Open Thread 150.5

This is would usually be a hidden open thread, but I’m promoting it to front page to say a couple of things:

1. Future of Humanity Institute asks me to advertise their free pandemic modeling software for hospitals, policymakers, and anyone who just wants to play around with free pandemic modeling software.

2. People seem to be confused whether my face masks post last week was coming out against or in favor of face masks. Although it’s a complicated issue, I meant for it to conclude that (modulo the importance of reserving them for health care personnel), wearing face masks is probably helpful.

3. On Friday, I stated that people should stop smoking to reduce their risk of serious lung complications of coronavirus. Although that conclusion was supported by one Chinese study and by common sense, a few people have pointed out to me that more recent studies show the opposite. This study of Chinese patients finds that smoking and vaping are not dangerous in coronavirus and may have “a protective role”, possibly due to downregulation of ACE (but note that the lead author has a history of getting funding from e-cigarette companies). This study from China finds that although never-smokers have better survival rates than current-smokers, former-smokers do worse than either, which would argue against quitting right now. And this study confirms that quitting smoking can upregulate expression of coronavirus receptor genes (though it finds that smoking does as well).

I’m pretty suspicious of this research. It’s new, lots of it isn’t yet peer reviewed, and it contradicts itself in places. The former-smokers-do-worse effect is reminiscent of the teetotalers-do-worst effect in alcohol research, which is probably because very sick people get told to stop drinking, and so teetotalers are a disproportionately sickly population. Everything is working off a few heavily-biased mortality numbers in China. And also, even if quitting smoking increases your coronavirus mortality risk it will still be very good for you on net.

Still, the most recent research does apparently show that the advice I gave you yesterday was diametrically wrong and could kill you, so I figured I had better get that out there.

1,423 thoughts on “Open Thread 150.5

  1. johan_larson

    Sweden is doing it differently.

    While countries around the world impose strict measures to stop the spread of the new coronavirus, Sweden has followed a different path: no lockdowns, no school closures and no ban on going to the pub.

    The Scandinavian country is pursuing what Prime Minister Stefan Lofven calls a “common sense” response to the pandemic by keeping the country largely functioning and aiming health measures at the most vulnerable.

    “We who are adults need to be exactly that – adults. Not spread panic or rumours,” Mr. Lofven said in a televised address to the country last week. “No one is alone in this crisis, but each person has a heavy responsibility.”

    The approach has put Sweden at odds with many countries across Europe, including its neighbours – Denmark, Norway and Finland – where almost all public venues have been shut and people have been ordered to stay indoors. In Sweden, most bars, restaurants and schools remain open, and people continue to mingle in parks and on city streets.

    The government has introduced social-distancing guidelines and encouraged people to work from home. Gatherings of more than 50 people have also been banned, and some businesses, notably cinemas and ski resorts, have voluntarily closed. But few of the measures are mandatory, and almost no one expects Sweden to adopt the kind of fines and police checks that have become commonplace in Britain, France, Spain and Italy.

    This is an odd thing for the Swedes to be doing. I suppose a relatively light case load is part of why they can be a bit casual abut this; things are much worse in other European countries. Here are some numbers of cases per million:

    Italy 1906
    Germany 1012
    France 905
    US 741
    Sweden 551
    UK 497
    Canada 299

      1. johan_larson

        Darn it, wrong thread. It’s too late to cancel my posting here, but I’ll repost to the current OT.

  2. Paul Brinkley

    Dan Carlin just put out his first Common Sense episode in almost two years. I’ve listened to only half of it so far, but I keep thinking, if ever there was someone who needed to hang out in places like SSC, it’s Carlin.

    Has anyone else listened to it?

    Where does Carlin usually go for discussions? I see no forum links on his site, but I do hear him refer to one occasionally. It doesn’t seem to be Twitter or Facebook.

  3. rahien.din

    Update on renin-angiotensin-aldosterone system (RAAS) inhibitors in the context of COVID-19. This is from Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19, NEJM March 30 2020.

    We have basically no preclinical or clinical data on which to base our actions. But, we do know that COVID-19 attaches to the cell and gains entry via the ACE2 receptor. Variations in the expressivity of ACE2 may account for the clinical spectrum of COVID-19 infection.

    The concern with RAAS inhibitors is then : the body’s response to any perturbation is to push back. So, its response to RAAS inhibitors may be to increase the expression of all ACE receptors, giving the virus more targets. Thus, these drugs may be unhelpful.

    Given that the RAAS system is extremely important, these drugs may even be potentially harmful. If the body responds by increasing the activation of the RAAS system in general, then this could cause huge problems. Lots of organs have ACE2 receptors, so there is the potential for worsened end-organ dysfunction if we are wrong. Moreover, the RAAS axis is extremely complicated – this all falls under the general medical dictum of “the dumbest kidney is smarter than the smartest doctor“, IE, screw with the kidney at your own great peril.This has led a number of centers to stop ACE inhibitors and ARB’s in all their COVID patients.

    The linked paper suggests a competing hypothesis. If ACE2 is essential for viral entry, well, we already have drugs that block ACE2, and so they should block viral entry. Why not add these drugs to treatment regimens for COVID-19 patients, and reduce their infectivity?

    Furthermore, this may actually prevent end-organ damage. ACE2’s job is to downregulate the RAAS. We know that the virus gains entry via ACE2, but then, it downregulates ACE2 once inside (so to increase infectivity by allowing viral particles concentrate attack on uninfected cells.) This downregulation of ACE2 (and local upregulation of the RAAS system) facilitates a local inflammatory response. In mouse models, this local inflammatory response leads to acute lung injury – meaning, acute respiratory distress syndrome (ARDS), the bad thing that requires mechanical ventilation. There is reason to believe that the local inflammatory response also leads to damage in other organs, such as the heart. So, we should consider strongly that RAAS inhibitors may actually be helpful.

    There are two ongoing double-blinded randomized clinical trials examining the use of the ARB losartan in COVID-19 patients. Both are out of the University of Minnesota. One is trying it in hospitalized patients, one is trying it in patients who have not needed hospitalization.

    We could also consider using ACE2 itself as a medicine. This would not necessarily prevent viral infectivity like RAAS inhibitors might, but, it could lessen the chance or degree of ARDS by reducing the local inflammatory response. In a 2017 pilot study of patients with ARDS due to other viral infections, giving people infusions of recombinant ACE2 resulted in lower sytemic blood levels of angiotensin II – meaning, the enzyme was still active despite not being on the cell membrane. However, that study was not powered to detect any clinical enpoints, and there are a lot of unexamined variables. We don’t know if that would work and the concerns above would still apply, but at the very least it seemed to be safe.

    At the very minimum, we should probably not be empirically taking people off their RAAS inhibitors, especially if they have significant heart disease.

  4. Christophe Biocca

    Shoppers Drug Mart (Canadian Walgreens) in Kitchener, ON is running out of many staples and limiting quantities of eggs/rice/pasta etc to 2 per family. I haven’t checked other grocery stores yet (I was there to pick up packages at their post office, I don’t get groceries from there anyways), and there’s a good chance this is specific to them (they’re right downtown, close to the transit terminal, which is convenient for many people who don’t drive), but this is clearly a suboptimal outcome.

    What surprises me is I see no one raising prices on goods in short supply (TP/hand sanitizer last 2 weeks, durable food now). Is this because price-gouging laws are actually enforced (and are applicable to all these various goods), because of store policies against such behavior, or something else?

    It seems to me like retailers are overlooking $20 bills on sidewalks repeatedly, and I don’t have a good explanation.

    1. Robin

      Probably if they raised the prices now, it would be very bad PR.
      I have read about supermarkets who demand an additional 5€ for the second pack of toilet paper and 10€ for the third, which will be donated.

      1. Edward Scizorhands

        Which is why state governments should mandate price increases.

        Take the PR load off of the stores.

        I’d shout it from my rooftop if there were anybody outside to hear me.

        1. silver_swift

          Which is why state governments should mandate price increases.

          That just puts the PR load on the governments, which are typically composed of (or at least lead by) people whose job depends on being popular enough with enough people to get re-elected.

        2. Christophe Biocca

          Considering the governments are the ones leading the charge against “price-gouging”, not gonna happen.

          1. Edward Scizorhands

            The people who are currently breaking the system are typically the ones with the power to stop breaking and fix the system.

            Do I expect all 50 states to act correctly? Hell no. But if a handful of states act correctly and follow this plan, those states will see supplies of hand sanitizer and TP return to their shelves. When other states wonder “how come those other states have TP on their shelves?” you can explain the reasoning to them. Many will resist wanting to hear the right answer; that’s fine. At least we’ve gotten most of the states to fix the problem, which is better than we are now.

          1. Edward Scizorhands

            Because it takes the problem out of the hands of the store. The store isn’t losing the good will of customers; they are just obeying the law.

            “By government decree, surge pricing is in effect on toilet paper.”

            Once people see toilet paper is back on the shelves and available at some price, people will calm down. As the shelves fill, surge pricing is gradually lowered.

            The worst-of-both-worlds solution is to have low prices on the primary market and true prices on the secondary market, which begs for hustlers and hoarders to buy it up. Force the primary market to raise prices at least to the level of the secondary market, and the hustlers and hoarders will stop.

          2. albatross11

            Part of the increased demand for TP is panic buying, but some is due to the desire of everyone to keep a queued-up supply so they don’t have to go to the store as often, and some is due to the fact that everyone’s home all day. A month ago, most of my family spent about half our day somewhere other than home, using toilet paper there instead of here–now, we’re all here all the time.

          3. Conrad Honcho

            Double the price of TP, but institute “buy one, get one free, limit one per family.” You can panic buy, but you’re paying double for everything over two packs.

          4. Matt M

            Double the price of TP, but institute “buy one, get one free, limit one per family.” You can panic buy, but you’re paying double for everything over two packs.

            I’ve seen some viral images coming out of… I want to say Denmark, where some stores have a policy of “first item is normal price, second item is 5x more expensive.”

            I think technically that would still violate price gouging laws in most US jurisdictions, but the public reaction to it seems to be positive (i.e. people who would get really upset at ‘every item is 2x more expensive’ are fine with this scheme)

        3. Deiseach

          You have to consider the entirety of the public. Doubling or tripling prices may restrict people who would bulk-buy, but that only affects the people who have enough spare money to rush out and buy twenty packs of toilet paper in one go. Make the item two or three times more expensive, you may then force Joe Hoarder to only buy the usual amount.

          But now you’ve made Susie Precarious – you know, one of the people at-risk because they don’t have/can’t afford health insurance, so continue going to work and don’t go to the doctor/hospital even if sick because they’re in low-paid jobs or even on welfare – unable to afford even her ordinary usual amount of toilet paper/hand sanitiser/tinned beans/rice.

          So then you have a news story featuring a tearful Susie talking about how the new price increases means she can’t afford to feed her kids. Guess who now gets the blame? The government that mandated price increases, not the people who could afford to rush out and splurge on hoarding.

          1. Edward Scizorhands

            It’s surge pricing or ration coupons.

            And since ration coupons can be traded for money, giving everyone money is the easier version of giving everyone ration coupons.

            And, hey, we are already giving everyone money.

          2. baconbits9

            The average member of the public would definitely prefer ration coupons, IMO

            Only until they started waiting in lines and still couldn’t get what they wanted.

          3. JayT

            Under the current scheme, Joe Hoarder bought it all while Susie Precarious was at her second job, so she gets no toilet paper at all. Under the doubled price scenario she could buy half as much as normal and be more stingy with her use. There’s no perfect solution to problems that show up in an emergency, but the second option is obviously better.

          4. TheAncientGeekAKA1Z

            You can have ration *books* that are for a specific individual.

            > There’s no perfect solution to problems that show up in an emergency, but the second option is obviously better.

            While the third solution, controlling quantities directly rather than via price, is better still.

          5. albatross11

            One important difference is higher prices also encourage more people to want to sell the thing that’s in shortage, whereas keeping the price doesn’t.

            Another important difference is that prices allow a lot more flexibility. Imagine giving toilet paper rationing books, one for each household. The home with six kids isn’t getting enough, and the home with one pensioner has a pile of the stuff in the closet. Or she sells her excess TP or lends her ration books to the family with six kids, probably violating some dumbass law somewhere.

        4. albatross11

          I think a governor, mayor, or president might even be able to do it just with public speech, by giving them cover. Have the governor and state attorney general standing together to give a statement like “In light of the constant shortages of toilet paper and hand sanitizer, I really think it would make sense for stores to temporarily double their normal prices on those things, and we would certainly not prosecute them for that under these circumstances.”

          This works as a Schelling point–all the stores know they can raise prices together, they won’t get arrested, and if everyone does it together, the public won’t blame any one store. Plus, toilet paper and hand sanitizer will probably be easier to find.

          I think demand for hand sanitizer has just massively increased–it used to be that only a small fraction of people wanted it and people didn’t use it except after handling something dirty/before eating, now everyone wants it and uses it all the time. (And widespread availability of hand sanitizer and masks is, IMO, a prerequisite for stepping down from the current lockdowns to something a little less restrictive!) Eventually the price will settle into a new equilibrium–probably only a little higher than before, but higher.

          OTOH, stuff like TP and pasta are different. The demand has gone up there for, as far as I can tell, about three different reasons:

          a. Everyone is switching from food that goes bad quickly to food that has a long shelf life.

          b. Everyone wants a bigger queue of pasta–where formerly you had a couple boxes of rotini in your house, now you want like ten boxes so you don’t have to go to the store so often.

          c. People are buying because they fear they won’t be able to get it later.

          (a) is an increase in demand that will stick around, but (b) and (c) should pass–once I have enough pasta queued up in my pantry, I can just buy more to replace what we’ve eaten.

          1. Matt M

            a. Everyone is switching from food that goes bad quickly to food that has a long shelf life.

            Oddly enough, in my area, pasta and rice are plentiful, but it’s near impossible to find most varieties of fresh meat.

          2. Rebecca Friedman

            Yeah. Minor caveat, of course, but as of yesterday our local grocery store was pretty much out of pasta, rice and flour, but they were also out of some fruits/vegetables, desperately short on many more. And the ones they didn’t have tended to be quick-spoilers like green beans or berries (they had 4 boxes of strawberries, more of raspberries and blueberries but still not very much), while they had significantly more of long-term stick-around-forever things like sweet potatoes or apples (or moreso, ordinary potatoes, though I grant those are not really vegetables).

            I think people are adding more than switching, perhaps planning to switch in a week or two when their fresh meat/produce has all been consumed and they don’t want to go back to the store.

          3. Edward Scizorhands

            I think all the different reports of what stores do and don’t have is the result of a sudden shortage, followed by a staggered delivery system that brings things back in irregular intervals. The store normally handles all that stuff so we’re completely unaware.

    2. AlesZiegler

      They are afraid of consumer backlash and longterm reputational damage associated with it.

    3. Kaitian

      A bunch of supermarkets in Germany have gotten creative with the toilet paper (splitting packs, raising prices from the second pack onwards, selling unusual brands and types) and have generally been criticised for it. So it’s probably mostly an intent to avoid bad PR. Most of these things will be available in normal quantities again once the hoarders have filled their pantries, so it makes sense for a supermarket to avoid irritating their customers.

    4. Garrett

      Most people are irrational and would hate the company for doing so. There are many good case reports in the past where either the backlash or the legal repercussions were so significant that nobody wants to take the associated risk, even if the higher costs are directly consumed by the costs of procuring the materials for sale. (That is, the seller isn’t making any more money off of the sale)

    5. convie

      I guess you haven’t been paying attention to the news but the province has been coming down hard on price gouging.

      1. Christophe Biocca

        After a quick google, it seems TP/hand sanitizer are covered but food isn’t. So to the extent this is driven by government action we could see diverging behavior on those two fronts.

        1. Matt M

          Except that the PR issue still applies.

          A small mom and pop grocery might risk raising prices on whatever they legally are allowed to – but the big national chains won’t take the PR risk. It’s a potential long-term issue whose risk outweighs the benefit of temporarily making a bit higher margin on meat or whatever.

    6. baconbits9

      I would suspect that the grocery stores are already seeing higher effective prices paid. Grocery stores practice a lot of price discrimination, thrifty shoppers buy in bulk when they have sales and use coupons, less thrifty shoppers buy what they want when they want it. Currently everyone is paying pretty much the marked price for what they want, and they are (were) getting maximum traffic per employee for multiple days.

    7. Gerry Quinn

      Aldi upped the price of canned mackerel from 47c to 53c a couple of weeks ago. But I didn’t hold it against them, they are generally low-priced and their prices rarely change. Actually when they want to increase the price of something they have a tendency to get embarassed and take it off the shelves for a bit. (Over the last few years they are tending to add some ‘value-added’ stuff, in contrast to the old cheap Aldi. But that is a separate issue, their good cheap stuff is still good and cheap.)

      (Even at 53c, it’s some damn cheap protein and oil, goes well with rice, any way you like it.)

  5. Purplehermann

    I thought variolation was just infecting people with a lower amount of the virus.
    @TheNybbler pointed out that it is something else, so thanks.

    My earlier post was meant to be purposely infecting people with small amounts of the virus

  6. johan_larson

    Welcome to Hollywood. Your Executive Producer is thoroughly sick of WWII movies, and wants a definitive parody of the genre that will cure all of us of hedgerow-envy forever. When this film has done its work, anyone who makes another movie about the Battle of Britain, Stalingrad, D-Day or Iwo Jima will get nothing but an earful of giggles.

    Describe the film you propose to make.

    1. Nornagest

      I’d say a slapstick farce set in a German prison camp, but that’s just Hogan’s Heroes.

  7. Alexander Turok

    Is there anywhere else where conservatives and nationalists are more likely to make the argument that we can’t shut things for corona down because of the economy? If not, are there any reasons why conservatives and nationalists in America have this opinion? You can identify historical reasons why, for instance, guns are particularly important to American conservatives and nationalists and not important to conservatives and nationalists in many other countries. What I see is that it’s all emanating from Donald Trump. There are minor figures who aren’t Trump fans who are saying similar things, Ann Coulter and John Ioannidis, but I don’t think their ‘arguments’ would be listened to widely if not for people looking for a rationalization for agreeing with Trump. I’m starting to think of Biden as a disease of the skin, Trump as a disease of the heart.

      1. albatross11

        I think acymetric is right, and further I think it’s dumb to spend a lot of energy trying to decide whose team is for each policy. Instead, maybe look for the smartest people making each argument and see how the whole thing holds up?

        The strongest argument for not doing lockdowns is the idea that we may accept all the costs of doing the lockdowns (huge number of unemployed people, whole industries wiped out, a major recession) and still end up with about the same number of deaths as if we’d just said “old and sick people, stay home and get your food delivered; the rest of us will be at work unless we’re too sick to come in.” If that’s how it works out, then shutdowns were a dumb idea.

        Another possible argument for not doing lockdowns is that the economic costs will be so high they’re even worse than the costs in sick and dead and disabled people we’ll get from letting the disease spread. This isn’t crazy to think–imagine if we have a global economic crash that’s worse than the great depression, and end up with 40% unemployment and widespread poverty for the next decade–that would be so horrible you’d want to accept a fair number of deaths up front to avoid it.

        The strongest argument for doing the lockdowns is the idea that we can accept all these costs and actually substantially decrease the number of people who die of this crap. One way for that to work is by spreading out the impact so we don’t have all the hospitals overflowing and all the doctors sick with COVID-19 in the same month. Another way is by actually getting R_0 down below 1 and making the disease disappear. Still another way is by getting the number of infections and rate of spread down enough that the rest of the medical system can catch up and give us, say, rapid tests, workable treatments when we get sick, enough PPE / safe protocols for treating people that keep us from having all our doctors and nurses get sick, maybe even a vaccine.

        Another argument for lockdowns is that if we get a Northern Italy-level meltdown of the medical system, there will be such public demand for lockdowns that they’ll happen anyway. Again, you could argue this, but it seems plausible to me.

        On balance, I’m convinced lockdowns now make sense, and I hope to God everyone is using this time we’re buying at great cost to get ahead of this crap. We can’t stay locked down forever, and we need to be working out how to come out of the lockdowns now. OTOH, for the one state where I know someone peripherally involved in the response, things don’t look good on that front. The person I know has been in on some of the meetings of the people trying to plan a response, she’s the only one in the room with any relevant expertise, and she’s not involved in any of the major decisions. The people making decisions are political/administrative types who know nothing about public health, epidemiology, statistics, virology, etc.

        1. acymetric

          This is a great post, I just want to single out one concern I have (this isn’t directed at you, it’s just a concern I have generally and this gives me a chance to bring it up).

          If that’s how it works out, then shutdowns were a dumb idea.

          The concern here is there isn’t really any way to prove, or even just show strong evidence that the lockdowns were unnecessary after the fact. People who support it now will always just say “well it would have been worse without the lockdowns” and it is going to be hard to disprove that.

          In a vacuum, that isn’t actually a huge concern, but in reality it probably means that we’re going to massively overreact to every new virus that pops up every few years (because they do, and usually they are ultimately no big deal). I guess if we start planning our economy and society at large around this kind of event a couple times a decade it would be fine, but I doubt we’re doing that or that we ever will.

          1. LesHapablap

            Overreaction, panic and ignoring unseen costs seems to be the norm. See: plastic bag bans, human trafficking. The CDC itself has apparently been more concerned with stopping vaping than preparing for pandemics.

          2. matthewravery

            If that’s how it works out, then shutdowns were a dumb idea.

            To push back a bit on this, you can’t argue that “this specific implementation of shutdowns were a bad idea” and then state, in a vacuum, that “do nothing” was a better option because “do nothing” was never a realistic option. The same political and administrative forces that influenced the way we implemented shutdowns would’ve existed if leadership had chosen an alternative plan.

            In whatever hypothetical future autopsy of the US response that you’re doing, you have to present a realistic course of action that could’ve been taken under the same set of constraints that existed in the real world. Otherwise, it’s apples and oranges.

          3. DavidFriedman

            The concern here is there isn’t really any way to prove, or even just show strong evidence that the lockdowns were unnecessary after the fact.

            Proof is a high standard, but if a country reasonably similar to us, such as Sweden, doesn’t have a lock down and does no worse than we do with a lock down, that’s at least evidence.

          4. DavidFriedman

            you have to present a realistic course of action that could’ve been taken under the same set of constraints that existed in the real world.

            Does this qualify?

            1. Ask everyone over 65 to stay home, self isolating from anyone not part of their quarantine. Offer low income people a modest subsidy to help make it possible, provide a free or inexpensive grocery delivery service for them. Perhaps provide free quarantine hotels for the small minority who have no practical way of doing it themselves.

            2. Ask everyone else to avoid large groups, practice social avoidance, wear masks. Perhaps make sure masks are available. If you can’t, make readily available online instructions for home made masks — which seems to have happened.

            3. Wait until everyone under 65 who is going to get the disease has gotten it and recovered (or, much more rarely, died of it). Then stop 1 above.

          5. Purplehermann

            @DavidaFriedman I think you’ll have some difficulty work that, the elderly aren’t great at accepting that they are elderly ime.
            I can think of multiple people right now who are very much at risk, but kind of poo-pooed concerns from multiple people.
            They aren’t flouting the guidelines for non at risk people, but aren’t willing to accept their vulnerability.

            As for limiting large groups, this doesn’t seem to actually slow the virus all that much, and again I am incredulous that the rest of your provisions would work all that well.
            Unless people feel the government is taking things very seriously, they don’t either.
            (In my neighborhood I’ve watched the way people change their behaviour as goverment measures got stricter. Still not perfect, but before the government started getting very serious, social distancing wasn’t really followed.
            I’ve seen this in most of my social circles.)

            3. I assume we would need to be able to do a ton of immune body tests for this

          6. acymetric

            @matthewravery

            To push back a bit on this, you can’t argue that “this specific implementation of shutdowns were a bad idea” and then state, in a vacuum, that “do nothing” was a better option because “do nothing” was never a realistic option.

            That’s true, except that I never said anything about doing nothing and wouldn’t because I certainly don’t think that would be the right approach. There is a lot of middle ground between “shut down everything for 3-6 months” and “do nothing” that could be explored. But I don’t expect anybody to be convinced they were wrong (on either side but especially on the side whose policies are actually being implemented) no matter what evidence is available to suggest they were, which was the point of my post..

          7. MisterA

            Does this qualify?

            Not really, that specific plan is the one that was rejected by the US and UK after initially being their preferred option, after they ran the numbers and realized it doesn’t work.

            In particular, all that stuff about how this mostly only kills old people is only true as long as you have enough ICU units for all the young people who need to be hospitalized. A significant percentage of even people in their 20s and 30s still suffer severe symptoms, but are much likelier to recover if treated- but if they all get sick at once, most of them don’t get treated and they die.

            Sweden does appear willing to run the experiment, though, so I guess we’ll see.

          8. The Nybbler

            A significant percentage of even people in their 20s and 30s still suffer severe symptoms, but are much likelier to recover if treated- but if they all get sick at once, most of them don’t get treated and they die.

            Treated how? What evidence is there of this? Yes, the hospitals will give oxygen and fluids… but do we know that actually helps anything?

            Here’s the New York City data.

            As you can see, this really is age dependent. Not just deaths, but hospitalizations and to a lesser degree symptomatic cases (asymptomatic individuals are not being tested).

            (It’s also worse for men than women, something no one has been talking about)

          9. albatross11

            There are gradations of lockdown. At one extreme, everyone is told to stay in their house except to get groceries or walk dogs. At another extreme, everything is normal but old people and people with chronic conditions are advised to stay home and wash their hands a lot. My guess is that we will spend a lot of time in-between these two extremes, even though right now, we’re more toward the first extreme.

            Before the schools shut down, my workplace was encouraging working from home, allowing very generous sick leave, and explicitly asking workers not to come in if they were sick. They had the janitors going around wiping down doorknobs with disinfectant a couple times a day. I expect that when we go back to work, that will continue, probably for the next year or more.

            A step down from the full lockdown would look like that generally. Schools would be in session, but extracurriculars would be canceled and sick kids would be sent home for a week with a nastygram to the parents. Big public gatherings would still be banned (no SXSW, no academic conferences). Restaurants might be allowed to stay open, but with mandatory daily fever checks for employees and each party seated 6 feet apart from all other parties. Masks and hand sanitizer would proliferate, and every surface would be being sprayed with Lysol or bleach solution as often as anyone could manage to do it. We’d still be having Mass every Sunday, but the archbishop would give a dispensation to anyone who felt it wasn’t safe for them to attend in person, nobody would be shaking or holding hands, and we’d all try to sit further apart. Basically the stuff that was happening in the week or two before the shutdowns happened.

            What’s the difference in R_0 between those different policiies? Probably pretty substantial–closing down the schools and most workplaces probably matters a huge amount. But determining how this will fall out is basically an exercise in mathematical modeling, and there’s no way to actually know without running the experiment.

          10. matthewravery

            @acymetric-

            Apologies, I didn’t mean to imply that you were advocating a specific policy. “No intervention” was a generic alternative I’ve seen thrown out. My point was that, whatever the alternative suggested, the analysis needs to occur within the same set of constraints as the actually-implemented option was.

            I consistently see throughout SSC discussions of COVID a desire to simplify the modeling/decision-making by convenient assumptions about implementation, time effects, and path dependence. (Typically, they’re ignored.) As we criticize the choices made by various agencies and governments, we should at least bear these in mind as limitations they face that may not be readily apparent to armchair epidemiologists.

    1. MisterA

      I am curious to see what happens now that Trump is on TV saying we need to keep everything shut down or else millions of people will die.

    2. EchoChaos

      Is there anywhere else where conservatives and nationalists are more likely to make the argument that we can’t shut things for corona down because of the economy?

      You’re conflating two groups. Centrist and center-right conservatives are likely to make this argument. They’re attuned to the economy, more likely to be working class (and hence hit hard by this), and more about GDP.

      Nationalists are calling for locking everything down and crushing the disease, GDP be damned.

    3. LesHapablap

      The coronavirus thing about the economy maps directly onto climate change debates. But I agree with acymetric, at this point it is definitely not just conservatives and nationalists. I am seeing many op-eds in newspapers all over the place by epidemiologists calling the lockdowns an overreaction. And politicizing this decision by making this an us vs. them issue would be a disaster.

      1. Gerry Quinn

        An over-reaction is a win for the radicals, ultimately.

        (That’s just a general observation. I really feel like I don’t have a horse in this game. I mean I do obviously, insofar as I am a horse. But politically… it’s really getting time for a Revolution, isn’t it?)

    4. Drew

      The basic debate in politics looks like: “There’s a problem, and I have a plan to fix it! We must act!” vs “No, that plan is flawed, or not nearly as cost-effective as you’d think.”

      Over time, people form mental habits. The current situation seems to follow from those habits. People who think that we need major government intervention in [x] also think we need intervention here. The people who think that the interventions proposed for [x] are going to be ineffective and costly think that the lockdowns will be ineffective and costly.

      1. Nornagest

        Any given topic is pretty likely to look like that, but I’m not sure responses to different topics correlate all that well. For example, the right’s on the “something must be done!” side on immigration reform, while the left’s on that side on healthcare reform.

    5. Wrong Species

      If you shut down the economy for one day, we can obviously handle it. If you shut it down forever, that’s just not going to work. My guess is that after about two-three months, the balance tips towards it not being worth the effort. But surely this is the kind of thing where advanced economic models could help decision making.

      I don’t want millions of people to die in a pandemic. But you don’t want be paralyzed by fear. What kind of society is that?

      1. Clutzy

        My estimation would be similar. After 2 months of lockdown each additional month would, in my estimation, kill more people than C19 ever could if people just generally changed their habits to cleanliness and mask wearing and maybe the avoidance of 100+ gatherings.

        1. keaswaran

          Is there any evidence that would be relevant to this belief about particular months of lockdown? This seems quite plausible if two months of lockdown manage to get the infection rate back to what it was in late February, and we have testing and contact tracing capacity to keep it there. But if we don’t have that capacity, then we might just alternate between two months on lockdown and one month off.

          1. Clutzy

            Its just my general sense. Even the kind of cycling you are talking about would still kill a lot of people from lockdown-related deaths. Some studies I’ve seen is that we could be at 30% unemployment. Some estimates say that would be over a million extra deaths annually.

    6. Radu Floricica

      I’m completely disconnected from US public discourse right now, except from SSC, but I want to register a prediction: Haidt’s moral foundation theory would say that most democrats/left favor lockdown because they’re focused on possible victims to the exclusion of anything else. A small minority will grumble at having to obey rules, but won’t be openly against the lockdown per se. The rest of the world will be split – only the left is more or less monochrome on the issue.

      1. acymetric

        I don’t think support from Democrats is nearly as universal as you think it is. Consider which economic groups generally lean toward which parties, and then consider which economic group is most impacted (short term, at least) by being out of work because their work can’t be done remotely.

        1. Matt M

          This should be a thing, but it doesn’t seem to be.

          As far as I can tell, the official Democrat position is that the lockdowns won’t actually harm lower-income/vulnerable populations, because the government can just give them stimulus checks and unemployment which will totally make them whole for all this. And if that doesn’t happen, it’s only because Republicans stopped it from happening.

          1. acymetric

            That’s the official position of the party, not necessarily the position of the people. The Democratic party is clearly all in on lock downs. I’m fairly certain there is a sizable segment of their base (though not a majority) that is not on board with it.

            Democrat leaders love taking support from their traditionally strong demographics for granted, so this wouldn’t be terribly surprising.

          2. Matt M

            My read is that working class Dems are currently trusting that this will work out the way their leaders are claiming – that the government will make them whole.

            Now, when weeks/months pass and it turns out that it doesn’t work out that way, they may change their minds. Or they may believe whatever they hear on the news, which will almost certainly be something like “Pelosi and Biden favored a massive stimulus bill that would have helped you, but Trump and the GOP blocked it.”

        1. Radu Floricica

          The left in unique in being all about caring about vulnerable people, with a spot of independence thrown in. Not sure if it’s a new thing historically or there was always a minority behaving that way.

          Theory says the right has more things it cares about. They care about other people, of course, but they can also understand the need to follow authority, or the idea of some things being sacred, or fairness, or loyalty. It’s more difficult to predict which one surfaces in a certain situation, so I doubt one in particular will dominate, or even two.

      2. Matt M

        I think this is right. Among the people I know in the US, everyone I know on the left is completely and totally in favor of the lockdowns, without any hesitation whatsoever.

        On the right I think it’s about evenly split into thirds: One third completely in favor of lockdowns, one third opposed, and one third that is, let’s say, “cautiously obedient” (as in, they aren’t really sure what’s best but will lean towards lockdowns).

        1. EchoChaos

          I hope this doesn’t sound uncharitable, but my feeling is that if it was a left-wing President whose economy was at risk during an election year, the left would be less unanimously in favor of lockdowns.

          If you look at localities by ideology, the left-wing areas, especially New York, were very slow to lock down relative to the right-wing ones.

          1. keaswaran

            “If you look at localities by ideology, the left-wing areas, especially New York, were very slow to lock down relative to the right-wing ones.”

            This doesn’t seem accurate. If we look at the 15 states that still haven’t issued lockdown orders, 11 of them are solid red states, with only Iowa and Florida (as purple states) and Georgia and Texas (as reddish-purple states) being counterexamples. Out of the 35 states that have issued lockdown orders, only 9 of them didn’t vote for Obama (Alaska, Idaho, Montana, Arizona, Kansas, Louisiana, Kentucky, Tennessee, West Virginia – and I believe here, Arizona was late, and Louisiana has been particularly hard-hit so may have acted faster than its politics would otherwise suggest).

            https://www.businessinsider.com/us-map-stay-at-home-orders-lockdowns-2020-3

          2. matthewravery

            As of today, NY, NJ, Louisiana, and Mississippi look to be among the least forward-looking, while CA, OH, and Washington are looking like they did a relatively good job.

            I think you have to squint really hard to see a pattern based purely on political leaning.

          3. EchoChaos

            @keaswaran

            Thank you for the update. This is a good look at it.

            I will correct my priors here.

            And note that Louisiana is one of the few Southern states with a Democrat governor, although very right-wing for a Democrat.

          1. Conrad Honcho

            Three easy payments of $19.95?

            If the hospital system is overwhelmed, the economy is screwed anyway. So I’m fine with locking down for another few weeks. But after that we’ve had plenty of time to prepare and the cure gets worse than the disease.

            Also, my quality of life has improved. My job is in zero danger from this, I’m working from home, getting paid and basically living in my gameroom. It’s like I’ve died and gone to heaven.

          2. acymetric

            So I’m fine with locking down for another few weeks.

            Bad news, it isn’t just going to be another few weeks.

          3. Matt M

            Bad news, it isn’t just going to be another few weeks.

            Yeah, I suspect this is what will ultimately shift a lot of Republican opinion.

            Trump originally said “15 days.” Then when the 15 days is up, he said “whoops, another 30.” At the end of April when he comes out and says “did I say 30? I meant 90!” I think a whole lot of the “cautiously obedient” camp is going to convert to “opposed” which might cause him to re-think his position.

          4. Conrad Honcho

            Yes, if that happens, I will then change my opinion. That’s the “cautiously” part of “cautiously obedient.” Temporary lockdown is okay, indefinite is not. If at the beginning of May the lockdowns haven’t helped and we’re still seeing exponential growth, then fuck it: we’re going to be dealing with the illness anyway, we might as well not (further) crash the economy at the same time.

          5. albatross11

            Even when the full lockdowns stop, it’s going to make sense to have as many people as possible working from home. That’s part of lowering R_0, which we’ll want to keep doing until everyone is immune because they’ve had this crap or been vaccinated for it.

          6. Gerry Quinn

            Ditto. Let’s give it the old-school try, but if it doesn’t work we have to take another strategy.

        2. acymetric

          Obviously we’re in different bubbles, so I can’t claim my sample is any more representative than yours, but I’m pretty far left and I’m not in favor of the lockdowns (except for the part where I get to work from home, which I wish would last forever).

          I also have a lot of friends, family, and general acquaintances in the service industry who are definitely not Republicans and also do not like the lockdowns (for presumably obvious reasons).

          1. Matt M

            I also have a lot of friends, family, and general acquaintances in the service industry who are definitely not Republicans and also do not like the lockdowns

            Interesting. Most of my family is “working class Democrat” and they seem totally in favor of the lockdowns (for the reasons I’ve described above, they trust that the government will compensate them for any economic harm they suffer)

          2. acymetric

            Could be a matter of how much someone trusts the government…maybe an age thing? The people I know here definitely skew younger (early to mid twenties), except a few bartenders who are my age or older.

            Quite a few people I know (who are out of work, not the folks who are essential or who can work from home) are already working on what they need to do to break their lease in the next couple months. Pretty sure they’re not expecting the government to make them whole.

          3. AliceToBob

            Could be a matter of how much someone trusts the government…maybe an age thing?

            This is my (limited) experience too + what Matt M is suggesting. Older conservatives I know are scared and enthusiastically for the lockdown. Friends in a similar age range as me are typically left-leaning and trusting of their governments (not all in the US), and they are also in favor.

        3. Jaskologist

          I think the primary predictor of lockdown support is whether or not it will cost you your job.

          The most visible part of the left is the “extremely online” portion, which is also the part most likely to be able to work from home. (Note that this is not necessarily representative of “the left” in general.)

          Trump’s base is the working class, whose jobs are much more at risk. No surprise that he’s more attuned to the downsides of lockdown.

    7. AlesZiegler

      I think that this is essentially libertarian position (which does not mean that all libertarians hold it, of course), so whenever you see political faction that is a mix of conservativish and libertarianish views, as opposed to National front style conservatism, they tend to make that argument. And it happens a lot in Europe as well as in the US. You are probably familiar with Britain, but also Germany under Merkel was honestly quite slow in imposing lockdown. Also Netherlands.

      But left wing governments in Europe were also slow in imposing lockdowns.

      US seems different since Trump was elected as an epitome of nationalist conservatism. But I do not think he really subscribes to that ideology, or any other ideology. This normally does not matter too much, since politicians including him tend to pursue platforms on which they were elected, but it matters in this freak event. Reaction on it was not part of his platform.

      1. Conrad Honcho

        But I do not think he really subscribes to that ideology, or any other ideology.

        This. Trump is not an ideologue. He is a pragmatist. When he thought things would be “better” without shutting down the economy he was cheering on the stock market. When he thought things would be worse without a lockdown, we got the lockdowns.

    8. eric23

      I suspect you will see this in countries with a conservative leader who has been proactive, like India or Israel.

  8. DavidFriedman

    It looks as though the CDC is gradually shifting its position from “face masks are useless and ordinary people shouldn’t wear them” to “everyone should wear them.”

    If that happens, what are the consequences for the CDC? In a very different society one can imagine the people responsible for the initial advice committing suicide from the shame of admitting that they had been contributing to the problem instead of reducing it. In another sort of different society, one can imagine them explaining that their original advice was a noble lie, intended to save masks for medical personnel — although that runs into the obvious objection that lots of people could make masks for themselves if advised to do so.

    In our society, can a high level bureaucrat admit very serious misdeeds, and if so how? As far as I know, Isaac Ehrlich (not a bureaucrat, but a high profile figure) has never admitted that what he wrote in The Population Bomb was wildly wrong. It seems to be now pretty widely recognized that the diabolic child abuse cases were modern witch hunts, convicting innocent people of imaginary crimes, but have any of the prosecutors responsible resigned their offices and attempted to compensate the victims?

    Some people, such as Trump, are pretty clearly shameless, but it sometimes feels as though everybody is.

    1. Skeptic

      Cynical take:

      There will never be any specific person or persons that actually take the blame. We will never know the names of any of the actual decision makers, ever. In the US the status of the CDC is and will remain independent of being correct or even remotely successful at fighting/preventing a pandemic.

      1. Matt M

        This. It seems like “inside sources” have already conceded to mainstream journalists that the “masks don’t work” thing was a noble lie. That’s the most contrition we’re ever going to see. No specific individual is ever going to admit it publicly. It’ll just be one of those things that everyone knows.

    2. Kaitian

      I guess they could argue that the situation has changed: masks are not useful when they’re sold out and ten per million people are infected, but they’re helpful when many masks are available and infection rates are higher.

      They could also argue that their available information has changed, and the new evidence has convinced them that masks are more useful for this virus than they thought.

      I don’t know if either of these things are true (though I think they’re more likely than “we have decided to stop lying for no reason”). But they’re certainly explanations they could use.

      In my experience, it is very rare for people to admit they were wrong. Generally they make excuses. I can’t tell if they’re just trying to save face, or if they’re honestly holding on to the belief that their intentions and general theories were correct, even if they may have produced a non optimal result.

      I don’t think CDC officials committing ritual suicide or engaging in some other public self flagellation will improve the situation in any way. The best thing they could do right now is to publish a good explanation of why their recommendation has changed. Then again, maybe most people would only be confused by that, and public health would benefit more from just giving clear guidelines without any caveats about how they came to design that guideline.

      1. Purplehermann

        Au contraire, suicide in case of horrible failure in public offices would put a strong incentive on competent policies, as well as making people trust the CDC more (“whoa, they take failure seriously”)

      2. LesHapablap

        If people don’t admit their mistakes they are doomed to repeat them. If you had a coworker that wouldn’t admit when they screwed up, what would you think of them?

      3. DavidFriedman

        To take a real world example, the failure of most of the people who, fifty years ago, were confidently predicting that unless something drastic were done about population increase it would have terrible effects to publicly admit that they were wrong and their critics were right is one of the reasons I don’t trust similarly authoritative claims about climate today.

        Sowell makes a similar point with regard to the fact that legalized abortion and widely available contraception were followed by the precise opposite of the effect, reducing the number of children born to unmarried mothers, that supporters of those changes predicted in arguing for them.

        1. Adrian

          Two counterpoints:

          1) Regarding overpopulation: That problem has been solved (at least in the developed world) essentially as a second-order effect from technological progress. I don’t think we should rely on climate change being automatically solved by some other, indirectly related process – most problems aren’t.

          Note: In the past, some environmental problems have been solved through technological progress, but only after and because a lot of people made a big fuzz about them, and regulators took action. E.g., CFCs.

          2) Regarding birth control: Group A making incorrect predictions about large-scale human behavior from intuition-based arguments should not influence your opinion about whether group B makes correct predictions about large-scale non-human systems from science-based models. Your argument boils down to “some guys were wrong about something for some reasons, so these other, unrelated guys are probably wrong about this other, unrelated thing for other, unrelated reasons”.

          1. DavidFriedman

            Your argument boils down to “some guys were wrong about something for some reasons, so these other, unrelated guys are probably wrong about this other, unrelated thing for other, unrelated reasons”.

            They aren’t unrelated. In a general sense they are the same guys — the NYT, lots of high visibility academics and pundits. In some cases literally the same guys.

            Obviously it is possible that this time they are right. But almost all of us judge such things on second hand information rather than evaluating the evidence for ourselves. For most people, the reason to believe climate is a very serious threat is that lots of high status people say, with great confidence, that it is.

            The fact that the same was true in the population case and what happened was the opposite of their predictions, things getting better in poor countries with growing populations instead of worse, is a reason to give little weight to that particular reason for belief. The further fact that the people who were wrong about that are mostly not saying so, apologizing, trying to figure out how so many of them were so confident in a false belief, is evidence that believing the truth is not a high priority for them — almost certainly a lower priority than believing things that let them feel good about themselves and fit in with the people who matter to them. That’s a further reason to discount their claims.

            So far as the substantive similarity between the two issues, both hinge on the same mistake. You have a change that has both large negative and large positive effects, both spread out over a long and uncertain future, hence of quite uncertain size. You look for the negative effects, make generous estimates of them, don’t look for positive effects and when you come across any make conservative estimates. You conclude that the net is large and negative.

            I raised that issue in the population case almost fifty years ago. When the climate case came around I looked sufficiently carefully at the arguments to conclude that the same thing was happening.

            This is a webbed talk I gave on the problem common to both. If curious about the details of my views on climate, you can find lots of them on my blog.

    3. The Nybbler

      There will be no consequences for the CDC or the FDA for their errors. The FDA continues to do the minimum regulation relaxation necessary to make it look while they are being flexible, while really not — e.g. they’re allowing NIOSH non-FDA N95 masks and masks meeting certain foreign mask standards, but not KN95 (which is pretty much the same). They’re allowing antibody testing, but only in clinical settings. They’re approving prescription of hydroxychloroquine, but only in hospitals (so it doesn’t override governors’ decrees against such prescription). They allowed hydrogen peroxide vapor sterilization of PPE, but limited it to 10,000 per day. That pissed off the Governor of Ohio who apparently went to Trump to get it relaxed. The FDA will continue doing this, because that’s what it does. That’s what a safety culture is all about: limit all possible risks of your actions and of actions you approve. Risks of not approving? Not your problem, unless Trump decides to come down and go all “The Apprentice” on regulators… but even then, the courts probably will have their backs.

      1. Purplehermann

        Why does that show “pretty much the same thing” ?(kn95 vs n95)

        There is more leakage. Is the difference unimportant?

        1. Evan Þ

          How do kn95 masks compare to bandanas?

          They’re better than the alternative currently being used, so they should be approved.

          1. Purplehermann

            Less of this please.

            My question wasn’t about whether to approve them, it was about why it is being called “pretty much the same” when a field in the document has the kn95s at a different spec (and it seems relevant).

            Approving things as A-grade products willy nilly is a bad idea in general. The reason they aren’t being used instead of surgical masks is that they are more expensive (and legally are the same thing).

        2. The Nybbler

          There isn’t more leakage. There’s no leakage requirement for the N95 mask, which is why it’s N/A in that table.

          1. Purplehermann

            I understand that there is more leakage, N95 masks have <=5% or something like that (Scott's article on masks has a link to studies on leakage).

            Is leakage unimportant in regards to corona?

          2. The Nybbler

            I repeat: there isn’t a leakage requirement for N95 masks (there is for the exhalation valve, but presumably we’re interested in masks without such). That’s why the column is N/A in 3Ms chart. Scott’s studies compared either N95 or FFP2 (a European standard) masks with surgical masks; KN95 masks were not included.

          3. Purplehermann

            I understood what you wrote.

            Scott brought specs for leakage. There is less leakage in the specs for N95 than the specs for the KN95 (shown in 3M)
            I am contradicting your assertion that there isn’t more leakage.

            Is leakage unimportant?
            I am asking a question about leakage, and whether it is irrelevant from a medical standpoint

          4. The Nybbler

            Scott brought specs for leakage. There is less leakage in the specs for N95 than the specs for the KN95 (shown in 3M)

            I am contradicting your assertion that there isn’t more leakage.

            Scott did not bring specs for leakage. He brought studies of leakage, for N95 (and not all N95 maks, but particular N95 masks) but no KN95 masks, and likely not in the same conditions as the tests used for the KN95 tests. In fact, if you look at the numbers, they’re all over the place, probably because of different conditions used in the different studies.

            If you’re working off Scott’s data, you have no studies for KN95 masks. There is no spec for N95 masks. Therefore you have no basis for comparing the two on leakage.

          5. Purplehermann

            Huh, didn’t realize specs and studies can’t be compared.

            Could you explain why? Intuitively I would think they would be pretty similar

            [Edit: I assumed until now that to qualify for a spec a mask would go under a few different tests in different situations, similar to the studies scott brought. That is, that the studies scott brought let us know the practical specs of the mask.]

          6. John Schilling

            Huh, didn’t realize specs and studies can’t be compared.

            Could you explain why? Intuitively I would think they would be pretty similar

            A specification is a minimum (or, depending on context, a maximum). The performance of real systems is typically better than spec, often much better. Performance is what you usually get off the production line. Specification, is how bad it has to be for you to throw it in the trash as it comes off the production line, and nobody likes to throw half their output in the trash because it failed to meet spec.

            If you’re comparing two things made to different specifications, noting that Specification A is tighter than Specification B is evidence but not proof that A will work better than B. But if all you know is that the measured performance of A is tighter than the specified requirement for B, your case is particularly weak because B is certainly better than specified by some margin and you don’t know what that margin is.

            And, in my experience, various forms of “leakiness” are one of the places where specified requirements and actual performance are often widely different.

      2. Deiseach

        They’re approving prescription of hydroxychloroquine, but only in hospitals

        Why is this a bad thing? We’ve already had one person at least in this entire thread complaining about Trump recklessly encouraging people to drink fish tank cleaner by careless words in a public speech and from what I’m reading, this is the kind of drug that is “okay at right dosage, very bad for you at wrong dosage, and the line between right and wrong is hair-thin” so being prescribed under medical supervision should in theory prevent “tragic deaths of couple who thought this was okay to take this drug”?

        At the very least, you’d hope that “this is a drug that can only be obtained from hospital doctors” will stop any more people from taking whatever chemicals they have lying around at home.

        1. The Nybbler

          Why is this a bad thing?

          That sort of depends on if it works or not. If it works, the governors and regulatory agencies are denying people life-saving medicine out of pure bureaucratic conservatism. If it doesn’t work the point is moot.

          At the very least, you’d hope that “this is a drug that can only be obtained from hospital doctors” will stop any more people from taking whatever chemicals they have lying around at home.

          The FDA order has no effect on fishtank chemicals (which are apparently in short supply anyway)

        2. Theodoric

          It’s still a prescription drug, so it would be still be “prescribed under medical supervision” if someone not hospitalized took it; the supervision would just be by their regular doctor or an urgent care doctor or something.

          1. albatross11

            If hospitals are overwhelmed, you’d like to allow doctors to prescribe something to their patients who likely have COVID-19 infections, so the not-super-sick patients can be treated at home. Ideally, there’d be enough of the drug to put people on it when they got flu-like symptoms, and maybe head off the pneumonia.

    4. JayT

      So, I’m now convinced to wear a mask when I go out to the store. All I have at home are N95 masks that my wife (who is immunocompromised) uses when she has to go out. So my question is, should I go ahead and use one of those, or should I save my small supply for my wife? I don’t really have any other options other than maybe using a scarf or something. Also, if I use the N95, do I need to shave off my beard for it to help, or would it still do as much as something like a surgeon’s mask even if I have a beard?

      1. HowardHolmes

        This is a question? Of course, save them for your wife! Use a bandana until supplies are available.

      2. Purplehermann

        If it’s an option I would stop leaving the house.

        If the supply is large enough that you can just not walk outside without a mask that would be best imo.

        What happens if you run out? Why is she leaving the house? These are all questions you have to ask.

        Just take into account that if you get it, there’s a high chance she gets it

      3. Edward Scizorhands

        Is your wife going to have to go out for some reason?

        Remember that saving yourself from being infected is saving your wife. If you use the N95 use it right.

      4. JayT

        The only reason my wife goes out is for doctor appointments, which is every other week. The only other reason I’ve gone out is for groceries, so I’m going out about once a week.

        How long can you wear an N95 before it’s no longer helping?

        1. Evan Þ

          Any reason you’re going out for groceries every week? If you’re limiting your trips that much, I think it’s worth it to buy larger quantities or get delivery.

          1. Edward Scizorhands

            When I hear “going out for groceries once a week” I think “good job getting it down to so infrequently.”

          2. JayT

            I normally go to the grocery store like five times a week, so buying large amounts of groceries is something I’m still perfecting. I’m trying to get it down even lower, but there will still be times that I need to go to pick up prescriptions.

        2. Lambert

          Given that the normal use case is protecting against a large amount of mildly dangerous particulates/contaminants, it should be able to deal with normal air for quite a long time.

          Don’t take my word for it, but I’d expect them to fail from age or becoming infested with unrelated microbes. In a dusty environment, they will eventually clog up but I don’t see that happening fast if at the shops/in the street.

        3. Radu Floricica

          How long can you wear an N95 before it’s no longer helping?

          Many resources for reusing masks online. But in my experience: I’ve been using them woodworking to keep out fine dust, and I’ve been basically treating them as completely reusable. Used them until they were too filthy or we got a new one.

          In current scenario, you want to treat them as “dirty” simply because you went out of the house wearing them – just like you should treat your jacket or wallet. I think leaving them sitting for 1-2 days should be more than enough, given they’re closer to cardboard than plastic.

          1. JayT

            This is actually the same reason I had the N95 masks to begin with, and I’ve always used them until they were filthy. However, when I’m trying to keep sawdust out of my nose I’m not looking for 100% filtration, just better than nothing.
            It does sound like if I use a mask for an hour or so once a week that it should last a while.

      5. DavidFriedman

        You don’t say how small your supply is. Can you use a mask then leave it somewhere, perhaps your car, for three or four days, then you and your wife uses it again?

        1. Evan Þ

          Do you have citations for that delay effectively disinfecting a mask? It’s about to be personally relevant for me this evening.

          1. DavidFriedman

            I have citations for the claim that the virus falls to undetectable levels on most surfaces, such as plastic and metal, in three days, on some surfaces, such as cardboard, on one day. I don’t have citations specifically for masks.

            I also have (i.e. have seen) citations for the claim that 70°C for half an hour will destroy the virus — I don’t know whether that would also damage your mask. Also that washing with either soap or dilute bleach will destroy the virus — again I don’t know how practical that is for your mask.

            I’ve been using the three day rule for packages and mail, one day for packages that are all cardboard.

        2. JayT

          I only have three right now, and my wife has only used one so far. She’s used that one twice. If they can be used for a long-ish amount of time, then I would feel better about using one of them and letting my wife have the other two. If they only last for a couple uses, then I would be more likely to leave them for my wife.

          1. albatross11

            I’d reserve one for you to use while shopping, and the others for her to use.

            There are guides to disinfecting the masks in various places, but I don’t know how well nailed down they are. I’ve heard that 30 minutes in a 70 degree C oven (around 160 F) will sterilize them without damaging them, but I don’t know whether this is solid or not.

    5. Doctor Mist

      Correction: I think you mean Paul Ehrlich. Isaac Ehrlich was a bureaucrat, for a time, but he did not write The Population Bomb.

    6. Andrew Hunter

      I mean, I think you know the answer to this, but no, of course not. The systems are specifically designed to perpetuate themselves and the people behind them; to the extent they do anything of their own purpose (stop diseases, etc) it’s coincidental.

      I think we’re waiting for the federal government to entirely collapse before anything meaningful changes.

    7. Corey

      How sure are we all that it *was* a noble lie, and not just conventional wisdom + not many infected people + not thinking asymptomatic spreading would be as common as we now think?

      1. DavidFriedman

        I’m not sure it was a noble lie — Scott in his post argued that it wasn’t, since the CDC took that position pre-Corona. More likely conservatism and bureaucratic irresponsibility. They didn’t want to say masks did help since it wasn’t clear how much help they were, so they said they didn’t.

        1. albatross11

          I’m sure it wasn’t–this was guidance that was given out long before this crisis, and was echoed by the TWIV hosts. They’re doing an academic virology podcast, and it’s hard to believe they’re worried about perpetuating noble lies. Further, they were saying masks didn’t help long before there was any concern about a mask shortage during a pandemic here in the US.

    8. rahien.din

      There won’t be consequences. That is exactly the way we want it.

      We find ourselves in a state of incomplete information. The only way to get the information we need is to observe failure modes. If we want to avert disaster, we are forced to act without complete information. And if we succeed, we will remain uncertain as to what actions were worth taking, because we can’t weight for unobservable failure modes.

      The only way to be correct is to take action despite incomplete information, despite the fact that some of your actions will be – all your actions could be – dead wrong. That can resemble incompetence, and you can still fail, but it’s the only pathway on which success is possible.

      Incompetence is being unwilling to act in the face of uncertainty. If we punish people for the natural outcomes of action under uncertainty, and subsequently no one is willing to act under uncertainty, then we have incentivized incompetence.

      Even claiming “The CDC messed up on X decision” – very clearly fair – an organization can only learn if it is allowed to persist.

    9. 10240

      In a very different society one can imagine the people responsible for the initial advice committing suicide from the shame of admitting that they had been contributing to the problem instead of reducing it.

      Of course one effect of such a custom would be that they would be even more reluctant to ever admit that they have been wrong.

      1. AG

        Yep. Aren’t we in “if the punishment for burglary is death, and the punishment for treason is death” territory here? If we executed anyone who ever declared allegiance to the enemy, why would they ever defect?

        In situations where we can easily replace the people in charge, then a “kill the failures” approach works. However, we’re in an era where everyone in charge of anything, public or private, is too big to fail, and the process of booting the old guy, vetting the new guy, and then onboarding the new guy is far too onerous, especially during a time of crisis. (This is, after all, why Trump loves him those acting director appointments.)

        1. Mary

          No. Because observing that that death penalty would be better than done does not force us to impose the death penalty.

          Albeit when it is morally certain that lying to us killed people, the penalty had better be severe.

          1. AG

            I should clarify that I don’t literally mean a death penalty. Given that the consequences people felt most strongly about in this forum for years was often about getting cancelled (Brendan Eich), it seems that simply getting fired or resigned is already too severe an incentive. So, the people in power just dig in and use confirmation bias after the fact and claim that they were vindicated, amongst complex results, as we’re seeing with the recent praise for Cuomo.

            Saying that Cuomo should resign if he changes his mind does not incentivize Cuomo to change his mind. Being able to easily boot Cuomo out of office and onboard a new guy is undemocratic, but might get someone with the opposite stance as Cuomo into power more easily. Or, alternatively, we offer incentives so that Cuomo benefits if he responds to evidence quickly.

      2. DavidFriedman

        I’m suggesting shame leading to suicide, not a death penalty. That only requires that the person responsible realizes what he has done — at which point admitting it and then killing himself, or retiring to a monastery, or … is what his conscience requires.

        1. The Nybbler

          This selects for both people with no conscience and people who will never admit to themselves they are wrong.

        2. 10240

          I interpreted shame as distinct from guilt, triggered only if the fact that the person failed becomes public consensus.

    10. matthewravery

      You seem to be presupposing that changing these recommendations implies a massive screw-up. What if it’s a minor screw-up? What if the difference in public health under the condition of “No one wear masks” is a rounding error worse than under “Everyone wear masks”?* If this is the case, then the CDC should still make the change in recommendations, and your question is nonsense.

      *This is perfectly plausible. For example, perhaps masks have a marginal effect on transmission when worn by the general public and also reduce stocks available to medical professionals, for whom they make a big difference. In this case, a small difference in the relative rates and availability of masks could lead to different recommendations while have a small net effect.

      1. albatross11

        This. I think there’s good reason to use masks, and to encourage their widespread use, but I’m not at all sure this is going to have a huge effect. If aerosol transmission is important, bandanas/surgical masks are probably better than nothing, but not great. If it’s mainly surface contamination, then the only thing a mask does for you is make it harder to absentmindedly chew on a fingernail while riding the subway. If it’s mainly close contact, then they may help some but the better answer is to move further away from your neighbors.

        1. Conrad Honcho

          If it’s mainly close contact, then they may help some but the better answer is to move further away from your neighbors.

          Seeing people wearing masks is also a reminder to move further away from them and others?

    11. pjs

      Masks have not been proven in published, peer-reviewed, randomized controlled trials to be useful for COVID-19 _specifically_. And the idea that one can rely on masks to keep safe from COVID-19 is without firm scientific support and is probably wrong anyway, if not dangerous. Therefore false: “we should consider wearing masks”.

      That seems to be a common schema for the media’s ‘debunking’ argument that is being trotted out for pretty much everything these days. And it works just as well for masks as anything else. CDC can borrow this popular line of reasoning.

  9. Le Maistre Chat

    How bad do y’all think the market will get in Q2?
    How low will the S&P go before it’s time to passively invest in it again? What bond ETF should I be in given the behavior the Fed/Treasury is pursuing for the pandemic?

    1. Matt M

      I’m really having a hard time understanding why the market isn’t absolutely cratering right now. My model of how things work must be way off, because I’m hearing stuff like “Goldman Sachs forecasts 2nd quarter GDP growth of -25%” and meanwhile the stock market is acting as if it’s just a slightly unimpressive quarterly forecast or something.

      I’m still waiting for SPY to drop below 150, but at this point I have no idea if/when that’s going to happen.

      1. Le Maistre Chat

        I’m still waiting for SPY to drop below 150, but at this point I have no idea if/when that’s going to happen.

        SPY 150 = S&P 500 craters to 1500 from this evening’s 2587?
        I’m as baffled as you are. I would think the efficient market would be cratering that much while only select stocks like AMZN and the majority of the dividend aristocrats rally.

      2. Conrad Honcho

        This. I opened my eTrade account and put in some money, but I’m waiting to buy anything because I’m expecting a massive crash. I don’t understand how people aren’t jumping off of skyscrapers when you hear “the US economy is going to contract by a quarter.”

        1. The Nybbler

          I don’t understand how people aren’t jumping off of skyscrapers when you hear “the US economy is going to contract by a quarter.”

          I work in a skyscraper full of finance people. I suspect most of them are just too depressed to get past security to the roof.

          1. albatross11

            See, this is where the obesity epidemic pays off for us. The only way to the roof is via the stairs….

        2. baconbits9

          This. I opened my eTrade account and put in some money, but I’m waiting to buy anything because I’m expecting a massive crash. I don’t understand how people aren’t jumping off of skyscrapers when you hear “the US economy is going to contract by a quarter.”

          Because the medium expectation right now is that the US economy has a V shaped recovery and fills that gap back in less than 3 quarters. From an earnings standpoint 3 months loss of revenue is huge, but if it is all back in 9 months then you are just looking at 1/30th-1/40th of a companies 10 year revenue. Even with some steep discounting you shouldn’t get to much more than a 20-25% draw-down in prices.

          1. Conrad Honcho

            I’m just mad I didn’t buy Disney when it was in the low $80s. Now it’s back up almost at a $100. Crash again you damn rat!

        3. Chalid

          It’s not going to contract by a quarter. The 24% (revised to 34% actually) number is annualized.

          1. Chalid

            The numbers are “annualized” which means they are is the amount of GDP loss you would get if that rate of contraction was sustained for a whole year. But this contraction is only happening for one quarter.

            (1-0.34)^0.25 ~ 0.9 so a 34% annualized decline translates into about a 10% drop in actual production going from Q1 to Q2.

      3. Alexander Turok

        Did you forget that the market has already tanked? That expectation is priced in. Time to buy is now.

        [Full disclosure: I bought during the downslide and have lost money.]

          1. baconbits9

            The lows have little to do with the news directly, the absolute lows were largely forced selling from margin calls etc, almost every crash looks similar to this with a sharp downward spike, a bounce and then another decline.

          2. acymetric

            I think a lot of investors were predicting similar things privately even if it wasn’t a prediction openly being made by experts yet.

            I wasn’t predicting unemployment that high, but I did think the GDP would do worse than that.

          3. baconbits9

            I think a lot of investors were predicting similar things privately even if it wasn’t a prediction openly being made by experts yet.

            You don’t even need those predictions to exist, uncertainty will drive down markets pretty heavily. In some cases 30% UE and -25% of GDP is better than ‘who the eff knows what will happen’.

        1. Chalid

          I’m definitely not an efficient markets purist but I think it’s fair to say that the easy money opportunities are gone.

          Six weeks ago you had a huge information edge if you were just aware of coronavirus and realized it was going to be a big deal, and there were lots of ways to turn that edge into money.

          Now, everyone in the market is thinking hard about coronavirus, probably harder than you are. There’s not much reason to think your opinions on the epidemic are better than the market’s now.

        1. baconbits9

          I have heard this and I find it…. dubious at best, or at least weak in explanatory power. If re-balancing was a major cause then you would have large funds selling bonds and buying stocks, which would mean bonds should be taking a hit. As it stands bonds have been flat or up across the board (treasuries, junk, investment grade) while the rally went on.

      4. Mark V Anderson

        I’m really having a hard time understanding why the market isn’t absolutely cratering right now.

        Whereas I am having a hard time understanding why it has gone down so much. This us a temporary contraction — it is 100% related to the virus. Yes, the virus will be affecting us for a year or two, but presumably less so as time goes on as the world gets a handle on how to handle this thing. Stock prices are based on discounted cash flows, and there is no reason cash flow will be lower two years from now. It is now time to buy.

        1. baconbits9

          If that is your view then it seems hard to accept that the S&P was properly valued prior to the crisis. P/E ratio for the S&P was over 23, well above the historical average, the market cap of various indexes to GDP was at all time highs, and corporate debt ratios were at all time highs as well.

        2. keaswaran

          “Stock prices are based on discounted cash flows, and there is no reason cash flow will be lower two years from now.”

          For any particular company, if there’s an x% chance of going out of business entirely, then that should be an x% discount, on top of whatever the expected loss of cash flow for the intervening year or two is in the (100-x)% chance of eventual recovery.

      5. Gerry Quinn

        I guess everyone is assuming things will probably get back to normal (with a possible baby boom / carnivale type effect on top).

      6. DarkTigger

        1) The market had tank already in expectation of the bad news to come.

        2) As the people on reddit but it: Money Printer goes BRRRRRRRRRRRRRRRRR.
        The Fed has (as you might have heared) put up an 2 Trillion Dollar programm to prob up the bond market, which keeps companies running which otherwise would be in danger of going bankrupt.

        1. Matt M

          The government/fed also tried multiple significant interventions to save us all in 2008/2009 and none of them worked (at least, they failed in keeping the stock market from losing half its value and of unemployment being quite high for several years).

          What makes people think this time they can totally execute perfectly to avoid any similar outcomes?

          1. DarkTigger

            If people think that, I don’t know why they would.
            All I’m saying is, when the stock markets have one of the fastes raises in one week in history while the fed is pumping literally trillions in said markets, I suspect a correlation
            That is very different from expecting it to perfectly avoid all bad economic outcomes this crisis has. The corona crisis might be a catalyst for the bond crisis that was looming, on the horizon for some months now. Everything the goverments do to migitate that crisis, might help, or might make it worse. I don’t know.

            But when you ask me why the stock prises went up despite all the bad news last week, I wager it’s said interventions. That can change again tomorrow. (Hint: as of now S&P 500 and DowJones look like it might even change today.)

    2. baconbits9

      Standard disclaimer: this is not professional financial advice.

      Every Bear out there seems to be saying 2100 (with a few saying 2000) as the test for the S&P, where if it breaks there (that is drops below 2100 and then either bounces back up toward 2100 but not sticking above it or plummets straight through to 2000) then you have the possibility of an absolute market route. No buyers, mass forced liquidations, hedge funds blowing up on a regular basis etc and testing of 1800 and possibly 1500s (ie 2007 and 2001 highs).

      My guess is that the Fed would start buying equities somewhere in the 1800-2000 range for the S&P 500, but they have also been the most aggressive ever so far so that might well be under their range.

      What bond ETF should I be in given the behavior the Fed/Treasury is pursuing for the pandemic?

      No idea. I mean some idea. I’m 2/3rds long dated treasuries and 1/3rd TIPS right now (technically ETFs for those things). With the Fed promising to buy corporate debt I am tempted to move money toward investment grade bonds, but having only ETFs available in our 401k that carries a lot of risk from corporate downgrades. Interest rates are low enough now that I am getting nervous about that position. I really don’t want to be in bonds at all, but have little choice there, and cash is basically the only alternative (and not literal, perfectly safe cash either. This is near the end of the 40 year bull market for bonds. Best case is Japanification and near zero rates for decades to come, worst case is defaults and rising interest rates killing your capital. In this situation you want to be out early rather than late.

    3. matthewravery

      IDK why you assume the only direction it can go in Q2 is down. Right now, there’s just high uncertainty, which means volatility not losses. There are still upside cases that exist.

      I think its fair to say the market has priced in current information at this point. I haven’t stopped my passive investments or changed allocations, and I don’t think anyone who doesn’t specifically want cash on hand right now should, either.

      Maybe you know something that the market doesn’t, but that’s not generally a good strategy. (I’ll grant that it probably was in February, but good luck knowing when you know more than Wall Street.)

  10. Beans

    I find it interesting that I am definitely getting acclimated to putzing around inside 98% of the time. A week ago I was much more disoriented and frustrated, but now it just feels like this is how big the world is. I don’t know whether going out as normal again, whenever that can happen, will feel good or not.

    1. HowardHolmes

      My wife and I live on five acres. Even pre-Covid we typically left the property once per week (groceries). Sometimes twice (doctor, dentist, Home Depot). Such a life comes highly recommended.

      1. DavidFriedman

        We went for a little over two weeks with none of us going anywhere, aside from a walk outside with nobody close. My wife and daughter went shopping yesterday and today, carefully, and we now plan to stay in for at least the next month.

        We have only about a third of an acre, but that’s still sufficient room for a lot of fruit trees (citrus and avocado currently still bearing, stone fruits due in another five or six weeks). Five acres would be great.

        Under ordinary circumstances my wife goes shopping several times a week and we all go out to dinner at least once a week. So a considerably less isolated life than yours.

        1. HowardHolmes

          We haven’t eaten out for years. Five acres is a bit much. We work outside every day, but two would keep us plenty busy.

    2. baconbits9

      I’m going a little nuts here. I was accustomed to being home 22 hours a day, but 24 with three kids under 7 and it is getting tough. We have also been self quarantined for a week+ longer than most, so we are in week 4 here.

  11. souleater

    I work Engineering in a mid sized company in west palm beach, when I happened to overhear 1 coworkers asking another if he’d ever heard of SSC which he coincidentally had. now, obviously, this is not a coincidence because nothing is ever a coincidence, so I went over and said hello and made 2 new friends.

    There are probably 12 people within earshot of me from my cubical, which would suggest that 25% of my coworkers are secretly SSC readers.

    What would be the best way to get any more secret SSC readers to reveal themselves by placing things on my cubical desk or walls?

    I’m thinking get a picture of a cactus saying “universal love”

    As an aside, we should come up with some symbols or phrases to self identify.

    1. j1000000

      I would not catch the cactus reference. I do see that it’s (parenthetically) on the top post recommendations page though, so now I feel ashamed and am wondering what other Great Posts I’ve missed.

    2. Conrad Honcho

      Something like {kind, necessary, true}. I’m not good enough at set notation to write that as “proper subset of {kind, necessary, true} with cardinality >= 2.”

  12. Well...

    It seems like there’s been big game-changing things that happen fairly close to once every ten years, or at least I can name one within a few years of each of the last four years ending in 0:

    1990 – Fall of the Soviet Union
    2000 – 9/11
    2010 – Not as sure about this one but maybe the crash in ’08?
    2020 – C19

    I invite you all to find a better example for 2010 and others for previous years ending in 0. How far back does it go until the pattern breaks? WWII’s end, with the first tactical detonation of a nuke which ushered in the age of nuclear paranoia, was smack in between two such years, so maybe that’s it.

    1. JayT

      The Great Recession would definitely be 2010’s event if you are going to call 9/11 2000’s. I can’t think of anything around 1980 though. Maybe the Three Mile Island accident? My impression is that it really changed the public’s view on nuclear energy.

        1. Le Maistre Chat

          The big change in 1980 was the end of stag flation.

          Stagflation just feels like a ’70s cultural artifact to me, not a real macroeconomic issue. Like I can imagine suffering through hyperinflation because the government thinks it can do good by printing more money to chase fewer goods (uh oh…) but I can’t imagine living through stagflation without disco and bell bottoms and Jimmy Carter…

      1. keaswaran

        The only other contenders for 2010 would be (in US politics) the Tea Party and Occupy movements and (in global politics) the Arab Spring and associated social media revolutions (possibly including the Green Revolution in Iran in 2009). It definitely seems like the Global Financial Crisis far surpasses those, even though those others might be seen as the precursors to the social-media-prompted global electoral breakdowns of 2016 (Brexit, Trump, Duterte, Bolsonaro, and the near-failure of the Colombia peace deal).

        1. Del Cotter

          I’m amused that the official departure of the UK from the EU in January is now not only not the event that makes the whole world sink into the abyss of a new Dark Age made more sinister and protracted by the lights of perverted science; not only not the event that plunges the island of Britain into a Mad Max dystopia where visiting celebrities holding microphones plead for donations as they stand next to little children with flies on their faces and distended bellies; not only not the big game-changing event of the decade; not only not what future historians will answer to the question “what happened in 2020?”; but not the big news story of the first quarter of the calendar year.

      1. ltowel

        I’d argue Medicare/Social Security for 1960s. Or if being strict about the year, the civil rights act.

    2. Well...

      I wonder if the killing of Bin Laden in 2011 might count, if people think that was a Schelling point marking the beginning of the end of public interest in war-on-terror/terrorist-hunting?

      1. Well...

        Quiet, you.

        Yeah, even +/- 2 years covers a pretty broad swathe. But I think in the back of my mind I was trying to limit myself to a total sum variance of 6 years every 4 decades.

    3. Karatasian

      As it is April Fool’s day, here is some news from the Planet Karatas:

      The pattern of ten-yearly events began in 1980 with HIV/AIDS and will continue until at least 2080.

      It is connected with the rise in interest in Indian culture and mysticism that occurred in late 1960s.

      The gulf war and collapse of communism were predicted by the Sufi Sheikh Abdullah Daghestani (1891-1973) in the 50s-70s.
      He also predicted the inundation of Cairo, presumably by the collapse of the Aswan Dam.

      Another “coming attraction” will be a major flood, probably caused by a flank collapse on La Palma.

      1. Well...

        He also predicted the inundation of Cairo

        Is this a reference to all those scapegoat pigs people slaughtered in response to swine flu? 😀

    4. keaswaran

      My closest guess for 1980 is the Reagan/Thatcher revolution and the start of the “Great Moderation” and eventual “Washington Consensus”. But a lot of trends start around 1970 (maybe 1968-1973) when the post-war boom ends.

  13. ana53294

    While people criticise soft Western values and praise the Chinese for their obedience, I think that Spaniards in general have been way too obedient. And the media way too pliable. The opposition does not exist; checks and balances don’t exist.

    Ordinary people are starting to break confinement rules. The only thing that surprises me is that there are only 60,000 cases for a country with 47 million. But then, the level of social pressure and vigilantism is quite extreme.

  14. EchoChaos

    So Virginia has put a lockdown in place until June 10, which is… a long lockdown.

    I am wondering if we’re now seeing a herd effect where no politician wants to be blamed for being the weakest on quarantine, so they’re just putting out random dates.

    Shutting down for over two months is simply absurd at this point.

    If at the end of April we still need to shut down for May, we can do that then.

    1. Matt M

      Yeah, this is definitely an out of control purity spiral. Everyone is trying to out “I’m taking this seriously!” each other.

        1. Well...

          Although…while perhaps not ideal, a purity spiral is probably not the worst thing when trying to stop the spread of a virus.

          1. albatross11

            The problem is if the decisionmakers either:

            a. Don’t understand the decisions they’re making very well, so are responding to the wrong things.

            b. Are mainly making signaling sorts of decisions (show how much they care) rather than actually useful decisions.

            There’s a huge opportunity here for cargo-cult type behavior, where a bunch of people who never did (and never will) know much about how viruses work get the idea that some behavior is desirable (locking everything down, telling everyone to go out and party because it’s all a media hoax, whatever), and make a lot of bad decisions, because they don’t know what they’re doing. They don’t have a good internal model of the problem, and so their solution won’t make sense except by accident.

            I support widespread shutdowns now. But we *really* need to be planning, right now, for the next phase. How do we start things back up without just getting a big flare-up again? What information do we need to know how to do that, and how can we get it?

            There are papers that have modeled/simulated this, and they often show that when you raise the shutdown order, you get a flare-up of cases. There are probably ways to avoid that if we think things through carefully, and raise the shutdown order gradually, along with making sure we keep the necessary stuff running with minimal disease transmission.

            Really, once we have worked out how to run, say, a factory or warehouse or office with minimal disease transmission risk, that will give us a blueprint for slowly opening things back up.

          2. Well...

            I agree with all that. I’m just saying as far as irrational spirals go, a purity spiral might be one of the less bad ones to be in right now.

          3. johan_larson

            It is if the only way to display purity is by wreaking economic devastation.

            Let’s keep in mind that plenty of these decision-makers need to get re-elected some day, and saving us from the virus but landing us in a depression is a really good way to not get re-elected. The unemployed have plenty of reason to vote for anything but the status quo.

          4. baconbits9

            Let’s keep in mind that plenty of these decision-makers need to get re-elected some day, and saving us from the virus but landing us in a depression is a really good way to not get re-elected. The unemployed have plenty of reason to vote for anything but the status quo.

            We should also keep in mind that

            1. These decision makers are largely unqualified to make long term economic decisions
            2. They have already tried to head this off at the pass with massive payouts to people

          5. albatross11

            These decisionmakers are overwhelmingly not the kind of people you’d want to have making this kind of decision, in terms of health, economics, science, statistics, etc. Our political system creates a lot of dysfunction, and we should probably think about how to have less of that after we get through this crisis.

          6. DavidFriedman

            and saving us from the virus but landing us in a depression is a really good way to not get re-elected.

            FDR’s case suggests the opposite. The depression had started before he got elected but it continued under him until interrupted by a war, and the only thing that got him out of office was dying.

          7. Faza (TCM)

            I’m gonna have to disagree, strongly.

            Spirals, in general, are a very bad idea, because you run the risk of ending up with a cure worse than the disease. An increasing risk, ‘coz that’s the nature of spirals.

            Lest we forget, Italy – the Sick Man of Europe – has been on lockdown since the 12th of March at the latest. Going by Wikipedia, they had 10,590 active cases and 827 recorded deaths at the time.

            Three weeks or so later (as of the 30th), they have 75,528 active cases (a roughly 7-fold increase) and 11,591 deaths (a roughly 11.5-fold increase). That’s… not exactly a strong endorsement of the efficacy of these measures in curbing either cases or deaths.

            How about Spain? Third in number of cases, second in number of deaths, as I write. Wiki says the state of alarm was instituted on 14th March (@4,906 active cases, 133 deaths, as of the 13th). As of the 30th, there were 63,460 active cases (x13) and 7,716 deaths (x58).

            The incubation time for COVID-19 ranges from 2 to 14 days, with 5 or 6 being typical. This means that if we consider Italy and Spain to be a disaster, it is one that has occurred despite the lockdown measures. Now, you can try to argue that without the lockdown it would have been a lot worse, but for that you’ll actually need to show data – not models.

            What about China? They managed to contain it through lockdowns, haven’t they?

            Yeah… I think that China solved the coronavirus problem in its own inimitable way: by going back to their roots and putting the kibosh on disclosure. It’s not like they don’t have the means to steer the flow of information out of China. How do they get away with it? A simple explanation is that perhaps they realized that COVID-19 isn’t as big a deal as they thought. If the disease isn’t causing many excess deaths (fatalities are concentrated among the old with co-morbidities – i.e. people likely to die anyway), they can simply adopt the “herd immunity” strategy, restart their economy and trumpet the wisdom of Xi’s government. Who’s going to gainsay them? The WHO?

            I’m not exactly blowing bubbles here. There’s some questioning of the accuracy of the official numbers already. Also, let’s be honest – the 3,309 official reported deaths is peanuts when it comes to China or even just Hubei province. It won’t even register in the mortality statistics.

            Speaking of which, the place to keep watch of – if you care for that sort of thing – is the Centre for Evidence Based Medicine’s England and Wales mortality during the COVID-19 outbreak – the only research I know of that attempts to determine the effect of COVID-19 on overall mortality and compare it to previous-year averages.

            Sadly, they are limited by the speed of the Office for National Statistics, so the latest update (today, 31st of March) includes data up to the week ending on the 20th of March, inclusive. I eagerly await the updates over the next couple of weeks.

          8. albatross11

            I think it’s:

            5-8 days from exposure to symptoms
            A week or so of overt illness that usually isn’t so serious
            Some subset of people progress to pneumonia and end up in the hospital

            That is, I think there’s more likely a 2-week delay in there instead of a 1-week delay. I don’t know how much that matters, though.

          9. Faza (TCM)

            Given that it’s been around three weeks since the lockdowns were instituted, I’m not sure it does, either. If the lockdowns are effective in keeping people from being infected, shouldn’t we expect the number of visible active cases (i.e. symptomatic patients who have neither recovered nor died, yet) to peak out around two weeks after social distancing measures are put in place? That’s not what we’re seeing, though.

            It could be an artefact of the testing regime, but that simply means that testing misses a huge number of active cases that can be subsequently “discovered” when more testing is performed. This is not unexpected, given that we know from the Vò tests that the majority of carriers are likely to be asymptomatic (but may develop symptoms at some point in the future).

            However, if we assume that the number of people actually infected is greater than the number of cases detected, we must reappraise our mortality estimates as well. Everyone focuses on CFRs because they are available, but those are poor measures, liable to distortions from both how we identify cases and how we record deaths. What everyone should care about is IFR – how likely are you to die if you become infected – and if we assume that we’re missing most infections, that’s gonna be a good deal lower than the CFR – if only because people don’t die asymptomatically (in other words: we notice when they’re dead).

          10. Del Cotter

            Faza says the hardest hit European countries weren’t the tardiest lockdowns, but they were. The FT has the four hardest hit countries as Italy, Spain, France, and UK (11,591; 8,189; 3,024; and 1,789 as of this afternoon). They were the four countries that waited until the most deaths to lock down (827; 200; 175; and 320).

          11. Del Cotter

            It’s not true there’s a purity spiral. The Danish PM is bragging Denmark could end lockdown in April. If there was a purity spiral she’d be ashamed to say that.

            It’s not a purity spiral if there is a range of positions and you think they’re all the wrong side of you. You might be the purist.

          12. Faza (TCM)

            @Del Cotter:

            Faza says the hardest hit European countries weren’t the tardiest lockdowns

            Funny, I don’t recall saying anything of the sort. I just read my posts and can’t see it at all. Could you please point it out to me?

            Regardless, the number of deaths at the time of lockdown is a poor measure of anything. At best it tells us how many deaths could have been avoided – if the lockdowns are effective at preventing infections and – subsequently – death of some of the infected.

            What I did say is that these two countries (Italy and Spain) have been under lockdown for a good while now and both the number of cases and the number of deaths have kept rising – they have overtaken China on both metrics at this point, considerably so on the latter (Spain has two-and-a-half times as many deaths; Italy 3.75 as many).

            ETA:

            It’s not true there’s a purity spiral. The Danish PM is bragging Denmark could end lockdown in April. If there was a purity spiral she’d be ashamed to say that.

            Even purity spirals come to an end, you know, because most people aren’t that desperate to sign suicide pacts.

            Currently, people have started realizing what being under lockdown really means – and most places aren’t China. I’m just waiting to see who blinks first.

          13. Le Maistre Chat

            @DavidFriedman:

            FDR’s case suggests the opposite. The depression had started before he got elected but it continued under him until interrupted by a war, and the only thing that got him out of office was dying.

            Not saying you’re wrong, but I’m going to fact check you here because of your bias.
            What month or quarter of the Great Depression was peak unemployment, and how high was it when FDR started up the war economy (defense manufacturing and the draft started well before Pearl Harbor)? What quarter did US GDP turn the corner from negative to positive growth?

          14. Edward Scizorhands

            What I did say is that these two countries (Italy and Spain) have been under lockdown for a good while now and both the number of cases and the number of deaths have kept rising

            I cropped this image from https://www.ft.com/coronavirus-latest (thanks to @Douglas Knight for the pointer)

            https://imgur.com/jaTApMW

            8 days after lockdown, Spain crossed the line so deaths were doubling in less than 2 days time (previously ~1.5 days).

            When Italy locked down, deaths were doubling every 2.4-ish days. 13 days later, they crossed to 3 days time.

            It takes time for the lockdowns to take effect.

          15. Cliff

            Italy and Spain’s experiences seem like exactly what we would expect if lockdowns work. Both have leveled off after a certain delay. I’m actually not sure what Faza’s point is. He thinks lockdowns are ineffective and do nothing? That seems like an extraordinary claim.

          16. Faza (TCM)

            @Edward Scizorhands:

            I’m not sure what you intend to show with this chart.

            If one person dies today and another person dies tomorrow, we’ve had deaths double over one day. Is that a cause for concern?

            The time to double cumulative deaths will naturally flatten regardless of interventions, because:
            1. the more people have died already, the more have to die to keep up the rate of doubling,

            2. as more people die, the susceptible segment of the population decreases and we have no reason to believe that young people will suddenly become more likely to die once all the old and already ill people will die off.

            This latter point bears elaboration. Assume that, if left completely unaddressed, COVID-19 would kill x people, in line with what we already know about how the disease spreads and progresses.

            Initially, we would expect to see the number of deaths rise rather rapidly, as the susceptible population begins to fall ill and die. Again, if you have had only one death, another death will double the number of deaths. However, each additional death beyond that will contribute progressively less to the doubling rate, because you’ve had more prior deaths.

            After a while, most of the population would have already been infected and either died or recovered, flattening the cumulative death curve.

            Leaving all of that aside, the fundamental problem with using COVID-19 deaths for anything is Goodhart’s Law.

            @Cliff:
            I’m not saying lockdowns do nothing – it would be an extraordinary claim, indeed, to say they have completely no effect on the rate of infection.

            The question is what they are doing and whether it is a thing worth doing given the cost of doing it.

          17. AlesZiegler

            If lockdowns work, they work with a delay. Italy had a lockdown in Lombardy since 8 March, which is 22 days, in the entire country since 9 March, but also all nonessential things were shut down only since 21 March. Wikipedia entry on a severity of stages of the Italian lockdown is confusing.

            I think that to declare on the basis of available data, in light of a length of Italian lockdown, that lockdowns do not work, would be a feat of extraordinary overconfidence. Opposite is also somewhat true, albeit to a lesser extent, since our evidence that lockdowns work depends on how seriously you take data coming from China, whose validity is in dispute.

            And if lockdowns work, in the absence of other available solutions, not doing them means likely death of 1 %? 2 %? 0,5 %? We are not sure, but nontrivial part of the population of given country.

            Of course people have different values and thus will came different conclusions on what choices regarding lockdown should be made, given those facts.

          18. Doctor Mist

            If one person dies today and another person dies tomorrow, we’ve had deaths double over one day. Is that a cause for concern?

            It is if the trend continues, obviously: two people die tomorrow, four people the day after, eight the next day.

            Perhaps you could rephrase your question?

            The time to double cumulative deaths will naturally flatten regardless of interventions, because:
            1. the more people have died already, the more have to die to keep up the rate of doubling,

            If the disease is spreading exponentially, it will have no problem accomplishing this until the population saturates. If there have been only 8500 deaths there, they are not yet close to saturation.

            Initially, we would expect to see the number of deaths rise rather rapidly, as the susceptible population begins to fall ill and die. Again, if you have had only one death, another death will double the number of deaths. However, each additional death beyond that will contribute progressively less to the doubling rate, because you’ve had more prior deaths.

            I feel you are invoking Zeno’s Paradox here, as if you are arguing that an exponentially growing death rate is impossible.

          19. LesHapablap

            EDIT: Dr. Lin’s updated doc has different numbers

            Time from infection to death is 17 days on average (source from March 13 Dr. Lin)

            Italy began lockdown on March 9th, 22 days ago, so we should see some effect in numbers of deaths. From here deaths are increasing by 8% per day, instead of the 15-20% per day earlier on.

            If the IFR is .9% (most estimates are between .1 and .9 that I’ve seen) and cumulative deaths today March 31 were 12428 (from the above worldometer link) that means there were 1.4MM cumulative infections on March 15th.

            If infections were growing at 8% per day from the lockdown, then that means today there are 5.2MM cumulatively infected, in a population of 60MM. In two weeks, at that rate, there will be 15MM infected and knocking on the door of herd immunity.

            My hope is that by mid-May Italy is seen as the worst case scenario of letting it run, and that the worst case is not that bad, and other countries let their restrictions up because they ‘now have enough testing capability’ and enough masks and we all get back to work.

            Oh, and I’m hoping that we don’t end up in a war with China. There is a lot of pretty crazy talk about China recently. A couple months ago it was “China has bought the world time with their expensive measures, and the west squandered it” and now it is “China has intentionally released this virus to sabotage the west” and I’m concerned that if people get very desperate (economically or otherwise) this will blow up into a war.

          20. Del Cotter

            The quantity of infections and subsequent deaths there have been is nothing like enough to have depleted the pool of susceptibles yet. That is not the source of the deviation from exponential growth.

            This slowdown would not yet have been a slowdown, would not yet have stopped under a business as usual SIR scenario, but would still be in the exponential growth phase now. The slowdown is the result of the lockdown. It just took a few weeks to kick in.

          21. Del Cotter

            As of tonight, the FT has stopped plotting cumulative numbers and is now plotting seven day moving means. The graphs now show Italy has peaked.

            But another way of saying that is that it is now at the peak rate, 50,000 cases a week. The lockdown has been successful, but now is certainly not the time to end it, with so many new infections coming fast. They need at least the whole of April to bring the numbers down like Wuhan. At least. It would have been better if Italy had started earlier.

            America will not benefit economically from having dragged its feet before completely locking down. It would have been better off if it had started earlier, and nationwide.

          22. 10240

            @Faza (TCM) et al. The number of newly diagnosed infections is more informative than the number of active cases, as there is even more delay until death or confirmed recovery. If the Italy lockdown works, we should expect to see the number of new diagnoses to peak 1.5–2 weeks after the lockdown. That is what we see.

            If infections were growing at 8% per day from the lockdown

            @LesHapablap They weren’t. New diagnoses are down to 4–6% in the last few days, and those are at a delay compared to when the actual infection happened.

          23. The Nybbler

            would not yet have stopped under a business as usual SIR scenario

            There is no “business as usual SIR scenario”. Epidemics do not usually follow the unstratified SIR model. The CDC estimates the 2009 swine flu infected about 61 million Americans, so about 20% of the population. R0 is estimated to be between 1.4 and 1.6, so 20% of the population is not only below the epidemic final size, it is below the herd immunity threshold.

          24. Del Cotter

            Point taken. But I don’t think the curves of confirmed cases or deaths would have been as low as they have been, if the respective governments had continued as usual without the lockdowns. Covid-19 has a higher R0 than the 2009 swine flu and a higher fatality ratio. I don’t agree that three weeks of lockdown have not helped, nor that the currently flattening curves represent a decrease in the susceptible population.

    2. Bobobob

      I fear the inevitable flare-up once the lockdown is lifted. Not because I’m afraid of getting sick, but because millions of oversensitized people will likely overreact and go into panic mode.

      As an analogy–I’m very sensitive to noise, and I used to live in an apartment with a neighbor who liked to have loud parties. At 2AM, the music would stop, and I’d be immensely relieved–until it came back on at 2:30 and I was 10 times as agitated as before.

      A COVID recurrence would be like the loud music coming back on, on a national scale.

    3. John Schilling

      Two months is, IMO, a reasonably good best-guess for how long a lockdown will need to last if you don’t already have a solid plan or what to do next and are developing your contact-tracing plan from scratch. But announcing up-front that it’s going to be two months, is going to make it difficult to walk back to one month if the situation develops in such a way that one month is enough. And, as others have noted, it risks driving a purity spiral in which the next governor says “OK, my lockdown is going to be four months!”

      1. baconbits9

        But announcing up-front that it’s going to be two months, is going to make it difficult to walk back to one month if the situation develops in such a way that one month is enough

        Why? It would seem to me the opposite would be true, its much easier to announce good news later (we beat it, lock down to be lifted early) than to add bad news later. If you announce that lock down should beat the virus in a month then it is at least plausible that you will lose credibility in month 2 when you have to admit that you are wrong. Considering credibility is central to lock downs working that is a bad risk.

        1. John Schilling

          The good news will not be “we have completely eradicated COVID-19”, so lifting the lockdown before the pre-announced date means handing your political enemies every subsequent death as your fault for having lifted the lockdown “early”.

          1. EchoChaos

            Basically agreed with this.

            Unless you have a vaccine, you are going to have a hard time lifting quarantine early. But if you set rolling “we’ll reassess in two weeks”, then you can actually lift it when it makes sense for “Hammer and Dance” style tracing.

          2. baconbits9

            This seems doubtful as everything being discussed is in terms of ‘flattening of the curve, and no one is claiming to end things perfectly and the public isn’t that dumb, plus the converse is also true. Order lock down and say it will be over in a month means you will be making people mad in a month and providing fodder to your opposition then, at a date a month closer to the election.

          3. baconbits9

            But if you set rolling “we’ll reassess in two weeks”, then you can actually lift it when it makes sense for “Hammer and Dance” style tracing.

            People hate uncertainty, and businesses really hate uncertainty. Rolling two week decisions just scream ‘we have no clue’ once they start getting rolled long, and also sets up having to repeatedly admit you are wrong in the tougher scenarios. Promise 1 month and it can be that you have to admit that you were wrong and now its 6 weeks, and then at 4 weeks you are admitting you were wrong twice before and its 2 months, and that is assuming you get away without having to make a statement about being wrong on the off weeks. Basically you are committing to highlighting your failure several times should it go against you.

    4. Alexander Turok

      It’s the classic strategy of “under-promise and over-deliver.” Make everyone think it’ll last until June 10, then lift it on May 15 and say it can be lifted only due to the effective government response. It’s what Trump would do if he were competent.

      1. Matt M

        Anyone willing to bet on this? I’ll throw down $100 for charity that any quarantine currently announced with a specified end-date will not be lifted before that end-date.

    5. Clutzy

      The real problem with lockdown orders is they are local, but the bailout packages will be federal.

      If governors were forced to decide between lockdown and re-allocating 50% of the budget to paying a temporary UBI (most of that would have to come from public employee salaries and pensions (who are huge lobbying forces in every state), then we would get reasonable measures.

        1. Clutzy

          Well of course. Thats why governors should be forced to balance the interests of apoplectic public employee unions with their desire to lockdown the state for months.

        2. Matt M

          My prediction (for the US at least) is that the absolute longest these lockdowns can last is until September or so – when the next school year is scheduled to resume.

          Because if you start cancelling next year’s school too, localities are going to have to start laying off public school teachers, who have strong unions and stronger public support. Public schooling is too popular to suspend indefinitely. And if you concede that they can re-open, it’s hard to argue that other stuff can’t too…

          1. Alexander Turok

            Not if they start distance learning. The only thing they’d have to fear is that some parents would start home-schooling and “withdraw” their kids from the official school system, causing them to lose money.

      1. Edward Scizorhands

        I doubt we’re ready for it now.

        But after we get over the coronavirus, and the epidemiologists and economists study all our efforts, I hope that governments announce that deliberate infection — with low doses of viruses, of low-risk populations, who are then held in quarantine and given the best care possible, before our health care systems are overwhelmed — is one of the methods we should have on the table. Not necessarily that it’s the right one to use for any particular virus, but when you are facing 100K-200K deaths, we are discussing how to save the most lives, so it should not be verboten to offer it.

    1. Radu Floricica

      They aren’t even testing antibodies to see which people are already immune. Would be useful for health workers.

        1. AlesZiegler

          Chinese are producing antibody tests. Czech government bought over hundred thousand of them, and other countries as well, I think.

          1. The Nybbler

            Apparently many of the Chinese ones (in particular those exported to Spain) didn’t work. However, companies in Singapore and South Korea both produce them.

          2. AlesZiegler

            @The Nybbler

            Here in Czechia it was also initialy reported that they don´t work, but then it emerged that they were used improperly (instruction manual was probably in Chinese; at least that was the case with respirators bought from the same country). I wonder whether something similar happened in Spain.

      1. The Nybbler

        They are in SOME countries. The US FDA is making it as hard as possible, limiting quantities of tests and requiring the testing be done in a clinical setting.

    2. Machine Interface

      Because that’s the worst immunisation method avalaible. There’s a reason variolation was quickly phased out as soon as smallpox vaccine was avalaible.

      Given what we know of coronaviruses, it’s not even clear that variolation would have any positive effect in this case.

      1. Purplehermann

        Why wouldn’t there at least be experiments checking if it works? What we basically need right now is a stop gap measure that doesn’t wreck the economy, variolation seems to be a good candidate .

        Smallpox was very different from covid19, the death rates from smallpox variolation were apparently similar to the normal death rates from covid19.

        It was still used before vaccines were available, there is no vaccine available for covid19 currently, why is variolation a worse idea now?

        1. The Nybbler

          Variolation probably worked in the case of smallpox largely because of variola minor. The most successful variolation was done by people who selected those with mild cases of the disease as the source for the variolation material, many of which were likely due to that less-lethal virus.

          As far as I know, there is no SARS-CoV-2 “minor”. If SARS-CoV had not died out, SARS-CoV-2 would BE the minor.

          1. Purplehermann

            @The Nybbler good point, thanks.

            There may be a parrallel here to smallpox, if higher initial exposure and/or having the lower respiratory tract exposed intially raises dearth rates by a significant amount (and at least one of these things being true seems likely, and both are plausible)

    3. Purplehermann

      This really bothers me, mostly because herd immunity through letting all the healthy young people get it naturally is being discussed (recently in my country too), without talk of strategy how to try lowering the death rate.
      Variolation seems like a ‘cheap’ way to try to improve the strategy and is being ignored.

      1. Loriot

        The issue is that nobody knows if variolation would actually help with that and has a high risk of making things worse.

        1. albatross11

          I think variolation is simply an instance of vaccination. We have a pretty well-developed science of making vaccines now, with existing techniques for designing them and testing them and such, and it’s hard to imagine that variolation would be better than that. The only time it could have any place, IMO, would be something where you isolated a few hundred young, healthy healthcare workers (maybe Army doctors and nurses) somewhere, infected them all with as mild a dose as possible (drip one droplet full of infectious virus into their eye, say), and hope to have a set of young, healthy people with immunity who can work in your hospitals. I’d support allowing people to volunteer for this, and offering them a pile of money for doing so–I think the informed consent issue would in practice be less worrying if you were dealing with healthcare professionals, since they’d surely know what kind of risks they were running.

          The potential downside is that you might get a bunch of serious cases, perhaps including a few people dying and several more ending up permanently disabled thanks to lung or heart damage.

          1. Purplehermann

            1. Vaccines take time to develop, assuming we manage at all. Variolation can be done very soon. Because time is the big factor making governments consider taking risks (economy issues) variolation has a very large advantage- it might get us out of the economy vs millions of lives tradeoff.

            What you mention should certainly be done, considering medical workers seem to be dying at higher rates than their equivalents in the rest of the population.

            Is there any reason to think there will be more serious cases this way than the naive herd immunity plan?

          2. albatross11

            If we’re doing variolation, would it make sense to do other experimental vaccine attempts at the same time? There are risks to experimental vaccines, but most of them don’t risk making you sick themselves. If we can grow enough COVID-19, we could just try inactivating it with heat or formaldehyde and then injecting it into volunteers, and see if it helps. Or start growing spike proteins in yeast and injecting spike proteins plus adjuvant in volunteers.

            I don’t know how quickly this could be ramped up (producing a lot of vaccine is going to take time), but I think it would be at least as sensible to do as variolation. Again, you’d do it to healthy volunteer healthcare workers, in hopes of getting an immune population. I think the most likely failure mode for either of these would be not getting an effective immune response, but they would have 0% chance of giving you SARS-CoV2. There are some vaccines that make you more susceptible to the disease, though–that’s rare, but it happens sometimes. That would be the real risk.

            FWIW, I’m a moderately high risk person. I’d volunteer to get either of those kind of experimental vaccines.

          1. Kaitian

            The lockdown measures are intended to make sure people get the disease a few at a time, as opposed to all at once. If variolation was to be useful, you’d have to do it to a lot of people at once. If it causes terrible side effects in more people than a normal covid infection does, you have made things worse.

            Even if it does not cause terrible side effects, many ethical systems (and insurance companies) think that “letting X happen” is less bad than “causing Y to happen”, even if X is worse than Y.

            If you want to run trials until you’re sure that the variolation has no terrible side effects, at that point you have lost any advantages over a normal vaccine (which is being worked on at full steam).

          2. Purplehermann

            @Kaitan if we just infected people with the virus in much smaller amounts, there would not be any worse side effects (unless rhere is a homeopathic effect…).

            I think it would be much better as far as not overloading the medical system goes, you can choose the number of infected at any one time

          3. Kaitian

            @Purplehermann

            We’d have to work out an amount of virus that will produce a big enough immune reaction to protect you, but will rarely cause the full blown illness. That’s probably not trivial. You’d also have to administer the virus to people in some way. Someone upthread suggested using eyedrops – it’s not out of the question that this could have some eye related side effect that normal covid won’t have.

            Then you have to make sure the variolated people don’t go around spreading the virus to others. If variolation produces a bunch of additional asymptomatic carriers, that’s pretty bad.

            It also won’t let you choose the number of infected, because the virus will still be spreading elsewhere. If we could stop that, we wouldn’t need any other measure. And if the healthcare system is already struggling, any additional covid cases through variolation would make things worse in the short term at least.

            I don’t think variolation is worse than letting the disease run rampant, but I do think there are good reasons not to immediately assume it would be an easy way out.

          4. Purplehermann

            @Kaitian
            It wouldn’t let you choose everything, no.

            The bonus there is that we can choose a flat number (that takes into account the projected number of serious cases in the next few weeks, and yes isolation would be important) that wouldn’t overwhelm the healthcare systems.
            This seems like a serious advantage to me over the exponential spread with a week delay for symptoms that comes from natural spread.

            I would probably go with mouth not eyes, but I’m sure there are people better able to decide on that.

            Figuring out the dose shouldn’t take more than a few (two really) weeks.

    4. John Schilling

      Because this isn’t the eighteenth century, and we know lots of better ways to make vaccines than variolation. We have justifiably high confidence that at least one of these will work.

      This being the 21st rather than 18th century, we also “know” that we need to test whatever we come up with for about a year on small test groups before we put it into general use. But that requirement doesn’t magically go away because we use an old technology to make the prototype vaccine in the first place.

      If we’re going to wait on a year of testing before we introduce the new vaccine, then we’re almost certainly going to come out of that year with a safe, effective vaccine developed using more modern techniques. If “let’s use variolation!” is your way of sneaking in eighteenth-century accelerated testing protocols, then A: bait and switch and B: oh hells no. If we’re going to accept the risk of an accelerated testing regime, then we want to be explicit about that up front and we want to take that risk with a modern vaccine rather than something as inherently risky as variolation.

    5. keaswaran

      Presumably this is only expected to provide benefit once we are able to track and contain the spread from existing cases. Variolation is useful if our infection rate is too low to provide wide scale immunity. But right now our problem is not that our lockdowns are too effective and the disease is spreading too slowly, but rather that our lockdowns haven’t even flattened new infections yet, so we are still constantly being surprised by who is infected.

      I predict that if, in a month or two, infection rates are under control, and we have good testing and tracking, that some localities will start discussing the idea.

  15. Florian Breuer

    In most discussions about modelling the disease and when people talk about herd immunity, there always seems to be the assumption that, once one has recovered from Covid-19 one becomes immune to it, and so one can’t get it or transmit it again.

    But this is not true for the other four common human coronaviruses. We keep getting them again and again. It’s no big deal, since they only cause common colds, but we’re obviously not immune to them (at least not long term) and certainly do keep spreading them. This is different to most other viruses, such as influenza viruses. We do become permanently immune to those after recovery, but the flu viruses mutate so fast that new strains evolve every year. Coronaviruses, by contrast, seem to be fairly stable.

    So here’s a theory: Perhaps SARS-CoV-2 is really not much different to the other four common human coronaviruses, and the properties they have in common are the following:

    They cause mild illness when we get them for the first time as children, and once we’ve had them, we can get them again and spread them again, but they only cause mild illness.

    The only reason Covid-19 is so dangerous is that most of us are encountering it for the first time as adults. Perhaps the other four would be just as deadly to an old person who has somehow never encountered them before.

    If this is true, it would mean that we cannot develop long-term immunity, which is okay for those who have survived it, since any subsequent reinfections will be mild, but there is no long-term protective herd immunity that could protect the vulnerable: eventually, everybody will get it, unless we develop a vaccine in time.

    This is only a theory, and hopefully it is wrong. In a few years it will be clear whether or not it is true. in the meantime we might get clues from history. Each of the other four human coronaviruses might have caused a similar pandemic when it first appeared. Is there any historic reference to a plague that mysteriously spared children? What about cases where isolated people were contacted for the first time?

    1. Kaitian

      That’s an interesting thought. It seems that the “common cold” corona viruses and SARS both have the property that antibodies for them disappear after some time.

      I think the most uncertain part is your assumption about how dangerous the virus is per infection. We do see some people getting chickenpox or EBV as older adults, and they usually have a bad time. So if all corona viruses are only harmless for children, we should also see some older adults who have never had the common cold dying from their first corona virus encounter. I don’t think we do, but maybe it’s rare enough that we don’t notice.

      I’ve never heard of a historic plague that would be a good candidate for a corona virus. But there are two complications: if some of the indigenous Americans died of corona in addition to all the other old world diseases, I’m not sure that anybody would have had the opportunity to notice. And the current corona virus seems to most often kill people who were already very unhealthy and may not have lived to that point at all before modern medicine.

      On the other hand, it seems that the original SARS was inherently more deadly than Covid-19, it’s also possible that Covid is inherently worse than the common cold coronas, and will not be just a cold if you get it a second time.

    2. Radu Floricica

      IANAD. What you’re saying seems reasonable, and to a point it’s probably true: we’re reacting badly because it’s a new virus, subsequent infections are likely to be easier and so on. But there are a few things that don’t fit: the way it attacks the lungs and the way it targets the weak are quite new, both to respiratory infections and viruses in general. Not “new” as in “out of what you’d expect a virus to do”, but still do not really fit in the “severe common cold” scenario.

    3. Purplehermann

      If there is no long term immunity, could variolation for most of society at once kill the virus off entirely?

      1. eric23

        You mean like the campaigns to vaccinate all of humanity against smallpox and polio? Possible but extremely difficult. We haven’t yet managed for polio, where you get vaccinated once and it lasts a lifetime. It would be much harder to get all of humanity variolated *within a few months*.

        1. albatross11

          Interestingly, a big problem with polio is that the best vaccine for it is a live attenuated virus (it gives you immunity but not polio), but very rarely, that virus mutates back to a virulent form, and people shed the virus after immunization. So when you’re vaccinating with the live virus vaccine, you’re causing a few new cases of polio to spontaneously show up in the community every once in awhile. If everyone’s vaccinated, this is acceptable–little kids shed virus that might mutate back to virulent form if it circulated for awhile, but adults are all immune so who cares? But if not, then you can get new outbreaks with paralysis and such due to vaccination. The dead virus vaccine (“inactivated”) is harder to handle and administer and I think isn’t as good, but won’t ever revert to a virulent strain and cause a new outbreak.

          1. Statismagician

            Also, polio specifically is way out on the diminishing-returns end of the cost-benefit curve; there are like seventy active cases worldwide and they’re all in rural Pakistan/Africa among groups with really awful sanitation infrastructure and recent proof that the CIA sometimes uses fake vaccination campaigns to spy on them.

        2. albatross11

          If there’s something that’s 10-20x as bad as the flu when you get it and it requires a yearly shot, I think you’ll get much wider compliance on that than on flu shots.

      1. Kaitian

        If you can vaccinate enough people, the disease will stop spreading, even if they’re only immune for a year or two. You could also use the vaccine in a targeted way: if someone is diagnosed with covid, you vaccinate a few hundred people around him, and it should not spread further.

        I guess it’s also not totally unbelievable that a vaccine may be found that causes longer, more reliable immunity than going through the infection. But there’s certainly a middle ground between “lifelong immunity” and “no vaccine”.

  16. Deiseach

    Some good has come out of the current situation – from my sister in the Wee North:

    This time of year they start practising the for the 12th so no flute and piccolo rehearsals of the same blooming tunes over and over again…..God is merciful!!

    😀

    That’s the 12th of July (the other Glorious Twelfth), a whole three months away, so you can imagine the relief from the shrill piping of piccolos day in and day out like insects stridulating in your ear!

    Though there are downsides, too:

    Hi am presently queuing outside Asda it is like Soviet-era Russia

    I’m not sure they had Asda in Soviet-era Russia, but oh the humanity!

    There does seem to be some reduction in infection rates in the Republic of Ireland thanks to the measures adopted so far, but there’s still a long way to go yet before anything can be definitely said to be over the worst of it. We’re getting PPE supplies in from China, so the manufacturing must be starting up there again and they must consider the worst of the outbreak over if they’re willing and able to export surplus medical equipment.

  17. Iago the Yerfdog

    I plan on getting Doom Eternal soon, but in lieu of it I’ve been playing the original Doom, Doom II, and Doom 64 on Switch. It’s been quite a while since I really sat down with the intent of a full playthrough. So far I’ve gotten through the first three episodes of Doom, the first 20 maps of Doom II, and about half of Doom 64.

    What surprised me is how much less I’m enjoying Doom II than either the original or Doom 64. The original has been amazing, and while Doom 64 is a little odd, I’m enjoying it. But Doom II is just… I don’t know quite how to describe it. My biggest complaints are probably (1) how “open up a wall and unleash a horde of imps/demons” is seems to be a go-to tactic for providing difficulty, and (2) how many of the maps are just straight-up confusing (the worst offender so far for me is probably map 19, “The Citadel,” in two ways: it’s confusing to navigate around in, and also confusing because you actually only need two keys to get to the exit, despite it looking like you need three). And then there are the straight-up troll levels, like 8 (“Tricks and Traps”) and 20 (“Gotcha!”), which are at least properly labelled.

    I’ve had to bump the difficulty down a notch for Doom II, which would be fine if the difficulty felt more fair and consistent, but it seems to spike up and down.

    I’m still enjoying it and plan to complete the playthrough, just… wanted to whine a bit.

    1. Radu Floricica

      Best way to play Doom 2: start each map with just the pistol. When you do them all, up the difficulty and start again. I don’t think I’ve had so much fun with any other game.

      1. Iago the Yerfdog

        I may give this a try. The Level Select feature on the new ports (I don’t remember this being in the original) seems like it would make it pretty easy to do this.

        1. Radu Floricica

          It was. Not sure how it looks now, but there was a different executable file which allowed you setup a bunch of stuff before launching, among them to warp to a certain level.

          Lemme know how it goes. For me it just reinvented the game – blasting everything with a shotgun gets repetitive, not to mention that you can always plasma your way out of trouble. But trying to figure out how to get past a Cyberdemon with a pistol has more of a puzzle feel to it.

      2. Paul Brinkley

        I remember playing all three episodes of original Doom with just a pistol. Even after picking up other weapons – still, pistol. Pistoled the entire thing. Took forever to take down Barons, let alone Spiderdemon. But I had fun.

        I think I gave up on that when I was facing crap like arcane demons that could respawn everyone in Doom II. At least, that’s my memory.

        Meanwhile, have you tried Heretic and Hexen?

        1. Radu Floricica

          Oh, I used other weapons when I found them. That was part of the fun – I was happy again to find them. Just at the end of the level it’s reset.

          Yeah, played those too.

    2. Iago the Yerfdog

      I’ll have to give it a try. From what you said, it sounds like I’m through the worst of the maps in terms of quality, but if I need a break at some point I may play through SIGIL.

      Part of my goal for this playthrough has been to play the maps in release order: the first three episodes of Doom, then Doom II, then Thy Flesh Consumed, then (maybe) the Master Levels, then Final Doom. The “about halfway through Doom 64” was done before I decided to go that route.

      But since SIGIL wasn’t part of the original releases, I guess I can insert it at any point.

  18. LesHapablap

    What will be the social and cultural effects of the coronavirus and lockdowns in the west?

    Will it change the way people eat?
    Socialize?
    Will it reduce or increase social trust?
    Will it change what people spend their money on and how much they spend?
    What good things do you think will come from it? Bad things?

      1. Radu Floricica

        Huh. People have obviously started cooking more, so I guess it’s a safe bet that some will continue to do so.

        1. Well...

          It’s interesting:

          Many (most, at least in my area) restaurants remain open, but for take-out/delivery only. Pretty much all of the restaurants I’ve seen have gone out of their way to communicate both 1) how they’ve ramped up their food safety procedures or have always had very robust ones, and 2) how badly they still need business to remain open.

          That this virus has nevertheless so drastically reduced people eating out might reveal how much value people placed on the restaurant environment, rather than the food or the convenience. Though, people’s restricted finances is probably also a huge factor.

        2. baconbits9

          I think the largest effect right now is that people have more time. The actual financial losses are only just hitting (most people’s pay is 2-4 weeks behind actual employment) and they have been promised to be papered over for the first few weeks as well. The laid off obviously have more free time, but new remote workers have dropped their commutes (plus a lot of the daily preparation for commuting like dressing for work isn’t as complex), and even those still working have less traffic to deal with and everyone basically has fewer out of the house activities and all the time from that.

          1. Faza (TCM)

            I think the largest effect right now is that people have more time.

            I think that’s an optimistic assumption.

            Here in Poland, schools are closed. We don’t have mandatory work-from-home, yet, but those of my co-workers who have kids pretty much have to.

            The net result is that they have less time, especially since the general idea for “how to teach children remotely” seems to be “give ’em a bunch of homework” – that the parent will have to supervise on top of doing their work and managing a family that’s cooped up in a not-so-big space and starting to succumb to cabin fever.

          2. baconbits9

            Sure, specific situations where both parents are still working full-time with kids out of school will be tough for them, but outside of that specific subsection overall time is higher for most demographics.

          3. Faza (TCM)

            I mean, if you take commuting out of the equation, sure.

            However, on the flip side we have things like people losing the ability to eat out, so they must account for longer food preparation times.

            Then you have folks like me, who aren’t affected one way or the other. I still commute to work (won’t be working remotely unless they force me) and have pretty much the same amount of time as I had before.

            I expect it to be a wash at best, but likely to come out poorly overall. Other than commuting, I can think of precious few places to save time, given that “fewer out of the house activities” generally boils down to “less ability to do the things you want to do”.

          4. JayT

            You not only gain time with no commute, but you can also get food started while you are still working. I plan on slow cooking some ribs today, and I’ll get them started while I’m still “on the clock” and would normally be at the office. Once I go back to commuting, I’ll go back to only being able to do meals like this on weekends.

          5. Conrad Honcho

            Slow cooked ribs are delicious. However, if you’re using a crock pot, be sure to put it on the back porch or in the garage, because it will make your entire house smell like ribs for two days. Ribs smell great when you’re hungry. They smell sickening at 3am when you just want to sleep.

          6. Cliff

            t will make your entire house smell like ribs for two days. Ribs smell great when you’re hungry. They smell sickening at 3am when you just want to sleep.

            But surely you get acclimated??

          7. Conrad Honcho

            My wife and I did not. That was a rough night. Just gross meat smell all through the house all night. First and last time I slow cooked ribs inside the house.

    1. The Nybbler

      It’ll fade to nigh-undetectability within a year after the lockdown ends. Except that people will be even more willing to accept government-by-decree.

      1. Le Maistre Chat

        The freaking out about Viktor Orban suggests they won’t accept government-by-decree except from their own half of the political spectrum.

    2. albatross11

      An obvious change is that millions of people are getting accustomed to teleconferences instead of in-person meetings, and to teleworking. A lot of them will want to keep doing that, and a lot of bosses will be more comfortable with it now.

      Another change: every state in the US is going to distance learning now for all their students. Why isn’t this always an option for kids who, for whatever reason, are finding that the local public school isn’t working for them? Maybe they get picked on, maybe it’s a 40 mile bus ride away, maybe the local public school doesn’t teach calculus, maybe they’re sick a lot–just let them all do a homeschool-like option where they’re taught remotely online. I suspect this option will be a lot easier to get in the future.

      1. Conrad Honcho

        I’ll give you the telework one because computer-savvy grown-ups can shift into that mode pretty easily and find their productivity doesn’t go down. For an awful lot of kids there will be a performance hit doing distance learning under this regime, if not because their household doesn’t have the equipment or expertise to make it work, then because the teachers are scrambling to provide instruction.

        My transition to telework has been smooth and painless. My kids’ schools’ transition to distance learning not so much.

        1. albatross11

          I suspect it will get smoother, though. The whole country is gaining a *lot* of experience in distance learning for kids.

          1. acymetric

            In 6 months to a year, maybe. You’re still probably looking at a year of mostly or at least partly lost education for a lot of kids if we don’t start back up in the fall.

      2. keaswaran

        I expect there to be some continuation and some rebound effect. Telework will increase in many contexts, because it will have been tried, and discovered to work in some of them. But there will likely be other contexts where telework will be banned, and in-person conferences will be stepped up, as companies recognize just what they were missing during these few weeks or months.

    3. AlexOfUrals

      All the restaurants which didn’t have their menu on their websites are now getting punished for it, I hope by the end of the quarantine all of them will have learned the lesson. Somebody on Facebook mentioned that stores suddenly became much more willing to ship items previously available “in store only”. And as albatross11 said, hopefully remote work will be much wider accepted afterwards.

    4. HowardHolmes

      I was thinking it seems reasonable that church attendance in U.S. will not return to previous levels.

        1. theredsheep

          There’s going to be a great deal of unemployment, it seems, and churches traditionally form community support centers. They could easily play that role again.

        2. HowardHolmes

          Being the one who doesn’t think anyone really believes in god, I also do not believe that faith changes in foxholes. Everyone knows they cannot rely on god to fix this.

          1. HowardHolmes

            Eyeballfrog

            I think you have a poor model of religious people.

            Given that I have a degree in religion and was once a preacher, where do you think specifically my model errs?

        3. Corey

          Anecdata: I’d been ready to try atheist church (Sunday Assembly), but of course now have to put that off until the dust settles.

      1. Kaitian

        I mean, some of the old people who are the most reliable church-goers will die, but everyone else will probably be back in church once the lockdown is lifted, at least to the same degree as any other large gathering.

        For many rural people, church is an important center of community life, some churches are really attractive activities, especially for people with children — and obviously some people go because they see it as a religious obligation.

      2. John Schilling

        I’m going to guess that the marginal churchgoer is going to be more, not less, likely to attend church regularly when the lockdowns end. Note that the marginal churchgoer, for attendance purposes, is the one who vaguely thinks they should be attending every Sunday but really only makes it once or twice a month because life intervenes. Those are the ones who are likely to see either their religious faith and/or religious community life take on greater meaning. The Easter-and-Christmas nominal Christians may make up a larger fraction of the population, but a smaller fraction of butts in pews on the average Sunday so even if they all stay away over residual coronavirus fear, they won’t change the attendance numbers very much.

      3. HowardHolmes

        I figured that with a few weeks off from church other habits will develop. People will realize how much else can be done with Sunday morning. People will realize that the sky did not fall when they missed church. People will find more ways to rationalize that watching a religious program on TV will count. People will discover better ways to spend more limited funds.

        1. theredsheep

          Most people who regularly attend church have family and/or friends at church too, and sometimes non-worship activities. The lazy worshipers you describe have in all likelihood already ditched under less trying circumstances, as social pressure to attend has declined considerably and it’s become decidedly uncool in many circles.

        2. smocc

          I suspect that the US is pretty far past the point where the people who go to church regularly do so only out of habit, such that merely not going for a while will make them realize there’s other things they could be doing. The people who go to church when they think that they could be doing better things are by and large already not going to church. The people* who do go to church regularly are for the most part fully aware that there other things they could be doing and keep going to church because it serves some purpose for them.

          If I had to predict I’d guess that we’d see some people who were on the margin fall off the wagon for a little while, some people who had attended sporadically attend a little less sporadically for a little while, and then a quick return to whatever secular trends were there already.

          *Independent adults anyway

          1. HowardHolmes

            Experience is a strong teacher. Until someone experiences not going to church for a while, they do not really know what it is like. It could be better or worse than they think. I am just guessing that some will learn of alternatives they did not know of before. Again, to KNOW from experience is not the same as knowing from talking or thinking about it. IMO there are a lot of people going to church who do not know why they are going…there are a lot of people doing a lot of things who don’t know why. They do what they know they can do and avoid everything else. The virus will force a lot of people to do things differently because they learn what is possible. There will, for instance, be more staying at home than going out in general.

          2. smocc

            As I said, I think the number of people who will suddenly learn from experience that church wasn’t doing anything for them is very small. Probably roughly the same size as than the number of people who will learn from experience that they really do miss going to church and will start attending more regularly afterwards.

            36% of American adults that attends church at least once a week. Imagine asking one of them why they attend church regularly. What reasons do you think they will give?

          3. HowardHolmes

            36% of American adults that attends church at least once a week

            This is based on interview. Half are lying. In studies where actual attendance in an area was counted, the results are that about half as many attend as say they do.

          4. theredsheep

            I’m not sure what point you’re trying to prove here. I went to church as often as I could before COVID hit–though I often had to work Sundays–and will be going back when it’s an option again. I get the feeling you’re assuming religious people are largely passive and cowlike, if not outright stupid, but regular church attendance is increasingly countercultural and comes at a cost. We don’t fail to realize that we could be sleeping in on Sundays, nor fail to enjoy the free time we have. We simply feel there are things we value more.

          5. smocc

            Great, that makes my point even stronger. What percentage of the remaining 18% of people who still go to church regularly are doing so only because they don’t know anything else?

            When I think of my congregation I am sure that if you asked regular attendees a large majority would be able to list several specific reasons they go to church instead of doing other things on Sunday. Heck, “why go to church on Sunday” is a fairly regular topic of discussion in Sunday School.

          6. HowardHolmes

            The red sheep

            I went to church as often as I could before COVID hit–though I often had to work Sundays–and will be going back when it’s an option again.

            So I’m not talking about you.

  19. johan_larson

    And in other happy news, the alcohol industry seems to be doing just fine despite the COVID-19 pandemic:

    The U.S. alcohol beverage market has not experienced any major disruptions because of the COVID-19, or coronavirus, outbreak, industry experts said, and consumer demand for alcohol remains strong.

    New York-based Cowen Inc. held a COVID-19 Virtual Conference Series with experts such as Lester Jones, chief economist for the National Beer Wholesalers Association, and Sarah Barrett, executive editor for Wine & Spirits Daily. Cowen’s report of the conference showed the supply chain is uninterrupted (at least for now), off-premise bumps are expected and timing remains the biggest question moving forward.

    Distributors have supplied the requisite amount of product into their respective channel and should be able to efficiently balance the mix between core alcohol beverages and other need-based products moving forward, the report said.

    Consumer demand for alcohol remains strong, evident in high traffic and velocity in off-premise. There is no firm timeline on when social-distancing measures will end, resulting in consumers loading their pantries with alcohol.

    “This should provide a near-term bump in off-premise alcohol sales and help to partially offset the lost consumption that will be felt in the on-premise channel, which typically accounts for 18% to 20% of total volumes,” the report said.

    1. Statismagician

      I know a higher-up at one of the big alcohol-distribution companies. He describes as ‘not exactly recession-proof, but definitely recession-resistant’ industry, and apparently the same is true of pandemic.

      1. DarkTigger

        Just wait a little. In Germany the liqeur producing industry has started to have problems getting their hands on ethanol last week, as all incoming production is to be reserved for disinfectants.
        Obviously that won’t hit beer and wine producers.

        1. johan_larson

          Well, if you’re making whiskey, you age your stock at least five years and sometimes 8/10/12 years. A six-month problem like COVID-19 should hardly affect you at all. That’s just not the timescale you live in.

          1. Statismagician

            I don’t think this is true for American whiskeys/bourbon; my understanding is that the higher grades are only required to age 4 years and the lower ones don’t have specific requirements. Some of that’s because we’re uncultured boors who want instant gratification, some of it’s because Kentucky has way more annual temperature variation than Scotland and we don’t want to give more to the angels than we absolutely have to.

            However, I’m not sure how ethanol being used for sanitizer production would really matter, since my understanding is that all the alcohol content in whiskey comes from fermented grain. I could be wrong, of course, and presumably the German spirit producers are making something other than whiskey in the first place.

        2. The Nybbler

          Does this really help or is this theatre? I’d expect alcohol (not just ethanol) for disinfectants to be produced from petroleum and other fossil feedstock at scales much larger than ethanol produced for drinking from agricultural products.

        3. DarkTigger

          @The Nybbler
          Ethanol is ethanol, isn’t it. As long it is high enough proof, it will do the trick.
          And when the ethanol stocks run short, you have to take what you have.

  20. Spookykou

    Can I take the other tack and skip the rally and Cairo and wallow in my epistemological helplessness in peace.

    1. SCC

      I was referring to a historical event that touched me profoundly – several years after I fought side by side with Egyptians in a minor forgotten war in the MidEast, a plague of a virus swept through Cairo, and although the plague was not transmissible from our friends the pigs to us humans, the incompetent clowns at WHO or somewhere like that allowed the plague to be called the swine flu, and evil bureaucrats in Cairo ordered every pig to be killed, in their cold-heated ignorance about what should be done at such times. (one or two details are a little off but I always do that, it is a stylistic thing)

      And all the pigs were killed, and for weeks the good people of Cairo suffered tremendously from the effects of the over-piled garbage on the street that the pigs used to take care of.

      And almost nobody on the internet cared – if I remember right, Jerry Pournelle spoke about it a little, and maybe Matt Drudge had a little side bar on the bad effects of the slaughter of all the swine in Cairo —-

      but almost nobody cared. I remember.

      That was when I Realized that almost nobody who talks for a living really cares about anything, it is almost always signaling.

      One of my missions in life since then has been to point out to people who are wasting their lives talking that they should actually do something.

      Forgive me if I was not clear —– almost everyone reading these words has done good and profoundly important things for others.

      But I know something about talkers and braggers that you don’t know.
      Reread my comment, you are intelligent, and you can figure it out.
      Trust me I am nothing remotely like a troll.

      1. Clutzy

        I was a bit obsessed with it as I volunteered at a hospital at the time, and actually used pig blood a lot in my research.

        While I don’t really remember the suffering of the people, I do recall thinking it was obviously incredibly dumb. First it was wrong, but second even if was a disease carried by pigs where slaughtering them would eliminate a vector, it would probably have had to be an insect based disease like Black Death, and killing the rats during a plague never worked for that.

  21. Well...

    You can tell yourself all day long that you are rational and altruistic and wonderful

    Does anyone actually tell themselves these things, ever? Well, maybe some people do, like fleetingly, almost by accident, between two other thoughts they’re deliberately having. After all, human psychology is a complicated natura–hey wait a minute!

    If anyone reading this truly remembers their thoughts relating to the events in Cairo which I have described, I would love to hear about it. But trust me, you probably don’t remember, because you just didn’t care.

    I don’t remember them, but it occurs to me now that if you’d made it up it would be one heck of an April Fool’s prank, and I wish I’d thought of it first.

  22. FrankistGeorgist

    Look I may not be able to articulate how glass is made or the pitfalls of distillation or indeed the deepest intricacies of the class system but I stand by my remark about glass vodka bottles.

    1. SCC

      You are my favorite commenter EVER!

      By the way, my comments have been deleted before, not that I care, that is not how I roll, but I hope you read this first

      YOU ARE MY FAVORITE COMMENTER EVER

      Maybe someday we shall talk, friend to friend, about what I learned about the class system in its primal state in Kolyma, years before we were born, and about what you know about one of God’s greatest blessings to man ….. vodka in glass vodka bottles

  23. Le Maistre Chat

    “The Door to Saturn”, or satirical SF starring sorcerers
    Part of Clark Ashton Smith’s Hyperborea cycle, first published in the January 1932 issue of Strange Tales of Mystery and Terror.

    Morghi, the high priest of the elk goddess Yhoundeh, came before dawn with underlings to arrest Eibon at his house for heretical wizardry, for he still worshiped the long-discredited god Zhothaqquah (Tsathoggua). They were surprised as well as disappointed to find him absent. His servants are tortured and presumed innocent. They found no secret passage, not even by searching under the idol.

    This he had done with extreme reluctance, for the squat, fur-covered god with his bat-like features and sloth-like body, was fearsomely abhorrent to the high priest

    A search of the house turned up no clues, though such suspicious items as “disagreeable and gruesome paintings on rolls of pterodactyl parchment” and totem poles carved with the eldritch abomination along with the seal, the mammoth, the giant tiger, and the aurochs. Then Morghi perceived a hidden door behind one of the paintings… but in the outer wall of an upper floor. This is the title Door to Saturn, which Eibon received as gift from the god “after years of service and burnt offerings” (don’t let a Player Character Plane Shift without them).

    it would be difficult if not impossible to return to Earth from Cykranosh — a world where Eibon might find it anything but easy to acclimate himself, since the conditions of life were very different from those in Mhu Thulan,

    Gosh, you don’t say.
    Smith’s description of a gas giant’s surface is, well, weird. There’s ashen soil, instead of water “some liquescent metal resembling mercury”, air is breathable although “Eibon did not care for its sulphurescent odor or the odd puckery sensation it left in his nostrils and lungs.” and he walks without mentioning different gravity and air pressure. Also, Saturn’s rings are cyclopean.
    There are “a kind of bluish-purple obsidian cacti, with limbs that ended in formidable talon-like spines, and heads that were altogether too elaborate for either fruits or blossoms.” that seem to be alive. After seeing them, Eibon met Hziulquoigmnzhah, a relative of Zhothaqquah, who “drank of the liquid metal in a hearty and copious manner that served to convince Eibom of its godship; for surely no being of an inferior biologic order would quench its thirst with a beverage so extraordinary.”
    Hziulquoigmnzhah told Eibon “Iqhui dlosh odhqlonqh,” and then walked away, at which point Morghi came up pronouncing the writ of arrest. Eibon drew his bronze sword and pointed out that no Earthly power mattered when they were alone here with no way back.

    “I have been conversing with one of the gods of Cykranosh,” he said magniloquently. “The god, whose name is Hziulquoigmnzhah, has given me a mission to perform, a message to deliver,

    Magniloquently!
    Morghi grudgingly accepts to stick together until he can find a way home, upon which Eibon will still be tortured by the elk inquisition. Peacefully they ate and drank with frugality, since the supply was limited, and the landscape was… likely not even organic, being described with terms like “sharp metallic foliage”. Eventually they met some indigenous sapient bipeds, whose faces are on their torsos like the legendary Blemmyes. Eibon saying “Hziulquoigmnzhah! Zhothaqquah! Iqhui dlosh odhqlonqh!” makes them bow down and take the pair in as honored guests for several months… during which time they were able to eat the local food. Confusing.
    They learn that these people have no idea what “Iqhui dlosh odhqlonqh” means – though the neighboring Ydheems do – and their graditude actually resulting from guiding an animal back to them. They also like the fact that Eibon and Morghi have heads, and want them to mate with the insect queen-like “national mother” because they themselves evolved from ancestors with distinct heads and feel “eugenic sorrow.”

    Eibon and Morghi were quite overcome by the proposed eugenic honor. Thinking of the mountainous female they had seen, Morghi was prone to remernber his sacerdotal vows of celibacy and Eibon was eager to take similar vows upon himself without delay.

    There is also the custom of cooking the national mother’s husbands and feeding them to her when they are too old or worn out to fertilize. So the Earthly pair ran away while everyone else was asleep.

    And during the following day they journeyed among more than one of those unusual races who diversify so widely the population of Saturn. They saw the Djhibbis, that apterous and Stylitean bird-people who roost on their individual dolomites for years at a time and meditate upon the cosmos, uttering to each other at long intervals the mystic syllables yop, yeep, and yoop, which are said to express an unfathomed range of esoteric thought.
    And they met those flibbertigibbet pygmies, the Ephiqhs, who hollow out their homes in the trunks of certain large fungi, and are always having to hunt new habitations because the old ones crumble into powder in a few days. And they heard the underground croaking of that mysterious people, the Ghlonghs, who dread not only the sunlight but also the ring-light, and who have never yet been seen by any of the surface-dwellers.

    Upon reaching a Ydheem settlement, there’s an avalanche of edible fungi; not fatal but rather inconvenient. They recognized the name Hziulquoigmnzhah and the words “Iqhui dlosh odhqlonqh,” which caused them to carry all their belongings out of the inundated town and build a new one. For those words meant “Be on your way,” and the god had addressed them to Eibon only as a polite dismissal. As honored guests of the Ydheems, life was safe, for they chose to reproduce in the normal way.

    Morghi, however, was not entirely happy. Though the Ydheems were religious, they did not carry their devotional fervor to the point of bigotry or intolerance; so it was quite impossible to start an inquisition among them.

    Back in Hyperborea, Morghi’s underlings had to wait for a dispensation from his successor to leave the stupid house of the heretic and go back to their normal lives. A general belief spread that Eibon had mystically escaped Mhu Thulan by powerful magic learned from Zhothaqquah and made away with Morghi into the bargain. So Yhoundeh’s cult declined and there was a revival of Zhothaqquah in the last century before the encroaching glaciers ended civilization.

    I don’t know what to make of this story. It feels like a rehearsal for the style of Jack Vance (starting circa 1950?), but it’s not proper science fiction, what with humans breathing and eating on the surface of Saturn. Perhaps it was written in the shadow of Voltaire’s Micromegas, where a giant from Saturn with 72 senses meets a space traveler from the Sirius system who has 1,000 senses and is several times his height, and they visit Earth to make fun of philosophies Voltaire didn’t like. But this is also framed as a story set in Earth’s past when magic worked.

    1. John Schilling

      and he walks without mentioning different gravity and air pressure.

      Interestingly, Saturn’s “surface” gravity is close enough to Earth’s that you’d probably need measuring instruments to be sure there was a difference. And there i certainly a region where the atmospheric pressure is Earthlike.

      The bit where the air is mostly hydrogen and helium would be inconvenient, of course, as is the part where there isn’t a solid surface to walk on, but it’s not clear that those things were well understood when Smith was writing. So I’ll give him the Barsoomian grandfather clause, but if we really want we can put the story on the back of some truly gigantic leviathan blimpoid floating around in the Saturnian atmosphere and maintaining a breathable mix under a translucent membrane on its back. Presumably the leviathan uses the oxygen the way we use e.g. sugar, as something to react with the local atmosphere when it needs energy.

      1. rmtodd

        This wouldn’t be the only SF work from that era that was a bit in error about the breathability of Saturn’s atmosphere and the presence of an actual solid planetary surface. Or even the only SF work from that era with that error written by someone named Smith. Recall that other famous Smith-surnamed author, Edward Elmer Smith, had a scene in Spacehounds of IPC where Stevens and Nadia had to go to the surface of Saturn to repair the broadcast power station the Titanians had put there…

        1. Del Cotter

          lt’s a pity that Gerard Kuiper’s discovery, that Saturn’s moon Titan has an atmosphere of its own, was more than a decade in the future.

    2. Gerry Quinn

      I think Vance’s seminal _The Dying Earth_ was published in 1949 – the first book he got published.

    3. Deiseach

      It’s definitely influenced by Dunsany, so think of it more like the Dreamlands tales of Lovecraft (also influenced by Dunsany) rather than either horror or science fiction – it’s slightly tongue-in-cheek arch science fantasy, and the setting doesn’t matter too very greatly. It’s certainly not aspiring in any fashion to be anything near realism, so the different gravity etc. isn’t a consideration at all.

      Read it for the exotic colour and the deliberately understated prose which again gets the kind of circumlocution in description by way of the influence of the faux-Chinese style of The Wallet of Kai Lung and its successors (which were wildly popular back in the day):

      This the unseen did a moment later, still keeping his gun in an easy and convenient attitude, revealing a stout body and a scarred face, which in conjunction made it plain to Kai Lung that he was in the power of Lin Yi, a noted brigand of whom he had heard much in the villages.

      “O illustrious person,” said Kai Lung very earnestly, “this is evidently an unfortunate mistake. Doubtless you were expecting some exalted Mandarin to come and render you homage, and were preparing to overwhelm him with gratified confusion by escorting him yourself to your well-appointed abode. Indeed, I passed such a one on the road, very richly apparelled, who inquired of me the way to the mansion of the dignified and upright Lin Yi. By this time he is perhaps two or three li towards the east.”

      “However distinguished a Mandarin may be, it is fitting that I should first attend to one whose manners and accomplishments betray him to be of the Royal House,” replied Lin Yi, with extreme affability. “Precede me, therefore, to my mean and uninviting hovel, while I gain more honour than I can reasonably bear by following closely in your elegant footsteps, and guarding your Imperial person with this inadequate but heavily-loaded weapon.”

    1. broblawsky

      No. Signal-boosting can cross echo chambers, particularly in times of crisis like these. Trump is still responsible for misusing his bully pulpit.

      1. Clutzy

        I don’t see how this theory applies.

        First there is the problem that Trump said a true thing that this drug may work. That this drug has a name that sounds like other things is not on him. Nitroglycerin is a common drug also, if the president mentions that in a talk about heart disease and a crazy person blows himself up trying to make it himself or eats dynamite that’s not really related.

        Second it distances him further, because her priors would be to disbelieve what he said. This plays perfectly into my Drunk Pete Rose analogy from last thread. We can’t demand Ray Fosse stay 10 feet from anything fragile at all times because Pete Rose is always drunk and sneaking around trying to tackle him.

        Third, there is actually a more plausible scenario that is quickly accumulating evidence, this was a spousal murder, or murder-suicide where the suicide portion was averted.

      2. Deiseach

        Trump is still responsible for misusing his bully pulpit.

        Well then, you should be absolutely blasting to hell and damnation the irresponsible person who posted this over on the SSC sub-reddit, because they’re only encouraging more impressionable people who read this kind of “wonder drug to treat the virus!” material to rush out and consume fish tank cleaner. I hope you go straight over to the sub-reddit to tick them off for being so careless!

        Or is it different when it comes from Really Smart Person deciding for themselves that they’ll take the risk of taking a drug which they source themselves and dose themselves and are not under medical supervision? Because I didn’t hear anything from Trump about hydroxychloroquine (it doesn’t appear to have been covered in our news) but I have read a couple of similar “I’ve decided for myself that this drug is what I want to take just in case I might get the virus” pieces from Really Smart People on fora for other Really Smart People.

        I think that’s every bit as irresponsible, or even worse, because these are people who do consider themselves a cut above the common herd when it comes to Understanding Science, and they would have unwarranted credibility when recommending such ‘miracle cures’ amongst their own circles of family and friends – Jason is so smart, he knows all about this kind of thing, if he recommends it then it must be okay!

        1. Mary

          Whataboutism is an attempt to blame the person who notices, rather than the one who applies, double standards.

          Since the latter is the one in the wrong, it is wrong.

        2. broblawsky

          No, whataboutism is an attempt to invalidate an opponents position by charging them with hypocrisy for not criticising some behavior. I don’t believe my position is hypocritical, because I don’t think I’m ethically obligated to criticize every person who promotes pseudoscience, just the most prominent pseudoscience promoters.

    2. toastengineer

      So, this is not my theory, it’s secondhand from a Youtube comments section or something. But… d’ya think maybe this lady intentionally poisioned her husband and knows she can count on the power of the Incredible Human Mindkill to prevent anyone from suspecting her?

      1. Iago the Yerfdog

        Completely unrelated, but I searched for “Incredible Human Mindkill” (without quotes) on Startpage.com and got the PS2 game Drakengard as the “instant answer” Wikipedia link.

        Just thought that was amusing.

      2. Deiseach

        I think murder-suicide is stretching it, ordinary human gullibility and stupidity (if you’re going to take a drug without consulting a doctor first, why the heck would you not research it more?) is to blame sufficiently. That he died and she didn’t is simply down to dumb luck and however they dosed themselves.

        1. toastengineer

          Well, the theory is that it’s not a murder-suicide, she intentionally gave herself a non-lethal dose to allay suspicion.

  24. ana53294

    I feel like there’s some fundamental thing that is not understood either by me or by the people who are OK with shutting the economy for months.

    Even in the EU, Germany banned the export of gloves and medical equipment. So much for the European “Union”. Saying, right, money doesn’t matter, we’ll just print more/get more debt, and put the whole country on welfare. But the thing is, for that money to buy stuff, somebody needs to make that stuff. And it doesn’t seem like a sure thing anymore we’ll be able to buy stuff from other countries anymore, because if they need the stuff, even if your country needs it more and is willing to pay a higher price, they can just ban export.

    And giving exceptions to people who produce stuff considered “essential” is not enough, because everything is linked.

    The shutdown of hotels and travel means agro workers cannot travel. Agro workers can’t travel, that means that there is not enough workers to collect harvests. And who can guarantee we can buy food from other countries?

    The cost of shutting down the economy is not measured just in money. A few points in GDP are not just money. Those are lives destroyed, people malnourished, and enormous reductions in QOL.

    1. Hoopdawg

      It is, of course, extremely irresponsible for governments to leave their citizens without support in these difficult times, but this is unrelated to the shutdown. Our advanced economies produce enough necessities of life for the entire population to thrive on a fraction of its productive output. What’s lacking is a will to help people.

      The solution is not to stop the shutdown, which is needed to fight the epidemic, and bound to happen anyway when everyone is either sick or self-isolated at home. The solution is to stop giving primacy to ideology that prevents governments from helping their citizens. Incidentally, it’s the same ideology that now calls for lifting the shutdown.

      1. albatross11

        Hoopdawg:

        Since you’re responding to Ana, I guess that would be the Socialist (center left) party, who are running things in Spain? As opposed to, say, the Republican (center right) Trump, who has extended shutdowns for another several weeks?

      2. ana53294

        Our advanced economies produce enough necessities of life for the entire population to thrive on a fraction of its productive output.

        Not at a time when supply lines are challenged and each country has to fend for themselves. Now is the time when we need people working in factories more than ever, to make sure we do not run out of critical stuff produced in a factory overseas.

        And while the US may be able to produce everything they need with the shutdown, that’s partly because the shutdown is not as draconian as in Spain. And the US in huge.

      3. Alexander Turok

        Our advanced economies produce enough necessities of life for the entire population to thrive on a fraction of its productive output.

        Have you ever attempted to quantify:

        1. How much the economy produces, per person?
        2. How much, per person, is necessary to “thrive,” in the way you define it?

        If not, how sure are you that your statement is true?

        1. eric23

          It seems pretty clear. Compare the output per person 50 or 100 years ago, when people seemed to be generally happy and thriving, to the output per person now. It is a couple orders of magnitude higher now, I believe.

          1. DavidFriedman

            It is a couple orders of magnitude higher now, I believe.

            Maybe one order of magnitude if you go back 100 years, depending on where. Not nearly that if you go back 50 years.

            Unless you are thinking of China, and 50 years ago people in China were not thriving.

          2. Alexander Turok

            It’s one order of magnitude at best. Agree that:

            1. It considerably above subsistence.
            2. People living at subsistence will generally be happy due to hedonic adaption.

            But by this standard, America’s poor are far above subsistence already. I presume Hoopdawg would set “thriving” considerably above it as well.

      4. baconbits9

        Our advanced economies produce enough necessities of life for the entire population to thrive on a fraction of its productive output. What’s lacking is a will to help people.

        Why would these be independent things?

    2. Loriot

      The choice isn’t between “shutting the economy down” and the status quo. The choice is between shutting the economy down or getting it shut down for you by millions of people dying.

      1. ana53294

        Or, you know, instituting reasonable precautions like asking people to wear masks, checking temperature daily (and asking people who have a fever to stay home), doing extensive weekly testing, and keeping the economy on at least half gear to make sure we can feed the millions we are supposedly saving.

        While keepin those who can work from home working from home, that is.

        1. MisterA

          Or, you know, instituting reasonable precautions like asking people to wear masks, checking temperature daily (and asking people who have a fever to stay home), doing extensive weekly testing, and keeping the economy on at least half gear to make sure we can feed the millions we are supposedly saving.

          The UK abandoned that strategy for a reason – they reran the numbers and are pretty sure that approach still leads to millions dead (which still winds up shutting down the economy afterward).

          1. edmundgennings

            At risk of sounding like General Turgidson, even in the worst case scenario I am not saying we would not get our hair mussed but would 1.something percent of the population dying really shut the economy down? It would be spread over a few months as would the much higher number of people with varying degrees of non fatal symptoms. I have hard time imagining that shutting the economy down.

          2. MisterA

            My understanding is that a lot of the problem is that it wouldn’t be spread over a number of months. The models basically say that the type of mitigation efforts you’re talking about still don’t stop the virus from spreading so fast that everyone gets sick at essentially the same time, the hospitals become overwhelmed, and almost everyone who needs intensive care (ie, 1 in 5 infected people even among the young) just dies instead.

            So instead of everyone staying home and grinding the economy to a halt because the government said so, now millions of people are dying (which obviously carries its own hefty economic cost) and THEN everyone stays home because they’re actually scared and taking it seriously now that it’s too late, so the economy still grinds to a halt.

          3. albatross11

            Yeah, it’s important to remember that if we actually get our medical system collapsing under the weight of dying pneumonia patients, and 1-2% mortality in the population plus another several percent of people super sick and permanently disabled by the disease, we’ll get the lockdowns anyway–most people will refuse to send their kids to school or go out in public anyway, and politicians who want to still have a political career come the next election will get out in front of that.

          4. Matt M

            we’ll get the lockdowns anyway–most people will refuse to send their kids to school or go out in public anyway

            Of course, this is completely and entirely speculative.

            It’s plausible, but hardly certain. Even if we crank up both our prevalence and fatality estimates to account for a “hospitals overwhelmed” scenario, say we estimate something like 20% prevalence and 2% fatality rate, that still means that the overall fatality rate for society at large is 0.4%. Plenty of people still won’t know a single person killed by this disease.

            I don’t know how bad things have to get to start triggering massive “voluntary” quarantines. But the answer would seem to be “worse than Italy” at the very least.

          5. ana53294

            I don’t know how bad things have to get to start triggering massive “voluntary” quarantines. But the answer would seem to be “worse than Italy” at the very least.

            Yep, at least in Spain, if it weren’t for the fines, people would get out.

            And so far, kids don’t seem to be dying from the coronavirus, so unless the parents are vulnerable, why wouldn’t they send the kids to school? If the parents are not locking themselves also, I can’t imagine them wanting to lock the kids.

          6. MisterA

            @MattM

            Even if we crank up both our prevalence and fatality estimates to account for a “hospitals overwhelmed” scenario, say we estimate something like 20% prevalence and 2% fatality rate, that still means that the overall fatality rate for society at large is 0.4%. Plenty of people still won’t know a single person killed by this disease.

            That’s way too optimistic. Italy currently has an 11% case fatality rate due to overwhelmed hospitals. The total population fatality rate in the city of Lombardy is .07% of people having died of COVID 19 already, with hundreds more added every day. And that’s with a lockdown in place.

            For a scenario where we aren’t in a lockdown and the pandemic just gets to spread unchecked, increase that number. A lot.

            EDIT – Went back and edited the Italy numbers, since the most recent numbers are even worse.

          7. Matt M

            The total population fatality rate in the city of Lombardy is .07% of people having died of COVID 19 already, with hundreds more added every day. And that’s with a lockdown in place.

            So, still less than 1/10th of 1%.

            What’s your estimate of the population fatality rate that would be needed to get significant portions of society to start voluntarily quarantining themselves?

            Mine is at least 1%, based on that being a level wherein most people will likely know at least one person who has died. I think that’s the bare minimum required for people to be so afraid of this thing they’ll risk unemployment to protect themselves.

          8. MisterA

            So, still less than 1/10th of 1%.

            In the first three weeks, with total lockdown in place.

            Try not putting in a lockdown, and let it go for months. What do you think it gets up to? I am not sure – nobody has been willing to try it yet – but the general consensus I have seen from every epidemiologist willing to put a number on it looks like 40-80% infection. If you see the same case fatality rate as Italy, that comes out to a 4% general population mortality rate at the low end, 9% at the high end.

            And that’s assuming the hospitals are only as overwhelmed as they currently are in Italy, with the lockdown, and that it doesn’t get much, much worse.

            Now, I don’t think it would actually get up to those numbers, because like Albatross, I am almost sure that there is no state in the world that won’t lock down in the early stages of something like that. But I don’t really see the wisdom in ending the lockdowns to let it get started before shutting back down in a panic after the inevitable results start.

          9. Edward Scizorhands

            There are 181 million people over age 35 in the US. If you have a 11% fatality rate, that’s 20 million dead people.

          10. acymetric

            There are 181 million people over age 35 in the US. If you have a 11% fatality rate, that’s 20 million dead people.

            Only if you have a 100% infection rate, right? I mean, you still get quite a lot of deaths if you only have a 60% infection rate, but I’m also not sure why we would expect an 11% fatality rate for the over 35 demographic.

          11. MisterA

            but I’m also not sure why we would expect an 11% fatality rate for the over 35 demographic.

            Because that’s what we actually have today in the one place where the hospitals have been totally overwhelmed.

          12. acymetric

            Because that’s what we actually have today in the one place where the hospitals have been totally overwhelmed.

            Then using “35 and up” is wildly misleading, because the age distribution is not the same in the US as it is in Italy, and the death rate certainly isn’t the same all the way across that age group in either country.

            I see one place reporting a mean age for deaths in Italy at 79.5, so I’m not sure what it could possibly have to do with 35 year olds, or even 50 year olds. It’s simply the wrong place to start if someone wants to do this kind of analysis.

          13. Matt M

            MisterA,

            I think you’re forgetting what it is I am actually arguing here.

            The assertion from albatross (and he’s hardly alone, it’s a super common belief as far as I can tell) was basically something like: In the absence of a state-enforced lockdown, the disease will run so rampant and cause such devastating consequences that people will end up voluntarily locking themselves down anyway out of fear of the disease.

            My only point is that this is entirely speculative, and would probably require basically orders of magnitude worse outcomes than we are currently seeing, even in the worst-hit places.

            That’s not to say it’s impossible. It may be true that the measures taken by Italy did, in fact, improve their outcomes by an order of magnitude and that without those actions, it would really be that much worse and would reach levels sufficient to make people that terrified.

            I don’t think we’ll get a test case of this in the western, developed world. As you say, no well-functioning state will allow things to get to that point without enforcing draconian lockdown measures.

            We may end up with test cases in the third world, or places where the state simply doesn’t have the support and/or resources necessary to enforce such measures. But then there will be plenty of confounders there as well.

          14. soreff

            @edmundgennings

            At risk of sounding like General Turgidson, even in the worst case scenario I am not saying we would not get our hair mussed but

            The epidemiologists are definitely starting to sound like that…
            250,000 dead, 10,000,000 dead… I keep expecting to hear
            “to choose between two admittedly regrettable, but nevertheless *distinguishable*” in this case post-epidemic…

        2. Radu Floricica

          We will, I think. I hope. The initial quarantine is necessary to stop the exponential. And there’s another catch – if the quarantine is working, the decrease is also very steep, so an extra week of quarantine is pretty valuable in terms of infections extinguished.

          So after anything from 4-8 weeks, depending on how well it was implemented, we’ll go back to almost normal and ask people to take precautions.

          And here we’ll hit another snag: they won’t. Even I don’t follow a perfect quarantine. But here at least you see older people walking the streets without a care or social distance. We have fines too, pretty big ones. But you can’t really fine people for not keeping minimum distance or not wearing masks – definitely not when you can’t find masks to buy.

        3. Thomas Jorgensen

          Cant ask people to wear masks without any masks available for them to wear. Anyone scaling mask production up in the required manner?

          1. Radu Floricica

            Everybody, probably. In Romania we have a furniture company that switched from making couches to masks. They’re pretty big – can’t remember the name right now, but they’re supposed to make something like a third of european Ikea furniture

          2. EchoChaos

            @Conrad Honcho

            And Brooks Brothers.

            Turns out making clothes and pillows here in the USA gives us the means to rapidly switch to “wartime” production if needed.

            Onshoring now.

      2. ksdale

        Or perhaps there is a middle way where we try much harder to produce the necessities of life while avoiding most of the dangers of the pandemic? There seem to be a lot of people that just assume an abundance of necessities and assume that the abundance will continue indefinitely while everyone’s sheltering in place and so respond snarkily to any suggestion that the cost of shutting down so much, so haphazardly may be too high. I am not at all a “the cost is worth it” type of person, but I am continually surprised at how quickly people dismiss the question of “are we going to produce enough stuff?”

        I’m not sure I agree with Hoopdawg that advanced economies produce so much. I definitely agree if we define “necessities” to mean technically enough calories and technically clothes and technically four walls and a roof for everyone, but I think there’s a good chance that the aforementioned fraction of our productive output would actually feel like grinding poverty.

        To be clear, I’m not suggesting we just open up and try our luck. Korea seems to have demonstrated that you can both contain the virus and mostly continue on with life, provided the will exists. Obviously containing the virus is of primary importance, but it also seems obvious that printing money doesn’t make necessities appear out of thin air.

        1. ana53294

          There seem to be a lot of people that just assume an abundance of necessities and assume that the abundance will continue indefinitely while everyone’s sheltering in place and so respond snarkily to any suggestion that the cost of shutting down so much, so haphazardly may be too high.

          That’s what I mean, but also pointing out that we need to produce that stuff in places that will sell it to us.

          1. ksdale

            I think that’s a great point as well, that even if things keep running, we’ll still have problems if borders are closed or stockpiles are built up.

        2. Loriot

          Well, we’re doing our best to become South Korea, but it’s going to take a month or two of containment to even have a hope of getting there.

          It’s difficult for me to engage with this argument because it’s so hard to tell what you’re actually advocating. It sounds like “implement containment measures like we’re already doing except do it better”. Do you think the particular choices made in particular areas about what to shutdown or not shutdown are incorrect?

          1. The Nybbler

            South Korea put the djinn back in the bottle. We can’t. We’ve got 160,000+ _confirmed_ infections, most concentrated in the NYC area but the rest widely dispersed. We have basically no idea about low-symptom or no-symptom infections, because we still can’t test fast enough to keep up. There’s no practical way to reduce the number of infections to the point ordinary public health measures can contain them. Even if there were, there’s still the rest of the world; doing so would mean maintaining international travel restrictions indefinitely.

            The South Korean way is no longer an option, and probably hasn’t been since January. This epidemic is running to its natural conclusion, one way or another.

          2. mtl1882

            The whole South Korea argument seems to ignore the most crucial aspect. If my understanding is correct, South Korea and some other Asian countries who were affected by SARs decided they better be ready for when something like that happened again. They built a strong pandemic-specific response structure with clear protocols, voted into place by their legislature after extensive public discussion. So most people were on board or at least aware that this was in place. Therefore, when the virus hit, it was very easy to shift right into a well-designed response mode.

            Culture and government structure and attitudes towards technology most likely contributed to their decision and ability to address the problem and put a good system into place, but the response was good because they were ready. No one who hadn’t planned could just become South Korea if they were starting from scratch when the virus hit. Nearly all the credit is being given to the swiftness of the response, when most of it should be going to having a response ready-made. Our confusion on this issue is obscuring our major failing–most American leaders talk like they didn’t realize pandemics could happen in the modern world, and that they couldn’t have been expected to prepare for this, despite things like SARs. It’s too late now to become like South Korea.

          3. 10240

            @The Nybbler I expect that two months of Italy or China-style lockdown would reduce the number of cases to near-zero. After that, extensive testing and contract tracing can be used to limit the spread of new infections from foreigners or remaining sporadic cases.

          4. The Nybbler

            @10240

            I don’t believe we can lock down the entire nation, or even the New York City area, for a month, to the extent that Wuhan was (not sure what Italy is like). And we clearly don’t have the ability to test enough; because of that long incubation period we’d have to be testing a whole lot of healthy people, not just sick people.

            I’m not even certain Wuhan actually managed to stop the epidemic. There’s rumors that the actual death numbers are much higher — 42,000. If that’s the case, it’s entirely feasible that the epidemic mostly burned itself out, rather than being significantly affected by the lockdown.

            The evidence is that South Korea stopped it, but they had a smaller problem than we have now. And apparently an FDA and CDC equivalent that aren’t so hidebound.

          5. DavidFriedman

            And we clearly don’t have the ability to test enough

            Why not? The technology is known, the cost doesn’t seem high relative to the scale of the problem. Why couldn’t we, in the fairly near future, be testing a sizable fraction of the population every month?

          6. Edward Scizorhands

            Whatever testing problems we had in the past, the US is ramping up testing capabilities like it’s going to war.

          7. The Nybbler

            Whatever testing problems we had in the past, the US is ramping up testing capabilities like it’s going to war.

            Only a war we want to lose. Specimens tested hit a peak on March 17. New Jersey in particular has been getting _more_ picky about who they test, not less.

            @DavidFriedman

            Why not? The technology is known, the cost doesn’t seem high relative to the scale of the problem. Why couldn’t we, in the fairly near future, be testing a sizable fraction of the population every month?

            PCR testing as I understand it requires trained people to do it, which may be the limit there. As for other kinds, I suspect it’s simply that we’ve allowed too much regulation to accumulate, and as a society as a whole we’re too risk-averse to lift enough of it lest something go wrong.

          8. Edward Scizorhands

            Specimens tested hit a peak on March 17.

            Those are CDC tests. There are about 110K new tests happening each day.

            https://slatestarcodex.com/2020/03/29/open-thread-150-5/#comment-873092

            https://covidtracking.com/api/us/daily.csv

            New Jersey in particular has been getting _more_ picky about who they test, not less.

            Given they are in the middle of a very serious outbreak, even having a lot of tests means they need to use them wisely. They are doing about 5000 tests a day: https://covidtracking.com/data/state/new-jersey/#history

          9. eric23

            “There’s rumors that the actual death numbers are much higher — 42,000.”

            Even according to those numbers, the deaths have STOPPED at a relatively low number. The official death toll in China is 3312. The rumors suggest it was actually 42000. With the infection toll increasing by about 33% per day per lockdown, that implies that China did exactly what they claim they did – they just did it eight days later than claimed. Why exactly would that be important news?

          10. baconbits9

            they just did it eight days later than claimed. Why exactly would that be important news?

            It would be substantial news, it would make it vastly more likely that their infections rate was a lie, and much more likely that they will get a second wave as they end lockdown.

          11. The Nybbler

            No, they are not CDC tests. CDC tests are the blue bar. The orange bar is public health lab testing. However, they don’t match the covidtracker data, so I’m not sure what the discrepancy is. New Jersey doing 5000 tests a day does not show “ramping up”.

            @eric23

            If deaths stopped at 42,000 in Wuhan, and the IFR is around 1%, infection rate in Wuhan is about 4.2 million. Wuhan population is about 12 million, so it’s conceivable all the lockdown did essentially nothing and the epidemic burned out on its own. This also implies they won’t see a big second wave in Wuhan.

      3. LesHapablap

        About a million people who are 70+ and already sick. Very few who are in the workforce.

    3. Alexander Turok

      No one in America is going to wind up malnourished because the economy shut down bar a few hobos. If anything the health of the people will improve if food became a tiny bit more scarce. I agree that GDP maters, but even with very low values of cost-per-life the quarantines are clearly worth it.

      1. Le Maistre Chat

        GDP maters,

        Evidence isn’t in on whether quarantining everyone will increase Gross Domestic Production of babies.

          1. acymetric

            Someone already brought this up in a previous OT, but 3-6 months of births does not make a generation.

          2. John Schilling

            No, but a generation can get its name from a singular, brief period within its cohort. “Boomers” and “millenials”, for example.

          3. acymetric

            The baby boom (Boomers) lasted for years, not just a few months. Millennials just means pretty much anyone who was old enough to talk and under 20 at the turn of the century. I stand by the point.

            We also haven’t (yet) named a generation after a national disaster, and I wouldn’t expect that to change now.

          4. anonymousskimmer

            Agreeing with acymetric, the “war babies” are a subset of the silent generation. They did not give their name to that generation, and there’s no reason to believe any smaller event would give a name to a whole generation instead of a subset of that generation.

          5. viVI_IViv

            Wouldn’t it make more sense to re-align to K-selection?

            No, the lower the expected lifespan and the higher its variance the more r-selected you want to be: gonna pass on these genes before Corona-chan gets you.

            To be fair, the effect would be stronger with pathogens that increase infant mortality, like malaria, but our pathogen response instincts don’t necessarily perform accurate evolutionary fitness estimates. Whatever behavioral adaptation that evolved to deal with malaria and the plague is going to be triggered now.

      2. ana53294

        The US is a huge country. It may be OK. I any country has a chance, that’s the USA.

        But other countries don’t, especially if they* start banning exports.

        *Meaning countries en masse.

        1. eric23

          The EU is a huge economic zone. China, India, Brazil are huge countries. They all have a chance by these standards.

          Also, nobody is going to ban imports, the chance of getting infected from an item that’s been shipped across the world is infinitesimal.

          1. ana53294

            Nobody has banned imports. Exports have been banned. The EU is not a single country, and borders have been closed, and critical exports have been banned.

            China, yes. But I’ve heard many things about India and Brazil not being very unified countries. There are internal borders, different legal systems, and the roads are terrible.

    4. JPNunez

      All economies will need to adapt and do a lot more testing in the workplace. China had this system for a while in Wuhan, where they would check the temperature of workers before the workday started. This kind of thing will need to be enacted for critical activities, soon, if we believe the pandemic may last too much.

    5. viVI_IViv

      The shutdown of hotels and travel means agro workers cannot travel. Agro workers can’t travel, that means that there is not enough workers to collect harvests. And who can guarantee we can buy food from other countries?

      That could be a concern only for densely-populated city states like Singapore (which however is probably at low risk because Corona-chan seems mostly under control in East Asia).

      In any decently sized European country, like Spain, agricolture produces orders of magnitudes more calories then required to feed the population. Normally, most of these calories are used to feed livestock, which convert them very inefficiently to tastier calories. But even if agricolture is severely disrupted, even after stockpiles are exhausted (which is probably going to take months), even after all the cows, chickens, pigs, sheep, bats have been eaten, even if only 10% of farmers work, there is going to be enough food not to starve.

    6. AlesZiegler

      Obvious solution is to treat food production as an essential industry exempt from the shutdown. And I think most countries are doing exactly that.

      1. Loriot

        I think the OPs contention was that governments would inevitably screw things up and shut down industries which produce things essential for food production. I am unconvinced.

        1. albatross11

          At some point, you get down to the socialist calculation problem. We define healthcare, transortation, and food as critical services, but no person or committee knows everything that goes into those things and can’t be substituted. Maybe there’s a critical role being played by some apparently unimportant thing that you shut down, and you notice the problem only when it turns out that the plastic lid factory you closed down a month ago made a lid for a container that was critical for someone making a part that’s used to maintain ventilators or something.

          This is a good reason to be pretty forgiving in what gets considered an essential business/service. OTOH, I hope state/local health departments are putting out guidance for how to run essential services. The feds should be publishing model guidance of this kind, too, as soon as they think they know enough.

        2. ana53294

          The Spanish government tried to shut down the metal working industry. Industry experts had to explain to them that some industrial processes can never stop, without permanently damaging equipment.

          Only the industry using lawyers and protecting itself avoids governments screw up. The government had no idea that you can’t just shut down steel mills. There’s a reason why steel mills don’t close even on Christmas day.

          And I’m just not sure the next critical industry they try to shut down will be able to make the right arguments to defend themselves. I am pretty sure that at some point some industry that is actually critical will get shut down. I think some things that are quite important have already been shut down.

          For example, car repair shops have been closed to the public, only fixing trucks, busses and ambulances. But what about the doctors, nurses, cleaners, and other critical personnel who need to repair their cars?

          1. acymetric

            Industry experts had to explain to them that some industrial processes can never stop, without permanently damaging equipment.

            This doesn’t surprise me upon hearing it, but I had never heard or thought about it before. What kind of processes must run continuously?

          2. ana53294

            This is the Spanish news article I’m roughly translating.

            Well, a blast furnace, apparently, requires careful shut down, and constant maintenance* during shut down, and it would take months to put it back on again.

            To me, that basically means can’t shut down without consequences.

            *Maintenance that requires more workers than just keeping it running, apparently.

            EDIT: article that explains difficulty of restarting a blast furnace.

            In the US, steel mills are idling, not shutting down. But I guess idling still requires some personnel?

          3. baconbits9

            I have no insight on what processes can’t be stopped, but speculation is that oil will go negative in price soon as storage runs out because ramping down oil production is very expensive and difficult.

            I suspect there are going to be lots of sectors hit that have perishable items. I know a lot of small scale market gardeners exist by selling very fresh, high quality produce like lettuce to restaurants and these guys are really screwed. Not only are their current crops likely to be worth a fraction of what they hoped, they have no idea if they should be continuing to plant for the next rotation that is 6-8 weeks from harvest. They can’t simply shut down for 3 weeks as that would basically mean no income fro 9-12 weeks and they have no real way to estimate production for 6 weeks from now.

          4. Eltargrim

            @acymetric

            Not an industrial process, but an example of a medical and scientific one: nuclear magnetic resonance (NMR) spectrometers, known in the medical field as magnetic resonance imaging (MRI) machines.

            These instruments rely on superconducting magnets, which are held in a bath of liquid helium, which in turn is in a bath of liquid nitrogen. If the helium runs out, there can be serious damage to the instrument, and repair is effectively impossible. If you top up the liquid nitrogen on a weekly basis, you can manage to keep the liquid helium fills to a few times a year.

            Shutting an instrument down properly takes weeks (at the least), the presence of manufacturer technicians, and is never a sure thing; the proper shutdown procedure still has risks. Starting the instrument up also has risks of damage, possibly losing field strength (which can be quite detrimental).

            Even if a lab shuts down, it’s quite possibly worth keeping up the cryogen infrastructure, as the alternative is risking the loss of millions of dollars worth of equipment. I’m listed as essential personnel in my lab, as I’m one of the people trained for doing these fills (filling four magnets today).

          5. keaswaran

            Where have car repair shops been closed to the public? Everywhere that I’m aware of explicitly lists car mechanics as “essential business” (though not all include bike repair shops).

      2. baconbits9

        Obvious solution is to treat food production as an essential industry exempt from the shutdown. And I think most countries are doing exactly that.

        You need food production and distribution. Anything that requires migrant labor is going to be hamstrung by travel restrictions and exempting those workers is problematic. Distribution of food is going to take quite a bit of work, suppliers to tourist areas are going to see a collapse in demand without any obvious new market opening up for them.

        1. AlesZiegler

          I think that those are solvable problems that will be solved. Food prices might increase but I am not worried about mass starvation.

          1. baconbits9

            Of course the problems are solvable, but that is true of almost every instance of hunger/starvation/famine, the issue is that these problems are being created and have to be solved while another crisis is being dealt with. A few days ago Vietnam (3rd largest rice exporter in the world) temporarily halted new rice sales for export, and reports are that Venezuela is shipping half their normal soybean crop due to logistical issues with the shut down.

    7. DarkTigger

      Germany has relaxed the rules for medicinal supplies, for places that have no other possible ports of entry than Germany (i.e. most of the supply we have here is imported from China as well).
      The EU is negotiating rules for agricultural workers to travell inside the EU. Also most of the stuff that depends on travelling workers is more luxury food (wine and asparagus) than essentials.

      But yes, I find myself qouting The Big Short regularly recently: “Every point unemployment goes up 40.000 people die. Did you know that?”

  25. souleater

    Has anyone recieved a “letter of safe passage” from their employer indicating they’re an essential worker?

    It seems the intent is you are to present this letter to a police officer in the event that you are stopped for violating a shelter in place or curfew order.

    But lthis doesn’t have any legal weight, it just indicates your employer considers you essential.

    Has there been any cases of people being arrested that a letter from you employer would have circumvented? Or is this just theater?

    1. Matt M

      I’ve got one!

      My employer has specifically said “You don’t legally need these yet – but you might later – so keep it around just in case.”

    2. acymetric

      Are any cities/states arresting people for violating the shelter-in-place orders? Generally what I’ve seen is mostly “warnings” or maybe a fine/citation. I don’t think I’ve heard of anyone getting arrested over it.

        1. acymetric

          I was talking about individuals being out and about (either for work or for other reasons), not someone holding a large gathering. I don’t think that example is really relevant to the question in the OP.

          1. fnord

            Fair enough. I included it as the next best thing, but you’re right it isn’t really relevant to the “letters of safe passage” issue.

            (PS, Scott, I accidentally the report button while trying to hit the reply button. There’s no reason to report that comment, please ignore. I guess I have tumblr muscle-memory to click on the bottom right of a post rather than the bottom left, sorry).

      1. Beck

        There was an arrest in Montgomery last night for violation of the curfew that just went into effect.

        The curfew seems like it’s just a “stop and frisk” program dressed up as a quarantine measure, though, so no real surprise.

    3. Eric Rall

      I have friends who are essential workers (mostly health care related), and at least one of them has a letter from her employer. My understanding is that her employer doesn’t expect it to be necessary, but it’s a low-cost precaution that could make her life a bit easier if it is, so they went ahead and did it. Her letter is on her employer’s letterhead, and it states her profession and cites the provision in the local Shelter-in-Place order exempting health care workers from the lockdown.

      I’m pretty sure the letters aren’t currently necessary, since the current batch of lockdown orders exempt several activities for non-essential workers. If I get stopped on the road, and I tell the cop I’m going to the grocery store or a doctor’s appointment, how is the cop to know whether I’m telling the truth or not?

    4. broblawsky

      I got one. My company makes components for medical devices, including portable ventilators, so I’m pretty sure I could run red lights right now without legal consequences.

    5. bean

      I have such a letter, although I’m working from home for now. I’d guess it’s as much about protecting the employer as the employee. If the employee gets into trouble with the cops and just has to go “honest, officer, I’m on my way to work as an essential employee at X”, particularly if X is some generic shipping firm instead of the local hospital, the employee is likely to be somewhat unhappy. In this case, the employer gets to blame the cop.

    6. A Definite Beta Guy

      I received letters. Within the US, there is not yet enforcement on standard travel, but there are restrictions in Spain, Italy, and France from what I understand. Not really sure the US is ever going to go that far. The most I would expect to see in Chicago is some increased police activity around the places where people are likely to congregate.

    7. John Schilling

      I have one, I’ve never been stopped while going in to work, and I’d be somewhat surprised if that were ever to happen – to me, or to others in the United States on any significant scale. The police are going to go after the people who are hosting unauthorized large gatherings, including but not limited to non-critical workplaces, rather than try to hunt down unauthorized individual commuters.

      But, it cost next to nothing to print the letter, so why not.

      1. Radu Floricica

        Myeah, common sense. Here cops are stopping random people in cars in the city. And there’s intense talk on what exactly means “shopping for necessities around the house” – is it 1 km? 1.5? 0.5? So far seems pretty certain that if you meet the wrong cop you can get a fine for going to a larger supermarket. And the fines are stupid high for Romania – they just upgraded them from 1.5x to 15x minimum wage.

        Meanwhile the transport company in Bucharest reduced the number of busses.

    8. matthewravery

      Some letters indicate that Federal officials say you’re essential for national security. IDK if they’re any more legally relevant than others, but the signators have nicer titles.

      I only mention this because not all letters are necessarily equal.

    9. AlphaGamma

      My employer offered them- I work for a Dutch university which is sufficiently close to the Belgian border that lots of people commute from Belgium, and Belgium has a stricter lockdown in force than the Netherlands. In particular, they have put up police checkpoints at the border. I’m not sure if someone trying to cross without such a letter would be arrested or simply turned back.

      (The vast majority of us are working from home, as lab work has been reduced to a minimum and classes have been moved online, but there are still a few people coming in to keep things running and conclude high-priority experiments. I’m not currently one of them, and my commute doesn’t cross the border anyway.)

    10. Garrett

      My full-time employer hasn’t, because I can work from home and neither my employer nor my position are “essential” at this time.

      I’ve received an email from one of the ambulance services I volunteer with, thou no formal letter on stationary kind of thing. I find this funny because when I go for a shift I’m in uniform, I have several pieces of issued ID, etc.

  26. morris39

    Very interesting for me why some things seem uninteresting/unimportant. One such is that Canada and Australia both have experienced corona virus cases and deaths over the last two weeks that are much lower than other western countries despite similarities in culture, travel, urbanization, government measures, testing etc . For example compared to US the death rate/case ratio US/Ca 4.5/2.5. Not easy to spin?

    1. snifit

      I’m not sure what you mean. Government measures and testing have been vastly different in Canada and the US. Not easy to spin what?

      1. morris39

        Look at this country comparison https://www.worldometers.info/coronavirus/ and observe the large variation.
        Self isolation recommendations are similar but implemented at slightly different times (days) and testing in Canada is similar to EU countries but more than US. Tests can influence the # of reported cases but not the death rate very much.
        Spin? Seems there are confident predictions despite the the obvious gaps in information needed to build useful models, confident enough to attack others as incompetent or motivated.
        Christopher Balding presented a reasonable but unexciting evaluation, based loosely on reductio ad absurdum. See his Balding’s World blog.

    2. eric23

      Canada is actually doing worse than California (more cases and a smaller population). Australia is only doing slightly better. The US looks bad primarily because its cases are dominated by New York, which had the combination of being a major travel destination, and irresponsible delay in locking down. The rest of the US is lacking one of those two factors (except Lousiana and Florida).

      Also, most of Australia’s travel is from Asia which has not been hard hit by coronavirus (hahahaha but true).

  27. roflc0ptic

    If, like me, you’re curious about “What exactly is so hard about running ventilators?” Physiological Basis of Mechanical Ventilation

    This paper upped my concern that we don’t have enough trained technicians to operate ventilators. With a ventilator/hospital bed shortage, it seems like deaths won’t scale linearly: more sick means a higher percentage of deaths. Even with enough ventilators, I now doubt that deaths will scale linearly with illness. A money quote: “Once mechanical inspiratory time becomes less than neural inspiratory time, double triggering is inevitable (4). Protocol enthusiasts believe they are delivering a Vt of 6 ml/kg, but the patient is receiving 12 ml/kg—a setting proven to increase mortality.”

    The paper has substantial snark snark about how protocol-based ventilation leads to worse outcomes, so maybe it’s an artifact of some internecine struggle in the respiratory technicians guild, but… even if “protocol enthusiasts” are bad no good people, I still want more of them.

    1. theredsheep

      (I’m an RT student, first-year, haven’t gotten into this yet)

      Just to start: the term is respiratory therapists, not technicians. This is a sore point. If you call an RT a technician, s/he will knock you down and forcibly intubate you on the spot, with no machine on the other end of the tube. You’ve been warned. The author is a pulmonologist, not an RT, but still.

      With that said: yes, vent management is complicated. I don’t totally understand what he’s getting at–I understand about half of it, could probably follow most if I sat down and went line-by-line with references. I gather he’s wary of assist-control, which is (IIUC) the most commonly used ventilator mode. How one syncs it up with the output of the inspiratory control centers way up in the medulla and pons is beyond me, but he’s a pulmonologist.

      https://www.amazon.com/Ventilator-Book-William-Owens-ebook-dp-B07D3142ZM/dp/B07D3142ZM/ref=mt_kindle?_encoding=UTF8&me=&qid=1585600078 is free to read if you have Amazon Prime and a Kindle; it’s a bit less abstruse. I just got the print version of the first edition in the mail today (meant to get the 2e, oh well). Still meant for physicians to read, not the general public.

      1. roflc0ptic

        Mea culpa. Therapist. FWIW, technician is a word of respect in my vernacular. But I’m a software guy and I cringe when people say I’m in “IT”, so… I get it. Therapist.

        Yeah I’m sure I only got a cursory understanding. I had inferred that the machines responded to signals by the “inspiratory control centers” in the form of patients attempting to breath. My high level takeaway was that misconfigured ventilators end up failing to match breathing patterns and cause increases in patient mortality. This explains why the whole “machine pumping a bag of air” thing is less than ideal.

        For people reading along: That book is also available on libgen (dot) is. I’m definitely not going to read it, because I’m resolving to do something other than waste all of my time reading about COVID-19.

        However, theredsheep – I’m still willing to waste a lot of it. It seems like you’re in an excellent position to go get educated about ventilators and report back. We have all of these questions! How do ventilators work? When are they clinically indicated, and what’s the evidential basis of that? How often do they kill people instead of helping them? Is the lack of respiratory THERAPISTS going to be unfortunate, or catastrophic?

        1. theredsheep

          I can already answer the last one, albeit with low confidence: probably worse than “unfortunate,” possibly not as bad as “catastrophic.”

          The problem is that we’re also short of PPE (personal protective equipment, like N-95 masks). Without masks and such, hospitals have to act very defensively, which means they’re extremely reluctant to give a COVID patient anything that might aerosolize their secretions. Which, in layman’s terms, means handheld inhalers instead of the easier neb treatments, and if a patient can’t get by on low-flow nasal cannulas (up to 6 liters of O2 per minute) the next effective option is to go all the way up to intubation and a ventilator, which creates a safe closed circuit. So lack of masks and such means a lot more patients on ventilators.

          PPE shortage is also a problem because, aerosols or not, it’s hard for RTs to protect themselves. So some of them are going to get sick. Some RTs are elderly, or in poor shape (as are nurses). There’s talk of bringing back retired RTs, which strikes me as a great way to get more patients if we don’t get more of the damned masks.

          And of course RTs are feeling quite demoralized by their bosses throwing them into the room with a sick patient when they’re either reusing the same mask all day or else going in with bandannas around their faces. And by “demoralized” I mean “pissed off.” Like Soviet peasants getting ordered to charge German tanks, only in this case Stalin can’t shoot them for retreating so it’s only love of the Motherland and need of a paycheck that keeps them there. And RTs are already kind of grumpy, because respiratory departments are usually understaffed and, as you might have noticed, nobody in the broader world acknowledges that RT exists.

          Now, this might not be “catastrophic” in the sense that I don’t know how screwed we would be anyway. I can’t get a solid figure for what percentage of patients on a vent for COVID die. There’s a rumor going around that the worldwide average mortality is around 80% for them, but I’ve never been able to dig up attribution for that. More sober estimates put it around 50%, but I haven’t seen a lot of math for that either. Who knows?

        2. theredsheep

          Aww, hell. I’m going to go ahead and make this a separate reply, because it might take more than my remaining thirteen minutes to describe this idiocy. Just read this in an ad from Ford on Facebook:

          “Starting in April at our Rawsonville Components Plant in Michigan, we’re producing a ventilator with GE Healthcare leveraging the design of Airon Corporation’s FDA-cleared ventilator with a target production of 50,000 units in the next 100 days. The ventilator is designed to operate on air pressure without electricity, making it a versatile solution to help those fighting COVID-19.”

          There’s a picture of an archaic-looking device with dials and such. How do I put this? We already had a device that operated on pure air pressure and could be used as a ventilator in a pinch. It’s called a Bird IPPB machine, first designed in … I don’t even know when. The sixties or thereabouts. They were finicky, confusing contraptions that broke when you looked at them wrong and could only be fixed by a handful of specialized elderly mechanics, but they could be used as ventilators. The last Bird machine at our one local hospital that still used them (at the insistence of a hidebound MD) broke six months ago and was wheeled out to the trash in triumph by a rejoicing RT.

          There’s no computer. No versatility, no fine control, just crude mechanical parts. My FB group is torn between screaming and laughing. Ford is going to produce 50K of these pieces of shit?

          1. Garrett

            If you haven’t seen it, here’s a good (if rambling) interview with a CCRN at an academic hospital dealing with this issue right now. It’s a little more focused on the critical-care medicine aspect of it. The main problem seems to be that such high pressures need to be used for ventilation that it impairs blood flow through the lungs. Which then needs to be compensated for with high and carefully monitored levels of pressers, which are themselves almost at the level of killing the patients.

            One of the top YouTube comments is: “3rd Year Med Students take note: This is a MasterClass in cardiac care by a Nurse Practitioner at the top of her craft. Close your books. Listen up.”

          2. theredsheep

            Oy. Watching it at 1.5x now. The hell of it is, she says they’re getting a lot out of a specialized vent mode (haven’t learned about those yet, but it’s one of the less common ones). Those aren’t remotely possible with these simple pneumatic machines, AFAIK. No computer.

          3. Garrett

            Right. Which is why I suspect that a huge amount of the work being done to create open-source ventilators isn’t going to help. This isn’t a simple case of temporary muscle paralysis where simple air in/out will do.

      2. DarkTigger

        Sorry, but you just declared yourself to be the sitting expert on the topic.
        I heared an interview with an (I think) Italian RT who said, that one of the problems with COVID-19 is in laymens terms that the lungs of ciritcal patients are so full of fluid, that pumping enough oxygen into there lungs to create sufficent saturation in the blood, would need so much preasure that you are in danger to damage the lungs of the patient even further.

        That sounds like another case for “we can’t just let an standard process handle this”, or is this wrong?

        1. theredsheep

          There are several different ventilator modes and settings to tweak, and if you do it wrong it’s quite easy to seriously injure or kill a patient even if they don’t have COVID. I’m reading The Ventilator Book now (and my classes are back up, we’re learning the basics of intubation). Between that and what I’ve gleaned from RT chat on FB, it seems the easiest way to jack someone up is overdoing it with volume or pressure and damaging the lungs.

          This isn’t a matter of blasting in O2 with high-pressure flow, but of maintaining sufficient pressure at the right points in respiration to keep the airways open so they can absorb O2 normally in spite of their excess fluid load. Most of the elastic recoil force of the lungs comes from surface tension under normal circumstances. I would imagine that extra fluid is extra tension.

          COVID is, in the ICU, a variant on ARDS, acute respiratory distress syndrome, which we know how to deal with. https://www.oakesacademy.com/public/Coronavirus-Clinical-Collaboration.cfm is a professional crib sheet by respected authorities in the RT world. They recommend pressure-based settings to guarantee avoidance of barotrauma, and discourage allowing spontaneous breathing–the most commonly used vent mode is assist control, where the patient is free to breathe on their own and the vent is just making sure they do and helping where necessary.

          So this is definitely not business as usual. The video in the link above your comment, by Garrett, mentions some success with a less-common mode called APRV (I think, can’t watch it again right now). Proning is also apparently quite important–that’s when you lay the patient face-down, which helps for complicated reasons I don’t really understand yet.

          Bottom line, we’re working out ways to treat it, but it’s learn as you go and it’s pretty brutal. Nobody sounds exactly sure what kind of PPE is necessary, and staying in PPE all day is exhausting, especially if you have to code a patient. Chest compressions are very rigorous exercise when you’re all covered up like that.

    2. Mark V Anderson

      I’ve been trying to figure out what a ventilator is. I went to Wikipedia, and it appears they can be different things.

      Wikipedia

      My wife had a ventilator after she had heart surgery a number of years ago, when she was recovering in ICU. It was a terribly invasive thing, and I very much wouldn’t want anyone with minimal training to use it. But the Wikipedia article says what my wife had was for the intubation ventilators. It seems that CBAPs and other ones are non-invasive. Maybe they don’t need so much training. We need to distinguish between the types.

      1. theredsheep

        We’re talking about invasive ventilators here. Non-invasive ventilators are a less drastic option not currently in use because of biohazard from aerosolized virus combined with inadequate PPE.

        1. albatross11

          Maybe instead of worrying so much about ramping up production of ventilators, we should be worrying about modifying the non-invasive alternatives (high pressure O2, CPAP, BPAP) to reduce or eliminate the aerosol threat.

          As I understand it, the high-end ventilators are only used on very sick people and require constant supervision by an expert RT, of whom we will presumably be short during a flood of COVID-19 cases. Finding a way to get the next tier down of care working in a safe way would IMO be a bigger win than getting more ventilators.

          1. theredsheep

            1. Find a large public building that isn’t being used–not difficult at present.
            2. Move a bunch of Bipap machines, O2 tanks, etc. in, and assign medical staff there.
            3. Blanket the airwaves with “if you think you have COVID, come on down to your local COVID ghetto (formerly Bob’s Gym/New Spirit Megachurch/that creepy old mall where the stores are 75% empty).”
            4. Test in the parking lot, throw positives in there where they’re free to spew noxious pathogens everywhere. Keep a couple of vents on hand for crashes, with the intention of moving to the hospital if it gets dire. Now only providers need to worry about PPE most of the time; people with ordinary illness are at a much lower risk.
            5. When this is over, Bob’s Gym is remembered for coming forward and donating space in a time of crisis.

          2. CatCube

            1. Find a large public building that isn’t being used–not difficult at present.

            It sounds like convention centers are the first choice right now. As General Semonite (the Chief of Engineers) put it, (at 10:00 [ETA and 20:19] in this video) it’s more efficient to work with convention centers as they have experience with reconfiguring spaces quickly, and they can apparently figure out how to isolate between wards properly even with the large spaces.

          3. albatross11

            I suspect it’s probably *way* more dangerous to be a COVID-19 patient in that room than out of it, because you’re exposed to a ton of aerosolized virus. The people on the CPAP machines might not be (I don’t knot if they do some kind of HEPA filtering first), but anyone not on one of those machines is inhaling high doses of virus particles with every breath.

            In my very limited understanding, the problem here is that when I provide you with pressurized air/oxygen, I’m also helping spread all the particles in your exhaled breath all around the room. So I think you’d need individual rooms/spaces for each patient, with some kind of continuous air filtering to keep the place from becoming a swamp of viral particles, and a fan pulling air out to keep the room at negative pressure so the viral particles don’t spread out across the building.

          4. theredsheep

            Dunno; if you’ve already got it bad enough that you require more than 6 liters of oxygen (roughly equivalent to 45+% of the air you breathe being O2) to stay satted, do a few more germs in the air make a significant difference? I imagine you’d want to segregate mild and moderate cases at a “COVID center,” and have basic partition separations to discourage the spread of opportunistic infections as a matter of basic sanitation. Beyond that, hey, I know how to give neb treatments, set up nasal cannulas, take vital signs, and do chest compressions, and not a lot else. Not an epidemiologist.

  28. Perico

    On Open Thread 150 there was a discussion about alleged tanks in the streets of Spain due to the coronavirus crisis. I meant to challenge that claim back then, but the forum software ate my post. Since the story has been mentioned again in this thread, I’ll try again.

    I have made an honest effort to search recent news about this incident, and found nothing. While it is true that the army has been deployed across Spain (mostly to disinfect areas or to work on field hospitals), I have seen no mention of tank-like vehicles. All pictures or videos I found showed only wheeled military vehicles, some of them somewhat armoured, but with no obvious mounted weapons. This also applies to the links provided by ana53294 in the original thread – the closest one showed an armored truck (no guns) on the streets of Albacete.

    The only thing I found related to the story was an article in a supposed fact-checker site I’m not familiar with (so I’m not endorsing it) arguing that this is a false rumor spread over whatsapp: https://www.newtral.es/no-el-ejercito-no-ha-sacado-un-tanque-por-la-calles-de-tudela-para-combatir-el-covid-19/20200324/ . The vehicle in question is a Centauro tank destroyer, the same mentioned in the original story.

    Is there any evidence, other than second-hand accounts, backing this story?

    1. ana53294

      No, there isn’t. I’ve been searching and searching, and I haven’t found anything. And yes, that story about the tank destroyers in Tudela was a fake, which is why I didn’t link it.

      But I have been told by people who had first-hand experience in seeing the tanks, and social media is getting severely moderated. I’ve got no proof I can offer, but I do believe my sources.

      And my sources are not brave enough to take photos.

      1. johan_larson

        Well, Spain has a particularly bad case of COVID-19. It’s currently at 2052 cases per million. Here’s how that compares with the other larger nations of Western Europe:

        Italy 1750
        Spain 2052
        France 799
        Germany 857
        UK 370

        And elsewhere:
        US 570
        Canada 228
        Australia 191

        It sucks that people are getting pushed around by cops and the military. But given the severity of the problem, it makes perfect sense that the government is acting with urgency.

  29. TheContinentalOp

    Michael Fortier was an accomplice to the OKC bombing; he helped Timothy McVeigh scout out the Murrah Building. Fortier agreed to testify against McVeigh and Terry Nichols in exchange for a reduced sentence and immunity for his wife, Lisa. She helped make a fake driver’s license for McVeigh.

    In 2006 Fortier was released from Federal Prison having served 10.5 years, and entered the Witness Protection Program where he was given a new identity.

    My question is: “Protection from whom?”

    McVeigh is dead, and Nichols is serving 161 consecutive life terms.

    I guess the answer is protection from vengeful relatives of the bombing victims. Has this happened before or since, where the person in the WPP is being hidden not from the people he testified against, or some huge criminal organization , but from average Americans?

    1. herbert herberson

      Whether or not they actually need physical protection, they probably appreciate the formal assistance in hiding their past from their neighbors, acquaintances, and co-workers, and if someone anticipated that when the deal was negotiated it would have helped to sweeten the pot.

  30. ana53294

    Paging @Le Maistre Chat

    When I heard about all the politics in Portland, I thought it was just a crazy city, but it seems the whole state is crazy?

    Oregon shutting down all schools, including online charter schools. Discussion at MarginalRevolution seems to agree this is to avoid people enrolling into these schools and thus starving public schools and teacher unions.

    1. Matt M

      Electoral politics in Oregon are such that while the whole state isn’t crazy, the crazies in Portland hold a slight (but consistent) majority and are therefore able to dictate their crazy on the entire rest of the state.

      I originally heard the justification for this was that holding school online would “violate the principles of equity and inclusion” (because not every child has a computer and an internet connection, you see) and was therefore unacceptable. Which is 100% believable to me.

      1. Edward Scizorhands

        It is a valid point.

        But there are better remedies. In a well-funded place like Portland, typically there are only a few families without sufficient Internet and the city can buy hotspots for them.

        1. ana53294

          Except that there appears to be a looming laptop shortage.

          And for social distancing to make any sense, it should be personal laptops, not communal desktops.

      2. ana53294

        “violate the principles of equity and inclusion”

        That’s a very zero-sum view of education.

        And kids with the right parents would be able to get good online schools anyway. It’s just that online schools increase the number of right parents to potentially everybody with a laptop and home internet.

        One of the things I’m finding surprising with this crisis is how many people don’t have internet at home. Or a computer. Seriously – how do they do stuff? For anything more serious than a post on facebook, like online banking, looking for flights, comparison-shopping, and managing my investments, I need a device with a screen >=12 inches, plenty of USB ports, (I’ve tried optical/bluetooth keyboards, they’re too annoying), and more memory than a cheap smartphone.

        1. Lambert

          With great and increasing difficulty.

          Bank branches are closing all over the place and it’s causing real problems for the elderly.

          1. anonymousskimmer

            When various people bring up the relative economic benefits of X technology, it’s important to recognize the relative economic harm that befalls people without this technology.

          2. Spookykou

            I am a bit confused, do you mean the harm of not having it, or that the adoption of new technology causes older methods to be phased out and those reliant on the older methods are harmed?

            To the case at hand I thought online banking didn’t actually close many branch offices, it just saw their staff depleted, because people make bank accounts with the closest bank to their home so even if everyone does online banking the banks still want a lot of local branches.

          3. DinoNerd

            Indeed. I’m unfortunately already into the age group where “easy, obvious, modern” user interfaces are neither easy nor obvious. Any UI change is a puzzle to be solved, that makes the tool unusable until I’ve solved it. And I’ve been developing software since 1978 – not hiding under a rock, using typewriters and carbon paper;-(

            With regard to banking, I’ve mostly stopped trying to deal with ATMs (screen glare, no table space to endorse checks, checks that won’t deposit, random unordered extra cards that then don’t work in the ATM) and go straight in to talk to a person in an office with a desk (no one looks like a classic bank teller), whenever I have anything to deposit. I use online banking still, but I imagine they’ll eventually “improve” it so much that I won’t trust it to do what I actually intend. And as for voice menus – I haven’t yet figured out how to speak such that one of them can understand me.

            And I’m not on the wrong side of the digital divide financially – I have decent broadband, and almost all the toys. (We have 5 computers among 2 people, and I have cell phone, tablet, kindle, and used to use activity tracking watches. The only thing I refuse to acquire is a “smart speaker” – and any internet connected applicances.)

            The stuff just isn’t designed to be easy to learn to use – or to stay learned. After a certain age, learning to do the same damn thing, for the fortieth time, would be difficult enough if the new interface came with instructions; without them, it’s much worse. The other 39 methods I’ve already learned create interference and confusion. And while I can certainly still learn, I’d much rather spend the effort learning something new, or interesting.

            I can’t imagine what it would be like for someone who hadn’t been able to afford most of the toys, and hadn’t been forced to keep up to date, at least somewhat, in order to stay employed.

          4. Loriot

            This reminds me of a time my mom brought me along to try to teach an elderly woman how to use Gmail. It felt like trying to teach someone how to use a doorknob, as in she was failing to understand things so basic that it was difficult for me to even imagine how to explain them. Even my mother privately admitted afterwards that it was a lot more excruciating than she expected.

            P.S. Have you tried mobile check deposit? Also, why wouldn’t you endorse your checks *before* going to the ATM?

          5. Spookykou

            While I agree learning a new UI is obnoxious I have mostly interacted with that through trying to learn new art software. It took me forever to get a decent handle on Photoshop but my impression is that this has been generally helpful to me when using new art software. Maybe art software is unique though in that everyone wants to be Photoshop so they crib icon design.

    2. Le Maistre Chat

      Up to 59% of Oregonians live in the Portland metro area (2.479 million out of as free as 4 million). Another 4% each for Salem and Eugene, which have similar demography, housing markets, etc.
      So the way representative government works, the crazy Left gets everything by securing more than half the voters in more than half the districts, where 67% of districts are a city/Portland suburb. So optimistically Oregonians could be 100% sane in all rural areas and nearly 25% of urban ones and you’d still see this effect.

      1. ana53294

        Right. This is a very good point in defense of the electoral college system. Because if it weren’t for that, the country would indeed be ruled like Oregon is being ruled.

        I kind of thought that US coasts are more densely packed than that, but I guess it’s just the East Coast and California.

        1. anonymousskimmer

          This is a very good point in defense of the electoral college system.

          This is actually a good point in defense of a triumvirate or a parliament.

          In a one-person-wins system that one person will either be elected by a majority, or a minority, and will do things contrary to the stated preferences of the minority/majority regardless.

          Yep, lots of free room on the coasts in Washington and Oregon (and North California).

          1. Matt M

            Yep, lots of free room on the coasts in Washington and Oregon

            Eh, not really.

            Unlike most of the east coast and Southern California, the Pacific Northwest has coasts that are almost immediately bordered by densely-forested mountains. There’s really not much “space” to put a large-sized city in, even if you wanted to (and there’s no real reason to want to).

        2. Not A Random Name

          I think quite the opposite is the case. If the candidate with the majority of votes is elected that’s exactly what I want out of a voting system. And where those votes are located should be entirely irrelevant.

          I see no good reason why my vote should be worth more than somebody elses just because they’re living in a denser area. They’re no more or less a citizen or a human than me, their vote should count as much as mine. Not doing that is what sounds like insanity to me.

          That said, I make exceptions where it’s immediately obvious that giving equal voting power leads directly to bad outcomes. Nothing comes to mind right now but if those circumstances exist then this opinion is not the hill I’ll die on.

          1. AG

            Seems like the issue here is that our states are just too dang large. Let the metros split off into their own states, which limits their power on some issues over other areas. We can still balance the Senate by letting said metros split into multiple states as well. If Rhode Island can be that small, so can the 3-5 states of NYC!

          2. anonymousskimmer

            1) What of the suburbs?
            2) In particular states, given the demographics of large cities, how do you avoid the various civil rights interpretations of the Constitution?
            3) If this gives the residents of D.C. representation and electoral rights it can’t be all bad.

          3. Le Maistre Chat

            1) What of the suburbs?

            In Portland’s case, the suburbs are integral. “Metro” is an actual level of government, and they’re all connected by mass transit. It doesn’t have “car suburbs.”

          4. Mark V Anderson

            @LMC
            Portland is on the border of Oregon with Washington. When you talked about the population of the metro, were you including Washington suburbs?

          5. Le Maistre Chat

            Vancouver, Washington is legally distinct from Metro Portland and light rail doesn’t run over the Interstate bridges. Maybe Tri-Met buses do.
            I wasn’t intending to include any Washington suburbs in the 2.479 pop estimate, but I could have accidentally.

          6. DavidFriedman

            their vote should count as much as mine. Not doing that is what sounds like insanity to me.

            Is the reason behind this some philosophical principle that gives 51% of the population a moral right to make decisions for the other 49%, or do you have a political theory implying that simple majority vote produces better outcomes than any of the alternative systems?

        3. Nornagest

          Even California’s too big a state to have anything truly comparable to the DC-New York-Boston metropolitan axis going on, where you can drive all day at highway speeds without ever leaving somebody’s city limits. LA and its suburbs are about as close as it gets, but head south from San Clemente or north from Santa Monica and things get sparse real quick; southbound, it only lasts about twenty miles before you hit Camp Pendleton on the outskirts of the San Diego metro area, but heading north along Highway 101 the only thing big enough to call a city before you reach the SF Bay Area is Santa Barbara, at 90,000 people and about 100 miles away.

          Bakersfield is only about 100 miles from San Fernando, another LA suburb, and at 400K people it’s much larger, but that’s far inland and not particularly Left Coast culturally. And, really, you don’t want to go to Bakersfield.

        4. keaswaran

          “So the way representative government works, the crazy Left gets everything by securing more than half the voters in more than half the districts, where 67% of districts are a city/Portland suburb. So optimistically Oregonians could be 100% sane in all rural areas and nearly 25% of urban ones and you’d still see this effect.”

          “This is a very good point in defense of the electoral college system.”

          Isn’t this exactly backwards? In an electoral college system, where the overall control is decided by the majority winner in a majority of districts, you should expect to get this kind of thing, where a small minority manages to be concentrated in a way that makes it the majority in enough districts to win out. But in an overall plurality system (or a proportional system, or something else), you can’t get control unless you’re actually a majority overall.

  31. Ventrue Capital

    @Scott Alexander:

    This study of Chinese patients finds that smoking and vaping are not dangerous in coronavirus and may have “a protective role”, possibly due to downregulation of ACE (but note that the lead author has a history of getting funding from e-cigarette companies). This study from China finds that although never-smokers have better survival rates than current-smokers, former-smokers do worse than either, which would argue against quitting right now. And this study confirms that quitting smoking can upregulate expression of coronavirus receptor genes (though it finds that smoking does as well).

    I’m pretty suspicious of this research. It’s new, lots of it isn’t yet peer reviewed, and it contradicts itself in places. The former-smokers-do-worse effect is reminiscent of the teetotalers-do-worst effect in alcohol research, which is probably because very sick people get told to stop drinking, and so teetotalers are a disproportionately sickly population. Everything is working off a few heavily-biased mortality numbers in China. And also, even if quitting smoking increases your coronavirus mortality risk it will still be very good for you on net.

    Still, the most recent research does apparently show that the advice I gave you yesterday was diametrically wrong and could kill you, so I figured I had better get that out there.

    “I’ve been thinking of taking up smokin’, but this clinches it!”

  32. matthewravery

    Welp, here we go. This could be very good or very bad:

    FDA authorizes widespread use of unproven drugs to treat coronavirus, saying possible benefit outweighs risk

    Couple of things:
    1. I hope they’ve made sure production can ramp up to meet the potential demand (the article mentions “millions of doses”, but IDK how many people that actually treats)
    2. I hope they’ve made sure folks with on-label needs are going to be taken care of
    3. I guess this means the more recent data on this has continued to be positive?
    4. If I read the article right, it means broader access to the drug to hospitals (where some docs were already prescribing it off-label) but no updates to prescription guidelines. Which I think means the docs just have more options which I think is probably the right call.
    5. I super hope they’ve set up some sort of tracking and reporting infrastructure to rapidly collect and disseminate information on the success (or lack thereof) of treatment and the severity (or lack thereof) of side effects. This is arguably the most important component.

    1. J Mann

      My guess is neither very good nor very bad, although of course I hope for any good – do countries that have these drugs in their treatment regimens have much lower or higher death rates than anyone else? (I know it’s hard getting consistent data, but you would think if these were a miracle drug or a death sentence, we could tell).

    2. Matt M

      If you thought off-label prescribing was generally good/bad three months ago, I see no reason for your mind to have changed in this specific instance/example.

      Unless you think individual doctors are now in a state of mass panic and hysteria, nothing has really changed. If you trust doctors to make these types of decisions, this is good. If you don’t, it’s bad.

      1. matthewravery

        Doing things a little isn’t the same as doing things a lot. Any negative consequence are now magnified. (As are positive ones!!)

        And while I don’t think mass panic and hysteria have hit, I think mild panic and hysteria certainly have in some places. You also have the fact that patients can be very obnoxious when requesting specific drugs that they know the names of even when doctors would rather not prescribe them. (This is one of the reasons why prescription drug advertising works!) Many of the doctors who will be making these decisions are also going to be over-taxed working full-time and own’t have the bandwidth to engage in the most minute findings on the emerging qualities of the treatment. They’ll probably rely on word-of-mouth, personal experience, and any subsequent statements from regulatory bodies. And some will also submit to the will of patients who want the New Miracle Cure just so that they can move on to other cases.

        Then there’s the general case that, while off-label prescribing happens in many cases, they’re typically far smaller than “millions of US citizens in the next few months” and they typically have longer track records establishing efficacy.

        So I do think it’s fair to view this scenario differently than off-label prescribing in general.

        1. Matt M

          Do we have any numbers on how common off-label prescribing actually is?

          My suspicion is that it’s not nearly as rare as you think it is, but I honestly don’t know for sure.

          1. sharper13

            According to the top response on a quick google search, 20% of prescriptions are for off-label use.

            Which is why one of the more life-saving things we could do with the FDA is to make the efficacy portion of safety and efficacy testing/certification for new drugs completely optional. Bonus points if a drug in widespread use elsewhere (say, Europe, or Japan) can use those tests/data to quickly satisfy the safety part.

          2. matthewravery

            It’s not that off-label prescription is rare, it’s that you don’t this much off-label prescribing of a single medication for a single disease.

            Think of it this way: If there are 100 drugs, and each has an off-label use, and you’re 90% sure that each will work well for their respective off-label applications, it’s very useful to prescribe the drugs. Sure, 10% of these off-label uses are pointless, but that’s okay because the other 90% of the time, you do a lot of good. If you have 1 million potential off-label uses, about 900k of those improve things and only 100k make things worse.

            On the other hand, if you have one drug that you’re thinking about prescribing off-label, and you’re 90% sure it’ll help, but you’re prescribing it 1 million times, then you either get 1 million people that you help out (90% probability) or you get 1 million people who you make substantially worse off (10% probability). Because it’s a one-off, it’s much riskier.

          3. Garrett

            Off-label use also ranges from “Dr. Oz said taking this drug will re-align my chakras” to “well-tested drug with minimal side-effects being used for the same indication but an unapproved route of administration which has many quality blinded trials in the literature supporting this use”.

  33. salvorhardin

    The latest executive power grab Orban got his gerrymandered-supermajority party to agree to in Hungary looks really awful from the English language stories available, indeed rather Ermachtigungsgesetzlich:

    https://www.politico.com/news/2020/03/30/hungarys-viktor-orban-wins-vote-to-rule-by-decree-155476

    Is it in fact as bad as it looks? If not, why not? In particular, if Orban continues this state of emergency past the point where other EU countries return to the normal non-pandemic-time regime, shouldn’t that get Hungary kicked out of the EU?

    1. Loriot

      I’m not sure anything short of literal tanks in the streets could get Orban kicked out of the EU. Breaking up is rather inconvenient.

      1. Le Maistre Chat

        The Socialist government of Spain has put non-literal tanks in the streets (Centauro tank destroyers, technically) over the virus.

    2. EchoChaos

      “The shadow of fascism is forever descending on the United States and landing in Europe”

    3. AlesZiegler

      Well who knows what will happen with the EU in a few months. It is not exactly most stable of countries; because it is not really a country.

  34. Edward Scizorhands

    Mask anecdote:

    My wife made me one. I went out to run an errand on Friday and I was the only one wearing one.

    I ran an errand to the grocery store today, and there was one other customer in the store wearing one.

    It’s spreading! We can flip this social expectation.

    I’m possibly late with this, but the medical establishment seems to be flipping as well.

    https://medium.com/@Cancerwarrior/covid-19-why-we-should-all-wear-masks-there-is-new-scientific-rationale-280e08ceee71

    Tweeted by Dr Gottlieb: https://twitter.com/ScottGottliebMD/status/1244460977615253504

    1. Loriot

      When I went to the store on Sunday, I’d guess that maybe 30% of customers were wearing masks. But I live in an area with a large Asian population as well.

      1. Well...

        Same here (both for having gone to the store on Sunday and for seeing maybe 30% of people wearing masks) except we have very few Asians and instead a lot of Africans.

        Mask-wearing seemed pretty evenly distributed among whites, American blacks, and Africans.

        1. Loriot

          It’s not limited to Asians in my area either (though it is more prevalent), I just thought it might have influenced things.

    2. A Definite Beta Guy

      I went to the store with a legit mask leftover from a home improvement project. I’d say around 10% of people were wearing masks, but around 50% were wearing gloves.

      My friend…uhh…yeah, he includes wrap around goggles and earmuffs as well.

      1. eric23

        I was given gloves before entering a supermarket a few days ago. An unappreciated benefit is that I no longer touched my face, because it felt disgusting to do so on an instinctual level.

    3. Radu Floricica

      Strange. In.Bucharest it’s well over 50%. Not used to being at the forefront of… anything.

    4. Kelley Meck

      This story has me persuaded: https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak?

      TLDR: City an hour Seattle, with no confirmed cases in that county. Church choir practice of 60, no one has any symptoms whatever, everyone uses hand sanitizer coming in and leaving, everyone avoids touching each other or each other’s stuff… three weeks later, 2 deaths, 45+ confirmed infected.

      Masks were not used. It seems to me that getting back to something like ‘business as usual’ in this country will be a lot more possible if we normalize wearing masks.

    5. matthewravery

      Shopping last weekend, I’d say about 10-30% of folks had some type of improvised mouth/nose cover. I’m encouraging family to use them as well.

    6. j1000000

      When I go to the supermarket I now wear a scarf as a mask — not for my own health, b/c I’m a healthy young(ish) person, but for the sake of my parents, whom I’m now shopping for and whose groceries I’m holding in my hand.

      My previous sense was that the science said this does nothing. But I couldn’t shake the intuition that it at least helps prevent big droplets from getting on the food in case I do have corona and am asymptomatic, so I kept doing it. Would Dr Gottlieb say that I’m right to wear that scarf?

    7. keaswaran

      I went grocery shopping this morning in Texas (incidentally, it appears that Monday morning a few minutes after opening is a good time to find paper products in the store – we got both paper towels and toilet paper, after several weeks of seeing neither). On previous visits, I’ve only ever seen one or two people wearing masks. Today there were a bunch – somewhere between 10-30% I would guess, with at least two of them being what I assume are N95 masks. I think the only Asian person I saw in the store was one of the mask-wearers, and otherwise it was the same sort of mix of white, black, and hispanic people as the rest of the customers.

      I should probably get masks for grocery shopping.

      1. Gerry Quinn

        I was in the supermarket this afternoon (Ireland) and nobody was wearing one. I think we ran out.

    8. Rebecca Friedman

      I went to Costco today, and about 50% of people were wearing one – Bay Area, so we have significant populations of very many ethnicities. I think more of the people wearing masks looked Asian, but obviously discount for result that confirms expectations. Split about 50/50 between surgical masks and rigid-looking masks that Mom said were for home improvement, plus two homemade-looking masks (color-coordinated) and one guy using a scarf.

      Nobody on the streets, walking around, had a mask – 0/10. It might be that the grocery store is more crowded, so people are more inclined to assume they need one, but I also wonder if taking walks selects for people who are less worried, and grocery shopping doesn’t – perhaps the kind of person who would wear a mask for a walk isn’t taking very many (or any) walks right now.

    9. Le Maistre Chat

      I just realized that most women own hooded sweatshirts and at least one kind of tight black pants/bottoms.
      If you have to resort to a homemade mask, use black cloth and be a ninja.

  35. eqdw

    Is anybody else getting the sense that this current government/social focus on procuring a large number of ventilators is a pointless waste of time?

    I was reading some sources the other day and both preprint papers and social media anecdotes seem to confirm that a large majority (>80%) of COVID patients who are ventilated die anyway. It strikes me that, in light of this fact, procuring large numbers of additional ventilators in order to reduce overall COVID fatalities is not the greatest use of scarce resources.

    It seems to me kind of like streetlight policymaking. Nobody really knows what to do about COVID infections, beyond ‘quarantine the sick, treat symptoms, and hope for the best”. But that’s not a very inspiring message. On the other hand, vents: they are physical things that we can manufacture, they are a highly visible, easily explained, easily measured variable that can be shown to increase over time. They’re a highly visible symbol of progress against the virus. My only concern is that increasing the number of vents available will not make that much progress on anything that matters

    1. Matt M

      +1

      Agree with all of this. Every politician (and many private sector leaders) are optimizing for “what can I do to look like I’m helping in solving this problem.” And “produce more ventilators” is a pretty easy answer to that question.

    2. Edward Scizorhands

      Not necessarily agreeing, but I remember a news conference in NYC where the doctors said the bottleneck was more staff to run the ventilators.

    3. Loriot

      I’ve sometimes wondered this myself. It seems like focusing on PPE and tests would be a lot more effective. But I suppose the counterargument is “we should do all of those”.

    4. Chalid

      Life-years are worth a lot, so paying $50K for a ventilator that is used on 5 people and saves one is a huge bargain.

      One also expects that as ventilators become more scarce the success rate with them will go up, as they are reserved for the most appropriate cases.

    5. Le Maistre Chat

      I was reading some sources the other day and both preprint papers and social media anecdotes seem to confirm that a large majority (>80%) of COVID patients who are ventilated die anyway. It strikes me that, in light of this fact, procuring large numbers of additional ventilators in order to reduce overall COVID fatalities is not the greatest use of scarce resources.

      I’ve been saying over and over that “Flatten the curve! 40-80% of you will get it, and we’re locking you down so the health care system doesn’t get overwhelmed!” is ridiculous statesmanship.
      I’m down in Kentucky, where the Governor has been ahead of others relative to cases. Which is nice, but with no containment it just means our Boomers will get infected later and die at the same rate as New York unless mass testing (buy ABT) and contact tracing are possible before interstate travelers destroy any gains.

    6. Tatterdemalion

      I think this is dangerous nonsense.

      “Social media anecdote and preprints” is a polite way of saying “zero solid evidence”.

      And even if your number was correct (which I don’t think it is), if you put 20 patients onto a ventilator over the course of a year-long outbreak, 4 of them survive, and one would have survived otherwise, you’ve just saved 3 lives.

      The first link on the cost of ventilators I’ve found is https://www.independent.co.uk/news/world/americas/coronavirus-ventilator-new-york-cases-andrew-cuomo-price-cost-a9431861.html. I don’t vouch for it (I’m don’t think “we shouldn’t bother with ventilators” is a take worth spending much effort refuting, I’m afraid), but it quotes the cost of a ventilator at $45,000. Let’s say it costs as much again to run for a year. You’ve just saved three lives for $30,000 a pop.

      For some comparison points, in the UK the NHS will fund treatments that add about /one year/ of life for £30,000. In the US, https://fivethirtyeight.com/features/what-should-the-government-spend-to-save-a-life/ suggests the government should be spending orders of magnitude more than that to save a life.

      Approximately 100% of informed opinion is “we desperately need more ventilators”. Challenging that without something far more solid than what you have is massively irresponsible.

      1. Chalid

        It’s not irresponsible to just ask questions here. If he were publishing articles or giving speeches about it, that would be a different story.

        1. roflc0ptic

          Yeah. From my read, eqdw hasn’t proven what they’re arguing. And if eqdw was starting a ventilator truther campaign on this basis, it could qualify as “massively irresponsible.” But they’re not.

          The wonderful thing about SSC and adjacent groups is that we get to be utterly wrong about stuff without being told that our misconceptions are somehow a moral harm.

          People should *absolutely* be asking if the focus on ventilators is worthwhile. People should *absolutely* be asking if lockdowns are an optimal response in the current situation. Even Robin Hanson out there in the wilderness arguing for variolation is worth considering. I think he hasn’t made a particularly compelling argument yet, but hey. If we reject dissenting perspectives out of hand, we deprive ourselves of the opportunity to be correct on the off-chance they’re right. Let’s not lose this norm just because there’s a plague. Being rational matters even more when the stakes are high.

          1. Chalid

            The variolation stuff seems well worth experimenting on to me. We have the advantage here that we can test it in healthy 18-year-olds with virtually no risk of killing anyone. Use variolation on young healthy people and see if they develop symptoms that are significantly less bad than normal cases, and check them for antibodies. If results are good you can carefully generalize to larger and more at-risk populations.

        2. Tatterdemalion

          Reread the post I’m responding to. It isn’t just asking questions. It’s not even “just asking questions”, which I’m sure is a game you know (FWIW, I think that in some ways it’s a point in favour of eqdw that they’re not playing it). It’s actively putting forward opinions.

          The only question mark in the post is at the end of a rhetorical question of the form “does anyone else agree with me that X is true?”, not “is X true?”. After that, it’s just straightforwardly stating opinions, with nary a question in sight.

          1. Skeptical Wolf

            I think this is dangerous nonsense.

            eqdw led off with a statement (the one question mark) that clearly established how certain they were of the following statements (not very). Then they proceeded to describe what information sources led them towards that idea. This was clearly an attempt to resolve confusion.

            I want this space to remain a place where people can ask for and receive correction, second opinions, and independent analysis. Attacking someone for being confused and asking about the source of that confusion works against that goal. Please stop.

      2. Le Maistre Chat

        Ventilators are a bargain when they save 1 out of 5 lives attached to them. The big picture question is whether putting 320 million people under house arrest just so there’s always an ICU bed or ventilator for each old person who needs one is worth it. Does everyone getting to live their life and the health care system getting totally slammed only raise COVID deaths by 20%?

        1. eric23

          You do know that COVID patients consume a vast array of medical resources besides ventilators?

        2. keaswaran

          Back-of-the-envelope calculation – let’s say that we expect 50% of Americans to get the virus one way or another, so that there should be about 150 million infections. Let’s assume a 1% mortality rate with the shelter-in-place measures, and 1.2% mortality without them. That’s 300,000 lives saved by the measures. At a rate of $9 million per life (the amount used by the EPA and DOT when assessing environmental regulations and traffic safety construction projects) that’s $2.7 trillion. That’s about 15% of GDP. I’m not sure exactly how to measure the difference between the economic disruption caused by the shelter-in-place measures and the economic disruption that would be caused just by baseline fear of a new virus spreading, but it’s not obvious that it’s much larger than 15%. So even assuming only 20% change in mortality, these measures seem to be at least on the right order of magnitude for the number of lives saved, though the calculation will depend on some details I haven’t worried about yet.

    7. roflc0ptic

      Is there any other medical intervention that has degree of impact? Anywhere close?

      Let’s assume 80% of people who die of COVID-19 will be put on a ventilator. Let’s assume there’s an 80% mortality rate for people who get put on ventilators. Gonna just use concrete numbers:

      100 people will probably die:
      20 die outright.
      80 get put on ventilators
      64 eventually die.
      16 live because of ventilators.

      So based on these assumptions, ventilators cause a 16% difference in mortality rates. On its face, it’s definitely not a “pointless waste of time.”

      As far as cost benefit – when you say “limited resources”, which limited resources are you referring to? What is the opportunity cost here? To make that case, I think you’d have to show what they should be doing that they’re not doing, and how ventilators is getting in the way of that.

      Personally, I’m disturbed by the total lack of evidence that the politicos in the US are setting up infrastructure for contact tracing. But I don’t think that’s a case of opportunity cost: it’s not either/or.

      1. Loriot

        > Is there any other medical intervention that has degree of impact? Anywhere close?

        My intuition is that PPE is more effective. Having healthcare workers not get sick and die is really important to saving lives as well, and if we make enough masks to distribute to ordinary people, community transmission goes way down as well. But like you said, it’s not either/or.

        1. eric23

          That’s absolute true. But irrelevant. I don’t think anyone is saying to hospitals “you can have PPE or ventilators, pick one”.

          1. Gurkenglas

            Then you should say the question is wrong, not the answer. I disagree that the question is wrong, though: Money and public attention can be allocated to PPE or ventilators and some distributions will save more lives than others.

          2. eric23

            There is no reason not to have both. They are both cheap, relative to their projected benefit and to the sums of money available to the government.

        2. theredsheep

          I’ve posted this elsewhere in this OT, but I don’t know how to link to the reply, so I’ll say it here too: the two problems are interlinked. Because of PPE shortage, intermediate options for therapy are being eliminated from consideration for fear that they’ll cause airborne droplets and spread the disease. Everyone who can’t survive on a low-flow nasal cannula gets a full-on intubation. PPE shortage —> (exacerbated) ventilator shortage.

          1. theredsheep

            Yeah, I remembered how to do it about five seconds after I posted that. Oh well, I saved some other people the nuisance of clicking on a link. Thanks.

      2. roflc0ptic

        I pulled that number from eqdw: “a large majority (>80%) of COVID patients who are ventilated die anyway.”

        You’re right: it doesn’t account for the “needlessly ventilated” category. My priors heavily weigh towards “doctors are not needlessly ventilating people”, so I’m willing to assume it’s somewhere in the single digits, and round it out of my argument.

        I probably should’ve been clearer: the numbers I’m using are inaccurate. I think they’re accurate enough for purpose, which is pushing back against the claim that ventilators are a “pointless waste of time.”

        1. roflc0ptic

          If you want a better answer, I imagine you could construct one by looking at the question: what are the clinical indications for mechanical ventilation? https://www.medscape.com/answers/304068-104774/what-are-the-indications-for-mechanical-ventilation and determining what the evidential basis for mechanical ventilation as a medical intervention is. Armed with that, you would have a baseline for reasoning about COVID-19 ventilations.

          Looking at that medscape page, it says the indications are “Bradypnea or apnea with respiratory arrest”. Not a doctor and don’t know the survival rate of that without ventilation, but “respiratory arrest” sure sounds like a death sentence.

        2. roflc0ptic

          Well. I started looking a little bit. I was also entirely discounting the percentage of people who die from ventilation who would otherwise not die. I imagine that it’s low, but based on reading further about ventilation, it’s definitely not zero. I’m adjusting that number in my head up from rounding error to… not rounding error.

  36. Purplehermann

    Nutritional studies are generally observational by necessity.

    Could lock down / shelter in place orders allow for some good studies?

  37. DragonMilk

    I imagine people are cooking more than before – what are some decent and easy recipes maximizing nonperishable foodstuffs?

    For me, all I have is Chili:
    Can thaw frozen ground beef
    Canned beans and canned diced tomatoes
    Chili spices good to go
    Onions and peppers…I guess you can grow and last ok? Can we freeze these?

    1. Loriot

      So far, the only new recipe I’ve experimented with is roast potatoes.

      1. Cut a potato into small chunks.
      2. Put them in a bowl, drizzle oil over it, and mix it around until they’re approximately covered
      3. Put it in the toaster over at 400-425 for 35-40 minutes. Optionally turn them over halfway through.

      It doesn’t taste particularly good, but it’s cheap and easy to make. I typically eat some fruit with it so it’s not so bland.

      1. broblawsky

        Try roasting potatoes at 450, then pulling them out and letting them cool for ~10-15 minutes while your oven heats up to 500, then putting them back in for ~10 minutes. This duplicates the double-frying process that makes McDonald’s french fries as good as they are.

        Edit: Also, it doesn’t sound like you’re adding salt?

        1. Loriot

          I have tried adding salt, but it doesn’t seem to make much difference. I do still sprinkle salt on them, but it’s easier to just add blueberries to mitigate the taste and provide more calories.

          1. roflc0ptic

            Salt is much more effective when it has had a chance to diffuse throughout whatever you’re cooking. To improve flavor, you could modify your approach:

            1. cut potatoes
            2. in a bowl, coat potatoes in oil and a reasonable amount of salt
            3. let sit for several hours – the larger the pieces, the longer diffusion will take
            4. bake

            Alternatively, you can boil the potatoes part-way before you bake them, and use an unreasonable amount of salt. You’re pouring the water out, so any extra salt goes away. The objective is to create a lot of diffusion in a short period of time.

            Most things that you add salt to benefit from giving time for the salt to diffuse. How much time varies by material: red meats can take a day or two, chicken a day, beans a couple of hours, vegetables 15-30 min, fish 15 min. Even stuff you’re going to blend up where you can add salt later in the process, e.g. mashed potatoes, needs *some* time for the salt to spread itself evenly throughout the medium.

            Related to this: I highly recommend “Salt, Fat, Acid, Heat”. There’s some fluff there, but it gives you a really helpful framework for thinking about the components of tasty food. Nothing has improved my culinary life like getting a copy of that book, and… sharing it with my girlfriend who does most of my cooking.

          2. roflc0ptic

            Oh, additional thought, also straight out of Salt Fat Acid Heat – you say that blueberries improve the flavor. I google it, and blueberries are a very acidic fruit! Often sour cream (or salsa) will serve the function of making potatoes more acidic, and therefore more delicious. Blueberries should have the same effect, but with the downside of adding sweetness and some weird flavors/textures.

            Instead of blueberries, you could experiment with adding just a couple of drops vinegar to a potato chunk, post-cooking, and see what that does to the flavor. You don’t want to add so much that it tastes like vinegar, you just want to add enough that it tastes… richer and better. You can try a couple of times to see what the goldilocks quantity is.

            It’s possible that adding vinegar before baking will help (again, diffusion!), but it’s unclear to me how a higher pH will interact with trying to brown the stuff when baking, or if all of the vinegar will just evaporate off, or if vinegar will somehow mess up the structural integrity of the starches, but it seems ripe for some experimentation.

          3. FrankistGeorgist

            Vinegar like any acid causes potatoes to stay more rigid and brown less. Adding baking soda to boiling water alkalizes it, increasing browning and causing them to cook more on the outside than the inside – used to great effect by the Best Crispy Roast Potatoes recipe.

            Definitely hold off on vinegar until after the potatoes are cooked, though I do advocate more acid is more better for most everything.

          4. cuke

            I do a variation of this that looks like:

            Cut potatoes into pieces and throw into a bowl with:

            Olive oil
            Tons of salt and pepper
            Garlic (fresh, powdered, whatever)
            Thinly sliced onions
            And then any one of these:
            Smoked paprika, chili powder, cayenne powder, thyme, rosemary, curry powder

            Stir it all around and then spread onto sheet pan.

            You can fling grated cheese of any kind over the top of it in the last five minutes of baking.

          5. gleamingecho

            +1 on FrankistGeorgist’s recipe link plus post-cooking vinegar suggestion. If you have it/can eat it, bacon fat will keep the potatoes from sticking to the pan, too.

          6. Deiseach

            Instead of blueberries, you could experiment with adding just a couple of drops vinegar to a potato chunk, post-cooking, and see what that does to the flavor.

            This is why over here we put vinegar on chips 🙂 (Oh gosh, proper chip shop chips in the brown paper bag with the tang of vinegar rising off them – now I’m hungry…)

            I’ve never tried it with roast potatoes, but it seems to me you could do something with one of those fancy balsamic vinegars (or even a cheap one) as a glaze – and looking around online, yes indeed you can!

      2. albatross11

        We roast vegetables all the time in our house. For root vegetables (potatoes, sweet potatoes, carrots, maybe an onion cut into 1/8ths) we cut them into pieces (maybe 2cm on a side,), coat them with a mix of olive oil and spices (I use about 1/3 cup olive oil to a tsp each of salt, garlic salt, paprika, italian seasoning + about 1/4 tsp of pepper)–that gets 40-45 minutes or so in a 350 degree oven. They’re done when the potatoes are tender all the way through and don’t have any chewy bits on the inside. If you don’t mind scrubbing with a brush, leaving the peels on the potatoes seems to add something nice; the sweet potatoes get peeled and diced.

        Other vegetables get the same coating, but go in a little later–about 30 minutes. That’s stuff like broccoli, brussels sprouts, mushrooms, and squash. (Roasting eggplant didn’t work out at all for us–it’s too watery. But most vegetables do great this way!).

        A typical meal I’ll make is to make roasted vegetables (the potatoes provide the starch, the rest provides the vegetables) and oven-fried pork chops or chicken. That is:

        a. Coat the pork or chicken in a “glue” made from a couple beaten eggs.

        b. Then coat it in bread crumbs, ideally italian seasoned panko bread crumbs. (We just buy those from the store, but you can also coat with flour, instant mashed potato flakes, crushed crackers or potato chips, etc.)

        c. Put it on a metal pan that’s been sprayed with Pam.

        d. Drizzle some melted butter or olive oil over it.

        e. Bake in the same 350 F oven until its internal temperature is good (145F for pork, 165F for chicken).

        You want to flip it once, using a metal spatula so the coating browns a little on both sides. Typically, I’d put the root vegetables in first, then the meat and other vegetables, and it would all be done about 30-35 minutes after I put the meat in. But that depends on the thickness and type of the meat, so check.

        1. acymetric

          Yes, roasted veggies can be delicious, and the seasoning you mentioned is key (the OP didn’t seem to be using any). I would add asparagus as another vegetable that comes out really well when roasted (my favorites are sweet potatoes, broccoli, and asparagus…potatoes are good but nothing terribly exciting).

        2. AG

          Not only are roast beets delicious, but you can freeze them, too! So you can roast those in bulk.

      3. Deiseach

        Do you parboil your potatoes first before roasting them? Also, use lots of fat – ideally something with a flavour like fat from the roast meat – and season them well. Use all kinds of seasonings and let them get crispy, fatty and delicious (but not an everyday thing else you’ll be the size of a Zeppelin once the lockdown is over).

        Eating half-raw spuds on their own or with fruit is not the ideal way to do it. As part of a full dinner, or as leftovers from ‘I cooked so many the day before’ yes (with maybe some of the left-over meat from the dinner fried up with some onions, a bit of garlic, whatever seasoning herbs you fancy, heck throw the left-over veggies into that frying pan with ’em all – have you any of the gravy you made with the meat juices and vegetable water as well to pour over the resulting delicous ‘clog your arteries but what a way to go’?).

        Half-hearted “I drizzled a sad dollop of vegetable oil over these forlorn spuds, stuck them in a mini-oven for thirty minutes, and am now eating them plain with a side of grapes” – no. Here’s a recipe that calls for duck fat, rosemary and garlic. This one uses flour and salt.

        Meat fats are the best, but you can use vegetable oils -just remember: parboil the spuds first, use loads of oil and really hot, coat them in salt, pepper, garlic powder, herbs to season, and roast them till they’re crispy and golden and sinfully gorgeous.

        EDIT: To add to what albatross11 is saying, traditionally if you’re roasting a joint of beef or a chicken/other poultry (duck just runs with fat), once the fats start collecting in the bottom of the roasting tin is when you’d throw in the spuds to roast; that way they soak up all the fatty flavourful goodness.

        You can see from the above why I struggle with my weight 🙂

      4. A Definite Beta Guy

        Get some aromatic spices, cook them with the oil, THEN toss the potatoes with the oil. Throw them right in the saucepan, cover the lid, shake em all around.

        Also, bacon fat is better than oil, if you have it.

        1. Loriot

          I’m just using cheap vegetable oil because that’s what I have on hand and I’m not enough of a cooking expert to understand the differences anyway.

          1. albatross11

            Olive oil adds a nice flavor that you don’t get from canola oil/rapeseed oil (probably what you’ve got in your cheap vegetable oil). OTOH, olive oil starts smoking at a lower temperature than canola oil.

          2. Deiseach

            Cheap vegetable oil is okay for preventing stuff sticking to the pan or roasting tray, but it has little to no flavour (and you don’t really want it to have).

            Olive oil and meat fats have a lot more flavour and when roasting spuds (or vegetables) you want them to soak up all that delicious fatty goodness but not go soggy – thus the high temperature to heat the oil and cook the spuds, and why you have the spuds parboiled (or if you have leftover boiled spuds from the day before) so that they’re already cooked; trying to cook raw potatoes by roasting them just means they’re tough on the outside and soggy inside with the trapped steam.

            Basically it all comes down to what you think will taste the best for seasoning etc. I’m not a cooking expert by any means, it’s all trial and error!

        2. Edward Scizorhands

          I feel really smart for having saved up bacon fat over the past few months!

          I started saving it and using it to cook liver (based on advice here at SSC) and saitan.

          Huh, that reminds me: I should probably prepare some saitan next weekend, and fry it up in bacon grease.

          1. Deiseach

            This is why people had dripping mugs! Or at least how it was done when I was a child; the big earthenware mug that your mother used to pour off the fat from the roasting tray into, then put into the fridge to cool and keep.

            Layer of fat on the top and the jelly (aspic) underneath, use the fat for cooking and the aspic for making stock or gravy.

            Everything old is new again 😉

      5. anonymousskimmer

        Cut them into slices about a quarter in thick. Cover the pan with foil and oil the pan a bit, and you can spray some oil on top of the slices too. Shake on some salt, pepper, and cumin. Bake until they start looking good (browning and bubbling on top).

        But while I don’t hate mixing sweet and savory, mixing potatoes and blueberries seems like a bad idea to my tastebuds, so your mileage may vary.

      6. gbdub

        Shaggy potatoes:
        Peel potatoes and cut into 2-3 inch chunks
        Boil for 5 minutes (not cooked through)
        Drain the water, then shake the potatoes in the pot (with a lid on) for a few seconds. Your potato chunks should now be “shaggy” looking
        Preheat some oil or rendered fat in a roasting pan in an oven at 400 deg, enough to leave a decent layer in the pan
        Arrange your tater chunks in a single layer in the hot oil
        Bake for an hour, turning every 15 min, until brown and crispy on the outside
        Remove from oil and sprinkle with plenty of salt and seasonings while still hot

        The “shaggy” step creates a layer of mushed up potato on the outside that the oil penetrates creating an ultra crunchy layer.

    2. Kaitian

      Onions and dry beans / lentils / peas last a long time. You can make various things with them:
      – Dal or chili to eat with rice
      – lentil Bolognese to eat with noodles
      – noodle soup with lentils
      – fried rice with beans (and other vegetables)

      You can also buy UHT milk and make milk rice.

      Most vegetables can freeze, but it’s better to buy them frozen, because your home freezer is likely to make them unpleasantly change texture. Onions and garlic, potatoes and apples should be fine unrefrigerated for weeks or months.

      We generally cook noodles with vegetable or lentil sauce, some of the rice dishes listed above, or frozen pree cooked meals. It’s not exactly gourmet, but it is enough variety to get through the quarantine without getting bored.

      1. rubberduck

        Where do you find UHT milk? (In the USA). I haven’t seen it in any grocery stores in my area and ordering online doesn’t seem economical.

        1. anonymousskimmer

          Whole foods has it. I’ve seen it in other stores too. It is not refrigerated, so find it where the oat and almond milks are located.

        2. Kaitian

          I’m not in the USA, but certainly grocery stores must have it? If they don’t, you might be able to use milk powder, or use soy / almond milk which is usually shelf stable. Or figure out something with condensed milk or coconut milk, though these are quite different from normal milk.

        3. Anteros

          I’m really surprised that UHT milk isn’t prevalent in the US. I would have thought it would be even more common than where I live (France) where it’s just as common as fresh milk.

          1. FrankistGeorgist

            There actually are UHT milk brands commonly available at American supermarkets, particularly organic milk, the funny thing though is that they’re refrigerated in America anyway, just because that’s how Americans feel milk should be.

          2. Loriot

            I was surprised when I read about UHT milk the other day, since I had basically never heard of it.

            Apparently, people tried to introduce it to the US back in 1993, but it failed because customers were suspicious of any milk that wasn’t refrigerated. It could probably still take off as long as you market it right.

            I suppose it’s just one of those weird cultural quirks. Sort of like how Americans think Europeans are irrationally afraid of food coloring and GM crops, among other things.

            I was amused when I first visited Germany and discovered that the orange Fanta there is colored like orange juice rather than being literally orange colored like it is in the US.

          3. The Nybbler

            UHT half-and-half in single-serving containers has found a niche in the US, at diners, hotels, and lower-end coffee places, because it lets them leave the stuff out without getting dinged by the Food Police.

          4. Loriot

            Also, people are used to putting small plastic containers of stuff in their drinks, so they probably don’t think about it the way they think about a jug of milk at the grocery store.

            If you had asked me before, I would have assumed those little plastic things were just fake milk if I thought about it at all.

          5. Edward Scizorhands

            I thought they were some kind of fake milk, too. The UHT market should change the labelling on them to tell people “this is real, honest-to-God milk from a cow.”

          6. Loriot

            P.S. What really boggled my mind was learning that Canadians buy milk in bags. I’ve seen giant bags of milk loaded into dispensers at cafeterias before, but the idea of people buying bags of milk at the supermarket just seems completely alien to me.

          7. Statismagician

            I’d love that, actually; milk bottles taking up too much space in the bin is a recurring minor annoyance.

          8. Gerry Quinn

            UHT milk was a thing for a while decades ago. Nowadays ordinary milk lasts for ages and has no separate cream, so I assume they are doing it to all milk.

          9. albatross11

            You can buy shelf-stable milk (Parmalat) here, too. Probably not so easy to get *now*, but a month ago, you could get it in any grocery store around here.

          10. nkurz

            @FrankistGeorgist:
            > the funny thing though is that they’re refrigerated in America anyway

            I don’t think that’s a sufficient summary. While it’s true that the major national brands of organic milks (like Horizon) sold in rectangular half-gallon containers and gallon plastic jugs are UHT pasteurized, and have two to three-month long expiration dates, most are _not_ aseptically packaged. You are right that you can probably get away with not refrigerating them for short periods, but they are not designed to be shelf stable. The claimed expiration dates are only valid if they are kept refrigerated.

            By contrast, there are also 1L “bricks” of milk (and smaller single serve boxes targeted at children) that actually are shelf-stable. These generally have no twist-off spout, and have a six-month or longer expiration. While they are occasionally sold refrigerated, they are more typically sold non-refrigerated. The difference is that these are aseptically packaged, so that they remain are truly sterile.

            This Cornell “Dairy Food Science” note is not particularly clear, but it’s the best resource I can find: https://foodsafety.foodscience.cornell.edu/sites/foodsafety.foodscience.cornell.edu/files/shared/documents/CU-DFScience-Notes-Milk-Pasteurization-UltraP-10-10.pdf
            Pay particular attention to the tables on the 2nd page, specifically the boxed region in the right hand column of the lower table.

            (Please correct me if I’m wrong about this. I looked into it closely several years ago, and it’s possible that things have changed since then.)

        4. DavidFriedman

          Walmart apparently carries it, although most of the stores in our area are out of stock at the moment and I don’t think they deliver it. At the moment, milk is one of things we expect to run out of in the next month, due to limited refrigerator space, and the rest of my family is very negative on using powdered milk, which makes UHT milk interesting to me.

          1. nkurz

            It might be worth distinguishing two different types of dried milk. Most milk powder sold in the US is nonfat dried milk (NFDM), and while it works in cooking and is very shelf stable, most people find it doesn’t taste very good when reconstituted as fluid milk.

            But there here is also whole-fat (or full cream) dried milk, which is relatively common in areas where refrigeration is scarce or milk is less commonly consumed. Because of the fat, it has a shorter shelf life (a year or two unopened as opposed to decades). And it’s harder to mix. But unlike the nonfat dry milk most people revile, it can actually taste good!

            Peak and Nido are decent brands, and available (although currently expensive) on Amazon. They are also often available in Asian or Mexican grocery stores. The best I found, though, was the WFDM made by Humboldt Creamery. It’s actually good! They don’t sell it directly to the public (I was using it commercially). But at one point it was being sold bulk at Rainbow Foods in San Francisco, and it’s quite possible there are other resellers if you search around.

          2. Gerry Quinn

            I got in some green tea. I need my tea, and I will drink black tea without milk if I have to. But while I much prefer black tea and milk to green tea, the latter doesn’t need milk.

          3. Rebecca Friedman

            @nurkz

            Thank you!

            We drink skim milk at home, though. To me, the nonfat dried milk tastes a little off – rather as whole milk does. So I think that would introduce a new problem!

            Thought appreciated, though!

    3. FrankistGeorgist

      A simple curry is always a can of coconut milk and some pantry spices away, and great refrigerator velcro. Likewise paprikash and Marcella Hazan’s tomato sauce are great for making assorted stuff feel like a dish. I’ve always been a huge fan of sardines which are shelf-stable protein, albeit divisive. Canned salmon is basically only good for salmon cakes, but there are worse things to have in an evening.

      I keep quite a lot of panko breadcrumbs around, which is a nice way to add textural contrast to basically anything. I’ve even just toasted some with oil and garlic and dumped it unceremoniously on things, still does the job.

      I’m actually eating less canned food and beans than ever, due to an Amish hookup and a congenial butcher. The biggest change is that local stores are out of butter, but chock full of ghee. I cook everything in it now which is delightful, and a habit I’ll likely keep up.

      Edit: Also buttermilk! I can never believe how long it lasts and is lovely for baking and marinades.

      1. toastengineer

        Water + cashews in a blender makes cashew cream, which can be used as a dairy substitute or substitute for the coconut milk in curries.

    4. DavidFriedman

      The obvious one is homemade bread. The main ingredients are flour, water, and yeast, and you can use sourdough if you run out of yeast. Fresh bread is a luxury food, it’s reasonably nutritious, and flour is cheap and keeps without refrigeration. Butter to go with it requires refrigeration, but olive oil doesn’t.

      Lentils are a little easier to cook than most other beans. We have a medieval lentil dish that’s easy and good, basically lentils, onions, and eggs poached on top. If anyone is curious the recipe is webbed in some of what Betty and I have published.

      You can get dried onions and peppers.

      1. Gerry Quinn

        Porridge oats, yogurt and baking powder make a good bread too.

        Butter requires refrigeration? Granted butter in Ireland is salted, but I keep it in the cupboard for months. (The block stays in the fridge.)

        1. cuke

          Could you elaborate on porridge oats, yogurt, and baking powder making bread? That sounds good.

          Also, please explain “the block stays in the fridge” — what block?

          My people came from Ireland a long time ago and it sounds like I need to learn some things about butter and bread from them.

          1. Gerry Quinn

            It’s super simple: mix up one volume (500g) of Greek-style yogurt with two volumes of porridge oats and a teaspoon of baking powder. You can put in raisins, pumpkin seeds, whatever.

            Here’s a more official recipe: https://glenisk.com/recipes/porridge-bread

            You’ll find a lot of variants on the internet, but basically a recipe is just a guideline, and anything adjacent will work.

            By “the block” I meant the block of butter. I keep butter I’m using on a dish in a kitchen cupboard because it will be too hard to spread straight from the fridge. (TBH, it can be hard to spread anyway…)

          2. Gerry Quinn

            I think they are just rolled oats. Porridge oats is what they are called here. Porridge disgusts me, but I have nothing against oats.

          3. Lambert

            Rolled oats or sometimes rolled oats that have been further shredded/chopped/disintegrated so you can make the porrige faster.

      2. Lambert

        Anyone got some advice on how to deal with a strong white shortage?
        It seems that everyone else had the same idea and has cleared the shelves of flour.

        I have limited quantities of strong white, soft white, rye, spelt and cornmeal.
        There’s still strong wholemeal around, as well as mealy potatoes.
        And I panic bought a *lot* of rolled oats (may have to live off flapjack for a while).

        I’m guessing sourdough is more versatile than S. cerevisae for weird grains. My plan is to mix strong white or brown with the other grains/starches to make vaguely rustic breads. Anyone know how to get a good crumb under these conditions?

        1. DavidFriedman

          Another linguistic novelty —”strong white” is an unfamiliar term to me. Does that mean what we would call hard wheat flour? Is “strong wholemeal” what we would call whole wheat flour made from hard rather than soft wheat?

          Or is the “strong” a marker for something else?

        2. littskad

          A make granola in bulk about once every other week (I have a large family to feed). You could use up some of your rolled oats that way. Here’s the basic recipe:

          42 oz rolled oats (this is a standard large container in the US)
          12 oz chopped nuts
          8 oz coconut
          10 oz chopped dates (or raisins or other dried fruit or berries)
          —–Put these in a very large pan roasting pan and mix them together. (I use an aluminum one that’s intended to be disposable, but I reuse it over and over.)
          Then make a sweetener/flavor mix:
          2 cups of sweetener (honey or maple syrup or (2 cups some sort of sugar combined with 1/2 cup water) or whatever)
          2/3 cup neutral oil (canola or whatever)
          1 Tablespoon salt
          ——-Put these in a saucepan and stir and heat over medium heat until it simmers for a bit. Depending on what you use, it may foam up, so use a largish saucepan and keep an eye on it. You can add other flavors if you want: 1/2 cup of cocoa powder; or 2 Tablespoons of cinnamon; or 2 Tablespoons of vanilla extract (add extracts after you take it off the heat).
          ———Pour the liquid over the dry ingredients in the roasting pan, and stir it. Keep stirring it until all the oats and stuff are evenly coated. Yes, keep going, it’ll take five minutes or so of stirring.
          ——–Put the pan in a cool oven (I use 250 degrees), and cook for two hours or so, give or take half an hour, taking it out and thoroughly stirring it every 20 minutes or so. This is doing two things: slowly driving off the water that was in the liquid mixture, and roasting the dry ingredients in the oil and sugars. It will be pretty soggy the first few times you stir it, but you’ll notice it gradually getting dry and slowly darkening/browning. You can’t really hurry this: it’s not at all hard, but does take time. After it’s all dry and crunchy and a color you like, take it out and let it cool to room temperature, then store it in closed containers.

          My favorite combination is maple syrup with walnuts, but honey/pistachio, vanilla/almond, cinnamon/pecan, cocoa/pecan also work well. I’ve also made the sweetener with a lot of applesauce and got a very good apple flavor; mashed banana also worked really well; as did peanut butter. It’s very versatile, really.

        3. FrankistGeorgist

          Using an autolyse and a food processor this recipe makes a bread with a light, refined sandwich loaf texture out of only whole wheat flour – but it’s formulated by an American for American style ingredients so results may vary.

          If you want to extend bread flour with available whole wheat, this recipe for English muffins is excellent and easy.

          As rustic breads go this is a personal favorite, although again relying on a mix of bread and whole wheat flours. And quite a lot at that. Lovely texture though.

          Potato bread doesn’t use high gluten flour and is delicate and soft.

          An all-cornmeal cornbread is also an option, although not to my yankee tastes. Polenta, once set and crisped is hardly bread but is starchy and delicious and sliceable.

    5. rubberduck

      Almost any beans taste good with canned tomato (paste or diced tomatoes in juice). Fry up some onion and/or garlic, add cooked or frozen beans, add tomato and water if needed, season however you’d like, maybe add some lemon juice.

      Also, crepes! 1.5 cups milk, 1.5 cups water, 2 cups flour, 2 eggs, pinch of salt, mix everything until batter is smooth and not too thick, fry on a nonstick pan. If you use an egg replacer and plant-based milk then all the ingredients are either nonperishable or can last a long time in the pantry. (This recipe makes a lot of crepes so halve it if you don’t have many people to feed.)

      1. Anteros

        Eggs in the fridge are good for a few months and UHT milk keeps indefinitely.

        Are your crepes nominally for sweet purposes, or savory?

        1. rubberduck

          Either way works, the crepes are pretty bland-tasting. My family is Polish so for savory crepes we fry up mushrooms + onions as a filling– adding cheese (Swiss or mozarella maybe) would make it less healthy but help the filling stick together better. For sweet, we mix soft white cheese (“Farmer’s cheese” I think?) with sour cream and vanilla sugar and use that as a filling, with jam or confectioner’s sugar on top. But probably any normal filling would taste good. For quarantine I would go with jam or applesauce and eat them for breakfast.

          1. DavidFriedman

            There are a variety of things that might be called soft white cheese. Cottage cheese is the most common in the U.S. Ricotta is somewhat similar but not the same. Quesa Fresca, which is quite different would fit as well. So would cream cheese, which is something that makes sense in crepes.

          2. JayT

            I would guess he’s using cottage cheese, because that’s what my Lithuanian grandmother would use.

          3. rubberduck

            No, not cottage cheese- too liquidy. It’s similar but drier, that’s why you mix it with sour cream to make a paste. This link describes it well, I’m not sure what could work as a substitute but maybe cream cheese could taste good.

          4. JayT

            You can drain/press cottage cheese, so that would probably be the closest thing easily available. Normally when I see “farmer’s cheese” it’s at Mexican markets, and the cheese is similar to cotija.

        1. rubberduck

          Hmm, I haven’t tried it but I don’t know if that’s a great idea. Bisquick has baking powder in it and you don’t want your crepes to rise much, since you want them to be flat and flexible and if they turn out too fluffy they could break apart when you try to fold them or roll them up.

    6. ReaperReader

      Pasta bake: cook pasta, cook veggies if needed, fry protein if needed (canned fish can be tossed in), mix together, put cheese or breadcrumbs on top, heat in the oven until top is crispy.

      Fried rice: basically pasta bake except you put the veggies and protein in a frypan to cook and then add the rice and fry for a few minutes. Start off with cold cooked rice.

      Rissotto: look up a recipe but basically you start off with frying uncooked rice, then add liquid to be absorbed. Add veggies during the process as they need cooking, put protein on top at the end (cooked if need be).

      All of these can be made with frozen or dehydrated veggies and meats.

    7. cuke

      Infinite casseroles can be made from combining items from these groups and baking at 350 for 45 min:

      1. Carb: cooked pasta, rice, bread crumbs or pieces of bread or crackers, or any other grain, tortillas cut up or tortilla chips, or potatoes

      2. Protein: canned tuna, sardines, fresh meat cooked, sausage, eggs, cheese

      3. Vegetable: broc, cauliflower, frozen mixed veggies, spinach or other greens, summer or winter squash, canned tomatoes, canned beans

      4. Flavor: chicken broth, basil/thyme/oregano, tamari/ginger/garlic, salsa/chili powder/cumin, etc

      1. A Definite Beta Guy

        Yeah, this is pretty much the best answer. Casseroles can be made from exclusively pantry ingredients, are very tasty, are very filling, and are easy as hell as to cook. Also great for leftovers!

        I will add that you can also get canned chicken, canned beef, canned any protein. You are not reliant on fresh or frozen meats (I see fresh poultry is becoming scarce).

    8. AG

      College dorm dishes are all about this, aren’t they?
      Fried rice is rice, canned ham, frozen veggies, and optional eggs.
      Instant ramen can be spruced up easily with frozen veggies and meatballs.
      For that matter, then most basic Asian and Italian dishes apply so long as there’s no cheese. Pasta/noodles/rice, frozen meat, frozen veggies, and canned/bottled sauce plus dried spices.

      If you really have the freezer space, though, go nuts with making and freezing dumplings.

      Not non-perishable, but frittatas refrigerate well, so you can buy two week’s worth of eggs, use half fresh as normal, and the other half for the frittata before they go bad. Low-effort recipe is 1/4 dairy of choice (milk or sour cream) to every 6 eggs, add whatever veggies and meat to the mix, slow cooker for 3-4 hours on low, or 1-2 hours on high. Can make for 4-6 servings.

    9. Gerry Quinn

      Short version:

      You can freeze everything

      You can microwave everything

      All else is luxury

    10. proyas

      Things I’ve discovered thanks to being forced to eat every obscure bit of nonperishable food in my house:

      1) Buckwheat becomes palatable if honey is mixed into it.
      2) Powdered peanut butter can be mixed with simple ingredients to make a tasty and filling noodle sauce: https://parade.com/842362/communitytable/asian-peanut-noodles-using-peanut-butter-powder/
      3) Dried beans are more trouble than they’re worth to prepare. Just buy canned beans. They’re already tender and only need to be heated up to eat.
      4) Easy recipe: Combine 2 parts water, 1 part dried white rice, 1 part canned beans, and spices of your choice (I used a packet of Ramen noodle seasoning) in a rice cooker, and cook it as normal. The result isn’t the best meal ever, but it’s very cheap and nutritionally balanced.
      5) Milk’s importance as an ingredient in even the simplest recipes can’t be overestimated. Evaporated milk should be part of your disaster stockpile.
      6) Coffee whole beans need to be pulverized into a powder, made of particles no more than 1 mm in diameter, to make good coffee. A blender isn’t well suited for this, and the chunks will be too large, making the coffee too weak and light-colored. You need a dedicated coffee grinder.
      7) Canned ham is different from, and in my opinion, inferior to SPAM.

      1. Gerry Quinn

        They should sell it with a label: “WORSE THAN SPAM”. People would buy it, just to see. (You could include a coupon for Pink Slime, I guess.)

      2. AG

        But is canned ham different from canned Vienna Sausage?

        (Also, you can still use coarsely ground coffee if you cold brew.)

  38. Two McMillion

    A question for the economics gurus among is: can there ever actually be such a thing as wages below cost of living?

    My mental model says that as wages for a job increase, the number of people willing to do it also increase. Thus wages for a given job will be determined by the people willing to do it for the least amount of money. If someone is willing to do a job for literally not enough money to live on, that person will eventually starve to death, and they’ll have to be replaced by someone who demands a higher wage.

    Am I right here or am I confused?

    1. Loriot

      Theoretically, in the long term, with a lot of caveats. But in the long term, we’re all dead.

      Someone who is desperate might be forced to take a job for below the cost of living, even if it means starving eventually, since it beats starving today.

      It’s also common for people to work multiple jobs to make ends meet.

      And of course, there’s all the caveats about subsidies and external sources of support. People working at low wage jobs may be relying on food stamps, subsidized housing, and other public or private assistance programs.

      There’s also the issue that “the cost of living” is not static. If you are sufficiently desperate, you can save money in a lot of ways, but they aren’t good for anyone long term. For example, people living packed together in buildings that have never seen a fire marshall and then die in a preventable fire.

    2. Matt M

      I think this entire model is wrong. It assumes way too much – mainly that people have one job with a set wage that is entirely inflexible.

      Like, there are calculations which suggest that being an Uber driver is not economical – that it doesn’t pay enough for someone to “make a living.” And yet, there are tons of uber drivers. Mainly because for most of them, it isn’t their sole means of earning a living.

    3. Jon S

      People volunteer to work for 0 wages in many contexts. 0 is presumably below the cost of living. Reasons why this is possible also apply to positive wages below the cost of living.

    4. fibio

      Wages can and frequently have dipped below the cost of living. It rarely happens in a modern society but in essence this is what happens when a famine occurs, either the materials for living are in too short supply or people have no worthwhile work to do, leading to mass die-offs. Generally this is a short-term occurrence, although, that’s short-term at the level of an economy so can last for decades and persist long after an unconscionably large number of people have starved to death.

      In more modern senses, people can easily find themselves working jobs that pay wages less than what they need to live. There’s a number of reasons this situation persists, number one is savings. If you need $100 a week to live and the only job you can find pays $80 then working the job makes sense as long as you have savings to fall back on. The other is credit both fiscal and social. As many teenagers prove you can flourish on a less than starvation wage as long as your parents are willing to feed and clothe you in the meantime. This extends through to adulthood, if you can’t make rent you might be able to couch surf until something better comes along.

      At a societal level, it is rare that wages dip below starvation levels and generally happens due to external factor. The time when a cabal of railroad companies conspired to reduce wages below starvation levels in the US almost sparked a second revolution, so no one is too keen to see it happen on a regular basis. One of the reasons unemployment is a thing is not kindness but as a sop to stop unemployed revolutionaries rioting.

    5. SamChevre

      The biggest thing you are missing is that some people don’t need a living wage, so some jobs can be permanently filled with those people. At the low end, typical “teenager jobs” can be filled by 14-16 year olds: they generally don’t pay enough to live independently, but 14 year olds aren’t generally trying to earn enough to live independently. At the high end, some jobs are functionally volunteer work with incidental pay–and tend to be taken by wealthy people with other sources of income: think of some museum docent roles, or directorships of some charities.

    6. DavidFriedman

      This was a live issue two hundred years ago. The “iron law of wages” held that wages would, in the long term, be at the level at which the working class just reproduced itself — not literal subsistence, since that meant enough so a couple could raise kids. Ricardo, who was the best early theorist, recognized that “would” was not the same as “could,” that what the equilibrium wage was would depend in part on the tastes of workers. If they had relatively luxurious tastes, that would make the wage level at which they were willing to devote resources to producing and rearing children higher, hence make the equilibrium wage higher. He concluded that the friends of mankind should wish that workers would have luxurious tastes, since workers were most of the population and that gave an equilibrium at which they were better off.

      Current real wages in the U.S. are about thirty times what the global average was through most of history, so wages literally below the cost of living are not a real issue — people who talk in such terms are implicitly assuming “living at what modern people would regard as an acceptable level.” But so far as your question is concerned, one could imagine a situation in which wages for a while were below the level at which an individual could support himself, with individuals either living off savings or charity or gradually starving to death.

      1. AG

        The cost-of-living cliff is an issue, though, especially for housing. If you make below a certain amount that is still 10 times the global average through most of history, then you can’t afford to live in any of the housing available, and then the systems that make it hard to get a stable job without stable housing kick in, as well.

        See also the above thread about how inequality is exacerbated through access to technology. Some places literally do not allow someone to apply for a job by walking or phoning in, so despite the internet being a luxury by some measures, it’s also a very real gate by others. (Or see how this already assumes that one must have a phone.)

        When the intermediate between “have home, phone, and internet” and “homeless, no phone, no internet” does not exist due to modern regulations, the argument that “wages literally below the cost of living are not a real issue” is far from a sure thing.

        1. Eric Rall

          Part of the problem is that 19th and 20th century anti-poverty reformers succeeded in passing a great many rules the regulate provision of poverty-level essential goods and services out of existence, leaving something like “lower-middle-class” as the bottom rung of available lifestyles, at least short of the proverbial “living in a van down by the river”. The intent was to induce slum landlords and the like to provide lower-middle-class options instead, based on a theory that the fundamental problem was a lack of bargaining power by people living in poverty.

          They probably did succeed to an extent, and they no doubt appear to have succeeded more than they actually did because of the enormous overall standard-of-living improvements generated by real economic growth. But there’s also been a cost of leaving no good options (other than relying on alms, public or private, when they’re available) for people who can’t afford the new minimum.

    7. keaswaran

      It depends on what fraction of the population has a spouse/parent/adult child/welfare check that helps pay some of their cost of living but won’t pay all of it.

    8. Del Cotter

      Yes, there can be wages below the cost of living, if the worker has some means to bridge the gap. The restaurant owner can pay a waitress less than a living wage, if she can make up the difference from