5 April 2020
Each Sunday, a friend has been organising a two-hour call for friends (mostly from the finance, economics, and policy world) to hear 10-15 experts talk about the COVID-19 crisis. This has now grown to hundreds of attendees, with a consistently all-star cast of speakers drawn from many different fields. and a fascinating conversation.
Tonight’s installment, the third in three weeks, was no exception. We had professors, historians, economists, working doctors, a data scientist, investment bankers, experts on the developing world, a great urbanist, and more.
As with past conversations, it was held under the Chatham House Rule, meaning I can share a summary of the content but not the names of the participants. As with each of these, the notes are as near-verbatim as I can make them, and almost real-time (apologies for typos).
If I had to pick out a few highlights:
- A major media CEO talked about how re-starting is going to be much harder than shutting down was. He also pointed out that for his business (and this will apply to other businesses as well), they are still getting revenues from prior projects (rights in this case) but have slashed cash expenditure in new projects. This means cash flow is good right now in that business. But next year there will be a double-whammy as they start putting out cash again for new projects, and don’t have cash flow from projects they would ordinarily have launched in 2020.
- Several speakers discussed the impact on the developing world, which was sobering. “There, it’s not economic impact vs health impact; it’s health vs health. Starvation has a high fatality rate.”
- Another speaker talked in stark terms about how different the experience of quarantine was for the poor vs middle class/wealthy in the US and other developed economies. How would a family of 9 sharing one bathroom, or three generations in a trailer, shelter in place for months? What about laundry, for example? He sees significant political consequences.
- We heard form a number of historians and economists who took a broad, historical view. The key message was that the battle between humans and microbes/viruses has been waged throughout human history, particularly since we settled in towns and cities; and that humans are gradually winning the battle. We have knowledge and tools today that we have never had before, and we will win.
- One speaker discussed the stark difference in fiscal support between the US, at 10% of GDP so far, and the Eurozone, where France, Italy, and Spain have pledged around 1.5% of GDP. He was concerned about Italy in particular, with debt-to-GDP at 150%. “Too big to fail and too big to bail.” Italy doesn’t have its own monetary policy and can’t devalue.
- An. anesthesiologist talked about how mechanical ventilation may be doing more harm than good. 80% of people put on ventilators go on to die. Now experimenting with high-flow nasal cannula as an alternative.
Topic: How will pandemic impact the automotive industry?
Bio: Executive Director of HIS Markit Automotive Advisory
- Expect major consolidation with those with strong balances sheets acquiring. Auto parts companies in particularly will consolidate. Larger companies will do okay. We worry about the deeper supply chain, tier 2. Mom & pops will have a lot of difficulty.
- New business models will arrive. Used car market will be a focus
- Rental car companies? There will be consolidation. They will not replenish fleets until sometime next year when travel restarts.
- What about majors? Will they go bankrupt? GM? Stock has fallen by half. They will be fine. We are most worried about people like FCA and Ford who are exposed to North America. Nissan also, they entered pandemic in bad shape.
Topic: How will the pandemic impact TV, Entertainment and Theme Parks
Bio: CEO of a large media company.
- Vast majority of our team are working from home
- Those who come in are either news people or technical people getting signal out there.
- We’ll never go back to the old way of operating — it’ll be some hybrid.
- Our internet provision business will do well assuming the network stays up. Some of those who are on auto pay are switching it off which suggests they will have trouble paying the bills.
- Sports: no sports events happening anywhere. The chain of payments from consumer all the way to player will at some point cascade, hasn’t happened yet.
- Our TV & Movie cash budget has been cut 90%. So that is helping cash flow since we’re still being paid on catalogue. But that will be a double-whammy next year when we don’t have revenue from what we would have produced this year and have the cash expenditure out next year
- People are watching more TV, more linear, more news — that’s a positive on advertising; but the economy is tanking which is a negative
- Theme parks are shut almost everywhere. However, in Asia, construction is going on full steam — but with extensive testing, quarantine, etc. Have to operate in a secure bubble.
- It’s going to be much harder to start up than to shut down.
- For theme parks I asked whether we could open July 1 and test everyone, 5-minute test, but once you’re in you’ll know everyone was negative. There were 35 good, complex reasons why that wouldn’t work. This business is hemorrhaging profitability.
Topic: The pandemic and urbanization
Bio: Economics Professor
- Unprecedented body blow to the urban world
- Density helps trade, F2F collaborations, but there are demons
- Crime, traffic, and contagious disease are the demons.
- If you’re close enough to exchange ideas you can exchange viruses.
- This was true in Athens & the Peloppenesian war, and again stopped Justinian in Constantinople
- Until recently disease was the main problem of big cities. City children lived much shorter lives than those in the country.
- The prosperity of the last century came about from sewage, fresh water, and some restrictions on freedoms.
- NY continued to have cholera epidemics for 25 years — e.g., 1849 epidemic — afterr fresh water arrived. Poor neighborhoods wouldn’t pay.
- If you don’t have fresh water you don’t wash your hands.
- NY only became healthier after 1866 after the board of health came in and fined tenements that didn’t connect to the sewers.
- Cities spent as much on water in 1900 as the federal gov’t did almost in total!
- This solved most pandemics except for droplet-borne ones.
- To stop pandemics of the future we will have to spend billions, but it will be worth it.
- Possible to imagine a world that will be less urban and less connected.
- But for much of the economy can’t imagine a prosperous world without F2F interactions.
- Farms & factories have great output but highly mechanised
- Low skilled employment is largely in services in urban oe
- 1/3 of our labor force in the US is in F2F activities like hospitality.
- 43% of businesses in our sample have closed.
- Retail armaggedon. Job numbers will get worse.
- Firms are running out of cash quickly. Many only have 2.5 weeks of cash.
- Many firms are optimistic about being able to reopen, but they may be optimistic.
- CARES act is not stimulus, it’s insurance.
- In developing world this will be deadlier. More people died from starvation in the plague of Athens than from disease.
- Economic vs health tradeoffs in the developing world are really health vs health. Starvation has a high fatality rate.
- Investment in science is necessary to let us reopen the cities.
- Big Q: is this once every 100 years, or once every 3 years? It’s within our power.
Topic: How will the pandemic effect the Developing and Emerging Markets
Bio: Former Emerging Markets Chief Economist at major investment bank, now at think tank
- Could problems abroad cause problems in the developed world?
- Three big problems:
- 1. Eurozone area problems — could be a debt crisis
- 2. China could slow down a lot like Japan did
- 3. Emerging market debt defaults, they are half of the global market.
- France, Italy, Spain being hit worse than the US. Not only manufacturing, but tourism — will not recover quickly. Italy: 7% of GDP is tourism. It’s another major shock for them.
- Euro straightjacket limits ability to jumpstart economy — constraints on their ability to take fiscal measures. US has taken 10% of GDP in measures. It, Es, Fr — 1.5% of GDP.
- Italy has huge public debt. 150% of GDP, weak banking sector. Will need to be propped up by the ECB. 10x the size of Greece, too big to fail, too big to bail.
- Already had problems with a credit bubble, excess capacity all over, too many houses, too much real estate.
- This will trigger defaults, clog up banks with bad loans. Won’t be a collapse, but will be like Japan in 2000 after their boom — zombie companies. Too much credit. Wills slow growth. Big impact on commodity prices. That also will hit EMs hard.
- Emerging markets
- Perfect storm. Commodity price bust; now record pace of capital repatriation, marketing coming at — $100B out in a single month. Huge pressure on currencies. Also weak demand from advance countries.
- Corporate sector have borrowed too much, much of it in USD-denominated debt. Brazil, South Africa, etc. currencies have already depreciated 25% —makes it hard to repay the debt.
- Will see wave of defaults, e.g., in Turkey, but could see them in Latin America as well.
- This all makes it hard for the US economy to recover.
- Q: what if world restarts in 2-3 months? A: damage already done. US collapse provoked collapse in Europe. How did they get the economies going? Say, Italy. Can’t devalue, doesn’t have own monetary policy … deep in recession and stuck, don’t have a mechanism for external stimulus
Topic: The need for global data on the pandemic and what we can and cannot say based on the available data
Bio: Founder of a website providing rich data on many key topics including COVID-19. Data scientist, academic, researcher.
- We are an open access scientific project. Mission is to study the large global problems, to bring together best research and best data, present as clearly as data, and how we can make progress.
- We have a wide scope, but we focus a lot on disease and health. We are global and long-term.
- For a small science publication — we had 20 million visitors last month, and many more use it for their research.
- On pandemic, we started in February. Our team of <10 focused all efforts on it.
- Goal is to provide the data to allow everyone to understand what is happening. Help people understand how different companies are doing relative to one another. The differences will become broader. Learn from the ones doing better.
- Early on we focused on getting the media’s reporting right — BBC, FT, newspapers around the world. A crucial mistake early on was to focus on the current numbers of deaths and cases. But the right focus was on the growth rate.
- Now we are shifting to work on testing data and on the poor data on the pandemic globally. A crucial problem now is undercounting. We know the total number of cases is much larger than reported cases. We know this from research that looks at the ratio of deaths to cases. We think only 16% of cases in the US are reported — real number 6x higher. In Italy, only 6% are reported. Not even the number of deaths are right in Italy. We see this from the excess mortality statistics.
- Testing data is crucial. Everything we see has to be interpreted relative to the level of testing. Iceland for example has tested 6.5% of the total population. The US is 20x behind Iceland. Poor countries are doing almost no testing. Indonesia has done 26 tests per million! No wonder we don’t see cases or deaths.
- Korea, Singapore, Norway; also Veneto in northern Italy — did well because they tested early and extensively.
- Vaccines might be far away but testing is available now.
- We want to put pressure on the gov’t to increase testing.
Topic: News and Market Reaction
Bio Professor Business and Economics, author
- Value destruction is already at level of GFC and early depression.
- What is new is the role of coronavirus.
- We are looking at next-day reporting of stock market falls, to understand how people are understanding it.
- If you look since Feb 24 — 90% of big moves were attributed in next-day accounts to the economic fallout or to policy responses.
- Prior to Feb 24 to 1900, how many such big moves were there attributed to the coronavirus? Zero. The last several weeks are extraordinary in that way.
- The point is that flu and influenza never, in the contemporaneous perception, caused the market movements.
- Paper looking back to 1985: we had computers read articles. No prior virus (SARS, H1N1) registered as a perceived reason for volatility.
- Why? The human health impact can’t be all of it.
- Unlikely the mortality rate in the developed world will exceed the Spanish Flu.
- But Spanish Flu had little visible impact on markets or market volatility at the time.
- Why? One reason might be that info difuses more rapidly than back then. Is that really it? Don’t think so.
- One way to see this is to look at movements over weeks and months during Spanish Flu. Nothing like this back then.
- Two other explanations which I give much more weight to.
- 1. Interconnected nature of modern economy. E.g., F2F interactions, personal services, for much our economy. Not a manufacturing or agrarian economy anymore.
- 2. Dramatic policy response. Voluntary and compulsory efforts to social distance. This has shut down most of the economy.
- Q: In 1918 people kept going to work to factories. Is it because we’ve changed our behavior? A: yes, very different economy today.
Topic: The pandemic fallout on municipal bond credit
Bio: Former head of municipal bond research at a major investment bank
- We’ve seen centuries of pandemics
- Muni market will survive, with pain
- State & local revenues will mirror economic performance
- Great Recession did not produce waves of defaults.
- V-shaped vs U-shaped recovery is the bid question.
- The colonies issued their own currencies, was a disaster. States gave up the right to print money but not to borrow money. That is muni market. States can borrow.
- There are around 80K muni issuers.
- No state has defaulted since 1937.
- Many states are like nations-states — e.g., California, 40M people.
- Most states are AAA, all investment grade though IL close to the edge.
- Many kinds of bonds, more than in corporate, lots of structures.
- On the governmental side, there are tax/revenue-supported credits, primary user in the public, bonds are publicly owned.
- Privately-owned families are financed by non-gov’t bonds. These can borrow via a public conduit.
- If a city shuts down, everything shuts down. So very few defaults in the muni market. Expect that to continue.
- That said, pandemics are negative for all bonds.
- Ratings agencies are giving warnings which is to be excepted.
- Consumption declines impact state tax revenues. Income tax receipts are going down, The rich have stock market launches. Delay of state taxes by 3 months doesn’t help.
- State of NY’s new budget is probably already $10B in the hole.
- Looking at Munis, worry about how essential they are, worry about whether pensions are funded, worry about travel and entertainment.
- But the Fed is buying bonds, increasing liquidity, possibly another stimulus bill.
- There will be defaults. They will be a small % of the market, mostly private purpose. Unrated bonds, around 10% of the market, will have credit problems.
- If state or local gov’t it’s Chapter 9 not Chapter 11.
Topic: Logistics prevents quarantine for poor Americans and urban poor in EM mega-cities – What Happens?
- The pandemic gap: most discussions in the media are viewed through the lens of the wealth.
- This will hit the poor much harder. IN the US and globally.
- This will evolve into a disease of the poor. Economic and moral consequences.
- Big political consequences as well.
- In the US, we are talking about this by people like us, people who are sheltering at home in nice homes, able to work.
- The reality for many Americans is that you can’t quarantine. Not everyone can continue to do it. There will be pushback. The logistics are too awful. Look at Patterson Houses in the Bronx for example.
- “Shelter in Place”: if 9 people share 1 bathroom in a fourth-floor walkup, will you spend three months?
- Home life is complex for poverty. You don’t have deep freezers for storage or green spaces to escape for. What about laundry? Laundromats are not an option.
- The wifi gap. People go to McD’s for wifi. Many poor Americans don’t have wifi, don’t have cars to drive to go to parking lots with wifi.
- If you live in trailer with three generations there? Will you stay there?
- This will have political consequences. Especially if this goes into May.
- Look at Jakarta to see how almost 1 billion people live. They can’t socially distance. Sanitation isn’t there.
- This will be disastrous morally and politically.
- Our inequality is rarely so exhibited as it is now.
- The wealthy are generally surviving and getting on.
- The poor are having to work to keep it going. It will kill them because of lower health quality.
- Also these will be reservoirs of the disease that can carry it back into the developed world.
Topic: What are the pandemic’s implications for international relations
Bio: Professor at Stanford University
- It doesn’t change things all that much.
- Cold War was very unusual.
- Looking at different kinds of countries today:
- Consolidated democracies. Europe other than Germany haven’t done that well as far as I can tell. US in in the middle; worse than Korea, better than Italy and Spain. US is neither leader nor inept.
- US has not been leading effectively since the Cold War. A book, Deaths of Despair — declining life expectancy for uneducated whites. People without college degrees seeing life expectancy go down — same as Soviet Union in 1980s.
- Upcoming election: these are not great candidates on either side.
- We can see that even Spain and Italy, democracies, didn’t react well.
- No indication that we have a leader who will deal with deaths of despair, or deal with this crisis in the US.
- Consistent with the last speaker.
- For 40-50 years we had a system that worked, since US had effective leadership. It depended on the US functioning effectively internally. We don’t have this today.
Topic: How are ventilators working to save Covid19 patients?
Bio: Anesthesiologist in the US
- Ventilators may be doing more harm than good.
- Very fluid situation.
- Poor data collection, no studies, no science. Disjointed treatment plans.
- Fragmented processes with bad outcomes.
- Ventilators are a prime example.
- Difference between life and death is being placed on a ventilator.
- 7-10 days after infection
- This is our last line of defence, big bazooka.
- If you fail the ventilators, very few solutions left.
- Looking at NY and NJ, the ventilators may be causing some kind of trauma or progression of the disease in the lungs.
- When the virus replicates in the lungs you get a significant immune response.
- Thick layers between lungs and blood stream, oxygen having trouble passing through.
- Ventilators may be causing the thick layers to become scar tissue.
- High death rate if put in ventilator.
- Equivalent or higher than if you were infected with Ebola in 2014.
- ICUs and anaethetisioligsts are revoking at this.
- How to ventilators help? Breathing tube, you can provide more oxygen, and you are pushing it through the thick better to get the O2 into the blood.
- What seems to be happening, changing treatment modalities to use high-flow nasal cannula, keep patients off of ventilators, may have better outcomes.
- We are considering dual therapies but info so far the results do not appear promising.
- Waves of patients requiring intubations, setting new records every day.
- You never hear about the anaesthetist equipment shortages, we need to use specialised equipments. The source of our equipment is Wuhan! Significant lag time to get the batteries we need for example.
- They are being allocated to hotspots in the US.
- Mentally has been very difficult.
- At time of incubation we are speaking to families to ask where they would like remains stored, since 80% will die.
Topic: How are major hospitals dealing with the Pandemic?
Bio: Cardiovascular Surgeon in the US
- I work at a large suburban hospital near a major hotspot.
- Lots of sick patients
- We expected to peak in the next two weeks.
- We couldn’t have imagined this.
- Entire hospitals are devoted to COVID, everything else has come to a complete halt.
- Resource allocation of PPE: you need an extraordinary amount. A single round uses a huge number of gloves, gowns, masks.
- Many doctors around the country are sick,I know many of them. Some mild, some in ICU, some on ventilators.
- Once patients have been triaged, ICU specialists take on the patients.
- Some need immediate incubation & placement on ventilators; others are more stable. Usually admitted to a floor just for COVID patients.
- On ventilators: treating huge cytokine release, inflammatory response. Requires high dose steroids.
- Renal insufficiency, some renal failure.
- Risk of multi-organ system failure which causes death.
- We are treating so much at once we don’t know what is working.
- Broad set of symptoms. Sometimes first admitted to non-COVID unit, then become COVID positive, and can infect a “clean” unit.
- Some hospitals plan to transfer patients who are stable to field hospitals. But will only work if the appropriate patients are sent there.
- Large hospitals have surge plans for catastrophes.
- Most have put these plans in place.
- Elective surgery has been cancelled across the country. Only dealing with emergencies.
- We have not converted every OR in my hospital to an ICU. We do have enough resources right now.
- Our patients are avoiding coming in if they can.
- Testing has continued to improve almost daily.
- Inpatients and health care workers get results quickly.
- Highly persistent, even on surfaces. Highly contagious.
- Greenlight in early May to begin operating again.
- 1/3 of patients who go on ventilators come off of them.
Topic: Pandemics in Economic History
Bio: Professor of Economics and History, author
- Go back to William Mcneil, U Chicago historian. He pointed out that we can look a a long struggle of people vs microbes and viruses throughout history.
- Once in a while a plague changes the course of history.
- Roman times, Justininan plague; black death.
- Much of pre-columbian population of the Americans were destroyed by pandemics brought by Europeans — smallpox and measles.
- How have pandemics changed as a result of economic development?
- Bad news: Higher integration of the world means microbes get around the world faster.
- Every pandemic we know about is the result of two societies being in contact which were not previously.
- Now they can spread simultaneously globally. Three months is a very short time in history compared to past epidemics!
- Possible that viruses and microbes are mutating faster, not sure.
- Good news is that we are finally learning. This pandemic is very different, even than the Spanish Flu. In 1918 people did not understand at all, did not know it was a virus.
- We are so good at handling infectious disease that this pandemic is a surprise!
- Deaths from infectious disease had fallen from 800 to 60 per 100K people.
- Dangerous to generalise from history here. Despite all of the problems, we are much better equipped to deal with this than anyone ever was before.
- We are throwing everything at it.
- We will have vaccines faster than every before.
- The techniques we develop will prepare us for the next one.
- Over the long run we are winning the long-term battle of people against microbes!
- This isn’t going to be the Black Death or the Justinian plague.
- We sequenced the virus within a few weeks. We know the enemy.
- May be some good results.
- May get better at working from a distance.
- Once we have a vaccine, hopefully will end the anti-vax movement.
Topic: How does the current pandemic resemble the 1871 Horse Epidemic
Bio: Professor of History
- Started in Toronto, spread rapidly throughout NA, hit every city. Took one year to burn out.
- Horses got very sick, many collapsed.
- No social distancing for horses!
- 95% of animals got sick quickly.
- Those that had to work anyway often died.
- 75% of horses and mules died
- Most of them were unable to work for 3-6 weeks.
- Caused economics and social shock.
- Revealed dependency of supply chain on horses: coal, fuel, harvests were rotting.
- Railroads relied on horses to take material to/from depot.
- Railroads wouldn’t even stop because they ran out of places to put packages that had piled out.
- People didn’t catch it but economic anxiety caused people to stay at home. Bankrupted many people.
- Some people think it caused the panic of 1873, a major recession.
- People couldn’t congregate because they had to walk everywhere.
- Wedding and funerals were disrupted.
- Had it lasted, could have cut off heat and food for the winter.
- Anti-cruelty movement came out of this.
- Confused national debate among scientists and doctors. What caused the disease? What was it? How could you prevent it?
- We’ve come along way since then. Easy to map the spread. Each newspaper discussed it. It was national news.
- Early epidemiology could see that it was spreading radially from Toronto along the main transit routes.
- Germ theory was in its infancy. Microscopes weren’t strong enough.
- We don’t know what the disease was for sure.
- This focused national attention on the problem and it led to the first vet schools.
- This in part led to the replacement of horses with machines. Cities encouraged that transport companies experiment with steam, hydraulics, cable cars. This accelerated trends that were already underway.
- It didn’t last long enough to cause lasting change. The duration of the epidemic matters to know if it will cause long-term change.
Topic: 1918 Flu
Bio: Author, works in emergency care research funding
- Happened in the pre-antibioitic period. Although they don’t treat viruses, they do treat the secondary bacterial infections. It is these that cause pneumonia and were likely responsible for mosts of the deaths.
- Even today, secondary pneumonias are an issue.
- We have tools they did not, antibiotics, against secondary complciations.
- We are in a very different state. Today we have >100 drugs in trials.
- Doctor back then would have arrived on horseback; was the same doctor who would deliver your baby or set a broken bone. Today we have specialists.
- Fear is a big factor. Back then people didn’t know what was killing them. Experts gathered to discuss it after three months of deaths. Famously, the Chicago health commissioner said that people should be kept from fear.
- People are afraid today too.
- We are around 325K infections in the US, 9K deaths. This is around 3% crude death rate. That’s up there with the 1918 death rate. That will fall as we discover more asymptomatic carriers, discover more cases through testing. Still a staggering number. In 1918 it was 2-3% death rate; some saw 80% (e.g., in one town in Alaska with elder population).
- The fear is common to the two epidemics.
- What happened in Fall 1918, when it came back, it was much more deadly. Don’t know if that will happen here.
- Other coronaviruses are “winter viruses” and subside, are less transmissible, in warmer & more humid summer weather. We’ll see what happens, and then what happens in the autumn.
- Q: Does that mean in places like Florida and Indonesia will have lower transmission. A: In general, yes. But many other factors at play. Density of population is very important. A lot of people in a small area, may transmit even in a climate poor for transmission.
- MIT paper in the last week says less of a problem in warmer climate but data still Evolving. Need to look at the data on a per 100K population basis.
Topic: How literature can help us make sense of crises like now.
Bio: Professor of Slavic Literature
Requirement: Please read short story The Bishop by Anton Chekhov.
- Putin might be thinking that this is relatively minor compared to what Russia has been through.
- Bleak House by Dickens would be good to read. The wealthy people ignore the slum going through a disease. The heroine catches it, comes close to dying, is marred by smallpox.
- I asked you to read this story to understand the psychological aspects.
- When reading reporting, big picture are statistics not individuals.
- Hero doesn’t know he’s ill at first. Experience of the illness merged with his loneliness.
- Great literature lets you experience what others are from within.
- He dies of typhoid.
- I don’t agree that the hero is unsympathetic.
- His relationship with his mother is because after being abroad for 9 years she can’t relate to him any more. People stand up in his presence because he’s a bishop. He doesn’t know how to overcome it, despite trying.