When Personal Rights Collide with Social Well-Being

Context

A personal interest in politics is looking at how individuals and groups deal with situations where personal rights collide with the rights of other individuals, groups and society as a whole. My approach has been to look at various affected people and groups individually and/or society as a whole. The point of looking at affected people and groups is to try to get an at least semi-objective feel for (1) how much of a burden on rights that (i) a new social situation, (ii) a new law or regulation, or (iii) a new imposition of existing government power imposes on adversely affected people, groups and/or society, and (2) how much of a benefit accrues to affected people, groups and/or society. The analysis tries to be ideologically and morally neutral or blind, socially realistic and objective in assessing benefits and burdens.

The two detailed analyses I've done so far focused on burdens and benefits of legalized same-sex marriage (SSM) in two contexts. The first is SSM burden and benefit on freedom of religion and speech (that analysis is here). The second is SSM burden and benefit on freedom in commerce (that analysis is here). The two analyses are very different because the groups and their sizes differ and because the size or severity of impacts are often quite different. The basic lessons from those two analyses are:

1. With some exceptions, most people who complain that their freedoms and rights are burdened (~90%) tend to grossly overstate the seriousness of the burden they actually experience. Most rarely acknowledge that any expanded freedoms or rights for benefitted people and groups even exist. If acknowledged at all, the expansion is usually attacked as illegal, not American and/or immoral or evil. Some see literal brute tyranny in situations were the degree of burden on themselves and people in their group is low to almost none at all.

2. Most people who benefit tend to understate the impact of the expansion of freedom and rights for themselves. Many of them seem to be almost completely silent, as if expanded freedoms for themselves or groups they identify with is shameful or wrong somehow. That perception may be skewed by the information sources I usually rely on.

Sporadic protests against state lockdowns continue in various places. This discussion superficially considers the collision between people who oppose lockdowns to slow the spread of coronavirus and states who impose lockdowns in the name of public health. At the rate I do it, a complete analysis would probably require about 30-60 hours. As explained below, a coronavirus analysis is much more complicated than SSM analyses.

Protests against coronavirus lockdowns: 

Freedom of movement and commerce vs public health

 In theory, everyone in society can be infected and experience effects that range from undetectably mild to death. People over the age of 65 face significantly higher risk of death. The death rate is uncertain because there is insufficient testing to know what it is. So far, there has been about 68,000 deaths in the US, with the total possibly reaching at least 100,000 in the coming 4-6 months. The efficacy of lockdown measures, including wearing masks, is uncertain. The slow, inept US response may have neutered state efforts to reduce infections. Compounding the federal failure, are states that refused to impose lockdowns, possibly making unrestrained virus spread nearly impossible to stop. In view of the uncertainty of ultimate deaths, the death rate and the economic cost-benefit of lockdowns, specifying economic and public health benefits are hard to objectify. One can make uncertain estimates at best.

In terms of rights and freedoms, economic freedoms and freedom of movement burdens here are moderate to high for various groups. Some people will lose their jobs permanently or for months, possibly for years. Some or many of those people will lose their homes. The US debt will increase by trillions. The added debt will probably be about $8 trillion in the next year or two, maybe significantly more. That will probably exert negative effects on social spending such as food stamps and welfare, which in turn will have a range of adverse effects on affected groups.

As seen in other contested situations, some see outright illegality and tyranny in the burdens the lockdowns impose.

As with SSM opposition, lockdown opposition focuses on lost freedoms of burdened people and groups. Protests are usually mostly or completely silent about social benefits, such as not spreading infections to vulnerable people. Protestors see themselves as free-thinking and patriotic.

Compared to actual tyranny in places like North Korea and China, an allegation of tyranny here is an exaggeration. Compared to pre-lockdown America, the burdens on individuals are moderate to high. Moderate for people who do not lose their jobs or homes, but high for people who do lose a job and/or their home. Some families will be devastated and irreparably broken. Those costs are real and not trivial.

Some lockdown opponents are openly defying and even mocking the use of masks as a means to reduce the spread of the virus. The efficacy of masks is unknown, making mockery easier but not rational.

Because the pandemic has been politicized, the lockdowns are adding to polarization, which is socially damaging. Polarization cements existing social distrust and ill-will while fomenting new distrust and ill-will. It is hard to pin that kind of damage down, but it is not trivial. Also, the politicization is accompanied by misinformation and lies that distort the reality of the situation. That tends to inflame emotions and thus irrationality. There is social damage in all of that. Some of it is overtly threatening violence, despite being labeled with deflecting euphemisms (lies) such as being heavily armed in public for 'added security'.

 

Some of the protests make valid points. For example, some freedoms probably do not pose a risk of spreading the virus. It is likely that restrictions on those activities are going to be relaxed fairly soon. But even there, false information is sometimes mixed with valid criticism.

 That the pandemic has been politicized for the president's re-election is also polarizing and thus socially damaging.

A healthcare provider trying to make a point, 

but probably failing

Given the uncertainties, the cost-benefit of the lockdowns so far is hard to estimate. As this issue continues to polarize and divide Americans while inflicting major damage on our economy and and adversely affected people, it seems that America probably should ease restrictions in stages with advice from experts. It is hard to shake the feeling that since the federal effort failed due to a too slow and far too incompetent response, there may be no choice but to relax lockdowns fairly soon. One can only hope that the remaining uninfected vulnerable people can somehow be protected, but that seems unlikely.

We may have reached a point where American society more or less abandons those vulnerable to the virus to those who are vulnerable to the economy. What an awful situation we are in. What an awful choice.

Some Information About Remdesivir

Short summary

Remdesivir is a moderately potent anti-viral drug. In clinical trials to test safety, the drug appears to be reasonably safe and well-tolerated. The data on whether it can decrease the death rate shows it does not do that. But what the data does appear to show, and this needs to be confirmed, is that the drug significantly shortens the time it takes a person to recover from the infection.

What remains unclear to me are (i) what "recovery" from the infection means, or how it is defined, and (ii) how early in the infection the drug needs to be started for it to have enough time to have a significant beneficial clinical effect. If the drug is started too late in a person's infection, it cannot save them if they are going to die with or without the drug.

Short technical summary

The FDA gave emergency authorization to use Remdesivir to treat the Covid-19 infection. Stories in the news yesterday indicated that some strange things had been going on in the process of authorizing use of the drug. One strange thing was a change in the 'clinical endpoint' for the drug from a reduced death rate to a reduced time to recovery, which went from 15 days to 11 days. That reduction in time to recover was called 'significant'. In drug development, 'significant' almost always means statistical significance of p < 0.05 (p means probability).

The p < 0.05 statistic means that there is a 5% chance the observed efficacy of the drug is a fluke or a false positive. A p < 0.05 value is only a modest showing that the drug is active in whatever clinical test it is analyzed in. It is preferable to hit a p-value of  0.01 or lower to have greater confidence that a drug's observed clinical activity is real.

In vivo: an assay or test in an animal or human

In vitro: an assay or test not in an animal or human, typically in cells growing in tissue culture or in cell extracts or artificial assays for individual enzymes

A February 2020 paper in the journal Cell Research reported basic antiviral activity and in vitro toxicity data for remdesivir. The drug returned values of EC50 = 0.77 μM; CC50 > 100 μM; SI > 129.87. That indicated a moderately potent drug with a relatively low toxicity profile in vitro.

The EC50 = 0.77 μM value means that at a concentration of 0.77 micromolar (μM), the drug inhibited viral replication by 50%. The EC50 is the half maximal effective concentration the drug shows in an assay. EC50 = 0.77 μM means that remdesivir is moderately potent in this particular assay. Drugs with an EC50 of 0.1 μM or lower are usually preferred.

The CC50 > 100 μM value refers to the concentration of the drug needed to kill half of the cells used in the assay. It is a general indicator of how toxic the drug is. In this case, the cells used were epithelial cells from monkey kidney. The cell line is called Vero E6 and it was developed in the 1960s. Thus, a drug that is not very toxic will have a high CC50. The lower the CC50, the more toxic the drug is. A CC50 of > 100 μM indicates that remdesivir is moderately toxic for Vero E6. It does not provide detailed information about how toxic remdesivir would be in humans.

Clinical trial experience with remdesivir in humans indicated a fairly low toxicity:

"Intravenous infusions in previously phase I clinical trials have good safety and pharmacokinetic properties. Also, no cytotoxicity, hepatorenal toxicity, or no serious adverse reactions related to metering have been observed in climbing experiments. Subjects were tolerant in studies that repeated 150 mg intravenously daily for 7–14 days. Remdesivir did not show any renal injuries in a multi-dose study."

The selectivity index value, SI > 129.87, is just EC50 ÷ CC50 (0.77 μM ÷ 100 μM). The higher the SI, the better the efficacy vs safety profile for the drug is in the assay used. Since remdesivir is not very water soluble, the CC50 is expressed as > 100 μM instead of = 100 μM. The real selectivity index cannot be evaluated due to the low water solubility for remdesivir, but it is likely to be higher than 130. However, since the SI is for an in vitro assay, it is not nearly as important as the reported toxicity and efficacy data obtained from controlled human clinical trials.

Remdesivir is a ribonucleotide analog that the virus uses to replicate itself and by incorporating the molecule into viral RNA and stopping complete duplication of the viral genome. The similarity of the remdesivir structure to natural ribonucleotides in essence "tricks" the virus polymerase into using it in place of real ribonucleotides that are always present in human, animal and cells of other kinds of self-replicating life, e.g., plants. This is a chemical strategy that has been used against RNA viruses for decades, including the first analog used to treat HIV, AZT (azidothymidine), back in the 1980s.

Remdesivir

Vaccine Risk Shift to Taxpayers

Context

When drug makers ramp up drug or vaccine production before clinical trials and data analyses are complete, it is called “at risk” production. The risk lies in the FDA’s refusal to approve the drug or vaccine on safety and/or efficacy grounds. All drug and vaccine production is usually costly, so the risk tends to be high. Companies tend to hesitate to produce at risk unless they are confident about their safety and efficacy data. The upside of at risk production is that once FDA approval is received, product sales can occur almost immediately after approval. Each day of sales protected by either market exclusivity or patents is precious. Each day can be worth millions in profit to a company.

Risk shift

The Washington Post reports that under a federal government effort, called “Operation Warp Speed”, taxpayers will assume the risk of at risk production of Covid-19 vaccine. That seems like a dumb name. Maybe the president dictated it. It sounds like him. Whatever.

Operation ludicrous speed

The downside is that taxpayers will have to pay the cost of at risk production if the vaccine fails to be sufficiently safe or effective. The upside is that if a vaccine does get FDA marketing approval, it can be at least fairly widely available within a few weeks. The goal of the effort is to have a vaccine publicly available by January of 2021. If that timeline pans out, it would be an amazing research and production achievement in such a short time.

The risk shift to taxpayers illustrates a key aspect of America’s for-profit healthcare system. Namely, it is a for-profit industry. Companies will not take risks that do not pass muster with internal company reviews, even if the risk could save many lives. Taking excessive risk can open a company and its executives up to shareholder lawsuits. Shareholders hold shares to make money, not to make people safe. That is the cold, hard reality of American healthcare. Profit, not service to the public interest, is the overwhelming moral imperative of capitalism.

Incoherent, self-serving drivel from our endlessly blame-shifting Blitherer-in-Chief

Naturally, the president chimed in. WaPo writes:

“President Trump said it is not too optimistic to try to produce roughly 300 million doses of vaccine in eight months, enough for the entire country.

‘No, I’m not overpromising. I don’t know who said it, but whatever the maximum is, whatever you can humanly do, we’re going to have. And we hope we’re going to come up with a good vaccine,’ the president said at the White House.

He added that ‘we’re going to fast-track it like you’ve never seen before, if we come up with a vaccine.’

Asked who is in charge of the effort, Trump said he is. 

‘I think probably, more than anything, I’m in charge. And I’m the one that gets blamed. And I get blamed anyway,’ Trump said.”

“I don’t know who said it.” That pretty much sums up the president’s grasp of things like science, the Covid-19 pandemic and reality in general.

“I think probably, more than anything, I’m in charge.” Probably in charge? Har, har, har! He will claim to be in charge if the effort works. But it will be the fault of Obama, Hillary’s Benghazigate and/or emailgate or something like that if it fails.

Sarcasm: Russia, if you’re listening, please find the missing emails. That is where Covid-19 came from and the vaccine recipe is in there too. Ludicrous speed on that hacking, please.

The fact that the president waited this long to jump to warp speed does mean he will be blamed for the needless delay because the delay was needless and he should be blamed. Why do this now and not three or four months ago? That inexcusable incompetence-driven delay is on the president, not Barak, Hillary, Pelosi, Schumer, the New York Times hidden emails or anything or anyone else.

Even at this very late date, the president clearly does not grasp the scope or gravity of what America is facing right now. He is amazingly clueless.

A sincere wish for the future

Maybe one day, the news won’t be so endlessly bad and idiotic. Maybe one day American politics will return to some reasonable degree of coherence and some reasonable grounding in facts, sound reason and transparent accountability. I do not know when that day will be, but I hope it is very soon.

‘MOST PEOPLE JUST DON’T THINK,’ SAYS SELF-HELP GURU JESSE ELDER AS HE FILMED HIMSELF WALKING GARBERVILLE’S MAIN STREET YESTERDAY

Texas man, Jesse Elder, self-described “Millionaire Mentor, an Improv Philosopher, former MMA fighter turned entrepreneur, and also the author of The Upgraded Life”, rolled through Garberville yesterday, walking and filming himself giving a monologue on critical thinking.

Elder, whose website says “his popular Mind Vitamin videos, online courses, events, and private coaching [teach] others how to create their own success and fulfillment, reclaim their personal freedom, and master their reality,” argues in the video that confusion is key to critical thinking as it allows one to ask the right questions.

With the empty streets of the tiny Southern Humboldt town lit by sunset, the self-help guru explained to viewers that he is traveling through on his way towards Seattle.  Elder is apparently unworried about catching COVID-19. He says he’s “wearing his mask on the inside in the form of a wolverine-like immune system.”

He adds that if anyone is concerned about “catching some sort of thing” from him as he reads “the look of fear on their face,” he alters his trajectory to stay more than six feet away from them.

Video  was filmed in Garberville by Elder and posted on Facebook. Unfortunately, they may make it difficult for some to view.

To view:

https://kymkemp.com/2020/04/29/most-people-just-dont-think-says-self-help-guru-jesse-elder-as-he-filmed-himself-walking-garbervilles-main-street-yesterday/

The Continuing Failure of the Mainstream Media

CONTEXT

Before the 2016 election, the broadcast media gave the president more far air time than other candidates. An estimate the New York Time published in March 2016 was that the free air time was worth about $1.9 billion to the president's campaign.

NPR's failure

NPR's Morning Edition program broadcast a 4-minute segment on how the Trump campaign is raising money for the 2020 elections. It is a fluff piece. It is very supportive of how the president is harvesting cash from the public for his campaign. The segment sounded like an advertisement paid for by the president's re-election campaign.

There was no mention of Biden or his campaign anywhere in today's Morning Edition program.

I found the segment to be highly offensive. I wrote to NPR complaining about supporting the president's re-election without also supporting Biden's election campaign with equal air time and an equal tone of approval.




Questions: Am I overreacting and this piece isn't anything of importance to the president's re-election? Should Biden be given equal airtime for every second that NPR and other broadcast sources give to the president?

Coronavirus Update 9

Some states are going to start reopening their economies within the next few days and weeks. That is coming despite a persistent inability to do large scale testing in the US. Reopening has already started in some places such as Georgia and Alaska. Some states never issued stay-at-home orders and are under various degrees of business and health care closures. Despite assertions from some governors that it is safe to begin to reopen, there is no way to know that without large scale testing. In essence, each state will be a separate experiment in how the Covid-19 pandemic will play out.

Absent testing data, it will be basically impossible to follow the course of the infection in detail. The number of infections and deaths could increase in coming weeks. The president continues to reject responsibility for spearheading and coordinating testing efforts. The New York Times commented: “A White House document makes clear that the states are still primarily responsible for testing and that Washington is only the ‘supplier of last resort.’” Clearly, the president has rejected a major role for a federal government testing effort, despite being the only source of national authority for coordination efforts. That level of incompetence and stupidity is incomprehensible.

The new set of symptoms

The CDC announced that it now considers nine symptoms to be common to most Covid-19 infections. Previously, three symptomes were considered dominant, i.e., shortness of breath, cough and fever. The list now also includes chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell. These nine symptoms most commonly appear at two to 14 days after exposure to the virus. This nw listing of overt symptoms is an astonishing change in how the disease is perceived by the CDC. Why it took this long to simply see what the dominant symptoms are suggests that there is a profound problem or dysfunction in the CDC. This revelation comes weeks after hundreds of thousands of cases have been observed.

My guess is that the president has neutered the CDC for his personal political reasons. Maybe the president has muzzled the experts. Maybe he put incompetent loyalists in charge. Whatever the reasons, it is very hard to understand why it has taken this long to simply characterize the main symptoms of the disease, except for attributing it to factors such as the president's typical gross incompetence, his blatant dereliction of his duties, concern for his own re-election, and/or just plain corruption.

People still trust Trump

Reuters reports that an astounding 47% of Americans report that they are “very” or “somewhat” likely to follow recommendations the president makes about the virus. Although that is a 15% decrease from a poll at the end of March, it is arguably staggeringly high in view of how poorly the president has performed so far. The poll did indicate that 08% of democrats and republicans will not take the president's advice to inject themselves with bleach or other disinfectants. At least that sliver of reality appears to have sunk in with Americans. Reuters comments that the president’s popularity remains stable: “Overall, Trump’s overall popularity has not changed much over the past week. Forty-three percent of Americans said they approve of his overall job performance, and the same number also approve of his handling of the COVID-19 pandemic.”

Where we are and where we are going

Given America’s feeble, failed federal response to Covid-19, the imminent reopening of states and our continuing inability to do adequate testing, it now appears reasonable to speculate that the virus is going to spread through almost the entire US population. Isolated pockets of people may avoid the disease, but most of the US population seems destined to develop herd immunity on its own whether we want to get immunity that way or not. That will probably happen before a widespread antiviral treatment or vaccine becomes available. It also assumes that once people recover from an infection, they will have protective immunity. That is an open question at the moment, but it is reasonable to think that that protective immunity probably will result in most people who survive the infection.

Some evidence indicates that an antiviral drug now in testing, remdesivir, may be somewhat helpful if given fairly early in the course of the infection. That is good news, but it needs to be confirmed. Also of concern is whether the company can ramp up to large scale production if the drug does prove to be useful. Also, a team in England is optimistic that an effective vaccine they are developing can be available by September of this year. If that comes to pass, it would about as close to a medical miracle as humans can muster in such a short time.

That is something no longer possible from the US government. It is too late for that.