Diatribes of Jay

This blog has essays on public policy. It shuns ideology and applies facts, logic and math to social problems. It has a subject-matter index, a list of recent posts, and permalinks at the ends of posts. Comments are moderated and may take time to appear.

16 February 2020

How to Stop a Pandemic


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

[For brief comment on the Dems’ Nevada debate, click here. For the terms of permission to re-post, link to, copy, translate, distribute, publish, display and transmit (but not modify) the following post, click here.]

Introduction

1. What anyone can do 2. What government and business can do
Conclusion

Introduction. The germs that spread pandemics—mostly viruses and bacteria—are invisible without special equipment. But if you know how they move, you can understand how they spread disease. That requires thinking through physical detail—a process familiar to most scientists and engineers, as well as medical personnel.

Germs travel from person to person in four ways. They move: (1) in animal “vectors” (mosquitos for malaria and yellow fever, and rats and fleas for bubonic plague); (2) in body fluids or tissue (HIV/AIDS, rabies, ebola), (3) on things (which can be solid like doorknobs or porous and flexible like hats, bedclothes and clothing) (many diseases, including respiratory viruses like the new coronavirus), and (4) through the air, usually in droplets (colds, coronaviruses, flu, TB).

Although we believe coronaviruses originated in animals and jumped to humans, they are not known to pass among humans via animal vectors. Transmission through body fluids and tissue is mostly an issue for medical personnel and intimates of the sick. That’s why HIV/AIDS, rabies and ebola never reached a pandemic stage. So to stop this pandemic, we should focus on the last two means of spreading: objects and droplets.

Germs that are still active on objects or in the air have a big risk of spreading. That’s why the greatest modern pandemic so far—the worldwide Spanish flu epidemic of 1918—was so devastating. It killed an estimated 50 million people, about the same as all of World War II.

Two developments have substantially increased the risk of pandemics since 1918. First, the world’s population has nearly quadrupled [point 12], from 1.9 billion in 1917 to 7.5 billion a century later. People are now living closer together, in larger and more densely packed cities, than ever before. There are also more people living closer to animals, and eating more undomesticated ones (“bush meat,” as the Aussies call them). Animals are a potent source of newly mutated viruses.

Second, global travel is incomparably faster and denser than a century ago. The world’s first scheduled commercial passenger flight came in 1914, in Florida. Now passengers can fly within or among continents on over 100,000 scheduled commercial flights each day. A person who catches the coronavirus in Wuhan can be in Beijing, London, Mexico City, Moscow, New York, Tokyo, or Toronto the same or the next day.

So how can our species ward off this new coronavirus, or the inevitable next threatened pandemic, when we can’t perceive the germs that spread it without equipment that only specialists have?

As it turns out, there are lots of things we can do, especially for viruses like the new coronavirus. Some of them are simple things that anyone can do—even things that everyone in developed nations does daily. Other things only government or business can do. Some precautions may require cultural changes. Read on.

1. What anyone can do (in roughly descending order of its effectiveness divided by its difficulty).

a. Don’t touch your face, except immediately after washing your hands. The easiest way to make yourself sick by contact is to touch on or near your head’s orifices (mouth, nostrils, eyes and even ears) with hands that have contacted a transmissible virus. This is so not just for the new coronavirus, but for flu and the common cold as well.

You never know when you’ve contacted germs, because they’re too small to see. Anyway, all of us tend to forget things we’ve recently touched. So the best preventative strategy is to train yourself not to touch your face at all, or to do so only through clean tissues, towels or handkerchiefs, or after washing your hands thoroughly.

b. Wash your hands. You can practically shut down germs’ object-driven pathway to infecting you simply by washing your hands. But you have to wash them far more thoroughly and more often than you are used to doing.

Experts say a thorough preventative washing should take 21 seconds. You have to thoroughly wet your hands, especially the pads and sides of your thumbs and fingers, which are most likely to contact objects. You should saturate and scrub them with soapy water, then rinse them thoroughly until they no longer feel slimy. If you want to do a good job you should imagine yourself as a surgeon about to enter the OR.

To avoid further contamination from water faucets, it’s best to touch them only through clothing or a paper towel, or (if you have to) with the back of your hand. That’s why many public restrooms, especially in airports, have photocell-based no-touch taps for water and soap. It’s not to encourage laziness or even to conserve water and soap. Instead, it’s to curb the spread of disease.

The best times to wash your hands are: (1) whenever you enter your home from outside, (2) before and after eating (because you might pick up germs from the table, plates or utensils), and (3) before and after going to the toilet (because you might transfer germs to your private parts or pick them up from the toilet seat, faucet handles or door knobs). On leaving a toilet, it’s best to push swinging doors with your feet and to touch flush levers, water spigots, and door knobs with toilet paper or a paper towel. (Cruise ships have started putting wastebaskets neat toilet doors to make it easier to do this. Many airport toilets now have “doorless” and therefore “touchless” entryways, with a bend for privacy.)

Why is washing your hands so important? Your hands are the only parts of your body that regularly touch objects outside of your home. If they then touch your face (see the previous item), they can easily transmit a respiratory virus.

Furthermore, your hands are perfect storage media for germs. Unlike your clothes and shoes, they stay at about body temperature, even in hot summer or (after you don gloves or mittens) in winter. In contrast, the bottoms of your shoes get wiped off every time you take a step, and your clothes get dumped into the hamper and washed mostly without your touching any parts that might have touched seats.

c. Stay home when you feel sick, or if you think you’ve been exposed. Self-quarantine, aka self-isolation, may be the most powerful means of stopping an epidemic from becoming a pandemic. Unfortunately, it encounters psychological and cultural pushback. But for that pushback, this simple measure would be the very first item on this list.

In an ideal world, how would self-quarantining work? If you woke up feeling the slightest bit ill, you would simply stay home and phone in sick. If you started feeling sick while out at work or at school, you would go home. Thereafter, you would attend no social events or entertainment outside your home. You would meet no one in person but would communicate electronically. You would not go back to school or to work.

You would also go home and stay home if, based on all the information you know, you think you might have been exposed to a potentially deadly virus. You would do this, for example, if you discovered that authorities were testing everyone on a plane you recently took, or people at your school or place of work. You would stay home until you were informed that the plane, school or workplace had been cleared, or you personally had tested negative.

During your self-quarantining, you would assiduously avoid crowded places, including public transportation, theaters, stadiums, gyms, stores and supermarkets. You would not leave your abode, except maybe to exercise on uncrowded streets or in parks, keeping your distance from others.

Your family, friends, neighbors, home-delivery businesses, or, in the worst case, public servants would bring food to you door. In any a house or non-single apartment, you would stay in a separate room or suite, preferably with a separate bathroom, from the rest of the residents.

You would not come out of your self-imposed quarantine until you had been cleared by medical professionals, or until you felt much better and were no longer sneezing, coughing or blowing your nose. If you got sick enough to require medical attention (which you or your family, neighbors or friends could verify by telecommunication), medical professionals would visit you at home, with appropriate protective gear (including hazmat suits in an epidemic). If necessary, they would take you to the hospital in an appropriately protected vehicle. Or you could drive to a designated hospital in your own or another’s car, provided the car itself were quarantined and/or professionally disinfected afterward.

Even in advanced nations, human society is not yet ready for this ideal regime of self-isolation. Unaccustomed to it, and not compelled by law, people would get bored, become selfish and thoughtless, and break their quarantines, perhaps in catastrophic ways.

The necessary social infrastructure and sense of obligation to others, let alone patriotism and public spiritedness, has not yet fully developed, even in China. And of course no nation yet has the physical infrastructure to bring food to the doors of the poor or isolated or to transport them safely (in terms of infection risk) to hospitals with good testing facilities and isolation wards.

Yet the Internet makes such a quarantine possible, at least in theory, by facilitating communication between self-quarantined individuals and the world outside their homes. It even permits a degree of diagnosis by “telemedicine,” at least for purposes of triage. Workers and students could keep up, or at least remain apprised, by telecommunication. Likely a majority, if not the vast majority, of workers could work remotely over the Internet for the short time needed to confirm or rule out a serious communicable disease. While self-quarantined, everyone could maintain family and social contacts through electronic means, including e-mail, text messaging, and video phoning (FaceTime, Skype, Google Hangouts, etc.).

In my view, we already have most of the infrastructure to implement an effective regime of self-quarantining like this. The principal obstacle—besides lack of enough mobile medical personnel—is cultural. The US and other developed nations still have a macho culture that discourages absences from work or school. People who go to work or school when they are sick, despite the difficulty and real pain, are seen as heroes of a sort. Sometimes they see themselves that way.

We must change that maccho culture as quickly as we can. In its own way, it’s as counterproductive as people in Africa hand-washing the corpses of their dead relatives and contracting ebola in so doing. We need to assess people who break quarantine, whether self-imposed or required by government, as what they are: selfish, thoughtless and anti-social. Bosses and underlings, employers and employees, teachers and students—we must all recognize self-quarantine for what it is, an act of patriotism, social good, and love for family, friends, neighbors, region and country. Getting this right (including distinguishing sincere self-quarantiners from malingerers) will take time.

The stringency of the self-quarantine regime of course should depend upon the nature of the threat. Against today’s coronavirus, for example, the regime probably should extend no further than Wuhan, Hubei province, and other areas of China and abroad within the immediate vicinity of known foci of infection. There’s no need to go overboard and spread terror, or to impair the economy far from any known threat. But it stands to reason that rapid self-quarantining could be a powerful means of containing the virus in each “virgin” but newly infected town, street, office, school, apartment building or community.

With existing resources, centralized authorities could determine the geographic extent of the optimum self-quarantine zones and communicate them to local authorities, or even directly to the people affected, over the Internet and public media. But of course the regime’s ultimate effectiveness would depend on the availability of physical resources to test people in their homes, feed them, and transport them safely to treatment centers if necessary. Developing a robust infrastructure for all these tasks will take some time, as China’s recent experience shows.

A less-stringent form of this regime might also be useful in cases of local outbreaks of less deadly diseases, such as the flu. At very least, we should start by putting the kibosh on the cultural notion that it’s a good idea, and maybe heroic, to go work or school when you feel sick. That change needs to begin right now.

d. Wear a mask to protect yourself and others. Wearing a mask can protect both you and others from being infected by virus-bearing droplets formed in coughing, sneezing, singing, talking and even breathing. But the protection masks provide is chancy, a bit like roulette.

Anything but a respirator might pass small virus-containing particles. And droplets stopped by a mask might migrate to your hands as you take it off—a good reason for washing your hands immediately afterward. As for protecting others, masks will not always stop an explosive sneeze or cough from letting virus-ridden droplets escape.

That said, masks are a lot better than nothing. You should wear them in public to protect others if you feel sick, as is even now customary in many Asian cultures. This is especially important if you live in an area, or work or study in a facility, where cases of a deadly virus have occurred. In fact, in such an area or facility it’s prudent for everyone to wear masks when in close proximity to others, and especially when in crowds.

Masks are good to protect yourself, too, but there are caveats. If everyone buys and wears masks, there might not be enough to go around for the people who really need them, including medical personnel, first responders, and people who live, work or study in places where infection has been confirmed. So while it’s probably reasonable for everyone in or near an infected area to have a small supply, it’s not reasonable to hoard lots of masks where there is no immediate threat. That said, I plan to keep a mask or two on me, in a sterile plastic bag, to wear whenever I fly or otherwise have to be in a crowded situation.

One such situation that most people probably don’t think about much is elevators. In big cities, many people both work and live in highrise buildings with elevators. They use elevators four or more times per day.

Unfortunately, elevators raise more than just the people in them. They elevate the risk of spreading a virus in two ways: (1) through virus-ridden droplets in a confined space, and (2) through viruses deposited manually on buttons, railings and hand-grips. You can avoid this elevated risk by: (1) taking the stairs instead (trying not to touch doorknobs and railings), (2) touching the buttons only indirectly (for example, through a tissue or with a clothed elbow), (3) refraining from touching anything else directly with your hand, and (4) wearing a mask to avoid those damned droplets. If there are (or reasonably may be) infected people using the same elevator(s), no one should accuse you of being antisocial or selfish merely for wearing a mask.

e. Don’t shake hands, at least not without thinking. When you shake someone’s hand, whether for greeting or for agreement, do you ever wonder what might be on it? In an infection zone or suspected infection zone in the middle of a pandemic, you ought to.

Human culture, in all its diversity, doesn’t just affect the ease of making a self-quarantining regime work. Even minor quotidian cultural habits like shaking hands or hugging can risk contagion.

With their mutual bows at a distance, the Japanese are best situated not to turn routine social interactions into possible contagion events. Socially conservative Brits, with their soft “hello” at a distance, are also pretty safe. Muslim women, with their “no-touch” regime, hijabs and chadors, are also relatively safe from both giving and receiving contagion.

But Muslim men may have to modify their hugs and even perfunctory kisses. Even more, many Americans, Latinos and Europeans, with their hearty handshakes, hugs, and kisses, may have to modify their behavior in order to stay safe when a pandemic approaches. Doing this won’t be fun or easy, but it may be necessary.

One can hope that a brief explanation and reference to the pandemic will suffice to avoid offense. Or you can wash your hands (and face, if necessary) in private immediately afterward.

2. What government and business can do.

a. Do or support good science to assess the threat. Accurate and reliable science are as important to facing an epidemic as are reconnaissance and military intelligence to fighting a war. For every threat of an epidemic or pandemic, the health profession needs to know at least four parameters of the disease. In declining order of importance, they are: (1) mortality, or what percentage of patients with the disease die from it; (2) the disease’s incubation period, or the maximum time between exposure to the germ and the onset of symptoms, (3) whether a patient can transmit the virus during the incubation period and, if so, when, and (4) the period during which viruses on objects remain viable and able to infect people (“viral longevity”).

At the moment, with think we know the first two parameters for the new coronavirus. The mortality lies between 2% and 2.5%. (It could be lower if, as some experts suspect, many mild cases of the disease in China have gone undiagnosed.) As for the maximum incubation period, which of courses fixes the length of quarantine, doctors worldwide are operating under the assumption, backed by clinical evidence, that it’s two weeks.

But the last two parameters, which are also crucial for fighting an epidemic and assessing its severity, are not well known. That lack of knowledge is itself good reason to follow common-sense precautions like not touching your face, washing your hands, and wearing masks under crowded conditions in places where people who are infected may be in close proximity.

Coronaviruses are similar in structure and operation to viruses for the common cold and influenza. So doctors can make educated guesses about the last two parameters by analogy to these other diseases. But those estimates are just that: guesses.

Furthermore, these vital parameters may vary among strains of viruses, for different people of different ages or with different genetic makeup, and (for viral longevity) under different conditions of temperature, humidity and the object’s surface (smooth or rough, impermeable or porous, organic or inorganic, metal or cloth). So only real science, with good experimental controls and an appreciation of the many sources of measurement error, can determine these parameters reliably, as well as their likely range of normal variation.

Once known, these parameters can be crucial not only in estimating an epidemic’s severity and speed of advance, but in planning effective countermeasures. For example, the infectivity during incubation helps determine how to isolate and house people during quarantine, and the viral longevity helps to decide whether and when housing and vehicles suspected of contamination can be used without expensive chemical disinfection. One of the reasons why the current coronavirus epidemic is so severe, and its prognosis so uncertain, is that the last two of these parameters are virtually unknown.

Tying them down is the work of elite scientists, in absolutely safe environments (such as in hazmat suits), which are expensive. That work is properly classified as “basic research,” which is usually funded by government for lack of any clear market. Rather than duplicate effort, governments should collaborate to parcel out this basic research to organizations such as the CDC (and its foreign equivalents) and the WHO, and to have other similar organizations verify the results to insure their reliability. Too much is at stake to use preliminary results without verification, except under the most exigent circumstances.

This is not work for private, profit-making firms because there is no profit in it. To insure the results’ full utility, they must be universally available, without charge or delay, preferably on the unrestricted Internet, as soon as the international medical community accepts them as reliable.

b. Develop vaccines and cures. For-profit firms also don’t do well in producing vaccines and medicines capable of stopping epidemics or pandemics. There simply isn’t the monetary incentive for investment that capitalism usually provides, let alone in the necessary time frame. This conclusion has nothing to do with ideology. It comes from economic analysis.

Before an epidemic or pandemic starts, there is no market for the vaccine or cure. Even after it starts, the market may disappear if the plague succumbs to mere good epidemiology (locating and isolating nuclei of infection), a mutation of the germ, or just dumb luck.

Once the epidemic or pandemic starts, there’s little time to develop a vaccine or cure, which might easily have been developed in advance, had the germ involved been known, or had it shared certain biological features with its predecessors. (The latter appears to be the case with the new coronavirus and its predecessors SARS and MERS.)

Worse yet, if the vaccine or cure works, in the very process of saving individuals it kills the market that the germ created, thereby also killing the return on investment for private companies and their investors. That effect, in turn, kills the incentive to develop the next vaccine, whether for likely similar future plagues, or in general.

So you can cite epidemics and pandemics as severe cases of market failure. The prognosis for capitalism curing this epidemic, or preventing or curing future ones, is not good. Even in so-called “Communist” China, this is one case in which our species relies too heavily on private business to do things that private business has no economic incentive to do, at least absent government support for research and possible collateral uses.

We are just going to have to recognize that preventing and/or curing epidemics such as the current coronavirus is, like most research in basic science, something that has to be funded collectively. In business terms, it’s a cost center, not a profit center.

This work doesn’t even seek profit, but human survival, health and happiness. It therefore requires collective support. In our modern world, that means government. Even if private enterprise does part of the work, government funding and supervision can reduce corruption, delay, and unnecessary duplication of effort.

Maybe this is something that the UN or the WHO can manage well. Who knows? It might just bring the nations of Earth together in common humanity (and humility) against a common enemy: mutated germs.

c. Enforce quarantines and encourage self-quarantining by making work (including military service) and school more flexible. In the meantime, both business and government can improve our species’ defense against this epidemic and our readiness for the next one. They can do so both by enforcing government-ordered quarantines and by reordering their priorities to encourage self-quarantining.

This reordering need not cost a lot of money. But it will require a lot of thought, management time and creative use of the Internet and related technologies. No one doubts that a universal and strict regime of self-quarantining like the one outlined above could go a long way toward stopping the current coronavirus epidemic, or any future one. But currently its effectuation is doubtful. It may, at present, be unachievable outside of small areas of the most developed nations.

This is partly is a matter of culture. Many nations’ cultures views regular attendance at work or school as a necessity, an aspect of good character, and even a part of patriotism. For obvious (if self-serving) reasons, many employers do, too. This goes double for military personnel, who are often expected to show up for duty even when hurt or sick, especially in wartime.

So to encourage an effective self-quarantining regime, both government and business are going to have to revise their cultures and their rules for more flexibility. Where individuals can work or learn at home, business and government can make doing so as easy and as free from penalties as possible. Where showing up personally is vital to getting the job done, they can make individuals and working units better substitutes for each other. They can make it easier to shift operations, particularly critical ones, for one geographic location to another.

Disaster planning already provides precedents and experience. Many government and business organizations have stored records, secrets and critical information online, but in multiple physical locations that serve as mutual backups. Similarly, if a factory in one location uniquely makes a critical component of a company’s products, management might have to split the factory among two or more locations. Or it might find another supplier elsewhere. Then if an epidemic strikes in one critical location, the company can still produce the component, although perhaps at reduced volume, in the other. In this way geographic diversification can improve quarantines while it ameliorates an epidemic’s economic effect.

In sum, enterprises will have to distribute their critical operations more thoughtfully, so that a whole enterprise doesn’t have to shut down if an epidemic and massive self-quarantining impairs or shuts down work in one geographic area. In the long run, this re-distribution of critical functions, much like distributed generation of electricity with solar arrays or windmills, will have other advantages, too. For example, some distributed locations may be closer to certain customers, near related research facilities, or in areas less prone to bad weather, flooding, or earthquakes.

Conclusion. The 1918 pandemic of Spanish flu was a clear warning to our species. But coming in the midst of humanity’s first global war, it didn’t get the attention it deserved.

Now we humans have had four pandemic threats in the last two decades: SARS, MERS, ebola and the new coronavirus. If you count HIV/AIDS, which started a generation earlier but turned out to spread less quickly because of its limited means of transmission, that makes five, or six counting Spanish flu.

We should have learned better from this century-plus of repeated experience. Early in the last millennium, the Black Plague changed the world. It devastated Europe and retarded the advent of democracy. It helped encourage wars by making hard-hit societies look vulnerable. Elsewhere and earlier, it had dissolved the great Mongol Empire, which once ran from deep in Europe to the Asia’s East Coast and was far more advanced than most Westerners know [Search for “its brutality”]. So the “darkness” of what we used to call the Dark Ages was due mostly to the Plague.

Those were the days before science, when people could understand the threat of a plague only in terms of superstition, evil spirits or the Divine. Now we know how communicable diseases travel. We can identify their agents in days or weeks and even decipher their DNA.

Yet two new superstitions have arisen. First, we believe that private markets are the cures for all ills, even when no relevant market exists. Second, we think that competition, if not open war, among different nations and societies is our first priority.

But viruses don’t care about private profit or capitalism. And none of the pandemic threats of the last century, including Spanish flu, has discriminated among victims based on their nationality, language, race, religion, sexual orientation, or political affiliation. If the viruses had been intelligent, which they were not, each would have exclaimed, “All your species’ DNA is nearly identical, so I’m coming after all of you, every one. I’m the new Black Plague.”

If we don’t rise to their challenge, the first half of our new Millennium may be as dismal as the pre-Renaissance part of the last millennium, despite all our species’ advances in science and social relations. If we really are an intelligent species, we can’t let that happen.

Copyright License: Google Blogger’s statistics show that someone recently hit on my Comment and Copyright Policy, I hope in connection with this post. Unfortunately, my policy is a bit opaque in that connection. So I hereby grant anyone, anywhere a worldwide, nonexclusive, royalty-free, limited license to re-post, link to, copy, distribute, publish, display and transmit (and translate into any other language, but not modify) the foregoing post in any form, manner or medium including on paper or by any electronic means, as long as the re-posting, copy, translation, publication, display or transmission contains: (1) all but not just part of Part 1 (What anyone can do), or all but not just part of Part 2 (What government and business can do), or both, and (2) the following credit and citation, verbatim: “by Jay Dratler, Jr., Ph.D., J.D., available online at https://jaydiatribe.blogspot.com/2020/02/how-to-stop-pandemic.html”

The Dems’ Nevada Debate

Well, it had to happen sooner or later. Better sooner than later. The terms “brouhaha,” “barroom brawl,” and “mud slinging” came to mind. From the very beginning, the six Democrats on the stage went at each other with hammers and tongs. As NBC lead moderator Lester Holt said before the first commercial break, they definitely had gotten “warmed up.”

A lot of the brawl was inside baseball, mostly lost on all but political junkies. Here are my general impressions of how it went, with points in declining order of importance:

1. Gravitas. Sometimes it’s good to listen to the music and not the words. I did that, mostly in retrospect, and came to an interesting conclusion. Gravitas was notable mostly for its absence.

Starting from the left, Mike Bloomberg seemed bemused that those present in the room didn’t recognize him immediately as the smartest person there, not just the richest. That’s not gravitas.

As apt and on point as she mostly was, Elizabeth Warren had a schoolmarmish and whiny quality to her. She made some good substantive points and kept on message. But her cheap shot at Biden, taking his remark about working with McConnell out of context, didn’t help. It was positively Trumpian. No gravitas there.

Sanders has something approaching gravitas. He’s imperturbable, stays on point, and rarely, if ever, resorts to cheap shots. (His 2016 refusal to debate Hillary’s e-mails comes to mind.) But there’s not much “give” in the man, and a lot of outrage. Gravitas requires inner tranquility and some flexibility, no?

Biden has lots of fight and, like Sanders, indignation. I wouldn’t go so far as to say he sounds like an old man shouting, “Get off my lawn!” Let’s just say that his emotional range is dreadfully narrow.

That leaves the two young “moderates,” Pete Buttigieg and Amy Klobuchar. Klobuchar did well in excusing her prior inability to come up with the name of Mexico’s president. But then she wilted under Buttigieg’s more substantive critiques. After that poor performance, I think her campaign is finished. We’ll see.

So if I had to vote on gravitas alone, I’d vote for Buttigieg. There’s an inner strength in his calm blue eyes, his soft and soothing voice (even while dispatching Klobuchar), and his near-perfect articulation that no other candidate can match.

I found myself thinking that, of all the six—and totally independent of policy—Buttigieg is the one I would most like to see in my living room for the next four years. Somewhat like Obama, he looks, sounds and acts like a president, and he has the kind of decency that our nation sorely needs. I can’t remember anyone exactly like that since JFK, although Carter certainly had the ability to soothe.

Buttigieg is young and inexperienced for a president. But I hope he winds up in the Cabinet and gets groomed for higher things. He might make a good VP—the traditional “attack dog” role, where he could reproduce his smooth knifing of Klobuchar.

2. Sparring makes perfect, but for what? At this point in the primary cycle, the lusty infighting may have been a good thing. It let candidates and their staff discover what works and what doesn’t, and how little you can say with 75 seconds to make your case and 45 for rebuttal. Warren, for example, should fire the staffer who gave her that cheap shot at Biden. It was beneath her and beneath the presidency.

Anyway, what all this verbal pugilism has to do with governing I’ve never figured out. I guess every culture has some form of ritual combat as a leadership test. This, apparently, is ours.

There’s little question that a candidate who can’t withstand jabs from colleagues, and give as good as she or he gets, has no chance of beating Trump, especially if Trump doesn’t duck debates. That’s why I think Klobuchar, as attractive as her empathy and decency are, is close to being out of the race.

But I put Trump’s likelihood of ducking debates as better than even. So all this good sparring may be for naught, except maybe as fodder for media ads. Its downside is that it could drive away some voters trying to decide what the Dems stand for and who’s the best one. So I wouldn’t want to see the brawl continue on to Super Tuesday. Teamwork is the thing most missing from the Dems’ skill set now. (See this post.)

3. AMLO. A moderator, not a competitor, threw down the gauntlet to Klobuchar about Mexico’s president’s name. At first I thought it an unfair “gotcha,” but then I thought again.

Andrés Manuel López Obrador has an easy acronym for non-Spanish-speakers to remember: “AMLO.” The Mexicans use it, too, even in newspapers.

But that’s not the point. Every progressive American should know at least his acronym and should support him. For of all the leaders of Mexico that I’ve been aware of in my 74 years, he’s the one closest to, and most trusted by, the Mexican people, especially ordinary workers. (I was coincidentally in Mexico during the 1968 massacre of students on the Zócalo. So I know how bad Mexico’s leadership can get.) AMLO is Mexico’s Bernie Sanders, but a bit more like Warren in rejecting left-wing labels and ideology.

International relations is not a zero-sum game, let alone with your closest neighbors. If Mexico’s economy thrives, so does ours. If Mexico defeats the drug cartels, we gain. If Mexico enacts stronger protection for workers and the environment, our workers and our environment benefit, too, and illegal immigration slows. With the confidence of his people and a reportedly pragmatic approach to politics, AMLO may be the best recent leader of Mexico to help bring all these things to pass.

So every Democrat running for the top job ought to be thinking of ways to work with AMLO to make our shared continent better. Mexico should never be a blind spot in Democrats’ policy, if only because it’s the immediate source of all the immigrants and asylum seekers that play such a big role in Trump’s demagoguery.

4. Bloomberg’s Role. Michael Bloomberg didn’t do nearly as well in the debates as (I confess) I had hoped. He lacks charisma and gravitas and apparently didn’t even take the trouble to practice. (His company Bloomberg, LP, is private, so he doesn’t enjoy the practice that CEOs of public companies get in answering public investors’ hostile questions in annual meetings.)

The apparent lack of serious attention to the process was not Bloomberg’s only problem. The others pummeled his weak spots before a Democratic audience: (1) his firm’s apparent mistreatment of women, (2) subjecting complainants to nondisclosure or “gag” agreements, (3) admitted lack of sensitivity to minorities’ perceptions and needs, and (4) switching sides between the GOP and Dems. Maybe he can draw some independents and Republicans to his side, but I don’t think he can hold the base. He seems likely to maximize the inevitable defection if Sanders doesn’t win the nomination.

So despite my hope against hope for the proverbial savior on a white horse, I don’t think Bloomberg is the one, unless he makes a miraculous improvement before Super Tuesday. As always, we shall see.

But more realistic Dems cannot depend on a savior. They must now begin to choose among the remaining five, while hoping that Bloomberg remains faithful to his pledge to use his fortune to help the people see who Trump really is.

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