignore is that people getting sick and dying is itself disruptive.  Take it from me, being sick for a week, convalescent for a week, still not full steam for a week, and then having to catch up is a whole lot more disruptive than getting a shot.  Getting a shot every six months is less disruptive than being out of action for two weeks every two years or so.  And having places you want to do business closed because everyone is sick is also disruptive.

Another part (and have have gotten this very strongly at work) is the sense that those of use who accept any sort of inconvenience in the interest of mitigation have been brainwashed by a sinister elite that is offering suggestions with no scientific merit, not to stop the disease, but simply to control our lives.  This view ranges from completely nuts (our anti-vaxxer arguing that the vaccine contains a microchip that will tell "them" about everything we do) to semi-rational (my boss saying that I an succumbing to propaganda, and that the people making these suggestions know less than they think).

Which leads to the subject of testing.  We need more of it, lots more.  Again, going back to personal experience, I knew that home testing existed.  I looked at the shelves of the pharmacy and didn't find any.  My boss had a test kit and explained that you have to go up to the counter and ask for one.  Well, the first time I asked the store was sold out, but I got one on a second try.  But tests are expensive ($24 for two).  And even more significantly, they are extremely hard to replace.  So when my boss first felt symptoms, he didn't want to "burn" a test, but asked for an appointment.  It took several days to get in and several more to get results and by then the whole office was infected.  I went ahead and burned a home test when it became impossible to deny that I had symptoms and actually found out before he did that I had it.  But by then I had met with five or six clients, called in a witness to a will signing, gone dancing, gone shopping, etc.  If home tests had been cheap and plentiful, everyone could have tested as soon as they felt symptoms or suspected exposure, and we could have stopped this a lot faster.  I also burned a test at the end of my quarantine to see if I was still positive (I was).  So now I am out of tests everywhere I look they are sold out.

Home tests have their drawbacks.  They are less sensitive slower lab tests and catch the infection only about 87% of time.  Tests are therefore sold in pairs with the recommendation that if the test is negative, take a second test two days later.  Two negative tests should be good enough.  Furthermore, the rapid tests are tests for antigens (proteins on the shell of the virus), a good marker for contagion.  And getting fast result allows people to quarantine and warn others sooner rather than later, a vital tool in stopping the spread. 

Furthermore effective, simple treatment is probably coming down the pike in the form of a pill that can be taken at home and can be much more widely affordable than monoclonal antibody infusions.*  Thus far the COVID pill has been 50% effective at preventing hospitalization and death in high-risk patients.  If taken early, could it prevent or at least mitigate illness altogether?  There is even hope that it may prevent household members from being infected.  Treatment is more effective the sooner it starts. Thus rapid, widespread testing is critical to important treatment.

So how do we make home test kits cheap and plentiful and how do we get people to use them?

Making home test kits cheap and plentiful is certainly doable.  Many other countries have done it.  The holdup in the US appears to be FDA insistence on a medical level of accuracy.  That creates an obstacle to production.  Joe Biden has promised to invoke to Defense Production Act to produce 280 million tests, but that is less than one test per American -- far too few to allow the frequency of testing that we need.  So the best way to increase production appears to be for Biden to change classification from medical device to public health tool to remove the FDA regulatory barrier. And that is my number one issue these days.  Let's all write to the White House to urge him to make the change.  Here is the link. Write or Call the White House | The White House.  

Some people have objected that making home test kits universal will lead people to stop reporting their diagnoses, making it harder to track the disease.  There are two responses to this.  One is that keeping track of the disease is merely an end to stopping it, and if the best way to stop it reduces reporting, so be it.  The second is that if COVID pills become widely available, people will have a strong incentive to report a positive test -- to get treatment.

But that still leaves the issue of getting people to actually use the tests.  Why should that be a problem?  After all, the fact that tests are sold out proves that they are in high demand.  Some 79% of Americans have expressed eagerness for home tests and an interest in regular self-testing.  Unlike all prevention measures, testing has not become a culture war issue.  It is often presented as an alternative to vaccines.

But given the overall trajectory of this country, can anyone doubt that if rapid testing becomes widely available it will become a culture war issue.  Swabbing the inside of your nose is uncomfortable.  Asking people to do it regularly is burdensome.  Already some people in the more paranoid precincts are spreading wild stories about something harmful on the swabs.  Saliva tests avoid the swab, but have to be mailed to a lab.  Some paranoid people fear the lab as well.  And who can doubt that once widespread testing becomes available, doing it regularly will once again make you part of the "sheeple" who have been brainwashed into fear, and will become an intolerable threat to freedom.

Weekly testing the workforce is offered as an alternative to vaccines.  How long before it starts to feel like harassment?  It is being proposed as a way to control spread in the schools.  Do you think ant-mask parents will accept the alternative?  No doubt there are Asian or Nordic countries where if people were asked to self-test before going restaurants or bars or large public gatherings, they would do so.  In the US they would not.  And imagine the outrage if any restaurant or bar or public gathering started requiring rapid tests as a condition of admission.**  Imagine the lines of people waiting!

In short, how do we avoid making COVID testing a culture war issue?  My advice would be to avoid fanfare.  Just have it show up on the shelves -- well advertised, but without a big governmental announcement.  Do focus group tests on how to sell it to the vaccine skeptics, but my guess is that the most effective pitch will be two-fold.  The closely track the reasons not to be concerned that self-testing will reduce reporting.  One is the emphasize the privacy and secrecy of the test.  Nobody else has to know about it.  And the other is to sell it as something to do out of self interest.  Find out soon so you can have effective treatment!

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*Presumably antibodies would continue to be used for high-risk patients.
**Actually, I am told that the Albuquerque Folk Festival did require rapid testing for everyone who did not present a vaccine card, but (1) that was presumably a distinct minority of people attending, and (2) it did not attract anti-vaxxer types.

Reflections on Catching COVID

Well, COVID is no longer an abstraction to me, or something that only affects other people.  I have now had it.  How has that affected me?

By way of background, I work in a five-person office.  Four of us were vaccinated; one is a confirmed anti-vaxxer.  All of us caught it.  The anti-vaxxer was diagnosed last, although in  hindsight he says that he may have been sick for several days and just in denial.  He also has diabetes and emphysema.  Unsurprisingly, he landed in the hospital.  Our office also has a young fellow only 19 years old, fully vaccinated, with no discernable risk factors, who also landed in the hospital.  The rest of us had only mild cases.

For me, my nose ran like a faucet.  The amount of Kleenex I used in the first few days was extraordinary.  Coughing and sneezing was less frequent that with a cold, but deeper -- terrifyingly deep.  I had sporadic, low-grade fevers, especially at night, never above 100.2.  I also had poor appetite, general fatigue, and insomnia.  The insomnia was the worst part of it. I did not lose my sense of smell or taste.  This lasted about a week.  I attempted to work from home, but my energy was extremely limited.  The next week my symptoms resolved except an about-to-sneeze feeling in my nose and a little post-nasal drip. But my energy was extremely limited.  Just walking around the block wiped me out.  My ability to focus on work was quite limited.  The following week I was well enough to go into work, but was still limited in how long I could focus before getting light-headed or brain fog and having to take a nap.  Since then it has been making up for lost time.

Infected people are supposed to quarantine for ten days from first symptom.  That means no shopping.  I learned to use Insta-Cart, and drive-up windows.  Three things I greatly came to appreciate -- pulse oximeters (my oxygen was fine), Kleenex with lotion (the difference is extraordinary given how often I was blowing my nose), and doing my own shopping.

So, thoughts on that.   

First of all, vaccines are far from perfect.  Four out of five people at the office were fully vaccinated, but all of us got sick.  I got the Pfizer vaccine.  It appears that Pfizer 47% effective at preventing infection five months out.  That means, even if we start giving boosters at six months, there will be significant numbers of breakthrough infections before then.  I personally got my first shot in April and my second on May 8.  That means I was considered fully vaccinated two weeks later, on May 22.  I felt sick enough to self-test on Sunday, September 26 and was probably contagious at least two days earlier.  So I was about four months out from the "fully vaxxed" date and probably about five months out from my first shot.

Second, this is not the same as saying that vaccines are worthless. My boss, a Republican but not an anti-vaxxer, concluded that vaccines are worthless at stopping the spread of COVID and merely mitigate its severity.  Yet he, himself, enrolled in a COVID study in order to get the vaccine early was was told that he was only their fifth breakthrough infection (his wife was the sixth), and their first in months.  He may very well be the beginning of a wave.  But the vaccine was apparently quite effective for a number of months at least.

Third, while people complain about the disruptions caused by mitigation efforts, getting the disease is also disruptive.  Five out of five people in our office were infected and got sick.  Granted, one stayed at his post for almost a week before giving out, and the next week some of us started coming back, at a highly reduced rate of efficiency, and without seeing clients.  But the disruption was absolutely real.  If everyone had gotten the disease at different times, the disruption would have been a lot less.

And finally, vaccines cannot do it alone.  We need much more rapid, abundant testing, and an effective treatment.

Memo to Democrats: Focus on What is Really Essential

 I must admit I have not been following all the in’s and out’s of the Democrats’ $3.5 trillion dollar budget, or becoming very emotionally invested in it.  Maybe that is burnout from Obamacare – I just can’t get that worked up over a policy initiative again.  But I prefer to think that is because I have some sense of the crisis we are facing, and of political reality.

So far as I am concerned, the bipartisan infrastructure package and the Democratic budget plan fit in the category of nice to have, but just not that essential.  I phone banked for the Democratic candidates for the Georgia Senate to keep Republicans from blocking what was really essential, but I was quite prepared to settle for that and not expect anything else.

At the time, I thought two things were really essential – getting out vaccines, and passing COVID relief to mitigate the economic impact.  Everything else was expendable so long as we could get that.

Well, in the clear light of hindsight, that was a mistake.  What was really essential was (1) getting out COVID vaccines, (2) passing COVID relief, and (3) dealing with any other crises that came up.  In the clear light of hindsight, at least four crises should have been foreseeable from day one (1) the border, (2) withdrawal from Afghanistan), (3) the usual natural disasters and (4) the debt ceiling.  The delta variant of COVID was not a foreseeable, crisis, but it is present and we have to deal with it.  

So, how do I grade this Administration?

Getting out vaccines.  Grade: A.  They did a fine job.  Anyone who wants the vaccine can have it.

Passing COVID relief.  Grade: A.  We have given the economy the boost necessary to recover.  

Withdrawal from Afghanistan.  Grade F.  We were completely caught off guard by the speed of the collapse and unready to get our people out.  Some people would raise Biden's grade to a D minus or even a D based on the catch-up evacuation.  Color me unconvinced.  The evacuation was too little too late and a bureaucratic nightmare.  That being said, the Taliban has shown some interest in keeping working relations with us and we have some leverage.  We are not going to get the Taliban to stop being the Taliban.  But with careful use of our leverage and skillful diplomacy (neither of which the Biden Administration has displayed much, but we can always hope), we may convince them to let our people out.  In that case I would be willing to raise Biden's grade to a D or even a C minus.

The border.  Grade F.  Any number of people have commented that Biden’s approach was the exact opposite of what would make sense.  Whatever else one thinks of Remain in Mexico, it was a huge political success.  It took the border out of the headlines and out of our discourse.  People who were outraged at the right of asylum seekers mistreated inside the US could not muster much interest in what was going on in Mexico.  Go ahead and call that cruel and inhumane and an outrage.  There are some political facts of life we simply have to live with.  There are also practical facts, like that the US simply cannot take in everyone who wants to come here.  Any number of people have commented that Biden took the exact opposite approach from what he should have done.  His actions were to withdraw Remain in Mexico on day one.  When chaos broke out at the border, he panicked and reduced refugee admissions.  Instead, he should have kept Remain in Mexico while increasing refugee admissions.  Refugees, after all, have already been vetted and processed in third countries and are being let in in a controlled manner.  That is what we want to achieve at the border.*  Certainly we could send assistant to people waiting to be processed. (Make it part of COVID relief if necessary).  We could make staying in Mexico an alternative to being deported to a dangerous situation.  (With all necessary executive procedures, which takes time).  And we could expand the number of immigration judges.  (That would probably command bipartisan support).  But Remain in Mexico is going to have to remain until our side comes up with a humane but controlled alternative.

Natural disasters.  Grade A.  Ever since the Hurricane Katrina debacle, Presidents have been conscious of the need to manage natural disasters well.  With the exception of Hurricane Maria in Puerto Rico, they have.

The debt ceiling.  Grade unknown so far.  But a C at best.  It should have been obvious from day one that more debt ceiling brinkmanship was absolutely predictable.  Republicans do it every time a Democrat is in the White House  Why didn't Democrats include the debt ceiling in the reconciliation bill?  Why didn't they deal with a procedure that apparently takes a minimum of two weeks more than two weeks before a looming default?  If Democrats abolish the debt ceiling altogether or raise it to 100 quadrillion dollars, I will give them an A.  If they manage to kick the can past the 2024 election, I will give them a B.  If they raise it enough to set off a future showdown but don't do serious damage, a C.  If the economy takes a hit from a flirtation with default, a D.  And if we actually default, and F multiple minus.

Delta variant.  Grade D.  Clearly we have a disaster on our hands, but I don't altogether blame Biden for two reasons.  One is that large numbers of people are doing everything in their power to sabotage all COVID mitigation attempts.  The other is that even countries that have done much better than we have are still having secondary waves of infections due to the delta variant.  The good news is that  promising treatment is now in the works.  The bad news is that we have a disastrous shortage of home testing.  We need to clear regulatory burdens to home tests, and we need to do it yesterday.  More on this soon.

So come on, Mr. President, get on it.  COVID, debt ceiling, border, getting our people out of Afghanistan, and future crises.  Everything else is mere luxury.

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*It was also highly predictable that the federal courts, which had already found Donald Trump's immediate overturning of Dreamers arbitrary and capricious would likewise find overturning Trump's policy arbitrary and capricious.