Since ancient times, societies have attempted to separate people with disease from those who remained unaffected, with references to self-isolation dating back to the Old Testament. As Covid-19 sweeps across the globe, we are advised to “self-quarantine” if we have recently returned from a part of the world where the virus is rapidly spreading, or if we have knowingly come into contact with an infected person. To understand the importance of self-quarantining during this modern-day pandemic, it’s helpful to look back to the history of the word “quarantine” itself, which traces its origins to medieval Europe.
Two linked trade ports
Like Venice, Dubrovnik (formerly Ragusa) has always been a city popular with travellers from around the world; today, both are Unesco World Heritage sites. During medieval times, Venice and Ragusa were powerful trade ports with intertwined histories: Ragusa recognised Venetian suzerainty from 1205 until 1358, but still retained much of its independence. In 1420, when Dalmatia (a coastal region bordering the Adriatic Sea, now mostly in present-day Croatia) was sold to Venice, Dubrovnik remained a free city in all but name.
The word “quarantine” has Italian roots: in an effort to protect coastal cities from the Black Death ravaging 14th-Century Europe, ships arriving in Venice from infected ports were required to sit at anchor for 40 days (quaranta giorni) before landing, a practice that eventually became known as quarantine – derived from ‘quarantino’, the Italian word for a 40-day period.
The Nurse Who Came by Sea
On Easter Sunday, as the noon sun bore down on New York City in bloom during what is surely its saddest spring in a century, a 50-foot white-hulled sailboat named Turning Point arrived in New York Harbor to berth in an otherwise empty marina in Brooklyn Bridge Park. On deck and ready to throw a line to the waiting dockhands was 26-year-old Rachel Hartley, an ICU nurse who had just sailed the nearly 250 miles from Hampton, Virginia — keeping watch overnight with her husband, Taylor, over the 34-hour passage — and ready to make the boat her home for the next two months. She is one of thousands of out-of-town medical professionals answering the call to provide reinforcements to the city’s hospitals.
Hartley, who has been a nurse since 2015 and spent two years working in an ICU, was working in surgical pre-ops in Lynchburg, Virginia, when, in early March, her hospital began to cancel all but the most urgent surgeries. Then, for several weeks, she said not a day went by when she was not “called or emailed or texted by one of the nurse-staffing companies” seeking people with intensive-care experience for coronavirus epicenters like New York: “Holy cow! There was such a need!”
She thought: “I’m not being utilized and I have training and skills to offer … [Because] my true bread and butter is critical care.” By then, she had already treated a few COVID-19 patients and her hospital was “bracing for a surge,” but she knew it would be “nothing like New York.” She gave her two weeks notice, and said good-bye to her colleagues. Since she and her husband, Taylor Hartley, a college recruiter and photographer (he took these pictures), owned a boat, they decided they’d sail up to New York in it to give her a place to stay.
The Man Who Beat the 1957 Flu Pandemic
Twenty biomedical companies. Seventy nations. An aggressive search for COVID-19 treatments and vaccines is underway worldwide. Yet even 21st-century technology can’t match one man who curbed a major influenza pandemic spreading across the United States in 1957.
Pioneering virologist Maurice Hilleman, now oft-forgotten, detected that pandemic from across the globe, convinced reluctant U.S. health officials to take notice, and single-handedly fostered a vaccine that became publicly available. All in just four months.
An irascible, no-holds-barred Montana farm boy born in the midst of the 1918-19 influenza pandemic, Hilleman survived diphtheria and Great Depression-era poverty to earn a PhD in microbiology and chemistry at the University of Chicago. Practical and impatient, he turned down the prestige of academia and primarily worked in industry, at the pharmaceutical company E. R. Squibb & Sons and later Merck & Co, where he led vaccine research for 25 years.
An iconoclast who slung swear words like the proverbial sailor, Hilleman helped develop an astounding 40 vaccines: to prevent measles, mumps, rubella, pneumonia, meningitis, hepatitis A and B, and other infectious diseases. The measles vaccine alone has saved an estimated one million lives a year. “Maurice’s genius was in developing vaccines, reliably reproducing them, and [taking charge] of all pharmaceutical facets, from research to marketplace,” biographer Paul A. Offit, MD, told the British Medical Journal for Hilleman’s obituary in 2005. The New York Times later noted that researchers credit him with “saving more lives than any other scientist in the 20th century.”
How accurate is the medical record? A comparison of the physician’s note with a concealed audio recording in unannounced standardized patient encounters
Saul J Weiner, Shiyuan Wang, Brendan Kelly, Gunjan Sharma, Alan Schwartz:
Accurate documentation in the medical record is essential for quality care; extensive documentation is required for reimbursement. At times, these 2 imperatives conflict. We explored the concordance of information documented in the medical record with a gold standard measure.
Materials and Methods
We compared 105 encounter notes to audio recordings covertly collected by unannounced standardized patients from 36 physicians, to identify discrepancies and estimate the reimbursement implications of billing the visit based on the note vs the care actually delivered.
Results
There were 636 documentation errors, including 181 charted findings that did not take place, and 455 findings that were not charted. Ninety percent of notes contained at least 1 error. In 21 instances, the note justified a higher billing level than the gold standard audio recording, and in 4, it underrepresented the level of service (P = .005), resulting in 40 level 4 notes instead of the 23 justified based on the audio, a 74% inflated misrepresentation.
$37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018
The scab & the wound beneath
The Bloomberg viral ironies did not end there. During his campaign, his prior folk wisdom emerged in a series of embarrassing videos of past sermons. In one, he lectured an Oxford audience about the banality and rote of farming, ancient and modern, claiming that he “could teach anybody to be a farmer.” Information technology, Bloomberg insisted, required “a lot more gray matter.” During the lockdowns in Manhattan, the country did not need any more multibillionaires with brains full of “gray matter” capitalizing Chinese communist government companies, but instead needed innovative farmers—you could call them “anybodies”—to keep sending a sheltered-in-place America the most diverse, safe, plentiful, and cheap food in the world.
The apparently consensually led China touted by Bloomberg has lied about the birth, origins, spread, and infectiousness of covid-19; sent over one million of its citizens into U.S. airports after Beijing knew that the virus was communicable; had countless more circumvent U.S. restrictions; falsely declared that the U.S. military created the virus; threatened to cut off shipments of medical supplies produced in China by U.S.–Chinese joint ventures; and caused several thousand American deaths while causing trillions of dollars’ worth of economic damage.
Not having control of the supply of needed medical appurtenances and medicines may be the Boomers’ version of the Greatest Generation’s waking up on December 8, 1941, and realizing that there was nothing in the American arsenal comparable to the Japanese Mitsubishi A6M “Zero” fighter or Type 93 “Long Lance” torpedo—and would not be for the months of hard fighting and dying ahead. Likewise, Beijing now enjoys enormous advantages in the short term as it inventories all the ways the American military, government, and consumers are China-dependent. Whether China has woken a sleeping giant in the manner of the earlier Japanese, or just a purring kitten, remains to be seen. One test will be whether we begin to recalibrate key American industries or unleash Adam Schiff to conduct yet another congressional investigation against his nemesis Donald Trump.
Before the epidemic, critics of globalization could not convince our best and brightest that enriching autocracies by asymmetrical trade policies would not eventually turn China into Jackson Hole or Palm Beach. Doubters of America’s China policy complained that running up staggering American trade deficits with China would hardly lure China into the family of nations—at least in the manner of Barack Obama, who in 2014 once boasted that his new outreach initiatives with Beijing, inter alia, would “help affected countries to strengthen capacity-building on health and epidemic prevention so as to place the epidemic under control as soon as possible.” How has China’s envisioned “epidemic prevention” and “control” worked out?
So the virus confirmed what many Americans had long suspected at home as well. “Trump Derangement Syndrome” was no longer a Republican talking point, but was exposed as a psychosis with real consequences for the entire country. In the initial weeks of January, when Trump was told by the who, the Centers for Disease Control, Dr. Anthony Fauci, and most foreign and American leaders that the virus, like the earlier Chinese-born sars virus, was containable, the President, like they had at times, compared it to a bad flu. But by January 31 he had reversed course earlier than many of his future critics, rejected the earlier insistence of experts that xenophobia, racism, and chauvinism, and not the virus, were the real enemies, and issued travel restrictions—the one step that stopped some fifteen to twenty thousand Chinese nationals from arriving daily into the United States, including on direct flights from ground zero in Wuhan. Altogether over a million Chinese had arrived in October, November, December, and January. After the restrictions were enacted, many more found ways to enter the United States on connecting flights from non-embargoed nations in Europe and Asia.
No matter. House Speaker Nancy Pelosi claimed Trump’s response to the virus had been “deadly” and later added, “As the president fiddles, people are dying.” At about the same time, she tried to delay passage of a joint congressional bailout bill intended to keep endangered small business and the unemployed afloat as she scrambled to insert funding for the Kennedy Center and Planned Parenthood.
A Resilient Farmer’s Market
A few photos from the first (outdoor) 2020 Dane County Farmer’s Market, organized for our “safer at home” and “social distancing” era. Oh, at the Coliseum rather than Capitol Square…
Dane County Farmer’s Market.
“Why is it that companies and governments always call on McKinsey when they could call on McLaren?”
One obstacle might be the boredom threshold. If you are used to a high-octane life on the Grand Prix circuit, a three-hour meeting with healthcare regulators might leave you wanting to bite your arm off. Once, by accident, I ended up as part of a project-management workgroup seeking regulatory approval for a drug: after the 18th Gantt chart, I experienced one of those moments where boredom becomes physically painful.
But the other issue at stake is the difference between deterministic and probabilistic improvement. If you engage engineers, you don’t know what you are going to get. You may be unlucky and get nothing. Or their solution may be so outlandish that it is hard to compare with other competing solutions. On average, though, what you get will be more valuable than the gains produced by some tedious restructuring enshrined in a fat PowerPoint deck.
But in business, let alone in government, it is only in crises that people find a budget for probabilistic interventions of this kind (in peacetime, nobody would have given Barnes Wallis the time of day). The reason is that both bureaucrats and businesspeople are heavily attracted to the illusion of certainty. Standard cost-cutting ‘efficiencies’ can usually be ‘proven’ to work in advance; more interesting lines of enquiry come with career-threatening unknowability.
One problem with this pretence of certainty is that cost-savings are more easily quantified than potential gains — so business and government are increasingly geared towards providing people with more, poorer things at an ever-lower price. Yet much evidence suggests that people like fewer, better things at a slightly higher price.
Indeed one reason why the world is in a mess is because, for a long time, the ratio between ‘explore’ and ‘exploit’ has been badly out of whack. Entities like procurement have been allowed to claim full credit for money–grabbing cost-savings without commensurate responsibility for delayed or hidden costs. The shadow of this is everywhere, from Grenfell Tower to PPE shortages.
Please Tell The Establishment That U.S. Hegemony Is Over
The core of the book is a survey of three different sources for the unraveling of U.S. hegemony: major powers, weaker states, and transnational “counter-order” movements. Cooley and Nexon trace how Russia and China have become increasingly effective at wielding influence over many smaller states through patronage and the creation of parallel institutions and projects such as the Collective Security Treaty Organization (CSTO), the Shanghai Cooperation Organization (SCO), and the Belt and Road Initiative (BRI). They discuss a number of weaker states that have begun hedging their bets by seeking patronage from these major powers as well as the U.S. Where once America had a “near monopoly” on such patronage, this has ceased to be the case. They also track the role of “counter-order” movements, especially nationalist and populist groups, in bringing pressure to bear on their national governments and cooperating across borders to challenge international institutions. Finally, they spell out how the U.S. itself has contributed to the erosion of its own position through reckless policies dating back at least to the invasion of Iraq.
The conventional response to the unraveling of America’s hegemony here at home has been either a retreat into nostalgia with simplistic paeans to the wonders of the “liberal international order” that ignore the failures of that earlier era or an intensified commitment to hard-power dominance in the form of ever-increasing military budgets (or some combination of the two). Cooley and Nexon contend that the Trump administration has opted for the second of these responses. Citing the president’s emphasis on maintaining military dominance and his support for exorbitant military spending, they say “it suggests an approach to hegemony more dependent upon military instruments, and thus on the ability (and willingness) of the United States to continue extremely high defense spending. It depends on the wager that the United States both can and should substitute raw military power for its hegemonic infrastructure.” That not only points to what Barry Posen has called “illiberal hegemony,” but also leads to a foreign policy that is even more militarized and unchecked by international law.
Cooley and Nexon make a compelling observation about how Trump’s demand for more allied military spending differs from normal calls for burden-sharing. Normally, burden-sharing advocates call on allies to spend more so the U.S. can spend less. But that isn’t Trump’s position at all. His administration pressures allied governments to increase their spending, while showing no desire to curtail the Pentagon budget:
Retrenchment entails some combination of shedding international security commitments and shifting defense burdens onto allies and partners. This allows the retrenching power, in principle, to redirect military spending toward domestic priorities, particularly those critical to long-term productivity and economic growth. In the current American context, this means making long-overdue investments in transportation infrastructure, increasing educational spending to develop human capital, and ramping up support for research and development. This rationale makes substantially less sense if retrenchment policies do not produce reductions in defense spending–which is why Trump’s aggressive, public, and coercive push for burden sharing seems odd. Recall that Trump and his supporters want, and have already implemented, increases in the military budget. There is no indication that the Trump administration would change defense spending if, for example, Germany or South Korea increased their own military spending or more heavily subsidized American bases.
The coronavirus pandemic has exposed how misguided our priorities as a nation have been. There is now a chance to change course, but that will require our leaders to shift their thinking. U.S. hegemony is already on its way out; now Americans need to decide what our role in the world will look like afterwards. Warmed-over platitudes about “leadership” won’t suffice and throwing more money at the Pentagon is a dead end. The way forward is a strategy of retrenchment, restraint, and renewal.
China Bat Expert Says Her Wuhan Lab Wasn’t Source of New Coronavirus
For the past 15 years, Chinese scientist Shi Zhengli has warned the world—in English, Chinese and French—that bats harbor coronaviruses that pose serious risks to human health.
The flying mammals are a likely culprit in the pandemic now sweeping the globe, and Dr. Shi and her laboratories in Wuhan, where the outbreak was first identified, have attracted suspicion.
Coronavirus May Mean Automation Is Coming Sooner Than We Thought
Now we have a reason to apply this level of automation to, well, pretty much everything.
Though our current situation may force us into using more robots and automated systems sooner than we’d planned, it will end up saving us money and creating opportunity, Xing believes. He cited “fast-casual” restaurants (Chipotle, Panera, etc.) as a prime example.
Currently, people in the US spend much more to eat at home than we do to eat in fast-casual restaurants if you take into account the cost of the food we’re preparing plus the value of the time we’re spending on cooking, grocery shopping, and cleaning up after meals. According to research from investment management firm ARK Invest, taking all these costs into account makes for about $12 per meal for food cooked at home.
That’s the same as or more than the cost of grabbing a burrito or a sandwich at the joint around the corner. As more of the repetitive, low-skill tasks involved in preparing fast casual meals are automated, their cost will drop even more, giving us more incentive to forego home cooking. (But, it’s worth noting that these figures don’t take into account that eating at home is, in most cases, better for you since you’re less likely to fill your food with sugar, oil, or various other taste-enhancing but health-destroying ingredients—plus, there are those of us who get a nearly incomparable amount of joy from laboring over then savoring a homemade meal).
Now that we’re not supposed to be touching each other or touching anything anyone else has touched, but we still need to eat, automating food preparation sounds appealing (and maybe necessary). Multiple food delivery services have already implemented a contactless delivery option, where customers can choose to have their food left on their doorstep.
Besides the opportunities for in-restaurant automation, “This is an opportunity for automation to happen at the last mile,” said Xing. Delivery drones, robots, and autonomous trucks and vans could all play a part. In fact, use of delivery drones has ramped up in China since the outbreak.
Speaking of deliveries, service robots have steadily increased in numbers at Amazon; as of late 2019, the company employed around 650,000 humans and 200,000 robots—and costs have gone down as robots have gone up.