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Mission Accomplished? Uh, Whoops, Not Quite!

By Shlomo Maital

Bush’s Mission Accomplished speech

   A small bit of 17-year-old history: In his “Mission Accomplished” speech (named for a banner displayed above the speaker) United States President George W. Bush spoke on the aircraft carrier USS Abraham Lincoln on May 1, 2003.   Bush stated it was the end to major combat operations in Iraq.  We won. Yay!  

   Bush’s claim —and the sign itself—became controversial after warfare in Iraq increased during the Iraqi insurgency. The vast majority of casualties, both military and civilian, occurred after the speech. 

   Fast forward. In the Wall Street Journal, Vice-President Mike Pence declares, just two weeks ago: “There Isn’t a Coronavirus ‘Second Wave’. With testing, treatments and vaccine trials ramping up, we are far better off than the media report.”   Meanwhile, the US is among world leaders with some 50,000 new cases daily. And President Trump? CNN reports: in mid June, “ when U.S. health officials reported nearly 27,000 new Covid-19 cases, President Trump said in a television interview that the virus was “dying out.” He brushed off concerns about an upcoming rally in Tulsa, Okla., because the number of cases there is “very miniscule,” despite the state’s surging infection rate.”

     Mission Accomplished? A victory lap?   Not quite. And people are dying as a result.

     My country Israel is no exception. We are among world leaders in new cases per 1,000 population. And the numbers are rising.   A bloated coalition cabinet is like a carving I once saw, a two headed snake, one head trying to eat the other.   This, after our Prime Minister took ‘credit’ for Israel’s astounding success in defeating the coronavirus.

     And it is no second wave. It is the continued first wave, of a sneaky wily piece of ribonucleic acid that is humiliating the vaunted brainpower of humans, 86 billion brain cells for each of the 8 billion or so people on earth. Two to zero, in favor of the virus.

     No, mission not accomplished. And the arrogance of claiming that it is, is itself criminal.

Remdesivir: Grasping at Straws!

By Shlomo Maital

     There is a massive amount of fake news circulating now about COVID-19, some of it racist, pernicious and dangerous. There is also well-meaning news, reports that want to bring hope but in fact are simply grasping at straws.

     A report now viral, emanating from the University of Chicago, is about how an anti-viral drug developed by a pharma company, Gilead, has helped seriously ill COVID-19 patients.

     Remdesivir is an antiviral medication; a nucleotide analog, specifically an adenosine analogue, which inserts into viral RNA chains, causing their premature termination. It is being studied during 2020 as a possible post-infection treatment for COVID-19 illness.

A U of Chicago doctor participated in an internal hospital video in which she reported that when seriously ill patients administered remdesivir, many recovered.

The video reached some hospital employees, who leaked it to journalists. That led to a highly optimistic report.

This is not a clinical test. There is no protocol, and no placebo (sugar pill given to some patients).

   The drug, made by Gilead Sciences, was tested against Ebola with little success, but multiple studies in animals showed the drug could both prevent and treat coronaviruses related to Covid-19, including SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

     We are all desperate for some good news. But grasping at straws is not going to help. The journalists who reported this “scoop” should have told us exactly what the source was, an internal chatty ‘gossip’ video of the kind that circulates in most hospitals.

     The journalist who DID inform us was the CNN medical correspondent, is Elizabeth Cohen, who has serious training and deep scientific knowledge. She has a Master’s degree in public health. Her colleague is Dr. Sanjay Gupta, a neurosurgeon; together they comprise “the horse’s mouth” and to mix a metaphor, a horse’s mouth that does NOT grasp at straws.

A Vaccine is Coming – from Pittsburgh

By Shlomo Maital

Univ. of Pittsburgh “Cathedral of Learning”

   Before the good news about a COVID-19 vaccine – a piece of history.

     In 1947, native New Yorker Jonas Salk accepted an appointment to the University of Pittsburgh School of Medicine. In 1948, he undertook a project funded by the National Foundation for Infantile Paralysis to determine the number of different types of poliovirus. Salk saw this was a golden opportunity to extend this project towards developing a vaccine against polio. He built a research team and devoted himself to this work for the next seven years. The field trial set up to test the Salk vaccine involved 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers.   Over 1.8 million schoolchildren took part in the trial.

    On March 26, 1953, Salk announced on a national radio show that he had successfully tested a vaccine against poliomyelitis, the virus that causes the crippling disease of polio. In 1952—an epidemic year for polio—there were 58,000 new cases reported in the United States, and more than 3,000 died from the disease. Dr. Salk was celebrated as the great doctor-benefactor of his time.

   Fast forward.   A press release from the NIH: https://www.nih.gov/news-events/nih-research-matters/microneedle-coronavirus-vaccine-triggers-immune-response-mice

   “After the identification of SARS-CoV-2, the genome sequence of the new coronavirus was rapidly released to the public by scientists in China. Several weeks later, National Institute of Health-funded scientists produced a detailed picture of the part of the virus, called the spike protein, that allows it to infect human cells. This spike protein is currently the target of several vaccine development efforts. And we see the graphic version of the corona ‘spikes’ everywhere…

   “Researchers led by Drs. Louis Falo, Jr. and Andrea Gambotto from the University of Pittsburgh have been working to develop vaccines for other coronaviruses, including the one that causes Middle East Respiratory System (MERS). They adapted the system they had been developing to produce a candidate MERS vaccine to rapidly produce an experimental vaccine using the SARS-CoV-2 spike protein.

   The team developed a method for delivering their MERS vaccine into mice using a microneedle patch. Such patches resemble a piece of Velcro, with hundreds of tiny microneedles made of sugar. The needles prick just into the skin and quickly dissolve, releasing the vaccine. Since the immune system is highly active in the skin, delivering vaccines this way may produce a more rapid and robust immune response than standard injections under the skin.

   “When delivered by microneedle patch to mice, three different experimental MERS vaccines induced the production of antibodies against the virus. These responses were stronger than the responses generated by regular injection of one of the vaccines along with a powerful immune stimulant (an adjuvant). Antibody levels continued to increase over time in mice vaccinated by microneedle patch—up to 55 weeks, when the experiments ended.

   “Using knowledge gained from development of the MERS vaccine, the team made a similar microneedle vaccine targeting the spike protein of SARS-CoV-2. The vaccine prompted robust antibody production in the mice within two weeks.

   “The vaccinated animals haven’t been tracked for enough time to see if the long-term immune response is equivalent to that observed with the MERS vaccines. The mice have also not yet been challenged with SARS-CoV-2 infection. However, the findings are promising in light of results from the similar MERS vaccine.

   “The components of the experimental vaccine could be made quickly and at large-scale, the researchers say. The final product also doesn’t require refrigeration, so it could be produced and placed in storage until needed. The team has now begun the process of obtaining approval from the U.S. Food and Drug Administration to launch a phase 1 trial within the next several months.

   “Much work still needs to be done to explore the safety and efficacy of this candidate vaccine. “Testing in patients would typically require at least a year and probably longer,” Falo says. “This particular situation is different from anything we’ve ever seen, so we don’t know how long the clinical development process will take.”

OK – it works in mice. Now for humans. A vaccine is on the way – and it may emerge again from Univ. of Pittsburgh.

 

   

 

 

 

 

What Do We NOT Know?!

By Shlomo Maital

  After more than four months of nonstop news/debate/discussion around COVID-19, it is astonishing how much we do not know. And as the saying goes, what you don’t know that you don’t know — is the worst; it can literally kill you.

   So here is my attempt to list, what it is we don’t know, that we NEED to know, about this tiny virulent enemy and hopefully, scientists are working on it.

  • For those who get COVID-19 and recover, are they immune? For life? For a short time? How long does the immunity last?
  • Like many viruses, can this novel coronavirus mutate quickly and attack those who contracted an older version? Are COVID-19 cases in the US characterized by the same genetically-identical virus as say in China, or different? If so, how different? And does it matter?
  • Intubation: Are we in too much of a hurry to put people on intubation (ventilators)? If such a small percentage of those intubated, survive, should we rethink this? And how different are the various kinds of ventilators (those used by anesthetists, oxygen ventilators, standard ventilators, etc.)?
  • Why are the death rates (those who die from COVID-19, as a % of those who are seriously ill, or in general % of those who contract the virus) different, radically, between one country and another?   How much of this is due to ICU expertise?
  • How exactly does COVID-19 spread?   As aerosol (tiny droplets that hang in the air for hours?)   As big droplets (that fall to the ground fairly quickly)?  
  • Are there drugs proven to be effective against COVID-19? What about the recently-approved anti-influenza drugs? Xofluza, Tamiflu, Relenza, Rapivab ? And, of course, hydroxychloroquine? (which seems to have severe heart side-effects among some patients).
  • Why are African-Americans more afflicted than Caucasians? Men more than women?
  • Will there be a second wave? And a third? How will we know in time?
  • How soon will we have a proven vaccine, and how quickly can doses be produced, to inoculate billions of people? How much will it cost? Can it be provided for free? How can the many companies working on a vaccine, in many countries, work together, to save time and save lives?
  • What countries have managed the COVID-19 crisis best, and what can be learned from them? There have been many variations on lockdown, ranging from easy (Sweden) to draconian (China, Singapore).   Which works best?
  • Somewhere, as we speak, a new virus is brewing and mutating somewhere; this is not the last pandemic. Can we organize a world-spanning organization (broader in span than WHO, with far more resources) that will be ready to tackle the next pandemic quickly and efficiently? With massive resources?  

 

I’m certain there are a thousand more things we do not know. Add your own questions… for each question above, there are multiple answers online, and many of them are fake or conspiratorial.   This simply adds to the fog.

COVID-19: Who’s In Charge? And Who Should Be in Charge?

 By   Shlomo Maital  

 

   OK – who’s in charge? Who is running the coronavirus pandemic show?

I think it’s pretty obvious – it’s the doctors, medical experts, epidemiologists and public health officials. As it should be. Right?

   No, I’m not so sure. Initially the focus worldwide was on stopping the spread of COVID-19 from China to the world. That pretty much failed, as expected – with millions of people travelling every week, and with some countries reluctant to share information, drastic quarantine measures came a bit too late. And now, COVID-19 is in some 70-80 countries. So – it has spread. Now what?

   Public health officials are in charge. And lacking medicine or vaccines, their tool is mainly that of quarantine. In Israel, a small country, with very few causes of new coronavirus, some 100,000 people are in self-imposed quarantine, for 2 weeks, largely because they have been in countries like France and Italy, where coronavirus existed.

     Quarantine may be rather ineffective in halting the infectious spread. And it is disastrous for the economy. You cannot simply shut down the world economy – people have to eat and drink and keep the wheels of commerce moving. It cannot really be done efficiently from home… the Internet is not yet up to it.

     So who is running the show? What we need is a small, powerful interdisciplinary team made up of political leaders, public health experts, epidemiologists, and yes, perhaps economists, and psychologists, and information experts, who will focus on the system – the big picture. How to deliver accurate information. (America gets a big ‘F’ on this one, largely due to its President, who brags that he is terrific at numbers and maybe should have been a doctor rather than an amateur politician). How to weigh cost-benefit in quarantine policies. How and when and whom to test for COVID-19. How to deal with public transportation and flights. How to run schools.

     You could in principle simply shut everything down and tell everyone to stay home. That would be disastrous, immensely costly, and harmful to the mental health of the nation. I don’t believe this is an option. So the question is, how to keep things running more or less smoothly, in the face of the coronavirus that is here to stay? For hat we need a systems approach.

     This is all new territory. We have not faced a real pandemic, post-1989 global economy. Each country needs an integrated team to make policy, and the world needs a similar integrated team to coordinate policies among nations.

       Perhaps, if something good will emerge from the COVID-19 crisis, it will be the understanding of how interdependent all of us are, everywhere, and how concrete and steel walls are not the answer.

  

My Two Key Skills: What are Yours?

 By   Shlomo Maital

Qwerty keyboard on an old Underwood typewriter

   After writing magazine columns on our failing schools, I reflected on what I myself learned in school.

   The two key skills I learned?   In high school, Grade 9 – touch typing. I learned to type very fast, 80 words a minute, owing to strong incentives to do boring exercises again and again. This turned out to be a crucial skill. I was able to put my thoughts on to paper very rapidly, as I could type almost as fast as I could speak. Probably, in another life, I would have chosen to be a journalist rather than an economist. That skill that I learned in 1956 has served me well for 63 years. I even worked one summer as a typist, typing invoices — I can touch-type numbers very fast, too.

       Note: I still have my mother’s old Underwood typewriter, with the QWERTY keyboard, designed so that the keys, operated by spring mechanisms, should not clash and tangle with one another… Qwerty is still the standard, even though typing has long since been digital – showing the inertia of human behavior. My late mother worked as a typist for the Provincial Government, Dept. of Agriculture, in Regina, Saskathewan; I’m forever grateful she urged me to learn touch typing. 

   The second key skill I learned was as a freshman in college, at Queen’s University, Kingston Ontario. All freshmen in Arts & Science, in those days, had to take Philosophy 1, given by A.R.C. Duncan, a Scottish philosopher of the old school. It was a tough rigorous course, covering the 3 branches of Philosophy – ethics, metaphysics and logic. I learned critical thinking, how to fashion a logical argument, what the various approaches to right and wrong are….. memorable, and something I use daily.  

   I fear today’s young people do not have the same privilege, and do not acquire crucial critical thinking skills.

….

   Dear reader: What, on reflection, did YOU learn in school, that turned out to be supremely valuable and relevant?  

Paul Volcker, 1927-2019: How He Saved the World from Inflation

By Shlomo Maital

Paul Volcker 1927-2019

  Paul Volcker has passed away; he was 92. Volcker served as Chair of the Federal Reserve Bank, appointed by Jimmy Carter in 1979.

   Volcker was a giant, physically, standing 6 ft. 7 inches tall – but also a giant in wisdom and courage. The US was afflicted by double digit inflation, from 1979 to 1981, driven by cost-push price rises and soaring oil prices.   Volcker quickly understood the threat. With the dollar serving as the world’s major, perhaps only, globally-accepted currency, US inflation threatened not only the US but also the global trading system, then struggling from recessions in 1973 and again in 1978/9.

   Volcker acted with what then seemed like outrageous boldness. He raised Fed interest rates to 21%.   This was unheard of. I can only imagine what today’s President, Donald J. Trump, would have said, had he (heaven forbid) have been president at that time. Trump wants zero interest rates, no matter what the economy needs, and has hassled current Fed Chair Jerome Powell over his unwillingness to promote cheap credit at all cost and at all times.

     Volcker’s move put a halt to the inflation, stopping it in its tracks, but also ground the economy to a halt, causing a recession, or what came to be known as stagflation. Partly as a result Jimmy Carter became a one-term President, defeated in November 1980 by Ronald Reagan. It was ironic that Carter lost partly because of a very wise and strong appointment that he made, to the Fed.

     We must remember Volcker and the strong independence of the Federal Reserve system that prevailed, until now. No President has dared messing with the Fed’s independence, until now. Research shows that nations with strong independent central banks fare far better than those where governments make their central banks into private money-printers. Trump endangers today’s Fed, and as a result, endangers the world. We should remember Volcker fondly, and recall the lesson he taught us.

 

Will Economists Say They’re Sorry? Don’t Hold Your Breath

By Shlomo Maital

  In Erich Segal’s gushy novel Love Story, and later in the 1970 film starring Ryan O’Neal and Ali McGraw, you hear this line twice: Love means never having to say you’re sorry.

   Really?   I thought that when you truly love someone and hurt them, you always always say you’re sorry and try to make amends. And if you don’t? Well, where’s the love?

     I am an economist. Led by Milton Friedman, we gave the world unfettered free markets, that in 2008 nearly destroyed the world economy – we’re still repairing the damage.   We gave the world supply-side economics (cut taxes on the rich and you get a cornucopia of investment spending!) and the Laffer curve (cut taxes and you get more revenues than before). We gave the world the idea that senior management is responsible only to shareholders, for maximizing profit – an idea business schools set in stone. Professor Friedman said it was wrong for corporations to give money to charity, for worthy causes, because the money belonged to the shareholders, it should be given to them.

     If you don’t believe me, read Binyamin Appelbaum’s recent book, The Economists’ Hour, a slashing indictment of all the false theories we economists dumped on a naïve, believing world. Appelbaum’s day job is writing editorials for The New York Times.

     The world right now is in a mess. It’s not solely us economists’ fault, but much is.  

     And it’s time to say we’re sorry. No, love is NOT not having to say you’re sorry. Double negative.

       Are economists sorry? I don’t hear a whole lot of apologies or even mild recognition of the damage we’ve done. And this is no Love Story.

       And the part that hurts me most?   Economists built their free-market ideology on one book, Adam Smith’s 1776 Wealth of Nations. The book was pushed to the ultimate absurd, “greed is good” (George Gilder).   But Smith was really NOT an economist, he was a moral philosopher, and his greatest book was Theory of Moral Sentiments (1759), where he said people seek the esteem of their peers, by doing good deeds. Which IS true!   And which is also a good prescription for finding meaning in life. And no, greed really is not good. It’s terrible.

     What if economists had built their discipline on THAT principle, earning our peers’ esteem, and not on free-market bottom-line unfettered capitalism?

       When the Soviet Union dissolved in 1991, Sovietology departments in universities all over the world shut down. Why? They got it wrong. They had not foreseen this startling development. They were utterly discredited.

       Perhaps then economics departments should shut down. As a way of saying, I’m sorry.  

     According to the Washington Post, “A great migration is happening on U.S. college campuses, English majors are down more than a quarter (25.5 percent) since the Great Recession, according to data compiled by the National Center for Education Statistics. It’s the biggest drop for any major tracked by the center in its annual data and is quite startling, given that college enrollment has jumped in the past decade.”

     Same holds for philosophy majors. So we will have a world of lawyers, and economists – who are ignorant of critical thinking and great literature? If we ever impeach economists, perhaps one of the charges will not only be laying the foundations for the Great 2008 Recession – but driving innocent students away from studying subjects that are truly important.

      

What Does It Take to Get the US Congress to Do the Right Thing?

 Dogged Persistence & a Late-Night Celeb

 By   Shlomo Maital   

John Feal hugging Jon Stewart

     After 9/11, many many of the responders and site-workers fell ill, as the toxic materials of the wreckage destroyed their lungs, livers and other organs. It’s hard to believe, but the Federal Government has been criminally slow to replenish the fund that helped pay for their medicine and care.

       On July 23, the Senate passed the 9/11 Victim Compensation Fund reauthorization bill. It will help first responders pay for health care through 2092. President Trump signed the bill.  

   Republican Senator Rand Paul, who voted for Trump’s $1.5 trillion tax cut, creating a $1 trillion deficit, voted against the bill, citing fiscal irresponsibility.

Well done, Senator. Make us proud. Make America great again.

       Here is what it takes to get the US Congress to do the obvious right thing.

         It takes John Feal. For the past 15 years, he has organized trips to Washington, hundreds of them, by ill, injured and dying responders, through his FealGood foundation. Feal is a demolition construction worker, who was injured while clearing rubble at Ground Zero and had part of his foot amputated. He has tried to persuade Congress to do the right thing since 2004.

         And it takes Jon Stewart. Born Jonathan Stuart Leibowitz, Stewart’s The Daily Show was for my money the funniest, most biting satire on television, for almost 20 years, since it began in 1999.  

           Here is how The Daily Beast’s Michael McAuliff describes how one dogged persistent citizen, Feal, enlisted a celeb, Stewart, and against all the odds – everyone said there was no chance to pass the bill before Congress went on vacation – got it done. Feal knew Stewart, because Feal had been on The Daily Show.

   “….when it came time to talk to lawmakers about the next bill reauthorization, [Feal] didn’t want Stewart to just read a statement he’d prepared with guidance from Hill staffers.     He wanted Stewart to speak purely from the heart, so he primed him.    He gave him a note in the morning about how much Pfeifer [a 9/11 first-responding firefighter who died as a result of the toxicity] and Stewart’s friendship meant to him. Just before going into the hearing room, Feal and former FDNY firefighter Kenny Specht presented the comedian with the fire coat Pfeifer had worn on his first job. Feal had bought it at a charity fundraiser the night before. He had dozens of responders sign it as a sign of thanks.  

   “I knew I was getting to him. I knew he was just a bowl of Jello,” Feal said.   In the hearing, Stewart was scheduled to go last. And as the proceedings progressed, Feal kept working on Stewart, pointing to the packed audience and empty chairs of representatives.    “He was just festering. I said, ‘Put the piece of paper away, and do what you do best,’” Feal recalled. “I think that moment was where we changed course. I think that’s where we took matters into our own hands. And I saw a window where we could get this done before the August recess, and I knew we didn’t have to wait until November, December like everyone else wanted.”

   Stewart’s talk went viral. He tore a strip off the Congressional representatives, chastising their utter indifference. “Your indifference cost these men and women their most valuable commodity: time. It’s the one thing they’re running out of”.   He was visibly emotional, and close to tears of rage.

   So what does it take today to get the US Congress to do the right thing? It takes one dogged, determined citizen, who somehow can enlist a celeb, who explodes spontaneously in righteous anger, at an outrageous display of indifference, by members of Congress who simply were not there. And media who helped the celeb’s talk go viral, playing it hundreds of times.

       Even stone-age fossil Senate Majority Leader Mitch McConnell could not resist it.

       So, how often will Congress do the right thing in future?  

       It seems to me the Babylonians invented the zero for us, so we could answer that question precisely.   Because, how often will the Feal-Stewart duo recur?

     

 

    

Life as Math: Break Your Problem Into Pieces
By   Shlomo Maital

   How do you solve real-world problems? Hard ones?   Not, say, partial differential equations…. But life problems, relationships, dilemmas, work, career, kids.

   Let’s turn to a new and wonderful book by Cornell University mathematician Steven Strogatz *.   His book is about calculus. Remember your college course Calculus 101? One you may have struggled with? Can you believe calculus can solve real-world problems, not just math problems?

     Start with differential calculus and derivatives. This technique takes a hard problem and breaks it down into very very small pieces. Try the same with life. Problem? Insoluble? Break it down. Take it apart. Use the method of seven why’s… why?, response, why?, response, until you get down to the infinitely small level..and the core of the problem.

     Next take integral calculus. Start small and build it up. Build the big picture. Take your seven why’s…   zoom out, then put the pieces together and ‘integrate’….add it all up.

        Strogatz shows how a geneticist combined with a mathematical expert to crack the HIV    problem. Drugs were developed to combat HIV and keep it from becoming AIDS. But there was a dilemma. Using the drugs prematurely might cause the body to develop immunity and endanger the patient. The mathematician plotted the curve of HIV virus in the body, over time, and how the body destroyed the virus…. And came up with the strategy, eventually, of the HIV cocktail – the combination of three drugs that has proved so effective and life-saving. This was done, using calculus, plotting the computing the curve of HIV virus ‘kills’ by the body’s immune system over time.

     Bottom line — tackle problems like a calculus expert. Break them down. Take a small piece. Work on it.   Understand the whole problem by understanding a small part of it.

* Steven Strogatz. Infinite Powers: How Calculus Reveals the Secrets of the Universe. 384 pages. Houghton Mifflin Harcourt 2019.

 

Blog entries written by Prof. Shlomo Maital

Shlomo Maital
July 2020
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