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April 14th, 2020:

What does “reopening the economy” look like?

We’ll find out (sort of) later this week.

Gov. Greg Abbott said Monday that reopening the Texas economy will be a “slow process” guided by public health concerns as he continued to preview a forthcoming executive order that will detail his strategy to reignite business in the state.

Abbott, who first hinted at his plans during a news conference Friday, said he’ll outline them later this week. Asked for more details Monday, he indicated his announcement will include a “comprehensive team” that he said will “evaluate what must be done for Texas to open back up, ensuring what we are doing is consistent with data, with medical analysis, as well as strategies about which type of businesses will be able to open up.”

“This is not gonna be a rush-the-gates, everybody-is-able-to-suddenly-reopen-all-at-once” situation, Abbott said during a news conference at the Texas Capitol in Austin where he announced $50 million in loans to small businesses suffering under the pandemic.

Abbott also told reporters to expect an announcement this week on whether schools will remain closed for the rest of the school year. Abbott previously ordered them closed until May 4.

[…]

As he did Friday, Abbott said Monday that testing will be a part of his announcement later this week on reopening the economy.

“We will ensure that a component of that will include adequate testing,” Abbott said, adding that he just had a hourlong conference call with Vice President Mike Pence and Deborah Birx, the White House coronavirus response coordinator, about the testing necessary to “safely reopen the state for doing business.”

That last part is interesting, since so far the state of Texas has sucked at doing testing. Far more of it will be necessary to really open society up again, or else we’ll be right back where we started, with this giant unstoppable risk that we’re all vulnerable to. I’ll wait till there are more details before I go too far down the rabbit hole, but the first question on my mind is will this override whatever stay-at-home orders there are still in the counties? You may recall, Abbott was perfectly happy to let mayors and county judges lead the way when the hard decisions had to be made about shutting down. Will he still respect them later this week when he wants to start things up, or will that all be yesterday’s news? How will the Abbott plan compare with the reopening plans in other states? Stay tuned and find out.

Judges have to do their part

Some could be doing better.

Harris County’s largest association of criminal defense attorneys on Monday called on local judges to halt in-person court appearances to help prevent the spread of coronavirus.

As the virus has swept across the nation, it has shut down wide swaths of everyday life. But in Harris County — where judges last month halted jury trials and many other court functions — some criminal judges have continued to require in-person court hearings and in-person reporting to pre-trial services.

Harris County Criminal Lawyers Association President Neal A. Davis wrote that such policies present a “threat to public safety and the impartial administration of justice.”

In the four-page letter — which was sent to the county’s 22 state district judges and 16 misdemeanor judges, Davis noted that video appearances are “easy and routine now,” and that local prosecutors are expressly forbidden from appearing in courtrooms, except in “the rarest of occasions.”

“For a Harris County Judge to require one party to physically appear and risk exposure to a deadly pathogen, and allow the other party to appear remotely, violates a judge’s appearance of impartiality, at a minimum,” Davis wrote.

[…]

Local defense attorney Patrick McCann said that while many misdemeanor judges were taking measures to mitigate the spread of the coronavirus, some district judges “have not thought through the implications of everything they’ve been asking the defense bar to do.”

“I’m glad the HCCLA is finally standing up for the average solo (attorney) that’s trying to keep safe, keep their family safe and still do a good job for their clients,” he said.

This is one of those things that should have gone without saying, but clearly we need to say it. It’s clearly unfair to have different rules for each side, and when those different rules put some people’s lives at risk, there’s really no excuse. The story does not indicate which judges are the offenders here, but I’m sure the names are known. All I can say is that the next time these judges come up for election, I would very much like to know who was doing the right thing and who was not. I hope that the various endorsing organizations will take that into account, and more to the point be as transparent as they can about it. I know that most people who vote in judicial elections don’t know a whole lot about the candidates in question. That doesn’t mean the information that is relevant to us shouldn’t be available. Please make sure that it is.

Treating COVID-19 patients at nursing homes

This is a huge can of worms.

When Larry Edrozo got a phone call from his mother’s nursing home in Texas City telling him she was being treated for the novel coronavirus with an unproven pharmaceutical drug, he had two questions: why was she getting the drug if she had not been showing symptoms, and who gave consent?

Helen Edrozo, 87, is one of 56 residents at the Resort at Texas City who tested positive for the coronavirus, and one of 39 residents being medicated with hydroxychloroquine, a drug typically used to treat malaria and lupus that has shown some evidence of possibly tamping down symptoms of the virus.

The use of hydroxychloroquine to treat coronavirus patients has drawn controversy globally as the medical community and public debate the ethics of testing a medication before significant research is available — and in the case of elderly patients such as those at The Resort at Texas City, on a population that is statistically more vulnerable to the virus. While President Donald Trump has touted the drug’s benefits, a large controlled study of hydroxychloroquine has not yet been completed, and some doctors warn the drug combination used for the experimental treatment could have severe, potentially deadly side effects.

Larry Edrozo was initially told by an administrator at the nursing home that Helen would not eligible for hydroxychloroquine treatment because she was not showing symptoms. But on Monday, a nurse at the facility phoned him to tell him that his mother’s carbon monoxide levels in her blood had elevated slightly and that she had already begun a hydroxychloroquine dose.

Edrozo was stunned. His mother has dementia, meaning that, as her power of attorney, he is supposed to sign off on any medical treatment she receives at the nursing home.

“I (told the nurse), ‘OK, well, since you’ve already started (treatment), I guess I would write in my notes that the question was raised about consent and what happened to that?’” Edrozo said. “I have not received a call back.”

Dr. Robin Armstrong, the medical director at The Resort, who prescribed the medication shortly after Amneal Pharmaceuticals donated 1 million tablets to the Texas Department of State Health Services pharmacy, said the decision was between him and his patients. He said he did not notify families before the drugs were administered because it was not necessary and time consuming.

“If I had to call all the families for every medicine that I started on a patient, I wouldn’t be treating any patients at all; I would just be talking to families all the time,” Armstrong said

But ethicists say informed consent is one of the most important factors in any treatment, and several people with family members at the Resort at Texas City being treated with hydroxychloroquine say that they were not asked to give consent, despite having power of attorney over their sick relatives.

Still, faced with the desperation of potentially losing his mother to the coronavirus, Edrozo felt he had no other choice than accept this course of treatment.

“When the people are blasting the doctors and the governor’s office about human guinea pigs, I’m sort of there with them,” Edrozo said. “But then I want to ask them, ‘What if it was your mother, or your spouse or your child?’”

As the kids say, there’s a lot to unpack here. At the most basic level, there’s nothing but anecdotal evidence that hydroxychloroquine has any effect on coronavirus. There are no studies worthy of the name showing that it would help. Maybe it will, maybe it won’t, we just don’t know. And that’s without taking into account the inability of these patients on whom the tratment is being tested to give informed consent for their participation. Or the fact that hydroxychloroquine is an actual drug used by people suffering from lupus and malaria, and Donald Trump’s obsession with it as an unproven treatment for COVID-19 means potential shortages for those patients. Did I mention that the doctor leading this effort is a Republican activist who got a supply of the drugs through political connections, and who therefore has a vested interest in making Trump and his hydroxychloroquine predictions look good? All this, and even if it does help some of these patients it won’t tell us anything about the effectiveness of hydroxychloroquine as a treatment because this isn’t a controlled study. Keep in mind, everyone who has recovered from COVID-19 has done so on their own. We’ll have no way of knowing whether the people at The Resort who recover would have done so anyway – that’s why doing controlled studies matter, so you can make valid comparisons. I very much get Larry Edrozo’s dilemma, but he and everyone else involved in this deserved to have full knowledge of the risks and benefits so they could make their own decision.

The Arizona/Florida Plan

Let’s call this the MLB Plan 2.0 for playing a season.

Major League Baseball, assessing myriad proposals, has discussed a radical plan that would eliminate the traditional American and National Leagues for 2020, a high-ranking official told USA TODAY Sports, and realign all six divisions for an abbreviated season.

The official spoke on the condition of anonymity because the proposal is one of several being discussed.

The plan would have all 30 teams returning to their spring training sites in Florida and Arizona, playing regular-season games only in those two states and without fans in an effort to reduce travel and minimize risks in the midst of the COVID-19 pandemic.

The divisions would be realigned based on the geography of their spring training homes.

The plan would allow teams to return to the comforts of their spring training sites for three weeks of training, which would also include exhibition games, before opening the regular season and playing a schedule with wholly different divisional opponents.

[…]

The Arizona-Florida plan has several advantages, including allowing teams to establish home bases with facilities they are familiar with. There would be 26 ballparks available to be used, including three major league domed stadiums – Tropicana Field in St. Petersburg, Florida, Marlins Park in Miami and Chase Field in Phoenix.

Financially, it could be a huge boon for the TV rights holders. You could have a captive TV audience the entire day. Games in Florida could begin at 11 a.m. ET and still have games in prime-time for East Coast teams and their fans. The time slots still would permit West Coast teams to play prime-time games in Arizona.

Baseball, even with the realignment, could still play 12 games apiece against their new divisional opponents and six games apiece against the other teams in the state. There would be at least one doubleheader a night when all teams are scheduled to play because of the odd number of teams in each state.

The DH would likely be universally implemented as well.

There could still be division winners and wild-card winners, perhaps adding two more wild-card teams to each league, or a postseason tournament with all 30 teams.

The winner of the Cactus League in Arizona would play the winner of the Grapefruit League in Florida for the World Series championship, utilizing the domed stadiums in late November.

See here for the previous, Arizona-only idea.Plan 2.0 followed pretty quickly, which suggests MLB heard the criticisms of that scheme and either had this in its back pocket or came up with it quickly. One potential problem with this idea is that each of the two “leagues” has 15 teams in it, and since there won’t be any travel between Florida and Arizona, that would lead to scheduling challenges. Those challenges can be overcome in a variety of ways, some more conventional than others. Again, we don’t know what’s truly realistic right now, and we don’t know what will actually work in the real world, but it’s a worthwhile exercise to try and figure out something that could work. It costs nothing to brainstorm, and who knows, we might be in a better position than we think. May as well be ready for it if that happens.