Category: Health

Litan and Mankiw Endorse Paying People to Take Vaccine

(p. 5) What’s the best way to get the economy back on track after the Covid-19 recession? Simple: Achieve herd immunity. And what’s the best way to achieve herd immunity? Again, simple: Once a vaccine is approved, pay people to take it.

That bold proposal comes from Robert Litan, an economist at the Brookings Institution. Congress should enact it as quickly as possible.

. . .

Recent research by the University of Chicago economists Austan Goolsbee and Chad Syverson has found that the government-mandated shutdowns account for just a small part of the decline in economic activity. The main reason people aren’t spending is that they are afraid to leave their homes and contract the virus. That hypothesis explains my own behavior. I have not stepped foot on an airplane or inside a restaurant for six months.

. . .

Immunology, meet economics. One of the first principles of economics — perhaps the most important — is that people respond to incentives. Applying this principle to the case at hand, Mr. Litan recommends that the government pay $1,000 to whoever gets the vaccine. With a large enough incentive, most Americans are likely to get vaccinated.

This proposal is textbook economics. (I’ve written some of the textbooks.) As all economics students learn, when an activity has a side effect on bystanders, that effect is called an externality. In the presence of externalities, the famous theorems of economics that justify laissez-faire do not apply. Adam Smith’s vaunted invisible hand can no longer work its magic.

A classic example of a negative externality is pollution, and the simplest and least invasive policy solution is a tax on emissions. In economics-speak, such a tax internalizes the externality: It induces polluters to take the cost of pollution into account by giving them a financial incentive to cut emissions. That’s why I have written here many times that a tax on carbon emissions is the best way to deal with global climate change.

Vaccination confers a positive externality. When you get vaccinated, you benefit not only yourself but also your fellow citizens by helping society take a step toward herd immunity. In this case, internalizing the externality requires not a tax but a subsidy, as Mr. Litan suggests.

For the full commentary, see:

N. Gregory Mankiw. “A Vaccine Subsidy Licks 2 Crises With One Shot.” The New York Times, SundayReview Section (Sunday, September 13, 2020): 5.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 9, 2020, and has the title “Pay People to Get Vaccinated.”)

The Robert Litan op-ed mentioned above is:

Litan, Robert E. “Want Herd Immunity? Pay People to Take the Vaccine.” Brookings Institute Op-Ed. (Tues., Aug. 18, 2020) URL: https://www.brookings.edu/opinions/want-herd-immunity-pay-people-to-take-the-vaccine/.>

The Goolsbee and Syverson NBER working paper mentioned above is:

Goolsbee, Austan, and Chad Syverson. “Fear, Lockdown, and Diversion: Comparing Drivers of Pandemic Economic Decline 2020.” NBER Working Paper #27432, June 2020.

“Operation Warp Speed, . . . , Is More Imaginative Than the Bureaucratic Norm”

(p. 11) . . . the blundering of the Trump administration, while real and deadly, may not be responsible for the bulk of America’s coronavirus fatalities.

. . .

. . . : the absence of challenge trials for vaccines (in which young, healthy participants agree to be vaccinated and then infected with the virus), the predictable expert resistance to at-home testing. But the most important one was the straightforward bureaucratic calamity at the C.D.C. that delayed effective testing for a fateful month.

An effective president might have addressed some of these problems. (Although Operation Warp Speed, the White House’s vaccine initiative, is more imaginative than the bureaucratic norm.) But overall they are problems with structures and habits rather than personalities — an institutional decadence that predated Trump and will persist when he is gone.

. . .

. . . the third thing you see when you look beyond Trump [is] the fact that so many countries in Western Europe, to say nothing of our neighbors in the Americas, have had death rates similar to ours.

This reality speaks not of exceptionalism but of convergence — and the possibility that the trends of the early 21st century have left us sharing more in common not only with France and Spain but also with Mexico and Brazil than most Americans might expect.

This, too, may matter long after Trump is gone. Where there are crises, in this dispensation, they are likely to be general rather than just American. Where there is decadence, it is the shared experience of late modernity. And if renewal comes to an exhausted West, it will not necessarily come through America alone.

For the full commentary, see:

Ross Douthat. “What Isn’t Trump’s Fault.” The New York Times, SundayReview Section (Sunday, September 13, 2020): 11.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 12, 2020, and has the same title as the print version.)

Open Offices Reduce Productivity and Spread Diseases

(p. B4) When historians of the early 21st century look back on the pre-Covid era, one of the absurdities they might highlight is the vogue for gigantic, open-plan offices. The apotheosis of this trend of breaking down barriers between co-workers must surely be Facebook Inc.’s 433,555-square-foot Frank Gehry-designed open-plan office at its headquarters in Menlo Park, Calif. Opened in 2015, it’s now a ghost town, a monument to offices vacated by the pandemic.

Cramming cavernous spaces with as many desks as they could hold might have increased serendipitous interactions, but it almost certainly reduced productivity and helped spread communicable diseases, including coronavirus.

. . .

Cue the “dynamic workplace,” a pivot away from the open plan, built on the idea that with fewer employees coming to work on any given day, offices can offer them more flexibility of layout and management.

While open offices and dynamic workplaces share similar components—privacy booths and huddle rooms to escape the hubbub, cafe-like networking spaces, etc.—they’re philosophically distinct. One is intended to be a place where people come (at least) five days a week, and get most of their work done on site. The other is planned for people rotating in and out of the office, on flexible schedules they have more control over than ever.

. . .

Research on hot-desking in office spaces, for example—where employees give up a dedicated space in favor of first-come-first-serve seating—finds that it decreases socialization and trust. This happens because employees figure they might never again see the person they sit next to on a given day, says Dr. Sander. In other studies, employees complain they can’t find their colleagues, that it’s a hassle to find a new spot to work every day, and that such arrangements ignore humans’ innate territoriality and desire to make a space their own.

For the full commentary, see:

Christopher Mims. “Goodbye, Open Office. Hello, ‘Dynamic Workplace.” The Wall Street Journal (Saturday, September 12, 2020): B4.

(Note: ellipses added.)

(Note: the online version of the commentary has the same date and title as the print version.)

Russia Approves Covid-19 Vaccine Before Completing Phase 3 Clinical Trial

(p. A6) MOSCOW — Russia has become the first country in the world to approve a vaccine for the coronavirus, President Vladimir V. Putin announced on Tuesday, though global health authorities say the vaccine has yet to complete critical, late-stage clinical trials to determine its safety and effectiveness.

Mr. Putin, who told a cabinet meeting on Tuesday [Aug. 11, 2020] morning that the vaccine “works effectively enough,” said that his own daughter had taken it. And in a congratulatory note to the nation, he thanked the scientists who developed the vaccine for “this first, very important step for our country, and generally for the whole world.”

. . .

If Russian scientists have taken an unorthodox route to the coronavirus vaccine, it would not be the first time. Back in the 1950s, a team of researchers tested a promising, and ultimately successful, polio vaccine on their own children.

For the full story, see:

Andrew E. Kramer. “Putin Says Russia Is First to Approve Vaccine, but Skepticism Abounds.” The New York Times (Wednesday, August 12, 2020): A6.

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

(Note: the online version of the story was updated Aug. 11, 2020, and has the title “Russia Approves Coronavirus Vaccine Before Completing Tests.”)

Shanghai Immunologist Says Phase 1 and Phase 2 Tests Show Chinese Vaccine Is Safe and “Highly Likely” to Protect Against Covid-19

(p. A8) The United Arab Emirates has become the first country outside China to approve emergency usage of a Chinese Covid-19 vaccine candidate, in a vote of confidence for a state-backed drugmaker racing global rivals to stop the spread of the coronavirus.

. . .

Tao Lina, a former immunologist with the Shanghai CDC, said in an interview that it makes sense for authorities to approve the usage of Chinese vaccines that have proved safe during the first two phases of clinical trials, given the scale of the Covid-19 crisis. Unlike medical drug treatments, vaccines work by triggering a person’s own immunity, he said. “I’m not at all worried about the safety of the vaccines,” Mr. Tao said.

While the level of efficacy of the Chinese vaccines being used including those of Sinopharm isn’t yet clear, Mr. Tao said the Chinese vaccines’ ability to induce the body to produce antibodies during previous clinical trials meant that they were highly likely to confer some degree of protection from the virus.

For the full story, see:

Chao Deng, and Rory Jones. “U.A.E. Approves Use of China-Made Covid-19 Vaccine.” The Wall Street Journal (Wednesday, September 16, 2020): A8.

(Note: ellipsis added.)

(Note: the online version of the story was updated Sep. 15, 2020, and has the title “In Global Covid-19 Vaccine Race, Chinese Shot Receives First Foreign Approval.”)

600-Year-Old Ginkgo Trees Are as Vigorous as 20-Year-Old Ginkgo Trees

(p. D2) . . . a January [2020] study on ginkgo trees, which can live for over a thousand years . . . found that 600-year-old ginkgos are as reproductively and photosynthetically vigorous as their 20-year-old peers. Genetic analysis of the trees’ vascular cambium — a thin layer of cells that lies just underneath the bark, and creates new living tissue — showed “no evidence of senescence,” or cell death, the authors wrote.

For the full story, see:

Cara Giaimo. “Holding On; Can Trees Live Forever? A New Study Adds Kindling to the Debate.” The New York Times (Tuesday, August 4, 2020): D2.

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

(Note: the online version of the story was updated July 27, 2020, and has the title “Can Trees Live Forever? New Kindling for an Immortal Debate.”)

The January 2020 study mentioned above is:

Wang, Li, Jiawen Cui, Biao Jin, Jianguo Zhao, Huimin Xu, Zhaogeng Lu, Weixing Li, Xiaoxia Li, Linling Li, Eryuan Liang, Xiaolan Rao, Shufang Wang, Chunxiang Fu, Fuliang Cao, Richard A. Dixon, and Jinxing Lin. “Multifeature Analyses of Vascular Cambial Cells Reveal Longevity Mechanisms in Old Ginkgo biloba Trees.” Proceedings of the National Academy of Sciences 117, no. 4 (Jan. 28, 2020): 2201-10.

Blocking Some of the Virus Reduces Odds of Catching Covid-19 and Reduces Odds of a Severe Case, If Covid-19 Is Caught

(p. D8) As the world awaits the arrival of a safe and effective coronavirus vaccine, a team of researchers has come forward with a provocative new theory: that masks might help to crudely immunize some people against the virus.

The unproven idea, described in a commentary published Tuesday in the New England Journal of Medicine, is inspired by the age-old concept of variolation, the deliberate exposure to a pathogen to generate a protective immune response. First tried against smallpox, the risky practice eventually fell out of favor, but paved the way for the rise of modern vaccines.

Masked exposures are no substitute for a bona fide vaccine. But data from animals infected with the coronavirus, as well as insights gleaned from other diseases, suggest that masks, by cutting down on the number of viruses that encounter a person’s airway, might reduce the wearer’s chances of getting sick. And if a small number of pathogens still slip through, the researchers argue, these might prompt the body to produce immune cells that can remember the virus and stick around to fight it off again.

. . .

Experiments in hamsters have hinted at a connection between dose and disease. Earlier this year, a team of researchers in China found that hamsters housed behind a barrier made of surgical masks were less likely to get infected by the coronavirus. And those who did contract the virus became less sick than other animals without masks to protect them.

. . .

But despite decades of research, the mechanics of airborne transmission largely remain “a black box,” said Jyothi Rengarajan, an expert in vaccines and infectious disease at Emory University who was not involved in the commentary.

That is partly because it is difficult to pin down the infectious dose required to sicken a person, Dr. Rengarajan said. Even if researchers eventually settle on an average dose, the outcome will vary from person to person, since factors like genetics, a person’s immune status and the architecture of their nasal passages can all influence how much virus can colonize the respiratory tract.

For the full story, see:

Katherine J. Wu. “Masks May Act as a Crude Vaccine.” The New York Times (Tuesday, September 15, 2020): D8.

(Note: ellipses added.)

(Note: the online version of the story has the date Sept. 8, 2020, and has the title “A New Theory Asks: Could a Mask Be a Crude ‘Vaccine’?”)

“Bench-to-Bedside Research”

Serendipity is a key driver of innovation in health care and in entrepreneurship. The book discussed below documents a key episode of serendipity.

(p. A17) For any cancer patient who has experienced the gruesome side effects of chemotherapy, it may not be surprising to learn that anti-cancer drugs have their origins in the toxic chemical agents designed for warfare. In “The Great Secret,” Jennet Conant describes how researchers stumbled on the therapeutic value of the same compounds that wreaked havoc in two world wars. The discovery revolutionized cancer treatment, but in Ms. Conant’s telling a story of scientific triumph is clouded by a parallel tale of official cover-ups and ethical quagmires.

Chemical agents were first deployed in World War I by the Germans, who had perfected mustard gas: It inflicted horrifying damage on the skin, eyes and internal organs. By World War II, the Allies had their own stockpiles of it. The official policy was to stick to the Geneva protocols and avoid their use except in retaliation for a first attack. Thus supplies of chemical weapons were sent to Europe in case Germany made the first move.

That plan went horribly wrong in Bari, Italy, on Dec. 2, 1943, when German planes bombed the Allied port, sinking 17 ships and killing more than 1,000 servicemen and hundreds of civilians.

. . .

Ms. Conant ultimately shifts gears to the postwar medical research—at what is now Memorial Sloan Kettering and other institutions—that led to a generation of cancer drugs. The research saga has been covered in other works, notably Siddhartha Mukherjee’s “The Emperor of All Maladies” (2010), but she does a creditable job of pulling the highlights together and keeping her focus on the less-celebrated figures who came out of the chemical-warfare complex.

The most fascinating of them is Col. Cornelius Rhoads, a brilliant but arrogant and overzealous scientist who fully grasped the importance of Dr. Stewart’s findings. Although his career ended in ignominy because of a rant against Puerto Ricans and allegations—stoked by a jesting comment he had made—that he had deliberately given his Puerto Rican patients cancer, Rhoads was an early champion of fighting cancer with nitrogen mustards. And he pioneered the concept of “bench-to-bedside research,” which allows doctors to draw constantly on new clinical evidence to treat patients.

For the full review, see:

Laura Landro. “BOOKSHELF; Life-Saving Toxicity.” The Wall Street Journal (Thursday, September 10, 2020): A17.

(Note: the online version of the review has the date Sep. 9, 2020, and has the title “BOOKSHELF; ‘The Great Secret’ Review: Life-Saving Toxicity.”)

The book under review is:

Conant, Jennet. The Great Secret: The Classified World War II Disaster That Launched the War on Cancer. New York: W. W. Norton & Company, 2020.

Neighborhood Center Delivered the Air-Conditioning that NYC Had Promised

(p. A7) It seemed like a noble idea to offer quick help during the pandemic: New York City would give away free air-conditioners this summer to low-income older people who are stuck indoors.

It turned out to be a far more complicated mission for the city.

. . .

The difficulty in getting a free air-conditioner left many seniors frustrated and confused by what they described as a bureaucratic, inefficient process.

Concepcion Reyes, who is 67 and has asthma, said she made numerous phone calls to a handful of city agencies from her stuffy apartment last week, after seeing her neighbor snag a free air-conditioner from the city.

“I’ve been in the shower two times already today,” Ms. Reyes, who lives at Holmes Towers, a public housing building on the Upper East Side of Manhattan, said last week. “I’m sweating bullets.”

. . .

Frustrated by delays, officials at the Stanley M. Isaacs Neighborhood Center in Manhattan spent nearly $30,000 on 56 air-conditioners for older people.

Rosalina Acevedo, who is 73 and diabetic, had one of the units installed in her bedroom at Holmes Towers in July [2020]. When she turned it on for the first time, she instantly felt relief.

“It was delicious,” she said.

Gregory J. Morris, the center’s executive director, said the city should have worked with community groups that could easily have provided a list of older residents with serious health conditions who urgently needed the units. The city had its own lists, and names were missing.

“They were desperate,” he said of the older people his center works with. “There was no timeline from the city. If you’re in the middle of a heat wave, do I wait longer for the city? Or do I step in and solve the problem?”

For the full story, see:

Emma G. Fitzsimmons. “The Wait for Promised Air-Conditioners Leaves Some Older Residents Sweating.” The New York Times (Saturday, August 22, 2020): A7.

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

(Note: the online version of the story has the date Aug. 21, 2020, and has the title “Older New Yorkers Sweat It Out, Waiting for Promised Air-Conditioners.”)

Asymptomatic Transmission of Covid-19 Reduces Value of Fever Checks

(p. A4) . . . while health officials have endorsed masks and social distancing as effective measures for curbing the spread of the coronavirus, some experts scoff at fever checks. Taking temperatures at entry points is nothing more than theater, they say, a gesture that is unlikely to screen out many infected individuals, and one that offers little more than the illusion of safety.

. . .

. . . a growing body of evidence suggests that many of those who are driving transmission are so-called silent carriers — people who have been infected but feel fine, and don’t have a fever or any other symptoms.

. . .

“We now have a better understanding of Covid-19 transmission that indicates symptom-based screening has limited effectiveness because people with Covid-19 may have no symptoms or fever at the time of screening, or only mild symptoms,” the C.D.C. said in a statement.

. . .

Evidence of asymptomatic spread dates back to early in the pandemic, but has been mounting ever since. A recent study from South Korea published in JAMA Internal Medicine in August offered even more proof, finding that infected individuals who don’t feel ill may carry just as much virus in their nose, throat and lungs as those with symptoms — and for almost as long.

. . .

A. David Paltiel, a professor of health policy and management at Yale School of Public Health, says these individuals are the “silent spreaders” who are driving transmission and sparking superspreading events.

“You are maximally infectious before you exhibit symptoms, if you exhibit any symptoms at all,” Dr. Paltiel said. “You can be exposed and incubating the virus, and be beginning to shed massive amounts of transmissible virus and be a superspreader, without actually exhibiting any symptoms like a fever.”

For the full story, see:

Roni Caryn Rabin. “Fever Checks Are on the Rise, but Are They Effective Gatekeepers?” The New York Times (Monday, September 14, 2020): A4.

(Note: ellipses added.)

(Note: the online version of the story was updated September 14, 2020, and has the title “Fever Checks Are No Safeguard Against Covid-19.”)

The paper in JAMA Internal Medicine discussed above is:

Lee, Seungjae, Tark Kim, Eunjung Lee, Cheolgu Lee, Hojung Kim, Heejeong Rhee, Se Yoon Park, Hyo-Ju Son, Shinae Yu, Jung Wan Park, Eun Ju Choo, Suyeon Park, Mark Loeb, and Tae Hyong Kim. “Clinical Course and Molecular Viral Shedding among Asymptomatic and Symptomatic Patients with Sars-Cov-2 Infection in a Community Treatment Center in the Republic of Korea.” JAMA Internal Medicine (published online in advance of print Aug. 6, 2020). Doi:10.1001/jamainternmed.2020.3862

Older Men Produce Fewer T-Cells Than Older Women

(p. A7) The coronavirus may infect anyone, young or old, but older men are up to twice as likely to become severely sick and to die as women of the same age.

Why? The first study to look at immune response to the coronavirus by sex has turned up a clue: Men produce a weaker immune response to the virus than do women, the researchers concluded.

The findings, published on Wednesday [Aug. 26, 2020] in Nature, suggest that men, particularly those over age 60, may need to depend more on vaccines to protect against the infection.

“Natural infection is clearly failing” to spark adequate immune responses in men, said Akiko Iwasaki, an immunologist at Yale University who led the work.

. . .

Over all, the scientists found, the women’s bodies produced more so-called T cells, which can kill virus-infected cells and stop the infection from spreading.

Men showed much weaker activation of T cells, and that lag was linked to how sick the men became. The older the men, the weaker their T cell responses.

“When they age, they lose their ability to stimulate T cells,” Dr. Iwasaki said. “If you look at the ones that really failed to make T cells, they were the ones who did worse with disease.”

For the full story, see:

Apoorva Mandavilli. “New Clue on Why Men Are Hit Harder.” The New York Times (Thursday, August 27, 2020): A7.

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

(Note: the online version of the story was updated Aug. 27 [sic], 2020, and has the title “Why Does the Coronavirus Hit Men Harder? A New Clue.”)

The paper in Nature discussed above is:

Takahashi, Takehiro, Mallory K. Ellingson, Patrick Wong, Benjamin Israelow, Carolina Lucas, Jon Klein, Julio Silva, Tianyang Mao, Ji Eun Oh, Maria Tokuyama, Peiwen Lu, Arvind Venkataraman, Annsea Park, Feimei Liu, Amit Meir, Jonathan Sun, Eric Y. Wang, Arnau Casanovas-Massana, Anne L. Wyllie, Chantal B. F. Vogels, Rebecca Earnest, Sarah Lapidus, Isabel M. Ott, Adam J. Moore, Kelly Anastasio, Michael H. Askenase, Maria Batsu, Hannah Beatty, Santos Bermejo, Sean Bickerton, Kristina Brower, Molly L. Bucklin, Staci Cahill, Melissa Campbell, Yiyun Cao, Edward Courchaine, Rupak Datta, Giuseppe DeIuliis, Bertie Geng, Laura Glick, Ryan Handoko, Chaney Kalinich, William Khoury-Hanold, Daniel Kim, Lynda Knaggs, Maxine Kuang, Eriko Kudo, Joseph Lim, Melissa Linehan, Alice Lu-Culligan, Amyn A. Malik, Anjelica Martin, Irene Matos, David McDonald, Maksym Minasyan, Subhasis Mohanty, M. Catherine Muenker, Nida Naushad, Allison Nelson, Jessica Nouws, Marcella Nunez-Smith, Abeer Obaid, Isabel Ott, Hong-Jai Park, Xiaohua Peng, Mary Petrone, Sarah Prophet, Harold Rahming, Tyler Rice, Kadi-Ann Rose, Lorenzo Sewanan, Lokesh Sharma, Denise Shepard, Erin Silva, Michael Simonov, Mikhail Smolgovsky, Eric Song, Nicole Sonnert, Yvette Strong, Codruta Todeasa, Jordan Valdez, Sofia Velazquez, Pavithra Vijayakumar, Haowei Wang, Annie Watkins, Elizabeth B. White, Yexin Yang, Albert Shaw, John B. Fournier, Camila D. Odio, Shelli Farhadian, Charles Dela Cruz, Nathan D. Grubaugh, Wade L. Schulz, Aaron M. Ring, Albert I. Ko, Saad B. Omer, Akiko Iwasaki, and Impact research team Yale. “Sex Differences in Immune Responses That Underlie Covid-19 Disease Outcomes.” Nature (published online in advance of print Aug. 26, 2020). DOI: https://doi.org/10.1038/s41586-020-2700-3