Just Desserts, Aerosols, and Stampeding Herds

Researchers Warn Coronavirus May Use Propellor Hat To Stay Airborne

Treatment update

Convalescent plasma: Bad news. Contrary to expectations, hospitalized COVID-19 patients in a Dutch trial did not benefit from convalescent plasma in terms of hospital stay, clinical improvement, or mortality. Probably because by the time the patients received their dose of plasma, an average of 10 days after getting sick, most of them had already produced neutralizing antibodies of their own. But this study was flawed – patients received their infusion an average of two days after entering the hospital instead of on admission, and – probably even more important – the plasma donors had mostly had mild disease and had consequently produced only low levels of antibodies. With earlier dosing, and a better choice of donors, plasma might work after all. Or it might turn out to be useful for preventing disease in health care workers or other high-risk groups – a shame, when so much hope has been placed on it.

Hydroxychloroquine: Here we go again. This time it’s researchers from Detroit who looked back at COVID-19 patients they had hospitalized between March 10^th and May 2^nd, and saw that those who had received hydroxychloroquine, especially combined with azithromycin, were less likely to die. This is undoubtedly true. But hold your horses, read this: “Based on these early reports, hydroxychloroquine alone and in combination with azithromycin was incorporated into our institutional clinical guidelines for the treatment of hospitalized patients with COVID-19.” In other words patients enrolled early in the study did not receive hydroxychloroquine, and patients enrolled late in the study did. But during March and April physicians learned a huge amount about how to treat patients with COVID-19, including proning, anticoagulation, corticosteroids, anti-cytokine antibody therapy, convalescent serum, CPAP, remdesivir, and how best to adjust their respirator settings. So the patients who received hydroxychloroquine, having been enrolled later in time, received much better treatment all around, making it impossible to tell what role, if any, hydroxychloroquine had in their improved prognosis. This study is useless. (Needless to say it’s already been picked up by the hydroxychloroquine czar in the White House.)

Sarilumab (Kevzara): This anti-interleukin 6 antibody, successfully used against rheumatoid arthritis, already had been shown to do badly in COVID-19 patients who were serious enough to be hospitalized but not enough to be on ventilators. The researchers went forward anyway with a trial in even sicker patients, those on ventilators, and failed so completely that they have now thrown in the sponge. Another once-promising drug bites the dust.

Vaccines: The CanSino vaccine has been approved by the Chinese army for administration to soldiers – whether obligatory or voluntary isn’t clear. This is on the basis of old data, from six weeks ago, that it induced an immune response both antibody and T-cell (at the cost of heavy side effects), in volunteers. Seems to me like a premature move.

Italians do it better

1)    COVID-19-related: Italy has fought the coronavirus to a standstill. There have been only 91 deaths in the past week. That’s fewer than in Alabama, fewer than in Pennsylvania – fewer even than Arizona reported on the single day of July 7^th. The total number of COVID-19 patients in Italian ICUs is running about 70, down from a peak of 4,000-plus at the beginning of April.

2)    Not COVID-19-related: My musician husband Alvin Curran came back Monday morning after a cappuccino at our crummy corner coffee bar asking, “You know why Italy is great?” In the bar he had noticed there was unusually symphonic music playing in the background instead of the usual pop. He concentrated a few minutes, then guessed “Morricone?” The barman simply said, “Un grande, one of the greats.” Ennio Morricone, the Academy Award winning composer of soundtracks for The Battle of Algiers, spaghetti westerns, and everything in between, had died the night before. The improvised memorial moved Alvin nearly to tears. 

Mask madness

The anti-mask brigade in the United States has now gone beyond impugning the macho of the covered to claiming the things are the work of the devil. As long as the Current Occupant keeps saying people wear masks only in order to spite him, the 40% of the American population who would be fine with him shooting someone on Fifth Avenue will remain blissly barefaced.

Remember the Lady from Jacksonville parody? Real life is now outdoing satire: (a friend tracked down the video link - watch it!)

Citizens speaking out at a Palm Beach County Commission meeting about a mask ordinance

Triage

I'm sure you don’t need me to tell you that the American epidemic is exploding. When Anthony Fauci warnedthe number of new cases could go up from 45,000 to 100,000 a day I frankly thought he was hyperbolating, but here we are just 10 days later and we’re over 70,000.

I mentioned in my last post that Arizona, one of the worst-hit states at present, was drawing up theoretical guidelines for who would have first dibs on lifesaving treatments, hoping those guidelines would never be needed. The very thought of that kind of rationing had shocked some Americans, at the height of Italy’s epidemic.

Just a few days later, Texas hospital doctors were already having to use, or improvise, similar guidelines in earnest. One physician from San Antonio Methodist Hospital said sorrowfully that he had found himself with 3 ECMO machines (Extracorporeal Membrane Oxygenation, a kind of external artificial lung) and 10 young people who needed one. Having to choose 3 who would get a halfway decent shot at survival and condemn the other 7 to near-certain death without even having any over-80’s to exclude a priori was, as he put it, “A level of decision-making that I don`t think a lot of us are prepared for.”

Department of Schadenfreude

Remember I said a couple of weeks ago that the UK – which locked down even later than the United States – would soon beat out Spain as having the most COVID-19 deaths per million of the world’s large countries? Well now it’s UK 654, Spain 607. The English went ahead and reopened their pubs anyway. The next worst are Italy, Sweden, and France, with the USA only lately coming within striking distance of its European competition: 405 to France’s 459. Give us another month or so…

Another Great COVID Denier, Brazil’s President Jair Bolsonaro, bites the dust – while presiding over an epidemic that has likely already claimed 100,000 lives, he’s caught a case himself, with fever, cough, body pain, and malaise that can’t be shrugged off as merely “tested positive.” 

Bolsonaro on July 4th with the American ambassador. Physical distancing? Masks?

Sweden: it’s becoming clear that their ill-advised anti-lockdown strategy not only cost thousands of lives, but it didn’t even manage to preserve the economy. Lose-lose.

Trump’s ill-fated Tulsa rally has now landed “dozens” of Secret Service agents in quarantine. The city's health officials now admit if you “connect the dots” it’s clear that the Trump rally is what led to their current spike in COVID-19 cases.

Pence’s trip to Phoenix gave COVID-19 to at least 8 Secret Service agents. What is it about the Secret Service?

Kimberly Guilfoyle, otherwise known as Donald Trump, Jr.’s girlfriend, seems to have exposed half the politicians in Montana (including the Governor and disgraced former Interior Secretary Ryan Zinke) to COVID-19 when she was there last week.

In Florida, one of the states that made a mad dash back to business as usual, more than 50 intensive care units are currently filled to capacity with COVID-19 patients, and many nurses are working 18-hour shifts.

Mississippi state lawmakers convened on June 28^th – in person, indoors, packed, and mostly unmasked – to debate whether to drop the Confederate battle emblem from the state flag. By July 9^th, 26 of them had tested positive for COVID-19.

Mississippi state senators on day of flag vote. Physical distancing? Masks?

Schlemiels or schlimazels?

“A schlemiel is the guy who spills soup. A schlimazel is the guy he spills it on”

People sometimes say that we Jews are smart. Here’s proof they’re wrong: in May, when Israelis were congratulating themselves on having beaten the coronavirus at the cost of fewer than 300 lives, Netanyahu’s government opened the floodgates – bringing the economy practically back to normal by the end of the month. New COVID-19 cases started surging almost immediately, among a rejoicing population that – among other things – held 2,092 weddings between June 15 and June 25. The big kind, with singing, dancing, and hugging. Now there are so many new cases that the authorities admit contact tracing is overwhelmed, and the number of seriously ill patients is threatening to do the same to hospitals.

Daily New Cases in Israel

What a second wave looks like

“Airborne transmission”

Every day this week I’ve gotten at least one email asking something like “Why has the WHO not acknowledged that the coronavirus could be transmitted via the air?”

The question gets it wrong, but the questioners can totally be forgiven – people assume airborne means what it sounds like. It doesn’t. Everybody, including of course the WHO, agree that the virus is mainly transmitted via the air, in the form of small droplets that are spewed out by infected inviduals when they cough, sing, talk, or breathe, can travel a few feet through the air, then fall quickly to the floor. The issue is whether or how often it is spread by much smaller, microscopic droplets in the form of a cloud called an aerosol that could potentially hang around in the air for several hours, and float away from the contagious person for 10 or even 20 feet, before drifting down out of range of nearby noses and mouths. 

Those kind of microdroplets are known to be produced in certain medical settings where health workers are in intimate contact with COVID-19 patients, but it’s not clear whether they are also created in other settings, and if so how important they are in spreading disease. It’s not even clear whether they can transmit COVID-19 at all – researchers haven’t succeeded in growing viable virus from those aerosols, suggesting they are made up of viral fragments, not infectious organisms. 

The issue went, so to speak, viral last week when 239 scientists wrote a letter more or less petitioning the World Health Organization to change their line on COVID-19 transmission and include aerosols as major culprits in addition to droplets and fomites. (Note: fomites have been demoted: it’s possible to get the virus into your body by touching a contaminated surface and then touching your face, but experts have decided it doesn’t happen very often.)

The WHO responded promptly to the 239 scientists with an updated report. But contrary to how it was billed in the New York Times, it did not conclude “that the virus is airborne” but that aerosols may possibly account for a small percentage of contagions, solely indoors (outdoor air carries away aerosols even faster than it does larger droplets), and probably only when distancing is ignored and ventilation is poor. I strongly advise reading the WHO document itself. Here’s a key excerpt, referring to the few COVID-19 clusters often attributed to aerosol transmission, notably one infamous episode in a Chinese restaurant: “The detailed investigations of these clusters suggest that droplet and fomite transmission could also explain human-to-human transmission within these clusters. Further, the close contact environments of these clusters may have facilitated transmission from a small number of cases to many other people.”

I’m a practical girl, and for me the aerosol story just reinforces what we already know we should be doing when we have to be indoors in the presence of other people: stay 1 or if possible 2 meters away from them, keep those doors and windows open, and wear a mask without deluding yourself it’s a substitute for physical distancing. I tend to dismiss other proposed measures except for exceptional circumstances. High efficiency air filters? According to the people who manufacture them, “in most buildings and in most situations, filters may be considerably less effective than other infection control measures including social distancing, isolation of known cases, and hand-washing.” Germicidal ultraviolet lights? Nobody’s shown they work against the novel coronavirus, and they can only be used in empty rooms. Since even the strongest aerosol advocates admit aersols only hang around in the air for a few hours, it should be just as effective to merely leave a room empty overnight. 

The virologist vanishes?

Anthony Fauci’s disappearing act can be seen as having either ended or moved into a new phase a few days ago when he published podcasts in the Wall Street Journal and Five Thirty-Eight suggesting among other things that, “Any state that is having a serious problem, that state should seriously look at shutting down.” Texas? Arizona? Florida? We’re looking at you. If Tony’s going to contradict Trump that blatantly, we have to wonder whether he may be about to disappear for real, not from the media but from his job. Already he hasn’t spoken to the President for more than a month and hasn’t briefed him for more than two.

Stampeding herds

Three days ago an article in the New York Times shot around the world: 68% of people tested in a Queens neighborhood were positive for COVID-19 antibodies. In an affluent neighborhood elsewhere in New York, only 11%. This report has been interpreted everywhere  from England to India to Israel to Nigeria to Brazil as proving that at least one little corner of the world is hitting herd immunity. Exciting, right?

But wait a sec, 68% of whom? Here’s who is eligible for testing according to the website of the outfit that offered the testing, CityMD. You can have a blood test:

- If you previously had COVID-19 symptoms (Fever, persistent cough, shortness of breath, body aches) and have recovered after 14 days. 

- If you received a positive test result for COVID-19 and have recovered after 14 days.

 - If you believe you have come in contact with someone who had the COVID-19 virus.  

Good god! Is that really what all that fuss is about? That people who live in a high-COVID-19 community and who have either been already diagnosed with the disease themselves or had typical symptoms will probably have antibodies? And those who live in a low-risk community won’t? This is news??? The 68% is real, the interpretation is crap. Is it possible that not one of those journalists took the trouble to check out who was actually tested?

Got Them Phase In, Phase Out, Out of Phase Blues

A Houston nightclub that's refused to close back down

Treatment update (not much news this week)

Remdesivir: Remember from last week that a dose of the drug, which was developed using taxpayer money and costs Gilead $1 (one dollar) to manufacture, might be priced at $50,000 if the drug does save lives, but only $1,170 if it turns out not to? Well, even Gilead doesn’t turn out to be as piggy as all that, and has set its price to hospitals at $520 per dose if the patient has private insurance, $390 if they have government insurance. But, appallingly, until the end of September Gilead is making remdesivir available almost exclusively in the United States. I.e. places like Brazil and India where COVID-19 is raging (and which incidentally are unlikely to be able to afford even those “bargain basement” prices), will have to either produce their own illegal generics or go without. Remdesivir won’t even be sold in the United Kingdom, despite now being theoretically available on the National Health Service.

Vitamin D: Several people have asked, so I’ll comment. Some observational studies have found people with very low vitamin D levels to be more likely to be infected with the novel coronavirus. But people who are poor, malnourished, live in nursing homes, etc. are the ones most likely to have very low vitamin D levels, making observational studies useless. I might mention that vitamin D has been proposed to prevent or treat many other diseases in the last couple of decades, and aside from a possible strengthening effect on bones it’s always fizzled. I’m with a review by the authoritative British NICE: if you’re considering taking vitamin D in hopes of preventing or treating COVID-19, forget it.

Hydroxychloroquine (Plaquenil): Here we go again. By now nobody thinks it can treat COVID-19, but for some reason a huge study will be testing it as prevention. Given that we already know the drug does nothing to prevent or mitigate COVID-19 among people who are already taking it for lupus, this seems to me to be a waste of resources. 

Passive immunity: Researchers at Tulane and, separately, at Sorrento Therapeutics, have come up with an artificial antibodies against COVID-19 that work in test tubes and might possibly be useful in prevention. Don’t hold your breath. 

Old vaccines: For months people have been floating the idea that existing vaccines against non-COVID-19 diseases such as tuberculosis (BCG) and measles/mumps/rubella might stimulate the “innate immunity” branch of the immune system in a nonspecific way, boosting resistance to the novel coronavirus. Now Robert Gallo, a worldclass virologist best known for his controversial role in the discovery of HIV, has leapt into the fray by proposing oral polio vaccine. The idea is plausible, and studies are underway.

New vaccines: Now even a New England Journal of Medicine article discusses how researchers might speed up vaccine development by deliberately infecting human volunteers. But these authors are more cautious than gung-ho, commenting that “A single death or severe illness in an otherwise healthy volunteer would be unconscionable and would halt progress,” and going on to basically rule out the approach by saying, “Critically, a rescue therapy should be available” – unfortunately, no such therapy is on the horizon.

Ostrich Variations

This internal guidance is designed to assist how Inseason actions discuss the COVID-19 pandemic. Option 1 - Preferred approach. Make no reference to anything COVID related. 

-       National Marine Fisheries Service guidance document, June 22, 2020 

Coronavirus deaths are way down. Mortality rate is one of the lowest in the World. Our Economy is roaring back and will NOT be shut down.

-       @realDonaldTrump, June 26, 2020

We have made truly remarkable progress in moving our nation forward. We’ve all seen the encouraging news as we open up America again.

-       Mike Pence, June 26, 2020

The RNC looks forward to holding a safe event in Jacksonville to celebrate the re-nomination of President Trump and Vice President Pence.

-       A Republican National Committee spokesperson, June 26, 2020

New COVID-19 cases in Jacksonville’s Duval county

I think we’re going to be very good with the coronavirus. At some point that’s going to just disappear.

-       Donald Trump, July 1, 2020

How long are Republicans – yes, it’s Republicans, not “Americans” – going to be able to keep up the pretense?

What they’ll see when they remove their heads from the sand

The Republican rush to reopen the economy just as the first wave of COVID-19 was in mid-crash has led to its inevitable result: new cases increasing in 40 of the 50 states, now surpassing 50,000 a day, with Anthony Fauci warningthey could reach 100,000. 

A NY Times headline ties major outbreaks to “Bars, Strip Clubs, and Churches.” The Onion’s satire, as so often, cuts a bit too close to reality: City Enters Phase 4 Of Pretending Coronavirus Over.

There are no countrywide statistics on COVID-19 hospitalizations (!), but we know hospital capacity is already near the breaking point from Miami to Mississippi to Houston to parts of California. Even open-it-up governors are having to reluctantly roll back their plans, and Arizona has drawn up official guidelines for choosing who will be put on lifesaving equipment in a pinch. The death rate hasn’t started to go up yet but inexorably, in a couple of weeks, it will.

This at a time when Western European countries have succeeded in bringing the pandemic to heel. In the past week deaths have averaged 18 a day in all of Italy, fewer than in Georgia alone, or North Carolina alone, or Virginia alone, three of the better off states. 

This graph would look even worse today

Some are surprised that a virus known for attacking the elderly has lately preferred the under-50's. I’m not. Between old folks sticking with our self-protective instincts, idiot Republican governors who opened up bars and nightclubs, and young people who think they’re immortal and call masks “submission muzzles,” the pattern makes perfect sense. A Facebook post last month saying masks are “stupid and so are the people wearing them” garnered 110,000 likes and 49,000 shares.

Even in areas where there are few enough new cases to make tracing and isolating contacts feasible, it’s not easy. In New York City, most COVID-19 patients hang up when the caller starts asking who they’ve been around. After a super-spreader party in one of the wealthiest towns of one of the wealthiest suburban counties in the United States, officials had to resort to subpoenas to get infected guests to name their fellow partygoers.

Here’s June at a glance, thanks to the National Geographic. On June 1^st the dominant color in the United States was blue (number of cases per 10,000 falling).

By June 28^th it was pink (cases rising), especially across the South and the West

Death tolls: the real McCoy

I’ve written about studies of excess all-cause mortality during the COVID-19 pandemic in New York City, Italy, and around the world, all of which agree that the number of deaths caused by the pandemic is much higher – generally by about one-third – than what you’d think from death certificates. I’ve been waiting months to see similar figures for the entire United States. Now we have some, and they’re even worse than expected: over eight weeks during March and April, in 48 states (two didn’t provide data), 87,001 more people died than predicted based on previous years, with only 56,246 of them (65%) attributed to COVID-19. So we can estimate that the real mortality due to the COVID-19 pandemic in the United States is about 50% higher than official figures claim, i.e. not 132,000 deaths so far but – alas – more like 200,000.

Finders keepers 

Remember those $1.4 billion in stimulus money sent to dead people? Including people who died as far back as 2018, whose vital status was so well known that their checks had “Decd” written after their names? Losers weepers, apparently – much of that money has left the government coffers for good, as cashed checks or directly into bank accounts. The feds can't even demand it back, because nothing in the law authorizes them to. In any case the IRS has no intention of doing anything beyond saying “pretty please.” 

Mutant COVID  Ninjas

There’s been lots of ink spilled this week over a mutation in the novel coronavirus that supposedly made it “10 times more contagious” in Europe and the US than in China. But this story has been around before, is based mostly on theoretical grounds rather than real-life observations, and has never impressed me. Early-phase R0, the number of people infected by each case, was calculated at 2-2.5 or 2-3 in China, and 2.4-3.1 in Italy. Most American states affected early in the epidemic had, similarly, R0s between 2 and 3. In New York estimated R0 was sky-high, 6, due to high population density and universal use of mass transit. Later in the pandemic, with variable degrees of measures such as physical distancing, R0 becomes less reliable, but as far as I can see there is little or no real-world evidence that the disease has become any more contagious. What we do have excellent real-world evidence for is that enforcing good mitigation measures, as was done in Europe, will rapidly decrease contagion rates. And that failing to do so, or backtracking prematurely, as in the United States, will allow infection rates to soar – whatever R0 you start from.

Black Lives Matter: more on a natural experiment

Evidence is accumulating that – surprisingly – the anti-racism protests following the murder of George Floyd did notlead to substantial rises in COVID-19 cases, presumably because of being outdoors. In fact they don’t seem to have led to any at all beyond perhaps one small outbreak in South Carolina. According to a summary by the Washington Post,Minneapolis, ground zero of the protests, has seen case numbers fall steadily during the past month, including in neighborhoods with large numbers of protesters in the streets. Same thing in New York City and in Philadelphia, Seattle, and Oakland. A study analyzing cellphone data in 300 cities concluded there was “no evidence that net COVID-19 case growth differentially rose following the onset of Black Lives Matter protests.” Officials in Houston have suggested the protests may have been one of the factors in their recent case surge, but I suspect all those prematurely reopened bars (see photo at top) deserve more of the blame.

Convincing those these data may be, even I find it hard to put my money where my mouth is and ignore physical distancing when I’m outside. Especially after spending three months in Berkeley, where people would cross the street if they risked passing within ten yards of you. Sitting at one of the tables crowded into my favorite outdoor bar, in the Colle Oppio park, can make my skin crawl.

Postscripts on Trump’s Tulsa fiasco

P.S.: the BOK Center actually did place “Do Not Sit Here, Please!” stickers on every other seat, to ensure physical distancing. Then Trump campaign volunteers went around the hall tearing them all off.

P.P.S.: remember Herman Cain, the black pizza chain executive who made a brief and unfortunate presidential run back in 2012? The poor guy picked up COVID-19 at that infamous Tulsa rally and is currently hospitalized in Atlanta

Cain at the Tulsa rally. No distancing, no mask

P.P.P.S.: Various campaign staff, Secret Service personnel, and Trump, Jr.’s girlfriend were also likely infected at the same event. 

Back to school? Zap the Zoom! 

Everybody wants to get students away from their screens and back into classrooms. Parents are sick and tired of playing teacher, juggling their work schedules, and having the kids constantly underfoot. Kids are sick and tired of having nobody to play with but their parents. Teachers are sick and tired of jumping through hoops to make virtual lessons as well as the real thing, and finding it doesn’t work. The good news is that reopening K-12 schools is feasible and safe. Children rarely get COVID-19 themselves and, in surprising contrast to other respiratory viruses, very rarely infect adults with COVID-19, so elementary schools can get back to business; to tell the truth, given the evidence from countries where schools never closed or have already reopened, I’m not convinced it was necessary to close them in the first place. Teenagers are mature enough to tolerate wearing masks and being spaced out in classrooms, and they gohome at night, so high schools can get going too. But residential colleges are another story. Many plan to reopen in the fall, causing considerable debate. I agree with one Times op-ed writer that the reopening plans are “So unrealistically optimistic that they border on delusional.” Adolescents think they’re invulnerable, and if they’re invulnerable they’ll party. Come on, you were all 18 once, you know I’m right.

Riding herd

Herd immunity is like hydroxychloroquine, an idea that won’t die until someone puts a stake through its heart. Will the novel coronavirus spread quietly around the globe until herd immunity will protect all the non-infected? Dream on. If the virus were left to itself and infected everybody, it would cause at least 50 million deaths worldwide. Fortunately, everybody prefers mitigation to that nightmare scenario. 

Even in New York City, where COVID-19 spread like wildfire, a recent CDC estimate – running antibody tests on blood drawn for other purposes – revealed that only 7% of the population had been exposed to it as of April. A previous survey covering the same period had come up with 20%, but it used much poorer methodology – and even 20% was lightyears away from the 60% or more needed for herd immunity. 

Sweden, which flirted with a herd immunity strategy by instituting a soft lockdown based on people’s good sense, is doing miserably. Its new cases continue relatively unabated while they fall precipitously in the rest of Western Europe, and its total number of deaths per million is coming within range of Italy’s. Nevertheless, only 6% of its population has COVID-19 antibodies. In late April many of us found the Swedish model interesting, and it gained a less than full-throated endorsement from the World Health Organization’s Mike Ryan. But Ryan later took it back, and by now both Sweden’s former chief epidemiologist and the present one,  who designed the gentler approach, consider it midguided.

The case of the vanishing virologist

Missed Anthony Fauci lately? Turns out he has to ask Trump’s permission to go on TV, and he often doesn’t receive it, because the country’s top infectious disease expert can’t be trusted to stay on message. In any case, the President regularly undercuts the guy’s suggestions. But then Trump has lost any interest he ever had in the pandemic – he’s supposedly cut COVID-19 out of the list of topics he’s willing to attend meetings about.

Knocked out of the park

Everybody from advertisers to fans is desperate to get pro sports back on track. They’re racking their brains for tricks on managing it in the COVID-19 era, from playing to empty stadiums to travelling the circuit in “bubbles.” But the virus is proving bubble-proof and has been sabotaging the whole enterprise by infecting golfers, basketball players, tennis stars, and football players, while some soccer stars have decided to give the next season a pass in favor of staying healthy.

We’re used to courageous athletes like Muhammed Ali, Tommie Smith, and Colin Kaepernick standing up for what they believe in. But it has to be a special historical moment when Kaepernick gets an apology like “We, the National Football League, believe black lives matter.” Apparently the upcoming ouster of the Confederate battle emblem from the Mississippi state flag – a goal of activists for decades ­– may have been due less to a sudden wokeness of local politicians than to threats by the National Collegiate Athletic Association and the Southeastern Conference to cancel games in the state if that flag kept flying.

Mississippi's old state flag

A monstrous gift?

Donald Trump has officially added his imprimatur to the lawsuit that is right now – in the middle of a spreading pandemic when millions of people have lost their jobs and thus their medical insurance – attempting to repeal the Affordable Care Act and thus leave tens of millions more without access to health care. Just to tell you how far off base this is from ordinary Americans, the people of Oklahoma, a deepest-of-deep-red state where Trump bested Hillary Clinton by 65% to 29%, voted this week to expand Medicaid under the ACA.

I considered billing Trump’s unspeakably cruel act as a gift to America, because it ought by itself to guarantee that the bastard loses the election this fall, dragging his party down with him. A Democratic Congress and Administration should be able to come up with a new improved version of the ACA that not even Trump’s judges will be unable to undo.

But, on reconsideration, that level of cynicism was too much even for me.