Water Entrepreneurs in Kathmandu: “The City Depends on Us”

(p. 1) KATHMANDU, Nepal — It had been 11 days since a ruptured valve reduced Kupondole district’s pipeline flow to a dribble, and the phones at Pradeep Tamanz’s tanker business wouldn’t stop ringing.

A Malaysian embassy residence had run perilously low on water, and the diplomats wanted to shower. They’d pay extra for a swift delivery. A coffee processing plant was on the verge of shutting down production after emptying its storage tank. It, too, would shell out whatever amount of money it would take. Across the neighborhood and other parts of the city, the calls were coming in so feverishly that Sanjay, a tanker driver, jokily wondered if he might get carjacked. “This is like liquid gold,” he said, jabbing at his precious cargo, large amounts of which seeped from every hatch. “Maybe more than gold.”

Dashing from filling stations to houses and factories and back, Mr. Tamanz tried to meet demand. His (p. 6) three tanker crews slept in one or two-hour spurts, often in the cramped, refrigerator-sized truck cabins, and kept the tankers on the road for up to 19 hours a day. He fobbed off business to competitors, an unusual practice in the cutthroat world of Kathmandu tanker men, and even sounded out a mechanic about converting a flatbed truck into a new tanker. With fat profits pouring in, the young businessman figured it might soon repay its cost.

But no matter how hard the crews worked or how furiously they pushed their lumbering vehicles over the potholed roads, there was no satisfying the city’s needs. The going was too slow. The water shortage too severe. By the time the pipeline was fully restored, some households had subsisted on nothing but small jerrycans for almost an entire month. “You know it’s not even peak season, but this is what happens here,” Mr. Tamanz said. “Just imagine what things would be like if we didn’t exist?” He trailed off as his phone rang once more.

In Kathmandu, as in much of South Asia and parts of the Middle East, South America and sub-Saharan Africa, these men and their tanker trucks sometimes prevent entire cities from running dry. Without them, millions of households wouldn’t have sufficient water to cook, clean or wash. Or perhaps any at all. And without them, an already deteriorating infrastructure might break down completely, as the tanker men know well. “The city depends on us,” said Maheswar Dahal, a businessman who owns six trucks in Kathmandu’s Jorpati district. “There would be disaster if we didn’t do our work.”

For the full story, see:

Peter Schwartzstein. “Merchants of Thirst.” The New York Times, SundayBusiness Section (Sunday, January 12, 2020): 1 & 6-7.

(Note: the online version of the story was updated on January 13, 2020, and has the title “The Merchants of Thirst.”)

Chris Rock on Covid-19, Blackface, and Cancel Culture

(p. 7) [Rock:] Part of the reason we’re in the predicament we’re in is, the president’s a landlord. No one has less compassion for humans than a landlord. [Laughs.] And we’re shocked he’s not engaged.

Did you ever see that movie “The Last Emperor,” where like a 5-year-old is the emperor of China? There’s a kid and he’s the king. So I’m like, it’s all the Democrats’ fault. Because you knew that the emperor was 5 years old. And when the emperor’s 5 years old, they only lead in theory. There’s usually an adult who’s like, “OK, this is what we’re really going to do.” And it was totally up to Pelosi and the Democrats. Their thing was, “We’re going to get him impeached,” which was never going to happen. You let the pandemic come in. Yes, we can blame Trump, but he’s really the 5-year-old.

Put it this way: Republicans tell outright lies. Democrats leave out key pieces of the truth that would lead to a more nuanced argument. In a sense, it’s all fake news.

. . .

[Itzkoff:] Jimmy Fallon drew significant criticism this past spring for a 20-year-old clip of himself playing you in blackface on “Saturday Night Live.” How did you feel about that segment?

[Rock:] Hey, man, I’m friends with Jimmy. Jimmy’s a great guy. And he didn’t mean anything. A lot of people want to say intention doesn’t matter, but it does. And I don’t think Jimmy Fallon intended to hurt me. And he didn’t.

. . .

[Itzkoff:] There’s been a wider push to expunge blackface from any movies or TV shows where it previously appeared. Have people taken it too far?

[Rock:] If I say they are, then I’m the worst guy in the world. There’s literally one answer that ends my whole career. Blackface ain’t cool, OK? That’s my quote. Blackface is bad.

For the full interview, see:

Dave Itzkoff, interviewer. “Chris Rock’s New Universe.” The New York Times, Arts&Leisure Section (Sunday, September 20, 2020): 6-7.

(Note: ellipses, and bracketed names, added.)

(Note: the online version of the interview was updated Sept. 24, 2020, and has the title “Chris Rock Tried to Warn Us.”)

Ranchers Will Protect and Invest in Brazilian Forest Land That They Own

(p. A1) POMBAL, Brazil—For the past 15 years, Carlos Pacheco has raised cattle in what was once virgin forest. When pastures went bad, he would simply cut deeper into the Amazon, one of millions of farmers who have helped strip away about a fifth of the world’s greatest rainforest.

Because he expanded into land he doesn’t own, he can’t use it as collateral for a loan to buy equipment and fertilizer, nor can he tap the expertise of a government agronomist. The upshot is that he uses more land to raise each cow than do legal farmers in the breadbasket of southern Brazil.

It may sound counterintuitive, but Brazilian authorities think giving Mr. Pacheco a deed to the land he farms might curtail deforestation. The idea is it could help him become a more efficient farmer, able to produce more on less land, and also make him hesitate to just walk away from depleted pastures and carve new ones. In short, it might discourage him and squatters like him from cutting ever deeper into the jungle.

“If this doesn’t happen, we will continue to deforest,” said the 49-year-old rancher, the leader of a tightknit group of several hundred settlers on the forest frontier.

The administration of Brazilian President Jair Bolsonaro wants to see if he is right. In February [2020], it plans to start handing out deeds to some 300,000 Amazon squatters, with a plan that might help but has raised a howl of disapproval for re-(p. A12)warding bad behavior.

. . .

Over the decades, 73-year-old cattleman João Bueno cut into the forest in Pará state to build a network of ranches totaling 45,000 acres, with 28,000 head of cattle.

He has a special document that allows him to produce and sell cattle to a slaughterhouse, but it isn’t a title, so it doesn’t allow him to use the land as loan collateral. Mr. Bueno said tapping credit would permit him to modernize his operation with fertilizer and techniques common elsewhere, raising three times as many head of cattle on the same acreage.

“Land without documentation is nobody’s land, so people take advantage of it to clear forest for pastures,” Mr. Bueno said.

For the full story, see:

Paulo Trevisani and Juan Forero. “Brazil’s Unusual Bid to Curb Deforestation.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A12.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the story has the date January 31, 2020, and has the title “Squatters Cut Down the Rainforest. Brazil Wants to Give Them the Land.”)

How “Single-Payer” Socialized Medicine Works for American Indians

(p. A1) EAGLE BUTTE, S.D.—Kate Miner walked into the Indian Health Service hospital, seeking help for a cough that wouldn’t quit.

An X-ray taken of Ms. Miner’s lungs that day, Oct. 19, 2016, found signs of cancer.

What exactly the IHS doctor said to Ms. Miner about her exam remains in dispute. Notations in her medical file indicate the doctor told her to come back for a lung scan the next day. Her family says they never were given such instructions and weren’t told of the two masses the X-ray revealed.

What is clear is that no further tests were done. And no IHS provider followed up when Ms. Miner returned twice more to the hospital, the only one on the Cheyenne River Reservation, over the next six months, medical records show.

Finally, on May 7, 2017, as the 67-year-old Ms. Miner lay crumpled on a hospital cot, the right side of her body shaking, a physician assistant ordered a CT scan, after her family insisted, according to the records and family members.

“You have two very large masses in your right lung. It’s probably a malignancy,” Ms. Miner’s daughter Kali Tree Top recalled the physician assistant saying.

Ms. Miner reached for her daughter’s hand and started to cry.

Ms. Miner’s encounters with the IHS, and her family’s repeated efforts to get her help there, illustrate how the federal agency can fail the patients who need it most.

For the full story, see:

Dan Frosch. “A Tragic Journey Through the Indian Health Service.” The Wall Street Journal (Tuesday, December 24, 2019): A1 & A8.

(Note: the online version of the story was updated December 23, 2019, and has the title “Kate Miner’s Tragic Journey Through the U.S. Indian Health Service.”)

Opposed by China and WHO, Trump Administration Declared Covid-19 Public Health Emergency on January 31, 2020

(p. A1) The U.S. imposed entry restrictions on foreign nationals and quarantines on Americans returning from the Chinese province at the center of the coronavirus outbreak, as markets tumbled over fears about the impact on global growth.

Health and Human Services Secretary Alex Azar declared a public health emergency Friday [Jan. 31, 2020]. He said foreign citizens who have traveled anywhere in China within the past 14 days would be denied U.S. entry, while Americans who visited Hubei province would be quarantined for up to two weeks.

. . .

(p. A8) “Many countries have offered China support in various means. In sharp contrast, certain U.S. officials’ words and actions are neither factual nor appropriate,” Chinese Foreign Ministry spokeswoman Hua Chunying said. “Just as the WHO recommended against travel restrictions, the U.S. rushed to go in the opposite way.”

For the full story, see:

Alex Leary and Brianna Abbott. “U.S. Curbs Entry to Combat Virus.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A8.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story has the date January 31, 2020, and has the title “U.S. Imposes Entry Restrictions Over Coronavirus.”)

Wasteful Administrative Health Care Costs

The study quoted from below suggests that the main cure for wasteful administrative costs is a “single payer” system, which is a politically correct euphemism for socialized medicine. I suggest that a better cure would be to eliminate the government middle-man, and make the patient be the payer. The patient as payer would seek and buy low-cost cures or therapies, which would shift efforts at healthcare innovation toward lower cost innovations. As has been suggested for education, vouchers could provide poor patients with the means to pay for basic care.

(p. B4) Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.
A new study, published Monday [October 7, 2020] in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.

. . .

Teresa Rogstad of Humana and Natasha Parekh, a physician with the University of Pittsburgh, were co-authors of the study, which combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy.

. . .

The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.

. . .

The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. Despite this high cost, the authors found no studies that evaluate approaches to reducing it.

For the full commentary, see:

Austin Frakt. “THE NEW HEALTH CARE; Up to 25% of Health Costs Called Wasteful.” The New York Times (Tuesday, October 8, 2019): B4.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the commentary has the date Oct. 7, 2019, and has the title “THE NEW HEALTH CARE; The Huge Waste in the U.S. Health System.”)

The print version of the academic article in JAMA mentioned above is:

Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the Us Health Care System: Estimated Costs and Potential for Savings.” JAMA 322, no. 15 (Oct. 15, 2019): 1501-09.

WHO “Expert” Committee Took Four Months to Endorse Widespread Mask-Wearing

(p. A1) GENEVA—Sylvie Briand landed in China looking for answers. Nearly a month had passed since word of a mysterious pneumonia had emerged. It was now late January and the World Health Organization was struggling to learn more about it.

Frustrated with mounting cases and limited information from China, the WHO’s top brass, including Dr. Briand, flew to Beijing to resolve a burning question: How easily did this new disease spread?

They met with President Xi Jinping. They had a phone call with local WHO staff just back from the Wuhan epicenter, quarantined after one developed a cough. Dr. Briand, the agency’s director of global infectious hazard preparedness, drew up a list of questions for Chinese health officials.

By the time the WHO received answers, the Covid-19 pandemic was stumbling into emergency rooms on three continents. Its spread around the world had already begun on Jan. 30 [2020] when the WHO declared a global public-health emergency, its one and only level of alert.

. . .

(p. A10) “Now is the moment for all countries to be preparing themselves,” Director-General Tedros Adhanom Ghebreyesus declared on Feb. 4, when the WHO reported more than 20,600 cases in 25 countries.

But that same day, the WHO also asked nations not to close borders—following its standard protocol, as such restrictions might discourage governments from reporting outbreaks. Within weeks, the virus landed on the agency’s doorstep, turning Geneva into a hot spot.

. . .

To write its recommendations, the WHO solicits outside experts, which can be a slow process. It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.

. . .

A review of the WHO’s initial response to the pandemic, based on interviews with current and former WHO staff, public-health experts advising it and officials who work with it, suggests that the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.

. . .

On Jan. 3 [2020], representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew. That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.

China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations, said Lawrence Gostin, professor of global health law at Georgetown University who has advised the WHO on international health regulation matters. “Once a government knows that there is a novel virus that fits within the criteria, which China did, it’s obliged to report rapidly,” he said.

China also flouted the IHR by not disclosing all key information it had to the WHO, said David Fidler, an expert on global health and international law at the Council on Foreign Relations. The regulations call for member states to provide the WHO with “timely, accurate and sufficiently detailed public health information available to it on the notified event.”

For the full story, see:

Betsy McKay and Drew Hinshaw. “Doctors Split on Best Way To Treat Coronavirus Cases.” The Wall Street Journal (Saturday, August 29, 2020): A1 & A10.

(Note: ellipses, and bracketed years, added.)

(Note: the online version of the story has the date August 28, 2020, and has the title “How Coronavirus Overpowered the World Health Organization.”)

Trump Administration Pushed FDA to Allow Citizens to Choose Vaccines Sooner

(p. A7) On Sept. 23 [2020], Dr. Stephen M. Hahn left a virtual meeting of the White House’s coronavirus task force to take a call from the president’s chief of staff, Mark Meadows.

Mr. Meadows was angry with Dr. Hahn, the head of the Food and Drug Administration, for pushing new guidelines for vaccine developers, according to two senior administration officials familiar with the call who requested anonymity because they were not authorized to discuss it. The F.D.A. wanted to require two months of follow-up data to make sure a vaccine was safe and effective, all but ensuring one would not be ready by Election Day as President Trump had promised.

Mr. Meadows told the commissioner the White House would not sign off on the guidance because it was unnecessary and would delay vaccine approval, so he should drop it, the officials said.

. . .

Mr. Meadows, Jared Kushner, the president’s son-in-law and senior adviser, and the president himself have called Dr. Hahn directly to urge him to speed up emergency authorization of vaccines and treatments, according to the two senior administration officials.

But despite the White House refusal to approve the new vaccine guidance document, the F.D.A. published the guidelines in briefing materials to an advisory committee that will discuss them on Thursday [October 22, 2020], effectively making them official.

For the full story, see:

Sheila Kaplan, Sharon LaFraniere, Noah Weiland and Maggie Haberman. “How the F.D.A. Stood Firm Against White House Pressure.” The New York Times (Wednesday, October 21, 2020): A7.

(Note: ellipsis, and bracketed dates, added.)

(Note: the online version of the story has the date Oct. 20, 2020, and has the title “How the F.D.A. Stood Up to the President.”)

Expense of Clinical Trials Reduce the Incentive to Re-Purpose Old, Cheap, Off-Patent Vaccines

(p. A5) “Retrospective studies are great and they provide some hints, but there are caveats,” said Dr. Shyam Kottilil, a professor of medicine with the Institute of Human Virology at the University of Maryland School of Medicine. “It’s very difficult to establish causality.”

Interest in the cross-protective effects of vaccines has led to efforts to repurpose old vaccines that may have potential to provide at least transient protection against the coronavirus until a specific vaccine against SARS-CoV-2 is developed and proven safe and effective, he said.

“But nobody knows whether this approach will work unless we test them,” Dr. Kottilil said. “To endorse this, you need to do really good randomized clinical trials.” There is little incentive for private companies to invest in expensive trials because the old vaccines are cheap and off-patent, he added.

For the full story, see:

Roni Caryn Rabin. “Are Past Vaccinations a Shield? It’s Doubtful.” The New York Times (Thursday, July 30, 2020): A5.

(Note: the online version of the story has the date July 29, 2020, and has the title “Old Vaccines May Stop the Coronavirus, Study Hints. Scientists Are Skeptical.”)

The Son of Jonas Salk Calls Operation Warp Speed “Absolutely Extraordinary”

A screen capture from the Replica Edition of the NYT, p. A4 for Thurs., Nov. 18, 2020.

(p. A4) A 76-year-old man in La Jolla, Calif., says he will get a coronavirus but not the way he got a polio vaccine when he was 9 — lined up in the kitchen next to his two siblings. Their father had sterilized the needles and syringes by boiling them on the stove.

The father was Dr. Jonas Salk, who had developed the vaccine.

. . .

At the time, the vaccine had gone through trials with small numbers of children. A trial with 1.8 million children did not begin until the next year, and the vaccine did not receive approval as safe and effective until a year after that — a timetable that he said made the development of coronavirus vaccine candidates in just months “absolutely extraordinary.” He said he had been concerned about pressure from the Trump administration to have a vaccine ready by Election Day. But he also said the decision to back the development of vaccines through Operation Warp Speed, the federal effort to accelerate vaccine development, “was quite positive.”

For the full story, see:

Barron, James. “Coronavirus Update; ‘l Just Didn’t Feel the Shot’.” The New York Times (Wednesday, November 18, 2020): A4.

(Note: ellipsis added.)

(Note: after considerable time spent searching, I was unable to find this article on the nytimes.com web site. I searched on 11/21/20 for the article that had appeared in-print on 11/18/20. In my experience, it is extremely rare for so recent a print article to be missing from the online web site. So, for documentary purposes, I have reproduced a screen capture of the article from the Replica Edition. (For subscribers to the NYT, The Replica Edition provides an online replica of the print edition for the previous 30 days of issues of the NYT.)

California Energy Shortage Partly Due to Government Mandated Price Ceiling on Energy Imported from Out-of-State

(p. B9) As California keeps facing electricity shortages, the discussion around its grid often veers to extremes.

. . .

Should California . . . have shut down less natural gas and nuclear power? That is definitely part of the issue, and future shutdowns might need to slow.

. . .

. . . at least some of the shortage is addressable through market rules.

For example, California has a hard import bid cap of $1,000 per megawatt hour. Christopher DaCosta, regional director of western power markets at Wood Mackenzie, says that surrounding areas have a softer cap and are able to pay more. During this summer, that meant power plants often rerouted electricity to higher bidders than California.

For the full commentary, see:

Jinjoo Lee. “To Keep Lights On, California Needs Power Play.” The Wall Street Journal (Thursday, September 17, 2020): B9.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sep. 16, 2020, and has the title “How to Keep the Lights On in California.”)