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Coronalinks 3/27/20: We’re Number One

The United States now has more coronavirus cases than any other country, including China, marking a new stage in the epidemic. As before, feel free to treat this as an open thread for all coronavirus-related issues. Everything here is speculative and not intended as medical advice.

Hammer and dance

Most of the smart people I’ve been reading have converged on something like the ideas expressed in The Hammer And The Dance – see this Less Wrong post for more.

Summary: Asian countries have managed to control the pandemic through mass testing, contact tracing, and travel bans, without economic shutdown. The West lost the chance for a clean win when it bungled its first month of response, but it can still recover its footing. We need a medium-term national shutdown to arrest the spread of the virus until authorities can get their act together – manufacture lots of tests and face masks, create a testing infrastructure, come up with policies for how to respond when people test positive, distribute the face masks to everyone, etc. With a lot of work, we can manage that in a month or so. After that, we can relax the national shutdown, start over with a clean slate, and pursue the Asian-style containment strategy we should have been doing since the beginning.

This is the only plan I’ve heard from anybody that doesn’t result in either hundreds of thousands of deaths, or the economy crashing so hard we’re all reduced to eating weeds and rocks.

I relayed some criticism of a previous Medium post, Flattening The Curve Is A Deadly Delusion, last links post. In retrospect, I was wrong, it was right (except for the minor math errors it admitted to), and it was trying to say something similar to this. There is no practical way to “flatten the curve” except by making it so flat that the virus is all-but-gone, like it is in South Korea right now. I think this was also the conclusion of the Imperial College London report that everyone has been talking about.

Thank you for not smoking

[EDIT: This part is possibly wrong, see here]

There isn’t a lot you can do to improve your chances if you get coronavirus, but one really important intervention you can take right now is to STOP SMOKING.

I try not to lecture my patients on their health failings. I am not a jerk to obese people or people who don’t get enough exercise. But I try to tell every smoker, at least once, to STOP SMOKING. Studies have shown that having a doctor or other authority figure say this actually helps a lot, and every person who STOPS SMOKING gains 5 – 10 years of life expectancy. There is nothing else you can do as a doctor or a human being that gives you a medium chance of saving ten life-years with a ten second speech. Everything that effective altruism has to offer pales in comparison. So even though I hate lecturing people – on this blog as much as in my medical practice – I suck it up and tell everyone STOP SMOKING.

If you need a reason to quit now instead of later, here it is: coronavirus is a lot worse for smokers. The virus kills by infecting your lungs. If your respiratory health is pretty good, you have lung capacity to spare and will probably be okay. If your respiratory health is already iffy, you will need ventilation and maybe die. From this article:

An article reporting disease outcomes in 1,099 laboratory confirmed cases of covid-19 reported that 12.4% (17/137) of current smokers died, required intensive care unit admission or mechanical ventilation compared with 4.7% (44/927) among never smokers. Smoking prevalence among men in China is approximately 48% but only 3% in women; this is coupled with findings from the WHO-China Joint Mission on Coronavirus Disease 2019, which reports a higher case fatality rate among males compared with females (4.7% vs. 2.8%).

[EDIT: In Sweden, men and women smoke equally but men still die more, so the gender argument may not be as strong as it sounded a few weeks ago]

I want to clarify that what I’m telling you right now is totally unprincipled propaganda, intended to take advantage of a moment of panic – realistically, on the list of ways smoking can kill you, coronavirus is somewhere near the bottom. Quick back-of-the-napkin math: assume you have a 30% chance of getting coronavirus this year, that smokers’ death rate is 4% compared to non-smokers’ 1%, so quitting smoking now will save you a 1% risk of coronavirus death this year. But about 10% of smokers get lung cancer eventually, compared to very few non-smokers, and lung cancer has about a 66% death rate, so it’ll save you a 6.6% chance of death by lung cancer. Honestly, coronavirus shouldn’t even figure into your calculations here.

But since you are panicking about coronavirus right now, you might as well use it as motivation to STOP SMOKING. Smokers’ lungs start to heal as soon as one month after quitting – so quit now, and if Trump makes good on his threats to stop self-isolation and restart the epidemic after Easter, you’ll be feeling better by the time things get bad again.

Some people have a lot of trouble quitting smoking. If you’ve been unsuccessful before and you don’t have good access to medical care, try e-cigarettes – whatever you’ve heard about them, they’re infinitely better than the real thing. If you do have good access to medical care, ask your doctor for bupropion (aka “Wellbutrin”, “Zyban”), a very effective stop-smoking medication. I have seen dozens of patients quit smoking on bupropion; my most recent success was yesterday. It’s a great medication, and the most common side effects are curing your depression, improving your sex life, and making you lose weight. If you’re worried about going outside to get it, remember that most US doctors and psychiatrists are seeing people by video now, and many pharmacies have started drive-thru and delivery services. Alternately, you could travel to your local pharmacy on a crowded bus, lick everyone who goes on or off, then stop in Wuhan on your way home for a tasty bowl of bat soup. It doesn’t matter, taking care of this now instead of putting it off would still increase your life expectancy on net.

Japan and other mysteries

Japan should be having a terrible time right now. They were one of the first countries to get coronavirus cases, around the same time as South Korea and Italy. And their response has been somewhere between terrible and nonexistent. A friend living in Japan says that “Japan has the worst coronavirus response in the world (the USA is second worst)”, and gets backup from commenters, including a photo of still-packed rush hour trains. Japan is super-dense and full of old people, so at this point the living should envy the dead.

But actually their case number has barely budged over the past month. It was 200 a month ago. Now it’s 1300. This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort.

The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.

But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am.

Some people have gestured at the Japanese being an unusually clean and law-abiding people. Maybe the government has just sort of subtly communicated “don’t do anything that will mess up our Olympics chances” and everyone has been really good at not touching their face. Maybe widespread use of face masks is much much more important than anyone has previously believed. I don’t know.

One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. Maybe they just needed a little bit of containment to tip them over the edge. I don’t know, things sure seemed bad in South Korea a few weeks ago (and in Wuhan). I am so boggled by this that I don’t know what to think.

Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.

Takeout

So far every US state and local self-isolation order has included exceptions for getting takeout or delivery food. I’m sure restaurants appreciate the business and consumers appreciate getting to keep that particular aspect of a normal lifestyle. But is it actually safe?

All the big organizations say yes. From Forbes:

“Takeout food seems to pose a very minimal risk of passing on coronavirus. Here, virology experts explain why….”There is no evidence that SARS-CoV-2 can be transmitted by eating food. I imagine that if this is possible, the risk is extremely low,” said Angela L. Rasmussen, PhD, a virologist in the faculty of the Center for Infection and Immunity at the Columbia Mailman School of Public Health, adding that she is not aware of any human coronaviruses that can be transmitted through food.

And the San Francisco Chronicle:

With dining in restaurants off the table, many Americans are wondering if take-out and delivery food options are still viable in the age of coronavirus. Luckily for people tired of their own home cooking, the answer is, by and large, yes.

According to the CDC, transmission of COVID-19 primarily happens person-to-person, so your largest risk is not in the food but in human interaction. Keep your distance as much as possible when picking up food, or request that delivery workers leave the food on your doorstep. As with other in-person interactions, remember to avoid touching your face and be sure to wash your hands thoroughly as soon as you can.

“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads,” the CDC says.

On the other hand, all of my friends who are actually worried about getting the condition are avoiding delivery food like, well, the plague. Their argument is that we know the virus can survive on surfaces for a while, so all you need is one food worker to cough on your food after it’s been cooked (or on food that doesn’t get cooked at all), and you’re screwed. Restauarants are supposed to follow sanitary precautions, but people familiar with the industry say these precautions are not so strong to 100% (or even an especially high percent) ensure you get un-coughed-on food. The CDC telling food workers they don’t need face masks does not exactly inspire confidence here.

I am really craving something other than the three or four things I can cook myself, and I have a lot of mutually-quarantined housemates to convince, so if any of you have any clearer estimate of the risk situation, please share.

Ventilator numbers

Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens (why are these numbers so different?). The head of a small ventilator company says they usually “sell 50 in a good month”.

Elon Musk recently delivered 1,255 ventilators to California from some of Tesla’s Chinese contacts, and promised to make more. Dyson, the British vacuum manufacturer, says it will be able to make 10,000 ventilators in time to help with the crisis – remember, that’s twice what the whole UK has right now. The American Hospital Association says 960,000 Americans may require ventilators during the pandemic – hopefully not all at once.

Ventilators also require trained staff to operate. I never know how far to trust medical people when they say something requires training. You would think doing a lumbar puncture requires training, but the training I received for this in residency was watching one (1) guy do it one (1) time, and then them saying “Now you do it” – which by the way is exactly as scary as you would expect. This is an official thing in medical education, called see one, do one, teach one. So when people say some medical task requires training, I don’t know if they mean “ten years’ experience and a licensing exam”, “watch it once and then we throw you in the deep end” or “we’re going to make you go through the former, but the latter would have worked too”. Hopefully ventilators are more like the latter and someone can train new people really quickly.

If you’re confused about the difference between ventilators, oxygen concentrators, etc, or you have clever questions like “can we repurpose CPAP machines as ventilators?”, you might like Sarah Constantin’s Oxygen Supplementation 101.

The British reversal

A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy.

They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.

But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technocratic hubris vs. complexity of the real world.

Maybe we should have taken it easy with the huddled masses

China had Wuhan, Italy had Lombardy. Two weeks ago, everyone expected Seattle or the Bay would be the epicenter of the pandemic in the US. Well, right now both of those places combined have about 3,000 cases. New York City has 30,000. The New York/New Jersey area has about half the cases in the US, and is rising fast.

What changed? Partly the international epidemic shifted from Asia (which has immigrant communities and transportation links on the West Coast) to Italy and Europe (which have immigrant communities and transportation links on the East Coast). Partly the West Coast had some good policy whereas New York had terrible policy (while California was instituting shelter-in-place, Governor Cuomo was vetoing NYC’s shelter-in-place order and later griping about the term shelter-in-place’s etymology).

But the other major factor seems to be density. NYC is by far the densest city in America, almost twice as dense as second-placer San Francisco. Density forces people together and makes infections spread more easily.

At least that’s the story. So how come San Francisco – again, number two on the density list – has been almost completely spared? How come, despite its towering skyscrapers and close links to China, SF has only 178 diagnosed cases – fewer than such bustling metropolises as Indianapolis, Indiana, or Nashville, Tennessee? How come the virus is so well-behaved in very dense countries like Japan, and so deadly in relatively sparsely-populated places like Switzerland?

I’m not sure. Maybe density measures are really bad? Like if NYC annexed all of Long Island, it would drop to having one of the lowest densities in the nation on paper, but this purely political act wouldn’t affect its coronavirus susceptibility at all. Maybe there are enough problems like this that all existing density statistics average very dense areas with less dense areas and so don’t tell us what we want to know for disease spread.

Consider Spain. On paper, it’s one of the least densely-populated countries in Europe. In practice, it’s a lot of rolling countryside plus a few very dense cities – four of the ten densest cities in Europe are there. Maybe that’s why it’s got the fourth most cases in the world right now, behind only China, Italy, and the US?

The worst-affected US city per capita isn’t any of the ones I would have predicted – it’s New Orleans. Nathan Robinson lives there and takes some guesses about why things there are so bad. By the way, it’s going to reach 89 degrees in New Orleans tomorrow; keep that in mind whenever someone says the virus can’t spread in warm weather.

Irresponsible opinions on meds

Donald Trump tweeted excitedly about hydroxychloroquine/azithromycin, a drug combination which looked good in a single small preliminary trial against coronavirus but is otherwise unproven.

A few days later, an Arizona couple took a fish-tank cleaner including the closely-related drug chloroquine to try to protect themselves from the disease. The man died and the woman is in the ICU.

First things first – from a medical perspective, what went wrong here? Fish tank chloroquine is chloroquine phosphate, which is a perfectly acceptable form of chloroquine approved for human consumption as the antimalarial drug Aralen. Chloroquine has lots of nasty side effects, but none of them are bad enough to kill you instantly. My guess is that the guy either took orders of magnitude too high a dose – the news articles just say “a spoonful” – or that there were other things in the fish tank cleaner. Interested to hear from doctors who know more about chloroquine on this.

Okay, now let’s get to the controversial part: is Trump responsible? He seems causally responsible, in the sense that his endorsement led to the overdose. But is he morally responsible? I just got done telling all of you that stop-smoking-aid bupropion is an amazing drug that can save your life. If one if you is an idiot and responds by taking 100 times the safe dose of some industrial chemical with bupropion in it, does that make me responsible for your death? Is the difference that bupropion is known to work, but chloroquine is only speculative? Why should this change how we distribute responsibility?

Maybe responsibility is the wrong lens here? Maybe Presidents should be aware that they have such an immense platform that all of their statements can be interpreted in absurd ways, and perform a cost-benefit analysis before saying anything at all? Maybe (to go back to my example), the cost benefit analysis passes muster for bupropion, because the chance that one of you does something idiotic and kills yourself is counterbalanced by the chance that many of you use it correctly and stop smoking? But responsible scientists were going to investigate hydroxychloroquine responsibly before Trump said anything, so his statement had no benefit and he should have thought more about the costs.

I appreciate this line of reasoning, but I hate it. It means you stop being able to communicate your real thoughts in favor of communicating whatever information a utility calculation says it’s most beneficial to communicate – which is fine until people very reasonably choose to stop interpreting your mouth movements as words. On the other hand, the President of the US is not really supposed to be a clearinghouse for medical information, and is definitely somebody whose words have direct effects on the world, so maybe we should make an exception for him.

For a fun example of how complicated this way of thinking becomes, @WebDevMason condemns the media for over-reporting on fish-tank-man’s death. She points out that that hydroxychloroquine may yet prove effective and become an important part of our arsenal against coronavirus. And when doctors start trying to prescribe it, a big chunk of the US population is going to know it only as “that thing Trump irresponsibly recommended even though it’s an ingredient in fish tank cleaners that kills you if you take it”. And they’re going to freak out and refuse. Might this also cause deaths? Who knows!

So who deserves blame here? Trump, for irresponsibly praising the drug? The media, for irresponsibly condemning Trump for praising the drug? Mason, for irresponsibly condemning the media for condemning Trump for praising the drug? Me, for irresponsibly praising Mason for condemning the media for condemning Trump for praising the drug? Had gadya, had gadya.

The third world

…is in really deep trouble, isn’t it?

The numbers say it isn’t. Less developed countries are doing fine. Nigeria only has 65 cases. Ethiopia, 12 cases. Sudan only has three!

But they probably just aren’t testing enough. San Diego has 337 diagnosed cases right now. The equally-sized Mexican city of Tijuana, so close by that San Diegans and Tijuanans play volleyball over the border fence, has 10. If we assume that the real numbers are more similar (can we assume this?), then Mexico is undercounting by a factor of 30 relative to the US, which is itself undercounting by a factor of 10 or so. This would suggest Mexico has the same number of cases as eg Britain, which doesn’t seem so far off to me (Mexico has twice as many people).

The developing world doesn’t have many ventilators and doesn’t have enough state capacity to enforce self-isolation very effectively. It’s full of very densely packed slums. It has a lot of dictators who like to deny the existence of problems and shoot anyone who keeps insisting a problem exists. It could get really bad.

I worry that nobody has the spare energy to do anything about this. The First World is busy saving itself. Rich countries will probably corner the facemask and ventilator supply. The kind of doctors who go to Doctors Without Borders are probably at home busy saving their countrymen. Everyone else is going to have such a bad time, with few reasons for optimism.

I’m not even sure what concerned people can do. Charities’ usual MO is to divert resources from First World countries to Third World ones, but First World countries are using all their relevant resources and won’t sell for any price – can you imagine trying to export ventilators from the US right now? You’d probably get arrested. Maybe the highest-leverage interventions are figuring out how to repurpose cheap pre-existing material for medical care – face masks made out of paper/cloth/whatever, ventilators out of ???.

Nigeria and Mexico and so on make me confused in the same way as Japan – why aren’t they already so bad that they can’t hide it? If the very poorest countries in sub-Saharan Africa were suffering a full-scale coronavirus epidemic, would we definitely know? In Liberia, only 3% of people are aged above 65 (in the US, it’s 16%). It only has one doctor per 100,000 people (in the US, it’s one per 400) – what does “hospital overcrowding” even mean in a situation like that? I don’t think a full-scale epidemic could stay completely hidden forever, but maybe it could be harder to notice we would naively expect.

How can you help?

Sanjay on the Effective Altruism forum has a post about the best places to donate [to fight] COVID-19. Some of these are long-term work of questionable immediate relevance – the Johns Hopkins Center on Health Security does great work, but I wonder if a donation now just means that they hire some better researchers in six months and produce better policy recommendations next year. Also, I predict biosecurity think tanks won’t be funding-constrained for the immediate future.

Development Media International and Univursa Health are their recommendations for where to donate to help fight coronavirus in the Third World, but as far as I can tell neither organization is publicly doing that yet – they just seem like the kind of organizations that could and will eventually have to.

The writer is not entirely sure you should donate to coronavirus control at all – everyone’s doing it and the field probably has enough funding to pick most low-hanging fruits. Remember that malaria still kills 400,000 people per year (about 20% of the expected coronavirus death toll) but is probably getting a tiny fraction of the funding and attention right now.

Give Directly, previously known for giving cash directly to poor Africans, is now also working on giving cash directly to Americans who are affected by coronavirus. You can read about their program here, and donate here.

The Frontline Responders Fund is working with Silicon Valley logistics company Flexport to try to transport masks and other medical supplies from producers to people who need them. You can read about them here and donate here.

r/CoronavirusArmy is the subreddit for people trying to coordinate various useful virus response projects. There’s the expected massive variation in quality, but some of them could be really helpful.

Worth it

A lot of people are secretly wondering whether preventing the potential damage from coronavirus is really worth shutting down the entire economy for months. You shouldn’t feel ashamed for wondering that. Everyone, including the US government, agrees that it is sometimes worth putting a dollar cost on human life, and there are all sorts of paradoxes and ridiculous behaviors you get trapped in if you refuse to do so.

Some people on this thread on the subreddit have tried to calculate it out, using the government’s value-of-one-life-year figures. There are a lot of variables involved that we can only guess at, but given some reasonable predictions, even at a low value of $30,000 per life-year it’s worth spending trillions of dollars to slow down the epidemic.

I don’t want anyone to feel uncomfortable discussing this, so if you disagree or have different calculations please feel like the comments here are a safe place to talk about it.

But no, You sent us Congress

The Senate mercifully approved a stimulus bill earlier this week. I say “mercifully” because watching the negotiations was painful. I still have no idea which party was Boldly Trying To Provide The American People With Necessary Relief and which one was trying to hold the bill hostage in order to add a wish list of stupid partisan demands.

The narrative I’ve been hearing from Democrats was that they were Boldly Trying To Provide The American People With Necessary Relief by giving loans to nonprofits, and the Republicans held it hostage by hamhandedly adding rules intended to guarantee that none of the loans could go to Planned Parenthood in particular – hamhandedly because the particular fig leaf they used – “no loans to nonprofits receiving Medicaid funding” – also disqualifies anyone else who helps poor people get healthcare.

The narrative I’ve been hearing from Republicans was that they were Boldly Trying To Provide The American People With Necessary Relief by giving loans and money to a broad selection of the American people, and the Democrats held it hostage by trying to make it about all of their pet issues instead. So National Review makes fun of Democratic demands that the package include rules restricting carbon emissions and expanding the bargaining power of unions. (see conservative satire site Babylon Bee for the complete list, YES I KNOW THIS IS FAKE).

But apparently all that got cleared up, and now the bill is under threat from – libertarians! According to the Washington Post, the main holdout in the House of Representatives is a “constitutional libertarian” who’s trying to prevent the House from voting remotely because the Constitution says it shouldn’t.

I have a lot of respect for principled constitutionalists who believe that the nation’s government should occasionally follow the document that they take a solemn oath to protect. But insisting on that now, of all times, seems kind of like closing the barn door after the horse has left, caught a plane to Cape Canaveral, boarded an experimental rocketship, gotten halfway to the Oort Cloud, and also some kind of weird terrorist group is threatening to start a nuclear apocalypse if anyone closes any barn doors. Just let this one go and get back to your noble-yet-quixotic crusade sometime when we’re not all going to die.

Getting it Right

It took the mainstream media a while to realize the seriousness of the coronavirus. The right wing has its own parallel media system, and I’ve heard accusations that it failed even worse, and for longer. I can’t comment on whether this was true at the time, but it seems to have improved; as of me writing this, fox.com, breitbart.com, nationalreview.com, and townhall.com all have front pages full of the same kind of frantic coronavirus news I would expect to see anywhere else. Reddit’s big pro-Trump subreddit r/The_Donald has a sticky thread of “President Trump’s Coronavirus Guidelines For America – 15 Days To Stop The Spread – READ AND FOLLOW”. Even the front page of Infowars urges readers Don’t Be A Covidiot – their term for someone who ignores the danger of coronavirus and doesn’t practice good social distancing.

Still, that was the result of a long battle. Just like on the left, a few prescient right-wingers had to battle to make their friends and colleagues realize the danger. I’ve heard Tucker Carlson deserves special honor for fighting the good fight when the rest of FOX was trying to downplay everything. Steve Bannon and Lindsey Graham also took a hard line and helped their colleagues see reason.

I’m not sure what the role of liberals (here used as a general term encompassing everyone except the hard right) should be in this process. I can only beg us not to mess it up. Calling right-wingers dumb for not getting the point fast enough risks messing it up; it could just make them more stubborn and angry. Also, Trump is the acknowledged world expert at reaching Trump supporters. If he thinks that calling it “the Chinese virus” will convince his xenophobic fans to take it seriously, consider not messing with that.

Short Links

Iceland has finally done what everyone’s been waiting for and tested lots of people to see how many are asymptomatic. They conclude that about half of carriers don’t know they have the disease. If there had been very many more asymptomatic carriers than symptomatic patients, it would have been good news – most cases never show up in the statistics, and all of our estimates of hospitalization rate and mortality rate would be much too high. Although it’s nice to be able to divide all of those by two, a lot of people were hoping we could divide them by ten or a hundred and stop worrying completely. This study suggests we can’t. [EDIT: jgr79 points out a more optimistic interpretation: the testing happened around March 20, when Iceland had 300 reported cases, but detected that 1% of Icelanders were positive, ie 3,000 reported cases. This matches all the other evidence that real cases outnumber diagnosed cases by a factor of 10 or so, and probably does mean we can divide observed mortality rates by that amount. Is everyone already doing this in their models?]

In 1918, people got so tired of containment procedures for the Spanish Flu that concerned citizens started an Anti-Mask League Of San Francisco.

Future of Humanity Institute has put up a dashboard making advanced pandemic modelling software available to the public. They are also also offering pro bono forecasting services to under-resourced groups like hospitals and governments in developing nations). They’ve asked me to help spread the word on this, and I will, but I’d be more comfortable if someone who knows their stuff can confirm it’s net helpful, so please contact me if you consider yourself informed enough to have an opinion on this.

Robin Hanson makes the case for variolation – deliberately exposing people to virus particles at low doses through routes that make the infection less dangerous. This operates as kind of a poor man’s vaccine, giving a very mild case that prevents the person from getting sick in the future. Has worked with many past epidemics (like smallpox), still unknown how to predict how it would work for this one.

Hall of shame: Bangladesh (where 25,000 people have gathered for a mass prayer rally against the coronavirus – if only the New Atheists were still around to offer opinions on this kind of thing). Mississippi, as usual (see this comment by an MS Redditor). Russia, as usual. Donald Trump is a permanent lifetime member at this point. The FDA is also probably a permanent lifetime member.

Last links post I included tech company Triplebyte in the shame list for refusing to let employees switch to work-from-home, then firing them. A representative of Triplebyte contacted me and asked me to explain their perspective, which is that they took the pandemic seriously and went all-remote around the same time as everyone else. The reluctance to let employees switch to work-from-home applied only to a few employees in early March, before the scale of the crisis was widely appreciated, and they say that they would have tried to make accommodations if they had understood the seriousness of the requests. They had been planning the downsizing for a while, it was really unlucky that it ended up in the middle of a pandemic, and they tried to make it as painless as possible by offering good severance pay, etc. I’m relaying their statement because I’m realizing it was probably unfair of me to single them out in particular – my hearing a lot about this was downstream of my having a lot of friends who work(ed) for Triplebyte, and my having a lot of friends who work(ed) for Triplebyte was downstream of them being a great company doing important work which all my friends wanted to work for. I continue to generally respect them and their vision (see here for more), and you don’t need to give them any more grief over it than they’re already getting.

Hall of fame: Service Employees International Union (“found” 40 million face masks and is donating them to local hospitals; what does it even mean to “find” this many masks in this context?), and Amazon (now giving workers double pay for overtime). And Brazilian gangs, in the face of government inaction, declared a unilateral quarantine order in Rio de Janeiro, saying “If the government won’t do the right thing, organized crime will”. I deeply appreciate the commentator who described this as “state capacity anarcho-capitalism”.

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957 Responses to Coronalinks 3/27/20: We’re Number One

  1. johan_larson says:

    Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.

    Could it be a lack of testing?

    One thing that I find troubling is that we keep tracking confirmed cases, without paying nearly as much attention to the asymptomatic (but still contagious). To really understand the extent of the disease, and therefore it’s danger and trajectory, we should be trying to figure out how many actually have it rather than how many have come in with severe symptoms, and have had the disease confirmed. We’re working with the wrong data, in a sense.

    Cudos to Iceland for testing more comprehensively, in an effort to get more accurate numbers.

    https://www.buzzfeed.com/albertonardelli/coronavirus-testing-iceland

    • DarkTigger says:

      I have heared a lot talk about Iranian doctors flat out claming their government is either lying or in denial.

    • Matt M says:

      To really understand the extent of the disease, and therefore it’s danger and trajectory, we should be trying to figure out how many actually have it rather than how many have come in with severe symptoms, and have had the disease confirmed.

      I’m also interested in the amount of people who come in with severe symptoms AND a personal connection to a confirmed case (the baseline requirement for getting tested in the US to this point) and still don’t have the disease. As far as I can tell, nationally this figure is around 85% (with significant variation by locality).

      If this disease is as infectious as everybody says, why are there so many people with symptoms and connections to cases who don’t have it?

      • Beck says:

        @ Matt M
        I noticed yesterday that, in some state at least, commercial and clinical labs aren’t required to report negative test results (for some reason).
        I imagine the states vary in how much of the testing they farm out and how much they keep in-house, so those numbers are probably pretty screwy, with the actual % of negative results being maybe a little greater than you get just looking at the reported values.

      • Radu Floricica says:

        That makes sense, “contact” still should give a very low infection number, probably around 1%. Around here “close contact” is defined to include “spending more than 15 minutes in the same room”, which is far from assured infection. Simple contact might be just being on the same plane or at the same party.

        Those 85/15% are so high because they count people with symptoms. Hmm. Come to think of it, if you know the incidence of all other respiratory diseases at this moment, you reverse engineer from that number an estimate for Covid incidence.

      • albatross11 says:

        Some of the testing may be too early to detect the infection, or too late, after the person has cleared it himself.

        • Matt M says:

          Can this really be the case if you’re testing people with symptoms?

        • masanlyrics616 says:

          It seems “epidemic of epidemics” is definitely happening at least at the top level. We have several separate epidemics in the US, for instance. But I don’t know that it’s happening “all the way down”. Maybe, though; it kinda looks like two separate sub-epidemics, one in Queens and one in the Bronx.

          Good point about the degree-weighted average degree; I think that boosts the importance of the “hub” nodes.
          Apna time Aayega

    • bzium says:

      Large-scale serologic testing (the kind that detects antibodies in people who already went through the disease) might be getting rolled out right now in some places.
      For example, in the Netherlands they’re going to be testing donated blood.

    • Brett says:

      They should follow up with all the asymptomatic cases in a week or two, see if any of them develop symptoms (I’m wondering if some of them get marked as asymptomatic because they’re still in the incubatory phase of it, the on-average 5 days before symptoms emerge).

  2. sohois says:

    On the takeout thing, Kenji Lopez Alt tackled general food safety including takeout/deliveries over at SeriousEats:
    https://www.seriouseats.com/2020/03/food-safety-and-coronavirus-a-comprehensive-guide.html#sick-from-take-out

    And largely came to the same conclusion as the media links, which is that there’s no special risk associated with getting takeout.

    The main risk factor is proximity to other people, so inasmuch as you have a higher chance of coming in contact with other people outside your own home, picking up food is a higher risk than having it delivered or cooking it yourself.

    Regularly wash your hands if you receive takeout and it should be fine. Give the rest of the article a read if there’s any general food worries, it’s pretty comprehensive

    • andrewnwest says:

      Related to this, Korea did contact tracing on every infection and there were no cases from food delivery. Food delivery is pretty common there, so we can at least say the odds are low that it’s a problem.

      • steve3920 says:

        Interesting! Do you have a source for that? I feel like the East Asian contact-tracers should have a treasure trove of information about how COVID-19 transmits, but I can’t find that information. (See also my comment below.)

    • teageegeepea says:

      Greg Cochran has suggested irradiating food with Cobalt-60, or perhaps really strong X-rays:
      https://twitter.com/JimDMiller/status/1241547872618844163

    • Taymon A. Beal says:

      The author of that article is a restaurateur and stands to lose his livelihood if people stop ordering takeout. I’m not going to just take his word that it’s safe.

      • sohois says:

        Prior to opening his restaurant, Lopez Alt was an extremely successful food blogger, and I would be surprised if his restaurant makes even a tiny proportion of his total income as opposed to his work for seriouseats or recipe books. Having read a huge amount of his work over the years, I can say he is one of the most trustworthy food sources you can find.

      • keaswaran says:

        I thought he was a food YouTuber and gets most of his livelihood from people interested in learning to cook at home.

    • OneBigOh says:

      What if you reheat the food? That should kill any viruses it still contains no?

  3. Greg55 says:

    The coronavirus is the first contagious disease with very unequal mortality rates: the 80+ group has mortality rate 310 TIMES higher than 20-29 group (Imperial College). For children it is less deadly than regular flu, for most population pretty harmles.
    So the most sensible strategy is to isolate the 60+ or similar group without disrupting the whole economy – I write from Poland.
    That is the strategy of the Swedish government: self-isolation of elder folks and self-isolation of anybody with symptoms https://www.zeit.de/politik/ausland/2020-03/coronavirus-schweden-stockholm-oeffentliches-leben/komplettansicht (read with Google Translate, as I did).

    • A1987dM says:

      Yes, but the rates of ICU-needing cases are much less elderly-skewed than that.

    • AlesZiegler says:

      Problem is that it is logistically impossible. How would you do that, ship all elderly people on some island until epidemic is over?

      • sandoratthezoo says:

        I mean, Molokai is pretty available now, isn’t it?

      • Brett says:

        This. 18% of the British population is over 65, or about 12 million people. Are you going to successfully isolate all of them from unsanitized contact for a month without it also being a hugely expensive logistical challenge?

        That’s not even getting into the death and hospitalization rates among the lower-risk rest of the population still being high enough to overwhelm the NHS in a “let it ride” scenario.

    • “The coronavirus is the first contagious disease with very unequal mortality rates”

      This is incorrect. Influenza is also a couple orders of magnitude more deadly for the elderly – https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-162 (Note – all graphs are log scale. Those lines are exponential increases in mortality.)

  4. toastengineer says:

    Brazilian gangs […] declared a unilateral quarantine order in Rio de Janeiro, saying “If the government won’t do the right thing, organized crime will”. Anarcho-capitalism FTW!

    Surely that’s a more central example of agorism than anarchocapitalism.

    • anonymousskimmer says:

      Claiming it is anarchocapitalism is a claim that Brazilian gangs don’t have a hierarchical organizational structure. On its face that claim seems implausible.

      • Cliff says:

        Does anarchocapitalism mean there are no firms? Or the firms somehow have no hierarchy?

        • anonymousskimmer says:

          I honestly don’t know. Anarcho-capitalism isn’t my thing.

          This is entirely firm driven though, so claiming anything is “anarcho” about it seems a bit much.

        • mitchellpowell says:

          In the Murray Rothbard / Mises Institute variety of anarchocapitalism, firms are allowed.

          • Le Maistre Chat says:

            How can anarchism “allow” or not anything except the existence of the state? You can jaw jaw at people all day every day about a “Non-Agression Principle” and they’ll still use force.

          • You can “not allow” something by a definition of anarchism such that if that something exists in a society that society is not anarchist. Most obviously, anarchism doesn’t allow the state — if there is a state, the society is not anarchist.

            The usual versions of anarchocapitalism do, in that sense, allow firms. That is part of the reason that some left anarchists don’t view us as anarchists. Their definition of anarchism does not allow hierarchical relationships, such as those within a firm, even if they are voluntary.

          • Act_II says:

            @Le Maistre Chat
            Bit of a sidebar, but anarcho-capitalism isn’t anarchism. I can’t speak to anarcho-capitalism, but anarchism opposes unjust hierarchies. Lots of anarchists have quite involved ideas about how an anarchist society should be structured that goes beyond abolition of the state. (Of course, a lot of them have different ideas. This is why you have all sorts of sub-factions like anarcho-syndicalists, anarcho-communists, etc).

          • Hoopdawg says:

            Their definition of anarchism does not allow hierarchical relationships, such as those within a firm, even if they are voluntary.

            Obviously, all voluntary relationships are consistent with anarchism, even if they form a hierarchy. Which is to say, a voluntary relation can have a hierarchical structure. What they cannot have are power and authority coming from a place in hierarchy. If you consider those a necessary element of hierarchies, then yes, those aren’t compatible with anarchism.

            In particular, we don’t believe a capitalist boss-worker relation, or a feudal landlord-tenant relation, can be meaningfully called voluntary. Or, to put it in stronger terms, we see private property as indistinguishable from a state.

            (None of this precludes firms as such, as long as one considers e.g. cooperatives to be firms.)

          • John Schilling says:

            I can’t speak to anarcho-capitalism, but anarchism opposes unjust hierarchies. Lots of anarchists have quite involved ideas about how an anarchist society should be structured that goes beyond abolition of the state.

            But presumably those structures are just heirarchies, so that’s OK.

            If anarchy becomes just another way of saying “things are structured the way I think is just”, then meh, who cares. And we’re still going to need a descriptive term for the set of social organizations without a violent monopolizing state at the center.

        • viVI_IViv says:

          Does anarchocapitalism mean there are no firms?

          If I understand correctly, anarcho-capitalism does allow firms as long as all pairwise transactions are voluntary.

          Now, an armed gang member showing up at your shop and telling you to shut down or else hardly fits the definition of voluntary transaction, so I don’t know what Scott and this Mason guy he cites were thinking: “state capacity anarcho-capitalism” is an oxymoron, maybe they were joking.

          In fact, the common critique of anarcho-capitalism is that it would immediately degenerate into the rule of gangs with state-like powers and behaviors, which is what we are observing in Brazil now (not really just now, it’s just newsworthy now), which is evidence against anarcho-capitalism being viable.

          • Hoopdawg says:

            Eh, another common critique is that many anarcho-capitalists wouldn’t even consider that a problem (you’re volunteering to live under a rule of a gang, because if you didn’t you’d just move somewhere else, eventually the best gang will have the most customers, that’s free market at work), and it’s always good to have explicit examples of this mindset to demonstrate it’s not just a strawman.

          • viVI_IViv says:

            you’re volunteering to live under a rule of a gang, because if you didn’t you’d just move somewhere else, eventually the best gang will have the most customers, that’s free market at work

            And of course during this crisis you can’t even “vote with your feet” because most borders are closed or severely restricted, and various countries even have internal movement restrictions (in some places you aren’t even allowed to leave your house without a valid cause).

          • Furslid says:

            Hoopdawg. I think the piece of the puzzle you’re missing is costs for switching gangs. As long as the extra costs of one provider’s bad management are less than the costs of switching, the customer is unlikely to switch. This means the firm doesn’t get the harsh discipline of the market.

            Right now I can’t switch my government service provider without leaving my friends, leaving my job, etc. There’s no other product with that level of cost to switch. Anarchocapitalists believe that by minimizing the costs of switching, this would allow the market to improve service.

          • Mary says:

            Rhode Island has started to stop cars with NY license plates and will be going to homes in search:
            https://www.bloomberg.com/news/articles/2020-03-27/rhode-island-police-to-hunt-down-new-yorkers-seeking-refuge

          • castilho says:

            Most anarcho-capitalists would argue we already all live under gang rule, they just happen to be very organized gangs that are good at building themselves a façade of legitimacy and convincing people they are better off under gang rule.

            From the point of view of an anarcho-capitalist, they at least let you choose which gang to be under.

          • viVI_IViv says:

            From the point of view of an anarcho-capitalist, they at least let you choose which gang to be under.

            I tought this is what democracy was for.

          • Lambert says:

            That’s everyone choosing what gang everyone’s under.

    • viVI_IViv says:

      From Wikipedia: “Agorism is a social philosophy that advocates creating a society in which all relations between people are voluntary exchanges by means of counter-economics, engaging with aspects of peaceful revolution.”

      “Peaceful” is not the word that comes to one’s mind when considering gangs that impose quarantines.

      Ultimately all form of anarchy are pipe dreams: there have always been and there will always be thugs with spears/swords/guns ordering people around, and as the current crisis makes clear, there are times when you actually want these thugs to do that, and if the ones with official badges wont, the ones with gang tattoos will do it in their place.
      “Non-aggression principle” looks nice on paper up until somebody can give you a deadly disease by sneezing in your general direction.

      • “Non-aggression principle” looks nice on paper up until somebody can give you a deadly disease by sneezing in your general direction.

        Unless that’s included as aggression. I mean it is a harmful invasion involving physical projectiles.

        • viVI_IViv says:

          But it is a mostly involuntary act, like other infectious acts such as spitting while you speak, scratching your nose and then touching handrails/door knobs/elevator buttons/food, or possibly even just breathing.

          Unless you live in a cabin in the wilderness with a stockpile of canned food you can’t completely self-isolate from other humans until the pandemics dies out by reaching herd immunity at unmitigated R0 (assuming that it does die out rather than becoming cyclic), so you want the R0 to be mitigated, but this requires armed enforcers limiting the personal freedoms of the people.

          Similar considerations apply to using taxpayer money or even emergency state control over the economy (e.g. the Defense Production Act) to boost the health care system.

    • Brett says:

      Seems redundant, since Rio’s Mayor has already initiated a lock-down. Maybe it will add some muscle to it.

      Bolsonaro hasn’t been helpful on this, but smaller-level authorities have done better in Brazil. Normally I dislike federalism, but it does have the advantage of not leaving it all up to a central authority to get right or foul up.

  5. tenoke says:

    >chance of saving ten life-years with a ten second speech.

    Nobody is stopping smoking due to a ten second speech at this point. At most, it can increase the chance fo stopping by a tiny amount. The math on this here is very flawed.

    >There is nothing else you can do as a doctor or a human being that gives you a medium chance of saving ten life-years with a ten second speech.

    If we are taking any of this at face value then giving a 10-second speech on not killing yourself to someone suicidal not only compares but it does more, so no.

    And just to clarify – I’m not nitpicking here, but genuinely think that misrepresentations here hurt a lot, especially when false (at least based on the logic here) statements like the one bellow can influence people’s behaviour and funding:
    >Everything that effective altruism has to offer pales in comparison.

    • Scott Alexander says:

      I think the studies on brief interventions do show that some people quit smoking because of their doctor saying basically “Hey, have you considered quitting smoking?” I agree it’s low success rate, but probably above one percent. I think I have had a couple of patients quit smoking because I talked to them. It’s not that they didn’t know smoking was bad for them before, just that they’d always vaguely intended to quit but never gotten around to it, and I was able to make “right now” the Schelling point for action.

      This works even better if their reason was that they didn’t think they could do it, and then I can sell them on bupropion and send them out with a prescription.

      Being suicidal is a pretty different situation, but taking your comparison absolutely literally, I think suicide hotlines are also good and have saved a lot of lives and I’m glad they exist.

    • Matt M says:

      Not sure I agree.

      Surely there’s some risk that we reach a point where everyone just assumes that “everyone knows smoking is bad” so nobody ever bothers to actually say “smoking is bad” anymore, right?

      And hearing it from your own doctor is probably much more effective than hearing it in a televised PSA from the ad council or whoever…

    • Radu Floricica says:

      The audience here is slightly more likely than average to listen to advice, and Scott has some pretty high grade social proof behind his prompting. Good combo.

      Plus, it is the kind of situation where it makes sense to quit, but our brains being what they are you either don’t think about it or just gloss over it “I have to quit smoking one of these days”. Having it shoved into your face at exactly this moment probably helps.

  6. denverarc says:

    Random thought – might the difference in different nations or regions spread be due to removing shoes on entry to homes/places of worship?

    Everyone seems to have focused on hands, masks, social distancing etc – but if there is virus on the ground (through spit or droplets settling) and you walk through it, then walk through your house you’ve just left virus all over your floors.

    Whereas if you take your shoes off at the door, the virus stays by the door instead.

    Japanese and Iranian culture both have shoe removal at the door as the socially expected norm, afaik. Just an idea, take it for what its worth.

    • Kaitian says:

      I’d think virus on the floor is not very worrisome, after all you don’t normally touch your floor with your face or hands. Touching your shoes to take them off when you get inside might be more dangerous (I’m aware that many people in Japan wear shoes that slip off easily without hands).
      In Europe you’d generally take off your shoes (using your hands) once you’re in the house, but there is no designated shoe removal area the way there is in Japan. So that might be the worst of both worlds.

      • viVI_IViv says:

        I’d think virus on the floor is not very worrisome, after all you don’t normally touch your floor with your face or hands.

        Young children and pets, however, touch the floor all the time.

    • Le Maistre Chat says:

      Hindus also take off shoes. Heck, it’s not wildly improbable that Japan got it from India, like it got the worship of about 20 Hindu gods.

    • Squirrel of Doom says:

      This seems very unlikely.

      Then again Swedes are fanatical about taking shoes off indoors, and are having inexplicably good results from a lax policy.

      My theory on shoe removal is that it’s primarily correlated to the muddines of the terrain.

      • DaveK says:

        When they tested the Sars Virus, they foud that different HLAphenotypes were associated with different levels of disease progression and severity.

        The severity in different locations could have to so with varying frequency of phenotypes in the populations.

    • Radu Floricica says:

      I was never very clear on whether spraying the streets with disinfectant is a good idea. We have some of that here, but I kinda suspect it’s a mixture of PR and way of spending money towards the right supplier.

    • aleksanderpwnz says:

      I don’t think the performance of Iran and Japan has much in common. The spread in Iran was slower than many other places, but it continued unhindered for weeks, and then shot up (I think death statistics show it’s probably stopped now). Japan has basically avoided almost all spread (apparently).

  7. rahien.din says:

    I do not support Trump. But we have to be fair to him in that specific exchange.

    The reporter asked him, “Are you opening the government to avoid a political disadvantage?”

    Trump’s reply is, “The only reason you ask is because you are losing a perceived political advantage, and thus are disappointed.”

    • anonymousskimmer says:

      No. Until he is “fair” to others, and “fair” about his own actions, there is no need to throw him softball questions. A politician should be able to handle normal questions, and so-called hardball or “unfair” questions based upon his long-term modus operandi, without DARVO.

      Trump has been politicizing this from the start. He claimed that no one wanted to shut down flights from China, even doctors, but that he was ahead of the game. I actually believed this for a while, until deciding to fact check.
      https://www.factcheck.org/2020/03/the-facts-on-trumps-travel-restrictions/

      • rahien.din says:

        Trump has been politicizing this from the start.

        Then there already exist numerous opportunities to criticize his actions.

        There is gold lying on the ground all around you. No need to dig a mineshaft through your driveway.

        • anonymousskimmer says:

          1) It is important that people be aware of DARVO, since those aware of DARVO are less likely to accept the cluster B’s (or regular person who is acting out-of-character unfairly) complaint at face value.

          It is incredibly important to call people out who implicitly take the side of a DARVO complainant by talking about fairness. Getting people to do this is the entire point of a DARVO complaint, so when it is done the DARVO complainer automatically wins (successfully makes the discussion about something other than the culpability of their actions).

          2) https://slatestarcodex.com/2020/03/27/coronalinks-3-27-20/#comment-871336

      • Spookykou says:

        It’s not clear to me that DARVO applies to the exchange in question, ‘you are just mad because this is bad for you’ does not look like, ‘why are you picking on me’.

        In general though Trump does constantly accuse the media of being hostile to him, but then, it really feels like the media is hostile to him. DARVO seems to imply a reversal where the abuser suddenly plays victim, but this abuser victim dynamic does not feel like it is at play in the Trump, American media, relationship where both parties are openly hostile to each other and have been, since about 2015ish.

        Also I don’t think rahien.din is saying the reporter couldn’t ask the question, rather they are saying Trump’s answer was a reasonable one. I am not on Twitter but I have a vague understanding of it’s form and I imagine this clip is being posted all over the place with captions like ‘look at Trump totally dodge this question about how he is killing people for votes’ or something similar. I think they are asking for fairness in our evaluation of any given interaction and not to just scream anytime Trump says literally anything. I could be misinterpreting rahien.din though.

        • anonymousskimmer says:

          “In general though Trump does constantly accuse the media of being hostile to him, but then, it really feels like the media is hostile to him.”

          And who started this hostility?

          “they are saying Trump’s answer was a reasonable one.”

          A singular response fully taken out of context can indeed be reasonable. It is not reasonable, however, to take anything a politician says out of the context of everything they have stated over the years.

          • And who started this hostility?

            You ask that as if the answer was obvious.

            The NYT, and much other media, has been hostile to Republicans and conservatives since long before Trump became a political figure — what their treatment of Trump himself was back then I don’t know. When Trump started his campaign for the nomination the media, as best I remember, didn’t take him seriously as a candidate.

            Perhaps someone who pays more attention to the mass media than I do can give a more complete answer, but it isn’t obvious to me that Trump started the conflict, although he has certainly vigorously played his side of it.

          • anonymousskimmer says:

            Thanks David. I tried to find this as well but couldn’t easily.

          • Alyosha says:

            One could argue that this hostility began at least 30 years ago.

            To DavidFriedman’s point, Trump has been a highly prominent public figure for his entire adult life, and nobody ever seemed to think he was a vicious racist until he ran for President as a Republican. In fact, he was praised by black leaders for working together with them to improve underprivileged minority communities.

        • Ketil says:

          It’s not clear to me that DARVO applies to the exchange in question

          First time I hear this term, so I looked it up on Wikipedia. Maybe that has the usual Wikipedia quality issues, but from the description, the term strongly assumes guilt of the accused, and pathologizes a perfectly legitimate defense for somebody wrongfully accused.

          Am I wrong to dismiss this as just a more quasi-intellectualized “believe victims” tactic?

          • anonymousskimmer says:

            Like everything it can be misused (and sure it could be argued I did misuse it in this particular case).

            I am not a psychologist, or an expert on DARVO. As a term this is still pretty new to me.

            If you look up real-life examples of DARVO you can see how it tends to play out. Many truly wronged people will deny, and even counter attack, but the actual mechanism of reversing victim and offender is pretty distinct.

            It’s also important to look at patterns in the histories two putative victims. If someone never accepts that they did anything at all wrong in this particular interaction, or have been to blame for anything in their lives, there’s a good chance you’re dealing with a self-defensive personality that is, at the very least, prone to using DARVO to deflect all blame to other people (whether the other party in this interaction, or third parties – “you’re wrong to blame me, it’s actually their fault”).

          • Paul Zrimsek says:

            One sign that you might be dealing with someone who never admits that they did anything wrong is if they put any complaint down to DARVO.

    • Paul Crowley says:

      What exchange are you referring to? Can you quote the reporter and Trump’s exact words so I can search for it? Thanks!

      • rahien.din says:

        So, I am bad at the twitters. I thought the link pointed to this particular exchange, but I was mistaken.

        But – in for a penny, in for a pound – it seems like that reporter tried to “Are you still beating your wife?” him, and got rope-a-doped.

        • Edward Scizorhands says:

          While I’m very critical of Trump, and Trump has a lot of fault here, the media needs to realize its own agency and stop with its “look what crazy thing I got Trump to say” game. Yeah, no shit. It was newsworthy the first dozen times. Not any more.

        • knzhou says:

          I agree that it’s quite clear that the reporter’s question was meant as an attack, to expose how stupid Trump’s statement was.

          Here’s the thing though: Trump’s statement actually was incredibly stupid and should have been attacked. Journalists are the only people in the country who get to challenge Trump in real time, face to face, so I’m glad they’re doing it.

          You’re letting whining over media bias take precedence over the actual facts. Yes, the reporter probably would have phrased it nicer if there was a Democratic president. No, that doesn’t change the fact that their point was correct.

          • Doctor Mist says:

            Trump’s statement actually was incredibly stupid and should have been attacked.

            You mean the statement that he was hopeful that we could be opening things up by Easter? You’re free to disagree with it — I think I do — but it’s far from obvious to me that it’s “incredibly stupid”.

            First, the experience of South Korea suggests that lockdown combined with aggressive testing (where we were slow to start but are making progress) can actually make a lot of progress in not a terribly long time.

            Second, the anomalies people point to, like Japan, like the actual infection rate in the captive population of the Diamond Princess, have made some well-informed people wonder if the world has overreacted. Again, I am inclined to think not, but when John Ioannidis says we have gone off half-cocked I have to wonder.

            Third, there is the people-management problem. If you tell people they are going to have to shelter in place for six months, lots of them will not even start and you’ll have to go all totalitarian on their asses to make it happen. If you say three weeks, you’ll get a lot more compliance, and three weeks later maybe you can say another three weeks and most people will have made their accommodations and will see that it’s not impossible. Sure, you’ll have to deal with disappointment, but at that point the necessity might be more obvious to everybody than it was at the start.

            All this makes me suspect that calling that statement “incredibly stupid” is (as usual) more a reflection of dislike for the speaker than an objective assessment of what was spoken.

  8. jasonium says:

    I wonder if humidity inside buildings has a substantial effect. Do the Japanese keep their offices and homes at a substantially different RH from other places? How about San Francisco vs. New York? I’m not suggesting the virus is airborne. Perhaps wetter or drier air has some significant effect on the pathogen’s ability to get to the type of tissue in which it thrives after a person has been exposed.

    • onyomi says:

      I remember a while back, maybe around the time of the Kyoto accords, there was a push in Japan, dubbed “cool biz” to save power by putting the AC thermostat around 75 f in offices instead of the usual 70 or whatever it was. I’m not sure how widespread that was adopted and whether it’s still adhered to, but it could be that Japanese offices are actually less cool and dry than others in general (though I also wouldn’t expect people to be running the AC at this time of year anyway in most of the places where the virus has thus taken off yet).

      I do think heat and humidity is likely an important factor (cold, dry air means more virus transmission, seemingly).

      *Edit to add: I looked it up and it looks like it is still around, was even warmer than I remembered (82 f… sounds awful…), but probably not in force till May, so maybe not a factor. But there could be a more general tendency toward that “don’t use the AC if you can open a window” sort of ethos.

      • ChrisA says:

        My Japanese friends all seem to live alone. It seems to be really common in the big cities there. Also a lot of people seem to eat in restaurants alone, compared to other places I have been. My guess is that virus transmission happens really efficiently in a home due the close proximity and shared eating and so on. Statistics I have seen say about 14% of Italians live alone, but 34% of Japanese live alone. Couple that with cultural differences in greetings (bowing vs cheek kissing, use of masks when sick) probably can explain much of the difference in transmission rates between the countries.

  9. Thank you so much for clarifying the Triplebyte issue! I’m not involved in any way, but a few years ago I observed a similar reporting experience with my current employer (Goodgame Studios of Hamburg, Germany), where they tried* to do the genuinely best thing they could in a shitty situation and got lynched for it, except unlike with the Triplebyte case here on this blog, it was never rectified and consequently they still struggle to employ people when they need them (though four years after the fact, it’s finally getting a little better).

    So I really appreciate that you’re forwarding that information. <3

    (* note: they did not manage to do the literal best thing they could have done, they also messed up in at least one regard, although that obvious miss came after the lynching had already happened and no one was paying much attention to them any more, but it belonged to the same narrative arc.)

    • Scott Alexander says:

      I’m not letting them completely off the hook – I still think they were unusually unreceptive to requests to work from home, from workers who they knew they were going to fire anyway soon – but I appreciate that there’s subtlety.

  10. midjji says:

    Swedish people do not smoke equally, women smoke almost twice as much. https://www.scb.se/hitta-statistik/artiklar/2018/farre-roker-fler-snusar/. A trend which will continue as it is considered girly to smoke among youths. General Tobacco use statistics are dominated by the use of snus, which while about as cancerogenic does not cause respiratory issues because it does not wind up in the lungs. But because people use tobacco roughly equally, and the rest of the world assumes tobacco is predominantly smoked, its easy to get this wrong.

    • Kaitian says:

      That’s really interesting, do young people use this form of tobacco too? I’ve only ever seen very old people do it.

      That might be an option for current smokers, too. If you can’t quit nicotine right now, you could switch to chewing tobacco or snuff and take some pressure off your lungs.

    • GearRatio says:

      Could you please back up that Snus is “about as cancerogenic(sic)” as smoking? Because it isn’t true; they struggle to find a strong link between Snus and cancer at all. This “all tobacco use is a dire threat comparable to smoking, it must be!” logic is killing tons of people and I really wish it would stop.

    • divalent says:

      “…dominated by the use of snus, which while about as cancerogenic…”

      Flatly not true. About the only cancer risk of snus *may* be a slight elevation in oral cancer, although the evidence is pretty weak for that, and the effect size is smaller than that for oral cancer for an occasional drinker.

  11. DarkTigger says:

    If the very poorest countries in sub-Saharan Africa were suffering a full-scale coronavirus epidemic, would we definitely know? In Liberia, only 3% of people are aged above 65 (in the US, it’s 16%). It only has one doctor per 100,000 people (in the US, it’s one per 400) – what does “hospital overcrowding” even mean in a situation like that? I don’t think a full-scale epidemic could stay completely hidden forever, but maybe it could be harder to notice we would naively expect.

    I expect those countries to have slightly increased death rates in the comming months.
    And in two or three years, some reputable medical or public health institute will publish a study estimating x-thousands additional deaths in Sub-Sahara Africa, in the first quater of 2020 or something like that.

    • Brett says:

      The age profile of sub-Saharan Africa is in their favor. About 60% of Africa’s population is under the age of 25, so they’re much more likely to either be asymptomatic or mild symptoms. They could still spread to people who are vulnerable, but it does help.

    • Mary says:

      The anecdotal evidence I have heard against Africa’s having a large scale problem is from a woman with a lot of African expatriate friends. Whenever there’s a death back in Africa, they get a call asking for money for the funeral. They are NOT getting a flurry of calls.

      • DarkTigger says:

        As I said slightly increased. As Brett said the population in SSA is younger than we are. Also Corona seems to spread slower in warm and moist climates, so they may get fewer and less severe cases. But I suspect we will never get an useful case fatality rate for some place in the Kongo where the next hospital is 15 kilometers away.

  12. jast says:

    But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am.

    Some things of note. Epistemic status: speculative
    1. Japan has the highest hospital capacity in the world – over 4x that of Italy or the US. Assuming some preparation, they would be noticing problems a bit later on.
    2. Less handshakes, more bows. Probably helps.
    3. Masks might really help a lot. For instance, Czechia has made masks mandatory for public transport and has seen slower growth than many other European countries, despite lax lockdown measures. It looks like they have low measured case fatality rate, too. But their testing may not be very extensive.

    Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.

    Iran’s reported growth rate has been basically linear for a while now. It looks to me like they have very limited testing capacity and thus just can’t report more, besides possibly wanting to cover up the situation. From what I hear from Iranian contacts, they’re having severe shortage of medical care capacity, with staff dying and hospitals looking for untrained volunteeers even 2 weeks ago.

    • Tom Chivers says:

      If Czechia isn’t testing, naively that would make their CFR look worse rather than better, wouldn’t it? 10 deaths out of 100,000 positive tests looks a lot lower than the same 10 deaths from 50 positive tests

      (I guess they might not be testing the people who’ve died, but that seems unlikely to have as big an impact)

      • jast says:

        Yes. Their CFR looks very good, too, so far. So they might have sufficient testing – unless they don’t test dead and hospitalized people much. I think this is the case with Iran. A contact reported deaths in his friend circle that were never tested. Eventually the all cause mortality statistics may give us a better picture of how bad they’re hit.

    • Edward Scizorhands says:

      https://twitter.com/shiroihamusan/status/1243430222751391744

      This infographic claims that masks are the reason the Asian countries are doing well. I haven’t verified it.

    • AlesZiegler says:

      Czech lockdown measures are very far from being lax compared to the rest of Europe. Also, masks there are mandatory not only for public transport, but for all outdoor activities (EDIT: which are themselves severely restricted).

      Progression of Czech cases and tests daily can be seen here, but it is written in Czech (surprise). Graph with a red line is cases, graph with blue line is tests. Overall, slightly more than 30 000 tests in a population of 10 million were performed as of yesterday.

    • Brett says:

      The masks really do seem to help a lot – much harder to spread it by coughing or sneezing, and probably also much less likely to touch your face with it on (at least once it’s on – obviously you have to touch your face to put it on).

  13. Jane Ire says:

    Does anyone have a good sense of where Australia specifically is at? To be more precise, if the authors of “The Hammer and The Dance” were to take a look at Australia’s approach, how would they score it? From where I’m sitting (Brunswick, Melbourne) the approach seems both pretty tough (stay at home, don’t go out if you don’t need to, work from home, school’s cancelled, testing at a really high rate) and also a little squishy and muddled (stay at home orders aren’t enforced legally, and like, hairdressers are open? and they can’t voluntarily close, I’m told, because otherwise the business couldn’t get a piece of the stimulus bill, & the employees can’t get unemployment benefits?).

    If anyone knows some good, Smart Person resources to follow re:Australia and the Covid, that’d be great too.

  14. jgr79 says:

    I’m not sure you took the appropriate thing away from the Iceland study. It found that half the people were truly asymptomatic. But it also found that 0.89% of the sample had the virus. Extrapolating to Iceland’s population that would mean 3000 infected. At the time they had 6 people in the hospital in the whole country and 1 death.
    It’s not clear exactly how to correct for the time lag between positive cases and hospitalization/death but a naive division of the numbers puts the hospitalization rate at 0.2% and the death rate at .03%.

    There’s so much error and assumption in there that I wouldn’t take those as actual numbers. But the fact that they’re 2 orders of magnitude lower than what we’ve seen should give us encouragement.

    Basically, we may not just be missing asymptomatic cases. We may be missing covid-19 cases that look like the common cold.

    • Squirrel of Doom says:

      The other angle is that the tests may have false positives.

      • lkesteloot says:

        What is the false positive rate of these tests? I saw one study (out of China?) that reported it as high as 80%, but I can’t find the link now, and that number seems impossibly high. But I’ve also heard that this is why the CDC is reluctant to test widely (people without symptoms) because it’s the combination of symptoms and test that gives confidence in the results.

        Relatedly, how would you even know the false positive rate of a RT-PCR test? Is there another more accurate test to benchmark against?

        • Statismagician says:

          Nobody knows yet – as you correctly notice, you need a more-accurate test to calibrate against and a much better understanding of the disease to design experiments.

        • anonymousskimmer says:

          Relatedly, how would you even know the false positive rate of a RT-PCR test?

          You have at least one positive and negative control for each batch or RT-qPCR, that are handled in the same manner by the same person. Preferably you have at least two of each control, one each handled before the first patient sample, one each handled after the patient samples.

          In the end you send aliquots of the RT-qPCR samples through a quick round of barcoded Illumina sequencing to verify that the amplicons are of SARS-CoV-2 RNA sequences.

          • anonymousskimmer says:

            Basically:
            1) You make sure the technician didn’t make a mistake and screw up or cross-contaminate samples.
            2) After you’ve made sure you haven’t screwed up the samples, you sequence all of the samples to ensure that they are from this virus and not from something else.

    • divalent says:

      A false positive rate of only 0.89% (i.e., true positive rate of 99.11%) would account for all of their results, and a false positive rate half that (true positive 99.55%) would bring their results in line with other data sets. (Particularly the Diamond Princess).

      Anyone know if a significantly better level of accuracy (>99.9%) is reasonable for this type of test? (Including lab/operator/collection contamination possibilities?)

      • 2dipsynock says:

        Here’s a discussion on false positive/negative rates for the covid RT-PCR test. The false negative rates seem much higher (~30x) than false positive rates. I also think the false positive rates are based on a single test and the most likely causes would be independent on a retest, meaning very few repeated false positives. Do we know if those happen? Retesting asymptomatic positives seems like an unusually good use of a test in the presence of a meaningful false positive rate.

        I think the main difference in Iceland asymptomatic rates and diamond princess rates is that they’re reporting different things. IIUC Iceland’s is asymptomatic at time of testing (I don’t see this explicitly mentioned anywhere, but with a possibility of a 2 week incubation and no explicit explanation either way I think you have to assume it’s at time of test only), but the ~18% from Diamond Princess is trying to model the full course of the disease. So if ~half the Icelandic asymptomatic cases later develop symptoms there’s no discrepancy at all.

        • albatross11 says:

          As I understand it, the RNA test is based on a throat or nasal swab. Those can be messed up in ways that don’t get a good sample, and my not-very-informed guess is that this probably explains some substantial chunk of the false-negative rate.

    • 2dipsynock says:

      During exponential growth disproportionate numbers of cases are recently acquired and haven’t yet developed symptoms, or the symptoms haven’t yet become severe. People in the 2-14 day incubation period will test positive on PCR then go on to develop symptoms later. The base assumption is that deaths significantly lag infections and you need to do complicated time corrections to figure out true fatality rates when most of the infected are alive and not yet recovered.

      To use some toy numbers, imagine the daily growth rate of true infections is about 20% day over day, the incubation time is always 5 days, and nobody does until after admission to ICU which according to here is typically 10 days after symptoms (when it happens, which is rareish, like 5-20% of cases). That’s 15 days after infection. If we start with 100 patients and a 1% true death rate when that first patient dies on day 15 there’ll be about 1500 infected and a 1% death rate will look like it’s only a fifteenth of that (~0.07%). The epidemiologists are aware of these effects and are trying to factor them into the reported fatality rates, though there’s obviously some approximations involved. (Part of this is messy because incubation times, symptom development time, and severity are presumably correlated, though I haven’t found definitive evidence of this).

      Do not read too much into the Iceland number, it is much more an upper bound of asymptomatic rates than a lower bound and I don’t think should make people reconsider prior estimates of only ~20% of cases remaining asymptomatic (from one of the cruise ships) or the IFR being around 1% (IFR < CFR).

  15. theodidactus says:

    On the last fractional open thread, we got an interesting discussion going about constitutional rights and whether shelter-in-place orders etc. violate them. I apologize if this is a discussion better suited for the fractional threads, but I’m not sure it’s strictly a culture war issue. Rather than a discussion about whether this or that order “really does” violation one’s constitutional rights (which seemed to be the bulk of the fractional discussion) My main reason for posting here is more of a prediction.

    The area where I think you’re likely to see the first successful challenge is in suspension of jury trials for criminal defendants. To my knowledge, in Minnesota anyway, lawyers are already marshaling arguments on this matter. Importantly, as a matter of historical trivia and argumentative effectiveness, these arguments can be made to sound in habeas, so they might work even if the bill of rights didn’t exist at all.

    There are all sorts of interesting solutions like remote trials (with telejuries!), but they would take too long to implement and likely be considered inadequate (the entire pool of jurors would have to be tech-savvy and laptop-equipped, telepresence might violate evidentiary or constitutional prohibitions. )

    • EchoChaos says:

      I don’t think it’s CW in the traditional sense, because the fault lines aren’t along the typical tribes.

      I am really interested in how it comes out as not a lawyer but always interested in such things.

      • theodidactus says:

        what is super interesting about the trial issue is that the solution might really be a strict binary: drop the charges or have the trial, corona-be-damned.

        • Anthony says:

          Just as with the overloaded traffic courts, defendants are asked if they wish to “waive time” – to waive their right to a speedy trial. In this case, I suspect defendants for anything less than the most serious crimes will be released – Alameda County already released a lot of prisoners from Santa Rita, and I can see courts and prosecutors just letting people go.

          Once jury trials resume, I expect a wave of arrests, as police departments may hold off on arresting serious suspects to avoid the possibility the suspects can have the charges dropped by demanding a speedy trial.

        • anonymousskimmer says:

          The Act provides a sanction of dismissal for violation of its time limits that may be with or without prejudice to reprosecution. In assessing whether dismissal should be with prejudice, the court must consider the seriousness of the offense, the circumstances leading to dismissal, and the impact that reprosecution would have on the administration of the Act and on the administration of justice.

          https://en.wikipedia.org/wiki/Speedy_Trial_Act

          So no, the law as it is forbids (at least federally?) this binary.

          The Supreme Court ruled on this binary non-federally:

          In Barker v. Wingo, 407 U.S. 514 (1972), the Supreme Court set out a four-factor test for determining whether delay between the initiation of criminal proceedings and the beginning of trial violates a defendant’s Sixth Amendment right to a speedy trial. The test requires the court to consider the length of the delay, the cause of the delay, the defendant’s assertion of his or her right to a speedy trial, and the presence or absence of prejudice resulting from the delay.

          https://en.wikipedia.org/wiki/Speedy_Trial_Act

          • theodidactus says:

            Barker has already been used to grant a coronavirus-related suspension of jury trials in a few states: https://www.supremecourt.ohio.gov/coronavirus/resources/2020-002OHAG.pdf

            However, just because Barker calls upon a judge to analyze the cause for the delay in determining whether there has been a violation of the speedy trial right, I don’t think that means Barker stands for the idea that if there’s a decent reason, we can simply delay trials indefinitely. The Defendant in Barker was in a very different situation than most of the defendants that are going to start mounting challenges (he was out on bail, and didn’t demand a speedy trial, and there were no signs that the delay prejudiced his case). The court makes particular note of this:

            “Barker was prejudiced to some extent by living for over four years under a cloud of suspicion and anxiety. Moreover, although he was released on bond for most of the period, he did spend 10 months in jail before trial. But there is no claim that any of Barker’s witnesses died or otherwise became unavailable owing to the delay. The trial transcript indicates only two very minor lapses of memory — one on the part of a prosecution witness — which were in no way significant to the outcome.

            More important than the absence of serious prejudice is the fact that Barker did not want a speedy trial.”

            I still think blanket, indefinite delays are going to present fact-patterns where the one factor that weighs vastly in favor of delaying the case is outweighed by other factors…it’s only a matter of time before the right case presents itself…now maybe prosecutors will simply dismiss these particular cases when they appear, but given how many cases are working through the system, I think some will still get through.

            I still maintain this is the best area to watch if you have strong opinions on how constitutional rights interact with lockdown orders.

    • unreliabletags says:

      Habeas can be suspended in an emergency, although maybe not this kind of emergency. Article 1 Section 9:

      The Privilege of the Writ of Habeas Corpus shall not be suspended, unless when in Cases of Rebellion or Invasion the public Safety may require it.

      • Evan Þ says:

        Hmm, so if Trump insists this virus was created in a Chinese bio warfare lab after all, can he then suspend habeas corpus?

        (AFAIK the Civil War left it as an unresolved question whether it’d take an Act of Congress.)

      • theodidactus says:

        The Habeas clause’s position in article 1 STRONGLY suggests the power to suspend habeas is legislative, not executive, and given the structure of article 1 it would then suggest it requires a legislative act (Bicameral vote, and presentment to the president for signature). That is also compatible with its use in English law (as a mechanism to CHALLENGE executive power, it wouldn’t make sense that the executive could suspend it simply by saying so).

        Opposite that, we do have Lincoln’s unilateral suspension during the civil war…but technically that was ruled unconstitutional by a circuit court and would probably have been held unconstitutional by the supreme court (the ruling was made by the chief justice, acting as a circuit court judge, which was procedure in that time). Lincoln simply ignored the ruling. Of course, that could happen under any future president (or the current one).

        As far as I know there has never been a ruling on what “rebellion or invasion” means. I can imagine some funny oral arguments.

        “Mr. Chief Justice, our BODIES are being invaded, and our very RIBONUCLEIC ACIDS are in rebellion!”

        • Evan Þ says:

          Chief Justice Taney did hold Lincoln’s suspension unconstitutional, but we don’t know what the other eight justices would’ve said. And then to make things more complicated, a few months later Congress retroactively approved everything Lincoln did. (And then they suspended habeas corpus themselves in 1863.)

  16. Tom Chivers says:

    Iceland has finally done what everyone’s been waiting for and tested lots of people to see how many are asymptomatic. They conclude that about half of carriers don’t know they have the disease. If there had been very many more asymptomatic carriers than symptomatic patients, it would have been good news – most cases never show up in the statistics, and all of our estimates of hospitalization rate and mortality rate would be much too high. Although it’s nice to be able to divide all of those by two, a lot of people were hoping we could divide them by ten or a hundred and stop worrying completely. This study suggests we can’t

    (Not that you’re saying it does, but) it doesn’t completely rule it out, if the disease has been circulating for longer than we realised and lots of the asymptomatic cases already happened; we’d need serological testing to check who’s already had it. But the 100 or 1,000 thing does sound extremely optimistic still.

  17. slovakmum says:

    Can somebody please tell me some expert opinion on a weird theory, that the current coronavirus has a bacterial intermediate host ? The ignored Slovak scientist justifies this theory by a long incubation period of the virus and it’s surprising resilience. One of the implications might be treatment of the infection by antibiotics. Also I do not know if model tests of survival have been done with virus particles or real infection material like sputum. I will post the link later.

    • slovakmum says:

      The translated text:

      A Slovak scientist believes he discovered a way to destroy coronavirus

      11. 03. 2020

      Zuzana Hrubá

      Associate Professor Vladimír Zajac, who works at the Institute of Experimental Oncology of the Slovak Academy of Sciences, proposed a new way to eliminate the spread of coronavirus from Wuhan, China. He claims that the virus behaves as a parasite that needs a host cell, and scientists should focus on what the cells are.

      “Every virus is a parasite. It cannot exist by itself. It is dependent on its host, a living cell. This is the basic condition of its existence. The virus is therefore a slave and not a king. What is the living cell that carries the viruses? ” These are the questions, which Professor Vladimír Zajac has been asking for 30 years. The appearance of the new coronavirus makes them even more pressing.

      About 30 years ago, he began working with Associate Professor Čestmír Altaner on the diagnosis of leukosis in cows. Its goal was to eradicate the disease throughout the then Czechoslovak Republic.

      “Bovine leukemia virus (BLV) causes leucosis. We have been able to gradually identify infected cows and have cleared a large part of Czechoslovakia from this disease, ”the scientist recalls.

      At that time, he and Associate Professor Altaner observed the progress of infection from infected animals to healthy ones and wondered how the infection was transmitted. “Gradually, I came to the conclusion that only a bacterial cell can be a host of viruses. I tested this idea and the results confirmed it, ”he explains.

      He also found the same finding in HIV research in the laboratory of molecular biologist Flossie Wong-Staal in the USA. “Even in the case of HIV, I managed to prove that its hosts could be bacterial cells. My original findings were published in several magazines, but the response was weak. Although I was invited to many conferences and our results were very accepted, there was no interest in the cooperation we needed. According to researchers, especially from the US, no one would approve such a project, ” says the researcher.

      Based on his earlier findings, doc. Zajac assumes that all viruses are transmitted by bacteria, including coronavirus. “It is generally said that viruses are transmitted by droplet infection. I say it is not so. They would have to exist outside the cell, and it is not possible, ”says the scientist.

      He adds that viruses are always transmitted by bacteria, and the current epidemic is not a coronavirus epidemic, but an epidemic of coronavirus-containing bacteria.

      Destroy bacteria, kill the virus

      “Several symptoms suggest this – the length of the incubation period, the level of contagion, and so on. A virus as a parasite is not a full-fledged biological form and is difficult to fight. Bacteria is a biological form and we can fight it. By destroying the bacteria carrying the viruses with antibiotics, the virus also ceases to exist. If this idea is confirmed, we could stop all viral infections in this way, ” he explains.

      According to Vladimir Zajac, such approach has never been investigated and poses an experimental challenge. “Bacteria from patients’ smears (from the rectum and throat) should be cultivated and see if they contain coronavirus. If so, my idea is right. Such an experiment is probably not possible in Slovakia so far, ” he concludes.

      Doc. Mgr. Vladimir Zajac, CSc. is a research fellow at the Institute of Experimental Oncology of the Slovak Academy of Sciences (SAS). In the 1970s he devoted himself mainly to the research of bovine leukemia virus (BVL) and its diagnosis in cows. Since 1981, he has focused on the molecular aspects of BLV infection.

      In the 1990s he studied the role of bacteria in bovine leukosis and subsequently in AIDS. Since 1994, he has focused on the diagnosis and research of hereditary form of colon cancer (FAP), including hereditary form of breast and ovarian cancer.

      Vladimír Zajac’s lifelong scientific work is based on the study of horizontal transmission of genetic information between eukaryotic and prokaryotic systems with a focus on retroviruses and the consequences of this transmission in cancer induction and AIDS.

      • albatross11 says:

        Nope, just wrong.

        Viruses infect cells in cell culture all the time–it’s a standard part of how they’re grown and studied. The labs do everything they can to keep bacteria out of their cell cultures!

        There are also animals raised in sterile conditions to have no bacteria. (Apparently this really messes up their digestion!) I’m pretty sure there have been experiments involving infecting such animals with viruses done.

        Also, if all viruses needed bacterial aid to function, then broad-spectrum antibiotics would be useful to treat or prevent viral infections, but they’re not.

    • anonymousskimmer says:

      He needs to explain how coronavirus is limited to entering the cells of a limited number of mammalian species, while also being able to enter a bacterial intermediate host.

      We understand the structure: https://newsroom.uw.edu/story/electron-microscopy-unveils-structure-coronaviruses-use-enter-cells

      We know the genome.

      Find something in either the structure or genome that allows entry (and presumably maintenance, if not replication itself) in two wildly distinct cell types.

      How would these bacteria spread the virus without replicating them? If they couldn’t replicate in the bacteria (and understand that the RNA sequences that allow RNA transcription and replication in bacteria are typically extremely different from those in eukaryotes) then the bacteria couldn’t spread them. Because without replication each division of the bacterial cell dilutes out the non-replicating virus.

      If somehow the virus integrated itself into the bacterial genome to replicate (became a lysogen), you’d still need to explain how it splices itself out of the genome, expresses all of its capsid proteins, generates RNA of itself to package into those capsid proteins, and exits the cell.

      There’s a far greater likelihood (IMO, not having read any of his data) in all of his data that close contact is spreading both a virus and a bacteria simultaneously, than that the bacteria itself is transporting the virus between hosts.

      An extraordinarily easy test of his hypothesis would be to culture the bacteria in a lab (1. if it can be cultured in the lab, and 2. presuming it has been identified), inoculate its culture with the virus, and periodically serially dilute the culture and perform RT-qPCR to see if the virus is replicating. Note that if you perform his chosen experiment you have a good shot of picking up non-maintained and non-replicated virus that survives the initial dilution into culture media. This is why you need quantitative RT-PCR, to demonstrate that the virus is indeed increasing in number, and not that some of it merely carried over.

    • Cheese says:

      Beyond ridiculous.

      We know the molecular structure of viruses. We can culture viruses. We can facilitate the building of viruses.

      I would put this bloke in the same category as flat earthers, young earth creationists and HIV->AIDS deniers you occasionally find working away in a lab somewhere.

    • Radu Floricica says:

      I’m pretty sure half the countries have researchers and “researchers” looking for it. In Romania “Polidin” got a lot of press, although I haven’t seen a single person to take it seriously. Oh, now that I look at it they’re actually squashing it. Good. (you’ll need to translate to english).
      We also have a research institute testing a vaccine – on that one I reserve judgement not being able to understand, though I am mostly skeptic.

      Point is, it’s pretty normal for all sort of attempts to pop up. The way they’re being dealt with is pretty ok: promising ones rise to the top, less likely ones are left to do their thing but mostly ignored, stupid ones are debunked, obvious crackpot and potentially harmful ones are squashed. (What we have here is closest thing to a martial law, and it allows shutting down sites. I approve.).

  18. Egregious says:

    So theres this facebook group of physicists sharing data analysis related to the virus and it’s spread. Could be of interest to people here, very heavy on graph fitting, possibly could use a more rationalist influence if anyone here has anything to contribute

    • Radu Floricica says:

      Yeap, been on it for a few days, it’s good. Most statistical talk goes over my head unfortunately, but there are probably people here that could read and possibly contribute. Also I think it started in italy because there’s a lot of italian there, but that seems to change.

  19. tmk18 says:

    Could the mystery of Japan be explained by Robin Hanson’s it’s the dose, dummy-theory? Maybe the usual mask-wearing in Japan caused everyone to only receive a very small dose of the virus so that everyone is mostly asymptomatic. This also kind of fits with the big outbreak in South Korea which came from a weird cult that had everyone in unusually close contact, which might have led to very large virus doses.

    Re: the results from Iceland, the results are only valid if the test has a very low false negative rate. I saw some reports that especially for mild cases, the false negative rate is relatively high.

    • Radu Floricica says:

      I was talking to a friend in Spain this morning about cultural differences adding up. We have an expression in Romanian: “las’ ca merge si asa” – hard to translate, but maybe “don’t bother, it’s ok like this”.

      He was telling me about a retirement home there absolutely ignoring health concerns – cook not wearing a mask, food being recycled from one meal to another and so on. Notably, the story came from a friend of a friend, not the news. I commented that the problem in “latin” countries is that such stories don’t really make the news, because they’re not that news-worthy.

      The difference might not be that asians wear masks, or that they bow instead of shaking hands, or god forbid embrace or kiss italian-style. It could be ALL of this together, plus a thousand small habits like making sure cooks take hygiene seriously.

      So roughly ranking cultures you could say that we expect asians to do best, then germanic countries, then anglo-saxons, then latins, then… I have no idea how seriously cultures in other countries take food hygiene.

  20. Johnny4 says:

    Does anyone have thoughts on the reliability of the information in this video?

    Some of it didn’t accord with my take on things, but overall I thought it was quite good and if it’s reliable it’s got lots of news you can use.

  21. Jaskologist says:

    I wish people would stop treating China’s numbers as if they’re honest.

    • Kaitian says:

      What would you like people to do? Ignore China’s numbers? Multiply them by 100? Use them, but write “OR MAYBE NOT” after each sentence?

      China’s numbers are reasonably in line with what other countries report, and the WHO says they’re accurate. So why trust them less than numbers from well known centers of freedom and democracy like Iran and Singapore?

      • Tarpitz says:

        I think Iran’s numbers are monumentally untrustworthy, as opposed to China’s, which are only somewhat untrustworthy.

      • and the WHO says they’re accurate.

        I have seen the following factual claim, but have not verified it:

        Early on, China claimed the disease was not contagious human to human. Taiwan claimed it was. Both claims were reported to WHO. WHO only passed on the Chinese claim, which we now know was false and was made by a government that, at that stage of the process, was actively trying to suppress public information about the disease.

        If that claim is true, it is a reason to heavily discount statements from WHO about China.

        • knzhou says:

          This is one of my least favorite narratives. In early January, Chinese scientists said that there was no evidence of human-to-human transmission. That is a completely different thing from claiming evidence of no human-to-human transmission. Moreover, this statement was made a few weeks into the outbreak, where the only evidence they had to go on was a few extra pneumonia cases showing up at hospitals, with most of the cases directly tied to the same market. So indeed, there was no evidence of human-to-human transmission at the time!

          So in these early days, China tells WHO “there’s something alarming going on here, but we don’t know what’s going on”. And WHO announces “there’s something alarming going on here, but we don’t know what’s going on”. And then a week later, as it’s clear the situation is getting worse, China does an incredibly visible massive lockdown and the WHO begins telling every country in the world to prepare for the worst. And of course the narrative that people take away from this is “WHO covered it up”, because in the end it doesn’t matter what happened, people will just believe whatever they already wanted to.

          • Is the Taiwan part of the story false — that Taiwan reported human to human transmission to WHO at a point when China had not and WHO ignored it?

          • knzhou says:

            That’s absolutely true, though their evidence was based on gossiping between doctors.

            But again, nobody has ever claimed evidence against human-to-human transmission. What is true is that in the early days, there wasn’t clear evidence for human-to-human transmission. That doesn’t mean that people in China were doing nothing, or advocating for doing nothing! Wuhan was very visibly locked down at 500 cases, despite huge uncertainty over what the virus was, where people had gotten it, how effectively it spread, how fatal it was, what the true case count was, all in the peak of a severe flu season that already was producing lots of unrelated pneumonia. And I mean, if you think the testing situation in the US is bad, they had to figure this all out while simultaneously identifying the virus and developing the first tests!

            We know all of these things much better today, yet NYC is not locked down even at nearly 25,000 cases. So whatever you think of the Chinese response, “cover up” isn’t the right phrase for it. By all measures, their response was faster and more visible than almost all Western countries’, even though the latter had the benefit of hindsight.

          • Douglas Knight says:

            To clarify “gossip,” Taiwan did not have any cases until after the WHO announced that it had human-to-human transmission. It had no direct information to pass on to the WHO.

            According to some sources, Taiwanese doctors talked to doctors in Wuhan and heard that the doctors were getting sick and concluded that it was human-to-human transmission. According to other sources, Taiwan merely asked WHO whether the disease had human-to-human transmission and it ignored the question, as they are not members. That’s a weaker claim, unless it was a leading question like “Is it true that medical workers are getting sick from this?”

            knzhou,

            The WHO statement on 14 January was more than just “no evidence.” It was “From the information that we have it is possible that there is limited human-to-human transmission, potentially among families, but it is very clear right now that we have no sustained human-to-human transmission.” Some sources claim that there were two statements on that day, the second worse, but I’m not sure which this one is.

          • DaveK says:

            How is New York not locked down?

          • Douglas Knight says:

            More specifically, an insomniac Taiwanese CDC official was browsing the Taiwanese equivalent of 4chan and found screenshots of various gossip, including the now famous “whistleblowers” Li Wenliang and Liu Wen. I don’t think either of them said anything about evidence of human-to-human transmission, only that this was a SARS-like coronavirus.

        • BBA says:

          The main lesson I’ve taken from the crisis is that WHO is an agency of the Chinese government and we can’t trust their statements on anything.

          All through Jan and Feb, WHO was saying “China has this under control and there’s nothing for anyone else to worry about.” This was parroted by every other source, left and right, with maybe some additional anti-racism sheen on the left and some fretting about the economic effects of overreacting on the right. Everyone deferred to the “experts”, myself included, but the experts were a bunch of liars.

          • AlesZiegler says:

            WHO declared coronavirus to be a global emergency on 31 January. And China does indeed appear to have it largely under control.

          • matthewravery says:

            Can you provide some links? I don’t recall that being the story anywhere. Perhaps I just wasn’t reading anything from WHO, though.

        • mfm32 says:

          The WHO has been heavily pro-China throughout this entire crisis. Perhaps the most obvious example us continuing to use the ~3% fatality rate that China experienced even when all the evidence pointed to a lower number (how much lower being very much open to debate). I’m not sure what they are quoting as the fatality rate now,

          There was an article / case report from the leader of the WHO delegation to China that was almost propaganda, including a demurral on the efficacy of traditional Chinese medicine in fighting the diseases. It was a really strange article I wish I could find again.

          Others have noticed as well (e.g. this article, which proposes an explanation that strikes me as a plausible).

          I would not trust statements by the WHO about China, the Chinese response, or even about features of the disease that might imply any level of mismanagement or incompetence in the Chinese response. As the article above indicates, the WHO has too much to lose by offending China, and China is notoriously prone to offense and to drastic response to offense on topics like this. \

          Once we are all out of the woods, there ought to be an evaluation of the Chinese government’s culpability in this crisis. The current praise they are receiving for their willingness to shut down cities ignore the self-interested suppression and misinformation campaigns they perpetrated in earlier stages of the outbreak.

      • Jaskologist says:

        Sometimes you just have to accept that you don’t have data.

        Here’s a senior WHO official commenting on how Taiwan is handling COVID. Do you find him trustworthy?

        This post starts with blind acceptance of a lie. Why trust the rest of it?

      • Alkatyn says:

        There’s been some attempts to more accurately estimate numbers, like this one done by locals in Wuhan using cremation numbers which gives a number of 46,800 vs the official number of 2,500. Obviously we can’t tell how many of the excess deaths were directly due to coronavirus, vs side effects of health system strain and the shutdown, but it’s illustrative

    • Jon S says:

      It would be pretty hard for them to be the wrong order of magnitude anyway – covering up exponential growth doesn’t work for very long.

      • albatross11 says:

        Yeah. If they have 2x the claimed cases today and 4x in a week and 8x in two weeks and so on, it’s not too many weeks until the piles of bodies make it impossible to continue the lie.

        • Matt M says:

          Why couldn’t they just hide the bodies?

          Didn’t they recently expel all western journalists?

          Aren’t we still unsure as to whether or not they’re keeping several million Uighurs in camps, despite having been speculating and looking into it for years?

          • knzhou says:

            Well, you don’t have to ask only journalists. You could ask anybody you know who lives in China, where it’s pretty obvious that the situation was bad in February and better now. I mean, you do know people living there, right? It’s not Mars, it’s a big country with about 1/6 of all the people in the world.

          • albatross11 says:

            +1

            China is a repressive state, but it’s not North Korea. There are tons of Chinese people in contact with friends and relatives around the world all the time. If there were piles of people dying of pneumonia everywhere in China, there’s no way it wouldn’t be widely known by now.

          • solresol says:

            Well, you could always report just under 4000 deaths, but mysteriously have 45,000 funeral urns for people to collect.

            http://www.asianews.it/news-en/Wuhan,-endless-queues-for-ashes-of-coronavirus-dead-cast-doubts-on-numbers-49673.html

            The CCP propaganda will probably be that they had the situation in Wuhan completely under control in March, but then those foreigners came in, along with Chinese citizens returning from overseas. And since all those other countries didn’t have the virus under control (not like China where the CCP has everything under control — perfectly under control), there was a deluge of people coming back to China, and they happened to bring the virus with them again. And y’know it’s all the fault of other countries as to why the death rate in China suddenly spiked up again after April 8th.

            And sadly, the WHO will probably repeat that as if it were well-established fact, because no doctor in Wuhan will be willing to publicly admit that they were given quotas of cases that they were allowed to report.

          • Matt M says:

            There are tons of Chinese people in contact with friends and relatives around the world all the time. If there were piles of people dying of pneumonia everywhere in China, there’s no way it wouldn’t be widely known by now.

            But how does this actually play out?

            Say I have a good friend in China. He messages me saying there are bodies everywhere and the CCP is lying and covering it up.

            So great, I go on Twitter or whatever and say “My friend in China says it’s all a massive coverup.” Everyone ignores me. Or demands evidence.

            Absent very solid evidence, the collection of which probably would automatically make my friend considered a dissident (as well as technically a journalist) and put their own life and freedom in great danger, it will be treated (accurately!) as simple rumormongering and conspiracy theorizing, will it not?

            Think about what kind of evidence it would take to make the WHO adopt an official public position of “China is lying and none of its numbers can be trusted.” Then explain to me a plausible mechanism of how that evidence gets collected and spread.

            As I said, we haven’t really been able to achieve that even with the Uighur situation and that’s been going on for years…

          • DaveK says:

            In a country Like China, photos and videos and the sheer volume of people talking about it would make it clear.

          • anonymousskimmer says:

            How do they share those photos and videos? Social media is curated by the central government. And while the central government is willing to let media contradicting local government remain up (as this allows the central government to swoop in and act like the corruption police it claims to be), it is not willing to let media contradicting the central government remain up.

          • Spookykou says:

            I live in China, I have notice no change in anything since Jan 25th when my campus was placed on quarantine to today.

          • John Schilling says:

            How do they share those photos and videos?

            Some of them directly call, text, or email their friends and family outside of China. This would be much harder to “curate” than social media, and Chinese government efforts along those lines are AFIK far from pervasive. They can prevent the collection and dissemation of accurate statistics, but they cannot conceal megadeaths or anything close to it.

    • inhibition-stabilized says:

      I was also somewhat skeptical of China’s numbers, but their actions–reopening movie theaters, closing borders to travelers from elsewhere–fit with their reported lack of new cases. So even if the total number of cases they’ve reported is off, I think we can be reasonably confident that they’re telling the truth when they say that they have few or no new cases.

      • Matt M says:

        Either that or they just switched to “herd immunity” strategy and decided the economic shutdowns weren’t worth it, and are no longer testing and covering up COVID-related deaths.

        I don’t trust the numbers coming out of China, Russia, Iran at all. I don’t trust the numbers coming out of slightly less corrupt countries (Singapore, Mexico) very much either. And the stats coming out of the western world may be reported in good faith but aren’t necessarily reported on the same basis, which makes it difficult to compare across jurisdictions.

        • Slightly less corrupt? Singapore is one of the least corrupt governments in the world, rated 4th equal in a widely accepted index (https://en.wikipedia.org/wiki/Corruption_Perceptions_Index)

          • Matt M says:

            Sorry, I probably should have said something like “authoritarian” rather than “corrupt.”

        • nupi says:

          Way too many Westerners in Singapore who won’t shut up for a monumental cover up of exponential growth. It is difficult to appreciate how well run their government is if you have never lived there.

          Finally, while not everything is perfect, corruption is not the word to use for the system they run.

          Disclaimer: Lived there in the beginning of the last decade.

      • denverarc says:

        They just shut their movies theatres etc again.

        What I suspect China is doing is

        1) Claim that they had eradicated corona domestically

        2) Relax the lockdown

        3) Blame all the new cases on foreigners coming back into China

        4) Locking down again, PR battle largely won for the party

        There isn’t much point restarting the manufacturing economy for one individual nation anywhere, these massive supply lines mean economies only restart when all of them can restart. If Trump has his way and the US carries on making things, they US will run out of parts in about a month anyway. If China starts making parts for the west again, they’d have nowhere to send them to and so on.

        • solresol says:

          You left out on important step:

          5) Make the official line that the virus originated in the USA, repeat it a lot in all media until everyone starts repeating it. Then make sure that that is taught in all history and medical books.

    • The Nybbler says:

      I wish people would stop trusting _any_ number of cases. No country, with the possible exceptions of China (if you believe them), South Korea, and Iceland, has done enough testing to determine the extent of the epidemic. This means that the confirmed-case numbers are wrong and more importantly, that changes in the confirmed-case numbers are almost entirely artifacts of testing changes. Which means that you can’t validly model anything from them.

      • Statismagician says:

        I just want to give this a gigantic plus-1,000 from an epidemiological perspective. We don’t know what’s going on, and we know we don’t know what’s going on, and my colleagues and I wish you’d all stop trying to forecast from known-awful data.

      • AlesZiegler says:

        +1

    • Brett says:

      They wouldn’t be easing up the lock-down if it was really out of control over there, but a bunch of the long-time China hands (such as James Palmer) believe that the reported death numbers in Wuhan are probably a lot lower than the actual numbers.

  22. herbert herberson says:

    So, for something like this, smoking weed (and other drugs, too, I suppose, although I don’t expect the meth and crack smokers to care) probably isn’t a lot better than smoking cigarettes, right?

    The fact that there is lower total smoke inhaled is a point in pot’s favor, but I’m guessing that the difference in inflammatory effects that make marijuana so much less carcinogenic than tobacco probably isn’t as relevant here (or possibly even a point against pot, given the recommendations we’re getting to avoid anti-inflaminatory NSAIDs?).

    Anyone have some back of the envelope thoughts?

    • Thomas Jorgensen says:

      … yhea, eat your weed. Seriously, there is no reason to ever ingest cannabis in smoke form, get baked from baked goods.

      • Le Maistre Chat says:

        But don’t eat your Weedies for breakfast.
        Unless you’re out of work and not driving somewhere authorized to stay open. Then I guess it’s OK.

      • gph says:

        >Seriously, there is no reason to ever ingest cannabis in smoke form, get baked from baked goods.

        Faster come on, easier to judge your high and determine if you want more. Might not be good enough reasons, but definitely reasons.

    • saprmarks says:

      I’m not sure this is true. After a brief glance at the literature, it seems to my non-professional eyes that everyone agrees there are theoretical reasons to believe smoking pot is bad for lung function, but that this relationship hasn’t played out in the data. For example, this study (summary, paper) did not find that pot smokers had decreased lung function (in fact, it found improved lung function for the first 10 years of pot smoking, but that’s probably an artifact).

      I encourage others to take a look at well, but first a word of caution: be really on your toes for non-good-faith reporting when you try to look into this. There’s a lot of it and it makes this really frustrating to actually look into.

      • anonymousskimmer says:

        (in fact, it found improved lung function for the first 10 years of pot smoking, but that’s probably an artifact).

        As a lay person this seems plausible in that pot smoking would encourage both deep breaths, and holding the deep breath for an extended period of time. Both lung exercises that could increase capacity.

        • Ketil says:

          Pure speculation, but there’s some evidence that a little radiation might lower cancer risk. Come to think of it, there are alleged benefits from low alcohol consumption as well. Maybe inhaling a little smoke (one joint per day, say) is beneficial in that it, er, exercises your defensive systems or something, but still allowing damages to be repaired?

          • herbert herberson says:

            For most of human history we were probably inhaling a lot more smoke than a contemporary non-smoker does right now (campfires), so I suppose it’s possible the respiratory system is somehow calibrated to expect it.

    • AlexSpark says:

      The average cigarette smoker smokes 10 cigarettes a day.

      I can’t find easy data for weed smoking, but 10 joints a day would, anecdotally, be incredibly heavy use. Even daily users often just smoke a joint or two a day.

      If the effects are at all dose dependent, then you’d expect the average weed smoker to look much healthier than the average cigarette smoker.

  23. Matt M says:

    The best argument I’ve heard in favor of vast economic shutdowns goes something like “Look, I appreciate your concern that vast economic shutdowns will do a lot of damage, but in their absence, what will happen is that 50% or more of the country will get this illness, mostly all at once. And although death rates are low, it’s still a very serious thing that could cause hospitalizations, and pretty much everyone who gets it and knows they have it will have to miss work anyway to avoid spreading it. If half the country is seriously ill, most businesses will not be able to operate in such an environment anyway, which would look an awful lot like… an economic shutdown. So the choice isn’t really between “mass illness OR economic shutdown” but rather is between “mass illness AND economic shutdown or economic shutdown without mass illness” and in that case, the latter is obviously better than the former.”

    As someone seriously concerned with the effects of economic shutdowns, I am interested in testing this logic. And I feel like we should be able to! Consider that right now, society has two main groups of people: the essential employees, and everyone else. The essentials are still out there in society, driving trucks, stocking grocery shelves, delivering your amazon packages, collecting garbage, etc. Their jobs are made somewhat safer by the rest of us staying home, and they’re all seemingly engaging in some sort of efforts to help promote health/cleanliness. That said, these people should still be at much greater risk of catching COVID than the normies, who are all staying home, except for the occasional grocery store trip (if there is a direct correlation between “time spent in grocery store” and “likelihood of catching COVID,” then the guy who works there 40 hours a week would seem to be at a hell of a lot more risk than me, who is there for ~1 hour a week).

    Should we not be able to track and monitor this? Can we keep track of the infection rate among essential employees and compare it to the non-essentials? Would this not provide evidence as to whether “social distancing” really works, and whether the “if people keep working, they’ll get sick and then have to stop working anyway” prediction is true? If that prediction is true, do I need to worry that my amazon deliveries and garbage removal services are precarious and could stop fairly soon, because all of those employees are going to get sick and be removed from the labor force?

    • AlesZiegler says:

      I doubt that delivery service drivers and employees of “essential” stores (grocery, pharmacy etc.) work in an environment conducive to the spread of the disease. Office work is probably much higher risk, but can be usually done remotely. Healthcare workers seem like main group of essential employees at risk of contracting the disease.

      • Edward Scizorhands says:

        I’ve heard pretty bad stories about the internals of shipping companies. Not the drivers, but the package handlers often work shoulder-to-shoulder and have a macho culture that hates the use of masks.

        https://www.nytimes.com/2020/03/21/business/coronavirus-ups-fedex-xpo-workers.html

      • Matt M says:

        The most relevant comparison might not be office work, but non-essential service-industry work.

        As in, do waiters at restaurants, or salesmen at car dealerships, or checkout clerks at clothing stores, etc. really possess a different risk profile than checkout clerks at grocery stores do?

        If you’re telling a small restaurant owner that the government forcing the closure of his business isn’t actually a big deal, because even if they didn’t, eventually all of his employees would be sick and he’d have to close anyway… and we eventually see a bunch of businesses with similar risk profiles stay open and not have that happen, it would expose that story/logic as a lie, would it not?

        If Kroger can stay open indefinitely and not have waves of employee absenteeism due to illness, why couldn’t any other similar business?

        • AlesZiegler says:

          As in, do waiters at restaurants, or salesmen at car dealerships, or checkout clerks at clothing stores, etc. really possess a different risk profile than checkout clerks at grocery stores do?

          They don´t. But if a risk associated with those professions is low in both cases, we should not expect to see a difference in outcomes.

          If you’re telling a small restaurant owner that the government forcing the closure of his business isn’t actually a big deal, because even if they didn’t, eventually all of his employees would be sick and he’d have to close anyway…

          Does anyone really tell them that? Because that is a pretty stupid logic. Good reason for closing “nonessential” business is that it reduces a spread of the virus. But obviously it has adverse economic consequences on business owners, that would not happen if they would be allowed to remain open.

          • Matt M says:

            Does anyone really tell them that?

            I am not a business owner, but I have encountered that argument extensively, on social media, and I think here on SSC (although I don’t have a link ready to cite).

          • AlesZiegler says:

            @Matt M

            Yeah, well, it is a stupid argument, like many things you encounter on social media

          • Matt M says:

            I don’t think it’s stupid at all. It’s the only argument I’ve encountered that, if true (and I concede this is a big if) presents a clear and obviously correct decision, that isn’t just a matter of opposing subjective values and preferences.

            Now you can believe it’s clearly untrue if you want, but a whole lot of people clearly don’t believe that.

          • matthewravery says:

            Think about it like this: If the people shopping at Kroger have been self-quarantining (aside from their trip to Kroger), they’re less likely to get infected and spread the disease to the Kroger employees than if they’d been working in a busy office, living with kids who just did a full day at school, etc.

            So by reducing the likelihood that Kroger customers have the disease, you make it less likely that those customers transmit the disease to the Kroger employees.

        • anonymousskimmer says:

          If Kroger can stay open indefinitely and not have waves of employee absenteeism due to illness, why couldn’t any other similar business?

          If no one goes in, no one can spread the disease to another. If only one person goes in, no one can spread the disease to another. It two people go in the odds of disease spread slightly increase. Etcetera.

          Likewise if one business is open, there is only one avenue for disease transmission. If two businesses are open….

          So which do you want open? Kroger which can serve the entire community, or the restaurant with its limited capacity?

        • Hoopdawg says:

          even if they didn’t, eventually all of his employees would be sick and he’d have to close anyway

          That’s not the point. The point is that eventually no customer would come and he’d have to close anyway. People who go shopping do so because they literally can’t subsist without shopping, which is simply not true about eating at a restaurant. They also take precautions and observe strict conduct norms while doing so (wearing masks, keeping 1.5 m away from another human being) which would make eating at a restaurant impossible even if they didn’t just avoid the place altogether.

          You are assuming a world where people would not react to the news of massive deadly epidemic and just mechanically live their regular lives until they get infected and hospitalized (or rather not hospitalized, because by that point the hospitals are long full). We are not living in such world, other people are human beings with human motivations, and would quickly start to self-isolate once they realized the severity of the problem.
          The trouble is, for a significant segment of the population this would mean the moment when hospitals are already overcrowded and dead bodies start piling up, at which point it’s already too late to contain the epidemic. Thus, it’s still better to act ahead of them and try to minimize the body count.

          • gudamor says:

            You are assuming a world where people would not react to the news of massive deadly epidemic and just mechanically live their regular lives until they get infected and hospitalized (or rather not hospitalized, because by that point the hospitals are long full). We are not living in such world, other people are human beings with human motivations, and would quickly start to self-isolate once they realized the severity of the problem.

            Do you have any data for this claim?

          • HeelBearCub says:

            The NBA, the NCAA, and LiveNation all shut down before there was any mandate to do so. Once it became apparent that Italy was horrific and an NBA player had the infection, it become blindingly obvious that continuing that economic activity wasn’t preferred. That’s pretty strong evidence that people do, in fact, respond to the threat of pandemic without being forced.

          • Mark Atwood says:

            A bunch of events had to wait until they were technically “forced” by government decree, so they could get their deposits back from the venues. Just “not doing it this year” would destroy the org, which means “no event this year, or any year after”. Also, many smaller events are LLC or S instead of C or c6, which have a lot less protection for the organizers, which means they were often *personally* financially liable.

            So, there is “forced”, and there there is “”forced””.

    • unreliabletags says:

      The economic argument is that we certainly cannot afford to stay home until we’re all vaccinated (18-24 months). And it might be the case that releasing the lockdown before then yields the same devastation as no lockdown at all. So it’s going to hit us just as hard no matter what, the only question is how much economic damage we’re going to inflict on ourselves before it does.

      Whether it’s possible to have a sustainable recovery in the absence of a vaccine is unknown, and being tested in China right now. If it works, then there’s still the question of whether the US could actually implement the measures necessary to achieve it.

    • keaswaran says:

      “Can we keep track of the infection rate among essential employees and compare it to the non-essentials? Would this not provide evidence as to whether “social distancing” really works, and whether the “if people keep working, they’ll get sick and then have to stop working anyway” prediction is true?”

      I don’t think it works like that. The infection rate of people working at cash registers depends on the infection rate among the people coming to visit those cash registers. If the people visiting the cash registers have lost most of their possible routes of infection, then they’re much less likely to bring viruses to the cash registers.

      That is, social distancing of office workers and retail clerks protects not just the office workers and retail clerks, but also the grocery store clerks that are still working. Just as flu vaccination of school children can protect senior citizens, even if the senior citizens themselves never get vaccinated.

      So you can’t do the counterfactual and say “if no one had been vaccinated we would all have the infection rate of unvaccinated people in a partially vaccinated society”, or “if no one had socially distanced we would all have the infection rate of non-distancing people in a partially socially distanced society”.

      • albatross11 says:

        I think you could get some interesting information from this kind of testing on how much impact the current social-distancing measures were having, though. In an ideal world, we’d take a bunch of still-open businesses across the country, and randomize them into different regimes of preventing infection.

        In group A, every high-touch surface is disinfected once an hour while people are at work, and everyone uses hand sanitizer every time they enter or leave a room. In group B, everyone wears an N95 mask, every office has a commercial HEPA filter going all the time, and the HVAC system is turned up to max out the air changes/hour in each room and the amount of air pulled in from outside. In group C, nobody is ever allowed to get within 2 meters of another person. In group D, we don’t do any of those things, but we do a fever check of every employee every day and send anyone with so much as a sniffle or cough home.

  24. steve3920 says:

    A key question I’ve been trying to sort out: How do people actually catch COVID-19?? Based largely on this article, my current very-low-confidence belief, in decreasing order of importance:

    * Top transmission risk: Being near (2 meters outdoors, farther indoors) someone coughing … or talking! Talking emits droplets / aerosols too. Is that the key to the pre-symptomatic transmission we know is happening? Wild idea: Maybe some spoken languages create more droplets and aerosols than others, causing country-to-country differences. Any linguists here? And/or maybe some cultures have closer face-to-face talking than others. Any anthropologists here? This factor would also suggest that universal masks are very important, and goggles may be wise too, along with physical distancing.

    * Second transmission risk: Air in or around public restrooms. (Or people farting elsewhere.) Apparently a SARS carrier with diarrhea was a super-spreader, infecting people 200 meters away!! That same link also discusses evidence that COVID-19 virus is found around bathrooms.

    * Last and least transmission risk: Touching contaminated surfaces then my face. While I am ranking this at the bottom, it could still be important, and I continue to take precautions around it, like literally not touching my face for the past month. Both the CDC and that article I linked at the top say that we should rank this risk at the bottom (and yes I have noticed the obvious contradiction with public health messaging), albeit with low confidence, and the Serious Eats guide heavily emphasizes the CDC’s belief that physical contact-based transmission is unimportant to justify the safety of takeout (although the article makes other arguments too). I am sufficiently convinced to get non-contact delivery from restaurants I trust to have generous sick leave policies, while transferring it out of the original packaging and not sticking food up my nose. 🙂 I do still think it’s a nonzero risk, but low enough to be worth it.

    Again, all this is very low confidence. I’m interested in other people’s thoughts.

    • mcpalenik says:

      Talking emits droplets / aerosols too. Is that the key to the pre-symptomatic transmission we know is happening? Wild idea: Maybe some spoken languages create more droplets and aerosols than others, causing country-to-country differences. Any linguists here? And/or maybe some cultures have closer face-to-face talking than others. Any anthropologists here? This factor would also suggest that universal masks are very important, and goggles may be wise too, along with physical distancing.

      One of my friends at the NIH helped make this video, which partially addresses your question about different languages:
      https://www.youtube.com/watch?v=qzARpgx8cvE

    • Ghillie Dhu says:

      Touching contaminated surfaces then my face

      OT bit of levity; I momentarily misread your “then” as “with”.

    • Humbert McHumbert says:

      I’m really confused about your first link. Literally everything else I’ve read about how it spreads says that aerosol transmission only happens in hospital contexts when someone is getting intubated or similar, and that spread primarily happens through droplets that fall to the ground rapidly within 6 feet. This UMN article, on the other hand, suggests that transmission typically happens due to small particles that don’t fall to the ground rapidly… but that this transmission is “short ranged,” only within 6 feet. But then the illustrations suggest that small particles become long-ranged after a while. WTF?

      • steve3920 says:

        Humbert—My understanding is that as the size of a droplet gets smaller and smaller, it (1) gradually stops being called “droplet” and starts being called “aerosol”, (2) stays aloft longer and travels farther, (3) becomes more likely to be inhaled, as opposed to landing in the eyes, nose, or mouth. The stereotypical aerosol transmission, e.g. measles, is all the way at the extreme of all three of these: tiny droplets that stay airborne a really long time and travel really far and are inhaled. The stereotypical droplet transmission is all the way at the opposite extreme: giant droplets that fall to the ground immediately and are not inhaled. Dr. Brosseau is proposing that it’s in between: big enough to fall to the ground pretty quickly, but small enough to be inhaled.

        You say “aerosol transmission only happens in hospital contexts”, and I think that’s right, as long as we clarify that we’re talking about what I am calling here stereotypical aerosol transmission. Here’s an example like that; they rule out stereotypical aerosol transmission because of the “pattern in who’s getting infected”, among other things (close contacts, not long range).

        Then we get to the dumb and annoying question: If this in-between case is what’s happening, what terminology do we use to describe that? CDC and WHO call it “inhaled droplets”, but Brosseau thinks the proper term is “short-range aerosols”. I don’t know who’s right, and don’t care. I think Brosseau is being annoyingly pedantic in dwelling on that.

    • SolipsisticUtilitarian says:

      The SARS super-spreader was in a context of faulty plumbing in that particular apartment complex, and was the only recorded case of fecal transmission for SARS. AFAIK, there have been no recorded fecal transmissions for Covid-19.
      I would rate that risk as lower than transmission through hand-face contact.

    • Abstract

      Mechanistic hypotheses about airborne infectious disease transmission have traditionally emphasized the role of coughing and sneezing, which are dramatic expiratory events that yield both easily visible droplets and large quantities of particles too small to see by eye. Nonetheless, it has long been known that normal speech also yields large quantities of particles that are too small to see by eye, but are large enough to carry a variety of communicable respiratory pathogens. Here we show that the rate of particle emission during normal human speech is positively correlated with the loudness (amplitude) of vocalization, ranging from approximately 1 to 50 particles per second (0.06 to 3 particles per cm3) for low to high amplitudes, regardless of the language spoken (English, Spanish, Mandarin, or Arabic). Furthermore, a small fraction of individuals behaves as “speech superemitters,” consistently releasing an order of magnitude more particles than their peers. Our data demonstrate that the phenomenon of speech superemission cannot be fully explained either by the phonic structures or the amplitude of the speech. These results suggest that other unknown physiological factors, varying dramatically among individuals, could affect the probability of respiratory infectious disease transmission, and also help explain the existence of superspreaders who are disproportionately responsible for outbreaks of airborne infectious disease.

      https://www.nature.com/articles/s41598-019-38808-z

  25. [Thing] says:

    So now Robin Hanson’s pushing variolation—deliberate exposure to the virus in the smallest possible dose that would cause an immune response—since there is some evidence that patients whose initial exposure was to a small amount of virus fare better than those exposed to larger amounts. I still think that, whatever its substantive merits, deliberate exposure is a non-starter politically, in rich countries. But maybe governments of poor countries that more clearly lack any good alternatives would be more receptive to the idea?

    I suppose international public-health NGOs wouldn’t want their fingerprints on this sort of thing for the same political reasons that governments don’t, but maybe some autocrat could be convinced it’s their best option, and pull it off without the NGOs’ help. They might even come out ahead of the US in the end …

    Although one difficulty is the lack of equipment to treat those who do inevitably get seriously ill. Part of Hanson’s case for deliberate exposure was that it would be very effective at flattening the curve, but how much does that matter if you have .01% of the ICU capacity of a rich country?

    • Scott Alexander says:

      Thanks, that’s an important point and I’ve added it to the post.

    • Edward Scizorhands says:

      Deliberate infection is a strategy worth exploring, and people seem scared of even talking about it, like even mentioning it means putting a bullet directly in Granny’s skull.

      There are lots of reasons it might be wrong for a particular virus, including this one. But it should always be part of the package of ideas.

      • teageegeepea says:

        Deliberate infection always needs to be discussed as paired with ISOLATION. Even asymptomatic people can spread it, so the variolated should still be set apart from everyone else for a while. Otherwise it sounds like the “let ‘er rip” approach of just letting the virus spread.

        • Edward Scizorhands says:

          Oh, definitely. And always with volunteers who can consent.

          Putting young health 20-year-olds in a hotel and dosing them could give us blood with antibodies that are a potential treatment.

          At the other end, the elderly patients in Italy who lost out on triage and died could have been infected two or three months ago and gotten treatment from non-overwhelmed staff.

          (Or, when we bring up stuff like that, we could set up safe zones on some island, like Guam (that, again, volunteers for this effort in exchange for money). Ship at-risk-but-otherwise-healthy elderly patients there on a cruise ship*, doing health checks of everyone every day. Close its airports to anything besides cargo. It’s too late to do this one now, of course.)

          I don’t know where these risks fall. but we should consider them.

          * I saw somewhere that it takes two weeks to sail from California to Guam. I don’t know if that’s true, but the distance should be appropriate timed that we naturally catch any infections.

    • palimpsest says:

      I recall from somewhere that one of the reasons variolation worked as well as it did is that Smallpox has two strains, one of which (Variola Minor) is less deadly than the others. Doctors would take variolous material from a particularly mild case to use for variolation, and this helped because these cases were much more likely to be cases of Variola Minor. This is a reason to worry that it wouldn’t work as well for COVID-19.

    • Corey says:

      I’m sort of doing that, I think, with my half-assed approach to social distancing (as compared to what I read on here).

      I’m staying home, not getting close to anyone when I shop, washing hands, began wearing a mask when out etc. But I haven’t been sanitizing the groceries or takeout (and have been sanitizing packages).

      • Nornagest says:

        I’d be astonished if a significant fraction of people even in lockdown areas were sanitizing their packages, let alone their grocery items. You just happen to be hanging out on a forum full of hyperscrupulous nerds — many of whom want to be alpha nerd, incidentally, and might not be entirely honest about exactly how hyperscrupulous they are.

        • The Nybbler says:

          This sort of thing is all over facebook-for-normies, according to my wife. There’s even a video going around from some surgeon about how to open your packages without contaminating the inside.

          I’m going the opposite way and not doing much, other than washing my hands after opening packages. But then, I figure there’s a decent chance I’ve had it already.

          • albatross11 says:

            We sanitize stuff we buy from the store, to the extent we can, if we want to use it right away. Or we let it sit for three days, which (based on some experiments that have been published) seems to be enough for the virus to mostly die off on most surfaces. That works for most stuff we buy.

            Packages can be wiped off with a Chlorox wipe or a paper towel with bleach sanitizing solution[1]. Fruit and vegetables can at least be washed. (We did both last time I went to the grocery store.) But for nonperishables, we’re just letting things age out in a back corner of our living room, with a sign on them saying “don’t open till Friday” or whatever. That’s pretty minimal effort–mainly just thinking about it.

            For opening packages, after you open the box, just wipe off the table where you set the box to open it and throw away the box–nothing special needed.

            [1] A gallon of bleach plus a recipe from the bottle of bleach or available on the internet will make a huge amount of sanitizing solution (what you use on counters and tables and even dishes–it’s safe to eat off when it dries) or disinfecting solution (much stronger, but if you use it on your counter or table, you shouldn’t eat off it directly without wiping it off later with water.)

          • Edward Scizorhands says:

            I wonder how much of this is “people are stuck in place, looking for something to do: this is something to do” on the sanitizing-packages front. And keeping people busy is an important thing to do.

            I still encourage my parents to do it, since they are high-risk.

            I am (only slightly) suspicious that the current shift towards wearing masks is “this keeps people busy and makes them think they are helping, even though they aren’t.”

  26. Douglas Knight says:

    But other pandemics don’t require ventilators the same way as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages.

    WTF

    The flu does cause pneumonia and does require ventilators. Isn’t this just like the flu, only 10x worse? 10x the ICU, 10x the deaths? I don’t know, maybe the flu varies, but the 2009 Swine Flu pandemic (H1N1) definitely involved ventilation.

    • Tarpitz says:

      Right, but if the rate at which it requires ventilation is vastly higher (an order of magnitude? Two?) then that explains a pretty big difference in appropriate response.

      • Douglas Knight says:

        The number of ventilators is chosen for the annual flu season. This disease requires 10x as many per infection. But the pandemic flu plans weren’t about annual flu. They were about a crisis in which the flu would be 10x as deadly, or spread faster, or hit a larger proportion of the population, all of which would require more ventilators. Everyone else writing pandemic flu plans wrote about ventilators.

    • AlesZiegler says:

      A source for this claim in that reddit post is a New Statesman article, which indeed mentions that dealing with a flu pandemic does require a lot of ventilators, and that these plans were tested and failed due to lack of ventilators, but they were not revised despite their failures to pass through testing.

      • Douglas Knight says:

        So you agree with me that Scott’s passage and the Reddit comment it’s based are not a great explanation, but rather make no sense. It was already a bad plan for the flu, not a plan for the flu that failed to carry over.

        ———

        But your source is wrong to say that this was already pointed out in the 2016 failure. The public statement about “inadequate ventilation” refers not to ventilators, but to ordinary airflow in the ER and waiting room:

        If you don’t know you’ve got a new disease then you don’t isolate people. There was overcrowding in the emergency room, inadequate ventilation, family and friends going through.

  27. danjos says:

    The one part of your mask analysis you did not touch on is the effect of masks reducing spread from the infected. Your analysis covered the uninfected side only. It would seem the R0 spread would be reduced if everyone wore masks outside. The mask itself would catch a portion (some or most) of the aerosols produced from coughing or sneezing. This could explain much of the current data from the Asian countries. Culturally the Asian countries have all adopted mask wearing to a much larger extent then Western countries.

  28. sadtoot says:

    if anyone is looking to donate to organizations fighting COVID-19, consider Partners In Health. cases in developing countries are low, they have a brief window of opportunity to contain the virus. PIH may be one of the best organizations to respond because they have existing contacts with local healthcare systems and governments, so they will be able to act faster than a global organization like the WHO or red cross.

  29. SteveReilly says:

    If you live in a small city that isn’t locked down, is there some reason that going for a walk would be bad? Assuming you stay more than 6 feet from people at all times, that is.

    I’ve seen people posting pictures on Twitter with captions like, “What’s wrong with these people?” and it will show people at a beach or a park. But I’ll notice that the people are standing 6 ft or more apart, so I’m wondering why anything is wrong with them.

    • Tarpitz says:

      Similarly, I’ve seen a series of angry tweets from Derbyshire police complaining about people going for walks in the Peak District instead of near their house, but apart from whatever presumably quite small increase in risk derives from their need to fill up their cars more often, I don’t actually see the problem here. Walking in a remote rural area seems probably better for public health than in the local park.

    • denverarc says:

      I think the idea is you limit the possibility of injury generally.

      If lots of people go for a walk in the countryside, some of them will twist ankles, fall or whatever. This takes resources away from already stretched health services. This is especially true with those wandering up mountains or in national parks who can also become lost or suffer from exposure.

      Same with going for a drive, there is a none zero chance of an accident. Small for each individual, no doubt but if large numbers of people engage in such activity accidents become a certainty.

    • Taymon A. Beal says:

      In most of the pictures that I saw, people didn’t seem to be consistently standing that far apart.

      • AlexSpark says:

        There’s stuff in the UK about it being okay to stand close as long as it’s a member of your own household, which makes some sense. If you’re going to be hugging at home, standing 6 feet apart in the park is just signalling.

        On the other hand, signalling can be important, so IDK.

    • bernie638 says:

      Just a guess:
      Tragedy of the commons? If there isn’t enough space for everyone who want to go out to stay 6 ft apart, as soon as people realize it’s acceptable, then it becomes overcrowded, and no longer acceptable?

      I live in a nominally locked down state, but they’ve kept the state parks open areas open, but closed the buildings, currently underutilized, but once word gets out, who is going to drive X min to go to the park, then turn around because they are exactly at capacity for people to stay six feet apart? If this needs to be enforced, X number of people total, then you need someone at the entrances, which is another person(s) becoming an exception to the “lock down” weakening to ability to sustain enforcement elsewhere.

  30. eucalculia says:

    Wouldn’t most takeaway food be perfectly fine (or indeed improved by) spending 10 minutes in then oven, which is surely enough to kill any virus?

    At least in the UK all the delivery services are doing no contact delivery, so it really does seem like it should be pretty safe (handle with care, etc.)

    • Conrad Honcho says:

      But I want sushi.

    • teageegeepea says:

      Irradiating food destroys viruses while still leaving it safe to eat.

    • 9-tsiak says:

      I’ve been ordering pizza, buying mcdonalds, etc.; then taking it directly to the oven, box/bag and all, for 30 minutes at 170 degrees. It doesn’t noticeably harm the flavor or texture, or even dry it out, since the packaging is closed.

      Just remember to wash your hands and the oven handle right after, and if you messed up and sat it down somewhere besides the oven, wash the surfaces it touched.

  31. Joshua Hedlund says:

    I am also concerned about the potential devastation on the Third World compounded by the lack of First World bandwidth to assist (compared to, say, Ebola). I barely have enough attention bandwidth to be concerned myself. Though there are a few possible reasons for optimism for poorer countries:

    – Fewer connections/travel/activity with the rest of the world compared to wealthier countries means the virus should generally take longer to reach outbreak levels, buying them more time.
    – Many poorer countries are in warmer climates, which *seems* to show some (not great, but some) evidence of having slower spreads
    – Many poorer countries, especially, in Africa have much younger average populations than wealthier countries (I suppose due to higher birth rates and probably because their older populations already died of a bunch of stuff that wealthier countries have delayed), which means the death tolls could also be markedly lower on average

    Some of these factors may be too handwavy or offset by other things or not rigorous enough to actually matter but I’m hoping they provides enough delays for the First World to get its act together and be in a position to assist developing countries before things get really catastrophic there.

  32. Michael Watts says:

    my having a lot of friends who work(ed) for Triplebyte was downstream of them being a great company doing important work which all my friends wanted to work for. I continue to generally respect them and their vision (see here for more), and you don’t need to give them any more grief

    But Triplebyte doesn’t operate on a vision of finding the right people and getting them into jobs. They’re very explicit that their model is to find people who are well-suited to pass job interviews at the companies they work with, and send those people for interviews — not to find people who are well-suited to perform in the jobs.

    After some harassment on Hacker News over this, they even changed their messaging to “we save you [the applicant] time by skipping stage one of a multi-stage application process”, replacing the earlier messaging of “if you can code, we’ll find you a job”.

    • Three Year Lurker says:

      Solving the goal alignment problem is extremely difficult, maybe impossible. The best we can hope for is something that looks a lot like a solution and works for a useful period.

      Job interviews are just another facet of the goal alignment problem in AGI. Intelligence Alice must work with another intelligence to accomplish some task. Alice must determine whether Bob is actually good at the task without investing the full resources and risk of carrying out the task. Bob meanwhile just needs to pass the test and gather resources during the task before abandoning it for his own goals.

      The problem is the same whether Alice is a corporation trying to hire someone, or a researcher creating an AGI. Triplebyte has merely admitted defeat in solving an uncomputable problem. After all, there is not a general solution for predicting (the test result is a prediction) the result of a computation (the task is a computation) without carrying out the computation.

      • Michael Watts says:

        Recruiters aren’t a new thing. Why is Triplebyte’s adjusted vision (“we send you the candidates you already wanted to hire”) more worthy of respect than any other recruiter? What are they adding to the world?

        Triplebyte has merely admitted defeat in solving an uncomputable problem.

        Not really; it’s not at all difficult to do a better job of cheaply predicting future job performance than companies currently do. Triplebyte has admitted defeat in the purely cultural problem of sounding trustworthy, not in the problem of psychometrics.

  33. Fishbreath says:

    The explanation I heard for the US’s position at or near the top of the world ventilator/critical care bed per capita leaderboards says it’s because of our largely-private health system. Competing health care systems want to attract customers, and do that by pouring money into the flashy, high-end systems so they can advertise that they’re better than your other choices on those grounds. On the other hand, nobody wants to be That Hospital System With A Lot of Beds and No Ventilators, so we come off poorly in the plain-old-hospital-bed reckoning.

    Germany, also high on the leaderboard, has a multi-payer, mandated-insurance health care system (or at least, that’s how the Wikipedia page seems to sum it up). Much of the rest of Europe, with, generally, fewer ventilators than Germany or the US, seems to lean more single-payer or single-provider.

    In the negatives column, I can’t recall ever seeing a hospital system advertise on the basis of ‘we have more critical care capacity than our competitors’.

    • Maxander says:

      In the U.S., if a hospital gets to put you on a ventilator, I’m sure they can levy a hefty fee from your insurance/copay. I don’t know how this compares to countries with sensible healthcare payment systems, but my impression is that a nationalized healthcare system shells out less for these kinds of procedures.

      A prediction from this line of reasoning is that, in non-pandemic times, rates of ventilation from the flu or similar should be much higher in the U.S. than single-payer/provider systems. (NB, a prediction; I don’t actually know if this is true.)

      • AlexSpark says:

        The doctor in the reddit comment linked above pointed out that in the UK, you don’t put a multiple-failure, frail, obviously end of life patient on a ventilator. All it’ll do is make them live an extra week or so in horrible pain.

        But in the US, you can charge their insurance/family thousands for that. It doesn’t benefit the patient, but if you ask a family “do you want us to do everything we can to keep her alive?” they’ll probably say yes.

        I think the stat you’d need to compare would be ICU survival rates. If the US rate is lower, then they might be putting end of life patients on there who should probably get palliative care.

  34. hnrq says:

    Is there any chance that COVID19 isn’t as bad as it looks? There are a lot of puzzling things about all of this. The Japan case really doesn’t make any sense.

    • Maxander says:

      Sure, there’s a chance. Like Scott mentioned, there is reason to believe that we’re underestimating the infection rate, which means that the relative rate of serious complications would be lower than it appears. For that matter, these tests only detect active infections – its possible that if we did a wide survey with antibody tests, which detect past infections (and immune status), we could discover that the virus has been quietly spreading for months prior to detection, causing low enough mortality to blend in with the flu, and that a high proportion of the population is already immune.

      Possible, but it would probably take some fine-tuning of various parameters, and we certainly shouldn’t count on such a best-case scenario.

      • sclmlw says:

        I worry that we’re reading some of the data wrong. We’re seeing an exponential increase in the number of positive test cases as we’re simultaneously exponentially increasing the amount of testing we’re doing. For example, we now have more confirmed cases in NY than all US tests performed (as reported by CDC) through March 13th. How can we know if there were more cases in February if we didn’t do the testing? What would a plateau/decrease/increase look like in the face of exponentially increasing testing?

        For example, say a hospital gets 40 tests to do one day, but then 50 the next. They get 4 positive tests back the first day, but 5 the second. By the end of the week they’re doing 80 tests, with 8 positive results and it looks like a 4-day doubling. But that doubling is an artifact of the increasing amount of testing being done, not representative of actual exponential growth.

        I’m not saying that simple scenario is what’s happening. I’m saying based on the data I’ve seen the raw numbers is the only thing being considered publicly as evidence that we’re currently within exponential growth, so I have no idea what’s actually happening with the real rate of growth. I ask, “are we in exponential growth?” and people point to the simple number of cases and say, “of course, look at the data!” I have, and I still can’t tell whether we’re in exponential growth.

        Does anyone have better data on this?

        • HeelBearCub says:

          Look at deaths by Covid-19. The number of deaths are much less responsive to simply increasing testing, as the first tests were already being done on the severely ill. These are still showing the kinds of exponential growth that shows that community transmission is ongoing.

          They are, of course, a lagging indicator, showing the progression of the infections about two weeks ago.

          You can go back and look at previous posts by Drum to see the daily progress.

          • sclmlw says:

            This is great, thanks! I’ve heard talk that attribution is a little weird in a few cases for cause of death, but I’d think that’s a consistent issue across time and should affect measurement on all dates equally. I suspect if we’re still seeing a daily rate increase we haven’t hit the inflection point yet. (although the article you link to provides cumulative numbers, I was able to calculate a daily rate of deaths and see that it’s still going up day-to-day from the raw numbers the article links to)

          • bernie638 says:

            True, but…Before testing, some of these deaths would have been coded as flu, or pneumonia, or something else (remember, a lot of the fatalities are older people/people with other complications). As you do more testing, you “see” more deaths due to the virus.

            i.e. no one would think it was unusual if the doctor said that the 89 year old grandmother died of pneumonia.

          • HeelBearCub says:

            Sure, “less responsive to more testing” is not the same thing as “not responsive to more testing”. There is some slop in these numbers.

            But Italy’s number show us that deaths do grow exponentially, and the other countries curves mirror Italy’s, so we have pretty strong evidence that the death numbers are in the right ballpark. You don’t get many cycles of doubling by missing earlier deaths.

          • sclmlw says:

            @bernie638 – Good point. In a country of 330 million people, it would be difficult to catch a trend of a couple dozen deaths a day due to one cause versus another spread across thousands of miles of countryside.

            @HeelBearCub – I also wonder whether we’re reading too much into Italy’s numbers. I see a LOT of talk that amounts to, “Italy says you’re next – watch out!” But then the more I hear about what’s going on there, the more I suspect they’re uniquely bad, and we’re learning too much from their experience that’s not generalizable – including the severity. Italy had lower health care capacity, it happened in one particularly region, etc.

            I start to wonder how much selection bias is going on when one or two particularly bad examples keep getting pushed out there, out of a possible global pool. I really start getting suspicious when any good examples of non-problematic areas keep getting dismissed, or each gets its own explanation of why it was okay that they did nothing, but the same thing won’t work elsewhere. I don’t KNOW anything (and I’m not saying we should do nothing); the situation is evolving too quickly. But I’m concerned we’re leaning so heavily on a very small n.

          • HeelBearCub says:

            @sclmlw:
            Again, go look at those charts.

            All those western democracies are following similar growth curves. A little more here, a little less there. There is no reason to think that Italy is an outlier at this point. Every place in the west that is far enough along in the outbreak is basically following the same curve. And that’s with the benefit of seeing Italy ramp up and therefore reacting earlier.

            Pointing at some country that isn’t as far along time wise in the outbreak and saying that their low deaths are at odds with Italy makes zero sense.

            We already know that NYC, Michigan, Illinois, and New Orleans are struggling to cope with the case load they are seeing. This is all in line with what we expect.

            You can point at S. Korea and other Asian countries, but they all had significant experience with SARS already. This is literally SARS-Cov-2. They’ve been running things differently, with mass testing ready to go, contact tracing, quarantine, etc. Maybe Japan is a puzzle, but that’s about it.

          • sclmlw says:

            @HeelBearCub

            I understand your point about the growth curves, and certainly the US has some states are seeing significant challenges. There are still some puzzles about why other states/cities aren’t worse off, but maybe they’re just behind the curve. No reason to write off the standard narrative about that just yet.

            I’m guess I’m not as willing to accept the idea that China and South Korea got this under control using contact tracing and quarantine.

            Especially the contact tracing point. That’s a method that could work to contain the spread of a disease in a maximum of a few hundred cases with a massive early effort in an isolated population. Yet people keep talking like it’s a silver bullet that can effect containment at the level of thousands of cases (South Korea) or tens of thousands (China and Wuhan), and that it’s effective in major metropolitan areas like Seoul and Shanghai well into community spread. Maybe if we’re talking about something with a different transmission route/rate, like HIV/AIDS, that’s possible. Maybe if the rate of asymptomatic transmission is far lower. Maybe if it’s in a remote region, like Ebola in West Africa. But with this?

            If we’re looking at South Korea and asking, “what happened there to get a different result?” I would think the explanation, “they were really successful with contact tracing” would be met with a high degree of skepticism – especially in this community. I think people are looking at countries with containment and assigning causality ex post facto, regardless of whether that causality makes any sense.

    • The Nybbler says:

      As bad as it looks where? It looks one level of bad in Italy (whose numbers seem to have stopped updating), a different (and much lower) level of bad in Germany.

      Personally I suspect it’s already spread very widely in NYC and has been since January, and we haven’t gotten the Italy-level death numbers.

      There are probably reasons for this difference. Age of population infected is definitely one of them; the worst hit area of Italy had 10% of its population over 80. Maybe there’s a genetic component and some people are more susceptible. Maybe the virus occasionally mutates into a super-deadly strain and if you get that one first, you’re out of luck. Some is likely artifacts of how deaths are recorded. Some is likely testing — I’d bet there were NYC viral pneumonia deaths never tested for COVID-19, for instance. Some may be living arrangements; perhaps getting it from people you live with (as in Italy) kills you lots faster than just getting it on the morning and evening commute.

    • e.samedi says:

      Does COVID actually look bad? The problem I’ve been struggling with during all of this is who to believe. On one hand we have the panic mongers on social media and the MSM, on the other we have the contrarians for the sake of contrariness. Where are the level-headed, just the right-amount-of-skepticism people? Also, who is thinking and writing about the hard questions such as at what point does the economic damage outweigh the potential deaths, or what are the longer term, second order effects of this crisis and the measures being taken?

      What is the right context for understanding the seriousness of COVID? The numbers reported on the JHU map have zero context. All the data I see seem grossly incomplete and perhaps misleading. The WHO, assuming it is trustworthy on this point, says that the flu kills between 290,000 to 650,000 people per year globally. COVID is currently at ~29,000 after a few months. That makes COVID look minor in comparison. But is that the right comparison? I don’t know. Maybe the idea is that COVID will continue for many more months, won’t have a seasonal drop-off like the flu, and will go on to kill 10 to 30 times more people. Again, I don’t know.

      I also don’t understand the role of ventilators. Do people who get very sick need ventilators and then fully recover? Do they partially recover? Or do they usually die after? I ask because I am interested and not because I have some Trolley problem like ethical decision in mind.

      Two things I do know. In matters of crisis leaders have to make cold-hearted decisions for the greater good of the group. Everyone who has been in the military understands this. You will be sacrificed for the survival of the group if necessary. This is the terrible and eternal logic of group survival. The second thing is that everything our modern media complex touches becomes worse. Forall x, x plus the media is worse than x by itself.

      • Do people who get very sick need ventilators and then fully recover?

        As best I understand what I have been reading, people who get very sick need ventilators, and even with ventilators usually die. I don’t remember the numbers, but I think it was over fifty percent.

      • The Nybbler says:

        Where are the level-headed, just the right-amount-of-skepticism people?

        We’ll only know in retrospect.

        I also don’t understand the role of ventilators. Do people who get very sick need ventilators and then fully recover? Do they partially recover? Or do they usually die after? I ask because I am interested and not because I have some Trolley problem like ethical decision in mind.

        Severe pneumonia causes lasting lung damage; I believe some lasting damages is done by the ventilation itself. And most people who go on ventilators for COVID-19 die, based on Wuhan data (warning: small sample). So those who go on ventilators who survive probably do not “fully” recover.

      • anonymousskimmer says:

        There are stages of ventilation: https://www.wisegeek.com/what-is-the-difference-between-intubation-and-ventilation.htm

        https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext
        As of Feb 27, 2020, coronavirus disease 2019 (COVID-19) has affected 47 countries and territories around the world. Xiaobo Yang and colleagues described 52 of 710 patients with confirmed COVID-19 admitted to an intensive care unit (ICU) in Wuhan, China. 29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.

        More info as to what “mild, severe, and critical” mean: http://www.cidrap.umn.edu/news-perspective/2020/02/study-72000-covid-19-patients-finds-23-death-rate

        A total of 81% of cases in the JAMA study were classified as mild, meaning they did not result in pneumonia or resulted in only mild pneumonia. Fourteen percent of cases were severe (marked by difficulty breathing), and 5% were critical (respiratory failure, septic shock, and/or multiple organ dysfunction or failure).

        The CFR (case fatality rate) jumped considerably among older patients, to 14.8% in patients 80 and older, and 8.0% in patients ages 70 to 79. Among the critically ill, the CFR was 49.0%.

        A smaller study today based on 52 critically ill patients at a Wuhan hospital confirms this finding. Thirty-two of the 52 critically ill patients (61.5%) died, and older age and acute respiratory distress syndrome were correlated with mortality.

        The authors of the smaller study also found that 30 (81%) of 37 patients requiring mechanical ventilation had died by 28 days.

        So the critically ill in the small study showing the death rates of those being ventilated had a somewhat higher fatality rate than the more general COVID-19 population labeled critically ill.

      • albatross11 says:

        Here’s what I think we know very solidly:

        a. COVID-19 spreads reasonably well in the community. We know this because it’s been spreading among people in several states without being detected for a month or so, largely because we didn’t have enough tests to find out if people who got sick with COVID19-like symptoms actually had it or not.

        b. Some patients with the virus get pneumonia serious enough to put them in the hospital, and some subset of those end up in the ICU/on a ventilator/dead. This set of patients seems to mostly be older people and people with existing lung/heart problems, but not always–some apparently healthy 30-year olds have gotten very ill with this thing.

        c. In some places, we’ve seen a huge spike of cases of very sick people flooding the hospitals, to the point where they ran out of beds and a lot of the doctors got sick from the virus as well and they ended up with piles of dead bodies. I don’t think anyone knows exactly why this has happened in those places, but Wuhan, Northern Italy, Iran, Spain, and now apparently NYC have all had huge spikes of infections and followed this patterm.

        d. Some other places have had some level of community spread and some deaths, but for some reason haven’t had a flood of people with life-threatening pneumonia overflowing their hospitals. The Seattle area had community spread for more than a month, and it mainly seems to have killed a bunch of old, sick people in a nursing home.

        e. As best we can tell, this virus spreads by close contact and surfaces–when you cough, sneeze, talk, breathe, eat, etc., you spread some droplets around.

        (i). The big droplets settle out within a couple meters of you, and can remain infectious (at least in lab conditions) for several days. But you have to touch the surfaces and then touch your eyes, nose, or mouth to bring the virus in contact with something it can infect.

        (ii) If you’re standing close to the infected person, those big droplets can land on your eyes, nose, mouth, etc., or just get inhaled into your lungs, and then you don’t need any touching of surfaces to get sick.

        (iii)In lab experiments, the virus remains infectious for several hours in smaller droplets–including ones small enough to stay suspended in the air for hours. Most sources seem to think this isn’t likely how it’s spreading most of the time, but who knows?

        If this is right, then preventing spread shouldn’t be so hard–disinfecting surfaces and hands, staying >2m away from everyone as much as possible, etc., is probably pretty good at avoiding catching it.

        The pattern of some places having a huge spike and others not seems like a mystery worth untangling, to me. But that’s speculative, so I’ll put it in another post.

        • albatross11 says:

          Why do some places melt down and others don’t? This is my amateur musing, and I’d love to see more qualified people weigh in:

          a. It’s possible we’re seeing different strains of the virus–maybe the strain that infected that Jewish community near NYC and the one that infected northern Italy was a super-nasty strain, and the one that’s been circulating in Washington State is one that only makes you very ill if you’re already very old and sick.

          b. Another possibility is that this has to do with the environment–something about the environment in NYC and Northern Italy is really great for this crap spreading quickly., relative to Japan/Taiwan/Washington State. Looking at NYC vs the Seattle area, density and public transit look like plausible guesses, but who knows? (Taiwan/Japan may benefit from norms about mask wearing–but it’s hard to have a more densely packed city than Tokyo, so I dunno. That doesn’t apply to Washington State.)

          c. It’s also possible this has to do with some kind of massive amplification by health care workers–it sounds like that was happening in Northern Italy for awhile. It’s easy to see how that could cause the number of cases to ramp up until it’s a major crisis.

          d. You could even imagine the selective environment for the virus being different in different places. In places where everyone’s watching out and trying not to spread/catch any colds, the strains of the virus that cause asymptomatic or mild infections may be the only ones that spread very well. Once your host is visibly sick, everyone avoids him; make him deathly ill, and everyone he’s been in contact with goes into quarantine.

          OTOH, in places where there’s a lot of hospital spread, the strains of the virus that do best are the ones that crank out a maximum number of viruses per hour and make their patient cough incessantly. If doctors are putting very sick patients on CPAP and that makes an aerosol, then the strains that make patients very sick are the ones that are most successful. That could actually select for strains that are good at spreading by aerosol and are good at making their hosts super sick.

          Comments?

          • The Nybbler says:

            I don’t think NYC has had higher mortality; I think it’s just had more cases. There were probably many early cases to begin with, from people coming from China during the early part of the outbreak. Then it spread a lot, probably largely due to mass transit and maybe elevator buildings.

            Consider that right now 1/3rd of tests in NYS are coming up positive. Washington State is more like 7%. I believe that’s indicative of far wider spread in NYS, even more than the confirmed-case numbers would indicate. And Washington has had more fatalities per confirmed case.

          • Chalid says:

            Another possibility is pure luck. An R0 of 2.5 can consist of a few people who spread it to 50+ others and a whole bunch of people who don’t spread it at all. If your town is unlucky and happens to have a couple super-spreaders early then you get an outbreak.

          • HeelBearCub says:

            One thing to consider is that Washington’s community spread may have actually started after NY. Remember that the initial deaths in Washington were confined to a single rest home where a visitor had been in, I think China, and passed on the infection to a very vulnerable population.

            Those early deaths make it look like Washington was first, but those early deaths weren’t the result of community spread.

          • Evan Þ says:

            @HeelBearCub, I think that’s unlikely. The virus from a Snohomish County teen at the start of March was genetically linked to the virus from someone who traveled back from China to Snohomish County mid-January, which means it’d been circulating in Washington State since then. It’s possible an infectious person came to New York City even earlier, but I don’t see any evidence of that. I think the differences are due to denser living in New York City and an earlier response in Washington State.

      • Aminoacid says:

        It seems to be pretty bad. I am a doctor working in emergency care in Brazil, and while I don’t work on a ICU, I keep contact with colleagues who do. I don’t have any translated links to give you, but the average amount of hospital admissions we have for Acute Respiratory Distress Syndrome In February-march is around 250-300 per week. In the week between March 15-21, we’ve had 2.250, and we’ve been seeing cases that are more severe than they should be for relatively young and healthy patients (like 40-60 year old patients with controlled hypertension needing ventilation with heavy parameters)

        Colleagues that work in the NY region report that hospitals that are used to see 4-5 hypoxemic cardiac arrest per week are seeing that number every day since last week, and they are projecting an even bigger spike in this next week.

        The official statistics on infection and death numbers tend to lag a bit, but what we’re seeing in the healthcare system is a rapid ramping up of demand for high-complexity care

      • keaswaran says:

        “The WHO, assuming it is trustworthy on this point, says that the flu kills between 290,000 to 650,000 people per year globally. COVID is currently at ~29,000 after a few months. That makes COVID look minor in comparison. But is that the right comparison? I don’t know.”

        Simple epidemiological theory states that if a disease has R0 of about 2 (as I believe both influenza and Covid have), then it will grow exponentially unless close to half the population has immunity, in which case it will spread through chaotic outbreaks that in the long run result in an annual number of infections approximately equal to half of the annual number of births.

        There are about 130 million babies born each year, so we should expect about 65 million cases of each strain of influenza per year, and about 65,000 deaths from each, assuming 0.1% mortality.

        Covid is in the exponential growth phase, so we should expect it to grow exponentially until we have 3.5 billion cases, resulting in about 35 million deaths, assuming 1% mortality. If it were really simple exponential growth, then we would expect half of those deaths to happen in the last week before the virus crashes due to having no new hosts.

        • The Nybbler says:

          Simple epidemiological theory states that if a disease has R0 of about 2 (as I believe both influenza and Covid have), then it will grow exponentially unless close to half the population has immunity

          Influenza is said to have an R0 of 1.3 (typical seasonal flu) to 1.6 (upper range for 2009 H1N1 pandemic). The usual estimate I’ve seen for COVID-19 is 2.3.

          Anyway, simple epidemiological theory is too simple. 2009 H1N1 is said to have infected 60 million people in the US. That’s 20% of the population, considerably less than the calculated herd immunity threshold (1-1/R0), let alone the calculated epidemic final size. Seasonal flus typically infect about 10% of the population.

  35. eric23 says:

    Like everyone else here, I have been debating coronavirus for weeks now on all manner of social media forums. But just debating has little impact on the world. Eventually I found a way I thought could make a difference. Two days ago I composed the letter below, and sent it to the mayor or other leaders of each of the 10 largest cities in the state of Florida. I got replies from several cities: a couple generic “thank you for your interest”, one “thank you for the helpful information” and one request to talk to me further on the subject (I referred them to other experts since I am not an expert myself). So it does appear that an intelligently worded inquiry that contains new information might make a real impact. In terms of projected effort per life saved, this might be highest-reward opportunity any of us are ever going to encounter.

    It strikes me that a similar approach could work for other parts of the US. Does anyone want to take this further, and claim a particular region or non-governmental organization to which they will write (so as not to duplicate other people’s effort), and attempt to identify an angle to the issue which the recipient doesn’t already know (as I did in my email) so that the email will be productive?

    ==============

    Hi,

    The tech startup Kinsa collects temperature data from millions of Americans with “smart” digital thermometers. Using this data, it can track disease outbreaks as soon as people develop fevers, long before they seek medical treatment.

    For several days now, Kinsa has observed an extremely high number of fevers throughout the state of Florida (not just in South Florida) – more than anywhere else in the US. This means that in the next week, Florida will likely witness an extremely high number of COVID-19 cases, much higher than any other US state. Given the high elderly population in Florida, this is a recipe for a catastrophic number of deaths.

    The only way to prevent most of these deaths is to immediately enforce a stricter lockdown than your city, or any other US area, has yet implemented. This means that all businesses and public areas must be closed for a period of two weeks, and all social encounters in public prohibited. Even “essential” businesses should be closed where possible; groceries and other vital goods should be delivered to people’s doors, rather than picked up by individuals going shopping. These measures are extremely urgent – the number of coronavirus cases in Florida is currently increasing by about 40% per day, which means that each day of delay will increase the eventual death toll by 40%.

    I do not live in your community – I am from [State], but seeing the death toll elsewhere and realizing that Florida will soon be the center of the epidemic, I felt compelled to bring these details to your attention.

    Thank you,
    Eric [Lastname]

    For a quick overview of Kista’s data and its implications for Florida, see:
    https://www.fox13news.com/news/map-shows-unusually-elevated-levels-of-flu-like-illness-in-florida
    https://www.abcactionnews.com/news/local-news/i-team-investigates/health-map-shows-tampa-bay-is-hot-spot-for-coronavirus%20-1

    For a thorough technical overview of why immediate lockdown is the only way of stopping a coronavirus outbreak, see:
    https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

    For full access to Kista’s data, see:
    https://healthweather.us/

    To follow up with an expert who can advise you of exact steps to take, I suggest messaging:
    https://twitter.com/TopherSpiro

    • Joshua Hedlund says:

      Interesting data set – thanks for sharing this – looks like it’s originally intended as a proxy for flu but due to the overlap in symptoms is also trying to be a proxy for COVID-19 as well? Looks like the fox13 link you shared is now 6 days old, which should be long enough for us to start testing this as a proxy.

      Looking at the worldometers chart for US states, Florida is ranked 7th for cases and 8th for deaths, despite a population rank of 3rd. It also had the *lowest* new reported cases yesterday for any state in the top 10, and the second-lowest reported new deaths. So there does not seem to be much signs of a major outbreak there.

      It’s possible that this will change drastically in the coming days, though I would have been more impressed if the data set had predicted the current hotspots of New York City (which has far and above the worst US outbreak thus far), or Louisiana (which is doing far worse for its size than any other state)

    • cxed says:

      This kind of strategy seems quite sensible to me. We have imperfect data, but we sure have a lot of it.
      Any one remember this?
      https://en.wikipedia.org/wiki/Google_Flu_Trends
      Seems like they should get that band back together.

  36. ShemTealeaf says:

    Are environment allergies a significant risk factor for Corona-related death or serious symptoms? I have bad enough allergies that I have congestion and a slight cough basically all the time, and March/April is usually when my symptoms are the worst. If I can start taking stronger allergy medication, is that likely to lower my chances of respiratory issues?

    • DaveK says:

      Yes, they are a factor then increases risk. I can’t say by how much.

    • albatross11 says:

      I suspect this also works the other way. Suppose I have a mild or asymptomatic case. I’m shedding virus when I talk/touch things after rubbing my eyes, but I’m not all that contagious. Now add in sneezing every 15 minutes and occasional coughing from my allergies, and I’m coating my surroundings with droplets full of virus.

  37. AlexOfUrals says:

    figuring out how to repurpose cheap pre-existing material for medical care – face masks made out of paper/cloth/whatever

    This was figured out a while ago, probably during the cold war. IIRC creating a makeshift face mask out of cotton wool and gauze (ватно-марлевая повязка) was even taught in elementary school when I was a kid in Russia. At least we certainly were told about the concept and shown what the thing looks like. Don’t think they teach it to kids nowadays, but knowledge definitely isn’t lost, instructions are easily googlable. Not that it’s of any help, with the government there being in severe denial. Besides, it looks ungodly awful even by Russian fashion standards, I can’t imaging people wearing it outside en mass.

  38. An Fírinne says:

    It’ll be interesting to see how the “China is to blame” crowd will square the US being No.1. China’s response was not perfect but I’m sure as hell glad the virus originated in China and not the US cause we’d be in even worse trouble then we already are.

    • Deiseach says:

      It’ll be interesting to see how the “China is to blame” crowd will square the US being No.1.

      But isn’t that what you would expect, though? The virus seems to have come under control in China, so now they’re in the decline phase. Given that it took time to spread through the West, now a new country will be the one with the most cases, most new infections, etc. and given that the USA is the largest single nation with a population infected, it is going to be the one with the most cases as the infection arrives and peaks?

      China is where it originated, like it or lump it, and the unfortunate timing to coincide with the New Year Lunar Festival meant that a lot of expats were visting home and then going back to other countries and bringing it along with them. It doesn’t need to be a conspiracy theory, but the early response from Chinese authorities (e.g. silencing their whistleblower on the grounds of causing public panic and false information) makes them at least a little culpable, or at least as much culpable as “Trump/name any other leader elsewhere you like screwed up the handling of this – if they’d only done X, Y, Z at the start it wouldn’t have been so serious!”

      • matthewravery says:

        It’s fair to argue that China’s response kept us from taking action in December, but it’s hard to attribute to China the West’s continued indifference in January and February.

        • Anthony says:

          Yeah – it’s not really fair to blame China for western “anti-racists” saying we shouldn’t impose border controls and snowflake-enablers telling people to not wear masks in order to not cause panic. They (the Westerners) would do these things without being on China’s payroll.

          • Loriot says:

            It’s a good thing the Deep State experts at the HHS recommended that Trump reduce travel from China then, or things might be even worse.

            https://www.factcheck.org/2020/03/the-facts-on-trumps-travel-restrictions/

          • keaswaran says:

            When exactly did the “anti-racists” oppose the border controls?

            My recollection is that border controls have been imposed twice. First was the ban on US entry by foreign nationals who had been to China within the past 14 days, and second was the ban on US entry by foreign nationals who had been to the Schengen zone in the last 14 days.

            In both cases, it looks like the border controls were designed to be ineffective, given that they targeted people based on nationality, rather than banning all travel by people who had been to the relevant place. Moreover, the Schengen ban was imposed on March 12, at which point it was already clear that there were multiple major sources of community spread within the United States, so that the travel ban was not relevant to local growth rates.

            Was there a point in time where there was an effective measure that was proposed, that anti-racists opposed?

          • Edward Scizorhands says:

            I don’t think they were designed to be ineffective.

            They were incorrectly designed, though.

          • Controls Freak says:

            In both cases, it looks like the border controls were designed to be ineffective, given that they targeted people based on nationality, rather than banning all travel by people who had been to the relevant place.

            Nah. That’s due to a constraint on the policy space in which they are allowed to plan. They can’t ban US citizens/LPRs from entry, as a class. If they did so, it wouldn’t be just the anti-racists who opposed the measure. They basically took your plan, “Ban people from these relevant places,” lopped off the, “…and we can’t ban those folks,” portion, and ended up with the resultant policy. Sounds like you’re basically in favor of what they did.

          • Edward Scizorhands says:

            They can’t outright ban entry to citizens. But they can do medical screenings and quarantine, right?

            FWIW, I’ve heard conflicting stories, from otherwise credible news sources, about exactly how the bans worked. So I’m not really sure any more exactly how they worked.

    • knzhou says:

      If you ever find yourself asking the question “can people manage to put together a narrative that pins all blame on their preexisting enemy, no matter what actually happens”, the answer is always yes. And of course, my friends and I will suffer for it.

    • blumenko says:

      At least for now, China clearly has had more cases than the US. They explicitly exclude asymptomatic positive tests from their numbers https://www.bloomberg.com/news/articles/2020-03-24/china-s-hidden-symptom-free-virus-cases-means-epidemic-not-over

      • Chalid says:

        The US is missing lots of cases too, though. Asymptomatic people largely aren’t tested at all.

  39. Edward Scizorhands says:

    On how Trump supporters saw Coronavirus a few months ago:

    https://www.vanityfair.com/news/2020/03/why-some-early-maga-adopters-went-against-trumps-virus-doctrine

    tldr: People who were early Trump supporters (Bannon, Tucker, Scott Adams, Cernovich) were all warning about it. Late Trump supporters (Hannity, Limbaugh) thought it was nothing to worry about.

    • Matt M says:

      Broadly speaking, it seems like there are two general categories of Trump supporters… those who see their responsibility to help influence Trump towards good ideas, and those who see their responsibility to help influence the public towards supporting Trump.

      People like Carlson and Cernovich see Trump as their audience. They devote their messaging towards telling Trump what to do (but in a respectful and sympathetic manner). Hannity and Limbaugh see the public in general as their audience, and devote their messaging towards telling the public to support Trump.

    • psmith says:

      Yeah.

      This experience is presumably not very relevant to questions mass media of any partisan bent, but I started laying in some extra supplies and getting some car and home repairs taken care of and whatnot in the first or second week of February specifically because a couple of right-wing or at least broadly right-aligned Twitter accounts I follow were sounding the alarm.

    • Loriot says:

      But has he caught The American Virus?

    • Loriot says:

      In case anyone takes this the wrong way, my previous comment was an attempt to demonstrate how petty the whole “chinese virus/kung flu” thing sounds.

  40. Edward Scizorhands says:

    On the other hand, the President of the US is not really supposed to be a clearinghouse for medical information, and is definitely somebody whose words have direct effects on the world, so maybe we should make an exception for him.

    As I said on a prior fractional thread, there are huge effects hanging on every single word. The surge of people trying to get back into the United States was because of confusing words said during an address to the nation.

    Trump has always resisted having his words filtered through a comms team. It is part of his brand. But it really really sucks for something like this. I’m not kidding when I say there are thousands of lives at sake each time.

    • cuke says:

      Yes, this. It seems clear to me that the moral calculus of “words the U.S. president speaks during a pandemic crisis briefing” is very different from “words I write on my blog” or “words I say over dinner.”

      Yes, true, we would many of us feel rather suffocated if we felt obligated to communicate all the time as if we were a U.S. president speaking during a pandemic crisis briefing.

      I mean, a psychiatrist or a psychotherapist has to be pretty careful about what words we use when speaking with someone in the midst of a major depressive episode, etc, right? It’s not that we are 100% at fault if a person goes home and kills themselves after talking with us. But it’s not like we’re without responsibility in that situation either, which is why there are specific words and protocols for those very fraught situations. Perhaps also why the CDC wrote massive guidance about how to communicate well with the public during a pandemic and why it would be better if people speaking at a pandemic briefing knew both what they were talking about and how to talk about it, to a pretty high standard.

  41. Yosarian2 says:

    Just speculating, but I was wondering the other day if perhaps some other closely related but mostly harmless Coronavirus has recently spread through the East Asian region in the past few years without being noticed, giving at least some people in that part of the world a lot more immune resistance to it than people in Western countries have.

    • ADifferentAnonymous says:

      I wonder the same. IIRC this is theorized as a reason older generations were less affected by the 1918 flu, so there’s precedent.

    • Salentino says:

      I was just speaking with a Japanese friend who believes that most people in Japan already have immunity to COVID-19. Whether that is true remains to be seen.

  42. Deiseach says:

    When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.

    Well the plan seems to have worked, BoJo has just tested positive! That seems to bring the number of “Cabinet members with COVID-19” up to three confirmed cases, nice to see that they’re practicing what they preach!

    I feel this falls under the heading of “be careful what you wish for”.

  43. Simon_Jester says:

    I think this post makes (at least twice) the fundamental error of modeling Trump as an analytical rational actor who is trying to optimize for goals that an average citizen would endorse.

    Alternate hypothesis: Donald Trump is a lazy (by presidential standards) narcissist with dementia, doesn’t see what all the fuss is about as long as he personally isn’t sick, wants the problem to go away so people can go back to talking about him, and has trouble thinking through or foreseeing the consequences of his actions.

    When Donald Trump tweets excitedly about hydroxychloroquine, it’s not because he’s even considering “what might the consequences be.” And it doesn’t even cross his mind “I don’t understand medicine and should wait until my many many medical advisors have sorted out whether this stuff will work.”

    Because- narcissistic- humility is not his Thing. It’s an impulsive “this sounds cool, will make people think I’m telling them how to cure their disease, and if it works the problem will just go away without further intervention from me like I’ve always wanted so people can go back to talking about me” action.

    When Donald Trump comments on the news that he doesn’t think New York really needs thirty thousand ventilators, that is not a rational calculation. That is the ramblings of a narcissist with dementia. The problem doesn’t affect him personally so it can’t be that serious, and he can’t keep track of information like “New York actually expects to have tens of thousands of people who are deathly ill all at the same time and who will need those ventilators to not die.”

    When Donald Trump calls COVID-19 “the Chinese virus,” he is not doing it as a calculated strategy to alert his base to the serious danger of the virus. He is doing it because blaming other people (particularly China) is a routine practice for him, because it deflects attention from his own handling of the problem and implicitly declares it to be Someone Else’s Problem, because he’s kiiinda racist (ask the Central Park Five), and because it doesn’t really bother him if a bunch of Asian-Americans get beaten up because angry Trump voters think they brought the virus to America. Because, again, narcissist.

    What we are seeing are the consequences of electing, as Scott described, a “high-variance” president, and the reasons why Scott was correct to endorse, essentially, “anyone but Trump” in 2016. The system kept lurching on despite his being a lazy narcissist with dementia as long as nothing seriously bad was happening, sure. But he’s simply incapable of doing anything constructive in a crisis. And his mere presence in a responsible position of power ensures that Bad Things will happen, or will get worse than they had to, because he obstructs other people from doing what is necessary and proper.

    Managerial competence, mental stability, and the willingness to take responsibility for one’s actions are very important traits in a leader. Trump does not possess these traits. As such, modeling Trump’s actions by thinking “If I were doing what he is doing, why would I be doing it” is simply incorrect.

    • sourcreamus says:

      Speaking of fundamental errors, this post commits the Fundamental Attribution Error.
      Trump tweets excitedly about chloraquine not because he is an evil narcissist but because it is an exciting idea that the pandemic may be cured by a easily produced medicine that is well known. I was excited when I first heard it, and if I was the twittering type I may have tweeted it.
      Trump questions the need for 40,000 ventilators because that number is based on a worst case scenario and the worst case scenario does not usually come true.
      Trump calls it the Chinese virus because that blames someone else and avoiding blame is what successful politicians do. The idea that a bunch of Asian Americans are going to get beaten up because the president says Chinese virus instead of Covid 19 or Sars 2 is just magical thinking.

      • Guy in TN says:

        The idea that a bunch of Asian Americans are going to get beaten up because the president says Chinese virus instead of Covid 19 or Sars 2 is just magical thinking.

        Rhetoric that stokes anti-China sentiment -> Anti-Chinese actions
        is “magical thinking”?

        People take cues from their leaders.

        • Clutzy says:

          Some people do some of the time.

          There is almost no evidence of type of politician influenced violence of this sort that is always speculated about in the media. The trope of “R politician talks negatively about XXX nonwhite demographic and whites in mobs start assaulting them” has been warned about all my lifetime with it never happening. It happened with Muslims around 9/11 and again when Trump was running. I recall no documented cases where there was actual proof. If we take the Scalise incident as the bar for culpability (as in, you shouldn’t blame Sanders for that, but you could if there was more evidence) no R would have been culpable in my lifetime.

          • Guy in TN says:

            The trope of “R politician talks negatively about XXX nonwhite demographic and whites in mobs start assaulting them” has been warned about all my lifetime with it never happening. It happened with Muslims around 9/11 and again when Trump was running.

            Are you unaware of racial violence that occurred in your lifetime, or are you just denying the causal link between racist rhetoric -> racist actions?

          • Anthony says:

            Guy in TN, most of the racial violence in my lifetime has been blacks rioting against whites, or sometimes against Jews, and the general pattern of black-on-white violent crime. Most racial hate crimes publicized in the media are hoaxes or have backstories which invert the media narrative.

            Most articles warning how rhetoric will lead to violence never give examples, because there just aren’t any.

          • anonymousskimmer says:

            What kind of proof would satisfy you Clutzy?

          • Clutzy says:

            Are you unaware of racial violence that occurred in your lifetime, or are you just denying the causal link between racist rhetoric -> racist actions?

            I am denying that there is a causal link between anything a major political figure has said in the last 30 years in America and any form of racial violence. IF I were to lower my standards on I think it would be pretty objectively true that the first politicians who would be caught up would be mayors in major cities engaging in antiwhite rhetoric.

            What kind of proof would satisfy you Clutzy?

            I think its a know it when you see it sort of thing. But something like a normal functioning person with a family committing violence in the name of something with a relative time nexus to a major announcement. Like what you often see with terrorism in the middle east. I’d also have to agree that the rhetoric was actually racial in nature, which the China stuff clearly doesn’t rise to IMO.

        • PorterBridges says:

          How about anti-Russian sentiment -> Anti-Russian action?

          The Democrats recently loudly stoked anti-Russian sentiment. My suspicion is you dismiss this when it doesn’t align with your partisan bias, and hype this when it does align with your partisan bias.

          • Guy in TN says:

            My suspicion is you dismiss this when it doesn’t align with your partisan bias, and hype this when it does align with your partisan bias.

            lol

            “I don’t know you at all, or what you believe in, but…uhh…you’re probably a hypocrite, and therefore your point is invalid”

      • Tatterdemalion says:

        The idea that a bunch of Asian Americans are going to get beaten up because the president says Chinese virus instead of Covid 19 or Sars 2 is just magical thinking.

        https://www.independent.co.uk/news/world/americas/trump-china-virus-coronavirus-asian-americans-attack-activism-a9422721.html

        That thing you’re saying won’t happen? It already has.

        • Edward Scizorhands says:

          That’s missing the “because.”

          Asian American friends who’ve been born here and lived here for decades have reported their first ever being shouted at in public. I believe it’s happening. I believe that Trump’s comments aren’t helping.

          But we’re still missing the “because.”

          • LGS says:

            Come on. Trump has a cult-like following; it’s not much of a stretch to say that emphasizing the virus is Chinese will cause his followers to be mad at the Chinese (and by extension, anyone who looks vaguely asian, apparently). Even Scott Alexander has hypothesized that “China virus” is effective because it appeals to the base’s xenophobia.

            And even Trump agrees: he has apparently said he will stop calling it “China virus”.

            So stop with this isolated demand for rigor. There is no way to prove that appealing to “xenophobi[a]” (Scott’s phrasing, not mine!) actually causes xenophobic violence. You’ll never get a proof for your “because”. But this doesn’t make appealing to xenophobia a wise thing to do when there is ongoing violence.

          • Edward Scizorhands says:

            Come on

            No.

            I believe it’s happening. I said I believe it’s happening. But when someone says they have “proof” which is just “activists say it’s happening” that isn’t proof.

          • LGS says:

            Not even sure what you’re trying to say. Are you disputing that there’s violence against Asians? But you said you believe it. Are you saying you believe it but there’s no “proof” of it? But nobody claimed to have a proof.

            Are you saying that you believe violence is occurring, but you think scapegoating Asians doesn’t encourage the violence? Then you’re making an isolated demand for rigor and deliberately failing to use common sense; even Trump agreed to stop calling the virus “Chinese” out of concern about racism. And Scott agreed that “China virus” is an attempt to appeal to xenophobia.

          • Are you saying that you believe violence is occurring, but you think scapegoating Asians doesn’t encourage the violence?

            I can’t speak for Edward, but I don’t think Trump was scapegoating Asians. If he is scapegoating anyone, it’s the government of China. It’s at least arguable that it deserves to get some substantial part of the blame.

          • LGS says:

            David, in this case your disagreement is with Scott, who said calling it “China virus” is an attempt to appeal to Trump’s xenophobic fans, and that this is a good thing somehow.

            Anyway, I personally agree with you that Trump was trying to scapegoat China the country rather than the people – this is what he said he was doing when he agreed to stop calling it that. I don’t think his xenophobic fans could tell the difference though, which is why this was a bad idea, as Trump now admits.

        • knzhou says:

          It doesn’t matter to them. The people you’re replying to will just move the goalposts back all day.

        • sourcreamus says:

          I am skeptical that the incidents are in the thousands. People who make a living as advocates have reasons to exaggerate. There are definitely some acts of violence against Asian Americans, but we have no idea how many.

          However, even if we stipulate that these people are correct, there is a third variable problem. Something is happening in the world that is inspiring Trump to speak negatively about China and for people around the world to feel negatively about China. Namely people who became infected in China have flown around the world and infected people in other countries. The idea that people would not have noticed this if Trump had called the Virus Covid 19 exclusively is magical thinking.

          Those people who enjoy violence are generally not those who follow politics closely. It is much likely that those who like to engage in violence are choosing asian american victims because they have heard on every news platform available the truth that the virus originated in China. These types of people would be committing the same acts if Andrew Yang or Mahatma Gandhi was president.

          Furthermore, the idea that speech automatically leads violence is one of the biggest threats to free speech today. There are plenty of examples of Trump fans being assaulted over the past several years, this does not mean criticism of Trump should be halted or curtailed in any way.

        • PorterBridges says:

          That reporting looks like searched for data to support a specific political narrative.

          I’m sure you can find some Russian Americans that unfortunately experienced some violence or slurs, and you can try and blame that on the Democrats stoking anti-Russian rhetoric + sentiment, in this exact same fashion.

          I presume you wouldn’t do that, because that’s not the political party you are trying to tar.

          • salvorhardin says:

            If you can actually find some instances of Russians experiencing slurs or discrimination plausibly motivated by anti-Russian political rhetoric, I’d be interested to see the evidence. My prior is that this doesn’t actually happen because, although the vast majority of people wouldn’t do those things on those sorts of grounds to any ethnic group, the vast majority of the people who *would* are Republicans. That is, your equivalence argument fails because stupidity and racism are not even close to evenly distributed between the parties.

          • PorterBridges says:

            @salvorhardin. it sounds like you are convinced the other party is stupid+racist, and you can justify absolutely any partisan argument from there.

            I like people, and prefer not to call them stupid, even if that’s true. It’s fair to say across every demographically broad political party, most people aren’t intellectual types.

          • salvorhardin says:

            Nope, you’re misunderstanding. I think the vast majority of Republicans are not stupid and racist. I simultaneously think that, *of the small minority that are stupid and racist*, the vast majority are Republicans.

            To make up some numbers to illustrate, suppose only 5% of people are stupid+racist, the other 95% not. And suppose the Dem/Rep split in the general population is 50/50, but in the stupid+racist subpopulation it’s 10/90. Then it’s simultaneously true that:

            — more than 90 percent of Republicans are not stupid+racist
            — the effect of Republican rhetoric on the behavior of the stupid+racist population is waaaay bigger than the effect of Democratic rhetoric.

          • albatross11 says:

            salvorhardin:

            I suspect you’re making an error here that has to do with whom you categorize as racist. For example, my understanding is that a lot of anti-Semetic hate crimes are carried out by blacks, most notably in the NYC area[1]. Those guys are probably Democrats if they have any political affiliation, in the same way a white guy beating some black guy senseless because he hates blacks is probably a Republican if he has any political affiliation. I think you’ll see a similar phenomenon for anti-gay hate crimes. Underclass whites and blacks are most of the perps. Many/most of those don’t have any formal political affiliation and never vote, but the ones who do probably go with the usual ethnic affiliation.

            [1] There are also a fairly significant number of anti-white hate crimes, which I think are almost always carried out by blacks. Again, that’s stupid and racist, but if the perps have any political affiliation at all, it’s probably Democratic.

          • salvorhardin says:

            Define “a lot” and “fairly significant” in a way that makes it possible to do order-of-magnitude comparisons to other data on hate crimes (and more importantly, if available, on bigoted behaviors short of hate crimes), and I’m certainly willing to look at the numbers. Not saying it never happens– I assume you’re talking about stuff like the Monsey machete attack?– just that anecdote != data.

          • EchoChaos says:

            @salvorhardin

            https://ucr.fbi.gov/hate-crime/2018/topic-pages/offenders

            The FBI keeps statistics on hate crimes in the United States.

            Blacks are substantially over-represented as a share of the population, and whites substantially underrepresented.

            Hispanics are slightly underrepresented, although some jurisdictions do not report ethnicity and lump Hispanics in with whites.

          • I simultaneously think that, *of the small minority that are stupid and racist*, the vast majority are Republicans.

            Data on racism is hard to get, in part because anyone compiling it is likely to have his own biases about what sorts are worth paying attention to. But if you are willing to take education as a proxy for intelligence, I’m pretty sure that Democrats are over represented at both the top and the bottom of the educational distribution, which would suggest that stupid people, insofar as they have a political affiliation, are more likely to be Democrats.

      • blumenko says:

        Again, this gets back to Trump’s position as president. Yes, the direct cause of him tweeting about chloroquine is his excitement about that, just like you may have done. You may have not considered the consequences of tweeting about it, because there probably would be no consequences. And yes most tweeters probably have some narcissism, but no harm, no foul. When Trump tweets about it, things happen. And he doesn’t change his attitude towards tweeting, either because 1) he is too stupid to realize that or 2) he is an “evil” narcissist, meaning he lacks the impulse to control his own actions when the negative effects could be large, in a way which would stop even your average guy with narcissistic tendencies.

        • sourcreamus says:

          You may underestimate how persuasive I can be in a tweet.

          The fact that millions or even tens of millions of people either read his tweet or heard about it yet only one couple decided to treat themselves with aquarium cleaner without looking up the correct dose, seems to indicate that the problem lies with the couple and not the tweet.

          While it now seems that taking chloraquine prophylactically does not work, it may yet turn out that it does, and Trump saved the lives of thousands with his tweet by giving it publicity.

        • albatross11 says:

          In general, Trump doesn’t think before he tweets/talks in the way you’re wishing for. He just isn’t the kind of person who worries about “who will rid me of this meddlesome priest” type problems. This is one more reason not to like him as a leader, but admittedly, probably not any of the top ten.

    • PorterBridges says:

      he’s kiiinda racist (ask the Central Park Five),

      You are referencing a well funded political propaganda effort that says the Central Park Five were arrested for no reason other than the color of their skin.

      From https://www.wsj.com/articles/netflixs-false-story-of-the-central-park-five-11560207823

      There were more than 30 rioters, and the woman known as the “Central Park jogger,” Trisha Meili, was not their only victim. Eight others were attacked, including two men who were beaten so savagely that they required hospitalization for head injuries.

      Mr. Salaam took the stand at his trial, represented by a lawyer chosen and paid for by his mother, and testified that he had gone into the park carrying a 14-inch metal pipe—the same type of weapon that was used to bludgeon both a male schoolteacher and Ms. Meili.

      • anonymousskimmer says:

        Calling for the death penalty when no one died is pretty extreme.

        And then Trump doubled down on this when DNA evidence showed that they were not the rapists.

        • PorterBridges says:

          The Central Park Five were convicted for assaulting other people, not just the jogger. If you read my comment before replying, Mr. Salaam confessed to bringing a 14-inch metal pipe to the park, which matches the weapon used to bludgeon John Loughlin as well as the jogger Trisha Meili.

          The DNA evidence didn’t contradict any of that.

          Next, the initial police report suspected multiple attackers on Meili (the jogger). One of the “five” said he just held her down, and didn’t actually rape her; holding her down doesn’t leave a semen sample but legally that is still rape.

          • anonymousskimmer says:

            Calling for the death penalty when no one died is pretty extreme.

          • PorterBridges says:

            Calling for the death penalty when no one died is pretty extreme.

            Those boys were assaulting, at least one armed with a metal pipe, were probably involved in maiming, and still possibly involved in a brutal rape. Skin color or not, people get upset about that stuff.

            If someone did that stuff to my daughter and hit her in the head with a metal pipe, I’d want them dead too. I don’t think that’s an uncommon reaction either.

          • Thomas Jorgensen says:

            … Eh.. assigning any non-neglbile probability to the central park five having anything to do with the rape with the current evidence is just flat out a dire failure at updating on evidence.
            There is a confession backed up by DNA evidence from a serial solo rapist. Guys like that dont change M.O, and while gang rapes happen, the salient fact about them is the *gang* part – group assaults mean a group who know each other commit a crime together, not random thugs coming across a crime in progress and going “lets join in on that”.

          • PorterBridges says:

            assigning any non-neglbile probability to the central park five having anything to do with the rape with the current evidence is just flat out a dire failure at updating on evidence.

            Even the lawyer who argued for the vacation of the convictions was clear that the Central Park Five were in Central Park assaulting strangers on the evening of Trisha Meili’s assault and rape.

            The DNA evidence didn’t conflict or invalidate the police report. The bulk of the confessions to involvement with the rape within an hour of entering the police station.

            And remember DNA evidence was extremely primitive in 1989. That was really before modern DNA forensics existed.

        • sourcreamus says:

          The Central park jogger was beaten so badly she lost 75% of her blood, had a skull fracture, and was in a coma for two weeks.
          It is amazing she survived it. The crime was as bad as a non homicide can be.

    • albatross11 says:

      Maybe Trump is really stupid and lazy and so hagridden with his own internal personality flaws that he’s super-ineffective and barely able to function. But if so, then he’s had a really astounding run of luck, what with winning the Republican nomination in 2016 against a bunch of well-funded, experienced politicians, then winning the election against a well-funded, experienced politician, and since then in pretty often controlling the media/public narrative despite the overt opposition of most of the journalists and news outlets of the country.

      I mean, maybe it’s all luck. But it seems possible that he’s really very good at this stuff. Perhaps not at running a government efficiently, perhaps not at messaging during a pandemic to minimize deaths/illnesses, but ISTM that he’s amazingly one-of-a-kind good at controlling the public narrative and getting people talking about him rather than whatever he has/hasn’t done. Let’s have a couple day outrage fest about whether calling it the “chinese flu” is racist and offensive, during which we don’t talk so much about whether the federal response to COVID-19 during February was managed well. Then let’s talk about some idiots poisoning themselves with pool cleaner and forget to discuss some other actual real issue.

      • anonymousskimmer says:

        He is really good at talking people into doing what he wants.

        There is evidence that demonstrates he’s not really good at successfully completing various things he wants, at least not without browbeating people into accepting less than he promised.

        but ISTM that he’s amazingly one-of-a-kind good at controlling the public narrative and getting people talking about him rather than whatever he has/hasn’t done.

        You’ve got a billionaire salesman who practices DARVO, and wanted to be president.

  44. Scoop says:

    Could someone – or several someones – who believes that Trump is really bungling this provide a list of things he should have done but hasn’t (or a decent article listing such things) and, more importantly, a list of things he should do immediately but probably won’t?

    I’m not a Trump fan, but it seems that most of our errors are entirely the result of the “experts” that we’re supposed to be following. Here would be my top three examples of “expert” decisions that made/are making this far worse than it should be.

    1. We did not implement travel bans fast enough. If, on Jan 9, we had mandated quarantines for anyone who had been in China (or in any other nation that had cases or did not implement similar quarantine laws) the number of cases in this nation would currently be zero. Every “expert” argued against that.

    2. Surgical masks very clearly work to slow the spread of this disease and many other diseases but our “experts” have spent years denying this very obvious fact because they won’t make such assertions without indisputable trial evidence and they won’t green light the sort of trials that would provide such evidence because a few trial participants might get sick.

    3. We have greatly slowed the development and deployment of tests and the trials of both treatments and vaccines by not waiving safety regulations that are (arguably) sensible under normal conditions but not now. Trump has always been more eager to waive red tape than the “experts” at NIH, CDC and FDA. You could probably fault him for going much further in overruling the experts and firing a bunch of folks at CDC for the test debacle, but people would have gone crazy if he’d done that, so things are still going slower than they should.

    • Edward Scizorhands says:

      > . Every “expert” argued against [travel bans]

      By putting “experts” in square quotes you have made this unfalsifiable.

      The travel ban was extremely limited and porous. I used to think Trump bought us a month of time with them, but after the UK said they didn’t think they would work I started reconsidering. Also notice how the US doesn’t really seem that far behind other countries.

      Border control is an important part of stopping disease spread. It should involve having facilities to hold people in roomy spaces for a few hours (or longer!) while they have their temperature checked. Their passports should be checked for any travel through any hotspots, not just their most recent destination. Many times the “screening” is asking if they visited a hotspot, to which the person can simply say “no.”

      Running the Federal government means being at the top of a giant machine that is monitoring thousands of low-likelihood-but-possibly-disastrous scenarios. Terrorist attack, loose nuke, chemical disaster, weather disruption. The vast majority of these never pan out and will never even be mentioned to the President. But when the risk becomes more serious, it’s time to start looking to see if we have the mechanisms in place to deal with it. The President needs good people under him who are willing to deliver bad news if necessary without fear of being shot for being the messenger.

      Then the President hears about what is needed if the threat becomes more likely. If it’s January 1 and the people looking at coronavirus think there’s only a 5% chance of a pandemic happening, ask what we will need if that happens. Knowing that we will critically need PPE and ventilators and medications is not something we needed to wait until March to know we would need. I don’t know the exact point at which the government starts making things happen, but at the very leas get phone calls in to the people who can make this stuff and ask them what’s stopping them from producing what is needed and how much lead time they’d need.

      When the FDA/CDC fucked up test production, he can react to that and start putting more resources in. (Was he even aware of it?) He could ask to buy other countries’ tests while we wait to get ours working.

      Right now, he should stop trying to sell the public on easy solutions. Stop talking about possible medical treatments, full stop. Stop making the jobs of people trying to enforce social distancing harder by talking about opening things up by Easter. This is probably going to be a long haul, and whatever post-hoc excuse you can make up to say that axxchsulayy he’s lifting people’s spirits or being encouraging, just stop.

      • Del Cotter says:

        What the US hasn’t done is a national stay-at-home order within ten days or two hundred deaths. The UK and Italy were late, but not as late as the US is being. It was doing well at first, maybe due to a ban on incoming travel, but once a disease is inside the country and in the exponential growth contagion phase, securing borders is no longer the answer.

        You may say the President can’t order that. %shrug%

      • Loriot says:

        The really damning part is that the virus was already circulating in the US by the time the so-called ban was put in place.

        But really, the important part is testing and monitoring the situation, which the US spectacularly failed at. Stories abound of people returning from Italy in February and not even getting a second glance at customs. Travel restrictions can buy you time, but Trump barely even did that and then spent the next month actively denying there was even a problem.

    • Jon S says:

      The lack of testing (initial, continued, obfuscated), lack of mask stockpiles, etc., has certainly lowered my opinion of the CDC a great deal. I don’t know whether Trump has contributed to relevant staffing deficits or whether a more competent president would have overcome some of the agency’s failings. Trump has done little to inspire the benefit of my doubt.

      More directly, he waited far too long to take the virus seriously. He continued downplaying the virus and arguing against precautionary measures (for businesses and individuals) well beyond the point when he should have known better. Areas with more Trump supporters continue to take distancing less seriously (at least according to anecdata – is it possible this is incorrect?). He failed to slow the spread in this regard, and I believe his comments about reopening the economy soon, etc., are continuing to hamper mitigation efforts.

      • albatross11 says:

        Making sure someone is on top of planning for stuff like this is the unsexy never-gets-a-newspaper-article part of what we actually want the executive branch (appointees 2-3 tiers below the president) to do. Competence at that has nothing to do with the stuff that gets you elected, except inasmuch as it correlates with hiring good people to run your campaign. But it’s something you definitely miss when it isn’t there and you need it.

        • anonymousskimmer says:

          what we actually want the executive branch (appointees 2-3 tiers below the president) to do.

          Right, everyone lower down than that has an actual daily job to do. It takes the higher level folks to coordinate large-scale, concerted job reassignment.

          This may be an argument for less hierarchy in executive branch agencies (so that people can self-assemble as needed), but no one would allow that kind of “deep state” to exist.

        • As best I can tell, the people seriously at fault in the federal government’s response to Covid are the FDA and CDC. My guess, which I haven’t checked, is that most of their top staff were appointed under previous administrations.

    • J Mann says:

      I’m skeptical of the worst of the “Trump’s fault” arguments, but IMHO,

      1) He could have acted faster. Testing rollout (a) occurred as planned and recommended by the experts in charge and (b) was a disaster. Every week sooner that Trump started bashing heads to get tests out the door would have been good.

      2) I would strongly have preferred if his initial messaging was something like: “This is very serious. We will get through it together, but avoid large gatherings, wash your hands, and stay home if you’re sick except for medical care.”

      3) Trump’s blustery style in press conferences and especially Twitter don’t give me a lot of confidence that he realized what a problem it was or that he’s engaged in fixing it.

      The best you can say for Trump is that he doesn’t seem to be interfering with Fauci et al. too much, but he also doesn’t seem to be doing much to help them.

    • Yosarian2 says:

      The biggest thing I would be critical right now is that Trump seems to be backing off on his earlier plans to have the federal govenrment buy a lot of ventilators quickly, partly because of the cost which was estimated to be about $1 billion. In general he has seemed slow to mobilize the federal government to do the kinds of things necessary to deal with the virus itself, especially in terms of making our medical system doesn’t get overwhelmed; he hasn’t really used the authority he claimed earlier to do so.

      https://www.nytimes.com/2020/03/26/us/politics/coronavirus-ventilators-trump.html

      He’s also said a lot of things that are clearly just not true to minimize the threat, and probably delayed people’s willingness to do social distancing early on in a way that did harm.

      • Edward Scizorhands says:

        partly because of the cost which was estimated to be about $1 billion

        $1 billion is a fucking bargain right now. Unless it’s choking out or bidding up something other people need, “$1 billion for ventilators” is the kind of thing that is now in the margin of error.

        • blumenko says:

          Read the article, there also issues of timing and amount of ventilators. And I don’t think it’s like GM has some unique access to ventilator manufacturing resources. If someone else could do it sooner and cheaper that would be better.

      • Scoop says:

        I’d agree that better early rhetoric on taking precautions to minimize spread might have helped significantly.

        As for the respirators, I don’t see much evidence that faster action would have made tens thousands of extra respirators available right now or in the next few days.

        Has any country that didn’t make a lot of masks and respirators before this struck been able to tool up so fast that they’ve avoided shortages in their hospitals? Not that I’ve heard of (though I’m certainly not monitoring this closely, so tell me if I’m wrong.)

        Look at Germany. They have a leader who is clearly bright and has been praised as pretty effective for more than a decade. They also have a much bigger manufacturing base (per capita) than we do. Yet I haven’t read stories about how their factories are already churning out huge amounts of respirators and masks.

        If they can’t do it, why should we think a better leader here could do it?

        • Matt M says:

          Look at Germany. They have a leader who is clearly bright and has been praised as pretty effective for more than a decade. They also have a much bigger manufacturing base (per capita) than we do. Yet I haven’t read stories about how their factories are already churning out huge amounts of respirators and masks.

          If they can’t do it, why should we think a better leader here could do it?

          +1.

          Maybe this is an isolated demand for rigor, but I’d really appreciate if people who want to levy harsh criticism on Trump’s COVID response provide a comparison alongside to another leader of a developed, western, nation whom they think did an obviously superior job.

          As far as I can tell, at a high level, Trump’s policy is basically the same as every other large western nation. I’m not seeing many examples of bad decisions he supposedly made that weren’t similarly made by Macron, Merkel, Johnson, Trudeau, etc.

          • Tim van Beek says:

            It is great fun comparing Merkel and Trump both regarding concrete policies, overall competence and communication. One has a PhD in theoretical physics, the other does not comprehend that “nuclear” isn’t a noun, or, possibly, what a noun even is 🙂

            Anyway, if you look at a decision made directly by the leadership:
            A hard factor is a federal coordination of the provision of PPE. This has happened in Germany on May the 4th (no pun intended), with the federal government stopping exports and centralizing the procurement (the federal ministry of health has taken responsibility). In the US, goverments, federal agencies and also foreign govenments are competing with each other right now trying to buy the stuff (if you believe what Governours are saying about this).

          • Out of the names mentioned, and probably every other world leader, he isn’t setting an example by standing a distance from his advisors during press conferences.

            He’s generally communicating poorly, and I don;t think “he’s always like that” is an excuse.

    • anonymousskimmer says:

      Every “expert” argued against that.

      Cite your sources for this claim. And it had better not be Trump.

      3. We have greatly slowed the development and deployment of tests and the trials of both treatments and vaccines by not waiving safety regulations that are (arguably) sensible under normal conditions but not now.

      Cite your sources that this is happening for this pandemic.

      Fortunately I can duckduckgo your question, and got a list in the first page of results: https://www.motherjones.com/politics/2020/03/here-are-17-ways-the-trump-administration-bungled-its-coronavirus-response/
      also: https://www.motherjones.com/politics/2020/03/trump-didnt-appoint-a-coronavirus-czar-because-he-feared-disloyalty/

      To add my own: He’s politicizing this pandemic like mad, which interferes with necessary intra-country and international cooperation.
      He’s telling the states to buy their own supplies (instead of promising to distribute as needed) while the federal government is outbidding them.

      I am happy that he reached out to North Korea, though. It’s quite possible a US government headed by a different president may not have.

      • Scoop says:

        Experts arguing against travel restrictions:

        World Health Organization chief Tedros Adhanom Ghebreyesus said Tuesday that widespread travel bans and restrictions weren’t needed to stop the outbreak and could “have the effect of increasing fear and stigma, with little public health benefit.” https://www.politico.com/news/2020/02/04/coronavirus-quaratine-travel-110750

        The problem with these measures, aside from social cost, is that they don’t totally work. In previous outbreaks, “things like travel bans haven’t materially stopped a disease getting into a country—they’ve simply delayed it,” Clare Wenham, an assistant professor of global-health policy at the London School of Economics, told us. https://www.theatlantic.com/international/archive/2020/03/coronavirus-covid19-xenophobia-racism/607816/

        It also seems to be true in the case of the coronavirus outbreak so far: China and Italy both adopted stringent restrictions on domestic and international travel but were unable to avert a pandemic. It’s true that case numbers finally started dropping recently in China, but as epidemiologist Bruce Aylward told Vox’s Julia Belluz, that can mostly be attributed to efforts to educate the public, identify cases, and rapidly isolate them. https://www.vox.com/2020/3/12/21176669/travel-ban-trump-coronavirus-china-italy-europe

        The Vox story, by the way, is titled why travel bans don’t work.

        Can you find a case of an expert in virology or epidemiology in some position of power at any government agency in the liberal western world arguing for serious travel restrictions before Trump issued his or arguing that Trump’s restrictions should have been far more stringent?

        And yet, clearly, full quarantine for anyone who could possibly be infected was the way to go by early to mid January. Trump erred in not doing this, but he erred less than the people who were supposed to know better.

        • anonymousskimmer says:

          Can you find a case of an expert in virology or epidemiology in some position of power at any government agency in the liberal western world arguing for serious travel restrictions before Trump issued his or arguing that Trump’s restrictions should have been far more stringent?

          You’re asking too much. These people report internally, not via twitter. I’m doing my best though:

          https://thehill.com/policy/healthcare/482103-trump-health-officials-defend-coronavirus-quarantine-travel-restrictions

          “The travel restrictions that we put in place in consultation with the president were very measured and incremental,” Alex Azar, secretary of the Department of Health and Human Services (HHS), told reporters. “These were the uniform recommendations of the career public health officials here at HHS.”

          https://morningconsult.com/2020/01/27/even-as-cdc-says-risk-of-coronavirus-is-low-in-u-s-worry-begins-to-spread/

          By Yusra Murad January 27, 2020 at 8:00 pm ET
          The CDC also raised its travel warning Monday to its highest alert level, recommending people avoid all nonessential travel to China.

          Other politicians were asking for a travel ban before Trump declared one: https://www.spglobal.com/marketintelligence/en/news-insights/latest-news-headlines/56764219
          Though admittedly in this article: “Fauci said both he and Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, told the senators that imposing travel restrictions was “not a good idea at this time.””
          https://www.inquirer.com/news/nation-world/coronavirus-china-wuhan-travel-ban-us-20200124.html

          January 23, 2020
          Travel ban halts flights between Wuhan and U.S., as airports prepare to screen passengers for coronavirus

          Trump one-upped it a week later to a full ban instead of a temporary ban to implement screening measures.
          https://news.cornell.edu/stories/2020/01/cornell-announces-travel-guidelines-response-coronavirus

          By Melanie Lefkowitz | January 29, 2020
          Following the recommendations of the CDC, the U.S. Department of State and International SOS, the university has designated mainland China as an elevated-risk destination. Until further notice, students are not permitted to travel to mainland China, and faculty and staff must obtain approval from Cornell’s International Travel Advisory and Response Team (ITART). The university strongly recommends that everyone reconsider even personal travel to China at the present time.

          • Edward Scizorhands says:

            The big problem was the ban was only on foreign nationals.

            Trump is an isolationist, and the isolationist’s tendency to want to lock down borders is a great idea for pandemics — but you have to have it apply to US citizens, too. The first case in Seattle was of a Seattle resident who had travelled to Wuhan, came back on January 15, and only decided to go to his doctor after reading about coronavirus online. It sounds like he was never even questioned about his trip.

            https://people.com/health/first-us-case-coronavirus-confirmed-washington-state/

          • Lambert says:

            Can you refuse to repatriate your own citizens like that?

            (the happy medium is to quarantine the people you’re ethically/politically obligated to let in.)

          • Scoop says:

            To Edward:

            You don’t really have to exclude anyone, be they American or not. You just have to make anyone who wants to enter the country go through a full quarantine.

          • Edward Scizorhands says:

            You of course let them into the country, but you find a way to handle them. At the limit, hard quarantine in government run facilities for 14 days. But there’s stuff you can do that’s a lot less intense.

            You can put lighter constraints on your own citizens. Maybe a home quarantine, and expect them to comply, because they are your own citizens and you can appeal to patriotism/public duty/threat of arrest-or-fines, tune as appropriate. Or if you have a test that costs $50 to run, your own citizens have that covered as part of their taxes, but foreign nationals have that tacked onto their plane ticket.

        • J Mann says:

          The problem with these measures, aside from social cost, is that they don’t totally work. In previous outbreaks, “things like travel bans haven’t materially stopped a disease getting into a country—they’ve simply delayed it,”

          Delay sounds pretty good – I’ll take all the delayed entry of coronavirus into my country that I can get.

          • Tatterdemalion says:

            Delay is only useful if you’re using the intervening time to do something useful, like stock up on ventilators, testing kits, etc.

          • HeelBearCub says:

            Since globally we assuredly are increasing our manufacturing capacity, which will allow increasing stocks, that seems like a pointless quibble.

            Now, are we doing it as quickly as possible? No. But that’s even more of a cause for delay.

      • Scoop says:

        Sources that government regulators have slowed/are slowing the mfg of ventilators and masks as well as the testing of treatments and vaccines:

        Too numerous to list, but here are some of the most absurd.

        The FDA just provided emergency use authorizations for some (but still not all) non approved respirators and personal protective equipment on three days ago. Three days ago!!! (There was a mini relaxation for PPE on March 3 but it was very limited.) https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ppe

        The NIH still does not propose to use direct challenge with live virus to speed the test of the 20 or so serious vaccine candidates that are out there. Here is a proposal from professors at Harvard and Rutgers that would shave “many months” off vaccine trial times. https://dash.harvard.edu/handle/1/42639016.

        The FDA will only let doctors use plasma from people who have recovered from the disease on patients whose lives are immediately threatened, and it only let them try the treatment on anyone as of March 24: https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds

    • orin says:

      Here is one example that I think illustrates the situation clearly:

      One February 12 Sen. Richard Burr received a briefing (not his first) about the potential impact of the epidemic and its potential effects. He reportedly sold ~1M in stock the next day. Over the prior week it was reported both in print and video that China was welding people into their apartment buildings in a desperate attempt to slow the spread. China had completed construction of multiple hospitals in an attempt to deal with an overwhelmed medical system. The death toll in China had surpassed that of the 2002-2003 SARS epidemic. The virus was spreading outside China. The WHO had declared a global public health emergency. And this is only what was publicly reported. I think it is reasonable to assume that Trump had a much clearer picture earlier than Feb 12 of just how bad the situation was likely to be.

      Now this is a statement made by Trump a full 12 days later (Feb 24), a time when the virus was exploding outside of China and best estimates of both the R0 and CFR by major organizations were significantly worse than the seasonal flu: “The Coronavirus is very much under control in the USA… Stock Market starting to look very good to me!”

      And on Feb 25: “”I think that’s a problem that’s going to go away””

      And Feb 26, a full 2 weeks later, when the SSC subreddit (for example) was getting flooded with concerned extrapolations of the data: “The 15 [cases in the US] within a couple of days is going to be down to close to zero.” “We’re going very substantially down, not up.”

      A day later still on Feb 27, when community transmission was rampant globally: “One day it’s like a miracle, it will disappear.”

      I think the above makes clear that, if we put aside what Trump may or may not have been doing behind the scenes, and consider the impact of public messaging has on public support for social distancing both culturally and regarding support for mitigation measures at the state and city level, then it is pretty undeniable that Trump’s was not only NOT using his bully pulpit to help the situation in any way whatsoever, but was practically doing everything he possibly could to undermine an effective response within the United States. I think his messaging alone, if different, would have altered the timeline of the mitigation measures at the local level by weeks, something that will probably literally cause the unnecessary deaths of hundreds if not thousands of Americans.

      I think his actions tell a similarly negligent story, but I’ll leave it there.

    • zima says:

      I think the main problem was that Trump didn’t spend February preparing, and also kept wrongly reassuring the public that everything was under control, which resulted in people not taking any precautions and being caught flat-footed. In February, we should have been stockpiling tests and masks, and warning people to begin voluntary social distancing. Large public events like Mardi Gras in New Orleans should have been cancelled. Also, the government should have been transparent with the public and told the public all the classified intelligence about how bad they thought this would be, instead of letting Senator Burr insider-trade on it. The fact that the stock market kept going up in February and then very quickly collapsed beginning the last week of February shows just how unprepared and unaware the public was. After this is over, we will need to know who in the government knew what when and what they didn’t tell the public in February. I think the early China travel ban was also a mistake because it encouraged the public to complacency. We would’ve been much better off if people had thought of this as a problem here from Day 1 and assumed it was already circulating rather than treating this as a China problem that did not require domestic precautions.

      Regarding your criticism on “experts,” no country on Earth, not even China, enacted quarantines or travel restrictions by January 9. The information known at the time did not support those. Not even the YouTube conspiracy theorists were out by January 9 yet. Acting on a hair trigger at the first sign of trouble is a counterproductive strategy in the long run because most of the time it really will be just the flu. Also, some doctors in Italy at least think it was already in Italy in December or even November, so it’s possible that even a January 9 travel ban would not have worked. Overall, it doesn’t seem like the travel ban has had much impact–some Western countries have had no or very late travel bans (Canada banned travel in March, the UK hasn’t banned travel at all) yet they have had no worse outbreaks than the US. Regarding masks, there are no masks available yet, so it makes sense to prioritize giving them to medical staff. Over the next few weeks, we’ll be producing more and China will be exporting more. At that time, people should start wearing surgical masks any time in public. I’d agree with the development and deployment of tests, but Trump is the boss of the government (at least the executive branch, which would include the CDC, FDA, etc.). He could easily waive enforcement of any regulations (no firings required). Trump has also seemed to adopted the CDC line about why they didn’t use the WHO tests, so it doesn’t seem like he would have waived red tape in this context.

    • e.samedi says:

      I’m not disagreeing with you but we won’t really have any idea of what was done well or poorly for years, maybe decades. It isn’t only the effects of the COVID virus itself we have to consider but also the actions taken in response. These together will have effects, most of which will take time to play out. Otherwise intelligent people consistently fail to take into account the time-delay factor and the law of unintended consequences in complex dynamic systems. The apparent “right” thing to do at the moment can, 10 years later, prove to have been the exact opposite of the right thing.

      An example of this is the impact of the 1960s Vietnam War on contemporary Mexico. Vietnam War results in massive increase in heroin use, causing Nixon to establish the War on Drugs in 1971, leading to the rise of the drug cartels, leading to the current state of Mexico. The ripple effect of the Vietnam War is still an active and on-going problem. And this is just one example of many. My point is simply that one needs to take a long term, historical perspective to gain any understanding, however limited that understanding might still be.

      • The Nybbler says:

        The apparent “right” thing to do at the moment can, 10 years later, prove to have been the exact opposite of the right thing.

        If I do something today that lets me survive until tomorrow, the fact that it results in a worse crisis 10 years from now really isn’t that important (because if I didn’t do it I’d be dead).

        The ripple effect of the Vietnam War is still an active and on-going problem.

        But none of that could be actually predicted, and the counterfactual scenarios would have had ripple effects _too_, and they’re still unknown. Suppose the US hadn’t gone into Vietnam. Domino theory proves to be correct, and Communism overtakes even more of the planet. This results in emboldened Communist states eventually directly attacking the US and Western Europe and global thermonuclear war; plutonium falls, everybody dies.

        Worrying about ripple effects so far beyond the range of forecasting doesn’t help.

    • albatross11 says:

      I think once the crisis arose, Trump was stuck with the experts he had. It would have been good for him to get ahead of things with messaging (tell everyone they should be really careful about this virus, wash their hands regularly, stay away from crowds, etc.), but he probably didn’t realize it was going to be this nasty in time. Most media/government elites didn’t, and I’m guessing it wasn’t too easy for someone like Faucci to get face time with the president or convince him if he did. And I expect that, during an election year, doing so would have gotten partisan media/pundits and politicians on the other side pushing back. (“He’s just trying to get people to stop coming to Biden/Bernie rallies!”)

      Once the crisis has begun, the big boss usually can’t do much other than throw money or political heft at the problem. Every president is obsessed with being *seen* to do something about the crisis when it’s happening, but usually there’s not much he can do at that point except make sure the people whose job it is to respond have money and political cover and maybe do some public messaging to try to keep most of the citizens pointed the same direction. (But Trump’s not exactly a unifying figure, so who knows how that would even work.)

    • 3. We have greatly slowed the development and deployment of tests and the trials of both treatments and vaccines by not waiving safety regulations that are (arguably) sensible under normal conditions but not now. Trump has always been more eager to waive red tape than the “experts” at NIH, CDC and FDA. You could probably fault him for going much further in overruling the experts and firing a bunch of folks at CDC for the test debacle, but people would have gone crazy if he’d done that, so things are still going slower than they should.

      It’s a myth that testing a new vaccine is just an unnecessary bureaucratic hurdle: new vaccines can easily be dangerous.

      • anonymousskimmer says:

        Or a waste of time.

        It’s plausible that if no testing was done everyone would have to be injected a dozen times or more to find a vaccine that worked. Very few people would put up with this, which would result in more infections than necessary.

      • albatross11 says:

        Imagine a slider bar for a new vaccine, where one end is “fast” and the other end is “safe and effective.” Nobody remotely close to Trump’s level can do anything at all about vaccine approval other than:

        a. Order the FDA to prioritize this vaccine approval (which they surely are already)

        b. Move the slider bar toward “fast.”

        (b) is something Trump can do, but he has no knowledge with which to decide how far to move it. For that, he gets to talk to some FDA administrators who talk to their underlings, and eventually there’s a set of technical people who can work out what can be done sensibly to speed up the evaluation of the vaccine, and try to update their procedures to stay at the best available point on the fast/safe tradeoff curve.

        Congress can also offer more money to the FDA, but probably that’s going to take a year or two to start bearing any fruit.

      • Scoop says:

        “It’s a myth that testing a new vaccine is just a bureaucratic hurdle”

        Obviously you need to test efficacy, but the NIH is adding many needless months to the process and I think the now-sainted Dr. Fauci is going to come out of this looking far worse than Trump.

        Moderna sent the NIH all the vaccine needed for a phase I trial on Feb 25. The first patient was injected on March 15, and everyone was patting each other on the back for acting fast.

        That’s insane. The first person should have been injected by February 26, and the rest should have been injected the instant it was clear the vaccine candidate wasn’t a fatal poison.

        It is also blindingly obvious that as soon as vaccine candidates begin producing significant immune responses (if they work well enough to do that), trial participants should be immediately and intentionally exposed to live virus. Here is a paper showing that it would speed vaccine testing by many months – https://dash.harvard.edu/handle/1/42639016 – but the testing establishment has spent so many years worried about protecting trial participants at all costs that this isn’t even being considered.

        This is crazy. This is literally the worst mistake we are currently making in this. These vaccines can be fully tested in less than six months. Perhaps none of them will prove effective, but there are at least 20 credible candidates.

        (Oh, and we should pay the companies to mass produce all of them now so we’re ready for widespread vaccinations the moment we get a positive result.)

        • albatross11 says:

          The problem here is that we have procedures that are absolutely the right way to do things like 99% of the time, but they’re unduly slow for a crisis. That’s also what bit us with the FDA’s involvement in the COVID-19 test. In nearly all cases, delaying a test getting to market for six months to really nail down the accuracy of the test is probably pretty reasonable; in this case, it cost us dearly.

          • The problem here is that we have procedures that are absolutely the right way to do things like 99% of the time

            What makes you believe that?

            Peltzman’s old piece found that one addition to the FDA requirements for permitting a drug cut the rate of introduction of new drugs in half while having no measurable effect on their average quality.

          • Medics who are in no way subject to the FDA are saying the same thing about vaccine testing.

        • CatCube says:

          What were the things being done from Feb 25th to Mar 15th that you believe were inessential?

        • keaswaran says:

          Vaccine trials need to take time because there are sometimes slow-acting side-effects. If we’re going to inject billions of people with this, we want to make sure it doesn’t cause paralysis six months down the line, or *increase* susceptibility to the virus a few months down the line, the way some past vaccine candidates have.

    • salvorhardin says:

      Peter Beinart has a good article in today’s Atlantic detailing how US-China cooperation helped the world avoid prior pandemics, and could have helped with this one if not for Trump’s malign neglect of the relevant cooperative institutions:

      https://www.theatlantic.com/ideas/archive/2020/03/breaking-china-exactly-wrong-answer/608911/

      As a bonus, it’s a pretty good general primer on why effectively fighting pandemics requires more globalism, not less.

  45. mizitch says:

    Great post! 3 thoughts:

    Amazon is still only offering paid sick leave if someone tests positive for covid from what I’ve read which is pretty horrible given the state of testing.

    Anarcho-capitalists think of all governments as being roughly equivalent to organized crime so not sure they’d especially cheer over Rio de Janeiro. It’s just another mob using coercion to try to stop the pandemic (though I’m guessing you weren’t being very serious there)

    Japan did close schools pretty early and hasn’t reopened them yet. Maybe mask wearing plus school closing is a pretty effective set of interventions?

  46. Le Maistre Chat says:

    1.5% of Americans are 85+, but 9% of patients hospitalized for COVID-19 are. (Source)
    10.9% are 65-84, but 36% ditto, and 46% of ICU cases are in that age range.
    I remember reading that if you get put on a ventilator, there’s a 44% chance you’ll stay on it until you die.
    Are ICU cases for COVID-19 ventilator cases pretty much by definition? This is something I’m really unclear on.

    • Kaitian says:

      I know of at least one person who was sent to the ICU with covid but was not immediately put on a ventilator. So anecdotally, such cases exist.

      From what I’ve experienced with a sick parent, the ICU breathing problems protocol is, in ascending order of severity:
      – oxygen tube to the nose. I think every ICU bed has this option.
      – CPAP mask for breathing assistance (I’m not sure if these can be used for Covid, because that actually destroys lung tissue, not just your ability to breathe). This is also considered a relatively low impact option.
      – some gross machine that sticks a tube through your ribs and sucks liquid from your lungs (in addition to the machines mentioned)
      – intubation with a ventilator. If the patient is elderly, doctors will actively warn you against this, because it is extremely unpleasant for the patient, they may well die anyway and it will cause long term damage if they survive. For younger patients it might not be as bad.

    • ADifferentAnonymous says:

      > if you get put on a ventilator, there’s a 44% chance you’ll stay on it until you die.

      I’ve seen numbers like this passed around, but I suspect that’s because many of the things that make you need a ventilator are problems that won’t just go away. Viral infections do go away if you buy the body time, so I’d be careful about extrapolating from the general case here.

        • Le Maistre Chat says:

          Geez. “29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.”

          That’s not a wholly satisfactory sample size (we should look at 1,000+), but it looks like having enough ventilators will only save the lives of up to 19% of ventilator cases.
          It also looks like we could get away with ~0.56 ventilators per ICU bed as governments ramp up purchasing.

          • soreff says:

            among those who required invasive mechanical ventilation was 19 (86%) of 22.

            Geez seconded.
            Within statistical error of
            “And I only am escaped alone to tell thee”

  47. m.alex.matt says:

    I have a lot of respect for principled constitutionalists who believe that the nation’s government should occasionally follow the document that they take a solemn oath to protect. But insisting on that now, of all times, seems kind of like closing the barn door after the horse has left, caught a plane to Cape Canaveral, boarded an experimental rocketship, gotten halfway to the Oort Cloud, and also some kind of weird terrorist group is threatening to start a nuclear apocalypse if anyone closes any barn doors. Just let this one go and get back to your noble-yet-quixotic crusade sometime when we’re not all going to die.

    It’s not really so quixotic. During an emergency is when you want to adhere to constitutional norms the most, because during an emergency is when you start setting precedents that start out, “Just this one time, because of the emergency”, and, fifty years later become, “This is just a normal part of the way we do things”.

    Principles that are not honored in the breach are not principles.

    Now, the proper way to ignore the Constitution on this one is to leave it un-commented upon right now, pass it over in silence, like we just forgot. Then, after the emergency has passed, someone brings it up later in a, “Wait a second, wasn’t that illegal?”, kind of way, there’s some hand-wringing about the matter, we admit it probably was, then we build provisions into the Constitution that explicitly allow for this kind of emergency and circumscribe the circumstances where it is allowed.

    That is, anyway, how it would work in a sane world. Too bad.

    • Del Cotter says:

      Shakespeare nitpick: the phrase “a custom more honored in the breach” means it would be better to honor your country and its customs by not honoring that one. Hamlet is saying that although it’s his country and he’s mostly proud of it, he’s still disgusted that his countrymen get sloshed at weddings and wishes they’d stop, tradition be damned.

      Although it seems to me that getting drunk and fighty at weddings is pretty international.

  48. craftman says:

    quitting smoking now will save you a 1% risk of coronavirus death this year. But about 10% of smokers get lung cancer eventually, compared to very few non-smokers, and lung cancer has about a 66% death rate, so it’ll save you a 6.6% chance of death by lung cancer. Honestly, coronavirus shouldn’t even figure into your calculations here

    Is that the right way to think about it? I would think 1% risk for this one year (and potentially future waves of the disease) vs. 6.6% risk spread out over the rest of your life should be more equivalent risks than they initially seem? The 6.6% has to be weighted further in the future such that the current risk of dying this year is less than 1%?

    Small quibble, but wondering if this is the right way to view these mortality statistics.

    • broblawsky says:

      Yeah, there will (eventually) be a coronavirus vaccine. There might never be a lung cancer vaccine.

      • Statismagician says:

        There cannot be a lung cancer vaccine, except in the broadest possible colloquial sense, and even then it would require technology indistinguishably from magic.

        • anonymousskimmer says:

          People are working on this.

          Two routes:
          1) mRNA vaccines https://www.nature.com/articles/nrd.2017.243
          2) injecting allergens directly into a tumor to which can stimulate an immune response that secondarily targets the cancerous tissue.

          • Statismagician says:

            To me the second doesn’t meet the definition of a vaccine, being more properly a very interesting treatment option – vaccines ought to confer immunity or at least resistance to novel infection by some pathogen (most properly) or case of some disease (more generally); allergen-injection is a mechanical trick to make a particular immune system attack a particular tumor, as I understand it.

            The first is definitely more arguable – my personal opinion is that they’re called vaccines essentially for marketing/grantwriting purposes, but I admit I’m not familiar with the research (they’re quite new). Thanks for pointing it out!

          • albatross11 says:

            Distinguish cervical cancer, where we actually do have a vaccine that will prevent most of it, because most of it is caused by a viral infection decades earlier.

  49. broblawsky says:

    Do we have any indications on whether vaping is a) as bad, b) worse, or c) better in terms of increasing the severity of COVID-19 infections? A quick Google Scholar search revealed nothing.

  50. craftman says:

    There are a lot of variables involved that we can only guess at, but given some reasonable predictions, even at a low value of $30,000 per life-year it’s worth spending trillions of dollars to slow down the epidemic.

    Has anyone run these numbers for a Finland-style “quarantine only elderly and at risk people” scenario? It seems intuitively that those who contribute most to the cost side of the quation (elderly who get hospitalized/die at a higher rate) contribute the least to the benefit side of the equation (economic productivity). Is it wrong to think we get a kind of pareto-80/20-effect where we can quarantine the 20% most susceptible and still maintain 80% of economic output?

    Or could we generate some kind of Laffer-curve shaped equation where we know the optimal age/health-risk factors to enforce a quarantine while maximizing output?

    • AlexSpark says:

      “At risk” includes people with diabetes, hypertension, obesity, asthma… I saw an estimate somewhere putting this at 40-50% of the population. Obviously some are higher risk than others, like elderly people with lung conditions, but it’s a pretty big chunk of the population. And we don’t have hugely clear, trustworthy data on which specific conditions increase mortality, and by how much.

      In practical terms, it’s a nightmare to actually segregate people. Do you isolate a whole household of four working people because one of them is high risk? How do you manage housing if you’re separating people? You could maybe isolate a care home if enough staff are willing the lock themselves in, but lots of old people live in the community and require some level of home help.

      You can run the numbers, but that won’t get you to a practical solution.

  51. Matt M says:

    What is the steelman for caring, even a little bit, about “total” cases/deaths as opposed to per capita?

    “The US has more cases than China” strikes me as important and worth noticing (assuming you believe the Chinese numbers). “The US has more cases than Italy” seems completely and entirely expected and doesn’t strike me as particularly informative at all.

    • EchoChaos says:

      The Steelman is that as long as we are still in the early spread and doubling stage, as long as we haven’t burned through a large enough percentage of the population that it affects spread and doubling (and nobody short of Monaco/Liechtenstein probably has), then all that matter are raw numbers because the doubling is not dependent on enough new hosts to be spread to because they are still functionally unlimited.

    • Del Cotter says:

      In the early stages, all countries are effectively infinite in size, so country size isn’t an issue. If the disease was caused by cosmic rays then the number of people getting the disease would be proportional to the number of people, but it’s not caused by cosmic rays, it’s caused by contagion, so the mathematics are different.

      In the S-I-R model, eventually country size kicks in when you start running out of S (for “Susceptible”) people. The dearest wish of each country’s government is to get the outbreak under control long before then.

      PS I can’t answer your call for a steel man because that’s a plea to fellow skeptics, and I’m not a fellow skeptic. This is just a plain old counter-argument from the opposition.

      • Matt M says:

        I mean, I guess it’s a plea to skeptics of the concept that the United States, at a national level, is doing something uniquely wrong. Because to me, that seems to be the unstated implication of these messages.

        Of course, if you subdivided the United States into all of its constituent states (like how the EU is subdivided into various nations), that narrative would collapse. California has fewer cases than Italy. US as a whole has fewer cases than EU has a whole (I believe, this may very well change soon), etc.

        • Del Cotter says:

          I just meant a steel man is necessarily that which you either think up for your opponent, or that you ask the others on your side to think up. If your opponent thought it up, it’s not a steel man, it’s just “the other side’s position”.

        • Del Cotter says:

          I was thinking about how you divide countries up or not, and came to the conclusion that the difference is whether the different outbreaks occurred at the same time due to extra injections of infected people from independent transport sources. If the outbreak in city x comes from city y, then it’s just the regular working through of contagion. If the outbreak in city x came from an independent source but much later so that it’s much earlier in its trajectory, then it’s a numeric irrelevance.

          On that basis you might be able to argue that the US is the victim of two outbreaks, one on the West coast and one on the East, and the East coast one is the bad one, and that’s only a little north of 50,000 cases, “only” as bad as Spain. However, I expect the East coast alone to exceed Italy and China within days.

          • The Nybbler says:

            The US has more than two outbreaks. There’s the huge NYC one, Boston, Washington DC, and Miami, Washington State, SF, LA, and Denver . It’s possible some of these are secondary to other US outbreaks, but they’re all cities with lots of international travel.

          • Matt M says:

            However, I expect the East coast alone to exceed Italy and China within days.

            OK, but what does that mean? The “east coast” is a pretty arbitrary unit of measurement. Do we all agree what it even is?

            And even if we did, there is no unifying policy of the “east coast” that is distinct from national policy. Specific quarantine policy is largely decided at the state/local level.

            But let’s say you’re right, and soon the “east coast” however you define it has more cases/deaths than Italy, France, and Spain combined.

            What useful information would that tell us? What would be the point of writing a headline that says “East Coast cases now exceed Southern Europe cases.”

          • Del Cotter says:

            Nybbler, the irrelevance of any center that isn’t NY is what I was getting at with the last sentence in my first paragraph. The logic of Zipf distributions (many small, one huge) plus exponential growth, means lumping and splitting don’t make any difference. For instance, it’s possible DC caught it from a Wuhan traveller and not NY, but it’s so tiny it’s not worth considering. I don’t take seriously that NJ had its own unique outbreak (right next door to NYC, really?) but if it did, even that’s small as a contribution to the total.

            tldr, I tried to meet the US splitter part way, and that wasn’t good enough.

            You could split the US into every individual state AND lump every European country into one, but that starts looking like an isolated demand for splitter, as if you’re trying to contrive a result out of the available data for emotional purposes. After all, why should not Madrid and Catalonia and Lombardy and Venice benefit from the same consideration?

          • Del Cotter says:

            We all agree what the US is, but you didn’t seem to like that. I was trying to help.

            I can’t agree to help as far as counting every single state individually, and I certainly can’t agree to both do that AND lump every European country into one, just to make the numbers come out right.

          • Matt M says:

            I don’t think there is any one “right” way to look at it, to be honest. My point is that they’re all pretty dang arbitrary.

            Given that most relevant policy in the US is made at the state/local level, the fact that “the US” has more cases than “Italy” does not tell us anything constructive about effective pandemic response.

            If the narrative could completely and entirely change just by drawing the reporting lines differently, it isn’t a very valuable narrative in the first place.

          • Del Cotter says:

            I just got through pointing out the narrative doesn’t change when you change the reporting lines, unless you make a heroic effort that ends up being fairly obviously special pleading.

    • matthewravery says:

      “The US has more cases than Italy” seems completely and entirely expected and doesn’t strike me as particularly informative at all.

      It depends on what you mean by “informative”. If you’re question is, “Are more people sick in the US or Italy?” it’s very informative. If you’re asking “Who handled the situation better?” it’s not that informative.

      Sometimes, simplicity is nice. For the same reason some people like “Home Runs” as a statistic for evaluating baseball players more than “Wins Above Replacement”, some prefer “people” more than “people scaled by some other number”. “Per capita deaths” isn’t more informative if you’re talking to someone who doesn’t know what “per capita” means.

      Other metrics (e.g., ICU beds) are frequently measured in raw rather than scaled numbers.

      For the analytically-minded, you’ll almost certainly want more context than the raw numbers will give you, but not everyone is analytically-minded!

    • Chalid says:

      One defense might be that there’s an inherent newsworthiness about big events. A hurricane killing 1000 people in the US is bigger news to Americans than a storm killing 180 people in Italy is to Italians, or a storm killing 1 person is to Icelanders.

      But yeah in general everyone should pay attention to per capita cases, deaths, testing rates, etc.

      • Del Cotter says:

        No. Per capita is a waste of time and distorts what’s happening. If an outbreak occurs in Elbonia, but Elbonia claims its nation has a population of 10 billion based on its non-contiguous territories on Mars, that doesn’t mean the Elbonian outbreak isn’t as bad as everyone else’s based on “per capita”. It’s still got an outbreak.

        All nations are petri dishes of effectively infinite extent at this time. Some of them have had a spore land within that petri dish, and where it lands there is a spreading spot. I will just about accept a plea from Americans (they’re all Americans) to the extent of agreeing to agree at their petri dish was so big it got a spore on two edges at about the same time by bad luck. I will go no further than that.

        I see the comments on the minutephysics YouTube explanation of Aatish Bhatia’s Covid trends page include calls to “scale as a percentage of the country’s population”. All Americans. That and the ones going “China isn’t reporting accurately, therefore your argument is invalid.” It’s motivated reasoning based on emotional discomfort.

        • Kindly says:

          Some kinds of per capita numbers are obviously useful. If for some reason I leave my apartment and travel to New York, and I want to quantify how bad of an idea that is, I’d want to look at per capita New York.

          An interesting measure is per capita weighted by population density, loosely answering the question: if a random person in Country X walks outside and shakes hands with the first person they see, how likely is that person to be contagious?

          • nkurz says:

            @Kindly
            > how likely is that person to be contagious?

            And the obvious followup that I’d love to see answered: Assuming that person is contagious, how likely are you to be infected from a handshake: a) If you immediately lick your fingers? b) If you go on about your day without touching your mouth? c) If you immediately properly scrub your hands? And how do these odds compare to getting close enough for a handshake but avoiding contact?

            I’ve seen almost no estimates of these risks (or any per incident comparables), but think they would help to calibrate my behavior.

          • keaswaran says:

            “Assuming that person is contagious, how likely are you to be infected from a handshake: a) If you immediately lick your fingers? b) If you go on about your day without touching your mouth? c) If you immediately properly scrub your hands? And how do these odds compare to getting close enough for a handshake but avoiding contact?

            I’ve seen almost no estimates of these risks (or any per incident comparables), but think they would help to calibrate my behavior.”

            It seems like the way to get here is to work backwards. I’ve seen estimates of R0=2.3 in a pre-social-distancing environment. That 2.3 is going to be divided among all the interactions the infected person had. So if the average person interacts with 23 different people during their infectious period (under pre-social-distancing rules), then it looks like each interaction had a 10% chance of leading to an infection. Presumably the vast majority of those people neither immediately licked their fingers nor immediately scrubbed their hands nor avoided touching their face all day. I don’t know if 23 is a useful estimate for the average number of interactions of an infected person over two weeks – likely the number is hugely different if you’re talking about a slum dweller or an office worker or a housecleaner or a librarian or a hermit.

          • albatross11 says:

            One tricky thing is that R_0 is an average. For R_0 = 2.3, that can mean most people infect two or three new people, but it can also mean that most people don’t infect anyone, but an occasional rare person infects a dozen people.

            On one side of this, suppose you’re already working at home and you live alone and mostly order delivery for food and groceries. You might not infect *anyone*. OTOH, suppose you’re a TSA agent who’s contagious but with very mild symptoms–you’ve got a bit of a cough and a stuffy nose, but nothing bad enough to miss your job patting people down and looking through their luggage. You might infect a hundred people today.

            I’m no epidemiologist, but I’m pretty sure the spread of the disease (and the measures to prevent it) change a lot depending on what that pattern looks like. For example, if there are a few superspreaders who are massively shedding virus everywhere, then concerts, conferences, and crowded restaurants/bars are serious bad news. If it’s more like most people maybe infect 2-3 people, then that’s still useful, but the impact is going to be a lot lower. Your main job then is to lower that average R_0 a bit for everyone–getting everyone to stay 2m /6 ft apart and hand sanitize, etc.

            SARS and HIV both had superspreaders. (ISTR there was an airline steward who had a huge impact in the early AIDS epidemic, because his hobby was anonymous sex with lots of guys in every city he visited.)

  52. Alsadius says:

    > I appreciate this line of reasoning, but I hate it. It means you stop being able to communicate your real thoughts in favor of communicating whatever information a utility calculation says it’s most beneficial to communicate – which is fine until people very reasonably choose to stop interpreting your mouth movements as words.

    Yes, this is a big part of why Trump won. Other politicians do this. Trump does not. You know that he says what he thinks. Even if what he thinks is insane, irresponsible, or literally physically impossible, he genuinely believes in the things he says. And that makes him seem honest, to a lot of people, because they’re so used to being lied to about everything that someone who lies unconsciously looks more appealing than someone who lies consciously.

    > what does it even mean to “find” this many masks in this context?

    A lot of non-medical masks are built to basically the same standards as medical masks. I remember hearing that P95 masks (common in the oil industry) are just N95s that also work against petroleum fumes. So stockpiles that work for things like that can be moved over to the medical side of things pretty easily.

    • Scott Alexander says:

      I don’t think Trump doesn’t do this. He seems to do it at least as much as anyone else, but his goals and styles are so different that he doesn’t immediately trigger the same response.

      Eg when he says something like “Despite what the Lamestream Media says, together we are going to conquer this virus and MAKE AMERICA GREAT! #HelpFirstResponders”, that seems like a very Trumpish way of inspiring optimism and keeping the narrative where he wants it to be. Even his nicknames seem formulaic enough that they feel like at one point Trump thought “Maybe if I gave people nicknames in this pattern it will help me control the narrative” and then he stuck to it. I don’t think any of this stuff reflects the way Trump actually thinks.

      • cuke says:

        I don’t understand what the relevance is of whether what Trump says is what he “actually thinks” or some other thing. Why does it matter?

        I would venture that even in our most intimate relationships, there is no clean bright distinction between “what I really think” and “communication to advance my utility.” One is not pure and the other sullied, and they are completely bound up with each other.

        Quite apart from Trump, we are all generally social creatures and our well-being depends a lot on maintaining relationships. Because of that, what we say and how we say it will always be heavily shaped by how our speaking may improve or jeopardize our connection with others. That’s not just scheming or manipulative; it’s also prosocial and healthy.

        And then let’s break apart a little the idea that in any given situation there’s something called “what I actually think.” I don’t know about you, but for me on any give topic, I have about fifteen competing thoughts and they shift in terms of their urgency to be said from one moment to the next. If I stand up right this minute and go brush my teeth and come back, chances are I’ll delete this comment because in the span of three minutes it will no longer seem worth saying. Would we say this comment represents what I actually think or something else?

        (I didn’t brush my teeth, so the comment remains. I think this is where executive function matters — that when it comes to action, which presidential speech always is, it matters what thoughts you prioritize to speak of the many possibilities that there always are. So I can let my ramblings sit here, they are harmless enough. But I wouldn’t dare to bring them to a presidential briefing on a pandemic.)

  53. felix says:

    Remember that malaria still kills 400,000 people per year (about 20% of the expected coronavirus death toll) but is probably getting a tiny fraction of the funding and attention right now.

    It’s important to note here that 2 million is the median prediction on Metaculus, not a mean! The expected number of deaths is probably much greater! Does anyone know how to get any “expected value” number out of Metaculus?

    I don’t really understand the site, but they show some distribution that’s the “community” prediction. The 50th percentile of that predict looks like it’s 2 million, but the community prediction gives a 7% of more than 100 million deaths, so the expected number of deaths is at least 7 million.

  54. Gumpalonia says:

    Did the world health organization just switch sides? I get that is a trollish sounding frame but based on this tweet it does indeed seem like an option. I mean if there was a virus like toxoplasma 2.0 that could take over, not just brains of single humans, but entire organizations, wouldn´t they use their influence to trick people to lay down their defences? And do this with rationally sounding arguments?

    Then again the argument from “false sense of security” seems weak, even for a human brain controlled by a virus. Is there any evidence that humans wearing masks actually take more risks? Or is it just an intuition? If the latter is true, it is kinda worrying. Any protective measure creates a feeling of security, wheather justified or not. Should WHO oppose seatbelts in cars because they can lead people to drive more recklessly? It´s such a bad argument with such a wide scope that even using it in the public discourse should be discouraged because it can be used against any protetive measures if there is no empirical evidence to back up the claims of behavioural changes. Can anyone steelman WHO:s guideline? If it´s true that the risky behaviour outweighs the protection masks provide, wouldn´t that show up in the data we have already?

  55. morris39 says:

    Canada’s corona virus per capita case/death rate is .33//25 that of US. Better than S.Korea. US/Canada demographics,culture and self isolation policies are similar.
    As far as I can find there is no discussion about this on blogs or in the media. Interesting why. Not much opportunity for attacking others?

    • Scott Alexander says:

      I don’t think South Korea’s raw numbers are impressive, I think they’re impressive in the context of having had the epidemic much longer than anyone else and still keeping low numbers. Canada, the US, the UK, etc all vary within a factor of 5 or something, but that doesn’t matter that much on the scale of an epidemic – ie Canada two weeks from now will probably have a higher per capita case rate than the US today.

      • morris39 says:

        Too early to know for sure. That S.Korea kept cases low after earlier exposure is at odds with other countries’ experience and seems impressive to me, especially since they reportedly do relatively more testing as does Canada and Australia. The ratio in cases/deaths for the last 2 countries vs US has been somewhat constant over the last 2 weeks, if you consider 2x constant.

  56. alchemy29 says:

    We probably are not overestimating the mortality rate by a factor of 10 or 100. For several reasons –

    One: Deaths are underreported as well as asymptomatic cases. Some number of COVID related deaths are being misreported as pneumonia, heart failure exacerbation or COPD exacerbation.

    Two: There are people who have the disease and will die, but have not died yet. The fatality rate for confirmed and closed cases (people who have either recovered or died) is actually 17% right now. And about 5% of confirmed cases right now are in critical condition.

    Three: The mortality rate will go up as soon as we run out of ICU beds (you already addressed this).

    I don’t know how epidemiologists are estimating unconfirmed cases but I have no doubt they are doing so. It’s standard practice for every other infectious disease – no reason they would forget to do so this one time.

    • Two: There are people who have the disease and will die, but have not died yet. The fatality rate for confirmed and closed cases (people who have either recovered or died) is actually 17% right now. And about 5% of confirmed cases right now are in critical condition.

      This doesn’t invalidate your underlying observation completely, but might call the 17% figure into question:

      I’m not sure that’s quite how the numbers work out. If you die, you presumably cut the time you would have spent being sick and recovering short – in other words, people who die tend not to be sick for as long as people who will recover. Conversely, that means that people who will recover will be part of the “not recovered” statistic longer than the people who will die.

      • anonymousskimmer says:

        I’ve read that critical patients (those with the greatest odds of dying) tend to remain symptomatic about 3 times longer than those with mild or moderate COVID-19.

      • alchemy29 says:

        I am not suggesting the 17% figure is anywhere close to the true mortality rate. But the (current number dead)/(total cases) isn’t right either.

    • soreff says:

      >Three: The mortality rate will go up as soon as we run out of ICU beds (you already addressed this).

      Yup. And even out of ordinary hospital beds with oxygen, in a moderately bad scenario.

  57. J Mann says:

    Random question – I have a friend who is doing home health visits for physical therapy. They are wearing whatever masks they have, but reusing them indefinitely because they can’t get more. (Our area is still relatively low but non-zero for detected cases, and he doesn’t visit people who are symptomatic.)

    I checked in my tool drawer, and I have one N-95 mask still in package, but it’s (best guess) 14 years old, and the CDC lists this model (Mine Safety Appliance Company Model 201-4) as “Obsolete 2/25/09.”

    Should I offer him my mask? It sounds like it is probably better than nothing, but maybe not much better.

    • craftman says:

      The CDC just ran tests on a bunch of expired masks (mfg date 2003-2013) and found the below models to still perform acceptably: [source: https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html%5D

      3M 1860
      3M 1870
      3M 8210
      3M 9010
      3M 8000
      Gerson 1730
      Medline/Alpha Protech NON27501
      Moldex 1512
      Moldex 2201

      I think re-using the mask indefinitely is a bigger problem than whether or not one is expired. I imagine an expired mask on its 1st use is more effective than a “new” N95 mask on it’s 10th use due to possible contamination from outside to inside the mask surface.

    • Anthony says:

      If nobody has a cough, and nobody is known to have COVID-19, washing/sanitizing the masks between visits should be enough. A properly-fit N95 is hard to breathe through, and an improperly-fit N95 is a waste of a mask.

      On the other hand, if it’s not by Kimberly-Clark, and is still in sealed package, it’s almost definitely still good. If it *is* by Kimberly-Clark, the testing failure rate is about 5% to 10%.

  58. Murphy says:

    I don’t think a full-scale epidemic could stay completely hidden forever, but maybe it could be harder to notice we would naively expect.

    keep in mind, there are refugee camps where the estimates for how many people are there can change from 3 million to 2 million when someone gets some better pictures of the camp from the air.

    If 3% of the population in such a camp died from something you might struggle to notice it from within the camp or even from within a family who’s lost a couple of members.

    Throw in harsher living conditions and it may well be the case that most members of the population inclined to die easily from infections are already dead. 3rd world countries can be harsh.

  59. salvorhardin says:

    Any data on what’s going on with Sweden? This article has obvious bias but still:

    https://reason.com/2020/03/25/despite-coronavirus-sweden-refuses-to-shutter-businesses-and-limit-gatherings/

    the summary is “Sweden is doing much less to lock things down than other countries, they haven’t even closed elementary schools, and their public health authorities say this is the right thing to do.” How might we distinguish between possible points of view on this, e.g.

    — is the article actually right, or is it understating the extent of Swedish lockdown and/or overstating the extent of Swedish public health authorities dissenting from those in other countries?

    — if the article is actually right, how/when might we know more about whether Sweden’s distinctive approach does ok for them or dooms them to the sort of economic and health disaster people would predict in other countries if they adopted this approach?

    • zakamutt says:

      (I live in Uppsala, Sweden)
      Restrictions on public gatherings are actually getting tightened to a maximum of 50 now: https://www.krisinformation.se/en/news/2020/march/further-restriction-of-gatherings

      My impression is that the article doesn’t make any wrong claims. It is true that we have no travel bans, and measures like closing secondary education (ages 15-18) and universities were taken a bit later than most other countries I heard about – about a week of lag, maybe? The decision not to close elementary schools is interesting, and I’m not sure what motivates it – maybe they think the kids are less contagious, or that they would be out and about messing with other kids whatever people did? I think people were arguing something like that here on SSC at some point…

      I was half-listening to the press conference where the new 50-person restriction was announced yesterday, and a some of the messaging did seem to center on the “personal responsibility” part of the equation – not being a covidiot, as it were. Mom went to a popular shopping Mecca (Ge-kås) around two days ago and found it had very few visitors, so it looks to me like people are actually practicing social distancing fairly well. When we went to pick up Sushi today people were clearly keeping their distance to each other outside the shop (but not inside, which was pretty cramped so uhh… I guess convenience is convenience). Keeping personal distance is definitely part of the culture here. You also don’t take too much of a hit when you call in sick, though this wasn’t perfect before March 11th, when the government temporarily suspended the pay-free day (karensdag) at the start of calling in sick.

      I do wonder about the testing strategy being mentioned, because from what I hear it’s not at all easy to get tested. If there’s an extensive contact tracing/testing strategy being spun up, it doesn’t seem to be online yet from what I can tell.

      Note that these are more personal impressions than actual data, and I don’t go out or socialize much with other Swedish people, so I might have a limited view.

      • salvorhardin says:

        Thanks, that’s useful.

        As a parent of an elementary school age child now trying to make some semblance of homeschooling work, I am envious of the Swedish parents who can still send their kids off to elementary school. I had assumed that they hadn’t closed the elementary schools simply from a cost-benefit calculus: much higher costs than closing high schools and stopping large gatherings of adults, uncertain benefits because we don’t know yet whether kids that age are significant vectors of asymptomatic spread.

        • HeelBearCub says:

          The initial takes I saw regarding closing elementary schools pointed out that, for any family that still has the available parents working, that usually means care of children by the elderly. Grandma and/or Grandpa are coming over to babysit. So closing schools increases the contacts, on net, of the most at risk population.

          So closing schools isn’t a slam dunk, especially in a situation where you aren’t also pushing parents back home somehow.

          • albatross11 says:

            I think the main idea with closing schools is that they’re a place where a single contagious person can infect dozens of people, and then that spreads out in a nice star-like pattern through the community, spreading quickly to different workplaces and churches and such. If the kids are carrying asymptomatic infections, the choice is probably between:

            a. A few kids have asymptomatic infections, visit Grandma, and she dies of pneumonia.

            b. A lot of kids have asymptomatic infections, visit Grandma, and she dies of pneumonia.

          • HeelBearCub says:

            c. Kids have infections and Grandma doesn’t get near them.

            Remember, we are looking at tradeoffs. When school closings started to happen, we still had most restaurants and other businesses open. Closing elementary schools, but not ordering “stay in place” isn’t particularly good at stopping the infection spread, but does ensure that lots of elderly are forced not to isolate.

            The people I saw raising caution about closing elementary schools were citing previous plans based on epidemiological models. Closing elementary schools, but not other businesses, looks good if the infection is particularly dangerous for children, which this one isn’t.

            Then you also have the issue that a good chunk of the healthcare provider workforce is of child bearing age, so eliminating childcare runs the risk of pulling resources from the healthcare system.

            I’m not saying schools shouldn’t be closed here in the U.S., I’m just pointing out that in a situation where people are still packing in to sushi joints shoulder to shoulder, closing elementary schools may do more harm than good. You have to consider that action within the broader framework of all the other actions taken.

          • Edward Scizorhands says:

            I think this is one of those things where, with a year or two to think about it and have a written plan, we could implement.

            We can keep the kids isolated from each other in small groups, group size probably related to age. It takes more manpower, but manpower is not a problem during a pandemic.

          • Le Maistre Chat says:

            Then you also have the issue that a good chunk of the healthcare provider workforce is of child bearing age, so eliminating childcare runs the risk of pulling resources from the healthcare system.

            And it’s shot up from “only nurses are women” to “a majority of nearly every specialty” over the relevant decades.
            It’s a complex situation where we want the teachers to stay on the job, but either you have to prioritize kids based on their parental occupations (two health care workers vs. one homemaker or newly unemployed) and mess with the structure of the school site so each 9 students form an isolated gathering of 10 people while every other kid must start homeschooling on a few days notice, or have each schoolteacher “telecommute” to their regular 30-35 students and shrug at the question of who’s at home with them.

  60. BrandonMarc says:

    I can explain New Orleans in two words: Mardi Gras.

  61. smilerz says:

    There are reasons to be skeptical of the numbers coming out of Iran, Japan and China.

    Wikipedia has a decent summary of non-official estimates.

    Tyler linked to an anonymously published paper on the Japanese situation.

    The governmental and media consensus is that Japan is weathering covid-19 well. This consensus is wrong. Japan’s true count of covid-19 cases is understated. It may be understated by a factor of 5X or more. Japan is likely seeing transmission rates similar to that experienced in peer nations, not the rates implied by the published infection counts.

    China recently reversed course and is closing cinemas again. Which doesn’t sound like the move of someone that has things totally under control.

    I don’t think any of these takes are certainly true – but it should increase skepticism a bit.

    • Jon S says:

      ‘understated by a factor of 5x or more’ is true almost everywhere due to insufficient testing.

      • smilerz says:

        I’d encourage you to read the paper – it calls into question the ‘Japan is under control’ narrative and describes a pretty catastrophic outcome to occur in a couple of weeks.

  62. With regard to the claim that we are number one, I noticed the following in a news story on a related topic:

    China also does not include asymptomatic cases in case counts.

    • J.R. says:

      Given the testing limitations in most of the US, is there any reason to believe that asymptomatic cases compose a significant fraction of our case count?

      • craftman says:

        The most important question is whether asymptomatic people who test positive build enough immunity to fight off an infection the 2nd time around.

        If they do, I think it’s very important to quantify how many people are walking around with immunity even though they’ve never shown symptoms or been tested. We could get to late-August still in lockdown and 40% of the population is already, unwittingly, immune.

  63. noyann says:

    Re-using masks — what works to get rid of nCov-19? This is not about sterilizing, that would require stronger measures. But just getting rid of this virus should be a large improvement, even if other germs remain active.

    Techniques this expert says are sufficient (parentheses mine):
    – Dry mask in oven at 70°C (pre-heated) for 30 mins. (In case the materials produce fumes, don’t heat food at the same time, and vent the oven thoroughly afterwards.)
    – Regular machine wash at 60°C.

  64. mingyuan says:

    Maybe instead of ordering takeout you could have Sam or Alicorn teach you to cook more things? And are you guys not having ‘family’ meals? My house is doing a different flavor of beans and rice for lunch every day and it’s surprisingly delicious.

    (Also worth noting that I’m a lot more risk-averse than most people due to being chronically sickly, so this is more based on there being any chance at all that takeout would give me COVID than on some principled and quantitative model.)

    • Members of my family would be happy to provide recipes to Scott for things that are tasty and reasonably simple. I expect many of his other friends would as well.

    • craftman says:

      This might be a false sense of security but when my wife and I get take out we have one person handle the restaurant containers (outside) and transfer the food to the other holding an oven/microwave safe dish, which then gets re-heated for some amount of time before eating (so no sandwiches or things that don’t survive an oven well).

      Whoever touches the takeout containers throws it all away outside, then comes inside and does a thorough hand wash and change of clothes before eating. Most definitely overkill and we are probably not reducing risk that much but it makes me feel better.

    • Harry Maurice Johnston says:

      I’m curious about the implication here that you can’t buy ready-to-cook food at the supermarket. Am I misunderstanding?

      (Just to clarify what I mean, this is one of our family favorites, this is another.)

      • viVI_IViv says:

        I would avoid anything that requires refrigeration, in particularly freezing. Apparently the virus survives for up to 72 hours at 4 C and possibly even years when frozen.

        If you really want this stuff, it’s probably a good idea to clean the package with alcohol or soap and water if possible.

        • albatross11 says:

          If you cook the food, you will destroy the virus. I don’t know of a source for how hot you have to make it to reliably kill the virus, but heating it to 160 F internal temperature is almost certainly going to do the job.

        • viVI_IViv says:

          If you cook the food, you will destroy the virus.

          Yes, but you’ll still have the virus on your hands, in the fridge, on the kitchen counter and so on. Will there be enough virus to give you the disease? I don’t know, but it’s not something I’d personally like to find out the hard way.

          • albatross11 says:

            The surface and hand contamination all seems manageable, though.

            a. Put the food into a bowl and throw the container away.

            b. Put the bowl in the microwave and heat it appropriately to kill anything it’s carrying.

            c. Wipe the surface the container was on, and the microwave controls, with a disinfectant.

            d. Wash your hands.

  65. Clutzy says:

    One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. Maybe they just needed a little bit of containment to tip them over the edge. I don’t know, things sure seemed bad in South Korea a few weeks ago (and in Wuhan). I am so boggled by this that I don’t know what to think.

    I am a moderately strong supporter of this view. I live in a big American city and compliance is…horrible. I went to CVS yesterday to pick up a routine prescription for my girlfriend that she only had 3 days left of. What did I encounter?

    1. Security guard with no mask standing 3 feet from the door.
    2. Random employee almost runs into me while I’m trying to get the pharmacist’s attention to pickup. No mask.
    3. Pharmacist assistant is in mask and has good practices.
    4. Person with no mask comes up right behind me in line despite signs everywhere.
    5. Leaving, the regular line is 3 people deep, no one respecting 6 foot rule, no masks.

    This is typical of what I’ve seen other times at other stores. My experience is maybe atypical, or maybe typical. My neighborhood as I’ve noted elsewhere is mostly Hispanic and Indian now that the students aren’t around. Also this CVS in question is at my neighborhood’s border with a mostly African American neighborhood, and so the mix was what you’d expect.

  66. The Nybbler says:

    Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens (why are these numbers so different?)

    The UK NHS practices evidence-based medicine. The US famously does not, and has extremely high medical costs. It’s not ALL being spent on administration. (We also have a surfeit of CT and MRI machines, or we used to anyway)

    NYC is by far the densest city in America, almost twice as dense as second-placer San Francisco. Density forces people together and makes infections spread more easily.

    NYC also has significant mass transit share (it’s by far #1 in the US, with SF being #2), and is one of the few cities where rich and poor alike use mass transit. Since the poor were unlikely to locally originate this disease (not being prone to fly overseas), this probably means there was lots of spread via mass transit in NYC compared to other cities.

  67. Guy in TN says:

    A lot of people are secretly wondering whether preventing the potential damage from coronavirus is really worth shutting down the entire economy for months. You shouldn’t feel ashamed for wondering that. Everyone, including the US government, agrees that it is sometimes worth putting a dollar cost on human life, and there are all sorts of paradoxes and ridiculous behaviors you get trapped in if you refuse to do so.

    What are some of the paradoxes/ridiculous behaviors that one gets trapped into by refusing to put a dollar value on the cost of human life?

    I can think of bizarre behaviors that might happen if you refuse to place a dollar value on human life, and then attempt to implement policies with the intention of maximizing economic value. But this can easily be avoided by not falling for this simple mistake.

    I have serious doubt that assigning dollar values to human life is something “everyone agrees” upon, considering in my political circles such a proposal would get voted down by >90%.

    • Matt M says:

      What are some of the paradoxes/ridiculous behaviors that one gets trapped into by refusing to put a dollar value on the cost of human life?

      We could eliminate all traffic fatalities by mandating the cars be constructed similar to tanks, and that the speed limit is 5mph on every highway. What stops us? Economic concerns.

      • Guy in TN says:

        There would also be utility concerns. It would be trivial to object to such a policy on non-economic value grounds.

        • Matt M says:

          Utility is an economic concept. You cannot separate the two.

          • Guy in TN says:

            @Matt M
            Scott said “dollar value”.

            If you want to say that all utility calculations are sort of like assigning a “value”, and therefore are sort of like “economics”, that’s whatever.

            But it’s simply not true that all utility calculations use dollar values.

          • @Guy:

            There is a very old article by Quang Ng, who is a utilitarian (and a very bright economist), in which he argues that you should do all your redistribution via tax and transfer and then make all other decisions to maximize economic value. I’m afraid I don’t have a link, and it may well never have been webbed, but the basic argument is that an inefficient legal rule that transfers to the poor has the same deadweight cost as straight redistribution plus the additional deadweight cost of its inefficiency. Since, in his utilitarian system, you have already redistributed to the point where the utility gain from an additional transfer due to declining marginal utility of income just balances the utility loss from the associated deadweight loss, the inefficient legal rule must reduce utility.

        • Maximizing economic value isn’t the same thing as maximizing utility because of the interpersonal comparison problem, but any increase in utility that doesn’t change distribution is an increase in economic value.

          In your world, where we don’t put a dollar value on human life, how do we go about deciding how much to spend per life saved on any of the multitude of decisions that affect lives? Do you put it by putting a utility value on lives instead, then estimating the marginal utility of income to the marginal taxpayer and weighting costs accordingly?

          • Guy in TN says:

            @David Friedman

            Do you put it by putting a utility value on lives instead, then estimating the marginal utility of income to the marginal taxpayer and weighting costs accordingly?

            Yes. I think this is the general rationale for taxation/welfare in the social-democratic state: To transfer wealth in a way that increases aggregated utility with the trade-off of decreasing aggregated economic value.

            If I recall, you once indicated that you would give a loaf a bread to a penniless starving man over someone willing to pay for it. Which indicated, perhaps, that you had methods other than economic value for gauging human utility.

          • denverarc says:

            Dollar Value is just another subjective calculation in and of itself.

            Usually based around the subjective values of the people who get to create and force others to use said dollars.

            There are no objective values anywhere, which is why this stuff gets political fast. My granmas life might have a subjective value to the state of $500m but you ain’t buying letting her die early for any price if its actually up to me or my family.

            The way we do it in reality is by acquiring coercive power and forcing our view on others and this will never change on the important matters.

          • DinoNerd says:

            AFAICT, we decide based on how upset the average effective influencer/voter is about the specific risk.

            As a non-C19 example “My child might get kidnapped” is much much scarier to US decision makers (and parents) than “my child might become an obese couch potato”. Yet the number of children kidnapped is much smaller than the number who are obese, with all the associated health risks.

            The set of people who do risk/benefit calculations is tiny, compared to the set who decide based on gut feel and/or the importance assigned to the problem by those around them.

          • Controls Freak says:

            If I recall, you once indicated that you would give a loaf a bread to a penniless starving man over someone willing to pay for it. Which indicated, perhaps, that you had methods other than economic value for gauging human utility.

            I think I would prefer the solution of giving the penniless starving man enough cash to buy a loaf of bread. (I think it’s information issues which cause some folks to go the other way ’round.) Then, if they preferred to spend the money on something else, that would be maximizing their utility function. I’m not sure whether DF would agree, but I think he might.

          • Controls Freak says:

            Also, for clarification, there is an ambiguity in who the “you” is. I imagine DF has a very different “you” in mind than Guy does.

          • HeelBearCub says:

            @Controls:
            My sense is Friedman wouldn’t agree (in principal), because in giving the bread, he would be satisfying his own “utility function”. Any gift of money would still be contingent on that satisfying his preferences.

      • keaswaran says:

        Irrelevant to the main point, but it seems that we’d do better at eliminating traffic fatalities by mandating that cars be like egg cartons than mandating the cars be like tanks. Egg cartons protect their contents without damaging things outside, unlike tanks.

    • Edward Scizorhands says:

      If you spend all your money on remedy X, you have no money left over for remedy Y, which might be better.

    • The most obvious example is that if a human life is worth infinity dollars, we should logically keep the quarantine in place forever.

      • unreliabletags says:

        Someone who values life so highly probably also values love and community. Isolation drags on individual well-being and the collective social fabric at least as much as it hurts the economy.

        Personally, I feel safe both physically and economically, but I’m pretty worried about loneliness.

    • Clutzy says:

      There are many, people have already brought up the speed limit example, there is also the scarce resource example brought up. Basically any pollution regulation needs to do this on both sides of the scale (how many lives will be saved/improved by the pollutant reduction, and how many will be killed/worse off because of the regulation).

      I mean, I suppose you don’t HAVE to express it in dollar amounts, but I guess some people find it easier to do that. The Shelter in place orders, after a certain amount of time will start killing people and reducing their lifespan and QOL (they already have), and you have to compare that to C-19 spreading a lot. Reducing it to dollars is easier for some, or you could make your own formula. Its kinda the same.

      • From the standpoint of economics, the basic argument is that individuals don’t have an infinite value for their own lives, as demonstrated by their behavior. Someone who did would sacrifice all other values to the goal of maximizing his life expectancy, which is not how people behave. Since value in economics is ultimately based on value to individuals, it makes sense to see lives as having a finite, although large, value.

        • anonymousskimmer says:

          @DavidFriedman

          Someone who did would sacrifice all other values to the goal of maximizing his life expectancy, which is not how people behave.

          I agree with your point, but as a matter of practice how could one determine whether someone was not sacrificing all other values to the goal of maximizing their life expectancy? People make mistakes in judgement all the time. Some drink sodium hypochlorite thinking it will extend their lives.

          • By observing them spending some of their income on things that do not increase life expectancy. They could always use it to see a doctor more often, or buy safer car, or … .

            Observing that they cross the street, or drive somewhere, when doing so has no connection with increasing life expectancy, since both of those activities have some (small) risk of getting them killed.

          • anonymousskimmer says:

            I should have been more specific in my question.

            How do you know they know that their spending or actions aren’t increasing their life expectancy?

            Maybe they have OCPD and believe that they have to cross the street at certain times to keep living. Maybe they believe that the odds of them continuing to live will decrease even more than the risk of being fatally hit by a car if they do not cross the street to get to their job, or the store, or what have you.

            I’m arguing into the absurd, but I’m just curious whether this problem has been considered vis-a-vis revealed preferences demonstrating a finite value toward one’s own life.

      • albatross11 says:

        Another way of thinking about this: We could do this same lockdown every flu season. It would probably massively decrease flu cases, and would save some lives. We don’t do that, because it’s not worth it in terms of the costs vs the benefits. (Though I expect COVID-19 will cause some interesting changes in how people behave that probably will slow future spread of flu. How many people learned how to wash their hands properly, acquired a habit of carrying hand sanitizer everywhere, and started coughing/sneezing into their elbow instead of their hand this year? Hell, maybe we coat all the high-touch surfaces with copper over the next few years and see a big drop in lots of disease.)

        • cuke says:

          If this is discussed elsewhere in here and I missed it please forgive my raising it here.

          I had thought the problem with ending a lockdown prematurely on supposed economic grounds is that we would get the economic crash either way. In other words, you let people go back to work and school while the virus is still spreading uncontrolled and what we get is massive breakdown in supply chains, services, healthcare systems and so on as huge numbers of people fall ill, and then you will have both massive fatalities and huge economic cost.

          It’s more contagious, more deadly, more debilitating than the flu; and there’s no vaccine and no natural immunity.

          It’s not that it’s never rational to weigh the costs of saving X more lives (ie, everyone drive tanks), but that in this instance without adequate testing/treatment/tracking etc, systems in place, the argument in favor of “saving the economy” by sending people back to work doesn’t actually make sense. The supposed tradeoff isn’t what would actually result.

    • Paul Zrimsek says:

      What are these political circles in which assigning dollar values to human life is beyond the pale, but assigning util values to human life is A-OK?

      • Guy in TN says:

        I come from the non-liberal left. We’re mostly on twitter.

        Probably some of the non-libertarian right would agree as well, but I’ll let them speak for themselves.

  68. Rusty says:

    For stopping smoking I really recommend Allen Carr’s Easyway to Stop Smoking. Read the whole thing from start to finish. It will take you a day or two at most. Follow the really simple and easy instructions. And most likely you will stop immediately and with no difficulty. If you are like me you will enjoy the process.

    • Anteros says:

      +1
      I enjoyed the process, couldn’t wait to finish the book, and pretty much believed I was a non- smoker by the time I put the book down. As it turns out, that’s precisely what I was.

  69. Rusty says:

    But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technochratic hubris vs. complexity of the real world.

    Is changing your mind disastrous??

    • Edward Scizorhands says:

      I think them publishing their theory, and within 3 days public scientist looks at it and tells them what’s wrong and the the government changing course is a great punchline.

      • Rusty says:

        Well you make a good point! I am still impressed they changed course quickly and didn’t try to stick to their guns.

  70. eqdw says:

    I would like to make two comments in half-assed defense of the president. I don’t particularly care about defending the president but I have been paying considerably more attention to things than most other people do and this is really triggering my “someone is wrong on the internet” instinct.

    The first is regarding the Chloroquine stuff. I was really happy when he mentioned it. For the better part of two weeks before the President first mentioned it in a briefing, preliminary data was coming out suggesting it is a relatively miraculous cure here. In fact, the data and anecdata coming out made it look so miraculous that I have been mentally discounting it as ‘too good to be true’. There were unofficial comments on various reddits from healthcare workers in France, in Spain, in Italy, in Korea, in China, all saying that they were using this as a front line treatment and it seemed to be working. Then that paper about the small preliminary trial came out that showed, again, frankly miraculous results. More papers have come out since then, some showing no effect, some showing strong effect. Overall, it would be overstating things to say that this is a proven miracle cure, but I think the smart money is on cautious optimism.

    And, as far as I could see, that’s what the president did. He mentioned that there is this anti-malaria drug that doctors around the globe are using off-label to treat coronavirus. He mentioned that it’s an active area of investigation that looks promising. He mentioned that he was going to fast-track the FDA to approve it for use (for this purpose? In general? unclear). He mentioned that his administration was working on securing a stockpile of it, if it turns out to be the miracle cure that was promised. He was repeatedly questioned about this by journalists, who accused him of overstating things and giving Americans false hope, and he repeatedly emphasized that he wasn’t saying this is a cure, he was saying he had a good feeling about it, it looked promising, and that they’re going to move fast to investigate it and make it available _**IF**_ it’s good.

    Now I’ve seen media coverage that suggested a very different perspective. I haven’t been paying close attention but it’s my understanding that some of the right wing media _has_ been irresponsibly reporting this as a miracle cure. I can imagine that the left wing media is accusing Trump of overstating things, possibly because they see right wing media _actually_ overstating things and they’re engaging in outgroup homogeneity bias. I don’t know, because I haven’t actually been paying attention to any “real” media, only primary sources for the most part.

    But again, I think the president’s comments have been totally reasonable and properly hedged and I don’t think it’s fair to attribute to him responsibility for people making stupid decisions.

    In particular I feel like this is very important because a point of view I see frequently expressed amongst the kind of center-left bougie blue-tribers I am surrounded by is some variant of “American sucks. Other countries elect actually smart people to office. Angela Merkel was a physicist ffs! But in America, we elect lawyers and career-politicians who know nothing about the complexities of our actual world, and end up implementing bad public policies while treating the public like dummies. Why can’t we have a politician who understands science and can actually talk science to us?”. I am sympathetic to this viewpoint, which is why I was so excited when Trump actually did that. There is preliminary scientific evidence suggesting that Chloroquine is a really potent weapon in the fight against COVID19. The evidence is preliminary, and more investigation is needed. Within a week of this evidence being published, the president of the United States was not only aware of it, but communicated this to the public. He did it with the appropriate level of caution, saying that it looked promising and they were going to investigate. He moved real fast (assuming he wasn’t lying about this, of course) to secure large stocks of it as a strategic public health intervention, _IF_ it pans out. And he was transparent with the country, just telling them this. So many people I know have been complaining for a decade about how they wish US politicians would be like this. Trump actually just was like this! And what happens? Does everyone else get excited about how for once in our lives the US Federal Government actually knows what its talking about? No, they find a dumb one-in-a-million human interest anecdote about people who somehow survived to age 60 without understanding that the dose makes the poison killed themselves, and they blame the president for this.

    Now it’s fine, in the sense of being a reasonable/consistent position, to blame the president for this. I am sympathetic to the point of view that the position of the presidency is so powerful that people _will_ read message into what he says, and that he has something of a moral responsibility to pre-emptively address that. That said, as best I can tell, he was as reasonable as possible while talking about this. If what he said is still “unreasonable” by some sort of appeal to widespread norms and morals, then that is equivalent to saying that the president can never talk about cutting edge science to the public, because the public is too stupid to understand it. And that doesn’t sit well with me. For one, iterating that attitude over time is a self-fulfilling prophecy, and if you treat your public like idiots who don’t understand science, they will become that. For two, “oh the public is too stupid to know what’s best, we’re just going to keep this a secret from them” is like one of the most stereotypically fascist/totalitarian ideas I can think of. But for three, the petty first-world problem that annoys me most of all, is that the president talking about science in this way is exactly what everyone I know has been demanding for a decade, and now when he does it, those exact same people say he shouldn’t have. So are we just not allowed to ever have politicians who know what they’re talking about in public, because the USA is a unique country that is uniquely unable to allow competence in public? That’s a very depressing perspective

    —-

    Second thing, “chinese virus”. I’m not interested in arguing about this, I don’t really care. I call it ‘wu flu’ because ‘wu flu’ is catchy. I’m not going to stop. Everyone knows what I mean, and I know what everyone means. Call it whatever. “A rose by any other name…” and all that.

    But I want to express to all of you, just in case you are not aware of it, that it’s not an arbitrary decision of Trump’s and it’s not motivated by racism or malice.

    (I do not have sources handy for any of what I’m about to say. However, this is a holistic synthesis of everything I’ve seen and read and I believe it to be true. Either trust me, or don’t. Like I said, I’m not arguing, I’m repeating facts I’ve heard. Make up your own minds whether you think these facts are real, whether you think I am trustworthy)

    Over the past three months there has been a sort of diplomatic cold war going on between China and the US. China extensively downplayed how bad this was to the outside world, while freaking out internally. They fed the world lies about this plague not being a big deal, not being human-transmissible, not being deadly, etc., when they knew these things were not true. They pressured other countries to keep borders with china open even as China started closing its own internal borders. They conspicuously denied access to the WHO delegation for like three weeks. They have engaged in an explicit propaganda push to rebrand this as the “Italian flu” worldwide (I saw some thing about leaked diplomatic instructions or whatever). They have been fudging their numbers massively and then pushing the blame to the US when the US’s relatively real numbers got worse. They have fired (nonlethal) weaponry at US naval assets in international waters near China, and made explicit threats of escalation in that regard. They have intentionally withheld supplies from the US, while giving conspicuous aid packages to European nations, to push a “we are the new global hegemon, we will help you” narrative. Most recently, various Chinese news outlets have been pushing the (presumed) conspiracy theory that the disease is actually a US bioweapons attack.

    I can tell you that there is a whole buttload of suspicious data points concerning the BSL4 in Wuhan and past experiments and patents on Coronaviruses. I can also tell you that if you post about this just about anywhere online, you will immediately get moderated away for spreading misinformation and conspiracy theories. Meanwhile, Chinese state media is openly pushing the politically bit-flipped version of this story.

    Now I’m making no claim regarding truth or falsehood of any of the things China is saying. I am also making no claim regarding the morality of what China is doing. Maybe they actually are the new global hegemon. Maybe the US lost its ability to provide foreign aid and now China does it and this is the new world get used to it. But the thing is, as the current (former?) global hegemon, the US has an understandable interest in preventing this from happening.

    In light of this, what can the US actually do, in a game-theoretic sense, to retaliate against all these Chinese actions in a way that disincentivizes them from continuing such actions? You can’t take military measures against them, because they haven’t done anything explicitly military and we would be the obvious bad guys there. Can’t engage in the same two-faced diplomacy; I’m not quite sure why, but we haven’t been. We don’t have the same authoritarian control over our media outlets, so we can’t start having the NYT pushing “chinese bioweapon” conspiracies. We can’t go on our own goodwill tour, in part because China is our supplier so we don’t actually have aid packages to give, and in part because we always do that so if we do it again we won’t get the same PR.

    Seen in this light, I argue, the President’s decision to conspicuously and obnoxiously refer to this as the Chinese Virus makes sense. He’s trying to react to China’s soft-pressure advantage-taking of the situation, in a way that is politically feasible. He’s going up there and every day sending a message to China: “You keep trying to blame us for this, I am going to remind everyone that it started in China. You are not pushing the blame onto me”.

    You might still think that this is stupid, or bad, or counterproductive, or whatever. That’s fine. I don’t see any real point or purpose to retaliating like this. It’s a check on China escalating but it’s also not super clear to me what the harm to us of China continuing to push absurd propaganda on its people is. I’m not trying to defend this naming choice as the right decision. What I’m trying to show is that from Trump’s perspective, it is not irrational and it is not motivated by hatred or bigotry. It is a response to a whole slew of similar actions that China is aiming at us, that for some reason everyone else is blind to.

    • Scott Alexander says:

      I agree chloroquine seems potentially exciting. All exciting-looking medical treatments eventually turn out to be fake, but of course we can always hope this is the one that isn’t. Not only could it save millions, but (and I admit I’m a terrible person), it would be so fun going back and linking all of the “how dare people say chloroquine is good!” news articles from the media alongside their “how dare you make people panic by saying this might be a global pandemic!” ones.

      In terms of nomenclature, I’m still holding out for “the bat flu”.

      [EDIT FOUR HOURS LATER: this probably isn’t the one that doesn’t turn out to be fake]

      • Le Maistre Chat says:

        In terms of nomenclature, I’m still holding out for “the bat flu”.

        Notice that Batman wears a mask that covers everything but his nose and mouth.

      • matthewravery says:

        Are people actually saying, “How dare you say chloroquine is good!” or are they really saying, “How dare you encourage take actions that will obviously result in irresponsible behavior in the middle of a pandemic!” Can one not be optimistic about potential future cures and simultaneously think the President should communicate about them in clear language?

      • Ant says:

        You should consider anything from Didier Raoult as you consider anything from Wakefield. It’s almost 4 AM so sorry in advance, I am going to be quick, unordered and mostly unsourced.
        _ Some of his paper has fabricated datas and he is dishonest (self peer review, review by friend, “author” of 3 paper per week).
        _ The study you linked is of poor quality (the comments reflect some of the criticism I saw about them). He released a second study yesterday, with more people but no control group and a huge difference between the conclusion of the study (huge success) and the datas (no real difference between the treatment and Chinese data).
        _ Raoul himself has position that I find ludicrous considering his job. Among others, he proclaimed today that he is against control group because his Hippocratic oath forbid them. In comparison, the latest study was qualified of “wild clinical trial” and “major scandal” due to major ethics breach.
        _ The only correct study on chloroquin and Covid 19 I heard of say “no effect”.

        * from his twitter account: “Notre étude porte sur 80 patients, sans groupe contrôle car nous proposons notre protocole à tous les patients ne présentant pas de contre-indication.
        C’est ce que nous dicte le serment d’Hippocrate que nous avons prêté. “

        • The Nybbler says:

          The only correct study on chloroquin and Covid 19 I heard of say “no effect”.

          That study had 14 out of 15 in the control group recover, IIRC, so it didn’t have the power to show an effect even if there was one.

        • eqdw says:

          > You should consider anything from Didier Raoult as you consider anything from Wakefield. It’s almost 4 AM so sorry in advance, I am going to be quick, unordered and mostly unsourced.

          This was something I was unaware of until the other day. I don’t think it changes the gist of my point, but I agree that I have somewhat reduced my estimate that Chloroquine will be an effective treatment

          Although in my defense I will point out that I did say:

          In fact, the data and anecdata coming out made it look so miraculous that I have been mentally discounting it as ‘too good to be true’.

      • Aminoacid says:

        http://www.zjujournals.com/med/EN/10.3785/j.issn.1008-9292.2020.03.03

        Here’s also a more rigorous study of chloroquine, which found no effect

    • orin says:

      China extensively downplayed how bad this was to the outside world, while freaking out internally. They fed the world lies about this plague not being a big deal, not being human-transmissible, not being deadly, etc., when they knew these things were not true. […]

      I don’t disagree with any of this, but to be fair, it was really obvious to the outside world that the situation was bad. I don’t seriously entertain the notion that US or any other countries intelligence was remotely fooled by any of this.

      • PorterBridges says:

        I don’t seriously entertain the notion that US or any other countries intelligence was remotely fooled by any of this.

        The World Health Organization (WHO) downplayed the virus, delayed calling it a health emergency, downplayed warnings from doctors in other countries, and assured the world in January that “authorities have found no clear evidence of human-to-human transmission”, and focused public efforts on criticizing the US as xenophobic for imposing travel restrictions against China; efforts that absolutely minimized the spread of the disease.

        China is absolutely influencing and corrupting the WHO. This successfully delayed and confused the world’s response.

        • A little worse than that. The WHO statement, as per Douglas Knight’s post, was:

          “From the information that we have it is possible that there is limited human-to-human transmission, potentially among families, but it is very clear right now that we have no sustained human-to-human transmission.”

        • orin says:

          You are picking-and-choosing dates. While I agree that the WHO was overly cautious in January (I was complaining about it at the time, and so were 100k+ people on multiple coronavirus dedicated subreddits alone), by the end of January they had declared a global public health emergency of international concern. Keep in mind that it was literally a month later that Trump said “within a couple of days [the number of US infected is] going to be down to close to zero”. I can’t imagine that was the position of the US intelligence agencies then, nor in January when the WHO declared it a public health emergency, nor long before that when we watched as China closed everything down and built hospitals and welded people in their apartment buildings and marched an army of hazmat suits down the streets spraying chemical disinfectants.

      • eqdw says:

        I don’t either. On the one hand, if there was evidence enough for a bunch of internet autists like me and my friends to see this coming back in January, there’s evidence enough for the leadership of the western world to know wtf is going on. Especially given that they have fancy intelligence assets whose full time job is to know these things, and all I have a bunch of people who are bored.

        I do not mean at all to absolve western authorities of their responsibility for incompetence.

    • PorterBridges says:

      it’s also not super clear to me what the harm to us of China continuing to push absurd propaganda on its people is. I’m not trying to defend this naming choice as the right decision.

      China isn’t just using propaganda on its people, China has elaborate and effective worldwide propaganda efforts.

      Read these:
      https://www.nationalreview.com/the-morning-jolt/chinas-devastating-lies/
      https://www.nationalreview.com/2020/03/china-is-pushing-a-zero-myth-on-covid-19-and-attacking-press-freedom
      https://www.nationalreview.com/corner/who-does-who-trust/
      https://www.nationalreview.com/2020/03/coronavirus-what-good-is-chinese-soft-power/

  71. Anteros says:

    Really great post, as usual. Nothing even to quibble about! One thing I agree with and think is worth emphasizing is that big developing countries with poor health services look like having virus problems that will dwarf what has occurred – and will occur – in the West. India, for instance, could end up with more deaths than the rest of the world put together, despite it barely registering as problematic today.

    I’m currently struck by how little anyone knows about how the world will look in three or six months time. Politically, economically, socially? All a complete mystery. Anyone any ideas about which countries will suffer the most, change the most, gain the most? I haven’t, but I’d love to see some predictions and then revisit them at the end of the year. My predictions would only be for surprises – and lots of them.

    • Vermillion says:

      I was listening to a podcast with Tyler Cowen (here) and one thing they predicted, which I agree with, is yes, of course, no one knows what the future will hold but one sure thing is there will be a lot more funding for biomedical research.

      • Anteros says:

        I agree with you, but I don’t think it’s obvious how long the extra funding will last. A year or two? A decade?

        If that seems ridiculous, bear in mind that the current level of funding is what we think appropriate in the post Spanish flu era. Which killed up to 100 million people – out of less than a quarter of today’s total population.

        • keaswaran says:

          It might be worth comparing to the way funding for counter-terrorism behaved after 9/11. I think it may have started to decrease a bit more than a decade after 9/11. But I don’t think it’s down to pre-9/11 levels yet.

  72. Radu Floricica says:

    At least that’s the story. So how come San Francisco – again, number two on the density list – has been almost completely spared? How come, despite its towering skyscrapers and close links to China, SF has only 178 diagnosed cases – fewer than such bustling metropolises as Indianapolis, Indiana, or Nashville, Tennessee? How come the virus is so well-behaved in very dense countries like Japan, and so deadly in relatively sparsely-populated places like Switzerland?

    People really really need to use different models for low vs high number of cases. Low numbers are not statistical – they depend entirely on human decisions and random events. Once you pass maybe 1000 you start to be able to use words like “rate” or “exponential”.

    Just realized it’s like riding a bike 😀 Or motorcycle. At parking-lot speeds you turn right to go right, and left to go left. Pass maybe 10mph, and – horror – you suddenly need to turn the either way around. Not messing with you – you literally turn left to go right, and right to go left. It’s called countersteering. These things happen.

    I’m not even sure what concerned people can do. Charities’ usual MO is to divert resources from First World countries to Third World ones, but First World countries are using all their relevant resources and won’t sell for any price – can you imagine trying to export ventilators from the US right now? You’d probably get arrested. Maybe the highest-leverage interventions are figuring out how to repurpose cheap pre-existing material for medical care – face masks made out of paper/cloth/whatever, ventilators out of ???.

    Your idea of taking a manual ventilator and making a pumping machine seems to have been valid. Lots of cheap, 3d printable ventilator designs out there – from very simple to quite complex. And some new mask designs, though much less than I’d like (certifications, most likely. also less glamorous). But on the bright side, once first world economies start producing masks, they’ll really produce masks. Probably enough to export, once the production lines are built/adapted.

  73. Freddie deBoer says:

    “I try not to lecture my patients on their health failings. I am not a jerk to obese people or people who don’t get enough exercise. But I try to tell every smoker, at least once, to STOP SMOKING.”

    HOPE I DIE BEFORE I GET OLD *guitar riff*

    (I have never been a smoker in my life)

  74. J Mann says:

    On the subject of take-out, is there likely to be much difference in risk between pizza (which comes out of an 800 degree oven and goes into the box) and salad (which somebody assembles and isn’t cooked), or are they likely to be similar, since somebody has to assemble the pizza box or there are parts of the pizza under the cheese or inside the dough etc. that might not get very hot?

    • albatross11 says:

      You could pop the pizza back into a moderately hot oven for a few minutes to kill anything on the surface.

  75. Nigeria and Mexico and so on make me confused in the same way as Japan – why aren’t they already so bad that they can’t hide it?

    1. Mexico had a head start of roughly two to three weeks, as compared to the US/Italy.
    2. While it squandered that opportunity, and community transmission is presumably running riot, it’s gonna take a while to show up in the stats.
    3. Reported cases will take unusually long to reflect reality, for tapping-head meme reasons: “can’t have confirmed cases of coronavirus if you don’t test [widely] for coronavirus!”
    4. Deaths won’t look all that bad in a relative sense, because Mexico has a crazy young population: median age of 27, compared to e.g. 47 in Italy.

    I think people are massively underestimating that last one – when it comes to deaths, the age distribution alone will dwarf any other factor (e.g. ICU beds per capita). Presumably it’s similar in most other developing world countries.

    • Le Maistre Chat says:

      4. Deaths won’t look all that bad in a relative sense, because Mexico has a crazy young population: median age of 27, compared to e.g. 47 in Italy.

      I think people are massively underestimating that last one – when it comes to deaths, the age distribution alone will dwarf any other factor (e.g. ICU beds per capita). Presumably it’s similar in most other developing world countries.

      This is looking like a plague sent to kill old people in Europe and the English diaspora.
      Compare the 1918 flu, “Those born during 1918 were 50 per cent more likely to die between the ages of one month and one year,” and which strangely killed 20-39 year-olds at a highly elevated rate.
      Of course the fact that it jumped from bats to humans in Wuhan, where they sell live bats as food, also looks like a moral dimension.

      • Statismagician says:

        I haven’t looked at this specifically, but I suspect that elevated mortality among young adults for the 1918 flu is just because lots of the healthier members of that group died in WW1, and lots of the rest were unusually vulnerable because living in a trench on a diet of insufficient rations and unimaginable stress isn’t great for your immune function.

        • Anthony says:

          I read somewhere that there was a flu pandemic about 25-30 years earlier that was the same base strain as the Spanish Flu, and less lethal, so people who’d survived that in their 20s and 30s had partial immunity when they were in their 50s and 60s.

        • Desrbwb says:

          That doesn’t add up, because flu deaths don’t really track with involvement in WW1. Nations like the US and Brazil, who hadn’t had to deal with the effects of 4 years of trench warfare, were hit as hard/harder than the European belligerents. Plus (most strikingly) it seems the pattern of ‘anomalously killing the young’ held up worldwide. So it really doesn’t seem that WW1 is a good explanation for the unusual mortality patterns. Especially as ‘this strain induced cytokine storm’ hold up far better imo.

    • pilgrimoftheeast says:

      I think that point about young population is very good. And when you call Mexico’s population crazy young, it’s still very old compared to that of Nigeria which has 18(!!!)

      • Lambert says:

        Note that average age isn’t a great metric. The delveloping world has high rates of infant mortality but a the expected lifespan of, say, a 15 year old isn’t that much less than in the developed world.

        • Kindly says:

          Are you saying that Nigeria has enough ~0 year olds to bring the median age down to 18 from 30?

          • Kindly says:

            That doesn’t look like an infant-mortality picture to me. The curve is remarkably even over the entire age range.

            That plot just makes me think that the median age is low because the population is growing very quickly.

  76. Act_II says:

    I appreciate this line of reasoning, but I hate it. It means you stop being able to communicate your real thoughts in favor of communicating whatever information a utility calculation says it’s most beneficial to communicate – which is fine until people very reasonably choose to stop interpreting your mouth movements as words. On the other hand, the President of the US is not really supposed to be a clearinghouse for medical information, and is definitely somebody whose words have direct effects on the world, so maybe we should make an exception for him.

    Don’t think of it as an exception, think of it as a sliding scale. Consider the Spider-Man Principle: “With great power comes great responsibility.” People who can make a bigger splash should obviously have their words and actions held to a higher standard. This applies most of all to the POTUS, but also to big media companies. Most bloggers are probably fine.

    Almost everyone has a bad take though. The anti-media-coverage case is just contrarian nonsense, and the takes on the left accusing Trump of having blood on his hands are completely overstating the point. This isn’t a “Trump is a murderer” situation, it’s just a good illustration that letting a moron air his unfiltered ramblings from the Oval Office has real consequences.

    In a weird way, this reminds me of discussions about stochastic terrorism. Rhetoric from influential public figures can have dangerous effects. Of course they aren’t directly responsible for those effects — it’s not like they asked for them, or planned them. But it still seems like they bear some responsibility for inciting them. There should be a more general term for this.

    • matthewravery says:

      Yes, all of this.

      And to add on, Trump specifically asked for this power and responsibility. He worked very hard to get millions of people to vote for him so that he would have this power. It wasn’t foisted upon him randomly.

      When you ask for power, you can’t complain when people hold you responsible for how you use it.

    • The Nybbler says:

      The concept of “stochastic terrorism” is in direct opposition of freedom of speech, and it is exactly what was rejected in Brandenburg v. Ohio. This idea that public figures (well, really, just Trump) should somehow be responsible for every action anyone else takes based upon their utterances, no matter how far removed those actions are from said utterances, is just as pernicious. It’s not a standard which allows for communication of anything.

      • albatross11 says:

        There’s a difference between morally and legally responsible. If you give a speech suggesting that it would be a good thing for your followers to go out and beat up some middle-class white kids to get even for their ancestors’ misdeeds, and then some of your followers do just that, we can’t arrest you for that. But we can certainly think ill of you, refuse to associate with you, and express bad opinions about you, etc. The first amendment only prevents us from arresting you, not the rest.

        • Tatterdemalion says:

          If you give a speech suggesting that it would be a good thing for your followers to go out and beat up some middle-class white kids to get even for their ancestors’ misdeeds, and then some of your followers do just that, we can’t arrest you for that.

          “Incitement to imminent lawless action” specifically isn’t a protected category of free speech.

          • The Nybbler says:

            “Incitement to imminent lawless action” specifically isn’t a protected category of free speech.

            And the example you were given is not “Incitement to imminent lawless action”. It’s a pretty good match to Brandenburg v. Ohio: “it’s possible that there might have to be some revengeance taken.”

          • An old issue.

            They never told the ramping crowd to card a woman’s hide,
            They never marked a man for death — what fault of theirs he died? —
            They only said “intimidate,” and talked and went away —
            By God, the boys that did the work were braver men than they!

          • albatross11 says:

            Yep. The way I’ve seen the “incitement to imminent lawless action” explained is that if I’m giving a speech and I say “we should rise up and kill all the rich people,” I’m fine, but if I continue with “…and there’s one of the bastards now–lets get him!” and then my listeners go attack they guy, then I’m subject to getting arrested and prosecuted for incitement.

      • Act_II says:

        It sounds like you have a chip on your shoulder about this concept that’s affecting your ability to reason clearly about it. A few things:

        -You said “The concept of ‘stochastic terrorism’ is in direct opposition of freedom of speech”. But it doesn’t make sense to put these in opposition; they’re different kinds of ideas. Free speech is a moral principle while stochastic terrorism is an observed phenomenon. Stochastic terrorism certainly provides a potential argument to limit speech, and you can certainly disagree with that argument, but that doesn’t make the phenomenon itself fake somehow.

        -Your aside about Trump makes me think you aren’t very familiar with the term. It long predates Trump; it was coined in 2002 and has seen increased use since the early 2010s or so. And the related concept of public figures indirectly inciting violence is famously much older.

        -There is such a thing as degrees of responsibility. As albatross11 said, nobody is going to toss Trump in jail for giving incoherent medical advice. At the end of the day, the most responsible people are the ones who tried to self-medicate. But there’s a direct causal link between the two events that a reasonable person could have expected and avoided — so he does bear some responsibility for the results of his words.

        -You said “It’s not a standard which allows for communication of anything.” This is just flat wrong. People who actually spend their careers in public service are quite good at communicating without horrible consequences. I don’t remember Obama having this problem, because he actually put thought and care into his words.

        • The Nybbler says:

          -You said “The concept of ‘stochastic terrorism’ is in direct opposition of freedom of speech”. But it doesn’t make sense to put these in opposition; they’re different kinds of ideas. Free speech is a moral principle while stochastic terrorism is an observed phenomenon.

          If it were merely an observed phenomenon, it wouldn’t use clearly loaded terminology like “terrorism”. It’s not merely an observed phenomenon; it’s a way of looking at the world, one in which people can be culpable for other people’s actions when those actions were possibly (not even in any direct cause-and-effect way) influenced by the first person’s speech.

          There is such a thing as degrees of responsibility.

          This is just obfuscation, taking refuge in complexity. It boils down to a binary choice: should Trump have refrained from talking about chloroquine because there was some chance that his speech might have inspired some fool to down a bottle of aquarium chemicals?

          • cuke says:

            I’d like to speak up for complexity without reducing it to obfuscation.

            There are degrees of responsibility, and most things we say, even the U.S. president in a pandemic briefing, are not going to be “all okay” or “definitely not okay.” Speaking more impulsively or more skillfully is not a black and white thing. Having a president who tends to speak impulsively, even during times of unprecedented crisis, is not as in the direction of skillful as we could use right now in my opinion.

          • Act_II says:

            The term is “terrorism” because it is primarily used to talk about, well, terrorism. As in, terrorist acts from seemingly random, disconnected actors (stochastic = random) that are predictable in aggregate but not individually. One obvious cause of stochastic terrorism is proclamations by public figures. What would you rather call it? I’m not saying the chloroquine incident is stochastic terrorism — I’m saying it seems related.

            I’ll gladly answer the binary choice. No, he shouldn’t have talked about it. However, if you really refuse to acknowledge degrees of responsibility, then I don’t know how you deal with even mildly complex moral situations in the real world. Sometimes responsibility is shared. Sometimes responsibility is shared, but unequally. It’s not a rhetorical trick. It’s just a fact.

          • The Nybbler says:

            Sometimes responsibility is shared, but unequally. It’s not a rhetorical trick. It’s just a fact.

            Sometimes it’s a _legal_ trick, as with “joint and several liability”. You get a jury to agree that one party has just some small amount of responsibility…. then you hit them with the entire bill. And that’s similar to what’s going on here. It doesn’t matter whether Trump has 1 iota, 10 iotas, or a mega-iota of responsibility for the couple taking the fish drugs; as long as it’s not zero, you get to say Trump shouldn’t have talked about chloroquine.

          • HeelBearCub says:

            you get to say Trump shouldn’t have talked about chloroquine.

            It’s not that he talked about it, it’s how he talked about it. There are ways it could have been talked about that would have been far, far less of issue.

            To repurpose Colin Powell’s Pottery Barn analogy, if a piece of pottery is precariously balanced on a shelf, and it gets knocked off, there is a difference between whether you are playing catch inside the store, even with a nerf ball, or whether you brushed it as you walked by it in a tight corner.

          • Act_II says:

            @Nybbler
            Okay, let me be even clearer. I don’t think he has a tiny amount of responsibility. I think he has a substantial amount of responsibility. I’m not trying to play some stupid trick. If anything, you’re trying to pull the opposite trick, where you round down any shared responsibility to zero.

            He should be careful with what he says because he’s the President of the United States. It was perfectly predictable that talking about untested miracle cures in the middle of a pandemic would cause dangerous behavior and self-medication from scared people. In fact, every statement he makes during the pandemic can affect how it plays out. That doesn’t mean to curl up and refuse to comment on anything, it means to act fucking presidential and actually plan his statements before they come out of his mouth.

          • Clutzy says:

            It’s not that he talked about it, it’s how he talked about it. There are ways it could have been talked about that would have been far, far less of issue.

            To repurpose Colin Powell’s Pottery Barn analogy, if a piece of pottery is precariously balanced on a shelf, and it gets knocked off, there is a difference between whether you are playing catch inside the store, even with a nerf ball, or whether you brushed it as you walked by it in a tight corner.

            Even in that scenario, whatever media outlet which freaked a couple out enough about a virus that they drank pool chemicals is the ones who agitated them. Its probably some media entity. No one watching the Trump speech would have thought those thoughts because they would be optimistic. The people drinking fish cleaner were incredibly pessimistic, so whatever drove them to that state was very non-Trump.

            If Amos Otis and Ray Fosse are playing catch in a Pottery Barn and a drunk old Pete Rose decides to smash into Fosse as he catches a perfectly thrown ball from Otis, Otis and Fosse did nothing at all that caused risk to the pottery, except for the risk that a drunk Pete Rose would get nostalgic for 1970 AND happen upon the Pottery Barn.

          • Act_II says:

            @Clutzy

            No one watching the Trump speech would have thought those thoughts because they would be optimistic. The people drinking fish cleaner were incredibly pessimistic, so whatever drove them to that state was very non-Trump.

            Sorry, but these claims are completely unsupported. There is no reason whatsoever to believe them. It makes no sense to shift the blame to the media — of all the things they do that can be classed as irresponsible, reporting the words of the president is one of the most justified.

          • HeelBearCub says:

            @Clutzy:
            If Ames and Fosse know that drunk Pete Rose is there and is likely to get involved in a game of catch, yeah, they have some of the responsibility. Doing something inherently risky in conditions that exacerbate that risk increases liability.

            People are justifiably freaked out in a time of rising pandemic. Trump knows this. There are more and less effective and responsible ways to communicate and he is engaging in the ones that are less responsible and less effective.

          • The Nybbler says:

            If anything, you’re trying to pull the opposite trick, where you round down any shared responsibility to zero.

            I’m the one claiming it’s a binary choice in the first place. And that no, Donald J. Trump is not responsible for fools drinking fishtank chemicals. Even if he mentioned that said chemicals looked like they might cure COVID-19. And even if it turns out they don’t. He would not be responsible even if he had even more authority in that regard (e.g. he was the Surgeon General or the head of the CDC).

            There simply isn’t any way to go from “An authority figure says chloroquine is a great drug for COVID-19” to an ordinary citizen who is not institutionalized saying “I should drink some chloroquine-containing fish drug without even checking the dosage” that doesn’t break the chain of responsibility.

          • anonymousskimmer says:

            I believe the culpability with Trump vis-a-vis the death was him emphasizing how safe these drugs were.

          • Clutzy says:

            HBC

            If Ames and Fosse know that drunk Pete Rose is there and is likely to get involved in a game of catch, yeah, they have some of the responsibility. Doing something inherently risky in conditions that exacerbate that risk increases liability.

            People are justifiably freaked out in a time of rising pandemic. Trump knows this. There are more and less effective and responsible ways to communicate and he is engaging in the ones that are less responsible and less effective.

            But the pandemic in the analogy is not Pete Rose. In your world poor Otis and Fosse can never go anywhere because Pete Rose is getting drunk ALL THE TIME and he tackles Fosse if he’s on the subway, in a Wal Mart, getting Cincinnati Chili, or in a pottery barn. The pandemic is Steven A. Smith talking about how Pete Rose should never get into the HOF, which Pete happens to see, and decides its the reason to get drunk that day (even though he gets drunk everyday regardless).

          • HeelBearCub says:

            @Clutzy:
            No. Ames and Fosse just don’t play catch in Pottery Barn.

            They still need dishes, but they moderate their behavior, go get them with due care, and tell Drunk Pete to sign autographs at the front of the store.

            They take the entirety of the unfortunate situation into account when they decide on their course of action.

          • Clutzy says:

            They still need dishes, but they moderate their behavior, go get them with due care, and tell Drunk Pete to sign autographs at the front of the store.

            They take the entirety of the unfortunate situation into account when they decide on their course of action.

            Drunk Pete tackles them at the worst moment whatever they do though. The media is basically the equivalent of a Trump stalker, which is almost fine because he’s President and we need to hold him accountable (although it would be nice to hold all presidents accountable). However, we need the media to be a policeman tailing a suspicious person, not a stalker. Its similar in many ways, but different in other ways, because the stalker is reckless. And we I don’t think its fair to assign moral culpability to people if they have a reckless stalker. Cus sure, maybe we can say, “Fosse should have been extra careful in the China shop because he knows Rose is drunk and about.” But Fosse also got tackled last month when he was in the bread aisle, and that send him careening into a shelf that happened to land on an old lady, and he also got tackled while waiting for the train, and that sent a garbage can onto the tracks that delayed the train for an hour.

            Your argument, when it comes down to the brass tacks, is that Trump cannot be president because the media does bad things when Trump is president.

        • mtl1882 says:

          I think virtually everyone agrees that the president should understand his words have consequences and speak with that in mind. That doesn’t equate to expecting them to always being able to hit the right note, especially in an emergency.

          When you’re speaking to the cameras on a regular basis in a high-pressure, constantly changing situation, probably not much sleep, etc., you just aren’t going to be able to sit there and parse this all through. His temperament and style aren’t amenable to doing that anyway, but that’s been true of many leaders–it has its upsides. Also, people who carefully parse words can often be just as misleading, and more intentionally. Trump has a lot to deal with right now, as do others around him who are probably saying questionable things and getting less attention (some health organizations seem to be making far more misleading statements far more deliberately). He’s not paying attention to exactly how things come across in every detail, nor should he be. The fact that this is a serious emergency does not raise the bar for these things—it’s the opposite, IMO. Fixating on words, which I agree can have serious consequences, still comes at the expense of way bigger things that happen to be going on, and there are way too many people parsing words. Only one family in the entire U. S. made this mistake.

    • Controls Freak says:

      stochastic terrorism

      …is hazy enough in its elements and enough of a superweapon that I simply do not consider any accusation of it from anyone until after I have seen them make the accusation against someone on their Own Team. I haven’t seen you ’round here long enough to validate your use of it. Nothing personal.

  77. quevivasbien says:

    I’m inclined to think that people are seriously under-valuing the economic damage of shutting everything down to fight the virus. A big part of the issue is that the cost (in lost output) paid today may not be the total cost you will experience over time. If, for example, you pay $1 trillion today to slow down the virus and assume that the economy does not automatically return to some long-term equilibrium trend afterward (which seems reasonable given the friction associated with reemerging from a recession; it’s the difference between modelling GDP as a difference-stationary vs. a trend-stationary process), then you will thereafter be stuck at a lower level of output, meaning that the total cost in lost output over time could potentially be many times what the initial cost was. If economic output grows in anything like an exponential fashion over time, then the cost of any reduction to output should also grow approximately exponentially over time as well. Of course, the economy is complicated, and things might not actually work this way, but even so, this should be at least big enough of a consideration to give pause to anyone worried about long-term welfare.

    Another complication is, of course, that not shutting things down would also have severe economic consequences as people getting sick would hurt output as well. (Matt M pointed this out already.)

    Even if this does end up tipping the utilitarian calculations in one way or another, I sadly don’t see this changing public response very much. Most people are not very inclined toward this type of thinking, and from personal observation I don’t think most people are inclined toward a position that assumes a dollar value for human life anyway.

    • Matt M says:

      Another complication is, of course, that not shutting things down would also have severe economic consequences as people getting sick would hurt output as well. (Matt M pointed this out already.)

      Just to be clear – this is a theory I have heard and that, if true, would constitute a logical argument for shutdowns. I am not at all convinced it is true. But the possibility of it being true certainly must be considered for anyone trying to actually model what the true cost/benefit of shutdowns is (which still seems to be a thing literally nobody has bothered to do).

    • Le Maistre Chat says:

      I’m inclined to think that people are seriously under-valuing the economic damage of shutting everything down to fight the virus.

      “Under-valuing” is a poor choice of words, because people can value things different amounts (Haidt’s moral foundations, etc.)
      Are people seriously under-estimating the economic damage? Yes. If the only legal jobs are white-collar work from home, working in a warehouse, and life-sustaining retail for 2 months, the economic damage will be huge. If, as looks likely, epidemiology experts will be voraciously recommending such measures for 18 months or until we have a vaccine, it’ll be catastrophic. Tucker Carlson is talking about it in terms of the total extinction of middle classes like small businesses and independent contractors, the petite bourgeois. Entire classes will either become homeless or bounce back from unemployment into the minimum-wage prolelariat with their savings wiped out.

      • cuke says:

        Can you give us reference to the epidemiologists who are saying they want lockdown for 18 months or until vaccine? “The hammer and the dance” is definitely not that. I haven’t seen what he’s describing recommended by any epidemiologists I’m following and so it makes Tucker Carlson’s talk (as you describe it here) seem unmoored from reality.

        • Le Maistre Chat says:

          Marc Lipsitch, a professor of epidemiology at Harvard, and Michael Osterholm, director of University of Minnesota’s Center for Infectious Disease Research and Policy, have told NPR that we can’t do “the hammer and dance.”
          Osterholm seems to recognize that an 18-month freeze on movement is unacceptable, while Lipsitch just kind of verbally shrugged.

          • matthewravery says:

            Osterholm basically says we’re fucked, which I don’t really get, since some places at least look less fucked right now than others.

            The most interesting criticism of “hammer and dance” that he brings up is the lack of testing reagents as testing ramps up. Without knowing specifics about the tests, this seems like a tractable problem to me. Does anyone know why we can’t ramp up reagent production at the same time as testing?

          • cuke says:

            My understanding is that we are ramping up reagent production.

            Marc Lipsitch specifically seems more pessimistic in that NPR piece than he is elsewhere, but it’s not clear based on what. He seems to be saying he suspects the outbreaks once we loosen things up will be much bigger than we can handle and that will send us more often back into freeze mode. He seems to anchor the more pessimistic view among epidemiologists right now and that’s fine.

            At the moment it seems like epidemiologists are mainly disagreeing about things that are understandable to disagree about because of the unknowns:
            1. how long will it take in how many places to flatten the curve where good policies and practices are already happening;
            2. how much compliance will we see from individuals and how much state leadership in enforcing distancing policies as time goes on;
            3. how quickly will PPE, testing, and treatment capacity get ramped up;
            4. what unknowns could shift the numbers significantly because we still don’t have accurate information as to fatality rate, ROI, and explanations for local variation;
            5. what chance events may sway human behavior strongly in one direction or another — a huge pileup of bodies somewhere or better than expected news from somewhere.

            Given all these variables and how much is still unknown — but will not remain indefinitely unknown — it seems understandable to me that some would be saying 4 weeks and some 10 weeks of lockdown practices before some areas can experiment with opening things back up. And that will obviously vary from one location to another. It seems understandable to me that a few scientists would have the most pessimistic view that we are going to spend more time in the coming 12-18 months in various stages of lockdown than not, even if it’s not 100% all the time.

            In this context where our experience is still limited — but growing every day — it seems irresponsible to me for political commentators to just go on air and wholesale catastrophize about the future. That’s an emoting thing not an information-sharing thing or even an analysis-based-on-evidence thing, so it strikes me as irresponsible. In the same way that Trump’s impromptu effusing about miracle cures also seems irresponsible, in the same way Trump’s threatening to “quarantine” NY, CT, and NJ without knowing what he’s talking about and then taking it back a few hours later seems irresponsible. Or hastily announcing travel bans without preparing airports for the hoards of U.S. citizens who will be flocking home and will contaminate each other before going onto their many final destinations. Freewheeling unscripted chatter is the opposite of what we need right now from people who have large platforms to speak from.

            There are things we simply can’t know right now without getting several weeks further into this nightmare and so speculating about what it will look like in two years or four years and suggesting there will be no more middle class, no more small businesses, and so on just seems like non-evidence-based freaking out. I am doing my share of non-evidence-based freaking out in the privacy of my own home here, but I don’t confuse that with rational thought or try to sell my version of it to others.

    • denverarc says:

      That isn’t really how economic calculation works.

      The classic one is always to say “which is best for the economy – making a cake or going to sleep under a tree?”

      The answer is “whichever one you freely choose.” Atm we are choosing to be less active, which is the economically best outcome, definitionally.

  78. dreeves says:

    I’m on the edge of my seat on the Japan and third-world mystery. Likely relevant: Patrick McKenzie is someone I respect a lot and who lives in Japan. Last week he said he had a prediction that he was socially constrained, as he put it, from making publicly so instead he posted a SHA512 hash of his prediction and said he’d reveal it in 30 days:

    https://twitter.com/patio11/status/1241551327743770624

  79. Maxander says:

    Probably-harebrained quasi-vaccine idea; we know that the coronavirus is descended from one of a set of extremely similar bat/pangolin/whatever viruses. Could we immunize people to (human-)coronavirus by injecting them with one of these animal-virus relatives? The comparison being to the original smallpox “vaccine,” which was a preparation of cowpox, a related virus that afflicted cattle.

    (This occurred to me after reading the discussion of variolation. The other thought which occurred to me from that discussion was that now there’s a radically unpopular Robin Hanson take I actually agree with. I fear that I’ve gone mad.)

    • alchemy29 says:

      That seems promising, but what if we create COVID-20? I don’t know how likely that is, but my god would that be a disaster.

      • Maxander says:

        Well, then you have a case of COVID-20 in a well-controlled environment (probably a research hospital) and you understand what you’re getting into; meanwhile, since people are out there eating bats that are infected with the same virus, COVID-20 just turned out to be a matter of time. That’s still on balance a win, albeit a much scarier one.

        • alchemy29 says:

          Are you proposing that people who receive the animal virus would be monitored in a hospital? For how long? Hospital space isn’t exactly cheap in normal times, and it’s worse now.

          since people are out there eating bats that are infected with the same virus, COVID-20 just turned out to be a matter of time. That’s still on balance a win, albeit a much scarier one.

          Viruses mutate randomly. Creating COVID-20 by injecting millions (billions?) of people with animal coronaviruses doesn’t save us from the next natural COVID. They would be different diseases. The next novel respiratory pandemic is just a matter of time anyway, but we don’t know if it will be a coronavirus.

          There is a much less mad-science solution. Fast track promising vaccine candidates to phase III while preparing the infrastructure to ramp up production as soon as there is enough data. There are two candidates that have already reached Phase I. An mRNA vaccine which has never been tried before, and a recombinant vaccine which has been proven to work before. I wish there was a promising inactivated vaccine because they have a longer track record of success. Live attenuated vaccines are excellent, but they take a very long time to develop.

    • Rebecca Friedman says:

      I’m pretty sure cowpox lived in cattle and afflicted humans who dealt with the cattle – milkmaids in most examples I remember. They developed the vaccine from afflicted humans initially, not cows.

      So it was already a human virus, and they’d had a chance to see what it was like (and I think to observe that it conveyed immunity to smallpox) before they started treating people with it.

  80. DNM says:

    I saw something a few days ago postulating that blood type affects COVID-19 impacts. Can’t find it now. Could this be related to different impacts than expected in certain countries?

  81. Lambert says:

    I wonder whether PFC-based liquid breathing ventilators would be any good at helping people survive COVID-19, if we developed the tech.
    I doubt we’d get it safe fore humans in time even if we manhattaned it. I just think the idea of breathing perfluorodecalin is kinda cool. I wonder whether it works for plant roots. Fluoroponics would be neat.

    • PsyXe says:

      I was thinking about that some years ago after watching a documentary on particularly virulent flu strains killing young, healthy people via cytokine storm. I’d previously read about a case where PFC ventilation had been used to save someone who had been rescued from drowning and whose lungs were full of dirty river water and debris, causing iirc massive infection. Think I actually sent a pathetic-sounding email to someone suggesting they investigate it, probably went straight to trash (I must have been barely more than a kid at the time) but I agree with you that it sounds like something that SOMEONE ought to be looking into

      • Lambert says:

        I think a bunch of people are looking into it, but it’s still in very early stages.
        Pouring a load of fluid directly into someone’s lungs has a lot of failure modes.

    • Garrett says:

      A better approach would be to ramp up the number of ECMO machines we have. But we apparently only have something like 250 for the whole country right now.

  82. Irenist says:

    My last comment on this got filtered, so I’m going to try a shorter version with fewer possible filter triggers and no blockquote.

    Scott discussed the “right wing” media ecosystem. It’s understandable that those sites might look right wing from Berkeley, but from Texas they all look pretty “normiecon.”

    The actual right wing on Twitter (whom I’d define if the examples I gave last time hadn’t likely triggered the filter) were on top of this early, and certainly never put out any “masks don’t work”-type misinformation. A lot of right wingers were apocalyptic doomsday preppers before COVID19 anyway, so they were predisposed to take this seriously.

    Which reminds me: now that we’re living through a zombie apocalypse-type event, the conservative side of Scott’s excellent “Thrive / Survive Political Spectrum” is looking pretty vindicated right now. Right wing “survivers” were stockpiling supplies last month while “thrivers” were still playing signaling games about Sinophobia around the name for the virus, and telling New Yorkers to be sure to gather in large numbers to celebrate the Lunar New Year, lest the Sinophobes win.

    • Null42 says:

      I’ve thought about that a lot. I’ve been trying to give more weight to sources who called this thing early.

      Serious question now, weird as it may seem. I would like to enlist on the right side of the culture war. It’s pretty clear to me that globalization, individual instant gratification, nonstandard relationship models, and pretty much every idea produced since 1960 (outside of natural science advancements) have led us into a pretty bad place.

      Unfortunately, I’m of partial Ashkenazi ancestry (1/2), so the alt-right is off-limits. What parts of the right are OK for me to join?

      • A1987dM says:

        Unfortunately, I’m of partial Ashkenazi ancestry (1/2), so the alt-right is off-limits.

        Well, FWIW Curtis Yarvin is half-Jewish too.

      • If you count libertarians as part of the right, you could join us — there are lots of Jewish libertarians. It is possible to be a libertarian and a social conservative, as long as you don’t want your view of how people ought to relate to each other to be enforced by the state.

        But there might be a problem with your hostility to globalization.

      • Le Maistre Chat says:

        Unfortunately, I’m of partial Ashkenazi ancestry (1/2), so the alt-right is off-limits. What parts of the right are OK for me to join?

        Become a religious conservative, obviously. Ancestry doesn’t matter there.

      • albatross11 says: