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”.

950 thoughts on “Coronalinks 3/27/20: We’re Number One

  1. masanlyrics616

    There are lots of hypotheses that I could imagine, but they all seem like they should be easily distinguished by the data. For example, the “epidemic of epidemics” would be really obvious. On a more individual level, I imagine that less dense communities have lower rates of flu than more dense communities, but I doubt that the densest communities have 100%. If that’s true, it suggests that it’s some other phenomenon. I think that individual variation of immune system strength is probably more important, both general general strength and acquired immunity to similar viruses is the main driver.

    If you gave me a graph and asked me to predict the effective R0, I would not simply average the degrees of the vertices. A random walk spends time at each vertex proportional to the degree, so I would use the degree-weighted average degree.
    Thank You
    Tere Bin

  2. Hibukki

    A summary of what each country’s doing, how reliable their reports are, how come things are so strange there, and so on:
    See country specific responses, a link I found from 80000 hours.

    For example,

    Japan:
    “There is a social norm that you should not cause trouble to other people,” says Kazuto Suzuki, an expert on international politics at Hokkaido University. “If you don’t take care of yourself and become ill, that is taken as causing problems for other people.” The coronavirus outbreak has resulted in the rigorous use of hand sanitisers and washing of hands, while not wearing a mask on the train would attract immediate disapproval.

  3. thetitaniumdragon

    The “11 day doubling time” in Iran is because they can only test about 3,000 people per day.

    Thus, they’ve been adding 3,000 people per day to their number of infected for the last week.

    This makes their doubling period look longer the longer it goes on. In reality, it is simply because they are limited to that many tests per day.

    There are mass graves visible from satellite, and even a week ago, WHO estimated that the true toll in Iran was probably 5x higher than the official numbers. It’s probably even worse now.

    Meanwhile, Wuhan was handing out about 45,000 urns full of cremains. The Chinese numbers are almost certainly wrong and a gross underestimate.

    Taiwan, Japan, Singapore, and South Korea do seem to have successfully contained this. Masks seem like the only really plausible possibility there, along with SK’s extremely aggressive testing program.

  4. tallfoul

    @scott:
    Please stop propagating Elon Musk’s claims, he has a history of making deceptive statements, and him taking credit for buying ventilators is probably one: In a recent Twitter post he takes credit for delivering 40 “ventilators” to the New York hospital system but the only device pictured in the post he replies to shows a CPAP machine, which the link in your post states are not recommended for use in hospitals and is probably not the type of device anyone refers to when they say there is a lack of ventilators. (If they were people would be donating their sleep apnea machines or hospitals would buying the one’s currently listed on Craigslist for <$200). So at least some of the machines Musk is taking credit for as ventilators are just CPAPs.

    Want to bet the majority of the 1200 "ventilators" that Elon Musk has donated aren't the type of critical invasive ventilators that are in a shortage in this crisis? This isn't a mistake either, Musk made tweets where he shows he knows the distinction between the machines.

    I hope you take this as a piece of evidence against billionaire philanthropy, which is often just status acquisition with no concern for anyone else's benefit, and also as evidence against "lie inflation" with respect to Musk.

  5. albatross11

    Dumb question: Is anyone screening flyers before they fly somewhere? ISTM that just telling the TSA to spend the next month checking temperatures with a forehead thermometer and asking people if they’ve been around any sick people lately would have a positive impact. If the feds can refuse you boarding on an airplane because your name is on a secret list somewhere[1], they can surely do so to avoid having you carry COVID-19 from New York to Kansas.

    [1] The no-fly list is an abomination, FWIW.

  6. Edward Scizorhands

    Is there a place where I can find coronavirus cases by metro region or province, for outside of the United States?

    Like, for Barcelona Province or for the metro-Paris area?

    1. Douglas Knight

      The FT (open access) has both Catalonia and Île-de-France. I don’t know where they got them from, but they give citations.

  7. The Nybbler

    OK, time for me to play amateur theoretical epidemiologist. Trigger warning: handwaving.

    We know that the simple SIR model predicts very high proportions of the population infected for an epidemic for even low R0; for flu we should see 50% of the population infected when it’s usually about 10%. We can take a good guess WHY this is true too: it assumes perfect population mixing.

    So what does this mean? It means if you consider your population of size N as a graph, it’s a complete graph and each edge has a node of weight R0/(N-1) representing the probability of spreading an infection along that node within a contagious period. This may model an elementary school class well; it’s pretty poor at larger populations.

    What do larger populations look like? They’re heterogeneous. Some people have connections with only a few other nodes. Some people have connections with many — “hubs”. Some people may have few connections, but they connect otherwise weakly-connected sub-networks. We can model the population as a graph (no longer complete) where each edge has a weight indicating relative likeliness of spread to the person, and we normalize the weights such that the average total edge weight for a node is R0.

    Now the handwaving: My intuition is that a network which looks like this will become unable to sustain the epidemic when average total edge weight between unrecovered nodes is less than 1. And that it will tend to happen when “important” nodes — those with high edge weight, or those connecting otherwise-weakly connected subnetworks — recover. And furthermore, this will tend to happen quickly, precisely because those nodes are well-connected.

    OK, now does anyone want to figure out how to run a simulation of epidemic spread on a network like this?

    1. Lambert

      Check out 3Blue1Brown’s latest Youtube Video. It’s far from a perfect model, but it shows how things happen in a network of subnetworks. (You get an epidemic of subepidemics)

      1. DarkTigger

        I seconed this. I thought of that video too. The video also has a great visualization for the simulation.

    2. Douglas Knight

      There are lots of hypotheses that I could imagine, but they all seem like they should be easily distinguished by the data. For example, the “epidemic of epidemics” would be really obvious. On a more individual level, I imagine that less dense communities have lower rates of flu than more dense communities, but I doubt that the densest communities have 100%. If that’s true, it suggests that it’s some other phenomenon. I think that individual variation of immune system strength is probably more important, both general general strength and acquired immunity to similar viruses is the main driver.

      If you gave me a graph and asked me to predict the effective R0, I would not simply average the degrees of the vertices. A random walk spends time at each vertex proportional to the degree, so I would use the degree-weighted average degree. (compare: the population-weighted density)

      1. The Nybbler

        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.

        1. Douglas Knight

          So, of course in the short term you see an epidemic of epidemics. But the question was what happens in the long run if you let it run its course. Are there any regions left untouched? Does the typical flu season hit every region? I don’t think so, but this should be known.

          The CDC has several measures of flu activity. In one, it says that the flu was “widespread” in each of the 48 continental states, even simultaneously in week 4 (more than just “regional” in that state). But another never shows ID or AZ as ever getting bad.

          Incidentally, the CDC flu dashboard has one graph in the lower right, showing positive flu tests going down, and another in the upper right, showing flu-like illness going up, presumably coronavirus. And we shouldn’t ask if “the flu” hit everywhere, but whether particular flus did. It looks like H1N1 did and so did Victoria, but the others didn’t hit every state.

    3. bernie638

      Thank you. I’ve been thinking something similar, but you seem to have a much clearer picture. Can you take the next step, how does this relate to different R0 rates? Does it burn through the subgroups faster, then stop, or does it jump between groups faster? Or does it have some other shape, if a flu strain were slightly more infectious, then it would ____, but if it were much more infections it would _____?

  8. vpaul

    Why is Cuomo getting so much love? NYC reacted way too late and everyone should have seen this coming. Schools were closed too late, shelter in place was given too late, subway is still running etc. It’s ridiculous and I’m angry.

    1. The Nybbler

      Because he’s Doing Something. The politician’s fallacy (“We must do something, this is something, we must do it”) exists for a reason. People often like decisiveness in a crisis, even if the decisions are stupid.

  9. DeservingPorcupine

    In case nobody said it, the only people responsible are the idiots who ate out of their fish tank.

    If people later refuse the drug because of idiots who ate out of their fish tank, they will be the only culpable new idiots.

    1. albatross11

      Yeah, it’s possible for both things to be true at onceL

      a. Trump should be more careful in his words, to avoid misleading people or encouraging people to do dumb or evil things. (In general, he’s never been careful in this way, which is part of his appeal, but sometimes backfires.)

      b. The people who poisoned themselves with aquarium supplies did something unreasonably dumb, and it’s not reasonable to blame the president for it.

  10. Chris Phoenix

    Scott: Re your edit on Iceland – It doesn’t look like you’re counting the newly-exposed cases that are showing virus but haven’t yet developed symptoms. Depending on their real doubling rate, a large fraction of those 3,000 could be in this category. Given the numbers from everywhere else, it seems over-optimistic to say Iceland demonstrates 10:1 infection:symptom rate.

    Of course it’s possible that subtle cultural differences (Is it OK to pick your nose or spit on the sidewalk? Do you eat fast food with your hands? Do you take off your shoes at the door?) cause some cultures to naturally variolate more than others. That could make a big difference in the infection:severity ratio.

  11. David W

    I’ve now read two ‘day in the life of an ER doc’ accounts that include something like ‘then I go home, strip in the hallway outside my door, wash my clothes immediately and shower.’ Followed up with something about being scared that it’s not enough, they will still infect their family.

    I am very confused by this. I thought the whole point of scrubs, which are pretty universal, was that medical people could do this self-sterilization at the hospital – street clothes into locker, go through shower, put on scrubs on the other side. And in reverse, dump scrubs into hospital laundry, shower, put on street clothes.

    What am I missing?

    1. albatross11

      For anyplace with any active COVID-19 cases, the local authorities should provide housing for medical personnel who don’t want to bring it home/to their communities. Get them a hotel room and carry-out food for dinner, pay for it like they’re at a conference. This would probably limit spread substantially all by itself–an obvious way for this to spread despite lockdowns is for doctors and nurses to track it back to their homes and neighborhoods and grocery stores and such.

      1. deciusbrutus

        Hospitals already have places to sleep and facilities to provide food. Why duplicate that?

        Make those facilities available to medical staff who wish to avoid the risk of infecting their families.

        1. anonymousskimmer

          I read a hospital worker commenting on this idea. It boils down to not having enough spaces to hot bed, as well as the cross contamination inherent in the hot bedding, not to mention the noise and uncomfortableness, IIRC.

          1. Clutzy

            Yeah. The in hospital sleeping situation is not good. Given that hotels are mostly empty, paying hotels a de minimus fee to house hospital workers with family that are particularly vulnerable is a no brainer move for states.

    2. Statismagician

      Some combination of:

      A) passing through hospital and other areas on the way out of work may plausibly expose street clothing to the virus as well as scrubs;

      B) near-pathologically excessive caution is a known feature of the American medical system;

      C) non-representative sample; the people writing/being quoted in these posts and articles are the ones who are the most worried about this. This goes doubly for physicians (and nurses and EMTs and etc.), who are obviously going to see way more of the worst things that can happen than some random guy off the street.

    3. Edward Scizorhands

      If there was only one COVID-19 case in the country, and it was in your secure facility, and you scrubbed down at your workplace exit, you’d be fine.

      But there is coronavirus everywhere in a hospital, even a really clean one. Walking out the exit probably puts it on their shoes, and then it ends up on their pants.

      I completely cosign albatross11’s statement. These workers should be good facilities and catered meals. (If you want to get really angry, google about nurses being kicked out of their homes by scared landlords.)

  12. deciusbrutus

    Re: Japan, Seattle, SF all doing better than expected

    Those areas are all coastal Pacific. Does “distance from Pacific coast” have any correlation or threshold relationship to “city does better than expected”?

  13. cuke

    This is a PSA about the increased access to remote mental healthcare (telemental health) in the U.S. during this time of elevated stress. Since Scott’s post is a catch-all about dealing with Coronavirus, I thought it might be helpful to add some information about how mental healthcare is being made more accessible.

    A few things:

    * This website is connecting people with therapists providing reduced-cost remote therapy in your state. I don’t know anything about them but they seem to be doing a good thing.

    * Many mental healthcare providers have moved in the past two weeks to providing telemental health, so even if say PsychologyToday or whoever doesn’t list a therapist as doing telehealth, they probably do now.

    * Most of the big private insurance companies have agreed to cover remote therapy in the same way they cover in-person for your health coverage. That now includes Medicare and Medicaid and it includes phone therapy as well as video, so you don’t even have to have internet access.

    * A couple of big insurance companies — Anthem and Aetna for now — are waiving patient co-pays for telemental health services. Other insurance companies are likely to do the same in the coming weeks.

    * The federal government has relaxed HIPAA requirements so that providers can deliver remote services using less secure means if the patient opts for that — ie, FaceTime, Skype, etc are okay for now when they weren’t before.

    * Fed and state governments are relaxing enforcement of the prohibition on cross-state practice of therapy, so if you’re stuck in another state or your therapist is, it’s likely fine to keep working with them.

    * There’s been an explosion of free online resources and previously paid meditation apps and courses are being offered for free. This guide is one decent round-up of resources.

    A lot of folks are experiencing new stress-related symptoms right now, whether physical or mental, including increased friction with partners and kids, insomnia, more anxiety and depression, difficulty concentrating, and the whole panoply of things we see with “adjustment disorder.” At the same time, we all want to stay out of doctor’s offices and hospitals if we can, which means tending to stress early so it doesn’t manifest in physical illness is a good idea.

    I hope others will add things I may have missed.

    1. albatross11

      The therapists’ office attended by two of my kids is now offering walking counseling–go for an hour walk around the neighborhood, saying a reasonable distance from other people and each other. There are some potential privacy issues, and it wouldn’t work everywhere (they’re in a particularly nice place to walk around) but this might be a nice resource for people who just aren’t comfortable with videoconference therapy. (One of my kids is utterly creeped out by this and won’t do it.).

    2. DNM

      Is there any cite available for your point about HIPAA and Skype, etc.? My therapist has denied me appointments for going on three weeks as the large parent conglomerate figures out telehealth.

      1. cuke

        Thank you Douglas Knight, yes that’s the link.

        I’m sorry that’s happening to you DNM, that’s really egregiously bad under the circumstances. Our first duty is to the well-being of our patients/clients and providing continuity of care right now is really important. You shouldn’t have to sit in limbo for three weeks.

        Therapists who can’t meet by video need to be offering phone sessions to their clients. It requires no special software and it’s perfectly acceptable under these specific circumstances and particularly if it’s the difference between providing some care and no care.

  14. epiphi

    It’s not confusing that Nigeria, in particular, has few cases. They have a really well-developed containment (disinfection + contact tracing + case isolation) infrastructure.

    During the 2014 West African Ebola epidemic, an Ebola-positive patient showed up in Lagos, one of the most dense cities on the planet, and yet the country only ended up with 20 cases total.

    My understanding (can’t seem to find a great citation for this, learned it from a CDC person at a conference) is that Nigeria’s internationally-funded efforts to eradicate polio (no wild polio since 2016!) helped to build world-leading containment expertise. The fact that Nigeria was able to contain Ebola was cited as an example of why international aid to fund healthcare infrastructure is worthwhile.

    For more background, here’s Ebola in Nigeria on Wikipedia, and a Scientific American article called How Did Nigeria Quash Its Ebola Outbreak So Quickly?

    Anyway, people have been talking about how many Southeast Asian countries have been well-prepared for COVID-19 because of all of the institutional knowledge developed during the 2003 SARS outbreaks. We should expect many West African countries to have similar infrastructure from the 2014-2016 Ebola epidemic- here’s a QZ Interview with Chikwe Ihekweazu, an African epidemiologist who sits on the board of the Public Health Foundation of Nigeria suggesting just that.

    (This comment cross-posted from LessWrong.)

  15. Mark Atwood

    We’ve got a fucking neo-tankie (subtype: 中国共产党) here. And a boring one at that. I’m out until he’s gone. I doubt I’ll be missed, but that’s okay.

    1. Paul Zrimsek

      If this is the sort of post we’re going to be doing without, I guess we can live with it.

  16. tb__throwaway

    There’s a theory that BCG vaccine (TB) helps strengthen you against corona, I’d recommend getting it if you haven’t, or especially for your older relatives (given that the cost/side effects is well-understood and near-zero, whereas the benefits based on the below could be serious):

    https://www.mpg.de/14610776/immune-boost-corona-virus https://www.sciencemag.org/news/2020/03/can-century-old-tb-vaccine-steel-immune-system-against-new-coronavirus

    https://foreignpolicy.com/2020/03/24/coronavirus-vaccine-health-care-workers-bcg/
    https://www.france24.com/en/20200326-australians-trial-tb-vaccine-to-fight-coronavirus
    https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1 (looking at the correlation between vaccination rates by country and corona spread).

    Very speculative: there are different strains of BCG, and allegedly the old (Soviet/Japan/Brazil) type/types is better. This could theoretically explain the different corona case loads between West/East Germany and between Japan + Thailand + Taiwan vs China + Iran (different vaccine strains).

    Here are images showing differing corona case loads between East/West Germany (East uses/used the Soviet vaccine), supposedly the population density does not explain this:

    https://upload.wikimedia.org/wikipedia/commons/thumb/a/af/COVID-19_outbreak_Germany_per_capita_cases_map.svg/1024px-COVID-19_outbreak_Germany_per_capita_cases_map.svg.png

    https://1.bp.blogspot.com/-gy6Hqe8f2aM/Xn1KqOJ5wII/AAAAAAAA0EQ/rIhBVz2uM5A1q3lH3FFGnsXeTTTyjVpZgCLcBGAsYHQ/s1600/germany.png

    Much more at https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html?fbclid=IwAR2MKAgIt2IRjPSf_S9F4HozW4z7BWjH9_9D5p3RmGGJtdh2wp5gkpdzOj8&m=1. If someone who actually understands vaccines could read this and provide thoughts and vet, that’d be great. If it does end up making sense, please do spread, given the high expected value benefit here. I just don’t know how easy it’d be to find old (Soviet etc.) style vaccines in the West.

  17. DNM

    I have a somewhat distant relative in the hospital with COVID-19, in a medically induced coma. This has of course made everything that much more real to me and I am trying to understand some trade offs better before I have closer relatives affected who may be looking to me for advice.

    I reviewed this link, posted above, and found it helpful. The absolute worst case to me seems to be going to the hospital, spending days or weeks in isolation and agony, and then dying alone. I am trying to figure out what the benefit really is of going to the hospital.

    For the ~50% of hospitalized COVID-19 patients who get oxygen supplementation, this is possible to do at home, and there are many references to doing so in Northern Italy. I have seen no references to this being done at scale for COVID-19 in the U.S., and the first article above explains this is because around 40% of these patients will need a ventilator after a few days anyway, and will need it too urgently for ambulance transfer to be effective. So as long as there is space in hospitals, once you need oxygen supplementation you are better off in the hospital from a likelihood to die perspective. Misery and isolation aren’t factored in to this analysis, and as hospitals fill up it seems imperative that mass mobilization of home-based oxygen supplementation happen. It buys say 3-4 days for 50% of people, and is all 50% of people need. I don’t see any mentions of this happening.

    From there, you go to ventilation. After reviewing a number of sources, none of which stood out, I am seeing numbers that 20%-40% of those that go on ventilators will ultimately recover. Ventilation is obviously not possible at home. I have not found very much about what the experience of ventilation is actually like. Are patients conscious? Is it painful? How aware are patients that die on a mechanical ventilator? Will they realize they are dying alone? I assume my relative who is in an induced coma is on mechanical ventilation, but I am unclear if the reverse is true, if all patients on mechanical ventilation are in induced comas.

  18. MasterofPuppets

    I can’t find the source because web search engines are filtering everything to do with COVID-19, but read an interview with the couple that drank the fish tank cleaner. In it she said they drank a heaping teaspoon with soda. A teaspoon of that powder is going to be approximately 3-4 grams or almost twice the lethal dose.

    Obviously, first don’t drink fish tank cleaner. Second, if you are out there sitting on vet drugs that are primarily for animals or fish antibiotics, don’t take those unless you are really in a pinch (like the medical system is effectively shutdown due to overrun). There are plenty of actual human drugs still available and getting a prescription for them at least as of writing this comment is not hard. Third, if things to devolve and you are in a real SHTF type moment where you might have to take animal drugs or die then at least look up the dosing before doing so. In fact, do it now just in case the internet goes down. If you aren’t sure what the dosing is then don’t take it. Poisoning yourself is probably going to kill you if the virus or secondary condition doesn’t. Fourth, don’t give animal drugs to third parties unless you are (1) in a SHTF type position (2) absolutely positive you know the correct doing and (3) at least let that person know if they take the drug it could kill them. Popping vet drugs for yourself is one thing. Killing someone else that thinks you know what you are talking about or offering something that is not inherently dangerous is morally/ethically something else.

  19. gleamingecho

    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.

    I am under the impression that you can’t get a respiratory virus by eating it. Of course, if you ate it and it somehow got from your food to your face to your nose to your lungs, or from your mouth down to your lungs, you could get it. But I wasn’t under the impression that you could get COVID from eating the virus.

  20. HeelBearCub

    If you are looking for the reasons to hope we can get on top of the problem, here is a twitter thread of some of the better news, from a US perspective. Andy Slavitt was head of the Centers for Medicare and Medicaid in the Obama administration.

    Things like Abott currently making available a 5 minute test, with 5 million tests per month to be produced.

    1. cuke

      Slavitt does one long thread every day rounding up many sources of research and news, and he does it in plain language. Though he’s clearly exhausted and needs a proofreader. Amazing guy.

      The other one I’ve liked reading, though less uplifting, is the head of surgery for Columbia Surgery at NY Presbyterian Hospital — he writes a letter that gets posted every day on Twitter here: @ColumbiaSurgery

      Josh Marshall at TPM — setting aside whatever you might think of him — has compiled a list/feed of epidemiolgists and research types posting on Twitter about the pandemic here: https://twitter.com/i/lists/1233998285779632128 . Even if you’d not logged on to Twitter you can just drop in on that list and it’s a fairly science heavy rant-free zone.

  21. alexschernyshev

    One thing that might help Third World countries a bit is corporate philanthropy.

    E.g.:
    – Morgan Stanley pledged $2M to the United Nations Foundation
    – Facebook gave $10M to WHO and promised more soon.
    – Apple committed 15M$
    – Google recently upped the ante and committed 800M$, of which 250$ is specifically earmarked to “help the World Health Organization (WHO) and more than 100 government agencies globally provide critical information on how to prevent the spread of COVID-19 and other measures to help local communities.” + 20M$ worth of Google Cloud credits for academics and researchers + 10k$ per employee gift match.

    That last one I’m especially hopeful for, since Google’s employees come from many countries across the globe. They might have good information where a relatively small amount of money can make a big difference on the ground, and doubling their charity donations seems like a good way to help a wide range of communities in a more targeted way.
    Google is apparently also matching public donations to WHO over here: https://www.google.org/crisis/coronavirus-relief/

    1. The Nybbler

      Why is giving more money to the WHO or the United Nations foundation going to help anything?

  22. Christophe Biocca

    Abbott Laboratories and their 5-13 minute test for COVID: Does anyone know when the threshold of detectability with this tests happens relative to contagiousness? Before, after, how much time lag?

    Because at those kinds of speeds and with sufficient available volume you could test people traveling between from areas battling active infections to one without them.

  23. eric23

    Density is not actually a factor.

    Cities bigger and denser than NYC – Tokyo, Seoul, Shanghai, Hong Kong; also Taipei, Singapore – have a minimal number of cases. Within NYC, Manhattan and Brooklyn have the lowest number of cases per capita, while the less dense boroughs have somewhat higher rates. Meanwhile, as you say, low-density New Orleans is much worse per capita than NYC.

    NYC vs San Francisco is a good comparison, which makes clear exactly why there are outbreaks in some dense areas and not others. On February 25 San Francisco declared a state of emergency; non-essential gatherings in city-owned buildings were banned on March 7, all large gatherings were banned on March 11, and the whole Bay Area locked down on March 17. Meanwhile, on March 3 the NYC Commissioner of Health called on NYC residents to “go about their daily lives”, on March 13 the mayor of NYC refused to close schools as demanded by the teachers union (schools finally closed March 16); on March 18 the NY governor refused to allow shelter-in-place for NYC, only changing his mind on March 20 (lockdown implemented March 22). The 3-10 day difference in response to a virus with cases growing 40% per day had predictable results: On March 8, California had more cases than New York state, by March 24 NYS had ten times as many cases as California.

    There is one way coronavirus spread is correlated with density, though not caused by it. Density is strongly correlated with volume of long-distance travel, which means that dense areas tended to get the virus first, from travelers. But those dense areas which responded appropriated (San Francisco, Seattle, all of East Asia) stopped their outbreaks, while those that did not (New York, Milan) have been devastated. Similarly New Orleans, which is low-density but is a tourist destination similar to dense cities, and which also delayed lockdown until March 22, has a high infection rate. Similarly small towns in northern Italy were hit worse than Milan, because they were closer to Alpine ski resorts where the virus spread. It’s all about policy and travel patterns, not density.

    1. The Nybbler

      Within NYC, Manhattan and Brooklyn have the lowest number of cases per capita, while the less dense boroughs have somewhat higher rates.

      The early cases likely entered the country in Queens (not just the airport, but the Chinese community in Flushing). And there’s a massive amount of commuting to Manhattan by outer-borough residents, which means more mass transit exposure for them than Manhattanites.

    2. Loriot

      I don’t think it’s safe to say we “stopped” our outbreaks yet, but it definitely seems to have been slowed down relative to the control groups. I’m pretty happy that the bay area took things seriously at least.

  24. Ketil

    Here’s a nice graph I was looking for the other day, showing the growth rate in deaths. (Wrong language, but I think it’s pretty clear). Death numbers are delayed a week or two(?), but are probably much more reliable than number of infected. E.g. we can see how Italy are now reaping benefits of their shutdown (a couple of weeks ago), while Spain’s more recent lockdown have yet to take effect. US and UK death numbers are doubling every three days, likely mimicking the infection rates a couple of weeks ago.

    https://www.vg.no/spesial/2020/corona/?utm_source=corona-widget&utm_term=d6&utm_source=vgfront&utm_content=row-3#verden-vekst-i-dodsfall

  25. Christos

    Hey, first comment on your blog, been a reader for years! Thanks for the article ^_^

    I don’t think you can use Iceland’s data to estimate the prevalence and therefore the incidence mortality rate.
    I mean, you could in the absence of better data, but screening was not randomized (so we can’t know the true prevalence) and we should correct for factors such as mean time from infection to death etc.

    I think the best data we have so far is from this paper which has not been peer reviewed yet though.
    According to it:

    “We estimated a prevalence of infection in international Wuhan residents repatriated on 6 flights of 0.87% (6/689, 95% CI 0.32%-1.9%). Adjusting for demography and under-ascertainment, we estimate an IFR of 0.66% (95% crI 0.39-1.33%)”

    Sure, testing is DEFINITELY needed to get an accurate view of the epidemic and current cases.
    But calculating mortality isn’t as easy as doing a division, imo.

    I hope we get better data soon 🙂

  26. clipmaker

    Some difference in covid-19 mortality rates between countries may stem from different national practices regarding BCG (tuberculosis) vaccination:

    We found that countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies. Countries that have a late start of universal BCG policy (Iran, 1984) had high mortality, consistent with the idea that BCG protects the vaccinated elderly population. We also found that BCG vaccination also reduced the number of reported COVID-19 cases in a country. The combination of reduced morbidity and mortality makes BCG vaccination a potential new tool in the fight against COVID-19.

    Links:

    * https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1
    * https://old.reddit.com/r/COVID19/comments/fqt3q4/correlation_between_universal_bcg_vaccination/flrzryu/

  27. Purplehermann

    Has anyone considered pollution levels?
    China high
    Iran high
    Japan low

    Italian cities high
    New York high?
    Etc..

    Not number of cases, severity of cases.

    Low pollution areas can hide cases more easily?

  28. blumenko

    Ok, but how does that lead to the disease dying out early? Consider something like the flu. It will basically infect at least one person in each of those connected subgroups, so wouldn’t each sub epidemic run its course until herd immunity is reached in each one?

  29. castilho

    You should probably make Brazil’s government lifetime members of the Hall of Shame as well.

    We’re one of the few countries in the developing world that actually could handle the pandemic reasonably well (We have around 61.000 ventilators, or 1 ventilator per 3.300 people, which isn’t actually that bad and could be expanded for a decent epidemic response)

    We also aren’t as connected as the US and European countries – we only got our first cases in late Febrary, with people coming back from traveling in Italy. By all measures, we had decent time for planning a response.

    However, our president has decided to go all-in on denying how serious the virus is. The Atlantic even called him “the new leader of the Coronavirus denial movement“. He’s accusing local politicians who have instituted lockdowns of plotting to destroy the country’s economy in order to use it against him later. His sons, who are local politicians in the wealthy parts of the country, have been saying this is all a plot by leftist politicians together with the People’s Republic of China to make him and Trump look bad. I wish I was kidding.

    He’s been going all in on hydroxychloroquine, touting it as a miracle cure. Here’s a tweet by one of his “special advisors” talking about it. (In Portuguese, but Google Translate should do a good enough job)

    The worst part is that he’s led a nationwide movement telling people to leave their homes and go back to their normal lives. The government actually wanted to make “Brazil can’t stop” into a nationwide campaign, but when a significant part of the population didn’t appreciate it, they just deleted the social media posts and now they claim there never was such a campaign. (Yet more Portuguese content)

    I actually made a post on Twitter, once again in Portuguese, chronicling the calls for people to leave their homes and go back to their normal lives made by Bolsonaro’s supporters.

    We aren’t exactly in a great spot right now. As of March 29th, we’re just short of 4.000 confirmed cases and we have about 114 deaths, but there is good reason to believe these numbers are very understated and that we are not testing nearly enough.

    Brazil now is in risk of becoming South America’s Coronavirus horror story, and all because of one increasingly deranged politician and his family.

    1. Radu Floricica

      Sorry for you man. Here in Romania we were a feather’s breadth from the same outcome – we still have those guys dominating the Parliament, but late last year they allowed the opposition to form a government mostly to set them up as scapegoats for this year’s elections. This turned out to be stupid luck, because the opposition gov is surprisingly competent. Not great, mind you, but far from the worst case, properly motivated and of a (classical) liberal bent.

      I just shudder when I think what could have been with the old government. We had a prime-minister that got there as an official puppet, but her master got into jail and her strings were caught by whomever could. She was historically incompetent, no economic education, and a socialist. Plus her party was more than a bit nationalistic. God, it would have been a bloodbath.

  30. yaolilylu

    The confusing lack of CV19 deaths reported in Japan might be somewhat explained by the fact that their elderly, aka the most at risk group, have been self isolating for like the past 20 years? They are the only nation that I know that has a word for dying totally alone: “Kodokushi (孤独死) or lonely death refers to a Japanese phenomenon of people dying alone and remaining undiscovered for a long period of time.”

  31. vaticidalprophet

    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)

    I wonder how real a factor this is. I live in Melbourne, a dense city with massive Chinese and Italian populations, which by this measure should have people dying in the streets. Australia is certainly significantly undertesting, but also certainly not (yet) facing that tier of problems.

  32. Hackworth

    The FDA is also probably a permanent lifetime member.

    I have heard about overregulation and catch-22 regarding testing because of deadlocking FDA rules, but can anyone explain to me why the FDA are the bad guys specifically because of that linked article? I can’t read it in full because paywall, but from what I could read, the FDA doesn’t want to use untested drugs on patients. How is that an unqualified Bad Thing?

    1. John Schilling

      Nobody wants to use untested drugs on patients, but how do you ever test drugs without, at some point, giving untested drugs to patients?

      OK, “tested” is a continuum, where you do what little testing you can in a laboratory and then give these minimally-tested drugs to literal guinea pigs and then to dogs and then you give the animal-tested drugs to healthy adult humans to see if it actively poisons them and only in the final stage test it on sick people. But wherever you draw the line for “now we start testing”, you are by definition doing it with something untested.

      The FDA is notoriously averse to this, and there how-to-test-drugs gearshift has only one setting – the one calibrated to produce a vaguely appropriate expected risk:reward posture when the promised reward is a marginally improved morning-sickness treatment to be used by pregnant women. Now that we’re looking for a cure or vaccine for a deadly plague for which there is no presently effective treatment, people are suggesting that maybe we should shift into a higher gear even though there would be some increased risk, and the FDA’s response is the same instinctive DO NOT WANT! that’s been their institutional default since 1960.

    2. Andrew Clough

      They essentially banned the huge number of certified labs in the US from developing their own Coronavirus tests while the CDC took their sweet time creating a gold plated test which ended up not working. At the start they were doing things like insisting private labs check that their tests worked on the original SARS too when the CDC wasn’t willing to hand out samples of SARS for good reason. We could probably have been ramping up mass testing at the start of February if we’d started with the relatively simple protocol that the WHO endorsed instead of not starting a real ramp up until the beginning of March.

  33. bernie638

    I really think that the lockdowns/shelter in place things we’ve been doing will turn out to have been a very bad idea. I understand the intent, but the actual implementation necessary to achieve the goal is unrealistic and always has been. Yes, China did it (successfully? (in Hubei?)), but there aren’t very many places like China in the world (thankfully).

    First, in the USA, this is all at the state level (which is better than fed), but why we would think that either the state or federal government would be able to come up with a good way to do this on short notice with a lot of other things going on.

    The talk of “all the smart people agree” on hammer and dance echoes what Admiral Rickover said in Paper Reactors, Real Reactors :(my parody)

    A paper lockdown almost always has the following basic characteristics: (1) It is simple. (2) It is far reaching. (3) It is cheap (4) It is enforced. (5) It can be implemented very quickly. (6) It is very flexible in purpose. (7) Very little development is required (8) The lockdown is in the study phase. It is not being done now.

    On the other hand, a practical lockdown can be distinguished by the following characteristics: (1) It is being done now. (2) It is porous. (3) It is requiring an immense amount of development on apparently trivial items. enforcement, in particular, is a problem. (4) It is very expensive. (5) It takes a long time to implement because of the development problems. (6) It is ineffective. (7) It is heavy-handed. (8) It is complicated.

    Eliminate any gatherings of greater than X? Is a bus a gathering >10 people, is a subway train a gathering above 50 people? Is a mass transit station a gathering of > 500 people? Please don’t answer, all 50 off the state governments are doing that.

    The lockdown/shelter in place, despite the harsh terminology, is (at least in my state) very limited. Seems like there are an awful lot of “essential” jobs. These aren’t well defined terms that everyone understands and agrees what things are “essential”. I am blessed to be working for a very large corporation whose CEO is likely on a first name basis with the governor. Turns out, after calling to get clarification, a very large (~9,000 person) construction project is “essential”. Other smaller businesses don’t get that answer quickly, and, somewhere there are different answers for nearly identical businesses. I imagine that a hobby store somewhere in the state askes and is told that, of course you’re essential since people have to have something to keep them occupied while their stuck in the apartment, while a different hobby store has been told that they need to shut down immediately since hobbies aren’t essential.

    Right now, no one is looking, and, the people who make a living manufacturing emotional content in order to sell advertising [the media] is on board, flag waving and apple pie to save grandma. That isn’t going to last very long. Soon, the “investigative journalists” are going to find the places where the decisions just didn’t make sense. Why is the pool store allowed to stay open so the Richey’s can spend their lockdown time swimming, while the family owned since 1845 hobby store was forced out of business? Why was the giant corporation chain store ____ allowed to continue operating while the very similar ___ store was forced to close, and by the way, let us tell you how much stock of the big chain company the governor owns!!!!!

    Also, Idle hands are the devil’s workshop even in 2020. Right now, it’s fine, but not for long, there will be trouble…… soon.

    Closing colleges was a horrible idea, whomever came up with that one hasn’t spent enough time actually interacting with the young adults of that age group. OMG, can you believe those kids acted like this is an extended spring break come early? Yeah, duh, what did you really expect? I’m an old retired navy chief, and it’s unfair to some, but as a fairly accurate stereotype we used to say that the young adults in that age group were “young, dumb, and full of” [a vulgar rhyming word]. Apparently, that’s still true. They believe that they are ten-foot-tall and bulletproof (and that’s generally true also), but now they are finally going home to visit mom and dad (but still socialize, after all, dating is more important to (as a generalization) them) and stay with parent(s) until they can return to campus, ugh. Not good for social distancing, you’d much rather have them passing a (to them) mostly harmless virus between themselves instead of to their (more susceptible) parents.

    Elementary schools closing was also a bad idea, if you don’t think that teachers can enforce handwashing and temperature checks, you haven’t been to a school recently. They have very strict enforcement of stand silently in line and march to class or lunchroom type stuff. Yes, kids share every germ and virus, but parents of the little ones are used to this, and in this case where the little ones have few to no symptoms (but they do spread the virus around), it’s better to have them at school then going home to the parents, then having them stuck at home either keeping a working parent at home, or (they are possibly already carriers) being watched by grandparents or older nanny’s (who are still going to invite the kids friends over [they will]). Even when the youngerish parent stays home to care for them, there is at least a possibility of convincing the parents to avoid touching surfaces then face, or maintaining distance, that really doesn’t work with kids under nine, hardly ever, they touch everything! If you have to take them with you to the grocery store, ugh, if there is any virus there, the kid will pick it up and bring it home.

    A short (three weeks at most) porous lockdown can be maintained, but after that (in countries without an authoritarian government and a state-run media) it’s going to go downhill and the rate of badness will accelerate exponentially.

    If the plan for success involves a serious lockdown for a period of greater than a month, and/or multiple periods for a total of that long, my prediction is that it will end badly (i.e. rampant non-compliance followed by increased “enforcement” countered by civil unrest.

    I may very well be wrong, but what is the backup plan if I’m not?

    1. The Nybbler

      I may very well be wrong, but what is the backup plan if I’m not?

      I’ve never been in the military, but I have read way too much military SF, and I believe the appropriate prayer is “For what we are about to receive, Oh Lord, may we truly be thankful.” The hospitals are going to get hammered, and we’ll just have to weather it; build more beds when we can, institute triage when we can’t. I’m of the opinion that in the New York area, this is already inevitable; even if the lockdown worked, it had already spread too far.

    2. mtl1882

      Yeah, I pretty much agree with this assessment. Even if the haphazard shutdown strategy was the best idea, or at least the best idea given available information, it is unsustainable, and we don’t seem to have a back up plan or be using the time we have now very wisely.

    3. albatross11

      bernie:

      I think how much tolerance people have for the lockdowns depend on:

      a. How restrictive the lockdown is. If it’s “we’ll arrest you if you’re outside your house without a very good reason,” that’s going to be incredibly unpopular. If it’s “the health department has ordered all the bars and restaurants in the state to do carry-out orders only, and the city police will break up any big parties they become aware of,” that will be tolerated a lot longer.

      This means people doing the lockdowns need to be smart about them–don’t impose dumb restrictions to be seen to be doing something, or without thinking about them. Every state and city in the country has a health department with people on staff who can make some kind of reasonable suggestions here.

      b. The economic impact of the lockdown. One thing that’s tricky here is that a bunch of businesses (bars, restaurants, hotels, airlines, cruise ships, amusement parks, concert venues, etc.) are losing piles of money right now, and some of that is from the lockdown, but probably most of it is the situation. The last time I went to a restaurant, and the last time I went to a coffee shop (both several days before the lockdowns started in Maryland), both places were almost deserted. Even if there were no lockdown, a bunch of these places would go broke over the next few months, because lots of people don’t want to catch something that’s about as easy to catch as the flu, but it makes you sicker and might kill you and nobody has any immunity to it.

      I think the right way to deal with the economics of the lockdown is for health departments and scientists to work out protocols for reopening businesses that can reopen, while minimizing the danger of transmission.

      1. bernie638

        I can’t disagree with that. I’m not looking at this from the economics perspective. I just see a lot more downside with a lockdown that I don’t think “all the smart people” are thinking about.

        “Every state and city in the country has a health department with people on staff who can make some kind of reasonable suggestions here.”

        I don’t believe that, I really just don’t. What are all the different inputs to make the parts that go into making a medical device? I’m guessing that there are some specialty chemicals, and some specialty plastics. Are they smart enough to understand that these chemicals that we export are really a critical business? What is the Non-active filler ingredient in pills? Do they know how to make sure that they don’t accidentally shutdown that business. Heck, I’m not even sure some bulk producers know exactly which end products they are feeding. What about the company that mines, refines and sells titanium dioxide, is that a input to something that is then shipped somewhere else, then made into a part for ventilators? Do they even know to object when the state government health department person shows up with the shutdown notice.

        Also why would you do it if you aren’t going to enforce it? Just another speed limit that we all ignore? If it is enforced, it’s not going to be evenly or correctly. Without clear guidance, the worst of the enforcers are going to be doing some terrible things. The merly incompetent ones will just do regular bad.

        Quick story, Across from Seattle there is a ferry and the terminal doesn’t have a parking lot. There is an extra lane on the side (like a breakdown lane) that everyone lines up in, once the incoming ferry empties, the line moves through the ticket booth and straight on to the fairy. Seattle passed a shiny new seat belt law, and one enterprising officer decided to walk up to each of these parked cars and hand out tickets to everyone not wearing a seatbelt.

      2. Theodoric

        City police learn of large party, go to break it up, attendees mouth off. Do you really trust American police to de-escalate that and handle it without violence?

        1. The Nybbler

          The cops just use violence. Nobody who isn’t bleeding objects, because everyone’s a blackshirt under COVID-19.

          1. Theodoric

            Right now, sure, and in fact, people are meekly dispersing when the cops command it, so it hasn’t even come up. But will people really tolerate living like this for several months?

          2. The Nybbler

            A few people will stop tolerating it. The cops will beat the living crap out of them, on camera. They’ll be applauded by the general population, and the next few people will think twice. Lather, rinse, repeat each time it becomes too much.

          3. albatross11

            I bet the total incidence of police brutality/beatings/shootings is down by a huge number since the start of the lockdowns. Yes, there will be cops busting peoples’ heads for mouthing off, and yes, that’s bad, but it’s not very specific to the coronavirus, and fewer open bars / big parties means fewer collisions between drunken idiots and cops with a chip on their shoulders.

  34. Michael Crone

    The incidental economist estimated the cost per QALY here at $75,000 to $2.5 million. (HT: David Henderson who has his own review of why this estimate is too low) The main difference is the between that estimate and the one on the Reddit thread estimate of $30,000 is the numbers of QALY’s saved by social distancing.

    My (pitifully low epistemic confidence, so, please try to give me more info here) guess is that the Reddit thread’s estimate of 70% infection rate and the use of the Chinese death rates is way off due to asymptomatic individuals not being missed in the denominator of the Chinese death rate calculations. (Also, it would be good to adjust the QALY’s down for the dead being typically less healthy than average.)

    Any thoughts?

    1. Le Maistre Chat

      I’m predicting that if we “flatten the curve” at a peak of 6,000 deaths/day in April (based on 150,000 ventilators and a max time of 20 days on one before patient is released to a non-ICU bed – 20% – or the morgue – 80%), we could lose up to 1.25 million American lives to COVID in 2020 through Election Day alone and lose trillions in GDP from shuttering non-essential sectors of the economy.
      Both facts logically follow from the “shelter in place and 40-80% of you will be infected; take your turns so the hospitals aren’t overwhelmed!” statesmanship authorities like Gov. Cuomo are pronouncing. God only knows what the President will pronounce.

      1. soreff

        Both facts logically follow from the “shelter in place and 40-80% of you will be infected; take your turns so the hospitals aren’t overwhelmed!” statesmanship authorities like Gov. Cuomo are pronouncing.

        80% seems a bit high… I haven’t heard anyone claim an R0 of 5…
        If unmitigated R0 is 2ish, and (yeah its a simple model) we need 1-1/R0 infection to
        burn out the epidemic, so 50% infection rate, and 50% asymptomatic infection
        (Vo’ and Iceland data) with
        say 2% CMR for symptomatic – call it maybe 1.5 megadeaths in the usa, give or
        take a factor of 2?

        1. The Nybbler

          1 – 1/R0 is not the proportion of people infected. It’s the size of the immune population when the epidemic stops growing. The proportion of people infected is given by

          F = 1 – e^(-R0*F)

          which is about 86% for R0 of 2.3.

          But the model does not reflect reality. Seasonal flu strains have an R0 of around 1.3. This gives a herd immunity proportion of 23%, and an epidemic final size of 42%. Seasonal flu actually affects about 10% (a bit higher this year). Note that that’s all flu strains; there are at least 3 this year and you don’t get full cross-immunity from an infection. So these models vastly overestimate spread in a real population (as you would expect, realizing that the models are of a fully connected population graph)

  35. quixotic

    Chloroquine overdose couple took 1 tsp of chloroquine phosphate each, according to the original reporter at https://twitter.com/HeidiNBC/status/1242238700995710977 Chloroquine is a well known drug except that it has a relatively narrow margin of safety, http://www.maripoisoncenter.com/wp-content/uploads/2015/03/CTR-Chloroquine.pdf
    Wondering how much a teaspoon actually was, I measured out one gram of fishtank chloroquine phosphate with a cheap milligram scale, and it was a little more than 1/4 tsp, much less than 1/2 tsp, so let’s call it 1/3 tsp (yes, I should’ve measured the delta, but I spilled while pouring into the weighing paper, and decided to be done wasting the stuff.) The initial dose for acute malaria or COVID-19 is 1 gram. They took three times that. Also, considering that they didn’t bother trying to find out the dose, I think it’s likely that “tsp” was of the “honey bring me a teaspoon” variety; i.e. the one in the silverware drawer that isn’t a soup spoon, and is even larger than 1 tsp.

    Trump presented it irresponsibly to the gullible, but sadly enough, I think that honesty is better than the flip side, which is deceitful guidance like “Masks won’t help you, don’t wear them” with the unspoken “because you’re too stupid to wear them right, and we need them for medical professionals.”

    Regarding food safety: COVID-19 is a respiratory virus, and attacks via the mucous membranes. While in eating the food does pass the mucous membranes, it’s also mechanically scraped by food and washed with liberal amounts of saliva. After that it’s in your stomach, which is an even more hostile environment, and I had assumed that the virus is not viable there. Unfortunately, I have a big but.

    This study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687858/ indicates that the digestive tract is a viable route for infection. In fact diarrhea is associated with worse outcomes, so it’s scary. https://www.healio.com/gastroenterology/motility/news/online/%7Bbe83bd7b-e901-4f87-85d4-c1ae26ace2ac%7D/diarrhea-may-be-common-symptom-in-patients-with-covid-19

  36. georgeherold

    Temperature! reading all that I kept thinking, ‘It’s the temperature or climate’ that looks to be the common denominator. (Well except for Japan… there can be more than one ‘thing’.)
    George H.

  37. BBA

    In the immortal words of Mike Tyson, everybody’s got a plan, until they get punched in the mouth.

    (Yeah, yeah, Clausewitz said it earlier, but Tyson said it best.)

  38. wgmccallum

    The article “Flattening the Curve is a Deadly Delusion” has a glaring flaw which I don’t see has been corrected. The author assumes the area under the curves stays the same when you flatten it. That’s how he gets the ridiculous time scale of a flattened curve. Even conceding that a normal distribution is the wrong curve, he doesn’t make this error clear. The area under the curve is the total number of deaths. If you decrease the initial growth rate of the epidemic then you lower the peak of the curve (“flatten the curve”) and you also decrease the area under the curve (as the graphics he mocks make clear). Granted it is not likely you will lower the peak enough to avoid exceeding the capacity of the health care system; he’s right on that score. But he sets up a false opposition between “flatten the curve” and his own recommendations. The only way you can flatten the curve is by decreasing the slope if the initial part of the curve, and the way to do that is by all the measures being recommended: social distancing, cancelling meetings, lockdowns, etc. The more severe the measures the more you decrease the slope. “Flatten the curve” is not a deadly delusion; it leads to the same conclusions he recommends.

    1. The Nybbler

      This is true (and everyone else missed it at first, too), but it _still_ takes too long.

      What I don’t know is how large the effect is. In the simple model I can only get about a 20% reduction in final size with one extremely-effective period of distancing, but the simple model is no good anyway.

      1. Douglas Knight

        Nah, it’s 80% false. If you ever want to end social distancing, then you either need “the dance” or you need herd immunity, for which you need to infect 1-1/R0 proportion of the people. Bending the curve can make a difference to how many of the remaining 1/R0 people are infected, but that’s all.

        1. The Nybbler

          Bending the curve can make a difference to how many of the remaining 1/R0 people are infected, but that’s all.

          Right, in the simple SIR model, the epidemic final size can never be below 1-1/R0. But for an R0 of 2.3, that’s about 57%, whereas epidemic final size with no intervention is 86%. But both these numbers have little meaning in the real world, where epidemics burn out before even reaching 1-1/R0. The simple SIR model is far too simple.

          1. blumenko

            And why is that? I have never been able to figure that out, or seen a better model explain it.

          2. anonymousskimmer

            I assume this model assumes even distribution both of members of a population and of the number and kind of connections between individual members of the population?

          3. The Nybbler

            The simple SIR model essentially models a fully connected population graph. This makes the math easier but isn’t a good model of a human population above the level of an elementary school class (or perhaps a cruise ship).

          4. blumenko

            Ok, but how does that lead to the disease dying out early? Consider something like the flu. It will basically infect at least one person in each of those connected subgroups, so wouldn’t each sub epidemic run its course until herd immunity is reached in each one?

  39. divalent

    There might be some counter evidence about smoking and Covid-19 from hospitalization data in China.

    “This preliminary analysis, assuming that the reported data are accurate, does not support the argument that current smoking is a risk factor for hospitalization for COVID-19, and might even suggest a protective role.”

    https://www.qeios.com/read/article/550

  40. DNM

    If you were, just hypothetically, part of a wedding currently scheduled for early July and felt it was culturally very important to celebrate with 100+ people from across the U.S., when would you reschedule the celebration for knowing what you currently know? A hammer and dance type approach makes such things impossible to plan with any certainty. Would you give 90% confidence a 80 year old flying across the country in September 2021 (18 months in) would be approximately as normal as it was in January 2020?

    1. Itai Bar-Natan

      Don’t set a date. Wait until everything calms down and we have a better idea how your country will fare and only then set the date to a time when it is safe.

  41. salvorhardin

    Ross Douthat today linked healthweather.us as a source of hope. Basically it’s crowdsourced fever incidence data from a company that makes smart thermometers. It shows a large incidence uptick in early March in precisely the places you’d expect it would, and then varying degrees of downtick since social distancing started. The NY area is still above normal seasonal trend but getting back toward normal, Seattle has been below normal trend for a few days, and San Francisco plummeted when our social distancing order started and we are now waaaay below normal trend.

    I really want to believe this is a good sign, especially the part about San Francisco doing way better than other hotspots. But I also want to resist confirmation bias and not spread false hope. So: how much credence should we really give to this data source and why?

    1. anonymousskimmer

      Huge demographic bias in who has, and is using, these smart thermometers.

      The people mostly likely to have and use them are the people most able to shelter in place, least likely to use mass transit to commute, etc….

      1. salvorhardin

        Fair point. Seems like you could easily correct that, though, by distributing these things to temperature checkers at obvious checkpoints (mass transit stations, grocery store entrances) and then random sampling would give you a way better picture of actual incidence. No? If so, it would give me hope that that, coupled with mask wearing norms for those same crowded places, could be an effective surveillance and control tactic for the “Dance” portion of the Hammer-and-Dance strategy.

    2. broblawsky

      Also, are people going to be using their smart thermometers after they get infected? It seems like this trend might be explainable by the existing population of smart thermometer users getting saturated and no longer reporting results.

      1. HeelBearCub

        The signal they are tracking is novel high temp readings. They are trying to capture spread, not duration of infection.

        They also say that they account for more of their devices being purchased and used. This data is just an adoption of something they were already doing for flu prevalence.

    3. Douglas Knight

      The fail to detect New Orleans.

      They claim that Florida is much worse than it appears. Possible. They claim that Florida started getting better on March 19th. Do you believe that? I don’t.

      1. salvorhardin

        So to believe that, you have to believe that:

        — the level of social distancing in Florida has increased enough since March 19…
        — to have made a large difference to the frequency of all illnesses that cause fevers…
        — among the sample of the population that uses Kinsa thermometers.

        I can totally believe that narrow claim. That sample of the population, as anonymousskimmer points out, is way more online and more affluent than the general population, and they may have voluntarily increased their social distancing enough to stem the tide amongst themselves even if the general population has not. It may also be that the level of social distancing that they’ve done is plenty to have a large effect on the ordinary seasonal flu and other fever-causing illnesses, but not enough to get R0 <1 for COVID. This is reminding me of the Hong Kong data where they basically hammered their regular seasonal flu this year down to zero in the course of anti-COVID social distancing.

        ETA: I bet the Kinsa thermometer population skews a lot younger too. More spring breaker types, fewer retirees/snowbirds. Which could affect both the propensity to make a large percentage change in the amount of social distancing, and the magnitude of the effect you get from that change.

        1. albatross11

          An intersting thing about this virus is that it spread first among the wealthier/better educated types who were jetting around the world to ski vacations, cruises, academic conferences, business meetings, etc.

        2. Douglas Knight

          It’s not just what happened since March 19. You also have to take into account lag from infection to fever, which is probably more than 5 days. I don’t think that Florida was social distancing on March 14.

          I don’t understand who uses Kinsa. Early adopters are young, but are they as young as college students? Are spring breakers early adopters? Do spring breakers take medical devices with them?
          One suggestion is that women monitoring their menstrual cycle would be a valuable source of data because they use a thermometer without selection for illness. But that doesn’t sound like college students to me.

          They say that they have 2-3x as many thermometer readings than last year, suggesting that their users are paying attention to the pandemic. But I don’t think it’s very important whether the user does social distancing, compared to whether the community does. In the limit of quarantine, of course it matters, but I don’t think that’s relevant.

  42. tossrock

    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 ???

    I think a possibly relevant thing here would be sharing knowledge about postural drainage. It’s a low-tech way to combat pneumonia by using gravity to drain fluid out of the lungs. Also, it’s extremely high leverage, because it’s a purely informational product and thus infinitely replicable.

    So, if you want to help, maybe get to work translating these diagrams into common developing-world languages, and sharing them to the appropriate networks?

  43. TheAncientGeekAKA1Z

    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.

    1. anonymousskimmer

      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.

    2. albatross11

      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.

    3. albatross11

      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.

      1. DavidFriedman

        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.

    4. CatCube

      What were the things being done from Feb 25th to Mar 15th that you believe were inessential?

    5. keaswaran

      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.

  44. albatross11

    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.)

  45. Eigengrau

    It seems the real danger in pushing hydroxychloroquine as a potential miracle cure is not so much that one or two random idiots will die drinking fish tank cleaner, but that there will be mass hoarding of the drug at the expense of those who actually need it.

    1. broblawsky

      And people who use it prophylactically assuming that it makes them immune to COVID-19 and spreading the virus further.

  46. TimG

    As someone who lives and works in NYC, I’m trying to be optimistic. Here is my optimistic model. Feel free to bring me back down to earth…

    Assume that it takes *around* the same amount of time to die from covid as it does to recover. In that case, you can estimate the amount of people who have recovered by multiplying the dead by the inverse of the IFR. My optimistic IFR will be .1%.

    In NYC we’ve had 400 deaths. With an IFR of .1%, that means 400k recoveries. 400k is about 5% of the NYC population. So 5% of NYC has already *recovered* from Covid.

    If we figure that it takes 14 days to get through the process (random guess), it also means that 5% of NYC was *infected* as of 2 weeks ago. Since testing has shown that infections have continued to grow quickly, a random ballpark guess is that around 20% of NYC is (or has already been) infected as of *now*.

    In this optimistic scenario, I’d say NYC would be on the doorstep of “herd immunity” like, within the next couple of weeks.

    If I was smart I’d create a spreadsheet with some predictions of these numbers for different IFRs to see how it matches the real data going forward. But I’m probably too lazy 🙂

    1. HeelBearCub

      My optimistic IFR will be .1%.

      Other than working backwards to your preferred conclusion, what’s your justification for this fatality rate?

      1. TimG

        Other than working backwards to your preferred conclusion, what’s your justification for this fatality rate?

        I don’t think it’s hard to argue that, particularly how testing is done (usually only on those that are really sick) that the IFR is significantly less than CFR. The best estimates I’ve seen of CFR seem to float around 1%. So, “significantly less than 1%,” I’d argue is less than say 0.25%. Optimistically, 0.1%.

        Part of the reason I justify my optimism is that Iceland — unlike most other places — has done much more wide screening. They’ve had very few deaths. This article says:

        Current data from Iceland suggests the IFR is somewhere between 0.05% and 0.14%.

        I realize that the reality could be way worse. But I’m hopeful that it isn’t 🙂

    2. broblawsky

      Edited: I was being unnecessarily pessimistic. We’re well beyond the point where doomsaying is useful, at least in NYC.

  47. StataTheLeft

    On the 22 March episode of This Week in Virology, Daniel Griffin, an MD/PhD running infectious disease for an organisation treating lots of COVID-19i patients in NY, says that lots of cases have had diarrhea or other GI symptoms including some for whom that’s their main symptom when they arrive at a hospital. http://www.microbe.tv/twiv/twiv-593/

    If that’s right, it seems to make it more likely that you could get sick from takeout.

    In a more recent episode, a coronavirologist explains that stomach acid does not kill coronaviruses.

  48. bernie638

    Mystery of Japan and the west coast:

    Totally spitballing here, I’m a medical ignoramus.

    Someone, I think it was Trevor Bedford on twitter a while ago (but I’m not good with twitter either), liked the incoming cases from China to sparks/embers thrown off from a campfire. He thought that there were a lot more infected people came in than we realized. Some of them infected very few people, and then the virus died out. Others infected a bunch of people, but not enough to produce a signal above the noise from all the other flu/cold stuff, and eventually died off. Eventually a case caught and started the forest fire.

    Could this be why the west coast areas with tighter ties to china seem to be better off right now? If this is more infectious than currently assumed, but with a small range, then the west coast had a bunch of small “fires” that have already burned out, clearing some of the underbrush. Not enough for herd immunity, but enough to slow the spread (the virus has to travel further before encountering a person without immunity).

    It kind of makes sense to me that people don’t behave like random dots intermingling. A lot of people have a few close friends/family who all hang out together. If everyone in the group gets the flu/cold/seasonal allergies at or near the same time, then go about their normal life never realizing they had Covid-19, but are now unavailable for future spread. Same thing with the normal infections that move through an office, or a school, some people went to the hospital, but no one was looking for this (no travel history), so it was coded as just pneumonia, or whatever. Eventually, once it hit the nursing home, and the flu study started testing for Covid, now they found more cases, but it had already infected some portion of the young resilient people (who don’t spend a lot of time mingling with the older crowd) hindering (but not eliminating) it’s ability for it to spread.

    1. Radu Floricica

      As far as Coronavirus is concerned, we’re an old forest ready for a big fire. No immunity to it. A fire big enough to clear the underbrush would have a pretty big chance to light up the forest.

      Anyways, we can’t confirm on infirm any of this kind of hypotheses until we do at least some antibody testing, and I haven’t heard of anybody doing it yet.

      1. bernie638

        Right, I just thought it was interesting.
        After all, when I think about it, a lot of kids get sick from passing germs around at school, at one point late last year the first grade class had a third of the kids out sick at the same time for two weeks (kind of rotating, one would come back and a different one would be out). They didn’t give it to the second grade or kindergarten, so when they were all healthy, it was gone.
        If a 2nd grader were to pick up the same bug outside of the school, it would spread through that class, with a possibility of getting it to one of the other grades. If, say one of them has a sibling in 6th grade who gets it, and also passes it to the art teacher, it would take off through the entire school, except first grade.
        However, if they just kept it in the second grade, they would work through it and it would be gone again.
        It seems at least possible that could happen a number of places with the covid, lessening the speed that it could spread when it does take off.

  49. morris39

    Per capita cases/deaths in Australia, Canada and S.Korea continue to be much lower than other western countries e.g. death rate 5 times higher in USA. The relative rates have been fairly steady over last 2 weeks. Testing rate in all 3 countries is high. Nobody notices.

  50. Maximoose

    I wouldn’t trust the Russia article too much. It relies too much on anonymous sources and innuendo but is surprisingly light on evidence. It wouldn’t be too difficult to film an overcrowded respiratory ward, would it? Yet instead the authors chose to rely on Prof. Solovey who is famous for predicting all ten of Russia’s past zero collapses in the past 15 years or so. (See a short selection of his predictions here: https://twitter.com/27khv/status/1240063082023604226) The article was moreover published 10 days ago; if there were indeed a massive cover-up (in the Twitter thread, Solovey was quoted as claiming 1600 deaths due to COVID on 03/17), mortality would probably have expoded by now, with not a chance of hushing things up. What we hear instead is… crickets. To be sure, things have become worse even judging by official statistics, but I’m still to see one piece of evidence that they are anywhere near the apocalyptic claims by Solovey et al.

    1. akarlin

      This is the correct – I deconstructed this conspiracy theory at “Western Journalists Really Want There to be a Huge Corona Epidemic in Russia” (Google search).

      Unfortunately, this blog has started eating all my comments as spam, so can’t link it directly.

  51. akarlin

    Iran – FWIW, the shrine lickers were arrested, and were facing charges that could see them getting sentenced to 75 lashes and/or imprisoned last time I checked on the story.

    Ironically, actual theocracies may have better prospects dealing with fanatics than countries with strong, politically influential religious constituencies.

  52. DaveK

    Haven’t read all the comments, but as far as the poorer countries.

    1. Keep in mind if we didn’t all know about the coronavirus, at this point it could still look like a really bad flue season.

    In poorer countries, particular in slums where disease rates and other forms of death or high, it may not be making a noticeable impact yet.

    2. Local governors of regions would be very wary of popularizing the knowledge of a corona pandemic as it could have severe economic consequences from shunning.

    3. In poorer countries there is much worse infrastucture, so there is less travel and many more people living in places where they come into contact with fewer people from outside their own region.

    4. Hygiene hypothesis. It’s clear that a lot of the fatalities and organ damage are coming from cytokine storms. If the hygiene hypothesis is correct, it would stand to reason that fewer people who got sick would have those complications.

  53. e.samedi

    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.

    1. The Nybbler

      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.

  54. Adam

    While you’re raging at Triplebyte, consider that a certain government agency issued an order to its contractors forbidding all work from home for anyone charging a contract with them earlier this week. Luckily for them, the relationship with many contractors is classified, so I can’t name and shame. We applied enough pressure to get them to reverse this ridiculous order after three days, but in the interim it sure came across as the government deliberately trying to kill people for no obvious reason. Given we have implemented shifts with an hour long gap between, effectively forbidding cross-shift real-time communication would have absolutely destroyed productivity, so they would have seen no benefit from doing this. It’s lose/lose all the way around, but they did it anyway. I’m guessing we’ll never get an explanation.

    Regarding New York, I have no idea how to measure this without being able to just track people down to the foot-level ground sample distance, but anecdotally from having spent plenty of time in Los Angeles, San Francisco, Seattle, and New York, it seems obvious that by the only relevant metric of ‘how many people daily come within less than six feet distance of you,’ New York is a lot denser than any other American city. The obvious New Orleans culprit is people spread it during Mardi Gras.

    Some of this is pure luck by timing. Imagine this happens four days later and South by Southwest isn’t canceled. Then Austin probably looks a lot like New Orleans right now. Most of the country could be looking a lot worse if we miss this by just a day or two and St. Patrick’s Day hadn’t been effectively shut down nationally.

  55. zima

    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.

  56. Autolykos

    @Bangladesh: It doesn’t happen often that Atheists can call upon Darwin to smite their enemies, but I guess this one qualifies…

  57. Jakub Łopuszański

    What would be the best counter argument to hypothesis presented by Wolfgang Wodarg, that the “epidemic” can be explained away as reclassification of ill people from “respiratory issues of unknown source” to “COVID-19” due to better testing?
    I thought that such hypothesis would predict that number of deaths remains constant over time, which seems to contradict observed overflowing of Italy’s crematoriums and health system. However one could object that deaths increase due to overflowing health system which is caused by hysteria and ad hoc reorganization of health care.
    Is there some clear cut proof, that we really have a new epidemic as opposed to spread of better tests?
    I’m worried, that “children being immune”, “young African nations being resistant” and “well prepared to handle a lot of eldery people Japan” are all consistent with the epidemic being just an artifact of giving new label to already existing problem.

    1. roflc0ptic

      When considering that hypothesis, I find compelling that:

      1. Many labs have independently verified the existence of a novel coronavirus
      2. Labs have developed multiple different tests for that virus
      3. Those tests have been deployed and determined that this novel coronavirus is spreading rapidly
      4. People with this novel coronavirus often get pneumonia and occasionally die
      5. Hospitals repeatedly claim that they don’t have enough ventilators to treat the rising number of patients with this “novel coronavirus”

      If there was just a baseline level of respiratory illness that is being reclassified, there would be no looming ventilator shortage, or an extant ventilator shortage in Italy, even if there was “chaos” in the medical system. You could assert that there *isn’t* actually a looming ventilator shortage, and that the ER docs and hospital admins and epidemiologists are just… hysterical and confused, I guess.

      Wodard’s theory as rendered here has a lot to explain. For starts: why are covid 19 diagnoses so correlated with extreme illness? Why are so many ER docs treating COVID-19 outbreaks lying/factually misinformed about the situation in their own hospitals? What is the proposed mechanism for this reclassification of respiratory illness – mass hysteria? Some kind of conspiracy to move us towards authoritarian regimes?

      It feels… very flimsy.

      1. Jakub Łopuszański

        I don’t link to his youtube video, because I’m not sure I should give him free publicity, but you can google it easily to hear from the first hand.

        I think that the most coherent version of the theory I can imagine is that respiratory problems are caused by a family of virsuses which have a mix of strains changing over time, where one mutation grows at the expense of others keeping the total count of infected constant. You could imagine that “elderly people” are the environment niche with fixed capacity, and viruses compete to claim it, and each particular strain such as nCOV-2, if successful, will initially be growing and then declining within it. You don’t even have to invoke “grows exponentially” here, because “exponential” number of observed cases can be a function of exponentially growing number of tests – observe that there are several factors which cause the number of tests to grow: production of tests increases, number of countries doing them and labs prepared to do them increases, and perhaps importantly, tests are performed on people from social neighborhood of previously tested which “by definition” will look like exponential growth.

        His proposed mechanism for why this happened is simple to verify: he claims that Wuhan is a city in which there is a lab which was the first to develop the test for this particular strain of virus, and they’ve started the testing there, and then shared the technology with others. No evil intentions implied – just a new development of new test and wish to help others.

        Now, I am not claiming this all is true. I just want to know how can I tell it is false?
        Looking at your list:
        1. is compatible with his theory
        2. is also compatible, perhaps even contributes to the “growth” of cases
        3. that is also compatible with the theory, unless we can prove that this observed growth is not cannibalizing other strains/other cases. Also he doesn’t necessarily claim that the nCOV-2 is old – it might be new or old. Being new actually helps his theory to explain the growth. But being old would also be somewhat compatible if we could attribute the growth to more testing
        4. That’s actually the premise of his theory: that elderly people die from respiratory problems such as pneumonia etc. but one often doesn’t know what was the root cause of catching pneumonia. And once you have a test for nCOV-2 you can see that the person has both pneumonia and COV-19, and then how do you classify it if they die?

        Which leaves us with 5 as really strong argument against his theory. Until one notices that closing some hospitals for patients other than ill for COV-19, moving everyone else out, moving doctors from one place to other, etc. can cause a lot of chaos and short term shortages. Anyway, do we have a concrete data on this?

    2. albatross11

      The phenomenon of bunch of hospitals in China, Italy, Spain, and the US all filling up with people dying of pneumonia at the same time, creating an unprecedented, hellish crisis in these hospitals, is inconsistent with this just being “we got better tests” or “we started paying more attention to pneumonia.” If we previously had the same number of people with life-threatening pneumonia but they weren’t getting any medical treatment, we would have noticed all the people being found dead in their homes.

      1. Jakub Łopuszański

        Yes, that would be inconsistent.
        But how can I convince myself that there really is unprecedented number of people dying of pneumonia in Italy?

        https://www.worldometers.info/coronavirus/country/italy shows that in last month (26Feb->26Mar) there were ~10k deaths in whole Italy attributed to COV-19.
        And https://www.macrotrends.net/countries/ITA/italy/death-rate shows that 1% of people in Italy died in 2019, which given that Italy has 60M people means that in 2019 50k of people died monthly.
        The https://www.statista.com/statistics/804762/main-causes-of-death-in-italy/ gives some data for 2014 showing that 10k-50k of all 600k yearly deaths can be attributed to “respiratory problems” (I don’t know which to clasify as “respiratory problems” hence the spread) so, one should expect that in the monthly 50k death toll betwen 800 to 4000 can be attributed to “respiratory problems”.
        This seems to be incompatible hypothesis that COV-19 deaths can be attributed to “respiratory problems”, because that would require 10k “respiratory problems” per month, or 120k per year, which would be twice as large as the leading cause in the latest chart, so wrong order of magnitude.

        Is this a correct proof?

        1. Anatoly

          A better observation to make is that the coronavirus deaths are highly concentrated in particular provinces/counties of Italy, making the gap between current coronavirus deaths and typical-or-even-extreme respiratory deaths *in those places* huge. There aren’t official stats for all-mortality for March in Italy yet (I don’t believe any Western country does all-mortality realtime reporting), but read this for some instructive data. Here’s some more data for Bergamo.

          1. nupi

            euromomo.eu shows substantially elevated mortality for week 12 in Italy. Only European country to do so, so far.

            Wodarg really should not get publicity.

    1. Three Year Lurker

      How do studies such as this adjust for people that had a wildly different household example growing up than what they earn as an adult taking the test? Or even a wildly different income from just a few years ago.

      For example, someone who grew up in a family on food stamps and free school lunch, years of unemployment, then transitions to high paid tech job in mid-life.

      I feel like there is some small segment for whom the “current household income” question puts them in the wrong bucket.

      Anyway, my result is that I have higher confidence that I have no melody or tuning perception better than chance.

      “Which of these two clips was singing out of tune?”
      “Uh, are they different?”
      “Which of these three clips in different keys is the wrong note?”
      “I swear you just played the same clip three times.”

      Scores: Overall: 101, Melodic Discrimination: 105, Beat Alignment: 100, Mistuning Perception: 97
      The scores don’t match my perception, so I wonder what score random chance earns on the test.

      1. noyann

        I had almost the same mIQ. Also problems with “what matching bucket shall I take?”

        I wonder what score random chance earns on the test.

        Repeat & roll dice.

      2. Radu Floricica

        It’s just a name. It doesn’t automatically inherit everything from the classical IQ. In particular, I’m pretty sure it can be improved with work. There are probably limits and some of it is probably genetic, but still. And I don’t think it correlates with household income, except possibly an inverse correlation. My family was perfectly adequate and intellectual, but with no interest in music whatsoever. Not surprisingly, I got an score of 92.

    2. ManyCookies

      I was 85 beat 95 melody 95 tone. I shall now make excuses.

      Was the beep beat super loud relative to the music, I found it difficult to follow along.

      I felt I could distinguish between b2b melodies pretty well, but I got tripped up keeping the logic straight (?) if 1+2 differed. “Okay 1+2 differed, so if 2+3 differ that mea- whoa 3 is starting, uhh shit was 2 low-high-low or low-way high-low and i missed 3”. I think I actually got all the ones where 1+2 were the same.

      I could tell a difference between tone clips and was kinda going on which one sounded better, I dunno if that’s the best strategy.

    3. Lambert

      Western common-practice and modern music ‘IQ’.
      General blah blah high modernism legibility streetlight effect it’s easier to test someone’s sense of rhythm in the context of a quantised sample than a highly rubato romantic piece.
      Possibly a viable highly-preliminary work to get a feel for what a standardised test for musical ability might eventually look like. Also a fun buzfeed-level quiz.

    4. Hefficurious

      126/116/119. Oddly the category I thought I’d do worst at turned out to be the best score.

    5. Eri

      I think of myself having an average ear, and I didn’t show any interested in music until late teens. 121 mistuning/120 discrimination/115 beat, averaging 118 total.
      Possibly I would perform better on the beat part but got tired eventually.

  58. panoptical

    “the Johns Hopkins Center on Health Security does great work”

    Do they? I only know of them from their Global Health Security Index, which rated the US as the most-prepared country in the world to handle a pandemic, by far (https://www.ghsindex.org/). Given how poorly that rating comports with the reality that we are now observing, in my mind they’ve lost whatever credibility they might have had through association with the Johns Hopkins name.

  59. LesHapablap

    If Italy reaches herd immunity, can we use it to determine the fatality rate?
    data from here
    Please let me know if this is valid or if there’s a mistake in here somewhere.

    Let’s assume there are two possibilities: an IFR or either .9% or .2%. And we need to figure out which it is.
    Assumption: 17 days on average from infection to death. Italy lockdown occurred on March 10th.

    If Italy’s lockdown was successful, we should see a sharp drop in deaths from March 27 onward. We will be able to tell how successful the lockdown was over the next week using the death numbers and be able to estimate a new doubling rate for infections. Once we have that information, we can monitor when deaths peak over the next few months to find when they reach herd immunity. From there we can estimate the IFR as below:

    Italy had 9184 deaths on March 27. If Italy’s IFR is .2%, then there were 5MM infections by March 10th. If the lockdown reduced doubling time to 5.5 days, that means 40MM infections today (March 27). In reality infections would have slowed down as the effects of herd immunity would have slowed things down. Either way we should see a dramatic decrease in deaths over the period April 10 to April 15.

    If Italy’s IFR is .9%, then there were 1MM infections by March 10th. Assuming the same doubling time of 5.5 days, that means 8MM infected today (and 70,000 dead by April 14), and reaching herd immunity for infections by April 10-15, and so seeing a drop off in deaths starting at the end of April.

    1. tg56

      If Italy’s lockdown was successful, we should see a sharp drop in deaths from March 27 onward. We will be able to tell how successful the lockdown was over the next week using the death numbers and be able to estimate a new doubling rate for infections. Once we have that information, we can monitor when deaths peak over the next few months to find when they reach herd immunity.

      I don’t think this quite works. Everyone talks about doubling times in terms of total cases (or maybe if their more rigorous active cases, though I haven’t seen much of that, e.g. talking about doubling times for South Korea or China currently) when it really should relative to current cases. There’s also likely a particular window of time when people are particularly infectious, and that probably ends well before the test completely free of the virus. As such, if the lockdown is effective isn’t that going to look like a steadily increasing doubling time going forward until it approaches the true with-lockdown doubling rate (which if the lockdown is effective enough to get R0 less then 1 is inifinte).

  60. deemer

    Quick comment on chloroquine dosage for fish tanks vs hoomans:

    I believe fish tank treatment typically sold as 10g (neat) powder packs => spoonful (tsp?) = 5g?

    Human dosage ~200mcg 2/day

    They ingested then, if I can count, 25,000 doses.

    Very Darwinian.

    1. The Nybbler

      Human dosage for malaria is here. Looks like 1.5g for the first day, then 500mg (not mcg) for two days after. Preventative dose is 500mg once per week. So they weren’t off by orders of magnitude, but they were off by lot.

      1. anonymousskimmer

        Fish tank fluid volume is presumably significantly greater than human fluid volume (for many fish tanks, at least).

        The fish tank forum I first read about this on mentioned adsorption to rocks and destruction in UV filters, which would required greater dosages as well.

  61. Chris Phoenix

    Seems like it would be very simple to do a study of A1C (measures a direct correlate of average blood sugar over the last N weeks) vs. COVID outcome, and get a potentially very important piece of information. How come no one has done that yet? Or how come I can’t find it easily online?

  62. Chalid

    We often hear that it will be ~18 months until a vaccine. But there are important diseases we have no vaccine for, e.g. malaria or HIV. And we have no vaccines for other coronaviruses (though my understanding that this is because other coronavirus diseases weren’t worth developing vaccines for). Is there some reason that we should be confident that success will come within an 18 month time frame, or indeed ever?

    I am aware that HIV has special features that make vaccine development difficult, which covid-19 does not share. But is virology/immunology well-understood enough that we can be confident that covid-19 won’t prove to be unexpectedly difficult in other ways?

    1. tg56

      I don’t know about ‘confident’, but we do have vaccines against certain animal coronavirus strains (e.g. Nobivac for dogs) and people do clear the infection, so it seems more promising then e.g. something like HIV.

      1. Douglas Knight

        That people clear the infection is, pretty much, a prerequisite for a vaccine. But, really, you’d like that people who clear the infection have long immunity, and I think that fails with coronaviruses. Different versions of Nobivac claim 1 to 3 years of immunity. That doesn’t sound long enough to me (though if we could do a dog year translation, that would be great). But it is longer than I’d expect. I’d expect 1-3 years from infection and less from vaccine.

    2. Bugmaster

      I would be surprised if an effective vaccine was developed in 18 months; it’s certainly technically feasible, but not for a country whose healthcare system is already in shambles.

      1. The Nybbler

        You mean the US? What does our crazy healthcare-payment system have to do with our pharmaceutical research system? They’re quite different entities. And of course US companies aren’t the only one’s working on vaccines; there’s at least one in Germany and one in Canada, off the top of my head. Probably a bunch in China though I’d take my chances with the disease before taking one of them.

  63. blumenko

    Sure, if I had $16Trillion, I could have made a lot of money at the bottom of the market. But I didn’t, no one did, so the government had to step in. If you are arguing they should have asked for more money fine, but the bailout benefited the government as well as those bailed out, so it definitely should have happened.

  64. PorterBridges

    Scott’s “Hall of Shame” omits China? They are the worst culprit in this.

    China got a clear warning with SARS, and still reopened the wildlife wet markets anyway. They’ve corrupted the WHO. They suppressed early warning signs. They’ve been engaging in all kinds of dirty propaganda on this. Their reported statistics and claims of zero new virus cases are surely bogus.

    Scott, implies that the label “Chinese virus” is simple xenophobia?!? That’s what the Chinese propaganda is saying. Wow!

    1. Machine Interface

      The vast majority of the media have been calling it “coronavirus” or “novel coronavirus” from the start. People who insist on calling it “chinese virus” have an axe to grind — as proven by how exageratedly offended they react when called out about it.

      1. tg56

        I tend to agree with respect to calling it Chinese virus or the like. That doesn’t seem to have been common till recently and definitely feels like a deflection tactic. I wouldn’t put the many naming variations involving Wuhan in the same category though (not that you did). Those were (and still are) pretty widely used as well and I don’t think carry the same connotations.

      2. EchoChaos

        People who insist on calling it “chinese virus” have an axe to grind

        Yes, but it’s an intentional axe because the Chinese are spreading the conspiracy theory that it was created by the US as a bioweapon.

        1. beleester

          The “Chinese virus” thing was spreading long before China started blaming the US for it.

      3. PorterBridges

        Ax to Grind?!?

        China threatening to have the USA “plunged into the mighty sea of coronavirus”; that’s an Ax to Grind. China is deliberately disrupting US medical supply chains to inflict damage:
        https://twitter.com/YanzhongHuang/status/1235300037875335170?s=20

        Does this tweet from WHO sound like independent health experts and watch dogs? Or like people who are deliberately parroting Chinese propaganda
        https://twitter.com/WHO/status/1217043229427761152
        https://twitter.com/DrTedros/status/1240877150468743168

        Do you think China really has eradicated the virus and has no new cases? And this is just completely honest reporting by the Chinese Government? Or is that just lies? Did they expel foreign media reporters maybe because they are hiding something?

        Lastly, China caused this virus. Their wildlife wet markets caused SARS, we had a clear danger sign, and China chose to open them back up anyway.

        1. Machine Interface

          Your reflexive, frantic rebuttal of a claim I haven’t made only consolidates the claim I did make.

      4. Adrian

        People who insist on calling it “chinese virus” have an axe to grind — as proven by how exageratedly offended they react when called out about it.

        Then, further below:

        Your reflexive, frantic rebuttal of a claim I haven’t made only consolidates the claim I did make.

        Please don’t do that here.

        Besides, please at least try to refute PorterBridges’ evidence before you insinuate that they have “an axe to grind”.

        1. Machine Interface

          No, I’m sorry but there’s a difference between aknowledging the bad things China does and engaging in propaganda tactics and inflammatory re-labellisation.

          The people who decided to talk about a “chinese virus” aren’t helping adress any of the things they claim to be concerned about — they’re just lighting up a boo light. One year ago these same people didn’t care about China at all, they were too busy hating on Iran. And a year from now they’ll have forgotten everything about China and will have moved on to the next nemesis du jour.

          This has nothing to do with sensible foreign policy or rational awareness of hostile actions against the west. This is about having An Evil Country to snarl at, while accusing anyone who doesn’t join in the snarling of being naive and manipulated, and anyone who denounces the snarling for what it is of being hysterical and easily offended. This is the pre-Iraq war mind killing rhetorics all over again.

          1. DavidFriedman

            having An Evil Country to snarl at

            But note the distinction between that and racism. The U.S. has, at various points, snarled at England, Spain, Germany, Italy and Japan. Only one of those was racially different from us, and that was at a point at which we were allied with China.

          2. PorterBridges

            This has nothing to do with sensible foreign policy or rational awareness of hostile actions against the west. This is about having An Evil Country to snarl at

            You (Machine Interface) are blaming/shame or “snarling” at a US political faction for blaming/shame/snarling at China and Iran.

            My argument is we should blame and shame the worst actors with the worst behaviors. And that is absolutely part of a sensible foreign policy and global political strategy. The governments of China (and Iran) are those worst actors with the worst behavior. They are much worse than Trump and Trump supporters.

            You aren’t explicitly defending the Chinese Government or disputing the claims against them; but you are objecting to vilifying China and in turn vilifying the political right that is vilifying China.

            I’d like another good editorial criticizing China from a Chinese dissident, born in China, living in the US
            https://www.nationalreview.com/2020/03/china-is-pushing-a-zero-myth-on-covid-19-and-attacking-press-freedom

            I’m criticizing Scott Alexander too. He lists a “Hall of Shame” in this post related to the virus, and sure, while he doesn’t explicitly endorse the behavior of the Chinese government, I don’t think any his Hall of Shame members have been as badly behaved and as damaging as China.

          3. HeelBearCub

            But note the distinction between that and racism.

            Machine Interface doesn’t appear to have said anything about racism. Bringing that up is just another way to try and point at a shiny object instead of actually addressing the point being made.

          4. Guy in TN

            My argument is we should blame and shame the worst actors with the worst behaviors. And that is absolutely part of a sensible foreign policy and global political strategy.

            I wish more people were candid enough to admit that the “Chinese virus” label is about advancing their foreign policy goals.

            I mean, I kind of knew this all along, but for some reason people usually try to conceal this with trollish shell-arguments (“I’m just being normal, saying where it came from”, or “why are you so obsessed with being politically correct”, or my perennial favorite “you’re just opposed to it because of virtue signalling”)

            So now that it’s all out in the open, guess what? My opposition to the “Chinese virus” label is about advancing my foreign policy goals.

          5. Desrbwb

            Guy in TN, what are your foreign policy goals, and how are they served by naming/not-naming a virus?

          6. Guy in TN

            My foreign policy goals include peace and harmonious relations with China, treating them as a nation of equals.

            Any rhetoric that lays the ideological groundwork for more tariffs, business-bans, sanctions, or (god-save-us) warfare, runs contrary to this goal.

            Any rhetoric that implies a “moral high ground” for the US that rationalizes an ethical double-standard runs contrary to this goal.

            I’ve quietly suspected over the past few weeks that the “Chinese virus” rhetoric was just a semi-transparent attempt to foster anti-China sentiment, with the goal of advancing anti-China foreign policy. Now that PorterBridges has said this plainly, I can upgrade this from “my suspicion” to “their stated motivation” (for at least some segment of the population).

          7. Desrbwb

            Is that realistic though?

            Sorry if I sound antagonistic, but precious little of what I’ve seen of China’s foreign policy suggests that’s feasible. China (or rather, the CCP) has made great gains basically exploiting the naivety, greed and/or complacent blindness of the West. They don’t appear to want a place at the table as one of an international community of equals. They want dominion and hegemony.

            Yes, America has been the Hegemon in the West since WW2, and World Hegemon since the end of the Cold War. But given a choice between American and Chinese Hegemony for the world, I’ll take America every time (which is a good chunk of why Trump looks like such a disaster, his contempt for soft power and overtly isolationist and short term transactional approach to foreign policy are dangerously destabilising and undermine the ‘flawed but preferable to the alternative’ modern status quo). Frankly, as immoral as the US is, it does have a noteworthy moral high ground over China. Don’t get me wrong, I certainly don’t want to see a war with China, that would be bad. But obsequious supplication towards China and the uncritical acceptance of CCP propaganda is hardly good. A shift of power towards Beijing is a bad thing for anyone who claims to believe in Western ideals of freedom.

          8. Guy in TN

            They don’t appear to want a place at the table as one of an international community of equals. They want dominion and hegemony.

            I haven’t seen any evidence that China intends to have “dominion” over the United States or any other unambiguously sovereign nation. There is no comparison to the United States. Describing the choice as “dominion by the US” vs. “dominion by China” is, and apologies for the bluntness, absurd. You do realize that China has military bases in a whopping five other countries, right? According to this list, that’s on par with Italy. Do you want to stop Italy’s “domination” too?

            But obsequious supplication towards China and the uncritical acceptance of CCP propaganda is hardly good.

            “Accepting CCP propaganda?” Can we quickly retire the assumption that people who disagree with you must be tuning into CCTV every night for their daily updates? This is shit-smearing, utterly trash-tier argumentation.

          9. Guy in TN

            I mean, I don’t actually read Chinese propaganda, so I don’t know what they are saying about this.

            But it’s anything like: “People in the US who call it ‘Chinese Virus’ are just attempting to foster anti-China sentiment in order to advance their foreign policy”, it turns out that would be right on the money.

            Maybe I should listen to Chinese government more.

          10. PorterBridges

            I haven’t seen any evidence that China intends to have “dominion” over the United States or any other unambiguously sovereign nation.

            Taiwan.

            Secondly, the South Sea. China recently created artficial islands to claim dominion over the South Sea that has long been used by other nations.

            I’ve quietly suspected over the past few weeks that the “Chinese virus” rhetoric was just a semi-transparent attempt to foster anti-China sentiment, with the goal of advancing anti-China foreign policy. Now that PorterBridges has said this plainly, I can upgrade this from “my suspicion” to “their stated motivation” (for at least some segment of the population).

            Also read National Review, they are quite harshly critical of the Chinese Government. You could say they are fostering anti-China sentiment, however that’s an underhanded phrasing.

            I mean, I kind of knew this all along, but for some reason people usually try to conceal this with trollish shell-arguments (“I’m just being normal, saying where it came from”

            Trump has a second purpose with the phrase “Chinese virus” in baiting/trolling his political adversaries.

            I’m nobody, but I try to be as honest and clarifying as possible for these discussions, and I personally don’t troll.

          11. Guy in TN

            China conquers an island off its coast in the 1940s-> China seeks world domination and hegemony? Come on, now.

            Taiwan and uninhabited artificial islands do not qualify as “unambiguously sovereign nations”. If you want to present convincing evidence that China is seeking world domination, I’m going to need far, far more than that. I’m going to need big events on the “Germany invades Poland” or “US invades Iraq” scale. I’m going to need events that are evidence that I really have to choose between living under US rule or living under China.

            But such evidence won’t be presented, because such evidence does not exist. “China wants to dominate the world” is just a back-filled argument the NatSec crowd came up with in order to try to sell expansion of US power and influence to wary skeptics such as myself.

            I mean, in any other context, would you take the evidence of uninhabited artificial island disputes, and events that happened in the 1940s, as evidence of a country seeking world domination? It’s almost comical. The Chinese warships will be on the California coast any day now!

            The dichotomy of “domination by China vs. domination by US” is just a classic false choice, used to rhetorically manipulate people into supporting more aggressive and nationalistic foreign policy than they would otherwise. It’s unserious.

          12. Guy in TN

            I mean, have you learned nothing from the Iraq War? The US government doesn’t actually care whether it’s a war of aggression or defense. What matters is “the national interest” (i.e., expanding US power), and they will lie, manipulate, and say the attack is just-around-the-corner if we don’t preemptively strike now, if that’s what it takes to get what they want. They know its bullshit. They know the public needs to be made to think it’s defensive. This is the game, and it’s always been the game.

            If you listen to the NatSec guys, you’d think US has never fought a war of aggression in its life. Never mind all those bombers and tanks somehow entering other countries borders, while they seemingly never enter ours. Funny that.

            Every time someone from the US military or government says “you are in danger from a foreign power” the logic, rational response is to reply “any words you say should be given the same weight as random static noise”.

          13. DavidFriedman

            China conquers an island off its coast in the 1940s

            ???

            Taiwan had been Chinese for a long time. China ceded it to Japan in 1895 after losing the First Sino-Japanese War. China got it back at the end of WWII.

            The relevant issue is that Taiwan became an effectively independent state when the Chinese communists successfully conquered the mainland of China, leaving their Nationalist opponents in control of Taiwan. Both sides continued to claim to be the legitimate rulers of all of China. I believe the Nationalists eventually abandoned that claim, but the communists did not. So the current government of China is currently threatening to annex Taiwan, although they have not yet done so.

            Whether that counts as threatening an unambiguously sovereign nation is a question the Chinese government and the Taiwanese government disagree about, but it is a country that has functioned as sovereign for well over seventy years, with its independence pretty clearly supported by most of its population. I’m curious as to why Guy accepts the CCP view on the question. Why does the history make China wanting to annex Taiwan less objectionable than if China wanted to annex Vietnam — which it fought a war with not all that long ago — or Mongolia?

          14. Guy in TN

            I’m curious as to why Guy accepts the CCP view on the question.

            Taiwan is clearly a disputed territory. I’m not “taking China’s side” here. But rather, I’m saying that ongoing border disputes dating back to the 1940s are exactly not the type of scenario that would lead one to think a country was on a quest for world domination. And certainly neither does disputes over uninhabited artificial islands.

            Should China’s dispute with Taiwan be taken as evidence that we have to choose “domination by China vs. domination by US”? Does Ireland’s dispute with the UK show evidence of Irish “domination”? How about Spain vs. Catalonia? This is the absurdity we are asked to believe.

            There’s no mandate that the US has to participate, or even take a side, in any of this. There is no invisible hand forcing us to do war, tariffs, sanctions, or anything. We could just say: “okay, we still choose peace” and the warships would never be at our borders. China’s dispute with Taiwan is as much as a “threat” to the US as Spain’s dispute with Catalonia.

            The war-chants of “ITS US OR THEM” and “WITH US OR AGAINST” are just lies. With Pearl Harbor as the sole exception, every war for the US in the 20th and 21st centuries has been a “war of choice”.

          15. Evan Þ

            @DavidFriedman, the government sitting at Taipei hasn’t abandoned that claim; they still claim to be the government of the Republic of China with the same borders as in 1949. My guess is at least one faction of them (the Democratic Progressive Party) would like to change this, but the government sitting at Beijing has threatened military action if Taipei ever declares they aren’t part of China.

            (I view Beijing’s behavior toward Taipei as morally despicable, but I agree it’s a very poor sign of a quest toward world domination.)

          16. DavidFriedman

            Does Ireland’s dispute with the UK show evidence of Irish “domination”?

            As far as I know, the U.K. does not claim that the Republic of Ireland is British territory which it is entitled to annex.

            Suppose it did. Would you take that as evidence that Britain was a dangerously aggressive power?

            I’m not disagreeing with your basic point. I don’t think it is clear that China is a threat to the rest of the world, except insofar as it is becoming powerful enough so that it could be — also true of the U.S., of course. But I thought your description of the Taiwan issue was odd. It isn’t a dispute between China and Japan, the country China seized Taiwan (back) from.

          17. Guy in TN

            In terms of ideological motivations, I think there really is a difference between “restoring what we believe to be legally ours” and “conquering what we believe is someone else’s”. This is key to determine if what you are witnessing is a border-dispute, or an act of conquest.

            I know it can get fuzzy at the boundaries. And I know that one could theoretically cynically advance the rhetoric of “restoration” while conquering the entire world. But most military actions (from the perspective at a single country at least) can be readily categorized as one or the other.

            It is clear that China believes, and has believed for quite a long time, that it is the rightful sovereign over Taiwan. And in contrast, China does not believe itself to be the rightful sovereign of Japan, Russia, or the United States. I think this matters, in terms of how much the US (and others) should be concerned with China’s actions.

            For example, if you are trying to gauge whether the Irish Republic is planning on world domination, it really does matter whether they believe that they are “restoring” what was taken from them by a foreign power, or whether they think they are “annexing” what they believe is someone else’s. (And apologies for using as an example a subject I know next-to-nothing about. I’m sure I’m butchering the details of the Irish/UK dispute here). To collapse this distinction, would leave Luxembourg trembling at the thought of the IRA.

          18. Desrbwb

            Guy, Hegemony does not require military bases or annexation (though that can be a part of it). That’s the entire premise of ‘soft power’. China repeatedly flouts international norms and refuses to play by the same rules as everyone else, from artificially controlling their currency to the whole building islands and flouting UNCLOS thing. Not to mention the whole ‘annexation of Tibet’ thing. China, at no level, gives the impression of being an honest actor, so they should not be given the benefit of the doubt.

            China doesn’t need garrisons if they already control the infrastructure of potential rivals (look at the Huawei 5G controversy).

            ““Accepting CCP propaganda?” Can we quickly retire the assumption that people who disagree with you must be tuning into CCTV every night for their daily updates? This is shit-smearing, utterly trash-tier argumentation.”

            It also it a misrepresentation of my point. It’s not ‘anyone with a differing opinion works for the CCP’, it’s ‘China is provably a bad actor (as can be seen in their handling of the current COVID crisis, from their lies being reported as fact by the WHO to claiming the virus actually started in the US), don’t blithely accept their reassurances that everything is fine and China’s actually harmless’.

            I agree, btw, that peace and harmonious relations with China would be great. I just don’t believe it’s plausible for the time being, because China ultimately wants to change the status quo, to the detriment of the West, and the Western values I care about (imperfect as their implementation undeniably is). Again, America isn’t a saint by any means, but that doesn’t mean China isn’t worse.

          19. The Nybbler

            I don’t believe what “annex” is the right term for what China threatens to do with Taiwan. Annexing Taiwan would be making it part of China; China maintains that Taiwan is already part of China and has always been. To them, invading Taiwan is just putting down a rebellion

            The uninhabited islands are actually a better indicator of China’s quest for world domination. It’s not about the islands themselves; it’s about the large swathes of airspace and ocean that control of the islands provide under international law.

          20. PorterBridges

            Taiwan and uninhabited artificial islands do not qualify as “unambiguously sovereign nations”.

            Straw man. Of course the uninhabited artificial islands aren’t sovereign nations; that’s not a reasonable interpretation of anything that I said or implied or the mainstream arguments in that dispute. The simple argument is Indonesia, Malaysia, the Philippines, and Vietnam are unambiguously sovereign nations. They’ve long used the South China Sea for vital trade routes, and China is encroaching and interfering with that.

            I mean, in any other context, would you take the evidence of uninhabited artificial island disputes, and events that happened in the 1940s, as evidence of a country seeking world domination? It’s almost comical. The Chinese warships will be on the California coast any day now!

            This dispute: https://en.wikipedia.org/wiki/Territorial_disputes_in_the_South_China_Sea

            The dispute is mainly about the international waters and airspace, not over the artificial islands themselves. The fact that you claim the dispute is about the latter is you just trolling and arguing in bad faith.

            Next, this is a straw man. I didn’t claim, imply, or even think that China was planning imminent military invasion of California. Nor, am I claiming that they are plotting military domination.

            There is a giant middle ground between your dismissal and mockery of China’s bad behaviors such as territorial encroachment in the South China Sea and your caricature of the other side where China is an imminent military threat to the US and the whole world.

            I’m making more reasonable claims, which I’ve already explained in this thread, and don’t need to repeat again in this specific comment.

          21. Guy in TN

            @Desrbwb

            China repeatedly flouts international norms and refuses to play by the same rules as everyone else, from artificially controlling their currency to the whole building islands and flouting UNCLOS thing.

            As I said at the beginning, my goal is to have peace with China. None of this is worth abandoning that. If you are willing to abandon peace with China over something like currency manipulation, or dishonesty of all things (hello every country on earth), then we clearly value peace at drastically different priority levels.

            . I just don’t believe it’s plausible for the time being, because China ultimately wants to change the status quo, to the detriment of the West, and the Western values I care about (

            “I want peace, on the condition that my power is never reduced in any way, and the ideology I care about is always advanced” is the same thing as “I want war”.

          22. DavidFriedman

            And in contrast, China does not believe itself to be the rightful sovereign of Japan, Russia, or the United States.

            Not at the moment.

            I think it was the view of Imperial China for quite a long time that gifts brought by foreign emissaries were tribute, all of the world being, in principle if not in practice, subject to the Empire, all sovereigns ruling only because the Emperor had endorsed their rule.

            But I think the present rulers have a somewhat more modest view of their position.

          23. cuke

            This is good: ““I want peace, on the condition that my power is never reduced in any way, and the ideology I care about is always advanced” is the same thing as “I want war”.

    2. Bugmaster

      I wouldn’t say “worst”, necessarily, but their initial attempt to silence the medical whistleblowers certainly contributed to the pandemic.

    3. wonderer

      Let me push back on this.

      China didn’t close the wet markets, true. How reasonable is it to expect them to do so when a large segment of their population sees the wet markets as part of their cuisine, culture, and livelihood? The 2009 H1N1 flu came from pigs. The 1918 Spanish flu might have come from pigs. Should we immediately ban pigs just in the case the next swine flu is much worse than the Spanish flu? Would you, personally, be willing to stop eating pork?

      Yes, China did suppress early warning signs. That said, they stopped suppressing early warning signs around the middle of January, and then started making Herculean containment efforts. Around this time, the WHO was sounding the alarm as well, whether corrupted or not. The US had 2 months to prepare, but didn’t. If China hadn’t suppressed early warning signs, and we had 3 months to prepare instead of 2, what makes you think the extra month would make any difference?

      Lastly, what’s your evidence that the zero new virus cases are bogus? Do you think lockdowns and quarantines like the ones China imposed are incapable of reducing the transmission of the virus? If so, why is every country now doing them (albeit not with as much zeal)?

      1. EchoChaos

        Would you, personally, be willing to stop eating pork?

        I mean, there are a couple pretty prominent demographics that do exactly that.

        1. wonderer

          And if those demographics blame the rest of the world for a swine flu pandemic because “they didn’t shut down their pig farms”, would PorterBridges agree with them?

          1. EchoChaos

            I don’t know if he would, but I would think it reasonable.

            If you pre-called “eating X is bad” and eating X does indeed turn out to be bad, then calling out the X eaters makes sense to me.

          2. Machine Interface

            In that case though we might as well shut down all animal husbandry through legal force and threaten to go to war with any country that doesn’t do so, since that has been and remains the principal source of pandemic diseases in human history!

          3. The Nybbler

            Smallpox and plague (Y. pestis) weren’t from animal husbandry. Nor measles, nor HIV (wild animals), nor cholera.

          4. Machine Interface

            Actually, measles most likely did – humans are the sole reservoir of the current virus, but its closest relative was the rinderpest virus, that infected cattle worldwide until its eradication in 2001.

            While rodents are the main vector of the plague, it can also be transmitted by rabbits, goats, sheep and camels.

        2. Radu Floricica

          You probably felt like the point had to be made, but for vegetarians it would be just adding a new justification for what they’re already doing. Humans do that 7 times before breakfast every day.

          But anyways, the problem is that you can’t give in to a bully. If you stop eating pork because of coronavirus, and stop eating chicken because of the chicken virus, and close wet markets because of the bat virus, you’re well ahead on a slippery slope to giving up most of what you like doing, for one reason or another.

          Ontopic, I don’t really know the extent and importance of wet markets in China. I’m pretty sure stopping the trade in wild animals is a good idea, especially live animals – it’s pretty clear to me that feeding a billion people by hunting is absurd, so wild animal trade cannot be an important part of the economy. It could however be an important activity for segments of the population (how large?). So I’m not in a rush to condemn China for not doing it sooner, but I’d definitely condemn them for not doing it now.

      2. AlexSpark

        I think they tried closing them after SARS. That just drove it underground, which is much, much worse in terms of disease monitoring. So they walked the policy back.

        Imagine how difficult it would have been to do contact tracing if everyone at the Wuhan wet market had lied about having been there.

  65. Bugmaster

    So, what will American society look like post-Coronavirus (assuming it exists at all) ? Here are my predictions.

    * 90%: Actually, there is never (*) going to be a “post-Coronavirus”; it’s already spread too far and wide to be completely eradicated. However, in about 4..5 years, with the combination of vaccines/treatments/herd immunity, it should be down to manageable levels — kinda like the seasonal flu, only way more deadly.

    * 90%: We probably won’t hit Great Depression-style hyper-inflation, but the coming economic downturn is here to stay. Unemployment will stay in the double digits, inflation will accelerate. Finding a permanent job will increasingly be seen as a rite of passage and a major accomplishment, though many people will eke out a living via temp-gigs .

    * 90%: China will emerge as the undisputed singular global superpower (I mean, even more so than it has already). It will buy out key chunks of Europe and Australia (via the Belt-and-Road initiative, or just through ordinary investments), and will make significant inroads into the US. The next wave of modern technology (telecom, biotech, etc.) will be mostly Chinese in origin. English will slowly begin to fade away as the lingua franca, to be replaced by some form of Chinese (most likely the simplified kind). No major country on Earth will acknowledge Taiwan as anything but a Chinese province.

    * 80%: Speaking of which, always-on contact-tracing apps and other surveillance tech will become ubiquitous, if not outright legally mandated. Privacy will become an outmoded idea, sort of like powdered wigs.

    * 80%: In-person service-based industries, such as restaurants, movie theaters, sports, airlines, etc., will not totally disappear; however, anything smaller than a national chain will be wiped out, and even national chains will be forced to drastically downsize. Eating out at a restaurant will be seen as a (potentially risky) extravagance; something you could perhaps do once or twice a year, assuming you take basic precautions.

    * 70%: Speaking of which, air travel will be reserved for the moderately wealthy: CEOs, politicians, etc. (I mean, those who can’t yet afford a private plane). It will be seen as a sort of karma: “yes, you might have more money than me, but at least I don’t have to risk my life and/or spend 14 days in quarantine multiple times a year”. Inter-continental tourism won’t exactly be a thing of the past, but will reach the status of a rare, dangerous, and expensive once-in-a-lifetime adventure.

    * 80%: On the other hand, working from home will become the new normal, for white-collar industries where it is feasible to do so. Large corporation will begin looking for ways to liquidate their massive office towers (thus contributing to the incoming economic depression).

    * 80%: Injuries/diseases of any kind will become much more deadly, since hospitals will be overflowing with COVID-19 patients for the foreseeable future. Dying of a broken leg will become much more likely than it is today.

    * 70%: After a few widely publicized mass deaths at church gatherings/sporting events/whatever, going to such gatherings will become socially suspect. Not unacceptable, exactly, but definitely not something that should be done frivolously. Eventually, this will extend to smaller gatherings as well. Thanksgiving dinners will be mostly restricted to immediate family members, game nights will be conducted over Skype, etc.

    * 60%: Casual sex will become even more dangerous than it is already, since condoms don’t protect against the Coronavirus. While hookup culture will not completely disappear (since nothing short of total extinction will ever stop horny teenagers), it will become much less prevalent. The “family values” of the Conservative dreams will experience a resurgence (modulo homosexuality, of course).

    * 60%: While face-masks will never reach near-total adoption like they have in Asia, they will become a lot more common, and will be seen as normal. They will be mandated for retail employees (those few who will still have jobs).

    * 60%: On the plus side, medical capacity and medical research will accelerate significantly. Many (though probably not most) of the FDA guidelines will be relaxed or abolished. News like “N people die from an experimental drug” will be seen as the unfortunate cost of doing business, while news like “Experimental drug rushed to market and saves M people” will become, if not the new normal, then at least more than just an aspirational goal.

    * 60%: Immigration enforcement will be tightened, and while borders with Canada and Mexico will not be completely closed, the flow of traffic back and forth will slow to a trickle. Illegal immigrants will acquire a more sinister reputation.

    (*) Yes, I know, “never” is a long time, the Sun will eventually die, etc.

    1. Machine Interface

      Chinese economy relies on the west buying a lot of stuff from them. If western economy collapses, China has the most to lose. I posit that alternatively, the crisis will be bad for China and instead favor its more industrially advanced and better prepared neighbors, South Korea, Japan and Taiwan.

    2. Desrbwb

      I’m surprised at how high you reckon a lot of those are.

      “60%: Immigration enforcement will be tightened, and while borders with Canada and Mexico will not be completely closed, the flow of traffic back and forth will slow to a trickle. Illegal immigrants will acquire a more sinister reputation.”

      Probably higher than 60% for the first bit (though unlikely to be permanent, especially on the Northern Border). As for ‘sinister reputation’ this is extremely unlikely to make the slightest difference, given how calcified and polarised opinions in the States seem to be on this issue.

      “60%: On the plus side, medical capacity and medical research will accelerate significantly. Many (though probably not most) of the FDA guidelines will be relaxed or abolished. News like “N people die from an experimental drug” will be seen as the unfortunate cost of doing business, while news like “Experimental drug rushed to market and saves M people” will become, if not the new normal, then at least more than just an aspirational goal.”

      Possible, though less than 50% imo. Also, would probably only last until the inevitable thalidomide style fuck up. It could also slow research, as if human testing becomes more dangerous, fewer people will be willing to sign up, and so less testing will get done (and no, ‘test this new drug on patients during full scale roll out’ is unlikely in the extreme).

      “80%: Injuries/diseases of any kind will become much more deadly, since hospitals will be overflowing with COVID-19 patients for the foreseeable future. Dying of a broken leg will become much more likely than it is today.”

      I’d say that’s pretty much 100%, especially in the short term. Long term, less convinced (see later).

      “80%: On the other hand, working from home will become the new normal, for white-collar industries where it is feasible to do so. Large corporation will begin looking for ways to liquidate their massive office towers (thus contributing to the incoming economic depression).”

      I’d say that’s 50-50 at best. Will employers be willing to accept a loss in productivity that seems to come from home working (in my anecdotal experience)?

      “90%: China will emerge as the undisputed singular global superpower ”

      This is one of the ones I find weird to have such a high confidence. A lot of the proposed fallout from this crisis seems to take the form of increased protectionism and less willingness to farm out stuff to China (see the whole ‘why does China make out medical PPE?’ conversation). I’d say there’s a far more than 10% chance of this hurting China in the long run, as other countries are less willing to work with China and look more to their home grown industries and/or more reliable allies.

      Most of the rest seem contingent on “Actually, there is never (*) going to be a ‘post-Coronavirus'”. Which is a weird claim, and would be pretty unprecedented in epidemiology as far as I can tell. The Spanish Flu didn’t stick around as some endemic spectre over the globe, why would SARS-CoV-2 be different? I’m also less sold on a bunch of the draconian measures currently in place becoming as accepted as you seem to think. Even if they’ll be in place for a while, I don’t think people will stop viewing them as an enforced, undesirable imposition. This looks like claiming that WW2 rationing would inevitably become a permanent institution because people had to operate with it for years, but that isn’t what panned out.

      1. keaswaran

        Wasn’t the Spanish Flu one of the standard endemic influenza viruses for several decades? I believe that’s been the usual fate of influenza pandemics.

        I think Covid 19 is likely to have the same effect, but be a bit more noticeable because of the higher fatality rate. Still, in the steady state, we’re likely to have a few million infections a year and a few tens of thousands of deaths a year, so it’ll be comparable to automotive fatalities. The deaths won’t all come in one month the way this number did this year.

        1. The Nybbler

          Wasn’t the Spanish Flu one of the standard endemic influenza viruses for several decades? I believe that’s been the usual fate of influenza pandemics.

          Not that virus itself, but descendants of it. Just as the most common strain of flu circulating now is a descendant of the 2009 swine flu. The sort of recombination influenza engages in doesn’t happen to coronaviruses, I don’t think, so you wouldn’t expect a similar result. SARS died out. MERS apparently has a reservoir in camels, but hasn’t managed to become endemic in human populations.

    3. Zonulet

      These are fascinating but how on earth are you 90% confident that there will never be a vaccine sufficiently effective that everyone can just line up for it and stop worrying? Sure, it may not happen, but we’ve managed it for dozens of other diseases.

    4. A Definite Beta Guy

      You think at the end of this China is going to emerge as the undisputed global superpower? They have a disproportionate control of the PPE market because it is low-cost and was offshored. N95 masks aren’t really that special, they are something you can buy from Home Depot, and they aren’t even the top-shelf items.

      At the end of this I suspect American leadership will be focusing more on how quickly PPE reserves were exhausted and increase the stockpile, with strategic plans to more quickly shift manufacture should it be needed. Hopefully this also applies to things like generic drugs, which we absolutely need and which is heavily off-shored.

      1. Bugmaster

        Just to clarify, I don’t think that China will ascend just because of the PPE market. Rather, they are simply going to accelerate their economic/political trajectory, relative to the West. They are already buying up small African countries via their Belt-and-Road plan; they wield a disproportionate amount of influence over Western media; their state-sponsored hackers are top-notch, rivaling Russians; their spending on AI and tech in general is unparalleled (they have the only practical 5G tech on the market right now), etc.

        What will catapult them into the undisputed top slot is their comparative disregard for human life. While Western societies enter total lockdown and suffer through an economic depression that lasts years (if not decades), China will restart their economy early (as they’re already doing), sweeping any resulting deaths under the rug. Unless they get hit by another, unrelated catastrophe, I just don’t see them losing.

    5. DavidFriedman

      I think you are vastly overestimating the effects. Two years from now we may or may not have a vaccine, but we will know much more about how to treat Covid, bringing the lethality level down to something similar to flu at present. Any long term effects will be due not to the continued existence of Covid but to changes in political, social, and economic institutions over a period of a year or so during which Covid was a serious risk.

      1. Bugmaster

        I’m not sure why you’re so optimistic about reducing the lethality of COVID-19. I am fairly upbeat abut reducing its infection rates, but, once a person is infected, I doubt that vaccines will reduce his symptoms. By comparison, AFAIK it took about 30 years for AIDS to become a mostly-survivable disease; even if I’m off by a decade (in either direction), we’re still talking decades, not years.

        1. keaswaran

          But in the endemic state, infection rates of Covid 19 should be comparable to infection rates of individual influenza flu strains, with mortality rates about 10 times as high as any individual flu strain, so only a bit higher than total influenza mortality. That makes it a significant new factor in overall death, but still substantially less than heart disease or cancer, and more like guns plus cars together.

    6. matthewravery

      I think anyone who is 90% sure about what COVID will look like in this country in four weeks let alone four years is way overconfident.

      1. Bugmaster

        Maybe, but I’m not basing my predictions just on COVID-19. Most of these trends have been going on for a while now; the pandemic just accelerated them.

    7. mtl1882

      If it sticks around, I find it really hard to believe most Americans, especially younger ones, won’t simply adjust their expectations as to risk and death. This won’t be some the result of wrestling with some logical or moral calculus, but simply a natural resignation to reality. People are adaptable, and it’s not like this kills or disables everyone it touches. For most of human history, getting very sick and/or dying was an every day risk for people of all ages. People were aware of this, regularly lost children, and the society did not shut down. Hospitals will stop prioritizing COVID-19 as the society adjusts, because it doesn’t make sense to do so at the expense of everyone else’s health problems. Families especially will not just give up socializing at holidays. Many people are willing to take the risk rather than give up having a game night or having sex. We’ll end up with some level of herd immunity. It will be tough, but many people take a lot of risks in order to have a life they judge worth living—a lot of people don’t have much interest in maximizing lifespan if that life is spent in quarantine, especially extroverts and people with fewer resources for whom it hits hardest. There will be a big economic hit that could lead to some of the changes you describe, but based on human nature, I find it impossible to imagine game night via Skype becoming a long-term normal. Traveling to other regions to see family and friends, where immunity levels can differ, may become much less common. But relatively quickly I think most people will come to accept it the way they accept that they might get into a car accident on the way to work, etc., or the way they’ve adjusted in the past to being at war and suddenly losing a lot of people in the community to combat. We’re just built that way.

  66. spencemo_c

    Confirmed case counts can be very misleading as different countries/states/provinces/cities test at extremely disparate rates, eg US states range from 357 to 7.5k tests per million residents (OK and NY respectively)

    To get an accurate context for reported #s, check out the charts at https://docs.google.com/document/d/1n3Rh0d1ewmay_MVS3fa6uOHbSMpF9tHD39_WXXb6vVI/edit?usp=sharing

    PS – While New Orleans confirmed cases per capita are very high, New York City’s numbers are still much much higher. As of 3/27, NOLA had 1k confirmed cases/million residents and NYC had 3.1k/MM. (Louisiana’s testing rate ranks #3 at 4.6k/MM after Washington, 6.1k/MM)

  67. Dog

    I’ve spent the last couple years living in Papua New Guinea (back in the US right now though), which I would call a third world country – most people are subsistence farmers, huts, not much infrastructure, etc. I think there is the potential for things to go either way, but there could be a very high death rate in if the virus takes hold.

    Negative Factors:
    1) No advanced medical care except in select areas, and care is not affordable for most. I would be surprised if there are more than 1 or 2 ventilators in the whole country.
    2) Many people smoke unfiltered cigarettes.
    3) There is already a lot of lung disease, particularly tuberculosis. Even people who have been treated for tb often have lasting damage.
    4) The culture is very communal, with people spending most of each day in close contact with large, interlocking kinship networks.
    5) The government response will be hampered by a lack of resources and by poor infrastructure and communications. Some regions have basically no contact with the government at all. Non-essential businesses have been ordered to close, but this is both meaningless and unenforceable for much of the country.
    6) Many people have magical beliefs about illness, and germ theory is not widely understood or accepted.

    Mitigating Factors:
    1) Much of the country is hot and humid, if this turns out to matter.
    2) People are outside or under open shelters with roofs but no walls most of the day.
    3) Population density is not very high.
    4) The mountainous interior and lack of infrastructure means there are a lot of isolated tribal groups with little outside contact.

    I think the most likely situation is the virus spreading quite slowly relative to the rest of the world, but with a high fatality rate. There might not ever be a clear peak, with many smaller peaks in each region or tribal group. Regardless, it may be almost impossible to know one way or the other. People are dying from lung disease all the time, and many deaths are probably never recorded officially to begin with.

  68. Thomas

    The Japan case. Most obviously, the Japanese government has an amazing ability to ignore things they don’t want to see, such as anything that might cause the Olympics to be cancelled. Now that they have been cancelled, expect testing and case numbers to jump.

    This reminds me of the big Hanshin earthquake. Huge scandal about the Yakuza and concrete quality causing buildings and railways to fail. The scandal disappeared from the news in about a week. Never heard of any prosecutions. I think some businessman committed suicide over it and the matter was considered closed.

    The numbers out of Japan have looked funny to me from the beginning. I lived there 15 years, and my takeaway is that no numbers unfavorable to Japan are likely to see daylight.

  69. truckdriver20

    I’m seeing a lot of speculation based on blog posts and so on here, but very little based on the (limited) communication our leaders in the US have given us. I’m looking at what they’re saying right now and it looks scary.

    I assumed that the current lockdowns were meant to get r<0 in order to entirely stop the new cases while we come up with a better plan. But it's looking to me like the regional lockdowns and rapidly increased medical production we are currently seeing is actually IS the plan, and that the goal is that a 3-6 month lockdown will not eliminate the virus, but will simply "flatten the curve" enough to get herd immunity by September or so.

    Ohio Governor Mike DeWine posts his model of the flattened curve here. Herd immunity by May with hospitals operating at 3x normal capacity throughout April. I think in a televised broadcast today he said that the peak would be in mid-May which is different than what this graph shows, not clear on why this is.

    New York governor Cuomo says that “It is going to be four months, six months, nine months… The timeline — nobody can tell you, it depends on how we handle it — but 40%, up to 80% of the population will wind up getting this virus. All we’re trying to do is slow the spread. But it will spread — it is that contagious.”

    Here is a Daily Mail article covering an announcement Surgeon General Jerome Adams made, echoing the same sentiments. He says “Everyone’s timeline is going to be different. Some places haven’t hit their peak yet. We’re trying to give people the testing data to make informed choices. It doesn’t matter if it’s Easter, Memorial Day or Labor Day. We know we want people to be thinking about what they can do now to get through as few deaths and hospitalizations as possible… The authority lies at the state level.” (He also predicts 30-160K American deaths this year which I don’t understand… if the entire population gets it, won’t the deaths be on the order of millions unless current CFR estimates are highly exaggerated?)

    It looks to me like this is perhaps in line with Ferguson’s new model, which seems to be the highest authority on the matter right now, and his stance that the virus is as deadly as previously thought but far more contagious. Still doesn’t explain why Korea could do what they did and we have to settle for mass death, but whatever.

    It could also be simply the result of local authorities doing everything they can possibly do to ensure that people won’t die in excess amounts in the total absence of federal leadership. I have hope that this can somehow change but I can’t think of any rational reason at the moment to think that it will.

    The upshot of this to me seems to be that this blog’s audience of mostly solitary white-collar workers, college students, NEETs, etc – ie people who can afford to completely lock down and stay inside – should be stockpiling as much food as possible in order to simply never leave the house or pick up any packages for potentially months while something like 3% of people are walking around with the virus or whatever the number is. Getting the virus while interacting with any other people at all seems (according to the model) to be probable and very scary because hospitals across the US will be on the brink of collapse. And keep in mind that these quotes are from the state governors that have shown the most competency and seriousness thus far – others like Mississippi’s are still denialists and their states will absolutely be blindsided unless optimistic models for the virus’s spread/lethality prove to be true.

    The silver lining I guess is that if this scenario plays out is that us locked-down white collar workers will in fact be able to weather the storm in this way and life could be entirely back to normal in six months, which I would consider to be a reasonably happy time frame.

    Let me know if this reasoning seems wrong to anyone.

    1. Le Maistre Chat

      Let me know if this reasoning seems wrong to anyone.

      No, this is what I’ve been saying all thread and even OT comments before this post went up. That’s their plan.
      I’m still going to leave the house every day for dog-walking. I still have to commute to the Amazon warehouse. I’m not at all worried about my health: the authorities can throw up huge tent hospitals if get a moderate case, and at my age I’d have like a 0.5% chance of needing an ICU bed, 0.25% for ventilator and 0.2% chance of death if my health was spherical-cow American average for my demographic (it’s better).

      1. truckdriver20

        Where are you getting these numbers? Last time I heard even 20-30 year olds had a 10% chance of needing hospitalization. I don’t have a completely clear grasp on what exactly this entails but my rough understanding is that it means you get pneumonia, and if untreated pneumonia is often fatal. Even in Lombardy death rates among the youth are extraordinarily low but in the worst worst case scenario where the health care system does “collapse” on some level and you simply cannot get care it doesn’t seem like your youth will protect you. You’re also ignoring tail risks of the death rate being worse than we anticipate due to demographics / mutation / viral load / whatever.

        Personally the odds of dying are low enough that if the choice was between living my normal happy life of going to bars and restaurants and raves and sleeping with women and so on and probably getting Covid vs. locking myself in my room for a year and being safe I would figure I can’t live in fear and should just enjoy life. But that’s not the choice, it’s between being locked in my room except for brief trips to the grocery store and probably getting Covid vs. being maximally prepared and paranoid and being safe. Seems like an easy decision.

        EDIT: I do have a backyard though and if I didn’t the decision might be harder. Not getting any sun or fresh air for months is definitely not good for your mental or physical health.

        1. Clutzy

          There is no way 10% of Youths need hospitalization when there is also a near 0% death rate. No disease or condition has ever worked like that. Perhaps 10% get admitted during certain times, but with a virus like C19 the only thing a hospital can do that a rando in a mask cant is vent you and push fluids. And if that were the case that 10% needed hospitalization the death rate among youths would be 5%. I suppose there might be a need to allow uncertified, but trained, folks like myself to be able to push fluids in an open air sort of place designed to optimialize social distancing (think a public park with lots of walls set up or something). Or you could put tents next to blood donation centers that already exist and have the workers there split time. Most of their time is spent waiting as is and people are probably donating less than usual.

          1. truckdriver20

            Why would this be so unlikely? From what I understand the overall death rate is ~1% and the overall hospitalization rate is ~20%. This fits roughly with pneumonia having ~5% death rate.

            For the 20-30 age range, ~10% hospitalization rate for a ~0.25% death rate does seem a little high but a .5% hospitalization rate seems way too low.

            The story I heard is that in the West people were shocked at the unexpectedly high ICU admittance for young people because they didn’t realize that the Chinese were counting certain pneumonia as a “mild” case.

          2. Clutzy

            There is a huge difference between being admitted during “good times” and needing hospitalization. A lot of hospitals admit people to push fluids and monitor in case something escalates. When I volunteered during college this was incredibly common in flu virus cases and in strepo-pneumonia.

            In many ways the normal practice is dangerous because having people in hospitals is generally bad for their health if they don’t absolutely need to be there. But I guess it milks out some money and its why America has so many beds to begin with.

            IMO almost no corona cases should be admitted unless they are going to ICU, because if you do the hospitals will become the new spreading point.

    2. The Nybbler

      I assumed that the current lockdowns were meant to get r<0 in order to entirely stop the new cases while we come up with a better plan. But it's looking to me like the regional lockdowns and rapidly increased medical production we are currently seeing is actually IS the plan, and that the goal is that a 3-6 month lockdown will not eliminate the virus, but will simply "flatten the curve" enough to get herd immunity by September or so.

      I don’t think it’s practical to eliminate the virus. It’s too late and has spread too far, particularly in the New York area. So planning on that would be a mistake. I also think it’s likely too late to do much flattening of the curve (and it would take too long even if you could).

      However — and this is something I missed when I looked at this earlier — if you can temporarily but significantly reduce the spread of the disease when there’s a large proportion of the population infected, you not only “flatten” the curve but you reduce the epidemic final size (total number of people infected), even after the restrictions go away. By how much I don’t know, because it would require a much better model of viral spread in a real population than I know about. Maybe some epidemiologists could figure it out.

      (He also predicts 30-160K American deaths this year which I don’t understand… if the entire population gets it, won’t the deaths be on the order of millions unless current CFR estimates are highly exaggerated?)

      The entire population is not going to get it. The only diseases that entire populations get have a much higher basic reproduction rate than is estimated for this virus — around 10 for chicken pox, 12-18 for measles, for instance, whereas the numbers for this virus I’ve seen are around 2.3. Estimates that the entire population will get it seem to be mostly based on simple models that massively over-predict other well-studied diseases such as influenza.

      It looks to me like this is perhaps in line with Ferguson’s new model, which seems to be the highest authority on the matter right now, and his stance that the virus is as deadly as previously thought but far more contagious. Still doesn’t explain why Korea could do what they did and we have to settle for mass death, but whatever.

      I don’t think that’s a credible model. It could be far more contagious but less lethal. It could be less contagious but more lethal. But it can’t be just as deadly and far more contagious, or we’d already be seeing megadeaths — and like you said, Korea couldn’t happen.

      1. HeelBearCub

        The idea is to buy time.

        Time to get medical supplies manufactured and distributed. PPE, ventilators, but perhaps most importantly tests.

        Time to develop medical mitigation and perhaps preventative treatment.

        Spend enough time in lockdown conditions, where hopefully R0 is going to be far less than one, and you get case loads down to the point where all that time to ramp up capability lets you do contact tracing and quarantine for new cases. If everyone had no new contact at all for a month, cases would go to essentially zero. That’s obviously impractical, but the point of the lockdowns is to push down case load.

        Who knows, maybe we get to the point where we can encourage the Asian mask culture, if it is shown that this is effective. I doubt we could do it, but we definitely can’t without time.

      2. truckdriver20

        > The entire population is not going to get it. The only diseases that entire populations get have a much higher basic reproduction rate than is estimated for this virus — around 10 for chicken pox, 12-18 for measles, for instance, whereas the numbers for this virus I’ve seen are around 2.3. Estimates that the entire population will get it seem to be mostly based on simple models that massively over-predict other well-studied diseases such as influenza.

        Thanks, I genuinely hadn’t heard that before. Certainly seems like good news

        I just looked up the figures for the Spanish flu and it only infected 20% of the population in the US and killed .5% while in the third world it killed orders of magnitude more. So this is good evidence that even the likely-inferior social distancing and medical care they had back then can be effective. For some reason I thought it was much worse than that

    3. DavidFriedman

      in order to simply never leave the house or pick up any packages

      It seems to be generally agreed that three days is long enough for any virus on a package to die — one day if the surface is cardboard. So getting a package delivered and leaving it on the porch for three days, which is the policy I’ve been following (one day if it is all cardboard), should be safe.

      That said, I think we have adequate calories for another month, plan careful shopping in a few days to improve that to reasonably normal eating for a month, enough calories for two months. By which time my fruit trees and my daughter’s vegetables will be bearing, which should help substantially.

      We would probably not be being that careful if it were not the case that my wife and I are old enough to be at serious risk.

      1. albatross11

        David,

        I’m not sure that’s quite right. There’s a half-life of the virus on different surfaces/conditions. I’m not sure how to determine the right initial dose. But if the half-life is (say) 6 hours on plastic, then three days gives you 1/4096 of the initial dose of virus on the surfaces. Is this enough? I’m not sure.

        1. anonymousskimmer

          Viruses aren’t radioactive elements.

          I’m no expert, but any half-life calculation for a virus is unlikely to follow a strict exponential decay curve.

          The values David is referring to were derived from at least one experiment testing if any remaining detectable infectious viral particles remained on various surfaces.

          1. Edward Scizorhands

            The papers I’ve seen certainly make it look like the virus, while not doing something exactly like radioactive decay, does shrink in strength enough that a half-life is a reasonable approximation for it.

          2. albatross11

            The zero readings seem consistent with the half-life model to me. But this implies that if they’d put 1000x as high viral concentration on the cardboard, they would still have detected some virus three days later.

            The half-life model is basically an assumption that the probability that a virus will degrade to noninfectiousness in the next hour is independent of how long it’s been sitting on that surface. If it has survived this long, its probability of degrading in the next hour is the same as it was the first hour it was on the surface. That makes sense when we’re imagining a lot of independent events that each have low probability of zapping the virus, not if we’re imagining that after a certain number of hours, the membrane has dried out and degraded and the virus is kaput. I don’t have a good intuition for which model is better here.

          3. anonymousskimmer

            @albatross11

            Plastic probably shows a random event half-life model, and maybe steel and aerosol. For copper and cardboard something additional is obviously happening (you’ve got at least two sources of viral-elimination events).

          4. Douglas Knight

            Zero error bars, but the point value is not zero. The point value is “limit of detection.” Of course when you’ve passed the limit of detection the error bars are zero.

          5. Edward Scizorhands

            Once the number of virus molecules has decreased enough, the surface is safe, even if the number is greater than zero.

    4. albatross11

      I think some people are thinking “flatten the curve,” but I’m more interested in getting R_0 down below 1, which I think is doable. Even after we end lockdowns, we’re probably keeping the schools closed and continuing some social distancing. Like, I expect that when restaurants and bars are allowed to reopen, they will have some rules about, say, seating people relatively far apart, wiping down all surfaces with disinfectant between customers, sending anyone who looks even slightly sick home, etc. I was taking a lot of extra precautions for the month or so before the lockdowns started (carrying hand sanitizer everywhere, keeping my distance from people), and I expect to continue that for several months after the lockdowns stop. Lots of other people will do the same. For that matter, I think I’m pretty-much a convert to doing online ordering + car pick-up or delivery for a lot of my shopping–there are lots of reasons to prefer that, but less exposure is one. With luck, we’ll even get everyone wearing masks during flu season in the future.

      The goal here is to stop or nearly stop the kind of invisible community spread that’s gotten us to this point. Then, we can find cases and track contacts to prevent further spread. This is stuff people have been doing for more than a century, so it doesn’t turn on complicated new policies thought up last week or stuff nobody’s trained to do, just doing stuff that’s already in the job description and training of various state department of health employees.

      1. The Nybbler

        The goal here is to stop or nearly stop the kind of invisible community spread that’s gotten us to this point.

        How do you do that and keep mass transit running?

  70. nzsharpe

    Regarding ways to make relatively effective masks/respirators for developing countries, my coworkers just released this, which seems to be the cream of the crop at the moment in terms of effective, quick to make alternatives to n95s if you run out of those but have access the materials needed for these.

    https://www.continuuminnovation.com/en/how-we-think/blog/an-innovative-way-to-support-medical-professionals-in-the-era-of-covid-19?fbclid=IwAR2HSGVvfOsbFLKp3AdOwjN3ykRer3dXC20G0XAGvRoMsDGbQ-oh55YhRvY

  71. InBalance

    Regarding hydroxychloroquine (HCQ)–

    In reality, tremendous resources and commitment are being poured into developing this angle of attack, in hopes HCQ will pan out as a miracle drug– for both treatment and prevention of CV — just as with malaria.

    Just a short snippet from recent Barclays analyst research–

    “Mylan recently announced that it has restarted hydroxychloroquine production at its West Virginia manufacturing facility to meet potential increased demand to test effectiveness in
    treating Covid-19. The company is also taking steps to initiate production of this product
    outside the U.S. in the coming weeks. Mylan expects to begin supplying product by mid-April,
    and with currently available API will ramp up manufacturing to 50M tablets (treating
    >1.5M patients).”

    Two other pharma companies are mentioned in the same report as having committed to donating a total of well over 100M doses over the next couple of months.

    This is very significant. Three major pharma manufacturers are gearing up to support treating millions of people using HCQ. A factory is being recommissioned just to make this drug.

    An MD in the family speculates that the first supply wave will also include e.g. 1 pill / day for front-line health-care workers, as a hoped-for prophylactic dose.

  72. Le Maistre Chat

    We seem to have a doubling time of 3 days for COVID deaths in the US. March 27 spiked to 400.
    March 30: 800 deaths?
    April 2: 1600?
    April 5: 3000?
    April 8: 6000

    I predict we’ll reach this number. This is the point where we could have all ~150,000 ventilators deployed where needed and 5% freeing up each day because the user has been moved to either a normal hospital bed or morgue (almost certain at the 20 day point). Flatten the curve there and about 1.25 million Americans could die through November 3.

    1. Buttle

      I have seen evidence, through my job, which I’m not going to get into, that Tesla is in fact moving forward with manufacturing at least some Medtronics ventilators. Just obtaining the parts, in the case I know of, is not straightforward, and will unavoidably take some time.

  73. User_Riottt

    Wow, really you can’t find any real criticism of that corporate bail out? I’d start here, which has several links to both left and right critiques. Basically;
    1.it’s more free money and lines of credit to the already huge and extremely wealthy companies (no immediate danger for them) with no real constraints on what they can do except an inspector general who can’t even subpoena. .
    2. Comparative to the 10 trillion for big business (via a FED special purpose vehicle) a relative pittance covered in red tape for small business which is just asking for the big to gobble up the small in nour already highly oligopolized markets. So If you thought that this last decade was an insane history repeating itself in farce version of the gilded age just you wait until this hits the fan.
    3. A measly one time payment that won’t even cover rent for most people and some modest expansion of UI. As usual, the people who need it least will walk away with everything and the rest of us are literally told to go hurry up and die to boost the dow.

    1. blumenko

      Rent is the least of our worries. If no one can pay rent, landlords can’t just kick everyone out. Who would they get to replace them? And no, UI that in some cases pays more than people were earning at work is not modest. And many of these large companies are overleveraged, and don’t carry cash. I would prefer bankruptcy reorganization for them, as they still have valuable assets, but no, they don’t just have cash to ride this out.

      1. anonymousskimmer

        landlords can’t just kick everyone out.

        They won’t necessarily kick everyone out. The largest landlords, at least, would probably be selective about it, aiming to gentrify and increase rents.

        1. blumenko

          In a free housing market there would be no further scope to do so, as they could have done that already. And I support gentrification, so I wouldn’t mind.

      2. Le Maistre Chat

        Rent is the least of our worries. If no one can pay rent, landlords can’t just kick everyone out. Who would they get to replace them?

        That’s going to get interesting if this policy lasts long. All renters will demand to keep living in their homes rent-free, i.e. transfer of property rights.

        1. User_Riottt

          That is not a transfer of property rights. The owner still has the asset. No one is suggesting no rent ever again, though I would probably support it purely out of spite if they did. We are literally kicking millions of people out of work (for no fault of their own), huge portions of which will not be eligible for UI, and requiring they stay at home inside. You think it makes more sense to make them homeless too? That ought to help flatten the curve.

          1. Le Maistre Chat

            You think it makes more sense to make them homeless too? That ought to help flatten the curve.

            No, of course I don’t. Them becoming homeless is the worst thing that could happen. But landlords losing all income from their investments permanently because no tenant has paid rent since March 2020 and they’ve gotten quite attached to “this is my home and I don’t pay rent” after the 18-month pandemic is pretty terrible too.
            Can you see uniform enforcement by police across all 50 states of a socialist rebellion against resuming rent payments?

          2. User_Riottt

            Oh, and the problem in that situation is the socialists? Not the presumably Mad Max type hellscape we would have to be living in for any socialist to think something like that would accomplish anything?* Whatever character of a socialist you have in your head is not remotely close to accurate. Try talking to one of us, we don’t bite.

            *If this or this is your landlord or they treat you like this then I absolutely would support them never paying rent. Hell, if they killed their landlord and I was on the jury I wouldn’t vote to convict.

          3. Mark Atwood

            I would probably support it purely out of spite

            If that’s an okay thing to assert, is it okay for me to assert what I would like to do “out of spite” to people who want to do such things?

            Or is it just “burn it own” ctrl-left types who get that privilege?

          4. User_Riottt

            Depends, how many people do you end up killing because you got so mad that someone offered rhetorical support for a hypothetical rent strike?

      3. User_Riottt

        And no, UI that in some cases pays more than people were earning at work is not modest.

        Compared to handing $10 trillion to the least deserving people in the world and practically begging them to oligopolized every industry so they can get away with wage and price fixing on top of the $29 trillion we handed them 12 years ago; you’re right, modest doesn’t do justice to to the ‘Burn this totally corrupt worthless sh*thole of a country to the ground’ I feel.

        1. blumenko

          To get such high numbers, you must include the Fed, and those are loans, which were largely paid back last time, and I expect this time as well.

          1. User_Riottt

            What interest rate do you think they would have gotten on the ‘free market’ for a loan big enough to keep them solvent? Did you guess infinity? If not guess again. A loan at a rate well below market value is still a subsidy, paid back or not. How much do you think the fed should have paid for toxic subprime mortgages? If you said anything less than full price and then just kept them on it’s balance sheet so no one would notice the write down, you don’t understand how corrupt Wall Street is. Over paying for worthless junk is also a subsidy.

            If I gave you $16 trillion at the bottom of the recession, had you pay practically nothing in interest, handed you a few million in no bid contracts and wasn’t even going to ask for all the principal to get paid back do you think you could turn that into $29 trillion to keep in 2 years? Because Wall Street sure can, hell an index fund probably would have walked away with more.

            Why do we even know any of this? Bernie Sanders and Ron Paul forced an Audit the Fed amendment into Dodd-Frank. Otherwise the ‘free market’ would have kept that bit to themselves.

            Why did the banks pay back TARP so quickly? They couldn’t pay themselves insane bonuses until they paid back TARP, no pesky rules with the FED.

        2. Luke G

          That 29 trillion number is meaningless. It’s counting the total transaction values, but the reasonable number to look at is the outstanding balance. Since the money markets where the Fed operates often use very short-term loans, it’s extremely misleading to look at total transaction values. For example, if the Fed makes an overnight loan of $1 billion today, and then does the same for the next 9 days, that’s $10 billion of total transactions. But it’s only $1 billion of outstanding balance at any time.

          1. User_Riottt

            LOL this isn’t the REPO desk. The majority of the money went to buy toxic MBS at AIG that should have gone for pennies on the dollar but we paid full price. Read the GAO report..

  74. theredsheep

    Okay, so, re: ventilators, and training for them, as I’ve said before, I’m a first-year RT student. I’m due to start learning mechanical ventilation this summer, and the summer semester had the reputation of being, basically, the widowmaker of the program. Most students who drop out of the RT program drop out in the summer, because they’re failing to master mechanical ventilation. It’s the hardest thing to learn, even if you’ve spent two semesters learning about lungs. My FB RT group seems to unanimously agree that nurses are not competent to run vents, even with hasty training–they’d prefer second-year RT students about to graduate, obviously. But even many hospital docs don’t really understand proper vent management. “Vent management” also entails a few ancillary skills like drawing arterial blood samples that can go very wrong if you mess them up, and which nurses don’t normally do.

    I expect you could trust a hastily-trained person to watch for a few of the most likely trouble scenarios and alert an RT, and it might get easier to define likely trouble scenarios as our understanding of this disease progresses. But that’s a guess.

    1. Le Maistre Chat

      Assuming we have to reach herd immunity because containment is failing in the US but “shelter in place”/”stay at home” is extended past Christmas, millions of people will need ventilators. We’ll try to deploy all the estimated 150,000?. But what happens regarding your specialized labor?

    2. albatross11

      Is it possible to supervise this remotely? Have a respiratory therapist in Nebraska or Israel or Taiwan Facetime to the nurse running the ICU in New York, and talk her through managing the ventilators in her ward? One benefit there is that the people managing the ventilators don’t get exposed, another is that we might be able to use experts who are someplace with little COVID-19 to help the people who are at the pointy end of the spear right now.

      1. theredsheep

        Well, I don’t know about vent management in detail yet, obviously. But to put a patient on or take him off really requires an RT on-hand–it’s quite easy to kill someone doing either. Arterial blood gas sampling, used to determine how to adjust the settings or take the person off, is very different from the kind of phlebotomy other professionals are used to, and is likewise dangerous. Possibly if things got really bad you could sub in venous sampling–I believe only the O2 will be wildly different–but I don’t imagine ABG is the standard because doctors enjoy more invasive and painful procedures. Probably you sacrifice some efficacy there. So I think remote work isn’t an option for RTs, there being so many hands-on aspects.

  75. Peter Gerdes

    I don’t understand why you can’t build an outbuilding next to the hospital (assuming they are out of negative pressure rooms and essentially use modified CPAP style ventilators. If only COVID patients are in the building and you put in some safeguards (shouldn’t be impossibly hard to beg pressure while building and run the outflow through a fire).

    If necessary put the docs in a modified scuba gear and maybe by that point you’ll have docs who have recovered or brave young docs willing to risk it (hell early infection of health care workers might even be a good in itself so they are immune and on their feet for peak).

  76. Brett

    There was a video making the rounds about how to sterilize your groceries, which then got some push-back from a food microbiologist on Twitter. Basically, wash your hands properly before you eat, and it’s not the worst idea to use a Lysol or Clorox wipe to wipe down the cardboard, metal, and plastic containers of grocery store stuff that you bring into the house immediately (fresh food and vegetables supposedly can just be washed in cold water). That said, there’s no indication yet that any case was spread this way, and the virus doesn’t last long outside of a body – even with plastic and steel (where it seems to survive 2-3 days), the actual amount present is drastically lower. As long as it’s not something someone was touching frequently, you’re probably fine.

    Also, plastic grocery bags are part of those huge pressed packs of them. If you pull off a bag or two, odds are nobody has touched the bags inside . . .ever.

    Japan does seem to be a mysterious case. There was some suppression of cases going on, but it seems like it was a combination of “everybody already wears masks and gloves when sick or sickness is going around”, closing the schools really quick, and a fair amount of social distancing.

    Good for Iceland – California is trying to get a random sample of the population to see how extent it is.

    No idea with Iran. They did finally do a big lock-down, although it may just be that a lot of cases aren’t being reported.

    The big advantage a lot of poor countries have going for them is the relative youth of the population – a higher share of their cases will be asymptomatic or mild. Who knows how many of those have already happened (does it even stand around when a bunch of people in the slums get a mild cough and fever?). But it does make me wonder if there’s a weather-link to it after all – the WHO says no, but studies seem to indicate maybe.

  77. Le Maistre Chat

    Death rate by age, from Italy.
    Let’s assume that we’ve screwed up containment so badly that 50% of Americans will get COVID-19.
    People 80 and older have a death rate of 24.6%. We know from China (sample size 52, though) that if you get put on a respirator, you have an 81% chance of dying in the hospital.
    There are 12.68 Americans age 80 and older.
    Locking down 330 million Americans enough that the health care system doesn’t get overwhelmed as 50% of the population takes turns getting infected would mean 1,263,308 people (81% of 1.56 million) age 80-119 still die. Locking everyone down for a long time saves 296,692 lives in that demographic compared to letting it run its course, entailing that absolutely nobody that old getting a ventilator due to triage rationing.
    There are 22.66 million Americans age 70-79. Run those numbers again: 11.33M * 0.169 = 1,914,770 people need a ventilator and 1.551 million still die as “flatten the curve” saves 363,770 septegenarians.
    There are 37.41 million Americans age 60-69. 1,066,185 will need ventilators. If the health care system never gets overwhelmed, 863,610 sexagenarians will still die and you save 202,575 lives vs. letting the hospitals get so slammed that only people 18-59 can get ventilators.

    How much privation and suffering for every American are those roughly 863,000 lives worth? Let’s even be pessimistic and say 70% of people get infected if we re-open the economy: 1.2 million.
    When we talk about “putting a dollar value on human life”, this isn’t just stock prices going down. It’s not just a recession where several percent of Americans lose their jobs and stress out while job-hunting. It’s estimated 30% unemployment while 50-70% of us take turns getting COVID-19. Plus the suffering of everyone 59 and under that can’t be quantified in dollars.

    1. Brett

      Fortunately, we have ways of mitigating that suffering with government spending. So it just ends up being a few trillion dollars anyways.

      1. Le Maistre Chat

        And 3,678,000 Americans age 60+ still die taking turns on respirators while our government orders the general population to lose their jobs and mitigates our suffering with deficit spending. 209 million citizens 18 and older * $1,200 a month * 9 months of 2020 = $2.257 trillion in deficit spending on UBI this year even if children don’t get a cent. “Flatten the curve” means several trillion a year deficit spending on UBI alone while probably >5 million people (when you count severe cases in people 18-59) die in non-overwhelmed hospitals.

      2. Acedia

        Confining hundreds of millions to their homes for months causes much suffering that isn’t related to money and can’t be cured or mitigated by money.

        There will be cost for this “social distancing” (euphemism for imprisoning the whole population) and economic upheaval in terms of poverty, depression, suicides, divorces, domestic violence, drunkenness and drug abuse – and many more issues I could not think of – some of these problems will play out over decades. I find it shocking how little attention is paid to all these costs amidst the single-minded “whatever it takes” attitude.

        1. albatross11

          Acedia:

          How would we estimate the size of those effects? It’s not intuitive to me how to determine even the sign of the effect of the lockdown on, say, mental health or family relations–for every depressed person made worse by isolation, there may be an incipient alcoholic who stops drinking because the bars are closed. For every marriage that breaks under the strain of a two-month lockdown, there may be another that’s saved as the family spends serious together time. Or maybe not. I really don’t know how we’d get a good estimate here.

          The economic costs are much easier to estimate–if total payroll goes down by $X during the lockdown, that’s not so hard to add up. Though I rather suspect that many families whose main breadwinners can work from home or are still getting a salary are also saving a lot more money than usual, since restaurants, coffee shops, bars, amusement parks, concerts, airports, cruise ships, etc., are closed down.

    2. Chris Phoenix

      You are assuming a false binary between death and full recovery. What percent of survivors will get permanent lung damage, and what will be the cost of that?

  78. Lambert

    Looking at positive rates as opposed to number of cases still isn’t perfect.
    It depends how well they’re targeting the tests.
    If you prioritise testing people who spend all their time french-kissing Lombards vs prioritising tests for hermits and anchorites, you’ll get very different results. As number of tests increases and the low hanging fruit* gets picked, these things will change. Being good at contact tracing will also raise apparent positive rates.

    *currently it’s so low-hanging it’s more of a root vegetable than a fruit

  79. blumenko

    The correct measure for density (in most cases and probably for this case as well) is population-weighted density, so it is the density that people see, on average. https://www.citylab.com/equity/2012/10/americas-truly-densest-metros/3450/ Note how NYC metro population-density far outstrips all other metro areas, but is more comparable in average density. Also, if you use this measure, then the effect of arbitrarily including certain areas becomes much less important.

    1. DavidFriedman

      The correct measure for density (in most cases and probably for this case as well) is population-weighted density,

      At a tangent … . This is why people greatly overestimate population density — they are averaging over people, not over acres. The existence of a vast area with nobody in it has a large effect on the average population density averaged over acres — population divided by area. It has no effect at all on the average over people, which is what people perceive, because there are no people in that area hence it gets a zero weight in the average.

      1. blumenko

        I do think there is a problem with population-weighted density related to graining. If two people are hugging in a large house, are they seeing a density of 2 per 36 sq. in. or 2 per 5000 sq. ft.? In practice obviously the latter, but I don’t know if there is a great theoretical reason for that. Also, if you live in a dense neighborhood on the edge of Central Park, do you see the density of the neighborhood or the sparsity of Central Park? It depends on how you draw the boundary, and I don’t know how they do it.

        1. keaswaran

          In practice, every site I’ve seen that calculates population-weighted density uses either census blocks or census tracts as their unit – that is, they calculate the density of each unit, and then take the weighted average of these densities, weighted by total population. I believe Central Park is its own census tract (with a substantially lower population than its neighbors, though probably nonzero, given homeless people) so that people living across an avenue from it see the density of the neighborhood.

          There’s surely different ways to do it, and I would really like much more population data that looked not at where everyone sleeps, but where everyone spends their waking hours (Manhattan has much higher density of people during the day than at night).

  80. Pandemic Shmandemic

    can you imagine trying to export ventilators from the US right now? You’d probably get arrested.

    Maybe lynch-mobbed if word got out, but what standing or emergency law/regulation/executive-order actually makes this illegal atm ?

  81. wordpress won't let me delete my account

    Sorry if this has already come up elsewhere… A few friends of mine (all in the US, none recently traveled outside the US) have told me they believe that flu- or cold-like symptoms they had late last year or very early this year might have been covid-19. Is there any reason this idea would be not-stupid? If people were running around with the virus undetected so early, the epidemic/pandemic would just have begun that much earlier, no? It just seems like self-soothing denial to me.

    1. albatross11

      My wife came back from visiting a friend (and doing basically every tourist thing she could think of) in San Francisco in early February; both she and her friend got very sick the next week with some flu-like respiratory thing that took them both out of commission for a couple weeks. It seems quite plausible that this was an early case of COVID-19, but it seems at least as likely that this was ordinary flu or some other respiratory bug. The only way to tell would be an antibody test for COVID-19.

    2. The Nybbler

      My (NYC) office has had several confirmed COVID-19 cases. It seems to me quite reasonable that others have had it and not realized it. I may have had it, though if so it was asymptomatic or very slightly symptomatic. We need antibody tests, but of course the FDA is making life difficult.

      If people were running around with the virus undetected so early, the epidemic/pandemic would just have begun that much earlier, no?

      Yes. I think it probably did.

    3. Cliff

      It shares most symptoms with the flu, so I doubt it. Unless they had shortness of breath then maaaybe?

    4. knzhou

      Exactly, it’s ridiculous. If a bunch of people you knew caught it in December, then the US would have been ahead of Wuhan, not 2 months behind. Our hospitals would have been overwhelmed by mid-January.

    5. Chalid

      If you have to quantify it, the US base rate of covid-19 as of December/January was probably in the neighborhood of 10^-6, and the probability of getting flu-like symptoms sometime in winter is in the neighborhood of 10^-1. Plug into Bayes formula and the probability of having having had covid-19 given flu-like symptoms in December or January is 10^-5 give or take a couple orders of magnitude.

    6. noyann

      hey believe that flu- or cold-like symptoms they had late last year or very early this year might have been covid-19. Is there any reason this idea would be not-stupid?

      If they had the seasonal flu shot then yes (not stupid).
      But they should not feel 100% certain and still take precautions.

    7. Kaitian

      Late last year: probably stupid, unless they actually visited Wuhan before developing symptoms (and even then it’s quite unlikely).

      Early this year: some of the people who believe they were early undetected Covid cases are probably right, but most of them just had a normal cold or flu. We won’t know more until there is widespread testing for antibodies.

      If you don’t have a very clear reason to think you had Covid-19, assume it wasn’t Covid-19.

  82. Aapje

    It seems to me that the only hope for the third world to get enough ventilators (and training?) is if:
    – Production ramps up very fast in the West & China (seems plausible)
    – The richer countries over-saturate relatively soon, which presumably requires R to be close to or below 1 (less plausible)
    – The third world manages to prevent an explosion of cases until the richer countries over-saturate (very unclear, were there few confirmed cases of swine flu in most of Africa because of a protective lifestyle or a lack of testing/healthcare or blaming deaths on other causes?)

    1. albatross11

      The ventilator thing seems like the wrong place to focus. If you go to the hospital with COVID-19, you have about a 6% probability of ending up on a ventilator. Once you’re on a ventilator, you’re already so sick that you’re fairly likely to die (I think 20% or so probability at least) even with extensive medical resources devoted to you, and I think you are extremely likely to have serious breathing problems for the rest of your life.

      Running out of ventilators is a result of lots of people getting such bad pneumonia that their lungs fill with fluid and start collapsing. It’s an easy-to-understand sign of how nasty COVID-19 can be. But my sense is that increasing the number of available ventilators is a super-hard way to make things better. Nor do I see a realistic path by which, say, lots of first-world countries who have just gone through a terrible respiratory epidemic that might return are shipping excess ventilators to the third world a few months later.

      1. Aapje

        The only alternative is to try to keep COVID down until there is a vaccine or anti-viral cure. At the moment, the poor countries are equally badly off as rich countries on that front.

        Ventilators lengthen the period where people can survive with fluid in their lungs and thus gives them a better chance to fight off the disease.

        The likely scenario with ventilator production is that it will scale up fast, where the high demand suddenly flips into a large oversupply. When that happens, it makes perfect sense to ship these excess ventilators to the second and third world.

  83. ana53294

    About Africa and the coronavirus. So, on the one hand, the young population of these countries means that they probably will have fewer deaths per capita. But on the other hand, 7% of sub-Saharan Africa has HIV. Although I’ve heard rumors that some HIV drugs work for the coronavirus, aren’t people with HIV going to be more susceptible to getting the virus?

    1. Lambert

      Wow.
      1 in 4 Swazis have HIV.
      All the percentages I saw about HIV levels in Africa are about an order of magnitude higher than I would have expected.

    2. User_Riottt

      If they have been taking their antiretrovirals they may have a decreased risk of catching COVID-19, its the ones with irregular access to meds that could be SOL

  84. yaolilylu

    I’m glad you asked about takeout food! Finally, a chance to repay the happiness debt I own Scott!
    I’m a chemo nurse, this is what I tell my high-risk patients:

    I personally don’t trust takeout that much because I think a lot of restaurant workers don’t have sick leave, so it’s more likely your food was prepared by someone symptomatic. But you can cut the risk to near zero by doing this:

    1. Wash your hands well
    2. Put your own bowl on your kitchen counter
    3. Pick up the restaurant container, and pour the food into your own bowl
    4. Throw away the restaurant container
    5. Wash your hands well
    6. Thoroughly heat up the food. (at least 70C for a minute, or whatever the best current guideline says)

    If you do this, in this order, you are extremely safe even if someone coughed viruses all over the food and the container. Heat would kill the virus, and handwashing would prevent indirect transmission from the bag/container.
    If anyone objects to this please let me know and I shall revise my patient education accordingly.
    Dear Scott, please keep well and continue writing the world into a better and more thoughtful place.

    1. Humbert McHumbert

      I thought it wasn’t possible to catch respiratory viruses by ingesting them on food. Don’t they have to come in through breathing or a mucus membrane?

      1. yaolilylu

        I don’t think anyone has said it’s impossible, CDC just said that they have no evidence of anyone getting infected through food. It is still possible that a few people have but no one figured it out. I agree it’s low risk but we can’t be 100% sure of that yet, I would much rather Scott have the option to make it safer (and his friends too, they sound like lovely people), if it was me I think the peace of mind with enjoying my food is worth the extra 3 minutes.

      2. dreeves

        I’m confused by this. Suppose a coronavirus-positive person coughed on your hand and then you sucked on your fingers. You’d probably get infected, right? So if the cook coughs on your breadstick or whatever, how is that much safer?

        1. Evan Þ

          I’m also confused, but I believe the “take-out is safe” argument would say that no you probably wouldn’t get infected by that.

          1. albatross11

            Yep, it would. But I’ll admit that I’m quite skeptical of this. If the idea that this stuff is being transmitted through high-touch surfaces like doorknobs and subway seats is true, then it seems inevitable that carry out food has some risks associated with it.

          2. Matt M

            But probably less risk by at least an order of magnitude, right?

            The risk of doorknobs is that dozens/hundreds/thousands of people have potentially touched them since they’ve last been cleaned.

            When it comes to your takeout food, how many people do you think have touched it. Definitely less than 5, right?

          3. Evan Þ

            @albatross11, following this line of reasoning, it’d be risky to grab a takeout breadstick and then rub your eye just as it’d be risky to grab a public doorknob and then rub your eye. But it could conceivably still be safe to eat a takeout breadstick, or to grab a public doorknob and then suck your thumb.

            I’m skeptical. But it’s conceptually possible.

          4. albatross11

            Your mouth is part of your respiratory system, connected to everything else. But Matt’s right that the exposure is much lower for carry out food–basically the few people who might have handled your food, rather than everyone who opened this door today.

  85. DNM

    Some health orgs (notably Kaiser) are reportedly now denying Chloroquine to those with long-standing prescriptions, e.g. those with lupus, stating that it will stay in their systems for 40 days without additional dosage. Reasonable, evidence-based forced sacrifice or utterly despicable?

        1. Edward Scizorhands

          And this is what I hold Trump responsible for, not the one-in-a-million who drank fish tank cleaner.* It is for encouraging the homebrew DIY crowd to hoard the necessary reagents for (1) what is a needed drug for people now, and (2) what could be a good treatment when used by doctors in hospitals.

          If it is a valuable precursor, hoarding it ain’t gonna help anyone, even me. I can’t show up at the hospital with it.

          * My wife thinks, maybe as a joke, maybe serious, this was a deliberate hit job by the wife to get rid of an annoying husband. I asked her to document 10 ways in which husbands could be annoying and she ignored me and looked at the cleaning supplies under the sink. Women, amirite?

          1. The Nybbler

            It’s not Trump followers who have been writing off-label prescriptions for hydroxychloroquine; the stuff’s been considered promising for months and that’s why demand has gone way up globally. And no one is hoarding “precursors”; drug companies don’t buy chloroquine phosphate in retail packs meant for fishtanks and convert it to hydroxychloroquine.

  86. VirgilKurkjian

    In regards to places like Japan, Iran, and SF having less severe crises, could it be that there’s a genetic component? Maybe certain ethnic groups, like Western Europeans, are more likely to carry genes that are related to serious adverse reactions.

    We’ve observed that there’s a lot of variation — some people have much more severe reactions than others. The Iceland data suggests that many people are asymptomatic. If there were genes that made the reaction more or less severe on average, or more or less likely to be asymptomatic, couldn’t that explain the unusual pattern?

    1. Loriot

      I find this ironic, since back in January, people were speculating here that Chinese people were genetically more susceptible than others.

  87. mitchellpowell

    Just in terms of extreme speculation, I’m wondering if this scenario is at all plausible:

    Let’s imagine that the world both fails to contain this thing, and fails to develop a vaccine. It sweeps through the population, everyone gets it, huge devastation, most people come out immune. After this, the only real fresh new population of humans capable of contracting it would be children, who almost never die from it.

    Is it possible that, a few decades from now, Covid-19 is mostly a disease that children get, which almost never kills anyone?

      1. The Nybbler

        Chicken pox can survive even with a very small susceptible population because there is (or at least “was”, I’m not sure how the vaccine changes this) a large infected-but-dormant population which can become actively infectious. I’m not sure how measles managed to survive, I assume it’s just so virulent that even with basically every adult immune that R=1 was maintained. The “common cold” coronaviruses allow for re-infection. SARS-CoV-2 isn’t that virulent and doesn’t leave lingering infection (as far as anyone knows), so I don’t see how it survives if it doesn’t allow for re-infection. If re-infection is possible (perhaps only in asymptomatic/low symptom cases) then it certainly seems possible it becomes endemic with very low mortality.

        1. Cliff

          I’m a bit confused about the re-infection thing. Some people made it sound like you could lose your immunity (to some given virus) after a certain period of time. But others made it sound like you don’t ever really lose it, the virus just mutates (which is what I had thought before). Anyone know?

    1. User_Riottt

      Beating off a coronavirus tends to only bestow immunity on someone for a relatively short window, proportional to the lethality the disease. SARS and MERS killed 40-60% of those infected and left people immune for a year or two IIRC; and the common cold only leaves you immune for like a week. So the guess is a few months of immunity maybe. So far the evidence is that there is immunity upon recovery but there have been some claims of re-infection (which may just be misdiagnosis on the first pass).

        1. thehousecarpenter

          I’m not sure if mutation is that significant a factor—most of what I’ve read about the cold emphasizes the fact that it’s caused by all sorts of different viruses and strains, each of which has its own antigens, so that the immune response is specific to the given strain. There are enough of these strains (over 100 of rhinoviruses alone) that you’re unlikely to acquire immunity to all of them in a lifetime.

          1. albatross11

            That’s the way I understood it too, FWIW. But I’m an interested amateur, not an expert.

  88. neworder1

    Anyone has experience with bupropion and how to deal with insomnia? It worked well for me, but I was basically unable to sleep (I have sleeping problems without any meds), so had to give it up.

  89. Chalid

    If NYC didn’t exist, you’d probably see no relationship between the epidemic intensity and density.

    So it’s probably better to assume no strong relationship between density and the epidemic, and assume that NYC is bad for its own idiosyncratic reasons.

    Note that NYC government is strongly incentivized to blame density to shift the blame away from its own failings.

      1. matthewravery

        Yeah, if people want to pile on to leaders who were willfully negligent, de Blasio should be right up there next to Trump.

        1. Chalid

          I mostly agree, except that I’m not sure where responsibility should be divided between de Blasio and Cuomo.

          1. Loriot

            Wasn’t there a case where Blasio said “prepare for news about a lockdown order” and Cuomo responded “noone’s talking about a lockdown and Blasio doesn’t have the authority to do it anyway”?

            I haven’t been following NY news since I don’t live there, but I wouldn’t be surprised if they were both to blame. At least the bay area where I live seemed to be comparatively on top of things.

  90. Daniel

    Please compare this “emergency room visits in New York City for influenza-like illnesses” chart:

    https://si.wsj.net/public/resources/images/OG-DZ740_ERSPIK_4U_20200318172118.png

    with this smart thermometer data of fever cases in NYC (start of second bump on Mar 2, peak of second bump on Mar 16):

    https://imgur.com/a/TbhLgIO

    Unfortunately the first graph halts exactly before we could figure out if it follows the reversal of the second graph or not. Also unfortunately, the WSJ article from which the first graph was copied is behind a paywall, so I don’t know what’s exactly their explanation for the steep rise. If it’s undiscovered corona cases, and if the two graphs moving together is not a coincidence, that would be great news, right?

  91. Irenist

    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.

    1. Null42

      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?

      1. A1987dM

        Unfortunately, I’m of partial Ashkenazi ancestry (1/2), so the alt-right is off-limits.

        Well, FWIW Curtis Yarvin is half-Jewish too.

      2. DavidFriedman

        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.

      3. Le Maistre Chat

        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.

      4. albatross11

        I’m not quite sure what the boundaries of the alt-right are, but I think there are a fair number of Jews, gays, non-Christians and nonwhites that are at least sometimes given that label. Certainly there are plenty among the people who get labeled as IDW.

        For intelligent and intellectually interesting conservatives, you might start with Charles Murray, Thomas Sowell, Razib Khan, Greg Cochran, Jonah Goldberg, Megan McArdle, and Steve Sailer. (In roughly descending order of quality of thought, IMO.). I often disagree with each one of them, but they all seem to actually be thinking for themselves, honestly trying to understand the world. As best I can tell from their writing/comments, none of them have anything against Jews or any kind of ideology built on hate. Many of them are somewhere in the human b-odiversity sphere, though (as an example) Sowell’s work is largely an attempt to refute those ideas, and McArdle thinks such things should not be discussed in public.

        1. Null42

          Alt-right, no. I think there are a lot of alt-lite and IDW people as you describe. IDWers aren’t actually on the right–they’re sort of the old liberals who valued freedom of inquiry and speech, which now puts them on the same side as the right, from what I can tell. I value the autistic-libertarian-engineering-rationalist complex (as I think of it) is very valuable to society in terms of advancement in the physical sciences and technology, I just don’t think libertarianism is where we need to go right now. COVID-19 makes it pretty obvious (to me at least!) we need more government and less individualism. The converse may have been true at other times, and may be true again at some point in the future.

          I actually think, while ethnostates have their place in countries that are that way already (I don’t think trying to introduce diversity into Japan would be a good idea), a racially based ideology would have disastrous results in a country this diverse. Everyone is too jumbled even for an Ottoman-style millet system (or Dutch pillarization). We’d just get a civil war.

          Libertarianism…sorry, I have a lot of respect for you guys as individuals (heh) but ‘socially liberal, economically conservative’ is the direction we’ve been moving for the past 50 years or so and seems to have produced an atomized society with no sense of the common good. I’m not the sort who thinks the opposing ideology needs to be wiped out–it’s good to have a few people pointing out overreach of state power, just like it’s good to have a few pacifists to remind us how bad war is–but we need to move in the opposite direction right now (IMHO).

          My big thing with religion is that I don’t believe in it, and my understanding is that you have to actually believe in it. I have never tried to talk anyone out of believing–it seems to do a lot of good for people, particularly in times of trouble and facing death. It’s the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions…in the part of that Marx quote everyone forgets.

        2. DavidFriedman

          As best I can tell from their writing/comments, none of them have anything against Jews or any kind of ideology built on hate.

          I can’t speak to most of them, but I heard Charles Murray give a talk in Israel at an event I was also part of, and Thomas Sowell was a student and friend of my father, who was Jewish.

      5. thomasbrinsmead

        >I would like to enlist on the right side of the culture war.

        You’re not on your own here. I doubt there are many who would like to intentionally enlist on the wrong side of the culture war. 😉

      6. Irenist

        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?

        The alt-right and libertarianism are, of course, the most mentally available possible affiliations for an SSC reader trending conservative. But, strange as it may seem, over in the dark matter universe half of America, there’s this thing called the Republican Party, and it’s kind of a big deal.

        It’s painfully lame and uncool (like lots of *truly* countercultural things), but I would urge you to explore becoming active in your local Republican Party. If you’re on the coasts, many of your fellow Republicans will be Jewish, too. If you’re out here in flyover country, many of your fellow Republicans will be Evangelical Christians who are philo-Semitic in an admittedly creepily essentializing way, but sure as heck aren’t antisemitisc.

        I’ve thought about that a lot. I’ve been trying to give more weight to sources who called this thing early.

        On Twitter, National Review columnist @michaelbd called this thing early. So did policy analyst @toad_spotted. So did the anti-war, capitalism-skeptical, pro-industrial policy cultural conservatives at magazines like The American Conservative and American Affairs.

        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.

        Indeed they have. Your opposition to global free trade places you squarely in the “American System” tradition of support for tariffs and industrial policy, the proud old Federalist / Whig / Republican tradition of Alexander Hamilton, JQ Adams, Henry Clay, Abraham Lincoln, and William McKinley. Modern proponents of this tradition include conservative policy analyst @Oren_Cass and many of the writers associated with The American Mind magazine.

        Cultural traditionalists like @wrathofgnon and the communitarian urbanists at the previously mentioned American Conservative Magazine are exploring ways to restore the Burkean, organic civic bonds the twentieth century so rashly threw away. Reformocons like Ross Douthat at The NY Times continue to try to harness the populist moment to push the GOP away from tax-cutting libertarianism and toward family-friendly fiscal policy. The checks going out to every American now were pushed hard by GOP senators associated with this tendency—Romney (tentatively), Hawley (populist), and Rubio (wonkish). Israeli thinker Yoram Hazony is pioneering a rediscovery of the moral case for nationalism to counterbalance globalization. Patrick Deneen has an incisive book out on “Why Liberalism Failed.” Religious conservatives at many of the magazines I’ve mentioned make persuasive cases for the psychologically destructive effects of cultural libertinism on the poor in particular that you needn’t abandon your atheism to engage with.

        As Scott once noted, “Right is the new left.” We are living through probably the most exciting intra-conservative debates since the heyday of Russell Kirk, WF Buckley, and Irving Kristol. The GOP is being dragged away from what many of us call “zombie Reaganism” into something new. Trump, for all his (many!) flaws, has helped catalyze the change by destabilizing the old GOP establishment.

        Don’t fritter your life away debating stale 70s ideologies like libertarianism and socialism. Do something truly intellectually adventurous—become a Republican.

        1. Null42

          Long and thoughtful. Thank you.

          I was familiar with AmCon, American Mind, Spotted Toad (thanks to Sailer), Douthat I read regularly, Hazony and Deneen I’ve heard of (and I even know about the Ahmari-French contretemps). Dougherty had a nice article on the cover of NR I read a few years ago in Barnes and Noble but I may follow him regularly. American Affairs I used to read regularly online until the paywall went up–good stuff.

          I’ve often thought about joining the GOP; it’s a relatively mainstream thing to do, and you can meet other people and actually move things in a direction you like. They still seem too hung up on free-market fundamentalism though. I also kind of feel bad helping to re-elect Trump given the way he’s flubbed this coronavirus thing (not that Biden is all that competent)–in general I don’t like to reward incompetent behavior. But, after 2020, that’s no longer a concern. I will probably seek out my local party then. For this regard, much thanks. 😉

          1. Irenist

            They still seem too hung up on free-market fundamentalism though.

            Indeed. The GOP is transitioning away from that, but it needs people at all levels of the party pushing away from free market fundamentalism.

            I’m excited you may soon be one of them! Enjoy your journey into conservatism. Glad to have you aboard.

          2. albatross11

            ISTM that the coronavirus response so far has been deeply unsettling–a reminder that the kind of people we put in power aren’t the right kind of people to be making decisions in any kind of a crisis. Lots of people who are good at words and politics, not so many who know what “exponential” actually means or could read an academic paper in anything technical and understand it, etc.

          3. DavidFriedman

            Lots of people who are good at words and politics, not so many who know what “exponential” actually means or could read an academic paper in anything technical and understand it, etc.

            On the other hand, the people who know what “exponential” means and can read technical papers are probably not competent at a lot of other skills relevant to the job, such as picking subordinates, speaking to the public in ways that work, getting things done in a political system with many players, and the like.

            The best solution may be to have leaders who are competent at those things, and competent at identifying the advisors who can be trusted to understand the things the leaders don’t.

  92. Lambert

    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.

    1. PsyXe

      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

      1. Lambert

        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.

    2. Garrett

      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.

  93. DNM

    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?

      1. DNM

        I think it was! That indicates both transmission and severity of symptoms have some correlation with blood type.

  94. Maxander

    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.)

    1. alchemy29

      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.

      1. Maxander

        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.

        1. alchemy29

          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.

    2. Rebecca Friedman

      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.

  95. dreeves

    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

  96. quevivasbien

    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.

    1. Matt M

      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).

    2. Le Maistre Chat

      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.

      1. cuke

        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.

          1. matthewravery

            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?

          2. cuke

            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.

    3. denverarc

      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.

  97. Act_II

    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.

    1. matthewravery

      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.

    2. The Nybbler

      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.

      1. albatross11

        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.

        1. Tatterdemalion

          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.

          1. The Nybbler

            “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.”

          2. DavidFriedman

            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!

          3. albatross11

            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.

      2. Act_II

        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.

        1. The Nybbler

          -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?

          1. cuke

            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.

          2. Act_II

            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.

          3. The Nybbler

            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.

          4. HeelBearCub

            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.

          5. Act_II

            @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.

          6. Clutzy

            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.

          7. Act_II

            @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.

          8. HeelBearCub

            @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.

          9. The Nybbler

            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.

          10. anonymousskimmer

            I believe the culpability with Trump vis-a-vis the death was him emphasizing how safe these drugs were.

          11. Clutzy

            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).

          12. HeelBearCub

            @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.

          13. Clutzy

            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.

        2. mtl1882

          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.

    3. Controls Freak

      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.

  98. Richard Meadows

    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.

    1. Le Maistre Chat

      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.

      1. Statismagician

        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.

        1. Anthony

          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.

        2. Desrbwb

          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.

    2. pilgrimoftheeast

      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(!!!)

      1. Lambert

        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.

        1. Kindly

          Are you saying that Nigeria has enough ~0 year olds to bring the median age down to 18 from 30?

          1. Kindly

            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.

  99. J Mann

    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?

    1. albatross11

      You could pop the pizza back into a moderately hot oven for a few minutes to kill anything on the surface.

  100. Freddie deBoer

    “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)

  101. Radu Floricica

    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.

  102. Anteros

    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.

    1. Vermillion

      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.

      1. Anteros

        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.

        1. keaswaran

          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.

  103. eqdw

    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.

    1. Scott Alexander Post author

      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]

      1. Le Maistre Chat

        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.

      2. matthewravery

        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?

        1. eqdw

          They are saying the second one, for the most part.

          I’m not arguing against the first one. I’m arguing against the second one. For someone who believes that the president’s comments about chloroquine were inappropriate, it is not clear to me what different comments he could have made that someone would think was appropriate, short of not talking about it at all

      3. Ant

        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. “

        1. The Nybbler

          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.

        2. eqdw

          > 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’.

        1. The Nybbler

          This is the one I referred to above. 14 out of 15 in the control group recovered; it didn’t have the power to demonstrate a positive result even if the drug worked.

    2. orin

      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.

      1. PorterBridges

        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.

        1. DavidFriedman

          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.”

        2. orin

          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.

          1. PorterBridges

            If you look at just one statement, you could reasonably draw the conclusion that you give, that the WHO were overly cautious in January, they made an honest error, that is understandable. But they have a long record of making suspicious statements.

            Most of the pundits at National Review are saying that WHO is deliberately echoing Chinese Government propaganda. I am convinced that they are right.

            Read:
            https://www.nationalreview.com/corner/who-does-who-trust/
            https://www.nationalreview.com/2020/03/coronavirus-what-good-is-chinese-soft-power/
            https://www.nationalreview.com/2020/03/china-is-pushing-a-zero-myth-on-covid-19-and-attacking-press-freedom

            Or in the poetic words of a Hong Kong dissident:
            https://youtu.be/L3tnH4FGbd0

      2. eqdw

        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.

    3. PorterBridges

      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/

  104. Rusty

    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??

    1. Edward Scizorhands

      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.

      1. Rusty

        Well you make a good point! I am still impressed they changed course quickly and didn’t try to stick to their guns.

  105. Rusty

    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.

    1. Anteros

      +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.

  106. Guy in TN

    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%.

    1. Matt M

      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.

      1. Guy in TN

        There would also be utility concerns. It would be trivial to object to such a policy on non-economic value grounds.

          1. Guy in TN

            @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.

          2. DavidFriedman

            @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.

        1. DavidFriedman

          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?

          1. Guy in TN

            @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.

          2. denverarc

            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.

          3. DinoNerd

            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.

          4. Controls Freak

            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.

          5. Controls Freak

            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.

          6. HeelBearCub

            @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.

      2. keaswaran

        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.

    2. Edward Scizorhands

      If you spend all your money on remedy X, you have no money left over for remedy Y, which might be better.

      1. unreliabletags

        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.

    3. Clutzy

      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.

      1. DavidFriedman

        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.

        1. anonymousskimmer

          @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.

          1. DavidFriedman

            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.

          2. anonymousskimmer

            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.

      2. albatross11

        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.)

        1. cuke

          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.

    4. Paul Zrimsek

      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?

      1. Guy in TN

        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.

  107. orin

    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.

  108. The Nybbler

    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.

  109. Clutzy

    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.

  110. anonymousskimmer

    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.

    1. Edward Scizorhands

      I’m very inclined to believe Federal government regulations interfered with efficient production. But one thing the Federal government can do is disable those regulations.

    2. anonymousskimmer

      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.

      1. Edward Scizorhands

        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/

      2. Lambert

        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.)

      3. Edward Scizorhands

        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.

    3. anonymousskimmer

      Thanks.

      Does the FDA and NIH and CDC have the legal right to waive these requirements?

      1. Christophe Biocca

        Does the FDA and NIH and CDC have the legal right to waive these requirements?

        In general, the FDA does:

        Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), the FDA Commissioner may allow unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when there are no adequate, approved, and available alternatives.

        They could approve the vaccines before there’s evidence of effectiveness, as far as the law is concerned.

    4. J Mann

      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.

      1. Tatterdemalion

        Delay is only useful if you’re using the intervening time to do something useful, like stock up on ventilators, testing kits, etc.

      2. HeelBearCub

        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.

  111. mingyuan

    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.)

    1. DavidFriedman

      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.

    2. craftman

      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.

    3. Harry Maurice Johnston

      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.)

      1. viVI_IViv

        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.

        1. albatross11

          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.

        2. viVI_IViv

          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.

          1. albatross11

            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.

  112. noyann

    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.

  113. DavidFriedman

    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.

    1. J.R.

      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?

      1. craftman

        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.

  114. smilerz

    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.

    1. Jon S

      ‘understated by a factor of 5x or more’ is true almost everywhere due to insufficient testing.

      1. smilerz

        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.

        1. aleksanderpwnz

          Why in a couple of weeks? Did they keep the situation under control for over a month, and then drop the ball just recently?

          1. aleksanderpwnz

            So they’ve just been hiding it much better than any other country on the planet?

  115. Yosarian2

    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.

    1. Edward Scizorhands

      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.

      1. blumenko

        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.

    2. Matt M

      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.

      1. Tim van Beek

        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).

      2. TheAncientGeekAKA1Z

        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.

  116. salvorhardin

    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?

    1. zakamutt

      (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.

      1. salvorhardin

        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.

        1. HeelBearCub

          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.

          1. albatross11

            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.

          2. HeelBearCub

            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.

          3. Edward Scizorhands

            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.

          4. Le Maistre Chat

            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.

  117. J Mann

    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.

  118. Murphy

    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.

  119. J Mann

    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.

    1. craftman

      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.

    2. Anthony

      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%.

  120. alchemy29

    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.

    1. Neike Taika-Tessaro

      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.

      1. anonymousskimmer

        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.

      2. alchemy29

        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.

    2. soreff

      >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.

  121. Jon S

    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.

    1. albatross11

      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.

      1. anonymousskimmer

        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.

      2. DavidFriedman

        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.

  122. morris39

    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?

    1. Scott Alexander Post author

      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.

      1. morris39

        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.

  123. Gumpalonia

    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?

  124. Edward Scizorhands

    > . 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.

    1. Del Cotter

      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%

    2. Loriot

      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.

  125. felix

    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.

  126. Alsadius

    > 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.

    1. Scott Alexander Post author

      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.

      1. cuke

        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.)

  127. Matt M

    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.

    1. EchoChaos

      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.

    2. Del Cotter

      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.

      1. Matt M

        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.

        1. Del Cotter

          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”.

        2. Del Cotter

          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.

          1. The Nybbler

            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.

          2. Matt M

            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.”

          3. Del Cotter

            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?

          4. Del Cotter

            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.

          5. Matt M

            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.

          6. Del Cotter

            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.

    3. matthewravery

      “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!

    4. Chalid

      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.

      1. Del Cotter

        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.

        1. Kindly

          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?

          1. nkurz

            @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.

          2. keaswaran

            “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.

          3. albatross11

            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.)

  128. craftman

    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?

    1. AlexSpark

      “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.

  129. broblawsky

    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.

    1. Matt M

      Our medical establishment can’t even really decide whether vaping itself is harmful or not.

      Good luck with this one…

  130. craftman

    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.

    1. broblawsky

      Yeah, there will (eventually) be a coronavirus vaccine. There might never be a lung cancer vaccine.

      1. Statismagician

        There cannot be a lung cancer vaccine, except in the broadest possible colloquial sense, and even then it would require technology indistinguishably from magic.

          1. Statismagician

            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!

          2. albatross11

            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.

  131. m.alex.matt

    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.

    1. Del Cotter

      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.

  132. Le Maistre Chat

    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.

    1. Kaitian

      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.

    2. ADifferentAnonymous

      > 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.