Los Angeles Times - 13.03.2020

LATIMES.COM/OPINION FRIDAY, MARCH 13, 2020A

OP-ED

J

oe, a semi-retired81-year-
old, never expected his Italy
guys’ trip to thrust him into
the front ranks of COVID-
patients. Joe’s story goes
against the grain of news about the
coronavirus now gripping the
world and providing epidemiolo-
gists and public health experts
with the challenge of their profes-
sional lives.
Joe is the patient of a medical
colleague, and he and his wife gave
me permission to tell their story. It
started with a ski vacation for 14
friends, united by their connec-
tions to the real estate industry,
who flew from Sweden, San Fran-
cisco and Los Angeles to a ren-
dezvous in Munich. From Ger-
many they traveled to Selva di Val
Gardena, a ski resort in the
Dolomite mountains of northern

Italy. Arriving on Feb. 21, they began their usual regimen of morning ski runs and afternoon lounging. Before long, they could tell something was off. Joe’s friend Pe- ter was the first to develop a cough and general malaise. Some of the others soon noted more shortness of breath than usual on the slopes. In the evening, normally robust ap- petites faded. By the time the trip ended, Peter was seriously ill with a cough and fever. He was hospitalized in Munich with pneumonia. Although Joe felt unwell, he was able to continue to Los Angeles. By the time Joe arrived at LAX on March 1, he realized that he might have been exposed to COVID-19. He called Dr. Jonathan Weiner, his primary care doctor, from the airport. Weiner, aware of the public health implications of a potentially infectious patient in a public setting, directed Joe to head home and arranged follow-up care there with the Los Angeles County Department of Public Health. Joe tested positive for COVID-19, as have all the other trip participants. He has no idea how they could have been exposed, although he thinks back to a crowded tram ride. Since testing

positive, Joe has been isolated from all direct interpersonal con- tact. Confined to a bedroom at home, he communicates with his wife, Barbara, by phone, text and Facetime. Barbara is quarantined too. Because test kits and lab time remain limited, and because she exhibits no symptoms, she hasn’t been tested and she won’t be un- less she develops a fever or cough. The couple depends on family and friends to drop off food. Bar- bara leaves meals for Joe on a tray at his bedroom door, then heads to another part of the house to text him. Joe, mask in place, opens the door, takes the tray and closes the door again. She carefully disposes of the paper plates, wearing gloves. The isolation routine will stay in place for 14 days or until Joe tests negative twice. Joe was the oldest trip partici- pant, but he has weathered COVID-19 better than most, with nothing worse than nasal con- gestion. He hasn’t had a fever at all, just a cough, which I heard occa- sionally during our phone discus- sions. Why would an 81-year-old like Joe sail through an encounter with the same virus that led to five friends being hospitalized and

with Peter remaining in critical condition in a Munich intensive care unit? Joe isn’t certain; he doesn’t know if Peter or the others had underlying health problems. COVID-19 is simply too new for us doctors to draw conclusions, but a few things stand out about Joe. His lifestyle is far healthier than most. He walks on a treadmill for an hour a day and works out with a trainer three days weekly. He has never smoked, drinks alcohol mini- mally and has a healthy diet. He had heart bypass surgery years ago, but other than that, he’s never had a serious illness. Joe generally feels good too: “The only reason I know I’m getting older,” he told me, “is that people seem to call me ‘sir.’” Joe is reluctant to ascribe what may just be good fortune to his lifestyle, but his experience offers lessons for everyone as the coronavirus spreads. First, despite our limited understanding of this disease, we can say that most cases of COVID-19 will prove mild, like Joe’s. Second, although the virus poses a frightening reminder of the power of nature to disrupt our lives, our own behaviors surely still make an important difference. Nonsmokers fare far better with

respiratory illnesses such as COVID-19. For many who may be- come exposed, it’s not too late to quit now and benefit prior to po- tential exposure. In addition, Joe’s decision to call his physician rather than going to an emergency facility may have saved numerous poten- tial exposures. And he is carefully cooperating with isolation, a chal- lenging but critical intervention to reduce the impact of the epidemic. We can be certain that more people are infected with COVID- in Los Angeles than have been tested, and more will be getting ill. We also know that minding our health — and the recommenda- tions to wash hands and maintain “social distance” — will prove the best way to limit the reach and impact of the disease. As a medical doctor, I’m in- spired by Joe’s upbeat attitude and his ability to shrug off a potentially lethal virus. It shows that among the older population and the vul- nerable, like most others, this in- fection can be less a serious illness and more a matter of management and control.

Dr. Daniel J. Stoneis an internal medicine and geriatric specialist.

Joe, 81, tested positive with barely a cough

In quarantine in L.A., Joe,

and his healthy lifestyle,

offers lessons for us all as

the coronavirus spreads.

By Daniel J. Stone

O

ne candidateinspired a stampede of voters on Tuesday. He also managed, for the time being, to take big money out of politics. But it wasn’t Sen. Bernie Sand- ers. The Bellwether of Burlington promised to do these things, but in the end, he wasn’t the one who got the big turnout without the big bucks. It was former Vice Presi- dent Joe Biden, a hoary has-been who reps what Sanders likes to call the “corporate wing of the Demo- cratic Party.” Once upon a time, Biden may have embraced that role. Decades ago, the first time he ran for president, he was an ace fundraiser — a sweetheart of the DNC, till that campaign fizzled and he was pro- claimed the “once hot” Democrat in a news headline. This time he started with an exceedingly mod- est war chest and low expecta- tions, only to build something more than momentum out of thin air. It should be said that the Biden of 2020 didn’ttryto run without big money. He probably wouldn’t have been averse to a lot of sweet corporate windfalls. And don’t expect him to turn them down now. They just didn’t come his way early on. Before his victories on Tuesday, he’d raised about $ million to Sanders’ $134 million in grass-roots donations. No wonder Biden’s touching but rattletrap campaign has had all the hallmarks of involuntary thrift. He didn’t just fail to appear in several primary states; in many, his campaign barely set up card tables. And the Biden comms efforts are still so threadbare that even his fundraising emails look like they come from cardboard boxes stamped “1987.” (We must have those bumper stickers blast- ing Reaganomics around here somewhere.) Biden hasn’t even paid an agency to develop a snappy hash- tag. #IAmTiredAndDon- tHaveAnyMoney, in fact, might have been the campaign’s default theme till about a week ago. At least it’s relatable. But, money or no, and razzle- dazzle or no, Biden voters have showed up. Biden added four of the six Tuesday night states to his win column, including the big prize, Michigan, and as of Wednes- day, he had pulled ahead in Wash- ington, which is still counting votes. All those victories followed his Super Tuesday blowout: Vir- ginia, North Carolina, Alabama, Tennessee, Oklahoma, Arkansas, Minnesota, Massachusetts, Texas and Maine. There is a theoretical “path forward” for Sanders, but Biden seems to be the presumptive no- minee now. It says something that President Trump, when he’s not producing COVID-19 covfefe on Twitter and from the Oval Office, is back to attacking him. Even Sanders, who announced he would stay in at least through Sunday’s debate, admits that Biden may be winning the “elect- ability” contest. Which brings us to turnout. The Sanders campaign regularly prophesied that new voters — voters who grew up with student debt, bank failures, rapacious capitalism and endless wars — would be impelled to the polls by the promises of a revolution that would lift up the working class. That prediction missed the mark, but Tuesday’s polling places were hardly empty. Indeed, there

was record-breaking turnout, especially in Michigan. It’s just that the votes were cast for Biden, from a formidable group now considered Biden’s coalition: African Americans, suburban women and non-college-educated whites. It’s admittedly hard to imagine Biden spiking anyone’s adrena- line. He’s low-key in the extreme on the stump. He’s regularly praised for “humility” now — an odd quality for a presidential candidate, from whom voters usually want dreams, ambitions, plans, pep rallies. But for a country suffering from tinnitus after four years of a head- banger president, Biden’s quietude is welcome. Election forecaster and politi- cal scientist Rachel Bitecofer calls the force that keeps prospective voters away from the polls “comfort.” When choosing a candidate, you ask yourself for whom (and for what) you’re going to forfeit your comfort — get a babysitter, change clothes, jump on a bus and stand in line at a polling place, or even make sure a mail-in ballot gets to the registrar on time. For decades, Democrats have given one answer: a dreamy candidate who makes their hearts race. Not this time. If Democrats have long been accused of wanting “savior” presidents — and staking everything on presidential elec- tions while ignoring the rest — this election may mark a turning point. If the Biden wave is any indica- tion, Democrats are no longer looking for that kind of perfection. They’ll settle for a break from the jackhammer noise — from Trump, from Michael Bloomberg, from Sanders, from cable news, from their bloviating relatives, from Twitter. The lesson going into next week’s primaries seems to be that voters will give up “comfort” because their situation now is not all that comfortable. Discomfort is ever-present even when we’re at home on the sofa self-quarantined with our hand sanitizer. A virus is stalking the planet. Kids are shut out of schools. Our savings are plummeting. The president is disturbed, senseless and tyranni- cal. What’s driving turnout now, and what will drive it in November, isn’t infatuation with a savior. We aren’t head over heels. We aren’t buying Big Ideas. We’ll move heav- en and earth to get to the polls, to turn in our ballots, because we want to stop tossing and turning and get some sleep again. And sleepy Joe is just the guy for bedtime stories and lullabies.

@page

Why ‘sleepy’ Biden

is what voters want

VIRGINIA HEFFERNAN

AFTER YEARS of President Trump, Joe Biden’s quietude is welcomed by many Americans.

Mandel NganAFP-Getty Images

T

he coronavirusis first
and foremost a public
health crisis, requiring
a public health re-
sponse. It is also an
economic problem, potentially a
severe one.
With increasing numbers of
people in quarantine, millions of
Americans avoiding certain kinds
of businesses, the canceling of
large gatherings, and investors ob-
viously worried about the future, a
coronavirus recession seems al-
most certain. Moreover, the his-
torically high economic inequality
that characterizes our economy
has created fragilities that exacer-
bate any shocks to our society.
The most urgent economic and
health priority for Congress is to
ensure that sick workers are able to
stay home without fear of losing
their jobs or their paychecks. Mil-
lions of workers lack access to paid
sick days. Yet new research shows
that paid sick days can reduce the
transmission of flu by 40%.
The workers least likely to have
paid sick leave are low-income
workers who may have a lot of con-
tact with the public, such as deli
workers and retail clerks. If they’re
only “a little” sick, they might go to
work because they can’t afford not
to, increasing the risk of infecting
their fellow workers as well as cus-
tomers. At the same time, they are
also employed by businesses that
are likely to feel the economic
downturn immediately.
The most straightforward way
to provide sick pay is for Congress
to require that all employers pro-
vide it to their employees — and the
program needs to be permanent so
we’re not scrambling the next time
a catastrophe hits. This won’t help
gig workers, but Congress can — as
House Democrats have proposed
— offer emergency extended leave
to those who need it, paid for by the
federal government, which will cov-
er everyone.
Beyond that, we need to take
action to avoid or mitigate a painful

recession. That job is made much harder by two factors that have nothing to do with coronavirus. First, because of high economic inequality there is less money in the hands of the people who do most of the consuming; a recession weakens consumption even more, with potentially disastrous results. We know from past experience that President Trump’s proposal for a payroll tax cut would not be spent as quickly as other ways of getting money to people — and certainly won’t help those thrown out of work. Second, the Federal Reserve has traditionally played an out- sized role combating recessions, but now has a limited toolbox, one that is largely designed to support financial market liquidity and lower interest rates, both of which it’s already used amid the current market meltdown to little effect. During the last recession, which began in December 2007, the interest rate was lowered to just above zero. Over the course of the most recent recovery, policymakers were able to raise the rate to just under 2.5 percent, and that is now again edging toward zero. Further lowering of interest rates isn’t a path available at this point. With limited options for mone- tary policy, we have to rely on fiscal policy — spending and tax policies that can shore up depressed de- mand so that customers have money to spend and manufacturers have buyers for their products. Truth is, we should have been rely- ing more on fiscal policy in prior recessions, too. When a recession is likely, we need to get money di- rectly and quickly into the hands of people lower on the income ladder and we need to make sure those programs are calibrated to ramp up quickly as the recession begins. This week, countless people are being laid off — think of the food service workers furloughed from college campuses closed down because of the coronavirus. A first step is to ensure that the Unem- ployment Insurance system covers

all those who need it. With states having made cut- backs in recent years, this will require an infusion of federal funds. Further, Congress should make it easier for people to access the system so that those out of work have some financial security. We also need to expand the na- tion’s nutrition assistance program. Especially with schools clos- ing, state and federal agencies need to make the process for getting supplemental nutrition sim- pler and faster. In the last two recessions, Con- gress and the White House sent direct payments to everyone in 2001 and 2008. We should plan to do this again and we should implement an automatic trigger so that these payments happen so long as the economy remains in a recession. The front line of the recession happens in the states. And, this time, it’s not just state budgets but state healthcare systems that are or will soon be stressed. To avoid having cash-strapped states cut- ting their health budgets, Con- gress should put in place a plan to increase the federal matching sub- sidies for Medicaid and the Chil- dren’s Health Insurance Program. Here, too, there could be a trigger that raises federal support during the economic downturn but then falls back as the economy im- proves. Economic research over the past decade has shown us what policies can work to mitigate a recession. A vaccine for COVID- won’t be ready for at least a year. We need to put in place emergency measures to get money to millions who will soon have trouble paying rent and buying food. Congress and the president need to act now, as we confront a devastating threat to our economy.

Heather Bousheyis president of the Washington Center for Equitable Growth and author of “Unbound: How Inequality Constricts Our Economy and What We Can Do About It.”

AN EMPTY departure terminal at John F. Kennedy International Airport in New York City
reflects the global travel slowdown over the coronavirus pandemic.

Spencer PlattGetty Images

Aid for workers laid

off by the coronavirus

By Heather Boushey

Los Angeles Times - 13.03.2020

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